Episode #357: 5 Nutrition Controversies Explained (Eggs, CICO, Cane Sugar, and More!)

15:05Dr. Austin Baraki:Not my favorite. Would not be my favorite lecture.

15:09Dr. Jordan Feigenbaum:I would leave. I would leave. particularly if she was the person presenting. So you're not an expert, clearly. Yeah, no hate comms, peace and love. Just maybe stop talking about this because you have a big platform and have a responsibility to convey good information. Yeah, I agree. All right, let's get into the first controversy. We're talking about eggs and dietary cholesterol, or as Dr. Tom Campitelli calls them in his best New Zealand accent, best Kiwi accent, eeks. Eeks. So what's the controversy here? Well, Well, the controversy is that the public and many health professionals are still arguing about whether or not we should limit dietary cholesterol in our diets.

15:48Dr. Jordan Feigenbaum:And eggs are the scapegoat because that's one of the most common foods that people eat that has dietary cholesterol in them. So why or where did this controversy come from? Well, the hypothesis was that dietary cholesterol directly and dramatically drove blood cholesterol levels up, thereby increasing the risk of heart disease. And this is as far back as the 1960s per the guidelines issued by the American Heart Association. It wasn't until the 2015 to 2020 dietary guidelines that an upper limit of dietary cholesterol was removed from the guidelines. And then if you look at the 2020 to 2025 guidelines, they say to keep dietary cholesterol as low as possible.

16:27Dr. Jordan Feigenbaum:So they reverted back to that. And then the 2025 to 2030 dietary guidelines, well, their scientific consensus doesn't even address dietary cholesterol at all, not even in the scientific consensus at all. So it's clear as mud in the dietary guidelines from a dietary guidelines standpoint. And not that anyone reads or follows these guidelines anyway, but eggs seem to get caught in the crossfire due to their cholesterol content. There have been a number of studies with different methodology and different results about whole eggs and whether they're quote good or not, which have been poorly reported by the mainstream media.

17:03Dr. Jordan Feigenbaum:Now, if you talk about eggs or dietary cholesterol or the social media, whether it's any other place, controversy abounds. Eggs are good or they're bad, or maybe it's just the yolk that's bad. Dietary cholesterol is terrible for you versus limiting cholesterol may be terrible for you because many hormones require cholesterol to make. So we're going to get to the bottom of this, try to come up with a consensus here. But Dr. Baraki, when you hear about people saying, look, you can't limit dietary cholesterol because as hormones.

17:33Dr. Austin Baraki:Is it just eye roll right to the back of your head or like? I do my best to, if there is an eye roll, I try to keep it internal and not visible to the party with whom I'm engaging as that's a poor way to enact belief change, as we have learned from some of our favorite resources here. But, you know, it just, similar to the Quack Watch segment, it illustrates that this person is probably not an expert in this area and they may well be deriving these narratives from, you know, certain internet and social media resources and things like that. And it's likely that they're relatively entrenched in their position, although sometimes that's more open to being changed.

18:11Dr. Austin Baraki:So, you know, in that conversation, I might ask, you know, what that's based on or where that comes from and actually see if the person's open to a conversation on it. But in general, you know, the cholesterol derived hormones are synthesized by their respective cells, the endocrine organs that make those things, but all the cells of our body can make all the cholesterol they need in order to do these things. And so there is a difference in the different compartments of the body where we can find and measure cholesterol levels. So I think that people, you know, have very inaccurate understandings of blood test interpretation.

18:47Dr. Austin Baraki:I think that we've talked about that at length before on the podcast, but the blood is just one compartment of the body. Just because you can measure something in the blood it doesn't tell you you know the entirety of everything about that substance in the person's body it can be in the blood it can be an adipose it could be in cerebrospinal fluid it could be in urine it could be in saliva it could be you know and all of these things are different body fluids or different body compartments where we can measure things so you know i can't just do a test in your blood for meningitis for example because that's a different compartment so i have to go into that compartment and sample that fluid and test that if I want to get a sense of it.

19:22Dr. Austin Baraki:And so there's cholesterol in the blood. There's cholesterol inside our cells. There's cholesterol in our cell membranes. There's cholesterol, like one of the biggest pools that nobody even realizes is like red blood cells carrying around, like within the red blood cells and the red blood cell membranes that we don't actually measure when we're measuring blood cholesterol levels because that's when we're measuring lipoprotein concentrations and what they're carrying in terms of cholesterol mass. So the point here is that it's easy to weave a simple sounding narrative to say some hormones come from cholesterol and so you want more cholesterol in your blood so your body can make hormones and there are so many you're you're like not just leaping you're like triple jumping over biological facts that are very important here to to consider when you're trying to come to these kind of conclusions and make recommendations on it yeah you've left you've left

20:10Dr. Jordan Feigenbaum:uh earth's orbit you're now in outer space that's how big of the leap that you've been you've been All right, so let's come up with a consensus here about dietary cholesterol and, you know, by proxy eggs. So the effect of dietary cholesterol, such as cholesterol in the foods that we eat or theoretically things that we drink, on serum or blood cholesterol levels as carried by the lipoprotein, so like LDL, HDL, et cetera. Well, it's nuanced. And it comes down to this other ratio. And look, these are going to be like long words, but I want you guys to follow along here. So there is a ratio called the P to S ratio, polyunsaturated to saturated fat ratio.

20:49Dr. Jordan Feigenbaum:And this has been calculated on the dietary pattern a person habitually eats. Now, the target would be 1.0 or better, whereas great or optimal, if you're a biohacker, would be about 2.0 or higher. The typical Western diet is 0.5 or so, sometimes lower. Some studies have measured as low as 0.3 in modern times in the United States. So when the ratio is low, that means the person is consuming low amounts of polyunsaturated fats and high amounts of saturated fat. There is a more significant effect of dietary cholesterol on blood cholesterol levels. So again, let me restate that. If this ratio is low, you're not consuming a lot of polyunsaturated fats, are consuming a high amount of saturated fats, there is a more significant effect of how much dietary cholesterol you eat per day on your blood cholesterol levels, as measured by things like LDL, for example.

21:43Dr. Jordan Feigenbaum:When the ratio is high, lots of polyunsaturated fats, low levels of saturated fat in the diet, this effect is much smaller. It's not to really say that there's no effect, although some studies have shown minimal effects here, but the evidence overall, going back long periods of time before you and I were around, Dr. Baraki, does indicate that basically going from no cholesterol in your diet to higher amounts does impact your blood cholesterol levels, but just maybe not that much, maybe not to a nefarious sort of clinical effect if you're consuming a lot of polyunsaturated fats compared to saturated fats.

22:22Dr. Jordan Feigenbaum:So overall, this effect is sort of complex. And if I had to tie this together, and I'll get your take on this too, Dr. B, that if somebody whose dietary pattern is rich in polyunsaturated fats, So from vegetables, fish, nuts, et cetera, whatever, and low in saturated fat. I really don't care what their dietary cholesterol levels are unless it seems to me that they're like a hyper absorber of dietary cholesterol, for example, or there's some other reason that I'd want to limit it. I just I'm less concerned. Right. And so at that point, I'd be like, this is probably where we not where we want to focus our efforts.

22:52Dr. Jordan Feigenbaum:I'd probably focus on like dietary fiber, medical management. If somebody is at high risk of heart disease, does that kind of jive with the your understanding of this?

22:59Dr. Austin Baraki:Yeah, I wanted to add some of the clarifications that have been baked into this discussion so far, because I think that perhaps in our efforts around public messaging on this, I think sometimes the message has gotten maybe a bit potentially oversimplified or has come across in a way to say that there's essentially never any significant impact of dietary cholesterol on blood cholesterol levels, and that's actually not entirely accurate. it, there is a lot of context around it that matters. And then even within that context, I think that there for most people, as it relates to their cardiovascular risk management, there are probably more important or stronger levers for us to be pulling on.

23:36Dr. Austin Baraki:And so there actually is or there would be a clinical situation in which I could envision myself addressing somebody's dietary cholesterol levels, but it is almost never the first or second thing that I'm assessing, right? So I'm much more likely to get a sense of what's the person's, you know, I'll take a thorough dietary history and from that try to derive my gestalt about their P to S ratio. Like are they consuming tons of high saturated fat foods or foods with saturated fats derived from animal sources most commonly, but also some other ones as well, and trying to shift that pattern into an unsaturated direction.

24:13Dr. Austin Baraki:That would be a higher priority because I think that's likely to have a bigger impact on various outcomes, including their blood lipids, but also several other things. and then I'm aggressively trying to work on the dietary fiber piece as we talked about in the last section as well. So aiming to get people to increase their intake of certain fruits and veg and legumes and, you know, higher fiber whole food sources. And if I've worked on all those things, I have an appropriate energy balance, I have appropriate, you know, physical activity, insulin sensitivity, sleep situation, I'm like attacking all the lifestyle pieces as hard as I can.

24:45Dr. Austin Baraki:And I have their dietary patterns set up the way that I think is, you know, reasonable, and they're still running, you know, higher than we'd like, on some of their their blood panels, then I might, you know, if there somehow still is a residual dietary source of cholesterol that is like significant, then I might actually target that. But that's a that's a later on step. Because I do know that going from some intake down to minimal down to zero, for example, does actually have an impact on blood levels. But it's just that that impact is not so large as to justify it as like a leading intervention, right off right off the unless somebody really wants to.

25:18Dr. Austin Baraki:And if they do, then fine. If they wanted to, again, if they said, I'm going to go to a zero cholesterol diet or something, it's like, okay, I mean, I want to make sure that we still are consuming a generally well-rounded and varied diet here, but I would not have concerns, for example, of, oh, your hormones are about to tank or something like that, unless you go into like a massive calorie deficit or something, but then it's not from lowering your dietary cholesterol piece. It's from the overall energy situation, which certainly can have an impact on hormones and things like that.

25:47Dr. Jordan Feigenbaum:Yeah. So to move on to eggs, so eggs, which do contain a decent amount of dietary cholesterol, are just part of a broader dietary pattern, just like any other type of food, which the dietary pattern being more predictive of health than any singular food that somebody may consume. So whole eggs and or egg whites can be part of a healthy dietary pattern. I am, again, not really concerned about the, quote, high cholesterol that's in eggs or really anything else if somebody's P to S ratio is really, really good. Again, it may be a step that you'd want to take to remove those sources of dietary cholesterol, but that's way down the line.

26:26Dr. Jordan Feigenbaum:And I don't even know that it would be part of this optimization thing for somebody who's otherwise healthy. It'd be more of like a, look, man, we're really pulling strings here. And honestly, for a person like that, they'd have to be very, very against taking a medication to further like optimize the risk, which I think would have a much bigger effect. And we don't get paid anything from pharma for saying this, but it's just like, look, if you're pulling out all these stops in your diet and your lifestyle to try to like optimize your risk of, you know, not having any sort of major adverse cardiac event, medications probably gonna have a bigger bang for your buck than the dietary cholesterol piece.

27:01Dr. Jordan Feigenbaum:Plus, like, if you love eggs, you know, I'd be like, I'm just saying like, your quality of life may be better that way. But if someone doesn't want to take medication, they really want to avoid them for whatever reason, that's fine. I'm happy to honor that and modify the diet accordingly. But that's, it's just a smaller effect.

27:15Dr. Austin Baraki:Yeah. And I think, you know, one little caveat that this brought to mind when you since you bring up medications is, if it were true, that dietary cholesterol had zero impact whatsoever on blood cholesterol levels, then ezetimibe would not do anything. Ezetimibe is a drug that inhibits intestinal absorption of cholesterol, right? So that's one side of the equation. So clearly there's some relationship there. However, if dietary cholesterol was this massive driver of blood lipid regulation and cardiovascular risk, then ezetimibe would have a much larger effect than it actually does. So ezetimibe's effect, broadly speaking, in like, you know, unselected kind of population level studies and things like that, the reason I caveat it that way is not like specifically stratifying people by hyperabsorbers or not, for example.

28:09Dr. Austin Baraki:Broadly speaking, the effect of ezetimibe is on the modest size. I still use it often, but I use it in higher risk patients or in those who have like statin intolerance or I want to use like low dose combination therapies, things like that. But looking at it this way, I think helps to kind of clarify the controversy here in that there's some relationship between them, but it is also modest. And then there are some people who seem to be like, you know, these hyperabsorber phenotypes for whom ezetimibe is likely to have a more potent effect on their blood lipids and potentially subsequent cardiovascular risk.

28:39Dr. Austin Baraki:Although that kind of assessing that and, you know, that sort of precision prescribing approach is not currently like kind of standard of care, I would say, in practice. If I have, I'm most often starting it in like the highest risk patients, but I've in recent years started to use it more often in low dose combination therapy with folks.

28:56Dr. Jordan Feigenbaum:Yeah. You would also predict azetamide to have a smaller effect on an individual has, is consuming a lot of polyunsaturated fats compared to saturated fats, you know. Yes, totally. The last two things I wanted to say, dietary cholesterol intake has basically no clinically significant effect on hormones. Nearly every cell in the body can make cholesterol, particularly the tissues that make hormones. It's not the rate-limiting step in hormone production. Instead, that's like the trophic signals you get to those tissues from like your pituitary gland, other sort of organs. And overall, I would have people focus on the dietary pattern, limit saturated fat from red meat and most processed foods, get most of your dietary fats from fish, nuts, non-butter dairy sources, and plant-derived oils.

29:41Dr. Jordan Feigenbaum:and dietary cholesterol is generally a lower concern for most with in this context this dietary pattern um for each one of these controversial questions i've put together what i consider to be some of the best resources like links to studies and you can read those and you know you're doing your own research but i'm i'm help i'm help i'm helping get to the right sources all right second controversy we're talking about caico calories in calories out not not to be confused with Keiko, who is a freaking stud on the platform, 10 out of 10 would want his bench press and deadlift and squat. Now that you mentioned it, gosh, can I just get as strong as him?

30:23Dr. Jordan Feigenbaum:All right. So what's the controversy here? Well, there's a very vocal group of individuals that are claiming that weight management is not just about calories in, calories out, that is energy balance, but instead it's about hormones, food quality, and other factors. If If you don't believe me, if you think I'm just making this up to talk about something on a podcast, I'd like to introduce you to Gary Taubes, Dr. Fung, Dr. Tro, a niche of, quote, women's coaches and the rest. You know, men don't understand weight loss in women because it's hormones. I assume they're not talking about, like, hormones at the level of the brain because in which case I could make maybe an argument there.

31:00Dr. Jordan Feigenbaum:So why is there this controversy? I think it's mainly because weight management is difficult, very, very challenging. And even when you look at some of the observational research on this, it's pretty interesting. So obesity rates are increasing, but self-reported food intake and food availability data suggest that that's decreasing amidst self-reported increases in exercise, albeit modest. So, for example, adjusted mean energy intake of U.S. adults decreased in the period between 2003 and 2004 compared to 2009 and 2010 by about 100 calories or so. During the same period of time, obesity rates went up by about 3.5%, 4%.

31:42Dr. Jordan Feigenbaum:And so there are alternate models that have been produced. So this carbohydrate-insulin model where people who eat more carbohydrates, their insulin levels go up. That causes more fat storage independently of energy intake. That's the sort of idea behind the carbohydrate-insulin models. CIM. And there's been other models around like ultra processed foods that like, okay, these ultra processed foods are devoid of various micronutrients and other sort of things. And, you know, it's not about calories just because you don't have all these nutrients and that makes you, you know, gain weight. Let's see if we can come to a consensus here.

32:14Dr. Jordan Feigenbaum:To date, there have been no successful challenges to the energy balance model for long-term weight management outside of a relatively rare condition called lipedema. The short-term changes in weight are mostly related to body water, so fluid, so gaining water weight, losing water weight. And overall, people vastly underestimate their energy intake. And it's generally worse in folks with excess body fat, excess adipose tissue. On average, people underestimate their energy intake by about 30%, but there's a wide range here. And people tend to overestimate their energy expenditure on average. The total amount or relative amount depends on the comparator.

32:53Dr. Jordan Feigenbaum:So how are you assessing, is this person's estimation correct or accurate or not? But compared to extremely accurate measures of energy expenditure, so doubly labeled water, people have overestimated their energy expenditure by over 100 % when recalling their activity level over the previous year. The other part of this is that exercise, because people count exercise, obviously, as part of their total daily energy expenditure. Well, it's not purely additive to your total daily energy expenditure. So for total daily energy expenditure, you have, you know, you basic life supporting processes, like keep the lights on that cost energy, there's some amount of energy that's required to digest, metabolize and otherwise store your food.

33:35Dr. Jordan Feigenbaum:And there's energy that's required to power yourself to move about your environment. And then exercise on top of that would be quote additive, meaning like, oh, well, I walked for an hour or two hours or did resistance training. People think, well, I burned X amount of calories here. So I just add that on top. That's not exactly accurate, especially in the chronic, like chronic exercisers. So people who've been doing it for more than six months. And so your body just tends to compensate by using less energy for these other processes to some degree. It varies amongst individuals and weight regulation and dietary practices are complex.

34:10Dr. Jordan Feigenbaum:So people, when they're losing weight or gaining weight, there's some level of what we call metabolic adaptation or adaptive thermogenesis. So some people who are, quote, like resistant to weight gain, well, their metabolism will speed up when they eat more in overfeeding studies or overfeeding situations. Similarly, when people are exposed to an energy deficit, some folks will be resistant to lose weight. Their metabolism will slow down a little bit. And same thing with hunger and satiety. These are very complex processes. The body may defend a certain sort of range of body weights. We'll talk about that more in one of these future controversy questions in this episode.

34:48Dr. Jordan Feigenbaum:So again, no successful challenges to energy balance. The ultra-processed food thing, yeah, they tend to have more calories and are less filling, thereby increasing energy intake on balance. So it doesn't really challenge the calories in, calories out sort of final common pathway. And so, yeah, it still remains as the proximate cause of weight management. It's undefeated. If your energy intake is greater than the amount of calories that you burn, you will gain weight. 100 percent, 10 out of 10 by definition. And if you burn more calories than you consume, you'll lose weight. Unless, again, there's some major fluid shifts that are going on for some other reason.

35:27Dr. Jordan Feigenbaum:This still encompasses all possible contributions from hormones, processed foods, individual variation, and so on. but in saying all of that and i think when people really are pushing back against calories in calories out what they mean what they truly mean is that hey look this isn't a great sort of strategy for a lot of people to lose weight they're like look calorie counting calories didn't work for me so calories in calories out it's bs like no what you're saying is that that particular intervention is not particularly helpful for a you know large swath of population And I agree with that.

35:59Dr. Jordan Feigenbaum:Crazy those days can be. You can pay professionals, nutritionists, registered dietitians to, quote, track their calories. And they're still off of their, you know, the actual amount of energy that they're taking in. So can you imagine what it's like in the general public? It just, yeah, I agree that counting calories is probably not a great intervention. But that doesn't mean that energy balance isn't like the rule or the law here.

36:22Dr. Austin Baraki:Yeah, it's, I think, easiest said that it is accurate but not useful. for a lot of people. And I sometimes think about it in terms of like internal and external validity, which are some science-y terms relating to when you do an ultra rigorous study under very particular conditions, that might not always translate into what it is like kind of quote unquote in the real world. And so if you lock people up in a metabolic ward study and you control every calorie that enters their mouth and is absorbed and is then metabolized into usable energy by their body, and you are also in control to the extent that you have control over it, over their energy expenditure, i.e., for example, their activity and things like that, then you can have quite confident and rigorous models and predictive methods to assess their body weight changes over time.

37:17Dr. Austin Baraki:The model will hold quite well in that sort of a situation. But then as soon as you exit that metabolic board chamber and you put people out in the real world, it is much more difficult to execute something like that to that level of rigor. And so the it's not to say that the energy balance situation is no longer accurate, but rather it is not kind of experienced in the same way. And so when you are just when when you are kind of reducing the weight management equation down to this for people, it's almost implied that it is the strategy. It's like, oh, it's the final common pathway. So that is the level where you should intervene.

37:50Dr. Austin Baraki:And maybe that's not the level where you should intervene and people are finding other kind of levels of this biology where interventions are more productive or more effective, either broadly speaking or for a given person. And so maybe intervening at that final common pathway is actually not the best place. And I think that is reflected in our own thoughts on this, where we're like a better place to intervene on this is at like the food environment level, for example, right, if that were feasible, because then that would have this cascade of downstream effects and benefits that ultimately would impact the calorie intake and potentially even the calorie, you know, output side of the sides of the equation, but not by intervening all the way at the end where we tell people just be in this like toxic food environment where you don't have to do anything.

38:36Dr. Austin Baraki:You know, you can get ultra tasty foods that have little satiating effects with like no activity requirements in life and just like stop eating. Right. Which is, that's functionally what that's saying is when you're intervening at the end versus whether that type of, how available that type of thing is at all is a much stronger determinant of people's likelihood to obtain and consume it. So I do think of it in terms of this internal external validity thing. And so the scientists who are thinking in terms of internal validity metabolic ward studies, to some extent are talking past the folks who are attacking calories in, calories out.

39:13Dr. Austin Baraki:Even the clinicians who you mentioned at the outset who were saying it doesn't work. And it's like, well, it's not a thing that can work or not. It is like the biological fact. But when you say it doesn't work, it suggests that you are viewing this as an intervention with poor external validity when applied to the real world that we all live in.

39:28Dr. Jordan Feigenbaum:Yeah, yeah. I would just also finally point out that any alternate model and their proposed interventions from that alternate model, whether it's carb reduction for the carbohydrate insulin model, whether it's reduction in ultra processed foods from this processed food sort of sort of model, they all dovetail into this final common pathway of reducing energy intake compared to energy expenditure. when matched for calories in, there's no weight loss advantage from having a, from consuming a low carbohydrate diet outside of short-term weight, uh, water weight losses, same thing for ultra processed foods or whatever.

40:04Dr. Jordan Feigenbaum:If there was this huge benefit, we tell you about it. Yeah. We'd be the first to tell you. Uh, but instead we're just telling you to maybe ignore these folks, uh, their advice surrounding, um, calories in calories out because ultimately misinformation. I agree. All right. Next controversy here on the Barbell Medicine Podcast, we're going to talk about slow metabolism or high fructose. So what's the controversy here? Well, it's, you know, everybody knows it's harder to lose weight as you age. It's a tale as old as time. And for those with weight struggles, well, they probably have a slower than normal metabolism because that's how they ended up, how they are, right?

40:40Dr. Jordan Feigenbaum:I mean, duh, you just think about it. That's the controversy. Why this controversy exists, again, I think it goes back to weight management is challenging. And it certainly does feel harder for some. Their experience at trying to manage their weight, whatever their goals are, for some individuals, it does feel like a much more monumental and in some cases even insurmountable task. And I think metabolism tends to be the scapegoat for, quote, all things that are beyond an individual's control. And I think this is really referring to an individual's genetics, their specific environment, and ultimately the response to the combination of those two things, a person's genetics and their environment.

41:17Dr. Jordan Feigenbaum:And so people are like, well, why am I having such a challenging time, you know, leaning out or achieving this particular physique or whatever compared to these other folks? It just must be my metabolism. It's slower. Does that seem reasonable to you as far as like why this controversy?

41:30Dr. Austin Baraki:see these conversations all the time, whether just age related or often like in the perimenopausal, postmenopausal world, things like that, just quite common kind of topics of conversation.

41:39Dr. Jordan Feigenbaum:Yeah. Okay. So let's see if we can come up with a consensus here. Metabolism as measured by your resting metabolic rate and its combination with your thermic effect of food. So that's diet induced energy expenditure, how much energy it takes to break down, store, metabolize food, et cetera, and your activity related energy expenditure. So all of that stays remarkably consistent as an adult until the middle of your seventh decade. So about 65 or so for most folks, it's a little bit longer. It stays pretty, pretty consistent for active. They're really like four distinct stages of quote metabolism where it's pretty much the same.

42:12Dr. Jordan Feigenbaum:So early, you know, childhood, adolescence, that's your second phase adulthood. And then after, you know, 65 or a little bit older, that seems to decline, but the most of your adult life, metabolism metabolic rate is effectively the same. And individuals with excess body fat, so individuals with obesity, they have the same metabolic rate per kilo of body weight. Sometimes it's even higher. Experimental evidence can show that as well, like up to a couple hundred calories per day. And there's no real difference in sort of like as far as weight gain goes and those who have a high basal metabolic rate versus a lower basal metabolic rate.

42:54Dr. Jordan Feigenbaum:So there's no real experimental evidence that shows that, look, people with excess adiposity, excess body fat have a slower metabolism than their lean counterparts. So I think what we're seeing here is just a sort of unique, I don't know, it's kind of like an experiment that's taking place in real time. Like we've changed our environment such that the genetics that are relatively stable are producing a pretty predictable response. Our genetics are not set up for the modern food environment, the modern activity environment where we are less active and where we have access to all of these foods that are very, very tasty, very desirable, easy to access, cheap, high in calories, but not very filling.

43:38Dr. Jordan Feigenbaum:And our genetics are such that like, what is this? So individuals were exposed to those, you know, far more than individuals who aren't based on where they live, based on their socioeconomic status or whatever, well, the outcome is predictable. They're going to gain body weight up until a certain point, and they're going to kind of plateau off. This is probably best modeled by what's called a dual set point theory by Dr. Speakman. Now, this is still kind of speculative, but I do like this model for conceptually understanding what happens with weight regulation in adults in developed societies.

44:09Dr. Jordan Feigenbaum:That is, there is a low body weight, body fat level that your body defends vigorously against once you start to approach it, because that would increase your risk of dying from disease or otherwise not having enough, quote, fitness. And I don't mean that in like a CrossFit type setting or like exercise related setting. I mean fitness in the biological – with the biological meaning like, oh, you can't reproduce because you're going to die, you're infertile, whatever. So vigorously defends against that should you approach that. and you have a upper level of body weight and body fat sort of set point that your body would theoretically defend against should you get up that high.

44:46Dr. Jordan Feigenbaum:But the problem, and that's like for a predatory risk, right? Or also reduced levels of fitness where now your fertility has been compromised, but that's so much higher than what society views as like attractive or desirable or whatever. And so we've seen this sort of gradual shift towards that upper end, towards that upper set point, but it's just much higher than most people would prefer.

45:08Dr. Austin Baraki:Does that seem plausible to you? Seems very biologically plausible. I think both of us have historically found this proposed model or explanation pretty compelling. I think that just selection pressures and sort of almost like incentives in a certain way, biological incentives as another term to describe what we'll call selection pressures or lack of selection pressures can have a super potent effect on like gene environment interactions here. Yeah.

45:33Dr. Jordan Feigenbaum:Yeah. And I think when people just blame their metabolism, maybe what they're really talking about, and this is something that is definitely true, maybe they're not really saying or not really meaning, maybe unintentionally, that their basal metabolic rate is slower on average than another person of similar body mass, lean body mass, activity level, whatever. Maybe they're not saying that, but what they're saying is like, look, when I try to change my diet or increase exercise, I don't get the same response that my friend does. And to that I say, yeah. Yeah. It'd be like that. And we can call that metabolic adaptation, maybe more technical term, adaptive thermogenesis.

46:12Dr. Jordan Feigenbaum:But yeah, people – changes in body weight produces changes in body mass. So you lose some lean body mass, for example, which in turn changes resting energy expenditure. That's somewhat predictable. But amongst individuals who are so, quote, unquote, resistant to weight loss, a number of other changes are going to occur. They're going to have a greater than normal reduction in their basal metabolic rate. They're also going to see a greater than normal reduction in their activity-related energy expenditure. And that's not just exercise. That's non-exercise energy expenditure. They're going to twitch less.

46:44Dr. Jordan Feigenbaum:They're going to shiver less. They're going to move less. and that's all subconscious, right? Their hunger is going to go up. Their feelings of fullness or satiety are going to go down. And for folks who are very, very resistant to weight loss, it's a tough road. I agree. And I understand that that experience is very, very challenging, you know, defeating and whatever. But that doesn't mean that you have a slow metabolism. All it means is that your genetic lot in life is much more poorly suited for the modern environment than some other folks. And yeah, if your intervention, if the proposal was, well, let's change the environment, we would say, yeah, let's do it.

47:21Dr. Austin Baraki:Yeah. And to the extent that's not feasible, you're living in the best time in history to have tools to manage it, right? Totally. It may not be your preferred method if it involves the use of certain meds or surgery or something like that, but we've never before had the level of, you know, potential intervention control over this as we do today at this moment. And tomorrow we'll have even more because a lot of these things are being studied. You know, this conversation around metabolism, there's two examples that I can think of that are really commonly cited. One is what you mentioned where somebody says, you know, I'm not getting the same results as this other person that I know.

47:55Dr. Austin Baraki:Or I know somebody who can eat a ton of food and they never gain weight. And then I, you know, eat very little and I feel like I either do gain weight or I can't lose weight. There's a couple variables there. One is just the intrinsic biological variation between these two people that may lead them to have different, you know, results from these things in the modern food environment. The other is something that we talked about earlier, that it's very likely that they are overestimating the amount of calories that that person is consuming in a 24-hour period, for example. Maybe they see them eat a large meal, but they don't see the meal that they skipped.

48:26Dr. Austin Baraki:Yeah, yeah. At a different point of the day. And they're severely underestimating the amount of calories that they consume. This is just what humans do. So there's some estimation inaccuracies there. There are probably some unaccounted for variables. And then, yeah, there's the biological variation between people. we could you and i could both sit here and complain that hey we could try running uh ed cone's deadlift program and we didn't deadlift 900 you know come on man sorry like just try harder it's not we're not you know the same organism uh we have you know different uh different things that are going for us and different things that are not in our in our in our favor here so there is some biological variation between people even if they are doing the same thing you know we put people on similar programs and we're going to see diverging results.

49:12Dr. Austin Baraki:You put people on a similar diet, you're going to see some diverging results for reasons that are both within and outside of their control. The other aspect of the metabolism piece, not just comparing between people, between adults, for example, is, well, it was different when I was younger. And, you know, when I was a kid, I didn't have to think about this and I could eat whatever I wanted and things like that. And by and large, I think that a lot of that, there's certainly some, depending on how long ago you were a child, there are likely to have been some changes in the food environment and things like that around and alcohol use and all sorts of other things that can come into the picture across the lifespan.

49:45Dr. Austin Baraki:But activity level is a massive, you know, variable that changes, you know, over that period of time, I think about some of my friends, kids these days that I see that are like in the, you know, four or five year old timeframe, and they're just like, constantly throwing their bodies around all over the place doing doing stuff playing, you know, just like hyperactive, you know, moving around arguably. And that's something that, you know, obviously if we saw an adult behaving in that way, we would view it as concerning or culturally maladaptive or something like that. Instead, they're, you know, maybe potentially sitting in office chairs in a cubicle for a fair amount of the day and perhaps not otherwise meeting or exceeding physical activity guidelines and things like that.

50:25Dr. Austin Baraki:So that's another variable that changes across the lifespan within a person that might be perceived as a decrease in metabolism. And it's like kind of, if you look at like maybe total, you know, activity that you're doing or something like that, but not your basal metabolic rates, not the, the, those types of functions that we can measure that appear to be quite consistent across the time, time span. And your dietary patterns have also shifted from childhood to adulthood. So there's a lot of like explanatory variables that can, uh, you know, get at these experiences that people have, and then kind of jump to the conclusion of it's, it's my metabolism that's, that's changed.

50:58Yeah.

50:58Dr. Jordan Feigenbaum:Generally speaking from like adolescence, we'll call it, or in childhood and adolescence to like adulthood, you're no longer growing. So sure, metabolic rate per kilo has gone down a little bit because you're no longer growing, especially not at the rate that you were. You're likely to be less active. And then again, depending on how much time has passed, let's say if you're in your sixth decade now, so you're in your fifties compared to when you were a child, you know, in the early eighties or seventies, oh, the food environment has changed drastically as far as also as like normal dietary practices.

51:26Dr. Jordan Feigenbaum:For example, much more meals are being consumed that are prepared outside of the home. Portion sizes are bigger, all sorts of stuff. But that doesn't mean that your metabolism has crashed.

51:35Dr. Austin Baraki:Yeah. If we transplanted you in your state with your current metabolism into a different food environment, you'd be likely to do fine if we had control over that food environment. If it was a better food environment. If we could set it up the way we wanted. Yeah. But we could also set it up in a way that's even worse.

51:49Dr. Jordan Feigenbaum:And we could predict the results there too. Yeah. Food industry would love that. This podcast is brought to you by ButcherBox. One thing I try to stay consistent with is keeping enough protein in the house so I don't end up ordering takeout a few times a week. That sounds simple, but between work and everything else, the grocery store trip is usually the first thing that gets cut. ButcherBox fixed that for me. They deliver grass-fed beef, organic chicken, wild-caught seafood, and more, all sourced to the standards they are transparent about. Every box is customizable, so you pick the cuts and the proteins that fit how you actually cook and what you're actually going to eat.

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54:27Dr. Jordan Feigenbaum:Let's just say it was kind of like a trust fall with the seam of my pants to make it through the end of the shift every time I had to bend over to examine a patient or tie my shoes. That's how I ended up trying FIGS. They are cut with actual stretch, they fit like real clothing, and they survive both the job and the squat program. Back to school season is here. So if you're in healthcare or you're training for it, that means a fresh round of long shifts in the hospital. And oh, by the way, you'll have to do some lectures too. Figs just dropped new colors and back to school styles and their stuff is built for exactly this job.

54:58Dr. Jordan Feigenbaum:In medicine, you never really stop being a student. Might as well look good doing it. Right now, Figs is offering 15 % off your first order at wearfigs.com with code FIGSRX. That's wearfigs.com, code FIGSRX. 220 minus your age. It's on your watch, it's on the treadmill, and almost nobody can tell you where it came from. Well, I will. It came from a review paper published in the 1970s by Fox and colleagues looking at physical activity and heart disease. Here's what 220 minus age actually is. Picture a graph with age along the bottom, max heart rate on the side, and a cloud of dots from a bunch of different studies.

55:33Dr. Jordan Feigenbaum:220 minus age is just a straight line that the researchers laid over that cloud. It wasn't calculated, and it wasn't tested against anything. Someone just looked at the scatter plot and drew a line through the middle of it and said, yeah, that looks pretty good. That's the whole origin story. And the data in that original paper didn't even support it. The author said, and I'm quoting, no single line will adequately represent the data of the apparent decline of maximal heart rate with age. They said 220 minus age just defines a line not far off from many of the data points. That's the pedigree, and 50 years later, it's the default on every smartwatch sold.

56:06Dr. Jordan Feigenbaum:And it's not even the best formula that anyone's come up with. The better fit is 208 minus 0.7 times your age. It still carries about a six-beat error, so what do you do? Like, if I'm going to program your conditioning, the easy runs, the cross-training, and the threshold work to make it faster for 16 weeks, I want to make sure the prescription fits you, not just a line that somebody drew through a cloud of dots. That's why I built a field test into the hybrid 5K and 10K templates at the start and again at week 8 because fitness changes. Any heart rate estimate can be off by enough to throw off your intensity and your subsequent training load, which matters a lot when you're combining lifting and running in a way that makes you stronger and faster at the same time instead of just burning you out.

56:46Dr. Jordan Feigenbaum:So you get a 20-minute field test to make sure that you're anchored to the right intensity. The template includes three 16-week programs, 5K beginner for those who haven't done much running before, and the 5K and 10K performance versions for those who want to go fast. All of the programs include three days per week of lifting with every conditioning workout fully written out. and it's available now on our website, barbellmedicine.com, where you'll get both the desktop files and the app version of the program. The app is free, as it always is. Just search Barbell Medicine in the App Store. And like all of our other programs, it's included free for the Barbell Medicine Premium subscribers.

57:18Dr. Jordan Feigenbaum:So if you want to get better at running without giving up your strength, check out our latest template, the Hybrid 5K and 10K program. Okay, back to the show. All right, welcome back to the Barbell Medicine podcast. We're talking about controversies in nutrition, And now we're going to talk about real sugar versus high fructose corn syrup. So what's the controversy here? Well, people believe that, quote, real sugar is better, more health-promoting, et cetera, than high fructose corn syrup. And this is actually topical because in a post on Truth Social, President Donald Trump said that Coca-Cola has agreed to use real cane sugar in U.S.

57:53Dr. Jordan Feigenbaum:production of their popular soda, Coke. Why is there controversy? Well, like I've always said, and I've been saying this for years, maybe since the start of Barbo Medicine. It's the three C's that people are bad at. That's chemistry, critical thinking, and Coke. I've been saying it forever. People know this. So with chemistry, first we can take sweeteners and put them into two groups, nutritional and non-nutritional sweeteners. Nutritional sweeteners have calories, contain energy. Non-nutritional sweeteners do not have calories or energy. So that non-nutritional sweeteners would be things like aspartame, stevia, et cetera, whereas nutritional sweeteners, There are basically three types of these.

58:33Dr. Jordan Feigenbaum:There's a monosaccharide. So there's one type of chemical that would be like fructose and glucose. There's a disaccharide. So there's two types of chemicals that are bonded together. That's like sucrose, right? This would be glucose and fructose bonded together. And then there's polyols, like a sugar alcohol. So we'll focus now on disaccharides, right? So table sugar, sucrose, and high fructose corn syrup. Those are both disaccharides. So cane sugar or, quote, real sugar is sugar derived from sugar cane. That's a tropical grass. It's called cane sugar instead of just sugar to differentiate it from sugar derived from other sources like sugar beets, but they're chemically the same.

59:11Dr. Jordan Feigenbaum:It's 50 % fructose and 50 % glucose bonded together. Now, you compare that to high fructose corn syrup. This is a blend of, yep, you guessed it, fructose and glucose, but just in different proportions compared to cane sugar. So it's either 42 % or 55 % fructose, and the rest of it is glucose. So slightly different as far as proportions, but chemically, they are the same. It's fructose and glucose together. So that's the first thing that people are generally bad at, chemistry. But there's your chemistry lesson. You can replay that so then you could be an expert in chemistry related to cane sugar versus high fructose corn syrup.

59:44Dr. Jordan Feigenbaum:Now we'll move on to the second C, critical thinking. People say fructose is bad, and by proxy, fruit is bad. So some, but not all, or even most studies on fructose ingestion alone show that compared to glucose ingestion alone, well, fructose can increase the creation of fat in the liver. This is called hepatic de novo lipogenesis. It's also less satiated or filling and so on. And these tend to be most problematic in a calorie surplus. Now, what those studies don't tell you are two things. One, humans by and large do not consume just pure fructose or pure glucose because table sugar is not pure glucose.

1:00:21Dr. Jordan Feigenbaum:and fruit is not pure fructose. And also de novo lipogenesis, that's a relatively minor pathway for fructose metabolism overall. So two important caveats there for this quote, external validity that you talked about earlier. And so then people will say, well, look, high fructose corn syrup is bad because of the excess fructose compared to sucrose. However, the data does not show this. When you look at actual data on humans eating the same amount of calories, but they're getting some of that from high fructose corn syrup versus sucrose. Again, we're talking about things that are chemically the same, just slightly different proportions.

1:00:56Dr. Jordan Feigenbaum:There is no difference in outcomes with respect to weight gain, with respect to lipid levels, with respect to fasting blood sugars, with respect to blood pressure, go on and on down the list, insulin sensitivity, whatever. They are the same. And so if you were good at critical thinking, you would say, well, look, I had this hypothesis that because ingesting large amounts of pure fructose, especially in a calorie surplus may be deleterious to human health. And your prediction was, well, because high fructose corn syrup has more fructose in it, that's going to cause unwanted outcome, whether it's weight gain, increases in blood pressure, increases in atherogenic lipoprotein levels.

1:01:33Dr. Jordan Feigenbaum:You would have to then go to the research and say, well, show me the data. Does this actually play out? And then you look at the data and you're like, oh, crap, it doesn't. Well, I guess I have to reject my hypothesis or otherwise modify it to fit this information.

1:01:46Dr. Austin Baraki:yeah fully agree it's been frustrating to watch all this play out uh being touted uh by the hhs i think as a win that they're wanting to switch u.s coke from that from uh you know to to real quote-unquote cane sugar as this kind of naturalistic sort of sort of thing that they're pursuing i mean if you look at historically rates of diabetes in mexico have consistently been higher than rates of diabetes in the U.S. If you wanted to take a very oversimplistic view on this, you're like, well, if this were such a strong driver of our diabetes rates in the U.S., well, what about the place where they do sometimes use a bit more of the cane sugar and things like that?

1:02:30Dr. Austin Baraki:So I wish that we were targeting things similar to our conversation in the first question about prioritizing, for example, things like dietary fiber and the fat composition in our diet and things like that, rather than, as our friend Dr. Nadilski recently said, he used one of my favorite commonly used phrases in medicine, rearranging deck chairs on the Titanic, meaning it is just doing something that is ultimately going to be futile. And it's coming from a place that is not reflective of good critical thinking because you could have conversations with these folks and say, I've actually sometimes wanted to do something like this to say, based on your hypothesis of the case or based on your understanding, could you describe to me the design of a study that would test this and they would probably describe a study that probably something like it has been done and if you showed that to them and that its results went in the opposite direction of what they expected then what happens and we know what happens in people's brains this is not i'm not attacking anyone in particular here but this is just what people do when they're tightly wedded to an idea or a hypothesis or a belief is that they'll immediately start scrutinizing and trying to find reasons to dismiss the evidence that they don't like.

1:03:40Dr. Austin Baraki:And so ultimately another potentially futile endeavor, but one that would be entertaining nonetheless, I think.

1:03:46Dr. Jordan Feigenbaum:Yeah. And the final C that people are bad at, again, I've always said this, always. Always. Coke. Coke. People are bad at Coke. Okay. Because this claim is that, well, just look at Mexican Coke and compare it to the Coke that sold Coca-Cola that sold the United States. Because Mexican Coke, you know, they use cane sugar and not high fructose corn syrup. And so, okay, one, in Mexico, yeah, generally the rates of type 2 diabetes and metabolic syndrome are higher in the United States. So, all right, that's strike one.

1:04:16Dr. Austin Baraki:That's a problem, yeah.

1:04:16Dr. Jordan Feigenbaum:Yeah, strike two, people, again, they claim that Mexican Coke, well, it tastes better and it's better for you because they use cane sugar instead of high fructose corn syrup. Well, that's not true either because Coke in Mexico has used high fructose corn syrup for more than over the last 10 years. Like, they've been using it for over a decade. And they're like, well, but it tastes better. I'm like, okay, well, it has a little bit more sodium in it, and it has more caffeine, and more proportionally are sold in bottles that affect the taste. And there's actually like a whole separate scale of like sweetness.

1:04:47Dr. Jordan Feigenbaum:I think it's called the BRICS scale, B-R-I-X, and it has to do with like how sweet the thing is. And they have to adjust the amount of sweetener in the product based on what vessel it's being sold in and the type of sweetener that they use. I think they also put sucralose in Mexican Coke as well. So anyway, more stuff going on here. But again, like I've always said, historically, people are bad at the three C's, which is chemistry, critical thinking, and Coke. So consensus here. I don't want people to get it twisted and say that we're telling you that high fructose corn syrup is uniquely health promoting.

1:05:20Dr. Jordan Feigenbaum:We are certainly not saying that. What we are saying is that it's no worse for you than cane sugar if consumed in the same amounts and we have no data to suggest that people consume more high fructose corn syrup in a similar food than they would regular sugar. They're both bad, to be clear. Generally speaking, I wouldn't want people to eat a diet that has a lot of added sugar from either of them. I would instead prefer that people consume those same foods with non-nutritive sweeteners if I could make a small change, meaning that they're sweetened with an artificial sweetener or a natural sweetener like stevia or monk fruit, whatever, than having added calories from cane sugar or high fructose corn syrup.

1:06:03Dr. Jordan Feigenbaum:But overall, your dietary pattern probably shouldn't be that sweet with respect to either added sugar or non-nutritive sweeteners either. So it's not that like high fructose corn syrups, we're recommending it. 10 out of 10, you should consume it. We're like, well, maybe your diet shouldn't have either in them.

1:06:17Dr. Austin Baraki:Yeah, I recall the first time I heard you say that final idea that like overall your diet probably shouldn't be super sweet all the time. And I thought that that was a reasonable kind of a take home suggestion for people that they might not have thought of in that way. Instead of micromanaging all these things, it's like if if you're constantly having sweet things all day, there's probably a problem here that we ought to address.

1:06:37Dr. Jordan Feigenbaum:Yeah, broader dietary pattern can be changed. But yeah, we're not saying high fructose corn syrup is uniquely healthy or that you should replace all of your cane sugar with high fructose corn syrup. We're just saying that replacing high fructose corn syrup with cane sugar is going to do nothing. Literally nothing. Pretty literally nothing except for waste a bunch of resources, time, attention, etc. And it's like all we're doing is placating people who probably shouldn't have confident opinions on this thing. And they're like, look at what we're doing policy wise. Yeah, real food, real sugar. It's like that seems to be a fallacy.

1:07:07Dr. Jordan Feigenbaum:Maybe maybe we shouldn't be asking for that. Yep. Agree. All right. Last controversy. We're talking about the anabolic window. This is still a thing people talk about. Oh, yeah. Oh, yeah. So what's the controversy here? Well, nutrient timing is a popular strategy for enhancing training adaptations and performance. From the standpoint of muscle strength and size, for example, the concept of a, quote, post-workout anabolic window has been proposed, whereby a limited time exists after exercise to optimize training adaptations. Some have gone so far as to claim that nutrient timing is even more critical to muscle development as total calories and total macronutrient intake.

1:07:47Dr. Jordan Feigenbaum:Like as far as why this controversy exists, I think that it's like a perfect storm. One is there's been this increased recognition that recovery from exercise is important. And there's been a lot of evidence on like sort of what mechanisms are at play. So like you exercise and you're depleting your glycogen levels in the muscle. You're breaking down muscle protein. And then if you replace them immediately, theoretically, your body will super compensate. You'll store more glycogen. You'll store more protein, have bigger muscles. So athletes at the highest level, there's often like very intensive efforts to right after they're done with a training session, they got to recover by some sort of mechanism, whether it's eating like whole foods or some sort of supplement.

1:08:30Dr. Jordan Feigenbaum:There's also a lot of marketing for supplements based around this. Oh, you need post-workout carbs and the specific type of carbs, whether it's a highly branched cyclic dextrin, whether it's pure glucose, whatever, something like that. And this focus on mechanisms like, ooh, this increases muscle protein synthesis or this increases the rate of glycogen replenishment or decreases the rate of muscle protein breakdown. All of those mechanisms are reasonable to investigate and discuss, but we can't blind ourselves to, well, what are we really looking for? Because I personally, I don't really care about my muscle protein synthesis rate compared to, well, what did my strength do?

1:09:08Dr. Jordan Feigenbaum:What did my muscle size do? How did my endurance performance do after this particular intervention? Muscle protein synthesis, muscle protein breakdown, glycogen breakdown, glycogen resynthesis rates, those are all short-term sort of proxies for like what's going on in the body to tell you like, well, is this person going to gain more muscle mass? Is this person going to gain more muscle size or muscle strength? Is their endurance performance going to be supported? But you can actually measure those things too. And so like measure the proxy if you want, that's fine for generating hypotheses, but then you got to test it later on.

1:09:45Dr. Jordan Feigenbaum:The last part here that I think also contributes to the controversy here is generally speaking, poor study design. Because a lot of the studies that led to this controversy about a quote-unquote anabolic window, post-workout anabolic window, tested untrained individuals who were previously fasted going into a session. And it's like, well, yeah, if you're fasted, that's a totally different person than someone who's fed going into a workout. And so the quote-unquote effects of post-workout nutrition would be different for somebody who is fasted compared to being fed. You see the same thing with intra-workout nutrition where people are like, oh, you got to eat like gummies in the middle of a workout.

1:10:26Dr. Jordan Feigenbaum:And it's like, well, maybe if you were fasted, that's different than if you were fed, and that's what the data shows. mostly unnecessary intra-workout nutrition unless the sessions are longer than about 90 to 120 minutes. That's mostly in either really high volume resistance training or a very intensive sort of endurance efforts or even prolonged efforts.

1:10:44Dr. Austin Baraki:Yeah, not an hour and a half or two hour session because your rest periods are 10 to 15 minutes long.

1:10:48Dr. Jordan Feigenbaum:Yeah, or you're yapping, you're spitting game. Yeah, which zero to 10 would not recommend. So let's see if we can come up with a consensus here and wrap this up. Based on existing data in the Fed state, there's little evidence supporting the need to immediately consume a post-workout meal. And most of the time, that's being recommended as a combination of protein and carbohydrates in that post-workout window. This is provided that a person otherwise eats the same amount of calories, the same macronutrient intake, et cetera. If fasted, whether overnight or otherwise greater than four to six hours between meals with no snack before a workout, sure, would recommend hustling to get a meal in, but that's mostly because you haven't eaten in a while.

1:11:30Dr. Jordan Feigenbaum:A few exceptions here. First exception, if there's a short turnaround before the next training session or competition. So for example, like eight hours or less than eight hours. Yeah. Post-workout nutrition, very, very important just because you have a limited amount of time here. But if we're talking about 24 hours or 48 hours between your next exercise session because you work out three days a week, which, hey, we're big fans of, this doesn't apply to you.

1:11:57Dr. Austin Baraki:Just go on living your life. Yeah, totally.

1:11:59Dr. Jordan Feigenbaum:If you have a very high training volume such that you're spending 20 hours, 30 hours a week exercising, well, because of that, you have a limited amount of time overall in your week to eat. And so at that point, post-workout nutrition becomes far more important just because you have a limited amount of time to take in enough energy to support your existing body weight and subsequent performance. So overall, I would recommend that folks eat somewhere between three to five meals per day, three to five hours apart, and it should produce a situation where an individual is fed for each workout and gets a meal after each workout.

1:12:33Dr. Jordan Feigenbaum:It's just the timing of that meal after the workout to me doesn't really matter unless somebody is like, look, I'm going to train again in a few hours or I got another competition in a few hours. If you prefer to train first thing in the morning and you want to be fasted, well, yeah, that post-workout meal is going to become more important, but not because of this quote post-workout anabolic window. It's mostly because you were fasted before and now it's time to eat yeah i remember getting i mean this was 20 years

1:12:58Dr. Austin Baraki:ago at this point but just getting blasted all the time with ads from like t nation for every possible supplement to take like pre-intra early intra late post before bed day off like they went they went hard with with that kind of stuff i'll be honest this is something that i haven't thought about ever uh in in years i think that there was a time very early on in my training career where you know, I didn't know anything and I was listening to, you know, the advice that was around at the time. So did try to get something in like probably a lot quicker than I needed to afterwards. But these days, uh, yeah, not something I think about really at all.

1:13:35Dr. Austin Baraki:And, you know, for example, recently with this move and, um, all the effort and work and how crazy those days can be, it's actually worked out best for me to try to get up and go and get some training in first thing in the morning before the day starts. Uh, and I get sucked up in projects or whatever else needs to happen around the house. And I've just gotten up and I've gone and I've been fasted and I've done my training, not because I prefer to train that way, but it just is. And I've not given any thought to this concern over my anabolic potential or my window in that timeframe. I just eat when I get back and then go on living my life.

1:14:08Dr. Austin Baraki:And ultimately it's fine. Is there any compromise? I mean, maybe, but it's also a compromise that would only be in the short term anyway. I would rather train fasted than not train or train fasted and maybe actually perform a little better when I'm energized in the morning compared to waiting until later in the day when I would otherwise feel bettered and ready to train. But I've been smoked by like working around the house all day or something like that, right? So there's a lot of trade-offs to consider. And this window is not one of them, at least for me. And I don't think it is for you either.

1:14:37Dr. Jordan Feigenbaum:Yeah, correct. Yep. I think ultimately that I just want to have my three to five meals a day. I eat when I eat. I prefer to have a meal within 90 minutes prior to exercising. And then because my – if it's 90 minutes before and then my workout session takes 90 minutes. So now I'm at three hours. Then I got to go home, a shower, whatever. It's another hour or so. Well, now it's four hours, but time to eat again. And so that's my post-workout meal. But I'm not like bringing a shaker to the gym and like I just finished my last set. I leave all the equipment out. I hustle to fill it up with water. I'm like, I got to get it in now.

1:15:12Dr. Austin Baraki:Yeah. Yeah. Yeah, body doesn't work that way, particularly when you were fed going into it, for sure.

1:15:17Dr. Jordan Feigenbaum:Here's my hot take. You ready for a hot take? Sure. I think that generally speaking, people consuming a lot of intro workout food, I think that's generally net negative for the vast majority of individuals. And here's why. One, most folks are not training at a high enough level and doing enough training where they have limited opportunities to eat otherwise. exercise that's one thing too most people are not training long enough where yeah really making sure that you have enough glycogen on board in your muscles to fuel activity is the rate limiting step to just look if you're training two three hours at a time different situation particularly for fasted but most people are not and so there's really no benefit to consuming food in between but instead what you're doing is limiting the sort of period between meals where your body is like figuring out how to deal with low energy availability, clearing sugar.

1:16:12Dr. Jordan Feigenbaum:You're just all perma-fed. And it's the same thing.

1:16:15Dr. Austin Baraki:Constantly postprandial.

1:16:16Dr. Jordan Feigenbaum:Yeah. Yeah. It's kind of like when people are in the hospital and they're getting TPN or something like that around the clock. And you're like, yeah. So in addition to the medical condition for why you're in the hospital, that's contributing to some insulin resistance and this, that, and the other, but you're also constantly fed. And so it's just like constantly grazing throughout the day versus having discrete meals, which is what you would prefer. And oh, by the way, the majority of foods that people are consuming in the middle of a workout are highly processed added sugar or whatever that are not very filling.

1:16:45Dr. Jordan Feigenbaum:And so to me, that represents a nidus for like excess energy intake. And I'm like, bro, you didn't need that. Most of the time, if you need to gain weight and that's the strategy you want to pick, like fine, I guess. But yeah, it's just funny to me. I see people with these huge jugs of basically liquid sugar, right? And they're just consuming it throughout a workout and they're doing like some bodybuilding stuff and i'm like yeah that definitely is not a context

1:17:08Dr. Austin Baraki:where that makes sense to me i think the ultra endurance stuff the you know super super high volume uh aerobic work things like that where they're sucking down gels uh on their you know 90 grams an hour training stuff like that that's totally fair i don't see any almost any situation where i'd be doing that in a in a lifting context um particularly if i'm training to my preference relatively frequently because i could not train that high volume in one session as often as i'd

1:17:33Dr. Jordan Feigenbaum:like to train in general how many people do you think that are having like you know during a lifting session 50 75 gram 100 grams of carbs during a workout from you know added sugar or just pure sugar whatever how many of those folks do you think are like i would never have a regular coke yeah right and it's like i mean you could if you wanted to that would be the time theoretically

1:17:53Dr. Austin Baraki:yeah yeah yeah in the same way that general dietary patterns probably shouldn't be that sweet you should probably also not always be fed there you go there you go all right well that is a

1:18:03Dr. Jordan Feigenbaum:wrap here on the Barbell Medicine Podcast. Five nutrition controversies that probably shouldn't be controversial. Just wanted to bring to your attention again. If you want to become a Barbell Medicine Plus member, you want to listen to the podcast ad-free, you want early access to them, you want discounts on our products, early access to our products, and all for the cost of about a cup of coffee a month. And the first month's free. Head to barbellmedicine.supercast.com. We'd really appreciate your support there. And before you guys go anywhere, please leave us a five-star rating and a review it really helps drive traffic to our podcast so we can keep bringing you all the latest nuance and health and fitness from everyone here at barbell medicine I'm dr.

1:18:37Dr. Jordan Feigenbaum:Jordan Feigenbaum we'll catch you next week and every week right here on the barbell medicine podcast