Episode 24: Doug McGuff talks about resistance training, myokines, strength and health

One could say that Dr. Doug McGuff is one of the pioneers of BMX motocross bike racing in Texas. He built the state’s first race track, having gotten hooked on the sport as a teenager in the 1970s.

The sport also triggered a deeper interest in fitness. As McGuff tried strengthen his core for bike racing, he discovered Arthur Jones’ Nautilus training technique and bartered janitorial services for a Nautilus gym membership.

McGuff’s interest and aptitude for studying the body led him to pursue medicine at the University of Texas in San Antonio. He specialized in emergency medicine, was chief resident of emergency medicine at the University of Arkansas in Little Rock, and a staff physician at Wright-Patterson Air Force Base Hospital in Ohio. McGuff is currently an ER physician with Blue Ridge Emergency Physicians in Seneca, South Carolina.

The other side of McGuff’s career is dedicated to fitness, or as he says—helping people never have to go to the ER. Realizing a lifetime dream, he opened up his own fitness facility in 1997 called Ultimate Exercise. The gym is dedicated to the type of high-intensity fitness training using the Super Slow protocol.

In this episode of STEM-Talk, McGuff talks about why this type of exercise is better for the body, safer, and able to prevent age-related conditions such as sarcopenia.

McGuff is the author of three books: “Body by Science: A Research-Based Program for Strength Training, Body-building and Complete Fitness in 12 Minutes a Week,” http://amzn.to/2fy7vKN (co-authored with John Little), “The Primal Prescription: Surviving the “Sick Care” Sinkhole,” http://amzn.to/2fLTBtl (co-authored with economist Robert Murphy), and “BMX Training: A Scientific Approach.” http://amzn.to/2fUhqPd

He is also featured in several YouTube videos on high-intensity training. His recent IHMC lecture, entitled “Strength Training for Health and Longevity,” is available at https://www.ihmc.us/lectures/20160929/.

2:03: Dawn reads an an iTunes 5-star review from “Guy who likes Chipotle,” which is entitled “Interesting and just complex enough.” “STEM-Talk does an amazing job of delivering high-level information on a variety of topics, without making it too complex to understand.”

4:21: Dawn introduces Doug and Ken.

4:47: McGuff says that as a young teen, shortly after getting interested in BMX bike racing, he started working out with his brother’s weights, which was transformational. “It is still the closest thing to magic or a miracle that I’ve ever experienced in my life.”

6:44: Also as a teen, Doug McGuff bartered janitorial services for a membership to a Nautilus gym, where he found a copy of a book by Nautilus founder Arthur Jones  (https://en.wikipedia.org/wiki/Arthur_Jones_(inventor)) about training principles. “It was the first book I ever read cover to cover. To say that book changed the course of my life would be a massive understatement.”

8:13: During the summer of 1994, McGuff met Arthur Jones, who greatly influenced his thoughts on exercise resistance training.

12:00: McGuff went into ER medicine because “It was rare to find something that I felt that I had intrinsic talent in. I felt like I functioned very well in that environment.” His career has focused on two things: taking care of people who fall down and get hurt; and trying to prevent it from happening in the first place.

13:00: McGuff talks about being a pioneer of BMX in Texas, as he built the first track there and went back to racing in the late 90s and won the state championship. He also trained some world champion level BMX racers.

14:30: Now he characterizes himself as “a practicing physician so busy with the chronically sick and massively debilitated; the chasm between day to day life and actually thinking about prevention is such a wide chasm that it’s hard to imagine.”

15:00: “I would love to see the day where the commercial says, ‘Ask your doctor if diet and exercise are right for you….’ Instead of whatever pill of the day.”

15:44: McGuff notes the idea of physiologic headroom, which economist Arthur De Vany came up with. “Physiologic headroom is the difference between the least you can do and the most you can do.” See De Vany’s book, “The New Evolution Diet”: http://amzn.to/2ewDOJ8

17:50: “The better part of our lives, in terms of our functional ability, are much less than what they should be.”

18:45: McGuff says that high-intensity interval training is what appears to reverse the biomarkers of aging, according to the literature on the topic.

21:00: In McGuff’s book, “Body by Science,” (http://amzn.to/2fy7vKN), he presents the concept of Super Slow training: lifting and lowering weights very slowly. This protocol emerged out of Nautilus, after Arthur Jones commissioned a University of Florida research study on osteoporosis. Ken Hutchins, an employee of Arthur Jones, was the primary person who defined and popularized the Super Slow form of resistance training exercise.

22:40: The protocol applied to younger subjects resulted in similarly good results.

23:18: More important is the style and intent (of lifting weights). “If your intent is to as intensely and deeply fatigue the muscle as you can…if you start weight-lifting with as gradual a load as possible, and then you just try to lift and lower with high effort, during that initial phase, depriving yourself of initial momentum allows the speed to express itself organically.” In one person, that cadence might be 4 seconds up, 4 down; or 8 up; 8 down. In most people that ends up being 10 seconds up; 10 down.

25:03: Commercial break: STEM-Talk is an educational service of the Florida Institute for Human and Machine Cognition, a not-for-profit research lab pioneering ground-breaking technologies aimed at leveraging human cognition, perception, locomotion and resilience.

25:23: Ken talks about the importance of avoiding injury when exercising and posits that Super Slow should be good in this respect.

25:48: McGuff says that he opened his gym, Ultimate Exercise, in 1997. They average 100-120 workouts per week. “We’ve never injured anyone in the facility…. That gives some credit to a slow cadence protocol. You can still get hurt [during a slow cadence protocol] if you don’t observe good biomechanics.”

26:40: The mastermind of “congruent exercise” is Bill DeSimone (https://en.wikipedia.org/wiki/Bill_DeSimone), which is based on using biomechanics to prevent injury.

27:45: At his gym, McGuff tells his trainers: “train ‘em hard as hell, don’t injure anyone, give them adequate recovery.”

29:00: “When we talk about sarcopenia, the population has it in their head that it’s a natural consequence of aging. And it’s not. Sarcopenia is a natural consequence of aging with our modern Western lifestyle injected into the equation.” McGuff notes this did not happen in hunter gatherer societies. “That doesn’t mean modern tech cannot be exploited to leverage those evolutionary adaptations.”

30:10: Age-related sarcopenia occurs when there is atrophy in the type II muscle fibers. “When you recruit muscle to do work, that happens in an orderly and sequential function.” You start with lower-order muscles to do work. Finally, you recruit higher-order muscles, which produce a lot of force output, but they fatigue very quickly. The latter are hard to get at, so you have to produce fatigue in a disciplined fashion.

32:54: An elderly person loses balance because if you go off the vertical plane (not on bone and bone tower), the only way to right yourself is by activating very powerful muscles to correct that posture deficit. “They fall because they don’t have the fast-twitch IIB fibers to yank them back into corrective posture. That’s why they go down like a tree in the forest.”

34:00: McGuff defines exercise as protocolized strength training; disciplined and aimed at achieving a deep level of fatigue rapidly. You can’t stand more than 12-15 minutes of that intensity. You want the minimal effective dose.

35:07: “Most people think of exercise as directly causing the adaption. The exercise produces the stimulus; your body receives it and makes a physiologic adaption.”

35:40: “I make a clean distinction between exercise and activity.”

36:41: “Once you create this physiologic headroom, you want to use it. It’s like having a Ferrari and being restricted to the school zone. It just doesn’t work. That’s not a bad thing.”

37:30: McGuff talks about muscular failure, a term coined by Arthur Jones meaning lifting and lowering weight, and getting to a point where you are trying to lift weight, but it won’t go. The problem is that failure in and of itself does not necessarily define an adequate stimulus. The desired stimulus is a meaningful depth of fatigue, or a substantial reduction in one’s starting level of strength. In the gym, one may reach muscular failure in a particular exercise without reaching an adequate depth of fatigue.

41:25: Ken notes that the Super Slow protocol, as described in McGuff’s book, is performed exclusively on machines, and asks whether this training transfers to what are sometimes called “real world” functional movements and basic movement patterns (squat, hinge, push, pull, carry).

41:50: “When people talk about functional movements and movement patterns, I find that they are fairly ill-defined. Human movement in a functional sense is inherent to our physiology and anatomy. What is necessary for those to express themselves in real world applications is that you have to have a motor that is able to drive the movements of that appendage.”

43:00: “The notion that you have to recreate those functional movement patterns in the gym under load for those functional movement patterns to be expressed out of the gym is a little bit of a false construct. Some of those natural movement patterns, when done under load, are very joint incongruent.”

44:47: Ken and Doug note that confusing “sport” and “exercise” can be dangerous.

44:55: Dawn asks Doug about low intensity training as typically prescribed for the elderly.

45:15: Exercise recommendations for the elderly are often off-base. People making them don’t understand how to invoke high-intensity and low force at the same time. Being physically active at a low level of intensity is part of our evolutionary and biological background. If you get at those IIB fibers, that type of activity expresses itself organically.

46:40: What happens is that you carry out a type of long-term, low-intensity activity that says: This animal is carrying out chronic low-level activity. This becomes interpreted as a negative thing—the stimulus to lose type IIB muscle fibers rather than gain them. “In the long term, you’ve jettisoned one of largest glucose reservoirs in your body, and you have therefore undermined insulin sensitivity.” This accelerates sarcopenia.

47:20: Ken notes that one often sees this adaptation in marathon runners. McGuff, says, “That is why marathon and ultra-endurance athletes look cachexic … because they delivered a biological stimulus to their organism that says these type-IIB fibers are unnecessary for this activity and we need to get rid of them.”

48:12: Dawn asks about exercise while traveling and without good access to good equipment.

48:30: Doug, replies that “We’ve gotten the notion that weights are a necessary part of the equation, and they really aren’t. Through infimetrics, I can provide an intensity of workout that exceeds one with weights. It’s hard to describe in a podcast, but Google McGuff’s name and timed static contraction protocol or infimitric YouTube videos.

50:00: Ken notes that Blood flow restriction training, such as Kaatsu, increases localized IGF-1 levels and sensitivity via accumulation of metabolites, particularly lactate and H (+) and asks if McGuff thinks this type of training is useful.

51:53: Doug discusses blood-flow restriction training, which can produce equal hypertrophy and strength adaptions using a much lighter weight. The theory is that you are concentrating the by-products of metabolism that occur during exertion locally within the muscle, for example the entrapment of local IGF production.

52:46:  “I think it is of benefit from several standpoints, one is the fact that it requires less resistance to get an equal result — that increases the safety margin and increases the safety margin for extremely strong people.”

53:37: When you use a slower-cadence protocol, that creates a high degree of sustained muscular tension that produces vascular congestion within musculature that traps metabolites in the same way blood flow restriction does.

54:48: Ken says he’s had good results using blood flow restriction (using the Kaatsu system). He particularly appreciates blood flow restriction training for those with painful or compromised joints given the very light weights.  Also, hotels often have a very limited selection of relatively light weights, which are no problem with blood flow restriction.

55:18: Dawn asks whether electrical muscle stimulation (EMS) training might offer promise as a way to safely hit fast-twitch muscle in all age groups and whether McGuff has experience with EMS?

55:40: Doug discusses his experience with EMS and thinks it does let you hit the fast twitch fibers.

57:07: When you lose motor units, body starts to disconnect enervation of motor units.

57:52: Elderly with sarcopenia also have deconstructed this neuro-motor connection to higher-order motor units. “Where EMS is useful as a therapeutic modality is being able to activate type IIB motor units at the end of the set, so when they reach fatigue, that’s not fatigue like a younger person who still has that connection intact. You could invoke EMS at the end of the set to wake back up those type II motor units. The enervation of those motor units wakes up as well.” He says this is a “stop-gap measure to rehabilitate the enervation of higher-order motor units.

58:55: Commercial break: STEM-Talk is an educational service of the Florida Institute for Human and Machine Cognition, a not-for-profit research lab pioneering ground-breaking technologies aimed at leveraging human cognition, perception, locomotion and resilience.

 59:20: Ken mentions that Brian Caulfied at University College Dublin has been doing interesting and important work on EMS in both athletic populations and older cohort groups.

1:00:00: Ken says he’s optimistic about the future of EMS as new companies, such as PowerDot are offering systems that run on smart phones, etc.

1:00:39: Doug notes that people often “conflate athleticism and health.”

1:02:26: Ken notes that myokines have both local actions within the muscle tissue but also hormone like effects that target distant organs.  He asks McGuff to discuss the role of myokines in exercise and the adaptations that occur as a result.

1:03:00: Resistance training is much greater than the sum of its parts.

1:04:30: Skeletal muscle is not just a tissue that produces movement. The muscle is the biggest and most active endocrine organ in our body; there’s a whole host of myokines—probably only of which a handful have been discovered. They are signaling locally and remotely—skin, hair, nervous tissue, cardiovascular system.

1:05:27: “The signals are going everywhere, and very few of them have been delineated thus far…. but the health benefits are becoming more and more obvious.”

1:05:46: The cytokines released by muscles have profound anti-inflammatory effects: they are the antithesis of metabolic syndrome and have anti-neoplastic effects. They are protective and reversive of neoplastic changes. “There’s a treasure trove there.”

1:06:30: Dawn asks about the role of myokines in tumor growth/suppression.

1:08:30: Doug says myokines have been found to arrest tumorigenesis for different types of cancer.

1:09:20: Different myokines are invoked by different forms and intensities of exercise.

1:10:35: Dawn asks how insulin sensitivity influences the production and sensitivity of myokines and Doug discusses their interaction.

1:12:11: Ken observed that recently the ketone body acetoacetate has been shown (in an animal model) to serve as a signaling metabolite in mediating muscle cell function and growth.   Specifically, acetoacetate potentiated the stimulatory effect of IGF1 on muscle cell proliferation and antagonized the inhibitory effect of myostatin. Ken asks McGuff whether he sees a role for endogenous (or exogenous) ketone bodies in augmenting myokine-induced hypertrophy.

1:12:47: “The answer is yeah, I think so.  It is just now becoming evident that those two operate by a similar mechanism.” Myostatin is a myokine that acts as a negative regulator of muscle growth.

1:14:00: With a sedentary lifestyle you can develop an overexpression of myostatin, one of the players in sarcopenia. It is upregulated in HIV, and certain cancer cells involved in cachexia.

1:14:18: “Acetoacetate has been shown to blunt its (myostatin) effect.”

1:15:10: Ketosis is when food supply is dwindling, and you tend to hunt and gather. The highest levels of physical output occur during hunting and gathering; it seems natural that ketosis and high level muscular activity would tend to occur/run in tandem. Those two things are running on parallel tracks biochemically.

1:16:17: Ken comments that both exercise induced myokines and ketone bodies appear to inhibit myostatin … yet pharma has spent decades looking for a safe and effective myostatin inhibitor.

1:17:00: McGuff refers to the Simon Melov paper which he found that 196 genes are expressed differently in youth and the elderly; they found an extensive reversal (back to their youthful levels) of gene expression in the elderly after physical training. Link to paper: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000465

1:19:42: Dawn asks Doug about his thoughts on nutrition and to what extent does he see nutrition playing a role in skeletal muscle adaptation to exercise?

1:20:10: McGuff is a proponent of the Paleo diet: “You can never exercise your way out of a bad diet.”

1:22:28: Ken and Doug discuss how obesity is a recent phenomenon and that poor nutrition is at the heart of the problem.

1:28:08: Doug talks about his book, “The Primal Prescription: Surviving the Sick Care Sinkhole,” co-authored with economist Robert Murphy (http://amzn.to/2fLTBtl). It talks about the ER as the de facto safety net in the American healthcare system.

1:31:08: “[Writing the book] has given me a front-row seat to decay and collapse of medical system in this country; how it happened; and how recent attempts to address through ACA have put it on steroids, and made the medical system impossible to navigate.”

1:33:10: Dawn closes out the interview. She mentions McGuff’s lecture, entitled “Strength Training for Health and Longevity,” which can be viewed at: https://www.ihmc.us/lectures/20160929/.

1:34:20: Dawn and Ken sign off.