Simple Exercises That Can Repair Tendons — Dr. Keith Baar

1. 0:00 – 1:14

   Start

   1. KBDr. Keith Baar0:00

      If you go and you sprain your ankle, and you go to the doctor, a very good doctor, very well-meaning, they're gonna give you a boot. And what is a boot? So I told you that a scar forms when we get stress shielding. What a boot is, it is a mechanical stress shielder. What it's designed to do is to take the stress off the tissue you've injured.

   2. TFTim Ferriss0:20

      Mm-hmm.

   3. KBDr. Keith Baar0:21

      If I've told you that the thing that's gonna cause that tissue to get a scar is that you take off the tension, what I've just done is I've made the problem worse.

   4. TFTim Ferriss0:30

      Yeah.

   5. KBDr. Keith Baar0:31

      I always tell people that the first recorded immobilizer for an ankle or a leg is from Egyptian hieroglyphs where they showed pictures four thousand five hundred years ago.

   6. TFTim Ferriss0:41

      [laughs]

   7. KBDr. Keith Baar0:43

      If I took you and you said you had cancer, you would not want a treatment that was developed four thousand five hundred years ago. You would hope that something new has been developed in the last forty five hundred years. That is where we are for our orthopedic situations. [upbeat music]

2. 1:14 – 2:01

   How I discovered Keith's work through a tweet about tennis elbow and rock climbing.

   1. TFTim Ferriss1:14

      All right, let's start off, Keith, just by saying thank you for the time.

   2. KBDr. Keith Baar1:17

      Hey, thank you. This is gonna be great. This, this should be really fun.

   3. TFTim Ferriss1:21

      Should be a good time. I have a lot of questions, and the start time for this was delayed because I was getting focused shockwave treatments with a doctor I think is very credible. And that is why we're starting late, which segues very nicely into our conversation. And I wanted to give the genesis story because I came across your work for the first time shockingly, it's astonishing to me I didn't come across you earlier, because I put a tweet online, not sure what the noun is for something like that on X at this point, asking about remedies related to tennis elbow specifically, and it was w- within the context of

3. 2:01 – 3:29

   Emil Abrahamsson's hangboard training protocol.

   1. TFTim Ferriss2:01

      rock climbing. And someone put up a video from YouTube by Emil Abrahamsson, I'm probably pronouncing that incorrectly, who is a high-level climber, great YouTube creator and teacher, who put up a video called something like Doing Hang Board Training Twice a Day for Thirty Days. And that is where he referenced a study of yours, or it may have been a review, I'm not sure exactly, but Minimizing Injury and Maximizing Return to Play: Lessons from Engineered Ligaments. And I just want to give people the punchline to this because-- and then I'll shut up and let the expert talk. He is a high-level climber. He climbs V15s, bouldering. He is incredibly good. And after thirty days of doing ten minutes a day roughly of hang board, not even full hangs, let's just say seventy percent body weight, so his feet are on the floor, kind of like a nice stretch [laughs] for ten seconds on, fifty seconds off, right? So, so a hundred seconds of tension per session. He, I think, added sixty percent weight to his maximum hangs, so this is weight attached around the waist. He went from something like a point five second one-handed hang on a tiny little ledge, I'm not using technical climbing language here, to thirteen seconds, and so on and so forth. And it just blew his mind completely.

4. 3:29 – 4:46

   The fundamental principles of strength training and connective tissue adaptation.

   1. TFTim Ferriss3:29

      So let's just start with asking, what is happening here? What are the adaptations that are allowing something like that to happen? And then we'll kick off from there.

   2. KBDr. Keith Baar3:41

      It's a great place to start because we think it actually shows something fundamental about strength, because what we do is... I'm in our strength physiology facility here and, and we normally think of strength as, yeah, we're gonna lift weights. We're gonna do something really, really heavy. And because that's gonna make us stronger, we know that when we lift heavy weights, we get stronger. And the reality is that there are certain, especially certain athletes like climbers, where they're doing all kinds of heavy lifts. They're doing all kinds of heavy work. They're doing all kinds of really dynamic moves. And what happens, what breaks down is they break down in their finger tendons, and they break down in the little pulleys within the tendons. And we had come to this because for years I had been working on how to make muscles bigger and stronger, and I always said, "Okay, bigger and stronger," because the definition in my old textbooks would say that the strength of a muscle is related to the cross-sectional area. It's proportional to the cross-sectional area of the muscle. And so I was like, "Okay, to get stronger, you need to be bigger." So

5. 4:46 – 6:12

   mTOR complex 1 and its role in muscle growth.

   1. KBDr. Keith Baar4:46

      I actually was really fortunate to be, to be part of the team where we discovered the, the small molecule in our cells that actually allows our cells to get bigger when we do resistance exercise.

   2. TFTim Ferriss4:57

      What is the name of that? Just in brief.

   3. KBDr. Keith Baar5:00

      So it's mTOR.

   4. TFTim Ferriss5:01

      Yep.

   5. KBDr. Keith Baar5:01

      So it's mTOR complex 1. It's the mechanistic target of rapamycin. So I'd been doing this. I had a laboratory. My first laboratory was in Scotland, and I was invited down by the English Institute of Sport to come to, to their cycling center, and they were like, "Okay, this is great. We need to-- we have these incredible athletes who are winning all kinds of gold medals, and we want them to get stronger." And so I go in there with my spiel about bigger muscles and all of this, and they're like, "Yeah, but we gotta carry that muscle mass." And I've got five years of data that shows me I'm getting these athletes stronger without making them any bigger. And in many cases, making them smaller. And I'm like, "Oh, well, so much for all the science that I've been doing for a long time." But then I had to figure out, okay, so how is this working? Or how are they getting people who are stronger without them getting bigger? And so what it came down to is if we have the little motors in our muscles that are going to produce the force, what we then have to do is we have to transmit that force, and that force has to be transmitted from our muscle where we're producing it to our bone where the movement is gonna occur. And that's gonna go through tendons, it's gonna go through connective tissue, it's gonna go through all of these proteins that are-- that we call colloquially force transfer proteins.

6. 6:12 – 7:59

   Engineered ligaments and the discovery of minimal effective doses for tendon adaptation.

   1. KBDr. Keith Baar6:13

      And so that was the first thing that we were thinking of. And then what we, what we were doing is we would make these little engineered ligaments. And so the goal at the beginning is, "Hey, I'm gonna make ligaments. You're gonna rupture your ACL. You're gonna send me, like, a, a sample that they'll take in the doctor's office. I'm gonna isolate the cells. I'm gonna make you an ACL in the dish in my laboratory. I'm gonna send it back to you so that you don't have to take your hamstring or the middle third of your patella, and we can replace that ruptured ACL." That's the idea, but we have to get them stronger. So we started looking at, okay, we know exercise makes these tendons stronger, but what about the exercise? And what we found is it didn't matter whether we stretched them twenty percent or five percent or two percent, the signals to get bigger and stronger were the same. But then we started doing for different timelines, and it started... The signal would go up, and then it would go away really quickly. And so the way that I explain it now is that your tendon, ligament, your bone, all of your connective tissue cells are a lot like my seventeen-year-old daughter. She's gonna listen to me for maybe five minutes, maybe ten minutes, and then she's gonna just tune me out. So I need to get all the information in in that five to ten minutes. So if you're gonna go and you're gonna climb, for example, like Emil would do all the time-

   2. TFTim Ferriss7:24

      Mm.

   3. KBDr. Keith Baar7:25

      He's gonna spend three, four, five hours at the wall doing different things. The tendons stop getting the signal to adapt at ten minutes. Everything on top of that was just wear and tear that could, you know, slightly cause problems. And so what that meant to us is that there's this minimal effective dose. So if I give you ten minutes of loading that is optimized for those connective tissues, whether it's tendon, ligament, cartilage, or bone, I can get you to get all of the signal from that whole exercise bout in ten minutes.

7. 7:59 – 10:58

   The refractory period between optimal tendon loading sessions.

   1. KBDr. Keith Baar7:59

      And so-

   2. TFTim Ferriss8:00

      Mm.

   3. KBDr. Keith Baar8:01

      That was the first part. The second part was how long does it take before I can get more signal to go through that system? Think of it like your toilet. I flush my toilet, it's gonna flush. But if, you know, when my daughter was younger, she would, "Oh, that was fun. Let me do that again." It wouldn't flush for a while. She needed to let the bowl refill, let the tank refill, so that I could flush it. So that's called the refractory period. How long do I have to wait-

   4. TFTim Ferriss8:24

      Mm.

   5. KBDr. Keith Baar8:24

      Before that next session? And what we found is about eight hours, six to eight hours later. And am-amazingly, that was almost exactly the same thing that other researchers had found for bone, that as little as, as few as forty stimuli with eight hours of rest was maximal for bone. We found that ten minutes of activity, whether you did walking or running or just holds, ten minutes worth, so ten seconds on, fifty seconds off, hundred seconds total, over that ten minutes, that's all the signal your s- your cells need. You wait eight hours, you could do it again. And so Emil's brother had lots of injuries, so he did it twice a day. His hands are healthy, now he can climb. Emil, because he's a huge, strong boulderer who does these dynamic loads, he had a really big effect of doing those isometric holds because he was getting all of the stimulus to make the muscle stronger, the brain power to stimulate the right muscles to have him to be able to contract that. What he was missing was he was getting too much wear and tear on the tendons, on the force transfer stuff. So when we just got him to do those ten-minute session, his force transfer capacity went way up, and now his grip strength went way up. And one of the best videos that he has is he becomes a competitor in the World's Strongest Grip competition.

   6. TFTim Ferriss9:42

      Oh, it's an amazing video. It's so good.

   7. KBDr. Keith Baar9:44

      And so these guys are twice his size, and he's grabbing all these things about the same as the, the people who are twice his size. And it's, it's awesome because Emil's smaller than me. He's a great guy and... But it's like, okay, so you're getting to the point where you have some of the strongest grip in the world, and all you're doing is these little things. You're doing your dynamic climbing, and you're combining that with these isometric holds.

   8. TFTim Ferriss10:09

      Mm-hmm.

   9. KBDr. Keith Baar10:09

      And so what we're improving is that ability to transmit the force between the muscle-

   10. TFTim Ferriss10:14

       Mm-hmm.

   11. KBDr. Keith Baar10:14

       That's making it and the bone that's trying to help us do the movement.

   12. TFTim Ferriss10:19

       Okay. So let me dive into a few aspects of that with clarifying questions just so we can keep folks who need Scooby Snacks engaged with just some prescriptive stuff. But before I get to that, let me just ask you, and we can come back to this 'cause I'm sure it's a large topic we could uncork. But in two thousand and sixteen, I interviewed David Sabatini on mTOR and then Navdeep Chandel on metformin, and we did it in Easter Island or on Easter Island, so Rapa Nui, after which rapamycin is named. And we had a great conversation. And you mentioned earlier,

8. 10:58 – 13:10

   Rapamycin's effects on muscle hypertrophy.

   1. TFTim Ferriss10:59

      I suppose, and I don't know if this is... Correct me if I'm getting this wrong, but the, the mTORC1 pathway as being key for sort of resistance exercise-induced hypertrophy muscle growth, right? Does that mean that taking something that has maybe more of a systemic effect like rapamycin, a lot of people in Silicon Valley and elsewhere take rapamycin for hoped-for longevity purposes since they've seen that demonstrated in some species. Are you making sacrifices on the hypertrophy side hypothetically or is-- or do you expect not much of an interference there?

   2. KBDr. Keith Baar11:32

      The short answer is that at the doses that they're taking for longevity, you have a minimal effect on the adaptation of skeletal muscle, but you're still going to have a, a somewhat negative effect. So for most people, that's not enough of a negative effect to see a difference.

   3. TFTim Ferriss11:51

      Mm-hmm.

   4. KBDr. Keith Baar11:51

      If you were trying to do high-level competition or build your muscles to the biggest possibility, that would prevent that to some degree. It's the same kind of thing that endurance exercise can do, 'cause endurance exercise like metformin can, can activate pathways that counteract mTOR complex 1.

   5. TFTim Ferriss12:10

      Mm-hmm.

   6. KBDr. Keith Baar12:10

      And so you've got this balance, and a lot of times what we're doing is, is people will target mTOR, not because for longevity. The thing that they're trying to do is they're trying to decrease systemic inflammation. Because just like our muscles, our inflammatory cells need mTOR activity in order to respond to the stress. Our muscles need mTOR activity to respond to the stress of lifting heavy weights, and to allow us to incorporate more of what we eat in our meals, more of the protein that we eat in our meals, into our muscles to store that protein, or those amino acids as muscle proteins.

   7. TFTim Ferriss12:49

      Mm-hmm.

   8. KBDr. Keith Baar12:49

      Our immune cells, they are doing similar things. They need mTOR activity in order to respond to an immune challenge. And so you do see the same thing with people who are taking rapamycin, is that they do have a little bit of an immunocompromised situation.

   9. TFTim Ferriss13:05

      Mm-hmm.

   10. KBDr. Keith Baar13:05

       And it's a similar kind of, you know, muscle compromised situation is what we'd say.

9. 13:10 – 14:48

   Protocols for tennis elbow rehabilitation.

   1. TFTim Ferriss13:10

      Got it. And I would say, folks, talk to your doctor, number one. And number two, watch your dosing, and look up the original applications of rapamycin [chuckles] before you start gobbling it like Tic Tacs. All right, I want to come back to the meat and potatoes, what you were just saying before, and ask specifically, because I've seen a lot of pain relief from imitating the Abrahangs, even though these are the 70, 80% body weight, feet still on the floor hangs that Emil demonstrates in his videos. It may not even be for my current problem, but just for people listening who may have, say, golfer's elbow, so people who have pain on the medial epicondyle, the knob on the inside, or tennis elbow on the outside, as I do. In the video, Emil is doing 10 seconds on, 50 seconds off for 10 minutes. Digging around online, there are other people who claim, can't believe everything you read, they're like, "As per Keith Barr, I am doing 30 second hangs, semi flexed, with two minutes in between for four repetitions." So one is a question on what you think the optimal load duration and rest intervals are for, take your pick, could be golfer's or tennis elbow. And then secondly is why isometrics? Because, for instance, 15 feet away from me I have a, a FlexBar. This is a device, it looks kinda like a churro, and you use it to apply eccentrics, right? And you hear a lot about eccentric loading for, say, tennis elbow.

10. 14:48 – 16:32

    Why isometrics work better than eccentrics for tendon healing.

    1. TFTim Ferriss14:48

       So those are the two questions, kind of how you would prescribe, like, the loading protocol in terms of duration, number of intervals, et cetera. And then why isometrics versus, say, eccentrics?

    2. KBDr. Keith Baar15:02

       This is the money question. This is, like, what I love about what I'm doing right now. So let's start with why the eccentrics, okay?

    3. TFTim Ferriss15:10

       And can you explain to people just... Like, if you're doing a bicep curl, folks, and you're lowering the weight after curling it up, that is the eccentric or negative portion of that movement. But you may be able to give more color for that.

    4. KBDr. Keith Baar15:22

       No, that's perfect. So when I'm curling up, that's my concentric move. When I'm holding it still, that's the isometric component. And when I'm, I'm lowering it, that's the eccentric component. All right. So when I'm completely healthy, and when everything is working perfectly within my tendon, it doesn't really matter what I'm doing as much. The reason that I say that is that your tendons, like any other tissue in our body, it's not a homogeneous tissue.

    5. TFTim Ferriss15:53

       Mm-hmm.

    6. KBDr. Keith Baar15:54

       But what it is, is a mechanical tissue. And what that means is I'm passing load through it. And so if there's strong parts and there's weak parts, the load is gonna go more through the strong parts, because they're stiffer.

    7. TFTim Ferriss16:06

       Mm-hmm.

    8. KBDr. Keith Baar16:06

       And so when I load quickly, load goes through the strong parts. When I have an isometric hold, the strong part gets tired, and the load then is put onto the rest of the tendon.

    9. TFTim Ferriss16:18

       That's if the isometric is long enough, or just by virtue of being isometric?

    10. KBDr. Keith Baar16:22

        By virtue of being isometric, but then the longer the isometric, the more evenly the signal is given to all of the cells within.

11. 16:32 – 23:28

    Stress shielding and how load distribution affects tendon healing.

    1. TFTim Ferriss16:32

       Got it.

    2. KBDr. Keith Baar16:32

       Think of it like this. The Rock and I are doing a tug of war together against somebody over there.

    3. TFTim Ferriss16:37

       [laughs]

    4. KBDr. Keith Baar16:38

       Okay? So at the start, it doesn't matter if I'm there or not, because The Rock is gonna be, like, putting in 900% of the, of what we're gonna put into that, that rope. I'm just standing there because, uh, for contrast, right?

    5. TFTim Ferriss16:52

       [laughs] Yeah.

    6. KBDr. Keith Baar16:53

       But then what happens is The Rock doesn't do much endurance work, that's how he gets so big, so he's gonna tire really quickly. And as he tires, suddenly I'm having to put more load on the, on the rope-

    7. TFTim Ferriss17:05

       Mm-hmm

    8. KBDr. Keith Baar17:05

       ... in order for us to maintain that position.

    9. TFTim Ferriss17:07

       Mm-hmm.

    10. KBDr. Keith Baar17:08

        We all had a sadistic gym teacher who said, "Okay, go to the wall there. Put your back against the wall. Go down and sit so that your legs are 90 degrees, and 90 degrees at the hip and the knee."

    11. TFTim Ferriss17:18

        Yeah. Wall sit. Yep.

    12. KBDr. Keith Baar17:20

        And you did a wall sit, and you're sitting there like, "I am not moving. Why the hell are my legs burning like the world is on fire?" The reason is that as I hold that position, my tendons start to relax. And as my tendon starts to relax, in order for me to stay there, my muscle has to contract more.

    13. TFTim Ferriss17:39

        Mm-hmm.

    14. KBDr. Keith Baar17:39

        And so what I get is I get creep in my tendon. Now, that's really important, because, you know, if you take a paper, piece of paper, and you just load it... And I don't know if you do... You do do videos, so I'll do this demonstration.

    15. TFTim Ferriss17:52

        And just describe what you're doing as you're doing it.

    16. KBDr. Keith Baar17:54

        I will. Yeah. So if I take a piece of paper, just like our tendons, piece of paper is made up of fibers.

    17. TFTim Ferriss18:01

        Mm-hmm.

    18. KBDr. Keith Baar18:01

        And in this case, it's paper fibers or wood fibers. In my tendon, it's made up of collagen. So if I load that dynamically, I'm loading all of the, all of the fibers within that. Now, if I tear this, and I... The people who are just listening, just take a piece of paper, tear it. And then just you have a little edge there.

    19. TFTim Ferriss18:21

        Mm-hmm.

    20. KBDr. Keith Baar18:22

        Now, if load goes through that, what's gonna happen is it's gonna tear across. But if I just go back and I dynamically load, it doesn't go through there. It doesn't tear because there's no load going through this.

    21. TFTim Ferriss18:33

        Mm.

    22. KBDr. Keith Baar18:33

        There's a beautiful set of papers done by this wonderful old Japanese professor named Hayashi, and what he did is he took a metal wire and he put it from the patella into the tibial plateau of a rabbit. He just tightened it so that there was no load going through the patellar tendon. And within two weeks, he had all of the indications that the tendon was scarred.

    23. TFTim Ferriss18:57

        Hmm.

    24. KBDr. Keith Baar18:57

        Perfectly healthy tendon, but it had tons more cells, it had smaller collagen molecules, and they were not directionally oriented. Those are the definitions of a scar. So if you have a scar, that's because you didn't get load through it.

    25. TFTim Ferriss19:10

        Mm-hmm.

    26. KBDr. Keith Baar19:11

        And so all I have to do in order to get load through this area is I just have to put a small amount of weight and just be patient.

    27. TFTim Ferriss19:18

        Right. And just, just for people who aren't seeing it, you're pulling from top to bottom?

    28. KBDr. Keith Baar19:21

        I'm pulling on the top and the bottom.

    29. TFTim Ferriss19:23

        Yeah.

    30. KBDr. Keith Baar19:24

        And now, eventually, the paper will tear right at the point where we put that original injury.
12. 23:28 – 24:22

    The misconception about eccentric loading for tendon injuries and why velocity matters.

    1. TFTim Ferriss23:28

       That's fascinating. So the whole eccentric thing, which has become kind of scripture in a lot of places, just like RICE, which we might talk about, right? [laughs] The rest, ice, compression, elevation, which we'll talk about at some point, hopefully, if we have time. It was a false positive in a sense, right? Or they thought it worked because of the eccentric nature of the movement, but it wasn't that at all, it was the reduction of velocity.

    2. KBDr. Keith Baar23:54

       Exactly.

    3. TFTim Ferriss23:55

       And maximal reduction of velocity is isometric.

    4. KBDr. Keith Baar23:58

       Yeah. And so if you're trying to hold the weight while you're doing that slow eccentric load, yeah, the weight is good, but from our engineered ligaments, it didn't matter whether we did a big movement or a little movement or a heavy movement or... What mattered was we got load through the cells, so the cells could sense the load, and that we did it and we could stop at about 10 minutes. And those were the two things that, that

13. 24:22 – 27:14

    Ideal duration for isometric holds (10-30 seconds) based on injury status.

    1. KBDr. Keith Baar24:22

       made the difference.

    2. TFTim Ferriss24:23

       Do you see any difference, I don't know if you were testing this in the lab- But back to the original question about intervals or duration of stressor, right? 10 seconds on, 50 seconds off for 10 minutes straight versus like 30 seconds on, two minutes off, 30 seconds on, two minutes off.

    3. KBDr. Keith Baar24:41

       Absolutely.

    4. TFTim Ferriss24:42

       Have you been able to draw any, not necessarily conclusions, but inferences-

    5. KBDr. Keith Baar24:46

       Yeah

    6. TFTim Ferriss24:46

       ... hypotheses worth testing as to what might be better?

    7. KBDr. Keith Baar24:48

       We actually do have really good data there. What we know is that when, when the tendon is pretty much healthy, we can do shorter duration isometrics. So we can do one to 10-second isometrics when we've got pretty good health. That'll get us our maximal signal without a problem. If I'm recovering from an injury, and the more mature the injury, the more problematic it is, now the system that shielded the injury is much better at shielding.

    8. TFTim Ferriss25:18

       Mm.

    9. KBDr. Keith Baar25:18

       So now I need longer for that to relax. So what it's akin to, The Rock has done a little bit of aerobic exercise now, so he's gonna hold on a little bit tighter for a little bit longer. So I need to go for a longer period if I've been training my big partner to do those longer duration things. So-

    10. TFTim Ferriss25:38

        Mm-hmm

    11. KBDr. Keith Baar25:38

        ... if they have been having to shield the injury for longer, now it takes me a longer isometric to get to the point where I can get that load evenly across the tissue.

    12. TFTim Ferriss25:50

        What would be the minimal effective duration for a long-standing injury? Let's just say tennis elbow. What would a reasonable duration look like?

    13. KBDr. Keith Baar25:59

        So the reason that we've gone with 30 seconds is we can do this. We can take out the tendons from animals, we can pull them in our machine, and we can watch the stress or the force that we need to hold it at that distance apart go down-

    14. TFTim Ferriss26:11

        Mm

    15. KBDr. Keith Baar26:11

        ... and it goes down exponentially. And by about 30 seconds is about 85% of the way to the bottom.

    16. TFTim Ferriss26:18

        Yep.

    17. KBDr. Keith Baar26:18

        And if you wait out to two minutes, you only get about 15% more.

    18. TFTim Ferriss26:21

        Diminishing returns.

    19. KBDr. Keith Baar26:22

        Exactly. At 10 seconds, you're still coming down a fairly steep curve, but you're getting some stress relaxation. But by 30 seconds, you've turned a corner, and you're basically getting diminishing returns from there. And so that's why for the, for the injured tendons, we're going at that 30-second hold. And then-

    20. TFTim Ferriss26:40

        Mm-hmm

    21. KBDr. Keith Baar26:40

        ... when you've got somebody like Emil, who's, who's doing pretty well, now we can go with a shorter hold. The other thing when we're talking about the climbers is the tendons aren't as big.

    22. TFTim Ferriss26:51

        Mm-hmm.

    23. KBDr. Keith Baar26:52

        So I don't need as long on my flexor tendon in my finger as I do on my patella tendon or my Achilles tendon.

    24. TFTim Ferriss26:58

        Right.

    25. KBDr. Keith Baar26:58

        My Achilles is my biggest tendon in my body. It's gonna take longer for the strong parts to relax than if I am looking at my flexor tendons.

    26. TFTim Ferriss27:06

        So let me tell you what I'm doing, and then I want you to critique it, if that's okay.

    27. KBDr. Keith Baar27:10

        Absolutely.

    28. TFTim Ferriss27:10

        This whole conversation is a pretext for me fixing my elbow. [laughs]

14. 27:14 – 29:22

    My elbow issues and current rehab approach.

    1. TFTim Ferriss27:14

       So let me tell you what's going on.

    2. KBDr. Keith Baar27:15

       Totally good.

    3. TFTim Ferriss27:16

       That's only half said in jest. Many, many, many years ago, this is like 20-plus years ago, did a lot of jujitsu and had my arm hyperextended a number of times.

    4. KBDr. Keith Baar27:24

       Yep.

    5. TFTim Ferriss27:25

       And like many men of younger vintages, felt I was invincible, so I would ice it, wrap it, and just go straight back to the gym, like an idiot. Now, that has come back to haunt me, and I love climbing. I'm not particularly great at it, but what happens is I take a long break, usually a few years, then I come back, I start climbing. Everything is great until I get to about 5.11A, where I start having these harder, for me, crimps, right? And at that point, my elbow goes absolutely berserk in that lateral epicondyle area. I think there's also some damage in the joint or joint capsule itself, but let, let's put that aside for now. I also have quite a bit of pain kind of lower tricep, near the elbow. But then I take a long break, I go back, and the process repeats itself.

    6. KBDr. Keith Baar28:20

       Yeah.

    7. TFTim Ferriss28:20

       Then I got very excited about fixing this with isometrics, and I thought to myself, "Okay," and we may not have time to dig into this, but I do have questions about collagen and vitamin C. So I've been taking hydrolyzed collagen peptide powder, we can talk about whether that checks the box or not, with vitamin C about an hour prior to doing isometrics. And then I've been varying, because the internet has different things to credit you with, and I don't know which are correct. One is, I, I don't have proper tools here, but I'm using a, basically a cast iron pan. And you can, for people listening, you can imagine I'm holding this in my right hand. The pan is pointing straight up, my elbow is by my side, and then I'm rotating so that the top of my hand is up and holding it in that... There's probably a better technical term, but kind of internally rotated position, holding that for 30 seconds, and then taking two-minute rest, another 30 seconds, and doing four total rounds of

15. 29:22 – 40:43

    Overcoming vs. yielding isometrics and optimal loading strategies.

    1. TFTim Ferriss29:22

       that. I've done that. I've also experimented with having my arm flat on a table and then pushing down on the top of the hand, so it's effectively like holding a reverse curl, you might think of, and have played around with that. What should I do to fine-tune that? What are your thoughts?

    2. KBDr. Keith Baar29:42

       So this is one of the reasons that one of my postdocs and I are actually starting a, a small company. We just spun out a company because-

    3. TFTim Ferriss29:48

       Ah, look at that

    4. KBDr. Keith Baar29:49

       ... what we're always doing is we're trying to figure out, how can I do this with a bunch of stuff that's not well suited for it?

    5. TFTim Ferriss29:56

       Mm-hmm.

    6. KBDr. Keith Baar29:56

       And so what we're doing is we're designing devices, and then we're instrumenting them so that you can see how much load you're putting through it.

    7. TFTim Ferriss30:04

       Mm-hmm.

    8. KBDr. Keith Baar30:04

       And you can then understand, like, "Okay, I'm gonna do this repetition. Here's my strength curve. Okay, there's my 30 seconds. Okay." Until those things are out, basically what we would say is you're trying to do exactly what you're saying there. First of all, when you have injury, what we're trying to do is we're trying to keep the kind of the pain on the scale of one to 10, we're gonna try and keep it at two or below.

    9. TFTim Ferriss30:27

       Mm-hmm

    10. KBDr. Keith Baar30:27

        Because what we want to get is we want to get load through there, but without getting too much load. We don't need a ton of load, remember. So that's what-

    11. TFTim Ferriss30:33

        Mm

    12. KBDr. Keith Baar30:33

        ... the Ab Hamstrings are good with. And there, you can start even with 40% of body weight.

    13. TFTim Ferriss30:38

        Mm-hmm.

    14. KBDr. Keith Baar30:38

        And it's independent of the load. And so as long as you can get load through the, through the tissue, that's fine. So if you have a really big damaged thing, basically your cast iron pan might be a little too much.

    15. TFTim Ferriss30:51

        Mm-hmm.

    16. KBDr. Keith Baar30:51

        And so you might be overdoing it a bit and getting a little bit more of the signal to the wear, which is what we're looking at. So what's your ratio of signal to wear? And we're trying to maximize the signal with minimizing the wear and tear.

    17. TFTim Ferriss31:04

        Yep.

    18. KBDr. Keith Baar31:04

        And so what we would do is, the other way to do it is to just take a, a tennis racket and find, like, a, like, a door jamb or something, and just put it underneath and just do the opposite.

    19. TFTim Ferriss31:14

        I see. Right.

    20. KBDr. Keith Baar31:15

        And then you can do that in both directions.

    21. TFTim Ferriss31:17

        Or a golf club. I've seen demos with that as well.

    22. KBDr. Keith Baar31:19

        Exactly.

    23. TFTim Ferriss31:20

        Or under a kitchen island, like I have in front of me here.

    24. KBDr. Keith Baar31:24

        Yeah.

    25. TFTim Ferriss31:24

        I got it.

    26. KBDr. Keith Baar31:24

        So-

    27. TFTim Ferriss31:25

        So you'd basically be pushing against it as an isometric.

    28. KBDr. Keith Baar31:29

        Yeah. And so that's called an overcoming isometric, because you're starting to... You're trying to overcome something. And the important thing there, and the reason that I like what's called an overcoming, think of it like a leg extension. When you're-

    29. TFTim Ferriss31:44

        Right

    30. KBDr. Keith Baar31:44

        ... starting with your knees both bent, you haven't touched the little pad down there to start extending your legs. Now, I put my, my feet against the pad, and I'm gonna extend out. I have to try-
16. 40:43 – 45:51

    Dr. Barr's movement prescription for my tennis elbow.

    1. TFTim Ferriss40:43

       I'm gonna give people just a couple of teasers. You have an incredible breadth of variety in your research. It's, it's kind of mind-boggling to me. I'm just gonna give people a teaser. We don't have to dive into it right now. You can't believe everything you read on the internet. But I believe you were involved in some research on ketogenic diets. Found that, I think it was a one-month ketogenic diet in middle-aged mice, I feel like a middle-aged mouse sometimes, increased muscle mitochondrial content significantly, though not in the brain or liver. So we could talk a lot about keto.

    2. KBDr. Keith Baar41:16

       Yeah.

    3. TFTim Ferriss41:16

       I am gonna stick with the isometrics, though, for a second here. I have just a few. Two are on exercise examples, right? So we talked about the tennis elbow a little bit, and the overcoming isometric with, say, a tennis racket under the kitchen counter. Is that the only movement that you would prescribe to someone like me for tennis elbow, or are there other varieties of movements, isometrics, that you would throw into the mix? That's question number one.

    4. KBDr. Keith Baar41:42

       So the thing for your extensors, so the extensors-

    5. TFTim Ferriss41:45

       Mm-hmm

    6. KBDr. Keith Baar41:46

       ... of the, of the forearm, they're gonna be rotational and they're gonna be extensors. So you have to do both. So you wanna do-

    7. TFTim Ferriss41:52

       Got it

    8. KBDr. Keith Baar41:52

       ... one that's, it's an extensor. You can do an isometric... And again, you can do it at any point along the chain. So if the muscle is in a long position, that helps a little bit.

    9. TFTim Ferriss42:02

       Got it.

    10. KBDr. Keith Baar42:02

        Again, thinking of it as an overcoming isometric, the muscle and the tendon are longer, so I can get a little bit more relaxation there.

    11. TFTim Ferriss42:09

        So let me describe the visual for folks. So the extensors are on the top of the forearm. Think about doing, like, reverse wrist curls, and you just had the wrist cocked down.

    12. KBDr. Keith Baar42:18

        Yep. So it's at the bottom of the wrist curl, where I'm about to start doing my reverse wrist curl. Now I just pull it up a little bit with a weight that I couldn't really lift the whole way.

    13. TFTim Ferriss42:27

        Mm-hmm.

    14. KBDr. Keith Baar42:28

        But now I can do that, and I can hold it in that fist below my forearm position, and I can try and extend my f- my fist up- And that's gonna get me that extension component.

    15. TFTim Ferriss42:42

        Mm-hmm.

    16. KBDr. Keith Baar42:42

        And then I'm gonna need that rotational component, which we talked about with the tennis racket.

    17. TFTim Ferriss42:46

        Got it.

    18. KBDr. Keith Baar42:47

        The biggest one for most people, and the thing that drives my students crazy now, is that every class, almost every class, I have them doing isometric lunges or isometric squats. An isometric lunge, I'll have them go down, hover the knee above, you know, and I do it-

    19. TFTim Ferriss43:04

        Mm

    20. KBDr. Keith Baar43:04

        ... for, okay, whoever beats me gets an extra point, an extra credit point. And we sit there and, and it's like a, you know, two-minute thing, but by the end of two minutes there's maybe one or two of us left, and I go, "Okay, that's enough times." But the reason I'm doing it is because now I get my quad tendon and my patellar tendon, and if I move forward and I shift forward and my knee is over my toe, I'm getting a good stretch on my Achilles tendon, or I'm getting good load through my Achilles tendon. And I've also got it on my backside. So the, the knee that's in the low position, now I've got quad tendon and patellar tendon there, and I've got a little bit on the plantar fascia on that foot.

    21. TFTim Ferriss43:41

        Hmm.

    22. KBDr. Keith Baar43:41

        So now in that one move, I'm getting pretty much all the tendons in my lower leg. I'll switch and do the other leg, and then I'll do like a, a side lunge. Those types of things, for most of us who are getting older, like to run, we're, we're sitting there and we've got... So now what I want to get is I need to get my knee and my Achilles. Those are the two things that are the primary thing for most people. Those isometric squats are amazing for it.

    23. TFTim Ferriss44:08

        And that's the split squat?

    24. KBDr. Keith Baar44:09

        Yeah, so it's like a Bulgarian split squat. So one foot in front of the other, just a long stride, go down.

    25. TFTim Ferriss44:15

        30 seconds would be the minimum effective dose?

    26. KBDr. Keith Baar44:18

        You can build up to that. So you start with 10 or whatever you can do, and then you build up and you get into that 10 to 30 seconds. If you've got existing injuries, we're gonna go more like 30 seconds. If you don't have any existing injuries, then you can go for 10 seconds.

    27. TFTim Ferriss44:31

        Mm-hmm.

    28. KBDr. Keith Baar44:31

        And what you're gonna find when you're doing these isometrics is your range of motion is actually gonna improve much better-

    29. TFTim Ferriss44:38

        Hmm

    30. KBDr. Keith Baar44:38

        ... than if we were to do a static stretch. Because if... when we're doing a static stretch, the muscle and the tendon aren't adapting in the same way as when we're doing an isometric hold.
17. 45:51 – 50:33

    Loading timing post-surgery and RICE protocol criticism.

    1. KBDr. Keith Baar45:51

       to get injured.

    2. TFTim Ferriss45:52

       Let me shift to just the timing question, and the timing specifically makes me think back to Professor Hayashi and his, his poor little rabbits, where he attached, I guess, I'm trying to recall this here, but basically some type of metal filament or wire, applied tension. Was this on the knee? This was on the knee.

    3. KBDr. Keith Baar46:11

       Yep. Patella to the tibia.

    4. TFTim Ferriss46:13

       Right. And then lo and behold, the adjacent natural tissue suddenly has all the indications of scarring and weakness and so on. How soon after surgery, and you can choose your surgery, ACL, take your pick, dealer's choice, would you start loading the site of injury/repair?

    5. KBDr. Keith Baar46:34

       So we do it the next day.

    6. TFTim Ferriss46:36

       [laughs] Yeah, yeah.

    7. KBDr. Keith Baar46:38

       We've had to have success in order for us to get there.

    8. TFTim Ferriss46:41

       Yeah.

    9. KBDr. Keith Baar46:41

       Because the first time we, we did this with, like, a rugby player, the, the surgeon was like, "Six weeks without loading." And we were like, "Let's load tomorrow." And so we agreed that we would do it at, like, seven to nine days.

    10. TFTim Ferriss46:54

        Mm-hmm.

    11. KBDr. Keith Baar46:54

        And that player got back fully a month faster than that surgeon had ever seen a player get back from that injury.

    12. TFTim Ferriss47:00

        Mm-hmm.

    13. KBDr. Keith Baar47:00

        And so that surgeon is now much more willing to do it at two days after injury because of that. If you look at general populations, Michael Kjær, who I think is the world's best sports medicine doctor for musculoskeletal injuries-

    14. TFTim Ferriss47:14

        How do you spell that last name?

    15. KBDr. Keith Baar47:15

        It's K-J-A-E-R. He's in Copenhagen.

    16. TFTim Ferriss47:19

        Oh. [laughs]

    17. KBDr. Keith Baar47:19

        So he's, he's Danish.

    18. TFTim Ferriss47:20

        Sorry, didn't realize that was gonna be that hard. [laughs]

    19. KBDr. Keith Baar47:23

        Kjær. It's Kjær, but he allows those of us who are, are language deficient to call him "Care".

    20. TFTim Ferriss47:30

        Got it.

    21. KBDr. Keith Baar47:30

        But he did a beautiful study with one of his trainees, Monica, and what she did is she took a bunch of his patients that had injuries, and she either had them load two days after injury or nine days after injury, and then she followed them for when they got back to sport. And what she found is the ones that they loaded at day two after the injury, they got back 25% faster than the ones that they loaded at nine days.

    22. TFTim Ferriss47:53

        That's incredible.

    23. KBDr. Keith Baar47:54

        That's typical. So as you said before, what is our standard of care? Our standard of care is RICE, okay? And so I'm gonna go a step further. If you go and you sprain your ankle and you go to the doctor, very good doctor, very well-meaning, they're gonna give you a boot. And what is a boot? So I told you that a scar forms when we get stress shielding. What a boot is, it is a mechanical stress shielder. What it's designed to do is to take the stress off the tissue you've injured.

    24. TFTim Ferriss48:24

        Mm-hmm.

    25. KBDr. Keith Baar48:24

        If I've told you that the thing that's gonna cause that tissue to get a scar is that you take off the tension, what I've just done is I've made the problem worse.

    26. TFTim Ferriss48:34

        Yeah.

    27. KBDr. Keith Baar48:34

        I always tell people that the first recorded immobilizer for an ankle or a leg is from Egyptian hieroglyphs where they showed pictures 4,500 years ago. If I took you and you said you had cancer, you would not want a treatment that was developed 4,500 years ago. You would hope that something new has been developed in the last 4,500 years. That is where we are for our orthopedic situations. I understand that you cannot put full load on a surgical repair immediately, but what you can do is you can take it out at the beginning of the day, you can remove it from the boot, and I can do some isometric loads with low jerk. So I'm gonna develop force slowly. I am going to make sure that there's zero pain, and I am gonna hold that, and then I'm gonna let that off slowly. And I'm gonna do that four times, 30 seconds. Now I've given load, and now I can put it back into that boot, stress shield it. I'm gonna take the boot off at night, and I'm gonna do it again. Just doing that, I'm getting those two loads, in this case, the Achilles tendon that we've ruptured. Now what I've done is I've accelerated my return to activity massively. Again, the key is we're not trying to be, "I'm the strongest in the world." We're trying to say, "I'm putting a little bit of load through that." Okay?

    28. TFTim Ferriss49:55

        Yeah.

    29. KBDr. Keith Baar49:55

        That is the key, is that you don't get all caught up in the machismo of it, and you just say, "I just wanna feel tension-

    30. TFTim Ferriss50:03

        Mm-hmm
18. 50:33 – 53:54

    Achilles tendon rehabilitation after surgery.

    1. TFTim Ferriss50:33

       So [laughs] just a question for a friend, because a friend of mine literally just sent me photos of his Achilles tendon surgery. He, a former super high level volleyball player, has not played volleyball in a long time, but is still very physically, or I should say muscularly strong, went back for an alumni volleyball game, and you guessed it, pow, snap, and into the OR. That's very recent, last few days. What type of isometric would you advise for that particular Achilles rehab?

    2. KBDr. Keith Baar51:09

       This becomes one of the issues that we have. And orthopedic surgeons, they hate me, okay?

    3. TFTim Ferriss51:16

       [laughs]

    4. KBDr. Keith Baar51:17

       And the reason they hate me is because the thing that they wanna do is they want it to be really strong when you leave the operating room. So what they do for that is they use all of these reinforced sutures that are going to stay in that tissue for a long time. Okay, so now I've got a really strong suture going through my, my tendon. So if you load that, where do you think the load is gonna go?

    5. TFTim Ferriss51:40

       It's gonna go to the sutures.

    6. KBDr. Keith Baar51:42

       It's gonna go through the sutures. So what happens is we don't actually load the native tissue. But the way that the surgeon does it is they don't do it so that you can't load the tissue at all, because if they did that, you'd never be able to bring your toe up, never be able to bend your ankle. So what they do is they have it so that the sutures will take all the load when you start to bend the ankle or you start to, what we call dorsiflex the ankle, and the tendon becomes longer. So what that means is we have to work in the shortened position. So we have to be in the plantarflexed, or our toe is pointing away from us.

    7. TFTim Ferriss52:14

       Mm-hmm.

    8. KBDr. Keith Baar52:15

       So what you do is you do that so he can take his boot off, and this is, again, this is from the science. I don't have the medical components. I always work with medical professionals who do this, who actually put the program into place.

    9. TFTim Ferriss52:27

       Yeah.

    10. KBDr. Keith Baar52:27

        But what the people that I work with do is they say, "Okay, we're gonna have you go in a relaxed position. You're gonna take the boot off. I'm gonna just have you be there, and now all I want you to do is against... You can slide yourself against a wall so that where your relaxed position is, you're just gonna lightly put tension on that. You're just gonna apply a little tension."

    11. TFTim Ferriss52:47

        On the bottom, like the ball of the foot, something like that.

    12. KBDr. Keith Baar52:49

        On the toes to the ball of the foot.

    13. TFTim Ferriss52:50

        Yeah.

    14. KBDr. Keith Baar52:50

        Yeah. And so all I'm gonna do is push against that little wall, and all I'm gonna do is make it so that I feel a little bit of tension through the area. Not so that I feel it pulling, not so that... I just wanna feel tension, and all I'm getting is I'm getting a stimulus to whatever little bits are around of the native tissue have been brought together.

    15. TFTim Ferriss53:09

        Mm-hmm.

    16. KBDr. Keith Baar53:09

        And what that's going to allow me to do is that's going to allow me to get that tissue to s- keep active. Because what can happen if you have these really reinforced sutures, and you're loading in a kind of traditional loading program where you're doing kind of faster movements, or you're doing maybe eccentrics or whatever it is, but you're not getting load through the native tissue, is that the native tissue becomes smaller and smaller over time. It's like Hayashi did. That's exactly what Hayashi did. And so what ends up happening is the native tissue doesn't become strong. And then eventually, we're putting so much load through the suture that the suture will eventually wear and tear and will break down. And when that happens, if we're not ready for it, we'll re-rupture the tissue.

19. 53:54 – 57:43

    Critique of orthopedic suturing techniques and recommendation for resorbable sutures.

    1. TFTim Ferriss53:54

       If there are, which I'm sure there are, some curious, open-minded orthopedic surgeons out there who are asking themselves, "Well, Keith, I'm open-minded. What would you recommend we do instead of suturing the way that we've been taught to suture?" What would you say?

    2. KBDr. Keith Baar54:10

       So you can do the same procedural suture. So you can go up and through the muscle, you can do all the reinforcement. But all we do is we say use a resorbable suture.

    3. TFTim Ferriss54:18

       You said reabsorbable? Is that right?

    4. KBDr. Keith Baar54:20

       Yeah, it gets resorbed into the body.

    5. TFTim Ferriss54:23

       Resorbed.

    6. KBDr. Keith Baar54:24

       It's the ones that-- You can see all of my scars. Those are the ones that I got that were inside the skin, so that they didn't have to open up the skin and go get them again.

    7. TFTim Ferriss54:33

       Mm-hmm.

    8. KBDr. Keith Baar54:33

       They become lactate basically, 'cause a lot of times it's a polylactate that they use to make them. Anyway, so I have a PhD student, the same one who's my rock climber, who's worked with Emil. We've got a paper that she, that she's the first author on- Basically showing that the Abraham's increased strength as much as Max Hang's in a population about 500 climbers. But she's an incredible surgeon, so what she did is she went into rats and she did... She cut the Achilles tendon re- and sewed it back with either a resorbable or a non-resorbable suture. And then she, at four weeks, she cut them out and just saw, w- is there a difference in the strength, and there wasn't any difference in the strength. The surgeons are really worried about two things with an Achilles tendon rupture. One is that we're gonna lengthen the Achilles tendon because it's not gonna be strong enough to the suture. If you used a resorbable suture, it wouldn't hold on long enough for it to prevent the lengthening of the Achilles. And what she showed is that even though we let the, the rats start walking right away, there was no difference in the length of the Achilles based on whether she used a resorbable or a non-resorbable. We saw that the resorbable actually had better, like, collagen synthesis markers-

    9. TFTim Ferriss55:48

       Mm

    10. KBDr. Keith Baar55:48

        ... than the non-resorbable, just kind of like what we would anticipate. So you can do the same repair, just understand that if you use a suture that's gonna resorb, that's going to allow you to then get the native tissue back if you are working with a team who is really good at then providing the load.

    11. TFTim Ferriss56:09

        Mm-hmm.

    12. KBDr. Keith Baar56:09

        So the best tendon surgeons in the world tend to be in Finland for some... I don't know why, but-

    13. TFTim Ferriss56:14

        Huh. Never would've guessed. [laughs]

    14. KBDr. Keith Baar56:15

        There's a history of studying tendon in Finland for some reason.

    15. TFTim Ferriss56:19

        [laughs]

    16. KBDr. Keith Baar56:20

        And so a lot of the Finnish surgeons use resorbable sutures, and they do early loading. They do that because they know that what they're trying to do is... All they're trying to do is attach the two ends so that the n- native tissue can, can become functional again.

    17. TFTim Ferriss56:37

        Mm-hmm.

    18. KBDr. Keith Baar56:38

        So that's really what we would tell your friend, is start in two positions. You have to do it in two positions now because remember, the soleus and the gastroc both come into the Achilles.

    19. TFTim Ferriss56:48

        Mm-hmm.

    20. KBDr. Keith Baar56:48

        The soleus muscle we use when we bend our knee and we push down with our toe.

    21. TFTim Ferriss56:53

        Like a seated calf raise, something like that?

    22. KBDr. Keith Baar56:55

        Like a seated calf raise is for the soleus. A straight leg calf raise is for the gastroc. We need both of those for properly loading the Achilles tendon.

    23. TFTim Ferriss57:05

        Mm-hmm.

    24. KBDr. Keith Baar57:05

        So what you would do is you take off the boot, or if you were worried about it, you could do it in the boot, and just push down on your, the ball of your foot in the boot, and you should feel tension across the back of the leg, and that should be enough to give you a stimulus. Hold it for 30 seconds, develop the tension over three to five seconds, hold it for 30 seconds, let it off three to five seconds.

    25. TFTim Ferriss57:28

        Mm-hmm.

    26. KBDr. Keith Baar57:28

        So again, you can begin to do it even in the boot. You can do it with a straight leg in the boot as well, and then you're not doing anything that your doctor didn't tell you to do. You're still keeping it immobilized if you want. But we're actually loading that tendon.

20. 57:43 – 1:01:12

    Multiple position isometrics for tennis elbow rehabilitation.

    1. TFTim Ferriss57:43

       So quick question on the tennis elbow, because you mentioned the soleus and the gastroc, and I was watching a video actually... [laughs] Surprise, surprise, if you look for one tennis elbow video on YouTube, you're gonna get seven million of them served to you. But I did watch one from Venus Williams, and, uh, she mentioned something that I had been playing around with intuitively when I was doing some of these exercises, which was, let's just say with the external rotation, like the tennis racket, I've been doing yielding and not overcoming, but I'll, I'll switch that. I'd been experimenting with having my elbow bent at 90 degrees, doing it with my arm completely straight, doing it somewhere in the middle. Is that advisable, inadvisable?

    2. KBDr. Keith Baar58:27

       Absolutely.

    3. TFTim Ferriss58:27

       Yeah.

    4. KBDr. Keith Baar58:28

       So one of the things some of the baseball teams that we work with are like, "Oh yeah, we were doing some stuff for the rotator cuff using your isometrics, and we were loading the rotator cuff, and everybody's ulnar collateral ligament was feeling better." When you're loading one thing, you're going to get one response when you're isolating that muscle and that tendon, that muscle tendon unit. When I change which joints I'm moving, now I'm getting a slightly different combination of muscles and tendons, and both of them are probably contributing to the pain that you're feeling. So if you're going to use that position, so yeah, a lot of people do the bent arm because that's what we're doing when we're doing a backhand.

    5. TFTim Ferriss59:08

       Mm-hmm.

    6. KBDr. Keith Baar59:08

       But you also have to think that if I do that with a straight arm, it's also going to have different contributions of the upper arm musculature, which then feed in and load the tendon differently.

    7. TFTim Ferriss59:20

       Yeah. And in my case, it's arm extended typically for the rock climbing, hopefully using my legs and pivoting more than pulling, but eventually it's this, and that's where I start to feel-

    8. KBDr. Keith Baar59:32

       Yeah

    9. TFTim Ferriss59:32

       ... it really get grumpy. Just to get really in the weeds here for a second, so would you do one position per workout, or let's just say it's four sets of 30 seconds, would you do a different position for each of those sets? What would you advise?

    10. KBDr. Keith Baar59:45

        I would rotate through. So I would do a 30 seconds on the external rotation with my, my elbow is bent at 90 degrees, one when it's straight, and then I could come back, I could do one with my arm up over my head.

    11. TFTim Ferriss1:00:01

        Mm.

    12. KBDr. Keith Baar1:00:01

        It sounds like you've got a lot of, a lot of tricep involvement. So what I would do is actually do something where I'm extending the tricep. So have a belt that goes down to the floor, and I'm trying to push up, like do a, like do almost like a head crusher, but now it's over my head.

    13. TFTim Ferriss1:00:19

        As an isometric.

    14. KBDr. Keith Baar1:00:20

        Yeah. So I'm gonna do it from here, and I'm gonna push it up. So it's on, like, a doorknob behind me. I put my belt around the doorknob, and now I'm gonna push up on that. So what I'm getting is I'm getting the forearms, but I'm also getting the tricep 'cause that's also inserting on that joint.

    15. TFTim Ferriss1:00:35

        Yeah.

    16. KBDr. Keith Baar1:00:35

        It sounds like for you, you've got contributions on both sides.

    17. TFTim Ferriss1:00:38

        It's a party. [laughs]

    18. KBDr. Keith Baar1:00:39

        So what we're gonna do is I'm gonna have maybe a, a little 30-second rotation where each one goes 30 seconds. By the time I get back, now I'm ready to do the first one again, 'cause I've done the three other ones.

    19. TFTim Ferriss1:00:51

        Yeah.

    20. KBDr. Keith Baar1:00:51

        And so that's perfect for the rotator cuff, 'cause I need to do- ... elbow abducted, internal rotation, external rotation, that's two. And then I need to do elbow adducted, internal rotation, external rotation. That's another two. So I can go through those 30-second isos and then rotate back through that, and I get the whole-

    21. TFTim Ferriss1:01:10

        Mm-hmm

    22. KBDr. Keith Baar1:01:10

        ... system in 10 minutes.

    23. TFTim Ferriss1:01:11

        Yeah. That's amazing.

21. 1:01:12 – 1:06:44

    Collagen synthesis, supplementation, and vitamin C timing.

    1. TFTim Ferriss1:01:12

       Let's talk about collagen synthesis, because you had mentioned that. I brought it up as well. At least in one 2017 study, athletes who took, correct me if I'm getting this wrong, roughly 15 grams of gelatin plus somewhere around 200 to 250 milligrams of vitamin C one hour before doing brief exercise, we can talk about what that brief exercise is, but had double the markers of new collagen formation in their blood compared to a control. Now, I've heard you talk about elsewhere some of the nuances and complexities of these markers, and how you might find that one goes up and one goes down from the intervention, so how do you evaluate that? But based on everything you have learned, researched, experimented with, reviewed, what would your current recommendations be, if any, for collagen/gelatin consumption? And not all products are created equal. There's a lot of garbage out there, but what might the parameters or criteria be?

    2. KBDr. Keith Baar1:02:16

       So the first thing is to address the last issue, because what you're looking for in any collagen supplementation is that the source of the collagen is from a skin source, from pelts-

    3. TFTim Ferriss1:02:27

       Mm

    4. KBDr. Keith Baar1:02:27

       ... of the animal. So fish skin, bovine skin. The reason that we say a skin source, 'cause a lot of people use bone broth, and bone broth is a great source of collagen. The problem is that most mammals, we store our heavy metals, we sequester the heavy metals in our bones. So when you do bone broth, you're also getting some heavy metal.

    5. TFTim Ferriss1:02:48

       Mm.

    6. KBDr. Keith Baar1:02:48

       So you just keep that as a background thing so that if you get it from the skin, there's not gonna be any of the heavy metal. So that's the only-

    7. TFTim Ferriss1:02:56

       Mm-hmm

    8. KBDr. Keith Baar1:02:56

       ... thing that we would say about a collagen supplement.

    9. TFTim Ferriss1:02:59

       Okay. You know, I accidentally got the right thing. I was like... I was looking at the back of this. I'm not gonna give them a free product placement, because I don't actually know what the quality is here, but this is a hydrolyzed grass-fed type I and III collagen peptide powder. But on the back, I was like, "Wow, will it even indicate..." And it does say ingredient, bovine hide collagen peptide hydrolysate.

    10. KBDr. Keith Baar1:03:19

        Yeah.

    11. TFTim Ferriss1:03:20

        If I'm saying that correctly.

    12. KBDr. Keith Baar1:03:21

        You're saying it perfectly. And so that's the only thing that we really are concerned with. Because you can say, oh, this is a Type I, Type III. It doesn't really matter, 'cause we're not absorbing the collagen as a whole molecule and just sticking it into our tendon. We're breaking it down to its building blocks. We're breaking it down to the amino acids. And the thing about collagen is it has tons of glycine in it and lots of proline in it.

    13. TFTim Ferriss1:03:44

        Mm-hmm.

    14. KBDr. Keith Baar1:03:44

        And so when we take just milk protein, like whey protein, if we take that after a heavy lift, our glycine levels actually dip in the period after, after eating it. And so that's work that Luke Van Loon has done, where he shows that there's a drop in glycine, probably because we're synthesizing more connective tissue protein than we have glycine. So all we're trying to do with the hydrolyzed collagen is we're trying to go in and we're trying to give building blocks.

    15. TFTim Ferriss1:04:11

        Mm.

    16. KBDr. Keith Baar1:04:11

        So it doesn't matter if it started from Type I, Type III. You want it from the skin, and that's gonna be mostly Type I and Type III, but that doesn't matter. It doesn't matter if they've done a super high secret peptide isolation, 'cause the peptides don't seem to play a big role.

    17. TFTim Ferriss1:04:27

        Mm-hmm.

    18. KBDr. Keith Baar1:04:27

        'Cause we've had some companies come to us and say, "Oh, well, you're gonna have to use a lower dose of ours because we have the special peptide," and it never works, and we always go back-

    19. TFTim Ferriss1:04:35

        [laughs]

    20. KBDr. Keith Baar1:04:35

        ... to the other dose.

    21. TFTim Ferriss1:04:37

        What dosing and timing do you recommend both for the collagen and for the vitamin C?

    22. KBDr. Keith Baar1:04:44

        We recommend taking those things together, just because the vitamin C is absolutely essential for your body's ability to, to synthesize collagen. Most of us have a perfectly normal level of vitamin C. We're not gonna get scurvy. We're not gonna get any of these things. But what we wanna do is if we're gonna increase collagen synthesis, we wanna also make sure that the cofactor for the enzyme that's gonna allow us to make and export that collagen is also present at a high enough amount. So we take them together. So we know for sure from studies that I was involved in when I was on sabbatical with Luke Van Loon in the Netherlands, that if you give a blend of whey protein with five grams of hydrolyzed collagen, you're gonna increase muscle connective tissue protein synthesis, and that's the first measure that's shown that, oh, connective tissue protein synthesis is sensitive to the diet.

    23. TFTim Ferriss1:05:41

        When is that being consumed?

    24. KBDr. Keith Baar1:05:42

        That one was consumed afterwards, but that was-

    25. TFTim Ferriss1:05:44

        After

    26. KBDr. Keith Baar1:05:44

        ... because it was a study on muscle.

    27. TFTim Ferriss1:05:46

        Right.

    28. KBDr. Keith Baar1:05:46

        The reason that the timing might matter is if I'm trying to target it to a tendon, the tendon doesn't have good blood supply. If I'm trying to target it to cartilage or ligament, it doesn't have good blood supply, and the way that those tissues get their nutrients is by getting either compressed or stretched, and the, the matrix gets squeezed of the liquid, and then as it relaxes, it's going to bring liquid in from the environment. If the environmental liquid has more of the amino acids and the vitamin C that we need to build more collagen, having the collagen base before you do your exercise, that's the ideal situation. Now, it's not always possible. It's still okay to take it afterwards, but if you're really trying to target it to one specific spot, take it before, about 30 minutes to an hour before.

    29. TFTim Ferriss1:06:35

        Mm-hmm.

    30. KBDr. Keith Baar1:06:35

        And then those amino acids are gonna peak right when you're loading, say, your rotator cuff.
22. 1:06:44 – 1:12:09

    Critique of BPC-157 and other injectable peptides for tendon healing.

    1. KBDr. Keith Baar1:06:44

       cuff.

    2. TFTim Ferriss1:06:44

       I've heard you describe some of these injectable peptides, BPC-157, I could, I could name others, as magic elixirs, and I'd love for you just to describe briefly, putting placebo effect aside, I mean, we could spend hours talking about placebo effect- But putting that aside, why people might see benefits but not for the reasons they think they're seeing benefits.

    3. KBDr. Keith Baar1:07:09

       Yeah.

    4. TFTim Ferriss1:07:10

       And then I'd love to ask you about some other orthobiologic stuff-

    5. KBDr. Keith Baar1:07:14

       Right

    6. TFTim Ferriss1:07:14

       ... if we have time.

    7. KBDr. Keith Baar1:07:15

       For BPC-156, we know that at least for the tendon and ligament cells themselves, it doesn't do anything, and we know that because we've engineered our little engineered ligaments. They're engineered human ligaments from human ACL cells. We then have treated them with BPC-156 or 157, and basically, there's no effect. It doesn't change, it doesn't improve, doesn't, doesn't impair. So if somebody wants to spend their money on that, I'd prefer that they just spend it, send it to me. I can send out a, a little link to, to the gift for my lab, and you can send it to the lab, and we'll do research with that money instead, and that'll be much better for your tendons. So the reason it might have a positive effect is one of the, one of the treatments for tendonitis and tendinopathy has always been pithing. Okay? Pithing is where you take something, or debridement. These are these-

    8. TFTim Ferriss1:08:05

       Mm-hmm

    9. KBDr. Keith Baar1:08:05

       ... really cool medical terms. Debridement means I take a scalpel and I go like this, and I make little lines in your tendon. I cut up your tendon and I make it weaker.

    10. TFTim Ferriss1:08:14

        Mm.

    11. KBDr. Keith Baar1:08:14

        Pithing means I stick your tendon with a needle a bunch of times. All we're doing is, remember, we're getting a scar because of stress shielding. If I start injecting a bunch of times into the strong part of that tendon, what I've done is put a whole bunch of holes in the strong part of the tendon. Now I can't stress shield the weak part, and that's actually potentially beneficial.

    12. TFTim Ferriss1:08:35

        Hmm.

    13. KBDr. Keith Baar1:08:36

        It's actually the reason we think that there's any benefit at all to immobilization, 'cause if by immobilizing I have made whatever strong part's weaker, now when I start to load properly afterwards, maybe it's gonna be beneficial. Like, we've done experiments in the, in animals where we, where we've got these 3D-printed casts that we can stick onto a mouse, and it just looks like the boot th-the doctor gives you. Three days later, if we take out the tendon, we've lost 15% of the collagen, 15 to 20% of the collagen in that tendon. It's mechanically about 30% weaker.

    14. TFTim Ferriss1:09:10

        Hmm.

    15. KBDr. Keith Baar1:09:11

        That's three days. The muscle mass decrease is actually smaller than the decrease in collagen within the tendon.

    16. TFTim Ferriss1:09:18

        Hmm.

    17. KBDr. Keith Baar1:09:18

        What we're doing when we do some of these things, like we're jabbing it with a needle, or somebody's gonna scrape you with a spoon and it's gonna push there, what we're trying to do is we're actually trying to... They say they're trying to break up scar tissue. What we're actually doing is we're actually damaging the healthy tissue, and the reason that that could potentially be beneficial is if I damage it, uh, just enough, now I can't stress shield. Now maybe I'll get a little bit of load through the weaker part of the tissue.

    18. TFTim Ferriss1:09:46

        Now let me stand in for some folks who are super fans of BPC-157.

    19. KBDr. Keith Baar1:09:51

        Okay.

    20. TFTim Ferriss1:09:51

        Just for a second. If I go on, let's just say PubMed, and do a little bit of a dig around, there are a few studies. Now, this is not ultra recent, but 2014, this is Molecules November 2014, pentadecapeptide BPC-157 enhances the growth hormone receptor expression in tendon fibroblasts. Now, people might cite this or something like it, but what you're saying is, in practice, you just have not seen it to make a difference.

    21. KBDr. Keith Baar1:10:19

        That's a really fun paper because basically, growth hormone doesn't have a direct effect on the tissue at all anyways. Growth hormone works on the tissue-

    22. TFTim Ferriss1:10:29

        Okay, let's hear more about this. This is interesting

    23. KBDr. Keith Baar1:10:31

        ... it works on the tissue because what it does is it increases the local expression of IGF-1. So whether your tendon cells have lots of receptors for growth hormone or not doesn't really help you.

    24. TFTim Ferriss1:10:43

        Hmm.

    25. KBDr. Keith Baar1:10:43

        What helps you with growth hormone is that either your liver is gonna make IGF-1 in response to it, or the fat cells or other things that are in the joints are gonna make IGF-1 locally around that tendon, and the IGF-1 has a positive effect.

    26. TFTim Ferriss1:10:57

        Hmm.

    27. KBDr. Keith Baar1:10:58

        If we take our engineered ligaments and we add growth hormone, doesn't change their mechanics, doesn't change their collagen content, but if we add IGF-1, we get this beautiful dose response.

    28. TFTim Ferriss1:11:07

        Huh.

    29. KBDr. Keith Baar1:11:07

        And so, yeah, the paper says you get more growth hormone receptors. Okay.

    30. TFTim Ferriss1:11:13

        Ultimately, who cares? [laughs]
23. 1:12:09 – 1:15:23

    Evaluation of orthobiologics' (PRP, prolotherapy, stem cells) effectiveness.

    1. KBDr. Keith Baar1:12:09

       tendon.

    2. TFTim Ferriss1:12:09

       Are there any other interventions that you think... I guess thinking has nothing to do with it, just believe based on the data or your experience, uh, could have some efficacy in terms of helping with connective tissue injuries? So I'll throw out a couple. Prolotherapy, PRP, shockwave therapy. I'm sure we could add dozens more to the list, but does anything pop out as plausibly credible or compelling to you?

    3. KBDr. Keith Baar1:12:38

       Not especially.

    4. TFTim Ferriss1:12:40

       Might depend on the injury?

    5. KBDr. Keith Baar1:12:41

       None in the lower body. The reason that I say that is that the lower body, I'll go in, get my shot, and then I'll walk out and I'll walk home.

    6. TFTim Ferriss1:12:50

       Mm-hmm.

    7. KBDr. Keith Baar1:12:50

       As soon as I took those first three or four steps out of the doctor's office, whatever I injected into my tendon, I've just squeezed it out, and it's gonna go everywhere within my body. It's not going to stay there. The reason that the upper body can work is I can immobilize it.

    8. TFTim Ferriss1:13:04

       Mm-hmm.

    9. KBDr. Keith Baar1:13:05

       Oh, I'm not gonna load my ulnar collateral ligament or some of my, you know, other tendons in my upper body, my, my rotator cuff. So I can hold that still and not put load through it. It has a chance to sit there. So what you'd have to do for ortho biologics to work in the lower body is you'd have to immobilize. Now I've got the complication of if I immobilize for three days, I've lost it.

    10. TFTim Ferriss1:13:26

        Yeah. Right.

    11. KBDr. Keith Baar1:13:27

        So that's where we get into the no part of it. The best physical therapist in the world is this guy, Rob Whiteley. He's out at Aspetar in Qatar, and he's wonderful because he's an Australian who has just gotten... He's been there long enough that people-- He gets to do whatever he wants to do. It's kind of like the grumpy old man thing. He'll tell you exactly what's going on. He went to this super high-end conference with all these o- orthopaedic surgeons, and he stood up and there he goes, "None of the crap that these guys are telling you about works," because they're all telling you to inject this, inject that. The only thing that works is getting load through the tissue.

    12. TFTim Ferriss1:14:02

        Mm-hmm.

    13. KBDr. Keith Baar1:14:02

        And he goes through the science of every single thing. This is PRP, this is stem cells, this is prolotherapy. And he goes through, and he just explains the data-

    14. TFTim Ferriss1:14:11

        Mm-hmm

    15. KBDr. Keith Baar1:14:11

        ... that when there's been a randomized controlled trial, there's no benefit. So patellar tendonitis, there's been a, there's been a randomized controlled trial where they don't know whether they're getting PRP or they're getting saline. There's no difference. There's no worsening, but there's also no improvement in your patellar tendon.

    16. TFTim Ferriss1:14:29

        This was lower body? Yeah, lower body.

    17. KBDr. Keith Baar1:14:31

        That was patellar tendon. Yeah, so lower body.

    18. TFTim Ferriss1:14:33

        Mm-hmm.

    19. KBDr. Keith Baar1:14:33

        The one place where they've seen it, I think, is in the rotator cuff, where there's a small positive effect. Again, we talk about collagen protein or whey protein. Whey protein will add about five percent, maybe a little bit less than that, to your strength gains or to your muscle mass gains. Collagen's probably about that two to three percent. If I gave you the best muscle-building supplement in the world, and you take it, and you just sit on your butt all the time, you are not gonna get bigger muscles.

    20. TFTim Ferriss1:14:59

        Right.

    21. KBDr. Keith Baar1:14:59

        Ninety-five plus percent of why we get bigger muscles, stronger tendons, all of these things, is due to the loading. There's gonna be maybe two, maybe five percent that's gonna be down to the collagen or to the whey protein. But because it's a lot easier to eat something or drink something, people are gonna focus on that. "Oh, all I have to do is eat collagen. I'm good."

    22. TFTim Ferriss1:15:19

        You have to apply the stressor.

    23. KBDr. Keith Baar1:15:21

        Exactly.

    24. TFTim Ferriss1:15:21

        You have to have the stimulus.

    25. KBDr. Keith Baar1:15:22

        Exactly.

24. 1:15:23 – 1:19:15

    JAK-STAT inhibitor drugs and their effects on tendon growth.

    1. TFTim Ferriss1:15:23

       But now I'll just push back a little bit. I totally agree that if you're just rolling around on a bed of PRP injections and then chilling with Netflix, probably not gonna solve all your problems. But, I mean, there's certainly things that I would imagine, and based on at least my interactions with some pretty high-level athletes, I would think can accelerate certain adaptations, right? I mean, if you put somebody on nandrolone and a little bit of cytomel and human growth hormone six days a week [chuckles] like, I would imagine that might accelerate certain adaptations. I'm not recommending anybody do that. But we were talking about, I guess, the orthobiologics like the PRP and the prolotherapy. But in addition to, let's just say, the collagen plus vitamin C, assuming that you're timing it correctly and applying a stimulus, are there any other adjuncts or supplements, doesn't need to be ingestible or injectable, that can accelerate the adaptations that we're hoping to provoke?

    2. KBDr. Keith Baar1:16:24

       So we've got data on an FDA-approved drug that improves tendon function. So basically-

    3. TFTim Ferriss1:16:30

       Mm-hmm

    4. KBDr. Keith Baar1:16:30

       ... what we did is we looked at the tendons of rats as they were developing, between seven days-

    5. TFTim Ferriss1:16:35

       Mm-hmm

    6. KBDr. Keith Baar1:16:35

       ... and twenty-eight days, and during that time, their Achilles tendon gets three times longer. Goes from three millimeters to nine millimeters, and their patellar tendon gets twice as big, so it grows in cross-sectional area by twice the amount. And we did genetic analysis, so we did transcriptomics. So we looked at all of the RNAs in those things, and in the patellar tendon that was getting twice as big, the major signal was inhibition of a protein called JAK or STAT. So the JAK-STAT pathway is actually a growth hormone-activated pathway, but what we found is that when you inhibit it, it was associated with growth. And so there's a series of drugs. If you ever watch TV, you see all of these drug commercials, and if you look up at any of your drug commercials and any of the drugs end in N-I-B, atacinib or baricitinib or any of those types of nib drugs, those are your JAK-STAT inhibitors. They're used for rheumatoid arthritis, and they're used for psoriatric conditions, skin problems.

    7. TFTim Ferriss1:17:30

       Yeah, psoriasis, et cetera. Mm-hmm.

    8. KBDr. Keith Baar1:17:31

       Psoriasis. Two collagen-based syndromes. So what we found is that when we use those drugs, the tendons that we engineer got bigger and stronger.

    9. TFTim Ferriss1:17:39

       Which of those drugs did you select and why?

    10. KBDr. Keith Baar1:17:41

        We selected three different ones that targeted different JAKs to see which of the JAKs were important. So we did-

    11. TFTim Ferriss1:17:47

        Mm-hmm

    12. KBDr. Keith Baar1:17:47

        ... a JAK1 inhibitor, JAK1,2, and a JAK3 inhibitor, and all of them were beneficial.

    13. TFTim Ferriss1:17:52

        Hmm.

    14. KBDr. Keith Baar1:17:53

        So we don't know exactly which one it is yet, and that's something we're working on. But we just finished a study, just a quick study on development. So what would happen if we gave these drugs to a developing organism? And we all know that part of the reason we grow is because we have collagen that works at our growth plates and pushes our bones apart so that we get taller. And one of-

    15. TFTim Ferriss1:18:16

        Mm-hmm

    16. KBDr. Keith Baar1:18:16

        ... the first things that we found is that the animals were forty percent smaller. So what that means is that they were getting bigger, they were differentiating the tendons, but they weren't, uh, able to push the growth plates apart because the collagen was actually acting as if, "All right, we're long enough. Now we have to get bigger."

    17. TFTim Ferriss1:18:33

        Hmm.

    18. KBDr. Keith Baar1:18:34

        And so what we think we're doing in that situation is we are, we're adapting so that the tendon is getting a stimulus where it can grow bigger and stronger.

    19. TFTim Ferriss1:18:45

        Hmm.

    20. KBDr. Keith Baar1:18:46

        But in growing it bigger and stronger, it prevents it from growing longer. And so that's the first drug that we know of that's been identified that affects tendon properties. We have other things that we're working on-

    21. TFTim Ferriss1:18:56

        Mm-hmm

    22. KBDr. Keith Baar1:18:56

        ... where I can give you a hormone that your body produces, and you will have a stiffer tendon.

    23. TFTim Ferriss1:19:01

        What hormone? S- so it's a cliffhanger. [chuckles]

    24. KBDr. Keith Baar1:19:03

        Yeah, it's a cliffhanger because it's not published yet, so, so I can't really give you that.

    25. TFTim Ferriss1:19:07

        [laughs] I got it. I got it. [laughs]

    26. KBDr. Keith Baar1:19:09

        If you had only, say, a thousand listeners, I would, I would be okay.

    27. TFTim Ferriss1:19:14

        Stand by for round two,

25. 1:19:15 – 1:23:03

    Drugs that increase risk of tendon ruptures (fluoroquinolones, AT-1 receptor drugs).

    1. TFTim Ferriss1:19:15

       folks. [laughs]

    2. KBDr. Keith Baar1:19:15

       Exactly, and there's also the opposite, which is drugs that people already know about that cause an increase in tendon ruptures.

    3. TFTim Ferriss1:19:23

       Cipro.

    4. KBDr. Keith Baar1:19:24

       Yeah, Cipro, but Cipro is actually only half As bad as some of the other drugs that we've found

    5. TFTim Ferriss1:19:30

       What are some of the other ones?

    6. KBDr. Keith Baar1:19:31

       So there's a study out of, again, Finland, and the first author is... Nyy is the last name of the first author. I can't remember the rest of it. All I have to ever search on my computer is nyy-

    7. TFTim Ferriss1:19:43

       [laughs]

    8. KBDr. Keith Baar1:19:44

       ... 'cause there's nothing else with those letters together except for a Finnish name. But what they did is they looked in the Finnish registry, all the people who ruptured their Achilles tendon, what were the medicines they were on?

    9. TFTim Ferriss1:19:55

       Mm-hmm.

    10. KBDr. Keith Baar1:19:55

        So you, you find the fluoroquinolone antibiotics.

    11. TFTim Ferriss1:19:58

        Yep.

    12. KBDr. Keith Baar1:19:58

        They're there, but they increased rupture rate about three and a half fold.

    13. TFTim Ferriss1:20:01

        I see. Of which ciprofloxacin would be one.

    14. KBDr. Keith Baar1:20:04

        Exactly. And then they found another class of drugs which are AT1 receptor drugs, so angiotensin receptor drug inhibitors.

    15. TFTim Ferriss1:20:11

        Ah.

    16. KBDr. Keith Baar1:20:12

        They're taken by over 15 million Americans every day.

    17. TFTim Ferriss1:20:15

        Mm-hmm.

    18. KBDr. Keith Baar1:20:16

        And they increase the rate of tendon rupture seven point six fold.

    19. TFTim Ferriss1:20:19

        Wow. What would be an example? What are some of the names of such a drug?

    20. KBDr. Keith Baar1:20:23

        Those are the sartan drugs.

    21. TFTim Ferriss1:20:24

        Mm-hmm.

    22. KBDr. Keith Baar1:20:25

        So if you're taking the sartan drugs, again, you wanna be careful with your physical activity. And this is not something that's really known. I went and did a, like a, a work in progress seminar at our orthopedics group, and the chairman of the orthopedics department puts up his hand and goes, "This could explain why I've ruptured this and this." And, and he goes through a list of like six tendons in his body that he's ruptured, or ligaments. And it's like, oh, yeah, that's probably a possibility because a lot of people who are taking them, that's, that's one of the most common things. But it's not really reported.

    23. TFTim Ferriss1:20:56

        Hmm.

    24. KBDr. Keith Baar1:20:56

        And so, again, that becomes a bit problematic because they are used by 15 million Americans.

    25. TFTim Ferriss1:21:02

        Wow.

    26. KBDr. Keith Baar1:21:03

        Yes, we're decreasing your blood pressure, but please don't exercise while you're doing it. One of the things we're working on is trying to see, is there a way that I can take what I need, which is the decrease in blood pressure, and can I figure out a way to do that without putting all of our tendons and ligaments at risk?

    27. TFTim Ferriss1:21:19

        Mm-hmm.

    28. KBDr. Keith Baar1:21:19

        Because as much as, yes, blood pressure is gonna cause cardiovascular disease, if you rupture your ACL, you are fifty percent more likely to have a heart attack than somebody who didn't rupture your ACL.

    29. TFTim Ferriss1:21:29

        Wait, what? Is that because of the decrease in activity or?

    30. KBDr. Keith Baar1:21:32

        That is because of the decrease in activity, yeah.
26. 1:23:03 – 1:26:19

    How estrogen affects tendon stiffness and injury risk in women.

    1. TFTim Ferriss1:23:03

       up, but before, before we start to land the plane, and we'll figure out how much time we have, but wanted to give, give something to the ladies specifically who are listening. Could you speak to injury risk, maybe it's ACL specific, and estrogen and maybe programming differences for men and women?

    2. KBDr. Keith Baar1:23:22

       Absolutely. This is absolutely essential component of what we do. So in our little engineered ligament... So I had a student come to me, and she's, she was an undergraduate student, I think she was nineteen at the time, and she goes, "I'm really interested in what you do because I've ruptured three ACLs." And I'm like, "You don't have three legs." "Oh, yeah, you've done the same one twice." Okay, so she's wanting to know why she's rupturing her ACL. And you go to literature and sure enough, women are four to eight times more likely to rupture their ACL. They're eighty percent less likely to have a muscle pull, okay? So what that is telling us is we pull our muscles-- We get muscle pulls when our tendon is stiffer than the muscle is strong. We get ACL or other ligament ruptures when there's too much laxity. Both of those two things could be explained if, if the tendon or ligament was less stiff.

    3. TFTim Ferriss1:24:14

       Mm-hmm.

    4. KBDr. Keith Baar1:24:14

       And so all she did, and all I had her do, was to take estrogen and add it every single day w- that we were making the ligaments at the low level that you would have normally around menstruation and early into the cycle. And then as you get to when the luteal phase would be, so that's when estrogen rises right before the woman's gonna ovulate, that goes up almost a hundred fold, the estrogen levels, during those three, three-ish days there. So all I had her do is add a hundred fold more estrogen, the exact levels that you would see in the, in a woman's body. And what we found is that the stiffness of the ligament went down. And then we looked at the collagen content. The collagen content was exactly the same, maybe a little bit higher. What we were fascinated by was this could explain... Like if you did this repeatedly, and we did this, we inhibited specific enzyme like, like what the estrogen was doing, and then we took that away and let them grow again. What happened was the stiffness differentials was maintained as they got stiffer again after that period. So what this kind of suggests is that girls, until they get into puberty, they're developing exactly the same as boys, the stiffness of their connective tissue. Now, as they get into puberty, estrogen starts to cycle. What we discovered is the estrogen actually inhibits a protein within the, within the tendon or ligament. And it's a really important protein 'cause what it does is it cross-links the collagen.

    5. TFTim Ferriss1:25:35

       Mm-hmm.

    6. KBDr. Keith Baar1:25:35

       And what that does is it makes it stiffer And so without changing the amount of collagen, if I cross-link it, the tendon gets stiffer. So when estrogen is present, we decrease the activity of that tendon, and what happens is it becomes stretchier.

    7. TFTim Ferriss1:25:49

       Mm-hmm.

    8. KBDr. Keith Baar1:25:49

       And so now, as that twelve to thirteen-year-old girl starts puberty, she's already stronger than the boys when she starts puberty. Now, she goes through these periods of intermittent decreases in stiffness, and now-

    9. TFTim Ferriss1:26:03

       Mm-hmm

    10. KBDr. Keith Baar1:26:03

        ... she can't transmit force as well. The stiffness of her tissues is going down, so her power goes down relative to the boys who are continuing to increase, and the result is a lot of the performance differences between men and women can be explained by the estrogen.

27. 1:26:19 – 1:29:00

    Testosterone's opposite effects on tendon compared to estrogen.

    1. KBDr. Keith Baar1:26:19

       If we look at testosterone again, you had mentioned earlier that some of it, s- you know, all, all you gotta do is take nandrolone or all of these-

    2. TFTim Ferriss1:26:27

       No, I didn't say all you have to do. I just, like, people who put together these cocktails-

    3. KBDr. Keith Baar1:26:30

       People will do these things

    4. TFTim Ferriss1:26:30

       ... do some pretty incredible things. Yeah.

    5. KBDr. Keith Baar1:26:31

       Absolutely. And so a lot of statisticians can go back to Major League Baseball, and they can say, "That person was taking steroids. That one, and that one." 'Cause what would happen is their performance would go up, and then it would drop off a cliff because what testosterone does is the opposite. It actually activates lysyl oxidase, and it decreases collagen. So what you get is you get a stiff tendon that has less collagen, and that's a brittle tendon. So that's why-

    6. TFTim Ferriss1:26:57

       Oh, yeah

    7. KBDr. Keith Baar1:26:57

       ... all of these guys juicing on testosterone-related products were getting stronger, bigger muscles, but then what they were getting is they were getting brittle tendons. So they would rupture a tendon because this big muscle is pulling on a weak tendon. And so now we've got this differential. Also, that effect on lysyl oxidase, which is the cross-linking enzyme of estrogen and testosterone-

    8. TFTim Ferriss1:27:20

       Mm-hmm

    9. KBDr. Keith Baar1:27:20

       ... that's one of the reasons why men have higher blood pressure than women because until women go through menopause, the estrogen that circulates monthly is actually decreasing the stiffness of the connective tissue in the aorta, and it allows it to stretch easier, so you have lower blood pressure. So there's all kinds of these things that are related to this connective tissue that we know about that is related to estrogen or testosterone levels.

    10. TFTim Ferriss1:27:44

        Is that fluctuation in connective tissue stiffness in women an evolutionary adaptation for birthing?

    11. KBDr. Keith Baar1:27:55

        Absolutely. If you know that at some point that if you have periodic inhibition of stiffness, there's also other hormones that will be produced late in pregnancy that will decrease tendon and ligament stiffness. That's relaxin is one of them. But if you start from a lower stiffness at the beginning, now as you go to relax to allow birth to happen, you don't have to relax from as high a level of stiffness. And so the job of the relaxin becomes easier so that the individual can give birth much more comfortably and have less trauma associated with the birth. And so, yeah, evolutionarily it makes sense, but it's also one of the reasons why we see a lot of the performance differences that we do between men and women. Because power is about how quickly we can transmit force. If I'm pulling on a stiffer tendon, I can transmit the force faster. If I'm pulling on a stretchy tendon, it takes me longer to develop force. So that's directly power. A lot of the differences that we see-

    12. TFTim Ferriss1:28:51

        Mm-hmm

    13. KBDr. Keith Baar1:28:51

        ... that we see between men and women's athletics and injury rate are down to this connective tissue component where we have increased or decreased stiffness.

28. 1:29:00 – 1:33:47

    Protein intake recommendations and timing.

    1. TFTim Ferriss1:29:01

       Keith, we've covered a lot of ground. I expected we would, and we haven't talked about a number of other things. I'm gonna make this one up to you. Do you wanna talk about, depending on which you think will be more interesting for folks and maybe... Let's leave it at interesting. Mitochondrial biogenesis and mitochondria in general. Or we could talk about protein intake and what, [chuckles] what amounts of protein you would suggest, in what intervals people consume for different purposes.

    2. KBDr. Keith Baar1:29:34

       As far as kind of the protein intake, I think most people have got that pretty well dialed in.

    3. TFTim Ferriss1:29:40

       Okay.

    4. KBDr. Keith Baar1:29:40

       What was the other one that you were suggesting?

    5. TFTim Ferriss1:29:42

       Oh, I was just very curious about PGC-1 alpha-

    6. KBDr. Keith Baar1:29:45

       Ah, okay. Yeah

    7. TFTim Ferriss1:29:46

       ... and mitochondrial biogenesis, but also things that have come since then.

    8. KBDr. Keith Baar1:29:50

       I think that that's probably a good one because then we can get into the ketogenic diet component as well.

    9. TFTim Ferriss1:29:55

       Great. Let's do it.

    10. KBDr. Keith Baar1:29:57

        But we can address this at the same time as talking about the protein component as well.

    11. TFTim Ferriss1:30:01

        Love this idea.

    12. KBDr. Keith Baar1:30:02

        Because these two things are gonna be related a little bit. 'Cause what we talk about is we talk about the science as... And Stu Phillips has been talking about this for a number of years, and now he's realizing that a lot of that was a bit of a problem with how we were measuring things. So what he was talking about is this intermittent up and down of synthesis and degradation that happens in muscle that's corresponds to feeding. That's really, really effective when we're looking at supplements like whey protein supplementation. It goes in, it goes out, we synthesize new protein and muscle, and it goes away.

    13. TFTim Ferriss1:30:34

        Mm-hmm.

    14. KBDr. Keith Baar1:30:35

        But as people started doing one meal a day, and people started doing other things where they're consuming a huge amount of protein in a small setting, the question became, is that going to really show a big difference if we look at this over time? A lot of Stu's, and to his credit, he says that, "No, that was just an artifact." When we look at it over more time, it doesn't really matter if you're taking every four hours that high protein. Luke Van Loon just had a paper while I was in his lab in Maastricht where basically what he was doing was he called it the barbecue study.

    15. TFTim Ferriss1:31:06

        [laughs]

    16. KBDr. Keith Baar1:31:07

        And it was feed people a hundred grams of steak-

    17. TFTim Ferriss1:31:10

        Mm-hmm

    18. KBDr. Keith Baar1:31:10

        ... and then followed them for twelve hours to see whether they were still absorbing the amino acids and the proteins from that. And all the way out as far as they were able to measure, they were still absorbing the amino acids that were from that original steak. The difference is one was a purified protein, a hydrolysate or a, or easily digestible protein. The other was a large amount of protein that our body's gonna take a much longer time digesting and absorbing.

    19. TFTim Ferriss1:31:36

        Mm-hmm.

    20. KBDr. Keith Baar1:31:36

        So the idea that we used to say, "Every four hours, you need to have .25 grams per kilogram body weight of protein," and that's- That's less the focus now. It's more just saying, "Look, we wanna get in about at least 1.2 grams per kilogram body weight of protein over the day."

    21. TFTim Ferriss1:31:53

        Over the day?

    22. KBDr. Keith Baar1:31:54

        1.6 over the day.

    23. TFTim Ferriss1:31:55

        Let's just do some math on this for a second because a lot of people listening are, are gonna be like, "Kilo-what?"

    24. KBDr. Keith Baar1:32:02

        So that's like saying the 20 grams of protein that's in a bar th- always says, oh, 20 grams of protein. The reason for that is the .25 grams per kilogram body weight and the 75 kilograms of the average American weight. Multiply those together, you get 20.

    25. TFTim Ferriss1:32:17

        Mm.

    26. KBDr. Keith Baar1:32:17

        And so what they were trying to do is get the minimal effective dose of protein-

    27. TFTim Ferriss1:32:22

        Mm-hmm

    28. KBDr. Keith Baar1:32:22

        ... into that one food.

    29. TFTim Ferriss1:32:24

        So 75 kilograms times 2.2 is 165 pounds. That must be [laughs] outside of certain states in the United States.

    30. KBDr. Keith Baar1:32:33

        Yeah.
29. 1:33:47 – 1:35:35

    Ketogenic diet effects on mitochondrial biogenesis and longevity.

    1. KBDr. Keith Baar1:33:47

       diet. So the ketogenic diet, yes, it's been used for a lot of things for time, but that's when we started looking at it because for longevity, a ketogenic diet is functionally doing what low-dose rapamycin does, which is it's gonna slow down mTOR activity, and that's gonna decrease inflammation 'cause we need mTOR for our inflammatory cells. So we did studies in mice where we fed them either a ketogenic diet, and we did this by feeding them exact amounts, one meal a day, and so they were getting time restricted feeding, they were getting slight, 10% fewer calories than they would need, and they were getting either normal chow, a low carbohydrate chow, but still enough carbohydrate that they didn't go ketogenic or a ketogenic diet. And what we found is that the ones on a ketogenic diet lived 13% longer than the ones on the control diet. Our control animals lived longer than anybody else's control animals 'cause my colleague John Ramsey is probably the best in the world at these longevity studies. So they're already living a long time. The increase in lifespan corresponds really well to the rapamycin effects.

    2. TFTim Ferriss1:34:52

       Hmm.

    3. KBDr. Keith Baar1:34:53

       And then there's Longo down at USC.

    4. TFTim Ferriss1:34:55

       Sure.

    5. KBDr. Keith Baar1:34:55

       And what does he say? He says low protein diet. The low protein-

    6. TFTim Ferriss1:34:59

       Mm

    7. KBDr. Keith Baar1:34:59

       ... diet is the other arm of that, 'cause if I need both insulin and amino acids to activate mTOR fully, I can either take away the carbohydrate and get rid of the insulin, or I can take away the protein and get rid of the amino acids.

    8. TFTim Ferriss1:35:12

       Mm-hmm.

    9. KBDr. Keith Baar1:35:12

       And so both of the diets work to increase longevity. One of them is gonna be much harder on your, on your muscle mass, and it's gonna be less applicable to humans, and that's gonna be the low protein diet. But they're both trying to do the same thing at a molecular level, all three of those things, the low-dose rapamycin, the ketogenic diet, and the low protein diets. They're all trying to decrease

30. 1:35:35 – 1:40:56

    Comparison of ketogenic diet, low protein diet, and rapamycin for longevity.

    1. KBDr. Keith Baar1:35:35

       mTOR activity.

    2. TFTim Ferriss1:35:36

       Quick interjecting question. We didn't have time to get into it. Maybe another time we'll get into it, but we talked about the Abrahangs.

    3. KBDr. Keith Baar1:35:42

       Mm-hmm.

    4. TFTim Ferriss1:35:43

       Then we talked about max hangs. We didn't talk about Abrahangs plus max hangs, right? Which seem to have an additive effect. Would you expect that ketogenic diet plus rapamycin would have an additive effect, or are you already checking the box so there's a null effect basically for one of them?

    5. KBDr. Keith Baar1:36:02

       That's one of the things that we're studying right now, to see whether that is gonna have an additive effect, and that both things together are better than one. We know that for the Abrahangs, they're doing two separate things. The same way that mTOR is activated by insulin and amino acids, their... Our muscle strength is our brain's ability to turn on the muscle, the size of the muscle, as we talked about earlier, but also the other component is the force transfer. And so what we do with the Abrahangs is we work the force transfer. What we do with the max hangs is we work our muscle mass and our brain's ability to turn on the muscle. When we do them both together, we get both of the stimuli together, so that's when we have the biggest positive effect. So the same-

    6. TFTim Ferriss1:36:43

       Mm

    7. KBDr. Keith Baar1:36:43

       ... thing could be true for the rapamycin together with the ketogenic diet, but we don't have the data yet.

    8. TFTim Ferriss1:36:49

       Mm.

    9. KBDr. Keith Baar1:36:50

       What we're saying is that one of the best things for muscle as far as the ketogenic diet goes is that, one, you have good amount of protein, so you're maintaining protein, you're maintaining the muscle mass. The second really important thing is because there's no carbohydrate, you have to use mitochondria to produce all your energy, so you produce better quality mitochondria.

    10. TFTim Ferriss1:37:09

        Mm.

    11. KBDr. Keith Baar1:37:09

        And the other thing that happens as we decrease mTOR activity is we activate a process called mitophagy. Mitophagy is when you break down mitochondria, and usually the mitochondria you're breaking down are the ones that aren't working as well.

    12. TFTim Ferriss1:37:22

        The old and the weak, culling the herd.

    13. KBDr. Keith Baar1:37:24

        Exactly. Culling the herd. Now we're gonna keep that herd stronger because we're culling the weak ones, and we're allowing that mitochondrial mass to be maintained. So what we found in the old animals that we had on a ketogenic diet is their strength was actually at the level of a young animal, and their brain function as well.

    14. TFTim Ferriss1:37:42

        Just for people listening, what are functions of mitochondria that people may not be aware of? What do mitochondria do?

    15. KBDr. Keith Baar1:37:51

        The mitochondria, the most obvious thing is they produce most of the ATP for our body, so most of the energy for our body. And so that's where you, you have to have mitochondria to break down fat.

    16. TFTim Ferriss1:38:01

        Mm-hmm.

    17. KBDr. Keith Baar1:38:02

        I don't need mitochondria if I just wanna break down carbohydrate, or I'd use the mitochondria slightly different.

    18. TFTim Ferriss1:38:07

        Mm-hmm.

    19. KBDr. Keith Baar1:38:08

        So it's one of the reasons why people go through the keto flu component when you go onto a ketogenic diet for the first time, because you're going onto a diet that has no carbohydrate. If you've been using carbohydrate as your primary fuel source and you don't have lots of good quality mitochondria, for a few days there you can't produce any energy, and so you feel like you're dragging and you can't move and you can't get out of bed because you're super tired, like you have the flu.

    20. TFTim Ferriss1:38:34

        Mm-hmm.

    21. KBDr. Keith Baar1:38:35

        That then turns around once you get enough mitochondria to start producing more energy to allow you to do your activities of daily living.

    22. TFTim Ferriss1:38:42

        Mm-hmm.

    23. KBDr. Keith Baar1:38:42

        The important thing is, and we've wrote a paper on this, is that if I'm an athlete, ketogenic diet is not for me.

    24. TFTim Ferriss1:38:48

        Yeah.

    25. KBDr. Keith Baar1:38:48

        Because I can't go fast. What I can't do on a ketogenic diet is I can't sprint. And it doesn't matter whether you are a marathoner or an ultra-marathoner, at some point, or maybe it does on an ultra-marathoner, but even a marathoner, at some point you're gonna have to sprint to go at a high quality level. And if anybody out there thinks that they can run the four and a half minute mile per mile pace to run a marathon to be competitive, and you're not using sugar and you're gonna use fat, that's just not really possible. You can't go that fast. And Professor Ron Maughan, who's one of the original sport nutritionists, he went through all the calculations for exactly how you're using carbohydrate to power that whole marathon, and that's also why you need to take in supplemental carbohydrate on your run, because if you don't, you don't have quite enough. You've got enough to get to about 22 miles, and what does everybody experience at 22 miles?

    26. TFTim Ferriss1:39:39

        Hit the wall.

    27. KBDr. Keith Baar1:39:40

        They hit the wall. So the reason that you can continue to the end is because you're taking in the carbohydrate along the way and your body can use that as a fuel.

    28. TFTim Ferriss1:39:47

        Mm.

    29. KBDr. Keith Baar1:39:48

        So again, we don't use a ketogenic diet if we wanna go fast, but if we're training for life, we see that it increases longevity, that the ketones themselves are really good for brain function. The biggest downside to it is your bones. So if you have a history of osteoporosis, on a ketogenic diet bone mass actually becomes really a problem.

    30. TFTim Ferriss1:40:07

        Mm.
31. 1:40:56 – 1:44:49

    Inflammation's role in adaptation and when to reduce it.

    1. KBDr. Keith Baar1:40:56

       on.

    2. TFTim Ferriss1:40:56

       You mentioned decreasing inflammation with the ketogenic diet. A lot of people think inflammation equals bad, let me turn it off. Let me gobble ibuprofen or Aleve while I'm icing everything that hurts. But I don't believe that is your particular recommendation for folks.

    3. KBDr. Keith Baar1:41:14

       Absolutely not.

    4. TFTim Ferriss1:41:16

       When is it right to inhibit inflammation and when is it not?

    5. KBDr. Keith Baar1:41:19

       Inflammation is absolutely essential to adaptation. There's a good study out of my former university, University of Illinois, Chicago, where they actually knocked out the inflammatory cells and they then gave a stimulus for muscle hypertrophy and the animals couldn't hypertrophy their muscles nearly as well. We know that if you take high levels of vitamin C and high levels of vitamin E, you actually decrease aerobic adaptations, because part of the stress is the reactive oxygen. So we know that. We know that if I take ibuprofen and I'm young and I, I've just done a heavy lift, I can decrease some of the adaptations, or if I sit in an ice bath, I can decrease some of the muscle protein synthesis that's gonna lead me to bigger, stronger muscles. What we have to do is we have to find that balance between inflammation and anti-inflammatories. Again, we're gonna go full circle to the start of the podcast and say, "I am not going to use anti-inflammatories that are pharmaceuticals or other things. I am going to use load as an anti-inflammatory." The reason that your muscle feels sore after you've done a heavy lift is because there's inflammation within the tendon. The tendon has a little sensory organ called the Golgi tendon organ. What it does is it senses tension on the tendon. So if I put a whole bunch of water in there or fluid, now there's more pressure and that's telling me that I've got more load on the muscle. I don't have a pain sensor, so I interpret that as pain. So if I do an isometric contraction, what I'm gonna do is I'm gonna squeeze all the water out of it and that's gonna get rid of the in- inflammation. So what I'm gonna do-

    6. TFTim Ferriss1:42:54

       Yeah

    7. KBDr. Keith Baar1:42:54

       ... is I'm gonna do shorter duration isometric holds, like even five second isometric holds are enough to squeeze the water out, and then I'm gonna do that again. Go back five seconds. So I can go right to left, so I'm gonna go five seconds onto my right leg, and then I'm gonna go over and I'm gonna do a side lunge to the left, then I'm gonna do five seconds on the left. What I'm trying to do there is I'm trying to use the loading and the muscle contraction to squeeze out the liquids from the connective tissues from the muscles. So now what I've done is instead of using something that's gonna turn off everything, I'm just adding a little bit of minor load that's not going to cause my legs to get heavy or anything, it's just gonna squeeze out some of the inflammation. And I start this the moment I twist my ankle. I sit there and I'm doing alphabets. So I'm going and doing capital letters where my toes are tracing the alphabet, and all I'm trying to do is I'm trying to make sure that I'm using load through the tendons and the ligaments that have just been sprained by that pull when I've twisted my ankle. And I can do that, and I can twist my ankle really badly, and I've done this where I've had a really bad inversion sprain playing intramurals here with my lab. At 55, that's not the best thing to do. But you do that, and then you're like, "Oh, crap, I sprained my ankle." But now, at least I know I don't ice, rest, and do any of that stuff. What I'm gonna do is I'm gonna do loads where I'm gonna put load through those, those ligaments. I'm gonna pull on them, hold it, release. Pull on them, hold it, release, and that's gonna pump all the liquid out. The next day, you wake up, there's still bruising there, but the l- ankle is the normal size, and I can go out for my run. What it tells us is it tells us that we've gotten into a bit of a habit. We're gonna do pressure ice. There's no harm in it, so let's do it. We're gonna compress. All of it is trying to do something that I can do if I just put load through that system. So I don't use the anti-inflammatories. I use load as an anti-inflammatory.

32. 1:44:49 – 1:46:01

    Timing of ice baths relative to training for optimal recovery.

    1. TFTim Ferriss1:44:50

       Ice bath, just as a fan of ice baths, mostly for mood elevation, kind of Vincent Van Gogh style, when they used to prescribe cold baths for melancholy. How much space would you provide after a workout or training stimulus before doing something like an ice bath?

    2. KBDr. Keith Baar1:45:05

       It's all about optimization, so if you are training for life, and you don't have to be the best you that you can be, then what you wanna do is you can say, "Look, do your ice bath in the morning, lift in the afternoon."

    3. TFTim Ferriss1:45:16

       Mm-hmm.

    4. KBDr. Keith Baar1:45:16

       That overnight, you've got mTOR activation all night long. Now you come out. If you turn off mTOR, no big deal.

    5. TFTim Ferriss1:45:22

       Yep.

    6. KBDr. Keith Baar1:45:22

       That's kind of what we're saying. And then if I do that, and I get out, and I do a warmup, and I go out and do my aerobic or my rhythmic exercise, now I can actually go into that with maybe feeling a little bit like the aches and pains are a little bit gone, and now I can do that aerobic exercise in the morning, and now I've got this split where I'm doing some of my strength when I'm my strongest in the afternoon, and for your supplementation question, right before my biggest protein meal of the day because I'm gonna have most protein at dinner. So now my strength is close to my dinner. I'm gonna then sleep and get all the recovery, and then I can get up, and I can do my endurance in the morning, and that's gonna allow me to actually optimize those combination of strength and

33. 1:46:01 – 1:47:46

    Parting thoughts.

    1. KBDr. Keith Baar1:46:01

       endurance.

    2. TFTim Ferriss1:46:01

       All right. Well, I think that's a beautiful place to wrap up. Keith, you do not disappoint. You're a beast, a gentleman, and a scholar. Thank you for the time. And for people who can't see the video, you have all of the weight training equipment behind you, which I know is your next step.

    3. KBDr. Keith Baar1:46:16

       Yep.

    4. TFTim Ferriss1:46:16

       Where can people learn more about you, learn more about your work, find you online? Where shall people find you if they want to learn more?

    5. KBDr. Keith Baar1:46:25

       I do things like LinkedIn, and I do Bluesky, so on Bluesky, I'm Muscle Science. So if you look for Muscle Science, all one word, you'll find, you'll find me there. And you can keep an eye out for the company that we're developing. It's called Sineux.

    6. TFTim Ferriss1:46:40

       Sineux.

    7. KBDr. Keith Baar1:46:41

       S-I-N-E-W. Sinew, like your tendons and ligaments, and then us, like U-S, so.

    8. TFTim Ferriss1:46:46

       I love it. All right. Keith, thank you so much for the time.

    9. KBDr. Keith Baar1:46:49

       Absolutely.

    10. TFTim Ferriss1:46:50

        I've taken a million notes. I can't wait to go find a tennis racket or a pan or a golf club to do my overcoming isometrics. And for everybody listening, we will link to all sorts of goodies, everything we've mentioned, including where you can find Keith in the show notes at tim.blog/podcast. Just search Keith B-A-A-R. Is there anything else, Keith, that you would like to add before we wind up?

    11. KBDr. Keith Baar1:47:17

        No, so that's great 'cause a lot of people don't understand necessarily the isometrics, what they look like. My medical school just came down and filmed a video of it, and it's up online, so I'll s- send you that for the show notes as well.

    12. TFTim Ferriss1:47:28

        Beautiful. We'll put that in the show notes. And everybody be safe out there, train smart, perhaps incorporate some isometrics. I don't know how you couldn't be tempted after this conversation. And until next time, be just a bit kinder than is necessary to others, also to yourself, and thanks for tuning in

Episode duration: 1:47:57