 Okay, let's start the final session of the staged talks, and we have some really great talks in this session, moving on to movement and more exercise physiology and some interesting things. So, it's my pleasure to introduce to you Dr. Doug McGuff, who has a book called Body by Science, and the title of this talk is Body by Science, a George Jetson workout for Fred Flintstone Metabolism. Thank you. The first thing I'd like to do before we get started at all is I saw Tom Naughton's lecture and it was just awesome. So in honor of that lecture, I want us to do a quick observational study. And what I want you to do is just to kind of, even into the back of the room and everything, is to stand up, take a look around, and look at everyone around you, because until this meeting convenes again, you will probably not be in a room with a collective body composition as good as this one's. Okay? And if you don't believe me about that, when you go home, stand up at the airport gate when you're waiting for your plane and compare the difference between what you see here and what you see there. And I think it is a very good observational argument that the paleo diet in all of its incarnations works. And it's also a good argument that high intensity exercise in all of its incarnations really does work. And the two combined together are very synergistic and very powerful, and that's what I want to provide support to in my talk. I want to give you an intellectual understanding for why you do what you do and why the two things when they're combined are very powerful. Now, for those of you who don't know what my credentials are, I will give them to you. I don't have any. I am a practicing board certified emergency physician. I don't have an academic affiliation. I can't show you a picture of the administrative building at my academic institution. I work at a place called Oconee Medical Center in an emergency department that sees 40,000 patients a year. The county that I work in is the county where the movie Deliverance was filmed, literally. And the little kid that played the banjo at the beginning of the movie, he's now about eight or ten years older than I am, and he is still a cook in the Waffle House. So that is my background. I run a personal training business using high intensity strength training. That opened in 1997. I had finally accumulated enough money to get all the equipment that I ever dreamed of for doing my own workout when me and my wife figured out that it was not going to go up the steps and into the bonus room over our garage. So my personal training business was born and the rest evolved from there. Now to be able to give you an understanding of why the paleo diet works so well and why it marries so well with high intensity exercise of all sorts, I'm going to have to teach you a semester of medical school biochemistry in just a few minutes. And that's a hard thing to do because medical school is probably the most anti-intellectual endeavor one could ever undergo. It's true. The learning is akin to drinking from a fire hose. It's like they say open your mouth and they let you have it. And the problem with that is is you learn to disregard the greater context for everything that you're learning and just try to memorize all the data that they're asking for you so that you'll be able to reproduce it on the test. So when I took med school biochemistry and memorized all the pathways, there was no distinction about linchpin steps and the whole process that really mattered and how it all fit together from an aerial view. So I give you this, med school biochemistry on a cave wall. As you can tell I'm not very facile with computer slide generation so this is a drawing that I made and a similar drawing that I made for myself in med school where I finally was able to understand the issues at hand. So I'm going to kind of show you what the different elements of this are. The thing inside the rectangle is just the cell and the outline of it is the cell wall. Inside the cell we're going to represent the mitochondria and then these other drawings up here represent other tissues in the body. This is my drawing for a muscle. This is my drawing for your liver. This is a drawing for body fat and I'm going to kind of go through the process of cellular metabolism. Glucose is going to enter the cell through an insulin receptor and it goes through a process that occurs within the liquid portion of the cell called glycolysis and that glucose is going to get metabolized through a 20 step process down to a chemical called pyruvate and in the process of that metabolism you are going to throw off some net energy in the form of ATP. And one cycle of that doesn't throw off a whole bunch of energy, it will throw off 4 ATP. But the key is that cycle can move fairly quickly and cycle quite rapidly. So even though the net production per cycle is low, it can haul ass. And that pyruvate is taken into the mitochondria and the mitochondria has an interesting story. From an evolutionary standpoint as animals climbed out of the primordial ooze they were largely glycolytic metabolizers and the end product of their metabolism was pyruvate. Mitochondria, it is theorized, were probably originally proto bacteria that developed a symbiotic relationship with the cell to consume the cell's waste product. So as the cell consumes, I'm sorry, as the cell consumes glucose and converts it to pyruvate, that pyruvate can get shuttled across the mitochondria and acted on by pyruvate dehydrogenase and then it goes through this process where it is metabolized to acetylcholacetrate, alpha ketoglutarate and generates through and through the respiratory cycle the byproducts produce a total of 38 ATP, a lot more energy per cycle within the mitochondria. And that's how energy moves through the cell in a normal condition. Now if the animal that is in possession of the cell becomes replete with energy, if they become very well fed then what's going to happen is, I think I need to take this off and hold it, what's going to happen is as this moves down and pyruvate gets converted to citrate, citrate will start to stack up within the mitochondria, what happens is that diffuses back out, is carried back out of the mitochondria and it acts on a critical enzyme up here, I put it in a little rectangle, critical enzyme in the process of glycolysis, phosphofructokinase gets allosterically inhibited and what that means is when citrate binds to it, it changes it's three dimensional shape so it no longer fits lock and key with it's substrate glucose 1,6 diphosphate, well big hairy deal, what that means is when it changes it's shape it becomes no longer functional but the good news is in a high energy state all of these enzymatic reactions are bi-directional so now you have energy input into the system comes through the insulin receptor but it gets blocked in a high energy state, it can go no further, well no problem so our adaptation is what we do is we go backwards up and back out and it's acted on by glycogen synthase and we take this excess glucose and we store it for future use and this is a big part of our big brain gamble as a species is our ability to store glucose for future use, now you can store average adult about 70 grams of glycogen in your liver and maybe 250 in your skeletal muscle, the glycogen in these two different places is for very different purposes though, the glycogen that is stored in your liver is largely for a moment to moment blood sugar control, your brain very much likes to see a stable blood glucose between 60 and 100 milligrams per deciliter of glucose to operate efficiently and the glycogen that is stored in there is tapped for that purpose, now the glycogen that is stored in muscle is for a very different purpose it is there for emergency usage on site, if you get in a flight or fight response scenario what is going to happen is the glycogen there can be broken down for usage on site in the muscle in question so it has a very different purpose and we will come back to that in a little bit but in our typical western diet we are getting a lot more glucose, a lot more refined carbohydrate than we have compared to an evolutionary perspective and if we took everyone in this room and we released us out into the wilderness and we said go hunt and gather, what we would find is that what you brought back for us to take an accounting of the macronutrient group that would be most difficult to find and the least amount brought back in terms of caloric amount would be carbohydrate and anyone that has been out taking survival training in the military or been out in a hunting situation or a survival situation will realize that fairly quickly that there is a lot more pharma to support your survival than there is flora, well it should then make sense that the signal to store energy should be predicated upon that which is least abundant in a hunter gather environment so when you have an abundance of that which is least abundant in the environment and the signal is going to become energy storage well that situation in the standard American diet in the western diet in modern times is put on steroids if we think about the amount of glucose that we can store in those two places it's not a lot now athletes can be trained to store much more glycogen than that but not a whole lot more glycogen storage diseases can result in a lot more liver glycogen being built up athletic conditioning can get you a little bit more glycogen within your muscle that's all true but what remains true is that no matter how close you are to these numbers any one of us could get up right now walk down one flight of stairs and within 10 to 15 minutes could have consumed enough to completely fill these stores and overwhelm the system well the system for storing this for future usage is for two purposes one is our big brain and the gamble that we need continuous energy supply for that brain whether it be in the form of glucose or ketones the other is we need a way to protect the cell from excess glucose deposition within the cell so we don't drive the end products of glycation that have been talked about we don't want to pour pancake syrup into the keyboard that's running this so part of that protective mechanism is to do something else with it and that's what's happening in the metabolic syndrome we have a situation where we are energy replete so this process gets stopped here we go back and store glycogen until we're full but if this keeps coming then we have only one response and that is to store it as fat for future energy usage so what happens is you get stuck at this level and the complicated story is that the this gets diverted glucose one six five phosphate gets diverted through a pathway called the pentose phosphate pathway that produces a high energy molecule and the citrate that built up gets converted to acetyl coa carboxylase acts upon it and goes through a series of reactions that forms palmitate this series of reactions the energy drives the formation of fructose one six phosphate to glycerol three phosphate link them together you got triglycerides it's stored as fat but what you need to know from much simpler terms is when energy stores are high and you can't go this way your glycogen stores are full and you can't go this way the only way you can go is here and that's where we are with the metabolic syndrome when you have the metabolic syndrome and this is stacking up on the bloodstream the response is to make more and more insulin but the protective reflex to that is to decrease the number of insulin receptors and their sensitivity so you have a situation where all energy input is being shunted towards fat storage but you also have the situation where someone that is now developing morbid obesity and the metabolic syndrome has energy trapping because their insulin levels are chronically high well how do you get stored energy out of the fat cell well it has to be acted upon by hormone sensitive lipase and the hormone that hormone sensitive lipase is sensitive to or one of them is adrenaline but it's also sensitive to insulin and if insulin levels are high you cannot cleave fat out of the fat cell for energy so you have a situation where as soon as their energy levels start to wane the morbidly obese have to eat again to get a feeling of wellness but then that gets shunted straight towards fat storage so if we follow under normal conditions glucose gets metabolized all the way through generating a total of 38 ATP once energy levels get high enough and your energy replete the citrate diffuses out inhibits this blocks you from going here you then store glycogen till that's full when you can't go this way you can't go this way it all goes towards fat now with that understanding we can now have an understanding of why paleo diet works and why high intensity exercise works and I want to discuss the contribution of high intensity exercise and this supports why we do sprints why we do sprint intervals why we do crossfit why we do high intensity strength training I want to support all those notions of exercise because what happens is it's triggering a primitive survival response and if you think about this this is truly a metabolic miracle it's a metabolic turn on a dime because if you think about when an animal is going to most need to invoke the fight or flight response it's going to be when if you watch the animal planet you will see most animals get attacked when they got their head down eating or drinking so here you have an animal that's in the midst of doing this but they metabolically are going to be able to turn on a dime and suddenly go from energy storage mode instantaneously to rapid energy utilization mode and that really is a metabolic miracle and the way that it happens is through what's called an amplification cascade and this is why high intensity exercise is so powerful is that what happens is that when you start to break down glycogen under this stress circumstance or under high intensity exercise you don't just do it on an enzymatic molecule by molecule basis you do it via an amplification cascade so if we call this glycogen phosphorylase we can say it's A, B and C it's a cascade A will just for sake of example actually activate 10,000 units of glycogen phosphorylase B each one of glycogen phosphorylase B will therefore activate 10,000 of glycogen phosphorylase C so you get a huge amplification and movement of glucose out of the skeletal muscle and out of the liver as well and that sets into motion a process where the entire metabolic syndrome can start to reverse because you're emptying out these glycogen stores so thoroughly they do have to be repleted and that's repleted by bringing up the number of insulin receptors and their sensitivity so that glucose can be utilized and so that it can be put back into the cell for storage. Now the important thing is the bulk of this metabolic shift is occurring onsite in the particular muscle that's working at that time and that this glycogen breakdown in the muscle is occurring via this amplification cascade therefore to occur optimally in an exercise regimen that you're constructing the muscle in question or the muscles in question must be directly in the line of fire. There are a lot of exercise modalities that you could undertake that are doing multiple different muscle groups at one time but you're kind of alternating between one and the other in the particular movement pattern that you're doing where optimally if you were really going to tap out that amplification cascade as much as you could you would want to have targeted work that's intense, unrelenting and is a well matched opponent meaning that it has to be attacking the targeted muscle groups in a continuous and uninterrupted fashion. To borrow words that Arthur Devaney likes to use and Nasim Talib likes to use the event must be extremal and far from equilibrium and anyone that's experienced this exercise whether it be CrossFit or high intensity strength training can attest that it is extreme and it is very far from equilibrium. It is a rare event. Done well it results in something called inroad and the way we define inroad is a momentary weakening of the muscle. So as you're doing very hard work with a muscle that's under continuous load you're recruiting motor units out of the muscle, little segments of the muscle are recruited in a particular order based on demand. You first recruit the slower twitch motor units that fatigue slowly and recover quickly. If the work's demanding enough you'll next bring in the intermediate motor units that fatigue and recover intermediate and if you've fatigued both of those rapidly enough then you will bring on board your fastest twitch motor units which fatigue quickly and recover slowly. The consequence of doing that is if this is your strength level and this is the weight that I've selected for you as you fatigue the window between the two starts to close. As it starts to close you feel extreme discomfort and panic. As they become equal to each other you can no longer move because if you had 500 pounds of strength and 350 pounds pinned on the movement you were doing say a leg press as you fatigue that window starts to close and when your strength level is 350 pounds and the weight 350 pounds movement stops. If you continue to attempt to produce movement you will get even weaker and the weight will overtake you and will actually drive you through the negative portion of the movement until you're completely fatigued. Well that loss of movement in my opinion is also a very preserved biologic function. If you think about it without movement you can't get food you can't keep from becoming food. So it serves as a very powerful stimulus for we need more of this muscle. Once again I just want to re-emphasize that the extreme old component you really want to place the muscle that you are working on in the crosshairs of a continuous load as opposed to just high intensity exercise that is for lack of a better word more focused on being a paleo reenactment or a functional movement. We got to think about really putting the muscles in the line of fire. Now in the wild in these fight or flight situations this accident this amplification cascade I'm sorry this amplification cascade we're trying to get at actually occurs by accident. You're attacked by a predator and you have to run or fight for your life or you're battling with a well matched opponent. A really high intensity exercise regimen if anyone's ever been in a wrestling match and experience the degree of fatigue that occurs with that that is probably the closest spontaneous thing that you will feel that is similar to what going through high intensity exercise is like. Then there's throwing rocks dragging a log pushing a sled a lot of the different crossfit incarnations are of this variety. If you experience this sort of indirect method of getting at this biochemical process that I've been describing for you what you'll see is that the systemic effect the metabolic effect you feel the met con if you will seems to be greater than the local effect. The loading will tend to be discontinuous. The goal is more extrinsic more reaching a certain number of complex movements 21 thrusters however you can get them. Well a lot of times you'll do seven or eight of them and then you pause and rest and you kind of let everything reboot and then you get four more and then you get three more until you've accumulated 21. So the loading is discontinuous. The other problem is that under these scenarios the forces tend to be high and carry some risk of injury and as a result you end up doing something that has been termed off-roading. Meaning you're doing lots of metabolic work without necessarily producing the in-line stimulus of glycogen emptying and localized muscle fatigue. The other thing is as the work gets harder the risk increases it becomes more dangerous. So the problem is is you're combining a very skill-based movement and you're carrying it to fatigue and as you fatigue your risk of having an accident and injuring yourself increases. What I try to do in my protocol is select a handful of compound weightlifting movements that are extraordinarily easy to carry out. I want to select movements that a patient or client that had cerebral palsy could perform in a good fashion and the reason is two-fold. One is for safety and two is I don't want the complexity of the movement to so overwhelm their psyche that they cannot focus on doing very severe hard work because that is where the good stuff is, the severity or the intensity of the work. So as you fatigue the risk of injury increases with fatigue and as a representation of that I got to say that I think a lot of people think that I have an ax to grind or I'm hostile to CrossFit and I am not. I love CrossFit. I love their sense of life. I visit their website every day. I watch a video before I do any of my own workouts because it's so inspiring. As a physician the place that I run, I try to keep my medical world separate from the workout world for medical legal risk reasons. As a physician I probably could not own a CrossFit box because if anyone got hurt they'd bury me under the courthouse in terms of medical legal risk. But one of the points I want to make is that this isn't just a concern that I have that's theoretical. If you visit the CrossFit forums and you go to their board you will find under the category of injury there are over 3,800 posts with over 28,000 comments. And if I just look at today's on my iPhone we have my rotator cuff injury, tenderness in lower back, leg numbness, dull left shoulder pain, my slap journey. That's just torn labrum in the shoulder joint. My supraspinatus infraspinatus drain, torn rotator cuff, possible labrum. My shoulder MRI results, training with a broken ankle. Any one ever ruptured rotator cuff overhead squats cause my arm to become numb. And it's on and on and on. But my point is that a lot of what's done there is skill based and is also movements that are functional and are paleo but are not congruent with our biomechanics. And a lot of the movements really particularly for the shoulder joint set you up to have impingement and injury. Now the characteristics of body by science or a high intensity strength training that focuses on very basic movements with a continuous load done at a slow pace and generally what I recommend to people regardless of the equipment you're using is to lift and lower the weight as slowly as you can without it deteriorating into stops and starts. And depending on the quality of your equipment it may be different. If you have the very best stuff that's made it can be 10 seconds up, 10 seconds down. If you're in a commercial gym and the strength curves and friction issues are not as ideal as they could be it may be 4 seconds up, 4 seconds down. But whatever it is as slowly and smoothly as you can so that you're under continuous load. In addition to continuous load that slow movement controls acceleration. Force is mass times acceleration. When things become ballistic force goes up greatly and your chances of injuring yourself go up significantly as well. That continuous loading we never let someone on any movement get in a position where they're resting on a bone on bone tower where the muscle can unload. We have them in a position where the weight is always loading the muscle and that causes inroding which is that rapid, deep paralytic fatigue. And the interesting thing is is done with this sort of protocol. As you get weaker you actually have less risk of injuring yourself. Reason being is because you're moving slowly and you're becoming more fatigue. The workout actually your risk for getting injured with any modality of exercise is always the greatest when you're fresh because you're the strongest and you have the most force producing capabilities. So a lot of times it'll be your first yank out of a deadlift or a snatch not the one towards the end where people get hurt is when the fatigue adds up and you start getting sloppy. But under this scenario you're literally getting too weak to injure yourself as you reach this deep level of fatigue. So what I like to think of doing with my clients is to get them in condition where they can then with greater protection go out and pursue the skills of functional activity. Separate the conditioning from the functional training so that they go into it. Now in the past the paleo skills and the paleo conditioning were inseparable and dangerous. You're only encountering them if you were running for food trying to keep from becoming food or fighting someone or trying to defend yourself. And the conditioning was coincidental to the skill. The two ran in tandem and the conditioning was just along for the ride. The other thing is that whatever the activity was the adaptation was very specific to that activity. And that's the thing that's neat about muscle is because with muscle whatever our training incarnation is we can all be right. Because muscle is probably some of has the best plasticity of any tissue in the body. It will adapt to whatever you throw at it. And from my standpoint I don't care what it is you favor or do I think the important thing is that you're throwing something at the muscle that demands an adaptation because an adaptation is where this stuff is. But the paleo skill and the conditioning the adaptation is very specific to that particular thing. If you're going to be doing snatches your skill conditioning will be very specific to snatches. And it won't necessarily transfer to thrusters or slam dunking a basketball. In fact it won't. Not directly anyway. So now under a more slow cadence controlled high intensity strength training approach we can keep skills and conditioning separate and safe. The conditioning is done deliberately. We're deliberately placing the muscle. We're not trying to show off or show performance. We're not extrinsically oriented. We're not trying to get 21 thrusters followed by 15 or something else in a 500 meter row. We're not doing something that is quantitative. We're trying to produce something that is intrinsic and qualitative. We're trying to put the muscle under continuous load and we're not necessarily trying to show better performance. We're trying to produce the most rapid and deepest level of fatigue in the shortest amount of time that we can. Both for efficiency sake and for the best bang for the buck. Under this scenario you can have the protective effect of the conditioning before you take on the learning of the skill. And this came home to me because I used to be one of the old school hit guys who was like you work out infrequently, you do nothing else in between and if you do you're going to compromise your results. And that failed miserably in my own facility. And what I started to realize is that when you give people this kind of conditioning you're giving them a Ferrari and I'm trying to tell them you can only drive in a school zone. What I have found is that the type of conditioning that high intensity exercise of any form seems to do is to wake up the active genotype, to trigger non-exercise activity thermogenesis. If you look in all these lectures and you look at the people that stand at the back of the room and pace and fidget and can't hold still it's all the crossfit guys and all the high intensity strength training guys. And it's because I think it really does express an active genotype that makes it hard to hold still. But I also now encourage my clients when they want to train more frequently I tell them to go out and find a sport. If they want to take up crossfit or do whatever please do so. Whatever your sport is weigh the risks and benefits. I was a professional BMX racer that's what got me into strength training in the first place. I have a BMX track built on the lot next door to my house disguised as landscaping and that's my thing. But it has its risks. I broke my ankle and I broke my foot and it sucks to be in a walking casper for eight weeks while you're working in the ER. But you can have the protective effect of the conditioning before you take on the skill. And if that skill is Olympic lifting you'll be better suited to do it without injury. So now you can truly focus on the skill without having to have the burden of bundling the conditioning in the skill conditioning in with it. And also without the risk of having fatigue compromise your skill conditioning. If you're going to learn a skill the accumulation of fatigue will harm the acquisition of that skill. So now you have the protection from injury but also you can practice the skill without having to worry about wrapping your conditioning into it so you can acquire it with more efficiency. So the message that I've tried to get across in my book and in my blog is a deliberate placement of the stressor in line because the metabolic effect we're looking for is something that occurs local and onsite in the muscle. Continuous loading which produces an extremal event that is a well matched and relentless opponent. The most intense type of high intensity strength training you can do involves no weights and no weight stack. The most intensive exercise that's ever been devised that produces the deepest level of fatigue is something called infometrics. And it's basically a machine that pits one limb against the other. So if you're doing a bench press one arm is doing up providing the resistance for the other arm going down and as you fatigue you match your capability one to one no matter what. The next thing is that the local effect that we're looking for is what produces the systemic effect and the systemic effect is extreme. The degree of Metcon you feel from doing five sets in this fashion will equal or exceed the degree of Metcon that you experience in doing fight gone bad or something of that nature. The focus is on in-road, on focused fatiguing of the targeted muscle and there's very little off-roading which is just producing a lot of metabolic work but because you're alternating between muscle groups you're sort of like that lizard in the desert that stands on two feet there's always a muscle group that's getting a respite. So you're doing a lot of work but not producing a lot of in-road and that produces off-road and it gets safer as you fatigue and you can condition before you learn your skill. But in the end what I really want to take from you is to not sell you on my version of exercise. What I want to sell you on is that the paleo diet is good. As an exercise geek I was not very into the dietary aspect of things until about 1998. I was asked to write an article for the Atlanta Journal of Medicine on my version of exercise and when they sent the journal to me saying here's what you wrote I happen to be on an opposing page of an article written by another author, Boyd Eaton. So that was my first introduction to the paleo diet and I had good success on my clients but I never did have really impressive success until we started instructing them in an ancestral or paleo type diet. And that made it perfectly clear to me that no matter what your incarnation of exercise is you cannot exercise your way out of a bad diet. No matter what the version of exercise is. Now it will allow you to stave off the wheels falling off as it were for a little bit longer. If we think of the whole metabolic syndrome as a tub overflowing you can think of the paleo diet as turning off the spigot and you can think of proper exercises pulling the drain plug. Well proper exercise of pulling the drain plug without turning off the spigot if you're already overflowing is not going to make much of an impact. But if you do both the amplified effect of the two together is so great as to almost not be believed. And that's the message that I want to give everyone is that whatever your version of high intensity exercise is that you prefer please do it. And if there are risks involved take them into account and still do it because the benefits regardless of the risks whether it's my program or anyone else are so great that it's worth it. And for people that are starting out in the process of a paleo diet I can only say that incorporating high intensity exercise with that is not something that you should be afraid of because it will really kick start the process for anyone that's wanting to take on a paleo diet. By virtue of the emptying out of those glycogen stores you really do make a difference in that regard. At this point I'm done. So you guys have any questions? I'll be happy to entertain them. Hello Dr. McGuff. I've had people who insist that the whole low carb way of doing things is wrong. The reason they give me is could you put up that graphic you had of your hand drawn graphic there? My biochem on a cave wall. Yeah biochem on a napkin there. I'm trying but I'm not getting it to respond. Oh I'm going the wrong direction. There we go. What they tell me is they insist that de novo lipogenesis is very difficult in the human body so when you sketch it out here the glycogen stores are already full we're putting more glucose into the system. My thought was it has to go somewhere. Your blood sugar is going to go toxic. So to me turning it into fat is the logical place where it would go. They insist that some people insist that de novo lipogenesis is very difficult for the body to do. It doesn't happen. Does it happen and if so how do we know that it happens? I guess the best answer is that we probably ought to walk and find Dr. Lustig and ask him but here's my opinion and this is just my opinion. My opinion is that their argument is probably true under normal physiologic circumstances but what we're dealing with in the standard western diet is very far from normal physiologic circumstances and I believe that's why we're seeing what we're seeing but if we try to apply biochemical knowledge from what should be normal circumstances to what are very abnormal circumstances I think that's probably where the argument falls down. But I would refer to people with fancier slides than me for that answer. Thank you. When your muscle reaches the paralytic condition as you call it, is the glucose completely out of the muscle then? No, that's not known and I don't know if the glycogen store is ever completely empty but I think it's safe to say that if you go to the point where you can no longer move the given load, you've reached muscular failure and you're pushing as hard as you can I think it's safe to say that you have done all that you can do and I think it's the most rapid and effective and efficient way to get at it while consuming the least recovery sources possible and exposing yourself to the least risk of injury. So your goal of this weight lifting basically is to drain one of the goals is to drain your glucose stores as well as build muscle, right? Correct. For two reasons. One is to aggressively empty the glucose stores and restore insulin sensitivity. The other is to aggressively recruit and fatigue muscle to stimulate a muscle growth process and a shift towards more fast twitch glycolytic metabolic profile. As you grow more muscle what you're doing is you're increasing the size of the largest glucose depository in your body and that has a very protective effect in terms of the metabolic syndrome itself. Hi. How important is continuous load in the context of training to failure? For example, are there studies showing that doing barbell curls is superior to doing alternating dumbbell curls which is in turn superior to doing a rest pause version of either? As to how important? Yes. Probably not real important. I think the real issue is that the intensity reaches a level that's high enough where you ultimately do reach muscular failure. There is some theoretical thought that having periods of rest but a rest pause may allow an even deeper level of fatigue. Right. So possibly a gain offset by a loss. Correct. What's offsetting for a significant portion of the population is that in order to do that you're going to be increasing your mechanical workload and that also increases your metabolic workload which is a good thing but that creates a level of work that for a significant number of the population might result in difficulties with recuperation from one bout to the next. Thank you. Hey Rob. Doc. Amazing talk. The science was great but really the pertinent question here, what's your friend time? The answer is I don't know. But I do play around with that stuff. I have a concept to row in my garage and I do partake of those sort of protocols and enjoy them immensely. I do love CrossFit. I love their sense of life and I love the Metcon aspect of it in particular. I love to lay on the floor gasping. It's just part of me. It's what I do. Well I don't know what a friend is. The only thing I know is that my daughter's name is Helen and that's not the one that I always hear on Rob's podcast I imagine. Well let's give another round of applause for Dr. Doug McGuff. Thank you.