Rhabdomyolysis Is Systemic

I know, I know. Some of you CrossFit or lifting veterans are tired of hearing about this. But I’m having an xkcd moment (pictured below) where I need to explain something. It’s important to me. And I haven’t been able to write anything in a while anyway.

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What are you crying about?

If you follow the 70′s Big Twitter you may have seen an exchange talking about a traumatic condition called Rhabdomyolysis, or “rhabdo”. I asked the lovely Shana Alverson (@ShanaAlverson) how she was feeling for CrossFit regionals, and she mentioned she had a mild case of rhabdo (seen below). I then asked a weird, inaccurate question of whether it was systemic or local. Then @TheSharkness said rhabdo was always local, which is a wrong statement, and this is why we’re here. Let’s get down to it.

What is rhabdomyolysis?

According to the A.D.A.M. Medical Encyclopedia:

Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances are harmful to the kidney and often cause kidney damage.

It’s a simple definition that is quantified by the disruption of the skeletal muscle membrane — remember this sentence because it’ll be important later. CrossFit et al. has an oversimplification stating that the muscle is damaged via exertion stress, the muscle leaks myoglobin — the protein that carries oxygen in skeletal muscle — and the circulating myoglobin interferes with kidney (renal) function, and can cause acute renal failure (which can very easily lead to death). This can occur, yes, but there’s more to it.

The disruption of the membrane of the skeletal muscle means that things that are supposed to stay in the muscle cells get out, and things that are supposed to stay out get in. It’s like leaving your door open and your dogs get out while the neighborhood cats come into your house and creepily spy on you. The point is that rhabdo is defined by this breach in the membrane, and even minor cases still have this shift in contents in and out.

Why is this a systemic reaction instead of solely a local one?

I’ll try to be as simple and concise as possible for the following. The pumps on the cell membrane get damaged and they can’t function properly. Potassium leaks out of the cell into the blood stream causing a high blood serum level of potassium (hyperkalemia). Calcium increases inside the cell, which destroys the muscle fibers (necrosis). Some other stuff leaks out of the cell like phosphate, myoglobin, creatine kinase (CK) and urate, which all have an effect on their respective serum levels in the blood. My point, the catalyst argument for writing this, is that these events are systemic as opposed to local.

For example, let’s say you eat 200g of sugar. Is there a systemic response to this? Regardless of the current adaptation of the person, the answer would be yes. Serum levels of sugar increase, therefore insulin levels increase to bring the blood sugar down. Insulin, along with all hormones, has a dynamic relationship with other hormones to regulate the amount of sugar in the blood and therefore we would see arbitrary repercussions from other hormones as a result. The same goes for blood levels of anything, particularly potassium and calcium. If these levels change from homeostasis, then there is a systemic response to return to homeostasis. This is systemic, hence validating my point that rhabdomyolysis is a systemic condition, even if it’s minor.

If you’re wondering what the hell is going on, it goes like this. Muscle is damaged and stuff goes into the blood that is not supposed to. Each part of that “stuff” can do bad things if it stays there. If the total effect of all of that stuff is not enough to kill the body, then the body, AKA the system, will have a response to regulate and control it. The end.

It’s not a semantics conversation because the exact definition of rhabdomyolysis states that not only does muscle break down occur, the contents of the cell will be leaked. Simply being really sore and having damaged muscles isn’t rhabdo. It’s defined by the stuff being leaked, and it’s more than just the myoglobin. For example, the potassium and calcium being in the wrong places can cause heart arrhythmias, which can throw someone into a cardiac code and potentially kill them if treatment is not available. And, if you’re still interested, the serious cases can cause other issues like compartment syndrome, sepsis, seizures, and DIC — which are just more easy ways to die.

I’ve studied anatomy, physiology, and rhabdomyolysis itself on a personal, academic, and medical level and have been fortunate enough to talk to ER doctors and nurses, medical doctors, physician assistantants, and more about it over the years. A few people will get full blown rhabdo where they need hospitalization and help to perfuse their organs, but most of us have just been really god damn sore and sluggish for days after a physical exertion beat down. That is the systemic response of the body trying to deal with the skeletal muscle membrane disruption.

As an aside, we treat regular non-traumatic muscle damage from things like squatting, pressing, and pulling as systemic stress anyway, so I could have just ended the discussion there.

If you want to learn more about rhabdo, I’ve written an article on how to avoid giving clients, trainees, or athletes rhabdo. The message is simple: don’t do too much shit too soon with people who aren’t ready for it. Also, be aware of the continuum of symptoms since rhabdo is a systemic condition that will be debilitating to training.

70′s Big Radio – Episode 18

This was easily one of the best podcasts we’ve done. We talked about Scott Mendelson’s pec insane pec tear, sorta criticized strongman training, something Eric Cressey said, and Tony Budding’s new Pro Fitness League, and a whole lot of shit that doesn’t make much sense but made us laugh our asses off.

Topics came from Twitter, and you can send us more @70sBig or on Facebook.

Search “70′s Big” on iTunes or listen/download HERE. Subscribe with your RSS app HERE.

QB’s Can’t Gain Weight? Bullshit.

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Adam Schefter works for ESPN and is an NFL reporter who gets all the “insider” information. The above tweet is talking about the top three quarterbacks that will be going into the NFL draft this year. These stats are gleaned from the NFL Combine, which allows the NFL personnel to evaluate the talent coming from collegiate sports to the NFL. It’s a lot of mental and physical testing to try and project how well these athletes will do in professional football, yet it is often incomplete because physical stature and prowess do not always make the best football player, though it helps.

I was listening to Mike and Mike on ESPN radio this morning, and they were talking with various experts on the size of these quarterbacks, particularly Manziel and Bridgewater. The important stats for quarterbacks, from an anthropometry perspective, are height, weight, and hand size. The hand thing is apparently a good projector of success (i.e. it’s easier to hold onto a football in adverse weather), but let’s ignore that. Height is also very important — seeing over the large lineman to throw a pass is important — but we’ll ignore that too. How much a guy weighs and fills out his frame is important because football is a rough, collision-based sport, and frail guys will not have durability. Especially when there are mastodons who weigh anywhere from 250 to 350 pounds wanting to crush your soul.

The experts point out that two of the above quarterbacks weigh 207 and 214. As a “lifting and athletic population”, we know that these guys aren’t heavy. Yet we also know that it’s actually kind of simple to add mass on to a guy, especially when their frame has room to fill out (as both of those quarterbacks do).

What I find baffling is how difficult the experts think gaining weight is. And I’m not even just talking about gaining weight for the sake of gaining it, like in Starting Strength-style linear progression. I’m talking about putting a focus on retaining athleticism, agility, and speed yet increasing lean body mass. Most rookie mini-camps don’t start until the end of May. Training camp starts in July. The season actually starts in September. How long was your linear progression? I got some pretty solid fucking progress in 8 weeks by moving my three-sets-of-five from 325 to 445 while increasing my body weight from 195 to 215 (in 2009).

If the experts think it’s difficult to put five, ten, or even fifteen pounds on a guy in three to six months, then either the strength and conditioning is really shitty, there’s no athlete compliance, or they don’t even try. I’m no expert in the realm of NFL strength and conditioning, and maybe we should get John Welbourn’s thoughts, but it sounds pretty stupid to see a 21 year old’s body and think that it can’t be improved. I’ve done it over and over with athletes, so why can’t they?

Shameless plug, but this diet style would help an athlete build quality mass and aid recovery.

Shameless plug, but this diet style would help an athlete build quality mass and aid recovery.

Edit: I forgot to mention what I would do for a guy that needed to retain athleticism but increase size. I’d have him lift three days a week in conjunction with his agility, speed, and/or skill sessions. He’d squat, press, row, and do pulling movements that wouldn’t interfere much with his other training (i.e. stuff like power cleans, RDL’s, and lighter deadlifts instead of trying to push his deadlift up). A quarterback would be doing weighted pull-ups and chin-ups, possibly some barbell pullovers. I’d throw a Paleo for Lifters diet at him, which would be a quality, clean diet of meat, potatoes, fruits, veggies, and good fats with a little bit of protein powder in quantities that would help him grow. It wouldn’t be all that hard for kids that are described as “not very thick” or having a “slight build”.

How do I reach these keeds?

I overheard some young guys — around 20 to 23 years old — talking about training. They were very enthusiastic and were seemingly sharing “insider knowledge”. One of them talked about a specific type of protein he bought from GNC, how it was good for “building”, and how he would transition into another kind in order to “maintain”. The other referenced his “older brother” and how “he said” that another product was very good, and that he only uses that brand. Then he talked about his older brother went and talked with people at GNC and Gold’s Gym for, “like, half an hour” to learn about working out and stuff. “He’s insane,” he said.

Most of you saw the words “GNC”, guffawed, and knew where this was going. The truth is, we were all there at one point. I remember carrying around a couple issues of Muscle and Fitness for reference (I was 17). One in particular was an barbell-only program. It was actually pretty useful at the time, because it was a poor, haggard man’s strength program that used barbells. Weird, huh?

There are thousands, possibly millions of guys like this. They are young, alarmingly skinny or small, yet enthusiastic. Those “conventional fitness” resources that they read may help them get a bit more muscular, but they’ll be horribly inefficient. A strength program with compound, systemically stressful movements with appropriate rest and caloric intake will work much faster. If they wanted to squat, bench, press, and row for sets of 8 to 12 reps, they will be able to use more weight if they were stronger. Getting stronger will result in bigger muscles. It’s a pretty simple formula that isn’t really preached by the alleged “experts”.

I wanted to intervene in the conversation. I wanted to say, “Look, do three sessions a week of a squat, a press, and a pull, eat over a pound of meat a day, and get a good night’s rest. That’ll be exponentially more beneficial than buying shitty protein powders and talking to weirdos with sea shell necklaces and shaved chests.”

But I didn’t. They never listen to a stranger. Before I started 70′s Big, I remember telling some high school football players in a Gold’s Gym, “Stop playing with these dumbbells and go over there and squat every time you come in here.” They didn’t squat that day. Fuck me, right?

I hate when people write critiques of training programs, methodologies, or how stupid people are without some sort of solution to the problem. For example, I talk about how much I hate hipsters, or vegetarians, or society’s notion that females should be starving and men should be shorn waifs, so my Revolution articles end with proposed action.

In this case, young and dumb kids may not listen to what you have to say, but maybe we should try? Maybe you can help them in one small way by suggesting they squat more often, eat meat instead of powders, or stop worrying about “body parts” and get stronger. But, your words will mean much more if you are a big, jacked, strong guy instead of merely being decently strong and kind of fat.

Eat clean food, jack fucking steel around, and don’t be as douchey as the roiding tanned weirdo who smashes sets of incline bench to pre-exaust his pecs and you might have a chance at reaching these kids. But it starts with you and your success.

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When Eggs Grow Stale

I’ve noticed some guys complaining about how bland their eggs are. Our own Arin Canecchio and Chris Riley go through spurts when they find it difficult to wolf down six eggs in the morning. I’ve eaten at least three or four eggs every day for almost ten years. Since 2009 I’ve eaten at least five, and usually more than six with peaks of eight or nine. To the complaining gentlemen, I say, “You are a fool.” Dress your eggs up and they won’t let you down. Here’s how.

USE BACON

How could you forget? Nowadays I hate to talk about how great bacon is because all of the hipster pieces of shit tasted it after several months of anorexia nervosa and realized they were fucking missing something. Naturally they rallied together — the most ironic hipster-piece-of-shit thing to do since they allegedly want to lead an independent lifestyle — to make a bunch of shitty t-shirts and memes and never shut the fuck up about it. Yeah, we get it, bacon is fucking awesome; WELCOME TO 1776 AND 1861 WHERE BEARDED AMERICANS ATE BACON WAY BEFORE YOU FORGOT HOW MUCH YOU HATED YOUR PARENTS WHEN YOU TASTED IT ON YOUR FIRST DAY OF LIBERAL ARTS SCHOOL.

Let’s move on. If you clicked the Civil War link above, you would have seen that bacon grease was used to fry beef and corn meal. Confederate and Union soldiers didn’t carry around chickens or delicate eggs, but we’re going to use the same principle.

Hipsters weren't the first to eat bacon.

Hipsters weren’t the first to eat bacon.

SELECTING YOUR BACON

Do you like skinny hipsters? Ptsh, then why would you want skinny bacon? I know of over 900 studies about why thick bacon is better, and they are all single day case studies where I cooked it, ate it, and pat myself on the back for such a solid decision. Thick bacon will cook better, have a better consistency, and yield an appropriate amount of grease (discussed later). I shouldn’t have to say this, but the bacon I’m referring to is the United States variety; Canadian and Australian styles are good, but standard Second Amendment loving Americans will call that “ham”.

BACON TO EGG RATIO

You read that title and thought, “Holy SHIT, I’ve never even thought about this,” didn’t you? I’m here to show you the way. After over 900 studies, I’ve found that two pieces of thick bacon for every two or three eggs is optimal. If you’re bitching about how it’s not enough, then you don’t understand scrambled egg cuisine and can kindly leave. If you’re bitching about how it’s “too much”, then you’re probably a) a terrorist or b) one of the aforementioned hipsters who googled “bacon” looking for a sweet meme to send to your hipster friends so you can ironically fit in with a social crowd instead of doing some squats and curls before bed.

CUT DEM BACONS

No, don’t cut your bacon like a young Ray Lewis; take your pieces of stacked thick bacon and cut it in two to three centimeter segments (for you neanderthals, that’s about an inch). The layers of the bacon pieces will separate when you cook it in the pan.

Bacon thickness as well as cut segment length.

Bacon thickness as well as cut segment length.

FRY THE BACON

Not too hot, mind you. If the temperature is too high, then you’ll just sear the outside too quickly and potentially ruin the consistency. On a stove where “10″ is “High”, I’ll go to 7.5 at the highest. If you want the satisfying sizzle when you put the bacon in the pan, then warm the pan, but it’s not organic to this operation.

WHIP YOUR EGGS

While your bacon is frying, you can prepare your coffee (I prefer a press pot) and eggs. Crack your eggs into a bowl, and whip that shit with a fork. If you use a whisk, then you’re like my 5’3″ mom. If you have a pair of testicles, use a nice, heavy fork. I take a lot of pride in my egg whipping ability; I’m the best on both sides of the Mississippi. On New Year’s Day, I whipped two dozen eggs. Proof below, fuckers.

The technique is a circular wrist motion. You want to think about pulling the eggs off of the surface, break that surface tension, and then push them towards the bottom of the bowl without hitting your fork on the bottom. The business end of the fork has an elliptical motion and the key is pulling the egg off the surface. If you do this quick enough, it looks like you’re separating the layers of the egg and results in much fluffier scrambled eggs without using any cream or milk (which are traditionally used to fluff them up).

ASSESS BACON GREASE SITUATION

Notice what’s happening here; you’re frying the cut bacon in a pan prior to cooking eggs. That’s because you’re going to put your scrambled eggs into the pan with your bacon. This how you’ll change your retardedly bland breakfast into a heavenly romp through taste and time.

You want your bacon to be cooked, but you don’t want it to be charred or overly crispy. Ideally, if you’re a sensible human, you’d want your bacon to have a slight chewy texture instead of crunchy. You wouldn’t cook a steak like a giant buffalo chip (i.e. piece of cow shit), would you? That’s almost as bad as not eating steak.

This bacon is almost ready.

This bacon is almost ready.

Aside from the bacon “doneness” is the grease situation. Too much grease will result in sweaty eggs; their texture will be oily and you’ll feel like you’re eating the stool of someone with cholecystitis. As crazy as this sounds, too little bacon grease is better than too much. Get a jar and pour your excess bacon grease into it (you can use that grease on your baked vegetables later that evening). Knowing how much grease you need for a given amount of eggs is a learned skill, but if you tip your pan at a 45 degree angle (as if you were going to pour grease into the jar), you wouldn’t want your pieces of bacon submerged. The grease does serve a purpose, so don’t pour it all out; it coats your pan to prevent the eggs from sticking, which is a huge pet peeve of mine. The picture below shows the grease pouring technique and the amount of grease before and after pouring.

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POUR IN AND COOK THE EGGS

I’m quite surprised at how some people manage to fuck this part of the process up because it’s very easy. Your pan will be hot enough to make any amount of eggs within a couple of minutes. Pour the eggs over the bacon, make sure your bacon pieces are evenly distributed throughout, and continue to use your spatula to move the eggs off the bottom and sides of the pan.

Letting the eggs sit in the pan, as if you were making an omelette, results in an overcooked eggsterior (I couldn’t resist). If your eggs have a slight browning, that means you’re doing it wrong. If you like that, refer to the charred steak comment above. There’s probably some validity to an argument that would claim you’re denaturing some of the protein by overcooking it, but we’ll save that for another day. Just remember: move the eggs around and off of the pan by flipping the eggs constantly until they are light and fluffy. The fluffiness will be highly dependent on your whipping ability. I also like to use the edge of the spatula to break up the eggs so they aren’t in big clumps. This will improve the texture.

CONSUME AND ENJOY

This next part can make or break your egg eating experience. Some of you will be amazed at how much the bacon will improve your eggs, but if you’ve eaten them like this before you may need something more. I prefer condiments on my eggs, namely ketchup (without high fructose corn syrup in compliance with Paleo for Lifters). Ketchup works really well with white potato hash browns, which you can buy pre-cut up or make from scratch in grass-fed butter or coconut oil. I also like Chipotle Tabasco sauce, but that’s more so for fried eggs or scrambled eggs eaten with my Sweet Potato Hash recipe.

A dozen eggs yields enough for two.

A dozen eggs yields enough for two.

And there you have it. If you’re hating your egg eating experience, you need to cook them with your bacon. Food doesn’t have to be bland, so stop doing all this hipster-like complaining and dress your eggs up.