Barbell Medicine Podcast

A 23-year-old soldier presents with hypertensive urgency and acute kidney injury. He thought he was doing everything right for his health—so what caused his system to fail? Dr. Feigenbaum and Dr. Baraki break down the clinical evidence and the surprising lab results.Timestamps[00:00] Introduction to the Case: The Fit Soldier’s Failure[01:07] Welcome and Mystery Case Framework[02:05] Patient History: The River and the GI Symptoms[03:53] Building the Differential: Infection vs. Dehydration[08:20] Initial Workup and the Hypercalcemia Discovery[14:14] The Medical Student’s Reveal: Supplement Reconciliation[18:05] Final Diagnosis: Severe Hypervitaminosis D[22:20] Metastatic Calcification and Permanent Vascular Damage[25:23] The Mechanism of Jaw Pain: Bone Resorption[28:34] Science Review: Debunking the Pilz (2011) Study[32:27] Fat-Soluble vs. Water-Soluble Risks[43:06] The Free Vitamin D Hypothesis[48:06] Updated 2024 Endocrine Society Guidelines[55:16] Final Thoughts: Vitamin D and the Endurance PopulationNext StepsFor evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized medical and training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/Key Learning Points The Testosterone Fallacy: Meta-analyses confirm that Vitamin D supplementation has no significant effect on testosterone levels in men who are not clinically deficient.The Fat-Soluble Risk: Unlike water-soluble vitamins, Vitamin D is stored in adipose tissue, meaning toxicity can persist for months or years after cessation.Metastatic Calcification: Severe Vitamin D toxicity causes calcium phosphate to deposit in arterial walls, potentially turning flexible vessels into rigid pipes.2024 Endocrine Guideline Shift: Updated medical standards now recommend against routine Vitamin D screening and universal high-target levels for healthy adults.The Natural Blind Spot: Patients often fail to categorize supplements as "medication," leading to dangerous diagnostic delays when clinicians do not ask specifically about over-the-counter products.The Mechanism of Bone Pain: Toxic Vitamin D levels can drive aggressive bone resorption, effectively "stealing" calcium from the skeleton and causing severe pain.Clinical Pearls Screening Protocol: Avoid routine Vitamin D blood testing for healthy, asymptomatic adults under 75 unless a specific condition like malabsorption or osteoporosis is present.Dosing Guidelines: For the general population, stick to the daily recommended intake (600–800 IU) rather than using high-dose bolus therapy or chasing a serum level of 30 ng/mL.Medication Reconciliation: Always disclose all "natural," "herbal," or "gym-based" supplements to your medical provider, as these can interact with other medications or cause direct toxicity.Timestamps[00:00] Introduction to the Case: The Fit Soldier’s Failure[01:07] Welcome and Mystery Case Framework[02:05] Patient History: The River and the GI Symptoms[03:53] Building the Differential: Infection vs. Dehydration[08:20] Initial Workup and the Hypercalcemia Discovery[14:14] The Medical Student’s Reveal: Supplement Reconciliation[18:05] Final Diagnosis: Severe Hypervitaminosis D[22:20] Metastatic Calcification and Permanent Vascular Damage[25:23] The Mechanism of Jaw Pain: Bone Resorption[28:34] Science Review: Debunking the Pilz (2011) Study[32:27] Fat-Soluble vs. Water-Soluble Risks[43:06] The Free Vitamin D Hypothesis[48:06] Updated 2024 Endocrine Society Guidelines[55:16] Final Thoughts: Vitamin D and the Endurance PopulationReferenceshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9478588/ https://link.springer.com/article/10.1007/s12020-020-02482-3 https://pubmed.ncbi.nlm.nih.gov/32446600/ https://pubmed.ncbi.nlm.nih.gov/21154195/ https://academic.oup.com/jcem/article/109/8/1907/7685305?login=false https://academic.oup.com/edrv/article/45/5/625/7659127 https://academic.oup.com/milmed/article/189/1-2/e417/7218964  Our Sponsors:* Check out Factor: https://factormeals.com/bbm50off* Check out Quince: https://quince.com/BBMSupport this podcast at — https://redcircle.com/barbell-medicine-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Biohackers and longevity clinics claim peptides are a side-effect-free sniper rifle for fat loss and injury recovery, but the reality is often buried in failed clinical trials and regulatory bans. Many popular compounds like BPC-157 have never undergone a single randomized controlled trial in humans, despite their reputation for Wolverine-like healing. This episode dismantles the hype surrounding the gray market, exposing the significant risks of immunogenicity and heavy metal contamination. Learn why modern load management and evidence-based medicine beat a research chemical bought with Bitcoin every time.Next StepsFor evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized medical and training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/Key PointsThe FDA Category 2 Crackdown: Federal regulators restricted many peptides because of the risk of immunogenicity where the body creates antibodies that attack its own proteins.BPC-157 Has Zero Human Data: Despite being marketed for tendon repair, there is not a single published human randomized controlled trial for this molecule.The MK-677 Prediabetes Tax: While it increases lean mass, human trials show zero improvement in strength or power while frequently causing insulin resistance.Retatrutide as the Weight Loss Godzilla: This triple agonist is achieving nearly 29 percent weight loss in trials by increasing energy expenditure through thermogenesis.Sourcing and Safety Realities: A study of 44 research chemicals found that only 18 actually contained the labeled compound, with many containing heavy metals.The 40-Amino-Acid Rule: The legal distinction between a peptide and a protein is based on size, which dictates how the FDA regulates these substances and how your body absorbs them. Timestamps00:03 Intro: The CJC-1295 Heart Attack Case05:39 Defining a Peptide: The 40-Amino-Acid Bright Line15:14 GH Secretagogues: CJC-1295 and Ipamorelin23:51 MK-677: The Oral Hunger Mimetic and Prediabetes Risk32:56 BPC-157 and the Lack of Human Data38:12 Immunogenicity: Why the FDA Banned BPC-15749:46 Retatrutide: The Triple Agonist Weight Loss Godzilla01:11:24 Summary: Peptides vs. Anabolic Steroids01:16:12 The Sourcing Spectrum: Pharmaceutical vs. Research ChemicalsClinical PearlsUse load management and progressive resistance training as the primary intervention for tendon and muscle injuries rather than unproven peptides.If choosing to use metabolic modulators, monitor fasting blood glucose and insulin sensitivity to avoid drug-induced prediabetes or metabolic dysfunction.Avoid the research chemical gray market entirely due to the high prevalence of under-dosing, contamination, and incorrect active ingredients found in third-party testing.Resourceshttps://pubmed.ncbi.nlm.nih.gov/16352683/https://pubmed.ncbi.nlm.nih.gov/18347346/https://pmc.ncbi.nlm.nih.gov/articles/PMC2657499/https://pubmed.ncbi.nlm.nih.gov/9849822/https://pubmed.ncbi.nlm.nih.gov/10496658/https://pubmed.ncbi.nlm.nih.gov/21298258/https://pubmed.ncbi.nlm.nih.gov/18981485/https://pubmed.ncbi.nlm.nih.gov/9467542/https://pubmed.ncbi.nlm.nih.gov/18981485/https://pubmed.ncbi.nlm.nih.gov/20554713/https://pubmed.ncbi.nlm.nih.gov/39813152/Duzel 2007Strinic 2017Sikiric 1993 He 2022https://pmc.ncbi.nlm.nih.gov/articles/PMC2289708/https://pubmed.ncbi.nlm.nih.gov/10469335/https://pubmed.ncbi.nlm.nih.gov/23050815/https://pubmed.ncbi.nlm.nih.gov/20536454/https://pubmed.ncbi.nlm.nih.gov/29986520/https://pmc.ncbi.nlm.nih.gov/articles/PMC4508379/https://pubmed.ncbi.nlm.nih.gov/41090431/https://pubmed.ncbi.nlm.nih.gov/38858523/https://pubmed.ncbi.nlm.nih.gov/20445536/https://pmc.ncbi.nlm.nih.gov/articles/PMC3136748/#R41https://pubmed.ncbi.nlm.nih.gov/25738459/https://pubmed.ncbi.nlm.nih.gov/33473109/https://pmc.ncbi.nlm.nih.gov/articles/PMC5826726/ https://pubmed.ncbi.nlm.nih.gov/31599840/https://pubmed.ncbi.nlm.nih.gov/18206919/https://pmc.ncbi.nlm.nih.gov/articles/PMC5820696/ Our Sponsors:* Check out Factor: https://factormeals.com/bbm50off* Check out Quince: https://quince.com/BBMSupport this podcast at — https://redcircle.com/barbell-medicine-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Experiencing a pins-and-needles sensation on a run or fearing the straight bar deadlift shouldn't be your fitness journey's bingo card. Many trainees abandon effective habits due to false narratives regarding physiological signals or myths regarding back safety. We break down the clinical reality of exercise-induced sensations, the ethics of modern metabolic medicine, and why your choice of imlpement is more about preference than peril.Resources and Next StepsFor evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized medical and training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/TopicsThe Hemodynamic Itch: Why vasodilation and increased blood flow to capillaries can cause mechanical stimulation of nerve endings during a run.Exercise-Induced Anaphylaxis: The critical difference between benign "runner’s itch" and a systemic medical emergency involving hives and hemodynamic instability.Medical Paternalism: Why withholding GLP-1 medications from patients who drink alcohol is a flawed clinical approach that ignores aggregate health risk reduction.The Seatbelt Analogy: Treating one health risk (obesity) is objectively better than leaving it untreated, even if other risks (alcohol) remain constant.The EMG Trap: Why electrical muscle activity data is a poor predictor of long-term strength and hypertrophy outcomes compared to longitudinal studies.Biomechanical Distribution: How the trap bar shifts load toward the quadriceps while the straight bar emphasizes the hamstrings and erectors without changing "safety."Clinical PearlsIdentify Red Flags: If itching is accompanied by wheezing, nausea, or dizziness, stop exercise immediately and seek emergency medical care.Prioritize Habituation: For benign runner’s itch, consistent training typically leads to physiological adaptation and symptom resolution within a few weeks.Shared Decision-Making: When choosing between deadlift variations, select the tool that aligns with your specific goals—use the straight bar for powerlifting prep and the trap bar for general strength or power development.Timestamps00:00 – Intro to the Direct Line AMA series00:43 – The Mystery of "Runner’s Itch": Mechanisms and Hemodynamics04:19 – Case Study: 24-year-old Marine and Exercise-Induced Anaphylaxis06:22 – Summary: Benign Itching vs. Cholinergic Urticaria vs. Anaphylaxis07:24 – GLP-1 Receptor Agonists and Heavy Alcohol Use10:57 – Beyond the Stomach: How GLP-1s Impact Brain Reward Pathways15:32 – Avoiding Paternalism in Medicine: Shared Decision-Making18:12 – The Great Deadlift Debate: Trap Bar vs. Straight Bar21:31 – Why EMG Data is Often Misleading for Trainees24:54 – Debunking the "Save Your Back" MythOur Sponsors:* Check out Factor: https://factormeals.com/bbm50off* Check out Quince: https://quince.com/BBMSupport this podcast at — https://redcircle.com/barbell-medicine-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Welcome to the Barbell Medicine Cholesterol Action Plan. Cardiovascular disease is the #1 killer globally. We just released a massive 6-part audio series and written guide to fix that.It covers ApoB vs LDL, the CAC score paradox, the P:S diet ratio, and Plaque Regression.The full series is available INSTANTLY for Barbell Medicine Plus subscribers.If you're not a subscriber, start here:https://barbellmedicine.supercast.com/ Our Sponsors:* Check out Factor: https://factormeals.com/bbm50off* Check out Quince: https://quince.com/BBMSupport this podcast at — https://redcircle.com/barbell-medicine-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

The wellness industry wants you to believe that menopause renders you fragile, fasting creates "cortisol belly," and birth control is silently destroying your skeletal health. These claims aren't just scientifically inaccurate; they act as "nocebo" barriers that scare women away from effective training and healthcare.We brought in the heavy artillery—Dr. Lauren Colenso-Semple, Dr. Loraine Baraki, and Dr. Spencer Nadolsky—to dissect the physiology behind these viral fears. Discover why your body remains resilient through hormonal transitions and why lifestyle or GLP-1s is a false dichotomy, Dr. Colenso-Semple: @drlaurencs1Dr. Loraine Baraki: @loraine_barbellmedicineDr. Spencer Nadolsky: @drnadolskyKey Learning PointsThe Menopause "Cliff" Myth: Menopause does not destroy your ability to recover or adapt to exercise.1 While aging may require programming adjustments, your muscles do not stop responding to tension and progressive overload simply because estrogen levels change.Cortisol Fear-mongering: There is no evidence that intermittent fasting or skipping breakfast causes pathological "cortisol belly" or visceral fat storage in women. Fasting is simply a tool for Calorie restriction, not a hormonal wrecking ball.IUDs & Bone Density: Levonorgestrel IUDs (hormonal) work primarily via local action on the uterus, not systemic suppression. Contrary to viral claims, they do not "eat your bones," and most users continue to ovulate and produce protective estrogen.The "Masking" Fallacy: Amenorrhea (lack of period) on an IUD is a known, harmless side effect of a thinned uterine lining. It is rarely "masking" a dangerous underlying condition like premature ovarian insufficiency.Birth Control & Performance: Population-level data shows that hormonal contraceptives do not clinically impair strength or athletic performance. While they increase SHBG and lower free testosterone, women are not "little men" dependent solely on testosterone for performance.GLP-1 Agonists (Ozempic/Mounjaro): Using medication to treat the appetite dysregulation of obesity is not "cheating." Muscle loss on these drugs is primarily a function of the Caloric deficit, not the drug itself, and can be mitigated with resistance training.Get More Value: Exclusive Content and ResourcesWant to support the show and get early, ad-free access to all episodes plus exclusive bonus content? Subscribe to Barbell Medicine Plus and get ad-free listening, product discounts, and more. Try it free for 30-days.Unsure which training plan is right for you? Take the free Barbell Medicine Template Quiz to be matched with the ideal program for your goals and experience level.For media, support, or general questions, please contact us at [email protected] Pearls & TakeawaysProgramming for Menopause: Stop treating menopause as a disability. Continue to lift heavy (RPE 6-9) and perform conditioning. If recovery lags, adjust volume (sets/reps) before blaming hormones.Protein Simplified: Ignore the complex "ideal body weight" math. Aim for ~1.6g/kg of total body weight, or simply add one extra serving of protein (like a shake) to your current daily intake.Medical Decisions: Do not remove an IUD or avoid birth control solely due to social media fear-mongering about bone density or "low T." These choices should be based on your contraceptive needs and symptom management (e.g., PCOS, endometriosis).Timestamps00:00 Intro: The "Fragile Female" Narrative01:00 Does Menopause Destroy Recovery?11:00 Muscle Fiber Types: Fact vs. Fiction24:00 Fasting, "Cortisol Belly," and Visceral Fat34:00 Protein Intake: Survival vs. Optimal41:40 Dr. Lorraine Baraki: Do IUDs Cause Bone Loss?50:00 Birth Control, Acne, and Athletic Performance59:00 Dr. Spencer Nadolsky: The Truth About GLP-1s & Muscle Loss01:05:00 Final Verdict: You Are Not FragileReferencesThomas, Ewan et al. “The effect of resistance training programs on lean body mass in postmenopausal and elderly women: a meta-analysis of observational studies.” Aging clinical and experimental research vol. 33,11 (2021): 2941-2952. doi:10.1007/s40520-021-01853-8 TWORoberts, Brandon M et al. “Sex Differences in Resistance Training: A Systematic Review and Meta-Analysis.” Journal of strength and conditioning research vol. 34,5 (2020): 1448-1460. doi:10.1519/JSC.0000000000003521Khalafi, Mousa et al. “The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis.” Frontiers in endocrinology vol. 14 1183765. 14 Jun. 2023, doi:10.3389/fendo.2023.1183765Staron, R S et al. “Fiber type composition of the vastus lateralis muscle of young men and women.” The journal of histochemistry and cytochemistry : official journal of the Histochemistry Society vol. 48,5 (2000): 623-9. doi:10.1177/002215540004800506 Hunter, Sandra K. “The Relevance of Sex Differences in Performance Fatigability.” Medicine and science in sports and exercise vol. 48,11 (2016): 2247-2256. doi:10.1249/MSS.0000000000000928Nuzzo, James L. “Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations.” Journal of strength and conditioning research vol. 37,2 (2023): 494-536. doi:10.1519/JSC.0000000000004329Verdell, J. Tyler MD; Acker, Matthew MD. Does the LNG-IUD decrease BMD in adolescent females?. Evidence-Based Practice 23(4):p 10-11, April 2020. | DOI: 10.1097/EBP.0000000000000601Jäger, Ralf et al. “International Society of Sports Nutrition Position Stand: protein and exercise.” Journal of the International Society of Sports Nutrition vol. 14 20. 20 Jun. 2017, doi:10.1186/s12970-017-0177-8Tan, Yimei et al. “Effect of GLP-1 receptor agonists on bone mineral density, bone metabolism markers, and fracture risk in type 2 diabetes: a systematic review and meta-analysis.” Acta diabetologica vol. 62,5 (2025): 589-606. doi:10.1007/s00592-025-02468-5Our Sponsors:* Check out Factor: https://factormeals.com/bbm50off* Check out Quince: https://quince.com/BBMSupport this podcast at — https://redcircle.com/barbell-medicine-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy