Doug McGuff: Resistance Exercise

[Music] this lecture is being brought to you in part by the generous gifts of these sponsors I drove from right next to Clemson University down to Pensacola to come here they offered to fly me but by the time you drive to Atlanta go through the TSA screening eyes is just better to drive so on the way down I listen to stim talks all the way down and I was telling Ken earlier today that nothing will trigger your sense of impostor syndrome like listening to these stim talks because everyone is just so so smart and that's both for me an advantage and the disadvantages Ken told you I'm an emergency physician that's my main gig in life and I'm an exercise gig on the other half of my life and I am NOT a scientist and not being a scientist gives me the benefit when talking to you guys of not having to be reserved not having to say more research needs to be done and that kind of nonsense I am here to tell you that if you are not doing resistance exercise of even the simplest variety you need to be and you're missing out and that's what this talk is about so how did I become so bullish on resistance exercise well it goes all the way back until I was about 14 years old I was racing in a sport called BMX and like many things that I develop a passion for I pretty much sucked at it I was getting beat all the time all the time my older brother who's 10 years older than me would happen to be taking a weight training course at the time and he had a little barbell set in the garage and I got the notion that well maybe I'll give this a try and see if it will help and you know age 13 14 I can't remember exactly but the difference that it made was the closest thing to a miracle that I have ever experienced in my life up until that time and since I mean it was really really dramatic so it really raised my game in that sport to the point that I became very dominant in it and one day when I was out training doing bike sprints I ran into this gentleman is pie in his late 50s very muscular looked amazing he was out jogging around the track where I was doing some sprint training and I kind of walked I was like how do you do what you do and it turned out he was an owner of a local Nautilus gym which were just flowering up at that time and he invited me over to come take a look and naturally it was way way out of my budget but being the entrepreneurial little dude that I was I barter janitorial services for a membership there and it was there cleaning out his office on his desk that I found the copy of Arthur Jones bulletin number two and I was kind of flipping through it when he walked in the offices I was like oh sorry didn't mean to he's like no no you can take it with me they gave me several copies when I bought the equipment first book I ever read cover to cover in one sitting I took it home and that set the course for the rest of my life all right so moving forward so in emergency medicine I've kind of reached a point in about the past decade where I've gradually developed a little bit of a professional crisis in emergency medicine so emergency medicine when I got into it was a very dynamic specialty and a lot of times you were seeing people with acute traumatic and medical emergencies that you could take a bold intervention on and things turned around it was a very positive feedback in a short span of time but as the health status of the population as a whole has taken this gradual decline that we'll talk about what I am experiencing now is that when I see a patient it's commonly a revolving door sort of scenario so now we're all on electronic medical records and when you pull up a chart on a patient you have a little tab at the top that says notes and you can click on it and you can see where there are previous visits have been and kind of get an idea of what might be going on with them in the past five years or so at least 90% of the time when I pick up a new patient they have been in the emergency department within the last week of that 90% the majority of them have been in the emergency department within the past 48 hours they are so sick that they almost always get admitted when they get admitted they get admitted to a hospital of service because the way medicine is structured now most physicians don't admit their own patients anymore it's a service that just does only inpatient care they're under immense pressure to get the patients tuned up and out quickly because of Medicare limitations I don't know if any of y'all have had the experience of having to go into the hospital be admitted and then come to find out that you were admitted under observation status and got stuck with a huge bill well know that your physicians that are taking care you are under immense pressure from the hospital administration from the government to get people out so I will see people that come in very sick septic with pneumonia put on a ventilator admitted to the ICU I'll be at work two days later and they're bouncing back on the ambulance so it's a revolving door over and over and what used to be dramatic saves feels like you're duct taping and patching and putting the wheels off a vehicle that are just falling off it is almost impossible to explain to you guys how sick people really are but to backtrack a little bit I do have two sides to my professional life the other side started to take root in 1997 when I opened to ultimate exercise and that was just a fluke of a hobby gone wild so I had a military scholarship for medical school I spent paid back my time in the Air Force which was not highly remunerated and when I finally got out in 1995 I had two years under my belt and I always wanted to have the best equipment to train on so I thought I'm going to try to accumulate a small set of the best equipment that I can have to do high-intensity resistance exercise with and I had kind of a bonus room over the garage kind of scoped out for it and had big plans turns out that when I finally got in the realm of ordering the equipment that it couldn't go there not without falling through the floor and crushing someone down in the kitchen so I had to find some space to put it in and I rationalized that you know if we trained a few clients it would be enough to pay for it so that's what I did and it blew up I mean it just did really really well and it turned into a legitimate business I thought when I opened this place that what I was going to do is get all sorts of young athletes with great muscular potential and we were just going to have this evil science experiment going on is going to be really cool well when you open a personal training center that's completely private and completely supervised you end up selecting for a different population and this is the population that would not be caught dead in a health club but and initially that was a bit of a disappointment to you but it turned out to be the biggest gift that I ever had because the people that came there were operating from a level of never having done this or having become deconditioned or having medical conditions and I think people assume that because I was a doctor it was sort of a medicalised thing when it really wasn't it was just you know a workout geek doing his thing but what I got to witness was the profound difference that minimal amounts of exercise that is difficult can make for people's lives I mean we had people come in on four-prong walkers that within 6 to 12 weeks had discarded it and we're now going on trips and taking tours and hikes and things of that nature I mean it was astounding the turnaround that people were making with it so start to evaluate these two different sides of my professional life I'm saving people from themselves the game and then on the other side it's the antithesis of that I am making that never have to happen or turning it around when it has and what I realized that we were creating in the process of doing this was something coined by another IHMC speaker our third of a knee and that's the term physiologic Headroom and dr. Devaney is for those of you don't know is kind of the father of the Paleolithic diet and health movement following Paleolithic patterns of activity and eating to optimize our genetic expression and he coined physiologic Headroom and defined it quite simply as the difference between the most you can do and the least you can do and the more that you can raise that the better the organism functions as a whole and we kind of found that out through the process of doing it extrapolating that over a lifespan you develop area under the curve so if the y axis on here is your your area your physiologic Headroom and the x axis is time across your lifespan the higher that is over time the greater the area under that curve and that is another term to describe that that's used commonly is the healthspan but what you'll find as we discuss this further as you improve health span you also push the envelope out somewhat for lifespan but it doesn't always work out that way one of the one of the real leaders in the world of high-intensity exercise recently dropped dead in this kitchen at age 72 a gentleman named Kim Lee Schnurr that was an Arthur Jones disciple and did high intensity but and that's tragic I mean 72 I believe is very young to just drop it but he was like the one-horse Shay I mean he had an extremely high physiologic Headroom uh and he did right until the day he dropped and did it suddenly which is way different than what we're seeing in society now where you start off with a relatively high physiologic Headroom but then that rapidly goes down and a lot of people are spending the latter half of their life just kind of humming along the bottom there and the problem is when it comes to physiologic Headroom when the most you can do approach is the least you can do the quality of your life goes way way down and all your health parameters track along with that and when the most you can do equals the least you can do that's called dead and that's not something that we want so with this notion of maximizing performance over a long span of time we need models for that and anyone know who this guy is tell me sir so this is satchel paige satchel paige was a phenomenal athlete he's a freak of nature it was said his may it was a pitcher and his most famous pitch was the fastball he was known for that Ted Williams actually who's one of the greatest hitters in the history of the game described his fastball as when the ball comes over the plate it's the size of a marble it's that hard to swing out and it's that fast the unique thing about satchel paige is he played most of his youth in the Negro Leagues and didn't get to play major league baseball until Jackie Robinson broke the color barrier and he became Major League Baseball's oldest rookie in history entering the major leagues at age 42 he was so good he had such a powerful rep he would draw huge crowds because he would have his whole infield and outfield sit down in the grass literally literally while he struck out the other side he played until he was a year older than I am now he played until age 58 and in his last game he pitched a no-hitter save a double that was hit by Carl Yastrzemski who is no slouch himself it was much much younger at the time so not only was he just this exceptional athlete the thing that was most shocking to people was how young how old he was and how well he performed at that age and no one could really understand it and reporters would constantly hound him about his age how much longer can he go on how do you do this and his response to them was always this how old would you be if you didn't know how old you was and I think that's an important question for everyone to ask themselves every morning when you get up now for me the key to answering that question is I feel great I feel every bit as good as I did when I was 19 but if I look in the mirror and ask myself that question I got to stand just stand back about 15 feet that helps me a lot so what's normal for humans is no longer common which is a shame because this is what normal for human beings should be when we compare ourselves against what hunter-gatherers would look like for instance so this is Clarence bass does anyone familiar with Clarence bass in this picture this is a workout on his 75th birthday he's currently 83 he looks every bit as good right now and you think well this guy just totally kills himself and works out all the time his workout regimen consists of one high intensity strength training session per week that lasts less than thirty minutes and one high-intensity interval aerobic workout per week one's done on Sunday one's done on Wednesday that lasts about nine minutes including warm up and cool down that's it along with a diet that is just completely devoid of processed foods so we're saying yeah that this is not really normal well hunter-gatherers actually on average live to age 72 and that age is inclusive of infant mortality and infectious disease you remove that from the equation you do have honor gatherers that live into extreme old age with high physiologic Hedren and what you'll notice is if you look at a similarly a similarly aged Aboriginal hunter-gatherer how strikingly similar the body habitus looks if you look at the thigh musculature of one versus the other it's almost identical so this isn't a freak thing this isn't an unusual thing this is everyone's birthright I mean really can function at this level if you deliver the appropriate stimulus and it doesn't have to consume a lot of time but unfortunately what is now common is not normal at all and this is where I live okay and this is an extreme example for sure but not really all you have to do is take a trip to Walmart and this is what we're dealing with and and look at what's going on here look at the size of those sodas I mean you got a gigantic jug of hummingbird food and high fructose corn syrup and pizza and the real shame of this is the distance between the care receiver and the caregiver is very very short and that's just not a good thing and one thing I'll tell you about this little 48-hour turnaround is that anyone remember Karnak to be incredible from Johnny Carson he could cold fold the envelope up to his head so I can pick up a chart I look at a patient sitting in a room I can pick up a chart and like carnac I can go 33 medicines every single person is on 33 medicines give or take one or two and the reason is because medicine is very protocol eyes now if your cholesterol gets above a certain level boom statin blood pressure gets a certain amount a syn hibbett ER get type 2 diabetes metformin get on ACE inhibitor for the renal protective effect well you get a little and that triggers depression because you're on the statin and then all of a sudden you're on a serotonin uptake inhibitor and on and on and on it's 33 almost every time I can pick up a chart it's 33 so that's kind of where we're at right now so what the hell happened seriously I mean these are teenagers in the 1950s this was normal this is what kids look like in the 1950s this is kids from a just a photo journal documentary done on kids on the beach in the 1970s now if not included any photos of kids on the beach today because I don't want you know someone to appear on here like oh my god that's mean he's using me of this I don't want a fad but you know y'all live in Pensacola you know what it looks like at the beach this is not what kids look like anymore well here's the bothersome thing to me is this is where they started what's happening to the kids now they're starting here and I'm here to tell you in the ER I am seeing elementary age kids with type 2 diabetes it is not uncommon it's very common so when that's the starting point when you've been subsisting on happy meals in utero and that's your starting point what are we in for this is what we got to mitigate against and what I want to demonstrate to you is that all these diseases of modern aging they're all related to skeletal muscle to muscle loss and it's because that is our most basic defining characteristic so recently I helped my daughter study for a biology course and we did King Phillip came over for gold and silver you know kingdom phylum well so what differentiates us in the kingdom Animalia from the kingdom plantae is movement we are heterotrophs we have to like catch our food and eat it plants they make their own where they sit their autotrophs skeletal muscle from a position of first principles is the most important tissue and it is why everything seems to be linked to that so if you want everything bad that can possibly happen to a human animal to happen all you have to do is two things immobilize and overfeed and that's where we are as a society and the undoing of it is actually pretty darn simple so if we consult with the American Council on Aging and ask them about health they will give us ten biomarkers of health and there we read them there and what I'm going to do is I'm going to go through each one of these biomarkers as identified by them and show you how it all traces back to skeletal muscle I'm going to take one and two together because to me they are really just interchangeable some of these things I think are a little bit misinterpreted or somewhat nonsensical it's where Western medicine kind of falls down on things and I'll point that out to you as we go along so how is all this mediated well this is the coolest thing that's come up in the last decade is this discovery of mild kinds and what mild kinds are it's somewhat like oxytocin that Ken was talking about is these are peptides they're chemical messengers that are released by skeletal muscle when it's performing work and these chemicals signal tissues throughout the body so they act in what's called an autocrine a paracrine and an in Akron fashion so autocrine refers to chemicals released in the muscle that spill into the locally working muscle and have a positive feedback to them so one of the first ones discovered was a negative regulator of muscle mass called myostatin it sort of puts a governor on how much muscle you can have and exercise actually down regulates that particular chemical messenger so that muscle growth can occur but also there are several different mild kinds that act locally to improve how well you dispose of glucose how efficiently you metabolize fatty acids and use energy in a paracrine fashion that's basically a muscle in one area just signaling a muscle in another area so this is why if you get someone and you take them into the gym and you have one guy doing barbell squats and nothing but his arms will get bigger but if you have a guy doing just barbell curls on a smaller muscle group his arms won't get as big as the guy that's doing just squats and then his legs will hardly get big at all because the spillover effect in the paracrine fashion is not as great and then most importantly is all these different endocrine functions here and they're listed bit by bit and that was the sense that I got when I was training clients is that this is so much more than just getting stronger this is affecting health parameters in way that I cannot explain but this explains it so it's acting on bone which down regulates this CN T F which inhibits osteoblasts it allows bone growth to occur interleukin 15 also signals bone for increased bone mineral density it inhibits mammary cancer cell growth the glp-1 which is stands for glucagon-like peptide one that increases insulin secretion in the pancreas but also protects against tumor Genesis in the gut so all these things are protective against cancer in terms of your body's metabolism its effects in the liver up regulate how well you dispose of glucose and fatty acids and make it such that you don't have to convert glucose into triglycerides and then store it as fat in the adipose tissue itself it's permissive towards increasing fat breakdown lipolysis you improve glucose uptake and disposal and also thermogenic browning so you take white adipose tissue which is largely just a big store of energy and a major depository of secreting cytokines that are very inflammatory in nature and you change them into brown adipose tissue and it's brown because it's just full of mitochondria and these mitochondria are uncoupled from their energy producing mechanism so rather than just making ATP it throws out heat so that's why you know you'll see you know infants have lots of brown adipose tissue around their spinal cord and everything to maintain core temperature in the brain we have brain-derived neurotropic factor for learning and memory and then we have things that affect cardiovascular function in terms of Genisys making new blood vessels and things of that nature so first we'll talk about muscle mass and strength so we've already talked about it being the largest endocrine and immunogenic organ in our body that's important but strength in and of itself is independent in terms of improving your functional capability and it's very much tied to balance particularly in elderly people now a lot of people think yeah the cerebellum and the brain and the balance organ and the inner ear deteriorates with age and that accounts for you know why old people tend to fall and have injuries but the real answer is they're just weak because if you watch someone that's weak and frail they're gonna walk like this because when you are loaded vertically you're standing on a bone-on-bone Tower the moment you break that 180-degree lock in your knees the muscles have to take the load and if you're not strong enough to do that then you're going down like timber and that's why if you're walking through the grocery store and there's someone that's very frail and you bump into them they're going down because they cannot make that correction and it's these stronger higher order fast which motor units that drop out first that are most needed for that and that's why they fall so much but the good news is in the research it shows a 30% loss of strength occurs over 12 years after age 65 and that's a lot but it can be restored in one year of strength training well here's the bigger hallelujah for you a 30% strength increase in an elderly deconditioned person to get that in a year for in my shop that's abysmal ok in 6 to 12 weeks we double people's strength it's like fishing with dynamite the the the adaptive response is extraordinarily well preserved in skeletal muscle if you deliver this stimulus and you let the body do its thing it will improve quickly and dramatically and this is important for reasons that I came to discover in my practice of medicine a few years ago I went to we have an emergency medicine residency that I teach and I went to journal Club and we were hosting the director of trauma from Vanderbilt and he presented paper on this palliate consortium that he was involved in founding the reason for this is used to be trauma surgery was like the Buck Rogers of surgery it was like you know being a fighter pilot it was the cool thing you know as knife and gun club dramatic save dramatic turnarounds people got better and we're discharged home with long life ahead of them now the number one occupant on trauma services at major teaching institutions nationwide is constituted by elderly ground-level Falls so frail person Falls they get a humeral neck fracture they break six ribs they get a pneumothorax a small liver laceration and they fracture their femoral neck just fall on your right side when you're frail that's what happens that's multi trauma that's very difficult to recover from from in a healthy state so if a young person gets in a car wreck has all those injuries pretty big deal well what they came to realize is that most of these elderly ground-level Falls were not surviving to discharge so they got a whole army of social workers to go and speak to the family members of these patients and figure out what was their pre-injury functional status and they came up with a very simple test to prognosticate what are we dealing with here and it was as simple as this if before the accident grandma can stand up out of a chair on her own power the chances of being discharged with the injuries that I described were around 85 90 % if grandma can get up out of a chair but she had to do it in a stepwise fashion using her arms to push off the arms of the chair and kind of rock and bounce herself up then it dropped to about 50% if grandma could not get out of a chair without someone to help her stand up out of the chair grandma was not going home so through that process they developed a more sophisticated assessment tool that every trauma service nationwide now has this little team of social workers and physical therapists and occupational therapists that go in with a battery of questions to determine your pre injury functional status and if you don't score high enough the next step is a meeting with your family and a calling in of hospice the stakes are high for not being strong it's really really important so to put this graphically this is a graph made by another IHMC speaker from the University of Miami Lea Miami Joseph Cigna really brilliant guy came up with this curve showing black is the physiologic Headroom or area under the curve for someone that's untrained but with training when you start training at age 50 you can bend that aging curve up more towards someone that's a lifelong trainer my personal experience is if you are not afraid of elderly people if you don't treat them like they're made of China that bent aging curve can actually rise up to where that life long training curve is because the adaptive mechanism is well preserved but untrained is going to trend down like that but worse another researcher patent Jones out of Texas State University which used to be Southwest Texas State University the party school in Texas said it's worse than that because what happens is your functional ability declines something happens and you have the sharp decline you gain back a little ground you never make it quite back to the baseline and then something else happens and then that kind of happens over and over again well and that's correct because these little dips is where I live in the ER when I go to work but what they're not showing you is they're showing dips that are happening you know five ten years apart if we take this here and blow it up those dips and rebounds are occurring in 48 hour cycles you're just skimming across the bottom of the functionality curve like a stone thrown across a pond and it doesn't take many of those 48 hour bounces before the stone stops skipping and you just go under the water and it's not a good thing it's something we definitely definitely want to work on reducing and the reducing it is simply a matter of using it or losing it and this is a visual representation of precisely that so what we're looking at is we're looking at the thighs of a human subject in an MRI machine so with MRI machine does is it takes transverse sections of you so if you imagine if I could take me lay me down with my feet facing towards you and then cut me up like a honey-baked ham and you look at one slice of the honey-baked ham at a time you get a representation of what's going on so this is mid thigh level so I'm doing this right so yep there's the 40 year-old triathlete this is muscle the white is fat the very bright white is bone marrow and the black around it is medullary bone as opposed to a sedentary seventy four year old and this pitcher is worth a lot because it does show you that the tissues of your body don't actually cooperate for the benefit of you they all have their own DNA and their DNA has been methylated in a certain way to turn on turn off certain genes say you're this kind of tissue you're that kind of tissue and they exist in competition with each other so if you give the wrong stimulus body fat gets the competitive advantage over skeletal muscle and body fat is a repository for all these inflammatory cytokines that drive the diseases of modern civilization and that's what you get but look at the very bottom what you get with a 70 year old triathlete someone that's just stayed with it that's used it they're at it actually looks a little better than the four year old triathlete they got a lower body fat level they got a little bit more skeletal muscle their bone density looks awesome so looking at this another way let's take someone that looks like the middle pitcher and do this this is an MRI of a thigh of a 92 year old subject after 12 weeks of resistance training that's yeah that's going from a bedridden person to someone that is independently functioning okay you're going from a skilled nursing facility back backwards not skilled not assisted living backwards all the way to the independent living apartment if you're living in the whole spectrum there and and that's amazing and here's the thing I can tell you is you know when you actually delve into the study and you look at the protocol on how they deliver the strength training mediocre at best this is not even well delivered strength training which is good to know because what I want you guys to know is it doesn't have to be state-of-the-art it doesn't have to be fancy it doesn't even have to be good because you when it comes to your resistance exercise you can be dumb about it because skeletal muscle is smart it's highly evolved in order to adapt so don't let any of this intimidate you away from just getting started so bone density this is a big deal in you know in the lay public and it's near and dear to my heart because an osteoporosis project was the genesis for the exercise protocol that I still use in my facility so Arthur Jones was doing research on how strength training would benefit elderly frail women with osteoporosis so they had to invent an exercise protocol that was not going to injure these frail people so they made a protocol where the movement was done very slowly very gradually very cautiously for safety reasons it turned out moving that dang slow is really hard and it continuously loaded the muscle it deeply fatigued it very aggressively so they were getting disproportionate results to what they were used to seeing and they're like yeah it's just because they're making up lost ground which is partially true but when they applied that kind of protocol to younger healthier athletes they were also seeing a more rapid rate of improvement the important thing though is it used to be thought that in order to get improvements in bone mineral density you had to provide high mechanical load and high stress to generate this adaptation but now we know that not completely but largely it's due to my own kind signaling you don't have to risk a fracture to increase bone mineral density so another thing that they list in our little ten markers of of health is body composition and everyone's learned the hard way and it's now more popular to realize it's not just a matter of calories in and calories out you don't have a little accountant inside your body counting out how much you ate and how much you burned that's necessary but not sufficient your body's tissues are in competition and the signals that you send your body determine how nutrients get partitioned so when you send a signal that says skeletal muscle is highly valued and we need more of it then you are going to selectively partition your nutrients for lean tissues rather than body fat and it's largely leveraged by interleukin 15 one of the mile kinds another thing that's important that's lost in society is an appropriate balance of energy signaling so mTOR mammalian target of rapamycin is an energy signaling molecule that is active when you are in energy excess and growth is taking place an pique is activated during low level energy states when repair is called out and breakdown us innocent cells by appropriately balancing those two things you restore health so much of what's accelerating aging is that mTOR because we are overfed and inactive is disproportionately elevated relative to AMPK and that signaling is a signal that actually accelerates aging and shortens the life span blood lipids this is something that I think is a little bit nonsense I really don't care that much about so when you go to your doctor and he measures your total cholesterol and we submit DL and they subtract your HDL from your total cholesterol and tell you this is your LDL it's really relatively meaningless so cholesterol being shuttled around your body is your body's way of dealing with a more upstream problem which is systemic inflammation okay so when your doctor says your LDL is too high and we want to lower it by putting you on a statin you got to realize that sort of like pulling cop cars out of Compton there's a lot of cop cars in Compton because there's a lot of crime but pulling cop cars out of Compton doesn't make the crime go away it's the same thing there you've actually made yourself more fragile for vascular disease because what the LDL is doing is taking cholesterol out to the periphery of the vessel to patch areas of inflammation on the wall of the vessel that are going to create a clotting cascade and trigger vascular events more importantly what strength-training does is not this that it lowers AIDS you know raises HDL and lowers LDL it does that because it's controlling insulin and it's opposing the inflammatory cytokines it's decreasing your overall systemic inflammation so that lipid profile is not necessary hemodynamics weight training also used to be thought of as something that was dangerous for the heart and the blood vessels you're gonna rupture your heart you're gonna you know you drive your blood pressure dangerously high actually turns out that even when your strength training at high intensity your systemic vascular resistance goes down because all the hormones that act on the receptors on the wall your blood vessels are acting to dilate those receptors so that you enhance delivery to the working muscle that lowers your systemic vascular resistance acutely but also chronically because these Maya kinds interleukin 8 and endothelial vascular growth factor are sending out all these signals to make more blood vessels more capillaries that is a massive amount of surface area you're making a bigger container for which your blood volume sits in blood pressure drops the work that the heart has to pump against is much lower and it on ments the pumping efficiency of the heart whatever comes in on the right side of the heart is the volume that gets pumped out of the left side what gets pumped out of the left side is what washes back during diastole when your heart relaxes it's that wash back that floods your coronary arteries and determines your coronary artery perfusion pressure well contracting skeletal muscle milks venous return and it greatly enhances venous return and therefore augments left ventricular ejection which therefore augments coronary artery blood flow it's a very powerful mechanism for protecting against vascular disease blood glucose control so not only by all the Myo kind mechanisms that we describe there in simplest form you have to realize that your muscle is the largest glucose reservoir in your body you can hold about 70 grams of glycogen in your liver you can hold about 200 250 grams of glycogen in your skeletal muscle that it's in your liver is to maintain a stable blood sugar for your brain what's in your skeletal muscle is for on-site usage but the extent to which you can create a glucose ink is the extent to which you improve your insulin sensitivity because of the need to replace it that also gives you much better flexibility of glucose disposal through your liver because you're not burdened with everything being packed to the gills so when every glucose store in your body is occupied and you take in more glucose then if we total up what's in your liver and what's in your skeletal muscle that's maybe one and a half two bagels worth of carbohydrate beyond that when you try to jam more in the liver has to protect itself so that you don't end up putting sticky glucose molecules all over the functional proteins and your by and the way it does that is through a process called de novo lipogenesis where it turns it into triglycerides stores it as fat so when you work hard with skeletal muscle adrenaline comes down and binds and then that Cleaves off so glycogen or glucose molecules sort of like a tinkertoy set so you activate an enzyme to cleave off glycogen but that enzyme goes downstream and activates 1,000 other enzymes each one of those and this is just theoretical each one of those binds to a tertiary enzyme that binds to a thousand it's an amplification cascade so one molecule of adrenaline released during high-intensity exercise is going to cleave off thousands millions of molecules of glucose it creates a huge glucose sink and a need to replace it and basically what you're doing when you do that is you're invoking the antithesis of the metabolic syndrome which is an over accumulation of glucose so they also value in the ten biomarkers aerobic capacity but they're doing it from an incorrect standpoint of cardiovascular it's not cardio that is some distortion that occurred just because when your only tools a hammer vo2 max testing the whole world is a nail what's really going on is you're training up the aerobic sub segment of metabolism is occurring in the mitochondria well the mitochondria if we take this whole slide the whole white area is a cell the mitochondria were actually ancient proto bacteria that lived outside single-cell organisms that used anaerobic metabolism to generate energy the waste part of that was pyruvate and that would get converted to lactic acid but lo and behold these proto bacteria could take that waste product and use it as food but these proto bacteria did a neat trick so when you're a single-celled organism you can only grow based on the energy gradient across your cell membrane so if you double in size your energy producing capabilities drop by 50% because your volume goes up two by two by two eight but your surface area only goes up two by two four well mitochondria these little proto bacteria was smart they had a double membrane and the inner membrane was folded folded folded so there's lots of surface area to create this energy gradient so they ate the waste of the single celled organisms well what ended up happening is these proto bacteria went inside the single-cell organism and they formed a symbiotic relationship because you had this organ that ate your waste and generated a ton of ATP so that you could grow into a bigger multi-celled organism well that's still true today the way to improve the aerobic sub-segment of your metabolism is by doing hard anaerobic work delivering pyruvate to the mitochondria as fast as it can handle it so when you do a high-intensity interval program or a high-intensity strength training session that lasts 12 or 15 minutes for a half hour and beyond after that you're still pumping lactic acid back to pyruvate and jamming that through the mitochondria at an elevated right as if you were walking on a treadmill running on a treadmill for 45 minutes gene expression this is cool so in the early 2000s a gentleman named dr. Silan Neal ah've conducted a study at the buck Institute for Aging in UC San Diego where he used a statistical method to determine genes that were differently expressed in aging versus youth and then for 26 weeks took elderly patients put them on a strength training program measured again and found that their DNA expression went back to youthful levels the same DNA expression as a 25 year old first time in human history from the epic of gilgamesh our oldest literature looking for the Fountain of Youth they found something that actually moved the needle on this I thought it was going to blow up hell resveratrol like prolong life in earthworms by a little bit and it flew off the shelves this happened and it was crickets and everyone in here knows why because it involves hard work and discipline as simple as that and this was based on a strength in pre increase of 50% which in my shop is abysmal we do much better than that in a really short period of time epigenetics and DNA methylation I don't know how many of y'all are following the work of David Sinclair and how methylation patterns on DNA kind of determine how youthful your DNA is and its expression but resistance training is reverting back to a normal gene expression by mechanism of methylation and the cool thing that this study showed is if you train people up for seven weeks and then you let them de train for seven weeks when they come back they come back really fast because those methylation sites are marked for memory and so that explains the muscle memory that we all have experienced firsthand but have never been really able to then brain factors brain-derived neurotrophic factor I'll kind of skim over this quickly it's produced in skeletal muscle but it up regulates it in brain by an unknown mechanism because it doesn't really cross the blood-brain barrier but it is low in Alzheimer's depression obesity it's an independent marker of mortality improving that is a big big thing and when we talk about all these things these 10 biomarkers and how we improve things we got to realize we're in this period where we're now able to extend life I don't know if anyone's followed the work of David Sinclair but there's he's found a mechanism of identifying something called a Horvath clock which is a clock that looks at the methylation pattern in your DNA for certain tissues and what it should be at a youthful level and how it degrades over time barring illness injury they can take a sample of someone's DNA at any point in time and they can almost to the day predict the day that you'll die based on your horvath clock but the thing is the ideal methylation pattern for all the tissues your body an extra copy of that is kept inside the cell that's accessible and he's now learned how to use that as a mechanism of reverting back to youthful expression they've done it in mice they've done it in retina they're now gonna try to do it in whole animals but that's their that's possibility now the paradox with that is for about the past five years every year life expectancy in the United Kingdom the United States is going down down down for all the reasons that we're talking about in the real shame of that is we are just now discovering that our evolution is somewhat different than other animals revolution we've always assumed that the real purpose was our body carried our DNA and our body was nothing but a rental car for our DNA and the real important thing was that we simply got to procreate and pass it on but what we're finding is we're analyzing is that humans their brain size in their lifespan evolved because the human animal has a very long rearing period and what we're finding is that what promotes our longevity and our brain evolution which from an evolutionary standpoint timespan wise was like jumping off a cliff and building an airplane on the way down was that we are a species that is able to produce intergenerational knowledge and wealth transfers and what that really means and that I become very sensitive to is excuse my language but ageism is okay when I was 35 years old as a physician all the way up until that time whenever I barked out an order or something need to be done quickly you know I kind of had the Doogie Howser problem all of a sudden at age 35 I barked out an order and people were like scrambling all over the place fallin over themselves trying to do what I asked and it stayed that way until about age 50 and somewhere between 50 and now the fuddy-duddy assumption kicked in and now in emergences I have a hard time getting anyone to do and it's it a I am here to tell you ageism is a thing and it is really really wrong because when we talk about intergenerational knowledge and wealth transfers that is our real value as humans and it is what drives us forward to survive longer is staying engaged staying interested I mean I am blown away that this many people will come and listen to something like this but I mean you're obviously engaged I mean your stellar crowd you know you're not normal at all not normal by societal standards this is important from a societal standpoint this is off the government website and it basically says that Medicare and Social Security are done for by 2026 okay and it's simply because of our population demographics this is just stages of population demographics shown here and it's just looking at birth rate versus death rate in this space in between here that's the post-world War two baby boom generation and what we have here with this high birth rate is we have a ton of people in the workforce relative to people that are receiving benefits well where we are now is right around in stage 4 stage 5 okay and that would have been bad enough if we were actually just spending the money that each individual person had set aside for themselves but instead like in the movie Dumb and Dumber we took it as a loan and put io u--'s back on the suitcase called t-bills and that's not really backed by anything of real monetary value so this is going to crash with a vengeance and that's even more reason for us to change our paradigm of how we think about aging and how we think about functional ability as we age we need a completely new paragraph paradigm to survive as a society and I think that's where appropriate exercise appropriate dietary interventions that are not hard to do can possibly save us because right now the demographic that I'm seeing when I go to the work in the ER we're in real trouble it's gonna break the system and there's hard decisions are gonna have to be made but hopefully if enough people will pick this up and run with it it will make the difference and it will save us so in the end resistance exercise it addresses all 10 of these biomarkers it increases physiologic Headroom does it across a lifespan and I think that it's also gonna serve as the bridge to technological advances to come I don't know if any of y'all are following the work of David Sinclair out of Harvard but for folks my age and older you feel kind of like Indiana Jones where he's sliding underneath the big stone door that's closing he pulls a whip through at the last second if I'm going to benefit from this I'm gonna have to survive long enough for it to come to fruition and I'm here to tell you resistance training is the way to do it so I really appreciate y'all's attention and if anyone's got any questions we'll try to knock them out [Applause] microphone thank you very much yes sir the June issue of the Harvard alumni journal not the Medical Journal but the alumni journal had a six-page article on chronic inflammation and it mentioned that the the issue was not what we position have been doing is trying to stop the chronic inflammation and they discovered that the real problem that chronic inflammation causes is being caused by the effects of the immune system attacking their chronic information and they mentioned that the immune system was not just not in the in the blood but all over the body and the dead cells or the casualties were causing the issue so talk about how exercise help somebody get rid of the the dead cells and the real cause of the effects of chronic inflammation well part of that is when we talked about balancing mTOR and ampk and restoring that balance through enhanced in early energy utilization so you're not over storing energy is one of the major things it's during periods of fasting and during low energy states where that repair takes place and the problem is is that senescence cells dying cells are sending out these panic signals that are saying you know take us out you know but when they're doing that they're sending these panic signals out to surrounding tissue that may be normal or that may contain alkenes which can be turned on by these panic signals so high-intensity exercise in particular does two things one is it changes the energy state so that you create an energy sync so that you restore this balance between mTOR and ampk but also it creates significant turnover of tissue you know you hear people talk about how much protein you need to support high intensity exercise and muscle growth what most people don't realize is not 100% of that protein is coming from dietary sources a lot of it is amino acid turnover the tissues themselves as a result of exercise so that also protects against that you know senescence cells triggering this inappropriate inflammation that drives these disease processes yes sir yes sir some time ago there was another speaker and he was talking about blood flow restriction exercises and he indicated that this technique even though it you had restrictions on your arms and legs could still benefit other parts of your body yes could you speak to how the mechanism with that yeah so part of what drives the exercise stimulus is not just the loading of the skeletal muscle but the metabolic changes that are occurring while it's doing hard work so what happens is the the cell itself is doing the work is running glycolysis at a very fast rate delivering pyruvate to the mitochondria at a rate faster than it can turn and faster than it can use pyruvate then gets converted into lactic acid that lowers the pH in the environment in that lowering of the pH is sort of permissive to the biochemical reactions that are driving the adaptive process what blood flow restriction does is it takes that process and it elevates it because you're not allowing these waste products to be washed out of the muscle as quickly the neat thing is particularly if someone has had an injury or a tendon problem or or something where they can't use a really high load you can get the same beneficial effect with a much lower load of training because of the metabolic environment that you're creating what I found in my own experience too is that resistance training that uses a very slow cadence creates intramuscular tension that has a similar damming effect to venous return that the tourniquet does so you get some enhancement of of that effect but it's by creating a local environment of acidosis and waste products that seem to Goose the whole process of the adaptation along somewhat I don't even know who to pick now let's go way to the back I think you sir yep so you spoke a lot about high-intensity training specifically how it in relation to weight training could you also talk to high-intensity interval training such as sprint workouts or just generic in endurance training like distance running sure so it all benefits okay we saw triathletes and what their body composition looked like on those cross-sections it's all beneficial high-intensity interval training is anytime you do exercise what you're doing is you're creating a level of work that's above baseline and to any extent that you raise that up you're going to turn that glycolysis cycle a little bit faster deliver pyruvate to the mitochondria a little more aggressively and all of your body's metabolism ramps up to respond so high-intensity interval training is just producing a higher output of work with a brief recovery period so that you in stepwise fashion are kind of jacking up those waste products and allowing them to accumulate in the same way that the blood flow restriction or high-intensity resistance exercise does then that debt has to be paid back by shuttling it through the mitochondria later that's why when you do a high-intensity interval protocol that takes four minutes like a Tabata protocol the aerobic benefit is similar to if you had spent a half hour jogging on a treadmill at a lower level because you're still you know half hour after you're done with your interval protocol you're still shuttling all that excess lactic acid and pyruvate through the mitochondria through the TCA cycle through the Krebs cycle and that sort of thing and the degree to which you ramp that up or ramp it down is kind of specific so if you want to be an endurance athlete you can improve your aerobic capacity with high intensity interval aerobics but if you want to express it more gradually over a longer race you actually have to practice that and I learned this the hard way Oh straining a world champion BMX athlete and we were doing a sprint interval protocol that was roughly is similar to Tabata and we were doing 30 seconds on and then 10-second respite and just back and forth like that and the average BMX race lasts less than 30 seconds and what we found was that his expression of his fitness deteriorated if it was not exactly precise to the work interval of a typical race so there is some specificity to these different adaptations so if you want to express it you're gonna have to rehearse it as well and that's true of anything whether it's strength training how you strength train that that sort of notion does that make sense to you yeah yes sir I wonder if you would comment on children and how they seemingly develop muscular tear in activity certainly without specialized equipment and maybe without any obvious exercise is this a different model from the adults you've been talking about how would you well the answer is no I mean if I have children that are presented to me that are deconditioned and I want to address that in an aggressive and time efficient manner I'm going to do with them exactly what I do with adult clients or adult subjects the thing is is with children they're more like hunter-gatherers if we just get the hell out of their way if you watch children at a playground they will have a very stochastic levy flight type pattern of their activity they run run run run and they go hard and then they stop for a second and then they go hard and they do something over here and they stop for a second it's very intense and interspersed with appropriate intervals of recovery and they spontaneously and organically orient themselves towards that type of activity but nowadays you know everything is supervised you know you got it drove me insane when my kids were little and we had to go to a soccer game it was like you couldn't play one quarter of a soccer game and everyone had to run off the field and have a juice box in a snack god I mean you guys remember playing outside all day long and you wouldn't come home to eat unless your mom like yelled at you to come in but nowadays you know we supervise our kids we drive to the soccer field we watch them go sit in our lawn chairs watch them play make sure no one fights no one yells is nasty and then like they've been playing for 15 minutes like everyone come in have juice and have it you know it's maddening but they will organically if you leave them the hell alone they were organically and spontaneously do what is necessary to optimize their physiology here's the cool thing though when I took my older decondition clients I found there is a threshold once you get them 40% stronger your average person will become unrestrained belen their activity level they go nuts once you awaken that act of genotype in the muscle they act like kids again they just go bonkers you can't get them to rest on that insightful note let's thank our speaker [Applause] you

Channel: TheIHMC

Views: 162,868

Rating: 4.8806162 out of 5

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Id: RwgywNZzEi4

Length: 68min 33sec (4113 seconds)

Published: Fri Nov 08 2019

Reddit Comments

[u/haole1]

The average American begins to experience a physical decline that begins as early as their mid-20’s and continues throughout the course of their life, terminating in the final decades of their life in a state of dysfunction and dependence. While this is becoming commonplace, it is certainly not normal. Our ancestors, as well as modern hunter-gatherers experienced a high level of physical functioning and health, that barring injury or infection, continued into advanced age. In this lecture Dr. McGuff will discuss the concept of physiologic head room and discuss the notion of a quality life not just measured in years, but in “area under the curve” based on high physiologic headroom throughout a full lifespan. He will show how a brief and infrequent regimen of high intensity exercise can reverse the diseases of modern civilization and how the new science of myokines (hormone-like substances released by working skeletal muscle) make this possible.

[u/greyuniwave]

IHMC lectures are amazing!

[u/gahblahblah]

What a fantastic informative talk. This guy is on point. A major longevity goal is to be like that 70 year old guy - still buff and fit enough to be living an active social life. To make 70 the new 40.

[u/BeautyandtheBeaker]

I sure hope this article title is true because it's one of the few life extension strategies that is truly accessible to most people right now.