Body Composition and Optimal Health

More than 60 million Americans have some form of cardiovascular disease and more than 2,600 people die from cardiovascular disease each day. Hypertension is found in about 50% of individuals above 55 years. Metabolic syndrome (Syndrome X), characterized by elevated blood glucose insulin responses, is one of the most common conditions seen today and is estimated to be present in about 22% of men and 24% of women.

A central factor in all of these conditions is altered body composition. Adults with altered body compositions are at high risk for developing:

• Cardiovascular disease
• High blood pressure
• Dyslipidemias such as high blood cholesterol
• Metabolic syndrome
• Type 2 diabetes

What is Altered Body Composition?

Body composition is a measure of the amount of body mass (weight) that is present as fat, bone, and lean muscle. Altered body composition may occur from increased fat and/or loss of lean muscle, which result in an increase of fat-to-lean body mass. Although the most common form of altered body composition is excess fat, decreased skeletal mass by loss of bone, such as seen with osteoporosis, is also a form of altered body composition.

Body composition can be determined by:

Body Mass Index (BMI): BMI is calculated from weight and height or can be obtained from an easy-to-use chart. Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI of 30 or greater are considered obese.

Waist Circumference or Waste to Hip Ratio (WHR): People who accumulate fat in the abdominal area (apple-shaped body) are at a significantly increased risk for developing diseases as compared to those with fat accumulation primarily in the hips and thighs (pear-shaped body). A waist circumference greater than 35 inches for women or 40 inches for men, or a WHR of 0.8 or greater in women, or 1.0 or greater in men indicates abdominal adiposity.

Bioelectric Impedance Analysis (BIA): BIA uses electric signals at different frequencies, which are impeded (slow down) on whether they are moving through the fat or lean muscle mass.

How can I Support Healthy Composition?

An important part of a clinical management program to improve body composition is adequate nutrition to support lean body mass, while appropriately limiting caloric intake. The low-calorie diets commonly used in weight-loss programs may not be beneficial, and such diets may produce side effects of fatigue, dizziness, and weakness, and result in loss of lean muscle mass. Research has shown that clinical programs that include a supplemental meal replacement are more successful for weight loss. Intervention for healthy body composition should always include resistance exercise as well, since increasing muscle mass increases energy needs, helps combat fatigue, and decreases the likelihood that fat mass will return after the program is completed.

Soy Protein, Isoflavones, and Healthy Body Composition

Soy protein is a high-quality protein source that may improve blood pressure and blood lipids. Based on a thorough review of the research literature, the FDA has issued a health claim stating that a daily consumption of 25 grams of soy protein as part of a diet low in saturated fat and cholesterol may reduce the risk of cardiovascular disease. Specific preparations of soy protein have also been shown to promote healthy body composition. For example, a soy-based medical food has been shown to promote lean body mass over a non-soy based meal replacement in a weight management program. And, perimenopausal women fed 40 grams of an isoflavone-containing soy protein daily for 24 weeks showed increases in lean mass, whereas a control group consuming whey protein did not.

Glycemic Index (GI), Fructose and Metabolic Syndrome

The GI assesses blood glucose response to a food, and research documents that people at risk of diabetes should maintain a diet with low GI foods. Recently, a soy-based medical food was shown to have a low GI, suggesting it could be a suitable source of protein and nutrients while maintaining a healthy blood glucose and insulin levels.

The source of sweetener in any food should be a considered as well, and fructose is a low GI, naturally occurring sweetener. Fructose is suggested as preferred sugar source for diabetics since large doses of fructose (50 grams) only modestly raise blood sugar or insulin levels, and small doses show virtually no effect on blood sugar or insulin.

Fiber and BMI

Fiber is known to promote healthy digestion, blood insulin, and blood glucose levels, as well as maintenance of healthy cholesterol levels; and, fiber associated with lower risk of cardiovascular disease. In the 10-year-long CARDIA Study of more than 2,000 adults, those individuals with the highest intake of fiber had the lowest body weight and WHR, and those with the highest body weight showed higher blood lipids and blood pressure. Fiber intake of 20 -30 grams per day should be considered in the optimal diet for promoting healthy body composition.

Homocysteine, Folate, Vitamin B12 and Optimal Health

Elevated blood homocysteine is associated with aging and obesity, and is an independent risk factor for CVD. Research also shows that it is associated with altered body composition in both adults and children. Folate and Vitamin B-12 are key vitamins that promote reduction of homocysteine levels.

Calcium, Magnesium and Potassium Balance

Early studies suggested restricting sodium may be helpful in older persons, but more recent data-including those from the large, multi-center Dietary Approaches to Stop Hypertension (DASH) trial-suggested calcium, potassium, and magnesium are more important in maintaining healthy blood pressure. Low intake of calcium is also associated with higher levels of body fat, and calcium supplementation had been shown to promote healthy body composition and decreased fat retention in clinical trials and animal studies.

Bone Health and Body Composition

Throughout life, skeletal and lean muscle masses are related. Bone density decreases dramatically after the age of 40, so that by 80 years of age, men have lost on an average of 12% and women 25% of bone. Major factors in bone health are adequate intake of bone-support nutrients, and weight-bearing exercises to promote new bone growth.

Calcium supplementation has been shown to slow or even prevent bone loss in older individuals. About half the weight of bone mineral is from phosphorus, and it is important that intake of phosphorus and calcium be in balance. Low magnesium, vitamin D and vitamin K levels are associated with decreased bone mass and increased prevalence of fractures. Supplementation with these nutrients is important in promoting bone density. In addition, research suggests that soy with isoflavones reduces the bone resorption often during and after menopause.

Carbohydrates And Fat Loss

Here's what you need to know...

• The amount of carbs you can eat while still losing fat is directly related to your insulin sensitivity. As a lifter or athlete, yours should be good.
• For many fit people, cutting carbs from 40% down to 20% of calories won't give them any additional fat loss benefit. So why do it?
• Start your fat loss diet at 50% carbohydrate intake, then adjust down from there only if and when it's needed to keep the fat loss going.
• Do not go by how you think you "feel." Go by the results you're actually getting.

Two people come to me for diet help. They both need to drop fat and improve their body composition. One is an out of shape 40-something stockbroker and the other is a fit movie star getting ready for an action movie. What should I do? Cut carbs right? For the longest time, fat loss diet advice has essentially been "eat less carbs." But it would seem ridiculous to give these two individuals the same diet advice, wouldn't it? Well, it is ridiculous, but that's what we've essentially been doing with the "eliminate carbs to lose fat" mantra.

At its most basic level, eating less carbs is good advice. Most people would benefit from eating fewer carbohydrates. But what we're discovering is that the level of carbohydrates that you can consume while still losing weight is directly related to your insulin sensitivity. More to this point, certain levels of carbohydrate restriction are unnecessary for individuals with good insulin sensitivity as it doesn't further enhance fat loss. So giving our stockbroker and movie star similar diets wouldn't make sense. Besides, everyone I know would like to eat as many carbs as possible and still reach their body comp goals. Wouldn't you?

The Impact of Insulin Sensitivity
Let's look at two different studies that have begun to explore carbohydrate cut points for eliciting maximum fat loss with respects to individual insulin sensitivity. In the first study, researchers wanted to look at the long term differences between a low fat diet (a "traditional" weight loss plan) and a low glycemic load diet with respects to changes in body composition. They found that after 18 months, regardless of the diet the participants were put on, they all experienced similar changes in body composition. Chalk that up as a win for the "a calorie is a calorie" crowd, right? Well, not so fast. In a secondary analysis of the data, the researchers separated study participants by insulin sensitivity. They found that the people with the worst insulin sensitivity had the best body composition changes on the low glycemic diet, and it didn't matter what diet the people with the best insulin sensitivity were put on – they got just as lean either way.

In another study, the A to Z Study, researchers put people on one of four diets: Atkins, Zone, Ornish, or a control diet (the LEARN diet – traditional low fat stuff). At the end of 12 months the people on the Atkins diet lost the most weight. Low carb rules! Again, not so fast. In a secondary analysis of this data, the researchers pitted the high (Ornish) and lowest (Atkins) carb diets against each other with respects to weight loss and study participants' insulin sensitivity. Just as in the previous study, people with the poorest insulin sensitivity lost more weight on the lower carb approach. People with the best insulin sensitivity lost the same amount of weight regardless of diet.

I'm a believer in the benefits of carbohydrate restriction, but I'm also a big believer in the fact that carbs are delicious. If cutting your carbs from 40% down to 20% of calories won't give you any additional fat loss benefit then why do it? Why not lose as much fat as you can with your carbs at 40% of calories and then reduce it after your fat loss begins to slow?

Exercise: The Missing Link from the Research
These two studies show that an individual's insulin sensitivity impacts the level of carbohydrates necessary to maximize fat loss. But in all these studies, exercise wasn't part of the fat loss strategy. Exercise itself increases muscular insulin sensitivity. This increases the amount of carbohydrates you can consume and shunt towards your muscles automatically. It's also important to note that the carbs that you cram into your muscles post-training stay there as your muscles don't have the enzymatic machinery necessary to release sugar from glycogen to the rest of your body.

Your insulin sensitivity should be better than most, so you'll find yourself in a place where you can lose just as much fat with a higher carbohydrate intake. Starting your body composition training with a higher overall carb count will give you greater flexibility later in your diet to reduce carbs when calories are at a premium.

What To Do
Don't start any body comp diet phase with your carbohydrates any lower than 40% of your total calories, then adjust from there. You may be wondering how much higher you can start since the A to Z study used the Ornish diet, which is upwards of 65% calories from carbohydrates. You can go higher, but 50% of calories from carbs is probably the max you'll want to go as it's important to remember that everything in your diet is connected.

As you eat more carbohydrates you'll need to eat less of something else (assuming that total calories is capped at a specific level since you're in a fat loss phase). You'll want to keep your protein intake at 30% of your calories and never lower than 1.6g/kg body weight. The rest of your calories will come from fat, which in this case is the remaining 20% of calories. So at the high end of your carb intake, your diet will look like this:

• 50% carbohydrates
• 30% protein
• 20% fat

Let's put some more numbers to that:

1. 2500 calories
2. 312g carbohydrate
3. 187g protein
4. 55g fat

Wait, that's a low-fat diet! What? Let's pause here. I'm not some crazy PhD keyboard jockey recommending a low-fat diet. This won't work for everyone. But if you're looking to lose as much fat as possible while eating as many carbohydrates as possible and you have good insulin sensitivity, this is how you should start.

The one thing you might be concerned about with this higher carbohydrate/lower fat approach is satiety or feeling full. With only 20% of your calories from fat, will you be satiated enough? No one likes to feel like they're starving just after they finish a meal. But satiety shouldn't be a problem as long as you're eating ample vegetables as part of your 50% carbohydrate intake. Here's how:

Vegetables - Eat them, especially high-fiber green ones and high volume veggies that weigh a lot but don't contain a lot of calories. You body senses how much a food weighs more than it does the calorie content of the food. Eating more vegetables is always linked to eating less calories and greater feelings of fullness.

Insulin - While it's often talked about as the devil when it comes to fat loss, most people don't realize that insulin is a satiety hormone. So the increase in carbohydrates will lead to a hormonal cascade that leads to increase satiety.

Protein - Protein is linked to increased fullness via multiple mechanisms in your body, from signals in your digestive tract to modifications in your brain. 30% of calories from protein will give you the lean body mass protection that you need as well as the fat loss/satiety benefits.

So satiety shouldn't be an issue. But if you find that it is, no problem, just drop your carbohydrate intake by 5-10% and adjust your fat intake according. Your new starting point would be:

• 40% carbohydrates
• 30% protein
• 30% fat

Forget How You Feel!
Don't just eat carbohydrates recklessly and then get upset when your body composition isn't improving. Don't blow this idea off because it doesn't "feel" right and carbs make you "feel" fat. Optimizing body composition is less about how you feel and more about how your body changes.

It drives me crazy when people say they "feel leaner." You either are leaner or you aren't leaner; it doesn't matter how you feel about it. Treat your body like a science experiment. Put the plan into action and measure how your body responds. Make adjustments to your diet based on how your body has responded, not how you feel about your body's response. Your newly visible abs will thank you.

Bodybuilding with Diabetes

The symptoms of diabetes may begin slowly and hard to identify at first. They may include fatigue, frequent urination, excessive thirst, and a feeling of becoming sick. When there is extra glucose in the blood, one way the body gets rid of it is through frequent urination. This loss of fluids can cause excessive thirst. Diabetes can also cause other symptoms such as blurred vision, slow healing of skin, sudden weight loss, genital itching, and gum and urinary tract infections.

People who suffer from diabetes must take extra precautions when wanting to exercise. These people should not exercise outside on very hot or humid days due to the increased risk of heat stroke or exhaustion. If you are exercising in warm weather , dress in loose-fitted clothing or special fabrics that promote heat loss. To prevent dehydration, drink a cup of cold water before and after exercise. If your exercise session lasts longer that thirty minutes or if you sweat alot, drink water during your workout. Make sure that you know the warning signs of heart problems such as jaw, arm, and chest pain, dizziness, nausea, irregular pulse, and unusual shortness of breath during exercise. Exercise, along with good nutrition, helps decrease body fat, which helps normalize glucose metabolism. Exercise also helps lower coronary risk factors such as high cholesterol and high blood pressure.

Type 1 diabetes is a lifelong disease which occurs when the pancreas does not produce enough insulin to regulate blood sugar levels. Without adequate insulin, glucose builds up in the bloodstream leading to increased hunger. In addition, the high levels of glucose in the blood causes the patient to urinate more, which also causes excessive thirst. Within five to ten years after diagnosis, the insulin-producing beta cells of the pancreas are completely destroyed and no more insulin can be produced. Type 1 diabetes can happen at any age, but it usually begins with people under the age of twenty-five. The exact cause of type 1 diabetes is unknown and only accounts for around 5 percent of the new cases formed each year.

Previously known as noninsulin-dependent diabetes mellitus, type 2 diabetes is the most common form of diabetes. 90-95 percent of people who have diabetes have type 2. People with type 2 diabetes produce insulin, but either do not make enough insulin or their bodies do not use the insulin it makes. Type 2 diabetes typically occurs after the age of forty years. A resistance to insulin develops, often accompanied by excess weight and leaving the pancreas unable to produce enought insulin to compensate.

Hypoglycemia is the clinical syndrome that results from low blood sugar. The symptoms of hypoglycemia can vary from person to person which can become severe enough to need treatment. Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the blood sugar returns to a normal range. While patients who do not have any metabolic problems can complain of symptoms suggestive of low blood sugar. Hypoglycemia usually occurs in patients being treated for type 1 or type 2 diabetes. Patients with pre-diabetes can also have low blood sugars on occasion if their high circulating insulin levels are further challenged by a prolonged period of fasting.

Living with diabetes is not fun, but by taking preventative care of yourself, you can do the things you want to do in life. Exercise and proper nutrition are very important to steps in recovery and you never know, maybe you didn`t have diabetes after all, you just needed a lesson in nutrition.

Incorporating Short Steroid Cycles Into a Weight Training Program

Q: “I started with classical progressive weight training, trying to add a rep every week and then when getting to 12 reps, increase the weight and build up again. That got to where it just wasn’t happening that I could add reps. I moved to 5×5, adding weight each week, and same story. Training similarly every week isn’t working for me. What could you suggest to change it up week by week, working steroid cycles into it. I want to gain more size and gain strength efficiency, getting stronger for my size. I’m fine with doing numbers to plan, and using a training book.”

A: What you’ve found is just a basic truth.

Once past the easy gains, it’s not possible to add say 5 lb per week every week. If it were, then we’d have guys adding 260 lb every year to their bench, their overhead press, etc. Those who had been doing this for say 5 years would have added over 1000 lb.

Adding a rep every week can be an even harder challenge, as an added rep typically represents about 2-5% more strength.

As you put it, changing it up week by week can allow for progression which is indeed doable.

One approach is to see for each exercise what weight you can do for two sets of 9, and what weight you can do for two sets of 3. Now figure some modest increase such as 5% to that weight for 2 sets of 3.

As an example, let’s say that right now in a given exercise you can do 2×9 with 120 lb, and 2×3 with 170 lb. A 5% increase on that weight would bring it to 180 lb. The difference between that 180 lb and the 120 lb is 60 lb.

The next step is that there will be six increments of working out between starting at 9 reps and ending at 3 reps. So you divide that 60 lb by six, and come up with 10 lb increases.

So what you will do is start the training cycle with 2×9 at 100 lb and with each further week drop a rep and add 10 lb. You finish at 2×3 at 180 lb, which is a 10 lb improvement on your start.

Steroid use can start in the 6-rep week and end in the 4-rep week, which provides a 3-on /4-off pattern. A more conservative approach is to use in only the 6 and 5 rep weeks, providing a 2-on/5-off pattern. Each of these require having the mental confidence to do the 3-rep weeks unassisted. Another way is to start use in the 6-rep week and continue through the 3-rep week, but you should then add in two weeks of differing training before starting the next cycle. This method allows two fewer cycles per year, but can be comparable for results.

This is only one approach; there are many good ways. As a general guideline, for most programs of extended duration, the most efficient time to employ anabolic assistance is in the last third or the last half of the program, according to how aggressive you want to be with steroid use.