Since the publication of the first FitGreyStrong blog ‘Sitting yourself into your grave‘ just over 2 years ago (click on the link or see the picture below), there have been a significant number of milestones and achievements that I would like to share with all of my followers.
The last 2 years have been very busy and productive. There have been several scientific critiques and analyses published as well as many blogs. These have been specifically directed at those amongst us who identify as Gen X or Baby Boomers and have primarily focused on health, fitness and nutrition-related topics or issues. The following provides a summary of the FitGreyStrong journey:
Including the globally popular 10,000 word commentary on how diet affects energy expenditure and weight loss (see hereand here)
How resistance training can affect the course of ageing (see here)
The perennial favourite “12 Reasons Why All Older Adults Need To Hit The Gym” (see here)
Nearly 1000 followers on Twitter and close to 8000 tweets
Over 800 Facebook posts
Close to 400 Instagram posts and;
110 YouTube video’s
There have been some very popular FitGreyStrong blogs/posts/tweets/videos and I have listed a short assortment of these below.
Most popular blog
The most widely read blog with readers from over 20 countries investigates how strength training can alter the trajectory of ageing and reviews the seminal work of Maria Fiatarone and colleagues back in 1990 (see here).
Most popular Facebook posts
The top 3 most popular Facebook posts were:
The sitting-rising test (SRT) that showed that the ability to sit down and stand back up again in a cross-legged position could predict the likelihood or risk of dying in the next 6 years. There have been over 100,000 views, 17 shares, 92 likes/loves and many comments (see here).
Modifying the Thomas test for one of the best stretches for the quadriceps, iliacus & psoas major (iliopsoas). A great way to improve flexibility of these muscles and improve hip extension ROM. There were over 1,000 views, 5 shares, 26 likes/loves and comments (see here).
The study was undertaken to elucidate the range of training-induced neuromuscular adaptations in elderly humans recovering from a period of disuse. It examined the effect of three types of training regimes after unilateral (one-leg) prolonged disuse and subsequent hip-replacement surgery on maximal muscle strength, rapid muscle force rate of force development, muscle activation, and muscle size. The popularity of the post was generated by the muscle scans of the thigh showing just how powerful resistance training is at inducing change in muscle structure and function. There were approximately 5000 views, 6 shares and 22 likes. It was also widely shared on other Facebook pages (see here).
Most popular Tweets
The top 3 most popular Tweets were:
Age-related dynapenia is weakly related to sarcopenia and is why we must look beyond just muscle mass (see here).
Motor effort training and low exercise intensity increases muscle strength and descending command in aging (see here).
Counter to the energy surfeit model of obesity increasing energy expenditure may be better for decreasing percentage body fat than caloric restriction (see here).
Late last year the international journal, Clinical Nutrition, published a FitGreyStrong critique of: Thomson et al. (2016) Muscle strength gains during resistance exercise training are attenuated with soy compared with dairy or usual protein intake in older adults: A randomized controlled trial. Clinical Nutrition. 35: 27-33 thus demonstrating that Exercise Scientists practising outside of academia have relevant and valid things to say about clinical research being conducted around the world.
Clinical Nutrition publication
The highlight of 2017, however, was being given the opportunity to present “Why the ‘strengthification’ of Gen X’ers & Baby Boomers is the greatest health challenge of the 21st century“ at the Ancestral Health Society of New Zealand conference in Queenstown in October where I postulated that muscular strength lies at the foundation of health, quality of life and functionality. The slide deck of this presentation can be viewed (by request only), so please either send me an email or use the contact form on the home page.
Presenting at the Ancestral Health Society of New Zealand
The future holds some exciting and challenging projects ahead so watch this space. Currently, FitGreyStrong is working on a journal editorial with some other researchers from around the world which will investigate and report on the importance of resistance training in older adults and the augmentative effects and safety of nutritional/drug supplementation.
Finally, I would like to express a big thank you to all those that have embraced FitGreyStrong and I hope to continue to bring quality information to all those Gen X’ers and Baby Boomers interested in advancing their health, quality of life and functionality.
Please share with those family and friends that are interested in ageing, health, exercise and wellness. The social media icons below will link it straight to your preferred platform.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
This before and after 6 month “transformation” was an individual experiment (n=1), which was inspired by my professional curiosity to test the validity of 5 key claims currently purported to be fundamental for improving health and body composition that I do not entirely agree with as an Exercise Scientist.
The first 3 claims are strongly and enthusiastically advanced by those that hold the view that most, if not all human beings, should severely restrict carbohydrates. This includes some carbohydrates that have traditionally been viewed as “good carbs” like, for example, sweet potato, pumpkin, parsnips, bananas, mango, apples. The fourth claim posits that saturated fat is a key driver of increased risk and incidence of cardio- and cerebrovascular disease. The fifth claim below relates to the notion that advancing age impacts the ability to alter body composition in a meaningful way – which it does – but the point is that much can still be done if the approach taken is scientifically and evidence-based.
The claims
They are, firstly, that CICO (calories in calories out) has been scientifically debunked and is not a fundamental determinant of body weight or % body fat reduction.
Secondly, that carbohydrates are metabolically toxic and bad for your health, worsening biomarkers indicative of inflammation, CVD risk and ageing such as BP, CRP, homocysteine & triglycerides-to-HDL ratio.
Thirdly, that carbohydrates sabotage and are antithetical to body fat reduction.
Fourthly, reducing saturated fat to ≤7% of total energy intake will substantially improve dyslipidemia and reduce inflammation, and hence, morbidity and mortality rates associated with vascular-related diseases.
Fifthly, that significantly increasing lean body mass or skeletal muscle tissue, and appreciably decreasing body fat in middle-aged men or women is difficult and cannot be accomplished.
Baseline-to-endpoint anthropometry & individual characteristics (25.8.16 to 17.2.17)
Age: 49
Gender: male
Height: 1.77m (5ft 10in)
Weight: 86.6 kg (191 lb) decreased to 82.4 kg (182 Ib)
Δweight = 4.2 kg (9 Ib)
BMI: 27.6 kg/m2 decreased 26.3 kg/m2
ΔBMI = 1.3 kg/m2
Waist circumference: 92.5 cm (36¼ inches) decreased to 86.0 cm (33¾ inches)
ΔWC = 6.5 cm or 2½ inches
Body fat percentage: 17.6% decreased to 10.4%
ΔBF% = 7.2%
Fat mass: 15.2 kg (33.5 Ib) to 8.7 kg (19 Ib)
Δfat mass = 6.5 kg (14.5 Ib)
Lean body mass: 71.4 kg (159 Ib) to 73.7 kg (162 Ib)
ΔLBM = 2.3 kg (5 lb)
6 month “transformation” experiment
Insights & learnings from this experiment for Gen X’ers & Baby Boomers are as follows:
1. For improvements to be seen in health and body composition, day-to-day consistency in relation to the fundamentals (what you eat and drink, regular daily exercise and good quality sleep) are paramount.
2. The NEAT effect cannot be underestimated. NEAT or non-exercise activity thermogenesis is the energy expended for everything you do that is not related to sleeping, eating and formal exercise.
Maximising NEAT – by increasing physical movement outside of formalized exercise during the waking hours (e.g. taking the stairs not the elevator, going for a walk after dinner with the family, taking regular breaks from desk-bound work etc) and decreasing time spent in sedentary activities (e.g. watching TV, playing Xbox, surfing the net, social media etc) – has a massive effect on total daily energy expenditure.
In adults, strong evidence exists of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers.
These relationships are independent of physical activity. What this means is even if you regularly exercise, spending a lot of your other free waking time in sedentary activities is seriously harming your long-term health.
During the last 6 months I have attempted to keep moving during the day as much as I could in addition to the formal exercise sessions I was doing.
Bottomline: get up and move around for at least a few minutes for every 30-60 minutes you spend sitting or lying around.
3. Resistance training was an absolute key component of this experiment. It is essential to all Gen X’ers and Baby Boomers embarking on any lifestyle-based intervention where improved health, physical function and body composition are desired.
I could write another 10,000 words just on this point alone but I will direct you to the below links for further reading that discuss the benefits of resistance training in more detail.
Resistance training is critically important to health and body composition (Picture: pixabay)
4. Aerobic exercise remains pivotal for all exercise-based programs designed to enhance health, function and body composition. Enhanced cardiorespiratory fitness (CRF) is one of the most powerful ways to reduce the risk of subsequent disease and research demonstrates significant risk reductions for all-cause, cardiac and some cancer-related mortality. The activities I performed very regularly were cycling, walking and a little bit of rowing.
However, whilst in a caloric deficit state too much emphasis on aerobic activity may lead to reductions in lean body mass (skeletal muscle). I would suggest therefore that the most effective programs have a good balance of resistive and aerobic exercise (50:50). Balance training/exercises for those over 60 would also be important given that the somatosensory system suffers a similar age-related decline in function. Balance can be improved provided exercises that challenge this system are undertaken.
5. Once a sufficient baseline level of aerobic conditioning is attained, I would suggest incorporating some HIIT (short for high intensity interval training).
My favorite HIIT session was an indoor-based cycling session that consisted of: 10-15 min warm-up @ 40-60% heart rate reserve (HRR) with 1 x 30 second effort @ rating of perceived exertion (RPE) 14-16; following warm-up I would perform 3 x 30 second sprint effort @ RPE 17-19 or 85-95% HRR with 3-5 minutes rest between efforts; then 1 x 4 minute effort @ 16-18 RPE or 80-85% HRR with 4 minutes rest then; 1 x 30 seconds sprint (intensity as above) with 3-5 minutes rest; 1 x 4 minutes effort (intensity as above); cool down 10 minutes & stretch.
There is an increasing body of evidence to show that HIIT is a potent, effective, time-efficient and safe form of exercise which dramatically improves many health and fitness components including but not limited to increased cardiopulmonary fitness, reductions in cardiometabolic risk factors and some preliminary data suggesting that it can attenuate the rate at which our cells age.
Interestingly, there is little consensus on whether HIIT is effective to facilitate improvements in body composition independently of dietary changes which reduce energy intake. Several recent systematic reviews and meta-analyses came to conclusions at odds to one another thus leaving this author somewhat perplexed by these disparities.
HIIT should only be performed once there is sufficient baseline conditioning but it is now accepted and utilised in many chronic disease conditions and to great effect.
6. I would suggest that using the concepts of periodisation and polarization of physical exercise and training are beneficial to those that have a good foundation of fitness.
Periodisation is a training concept and is applied in practice by coaches of elite athletes and/or sporting teams. Whilst it can be quite elaborate and complex at the very elite level, for the purposes of this blog and those interested in applying such ideas to their exercise plan/program, it is simply the alternation of heavier or harder periods/days of exercise/training with a recovery or lighter day/week of physical activity. What should be remembered is that you can’t smash out high-intensity exercise sessions day in day out. Such an approach will spell disaster and lead to a training implosion where you’ll either get injured, sick or burnt out. It should be noted that much of the research that has explored periodisation versus no periodisation in non-elite adults tends to show that no further benefit is achieved. Providing planned periods of recovery and rest, I believe though, are critical to successful long-term adherence and fitness/health-related outcomes.
What seems to work quite well for most 40+ year old exercisers is a 3-week on/1-week off approach; meaning 3 weeks of exercise/training that is hard/challenging followed by 1 week where you back-off and reduce the volume and intensity of the sessions. This approach also seems to work well within each training week too where you could alternate more difficult or challenging training sessions with easier and lower intensity days. For example, the week may look something like this:
Monday: Resistance training workout 1 (main movement patterns: hip dominant exercise like deadlift, horizontal push/pull exercises supersetted like bench press with bent-over barbell rows)
Tuesday: HIIT (as outlined above)
Wednesday: 1 hour easy walk (20-40% HRR)
Thursday: Resistance training workout 2 (main movement patterns: quad dominant exercise like squat, vertical push/pull exercises supersetted like shoulder press with chins)
Friday: HIIT
Saturday: 1 hour easy bike ride
Sunday: Resistance training 1
Monday: HIIT
Tuesday: 1 hour easy walk
and so on.
Polarisation on the other hand is the training concept of exercise intensity either being very challenging and intense versus light and not difficult. On a subjective rating of perceived exertion (scale 6-20), very intense exercise would be anything rated over 16 compared to something light which would be 8-11. Polarising training sessions in this way tends to assist and facilitate being able to manage and cope with the psychological challenges posed by very difficult and challenging exercise.
7. Total caloric or kilojoule intake was central to achieving reductions in body weight, or more specifically, fat mass. This experiment confirmed that body fat reduction will be achieved if an energy deficit does exist.
For a more extensive discussion and a review of the research that confirms the necessity of an energy deficit to reduce adiposity see here:
8. As shown below, I used MyFitnessPal to log my various meals. This enabled some methodology to ensure that the caloric intake was appropriate (so that I could create a calorie deficit), the macronutrient breakdown assigned was optimal to maximise fat loss whilst preserving LBM, and importantly that the quality of the diet was high.
MyFitnessPal app
Critics of “counting calories” suggest that it is virtually impossible to get an accurate daily total for both energy intake and expenditure – unless you are involved in a research study with quantifiable methods such as the doubly labeled water method, for example, to determine energy expenditure. It is therefore argued that such endeavours are futile. It is easy to see why this opinion holds sway with some given the following:
* Establishing an accurate resting metabolic rate (RMR) is fraught with difficulties and there can be significant variation in RMR even between two people with comparable anthropometrics (%BF, LBM), age and sex (see hereand here).
* Assigning accurate values for energy expenditure related to exercise is likewise challenging and are more often than not, overestimated (see here).
* Trying to ascertain an activity level outside of formal exercise sessions and estimating NEAT is open to error also.
* How do you account for dietary-induced thermogenesis which accounts for about 10% of TDEE.
* There is no way of knowing that the foods and quantities that have been consumed (even if weighed) are a true representation of the calorie content of those foods and therefore reflect actual daily intake.
Whilst it may very well be true that accurately quantifying calories is a difficult task, the critics miss something that I think is fundamentally important during the process of trying to positively alter body composition. You become accountable. By attempting to measure and record daily energy intake and expenditure as accurately as possible, an acute awareness develops of how much total physical activity (including formal exercise, NEAT-type activity and sedentary behaviour) is being performed, and what and how much is being eaten.
However, even if energy intake and/or expenditure is incorrectly or inaccurately measured and recorded you now have the ability to make adjustments and tweak what is consumed or what is expended. For example, let’s assume you set an energy deficit goal of 500 kcal/day and you consistently adhere to this for period of 4 weeks but after checking your progress notice that you have not achieved any weight loss. Whether this has been caused inadvertently or not, what this basically tells you is that either total daily energy expenditure has been overestimated and/or total daily energy intake has been underestimated.
If we accept that most people are creatures of habit then we can safely assume that the foods bought and consumed on a daily and weekly basis will be roughly the same (same supermarket, same brands, same eating patterns) so there is some internal consistency regarding the calorie content of foodstuffs consumed day-to-day and week-to-week, even if the calorie content is not a true representation. With practice, one can become very adept at making the appropriate adjustments to ensure that continued progress is made.
Keeping tabs on intake is effective for many
Notwithstanding that reductions in adiposity can occur in the presence of little or no change in body mass, and increases in LBM can obscure body composition changes, the fact remains that the capacity to increase LBM is finite and if a substantial amount of body fat is shifted this will be reflected on the scales. In other words, you rarely see someone reduce body fat mass by 20 kilograms and increase LBM by 20 kilograms; it can happen, but I have rarely seen this occur “naturally”. Therefore the use of good scales to track weight lost is a reasonable approach to take when larger amounts of fat loss are needed.
It is important to realise also that both RMR and energy expenditure for physical movement decreases commensurately with reductions in body weight so such changes need to be factored in as fat loss is achieved. As body mass decreases so to do energy requirements. If a large amount of weight loss is achieved, the caloric deficit will eventually disappear with no further weight loss realised.
For example, a 120 kg man who reduces his body mass to 100 kg will potentially reduce his resting energy requirements by almost 500 kcal and in some individuals this can be even larger and persist following weight regain (see here). These are important considerations during the weight maintenance phase given that a significant majority of people experience weight and body fat rebound.
Research does however demonstrate that those that keep tabs on their daily diet and physical acitivity levels are more successful in achieving the desired changes in body composition, and perhaps more importantly, maintaining these changes.
Finally, the claim that “counting calories” is a futile endeavour and does not lead to real changes in body composition is most strongly disputed by the ability of body builders and physique models to dramatically reduce body fat levels when readying themselves for competitions, shows or photo shoots.
It is generally well accepted that the magnitude of change in the myriad of bodily processes that regulate and “fight against” continued adipose fat mass reduction are directly proportional to body fat percentage and the amount of actual body fat lost. In theory then, further body fat reduction – when percentage body fat is already quite low – should be extremely difficult.
What this example shows is that recording energy expenditure and energy intake as accurately as possible and creating an energy imbalance aimed at influencing and enhancing adipose tissue lipolysis is possible and extremely effective. The greatest challenge nevertheless is avoiding weight and body fat rebound following any intervention designed to alter body composition. Certainly the evidence suggests that regular physical activity plays a fundamental role in successful maintenance of changes in body composition.
A special mention of whey protein is warranted. It is an excellent source of leucine. This amino acid is instrumental and has been identified as key in stimulating muscle protein synthesis (MPS) rates in the post-prandial state and following resistive exercise.
Older adults need higher levels of protein/leucine to maximally stimulate muscle protein synthesis (MPS) both at rest and following resistance exercise. Whey protein (WP) has been scientifically shown in clinical trials to significantly increase LBM and improve body composition. Recently, WP was shown to benefit diabetes by reducing postprandial glycemia and HbA1c, weight loss and satiety versus other protein sources.
FitGreyStrong now provide a high quality, leucine-rich (4 grams per serve) whey protein supplement that will help facilitate your strength, functionality, muscle gain or weight loss goals.
For more information or for purchasing options of the FGS whey protein blend see here.
There is abundant evidenceto show that when in a caloric deficit state, a diet higher in protein helps preserve skeletal muscle tissue (lean body mass). This is critical because the loss of muscle tissue negatively affects strength, physical function and will reduce basal or resting energy expenditure.
It is the long-term implications, however, that reduced skeletal muscle has on health, strength, mobility and functionality that are of a real concern. Researchers with expertise in this area now concur that for older adults 0.4-0.5 grams of protein per kilogram of body weight per main meal is required to ensure that post-prandial muscle protein synthesis (MPS) is maximised thus attenuating the loss of skeletal muscle with ageing over time.
See more here:
See Professor Stuart Phillips discuss the importance of protein here.
High-quality protein is essential for preserving skeletal muscle tissue
10. For carbohydrates I aimed to consume 2-3 grams per kilogram body weight per day. In absolute terms, this varied from around 170 to 240 grams/day with consumption of simple sugars from whole foods varying from 40-80 grams/day.
These primarily consisted of cellular carbohydrates and acellular carbs, whilst not excluded, were minimised. Examples of cellular carbs were sweet potato, pumpkin, kale, zucchini, carrot, apple, berries, banana whilst examples of acellular carbs are bread, bagels and rice.
I continued to eat honey (10 grams/day) in my morning smoothie (frozen berry, whole milk, whey protein, peanut butter, LSA) after my exercise sessions. I also didn’t completely eliminate added sugar indulging in 1-2 teaspoons of raw sugar in the occasional bowl of porridge. Nonetheless, added sugar from table sugar or derived from foods more highly processed were kept to a minimum.
The question is, of course, are carbs ‘toxic’ to health and do they thwart attempts to alter body composition? I very much doubt it but I need to caveat this statement with some comments.
Some believe these foods are fattening and toxic to health
Many factors modulate individual tolerability in response to dietary carbohydrates and the propensity to induce adverse health outcomes and worsening adipose-related body composition. Whilst not a finite list, chronic overnutrition and an energy surplus state, the amount of carbs, the type or source, when they are consumed in a meal, sleep patterns, stress, physical activity levels, the FITT makeup of weekly exercise sessions, sedentary behaviour patterns, age, metabolic and skeletal muscle/mitochrondrial health and genetics all interact and play a role in relation to individual tolerability. What may suit one person, may be metabolically problematic for someone else. Whilst it is not my intention to explore all these factors in depth there are a few key points worth acknowledging.
Research investigating the affect of genes to different macronutrient-based diets suggests that individual response varies substanitally so the idea that there is a particular diet template that suits everyone is therefore a myth. It is clear that genes interact with diet which necessitates individual experimentation, and trial and error to establish what is most suitable regarding the proportionate breakdown of macronutrients.
Manipulating the sequence of fat and protein ingested before carbohydrate can potentially reduce postprandial hyperglycemia. In type-2 diabetes patients, altering the sequence whereby carbs are consumed before or only after after high-protein and high-fat foods at each main meal (lunch & dinner), elicited the same weight loss but very difference effects on HbA1c, fasting plasma glucose, postprandial glucose excursions and other indices of glucose variability.
Increasing protein and swapping out carbohydrate for increased dietary fat should be considered and warranted in prediabetes and diabetes. For example, a recent studyshowed that after 6 months on a high-protein (HP) diet, 100% of the subjects involved had remission of their prediabetes to normal glucose tolerance, whereas only 33.3% of subjects on the high carbohydrate (HC) diet achieved remission. The HP diet group exhibited significant improvement in (1) insulin sensitivity (2) cardiovascular risk factors (3) inflammatory cytokines (4) oxidative stress and (5) increased percent lean body mass compared with the HC diet at 6 months.
This is the first dietary intervention feeding study, to the authors knowledge, to report 100% remission of pre-diabetes with a HP diet and significant improvement in metabolic parameters and anti-inflammatory effects compared with a HC diet at 6 months. It should be noted that the HP diet was also lower in carbs compared to the HC diet so the superiority of the HP diet inducing remission of pre-diabetes in participants cannot be solely ascribed to increasing dietary protein. What these results suggest is that prediabetes is most effectively treated (with respect to the diet component of the intervention) by concomitantly as a percentage of total energy intake, increasing dietary protein to ≥30%, whilst simultaneously reducing carbohydrates to ≤40%.
Could more of this be a boon for health?
Diets that reduce carbohydrate and increase dietary protein and fat generally elicit improvements in those suffering impaired glucose regulation and diabetes, including but not limited to, glucose tolerance, FBG, HbA1c, insulin resistance, insulin sensitivity, dyslipidemia, HDL-to-triglyceride ratio and hyperinsulinemia. It is therefore a case in point that when I ask the question – are carbs toxic? – the answer is going to depend on many factors as I alluded to above and needs to be considered in context.
Indeed for those that have serious metabolic impairment (i.e. type-2 diabetes) and significantly reduced capacity to dispose of glucose post-prandially plus an inability to adequately stabilize blood glucose to acceptable concentrations across the day, cellular carbs may even present tolerance problems for some. As such, this may necessitate a need to reduce and minimise all types of carbs to ensure maximal improvements in blood glucose regulation.
If carbohydrate reduction – in those with pre-diabetes and diabetes – yields the most favourable changes in metabolic biomarkers, does this therefore mean that everyone should be reducing carbohydrates to very low levels?
This raises one of the central questions that I was trying to explore with this n=1 experiment.
That is, would a primarily high quality carbohydrate intake 35-40% of energy intake (170-240 g/d) impair my health and stall changes to body composition?
Lastly, it is important to point out (see here) that total energy intake will modulate, to some degree, carbohydrate tolerability. An energy deficit or energy surplus state will have a profound effect on metabolism and glycaemia.
11. For dietary fat, I aimed for 1-1.5 grams per kilogram body weight per day. This was derived from nuts, seeds, pepitas, avocado, peanut butter, olive oil, coconut oil, LSA. Fat (mainly saturated fat) from full fat dairy foods (milk, cheese, yoghurt) was also consumed. Saturated fat from some of the protein sources (meat and eggs) was also not minimised. Saturated fat consumption as a percentage of total energy intake per day was around 15%, which is at least double and well above the recommended ≤7% per day. Fatty fish (salmon, sardines, mackerel) was consumed 2-3 times/week to ensure a decent intake of omega-3 long-chain fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).
For those that have known me for a while, I have held the view for over 20 years now that saturated fat is not a primary instigator of atherosclerosis, coronary heart and cerebrovascular diseases. After a careful and continued assessment of the evidence over this time, my opinion has not shifted.
There is no convincing evidence that reducing saturated fat to ≤7% of total energy intake – from say double or even triple that – has any meaningful effect on all-cause mortality rates. I continue to remain unimpressed by the evidence used to justify the position that saturated fat is atherogenic. Interventional research, where the intake of saturated fat is modified and decreased, results in little change to future morbidity or mortality. In some cases, such reduction has in fact been counterproductive and manifested in higher rates of morbidity and mortality.
A recent interventional studyshowed that consuming energy primarily as carbohydrate or fat (34% of energy from saturated fat or nearly 5 times the recommended limit) for 3 months did not differentially influence visceral fat and metabolic syndrome provided the diets were low-processed and lower-glycaemic based. Furthermore, in recent years, scientific evidencehas increased concerning the ability of lipids, in particular omega-3 polyunsaturated fatty acids (n-3 PUFAs), to positively influence muscle and overall physical function in older patients.
Bottomline: quality counts!!
12. My daily macronutrient breakdown based on caloric energy intake (EI) was approximately 25-30% protein, 35-40% carbohydrate, 30-35% fat. The percentages for the carb-to-fat ratio would vary day-to-day, some days higher in carbs, other days higher in fat, but protein would come in close to the 2 grams/kg body weight (∼30% of EI) each day. Simple sugars consumed per day varied from 40-80 grams.
I would describe this type of nutritional approach as an energy deficit, high-protein, moderate carb, moderate fat diet based on non-processed foods.
13. The picture below is a snapshot of my blood tests and is provided as evidence to demonstrate that for my physiology, the lifestyle-based intervention was very effective. All biomarkers were excellent and those indicative of inflammation were very low. Blood pressure measured 122/70 and was normal for the duration of the intervention.
Blood test health biomarkers
Summary
In summary, this n=1 experiment confirmed that improvements in health and body composition, with decreased body fat and increased lean body mass, can be achieved in a 49 yo middle-aged male. Consuming 35-40% of the diet as carbohydrates (170-240 grams/day) containing 40-80 grams/day of simple sugars, 2g/kg/d of protein or 25-30% (160-200 grams/day) and 30-35% fat (with 15% of energy intake derived from saturated fat), was effective and safe with no ill effects. Biomarkers measured through blood tests corroborated this.
Physical activity – both formal exercise sessions and increased NEAT – was an integral component of this experiment. Finally, I would like to finish by saying to all those that read this blog to continue partaking in resistive exercise 2-3 times/week or for those not doing any such exercise to seriously consider adding this to your weekly routine. The benefits over the long-term go well beyond any words I can write.
Disclaimer: All contents of the FitGreyStrong or FGS website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this blog or the FGS website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
FitGreyStrong fact: Weight gain occurs when total caloric daily consumption exceeds total daily energy expenditure. To achieve weight or fat loss there must be an energy or caloric deficit. Over 80 years of scientific research has confirmed this to be fact.
FitGreyStrong Advice: Don’t believe the hype. Food quality is a must and essential to good health. However, weight or fat loss will not be realised no matter how good your diet is unless an energy deficit exists. Increased total physical activity during all waking hours and an energy-deficit diet that is wholesome, natural, minimally-processed and nutrient-dense will provide a significant opportunity for weight loss to be achieved.
I’m going to make a confession. I have laboured over the last month to write this blog. I’ve spent hour upon hour trying my best to explain what I think is a simple concept. The strangest thing is the evidence published so far is conclusive but with so much shit floating around anyone looking to lose a few kilo’s in the New Year is faced with a major challenge. What info is good and what is bad? How does one decipher what advice to act on and what advice to send to the computer’s recycle bin?
As I explained recently the media and ‘rogue’ researchers have, in some ways, muddied the weight loss debate by promoting the idea that exercise doesn’t help (see here). There are many examples of the media misleading consumers by sensationalising material that has been poorly researched, lacks objectivity and obfuscates the facts.
Ironically, it is this type of questionable and controversial material that gains the most traction with the public. The confusion created by such reporting has had a truly dreadful impact on the public’s perception regarding the role of exercise for weight loss. Many health care professionals working in the field have also raised serious concerns about this too because there is the feeling that some people may simply avoid physical activity altogether.
Notwithstanding that compensatory mechanisms mitigate the efficacy of exercise in some people (see here), widespread consensus remains elusive regarding the very basic underpinnings of weight loss. It seems incredible in fact that in the year 2016 vigorous debate and disagreement continues to swirl. However, I believe that the writing was on the wall when Generation X’s were still kids. There was sufficient scientific research carried out from the 1930s to the 1980s to put to bed and move on from some of the most hotly contested questions relevant to weight loss. The two questions which continue to inspire fierce debate are:
1. Do calories really matter?
2. Is weight loss simply a matter of expending more energy than you consume?
Before outlining what the specific focus of this blog is I need to digress. I want to make clear that it is not my intention here to assess whether manipulating the macronutrient makeup of the diet – e.g. high fat versus high carb diets – yields superior benefits on metabolic outcomes such as fasting blood glucose or lipid profile. Of course, this is a very important question to address but I’ll have bitten off way more than I can chew to do this justice, so I’ll come back to this another time.
The only thing I will say is that the actual published research is mixed. Three meta-analyses and systematic reviews have been completed over the last 18 months assessing whether metabolic outcomes are affected by manipulating macronutrient composition. Two of the these (see hereand here) concluded that there were no differences on metabolic outcomes when the protein, carbohydrate and fat composition of the diet was varied; whilst the other paper (see here) suggested the opposite stating that dietary manipulation did alter metabolic outcomes.
Ok, let’s get back to what the focus of this blog is then.
Is obesity a disease?
The aim of the following is to shine a spotlight on and explore the mechanistic aspect of weight loss. You may be wondering…………. what the bloody hell does that mean? What I mean by ‘mechanistic’ is the basic physiological state required – in our species, Homo sapiens – to bring about weight loss.
To state this as simply as possible, when it comes to weight loss the single most important factor from a physiological perspective is that there exists an energy or caloric deficit. Eighty-five years of scientific research and investigation has demonstrated without equivocation that for weight loss to occur an energy deficit must exist. Total daily energy expenditure has to exceed total daily energy intake for any reduction in body mass to occur or vice versa for any increase to occur. Regardless of one’s age, race or gender this holds true. This really is the only conclusion you can draw if you actually read the studies that have been published in reputable peer-reviewed medical journals relevant to this area (see here).
Now some of you may disagree with me on this and you are not alone. Unfortunately, in my view, there are a number of dissenting voices from a variety of quarters that simply don’t believe this to be true. They passionately dispute this and contend that the total energy provided by the diet matters very little. What really counts is the metabolic effect food has on our body. An example of this type of thinking can be found here.
Supporters of such thinking, decouple weight loss and calories. They propose that the “metabolic propensity” to increase and store fat in the adipose cells is driven primarily by the quality of the foodstuffs ingested and the proportion of protein, carbohydrates and fat in the diet. “A calorie is not a calorie” because different foods of different qualities have different effects on our digestion, hormones, biochemistry, metabolism, thermogenesis, physiology and associated internal feedback loops.
Whilst the total energy or calorie content of food matters, what is significantly more important is the metabolic effect that food has on our body. All calories are not created equal, therefore, with the quality and type of food choices made and the subsequent metabolic effect that such choices have on our body ultimately determining if fat loss is successful or not.
The most significant and telling problem with this line of thinking is that there are virtually no respected and acknowledged researchers who believe it. I see this as a telltale sign that the dissenters are simply barking up the wrong tree. Virtually all leading obesity experts worldwide concur that unless there is an energy deficit, decreases to weight or fat mass are not possible irrespective of how good the diet is. The question needs to be asked, why is this the case?
FitGreyStrong’s take-home message to you up to this point is:
Unless you expend more than you take-in you ain’t going to see any changes to your weight or fat.
Resistance and weight training shows great promise to maximise fat loss
There exists consensus amongst nearly all scientists because of the following. Research undertaken with participants confined to an in-patient hospital setting or in facilities known as metabolic units are currently the most accurate way to scientifically determine the specific energy requirements needed for weight change. Such studies are usually expensive because they are very resource and equipment intensive. However, what they allow researchers to do is measure what is being consumed (energy in) and what is being expended (energy out) quite precisely – or at least, a lot more precisely than studies that involve free-living subjects.
In brief, the methodology of such studies looks something like this:
For the duration of the trial subjects have to remain in the hospital or unit.
Participants of these studies are allocated and given all consumables (food and drink) for the duration of the intervention.
The caloric content of what is consumed is a known entity and has been prepared and accurately measured.
The macronutrient percentages of the diet for protein, carbs and fat has been determined.
Physical activity is closely monitored, measured and accounted for.
Resting energy expenditure (REE) and total daily energy expenditure (TDEE) is estimated as accurately as possible based on the equipment utilised and methods employed in the study.
With energy intake and energy expenditure measured as close to actual as possible, investigators can now establish whether the prerequisite for weight loss is an energy deficit. Over the last 80 years or so there have been over 20 studies carried out that have assessed the effect of calorie and macronutrient manipulation on weight loss whilst in the strict confines of hospital or metabolic unit.
Evaluation of such research has shown that no major differences have been found for weight or fat loss when diets of different macronutrient composition but with the same amount of energy (i.e. isoenergetic diets) were compared. Results from these studies show beyond dispute that the key determinant for decreased weight is a caloric or energy deficit, not diet composition.
To look at the evidence another way, not one of these trials – not even one – has ever demonstrated an increase in body weight when daily energy intake is less than daily energy expenditure. Likewise, no such study has ever shown a decrease in body weight when daily energy intake exceeds daily energy expenditure. This remains so irrespective of the macronutrient breakdown.
To give you a taste of the studies that have incorporated some of the methods referred to above, let’s take a quick look at a few of these:
Study 1 – Graves and colleagues conducted a randomized trial comparing an energy-restricted high-protein versus high-carbohydrate, low-fat diet in the morbidly obese which was published in the Obesity Journal (see here). Eighty-eight obese participants (mean age, 46.7; mean BMI, 45.6 kg m squared) were enrolled in a 3-week inpatient and 48-week outpatient treatment. The study was novel in that it included cognitive behaviour therapy in the treatment. All subjects consumed a restricted diet (1,200 kcal/day for women, 1,500 kcal/day for men; 20% energy from fat, <10% saturated fat). The high-protein diet derived 34% energy from proteins, 46% from carbohydrates; the high carb diet derived 17% from proteins, 64% from carbohydrates. The primary outcome was 1-year percent weight loss and secondary outcomes were attrition rates, changes in cardiovascular risk factors and psychological profile. The three week in-patient period closely monitored and provided all food with the total energy content and macronutrient composition known.
No difference in BMI or weight reduction was detected for this period between each diet.
The authors concluded (pg.1774) that:
“the relative carbohydrate and protein content of the diet, when combined with intensive CBT, does not significantly affect attrition rate, weight loss and psychosocial outcome in patients with severe obesity”.
Study 2 – Golay and co-workers compared diets equally low in energy (1000 kcal) but widely different in relative amounts of fat and carbs on body weight reduction in 43 obese adults during a 6-week period of hospitalisation (see here). The diets were composed of 32% protein, 15% carb and 53% fat versus 29% protein, 45% carb and 26% fat. The first diet could be described quite well as a low-carb, high-fat diet and the second diet as a more balanced diet. After 6 weeks no significant differences were seen for weight loss, fat loss or waist-to-hip circumference. Energy intake, not nutrient composition, determined weight loss in response to low-energy diets.
Study 3 – Leibel and co-workers established in 1992 that even during very wide variations in the fat-to-carbohydrate ratio (fat energy varied from 0% to 70% of total intake) there was no significant variation in energy need and changes in body weight (see here). Sixteen human subjects were confined to a metabolic ward for an average of 33 days and fed precisely known liquid diets with protein derived from milk and fat varied from different amounts of corn oil. Total energy intake, not diet composition was once again the key determinant in modulating energy balance.
I could continue and summarise the other studies published but the overall findings are much the same as that described above. For a more extensive review of these type of studies please see here.
Confusion around this topic, I think, has been created by other research and weight loss trials that don’t take place in the confines of a hospital or metabolic unit, but rather use free-living subjects. These studies cannot accurately quantify energy intake and expenditure and they are hence plagued by problems.
Firstly, participants often have to record or attempt to recall what they ate and drank. It probably doesn’t surprise you then that this has been shown to be notoriously inaccurate. Even those studies that provide free-living subjects with their allotment of food and drink can’t completely prevent or control for individuals eating or not eating the food on their assigned ‘menu’. Secondly, energy expenditure is estimated via physical activity logs, diaries, pedometers or fancy equipment like activPAL (see here). Consequently, energy expenditure can often be under- or over-estimated so such data can be terrible misleading. To state the obvious, deriving definitive results and conclusions from these types of studies is going to be challenging.
In spite of the caveats mentioned above, the results from the many studies using free-living subjects concurs with the hospitalisation and metabolic unit studies. Two meta-analyses and systematic reviews published in 2014 and 2015 concluded the same thing:
“Both types of macronutrient-centered weight loss diets produced weight loss. Manipulation of macronutrient composition of weight loss diets does not appear to be associated with significantly different weight loss or metabolic outcomes.”
The massive 2014 review by Naude and colleagues (see here) assessed 228 studies making it one of the largest meta-analyses and systematic reviews available. Provided one reads and reviews such research with an objective and impartial mind it is implausible to reach any other conclusion.
A final comment: The one thing that I believe provides the biggest hint that total calories are indeed fundamental to weight loss is something that is noticeable in the methodology of the more scientifically robust studies. Of the research that has taken place in a hospital or metabolic unit setting there is one key characteristic that most of these studies determine before proceeding to the weight loss phase of the trial. Can you guess what it is? Researchers establish energy requirements (i.e. total daily caloric intake) for weight maintenance over a period of 1 to 2 weeks (see here). If for arguments sake, calories were not important for inducing weight loss, then establishing energy requirements for weight maintenance in these studies would be a pointless exercise.
Before I finish up I need to make some clarifying comments.
1. Those that make the claim that calories are not important in relation to the obesity problem or when trying to decrease body fat are doing, I think, either one of two things. They are ignoring the data produced from hospital/metabolic unit-based studies and/or they are misinterpreting and taking at face value the results of research conducted with free-living subjects.
2. There will be those that read this and conclude that what I am advocating or all that I think matters is calories, with diet quality just a cursory concern. I can hear some of you saying right now “….but surely 2500 calories of jelly beans or junk food is different to 2500 calories of atlantic salmon, walnuts, broccoli and berries.” Really? Well, yes, of course it is, thanks for pointing that out. A diet consisting of wholesome, natural, minimally processed and nutrient-dense foods is paramount to ensuring good health. I should state now that I am not suggesting for one moment that the quality of the diet is not important.
Food quality is key for health and weight management
3. Irrespective of how good a diet is in optimising the metabolic effect on your body, the fact remains nonetheless that it is still possible to gain weight eating a wholesome, natural, minimally processed and nutrient-dense diet. It is probably more difficult to do so, but regardless, you cannot escape the fact that you have to be in a consistent calorie deficit to lose fat or a chronic caloric surplus to gain fat.
For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to lose weight, improve muscular strength, physical function (how you move around during the day) and quality of life or programs to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
In my article titled “It can’t possibly be true, can it?” I questioned whether there was any foundation to the claim that inactivity is not a chief cause obesity and provided scientific evidence suggesting otherwise. Today I will try explain to you what the bottom-line is as to why exercise doesn’t work for everybody trying to lose weight. One thing I have noticed is that there isn’t enough time or effort – either in the media or on the net – dedicated to informing the public about why exercise does not work for some people and what can be done about.
Exercise has been successfully applied as an essential ingredient of many weight loss programs. By increasing total daily energy expenditure, creating a caloric deficit state is theoretically, at least, more likely. It naturally follows that the weight loss achieved will be correlated to the magnitude of the energy deficit created. In practice however this does not always happen. In fact, there are a number of studies and anecdotal evidence that show a significant proportion of exercisers eating an ad libitum diet (possibly as high as 50%) do not achieve the weight loss expected with as many as 15% actually gaining weight. These individuals are often referred to as ‘non–responders‘. Those on the other hand that do achieve weight loss from exercise are referred to as ‘responders‘. The question is, how is this possible and are there any practical solutions?
Energy compensation and exercise-induced fat loss
People respond differently to exercise:
Non-responders vs responders
These differences in response to exercise include:
Non-responders increase whilst responders decrease, total daily energy intake (all the food and drinks you consume on a daily basis).
Some of these differences apparently occur unbeknownst to the exerciser so there is some sort of compensation going on to offset the extra energy expended from exercise.
Non-responders increase their consumption of fat.
Non-responders experience much greater subjective sensations of fasted hunger (upon waking) and hunger across the day compared to responders.
Non-responders demonstrate an increased whereas responders show a decreased, desire to eat.
Non-responders satisfaction or feelings of fullness from meals is significantly reduced whilst there are no changes in responders.
Behavioural compensatory adjustments to exercise training in overweight women showed the loss of weight/fat mass or lack thereof, was attributable to an increase or decrease in spontaneous physical activity, respectively.
Resting metabolic rate may be reduced in non-responders but not in responders.
Brain function and weight control is poorly understood
If you are struggling to lose weight after starting an exercise regimen then you could be classified as a non-responder and should consider the following:
If possible, have some measurements taken by a knowledgeable professional that includes girths (such as hips, waist, thighs etc) and skinfolds where the subcutaneous fat can be approximately measured by calipers. By doing this you will be able to work out more precisely what changes are actually taking place. This is pretty important because some ‘non-responders’ will lose a considerable amount of fat but total weight loss may be only slight or actually increase (see King et al 2008). This will affect roughly 10% of exercisers that are trying to lose weight but these body composition changes are in fact desirable and favourable.
Monitor energy intake more closely and consider recording actual food and beverage intakes so you can keep tabs on this as you go. Given that ad libitum diets don’t seem to work too well for non-responders, recording your intake is a good place to start. Assuringly, research shows that those that diarise what they are eating and drinking are much more successful at weight loss and weight management compared to those that don’t, so start recording.
Recognise that if you keep accurate records of these things and create an energy deficit – the research that has been conducted in metabolic-ward studies suggests – that weight loss is highly probable. Based on an account of energy intake and energy expenditure, if the creation of an energy deficit does not elicit any change in body composition, it is likely that there has been an over-estimation of energy expenditure or an under-estimation of energy intake, or a combination of both. However, this now allows subtle changes to be made to energy expenditure or intake so that body fat mass reduction can be realised (see here and herefor great discussions on the crucial role calories play when it comes to fat loss or fat gain).
Ensure that your exercise program includes some resistance or weight training. The response to exercise of non-responders as outlined above is related specifically to 1-2 hours of aerobic exercise (i.e. walking, running, cycling etc). You may ironically achieve better weight loss if you back off the aerobic exercise but place a bit more emphasis on weight training or resistance-type exercise. Some researchhas shown that appetite is suppressed more so with resistance versus aerobic exercise and it is the changes of increased appetite in non-responders that presents a major problem when attempting to bring about sustainable weight loss. With respect to adults who are overweight or obese, Drenowatz& colleagues clearly demonstrated that resistance exercise but not aerobic exercise reduced fat mass.
Resistance training is very effective to facilitate fat loss
This form of activity also substantially reduces the risk of losing LBM (lean body mass = muscle tissue) in older adults (see Villarealet al). It is very common to see exercisers lose significant amounts of LBM when only aerobic exercise is undertaken while in an energy deficit state.
The loss of LBM is not desirable for 2 key reasons. Firstly, functional physical capacity could be affected in both the short and long term (see Villrealet al). Secondly, resting metabolic rate will be reduced thereby making weight loss more difficult and weight regain more likely (see herefor further discussion).
“Don’t put the cart before the horse.” By that I mean, the quality of what you decide to eat will have a massive impact on your success. A caloric deficit is the goal but it should be achieved with a diet consisting of wholesome, natural, minimally processed and nutrient-dense foods. Not only is this essential to weight loss success but more importantly generating good health.
No caloric deficit = no fat loss
To combat increased subjective sensations of hunger, then, as a start please make sure that the diet is high in a variety of vegetables, has several serves of fruit each day, contains sufficient and varied sources of protein and includes things like nuts, seeds and oils. This is pretty commonsense stuff but you need to put into practice what actually works. The make-up or quality of the diet appears to impact on subsequent appetite, sensations of hunger and feelings of fullness, so anything that assists in keeping the physiological drives to eat at bay are only going to be helpful (see Blundellet al).
References (in no particular order)
Drenowatz, C. et al. (2015) “The prospective association between different types of exercise and body composition” Medicine & Science in Sports & Exercise. 47(12): 2535-2541.
Manthou, E. and Gill, J.M.R. and Wright, A. and Malkova, D. (2010) Behavioural compensatory adjustments to exercise training in overweight women. Medicine and Science in Sports and Exercise, 42 (6). pp. 1121- 1128.
Melanson, E.L. et al. (2013) “Resistance to exercise-induced weight loss: compensatory behavioural adaptations” Med Sci Sports Exerc.August; 45(8): 1600-1609.
King N.A. et al. (2008) “Individual variability following 12 weeks of supervised exercise: identification and characterization of compensation for exercise-induced weight loss.” International Journal of Obesity. 32: 177-184
King N.A. et al. (2009) “Dual-process action of exercise on appetite control: increase in orexigenic drive but improvement in meal-induced satiety.” Am J Clin Nutr. 90: 921-927
Peterson N.D. et al. (2014) “Dietary Self-Monitoring and Long-Term Success with Weight Management”. Obesity 22, 1962–1967
Broom, D.R. (2008) “Influence of resistance and aerobic exercise on hunger, circulating levels of acylated ghrelin, and peptide YY in healthy males” American Journal of Physiology. 296(1): R29-R35.
King, N.A. et al (2012) “Exercise, appetite and weight management: understanding the compensatory responses in eating behaviour and how they contribute to variability in exercise-induced weight loss.”British Journal of Sports Medicine 46(5):315-22.
Villareal D.T. et al. (2011) “Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults.” N Engl J Med 364(13): 1218-1229
Blundell J. et al. (2010) “Appetite control: methodological aspects of the evaluation of foods.” Obe Rev 11(3): 251-270
For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to achieve the above-mentioned benefits or to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
