#262 - AMA #49： Heart rate recovery, strength training, rucking, kidney function, and brain health
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Summary
In today's episode, I'm once again joined by Nick Stenson to discuss a variety of topics related to exercise and the kidney. We cover questions around building muscle, heart rate recovery, homocysteine, and kidney function as well as a few follow-up topics from our latest Brain Ama episode.
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 atia at the end of this short episode i'll explain how you can access
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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 peter atia md.com forward slash subscribe so without further
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delay here's today's sneak peek of the ask me anything episode welcome to ask me anything
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episode 49 i'm once again joined by nick stenson in today's episode we discuss a few different
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topics we start by answering some follow-up questions we've raised around some exercise
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content including questions for people who are interested in starting to ruck questions around
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how one may think about building muscle versus maintaining it should you lift before or after
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cardio and finally some questions around heart rate recovery from there we dive into all things
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related to the kidney this is something i've spoken about before and quite recently and we've gathered
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a lot of questions around what blood tests are the best to measure kidney function and what levels
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you would want to be at how does this decline with age and why is it so important for anyone who cares
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about lifespan to have the highest possible glomerular filtration rate and make sure that the rate of
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decline as we age is kept to a minimum we end the conversation with some follow-up topics from our latest
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brain ama including those specifically around homocysteine and alcohol if you're a subscriber and want to
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watch the full video of this podcast you can find it on the show notes page if you are not a subscriber
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you can watch the sneak peek of the video on our youtube page so without further delay i hope you enjoy
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ama number 49 all right peter welcome to another ama how you doing doing very well i think we're just
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going to get right into it because we got a lot of good stuff to talk about today and we don't really want
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to run out of time and so what we did for today's ama is we're going to cover a few different topics
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the first of which is exercise now anyone who's listened is not going to be surprised we're talking
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about exercise it's a topic we've covered before but what we did is we really pulled questions that
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were follow-up from a lot of previous conversations that we haven't touched on before so these will
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hopefully be new exercise topics and also hopefully be really actionable for people as they think
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about how they should exercise what it looks like and so that includes questions around a lot of
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people are interested in how to start rucking you know what weight to do how to know when to ratchet
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it up shoes to wear kind of the more nitty-gritty and so we're going to get into that we'll also talk
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about kind of when you think about building versus maintenance in terms of strength training how you know
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where to break down those two as well as questions around should you lift before after cardio what one is
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quote-unquote better and then we also have some questions on heart rate recovery which is something
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we haven't necessarily dove too deep into so i think it'll be good to talk about that from there
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we're going to get to questions around the kidney and now the kidney is something that we haven't talked
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about a ton on the podcast but have a little more recently in the podcast with ethan weiss talked about
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it in ama 48 on blood pressure and so we pulled some questions from there which hopefully will be
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really applicable to people in terms of what do you even know about kidneys in terms of what is a
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good and bad metric as it relates to a blood biomarker because there's typical biomarkers that
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people track and i know there's ones that you track with your patients and kind of looking at the
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difference in those and what people should be looking at to determine kidney function as well as also
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talking about how kidney function declines as we age and what we know about that so much like muscle
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you always talk about because it declines you want to start as high as possible so getting into what
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do we know about the kidney as it relates to that so even if you're 30 40 50 and your kidney metrics are
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quote-unquote good how does that look for your age with what we know about decline and then we'll end
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with a few follow-up questions that kind of arose and topics from the brain ama that we're going to
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dive a little deeper on provide a little more clarification on as it relates to alcohol
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homocysteine we got a lot to do which is why we're kind of getting into it so anything you want to touch
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on before we hit it no that sounds like a great order of operations let's get to it so the first
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question is a set of questions which is around rucking so again everyone who's listened will know
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how much you enjoy rucking not only for the physical but also emotional benefits we've talked
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a lot about it in the past a lot of people are interested they kind of get their packs they are
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starting to do it and just have some more follow-up questions on the details and the specifics to start
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safely make sure they don't get hurt and also how to know when to ratchet it up so i think the first
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question that we get all the time is what weight should people start at when they're going to ruck so if
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someone says to you hey never ruck before i'm really interested in it how do i think about what
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the weight should be on my pack i don't think there's a correct answer to this question it's
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completely dependent on the the fitness and health of the person so for some people you know like if my
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mom said i want to start rucking i would say a far lower weight than if you asked me that question
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one end of the spectrum as little as just go out and walk let's just make sure you can walk
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easily safely comfortably with a backpack on your back that has nothing in it and then for others
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you you might say well let's start with 10 of your body weight etc i think you don't really need to go
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beyond about a third of your body weight so the answer is gonna ultimately probably get you to there
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but this is also highly dependent on the terrain how flat it is how uneven it is all these things
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make it obviously more or less difficult so i just think that the first few times you go out there
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it's hard to overstate how foreign it can feel on your shoulders on your traps and so you don't
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want to overdo it for a couple reasons one there's just a risk of getting injured but two you want to
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enjoy this right so i'm suggesting this to people i don't want them to go out there and get destroyed
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so when i have friends that come over to ruck with me for the first time i'm not trying to prove to
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them like how tough i am and making them carry the same weight i've carried because all it's going to
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do is leave them feeling like this sucks like that's not fun i don't want to do that again
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so when in doubt start low and it's if you come back from a ruck and you're like that just felt like i
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went for a walk there was no additional stress great had more weight the next time no i think that's
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a good point which is right like don't have an ego in it when you're starting and just start slow
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i also appreciate that you think i'm in better health than mama atia who's probably a little
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older than me so that's always appreciated the next question is people looking at packs and there's
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shoulder packs and there's shoulder packs with weight bands and you've talked about waistbands
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before but i think it's just important to just double click on it for 30 seconds which is do you
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recommend everyone gets a waistband to go with a ruck bag you know i certainly like it but there are
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very different styles of rucking i know people who really prefer to have all the weight in their
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shoulders and they don't want to have any of it on their waist and there's really three things to
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consider so there's the waistband right that allows you to if you cinch it down correctly it allows you
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to keep more of that weight on your hips there's also on the front of a backpack there's a little strap
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that keeps the the straps of the pack more or less tight and then obviously there's the shoulder pack
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meaning there's like the straps that are pulling on your shoulders okay so those are kind of like the
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three variables you can tweak i say experiment with all of the above i do think most people benefit from
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a hip belt because i think it is advantageous to put more of the weight on your hips than on your
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shoulders now for me personally i go one step further and i don't even buckle the little strap that
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joins the shoulder straps i like to have as little weight as possible on my shoulders and as much
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weight as possible on my hips so i'm cinching down like crazy on my hips and it's actually kind of loose
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on my shoulders again no right way or wrong way to do this but you want to get a feel of what what
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works for you i use a go ruck pack i have three or four of them here so i've got mine my wife's got hers
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we have like you know a couple bonus ones for when people come over to ruck we put uh hip bands on all of
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them and when folks come over to ruck with us we always recommend that they singe it down
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you mentioned terrain right so oftentimes you can ruck on different terrains we've talked in the past
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podcast with irene davis kind of on the minimalist shoe and kind of looking at shoes and how they work
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what would you recommend for people who are going to ruck maybe on a little more of a terrain is that
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something that they can do with a minimalist shoe do you want a shoe with more support kind of what
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do we know about that yeah my thinking has actually evolved here i went from the point where i thought
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you should be doing everything in a minimalist shoe 24 7 to now thinking no when i'm asking a great deal
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of myself the risk reward trade-off isn't worth it so i no longer use a minimalist shoe when i ruck
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although i did and now i actually like using the boot that's made by go ruck so the company go ruck that
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makes all these great things also happens to make a great boot by no means the only boot you have to
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go on but what i like is it's got an eight millimeter drop so it's a little bit easier on your achilles
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than a flat shoe which is a minimalist shoe and it provides a little bit of support again i'm pretty
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proficient at walking on uneven terrain but when i am walking down hills especially if i'm doing so on
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kind of a an uneven surface any little bit of extra support i can get that you know saves me or reduces
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the risk of rolling an ankle is worth it so in summary i do wear a somewhat supported shoe but if
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you saw it you'd still think it's relatively mild i'm not wearing like an enormous hiking boot but let's
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take that one step further what do i hunt in right well hunting is sort of similar to rucking except the
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terrain is typically even much worse and you may be carrying far more weight and yeah in that
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situation i'm wearing the most supportive boot i can wear because again i don't always get to see
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where my feet are going down if it's dark and all sorts of things so again playing the long game means
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run fast on the straightaway and slow on the curves a little bit and therefore when i have much more
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control over what i'm doing such as when i'm lifting weights and walking around the house or walking
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around town i can afford to be in a more minimalist shoe and when the stakes are higher
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i want to provide some support have we ever told the story before on the podcast the first time i
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think it was the first time you went hunting with jake muse in hawaii and you wore your minimalist shoe
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no no that wasn't that wasn't the first time it was the first time i went to that part of hawaii
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which was uh normally i had hunted with jake in in other parts that were just a little more
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civilized but this was a particular area very high in the mountains where there's just incredibly sharp
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lava rocks beneath knee-high grass so you can never see what you're stepping on and yeah i just went
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in a very very minimalist shoe and uh i turned out to be a strategic error i remember jake telling the
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story about it after just being like he saw you roll up in those shoes and he was just like this
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guy's not going to make it this is going to be a tough day it's a very very difficult four days
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yeah i believe it we also receive questions from kind of women specifically which is is there a
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benefit to women as well rucking and we know that there's like bone mineral density is so important
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for women especially as they age is that something rucking can help with and do you recommend that your
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female patients just like your male patients do possibly pick up rucking absolutely again any load
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bearing activity is beneficial the greater the load the greater the benefit so walking is reasonable
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better than swimming or cycling but rucking is better because you're under more load that said i also
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wouldn't want someone to think that rucking is good enough right so if we're really in the business
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of increasing bone mineral density you really have to lift weights there is no substitute right
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nothing else matters because even if you're saying well god i run like i'm you know i'm running
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that's got to be an even greater impact than rucking and it is by the way but you know you're only
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getting your lower body so we have to think about bone health across the entire body and simply put
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when you're picking up and carrying heavy things when you're pressing when you're pulling when you're
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lifting all of those things with weight are going to have the greatest impact on bone stress and it's
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that stress on the bone that leads to the remodeling that strengthens it so i think of rucking is
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an adjunct to that but not the primary mover and i just wouldn't want anybody rucking thinking now i
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can check the box of bone health i don't think it's sufficient that makes sense and i think we
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mentioned this on a podcast before but you do think if if you have a treadmill so if you live in
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the like northern states and it's cold in the winter like if you live in a place like minnesota
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for example where it snows in april yeah yeah yeah i've heard that that may happen in places like
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that that is true you know with the treadmill with like tweaking the weight on your back how high the
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treadmill is you could also do zone two rucking as an activity oh completely totally um again it's hard
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once you get to a certain level of fitness the only way you're going to get into zone two rucking is if
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you start to shuffle so there's a kind of cool thing you can do when you're rucking that is not
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running but it's moving quickly and it's it's like hard for me to describe but it's kind of like a
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shuffle run but it's much easier on your knees because you're not picking your feet up very high
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like you would in a running gait so imagine just sort of keeping your knees bent and shuffling your
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feet forward as fast as you can go you can certainly get to a point and i like to do that on the track by
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the way so i'll kind of ruck from here to the local school track and that's a lot of up and down up and
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down up and down and then the track i like to do like shuffle runs like i'll do quarter mile shuffles
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based on how fast i want to do that i can go way past zone two or i could park it in zone two
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and of course being on the treadmill you can throw i wouldn't recommend going very fast so here i would
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say you know let gravity do the work so you might want to set it to like two and a half to three miles
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an hour and then just slowly start to play with the incline are there other people rucking when
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you're shuffle rucking on the track or are you by yourself are there other people out there no i am
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by myself but there are kids playing sports on the field inside the track and they're looking at me
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like i probably looked at old people when i was a young buck thinking i was the cool kid and i saw old
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people doing really weird things like walking or whatever so yes there's no question i look like
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an absolute idiot doing this it's it's just it's undeniable hey we need we need to get a video of
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this you need to bring your wife or daughter with you one time and throw up an instagram video you just
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doing a quarter mile shuffle out there i'll do it i'll do that for sure just for pure comedic value
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i mean it would be beneficial so people can see what that shuffle looks like but um i would like
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to see the whole quarter mile so not kind of a 10 second i want to see the full awkward go around
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yeah it's it's yep very well moving on from rucking the next question that we kind of see come through
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is you talk about a lot centenary decathlon and you say you know your goal isn't to deadlift as much
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weight as you once could or absolutely max out on reps in terms of weight and instead trying to
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also think about maintenance and so a lot of people are wondering at what point do you make the switch
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from building strength to maintaining it you know how how could people think about that in terms of
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assuming you're doing that for uh trying to not injure and trying to not go too hard and so at what
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point do you do you start to think about that okay this is probably enough and now i'm going to
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