How Blood Flow Restriction Can Revolutionize Your Fitness – Dr. Jim Stray-Gundersen with Dave Asprey : 705

Bulletproof Radio, a state of high performance.

You're listening to Bulletproof Radio with Dave Asprey. Today's guest on the show is a person you might not have heard about, but someone whose work I think you are going to hear more about over the next couple years. He's a physician who's treated thousands of patients and a researcher and professor who's authored thousands of articles over a career of more than four decades. I deeply appreciate the chance to learn from the wisdom of my elders. And Dr. Jim Stray. Gunderson is definitely one of those people who has put so much time and energy into sports physiology, worked with Olympic athletes in various disciplines, and is now working on a kind of technology called blood flow restriction training that promises to have broad effects across your biology, not just for sports training. He does this through a company called Be Strong, and he's also the sports science adviser for the U.S. ski and Snowboard association, which, by the way, Bulletproof sponsored the US Ski Team last year for the Olympics, which I thought was particularly cool to see the Bulletproof logo on the jersey, the what do they call them, the bibs at Killington. That was cool. Jim, welcome to the show.

Thank you very much. Happy to be here.

What brought you 40 years ago into sports physiology? It seems like it was much less of a field when you got there. In fact, you might be one of the very earliest guys doing that.

It wasn't a field. I would say that I've always had a strong curiosity about science. Then my other strong curiosity and passion had been sports. And while for most of my education sports and school were separate, I had an opportunity after I had finished my surgical training to combine those things. And I did two postdoc fellowships, one in cardiovascular physiology and the other in human nutrition at UT Southwestern Medical center in Dallas, Texas. And after those fellowships, I joined the faculty there. And despite the fact I was a general surgeon in the divisions of cardiology and also orthopedics. But the intent there was to do something that was starting to be called sports medicine or exercise science. And they really, really didn't have a way of doing this before then. And we kind of pioneered the idea of, let's say a clinical physician, exercise physiologist or sports medicine physician. And from that I ran a lab and an educational situation for many years. That's kind of how we ended up here.

Along the way, though, you've been involved in the training and regimens for 100 gold medals and hundreds of world championships. That's some kind of elite level stuff there yeah.

In my athletic career, I was a fairly accomplished runner and cross country skier and, well, as a tennis player, but never quite good enough to make it. I was at a national level in running and cross country skiing, and I happened to get invited to a number of national team camps from time to time. Kind of the bummer of some of those introductions was I wasn't as good as the people I was competing against. But on the other hand, they saw value in me in terms of what kind of medical and physiologic knowledge I could lend to the effort. And my first introduction was both in long distance running, where I competed for the University of Wisconsin, which has a very good distance running tradition. And I also competed in cross country skiing at a national level, and I developed relationships within those sports. And then as things developed, I became kind of the science guy and the doctor for a lot of these groups.

You also wrote this groundbreaking study, Live High, Train Low, that really affected. I used to be a wannabe competitive cyclist back when I was a fat kid. Noticed fat kids aren't very effective cyclists. But I would, you know, go in races and road races and things like that. And I just always finish last at 5,000ft elevation because that's where I lived. But I remember thinking, wow, this idea that you're going to go live at 10,000ft in Colorado and you're going to go trained at the bottom of the mountain. And it always seemed, you know, like such a sexy thing to do. And it's because of the paper you wrote. And so you were, I would say maybe you and some Russian space program people are probably the early people looking at the effects of altitude on, on human physiology. What did you learn in that training? And how has your view of altitude changed over the last decades?

Yeah, so early on, let's say, I would say in the, in the 1960s, there started to develop a great interest in the use of altitude to train primarily endurance athletes. And there's all sorts of stories about athletes going up into the mountains and coming back in really great shape. The fact of the matter is, is that these are all anecdotes and almost no real studies had been done at the time. In and around this time, I was the physician physiologist for the US Cross country team, and we had a training camp in Dachshtein, Austria. We lived at about 2200 meters, or 6500ft, in a hotel, and we went and trained on the glacier, the Dachshtein glacier at 3,000 meters, or about 10,000ft, essentially. I found myself sitting in bars talking to the coaches about what's good, bad or indifferent about this. And everybody thought, you know, at that time, all of the main teams, the Norwegians, the Finns, the Germans, the Russians, everybody would congregate in Dachshtein for these training camps in the summer where, at the very least, we could find snow to ski on. This was also accompanied by East German coaches who were saying that, oh, the way to do this is to go to 2000 meters and beat the crap out of everybody. And if they come back from that in one piece, then they're going to be darn good athletes. So within that environment, I started to think about this, and I teamed up with a colleague of mine in Dallas, Dr. Ben Levine, who had spent some time in the Himalayas with mountain climbing and had done some medical care in Kathmandu, in Nepal. You know, what was really apparent and very apparent to me personally, was when we went up to the glacier to ski, we couldn't ski very fast. And if you go up to Everest, you can't move very fast. You can hardly do anything because essentially there's not enough oxygen to power what's going on.

Yes.

And. And I'm going, why is this doesn't make any sense. When. Why does going slow help somebody with race performance? And so Ben and I started thinking about this and discussing it. And in the meantime, I noticed that some of our skiers who lived in Park City, Utah, which is about 2,000 meters of altitude, basically 6,800ft in and around town, but they would go down to Salt Lake City, which is around 4,500ft, to do some of their harder sessions down there. They could exercise normally or at sea level speeds. The coaches felt they were getting a better, better training effect by going down low. So I'm going, a lot of this doesn't make sense, so there must be something else going on. And we also recognized that there had been a bunch of research done in the Andes where coal miners would live at sea level, and then they would go up into the coal mines at even 5,000 meters, really high altitude for a month and work in the mines. And then they would come back. And a researcher by the name of Reginafari ended up measuring how much blood they have after a month at sea level to after a month in the mines and showed that their red cell mass or their blood volume expanded when they went up to altitude. And I also put this together with the idea that, and this is now in the 80s and late 70s and 80s, early 80s, that there was a problem with blood doping in sport. There had been some studies done in Sweden and some use done in Russia of transfusing athletes before major competitions, them finding that was effective.

So for listeners who might not kind of know what that effect was, that's adding extra red blood cells, the same thing you would get if you lived at a high altitude so that they could perform better.

We knew actually basically back in Nazi Germany, the Germans would give their, their elite troops, the SS troops, blood transfusions and anabolic steroids to improve their performance in the field. And essentially this crept into various forms of athletics, which we now know as doping. So I had that fact, and then I had a fact that when people went up really high in the mountains, they increased the number of red blood cells they had. And, and I had the personal experience of going really slow when I tried to train at altitude. And Ben and I were putting our heads together and says, how can we explain this? And we thought, well, maybe it's not the training at altitude that's doing the thing for these athletes, maybe it's the idea of living there. And so we ran a whole series of experiments, literally over 10 years, where we tested various parameters of living high, living low, training high, training low, a variety of these different combinations to see which one was effective in improving sea level performance. The short answer is that Living high around 8,000ft or 2,500 meters for three to four weeks is a very effective way of increasing your red cell mass and thus your maximal ability to move oxygen or your VO2 max. And this directly helps your sea level endurance performance. And the other thing we found out is that this business of training slow up at altitude actually is a negative for sea level performance. So what we found is that if you come down low or low, where you can move at normal sea level movements, that, that was the best of both worlds. So we wanted to live high for three to four weeks and we wanted to train as low as possible during that time. And we found that to be a very effective way and legal and ethical way of enhancing sea level performance.

Now, the effect of living up high is definitely you grow more red blood cells naturally. Does it change hormones like epo, which is also used for doping, but it's a biological hormone.

The process of going to altitude causes an increased secretion of ep. The basic mechanism is this, when you go to altitude, your lungs cannot provide enough oxygen to the blood to completely fill those red blood cells with oxygen. So the saturation of those red cells goes down to, let's say 90% where at sea level, it's 100%. And as that essentially hypoxia goes through the kidneys. There's specialized cells in the kidneys that sense the saturation of oxygen or how much oxygen is around. If they feel there's not enough red cells for the amount of oxygen that's there, they start producing EPO or erythropoietin as a mechanism to kind of counteract this hypoxia. So then the EPO circulates and goes to the bone marrow, where it stimulates differentiation and replication of certain kinds of stem cells so that they end up developing into new, better red cells. And so this process happens when you first go to altitude, but you need to continue it to keep the stimulus on so the body doesn't shut the thing off. It takes about three or four weeks of this kind of stimulation to materially increase the number of circulating red cells.

I've worked with a couple different technologies over the years. I've spent time in Nepal and Tibet and in the Andes and Himalayas, familiar with the effects of altitude and performance. My wife did some Himalayan Rescue association work as a physician. So I noticed when I came back from Geez, that was several months up there. I felt like a great golden God for a while when I came back to altitude, which this definitely explains why. But since then, I've played around with intermittent hypoxic training, where at Upgrade Labs, which is one of the bulletproof companies in la, we have a thing. You exercise your breathing air that has no oxygen to drop your blood levels down to 87ish, and then you breathe pure oxygen afterwards. And the idea there is to uptrain a similar effect as if you're living at altitude. And there's another one that changes the rapidly cycles the air pressure that you're in. You're in a sealed compartment and it takes you up to Everest and back to sea level and rapidly cycles it with the idea that the slope of the curve is going to have an effect. With some studies behind both of those, have you noticed that there's a way that's more accessible than most people have jobs, have a hard time moving to Everest for a while and coming back down or even to Denver. How do we access this without crazy lifestyle interventions?

There's a couple ways that work. Most of the shortcuts have not been shown to work. One way we know that works was first developed by a colleague of ours by the name of Heiki Rusko in Uvaskula in Finland. What he did is he converted some hotel rooms to essentially altitude rooms by changing the concentration of the oxygen in the room from 21%, which is what it is all over the world, to around 15, 14 to 15%.

Yeah.

And simulating anywhere between 2,500 and 3,000 meters of altitude. But in that case, you have to spend at least half your day in there, or half the 24 hour period. You need to do it again for this three to four week period of time. How that plays out for people who live at sea level is they can convert their bedrooms or bedroom and living space into essentially an altitude situation. There are companies that have sprung up that make altitude tents. Basically, you're changing the environment you live in to one in which you're hypoxic. Now, that environment can be as small as a big plastic bag, or it can be as large as being up in the Himalayas, where it's everywhere. But what's critical in there is making the body hypoxic long enough so that you can stimulate this initial secretion of EPO and maintain it. Because there's redundant mechanisms that try to maintain homeostasis of what's going on. So you have to create a situation where you're convincing the body that it needs to change and adapt to this altitude environment.

Now this. You're also one of the guys who helped to create the World Anti Doping Association. What's the difference biologically between someone going and a professional athlete, let's say, doesn't have a day job, goes up to altitude, lives for three, four weeks, raises EBO levels, comes down and competes. You get another semi pro guy who has a day job, can't do that, and uses physiologically normal amounts of EPO to get his blood levels to the same. The same number of cells per liter as the other guy.

What.

What's the, like, what's. What's the perspective on that? I mean, I'm asking you as an expert on doping.

No, but, yeah, it's a very good question. And it's been put before a number of ethics professors and stuff like that. As at wada, one of the things that WADA does is it keeps a banned list of various drugs and methods which they consider unethical and illegal. The nitrogen tents came up in front of this and basically said, well, what's the difference between a nitrogen tent and living in Park City, Utah, or taking an EPO shot? And the difference boils down to a number of things. And we talk about pharmacological versus environmental manipulation. The positives about environmental manipulation is that the body always has its feedback mechanisms operative, so you're able to prevent the complications that can occur where with pharmacological manipulation, I mean, you can take as big a dose as is tolerated for a while, but if you take too much, it can kill you. And this is what happened with a number of Dutch cyclists in, I believe it was the 90s. And so again, we get back to these redundant control mechanisms that keep us safe when we are manipulating our environment, where that's not the case when we're administering a drug.

But if you're administering the drug in the same amounts and measuring, measuring your EPL levels are the same as the guy at altitude, that avoids all those ethical arguments, doesn't it?

It's very hard to do that. And on a practical basis, nobody does that because the amount of EPO that's injected overwhelms any kind of physiologic increase.

Got it. So it's a harder to dose thing. As an anti aging guy, I know anti aging doctors who use EPO in people with low blood volume. And as people age, they're using things that are on the WADA list, but they're using it to make older people young again.

May I interject just a second?

Absolutely.

Pretty soon, with the aging, the only people that aren't going to be using these drugs, whether it's anabolics or some form of blood doping, are the athletes. And I think you're right, the rest of the population is going to be enjoying themselves. So, you know, good point. You know, the, the problem is, is that with, depending on what exactly you do, there are health consequences that can be very negative associated with these various practices.

It's a serious conundrum and I don't know the right answer. I feel like full disclosure, no matter what, whether it's a training technique or a special swimsuit or an injected cocktail of non band things, whatever you're doing, it'd be nice if we all learned from what our best athletes on earth did, because our older people, who would probably benefit from knowing that there's science that gets lost in the secrecy of competition.

Absolutely. Yeah.

But it's guys like you who get to see 100 gold medalists, who get to peek behind the science.

Well, and to be very frank about it, there's tremendous pressure to succeed and to improve your performance. When you're at this international level, essentially, anything goes. We put these anti doping systems in place to protect the athletes, to have safe and fair events. Hopefully they abide by that. The lessons that are learned from elite Sport can be translated into helping the everyday population live healthier and better lives.

Your work is definitely a part of that. And I want to transition to talking about blood flow restriction training, which is introducing some of that hypoxia.

Yeah. So let me put out a quickie right here.

Sure.

And that is that as altitude training is to essentially creating an environmental way of getting an EPO injection, blood flow restriction training is a way of getting a growth hormone injection when done.

Love it. Okay. And I guess growth hormone is also banned.

Yeah.

Man, all these 50 year old athletes, their lives must suck.

Well, um, you know, doping control is only present in certain, in international sport.

Yeah.

So actually there have been a number of masters athletes, master cyclists as a matter of fact, who have been using EPO by usada.

So yeah, it's such a. I talked with Mark, Mark Sisson about this. He's an Ironman triathlete multiple times. You know, a really good athlete. He's not, I don't believe professionally competing now and he's just had. Now I use all that stuff and it's kind of ridiculous that I couldn't maintain my health as I was working to do this. And so I don't know how we're going to have my anti aging world. I imagine 100 year old athletes who are actually able to do it, I just don't know if they'll be able to do it without a little bit of a boost. So maybe we'll make an exception if you're over 100 and you're allowed to use a certain longer list. But that'll solve itself over the course of the next few decades, right? We'll figure it out.

Yeah. I think in any competition at any age, what's critical is a safe and an even playing field. And so what constraints have to be put on the athletes and their coaches and their doctors to assure a safe and even playing field is the right thing to do.

Yeah, a hundred percent agree with you. If it's not even, it's not real competition and then safety, we all know that a real serious athlete, most of them, if you ask them if you could be the best in the world for five years and then you don't care what happens afterwards, they're going to say, yep, yep. But then five years later when they're popping tumors or keeling over, they might regret their decision earlier.

Well, you know, there was a study that asked that very question. A majority of athletes said that they would be willing to win that gold medal even if it cost them their life. In a few years.

Man, that is a. That is a hairy ethical dilemma on both sides of it. I don't know that I. I know the answer. All I do know is that transparency is key so we can all benefit from whatever people do. Let's talk about blood flow restriction training, because if it's like a growth hormone injection and athletes aren't allowed to inject growth hormone, but they are allowed to do blood blood flow restrictive training, perhaps more of them are starting to do it. In fact, I know they are. Tell me about what bfr, which is not a big some kind of rocket from Elon Musk, but blood flow restriction training. Tell me about what it is, how you came across it, and what it does.

Blood flow restriction training started in Japan about 1966. It's been around for 50 years or so. Primarily developed by a Yoshiaki Sato, who was a young bodybuilder. He had an epiphany while he was at a Japanese funeral where he had to sit in a position for a long period of time. And we would say his legs fell asleep. But when he was able to get up from this position, he thought his legs felt like he had just done a really maximal intensity strength training workout. And he goes, I wonder what that's all about. So he started putting various straps and wraps and all sorts of things around him, around his legs. Started experimenting. After 30 years of literally trial and error of all sorts of things, he came up with an elastic, inflatable, relatively narrow device that he called katsu, which in Japanese means additional pressure. He In 1998 and 2000 were the first times where some of the stuff that he had did, he had started doing studies and were published in English, in Western journals. The west started hearing about this. In my case, it took another 10 or 11 years to hear about it. Dr. Sato treats katsu like a Japanese martial art where, you know, you come into his dojo and you have to scrub the bathrooms for three years before, you know, you ever get to do anything. And so he developed a series of disciples that do katsu in and around Japan these days. There's approximately 5,000 of them, and they do somewhere in the neighborhood of 50 to 100 sessions for people at their little katsu kiosks, mainly centered in Tokyo, but around, around Honshu and around Japan. I had the good fortune of being introduced to him and kind of being taken into the fold. From their standpoint, they wanted to reach out into the West. And from my standpoint, I was very intrigued by blood flow restriction training, kind of upsetting the balance of training. Basically, we were getting a really good performance benefit out of a workout that cost very little. So as things developed, I spent several years working with Dr. Sato. Then at a certain point, we decided to split up. I had a series of thoughts about how to make a better system, a better mousetrap. And I joined with my partner, Sean Weyland, at Be Strong to come up with a more affordable, more comfortable, safer and effective system that could be used anywhere, anytime. Really, that's what we're doing. And the basic mechanism is what we do. And this is, this is really not really widely known, but what we're trying to do is we're not trying to cut off blood to an extremity. What we're doing is we're changing the character of the venous outflow such that the working muscle is not getting the delivery of oxygen hypoxia, again, oxygen and blood in a manner in which it can sustain the work. And in many ways, that's what happens in the mountains too. So there's a lot of parallels. I would say that blood flow restriction training is local hypoxia, where altitude training is systemic or whole body hypoxia. The kind of. So what of that is that when muscle is asked to work, or any tissue is asked to work, but it's not getting all the oxygen it needs to replenish the ATP and the intercellular phosphates, the energy stores of the cell, that at some point a metabolic crisis is created. And this metabolic crisis then does a couple things. One is it stimulates local mechanisms to build more and better muscle and blood vessels and all these sorts of things. But it also, we become aware of this metabolic crisis. This is what we do when we listen to our bodies. When you've been on your bicycle in a criterium and your thighs are burning, that's your thighs are letting your brain know that there's a metabolic crisis going on there. That signal of a metabolic crisis or disturbance in homeostasis then causes the brain to react and among other things, put out a neuro humoral anabolic response. This has been documented by increasing levels of growth hormone after these kind of workouts. But it's really growth hormone is a marker for a whole constellation of anabolic hormones that are stimulated by these sorts of things. And it's also not that strange in the order of the same kind of growth hormone stimulation or the same magnitude of growth hormone stimulation that you get with a super maximal intense workout, where the metabolic crisis is caused by damage to the muscle. The difference here is that normally with these really intense or long duration workouts, you get damage. That is the signal for this change where with blood flow restriction training, we've just deprived it of the oxygen that it needs at the time and it's easily reversible. But we've created that metabolic crisis that elicits this signal. So what we get is we get kind of, you know, we kind of biohack the system. By depriving the working muscle of all the blood flow and oxygen it needs, we're eliciting this, the body's response to maximal, intense and damaging exercise.

Now earlier you mentioned you get a brief signal that then the body says, I don't need that anymore. What's different with BFR where okay, so for 20 minutes I had blood flow restriction, but now I don't. Why do you get a physiological change there but you don't get it from just general hypoxia? For the same period of time, your phone screen is aging your skin and wrecking your sleep at the same time. Artificial blue light goes from your phone screen straight into your eyes and deep into your skin. That light messes with your melatonin levels, interrupts your deep sleep and speeds up skin aging by breaking down collagen. The bodyguard's red light converter fixes this at the source. It's a first of its kind screen protector with real tech that converts blue light into beneficial red light before it hits your face. It turns your scrolling into a skincare routine. It supports healthier skin, reduced eye strain, improved sleep quality and fewer screen related headaches. Third party testing showed a 50% plus increase in red light exposure within the optimal range of 620-770nm. And this comes with zero compromise on your screen. The red light converter preserves your screen's true colors and full touch sensitivity. Beyond its wellness benefits, the red light converter provides ultra thin edge to edge protection for your device and bodyguard stands by their quality. Enjoy peace of mind with lifetime replacements, ensuring your red light converter continues to protect and support your biology. For the long haul, visit bodyguards.com and use code Dave for 25% off. That's bodyguards with a Z.com for 25% off. Why do you get a physiological change there but you don't get it from just general hypoxia for the same period of time?

Well, the systems are a little different and, and it's also, you know, it's not an instantaneous thing. After one session you have to be doing a training program with blood flow restriction to ultimately see the increase in muscle mass, the increase in strength, the increase in vascularity, the increase in bone density in tendon fitness, and all of these things that happen. And if you think it's really no different than any kind of intense training, we get the same kind of hormonal releases. It's just that we can't tolerate the intense training the way we can tolerate this easy or relatively easy blood flow restriction training.

So if you're not, maybe if you're injured, it's a great thing. So if you've torn your rotator cuff, you can still put the b strong bands on your arms, pump them up and do basic movement stuff, and you're going to be getting some recovery, I'm guessing, maybe even better than normal.

This is another really important facet. So let me differentiate between local effects of blood flow restriction training on the muscle that you're actually working, and then what I'm calling a systemic effect, which is this hormone release. And the hormone release goes everywhere. So any, any tissues that have been working or any tissues that have been injured are going to enjoy this anabolic hormonal milieu that's been created. So, for example, let's say, let's take the example of a rotator cuff that's been damaged. Now, that rotator cuff and that arm will not tolerate normal levels of training. But your legs and the other arm are perfectly good to do all sorts of things. So the general concept in rehab with blood flow restriction training is to exercise as much of the body's muscle as possible to get the biggest systemic effect, and then lightly in a way that doesn't negatively influence the healing structures. Do some exercise with them, and the consequence is that, number one, you stay fit in all your other structures. And number two is you optimize the heat, the rate of healing for the injured part.

So you might recover faster from doing this because of the systemic effects than if you had just done normal physical therapy or done nothing at all.

Yeah, absolutely. So let me take how much faster ballpark, you can say twice as fast.

All right, so everyone listening to this. You have an injury, it's not healing very well. So then maybe you start doing blood flow restriction. Now, if you're a professional athlete, you can't do this, but if you're the rest of us, you could also inject BPC157 peptide into the injured area and maybe you'd heal well, twice as fast from the peptide and twice as fast from the blood flow restriction, and pretty soon you're Wolverine, right?

Absolutely. I can show you, share an example with you. We had one of our Nordic combined skiers, ski jumping and cross country skiing, who fell on a jump four weeks before the Sochi Olympic Games. And he fractured his, the upper part of his humerus or his upper arm bone and he tore his rotator cuff. He broke, broke a couple ribs. Generally this was a season ending injury. It's season ending for a couple reasons. One is under normal circumstances he could do almost nothing to maintain his level of fitness. And when you do nothing, you lose your fitness very quickly at an elite level. The other thing is that normally it would take on the, or whether the numbers that doctors throw out is about 12 weeks to heal this kind of fracture. And we said, well, you know, that's not good enough. And the orthopod that we saw recommended that he go in and put a few screws in to fix this fracture. But that would necessarily take this athlete out of the Sochi Olympics. The athlete didn't like that answer. And at the time we were able to try blood flow restriction training with him. The short story is in six weeks he ended up competing in the Sochi Olympics and doing as well as if he had never had the fracture. It was also kind of nice because it was his sixth Olympic game, he was 37 years old and he was elected flag bearer for the US and just to annoy me, he carried the flag in his left arm, which is the injured arm during opening ceremonies. We were able to, number one, keep him fit while his shoulder got better. And number two, we were able to heal his shoulder quicker than would be expected.

What if someone has, say, anemia or post chemotherapy or something like that? They aren't doing so well even if they're bedridden. Can you still do this and get results?

Absolutely. There's a study ongoing right now. Well, one of the things is that sarcopenia is associated with morbidity and mortality in people that need to get operated on.

This means loss of muscle for people who don't have the medical word.

Yeah, if one is frail and has no muscle, then they don't tolerate big surgical procedures as well as the next guy. At UT Austin in Texas, they've started a study where they have patients that have some form of abdominal cancer and have had weight loss and are sarcopenic and they do a six week program of twice a week, b strong training sessions. What they want to do is ultimately study whether or not this improves morbidity and mortality. But what we know already is that we can improve their strength. And as measured by hand grip strength, we can improve their lean body mass, we can improve their ability to get around. So we're pretty excited about those results. One of the big healthcare crises in Japan is for seniors to take care of themselves. And the Japanese population is aging tremendously and they essentially don't have enough young people to take care of the old people. Dr. Sato and Katsu have gotten an award from the Japanese government where they take Katsu bands and they go into the homes of people that are essentially homebound and need someone to come into the home to do activities of daily living, the clothes, et cetera, shopping, that sort of thing. Within three months, these people don't need that extra person to come to the house anymore. Wow. And this is from a self esteem standpoint, from a use of resources standpoint, it's absolutely huge.

That's a big thing. I'm kind of attracted to the idea of putting the B strong bands on my arms and legs, standing at my desk on the bulletproof whole body vibration plate, bidding 20 minutes on a conference call, maybe doing an occasional air squat for good measurements. And maybe I'm holding plank for 30 seconds at the end and then just being done with it.

You could, you could do it now.

I could do that. And I'm going to be able to function though. Wow. I don't have any of the bands with me. I have some elastic things, but I don't have the puff up ones. I've ordered yours or this. I've asked my team to get yours because I recognize that yours are the ones I want. So I have some just cheapo ones meant for resistance, but they double for that. And I've done it with ice too. I have a Vasper machine downstairs which is not the same, but it provides whole body cooling at the same time and only for cardio, not for other muscle moving exercises. I kind of look at them as different. Yeah. Plus it's a commercial grade piece of gear. We have it at upgrade labs and all. I mean, you can't throw it in your suitcase like you can your bands. Your bands are very small. So I think there's benefits to being cold while you increase organ circulation and there's benefits to, you know, being at your desk and just getting it done. If so. A lot of people listen to this. I mean, they come from all over the place. It's a big show now, but I routinely hear from Wall street traders, entrepreneurs, you know, really busy executive types, Hollywood people. But it's kind of Asking on the vibration plate because how would I double down on it? But if I just literally before a call, just basically put these things on my arms and legs, took the call, maybe paced around the conference room table a bit, how much benefit am I going to get versus if I did.

A full training session in 20 minutes you can get more or less a full body workout and that's all, all you need on a daily basis. And essentially no special weights. You know, you might, you might have some hand grip things available. You can do calf raises. You can, I like the, I like.

The digital hand grip.

There you go.

Problems. I, I, I max it out every time. So I've got the heavy duty one. So hand grip training would be good. What else?

Arm curls. And if you don't, and you know I've got some five pound weight here, five pound dumbbells, that's great. And if you don't have in those bottle, a liter water bottle is good in each arm. It's that level of lightweight that's necessary. You can do push ups, you can do sit ups, you can do kind of lunges, you can do hamstring curls on your back. Essentially any kind of calisthenic can be used to do this. Calf raises, we usually like to do them in, in three sets of 30 repetitions for each exercise. The idea there is that with the essentially these 90 reps and these periods of rest, we end up exhausting the body, the working muscles, energy stores and being able to create this metabolic crisis. It's pretty amazing, to tell you the truth. When I was first introduced to this, I was pretty darn skeptical. But then I tried it a few times and I started reading about it and I'm continually amazed at how dramatic the results can be in very short order.

It seems like there's a variety of these hidden technologies where you do it precisely this way or you take advantage of some system that we didn't think about. There's another company that was just on looking at just cardio respiratory fitness and they are finding two 20 second high intensity intervals works better than three. So you know, like a seven minute workout three times a week gets you the cardio results of much, much more work. And I'm like, whoa. I grew up going, if you don't do an hour of cardio day, you're a bad person. Which means we're all bad people because you know, what the heck? But how does this work? This being the blood flow restriction b strong work. How does it compare for cardiovascular fitness versus you mentioned sarcopenia you mentioned healing, you mentioned muscle gain. So am I going to see VO2 max changes or am I just going to get swole?

Yeah, depending on the kind of training you do, you will see VO2 max changes. And I should say that the world's perspective on BFR has come from the weightlifting and bodybuilding community. So that's where most of the work has been done. But the principles are the same for cycling, running, skiing, all sorts of sports, soccer. And the key is creating this disturbance of homeostasis that releases a systemic response. And that's where you get. You know, you mentioned VEGF early on. There's some good papers now showing one of them in medicine, science, sports and exercise. First author is Larkin, and He showed that MRNA of VGF, HIF1alpha and a number of the nitric oxide synthase systems was upregulated by a BFR workout compared to control exercise.

I would love it if you defined VEGF and HIF1alpha. Longtime listeners have heard me talk probably more about HIF1alpha, but I think a lot of people don't know what those are.

And I would say to the more layperson that what these, what the. These are cytokines or hormones that are associated with building new and better blood vessels. Not only do you get stronger and bigger muscles from bfr, but you get more and better blood vessels. It's also exciting to think that these things can repair blood vessels. And because functionally these, these are entities or cytokines that help the endothelium, which is the main, the inner layer of, of arteries and, and capillaries and veins. And that is what is damaged by atherosclerosis. So if we can repair that damage, then we're talking about reducing heart attacks, stroke, a variety of other major killers of the population and major things that cause aging. Yeah, so it's very exciting. It's not just about building big muscles, it's about essentially upgrading all the systems that are involved in exercise.

VEGF and actually, and EPO are two hormones that are really interesting to me because when people are exposed to toxic mold, as I was, I did a documentary, by the way. If you're listening to the show and you have someone who says they have mold and they're acting crazy, watch moldymovie.com it's free. My gift to you. But I interviewed a dozen experts on mold and a dozen people who'd experienced it. And one of the telltale signs of both Lyme disease, which is quite often misdiagnosed, toxic mold and Mold itself is low levels of VEGF and low levels of epoxy. So I'm really intrigued to see what will happen if someone with chronic fatigue syndrome, which is another word for toxic mold exposure or Lyme disease, 90% of the time. I kind of study these things because I was diagnosed with all of them. What happens if they put blood flow restriction things on and sit there while they're watching TV because they can't really do anything else? I know, I've been there. Do they recover? Do you have any data on people who are just wrecked?

We have some good stories. None of this has been characterized in a, in a form of, you know, taking 20 people with chronic fatigue syndrome and putting half of them on a B strong program and the other half just doing the exercises and seeing who gets better.

You have exercise intolerance. You can't exercise when you have cfs. That's one of the problems.

Well, you, you can even do little stuff like opening and shutting your hands probably.

There you go. Yeah.

So you need to do some sort of motion, but you can't just sit there. But for example, with quadriplegics, we can electrically stimulate muscle and use blood flow restriction and still start getting the benefits. So it's not just about, let's say, putting on tourniquets, it's about combining. It's impeding blood flow so that working muscle can't get the oxygen and energy supplies it needs to sustain the work. But that can be very, very little work. And for the 90 year old who has trouble just getting around their apartment or their home, that's enough. One of the big things for seniors is getting up and out of a chair. Putting, put, put a set of leg bands on and try to get up and down from your chair. That's going to have a positive benefit. Getting back to your chronic fatigue syndrome or. There's. There's been a number of patients with, that have been dealt with and, you know, they, they express that they feel better and that they are more functional. But it's just kind of a good story. This has not been done in any kind of systematic, scientific way.

I can tell you there's probably a few thousand people listening who are recovering. Actually, there's probably a lot more than a couple thousand. Just, if I'm doing the math, there's a couple hundred thousand people listening. So there's probably 25 or 30,000 people now who are going, I have that and I'd like to get better. So there's going to be some additional discussion on social Media and all about what happens when you have one of these chronic fatigue things and you use this as a way to do it. I was fortunate that when I got taken out by toxic mold, I was able to spend a few hundred thousand dollars getting better. It shouldn't have cost me that much, but you had to find all the stuff that didn't work and they didn't understand what was going on. But now we understand more. But it still is.

Is.

It's a $25,000 problem for most people. And with your bands, what do the bands cost, by the way?

Our MSRP. MSRP is 429.

Okay, so under 500 bucks.

Yeah. For a full set. And.

And then if that replaces a bunch of hormones that you would have had to take it, they pay for themselves in, frankly, in a month for a lot of people who are sick. Right. So assuming it works. I was also really interested in the research that you've talked about on mitigating damage to the endothelium. So one of the things that kills, I call them the big four killers in my anti aging book. If you just look at the stats, it's cardiovascular stuff. And the endothelium, the lining of the arteries, is where the action is. What does the B strong system do for the endothelium?

Well, the part that's been documented is that if you do a set of B strong exercises like hand grips, arm curls, push ups, then calf raises, air squats, and, let's say, hamstring things just. Just acutely, and you do those with and without the B strong bands in place. When you don't do them with the B strong bands, you have almost NO movement and MRNA for VGF, HIF1alpha, and the nitric oxide synthase systems, which was the control work. But when you do them with the bands in place, you get very robust increases in MRNA released into the blood from these various things. So essentially, they took a blood sample before and after these exercise sessions with and without the bands and showed that there was a much greater increase in MRNA for these various things when you did the work with the bands. The assumptions are that when you increase these things over time in a sustained way over time, this will improve your endothelium. And if you improve your endothelium, as. As you were saying, you know, it's kind of like Drano for heart disease.

Incredible. So there, there's a lot of stuff here, and I'm. I'm always intrigued at this.

Let me say one other thing. So, yeah, we also have Some preliminary data about metabolic syndrome and which is being overweight, high cholesterol, high blood pressure and high blood sugar. And it's kind of the American disease.

It's what I had in my 20s. Yep.

And these people who had this syndrome were randomized to either a elastic BFR arm or to just doing the exercises themselves. And after three months, there was dramatic improvement in the group that did the BFR training and no real change in the group that didn't. In terms of hemoglobin A1c, which is a marker for hyperglycemia in the case of their resting blood pressure, in case of their lean body mass and subcutaneous fat, and in case of their lipid profile. Wow. So it's tremendously exciting.

I'm going to be playing around with this for the next few months because what you're doing is more impactful than I realized because I've looked at Kaatsu for a long time. It hurts a lot and it's. You have to go somewhere. It just doesn't meet my convenience factor, even though it's cool stuff. And what you've really made me think about is electrical stimulation. I've got some very high end electrical stimulation gear behind me. So I don't see why I can't put the bands on, put my feet in a bucket of water with electrodes in it and put the other electrodes up on my shoulders and then take a call.

Well, you have to be careful with the current on that kind of setup.

Yeah. It's not plugged into the wall kind of thing. This is a clinical grade electrical stimulation system for recovery. So it's not going to cause any damage, but that kind of thing. Wow. And then whole body vibration.

Well, as you say, the vibration plates, that's really good because you know when you're doing the vibration plates, you're actually activating a lot of muscles, postural muscles, to kind of keep you upright on this thing. And those muscles run out of their ATP and intercellular.

They do.

And so what happens is this just amplifies the whole thing. Wow.

Bulletproof has made a 30Hz vibration plate. We've been selling it for I think about eight years now. And it's one of the things I don't talk about very often, but Die Hard, Bulletproof all have it because that alone you see differences in a week standing on it for 10 minutes. But if you can put the bands on and stand on it and you're getting an amplified result, I could do that. It's not that. How long does it take to put the bands on it? I mean normal elastic bands takes no time at all. So you're talking like five minutes, probably less than five minutes for the whole body here.

I'm putting one on as we speak.

So it's a little. If you guys watch this on YouTube, we'll put this part up. But it's basically just a little. Looks like a blood pressure cuff kind of, but without all the dangly bits.

I probably shouldn't have this big sweatshirt on, but basically you just put it in here.

So this is different than the. If you go to Amazon, you see a bunch of elastic stuff which is not related to what this is.

Yeah, the elastic stuff or the non inflatable stuff. We're good. And is not controllable.

It's a little electric pump here that you hooks up to it.

This is just a manual thing and I'm good to go.

Oh, wow. And that hold it up just for a second, the manual pump. So it's a little squeezy pump, just like a blood pressure cuff. Okay.

Yeah.

And then a quick release thing. And now it's on, right?

And then it's on. And I can do, you know, hand grip exercise or whatever or we also designed this so you can do any kind of other exercise. I can go swim with this, I can ski with it, I can play tennis, whatever.

Wow, that's cool.

These are, you know, you mentioned that Katsu is somewhat uncomfortable and that sort of thing and in some ways not that affordable and in other ways kind of complicated to use. One of the big things that we've tried to do is get the benefits of Kaatsu, which is elastic, inflatable, controllable bfr but with without the associated problems. So you know, you just throw these things on and stand on your vibration plate.

Well, I'm really interested in anything that's going to let us get more exercise or not even more get the right amount of exercise in the minimal amount amount of time and minimal amount of inconvenience.

Right. And so, you know, another big thing is particularly pertinent for our athletes. Most of our athletes go over to Europe to compete in World Cups and that sort of thing. And you know, they can't at the ski team. They have really nice facilities and big weight racks and everything, but you can't put that in your suitcase. Our, our system weighs about two pounds altogether and it goes in your carry on. They can do work workouts on the plane over to Europe and they can do workouts in their hotel rooms instead of having to find some sort of gym to maintain their strength and fitness. So it's very convenient. Another big application is that busy businessman that you talked about who's traveling all over the place. And consistent exercise is kind of out of the question or at least very hard to do. And here you can, you know, whether you do it first thing in the morning or before bed at night, you put in 20, 30 minutes and you're good.

I'm going to ask you as someone who has 40 years of experience, after your education, all that stuff, you definitely have more experience than I do in life. How long do you think the average person alive today has the potential to live? And then I'm asking for you personally.

I would put on my non expert hat in this, but I'd throw out that I we should be able to double it. And it's in terms of talking about the average life expectancy. And one big thing is cutting out all the negative things that we do to ourselves. The positive things are eating, trying to eat right or responsibly and get regular exercise between those things. I think we can do a lot better than, let's call it the average lifespan of 80 these days.

And given your amazing access to technology and other lifestyle things, you're a doctor, you can pretty much get whatever interventions you want. What's a realistic number for you? I mean, you come from a different generation than me and you've led a different life. But I ask every guest on the show this.

Well, I kind of hope to go on forever, but I don't.

There's nothing wrong with that answer. I mean, that is the me too. There you go.

Another way of saying it is that my parents and three of my four grandparents all made it into their 90s. And that was, as you say, well before. There are all the things that are available today for even me, let alone my kids and everything else. So there's a lot of room there. And one of the other things I'd add to that is it's one thing to live to 120, but one of the things that I'm kind of focused on these days is what I'm calling, or what people have called health speed, where you want to be active, you want to be useful, you want to be not kind of groveling in your own saliva somewhere.

Yeah, being alive isn't what we're talking about. If you can't move under your own power with a brain that works without suffering through the day, every day, 100% with you. And part of My words. Erase that picture of aging. That's an unnatural deviation. Throughout most of history, you didn't get to do that, and no one wanted you to do that. They'd push you over the cliff, feed you to the lions, or you'd die in your sleep. And we didn't do the bizarre stuff we do today. So we're going to throw that out as our picture of being old. You're the old, wise and able to help a lot of people. Old, curmudgeon, testosterone deficient, and, you know, enjoying your beer until it's the end of days. But that whole, you know, tubes, monitors, wheelchairs, and. And, you know, all the other un. Just, you know, unpleasant things, we're going to take those away because they. They're unnecessary. With what we know today, I. I just believe that.

Well, here. Here's another semi bizarre thought is, you know, most of the problems, problems in the elderly are induced by gravity. So if we create a space colony in orbit, you know, there's no problem moving around. You're weightless.

See, that's the kind of thinking that gets us way beyond what people think is possible. I absolutely love that. Jim, thank you for being on Bulletproof Radio. Your website's B strong, as in just the letter B strong. And that's where the bands are available. And I. I think there's real science to this tech. After 40 years of working with hundreds of Olympic athletes, you could pick any tech you wanted.

You.

You pick this one for a reason, as, you know, after you've had enough time to evaluate more than a few. So thank you for just, you know, going out there and doing something unusual that could save all of us a heck of a lot of time.

Well, thank you very much. And my mission is to change the way the world exercises, so.

All right, well, you're doing it.

Thank you so much.

If you like today's episode, you know what to do. Head on over to itunes, wherever you listen to the show, and leave a quick review. It's like leaving a tip at a restaurant or something. For a podcaster or an author like me, Tell me how I'm doing. If it's worth 5 or 6 or 10, however many stars they have on there these days, I'd appreciate that. And if you buy the B strong gear, leave a review for that, too. Wherever you leave reviews for that, probably on their website. I have no deal with them. I haven't actually ordered it yet. I'm pretty excited about it. But I wanted to learn from the inventor before I placed my order. And I am going to get it and give it a shot because I think the science is strong enough and you guys have heard me test all kinds of other stuff. So that's how I roll. Have a wonderful day.

The Human Upgrade, Formerly Bulletproof Radio was created and is hosted by Dave Asprey. The information contained in this podcast is provided for informational purposes only and is not intended for the purposes of diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider carefully, read all labels and heed all directions and cautions that accompany the products. Information found or received through the podcast should not be used in place of a consultation or advice from a healthcare provider. If you suspect you have a medical problem or should you have any healthcare questions, please promptly call or see your healthcare provider. This podcast, including Dave Asprey and the producers, disclaim responsibility for any possible adverse effects from the use of information contained herein. Opinions of guests are their own and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guest qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have a direct or indirect financial interest in products or services services referred to herein. This podcast is owned by Bulletproof Media.