Barbell Medicine Podcast

The longevity industry is now worth over $100 billion per year. From DNA methylation clocks to multi-cancer blood tests and GLP-1 medications, the promises are bold.
But what actually predicts lifespan?
In this episode, Dr. Jordan Feigenbaum and Dr. Austin Baraki break down the science behind biological clocks, the real story on GLP-1–related muscle loss, and introduce the Barbell Medicine “Vital Five” — a clinically grounded framework for health and longevity.
Key Points:

The Three Generations of Biological Clocks: Understanding the evolution of DNA methylation tests from simple chronological markers (Horvath) to sophisticated predictors of mortality (GrimAge) and functional decline (DunedinPACE).
Descriptive vs. Prescriptive Metrics: Why a biological age score acts as a lagging indicator rather than a tool for clinical decision-making, compared to traditional risk factors like blood pressure and ApoB.
GLP-1s and Sarcopenia Reality: A nuanced look at lean mass loss during semaglutide and tirzepatide treatment, emphasizing the difference between total lean mass and actual skeletal muscle quality.
Weight-Independent Benefits of Incretins: Analyzing data from the SELECT and FLOW trials regarding the direct cardioprotective and renal benefits of GLP-1 receptor agonists.
The Limitations of Early Detection: Why multi-cancer early detection (MCED) tests can lead to diagnostic loops and how clinical utility differs from marketing promises.
The Barbell Medicine Vital Five: A definitive framework for longevity focusing on blood pressure, ApoB, VO2 max, relative strength, and body composition.
Neurodegenerative Research Outlook: A critical review of the EVOKE trials and the potential (or lack thereof) for current weight-loss medications in treating established Alzheimer's disease.

Next Steps

For evidence-based resistance training programs: barbellmedicine.com/training-programs
For individualized 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/
To consult with Drs. Baraki or Feigenbaum email us at [email protected] 

Timestamps:

00:00 Overview: longevity industry and proxy metrics
01:06 Biological age and DNA methylation clocks
08:18 Clinical usefulness and limitations of biological age testing
16:16 Multi-cancer early detection tests: screening tradeoffs
30:39 Exercise prescription for longevity (treat-to-target)
54:39 Protein intake and longevity: evidence and recommendations
1:07:23 GLP-1 receptor agonists: outcomes, misconceptions, and use cases
1:34:24 Hormone therapy (women and men): risks, benefits, evidence
1:49:19 Practical longevity tracking: “Vital Five” markers
1:58:15 Closing

References:
Biological Clock
https://pmc.ncbi.nlm.nih.gov/articles/PMC8853656/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC12038942/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11424583/  
https://pmc.ncbi.nlm.nih.gov/articles/PMC6366976/ 
Cancer Screening
https://ascopubs.org/doi/10.1200/JCO.2019.37.15_suppl.5574 
https://www.thelancet.com/article/S1470-2045(23)00277-2/fulltext 
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01700-2/fulltext 
https://www.nhs-galleri.org/ 
Exercise
https://bjsm.bmj.com/content/56/13/755 
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2807854 
https://pubmed.ncbi.nlm.nih.gov/35442242/ 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915309/?mc_cid=87bfcaaa3a&mc_eid=8786146256 
https://pmc.ncbi.nlm.nih.gov/articles/PMC9012529/ 
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428 
https://pubmed.ncbi.nlm.nih.gov/35228201/
https://pubmed.ncbi.nlm.nih.gov/35662329/  
​​https://academic.oup.com/biomedgerontology/article/77/4/781/6354429 
https://www.sciencedirect.com/science/article/abs/pii/S0025619625001004 
https://pmc.ncbi.nlm.nih.gov/articles/PMC12131147/  
https://pubmed.ncbi.nlm.nih.gov/18595904/
https://pubmed.ncbi.nlm.nih.gov/12242311/ 
Protein
https://pubmed.ncbi.nlm.nih.gov/40418846/ 
https://pmc.ncbi.nlm.nih.gov/articles/PMC7250948/ 
https://pubmed.ncbi.nlm.nih.gov/39110456/ 
https://pubmed.ncbi.nlm.nih.gov/24606898/
https://www.bmj.com/content/370/bmj.m2412 
GLP-1
https://www.cell.com/cell-metabolism/abstract/S1550-4131(26)00008-2 
https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 
https://www.nejm.org/doi/abs/10.1056/NEJMoa2403347 
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01296-0/fulltext 
https://link.springer.com/article/10.1007/s11154-025-09991-4 
https://pmc.ncbi.nlm.nih.gov/articles/PMC12338914/
HRT
https://pubmed.ncbi.nlm.nih.gov/25754617/ 
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00211-6/abstract 
https://www.nejm.org/doi/full/10.1056/NEJMoa2215025 
https://pmc.ncbi.nlm.nih.gov/articles/PMC4527564/ 
https://www.mdpi.com/1422-0067/25/22/12221 
Body Roundness Index (BRI) : https://www.barbellmedicine.com/blog/should-bri-replace-bmi/

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Lifting more weight doesn't always mean you've gotten stronger. In this foundational session, Dr. Jordan Feigenbaum and Dr. Austin Baraki introduce the Fitness-Fatigue Model to explain why "stalled" progress is often just a temporary masking of strength by accumulated fatigue. By learning to differentiate between a lack of fitness adaptation and a lack of recovery, you can avoid the "panic pivot" and maintain the long-term signal necessary for elite-level gains.
Supercast Sign-Up
For the 6-part audio series and Training Plateau Action Plan, sign-up for Barbell Medicine Plus:
https://barbellmedicine.supercast.com/
Key Learning Points
The Fitness-Fatigue Model: Understand the physiological duality of every workout—while a session builds your "fitness" (potential), it also creates "fatigue" that temporarily suppresses your performance.
Strength vs. Effort: Performance must be measured relative to RPE. If the weight on the bar increases but the RPE climbs disproportionately (e.g., jumping from RPE 8 to RPE 10 for a 5lb gain), your absolute strength has not actually improved.
Noise vs. Signal: A one-week stall is statistical "noise." Constant program hopping in response to a single bad session destroys the cumulative stimulus (the "signal") required for actual tissue adaptation.
The Root Cause Audit: Determining the "Why" behind a plateau.
Lack of Fitness: The stimulus is no longer sufficient to drive a new adaptation (Needs more volume/intensity).
Lack of Recovery: The fatigue is overwhelming the adaptation (Needs a deload or volume reduction).
Autoregulation as a Diagnostic Tool: Using RPE not just to prescribe load, but to "interrogate" your current state of recovery and readiness.

Timestamps
[00:00] Intro: Introducing the Barbell Medicine Plus Exclusive Series
[02:15] The Thought Experiment: 310x6 @ 8 vs. 315x6 @ 10
[05:30] Deep Dive: Defining the Fitness-Fatigue Model
[09:45] Interpreting the Stall: Is it a Stimulus Problem or a Recovery Problem?
[14:20] The Danger of "Short-Termism": Why Panicking Destroys the Signal
[18:50] Introduction to the 6-Part Audio Course & Actionable PDF

Pearls
The Pivot Rule: Never change a successful program based on a single week of data. Look for a 3-week trend of stagnant or declining performance (at the same RPE) before initiating a program pivot.
Peaking Mechanics: Most "peaking" protocols do not build new strength; they simply reduce fatigue to reveal the strength you've already built.
The stimulus-Recovery Trap: If you feel "beat up" but the weights are moving well, you likely don't need a deload yet. If you feel "great" but the weights are stuck, you likely need a stronger stimulus.

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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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