Key Moments
Red Meat, Deloads, and Pain with Dr. Michael Ray (Episode 22)
Stronger By ScienceKey Moments
Exploring red meat, deloads, and pain science for lifters, challenging old beliefs for practical application.
Key Insights
Red meat guidelines are debated: A recent paper suggests maintaining current red and processed meat consumption, challenging prior recommendations by emphasizing lower certainty of evidence and considering lifestyle preferences over modest health benefits.
Nutritional science challenges: Drawing conclusions in nutrition is complex due to the difficulty of conducting long-term, tightly controlled studies, leading to reliance on observational data with inherent limitations.
Proactive vs. Reactive Deloads: Deloads can be scheduled (proactive) or taken when fatigue arises (reactive), typically lasting 3-7 days and involving reduced volume and sometimes intensity, with complete rest weeks generally fine if infrequent.
Pain is complex: The biopsychosocial model of pain highlights that pain is not solely caused by tissue damage but is influenced by biological, psychological, and social factors, making it a highly individual experience.
Challenging traditional pain narratives: Common beliefs linking specific joint morphologies (e.g., acromion shape, FAI) or 'bad' lifting techniques (e.g., lumbar flexion) directly to pain or injury are largely unsupported by current evidence.
Empowering lifters in pain: Practical pain management involves education about the complex nature of pain, load management (adjusting RPE, volume), and willingness to challenge fear-avoidant movements, prioritizing returning to desired activities.
A JOURNEY TO ICELAND AND FEATS OF STRENGTH
The Stronger By Science team embarked on a trip to Iceland, a place renowned for strong people and unique landscapes. This segued into a recap of recent weightlifting accomplishments globally. Noteworthy feats included Lasha Talakhadze setting a new all-time world record in weightlifting with a 484kg total, surpassing previous records even from the 'Golden Age' of the 80s. Additionally, Andrei Saponghzikov benched 606 lbs at 198 lbs bodyweight, an extraordinary lead over competitors in his class, and veterans Dan Green and Lu Xiaojun showed impressive comebacks with strong performances, with Lu winning a world championship at 35 despite past injuries.
CONTROVERSY AROUND RED MEAT AND PROCESSED MEAT GUIDELINES
A recent paper in the Annals of Internal Medicine, led by Bradley Johnston, stirred controversy by suggesting adults maintain their current red and processed meat consumption. The study used the GRADE approach, which tends to favor randomized controlled trials, downplaying heavily observational nutritional data often used for prior recommendations. This led to online debate, with critics questioning the study's scope (e.g., not considering environmental impacts) and potential biases in panel composition. The study's conclusions, while seemingly contradictory, emphasize low certainty in the evidence for significant health benefits from reducing intake, alongside considering individuals' values and preferences.
THE CHALLENGES OF NUTRITIONAL SCIENCE RESEARCH
Nutritional science faces inherent difficulties in establishing clear cause-and-effect relationships due to study limitations. Tightly controlled randomized controlled trials (RCTs) are often short-term and expensive, while long-term observational studies, though capturing real-world outcomes, struggle with confounding variables and causation. This paper highlights how different methodologies interpret evidence, with an emphasis on the 'quality' of research. Critics argue that penalizing observational data, even if it's the only way to study long-term outcomes, skews results. The debate emphasizes the ongoing challenge of translating scientific findings into practical, population-wide dietary advice that accounts for individual preferences and the complex interplay of health behaviors.
INTERPRETING THE RED MEAT RECOMMENDATIONS
The panel's weak recommendation to 'continue current consumption' of red and processed meats doesn't mean these foods are inherently harmless, but rather that the potential benefits of reduction (modest decrease in cancer and cardiometabolic risks) are often outweighed by the 'undesirable effects' on quality of life and the burden of dietary change for most individuals. The authors acknowledge that informed individuals may still choose to limit consumption for health benefits. The key takeaway is a re-evaluation of the certainty and magnitude of previously touted effects, rather than a complete reversal of dietary advice. The discussion underscores the importance of a holistic view of diet, prioritizing nutrient-dense whole foods while acknowledging that moderate intake of red and processed meats, especially with mindful preparation, is likely acceptable for many.
PRACTICAL GUIDANCE FOR MEAT CONSUMPTION
For most people, a generally healthy diet includes abundant fruits, vegetables, fibrous grains, dairy, seafood, legumes, nuts, seeds, and lean meats. Areas to monitor include excessive saturated fats, added sugars, refined starches, and processed meats, which should be consumed in moderation and proportionally to overall energy balance. Trans fats and excessive alcohol should be avoided. When consuming red and processed meats, minimizing risks involves avoiding charring during cooking (which produces harmful compounds like PAHs and HCAs) and pairing them with antioxidant-rich foods. Marinating meats can also reduce nitrosamine formation during high-heat cooking. The goal is a balanced, moderate approach, rather than demonization or extreme elimination, contextualizing intake within overall dietary patterns and individual health goals.
UNDERSTANDING AND IMPLEMENTING DELOADS IN TRAINING
Deloads are vital for recovery and adaptation in training. Greg Knuckles highlighted two main types: proactive (scheduled, e.g., every 4-8 weeks) and reactive (taken when fatigue accumulates). Proactive deloads act as a prophylactic safeguard against overtraining, especially for general programs or distant coaching. Reactive deloads are self-prescribed based on how one feels, often lasting 3-5 days. The primary goal is to reduce accumulated fatigue, allowing the body to recover and adapt. Deloads typically involve reducing both training volume (30-50%) and intensity (15-20%), although the specific variable to reduce most depends on what causes the most subjective stress for the individual. Complete time off is generally acceptable if infrequent, such as a week every few months, balancing physical recovery with psychological restoration.
PROSPECTIVE DELOADS AND CLIENT MANAGEMENT
Eric Trexler introduced the concept of 'prospective deloads,' intentionally planning to overreach training intensity leading up to a planned break, like a vacation, to justify time off. This approach ensures the deload is genuinely needed. For coaching clients, especially online, monitoring fatigue is crucial. Eric uses detailed weekly check-ins covering mood, energy, and sleep to track trends, scheduling deloads reactively yet informed by a proactive calendar estimate. Sometimes, deloads are primarily for psychological restoration, offering a break from the grind of training, even if not strictly 'optimal' physically. This holistic view acknowledges that mental well-being is as important as physical recovery.
THE BIOPSYCHOSOCIAL MODEL OF PAIN
Dr. Michael Ray, a chiropractor with Barbell Medicine, discussed the biopsychosocial model of pain, which has largely replaced the traditional Cartesian model that assumes a strict mind-body duality where pain equals tissue damage. The biopsychosocial model views pain as a complex, subjective experience influenced by biological factors (like tissue damage or nociception), psychological factors (mood, beliefs, expectations), and social factors (environment, learned behaviors). This model emphasizes that pain is not always proportional to tissue damage; one can have significant pain without discernible tissue injury and vice-versa. Pain is conceived as an emotional output of the brain, designed to protect, but its experience is highly individualized.
CHALLENGING MISCONCEPTIONS ABOUT PAIN AND TISSUE DAMAGE
A major misconception is that pain directly correlates with tissue damage. Dr. Ray highlighted that research shows a poor correlation, especially in chronic pain. Imaging often reveals 'abnormalities' (now referred to as normative aging adaptations) in asymptomatic individuals. Conversely, people with acute, severe pain may have no identifiable tissue damage. Context plays a critical role, as demonstrated by soldiers in battle who can sustain severe injuries without feeling pain due to a goal-directed focus. An individual's thoughts, beliefs, and past experiences significantly influence their pain perception, making it highly subjective and not amenable to simple algorithmic assessment based solely on physical pathology.
JOINT MORPHOLOGY AND SURGICAL INTERVENTION DEBATES
Dr. Ray challenged the long-held belief that specific joint morphologies (e.g., acromion shape in shoulders or femoroacetabular impingement in hips) are direct causes of pain or necessitate surgical intervention. He cited studies, particularly on shoulder subacromial decompression and meniscus surgeries, where sham surgeries yielded similar outcomes to actual interventions. This suggests that the perceived benefit often stems from psychological factors like expectation and the placebo effect, rather than physical correction. Emphasizing structural 'abnormalities' can create negative patient beliefs and fear-avoidance behaviors, hindering recovery. The current evidence suggests that many morphological variations are normal adaptations and do not reliably predict pain or require surgical correction.
PRAGMATIC PAIN MANAGEMENT FOR ATHLETES AND COACHES
For athletes and coaches, Dr. Ray recommended several practical steps when dealing with pain. First, education is paramount: understand that 'pain doesn't equal bad' and 'don't panic' are critical initial messages. Emotional status directly impacts pain severity. Second, implement load management using RPE (Rate of Perceived Exertion) or RIR (Reps in Reserve) to adjust training in a controlled manner, empowering the individual. Third, if load adjustments aren't sufficient, alter exercise selection, temporarily removing painful movements and reintroducing them later. Finally, extreme or persistent pain may warrant professional consultation. The goal is to challenge fear-avoidant behaviors, build self-efficacy, and reframe pain as something manageable, not a barrier to activity.
MOVEMENT VARIABILITY, TECHNIQUE, AND INJURY RISK
Dr. Ray strongly criticized the prevalent narrative in the fitness community that specific 'bad' techniques (e.g., lumbar flexion during deadlifts, 'butt wink' in squats) are direct causes of pain or guaranteed pathways to injury. He argued that human bodies are dynamic and adaptable, capable of tolerating various movement patterns, especially with progressive adaptation over time. There's little to no evidence to support claims that specific 'imperfect' movements inherently lead to pain or injury. Instead, rigidly adhering to 'one right way' of movement can foster kinesio-phobia (fear of movement) and create negative long-term outcomes. The focus should be on finding subjectively comfortable and objectively effective movement patterns that accomplish the task, allowing for individual variability rather than imposing potentially harmful, unproven biomechanical narratives.
THE PERILS OF CLINICAL PRACTICE AND UNPROVEN THERAPIES
Dr. Ray highlighted the ethical challenges in clinical practice, where financial pressures can drive clinicians to seek profit through unproven alternative therapies (e.g., selling supplements, applied kinesiology). He described applied kinesiology's manual muscle testing as making 'batshit crazy conclusions,' drawing inexplicable links between muscle weakness and organ rotation or other unrelated issues. He critically compared the ethical implications of selling unproven remedies to making false biomechanical claims (e.g., knee pain from a 'torn meniscus') that stigmatize patients and lead to unnecessary, ineffective interventions. Both create false narratives that disempower patients and can have long-lasting negative psychological and behavioral impacts, underscoring the need for evidence-based care and patient-centered communication.
Mentioned in This Episode
●Supplements
●Software & Apps
●Companies
●Organizations
●Studies Cited
●Concepts
●People Referenced
Common Questions
The paper, published in the Annals of Internal Medicine, suggested that adults continue their current unprocessed and processed meat consumption. It categorized these as weak recommendations due to low certainty evidence, noting that traditional guidelines were based on observational studies with high confounding risk and often overstated effects.
Topics
Mentioned in this video
Lead author of the controversial paper on red and processed meat consumption.
Chiropractor with a Master's in Exercise Science, specializing in pain science and the biopsychosocial model, working with Barbell Medicine.
Philosopher whose ideas about finding meaning in suffering were referenced in the introduction to pain science.
Clinical athlete mentioned in reference to a Facebook discussion about sham surgery for meniscus injuries, which impacted the host's understanding of pain.
Previously dominant powerlifter making a comeback after injuries, recently deadlifted 793 lbs for 5 reps without straps, an all-time personal record for reps at that weight.
Classical scientist mentioned in the context of the historical divide between studying the body (permitted by the church) and studying the mind (reserved for the church).
Co-founder of Barbell Medicine, known by Dr. Rae and consulted with regarding pain and rehabilitative services.
Russian powerlifter who benched 606 lbs at 198 lbs bodyweight, a record-setting performance with more in the tank.
Georgian weightlifter who set the all-time biggest weightlifting total of 484 kg, surpassing previous records from the 1980s even with stricter drug testing.
Pioneering physician who, in the 1970s, advocated for the biopsychosocial model of pain, emphasizing psychological and sociological factors alongside biological aspects.
Futurist and author, referred to as an 'acolyte' for extreme longevity pursuits, potentially willing to make significant dietary changes for even small health benefits.
Australian researcher known for his work on pain science, specifically demonstrating that pain does not strongly correlate with tissue damage, especially as pain persists.
Powerlifter mentioned as having surpassed Dan Green in terms of current dominance.
Chinese weightlifter who won his fifth world championship at 35 years old (81kg class), beating out younger competitors despite an extensive injury history.
Yale researcher known for promoting plant-based nutrition, cited for suggesting a balanced approach to current nutritional knowledge.
Lifter famous for training once a week in very long sessions, an example used to illustrate that missing training time is not necessarily detrimental.
Philosopher after whom the traditional Cartesian model of pain is named, due to his concept of mind-body duality.
Co-founder of Barbell Medicine, known by Dr. Rae and consulted with regarding pain and rehabilitative services.
Co-founder of Logic of Rehab and Barbell Medicine, a close friend and colleague of Dr. Rae, with whom Dr. Rae collaborated on rehab philosophy.
Clinical athlete mentioned in reference to a Facebook discussion about sham surgery for meniscus injuries, which impacted the host's understanding of pain.
Founder of Goop, jokingly referenced as someone who might offer alternative, unscientific health remedies.
Organization co-founded by Dr. Rae and Derrick Miles, which they ran before joining Barbell Medicine.
Organization that formulated a collective definition of pain in the 1970s, which included the concept of 'actual or potential tissue damage' as a component of pain experience.
Where Dr. Rae worked as a research associate physician on a study related to physical activity in middle schoolers.
A network mentioned by Dr. Rae where he was exposed to clinicians who challenged his beliefs about clinical practice, leading to increased skepticism.
A scientific paper published in the Annals of Internal Medicine, led by Bradley Johnston, which sparked controversy by suggesting individuals continue their current red and processed meat consumption due to low-certainty evidence of harm.
Researcher whose 2014 work on defining injuries is referenced, emphasizing a multi-pronged approach beyond just pain perception or tissue damage.
A systematic method used to evaluate evidence and translate it into recommendations, emphasizing patient values and preferences, and conflicts of interest. It tends to favor randomized controlled trials over observational evidence.
A pseudoscientific diagnostic method used by some chiropractors that involves manual muscle testing to make 'batshit crazy conclusions' about unrelated health issues, often leveraging the placebo effect.
Sensory neurons that respond to potentially damaging stimuli by sending signals to the spinal cord and brain, involved in nociception but not directly pain itself.
The traditional, older model of pain, named after Rene Descartes, which posits a mind-body duality where pain is a direct and proportional result of tissue damage, distinct from the mind.
A powerlifting training program by Jim Wendler, alluded to as an example of a program structure that includes scheduled deloads.
A model that recognizes pain as an emotion influenced by biological factors (tissue damage), psychological factors (mood, beliefs), and social factors (environment, learned responses), challenging the traditional Cartesian model.
Signaling pathway associated with cell growth, including muscle cell growth, which is desirable for building muscle but often targeted for reduction by longevity researchers.
A hip joint condition where the femoral head and acetabulum abnormally come into contact, often diagnosed via imaging. Dr. Rae criticizes the biomechanical narrative around FAI surgery due to poor outcomes and emphasizes a humanistic approach to hip symptoms.
Hormone that promotes cell growth and turnover; desired by bodybuilders but often aimed for lower levels by longevity enthusiasts due to its association with aging.
Lifestyle brand founded by Gwyneth Paltrow, jokingly suggested as a potential employer for creating unscientific mineral guides.
An organization Dr. Michael Rae works for, focusing on pain and rehabilitative services, writing, and remote consultations for athletes.
Website that published an article summarizing the findings of the red meat consumption paper for those preferring a written format.
A major supplement company within the chiropractic profession, mentioned as an example of how some practitioners profit from selling products related to unsupported claims.
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