#196 - AMA #32： Exercise, squats, deadlifts, BFR, and TRT
Episode Stats
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Summary
In this episode of the Ask Me Anything podcast, I am joined by Nick Stenson, who has been working with me for over 10 years. We discuss a variety of topics, including blood flow restriction, testosterone replacement therapy for women, and exercise programming.
Transcript
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Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
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I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can
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access the AMA episodes in full, along with a ton of other membership benefits we've created,
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or you can learn more now by going to peteratiyahmd.com forward slash subscribe.
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So without further delay, here's today's sneak peek of the ask me anything episode.
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Hey everyone, welcome to ask me anything episode number 32. I am joined today for the very first
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time on this podcast by Nick Stenson, who you'll get to know during this episode, but basically
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Nick has been working with me, well, off and on for 10 years, but he's been working with me
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specifically around the podcast since we decided to do this, which is God, we're coming up on four
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years ago. It was in the spring of 2018, I think when we made that decision and Nick is going to
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be taken over for Bob on the AMA. It's a totally different vibe, but we had a field day. I felt
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this was probably a little bit more conversational and the hope is that because Nick is quote unquote
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a lay person and doesn't have the technical background that Bob does, that maybe he'll be
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interrupting me more and asking more questions and maybe that will provide a more valuable experience.
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So in today's episode, we talk about a bunch of things. We started off by doing some follow-up
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questions on blood flow restriction, which we had some great questions following the
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podcast with Jeremy Lineke. I think we go from that then into talking about some of my favorite
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lifts. So squats, deadlifts and hip thrusters though, not through the lens of blood flow restriction,
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but just more broadly talking about the importance of those lifts, how they fit into the overall
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ballpark of a centenarian Olympic training program. And after a pretty deep dive on all things
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related to lifting, we get into testosterone replacement therapy, both for men and women.
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So we double click on some of the things we discussed in the previous AMA on testosterone
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replacement therapy, specifically around the risks of cardiovascular disease. But also we do a little
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bit more of a clinical discussion around how we actually replace testosterone, what our targets
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of therapy are, what are some of the do's and don'ts. And then we actually get into some
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questions about females and testosterone replacement therapy. This is an area for which we have far less
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data. So there's a little bit more speculation, but we also talk about that. If you are a subscriber
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and you want to watch the full video of this podcast, which again, I generally recommend you do
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because we go through a number of figures here. You can find it on the show notes page. And if you're
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not a subscriber, well, I hope you become one, but you can certainly watch the sneak peek of this video
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on our YouTube channel. So without further delay, I hope you enjoy AMA number 32.
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All right, well, here we go. Another AMA. Of course, I'm joined with a new co-host for this episode,
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Nick Stenson. And Nick, we'll save the intros till the end, but you ready to jump into this?
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Yeah, let's do it. We compiled some good questions here. I think it should be a fun one.
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Yeah, you showed me the list that you were working on and it's got me a little overwhelmed. If we can get
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through it, I'll be super impressed, but you've, you've got a good, great question. So just tell
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me where you want to start. So we got a lot of good questions following the Jeremy Lineke and some
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of the exercise podcasts. So I thought we'd kind of start there and there's some blood flow restriction
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questions, but I thought it might be helpful for people before we get into some of those specifics.
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Just what is your current exercise routine look like each week? I know it's always changing,
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but if you can give people a rough overview, I think that will be helpful as we get into some
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of these other questions. Yeah. I mean, the actual macro structure of what I do has not changed much
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in the last year. The micro structure has changed a lot, meaning the exercises have changed a lot,
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but the macro structure is that on, let's see, Tuesday, Thursday, Saturday, Sunday are cardio days.
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So Tuesday, Thursday, Sunday are zone two. Saturday is either a zone two followed by a zone five as
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kind of a separate workout. So each of those are 45 minutes zone twos, and then kind of like a 30
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minute zone five as a separate workout that's done almost immediately after. So basically getting out
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of bike clothes and putting on stair climbing clothes. Alternatively, I might just do a longer
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bike ride on Saturday and make it more of an anaerobic workout. Uh, then from a lifting standpoint,
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it's Monday, Wednesday, Friday, Sunday is lifting. And about, I don't know, nine months ago, I switched
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to an upper body, lower body split. I used to lift three days a week and do upper body, lower body every
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day. So each day I was doing kind of pushing, pulling and hip hinging. And now the lower body component,
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I think is Monday, Friday, the upper body is Wednesday, Sunday. And I always lift after doing
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cardio because I think the reverse has been demonstrated to erode strength training gains.
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Peter, what happens if you miss a day? Cause I noticed you didn't say day one, day two, day three,
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you were very distinct on the days of the week. I know you typically don't miss a day, but if you
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miss Wednesday, do you just scrap those exercises and then just continue with your program? Or are you
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trying to make up in the interim? No, like yesterday, Sunday would have been a ride followed
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by lift day, but I was on the track the whole day and I knew, you know, I knew that in advance.
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So I just ended up doing that lift on Saturday, but obviously was shortchanged on the zone two for
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yesterday. So I will pretty much will never compromise a lift. I will always get those four
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lifts in during the week, no matter what. And sometimes it just means moving the days around or
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doubling up on a different day. And what about timing? Do you have a preference morning,
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afternoon, evening? Is that flexible as well within kind of your schedule?
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A little more flexible on weekends, but Monday through Friday and pretty much no flexibility.
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Those lifts have to be done first thing in the morning and not first thing in the morning. So
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morning routine is kind of more about the kids and stuff like that. But once they're out the door to
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school, it's around seven 15, seven 30. That's when I'll typically lift.
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Got it. I know from the Jeremy Lineke podcast, you were talking about how you were starting to
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incorporate blood flow restriction. So I think one of the main questions we saw from subscribers
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after that was, how are you utilizing that into your exercise program? Is that something you do
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every day? Is it days like you mentioned where you were just not really feeling it and it was injury
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prevention, or if you had an injury, you were trying to recover. How do you utilize that throughout the
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week? So I have really enjoyed blood flow restriction, especially since I got new cuffs.
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So when I started, I was doing it purely ghetto style and I still, I enjoyed it, but I wasn't even
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coming close to tapping into sort of what the potential of that was for the last, oh God,
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probably three months. I've been using the brand is actually called smart cuff and it's a night and
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day difference. So they're kind of absurdly expensive. I don't remember how much they cost. I want to say
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like $600 for the four cuffs, two upper body, two lower body, plus the device, which is what really
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makes it so essential. Meaning the device that is measuring occlusive pressure and pumping each time,
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but it makes such a difference that in my mind, it's just totally worth it. I do plan to try a couple
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of other devices out. There's even more extreme versions of this that apparently have better features
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like the katsu one, but my guess is there will be no bigger jump than the one I took from going from
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basically $20 junkie bands to, to these ones. And so I do BFR every day that I lift and I just do at
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the end of the workout, I'll typically do one to two exercises depending on the muscle. So today,
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for example, at the end of a leg session, I did a BFR leg press set at the end of an upper body session.
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I'll probably do a bicep set and a tricep set. And I'm always doing it in the way that we discussed
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on that podcast, but just for folks to remember, it's 30 reps, rest 30 seconds, 15 reps, rest 30
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seconds, 15 reps, rest 30 seconds, 15 reps. That is the standard prescribed procedure for BFR.
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You're doing this at a weight that is 30 to 40% of your one rep max. So the easiest way to calculate
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that is to take the weight that you can barely get 10 reps with. So what is your best 10 rep weight?
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Divide that by 0.75. So your best 10 rep weight is about 75% of your one rep max. And then you
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multiply the resulting figure by somewhere between 0.3 and 0.4, depending on how strong you are. So
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use an example, if your best 10 rep of curls is 40 pounds, you would divide 40 by 0.75, which what is
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that? That takes you up to 57 or something, I'm guessing. And then you would multiply that by
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somewhere between 0.3 to 0.4. I typically tend to go closer to 0.4. That becomes the weight that you'll
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use for the BFR. With these smart cuffs, you have a whole additional variable, which is it comes at
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three different pressures. So it calculates the pressure. And again, just for the refresher for
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folks, the purpose of blood flow restriction is to operate at about 30% of the occlusive pressure,
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the arterial occlusive pressure, which when you're using kind of crap, you know, just bands,
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you don't really have a sense of what your occlusive pressure is unless you're applying a Doppler signal to
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your distal extremities, which is very cumbersome. Instead, when you use these cuffs that come with an
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inflation device, they're actually measuring the occlusive pressure. So the first time you do it,
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it takes a little longer. And then it says, okay, now I know what it is for your arms and your legs.
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Do you want to go at the highest level of intensity, medium level intensity, or a lower level of
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intensity, which basically just adjusts the pressure. And you mentioned a Doppler signal for
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your other bands. Can you just remind people what that is in case they're using this with cuffs that
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don't have kind of what yours have? Yeah. The Doppler device, you'd have to buy one. And that's
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the reason I think like, if you're going to go to the trouble to buy a Doppler device, you might as
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well buy a smart cuff or something similar, but it's basically a medical device that we used to use in
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the hospital all the time when you can't feel a pulse. Like if you put your hand on your radial
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artery here, you can feel the pulse, hopefully if you're healthy. But in people who have peripheral
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vascular disease, you can't because their pulse is too weak. So the Doppler is basically,
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it looks like a little pen. You put it there with a little bit of jelly. So it has better sound
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conduction and it's basically sending a sound signal to the artery and it's recording that sound. So
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when there's complete occlusion, you'll hear nothing. And if there's only partial occlusion,
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you'll hear like a woo, woo, woo. And it's sort of picking up that, that sound. So what you would
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basically do is use this device to figure out how tight to go. But of course, then you're like trying to
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figure out like how tight to make the band to get to that occlusive pressure. And then how do you even
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know how to back off it? So you'd have to use a cuff that at least allows you to know how many
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millimeters of mercury you're putting in to figure out what complete occlusion is and then backing it
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down. In my opinion, it's just not worth doing that. No, that makes sense. One of the things I was
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surprised by, cause I was in your gym the other day and was just the difference between the two cuffs.
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And I think because of that, I asked you to pull them out just so you can show people,
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do you have them quick? Yeah. Yeah. So these are kind of what my cheap $20 cuffs were that I used
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for many months. You have two of these and you would kind of wrap them around your arm and your
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leg. And you sort of look like a bit of a heroin addict cause you're sort of like trying to squeeze
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this thing. Again, I would just York on them really hard until I would, my guide was once it hits seven
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out of 10 pain, that was probably the right spot. But I find that's very inaccurate. The current cuffs,
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this is the arm cuff. So it's obviously a much more rigorous cuff and you apply this, slap it on.
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Then a little device hooks onto here that hooks up to a little pump. That's where I program this thing
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and that will achieve the occlusive pressure. The other thing I really appreciate now is like,
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look at how thick this thing is just for the arm, right? Look at the leg one, like totally
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different, right? Yeah. Cause I could never get, I was never really doing BFR for my legs when I had
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that little blue thing. Whereas with this thing, wow, you get it, you get, you really are getting
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the true occlusive effect. And what are you using to measure the difference there? Or how do you know,
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like it's working? How can you tell us it just feel? Subjectively. Yeah. It's not hurting where
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the band is compressing me. I'm feeling that sensation of basically lactic acidosis throughout
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the entire leg, as opposed to just the pain of being constricted where the band is when it's a
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thin band. It's interesting to note the pressure of occlusion is much higher than systolic pressure
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because it's a function of how wide the band is. So I noticed today when I did my legs,
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the occlusive pressure was 158 millimeters of mercury. Well, that's way above my systolic
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pressure. My systolic blood pressure is very low. I tend to run super low in blood pressure as
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evidenced by the fact that I face planted in Brazil last month. And my upper body occlusive
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pressure with those cuffs is about 58 millimeters of mercury. So you have one that's like, or sorry,
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94 millimeters of mercury tends to be a approximate occlusive on upper body, 154 or something, 158 on
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the lower body. But again, it's also a function of the width of the cuff. So that's why I realized
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just knowing your blood pressure isn't enough to do this. Yeah. And you mentioned you always do it at
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the end of the workout. I assume that's purposeful. Have you ever played around with like prior to your
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actual workout and maybe others could speak to it for me personally? I just think when I'm
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doing my heaviest, most neurologically demanding component of exercise, I want to be a little
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fresher and I don't want to be as taxed. Whereas I kind of like using this as sort of a finisher
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or near the end. Sometimes I'll do, I'll still do something after this, but you know, like I'll do a
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dead hang is usually the very, very last thing I'll do. So I'll kind of mix it up a bit.
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You'll never do a dead hang with a BFR cuff on. I tried. It didn't, it didn't matter. It didn't,
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it didn't impair the ability to do it at all. Cause the dead hang is really about grip and that didn't
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seem to be impaired by the upper body BFR, but I have tried it once. What's your record for dead
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hang these days? Like a little over three, three 10. Jeez. But that's at the end of a workout. And I
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think, you know, if you do these fresh, I think you can go a little more. Yeah. Do you have a goal
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set in mind that you want to hit? I was super happy to get over three. I mean, most days when
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I do it, I just want to go to two, two 30 and not go to failure and just kind of build strength
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without failing every time. Lately, I've been doing a lot of finger pull-ups. I think I showed
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you that device. Yeah. Yeah. That thing is painful, super painful. Gives you a new respect for those
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climbers. Oh, that was the first thing I thought of. Cause walk people through, you're not doing all
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four fingers, right? You only are doing three and you're just straight in the pull-up position.
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I do both. So I'll usually start with four fingers, but that's very easy, relatively speaking. But the
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jump from four finger pull-ups to three finger pull-ups is so much harder than I would have ever
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guessed. Oh, I can't imagine. And are you looking to do two finger and one finger? Is that the goal?
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It's just to just lift yourself up. If I can do four sets of two, three finger pull-ups
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at the end of doing, you know, maybe three sets of four, four finger pull-ups, that's pretty good.
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For sure. One other question we had on the BFR was, do you ever do it in zone two training?
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Like, have you ever played around with that? Thank you for listening to today's sneak peek
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