Maximize Tissue Health with Dr. Keith Baar, Phd

Summary

Dr. Beau interviews Keith Baar, a muscle and tendon expert, about his research and findings. They discuss the practicality of research and the challenges of sifting through vast amounts of information. Keith Baar shares his background in kinesiology and how he transitioned to studying tendons. They delve into the importance of tendon as a master mechanical tissue and the implications for tendon injuries and rehabilitation. They also touch on the use of vitamin C and gelatin in enhancing tendon health and the importance of timing and targeting in collagen synthesis. The conversation explores the use of blends of proteins, such as whey protein and hydrolyzed collagen, along with vitamin C, to benefit the musculoskeletal system. The combination of these components can increase connective tissue protein synthesis and muscle adaptation. The importance of vitamin C in collagen utilization is highlighted, as it is essential for collagen secretion from cells. Fasted training can enhance adaptation by increasing metabolic stress and activating specific molecular signals. The timing of nutrient intake, particularly protein, is crucial for optimal muscle and immune system function. The concurrent training effect, where strength and endurance training are combined, may be influenced by protein intake and metabolic demands. The benefits of fasted workouts and the time dependency of glycogen depletion are discussed, with a focus on mitochondrial adaptation and connective tissue response. Splitting training sessions into multiple bouts can provide more stimuli to connective tissues while still achieving the same adaptive signal for the heart and skeletal muscle. Low glycogen training can be achieved by having a low carbohydrate dinner the night before a session, resulting in a fasted state without negative effects on the body. Multiple smaller sessions of rehab exercises throughout the day may be more effective than one longer session for tendon healing. The donut hole theory of tendon healing suggests that offloading a tendon can lead to scar-like changes, while loading the tendon can promote healing. The relationship between muscle mass and strength is not linear, and strength gains can be achieved without significant muscle growth. There may be a nutrition molecular pathway that can increase tendon lengthening, which could have implications for athletic performance and injury prevention.

Chapters

00:00 Introduction and Background

04:07 The Practicality of Research and the Importance of Foundational Work

08:29 The Role of Tendons in Muscle Growth and Adaptation

16:18 Effects of Different Loading Strategies on Tendon Health

25:12 Enhancing Tendon Recovery with Vitamin C and Gelatin

30:30 Targeting Nutrients to Specific Tissues through Blood Flow

32:43 Optimizing Protein Blends for Musculoskeletal Health

43:03 The Importance of Timing Protein Intake for Muscle Repair

48:45 The Concurrent Training Effect in Elite Athletes

54:44 The Role of Whole Foods in Protein Intake

01:02:58 The Impact of Nutrient Timing on Training Effectiveness

01:10:40 Stimulating Connective Tissues in Training

01:13:31 Balancing Glycogen Levels for Training

01:22:23 The Importance of Going Harder or Faster in Training

01:26:24 Understanding Tendon Healing and Growth

Dr. Beau (00:56.686)

you

Keith Baar (03:56.757)

Hey, Dr. Boo.

Dr. Beau (03:58.222)

Hey, how you doing Dr. Barr?

Keith Baar (04:00.117)

Not bad, that was everything.

Dr. Beau (04:02.03)

pretty good, man. I appreciate you coming on here.

Keith Baar (04:05.781)

Absolutely. Why don't you tell me a little bit about your program and everything and what the plan is for today.

Dr. Beau (04:16.174)

Yeah. and I'm recording by the way, cause I always hate missing stuff if we get into good stuff. So we'll cut whatever we need to, but yeah. I am a chiropractor. I'm here in Birmingham, Alabama. I was actually introduced to you, via another doctor beard on the science of ultra. so that's when I first kind of found out about you. And then since then I kind of went on a flurry of just, you know, reading research that predated obviously that podcast and, mainly is it a

Keith Baar (04:33.749)

Okay.

Dr. Beau (04:45.422)

pertain to tendinopathies and what you'd put into that field because it plays into, you know, a rehab based practice like ours. and I mean, we'll talk about this. Obviously it looks like it's kind of segued into, you know, more metabolics and, you know, molecular kind of, mechanisms within tissue and training. And that's, I have a lot of questions, which by the way, when I started looking through the abundance of research, I was like, holy cow, 226 articles, or at least that's what it says on research gate.

Keith Baar (05:07.477)

Yep.

Dr. Beau (05:15.342)

50 ,000 some citations and I was like, I've got a lot of research I got to do on this guy. So impressive.

Keith Baar (05:24.533)

Yeah, well some of it, well a lot of it's just luck being in the right place at the right time and especially at the time that I was doing some of these things, we were the first ones to do a lot of the molecular components and so when people go back and look and say, all right, we're doing this based on X, yeah, so we gotta cite this one. And because we had the opportunity to get some of that stuff in first, we get cited a lot. So it's really good.

Dr. Beau (05:37.582)

Yeah.

Dr. Beau (05:51.31)

Yeah.

Keith Baar (05:53.237)

We try really hard to make it so that the work that we do is repeatable and that we encourage people to repeat it and we try and be explicit in how we do things. So, yeah, hopefully that lends it to being kind of more accessible to not only scientists but practitioners and other people as well.

Dr. Beau (06:14.542)

Well, that's what I've appreciated is the practicality behind it. You know, some research, I guess all research has practicality if you can extrapolate and decipher, you know, what it means to you and your practice. But I feel like most of the things that I've seen from you, you know, that I was aware of or became more aware of as I kept looking at things, preparing for this, I was like, I could see how I could use that. And it's not just information that's kind of good to know, which I think is great in this day and age.

in my opinion from the practitioner side where we do get a lot of information that's just kind of like, well, what do I do with that? You know, and that's, I get that there's always more questions from research and sometimes that's the goal. It's not to answer something, but it can get a bit frustrating when there's just more information to peruse through and you know, you got to stay on top of it and you know, say what's next.

Keith Baar (06:46.805)

Yep. Absolutely.

Keith Baar (07:00.789)

Yeah, I know exactly what you mean. We sit there and there's hundreds and hundreds of articles that come out every week and you have to sift through to find the one or two things that are actually useful, both from a practice standpoint, but also from a science standpoint, because a lot of it is not useful and a lot of it isn't done as well as you'd hope. And so it makes it more difficult to actually figure out what is real and what's reliable.

Dr. Beau (07:13.55)

Yeah.

Dr. Beau (07:24.59)

Mm -hmm.

Keith Baar (07:31.221)

And so that's why a lot of people, a lot of scientists actually repeat the stuff that other people do because they want to make sure that if that's the new starting point, let's make sure that starting point is on solid ground. Let's make sure that it is part of a foundation that we can then build the future work on. And we get into a lot of problems when people don't go back and redo that foundational work. Or they redo it, they can't get it to work and then they don't publish it, they can't get it to work. And so nobody else knows.

Dr. Beau (07:49.07)

Mm -hmm.

Dr. Beau (07:54.094)

Yeah.

Keith Baar (08:01.365)

you know what? That really didn't work. And so we're all led down a path that goes in the opposite direction.

Dr. Beau (08:08.846)

Yeah, which I can, I mean, I'm sure you can think of plenty more than I can, but yeah, there's been various examples of things that we thought were true or a mechanism that were at play and we're like, eh, maybe not, you know, and that, like you said, it kind of rewrites existing things and then it explores a whole new avenue of research, which I mean, that's, I'm sure why you're, you know, in it, which I do want to back up for a second and.

Keith Baar (08:28.501)

So why don't we go ahead and start more formally now.

Dr. Beau (08:32.814)

Yeah, so as I said, I really appreciate you coming on the show. And the first thing I wanted to kind of talk about was actually, was this the plan all along? Because I saw in your, a little bit of your bio, you were, correct me if I'm wrong, your undergraduate degree at University of Michigan was in mechanical engineering, correct?

Keith Baar (08:55.093)

I was a kinesiologist, so I was old school, so I kind of went to college to become a gym teacher because I thought that is the perfect situation. But the reality is that I went into the U .S. and they don't train the gym teachers the way they do in Canada, so you don't get that holistic training. And so it wasn't as enjoyable.

Dr. Beau (08:56.942)

okay.

Dr. Beau (09:04.238)

Nothing wrong with that. Yeah.

Dr. Beau (09:19.694)

Yeah. Well, so then what was the shift? Like what happened? What spurred the, the want to go to graduate school and then how did you, I know I heard part of this on the Just Fly podcast, which I thought was an interesting story of how you got into working with tissue and tendons in particular, but what was that gap from, you know, going from a kinesiologist into higher level graduate studies?

Keith Baar (09:28.661)

Good.

Keith Baar (09:41.813)

Yeah, so I started, like I said, as a Kines major and one of the classes that I got to take, because at the University of Michigan, a lot of the sport coaches had to teach as well. And so one of the courses I got a chance to take was strength and conditioning from a guy named Mike Gittleson, who was for 20, 30 years the head strength coach at the University of Michigan. And then I just basically pestered him and pestered him until he let me become a strength and conditioning coach with the football team. So I...

I started from that strength and conditioning coach background and I was considering kind of next steps. I thought about medical school, but then I tried, I was a surgical assistant and did a bunch of stuff and I realized that it was a lot of repetition, a lot of the same thing all the time. And I was looking for something where I could be a little bit more creative. And so I thought, you know, coming from a home where both of my parents were professors and they basically could do

whatever they wanted to work on, whatever they thought was interesting. I thought that that was really cool. So started going graduate work from there. Went to University of California, Berkeley and did a master's degree. And there, the two things that were really important happened. One was I got exposed to Dr. Firestone, who basically was talking all about molecular biology and how you could have these.

Dr. Beau (10:47.662)

Mm -hmm.

Keith Baar (11:04.501)

genetic things that control what's going to happen at the tissue level or at the whole body level. And I thought that was really cool. And that was fairly new at the time because I'm old. And then the other thing that was probably significantly more important is I met my wife. So those two things were the things I took from Cal. And then I went and did a PhD at the University of Illinois, Chicago. And there what I was doing was I was trying to do what I wanted to do as a strength coach, which figure out

why some people got big and muscular when they lifted weights and other people did the exact same program and didn't get any more muscular. They got stronger, but didn't. So you get into this, well, why, what's causing the muscle to grow? There, what I did is I developed this model that was based on how we trained our athletes. And so I just electrically stimulated the nerve and what happened is all the muscles of the hind limb contract.

Dr. Beau (11:47.662)

Mm -hmm.

Keith Baar (12:00.085)

Because there's more muscle in the back of the leg than the front of the leg, that caused shortening contractions in the back, lengthening contractions in the front. And as everybody knows, when you're doing really heavy lengthening contractions, that's a greater stimulus for growth and adaptation. So within that model, I had muscles that were growing, say, 15, 16 % over six weeks, muscles that were growing seven or eight percent, and then muscles that weren't changing in size, all within the same animal and the same leg. And what that allowed me to do...

Dr. Beau (12:11.598)

Bye.

Keith Baar (12:28.245)

was identify a molecular signature that was basically the first time that people had talked about this protein kinase called mTOR, and it's important in the adaptation of skeletal muscle to loading, to exercise. And so what we did is we identified that the greater hypertrophy we saw at six weeks was exactly proportional to the activation of mTOR that we saw six hours after the single bout of exercise.

So our correlation was 0 .99 something. And so it was really, really high. And so that was really interesting to us because it suggested that this central regulator of protein synthesis was activated by resistance exercise. And when we activated it, we got bigger muscles. And so people then went on to start looking at mTOR for, yeah, exercise in people, because we did the initial studies in rats. They saw the same thing in people. They then showed that

Well, mTOR is activated by amino acids as well. So the reason why you're straight training plus your leucine rich amino acids are good is because leucine activates mTOR. So when you did the two things together, you got a bigger stimulus and you got more muscle growth. So that was the core of what I did for my PhD. And then I went to Wash U and I worked with John Hollins, he was the kind of father of endurance exercise. And he had discovered that mitochondria increase in muscle when you do endurance exercise.

Dr. Beau (13:46.03)

you

Keith Baar (13:55.286)

That was long enough ago that that was the first positive effect that people had seen of endurance exercise. Cause at that point people didn't know that it was good for them. So he was showing for the first time that the skeletal muscle showed a doubling of mitochondrial mass. And then what I did is took the molecular biology I'd learned from my PhD and brought it there. And we discovered this protein called PGC one alpha, which is important. It's what they call the master regulator of mitochondria. So

What we showed is that when you do endurance exercise, you activate or increase PG -suan -alpha. You make a smaller, more active form of the protein as well. And the result is that you get more mitochondria when you continuously do that. And so, so that allowed me to, to get kind of use the molecular biology to really try and figure out how endurance or strength training affected muscle. So historically I was a muscle biologist and that's where I was focused.

Dr. Beau (14:36.718)

Mm -hmm.

Dr. Beau (14:52.238)

Mm -hmm.

Keith Baar (14:54.997)

And that was basically where I was doing all of my work. And so the transition to tendon came when I started thinking that I could engineer muscles and just put whatever genes I wanted and make this super muscle that we could then maybe put into somebody or do whatever. But the guy that I was working with, Bob Dennis, who's probably one of the smartest people on Facey Earth, he was trying, he was doing things like he was taking little engineered muscles and he could swim fish around in a little.

Dr. Beau (15:04.718)

Mm -hmm.

Keith Baar (15:24.213)

little liquid that he had. So he would engineer these little robot fish and put two muscles there and then he would contract them and they would go back and forth so that you could actually have a fish that swam. But what he was finding was the muscles were pulling off of where he was tying them into the fish and so there we had to try and understand the tendon and that's where I started to kind of begin to appreciate tendon as a tissue.

Dr. Beau (15:50.574)

When that's, I saw a quote from one of your articles, and again, if it's misquoted, you let me know, but it said, tendon is the master mechanical tissue. And then in that same article, I believe, it talked about the, if the musculoskeletal tendonous junction experiences five time greater strain than the mid portion or the enthesis. And just yesterday, I had a patient in that had a distal biceps tendon repair where they basically, you know, cut the edge of the tendon off and then.

re -implant the muscle right into the radius. And he's about, I want to say seven, eight months out. And he just kind of asked me, he goes, am I just supposed to like, you know, full range of motion? He's doing everything. He's back in jujitsu. He's hanging off a pull -up bar. But he goes, it's just constantly sore. And I had been reading through all your work and I was like, well, you don't really have the dynamics at play. This would be my hypothesis. And I want to hear your input because you've removed that tendon and now you just have muscle, which has less dynamics in it.

Keith Baar (16:40.789)

Well.

Dr. Beau (16:47.086)

And then an enthesis, which is the stiff portion, but it's engineered, right? It's plugged into the bone. So my question there, which I didn't want to start here, but you kind of led me here. There's, we know there's ligament ization that occurs with like taking a hamstring or patella graft and putting it in an ACL. So we go in a year later and that's legitimately ligament. Does that happen with that type of, you know, plugging a muscle into a bone? Do we get tendon ization? Is that going to occur? Is that not, you know, the mechanism at play?

Keith Baar (16:50.837)

Thank you very much.

Keith Baar (17:15.957)

Yeah, so it's a great question and really so functionally what we have and this is part of just the change in mindset for me that's happened over the last 10 to 15 years is that if I look at a muscle now, so I used to be all focused on the muscle and the muscle and the muscle, but really what I've got is I've got the bone on one end, got the bone on the other end and that the muscle is actually just an expansion of the tendon where we stick

these contractile proteins in so that we can produce a force. So as we do that, now what we've got is we've got, as you said, tendon is this incredibly interesting tissue from a mechanics point of view, because on one end it's stretchy and then the other end it's stiff. So it's a variable mechanical tissue and that's why it's important. And so when you do take a muscle and you basically take out the tendon and you stretch it,

First of all, you're gonna start adding sarcomeres in series for most of us. That means the muscle's gonna get longer. We don't know what happens at the interface very well. We know that you're gonna form some sort of structure that's going to look like the anthesis or the bone ligament tendon interface, but we don't know exactly what that structure really looks like. And we certainly don't know whether you're regenerating the variable mechanics that you should have at the muscle end of the tendon. And so...

Dr. Beau (18:11.694)

Mm -hmm.

Keith Baar (18:37.845)

The best thing you can do at certain points like that is to try and load it in ways that are going to maximize kind of the properties that you're looking for. And there, what we want to do is if we take somebody who's never exercised before and we have them exercise, the tenons are going to get stiffer. Okay. Just because the structures are now getting load and they're now going to, when they get loaded and

Dr. Beau (18:54.51)

Mm -hmm.

Keith Baar (19:06.517)

in a single direction, more of the collagen becomes aligned. And as that collagen becomes aligned, it has more stiffness. But once we've started to train, and we're taking athletes who have trained for a long time, now how we load is going to make it so that we either have more stiffness at the muscle end of the tendon or less stiffness at the muscle end of the tendon.

Dr. Beau (19:17.038)

Mm -hmm.

Keith Baar (19:34.869)

Okay, so if we train with rapid movements that don't allow time for the collagen to kind of shear past each other, that is going to be these dynamic plyometric really quick movements. That's going to cause the collagen to work as a sheet and the collagen is going to then get stiffer at the muscle end of the tendon. That doesn't mean from bone to muscle it's going to get stiffer necessarily. It means that at the muscle end of the tendon you're getting a little bit stiffer.

Dr. Beau (19:42.734)

Mm -hmm.

Dr. Beau (19:56.686)

Mm -hmm.

Keith Baar (20:04.117)

And if that's the only way that you train with very light, very fast movements, over time, the muscle into the tendon becomes stiffer and stiffer. And what happens is eventually, because we're not giving a big load to the muscle, the muscle is not getting a signal to be strong. We're giving a tendon, we're giving a signal to the muscle into the tendon to be stiff. And now the tendon is stiffer than the muscle is strong. And now when we take a step, that's when we can, we can injure the muscle.

And we counteract that by doing heavy resistance exercise that does two things. It makes the muscle stronger, but it also means that we're lifting the weight slower. And as we lift the weight slower, the muscle end of the tendon, the collagen will slide. That'll break little cross -links that are in that area. And that'll result in less stiffness within between those fascicles or those, or the different collagen levels. Okay. So, so what that means is the muscle end of the tendon gets a little less stiff.

Plus, as the muscle fibers themselves get bigger, it pushes out the collagen fibrils. So now when I load them, they have to actually come together as they get pulled. And that also means that there's less stiffness in the system. So all of these things will give us less stiffness. So in an individual where I've got, I've basically removed the tendon, what I'm gonna try and do is I'm gonna try and do slower moves.

Dr. Beau (21:30.862)

Mm -hmm.

Keith Baar (21:31.317)

It don't have to be really, really heavy, but they have to be slow. So people know from their tenninopathy studies that, okay, the standard of care is slow eccentric loading. Perfect. That's great. But Michael, care is shown beautifully that if you do heavy strain training, it has the same effect on tenninopathy that slow eccentric had.

the two things have one important aspect in common is that they're both done slowly. So the heavy strength training, I'm moving the weight and the weight is going slowly. If I do that exact same lengthening program that's going to treat my tendinopathy, but instead of moving slowly, I just drop really fast. Now what I'm going to do is I'm going to have a negative aspect of that training. So the velocity at which we're loading is super important for treating tendinopathy. It's for

Dr. Beau (22:03.886)

Hmm.

Keith Baar (22:27.125)

getting that kind of variable mechanics and the muscle end of the tendon, all of those things. And so that's where we would then begin to use the slowest form of contraction, and that's maybe an isometric. And so for somebody who's coming back from removal of a tendon, we're going to do very early in the process, we're gonna do what we call low jerk isometrics. We're just gonna have them contract the muscle. And the low jerk component is, again, most of the patients, most of the people that you're going to see in your practice.

Their damage didn't come from from holding a stretch too long or from slowly moving into that stretch. Their damage came from playing tennis and smacking a ball. The ball is accelerating one way. You're accelerating the other. You get jerk on the tendons of the outer part of the elbow. You get tennis elbow or maybe they're going to be golfers. And now they're hitting a mat or they're hitting the grass. They're accelerating a club one direction. The grass is giving them resistance. They get that instantaneous jerk.

that's going to give them golfers elbow on the other side of the elbow. You're going to have lots of jumpers getting jumpers knee where they're getting dynamic jumps all the time. All of these things have this common property of jerk. Jerk is not that person that we hate. It's actually a physical property. So where I am is my location. The rate of change of my location, that's my velocity. The rate of change in my velocity, that's my acceleration. And the rate of change of my acceleration, that's my jerk.

Dr. Beau (23:50.286)

Mm -hmm.

Keith Baar (23:56.565)

So when I'm accelerating one way and there's something else accelerating the opposite direction, that means two accelerations are coming together. That's when we get jerk. The most common is like I'm going to go lift the weight. I'm accelerating the weight up. If I'm doing a deadlift, I'm accelerating up. Gravity is accelerating down. When I hit the bar, when I get that catch phase, that's the jerk. So when I'm reloading after an injury, I minimize that. And the way that I do that is I

Disperse that contraction over a longer period of time. So I begin so I slowly apply force over about a three to five seconds I'm gonna hold it there and then I slowly let the force off and that's ideal for keeping the jerk down so that the likelihood of injury is low and by holding that isometric now I get all this little shearing at the at the end of the muscle in your case and that's going to help that collagen that's within

the matrix of the muscle to begin to have some of the same principles of a tendon, where at the muscle end it's going to be more less stiff and at the bone end it's going to be stiffer. We wouldn't necessarily say that it's going to tendonize, but you're going to get something that's as close as you can in that situation.

Dr. Beau (25:12.59)

Mm -hmm.

Dr. Beau (25:18.83)

Well, and this is why I wanted to bring you on though is because I talk about your research all the time, in particular one paper that has beautiful illustrations in it that basically give the visualization of what you just explained about slower, heavier loading is gonna have a different outcome than faster, lower loading. I believe it's 30 % below, one rep max and below that, and then faster loading.

Keith Baar (25:19.701)

But very long.

Dr. Beau (25:45.07)

has different outcomes. And I just kind of try to point out when I'm teaching about running rehab or tendon rehab of we can extrapolate on that old heuristic of, hey, you start with isometrics, you move into eccentrics, then you move into concentrics and then ballistics. We can be a little more specific based on the injury at hand, the tissue profile also of the person that we're dealing with, right? Are they using whatever baiting criteria or, you know, the sport that they've played for years and how they've evolved or adapted.

But in that same article, which the other animation or the other picture that's in there, which is just amazing and it's been talked about and I looked up the outside magazine article that you're quoted in is the use of vitamin C and gelatin, which is one of the things that I know you've talked about a lot. But this always, again, I mentioned your name within the chiropractic PT realm and everybody's like, who? And I'm like, how does not everybody know who Keith Barr is?

Because these things, when you see it, and again, correct me if I'm wrong, a 2X increase in outcomes of tenninopathy just by adding, what is it, 15 grams of gelatin and 200 milligrams of vitamin C 30 to 60 minutes prior to exercise. I mean, just knowing that, if we were working with a professional athlete, let alone a stay at home mom that plays tennis a couple days a week, if we're 2Xing the results, I feel like that should just be.

why aren't you doing it, especially with such low cost interventions as vitamin C and gelatin?

Keith Baar (27:15.989)

Yeah, so it is one of the things that... One of the studies that a lot of people look to is the study that I did with Greg Shaw of the Austrian Institute of Sport where we fed people either 5 or 15 grams of gelatin. We've since done it with hydrolyzed collagen which has the same effect. And, you know, really before I even go too far, people say, what about this special one that comes from this company that's more exp...

We've never seen a difference between even the cooking gelatin that we get at the grocery store versus the hydrolyzed collagen. They all...

Dr. Beau (27:49.518)

which is what I tell people to buy. Because of your research, I say you can go get the 30 cent packet of gelatin and I'm pretty sure, and that's one of the questions I want to ask you, is there a difference between, which we can have a sidebar on, different types of collagen, hydrolyzed, bone broth, all, you know, there's lots of options.

Keith Baar (28:03.029)

Yeah. So the only thing I do is I tell people not to go from a bone -based source. So the bone broth works as far as the collagen goes. A lot of the gelatin works as far as the collagen goes. But where a lot of it comes from is from the bone, obviously for the bone broth. And so what we make sure people understand is that most animals, they store their heavy metals in their bones. So if you're going to take...

Dr. Beau (28:30.83)

Mmm.

Keith Baar (28:32.341)

you know cows and now boil down those bones and now we're going to isolate stuff out of there. Actually there's good data that says in bone broth there's high levels of lead and other things. So we try and stay away from the bone based ones and we try and encourage people to do a skin based one. And so that's the only real thing that you're looking for is something that comes from a pelt or a skin or you know, cause there's usually fish skin or pig skin or, or any of these types in people who are, you know, halal will go for the fish or

you know, if they have different, that's totally fine. But there's not really a fundamental difference in how you hydrolyze, for example. So if it's hydrolyzed collagen, totally fine. If it's gelatin, it's totally fine as well. It's a little easier to incorporate hydrolyzed collagen because it dissolves in relatively cold liquids. And so you can put it into, and a lot of people will put it into their coffee or they'll put it into other things that they have kind of at the same time every day.

Dr. Beau (29:12.43)

Mm -hmm.

Keith Baar (29:30.677)

and they just get into that routine. And the reason that that's important is because what we see with collagen synthesis is that we see this, you know, this cyclic nature to it. So there's a circadian rhythm that comes to it. There's beautiful work coming out of, out of England and now in Copenhagen that shows that there's a circadian rhythm to collagen synthesis, but also it takes about 24 hours for the collagen synthesis from your exercise yesterday to peak today.

So, so that's why we want to have that kind of collagen dose about the same time every day. If it's an hour before training, that's great because then you're going to target it to the area you trained. But it also means that when I do it again tomorrow, it's already, it's also going to get targeted in the same way. So if 24 hours later, collagen synthesis is higher than it is today because I exercised yesterday. Now I've supplied more amino acids, more building blocks for the, for the collagen. So the cells can.

make more college in potential.

Dr. Beau (30:31.662)

Can you touch on the targeting of it? Did they do radionucleotide studies with collagen on rats, looking at where it's going based on stressors and tendons? Am I wrong on that? Or what's the mechanism on targeting?

Keith Baar (30:41.589)

I haven't seen that. So, Osir has shown that when he gave kind of radio labeled proline, which should go into collagen because it's every third amino acid, or he gave it as hydrolyzed collagen that was radio labeled, he saw that more got into the musculoskeletal tissues.

when the mice or the rats consumed it as the whole protein rather than just the amino acid. In the skin, the amino acid got incorporated into collagen at the same rate, but it seemed like the musculoskeletal system, so the cartilage, the muscle, connective tissue, and the tendon, those things seemed to do better when you were giving a more native molecule like a hydrolyzed collagen or whatnot. So that's the only one that I've seen there.

The reason that we give it an hour before when we're trying to target a specific tendon is what we're trying to do is we're trying to use blood flow. Normally we use blood flow to deliver the nutrients that we want to the tissues we want. So one of the best things that everybody can do is after dinner is take a 10, 15 minute walk. All that's going to do is it's going to target more of those food items that you've eaten. So the carbohydrates, the proteins and the fats.

are going to go to the muscles that you're exercising. So you're walking muscles in that case. So that's an easy way to target what you've eaten using blood flow to specific tissues. The problem with our connective tissues, our cartilage, our tendons, our ligaments, there's not a lot of blood flow in these tissues. So what they normally do is they normally get their nutrients from the solution that they're in. So they're in, say they're in a synovial joint.

they'll get the synovium has a has a liquid in it that's going to allow as I load the tissue either compression for the cartilage or tension for the for the tendons and ligaments now what they're going to do is that's going to squeeze out the liquid that's in the tissue and then as it relaxes now it's going to suck liquid in from the environment if I've put the call it the hydrolyzed collagen or whatever into the system beforehand now there's more of that to deliver to those musculoskeletal tissue

Dr. Beau (32:43.79)

Mm -hmm.

Keith Baar (32:58.517)

And some of the work that I've just been doing on my sabbatical in Maastricht in the Netherlands was to use what's called a blend. So we know that there are specific amino acids in collagen, specifically glycine and proline, that are very low levels in, or relatively low levels in other protein sources like dairy protein. So most people will go out, they'll have a whey protein after they've done their exercise. And that's great for their muscles. We talked about...

leucine -rich protein, activate mTOR, you're going to get more muscle protein synthesis. The problem is that what you see in what Luke Van Loon's lab has shown is that after you consume just dairy protein or whey, glycine levels, for example, drop. And that means that it has the potential to become limiting. And so what we've been doing is blends of proteins that would have, say, 20 grams to 25 grams of whey protein with five grams of hydrolyzed collagen with the 50 to 200 micrometers.

Dr. Beau (33:28.942)

Thank you.

Keith Baar (33:57.749)

Milligrams of vitamin C and that seems to give a lot of really good signal to All tissues at the same time. So if you want to do things that are going to benefit the whole musculoskeletal system Having a blend like that where you combine some Milk based or whey based protein with a little bit of hydrolyzed collagen and some vitamin C That's a really nice combination and we've we've got data that's that's in review right now that shows that

Dr. Beau (34:03.662)

Mm -hmm.

Keith Baar (34:27.445)

we can increase kind of connective tissue protein synthesis in the muscle when you take muscle biopsies using that blend over placebo control. So what that's telling us is it's telling us that yes, the hydrolyzed collagen might play some sort of a special role, but having the whey protein, the leucine rich protein might also be beneficial. And we know that from some of the

some of the studies that we've done in the lab here, because if we use an inhibitor of mTOR complex 1, our little ligaments aren't as strong. And so, in fact, that's one of the ways that people have probably heard IGF -1 as a way to improve tendon or ligament function. The way that IGF -1 works is it activates mTOR complex 1, that increases collagen synthesis and decreases collagen breakdown.

Dr. Beau (35:00.494)

Mm -hmm.

Keith Baar (35:21.525)

And so we're adding the leucine -rich protein. That's going to activate the same thing that IGF -1 does, slightly different mechanistically. But when you do, say, the exercise together with that leucine -rich protein, now you've got the signals that are going to allow that tissue to get bigger and stronger.

Dr. Beau (35:21.71)

Mm -hmm.

Dr. Beau (35:42.542)

One of the questions I had for you, just because I know you've studied and you're, you know, the kind of synopsis of what your lab's looking at, you mentioned the leucine, you know, protein signaling in particular. I have a couple questions on this and I hope, I know I'm all over the place, but I have so many questions I want to ask you. You said there's kind of an additive effect when you see these things, like an entourage effect in a food -based source because of all of the other things like...

Keith Baar (35:58.485)

Okay.

Dr. Beau (36:09.358)

Are you studying these at all or have any other labs studied side by side like vitamin C? Like vitamin C is notoriously hard to absorb in a non -food base. So are you looking at that, like the synergistic effect of like, you know, is it the, you know, fructose with fiber plus vitamin C helps, and then it's hard if you have a synthetic, you know, ascorbic acid or something like that base. Is there anything out there?

Keith Baar (36:30.869)

Yeah, so the way that we've done this is basically by messing up a little bit. So what we've done is we've done it so that we had a vitamin C powder that we stored in our laboratory in front of the window in Northern California in the summertime. So it's getting totally getting blasted by the sun all day long. That experiment, we ran all of the experiments. We looked.

There was no increase in protein in collagen synthesis. And we did another experiment where we took, we were using Ribena or this basically a concentrated fruit juice that had about 50 milligrams of vitamin C and we made gummies. So in order to make gummies, I dissolved the gelatin in a boiling by boiling the Ribena. When you boil vitamin C, it kills the vitamin C and that one

even though it had the same amount of amino acids in it, you actually saw no increase in collagen synthesis. So again, the vitamin C is fundamentally important. What we use, we use a vitamin C powder. So we don't find that there's a problem with that. It could be that if you take the vitamin C together with collagen, there's not a problem, but maybe it's in a whole meal or something else, it becomes a little bit more difficult to digest.

But a lot of times what we'll do if I'm going to make this at home is I'm going to make a smoothie. There's going to be blueberries, strawberries. I'm not putting any vitamin C in there because the fruit is going to have that. And so I'm using the fruit not only as a flavoring to give it some consistency as well because it's frozen, but I'm also using it to deliver the vitamin C that I want.

Dr. Beau (38:08.718)

Mm -hmm.

Keith Baar (38:19.445)

Because I don't need it to be pharmaceutical grade vitamin C that's going to be in my system for a long period of time. I just need it to come in at the same time as my hydrolyzed collagen or my whey protein and these things coming in together so that the cells not only get the stimulus or the building blocks. And the reason that vitamin C is essential is because in order for the cell to spit out the collagen so that it can get into the tendon, the ligament, the cartilage, it actually needs vitamin C.

to add a little bit of a change in the molecule. And when you do that, it then can release from the cell. So when we do experiments in the lab and we wanna measure how much collagen the cell has made, all we have to do is take vitamin C out and then the vitamin C stays in the cell, or sorry, the collagen stays in the cell. So then I can just bust open the cell and measure how much collagen was there. And so if I take vitamin C and I add it in a dose dependent manner to my cells,

Dr. Beau (39:07.214)

Mm.

Keith Baar (39:18.581)

All that happens is when I collect the cells, I bust them all open. The ones that had the vitamin C don't have any collagen in them anymore because they've opened up and they've released their collagen into the meat or the matrix, whatever. And that's why vitamin C is essential. So if you see a lot of studies where there's no effect of collagen supplementation, many, many, many of those are done in an overnight fasted state.

Dr. Beau (39:35.886)

Mm -hmm.

Keith Baar (39:48.469)

where they supplement with collagen, but they don't provide vitamin C. And if you don't provide vitamin C, you're not going to make and export the collagen from the cells that you make it from. And so if you're just going to measure it in the matrix of say a muscle or of a tendon, you're not going to find it there if you don't have vitamin C because it's not going to be secreted from the cell and incorporated into the matrix. And so vitamin C we've known is important.

The first nutrition study ever done in the 1700s, there was a Scottish doctor. He basically took a bunch of sailors with scurvy and he fed them different things. One of them was like turpentines. I'm surprised anybody survived. But two of them got a lemon and two limes and those ones got better within a few days. And so they didn't know vitamin C was in the lemon and the two limes, but then they started giving all the sailors lemons and limes because they knew that that would stop scurvy.

Dr. Beau (40:27.886)

Yeah

Keith Baar (40:47.509)

And basically all scurvy is was that you'd stop producing collagen. So the result is your any old scars would open up, your teeth would fall out, your hair would fall out. All of these tissues where collagen is essential to bind you together would start to deteriorate. And you could fix that just by adding vitamin C. So for 300 years, we've known that the vitamin C component is really important. And so.

Dr. Beau (41:13.102)

It seems like more manufacturers of collagen products and supplements need to read some of the research because I mean, just with what you just told me, it's like vitamin C is the key that unlocks the ability to utilize collagen. But then if you see a standalone collagen for your coffee or something and that's not in there, I'm not saying that's useless if you eat it with food that has it, but it could be.

Keith Baar (41:37.685)

Yeah. So that part of the educational process is just making sure that when people, if people are having it in their coffee in the morning, that they have a piece of fruit, that they have a glass of juice, they have something that's going to give them vitamin C. Because just by just having the collagen itself isn't enough in and of itself. Within a mixed diet, you're going to get enough vitamin C through the day. But if you're not delivering those things about the same time,

Dr. Beau (41:58.606)

Right. Which I think is a great point.

Keith Baar (42:07.797)

And most of us have a small breakfast that maybe is a, especially in Europe, they're gonna have a coffee, they're gonna have like a bread -y thing, and that's gonna be their breakfast until lunch. They're not gonna really have fruits or vegetables until maybe lunch or dinner. If you're delivering your collagen four hours or eight hours or 10 hours before you're gonna have any vitamin C, yeah, your daily vitamin C is gonna be sufficient, but now you've taken your two signals and you've...

and you've separated them far enough where maybe they don't have the synergistic effect that they would have if we took them together.

Dr. Beau (42:43.086)

Well, I have a couple of questions about fasted trainings. I know you have some research on there, but talking about time dependent delivery of that. So for people that are doing intermittent fasting that maybe have just black coffee in the morning and are waiting till maybe 10 a or 11 a to eat their first meal, but maybe work out in the morning, what is the time dependency window on that? Like how much time do we have?

Keith Baar (43:02.677)

Yeah, so again, when we talk about taking something 30 minutes to an hour before, that's to get the optimal effect. So it doesn't mean that there's no effect if you take them later. And again, one of the reasons that you're not necessarily going to have as much blood flow, you're not going to have as many of the things to target it, but you're still going to get an effect by putting these things together and to taking them in together as one unit. And so what we would tell people to do is,

Don't worry about it if you're training first thing in the morning, you're, you know, cause this is what I do. I get up in the morning. If I don't train first thing in the morning, time is not really going to make it so that I've got another point in the day where I can train. So I train early in the morning before I eat anything. And then I'll come in and I'll have something kind of later on where I'm going to then bring in some of these things that are going to help my body respond to that training and adapt.

as optimally as I can. And so for me, that means having something that has a milk -based protein, has some collagen in it, has a little bit of vitamin C with it, and then maybe something, if I'm really pushing it, I'll get some Epicatechin -rich cocoa, and that's really gonna form the kind of core of what I'll do as far as my recovery after that training. So if I was taking people who are time -dependent feeding and they were gonna say,

not eat until 10, 11 o 'clock, totally fine. I would have something like that. They would have something where you've got a little bit of milk -based protein if you can handle it. Plant -based protein's fine. You're just gonna probably need to increase the total amount because it tends to be lower in leucine and it's a little bit harder to digest. So if I'm taking 20 grams of a whey protein, maybe I'll take 30 plus grams of say a soy or a pea protein.

Then I would take maybe five grams of gelatin with that or hydrolyzed collagen. I would put it all together if I'm gonna do it in a juice or I'm gonna do it in a smoothie, maybe a bunch of strawberries to give me my vitamin C because they're in season right now or whatever other fruits in season that's gonna give you that, great. If you're gonna do something like Epicatechin, you can do it with, I just use natural cocoa because it's...

Keith Baar (45:27.829)

It's fairly, it's a really good source. And so you, you just adding that, then you have to figure out your vitamin C unless you like fruit flavor chocolate stuff and that's fine. But you can do something that has a mixture like that and it's perfect for the rest of the day. Or you can eat something that's going to be say yogurt with some fruit. You can sprinkle a little hydrolyzed collagen on it. You can do it that way. There's lots of different ways you can do it. You don't have to worry about precise timing.

Maybe you're gonna get 80 % of the effect, but it's still a huge amount. Whereas, you know, if I'm elite, then that 20 % makes a big difference. If I'm not elite, if I'm just training for life, getting 80 % of the things right, that's a win. That's a huge win. And so that means getting my fruits and vegetables and getting some of one of these supplements maybe once a day, you know, relatively close to my training, that's a big win for me.

Dr. Beau (45:56.334)

Mm -hmm.

Dr. Beau (46:25.39)

Yeah. And I agree that sometimes we get in the weeds with this stuff with the light, you know, the general public and you know, we're going to granular when we should take care of the 80%. But if we're, if we stay granular for a second, when we keep mentioning leucine, and I know you've done some studies on, you know, leucine, supplementation and branched chain amino acids. So you kind of mentioned for different protein sources, leucine, you know, not being as high in a plant based protein.

Do you, is BCAA supplementation a net positive or negative? Should people be focusing on loose, seen rich foods like eggs or other things in addition or?

Keith Baar (46:59.765)

Yeah.

Keith Baar (47:04.565)

So I would, I always focus on the food component. The only time that I ever do any kind of supplementation is if the food is insufficient. So what I'll do is I'll look at my meal. If I'm going to have something that's maybe it's a carbohydrate based meal and it doesn't have much, maybe it's a hot day. I'm going to have a salad and it's going to be something that's going to have lots of veg, but it's not going to have much by way of protein.

Now what I'll do is maybe I'll add some cheese to it. I'll add some eggs to it. I'll put something that is a protein source on it. And there maybe it's not enough. So then maybe instead of having a water to drink, I'll have a milk to drink. That's basically how I would do it is I would focus on actually getting the food components and looking at what you're going to eat. And if it's not going to have enough protein, adding in either from

either a lean meat, an egg, cheese, any, or just, you know, instead of drinking water, drink milk, all of those different ways are ways to increase the protein content of what you're doing. And they're far better than sitting down and taking some sort of supplement.

Dr. Beau (48:15.534)

we'll get back to amino acid supplementation, but jumping into fasted training. So we've mentioned, you know, time to minute feeding and intermittent fasting, which it's, you know, it was huge there for a while. Now we're seeing some articles come out on maybe some cardiac risk and is it actually doing what we think it was doing or is it still beneficial? So I know this is a broad sweeping question, but from your standpoint, because I know you've done some studies on this and I saw, correct me if I'm wrong again, that if we do,

workouts in a fasted state, wasn't there increased protein synthesis that occurred with those workouts?

Keith Baar (48:50.741)

Yeah, so this is work that we've done some, John Hawley's done some, other people in the field have looked to say, if you want, especially if you're relatively high level, you can get more adaptation by doing some of your training in a low glycogen state. Not all of your training and you don't want to do it all the time. So the best study is probably one from John Hawley, where what he did is he took triathletes who are training multiple times.

They had the exact same amount of carbohydrate in their diet. One group, they had all of their carbohydrate in the first part of the day. They did their last training session. Their dinner after that would have protein and very low carbohydrate. And then they would get up the next morning and train in that low muscle glycogen as well as low liver glycogen state. And they saw about 3 % greater improvement in run performance than the ones who,

had the same amount of total carbohydrate, but had some of that carbohydrate after that second training bout. So what it tells us is that some of the reason that our muscles adapt to our exercise is because of the metabolic stress of the exercise. And so if we compound the metabolic stress of the exercise by adding a metabolic stress of doing it in a fasted state or doing it in a glycogen depleted state, we get certain molecular signals that are higher.

and that will provide an increase in adaptation that results in greater performance. So where we use this is mostly in either elites, but if we're not talking about elites, we're going to use this more in people who don't have a lot of time to train. So what we're going to do is I'm going to say, okay, you can only train say three days a week, but you have this goal of running a marathon. So what I'm going to do is I'm going to take one of your training bouts, it's going to be over here.

The other two of them, I'm going to do them together. I'm going to do one of them in the evening. And then you're going to have a low carbohydrate meal. So you're going to be in muscle glycogen depleted from the exercise that you did. You didn't replenish that. And then you're going to sleep. Your liver glycogen is going to be depleted to run your body while you sleep. You're going to run, you're going to exercise again the next morning and you're going to do that session in a glycogen depleted state.

Keith Baar (51:15.125)

muscle as well as liver. I'm gonna give you a little bit of black coffee in the morning just to get you so that you don't feel like it's as hard as it would feel like if you didn't have that. And you're just gonna train in that fasted, that muscle and liver glycogen depleted state. And now from those same three training bouts, I'm going to get more adaptation than if I had done those Monday, Wednesday, Friday, say. So that's how we would use it.

kind of in a structured system. If I'm doing it with elites, when they're in their base phase, now I'm doing two days a week where they're doing evening training, next morning local hygiene training, and I'm gonna do that twice a week and just have that as part of the component of their training. They're gonna train the other six days a week as relatively normal.

Dr. Beau (51:56.11)

Mm -hmm.

Dr. Beau (52:09.646)

Are there any specifics on the first meal after one of those back -to -back fasted training sessions? Is there anything that would be focused on or just typical, you know, good nutrition resupply?

Keith Baar (52:10.741)

settings on.

Keith Baar (52:18.069)

Thank you.

Keith Baar (52:21.749)

Yeah, just typical good nutrition resupply. I would, I would again focus on having protein because protein building blocks. The one thing that happens when you have those fasted training sessions is that you can become much more, you're much more likely to get say upper respiratory tract infections. And so what we'll do first, you know, if that's a problem for some people, we could maybe bring in some, some fish oils to as a kind of

something that we add into what they're doing to improve some of their immune function. But then when they do have that next meal, I'm gonna make sure again that it's gonna have loose and rich protein, because that's not only good for building our muscle, it's also absolutely essential for the functioning of our immune system. And so, when people were getting their vaccinations,

This is one of the things we were trying to make sure that everybody was doing was taking in leucine rich protein with the vaccine so that as you're having that immune response, you're giving your immune system all of this, you know, leucine rich protein that's going to stimulate and help that immune system respond to that insult. So whether it's getting a virus or getting a vaccine, we're going to want you to have of the of the food that you eat. We want it to be.

high quality protein is going to be the core of it. And we would do the same in this situation where we would put at the core, we're going to have a foundation of that high quality protein so that that's going to help our immune system fight off anything that maybe came in when we're doing this more stressful, low glycogen training. But it's also going to help us build, repair any damage that we've done. And then we're going to bring in the carbohydrate as a way to replenish the metabolic stores that we've.

Dr. Beau (53:45.742)

Mm -hmm.

Keith Baar (54:10.933)

depleted by doing that double training.

Dr. Beau (54:14.573)

So I work a lot and obviously, like I said, I found out about you from Dr. Beard's podcast. Work with a lot of ultra marathoners, do a lot of running myself and correct me if I'm wrong. So I know you're also becoming more efficient at glycogen, kind of pulling glycogen out of the muscle in the liver. So delivery mechanisms, is it actually having a metabolic response outside of just the, I guess, like a protein signaling response?

My assumption of what was being talked about is that you're becoming more efficient at fatty oxidation versus like having this fast burning glycolytic system.

Keith Baar (54:53.685)

Yeah, so basically what you're doing is you're getting more of that thing that we discovered, PG -21 alpha, because it's activated by that metabolic stress. You've put more metabolic stress on your muscle, you're going to get a higher PG -21 alpha. What that does is that increases the production of fatty acid oxidation enzymes. It increases the production of glucose transporters. It increases the production of mitochondria.

Dr. Beau (55:01.358)

Mm -hmm.

Keith Baar (55:18.613)

And so now when we go to exercise, we should have more mitochondria within that muscle. It should produce energy, more energy per unit of oxygen or more energy per oxygen inhaled. So we've got more mitochondrial mass within the muscle that we're going to use. And so now when we deliver oxygen, we can extract more of that oxygen, produce more ATP. And so yes, we've become a little bit more efficient at that submaximal level.

So what you would see is if you train this way repeatedly for say six to eight weeks, what you should see is when you go out and at a submaximal rate, and if I look at my heart rate monitor, my heart rate monitor should be a step or two lower because I'm not having to push as hard to go at that constant rate. Okay? So.

Dr. Beau (56:09.166)

Is that a sustained response or what is the, so let's say I continue the same training efforts, but I remove the fasted workouts. Is that sustained or does that have a shelf life?

Keith Baar (56:20.789)

So it will have a shelf life, but it's got a fairly long shelf life. It's basically what we see as people go from the base phase to specific preparation. That specific preparation, we're shortening up, we're speeding up, we're getting these things. But as we do that, we're losing our overall aerobic engine. So we're not giving as long and as prolonged a signal to the muscle to get all of those mitochondrial adaptations. So over time, we're getting a little bit less of that structure.

And that's causing our metabolic or our aerobic engine to kind of slow down a little bit. But now we're using that different training. So we all have experienced that by going from the base phase where we're trying to build that aerobic engine to specific preparation where we're trying to increase our performance by speeding things up by going short and fast. As we do that, it's just like when we talked about earlier when all I'm doing is short, fast movements.

Now I'm getting stiffer. That's making me more efficient. That's making me run faster. But when I'm doing that, I'm also not getting a signal to my muscle to be strong, but I'm also not getting as much of a signal to my muscle to keep the mitochondria that I have. So over time, I'm losing a little bit of mass and I'm losing a little bit of mitochondria slowly deteriorates. And then what's going to happen is next base phase, I'll get that back. And so that's what we're doing as we go from base phase to specific prep.

So we're trading off kind of aerobic engine for speed and performance. And so that's basically what we do is we go between those two areas.

Dr. Beau (58:03.342)

So talking about that mechanism of, you know, what's, you're not challenging the muscle the same way when we kind of go into that harder, shorter duration, you know, maybe more specific. So I pulled a quote from one of the articles that was looking at concurrent training. There's a big push in this hybrid athlete model now, which I guess a lot of people would say they are part of, like I lift weights and I do a lot of endurance stuff. I wouldn't say I'm necessarily specialized in either. So I don't know if that makes me a hybrid athlete or if I'm concurrent training or I just.

have variety, but it basically said like, this suggests that the inhibition of mTORS as a result of the activation of AMPK by endurance exercises is likely not a molecular mechanism underlying the impaired hypertrophy and strength with concurrent training. So is it more in the realm of what you were talking about or was there another mechanism that was found out or they're still looking?

Keith Baar (58:50.965)

So there is still, we are still looking. So one of the things that's really interesting as far as the concurrent training effect is that the concurrent training effect has been diminished over the last say 20 years. So when it was first identified by Bob Hickson in 1980, if you go back and you look at the diet, the diet was around 0 .8 grams per kilogram body weight of protein.

Now when we look at the diet, it's up around 1 .2. So one of the things that could be explaining the fact that people are able to be more of a concurrent training athlete is that we're increasing the protein content. And so there's mechanistically some of what happens as we do lots of endurance exercise. Well, if we do lots of endurance exercise, we need to have lots of mitochondria. Those mitochondria are able to produce more energy.

But it also can lead to a little bit of, it shouldn't lead to any loss of efficiency, but it does mean that you need more caloric input to maintain that bigger muscle, more mitochondrial mass and all of that. Evolutionarily, when protein was a limiting thing, because we did not grow, you know, we did not evolve at a time where we go to the store and get a big bag of whey protein and just eat as much protein.

we evolved when we're eating tons of roots and maybe we get some meat from time to time. If you're in that situation, you don't want to have huge muscles that need lots of energy because that's going to be problematic. So there are a number of these, what we call molecular breaks that prevent us from growing our muscles really, really big, especially when we have more metabolic challenges like endurance exercise at the same time. So really we don't see it now until we get

to really high training loads. So we're about to see the Olympics soon. You're going to see the rowers. Check out the rowers, especially the eights. The women's eights are, they can be 80 to 100 kilos. These are big, strong women. The men are going to be, they're going to be 6 '6", 240, 260 pounds, like 100 plus kilos. They're training 30 hours a week to row.

Keith Baar (01:01:12.629)

to get the endurance capacity in order to do that. The performance as a rower is directly proportional to your body weight. So the more you can maintain your muscle mass, the faster you are as a rower. So when you're training 30 hours a week and you have to be big and strong, have to have lots of muscle, that's where we're gonna see that still, no matter what we do, we're gonna see that concurrent training effect. We're gonna see it in our heptathlon athletes and our decathlon athletes.

but we're not gonna see it in the Monday, Wednesday, Friday, exercisers who go to the gym and they do weights and that's not an issue. We're seeing it more about with people who do seven, nine workouts a week or do long distances. So there's not gonna be a lot of your ultra endurance athletes who lift a lot of weights and suddenly gain lots of mass because they're running a distance. It's gonna make it really, really hard for them to build muscle.

Dr. Beau (01:01:50.318)

Mm -hmm.

Dr. Beau (01:02:09.358)

Well, that is the big push. I don't know if you're familiar with Nick Bear. You know, that's his thing is basically bodybuilding or functional bodybuilding with ultra endurance. And again, I don't know the actual supplement routine or if there's any, you know, other aids there. That's not what we're talking about. But some of this gets talked about of like facet workouts and, you know, supplementation around there. One of the other questions I wanted to ask you on the, you know, facet workout state is,

There's a big push in the, I would say just the popularized training realm of like you need some sort of amino acid supplementation, essential amino acids, if you're going to do a fast workout, in particular if you're doing multiples a week. Is there any validity to that or what would the thought process be on why that's important?

Keith Baar (01:02:57.397)

Well, there isn't any need. And the reason for that is, it comes from a recent study out of Luke Van Loon's lab by Yorn. What they did is they did what they called the barbecue study, where they fed somebody 100 grams of protein, and they looked over 12 hours. And you could still see protein coming in, or amino acids coming off of that protein for 12 hours.

So what that means is that if I take a big bolus of protein, so I've done my overnight fast, I've done my fasted training, and then I'm going to deliver a huge amount of protein, that huge amount of protein, I'm going to be digesting and absorbing for a long time, especially if I'm taking it from a food source. If I take it from pure amino acids, what's going to happen is it's going to go in and out, because those get digested, absorbed really quickly, and they're removed from the body really, really quick.

If I take it from a food -based source, now it's going to take a lot longer for those to get in, and it's going to stay around for a lot, lot longer. So if you are going to do, say, you know, the people who do one meal a day, for example, what we're going to do is I'm going to do that one meal a day, and I'm going to do it right after my biggest training bout. So if I'm going to do my weightlifting in the afternoon, say, I'm going to have my one meal a day right after that.

So then I'm going to take in a big, huge bowl of protein. I'm going to be digesting and absorbing that for 12 plus hours. What's going to happen is that's going to come in and that's going to get delivered more to the muscles that I've just exercised because our blood flow is higher to those muscles for about two hours so that they can regenerate and pull in the metabolic things that they've gotten rid of so that they can replenish glycogen. They can replenish some of the other...

energy sources, but also so that they can pull up amino acids and build that muscle again. Then I can do my endurance exercise the next morning, for example. And now I'm in a pseudo fasted state, and that's going to provide me a good stimulus to get a big endurance adaptation. So if I'm doing, say, one meal a day, I'm doing my endurance in the morning, I'm going to do my strength right before my one meal a day.

Keith Baar (01:05:16.437)

That's going to deliver those amino acids to the muscles that I've worked. And then I've got 12 hours before I go back and I run, I'm going to be in a somewhat depleted state when I do that. That's going to give me my stimulus to get full adaptation there. If you're going to supplement with amino acids, it's not technically fasting, obviously, but you can do that.

Yeah. And if I'm going to do that, I would just do a whey protein supplementation. And that would be enough to maintain the protein component. And it's just like we had talked about before where the, the collagen, the hydrolyzed collagen is given a lot of times just as an unflavored, no vitamin C. That's because it's supposed to be an ingredient in something else. So what I do when I use whey protein is I get a unflavored whey protein that is nothing else.

So in one scoop of 20 grams, it's got 80 calories because there's no sweeteners, there's nothing else. It's just whey protein. And now what I can do is I can put that into something and I can use that if I just wanna, if I'm trying to have an aesthetic where I'm trying to change and I've got a really tight calorie budget. Now what I can do is I can use that whey protein as a way to kind of deliver.

however many amino acids I need in a leucine rich protein that's got all of the amino acids, that's gonna be a high quality protein that I can use, but I wouldn't normally do that because I would normally use food to do that. And I would, but, and if you're gonna do that, the reality is you're not doing fasted training because you've eaten a whey protein. And so yes, you're gonna do a low calorie training.

completely, but you can do that as a, you can do that with tofu, you can do that with other protein sources that don't have a lot of other calories in them, and that could be just as good for, because, but that's again, something that people are doing because of some aesthetic that they want to achieve. It's not necessarily something that would be health -based or that would be positive outcomes in the long.

Dr. Beau (01:07:34.638)

I would have to assume based on everything you've said that, and again, I'm just using the example of kind of the workout and then a, you know, fasted state overnight workout in the morning, that there's going to be a time dependency on that workout in terms of benefit, right? Because if you start pulling further into glycogen stores, does it become, does it negatively affect you at all? Or is, if let's say we're talking, somebody wants to go run 20 miles in a fasted state, is there a point where it's like, you do need glucose in the system?

to still run for that period of time or is there benefit to a long prolonged effort over an hour or whatever based on fitness of what's going to put you into that realm of basically going back into that like short burn cycle.

Keith Baar (01:08:14.901)

Yeah, so there's lots of training techniques that have used either some sort of low glycogen or just longer training. So Arthur Liddiard used to have people run 100 miles a week only in singles so that you would be running 20 plus miles. And the reason that he was doing that is because he knew that you would deplete the glycogen. And as you deplete glycogen, yeah, your performance goes into the toilet. There's no question about that.

But then you have to have other sources of fuels and those other sources of fuels are going to be fatty acids predominantly, maybe some ketones or other things like that. But as you're bringing those in, those require the mitochondria, whereas carbohydrate only partially requires the mitochondria. So it's a greater stimulus to the mitochondria if you're doing these long sessions that have that...

extra depletion to them. The problem is when we look at the body as a whole, what you're getting is you're getting a great stimulus for the heart and skeletal muscle in that situation of this adaptive stimulus. But if I'm only working out in singles once a day, what I'm doing is I'm getting only 10 minutes to 20, you know, 10 to 15 minutes of a positive signal to all of my connective tissue.

because my connective tissues adapt differently to training than my skeletal muscle and my heart. My skeletal muscle and heart, if I go out and train for three hours, they're adapting for three hours. If I go out and train for three hours, my tendons, ligaments, cartilage, and bone stopped adapting at the first 10 minutes. Now all you're doing is you're picking up fatigue or you're picking up tissue level fatigue that's going to cause breakdown, but you're not getting any positive signal.

And so this is something that I've talked a lot with Camille Heron about because Camille started her master's degree is in bone mechanobiology. And she knew from a long time ago that bone responded to as few as four to 40 stimuli. And that's all the bone would need in order to get the maximal stimulus to adapt. And what she had always figured is if she did two sessions a day, she would get two signals for her bones.

Keith Baar (01:10:39.253)

her tendons, her ligaments. That's the part that she and I talked about is it's very similar for tendon, ligament, and cartilage. So by splitting that into two, I still get a muscle stimulus. The muscle stimulus is still say, if I was gonna do 20 miles, if I did 20 miles once, I get one stimulus for everything. If I get 10 miles in two different pouts, I get two stimuli for my bones, tendons, ligaments, and cartilage. And I get the same stimulus for my heart and my...

and my skeletal muscle. So that would be, if I look at this from a holistic viewpoint, that's a much healthier for the system as a whole, because we're giving as many signals as we can to our connective tissues. And we're still getting the same adaptive signal to our heart and our skeletal muscle. So I would be much more inclined to do something like that.

Dr. Beau (01:11:33.07)

Mm -hmm.

Keith Baar (01:11:38.229)

If you wanted to do some of the sessions in a low glycogen to get a higher signal to the muscle in the heart, then all I would do is take the second session of a day, make sure that after the dinner that night just was protein and low carbohydrates, so protein and fat. We usually do like a fish with some vegetables, like some broccoli or some.

some other vegetables that are relatively low in carbohydrates as well. And now what we're going to do is we're going to have fish in that. And then the next morning when I get up to get my, to do my next session, now I'm in a low glycogen, low carbohydrate state. Now I've got that signal that you're looking for from your fasted training, but I haven't had the negative effects on the system as a whole. And so I would be much more inclined to do something like that than to do big long fasted workouts.

Yeah, you're really tough if you can do that. That's great. If it's all about toughness, fine. But if you want to get the most of your adaptation, if you split those into two and you do one of the situ one of them, your carbohydrate replete so that you've got lots of carbohydrate, you do some more performance based moves because now you've got more carbohydrate. You should be able to go faster. You should be able to maintain that for a little longer. But then after

Dr. Beau (01:12:34.67)

Mm -hmm.

Keith Baar (01:13:00.853)

maybe three sessions a week if you really wanted to do it that often, but two to three sessions a week after that evening bout dinner has protein and vegetables and they're relatively low carbohydrate vegetables and now the next morning when I get up and train now I'm getting that same kind of fasted signal but I don't have to do it every day and I'm getting a much more holistically healthy way of training.

to have the same contact level.

Dr. Beau (01:13:31.118)

So if we were to take that same concept of using time to have the biggest stimulus on, let's say the passive tissue systems, let's keep on tendons. So let's say in the clinical realm, if I had to extrapolate that, would it be correct in saying, is let's say I'm a PT, a chiro, and I wanna send somebody home with home exercises for their Achilles tendonopathy, reactive, degenerative, whatever stage it's in, would it be better then to have

multiple smaller sessions of those rehab exercises throughout the day, rather than like, hey, can we come into the office for 30 minutes, do work, and like you said, due to temperature change and hysteresis, we stop losing the effect. Is that a better programming idea or is that not quite right?

Keith Baar (01:14:14.325)

Right.

Keith Baar (01:14:17.973)

Absolutely. Absolutely. And I know the structure is a little bit more difficult because, yeah, we want to have patients in for 30 minutes. We want to do a whole session. But the reality is that if I'm doing that, if I'm loading, say, and if it's just Achilles tendon, I can load the Achilles tendon after about, you know, 10 minutes of load, that Achilles tendon isn't going to get any more positive signal. All I'm doing is building up the negative signal, which is, you know,

There's two signals that happen from any exercise. One is the positive signal that the cells sense the exercise. They sense the exercise because of mechanical stimulus, because of a metabolic signal, because of some sort of signal. And that signal to those cells in our connective tissues, our tendons, ligaments, cartilage, and bone, seems to last about 10 minutes. And after 10 minutes, we're not getting a further benefit of that exercise.

But every time we load that tissue, it's getting a little bit more fatigued. It's getting a little bit more likely that we're going to get some small little damage that we then have to repair. So if we know that the 10 minutes is all we need to get the signal for the cells to adapt, then our training can be 10 minutes. If you want to do it in a clinical setting, what you can do is you can do, okay, what we're going to do is we're going to do 10 minutes on the right leg.

We're just going to focus on right leg. We're going to do, we'll do a few more different things. We'll do not only the Achilles, we'll do the quad and patellar tendon. Maybe we'll do some hamstring work. We'll do that on the right leg. Then we'll do it on the left leg. Now we've done it two separate 10 minute sessions. Now we've, we've, now we've got a 20 minute session where we've actually done much more and we've gotten more stimuli into the, into the, into the art problem tissues.

And now we're gonna then do that again, say at the end of the day. So if I start with my physical therapy in the morning, I'm gonna learn those, I'm gonna do those at the end of the day. And if I can do them twice a day, maybe once a day at the start when my tissue is really reactive and I'm gonna get more inflammation and other things, I'm gonna do that once a day, 10 minutes. And then as I start to build, now I can build in a second bout where I can do those two things eight to 10 hours apart.

Keith Baar (01:16:41.941)

And yeah, that's what I'm sending my patients home with is they're going to have a training plan that's going to have these two bouts instead of one bout because those two bouts are going to give me twice what that one bout gave me. Even if the one bout is the same time, same time under tension, I'm still going to get two signals from those two bouts, say eight to 12 hours apart.

Dr. Beau (01:17:07.15)

Well, we're gonna turn you into a sneaky longevity expert because I also saw an article that talked about what was it? Titled train hard, not long. And it was talking about bouts of three minute exercise of higher intensity. This is for longevity, correct? Not necessarily performance outcomes. But we started thinking more general public training for life. And we start taking concepts, right? Concepts, few methods or many and say, hey, there's benefits to facet workouts.

Benefits to how you program your workouts and not just hey, I got to get my 10 miles But maybe you know time dependency it's easier to do five miles in the morning five in the evening instead of having to do You know an hour and a half in the morning in terms of intensity You know we could talk about running or weightlifting whatever it is if we talk about intensity What what was the verdict you know out of that paper? Maybe there's been multiple papers looking at intensity over duration

Keith Baar (01:17:46.709)

Yeah.

Keith Baar (01:18:02.933)

Yeah. So again, part of what we're looking at here is that especially as we age, there's a number of different things that we have to take into account that happen within our tissues. The first thing is we all begin to lose this protein dystrophin that we know about because of this disease muscular dystrophy. And what that protein dystrophin does is it pins all of our muscle fibers together so that they work as a unit.

And when there's less dystrophin, you get more sliding. And as you get more sliding, you get more little holes in the membranes of the muscle and you get more damage that leads to soreness. So what you'll hear from older athletes all the time is I do the same workout, but I get more sore and it takes me longer to recover. Yes, because what happens is you're now getting, there's now less dystrophin, you're getting more sliding, you're getting more injury. And when we rebuild,

instead of when we were young and those fibers were held together tightly and they would move as a unit and there would be no damage, when I'm going to have my protein synthesis response after exercise, if I haven't damaged anything, I can build that muscle fiber bigger because that same amount of protein synthesis can make the muscle bigger. If I've had a slide, if I've had shear that's caused injury, now what I have to do is I have to regenerate. So instead of getting the same rate of muscle growth when we're older,

we get a slower rate of growth because we have to regenerate or repair the proteins that were injured, okay, and repair the muscle fibers that were injured. So that's one component of it. The other component of it is we tend to, maybe probably not your listeners who are, who probably do a lot of loading, a lot of exercise, but most of us in the population are becoming more insulin resistant.

One of the reasons that insulin is important is it what it does is it opens blood vessels that supply amino acids to muscle beds to allow us to synthesize protein. As we become more insulin resistant, we need to use other stimuli other than insulin to deliver the blood to the muscles that we want it to go to. That's where exercise comes into. We're using exercise as a way to deliver those amino acids much more as we're older.

Keith Baar (01:20:26.549)

What we see in young individuals is we do an exercise about today, protein synthesis is up, stays high, and then it actually stays high up to 48 hours later. When we look in older individuals, it goes up about the same, but it comes down much faster. So that would suggest that we maybe need to exercise a little bit more frequently, and it's probably because insulin resistance is higher. So we...

The reason that protein synthesis stays high is because insulin is helping to deliver amino acids and we're getting that highest protein synthesis in the younger muscle. So those things all go together. And then the last really important bit is when we just take people who are older who don't do anything, what they do is they lose the fast fibers first. We lose type 2A fibers because we have to, in order for us to recruit those type 2A fibers,

Dr. Beau (01:21:17.102)

Mm -hmm.

Keith Baar (01:21:24.789)

we have to go faster. Okay, so there's this thing called the Henneman's Size Principle, which is my brain's gonna send a signal, and the faster the signal goes, the more important it is, so that what I'm gonna do is the faster the signal, the bigger and the more motor units I get. And the bigger motor units are the ones that are the fast motor units, the two A's, the two X's. So if I wanna get those, because I'm getting...

older and I don't want to lose my type 2A fibers, the way that I can do that is I can either lift a heavy weight or I can go faster than I feel comfortable going. So if I just go out and I walk at an easy pace, which is what doctors usually tell people when they say exercise, that's not going to be useful for things like brain health. For brain health, we actually have to go faster than we feel comfortable going. And that's what I was referring to for these some of these longevity.

things is that it's going to be important that we, for us to deliver amino acids to the muscles that we have. But not only to the muscles themselves, but to the muscle fibers. So if I use my type 2X fibers, I am going to deliver more of the amino acid that I've eaten to the muscle, to the type 2A fibers. And so those are going to stay bigger. I'm going to be able to maintain my strength and a little bit of my speed for longer. So all of those things tell us that as we get older and

Dr. Beau (01:22:48.526)

Mm -hmm.

Keith Baar (01:22:51.797)

Again, the brain health component is really important, especially for people who have neurocognitive history in their family. Part of what happens is if we just put people on a generic exercise plan, they're going to go out. They're going to exercise at a comfortable rate. They're going to walk along. They're going to talk to their friends. That's great for your heart because at 40 % of your max, your heart is stretched fully. I'm getting a really good signal to my heart to have good adaptations.

The problem is that we've never seen positive changes in neurocognitive behavior or Alzheimer's disease or Parkinson's disease with self -selected pacing. But when we go over speed training, so we go faster or harder than we feel comfortable going, now we see that Parkinson's can be improved by that. We can see that Alzheimer's disease, you get improvements in brain function specifically within the regions that are affected by some of these diseases.

So the reason that we talk about going harder or going faster when you're old is because most of the time we tend to say, you're old, you shouldn't do anything. You're old, you shouldn't lift a heavy weight. We're gonna give you these little tiny weights to do. Don't wrap your old people in bubble wrap. All that's gonna happen is they're gonna die sooner. The best example is we all say, you're old, we're gonna move you out of your two -story house into a one -story house.

Scientific evidence shows that when you do that, the person who moves from two stories to one story, they die sooner than if they had stayed in the two story house. Because the struggle to go up the stairs multiple times a day, that's a higher intensity exercise. Going up the stairs is what keeps them alive. We know that one of the biggest things, one of the best predictors of longevity in humans is our muscle mass and strength.

Dr. Beau (01:24:25.166)

Thanks.

Dr. Beau (01:24:36.43)

Mm -hmm.

Keith Baar (01:24:43.989)

So why would we take somebody who is building their muscle mass and strength by going up and down the stairs? Yes, we're worried about them falling, but the biggest thing that we can do to prevent falls is to help them get strong. So if you're stronger, you actually have better balance. All of these things are gonna be all wrapped together. And so when we look at it, we gotta take bubble wrap off old people so that they can go a little bit harder than they feel like it. It's gonna be good for their brain, their heart. It's gonna be good for their skeletal muscles. Everything.

And then maybe what we're doing is we're exercising a little more frequently because it comes back a little bit. We don't have to go hard every single time. We just have to do enough to get blood flow to the muscles that we want to keep so that we can get delivery of what we eat to those muscles. And doing small bits of exercise is a great way to do that.

Dr. Beau (01:25:19.854)

Mm -hmm.

Dr. Beau (01:25:38.766)

Well, not to mention, I mean, there's benefits from a hormonal standpoint with, you know, lifting heavy weights and I mean, which, you know, now we talk about osteopenia and parosis and yeah, I mean, we could go on and on and on on the benefits and you know, there's benefits and that's the big thing. And the sad thing is, yeah, we need to remove the bubble wrap from our, you know, older population, but kids, I mean, the, the lack of movement vocabulary and the reductionist nature of, you know, whether it's, you know,

not specialization, but just kids don't have a huge movement profile at an early age now. And then we see that they have kind of an avoidance to these activities for the rest of their life from it. So it's like, it starts early of getting them used to it, but then not stripping it back away from them in a protective nature later in life. Well, I'll absolutely be burned at the stake if I don't ask this question by some of my colleagues. So the donut hole theory of, you know, how a tendon heals.

Keith Baar (01:26:22.997)

Yep.

Keith Baar (01:26:34.773)

Mm -hmm.

Dr. Beau (01:26:36.11)

Is that still the best model we have? Is that what's actually happening? Cause I know there's been some case studies that you've either been an author on or co -author of, that's not always the case based on whether it's supplementation or I believe some different loading protocols, but is that still basically the model that we should all be thinking is occurring when we see a tenopathy at hand?

Keith Baar (01:26:58.997)

So a tendinopathy is basically when load isn't going through a certain part of the tissue. So I can produce a tendinopathy in a matter of days by putting you into a boot, immobilizing you for a certain period of time. If I look at the tendon structure, it looks much more like a scar after that than it does like a healthy tendon. There's a really nice, so we've done a bunch of...

studies on basically what that suggests is that if there's no load going through a tendon, the tendon starts to look like a scar. What do we mean by a scar? Well, there's more cells in the tissue. The collagen fibrils themselves are smaller and the orientation of the collagen fibrils isn't as aligned. And there's a guy named Hayashi, he's a Japanese professor and he basically produced, took a healthy patellar tendon in rabbits.

stuck a metal wire through the patella, through the tibial plateau, and just tightened it enough so that there was no tension on the patellar tendon. Within seven days, the orientation of the collagen had changed. There were five times more cells. All of the things that we would consider a scar, he had produced in a perfectly healthy tissue that had seen no injury mechanism. We've done the same here in Davis using a rat model. We've seen it across all kinds of different situations.

When you remove tension, you produce a scar. So what happens normally in a tissue, in a tendon, when I get some damage and there's some injury, we break some collagen fibrils. And we do break collagen fibrils. Do we see the ends of collagen fibrils when we look using electron microscopes? No. But I can also produce a collagen gel in my lab by taking a solution of collagen, changing the salts.

and it'll produce a collagen gel. And if I go look for ends of collagen molecules, I won't find them. Why? Because collagen is an extraordinarily sticky tissue. And so what happens is that the little collagen molecules, any ends that are there are just going to stick to whatever's closest. And so you'll never find an open end because it's so sticky that's going to stick. So yes, you break collagen fibrils or you break collagen molecules.

Keith Baar (01:29:21.525)

And now what we've got is an area that is got some untethered and around it you've got perfectly normal collagen. As I change the directional orientation of the collagen because they break and now they stick to whatever they're close to. As that happens, now what I've done is I've changed the orientation of the collagen. And so what that means is if I pull on that, it takes longer for the orientation to get back to linear. And that's when it's stiff.

because that's when I'm loading the backbone of the collagen. So if I've got this region that has to do this before it can get tension on it, or in parallel with that, I've already got a region that's perfectly straight and can take the load, what happens is the load goes through the healthy part of the tissue in a process we call stress shielding. So when I've got a stiff tissue and a compliant tissue in parallel with each other, so that they go side by side,

And if I load them equally, all of the load is going to go through the stiff tissue. Because it's stiffer, as I go to load it, that's going to deform less. Well, it's going to deform and the one that is less stiff isn't going to feel any tension at all. Okay? That's just the way any tendon is going to work. So if I've got a tendon, especially a big tendon like an Achilles or a patellar tendon.

And if that damage happens in the center of the tissue, what happens now is the center isn't going to feel any of the tension because the tension is going through the sides. But as I pull it longer, it's actually going to get skinnier because the tissue is isovolumetric. So now the strength, all the strain is happening to the healthy part and it's being pulled together. So what you get is you get compression of the middle and you get tension on the side.

And the result is that you're compressing the cells within the center of a tendon. The cells in a tendon are the same from the same mother cells as the cells from our cartilage. So if I compress a tendon for any period of time, Catherine Vogel had shown this beautifully that if I compress a tendon, what happens is the cells start to produce large proteoglycans just like their collagen.

Keith Baar (01:31:47.413)

What do those large proteoglycans do? They suck water into the tissue. So now I've got a central core tendinopathy. I've got strong parts. And then I've got this compressed region. That compressed region is going to show me water. And so when I image using MRI, using ultrasound, I'm going to see a hole and I'm going to see a donut. And traditionally everybody says, well, treat the donut, not the hole. Well, that doesn't, that doesn't get you that.

never fixes the tissue. So what you have to do is you have to treat the hole. The way that you treat the hole is by understanding that the tissue is viscoelastic. And what that means is if I pull on it and I hold it, the healthy part of the tissue is really stiff at the beginning and then it's going to exponentially decay in its stiffness. And as it goes down in stiffness, what happens is it becomes less stiff than the scar.

Dr. Beau (01:32:18.542)

Mm -hmm.

Keith Baar (01:32:45.525)

And now what's going to happen is the scar is going to feel a tensional load, which is what it needs in order to fix itself. So if I hold a relatively lower intensity isometric for 30 seconds for even longer, what's going to happen is the healthy part that's shielding stress, shielding the injured part, that's going to relax. Now I'm going to get tensional load through the injured part. Remember I said that it only takes 10 minutes of loading.

to give the signal to those cells. So if I do four 30 second isometrics where I hold my tissue, so if I have a patellar tendinopathy, if I do say a Spanish squat or if I do an isometric leg extension and I'm just gonna pull on it and I'm gonna put load across it, I'm gonna do that for 30 seconds. Say it's an overcoming isometric, I'm gonna push out. You can do it as hard as you can, you can do it at 80%.

Dr. Beau (01:33:16.302)

Mm -hmm.

Keith Baar (01:33:42.037)

We haven't seen that it makes a really big difference. It's really the time component. And so I'm going to hold it for 30 seconds to 40 seconds, somewhere in there. Now what I'm going to do is I'm going to take a two minute rest. I'm going to do that again. I'll get four repetitions. That'll give me eight minutes of work. That's close to my 10 minutes. If I do that, what happens over time is I'm getting the signal to the central core that there's a directional load that comes across here.

And now it can actually start to synthesize a directionally oriented collagen in the place where that hole used to be. And it's not... Go ahead.

Dr. Beau (01:34:17.006)

And even though there's fluid within there, the tensile load overrides the compressive force against the fluid in that scenario.

Keith Baar (01:34:24.404)

So what happens, what happens, remember, viscoelastic means that what part of what I've got is the stiffness is the, is the liquid component. So if I hold it for longer, what happens is as that continues to lengthen, the fluid from in there is actually lost from the tissue to some degree. This is how we use loading to decrease inflammation in a connective tissue. So exactly. So I don't ever, I don't ever do big anti -inflammatories.

Dr. Beau (01:34:36.878)

dissipate.

Dr. Beau (01:34:42.67)

Yeah. OK.

Dr. Beau (01:34:47.726)

It's like ringing a sponge. Yeah.

Keith Baar (01:34:53.749)

What I'm going to do is I'm going to load and I'm going to hold because as I hold and load, what's going to happen is it's actually going to squeeze out all the liquid that's in there and then I'm going to release it and I'm going to do that again. And as I do that, what it's doing is it's squeezing out the sponge. And so over time, you're not going to suck in as much fluid because now what I've got is I've changed the material properties. I've given the right signal to that central core. And instead of making proteoglycans that are going to hold water, it's now going to make

collagen one in a directionally oriented manner, and it's going to regenerate that area of the tendon that has been damaged. And we've seen that happen in some of our case studies within seven weeks. That it's, that you've completely filled a hole in within the patellar tendon. And these are significant injuries within elite athletes. So it doesn't take a huge amount of time to do it. You just need to get in there and get load through that tissue.

that's going to allow stress relaxation for the donut. And then it's going to put load on the hole, directionally oriented load that is in the direction of that tendon. Because that's the signal that the cells are now going to use to directionally orient the matrix they make. And because they're being loaded in tension and not in compression, they're going to make type one collagen, and they're going to decrease the production of proteoglycan.

Dr. Beau (01:36:19.534)

So you said in the absence of load, you see a proliferation of cells within the tendon. But wasn't it Cubos article that looked at the cross sectional area of muscle versus tendon and offloading and you see the cross sectional area of muscle stays the same for six weeks, whereas tendon decrease in that same period. And wasn't that the whole drive for the non -off season for the NBA athletes and the rampant patellar tendinopathy?

Keith Baar (01:36:45.301)

Yeah, so, yeah, there's problems with that because anytime you offload a muscle, so again, Luke Van Loon's lab has shown that you lose about two kilos of muscle mass over five days from the quads. So, and that's with immobilization, but when you offload, you're gonna lose a fair bit of muscle. But what we've shown in our...

rat model is we lose about 10 % of the muscle mass over a handful of days, but we lose 20 % of the collagen mass. So yes, the tendon is actually, and Luke has shown that if he takes all of the tissues of the knee out, that the turnover rate of the achilles, or sorry, of the patellar tendon and of the anterior cruciate ligament is actually higher than skeletal muscle. It's almost twofold higher. So it's not surprising that then we're going to see collagen go down faster than we're going to see muscle go down.

And yes, this would mean that I don't want to have a period of time where I'm not loading my tissues. So if I'm a throwing athlete in baseball, they always shut you down for a period of like four months, no throwing. Well, that's horrible because those tissues, ulnar collateral, ligament, all of the tissues within the shoulder, you're going to atrophy for four months. And so then I'm going to start throwing again.

Dr. Beau (01:38:02.542)

Mm -hmm. And then you keep the force productions, the force production stays relatively high even in the face of a loss of some muscle mass. So now we can still, yeah.

Keith Baar (01:38:10.389)

Because there we're using we're using our fascial spring. We're using we're getting all of this velocity from from this fascial component But the tissues are no longer strong They're actually quite brittle because they've lost collagen mass and they've become a little bit more cross -linked And so that makes them more likely to get injured So a lot of the things that we've traditionally done as again healthy. we're gonna keep these people healthy. So we're gonna

You know, we're going to keep our old people from lifting weights or from doing stairs. We're going to keep our athletes from throwing or jumping in the off -seat. All it does is make them much more likely to get an injury in the future.

Dr. Beau (01:38:49.198)

Yeah, which is a interesting irony, but it pays the resiliency of humans and that we're constantly adapting one way or the other, right? Adaptation is neither negative or positive. It's just the direction you apply force or input. I don't want to take up too much more of your time, but I always ask these two questions to kind of end with. You can take them in whatever direction you want. The first one would be,

Keith Baar (01:38:58.197)

Okay.

Dr. Beau (01:39:14.766)

What is something that you long held true or believe that you have completely changed your mind on in the last maybe year or two? Is there anything that stands out?

Keith Baar (01:39:24.405)

So I'm going to open it up beyond a year or two. I used to, as a beginner, because I started in muscle, I thought that in order to get stronger, I needed bigger muscles. And that has completely and utterly changed. I can get people to be bigger and to be bigger without getting stronger. I can get people smaller that are significantly stronger and I can do every in between. So this relationship between muscle mass and strength.

is not nearly as linear as people or as I used to think it was.

Dr. Beau (01:39:58.83)

So what is the, so let's say we have somebody that gains no or like very little muscle mass or size but becomes exponentially stronger. What is the mechanism at play then?

Keith Baar (01:40:09.237)

So a lot of it is, again, there's two components that people focus on. Actually, there's one component that people focus on, muscle mass and then the neural component. Everybody's like, well, your brain is doing it. I don't think that those are the two components. I think that those are two. The last one is the force transfer component. And we've got data that we've just generated in about 600 rock climbers where we do a low force isometric where they put partial body weight.

on their fingers and they hold the partial body weight. It's like between 40 and 80 % of their body weight, just so that there's tension across the forearm muscles. And they do that for 30 days. They increase strength the same amount as if they hang as much weight from their body as they possibly could and do max hangs. And when you do the two of them together, they're additive, which means that when we're doing the heavy, heavy lifting, our brains...

are activating the muscle more and our muscles growing. When we're doing the light one, we're working on that force transfer component. When we do them together, we're getting a bigger increase in strength because those three components are actually what we have for strength. So when we're getting somebody who is getting stronger but not getting bigger, we're affecting how their connective tissue or that force transfer component of how they're doing the movement.

Dr. Beau (01:41:33.07)

Yeah, I cannot remember which paper it came from, but there's beautiful visualization of the windlass mechanism of the foot talking about those three subsystems playing together to create really good like, you know, drive or high threshold drive with a runner. So yeah, I love that. Okay, the flip side is what is something, and again, you're a researcher, this is literally what you do, but what is something that you think is true or this is the way it is, but there's no evidence to support that quite yet.

Keith Baar (01:42:02.965)

Keith Baar (01:42:08.245)

I don't know. That's a good question. So one of the things that we have recently shown is that there are specific pathways that are important in tendon growth. So in tendon hypertrophy, so it gets bigger. So we've just had a paper that shows that there are a class of drugs that can increase basically the cross -sectional area of a tendon.

We have preliminary data and we think that it's true that there's a different pathway that actually helps the tendon get longer during development, but also might be at play, say, after an Achilles tendon surgery where we get a longer tendon. And so we think that there's a nutrition molecular pathway that works that way that's important in tendon lengthening. It would be really interesting to look at in young athletes and in young people.

because if you can get the tendons to grow a little bit longer, maybe even just increasing collagen production as well, you might make taller athletes, you might make people with longer tendons who are more efficient and faster. So there's a little bit about that that we haven't done enough to know, but there's at least some hints that it might be possible.

Dr. Beau (01:43:25.006)

even that spurs my interest in you know 12 year old you know basketball player dealing with Oshkin slaughters you know that the growth the bone growth is outpacing tendon and we get it you know apophysial kind of traction so that yeah i think there's multiple applications to something like that

Keith Baar (01:43:37.397)

Yeah. That's one situation where the hydrolyzed collagen and gelatin has worked almost always for me. So my daughter was a big soccer player when she was like 10 to 12. All of her teammates were having either Achilles enthesotomies or Osgood's Flatter. Within two weeks of putting them onto hydrolyzed collagen and vitamin C, it would almost always go away. Like we didn't have a stick like the George.

Dr. Beau (01:43:46.798)

Really?

Dr. Beau (01:43:51.854)

Mm -hmm.

Dr. Beau (01:43:57.038)

and

Dr. Beau (01:44:05.198)

I hope you have stock in a company because if you don't and I post that, it's going to start flying off the shelf. Yeah, which is a good thing to know. It makes sense. And we talk about, you know, there's just a huge epidemic of just calorie deficiency within youth athletes. And then you talk about nutrient deficiency on top of that are in parallel. So knowing specifics like that are important.

Keith Baar (01:44:29.333)

And most young people don't like to chew their food and when you have to chew, because it's grisly, that's when you get the normal way to get collagen. So if you're avoiding all of those types of things, then it wouldn't be surprising that there are limitations based on intake that you can reverse really quite quickly, especially in growing individuals.

Dr. Beau (01:44:55.342)

Very interesting, all right. Well again, I know you're a very busy guy and I can't tell you how much I appreciate. I've been a fan of yours forever. I've been quoting your research articles in my classes, trying to get the word out to more people in my profession. So I just wanted to kind of give you a kudos. Obviously I know you're gonna keep doing this, so I'll keep tabs on you. Any last parting words or anything else that you're wanting to kind of leave the audience with before we jump off here?

Keith Baar (01:45:23.157)

No, that's great. Thank you for those kind words and thank you for having me. And then, you know, as things come up, I continue to post things. The only time that I actually go on X now is to actually post when there's some new stuff coming out of the lab. But we try and get that out there and we try and do everything that we publish as open access so that everybody can get to it so that it's not behind the paywall.

Dr. Beau (01:45:41.518)

and then.

Keith Baar (01:45:50.229)

And then if there is anything that's old that's behind a paywall, you can feel free to email me and I'll send it to you.

Dr. Beau (01:45:57.07)

I appreciate that. I'll put links to obviously what social media have out there. Some of the links, which a lot of these, like you said, are full text, non -paywalled. I'll put links to anything that we discussed specifically. Again, thank you, Dr. Barr, and hopefully I'll be able to talk to you sometime in the future and catch up with you on what you've been working on. All right, well have a great day. Thank you.

Keith Baar (01:46:16.085)

Sounds good. You too. Take care.

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