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Dr. Joel Rosen:
All right. Hello, everyone. Welcome back to another edition of our podcast where we have an amazing guest today, Stan Straight Gunderson, he’s a leader in the blood flow restriction area. He received a master’s in science from the University of Texas Austin, where he conducted several studies centered around blood flow restriction, and as it relates to the cardiovascular system, he continued his academic and research pursuits at the University of Texas in Austin, where he’s obtained his doctorate in exercise physiology and focused on vascular responses to hypoxia in older adults. He’s also a BFR master trainer and has worked with the ROI ROI Performance Center where he’s prescribed BFR blood flow restriction protocols and methodologies for clients of all ages and lifestyles. Stan has applied BFR in his own work with Olympians, elite military personnel.
And now he is a postdoctoral fellow in the sports science lab at the University of South Carolina, where he performs research teaches cardiovascular physiology, and investigates a wide range of sports-related topics, including blood flow restrictions, human cognition, Ergogenics, AIDS, and more. In addition, he continues his role as the be strong at p strong where, providing patient education and other content in an effort to expand and use the understanding of blood flow restriction, continuing the work of his father to provide a robust, efficient, and feasible method for all walks of life to gain the benefits of exercise. Stan, thank you so much for being here today.
Sten Stray-Gundersen:
Yes, thank you. Thank you for that introduction. It’s great. Yeah, well, that you did it all.
Dr. Joel Rosen:
I mean, the kudos go to you. I always like to ask our guests, especially if we’re going to be talking about their area of expertise, in this case, blood flow restriction, and how that might relate to longevity, health optimization, and even having some age reversal biometrics improved because of it. Tell us how you got into this area, Stan?
Sten Stray-Gundersen:
Yeah, well, it started with a relatively personal kind of relationship with my dad. For a long, long time, he had overseen a lot of my training. For those of you who don’t know, his sort of the live high train low methodology was his sort of brainchild, and Ben Levine. So I’m back in the early to late 90s. Throughout the 90s. He developed and did research on the idea of living at high altitude, but maintaining your output. In this case, it was for runners by training at sea level, or close to it at low altitude.
This this spurred a lot of current practices and strategies from particularly endurance athletes to you to either live at high altitudes and train at low altitudes, or live in high altitude tents, where you simulate by reducing the amount or increasing the amount of nitrogen in the air and sleeping for up to 14 hours in there that has sort of bled into a long history of working with Olympic athletes and military personnel. Anyway, I was very inspired by him as a kid and I kind of always wanted to be like dad when I grew up. But I was also a very committed and dedicated athlete, a youth athlete.
That culminated in a D-One soccer career at Dartmouth, trying to bounce around a few teams after that and the USL ended up getting injured. I had a great three tears of my MCL, you know, and before that, I’ve been using web flow restrictions in my training to to augment some of those training adaptations for soccer.
And a lot of success with that really was fascinated by the fact that we can restrict blood flow and improve performance with these things. But it wasn’t until I got injured that I was just sort of blown away by the capacity of Leffler restriction to not only maintain and improve my strength and endurance, but also accelerate my healing. It was I had, like I said, I had a great three tear of my MCL, sort of on the threshold of perhaps needing surgery, perhaps not I elected to not have surgery and and just use an aggressive rehab protocol supervised by my dad, at the time.
And so we were doing two or even three sessions of BFR per day to really augment and accelerate the anabolic milieu or anabolic environment to promote healing in the context of getting some alter G, anti gravity treadmill, walking in their daily stretching, really forcing my knee to adapt and recover. And so what would have taken me about three months to get back into playing capacity, I was able to get back in about seven weeks where I was functional, and about eight or nine weeks where I was, you know, at, you know, for lack of a better term race pace, or an actual game ready to play. So cut it, cut it down by about, you know how to, to, a third of what the normal time to play return to play with would have been. So that was really the the kind of aha moment, I ended up getting so fascinated. And so in the weeds with this stuff that I decided to pursue a master’s in exercise physiology, in general. And really, that expanded my interest in exercise and, and really the underlying physiology behind exercise, but also into the physiology behind blood flow restriction as it was at the time, it was really a burgeoning area of study, and a very fascinating thing to look into. So that’s kind of the long spiel of how I got interested in blood flow restriction, and really started from a personal sort of anecdotal standpoint, but then really dug into the research and, you know, sort of the rest is history.
Dr. Joel Rosen:
Now, that’s awesome. I’m excited to pick your brain on this. So for listeners who may not have heard of this before, what exactly is blood flow restriction? And what is it doing? And how do you do it?
Sten Stray-Gundersen:
Yeah, and actually, on that note, I, it’s funny, in recent years, the popularity has really accelerated, I would say, especially in the last year to two years, particularly in the PT world, the physical therapy world, essentially, every clinic that I know about is at least using it in some capacity. But really, blood flow restriction is restricting blood flow. And that can kind of take several different forms, when we we talk about with the strong is really a restriction of venous flow.
So we have, obviously, our arterial flow, which is bringing oxygenated blood from the heart into the systemic circulation, to be fed to tissues, whether that’s organs or skeletal muscle during exercise. And then we have the veins, which are sort of on the other side of things, they’re typically what you see as the blue in all those diagrams. And that blue sort of represents the deoxygenated cotton content within the veins.
So what’s special about the veins is that sort of different than the arteries is that they have these one way valves that prevent any backflow of blood back towards the capillaries, within that within the veins. And so when you contract a muscle, you’re actually contracting and squeezing the veins. But instead of going back down towards the muscle, it everything is pushed back towards the heart.
And so the idea is, you know, during normal exercise, we’re using the skeletal muscle pump to maintain venous return or how much blood is coming back to the heart through our veins. And simply the kind of goal of BFR is to simply put a little bit of an inhibition on that on that function, so that you have a reduced or restricted amount of venous blood coming back to the heart.
And this is just enough to disrupt the normally finely tuned regulation of blood flow to and from the muscle to induce a great disturbance of homeostasis. And that disturbance in homeostasis is essentially the fundamental stimulus for adaptation, whether that’s systemic or local, to that muscle, as you know, just along the same thread, there are also other forms of BFR, where you are going up to a limb occlusion pressure or arterial occlusion pressure, and then backing off anywhere from 40 to 80% of that value.
By doing that you’re in this case, restricting both arterial flow into the muscle and venous flow out. And so you’re kind of working on both ends. And we can talk about maybe the subtleties or nuances between those two different forms, but that’s kind of what has emerged. I will say the original form of BFR Kaatsu, that developed in Japan was really focused on restricting the venous side and this ALP or arterial occlusion pressure approach really manifested through the last 1010 to 15 years. Here’s within the research, and has really picked up steam, especially in PT clinics and the similar sorts of communities.
Dr. Joel Rosen:
Right, right applications and who’s doing them. So what we’ve been preparing for this this talk here today, Stan, I wanted to ask you about how is it mechanically applied such that the venous restriction is being tested or being stressed versus the arterial restriction? What’s the deal?
Sten Stray-Gundersen:
Yeah, so. So then, the primary difference comes down to the elasticity of a given cuff. So with a with a wide rigid cuff, or rigid cuff in general, and this is what you typically see with a with a blood pressure cuff, anybody’s gone into the doctor’s office and have their blood pressure, blood pressure taken, they’re using a, a blood pressure cuff, which is non elastic. And, and it’s important that it is non elastic, so that it’s able to occlude the artery.
When we occlude the artery, we can completely stop the flow. And by doing this, we’re able to then listen for a pulse. Once we hear once we hear that pulses start to emerge, we can then develop or determine your blood pressure, that 120 over 80 is representative of essentially the 120 and represents the pressure that’s exerted by the band to not include anymore, and then that ad represents the diastolic blood pressure, or the pressure, that there’s no more turbulent flow in that artery.
So when we’re talking about that sort of BFR, we’re going up to at any given pressure, it’s going to be kind of person specific. And it’s going to, at least to some degree, restrict that arterial flow. Now, with the venous side of things, you know, it’s important to mention that, during regular exercise, one of the limits to output is is return of blood back to the heart, from the muscles that are active. And so this sort of normally happens with exercise, I think the best example of sort of like a 400 meter run, if anybody is running those, by the end, your you know, your brain is, is screaming at your muscles to try to finish and keep your form. But it’s just very, very difficult to maintain that that output. And part of what’s happening, among other things, is essentially a lack of proper blood flow in order to maintain that output. And so this is sort of the environment that we’re trying to mimic when we use blood flow restriction.
Dr. Joel Rosen:
Gotcha. So just to clarify, the difference between applying a venous blood flow restriction and having a mix would be in the elasticity of the cuff.
Sten Stray-Gundersen:
Correct. And the main difference, the reason why that it can be is that the veins are much more easily compressible than the arteries. So the arteries have some very thick, smooth muscle that surrounds them, that are just more restrictive to collapsing. And so it requires much less pressure to restrict the veins or temporarily occlude the veins than it does to occlude the arteries. And anybody can kind of try this on themselves, you know, when you when you’re told to take pulse, we can put pressure on that given artery, and we can see that the pulse is maintained. Conversely, if you look at your superficial veins, you can collapse them fairly easily. And you won’t feel a pulse on there. So that’s kind of like a practical example of how elasticity is so important for maintaining arterial flow, but it can limit the venous outflow.
Dr. Joel Rosen:
Gotcha, gotcha. Okay, so and then in preparing for today, I heard your father talk about the term metabolic crisis. And so I’m assuming maybe correct me if I’m wrong, when you’re able to alter or modulate the return even though it’s not going to go in reverse because of the bi directional flow, that is changing enough of the intricacies of mediators and communicators and chemicals and gases, such that it creates a metabolic crisis? Is that how he intended to use the term? I wasn’t sure is that correct or not?
Sten Stray-Gundersen:
Yeah, I think it’s a very specific term to what’s going on in the muscle. So as we contract muscle, metabolic byproducts are produced. And normally in a in a healthy person with no issues with a submaximal exercise intensity, we’re able to clear out these metabolites out of the muscle, bring them through the veins, and, you know, through various mechanisms, primarily breathing out through the lungs.
We’re gonna Well, to offload some of these metabolites, a lot of the metabolites are also re-shuttled into either the muscle or the liver. There’s various processes that happen. But these metabolites that are produced, in particular, create an acidic environment, and also are associated with a hypoxic environment in the muscle. And this metabolic crisis that occurs, normally occurs during maximal exercise or maximal effort. And by by reducing the ability of the muscle to clear out those metabolic byproducts, you have a unit now you have a disruption imbalance in the equation.
So we’re producing the metabolic byproducts with relatively low intensity type exercise. And by restricting how much that is cleared, you have a buildup that is normally only seen with more high intensity type exercise. So there’s this this coming back to the this very commonly used phrase, this disturbance in homeostasis occurs in our body really, really does not like that. And so this is a major stimulus, this metabolic crisis leads to a disturbance in homeostasis, which elicits a robust, adaptive, adaptive response.
Dr. Joel Rosen:
Right now, that’s a great explanation. And I, you know, I was talking to you before we started in my past life, I had an exercise physiology degree. So I have a bunch of questions, but I was a trainer for many years as well. And so is that also synonymous or similar to the specific adaptation to imposing demands, but are the imposed demands a lot less intense to achieve the same results? Is that an accurate statement?
Sten Stray-Gundersen:
Yes, I mean, I would, I would kind of maybe not be correct, but the edit slightly is that the effort is the maximal effort or the perceived effort is critical. So that that still needs to be high. But what we’re able to do is make the absolute workload less to achieve that state. And this is particularly important for people who either can’t or won’t exercise. And for athletes who otherwise need to have either a lot of volume or very, very high intensity to achieve that state. And so sort of on both ends of the spectrum, it provides a nice way to get to that state of of adaptability, essentially, of essentially making the body plastic to to those stimuli. And, you know, hypoxia is a big part of that. But, yes, essentially, what you’re doing is you’re mimicking what we can achieve normally with very high intensity type exercise with relatively low intensity.
Dr. Joel Rosen:
Right, right. And I’m always amazed, then in terms of who comes up with this idea, you know, like, let’s do some restriction. That will help release growth hormones and that will be anabolic, and will still be able to achieve that really high perceived load for the body to adapt, I guess the question has to do with the term hypoxia. So hypoxia Is it maybe you can explain it from from your background and how it’s used from BFR. But from what I was showing you earlier, in terms of, if you’re not moving iron at a tissue, because you don’t have bioavailable copper, that’s going to cause your body to not respire at the cellular level effectively.
And that’s going to create some excitatory neurotransmitters fight or flight stuff. And that can create a cascade of inflammatory responses, which, which isn’t so great. And to make things worse, I tell people all the time, as best as you can, if you address the metabolic side of things and get your minerals balanced, if you’re under stress all the time. And you’re having difficult times with with with respiring at the cellular level because we’re in a pseudo hypoxic stage because of stress. How is it that with blood flow restriction Hypoxi is actually used in a favorable way? If that makes you understand the question?
Sten Stray-Gundersen:
Yeah, yeah, absolutely. I think this comes down to a sort of an overarching point of the poison is in the dose, right, the dose makes the poison. You know, particularly with exercise, exercise is an extremely stressed, full, stressed state. And the key with exercise is that we’re not doing it all the time. So there has to be a stressor, a stimulus, and then there has to be enough time for recovery to actually adapt set stimulus, right.
And so it’s these chronic periods of time, or this chronic hypoxia that results in pathologies and dysfunction, but doses particularly due to exercise or intermittent hypoxia, or altitude exposure, doses of these things are stimuli for proper function and healthy function, and more importantly, just adaptation to set stimulus. But we have to have that period of recovery to be able to do it up to that environment.
Dr. Joel Rosen:
Right? Right. So so the hormetic response is small, small. Okay. All right. So let’s talk about it. So in terms of best practices, I ended up getting one a while ago, when, you know, Kerry, who said it has been so helpful on the days, I bought, I have to admit, you know, I bought it maybe over a year ago, and it just kind of sat there, but I brought it out, and I started using it. And, you know, I want to be able to get the best out of it.
And with the patients that I work with that are exhausted and tired and burnt out, a lot of the time they just don’t have the energy to do the energy, right? It’s like, yeah, it’s like that conundrum of you’re not going to get experience if you’ve never had a job, but how do you get a job if you’ve never had experience? Right? So I guess, what are the best practices in terms of using it? What are the studies showing? Given that you can achieve that perceived load? What are we seeing in terms of responses?
Sten Stray-Gundersen:
Yeah, so kind of take your question backwards. But you know, to address the people who are sort of too tired to exercise, I think we’ve all felt like that, to some extent, I think the situation you’re talking about is, so there’s a daily fatigue and not feeling like you can do anything.
And what I would say to the very practical sort of solution for those sorts of folks, is just to do five minutes, give yourself five minutes of an even single limb exercise where you’re just doing bicep curls, or just doing tricep extensions, or even just sitting in your seat with leg bands on and doing some leg extensions.
Even doing that small amount, especially in the context of someone who is untrained, can have pretty profound benefits. I would say do not under us underestimate the power of even just a few minutes of of of, of rigorous or even with with the bands on you can do low, relatively, or relatively high intensity, while absolute low intensity type work. You know, as far as the research is concerned, what’s really started a lot of buzz about things is that we’re able to elicit adaptations, using light intensity exercises with VFR that are similar to what we achieve without VFR doing high intensity type work.
So you know, putting that in layman’s terms, doing things like high weight or high intensity type exercise is normally required to elicit increases in muscle size, or increases in via to max or increase increases in cardiac function. And now we’ve come to this place where if we restrict blood flow, while doing light intensity exercise, whether that’s walking or, you know, this, this looks different for different folks, you know, elite athletes or their light intensities with other would, to a lot of people be very, very difficult or very high intensity.
But for someone who is, you know, just getting their daily exercise walking their dog, they can put these bands on and elicit some positive adaptation, increase in muscle size and potentially increase to T max. So that is kind of what the research is saying what’s what’s particularly interesting about the research is not only are we getting increases in muscle mass, increases in muscle strength, but doing those walking exercises, which would normally only be affecting, you know, endothelial function, and therefore, the aerobic side of things via to max side of things, we’re seeing increases in muscle size from those more aerobic type activities, which is really profound.
The other thing is just by the mechanism of how it works, it targets both type one and type two fibers. So just normally trivial exercise light intensity exercise requires type one, fiber recruitment, and slow twitch fibers. But with BFR, what we’re doing is we’re using those primarily, those type one fibers during that initial set, maybe halfway through the second set, then we start tapping into those type two fibers, which are the most responsive or most adaptable to increase muscle size and strength. And that’s typically what people target when they’re doing high load resistance training. And so you’re really, in my opinion, getting the best of both worlds, by using blood flow restriction in concert with other forms of training.
Dr. Joel Rosen:
No, that’s great. And so as long as some like the why, like, you know, why? How has it been? Why does it do that? I guess that’d be the late layman’s question. Why is it that if we restrict blood flow, and we create somewhat of a metabolic chaos, and we don’t allow the full return of venous flow, to begin to expel that we can get the benefit of as if we’re doing high intensity lifting and train this type of this part of the muscle?
And you know, just as an aside, when we talk about longevity, forced exploratory volume is is a biomarker for longevity, and hand strength is a biomarker for longevity. Also veel to Max is a biomarker for longevity. So all of these things can be utilized for biomarkers for longevity. But I guess the question from a layman’s person is, why would it do that? Why would it have such a profound effect?
Sten Stray-Gundersen:
Yeah, I think, well, two part answer, I think there’s still much to be discovered exactly why that this is happening. There may be additional epigenetic factors that may be your turning on certain transcription factors that are responsible for a wide variety of healthy regulation of genes. But also, just from a more practical standpoint, it is mimicking what we can achieve with high intensity type of exercise. So I may have gotten ahead of myself with that kind of 400 meter track example. However, the metabolic crisis that develops occurs with not with high intensity type. The caveat here is that it requires high intensity, rights, and so especially for elite athletes, that is that is a huge cost.
They have to dip so deep into their, into their stores, into their resources, and which requires a lot of recovery to then adapt to that set stimulus, when we’re doing light intensity work with BFR, we don’t give in to their, to their resources quite as deeply, and therefore their recovery is so much faster. So then they can go for the next training session, feeling that much better, or not even having to recover much at all, you know, for the average person doing this three days a week, can elicit some really profound effects. And it really comes down to mimicking what we can achieve normally, with high intensity type exercise, you know, if you know, kind of getting into the weeds, this is associated with hypoxia within the muscle. And this is associated with acidity and acidic environment within the muscle, again, temporarily these things, if they’re chronic, they’re not good. It stimulates part of that hypoxia stimulus is actually to promote myocardial Myoko, mitochondrial biogenesis.
It also helps improve the health of mitochondria that are currently there. And so all of these things that are normally associated with high intensity type exercise, which is normally very hard to achieve and requires a comes at a large cost to recovery, we can do very frequently, and therefore, regulate all the beneficial adaptations that we can get from exercise by all these different sorts of stimuli in their downstream effects. Right.
Dr. Joel Rosen:
So Today’s podcast is brought to you by B strong blood flow restriction device. And you can see I have these be strong blood flow devices on my arms and you can’t see my legs, but you can put them on your legs don’t like a tourniquet. And like we’re talking about in this podcast, when you restrict the pressure of the venous blood flow back to the heart, you’re creating a metabolic environment that helps to stimulate growth without the intensity that you need to stimulate growth when you’re tired and exhausted and burnt out.
Now, you might be thinking, I don’t want growth, but we’re talking about mitochondria, regenerating or mitogenesis. And that’s important for energy production, removal of waste products, keeping your lean weight, being able to be strong and vibrant, and really helping you turn back the clocks of time so that you are Aging Gracefully. If you’re interested in saving a lot of money, Stan has given me a great discount on rosin, be strong 20 all one word rose and be strong 20 Wherever you watch this video, I’ll make sure I have the link and the discount code below. And get yourself these be strong bands to be able to improve your strength, your vitality, and ultimately, your age of quality living. Let’s go back to the video.
Dr. Joel Rosen:
That’s awesome. It’s almost like the analogy I come up with crazy analogies but I almost see like one of those team meetings where they go to the wilderness and they do all these different things and you’re only as fast as your weakest link. So they’re all huddled together having to cross the finish line in this hypoxic high repetition or low weight and ability to create that those changes is you call off the herd, right you kill the the weakened mitochondria and it only becomes stronger. I’m curious to know because obviously there’s a nitric oxide component to it.
Maybe you can get us into a little bit and also the car the the carbon dioxide. I’m curious to know your insight with that. Because from what I teach, I look at it as if you’re exhausted and tired. You’re not combining the food you eat and the air you breathe Need to produce ATP, but you’re also not producing h2o, and you’re also not producing co2. And low co2 is a good indicator that your, your, your PDH enzyme, the pyruvate dehydrogenase enzyme is inhibited, and it’s causing your pyruvate to turn into lactic or lactate or lactic acid and, and depleting carbon dioxide. So how does that work in terms of nitric oxide carbon dioxide and getting into a little bit of the weeds, they’re
Sten Stray-Gundersen:
not, that’s not that’s great, you know, to start with nitric oxide. So one of the things that happens with any form of exercise is when we go to begin exercising, we start producing metabolites which lead to vasodilation. This phase of dilation also leads to increased blood flow, and that increased blood flow is associated with increased what we call shear stress, or the fluid moving the blood fluid moving across through the artery.
When we have an increase in that flow, we increase the shear stress placed on the endothelial which is the the inner layer of all of the lines, all of our arteries and blood vessels, when we have an increase in that shear stress signals, the endothelial to release nitric oxide into the smooth muscle, which then causes an opening of that artery. Okay, so by promoting just simply by promoting visit dilation and promoting blood flow into a given area, we’re acutely and transiently increasing nitric oxide.
But it also stimulates more chronic adaptation of increased endothelial nitric oxide synthase, the enzyme that produces nitric oxide, so that when we’re not in an exercise situation, we just have higher amounts of nitric oxide, that are that is able to do a variety of processes. You know, there’s a famous researcher by the name of Ignacio who has made a, a life around nitric oxide. So we could, you know, I could tell you a million things that nitric oxide can do, and it really is a very interesting molecule, it’s a neurotransmitter. It’s an antiviral molecule. It’s a very, very interesting molecule in and of itself. But in the context of blood flow restriction in in, in blood flow, its primary role is evasive, dilator. When we visit, dilate are reasonably evasive, dilate arterioles, this promotes blood flow.
When we promote blood flow, this brings nutrients, oxygen into areas that require it. And so it’s fundamentally the molecule that allows for all of our tissues to be regulated in terms of specific factors that are turning certain genes on and off. But it literally keeps tissue alive by perfusing it with blood. So that’s, that’s one sort of avenue that we can talk about with blood flow restriction and nitric oxide, you know, the other thing and before we kind of maybe it’s a nice transition into the co2 discussion.
When we breathe through our nose, we have, we stimulate endothelial endothelial nitric oxides, I’ll call an e nos from now on e nos in our sinuses, and that produces more nitric oxide, which via dilates the blood vessels in and around our respiratory system. And so this breathing through your nose promotes enhanced blood flow as well. And, you know, I would say I know less about sort of the co2, low co2 and that sort of thing. You know, it’s funny, we always, you know, at least in when we talk about sort of hypoxia research, I have studied intermittent hypoxia, which is basically we keep an ISO cap neck, so that means no, no change in co2. We’re not having people hold their breath, per se. But there are studies where they do like rereading studies where you’re really shooting up co2.
And actually, it may interest some of your viewers to hear to know that the trigger to breathe in increased ventilation is not necessarily a drop in oxygen, it’s a rise in co2, as you probably well know, that we have chemo receptors, which are responding to levels of co2 in the blood, that initiate the increase in ventilation and respiration. So, you know, and actually, I’d love to pick your brain a little bit about this low co2 state, typically, we think of chronic high co2. Now, this is excessive levels of co2, right? being sort of a detrimental effect, particularly with sleep apnea patients, when we have long periods of high co2.
This can increase blood pressure and lead to a number of a number of methodologies. But I could also see, you know, coming back to this idea of homeostasis, there’s a homeostatic balance of co2 and oxygen that we need to maintain so you know, going too high is not a good thing but also going too low is also not a good thing.
Dr. Joel Rosen:
Right? I think that’s exactly it. I think you’re by creating that hypoxic state, and being able to get the benefits of the nitric oxide release, you’re harnessing co2, let’s just put it that way. And that’s helping the mitogenesis. But just as an aside, in the the pyramid that I showed you, we look at, no, nos two, nos three, so e nos and ionos. What I find very commonly is a pattern of people having more polymorphisms in I nos upregulation. So I nos is inducible, I believe, and and and you’re going to have that more for the pathogens, right.
So if you’re, if you’re under stress, and you have infections or exposures, and you have the polymorphism, it up regulates the demand of your ionos system, at the expense of suppressing the e nos. So it’s a cell danger response, it’s saying, Hey, we’re not really concerned about using this nutrient for blood flow, per se, perfusion, we’re more for immune signaling, more for killing, and then once that’s done, we can go back here.
But the challenge with that is, is that the perfect storm patients that I see, not only do they have the eye nos upregulation challenges, I mean, again, these are just these are, these are increased likelihoods. They’re not foregone conclusions, right. And then when you look at their enos, and they’re downregulated, so they’re going to be a and then event. If they have issues with BH four, which is by often what makes the nitric oxide, then they could be in an excessive state of not recycling that.
And then like you said, nitric oxide becomes uncoupled. And when that happens, you’re making Peroxy nitrite. So it’s a long way from saying nitric oxide is a very important compound, that if you don’t train through exercise and contraction, and in this case, blood flow restriction, you’re like anything going to be weakened for the times when you need it. And vice versa, when you train it, what I actually believe is happening is you’re making that nitric oxide endogenously in your own body by being able to create a redox balance of NAD plus to be available to make the nitric oxide. Sorry for getting into the weeds listeners. But ultimately, I did that to show off to Stan.
Sten Stray-Gundersen:
And if that makes sense at all, I don’t know, hopefully, it makes a lot of sense. Yeah, and you just clicked a lot, a lot, a lot of things just clicked in my brain when you when you as you said that. And you know, we can’t forget about neuronal loss, either. Nitric oxide has a huge function in the brain, both for visa dilating blood vessels in the brain, but also a host of other defense mechanisms as well.
And you know, just to your point, I think that immune response, that inducible nos is very important. As you know, nitric oxide promotes blood flow, which could theoretically help with symptoms of inflammation. When we have this immune response with inducible, nitric oxide, not only are we for, you know, sacrificing e nos, but we’re also doing that in the context of more inflammation. So having this having, you know, the necessity of nos, the nervous system, let’s say, focus more on, you know, getting rid of that infection in the context of inflammation just leads into, as you mentioned, before, sort of this positive feedback, where it just gets into a worse and worse situation unless we can pull out of it. And I think, I think a way to sort of pull out of that is by using exercise in that way to to help your own endogenous production of these things.
And I think BFR is just a really good, practical and feasible way to do that. consistently. And, you know, I think a really special thing about BFR is that you’re able to get a systemic metabolic crisis, if you will, in just five minutes, if you really, if you really go for it. And if you do it, like make it a 10 to 15 minute daily practice, you’re really up regulating all these things that are that are beneficial to what you just pointed out yourself.
Dr. Joel Rosen:
Yeah, and you know, the other thing that I think is really important, I don’t know if there’s studies on this but as I get older, I’ve been neurotic and OCD and trained myself to oblivion and crashed and burned. And there is the the dose or the poisons in the dose, right. And I believe now as you get older, you just don’t have the capacity to train like you did before Norwood. It’d be beneficial. But the problem is when it by by training, you’re releasing too much cortisol, and then that cortisol is very catabolic, and then it’s creating more problems with with your, with your energy systems.
So I’m wondering is there studies out there stand that show that because you can achieve that perceived exertion and get hypertrophic or anabolic changes or mitogenesis with blood flow restriction, that you don’t create the same kind of rise in cortisol that you would with those high intensity CrossFit type workouts? Do you know if there are studies that show that at all,
Sten Stray-Gundersen:
there have been some studies where they looked at salivary cortisol and testosterone acutely after BFR. Honestly, it’s a little bit all over the place, some have shown increases, some have shown less of an increase than we would expect. So there may be some methodological methodological issues there. Excuse me. I think the jury’s still a little bit out on that, I think. There’s also and you would know better than me, but and maybe, so maybe you can help me understand, but there’s also this prolonged cortisol release.
So you know, I think transiting increases in cortisol can be beneficial. It’s just this is sort of the cost that I’m talking about that is normally accompanied by high intensity exercise, is that you have multiple days of inflammation, maybe elevated like dysregulation of certain hormone pathways, ah, HPA axis, dysfunction, and things like that, you know, are a result of the exercise, even though the exercise was good. You know, there’s a certain cost. I think BFR is a way to avoid some of that cost.
And I think no more we’re, we’re more work that needs to be done. But I don’t really have a doubt that there are some bet positive responses to getting to that place that would normally be associated with high intensity with relatively light, like exercise. I think it plays into the sort of the recovery side of things. And I’m sure I’m sure that hormones have a huge part to play in that recovery process. Yeah.
Dr. Joel Rosen:
Yeah. I mean, I think that just like you said, the research design hasn’t been set up properly. I think if you went into it wanting to know, pound for pound, are you releasing less cortisol by doing blood flow restriction, but getting the benefits that you would have otherwise needed to get with high intensity cortisol spiking exercises, you’ll see that you’ll get that benefit? Quick question for you. I heard about some research. And I it was it intrigued me from a physiology standpoint, but he was talking about how concentric contraction is, is mitochondrial building and eccentric contraction? Is mitochondrial depleting? I’m not sure if you’re aware of that. But where does the blood flow restriction come in? Because I would almost think of is there a benefit of the isometric component to blood flow restriction? And or do you know about the, the concentric eccentric impact on on mitochondria, mitochondrial function at all?
Sten Stray-Gundersen:
Yeah, you know, I haven’t really heard of the mitochondrial response. Eccentric versus concentric. Although just, you know, I might, I may be misunderstanding, but I think it kind of makes intuitive sense. When you’re doing eccentric type training, you’re at a much higher risk. Coming back to the idea of risk. That doesn’t happen with every single muscle fiber, but you’re much higher risk of of disrupting the membrane of a given fiber when you’re doing the eccentric, right. So what we’re talking about for those who understand the eccentric portion would be the lowering portion.
So what I’m trying to do is I’m constricted can contracting my muscle as I’m lengthening those fibers. And so we can kind of think of the myosin head and actin heads being pulled apart as we’re lengthening that fiber. Concentric is the upward motion of that. And typically, we don’t see a whole lot of damage to the membrane when we do concentric based exercise. And so the the, maybe the impact of the mitochondria comes from the actual rupture of the muscle membranes that are maybe leaking out some contents within their Mitch, which may, you know, lead to mitochondrial dysfunction.
It’s also, by the way, the most inflammatory type of exercise and requires the most recovery after performing it. However, having said that, if you center training definitely has a place in exercise training and training protocols, because it’s a great way to build strength. So but again, you know, coming back to this idea of recovery, it requires a lot more recovery, there’s a greater cost to that sort of exercise.
And so, you know, particularly people who don’t want to be very sore if they do concentric based exercise with BFR. The chances of it getting sore are very, very low. And it can be very, very beneficial. I don’t want to speak too much on the mitochondrial side of things because I just I haven’t heard that and that’s very interesting in it, it makes intuitive sense to me. Now to discuss the isometric side of things, I think, very, very fascinating area. I don’t think we’ve done enough research on isometric contractions. We did a study at UT where we looked at different yoga poses which incorporate a lot isometric holds.
And which was interesting, we hypothesized that with bands on you would have an elevated blood pressure response. During these these isometric holds, right, we did not see a difference than then without the bands, which was, which was interesting. Having said that, during an isometric hold, that is one way to get a major reduction in venous return, right, you’re not letting the blood escape.
And in this way, you’re, you’re also building strength. You know, you can hold an isometric, you can hold a weight isometrically a lot, you can hold up an isometric position much with much more weight, and you could do a concentric motion, let’s say. So like you can hold 100 pound weight at the top right here, in an isometric hold. But maybe you can’t lift that up. So there are different techniques to be used with isometric contractions. I love isometric holds with with with the bands on, I think it really augments the, the effect of the bands and really what’s going on internally within the muscle and a lack of clearance of those waste products. So I love doing isometric holes with with with BFR
Dr. Joel Rosen:
right? So no thank you for sharing. So my from as you described it, my understanding is you centric can can still be hyper hyper, I guess stimulating for muscle growth and hypertrophy. But you’re you’re breaking down the mitochondria versus Cosette concentrically, you can have hypertrophy by and have mitogenesis.
And I think that’s some of those biomarkers is of lean mass or the number of muscle per, you know, the lean body weight per total body weight. Hand strength is based on mitogenesis. I heard that and when I heard this influencer talking about it, it was like, well, it’s not like you’re gonna go to the gym if you’re not using BFR. And just do concentric pushes, I mean, how are you going to do naughty centric stuff, but at the same time, he’s centric is part of the the complex of the movement.
And if you’re healthy, otherwise healthy, you’re not going to be concerned about shredding your mitochondria, because you’re doing a Centrix, I think the net gain of the concentric, the isometric, theocentric is is going to be prolonged devotee anyways, does that make sense?
Sten Stray-Gundersen:
Absolutely. And I think yeah, to clarify, central training is, is a really useful tool to build strength and hypertrophy, it just requires a little bit of recovery. So so you have to kind of consider that in, in your inter person or your your specific person context. You know, but I think Essential Training is a very, very good form of training. You know, and so one way that we do this with athletes, for example, is, and we do have different phases of training, you know, Kelby has done a great job of outlining sort of the eccentric, concentric amortization, sort of phases of running, for example.
And so you have like a phase that lasts weeks, two months of eccentric base training, where you’re really breaking the body down a building, really building a strong base strength base, and then you move more towards concentric type movements, where your focus is more on the concentric portion of that exercise, or that movement.
And so what this might look like in the gym is, when you’re doing that E centric base training, you’re really focusing on lowering the weight slowly, and then maybe even dropping the weight, you know, having a backup point here, and just going through that those are sort of your reps, where conversely, if you’re using more of a concentric based exercise protocol, you’re you’re actually just, for example, let’s say you’re doing a deadlift, you’re just picking it up, and then dropping it at the top of the lift.
So you can kind of get away with just doing the concentric motion of that other portion of that movement. But in reality, you’re stimulating increases in strength and Nannette, in particular, the great central nervous system stimulus to maintain strength. It’s actually amazing. It’s very, very hard to grow muscle. It’s very, very easy to lose muscle, but it’s also relatively easy to maintain. So once you get to a certain point, you can maintain with as little as three times per week per muscle group of a given exercise, and you’ll maintain that strength. All right.
Dr. Joel Rosen:
Yeah, no, I like the idea of blood flow restriction, especially for my demographic, they’re tired, they’re exhausted, but they need to move they need to contract with the ability to get it better benefits without having to go as intense and recover quicker. And I do believe that if studies were done, it wouldn’t be as taxing for them court from a cortisol standpoint, either, which ultimately you’re getting, you’re having your cake and eating it too. I believe with that, you know, in that sense.
Sten Stray-Gundersen:
Yeah. And I would say just as a recommendation for those sorts of folks, even just putting the bands on and going, again, through some very light type exercise, what you’ll notice is, Oh, I already have the bands on it, you kind of have this mental sort of Epiphany, like, oh, I can actually do exercise, you know, I already have the band’s on I’ve only been, I was only only told myself to do it for two minutes. But now I feel pretty good. If you get an endorphin rush, there’s been some evidence to show you get Endo, endo opioid release, or end of opiate release, which helps reduce pain sensitivity. So all of a sudden, you’re feeling good. And then it can motivate you to maybe do two more exercises, or maybe two more exercises on top of that. And so it really helps put you in a state where you’re more motivated overall, and not feeling that fatigue as much.
Dr. Joel Rosen:
Yeah, and I think too, like one of the things that you when you use the actual restriction, you feel a better neuronal connection to that muscle, right? Meaning like, you can feel that muscle contracting, because your mind is making that connection. It was funny, I was showing a friend of mine the other day, I mean, feel free to use this as your tagline if you want. But I was showing my friend this the other day, and I was explaining how it increases nitric oxide, this that the other, and he’s not a scientific guy. He says, Oh, so it’s pretty much Viagra for the muscles. Right? And like, I guess you could say that? I think it is Viagra for the muscles?
Sten Stray-Gundersen:
Yeah, well, yeah, it improves endothelial function. One of the most important functions of the endothelium is to increase blood flow. And so actually, you know, exercise in general can help promote sexual function, but I think this has a huge capacity to do that, as well. And, and to your point about the sort of mental muscle connection you know, it’s funny that we’re talking about the other day here in the department. But you know, bro science is sort of, sometimes it’s hit or miss, right? Sometimes it’s completely out there. And, you know, not a whole lot of evidence behind it.
But sometimes it’s really ahead of the curve. This mental muscle connection is interesting because, you know, bringing awareness to a certain area, whether you’re doing that through that muscle burn or otherwise, helps you recruit more muscle, and they’ve shown some EMG. studies using EMG, they look they look at the same intensity of exercise for the same load, and we’re seeing a little bit higher muscle activity, electrical activity in the muscle, with BFR versus not. So there may be something literally to more nervous system output into that muscle and the feedback that you’re getting as well.
Dr. Joel Rosen:
Yeah, that could I mean, I think it would be accelerate. I mean, I was training for many years. And you’re right, it would take a while, like I heard you talking about those initial strength gains are just the coordinating synergistic muscles and the neuro connections. But if you can accelerate that, too, because you’re establishing a, like, okay, now, like, I used to teach my clients when I would train and like, think about like, your muscles rolling into a ball.
And you’re not just like, aimlessly lifting these weights, but you’re connecting the brain to connect to make that into a ball and hold that. The quicker you do that, the stronger your muscles will be, the stronger you’ll be the quicker responses you’ll have.
And I think that, again, the BFR probably increases that real quick, because I gotta run I do have a hard stop, I want to make sure I ask you the maybe we do a part two, but I always like to ask our guests, and I’ll make sure they have links to the to the be strong training site so they can see where the where to get this and all the all the research you guys are doing. What would you tell the younger self to stand that you know, now, that would have helped or gotten you back? Or a quicker, longer one? More optimized health? As for the things that you might not have known then?
Sten Stray-Gundersen:
Yeah, that’s a great question. I would, I would say, you know, I’m 30 years old. I’ve been thinking about this a lot lately with this sort of transition. And one of the things is just to embrace discomfort, embrace, embrace the suffering a little bit. It’s amazing, you know, you know, I think BFR is a decent way to understand this is, it’s really you need to experience discomfort, you need to stress the system in order to properly adapt. And within that there’s time for recovery. There’s there’s a necessity for recovery to adapt to that stimulus, but just embrace the pain a little bit. And it’s funny, you don’t really remember a lot of those days where you’re not doing much or you’re watching TV or your couch potato.
Those days kind of all blend together in a lot of ways. But the day is where you experience discomfort and maybe it was for it ultimately, for a good cause or something positive in your life, you remember those days and at the end, at the end of the day, you know, your your history is what you can remember is the accumulation of all those memories.
So, literally, it makes me kind of come to the conclusion that the more that you kind of suffer in a good in, you know, towards a positive, you know, endless suffering, pointless sufferings, no good. But if you’re suffering for a good cause, or towards a goal, your life will be more fulfilled, and you will have a longer life as you remember it. And so what I would say is just kind of embrace that suffering and, and keep moving forward.
Dr. Joel Rosen:
That was so good words, that’s, you know, embrace the suck. I think that with today’s day and age with the, you know, with dopamine being there all the time, cell phones, notifications, text messages, Amazon Prime, 24 hour food availability, that we’re never uncomfortable, and we don’t embrace the suck. And you’re right, the Hormetic stress of something that your body’s not used to, by definition isn’t supposed to be pleasant, but it’s in the dose.
If you do too much, it will create challenges. But if you don’t do enough, it will create challenges. And you have to put yourself under a load which applies to the physiology, physiological response of, of the muscle, same thing in our life. Great, great advice. I appreciate your time. I wish I could talk longer than I do. But I gotta run. And and I look forward to potentially keeping the door open for part two.
Sten Stray-Gundersen:
Yeah, absolutely. I’d be happy to come back on Thank you so much for your time and I really enjoyed our conversation.
Dr. Joel Rosen:
Hi, thank you so much for watching our age reversing blueprint podcast. If you’ve made it this far, we sincerely thank you for your attention and your interest in reversing your age. If you’re looking to get more information on today’s topic or other podcasts that we’ve had, be sure to check out the show notes and be sure to check out Dr. Joel rosen.com. Have an awesome day.
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