Barbell Medicine Podcast

Can a simple one-second squeeze predict your risk of cardiovascular disease, cognitive decline, and all-cause mortality? Dr. Jordan Feigenbaum and Dr. Austin Baraki explore why grip strength has become the go-to metric for the longevity industry and why most people are interpreting the data incorrectly.
Timestamps:
[00:00] Intro: The Longevity Industry’s Thermometer Error
[01:42] The Neuro-Axis: Anatomy of a Maximal Squeeze
[06:43] The 35-3-5 Rule: Biomechanics of Grip
[09:12] Asymmetries and Clinical Red Flags
[17:31] Dynapenia vs. Sarcopenia: Why the Hand Fails First
[18:41] Normative Data and the PURE Study Statistics
[27:16] Genetics, Lean Body Mass, and Predictive Power
[31:44] Absolute vs. Relative Grip Strength (The Metabolic Signal)
[37:03] Bro-Science Beatdown: Neural Jitter and Training Readiness
[42:19] The Extensor Training and "Grip Maxing" Myth
[45:13] Programming: Systemic Training vs. Indirect Grip Work
[48:10] The Straps Debate: Are You Killing Your Gains?
[52:03] Final Verdict: Hierarchy and Health Priorities

Key Takeaways:
Grip is Systemic: Handgrip strength tests the integrity of the entire system, from the motor cortex in the brain down to the tendons and bones. It is a proxy for overall muscular quality and neurological health.
Predictive Power: According to the PURE study, for every 5 kg decrease in grip strength, there is a 17% increased risk of cardiovascular death and a 7% increased risk of non-cardiovascular death.
The Sarcopenia Floor: Clinical "red zones" for probable sarcopenia are <27 kg for men and <16 kg for women.
Relative Strength Matters: Relative grip strength (Grip Strength ÷ BMI) is a more accurate predictor of hypertension, diabetes, and dyslipidemia than absolute grip strength alone.
Don't Chase the Test: Direct grip training (crushers, etc.) obscures the predictive power of the test. To improve health, focus on indirect systemic resistance training (training the whole body) rather than "gaming" the thermometer.

Next Steps
For evidence-based resistance training programs: barbellmedicine.com/training-programs
For individualized medical and training consultation: barbellmedicine.com/coaching
Explore our full library of articles on health and performance: barbellmedicine.com/resources
To join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/

RESOURCES:
https://europepmc.org/article/med/1538102 
https://pubmed.ncbi.nlm.nih.gov/12188074/#/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC6322506/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC10777545/#/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC6322506/#/ 
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113637#/ 
https://pubmed.ncbi.nlm.nih.gov/31499496/#/ 
https://pubmed.ncbi.nlm.nih.gov/25982160/#/ 
https://www.sciencedirect.com/science/article/pii/S2095254620300752?via%3Dihub#/ 
https://pubmed.ncbi.nlm.nih.gov/27701433/#/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC5517526/#/ 
https://pubmed.ncbi.nlm.nih.gov/18271028/#/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC7344191/#/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7244054/#/ 
https://www.sciencedirect.com/science/article/abs/pii/S1388245710003561#/ 
https://pubmed.ncbi.nlm.nih.gov/25653226/#/
https://pmc.ncbi.nlm.nih.gov/articles/PMC6306785/#/ 
https://pubmed.ncbi.nlm.nih.gov/27619723/#/ 

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Dr. Feigenbaum and Dr. Baraki walk through the clinical workup of a 24 year old male presented with persistent weakness in his foot following weight loss of 22 pounds in two weeks. What could've possibly caused this?
The discussion pivots to the science of how fast one should lose weight. While athletes should prioritize slow loss to preserve performance and lean mass, the data for individuals with obesity suggests that the speed of loss may be less critical than protein intake and resistance training.

Timestamps:
00:00 - The Case of the Paralyzed Personal Trainer 
03:48 - How Doctors Build a Differential for Weakness 
12:08 - Interpreting Negative Labs and MRI Results 
15:04 - Identifying Foot Drop and Nerve Distribution 
20:53 - Understanding Nerve Conduction and EMG Studies 
26:06 - The Diagnosis: Slimmers Paralysis Explained 
32:56 - Are GLP-1 Medications Increasing Nerve Injury Risks? 
35:01 - Rapid vs Slow Weight Loss: Muscle Mass and Performance 
41:27 - The Truth About Metabolic Adaptation and Weight Regain
 52:33 - New Research on Weight Regain After Stopping Medications 
58:32 - Clinical Recommendations for Sustainable Weight Management

 Key Learning Points (SPOILER ALERT)
Slimmer’s Paralysis (Dieting Palsy): Discover how rapid fat loss depletes the protective structural fat pads at the fibular head, leaving the common peroneal nerve vulnerable to compression.
The "Two-Hit" Model: Understand how the combination of biological depletion (rapid weight loss) and mechanical provocation (aggressive stretching or squatting) triggers focal weakness.
Speed vs. Quality for Athletes: Evidence suggests that for trainees, a slower weight loss rate of $\sim$0.7% of body weight per week is superior for maintaining lean mass compared to faster rates.
Metabolic Adaptation as a Signature of Success: Why a reduction in resting metabolic rate is an unavoidable adaptive response to weight loss and not necessarily a predictor of future weight regain.
Diagnosing Focal Weakness: A step-by-step look at how clinicians differentiate between lumbar spine issues and peripheral nerve entrapment using physical exams and electrodiagnostic testing.

Resources:
Case: https://pubmed.ncbi.nlm.nih.gov/39809480/ 
https://pubmed.ncbi.nlm.nih.gov/29503139/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC12157737/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC11273815/ 
https://pubmed.ncbi.nlm.nih.gov/32576318/ 
https://pubmed.ncbi.nlm.nih.gov/20443094/ 
https://pubmed.ncbi.nlm.nih.gov/24372837/ 
https://pubmed.ncbi.nlm.nih.gov/25459211/ 
https://www.bmj.com/content/392/bmj-2025-085304 

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In this episode, Dr. Jordan Feigenbaum and Dr. Austin Baraki dissect the federal government’s 2026 Food Pyramid Reset and its radical shift in nutrition policy. They explore the history of industry lobbying that shaped previous guidelines and evaluate whether the new emphasis on protein and animal fats aligns with current clinical evidence. Finally, the doctors provide the framework for the Barbell Medicine Dietary Guidelines, offering a practical, evidence-based framework for managing the modern food environment.

Timestamps
00:00 - Introduction: The 1992 Food Pyramid vs. the 2026 Reset
03:11 - A History of Lobbying: From the McGovern Committee to the USDA
09:44 - Big Food and Big Tobacco: How the American pantry was engineered
17:15 - The Good: Protein floors and the official war on ultra-processed foods
27:13 - The Bad: Saturated fat, beef tallow, and the dairy hall pass
44:02 - The Ugly: The 25-gram fiber gap and the retreat on alcohol guidelines
54:10 - Economic barriers and the Healthy Eating Index scores
01:06:18 - The Barbell Medicine Dietary Guidelines: A practical framework

Next Steps
For evidence-based resistance training programs: barbellmedicine.com/training-programs
For individualized medical and training consultation: barbellmedicine.com/coaching
Explore our full library of articles on health and performance: barbellmedicine.com/resources
To join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/

Key Learning Points
Environment over Willpower: Weight gain is an emergent process caused by an engineered food environment that adds nearly 500 passive calories to the average American's daily intake compared to 1977.
The New Protein Floor: The 2026 Reset finally acknowledges that the old 0.8g/kg RDA was a "survival dose." The new range of 1.2–1.6g/kg is a victory for skeletal muscle health, though doesn't really change intake for many (if they even read the guidelines).
Incoherent Fat Logic: There is a fundamental conflict in guidelines that recommend beef tallow and butter while simultaneously advising that saturated fat stay below 10% of total calories.
The Fiber Gap: By emphasizing animal proteins over legumes, the new guidelines risk widening the already massive fiber deficiency in the U.S.
The 10:1 Rule: For better metabolic health, aim for a carbohydrate-to-fiber ratio of 10:1 (acceptable) or 5:1 (elite).

References
Barbell Medicine Guidelines Coming Soon! 
https://www.youtube.com/watch?v=inCEbKyWYwg (Trial of Big Food)
https://pmc.ncbi.nlm.nih.gov/articles/PMC12027923/ 
https://www.govinfo.gov/content/pkg/CPRT-95SPRT98364O/pdf/CPRT-95SPRT98364O.pdf 
https://pubmed.ncbi.nlm.nih.gov/31462476/ 
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001050 
https://pubmed.ncbi.nlm.nih.gov/6841553/ 
https://pubmed.ncbi.nlm.nih.gov/7068846/ https://pubmed.ncbi.nlm.nih.gov/6841553/ 
https://pubmed.ncbi.nlm.nih.gov/7068846/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC10552423/ 
https://pubmed.ncbi.nlm.nih.gov/26980437/ 
https://pubmed.ncbi.nlm.nih.gov/26843151/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC10552423/ 
https://pubmed.ncbi.nlm.nih.gov/26980437/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC6124841/ 
https://pubmed.ncbi.nlm.nih.gov/28889851/
https://www.ers.usda.gov/data-products/chart-gallery/chart-detail?chartId=58372#:~:text=As%20their%20incomes%20rise%2C%20U.S.,of%20after%2Dtax%20income). 
https://www.ers.usda.gov/data-products/food-price-outlook/summary-findings#:~:text=Beef%20and%20veal%20prices%20are,higher%20than%20in%20August%202024. 
https://pmc.ncbi.nlm.nih.gov/articles/PMC4733413/ 
https://pubmed.ncbi.nlm.nih.gov/26843151/ 
https://www.barbellmedicine.com/blog/how-to-eat-a-healthy-diet/
https://www.barbellmedicine.com/resources/calorie-calculator/ 
https://www.barbellmedicine.com/resources/macronutrient-calculator/

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Fiber is the most underutilized tool in human nutrition. While the internet is currently buzzing about the new food pyramid and debating processed foods versus beef tallow, most people are missing the actual structural levers that dictate health and performance.
Today, we are launching the Barbell Medicine Fiber Action Plan to bridge the gap between clinical science and your next trip to the grocery store.
If you are a Barbell Medicine Plus subscriber, you can binge the entire 4-part audio series and download the full Action Plan right now in the Plus feed. If you are not a subscriber, head to the link below to sign up for early access to the Action Plan and exclusive content.
Join Barbell Medicine Plus: https://barbellmedicine.supercast.com/
In this series, we move beyond the simple soluble versus insoluble labels and discuss how fiber can lower cholesterol, manage blood sugar, and regulate satiety. Nutrition should not be a social media shouting match; it should be a deliberate strategy for your health. Stop guessing, get the guide, and let us get to work.

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For decades, the health and fitness industry has blamed rising obesity rates on a lack of individual willpower and "poor choices." However, a landmark lawsuit in San Francisco argues that the modern food environment is a public nuisance engineered by food giants using a literal tobacco playbook. By manipulating "Bliss Points" and dismantling the natural food matrix, these companies have created an environment where healthy choices are the path of highest resistance. Understanding the shift from personal responsibility to environmental accountability is the first step in reclaiming your health.
Next Steps
For evidence-based resistance training programs: barbellmedicine.com/training-programs
For individualized medical and training consultation: barbellmedicine.com/coaching
Explore our full library of articles on health and performance: barbellmedicine.com/resources
To join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/

Timestamps
00:00 - The San Francisco Lawsuit vs. Big Food
01:46 - Legal Shift: Personal Choice vs. Public Nuisance
08:02 - Probabilistic Automaticity: Why Environment Wins
13:40 - The 500-Calorie Shift: The Rise of Energy Toxicity
16:11 - The Tobacco Playbook & The Bliss Point
22:33 - The Potato Continuum & The Food Matrix
28:09 - Yale Food Addiction Scale (YFAS) Data
33:48 - The BMJ Umbrella Review on UPF Risks
52:35 - Practical Strategy: Playing Offense at Home

Key Points 
The Public Nuisance Shift: Why legal strategy is moving away from "individual choice" toward holding corporations accountable for creating a toxic health environment.
Probabilistic Automaticity: Human willpower hasn't decreased since the 1970s; instead, the probability of making a "bad" choice has been engineered to increase through environmental cues.
The Bliss Point: How food scientists precisely calibrate salt, sugar, and fat to create a transient "nirvana" that mutes the brain's satiety signals.
The Potato Continuum: A framework for understanding how processing transforms a simple, satiating food into an energy-dense, hyper-palatable "drug."
Food Addiction Data: Why 14% of adults meeting the Yale Food Addiction Scale criteria suggests a systemic design flaw in our food supply, not a character flaw in the consumer.
The Tobacco Playbook: The historical link between cigarette manufacturers buying food companies and the subsequent optimization of addictive "mouthfeel" and delivery systems.

Clinical Pearls

Master Your Micro-Environment: Spend your "willpower budget" only once—at the grocery store. If hyper-palatable foods aren't in your pantry, they cannot exploit your fatigue at 9 p.m.
Prioritize the Food Matrix: Aim for foods high in protein and fiber that have "built-in stoplights," rather than ultra-processed items where the matrix has been dismantled.
Distraction-Free Feeding: Eliminate "subconscious eating" by removing screens during meals, allowing your brain to accurately register hormonal satiety signals like leptin and ghrelin.

References:
https://sfcityattorney.org/san-francisco-city-attorney-chiu-sues-largest-manufacturers-of-ultra-processed-foods/ 
https://www.lawforhoas.com/civil-code-section-3479-nuisance-defined 
https://www.naag.org/our-work/naag-center-for-tobacco-and-public-health/the-master-settlement-agreement/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC3667220/
https://pubmed.ncbi.nlm.nih.gov/22551473/ 
https://linkinghub.elsevier.com/retrieve/pii/S0195666325000819
https://psycnet.apa.org/record/2006-22447-006 
Maimati 2018 
Stephen 2020 
Machado 2019 
Young 2002
Zlatevska 2014 
https://pubmed.ncbi.nlm.nih.gov/37250387/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC6550161/
https://pubmed.ncbi.nlm.nih.gov/30040431/ 
https://pubmed.ncbi.nlm.nih.gov/31105044/ 
https://pubmed.ncbi.nlm.nih.gov/37813420/ 
https://ajcn.nutrition.org/article/S0002-9165(22)00584-6/fulltext 
https://pubmed.ncbi.nlm.nih.gov/38418082/ 
https://www.fao.org/3/ca5644en/ca5644en.pdf
https://www.mdpi.com/2674-0311/3/3/25 
Powell 2013 
Bhutani 2018 
Fernandez 2021

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