Wednesday, July 17, 2013

Do Chronic Energy Deficits Make Athletes Fat? The Longer & More Severe You Starve, the Fatter You Are. Irrespective of What the Calories-in-VS-Calories-Out Formula May Say

This is not an "anti-gymanstics" or "anti-runners" article, this is an anti-ruin-your-life-post for the average female and male gymrat.
Maybe you've read about the results Deutz, Bernardot, Martin and Cody published in their 1999 paper on the "Relationship between energy deficits and body composition in elite female gymnasts and runners"... in fact, it may be possible that I already mentioned it in the "Athletes Triad Series" (read more), but even if I did, the fact that I get messages like "I eat 1,100kcal/day and still gain, not lose fat" or "my girlfriend eats 900kcal/day and maintains that this is normal", tells me it does not matter if I mention one or two of the figures the authors compiled in this unfortunately highly "under-cited" paper (only 72 citations are referencing this article) twice.

If that makes just one of the victims of their own ambition rethink what he or she is doing, it was well worth... wouldn't you agree?

Can the elite be wrong?

Usually you would assume that elite athletes are doing everything right, they are the epitome of our modern understanding of "health". As a SuppVersity reader you are yet well aware that there is a disconnect between optimal health and performance and with the latter being in part dependent on having a certain look as it is the case for bodybuilding, figure competitions and the like this disconnect can be so huge that being successful may eventually require a non-genetically gifted athlete to sacrifice his or her health on the altar of a misinterpretation of "physical culture".

That being said there is a way more traditional and, contrary to bodybuilding, officially Olympic sport where similar rules apply: Gymnastics! Especially among the female competitors the paradigm still is - the thinner the better. And to make things even worse, in this case "thin" actually means "thin" as in "being able to hide behind a straw". Now, this is obviously not the case in any of the aforementioned disciplines and yet they claim way more victims of life-long dieting than those sports, where "being thin" is actually part of the game - and what's almost sarcastic, the tortures some professional and many hobby athletes subject themselves to are not even rewarded.
You will have to take the following figures with two grains of skepticism! One for the scientifically established bias due to under-reporting in female gymnasts (Jonnalagadda. 2000), and the other one for the discrepancy between factual and calculated energy expenditures, which is, due to the negative feedback chronic dieting exerts on the total energy expenditure, much narrower than the formulas suggest. And another thing, remember that we are talking about body-fat % not total body fat masses here!
Against that background you will probably not be surprised to hear that the vast majority of the elate female artistic (N=32) and rhythmic (N=11) gymnasts in the study at hand is consuming 1,002kcal less than they would actually need to satisfy their caloric demands.
Figure 1: Comparison of within-day energy balance in the four groups of elite athletes (left); largest energy deficit per hour and average 24h energy deficit in all athletes, gymnasts and runners (Deutz. 2000).
If you take a closer look at the data in figure 1 you will yet realize that the average medium- and long-distance runner is not much better off. Now, whether the latter is a necessary prerequisite to make it to the top or simply a result of being unable (for physical or psychological reasons) to compensate for the training induced increase in energy expenditure, is beyond the scope of this post and essentially irrelevant to the statistically highly relevant acorrelation between between energy balance and body fatness, I've plotted for you in figure 2.
Figure 2: Relationships (Pearson correlations) between energy balance factors and body fat percentage in all athletes, gymnasts, and runners (Deutz. 2000)
I hope that these results do not come as a surprise for the vast majority of those for whom this is not the first visit to the SuppVersity. After all, I have been trying my very best for years (hard to believe I am doing this "chronically" ;-) to scare you away from the chronic and towards the cyclic calorie reduction as a means to cut body fat and maintain muscle mass (note: with the relatively small study size not all effects reached statistical significance; for the parameters pertaining to the "energy out vs. energy in"-calculations the average dieter is so fond of, this was yet particularly noteworthy).

In athletes chronic "dieting" results in an increase in body fat percentage

The message is simple and so is the underlying mechanism. The chronic provision of an insufficient amount of energy leads to a metabolic downregulation that goes hand in hand with an increased disposition to store and a decreased disposition to let go of body fat.
Another note: This is not an anti-intermittent fasting article either. If you do IF to cut weight you will have an overall negative energy balance, just like on every other diet, but if you are doing it for life (for whatever reason), you should be meeting your daily energy demands. This means you would have a much higher energy surplus on the other hours - in essence the data simply don't apply to someone who is doing intermittent fasting on a maintenance diet.
The concomitant exercise induced physical stress lulls your body to believe that you are amidst a starvation period, where building muscle and/or maintaining more muscle than is absolutely necessary to sustain the regular exercise routines is a no go and each and every energy unit that that is not necessary to keep you from passing out will get stored to cover those hours with a per hour deficit of 750kcal (which is the average maximal deficit per hour in the rhythmic gymnast group).

Bottom line: Don't get fooled by the "Don't worry. That's not you, starve yourself! It's good for you - don't you feel it?" the little gal or guy in your shoulder is now whispering into your ear. The rule "chronic starvation = increase in body fat percentage" applies to male and female athletes, gymnasts, runners, sprinters, cyclists, fitness junkies, bodybuilders, footballers, ... and across a wide range of energy deficits.

You don't have to eat burgers and French fries all day, to meet your energy requirements. Living on chicken breast & broccoli for the rest of your life is neither necessary nor conducive to your goals, and that's even true for such profane goals as "staying lean"! And by the way - how much do you need (learn more)?
So say good buy to the little guy with the hunger high and use your brains and acknowledge to yourself: "I am a junky. A starvation junky!"  You are not? Well then check this out:
Addiction is a persistent, compulsive dependence on a behavior or substance. [...] Addiction has been extended [...] to include mood-altering behaviors or activities." (Livingston. 2008; my emphases)
And the main criteria for being addicted are a loss of willpower, fear of harmful consequences, an unmanageable lifestyle, tolerance or escalation of use and withdrawal symptoms upon quitting. Well if all that is not you and you. Stop working out like mad and return to eating normal without going crazy whenever you feel satiated, now!

  • Deutz RC, Benardot D, Martin DE, Cody MM. Relationship between energy deficits and body composition in elite female gymnasts and runners. Med Sci Sports Exerc. 2000 Mar;32(3):659-68. 
  • Jonnalagadda SS, Benardot D, Dill MN. Assessment of under-reporting of energy intake by elite female gymnast. Int J Sport Nutr Exerc Metab. 2000 Sep;10(3):315-25.
  • Livingstone, C. "addiction." Dictionary of Sport and Exercise Science and Medicine. 2008. Elsevier Limited 14 Jul. 2013


ProudDaddy said...

By chronic, do you mean longer than the 4 months it's going to take me to lose the 15 pounds of visceral fat that curing my metabolic syndrome will require?

Chuck Salloom said...

The other day I went over to my friends house. He is an amateur muay thai kickboxer/mma fighter. This article literally describes his condition. Starves himself for a while then relapses and goes on restaurant/fast food/junk binges, ending up at fatter and less muscled.

I tried to help him by going with him to the grocery store to fix his diet. All the while I'm explaining to him why he needs more food, mainly carbs, to fuel his training and active lifestyle. At the store, I threw in melons, bananas, huge yams, apples and all sorts of fruits to which he exclaimed to me, "but don't carbs make you fat?. ...... um......

To add to that he went over to GNC to buy overpriced herbal "fat burners", whey and all kinds of bullshit.

Who knows...Either a person will figure out that change is necessary or suffer the consequences?

Anonymous said...

What to do with a sedentary fat woman in this condition? My mother is like this article say, I estimated that she eat roughly 1000 kcal/day, 85kg and she's a neonatology nurse. I'm just asking what do you think I should advice her to start with..

Anonymous said...

So I guess the question becomes how do we diet to avoid this scenario? 3 weeks deficit to one week maintenance? Month long deficit to a month at maintenance? One surplus day a week? I have been trying to lose the "stubborn" fat for what seems like forever now, have avoided cutting my cals too low but man am I getting tempted...

Also I wonder how different the results would have been if this study was performed on people who actually lift weights.


ProudDaddy said...

I think I've mentioned the Bryner 1999 study in JACN before, in which folks doing serious resistance training on an 800 kcal diet actually INCREASED their REE! I have yet to read a criticism questioning their results. So, for now, I'm going with very low calories and serious weights. Any reasons not to?

Bob Woody said...

I had been on a long fat loss period after an overzealous bulk (hey it was my first ever) and experienced something similar. Near the end of six months of dieting (weekends with my wife were usually at about maintenance so it wasn't 6 months of pure dieting) I was eating a protein shake and large but not enormous meal a day and was not losing weight and maybe even looking a bit less lean.

Question I have is whether it was the prolonged period of dieting or the large calorie deficit? I had seen Layne Norton talk about Metabolic Syndrome, but a lot of people seem skeptical about its reality. Anyone care to weigh in?

Adel aka Dr. Andro said...

well, different rules apply, and with visceral fat usually goes when you sooth inflammation and go with a relatively moderate deficit. Something >20% for four month continously is yet counter-indicated even for those who have more than the cosmetic fat to lose.

Refeeds, and a 2 week break (after 4-6 weeks of dieting) with normal caloric intake are ways to avoid both fat loss plateaus, as well as negative side effects on body composition that work for both the "still heavier" and the "already lean" physical culturists

Adel aka Dr. Andro said...

I know, partly I am tilting at windmills here, but from time to time you got someone rethinking his or her practice and I guess that's well worth it.

Maybe you can ask your friend about whether or not he does not feel his performance suffers from all that (not to speak of his temper and sociability)

Adel aka Dr. Andro said...

first thing, she got to do some kind of exercise 3x a week 30minutes would be enough for the start; 2nd she got to clean up her diet completely (which is going to be a problem for someone on shift work, I see, but with the averge convenience food losing the fat and keeping the muscle is literally impossible in the long run); 3rd being a woman it's almost certain she is not eating enough protein, with the switch to fresh whole foods as a primary (you don't have to make a 100% transition from one day to another), she should also start incorporating additional protein in her diet to meet the 30g/meal rule =>

if she does that, it should not be a problem to increase the calorie intake to 1,200 kcal in the first step while losing more not less body fat. The goal does yet have to be to get her back up to the 1,800kcal zone.

Ah, lastly. I am not a "low carb guru", but if you are still chubby, you better stay away from anything that has regular sugar or HFCS in it completely. Don't worry all too much about the carbs in foods, but your "plate" will be protein + veggies + small(er) amounts of starchy carbs like pasta, rice etc. than that of an athlete; fruit as a snack is good, but not without protein, so a couple of slices of pineapple + a chunk of cheese = good, the pineapple alone = not advisable for your mum

Adel aka Dr. Andro said...

results could have been different, however if you breach a certain "margin" as far as the extend of the calorie deficit goes, resistance training alone is not going to save your ass.

The strategies you mention are all valid. It's important that you increase the calories gradually, also keep the protein intake level at ~1.5g/kg in all phases and don't freak out if you cheat once in a while. It helps avoid the real binges.

That being said, I gather you are talking about lower ab fat and since you mention weight lifting, I assume you are lifting weight. In that case cut your training sessions short, increase the density of the workouts and make them metabolically more demanding. Something like a SuperSet approach or a fast circuit training of which many people don't realize it can be done as part of a split routine helps tremendously.

Training 5x week intense, but only to the point, where you feel like king-kong (30-40min max) and leaving the gym at that point is 2x more effective in helping you to get rid than 3x week intense training to the point where you crawl out of the gym - in particular for the lower ab section and other "stubborn fat areas"

Adel aka Dr. Andro said...

can you give me the direct link, I would like to know the methodology they used to "measure" the REE... that being said, I don't doubt that happened, but if those were really fat guys we are talking about a whole different situation, where the exercise induced effects on inflammation and glucose sensitivity alone will ramp up the REE significantly. PLUS: I am almost 99% sure this was a study with a duration <=12 weeks

Adel aka Dr. Andro said...

personally, I agree with the practical implications that are attached to the way Layne talks about the problem and the results of his work with clients provide evidence that getting the calories back up will work ... at least if you believe what he's writing about that online and saying in interviews and personally I do, Layne is imho one of those "gurus" out there who are not all talk.

That being said, it is "metabolic damage" not "metabolic syndrome", which is the downregulation of the energy expenditure in response to long periods of starvation and the long and hard way to get that back up to the normal range that's the culprit here... this process WILL involve some additional fat gain that's probably faster, but in the end not worse than the kreeping increase in body fat from chronic dieting.

Alex aka Primalkid said...

Wow Adel you really busted a move with all these comments. *applauds*

Looks like I'm not needed here lol

Anonymous said...

Nevertheless, there have been previous studies which dismissed the myth that your metabolism shuts down with calorie restriction. If that was true, than the prisoners in concentration camps and starving people would all not become so underweight.

ProudDaddy said...

Yep, 12 weeks, BMI 35. Note that effect was absent for cardio exercise.

ProudDaddy said...

I seem to remember that fasting studies show that REE actually INCREASES for the first 3 days or so and then starts its march downwards. I don't know of any studies which tried to take advantage of this, say by using 3 day fasts followed by 1 day feasts, but of course the alternate day fasting studies might be instructive.

Was it Keyes who did the famous Minnesota starvation study? I need to look that up, since it involved normal weight subjects and couldn't be ethically repeated today.

Alex aka Primalkid said...

25% of the 40% drop in metabolism in the Minnesota study was because of weight loss (weigh less, need less energy to live), meaning only a 15% drop in metabolism. REE may increase during the initial period because your body senses starvation and increasing GH output not to mention relying more on protein for energy which is very costly.

cob alamin said...
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Chuck Salloom said...

Great comment Cob, I agree wholeheartedly.

ProudDaddy said...

So, if the price I have to pay to cure my metabolic syndrome is a drop in maintenance energy input from 2000 to 1700, it might be worth it! (GBS and very low calorie diets are the only likely ways to reverse pre-diabetes, etc.)

cob alamin said...
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Anonymous said...

Thanks for the response Adel, your advice is much appreciated.


Adel aka Dr. Andro said...

hmm... you did not mention the exercise :-) That being said, I am (again) not sure if you can expect the same from someone with normal BMI who is already working out - the RMR-maintaining effects of weight lifting are yet one of the reasons I would believe that the extend of the effect may be moderated in those who don't combine their chronic dieting regimen with a chronic overtraining regimen. Unfortunately I would estimate that the ratio of "overtrainers" to "undereaters" is about 7/3 among the men and 5/5 among the women. With many of them starting out as one and ending up doing both: Overtrain and undereat

Adel aka Dr. Andro said...

oh, you are Alex, you totally are. In fact I am chronically "overworking" at the moment ;)

Adel aka Dr. Andro said...

you are obviously right, ProudDaddy, I don't want to say that fasting / calorie restriction in general was *bs* - it's effects can in fact be more potent than many medications, BUT it is not something that should be done over extended periods of time / become a lifestyle for anyone who doesn't just want to lead a long, but also a happy, mobile, social, ... life and it should by no means be understood to be a ways to improve your physique towards the modern beauty ideal.

Adel aka Dr. Andro said...

I don't know if it really is "stupidity", but I agree that the result of laziness and convenience you describe is stupid, (un?)fortunately it is penalized with obesity, diabetes, heart disease and cancer

cob alamin said...
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Anonymous said...

I believe that the threshold refers to 30 kcal/kg of energy AVAILABILITY, not intake. Anne Loucks studies discuss the difference between availability and intake.

operant said...

Absolute values need to be mentioned here.

There's a world of difference between an obese 120kg man running a chronic 20% energy deficit and a 55kg woman doing the same.

Quite simply, the absolute quantum of macronutrients and micronutrients is a factor; no doubt there is a threshold below which malnutrition and excessive metabolic slow-down is a concern in smaller, leaner people.

Bottom line is that if you are smaller and/or already very lean, you need to ensure that you don't push your dieting too hard or for too long. If you have higher levels of body fat (say, 20% for men and 27% for women), it's a relatively minor issue.

Incidentally, there seems to be a view that metabolic slow-down in response to energy deficit is somehow pathological. This is curious, as it seems quite obvious that metabolic slow-down is a very well-matched adaptation to the absence of plentiful energy.

Gina said...

Middle-aged woman (post-menopause), formerly very active, still active by most people's standards (I now have some mobility problems related to an accident and after gaining some weight during my rehab. I lost it). Yesterday, I had a Bod Pod body composition assessment. It seems I have a 42% BF - even the technician unhelpfully asked me if I'd had any cholesterol checks recently and spoke to me gravely about how much visceral fat I must have.

I have a BMI of <22 (not that that is meaningful) and a waist-to-hip ratio of 0.65. Nonetheless, when I told my trainer, his response was, "Well, you're never having more than a lettuce leaf and glass of water for lunch again".

Reading your posts recently, I have realised that I've probably been meeting RDA allowances for protein but under-eating by your standard. I would be hard pressed to reduce my calories further (over the week, they average at <1400kcals per day). I'm plugging away at my weight-training but I'm pretty much restricted to weight machines and small free weights because of the mobility problems (and there are some additional restrictions).

I'm so horrified that I have little idea what to do for the best.

Alex aka Primalkid said...

Stop counting calories and work on transitioning to a whole foods based diet. You may already have done this. Regardless, assuming you have not, here are some general rules to follow that will simplify everything and help you build lean muscle while lowering the body-fat %.

1) Eat 3-4 meals per day, NO SNACKING!
2) Eat some animal with every meal, and make sure it takes up half your plate. Eggs and dairy are fine as well, but a slab of meat will be more filling. Get grass-fed if possible, if not then don't stress.
3) Fill the other half of your plate with vegetables. In fact, have an entire plate set aside for some fibrous greens.
4) Supplement your training with roots, tubers, and fruits as tolerated, but don't go crazy.
5) Enjoy healthy fats. Avocados, coconut, macadamias are all your friend.

cob alamin said...
This comment has been removed by the author.
Gina said...

I very much appreciate your advice because I'm at such a loss as to how to proceed.

The calorie counting is an innovation of the last few months because I switched to a modified ketogenic protocol for managing migraine and another neuro issue (it's been remarkably helpful for both: it's classed as 'modified' relative to the classic ketogenic diet for epilepsy). In a way, I'm grateful that I've done it because it enabled me to give a dead eye to the first 3 people who reacted to the report with, "You need to eat less and move more". (Until recently, I travelled/commuted by bicycle and my weekly mileage was 220-380 miles.)

Absolutely agree that having read through Suppversity's archive, I've been under-eating (animal) protein for quite some time. For many years, I've typically eaten up to 14 portions of vegetable and fruit a day (more vegetable than fruit) a day. In the last few months I've had to reduce this to meet the needs of the modified ketogenic protocol (averaged over a week, approx. 40% of my calories come from MCT oil alone, some of the remainder is from protein and carbs and the amount above that is from other fats).

My impression from the Suppversity archives is that I should work on reducing my body fat before attempting to add any muscle: I'm apprehensive about how I'd best reduce that body fat without losing any more of my scant LBM. The raw figures are <77lbs LBM and approx. 50lbs of fat mass.

Alex aka Primalkid said...

Given your fat-tissue amount, muscle loss is not a concern. It won't be until you become much more lean. If a ketogenic diet is helping with the headaches then stick with it, but eat more whole food fats. Instead of MCTs, eat some nuts, coconut, avocados, etc. They provide healthy fats, fiber, and countless vitamins/minerals/phytochemicals. Determine your maintenance calories given your level of activity and then just eat 20% less everyday. Start with 12-15 kcal per pound of bodyweight and adjust weekly based on weight change. You want to find where you weight is stable for 2 weeks before you start dieting.

Adel aka Dr. Andro said...

Ah, this is one of the posts I read and think: Damn, this requires a longer reply than I am able to provide atm and than forget to go back to it later.

Luckily, Alex already provided a very good guideline in his first answer.

I would still like to pick up a particular detail in your original post, Gina: The BMI and the fat-% are SO MILES APART that you are either bones and fat only (no muscle) or the reading you got was bunk. I suspect the latter, because it requires more than just pushing buttons to get an adequate reading from a bod-pod.

That being said, I would first suggest you calm down - you are certainly not going to die within the next 6 months from visceral adiposity.

Adel aka Dr. Andro said...

Now let's get to your recent success with the modified keto diet, which is probably a simple results of the 40% of calories from MCT oils. I am no fan of MCTs, because no sane individual would eat that much MCTs (coconut oil is only partly MCT and no one would eat pounds of it on a daily basis, if it were not for a horde of idiots recommending such practices on the Internet). The reason it works, is simple. It gives you the same readily available energy as high GI carbs would, without the propensity of sending you into a hypoglycemic state in response, when your totally depleted glycogen stores are sucking up the glucose so fast that there is nothing left for your brain (among the results are brainfog and headaches).

Based on the assumption that your body fat % CANNOT be >40% -- this IS impossible with 77lbs and a waist to hip ratio <0.7 (see for your CVD risk profile, which is ZERO). Think about it: You organs, your muscle, your bone, your blood and all the water in your body CANNOT weigh only 27lbs they CANNOT and unless you are lying to us, here, both your trainer and the person who did the podpod test are total idiots. I am sorry, usually I am not writing things like this about people I don't know and who cannot refute my accusations, but this simply is bullocks.

Adel aka Dr. Andro said...

Against that background your first priority should be to feel good, your second to build muscle slowly and your third to monitor the real amount of fat you gain with a measuring tape around your waist and photos you take every 2 weeks.

As far as the diet is concerned, I am no fan of ketogenic diets for people who are actually healthy - as a means to tread epilepsy or other pathologies and as a weight loss tool for the insulin resistant obese diabetic, yes. As something to follow for the rest of your life - no.

You may find what I believe to be a better alternative in my Interview with Sean Casey @

In essence you will recognize that many of the good suggestions Alex already provided in the first comment are compatible with this approach.

His second advice is yet based on the (imho) false assumption that you were fat. Thus, I would forget about the -20% calories / first you have to get up to those -20% calories, because I suspect you are way below that atm. In the end, you will yet have to et back to maintenance, which may given your diet history be -15% lower than what a calculator would be telling you. Don't worry, once you are hovering there for a couple of weeks, it will increase.

As far as the headaches are concerned. You should make sure to get adequate amounts of digestible carbohydrates, which is more than the occasional sweet potato after a workout. It is of primary importance to keep the liver happy and it's glycogen stores at ~90% most of the time.

It is very likely that the absence of this "emergency fuel" that is necessary to overcome the energy shortage that may occur in response to the unaccustomed ingestion of high(er) amounts of medium- to fast-digesting carbs which is the underlying reason of your headaches.

I will be posting something on the synergy of short acting carbs and protein on Monday. You may want to read that post for more details, but as for put a huge "!" behind the 30g of quality protein with every meal rule. Follow Alex advice to add vegetables to the plate and take my advice not to piggy bag on mixed carbohydrates, i.e. a combination of fast and short acting carbs like a piece of fruit and a starchy carb, e.g. potatoes, tubers, rice (basmati, unless you actually like brown rice, which nobody does), and the occasional serving (not a bowl!) of pasta.

If we do the math you got ~100g of protein and thus 400kcal of your energy intake already planned for. If you add another 120g of carbs and 50g of fat you are almost where you are now. I would add more carbs to meals after your workout but not go beyond 100g during this initial phase and eat more than the 15g of fat the above ratio would yield on the meals before the workouts (not immediately before, but e.g. breakfast, lunch if you train in the PM).

but I guess based on the elaborations in the previously cited interview you will get an idea of where this is heading.

Alex aka Primalkid said...

I never thought about the BMI / body-fat connection, good eye Adel. Definitely the body-fat estimate must be wrong.

Let us know if you have any other questions or concerns Gina, and keep us updated on how things go.

And I am really looking forward to Monday's post ;)

Cody said...

So here's my story.

I started out many years ago weighing 456 pounds and I'm 6'4" (I'm currently 39 years old). I found out I weighed this much in on an ER scale when I had strep throat.

This shocked the heck out of me. So I started strength training and walking. I got down to 390.

Then I could not lose weight for the life of me. I resorted to Lyle McDonald's Rapid Fat Loss diet (a modified PSMF) and had 1000 calories of almost protein. I also used ephedrine pretty heavily off and on.

I managed to claw my way down (over years of stop and start mind you) to a low of 312 and that's where I always stalled.

I would go off of the PSMF and rebound back up to 350, max.

Now, fast forward to last year at this time when I got full custody of my emotionally damaged pre-teen daughter. I had major, major stress in my life and started to feel awful. Like I couldn't even get out of bed. I resorted to a lot of fast food and gained 100 pounds within about 3 months.

I finally decided to give Carb Nite a try (it's cyclical ketogenic diet) and cannot lose weight for the life of me. It appears my bodyfat percentage has gone down a bit, but it fluctuates. My weight however, NEVER fluctuates. It's been 7 weeks now and not a single pound lost.

I'm eating under 30 grams of carbs per day, except on carb night, and I'm eating at least 70% fat.

I'm now trying to take protein down to only 30 grams or so per day in an attempt to break the stall.

I don't want to resort back to a semi-starvation diet. I can't help but feel my hormones are whacked. And I'm not sure what to do.

Where do I go from here?

Alex aka Primalkid said...

Okay, first off read what I wrote in the first response to Gina. Those basic guidelines will help you establish a healthy foundation with food which must be present for successful dieting. Work towards it.

That said, at your weight you're more than likely obese and any diet will work optimally for you so long as you eat less than you burn. Therefore, while working towards the above you should NOT in my opinion be on any type of ketogenic diet, PSMF (I'm very familiar with Rapid Fat Loss, and I am a huge fan of Lyle's work), or other drastic measure. Simply build a healthy relationship with whole foods (this means no processed foods, no fast food, etc.).

Once that relationship is built, just eat a normal whole foods diet for two weeks and track your weight, energy, mood, etc. When you have a pattern established, simply cut out food and don't worry about calories. So instead of having that handful of nuts, create your deficit by simply saying "not tonight!" Monitor your weight loss and enjoy. Ephedrine has been proven to be a safe and effective adjunct to dieting and may help via appetite reduction as well.

As for training, since I have no idea where you are currently, given your weight here is my suggestion: Walk. Start walking at a comfortable pace 3-4 times per week and work up to everyday. Try to go for at least 10-15 minutes of continuous walking eat time and build up to 30 minutes. Once you can easily walk for 30 minutes, try some walk intervals (comfortable pace for most the time but include *sprints* where you walk as fast as possible for 30 seconds or a minute before resting at the lower comfortable pace). Also perhaps work up to an hour of walking each day. If you have a gym membership and the weather sucks, using the same concept on an elliptical, stair-master (will be much harder), or cycle ergometer is perfectly fine. Bring a book to read or a Super Human Radio podcast to listen to.

Don't worry about strength training yet since you won't lose any vital muscle and the weight-loss that does result from muscle loss will only be excess muscle that was there to support your previous weight. However, once you feel comfortable to resistance train successfully, just do basic closed-chain bodyweight exercise such as squats, pushups (against a wall or knees on the ground to build up strength), and basic resistance band workouts.

As for the hormonal stuff, that could easily be a result of the yo-yo dieting and drastic measures. Also, if you are currently suffering from it I would bet money it is the carb-night ketogenic diet that is doing it, since a lack of carbohydrates mimic starvation and tell your body to shut down some key hormones.

Cody said...

I can easily walk for 30 minutes now I just choose not to. I'll work on that.

I also strength train with bodyweight/bands on Friday nights before my carb up.

It's my understanding that the hormonal issues with a ketogenic diet only occur after around a week? That's what the carb up is for once a week. And probably longer for someone who carries as much fat as I do?

So per your recommendations, how often would I eat starchy carbs (rice, potatoes, etc.)? I could easily eat over a pound of steak and another pound of potatoes at a sitting. Put a cup or so of sour cream on said potato along with about 4 TB of butter. And I still want dessert.

I'm not worried about muscle loss at all. Any real mass related to training will return.

Alex aka Primalkid said...

The hormonal consequences of a ketogenic diet are nearly immediate. As soon as liver glycogen becomes low you body thinks it is starving despite incoming calories. As far as starchy carbs go, you biggest concern is simply eating less. It doesn't matter what your diet is composed of so long as you eat less. That said, I would base your eating around lots of meat and fibrous vegetables to keep your appetite at bay. Throw in some starches and fruit if it keeps you sane, but don't overdo it. Shoot for at least 100g daily to keep your brain happy.

Rich said...

When you say "take my advice not to piggy bag on mixed carbohydrates". Do you mean not to eat different types of carb at the same meal?

Gina said...

Thank you for your thoughtful responses. There are a couple of things I would like to clarify if that's OK.

The migraines are the sequelae of a TBI. I've been through the usual prophylactic and management protocols which haven't been successful or for which I've experienced unmanageable side-effects. I opted to try out the modified ketogenic diet rather than move to a Topamax mix.

This version is known as the modified ketogenic diet because it relies upon MCT to generate some ketones which gives greater flexibility and food options for the remainder of the intake (the 'classic' ketogenic depends heavily upon drinking cream and oils for somewhere between 80%+ of calorie intake which reduces other food options). One overview of ketogenic protocols for neurological issues:

My goal is to titrate down to the minimum amount of MCT that I need and to tweak my food intake so that I can alter the food intake. I want to be careful that I do this while retaining the benefits because it is astonishing to have pain-free migraines (I still have some of the other corollaries but negligible pain) and I have few episodes of ocular distortion which is adding to my quality of life.

Gina said...

Dr Andro wrote: "Based on the assumption that your body fat % CANNOT be >40% -- this IS impossible with 77lbs and a waist to hip ratio...Think about it: You organs, your muscle, your bone, your blood and all the water in your body CANNOT weigh only 27lbs they CANNOT and unless you are lying to us, here, both your trainer and the person who did the podpod test are total idiots."
My total body weight is 127lbs, the Bod Pod estimated my LBM at approx 77lbs and body fat at 50lbs. So, I would assume the comment is based on a mis-reading of my original?

I would far rather not feel a kinship with a block of lard and would be delighted if the Bod Pod evaluation were incorrect. However, I did have it done in a University research department, by one of the researchers and he assured me that the Bod Pod is calibrated every day and has a good test, re-test record. This doesn't rule out some form of error but I'd hope it minimises it.

I would not have believed it possible to have a low 20s BMI but a morbidly obese level of body fat had it not been for the Shah and Braverman study, Measuring Adiposity in Patients: The Utility of Body Mass Index (BMI), Percent Body Fat, and Leptin
The authors report: "A total of 48% of women were misclassified as non-obese by BMI, but were found to be obese by percent body fat. This misclassification increased with age...48% of women ages 50–59 misclassified, and 59% were misclassified by age 70+". (I'm age early 50s.)

Judging by the scatter plot of figure 1, I'm an outlier, but it doesn't seem wholly implausible? It's the level of sacrocopenic obesity implied by the evaluation that unnerves me more than anything else as I would have thought that I had more muscle mass than that LBM of 77 lbs implies.

'Mash (Thomas Herbert) said...

I think that this all really depends on how lean you are to begin with. In regards to the Minnesota study Pilon covered this nicely here:

I must admit I still find it annoying that it is not clear in my mind...

- What actually constitutes "chronic calorie restriction" i.e. If someone is doing 16/8 IF four or five days a week and on those average 20% under calories, but potentially eats 20% more on the others. I assume this is NOT a problem.

- Pilon constantly talks about how how metabolism really does not slow down significantly, and really is related (set) via LBM which is not muscle mass but rather organ mass. Do we know for sure in relation to the first point that metabolism really does slow down if at all in any significance?

In my mind there is starving oneself, eating half your calorific requirements, eating two thirds your calorific requirements and cycling your calories. The first three are a chronic deficit and probably are different in relation to how much body-fat one has already already.

The last example is calories at maintenance but partitioned (made up for) over the period rather than daily.

But honestly what are we looking at weekly, monthly, yearly? How do we guage whether we are really in a chronic deficit or not?

ProudDaddy said...

Somebody give me some science on why a 600 kcal/day diet for two months with 3 hours of strength training per week FOR ME will be a bad idea. My BMI is 25. My BF%age, by both BIA and waist calculation, is 25%. I have pre-diabetes which is worsening every year and soon to be full-blown. I am 72 years of age and just had a baby whom I would like to be around for as long as possible. As I understand the science, only two methods have a good chance of reversing diabetes: gastric bypass surgery and very low calorie diets (with 600 kcal producing far greater success than 800). I obviously don't qualify for GBS, and continuing down my current path (stable weight, exercise, and metformin) is not going to cut it. At the end of two months, I should have a BF% of a still high 17% but hopefully far less hepatic and pancreatic fat. I expect my REE will be below normal and that I will probably never again be able to eat as much as hunger tells me I should. But I might be able to see my new son graduate from college!

Anyone have a better science-based plan?

Cody said...

I'm moving to eating low carb until 4 PM, and then eating protein and carbs at night. I'm adding in some Ezekial bread, lean turkey, lots of veggies, and some plain potatoes with salsa, or a little butter.

What do you think of the Israeli study showing eating carbs at night helps with weight loss? I've heard there may be other studies showing the same?

Adel aka Dr. Andro said...

@rich: I suppose I was not aware of the correct meaning of the word - sorry. I meant do not shy away from ingesting mixed carbs; almost all foods have mixed forms of sugars in them. Nothing to be afraid of there.

Adel aka Dr. Andro said...

@Gina: Ok, that obviously was a misreading on my part. But your BMI is still 22 or even lower? I am still not sold on the idea that you could be carrying tons of visceral fat. I mean BMI 22 and top wast to hip ratio? No, that just doesn't sound right. If that was the case you would have high CRP, high glucose, high cholesterol, high TRIGs (at least one of them or all)... which brings up two follow up questions.

Do you have any recent bloodwork that showed some abnormalities? And do you have regular menses (I hate this question, but as of late I came to realize it's quite a good indicator if something is wrong, healthwise ;-)

bod pod is also not an accurate measurement esp. in trained athletes

"Values for BFDXA [body fat dexa] and BFBP [body fat bod pod] also differed significantly (p < 0.05)[...] the correlation between BFDXA and BF BP was poor (r = 0.25, SEE = 5.73)

Adel aka Dr. Andro said...

I guess, it is difficult to say what the exact reasons for the benefits in the study you mention are. It could simply be a consequence of the switch, the not being able to eat junky snacks all day etc.

But let's start right from the beginning. First off - congrats you made the change before it was too late! And my commendations that you're still working on it.

However, my gut tells me that you are trying too hard. I know this seems hilarious, but the Ezekial bread, lean turkey, plain potatoes etc. That is the meal of someone who is so afraid of gaining back that his fear and determination to eat clean on 720 days of the year is holding him back.

Take away a little of the control here and invest it into your workouts.

Your case is by the way one of those, where even I would not vouch against trying a ketogenic diet, but what you have done hitherto was a protein craze and that's like starving yourself. I mean what is your body supposed to think if all the energy he uses must be produced by the liver from protein... you know when this is happening in nature? Close to the moment you die, because your body ate itself up. So in case you really want to go keto, first find out what keto means - low protein high fat no carb < that's keto; and unlike the high protein low fat no carb "keto" diet the fitness junkies like to ruin their metabolism with, it can really help people with more than just the fat on their abs to loose to get that weight down

Alex aka Primalkid said...

Cody this may also help you set up a standard ketogenic diet.

Gina said...

The BMI is <22 (ht: 64 inches; wt: 127lbs). I'm post-menopausal and in my early 50s so there are no menses.

I've had no indications of abnormalities from bloodwork but none of that is more recent than 10 months (and I should imagine that such a deposition of visceral fat as indicated should have been in place for >10months). As I have no symptoms, it would be difficult to justify requesting any bloodwork from my GP although I suppose that I might purchase a standard cholesterol panel from a pharmacy.

I'm beginning to realise that all of these public health horror stories about visceral fat in journals/newspapers are typically illustrated by photographs of people with obvious omentum aprons or 'pot' bellies, neither of which I have. I realise that the obvious 'hook' for all of these studies/stories is that nonetheless, visceral fat isn't readily visible and that is why it is styled as such an insidious menace, but, notwithstanding the Shah and Braverman study to which I referred above, I don't look as if I'm carrying 100 blocks of butter about my person (I looked at a chiller section in the supermarket and realised that 50lbs=100 blocks).

I'm not a trained athlete and as far as I can tell, those error margins in that study wouldn't encompass what would have to be an error of 17-20 percentage points in my case? Even at the outside margins of its error, it seems odd that a Bod Pod would so under-estimate my lean mass and over-estimate my fat mass. I took a look at these papers and I still don't understand how the error could be so substantial: (average difference of 5.3% between the Bod Pod and study's 4-compartment model) (Bod Pod underpredicts body fat in adult women as compared with the 4C model by 2 percentage points)

If my results are anomalous, that's one thing, but if the Bod Pod error rate can be quite so egregious then that is frankly disturbing and I wish they'd mention it when showing its use in various newspapers and TV programmes (where its reliability and accuracy are typically praised). The researcher who did my test emphasised the low variability and error rate.

'Mash (Thomas Herbert) said...

I wonder though if 600kcal/day provides you enough nutrition? By that I mean energy is one thing, nourishment is another. If I could recommend a book, do check out "The Perfect Health Diet" which will give you a fantastic foundation for increasing your nutrition whilst reducing your calories.

Gina said...

Dr Andro wrote: "So in case you really want to go keto, first find out what keto means - low protein high fat no carb < that's keto; and unlike the high protein low fat no carb "keto" diet the fitness junkies like to ruin their metabolism with..."

It's startling how modest the recommended protein intake is for ketogenic diets (see also the calculator to which Alex linked) and how much it varies within various styles of ketogenic (which one people select may be influenced by their health or metabolic state). (At the modest extreme, using Dr Ron Rosedale's calculations for the diet he recommends for his patients, I'd be advised to eat 17-21g of protein per day if I were diabetic and up to 26g per day because I'm not.) (For more of Rosedale's views on protein intake: )

There are diabetes forums where people have been following a ketogenic protocol while also monitoring their blood ketone levels for more than a year. For some diabetic people it seems as if comparatively small excess amounts of protein in a day will suppress their ketone production. (After reading Suppversity's archives, I'm curious about the impact of timing protein intake during the day albeit some people split their protein over 2 meals but others kept it at one meal because otherwise it seemed like an infeasibly small portion.) Very lengthy forum thread with people's experiences:

Gina said...

Just as an update, I am chomping my way through a hugely greater amount of protein than I have previously eaten in my life: it took a couple of weeks as I've found that amount of protein is appetite-suppressing (not an unusual experience, I gather). I've finally reached about 30g of protein per meal x3 or x2 a day and shall continue to bring that up until it's consistently 3 x30g daily.

Although I'm still in the 'using my own bodyweight' phase, I've added deep/parallel squats, bench presses, and inverted rows as compound movement additions to my usual (tiny) free weight-training workouts. We're working on a way for me to include a deadlift (either raised or a rack pull) as a compound movement in some of the workouts but we're not there yet.

Gina said...

Further update: although my free weights are still embarrassingly small, I am increasing both the weight or number of repetitions in a set (as appropriate).

I can now back squat a broom handle in 5 sets of x10 repetitions :)

I've been advised to have a DXA scan to check the Bod Pod assessment. It seems absurd but until the original data are confirmed or contradicted, it makes it difficult to plan a workout schedule or to aim for a particular dietary goal with any degree of confidence.

Alex aka Primalkid said...

Gina, awesome to hear! Keep plugging away at the exercise and dietary protocols and let us know if you get the DXA done. I'm curious to your results.

Anonymous said...

Calorie deficit is needed to lose fat. End of story

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