The Most Hidden Calories
The Most Hidden Calories
There are many obscure saboteurs waiting in the shadows when changing one's nutrition. There are internal doubts. There are external doubters. There are errantly-labeled "healthy foods." There is misinformation. There are stress responses. There are hormonal cascades. There are "role models" whose experience is singularly anomalous and in no way helpful. All of these add up to be an invisible noose snugly tied to the necks of people struggling with body composition change. Every time they look for the rope that's holding them back, they can't see it; but they can always feel it choking their progress. It's time to shred the rope.
For us to get on the same page, we need to start by clarifying 8 things:
1.) Calorie counting is generally not a sustainable lifestyle; it is best suited as an introductory eye-opener for new clients, a short-term trouble-shooting effort, a method of tracking for physique athletes in show prep, and a marker for getting ENOUGH calories for the competitive strength athlete or mass gaining client.
2.) Until you've done first-hand research on metabolic output, almost everything you know about metabolism and calorie burn is false. Twelve years ago I began running experiments with equipment that directly measures (rather than infers or approximately calculates) your actual oxygen consumption and thereby calorie use. Generally, the larger you are, the higher your metabolism. Skinny people don't have high metabolisms. That's demonstrably false. They have superior distribution of calories, whatever the amount. The holy grail is not rate. It's distribution.
3.) Eating more calories raises your caloric burn. Eating less lowers it. When "experts" calculate the calories you use, and prescribe you a "deficit" plan, it's snake oil. Your body adapts to the lower number almost immediately. You can measure this.
4.) Long bouts of steady state "cardio" suppress metabolism. Think about it. Everything your body experiences is a message. If your body experiences long exertion, the message is that it needs to be better adapted to long exertion. The adaptation is lower metabolic rate at rest in order to conserve energy for the next long bout. That's not to say there's no benefit. Certainly when people are going from completely sedentary to incorporating movement, there's a significant benefit. But longer bouts at moderate exertion make it impossible for a non-lean person to cross the threshold to being lean.
5.) Anaerobic work (high intensity and resistance training) is the only scaleable method of metabolic rate improvement; but, again, what we are actually interested in is distribution. The brief intense demand of anaerobic work will raise calorie burn for many hours (up to 72) after the exertion; but more importantly it distributes whatever calories you take more toward lean tissue. This is wholly independent from increased time of effort or increased daily steps. Anaerobic work can keep improving your body composition even if your hundredth workout is the same amount of time as your first. The focus is increased intensity. Classical low or moderate intensity steady state activity (walks, jogging, typical versions of "cardio"), on the other hand, only works progressively if you can continuously realistically do more and more time, working up to hours per day every day. When two hours of walking or jogging doesn't cut it, you'll have to do two and half. When that stops working, you'll have to do three. Forever this ante up continues. Alternatively, anaerobic work, by definition, cannot be performed for more than about 45 seconds at a time, and then you must rest before revisiting the intensity again. Including rests, anaerobic workouts can be about 15 minutes long, and need not be more than 45 minutes. They also don't need to be performed every day for results, because of the metabolic carryover, unlike low/moderate aerobic activity.
6.) Growth of any tissue (including fat) requires certain cascades, namely insulin release. 10,000 calories of dietary fat CANNOT stimulate insulin production. 10 calories of carbohydrate DOES stimulate insulin production. Anything that tastes sweet can set off a Pavlovian switch that stimulates insulin production. It had few or no calories, but now you have a growth cycle churning. What happens next? You get hungry. You eat. You feed the growth.
7.) Lower metabolic rate and lower calorie burn correlate to longer life expectancy. The only people on earth who make it past 100, 110 or 115 years old are small people who eat tiny amounts of food and have slow metabolisms. Burning more calories is not necessarily a worthy wellness goal. Pause for a moment. Would you prefer to have a 12,000 calorie per day metabolism that is directed at storing as much fat as possible and shortening your life or would you like an 800 calorie per day metabolism directly solely at lean mass, organ and brain integrity which will add years to your life and life to your years? People say your heart only has so many beats in a lifetime, so you have to conserve those beats. I don't think there's necessarily any science behind that statement, except for the fact that at prolonged elevated heart rate you train the heart to be inefficient. As your beats per minute increase, your stroke volume decreases. On top of that, elevated heart rate is indicative of sympathetic nervous system response or stress. Lean people and long lived people generally manage stress well. Purposely subjecting yourself to long bouts of stress is the definition of bad stress management. You are going to die younger and less healthy if you fall into the cardio volume trap.
8.) All calories and macronutrients are not the same. Despite the attempts of Dr. Twinkie and others, there is a very simple way of proving to people that it's not just about calories or macros. Have them drink snake venom, eat mad cow disease prions, or imbibe gasoline. The first is just proteins and peptides. The second is simply a protein. The third is just calories. There are many other examples; but this tends to drive the point home. Edible and well-tolerated foods are no different. They all fall on a continuum of harm-to-help. It's not that any one compound is all good or all bad. They are on a gray spectrum which approaches one end or the other based on timing, goals, individual epigenetics, hormone balance, and dose size, etc. This is why elimination diets and avoidance of gluten or other foods is not a fad or pseudoscience. Different foods can be inflammatory for someone even if they are generally classified as "healthy foods." Proteins are a set of instructions. Grain proteins, for example, send nasty signals even for those who can tolerate them well. Very educated people have contended this; but the fact remains that NO ONE has demonstrated that even gluten-tolerant humans can create an acid or digestive enzyme that breaks down the composite gluten protein into dipeptide and tripeptide bonds (the definition of a safe and usable protein). Fats are used for many things, including hormone production and cell membrane integrity. Vegetable oils, for example, are not easily converted to needed hormones, nor do they make healthy cell membranes. Carbohydrates fuel things. Certain types of fiber, for example, feed helpful bacteria. Sugars, even natural fruit sugars, feed deleterious bacteria, parasites and cancer cells. I repeat: all calories and macronutrients are not the same. Don't confuse the brilliant adaptability of the human organism with substance similarity. We can use mold to make antibiotics. Some bodies survive infection because of penicillin. Some bodies die from the penicillin.
Now that roughly we are on the same page, understand that almost every calorie is a silent saboteur when you are in a state of inflammation and fat tissue growth. The body is either in an anabolic state or a catabolic state. That is, either the systems of the body are building or they are breaking down. These states are mutually exclusive, cascading throughout the day like the ebb and flow of tides. So our job as sculptors of a new body is to direct the breakdown periods toward fat and minimize muscle degradation. The job during building periods is to direct energy disproportionately toward lean tissue and away from fat. Don't try to create high tide during low tide. It doesn't work that way.
As a grown adult, if you are already heavy and did not just complete an intense task, anything you eat will predominantly grow more fat. Eating is anabolic. If your body doesn't have a very stressed reason to grow bones, ligaments, tendons and muscle, anabolism is exclusively fat tissue growth. Eating shortly before exercise is confusing to the body. Are you signaling it to utilize fat stores and stress muscles to depletion so that you will adapt to be leaner and stronger? Only if you're fasted. Otherwise, you are signaling it to defend fat stores and avoid the level of stress to muscles that actually brings about adaptation for size, speed, strength and endurance.
This is biology. And, sadly, even among very knowledgable and accomplished coaches and athletes in the fitness industry, the concensus opinion is the opposite. The myth is propagated by successful trainers and competitors who succeed in spite of doing this incorrectly. They eat before workouts. They eat carbs in the morning. Most of them are extremely determined people. Some are genetic freaks. Almost all of them are leaner, carrying more lean mass and far more active and more powerfully stressing the body than the average human. They have different proportions of signaling to begin with. And some more yet are playing by a different set of rules altogether, because they are regulating hormones with exogenous substances. But make no mistake, they all would progress more rapidly and with less effort if they played by the laws of biology.
Let's compare two examples of what people incorrectly think of as "good" or "bad" behavior in different people with the same body weight to outline how this can pan out far differently than what you'd expect:
Individual (A) - He's a 25 year old lifter weighing 200lbs at 5% bodyfat. He performed a 40 minute anaerobic workout yesterday, consisting of deadlifts up to 500lbs, so his 190lbs of lean mass still has a severely upregulated glucose transport status (meaning his muscles, tendons, ligaments, bones, nerves, heart cells, etc. are still ready to soak up whatever energy is out there). It's morning, so his testosterone is at its peak, further directing energy toward bone, ligament, tendon and muscle synthesis and improved brain tissue integrity. He slept well, so the peak is significant and his nocturnal growth hormone release was optimal. Despite cortisol coming off of its peak when waking (which generally makes fat cells vie for the lion's share of food), he only has 10lbs of fat to exert a vote on the matter. He can eat a whole 24 inch birthday sheetcake and the worst case scenario is his workout later today might be slightly more lethargic. He doesn't have to "burn it off" because his body directs all calories toward cognitive and physical performance. There's nothing to burn off.
Individual (B) - She's a 45 year old sedentary professional weighing 200lbs at 30% bodyfat. She did cardio yesterday for 90 minutes, which supressed her metabolism and the very little testosterone she could have. She did not sleep well, because she had stress hormone release at night and in turn the corresponding insulin release, worrying about the following work day, so her nocturnal growth hormone was non-existent. She enters the day defeated from a physiological perspective and her 60lbs of bodyfat have a 10 to 1 vote over her 140lbs of lean mass. A small bowl of kashi cereal or Greek yogurt will only be used to grow more fat and perpetuate the stress cycle. But she heaps on top of that a glass of orange juice which skyrockets her insulin immediately. She fastidiously watches her Fitbit steps for the day, ensuring she gets over 15,000 to "burn off" the 2:00pm "healthy" granola bar she couldn't help but eat because her blood sugar and willpower sunk to its lowest point around that time of day. It's futile, because her insulin spike from a late afternoon apple, the granola bar, Panera at lunch and the morning cereal protect her fat cells from being touched today. Her dexa scan for the year shows yet another year of bone mass loss, even though she eats just a little less food than when she was in her 20s, emphasizes calcium intake more than ever, and makes a concerted effort to be active. The rule she lives by is "balance" which ends up continually depriving her body of sufficient vitamins, minerals and fatty acids; all the while she continues eating a diet predominantly made of carbohydrates which continues to signal her fat cells to grow or at least be protected. Her weight watchers points are generally spot on; yet she continues to grow heavier and fatter with every passing year.
The diligence of Individual (A) can be far far less than Individual (B). (A) has the scales tipped in his favor and he would have to work hard against himself every day for many consecutive days to undo all the good. If he ate a sheetcake every morning for a year, he would eventually interrupt and invert certain hormone cascades which have kept him lean. (B) has the scales tipped against her and she has to fight dutifully to get the battlefield moderately fair. Her eating and activity are complete nonsense for her current hormonal status. If she stopped working out, or only did anaerobic workouts, and ate ketogenically for 10 days in a row while focusing on stress management, she'd exit the inflammatory trap immediately.
So the trap persists. Every calorie is a hidden saboteur until the scales are in your favor. Every calorie is a bad calorie until then. Some are less bad than others, yes. But all will continue working against you, until you cross the threshold of favorable momentum.
Why Imposed Extreme Rapid Weight Loss Always Fails
And What To Do About It
In the first week of May 2016 dozens of friends, family members and clients independently forwarded us a New York Times article about an extreme weight loss show winner who ended up subsequently regaining weight and how his was a typical outcome. For people outside the fitness industry this was news. For those of us inside, it's old hat; and there are genuine physical reasons why it's so common. There also happen to be ways to counter it.
One of my very first clients about 12 years ago was a young woman who had done gastric bypass the year before we met. She lost 80lbs within the first two to three months after the surgery. In the three months prior to meeting me she had gained back all 80lbs plus an additional 25lbs. I thought this was an anomaly, but over the course of time I discovered that 10+ year post-op fail rates on medically directed extreme weight loss are nearly 100% (if we define "fail" as significant weight regained and the patient still at an obese to super obese BMI).
There are statistics that sound better than a 100% fail rate, but scrutiny doesn't bear them out. The most promising rigorous long term study on extreme weight loss via bariatric surgery, conducted by doctors at McGill University Health Center, pegged long term fail rates as low as 20.4-34.9%. This seems a lot better than 100% until you read the article carefully. Only 83.8% of the proposed sample population was followed, over 3% of patients died before the study ended, not one patient reached a normal body mass even at the lowest post-op weight, and all participants ended up still obese. Pay close attention to what's happening here. This is an internal study. The McGill University Health Center is loathe to collect or showcase data in a way that reflects badly on its outcomes. These are essentially the most promisingly-interpreted statistics on weight loss surgery capping out at a 79% or 65% success rate, but only when the authors have included exclusively the survivors, the most successful participants, and defined "success" as a BMI anywhere lower than pre-op. That's abysmal. Imagine that a participant started at a body weight of 450lbs, lost 50lbs of muscle, tendon, ligament and bone and another 50lbs of fat, then subsequently gained 99lbs of fat (this is a typical body composition outcome for most extreme weight loss participants). According to these authors, as long as that person is still the same height or taller, he would be considered a "success" at 449lbs despite netting a 99lb fatter and less lean body composition simply because his BMI is less.
It's called padding the numbers. Caveat emptor. Health centers aren't the only ones who do it. Stock analysts, mutual and hedge fund managers craftily choose the lowest price in a quarter and the subsequent highest price to outline their "incredible performance." Certain Buddhist monasteries make would-be students suffer for days outside in order to ensure that only the most dedicated will enter. The most elite schools require only the most motivated kids, because they haven't the first clue how to help the unmotivated. There are surgeons who only take the most promising patients, because they want to tout good numbers. I know coaches who only take the most self-motivated clients to begin with. In fact, any time a program emphasizes "success stories" above brand and methodology, they forever have a sampling bias in future customers. They obtain customers who would've succeeded just as well or better without any of their guidance. It's a great racket for a business, but only if you want to develop zero troubleshooting skill and eternally be incapable of helping the Everyman. Sadly, the very people most capable of helping tough cases will, by definition, be the least well-known. Thus, the most popular "experts" are an easy target to dismantle. The real experts developing pertinent wisdom are doing so by suffering in the trenches. By virtue of being in the trenches, they are not filming infomercials, creating reality shows, writing best-selling fad fitness books and uploading a selfie every twenty minutes.
If you've ever been online or watched any television, you've seen countless 30, 60, 90 day transformations and testimonials. They're a dime a dozen. People get lucky. People get motivated for 4-12 weeks. There's absolutely nothing special or particularly enriching to be learned from these. Now think to the 5 year, 10 year, 15 year transformations. You probably can't name one. They do exist, but they seldom start out in an exciting manner.
The incorrect but typical explanation levied is that the person on the extreme weight loss program never built the mental, psychological and emotional apparatus to become a thin person; thus, they're destined to fail once the strictures of external imposition are loosened. Surgically altered stomachs eventually distend. Lap bands eventually yield. Sooner or later people have to live in the real world, and not on a retreat or television show with a questionably-experienced celebrity trainer and medical doctors looking for some sort of fortune or fame by virtue of ignoring the best parts of their training.
It's an incorrect explanation, or at least insufficient, as I'm sure there's something to it. We all know people who just haven't ever learned to manage themselves in any aspect of their lives, whether it's academic discipline, work ethic, eating, exercise, practice in their chosen art, sport or music, relationships, or just good 'ol follow through on what you say you're going to do. We're humans after all. So, yes, I agree: we have an epidemic of lack of internal integrity and self-discipline. However, that's such a weak offloading of responsibility to the very people who are busting their butts trying to lose weight and struggling. They're working hard; and we owe them a more satisfying explanation than "pick yourself up by your bootstraps," when they haven't boots, or straps or hands.
I'm never one to sweep aside the psychological component. Healthy behaviors are not as exciting or sexy as "extreme rapid weight loss." We give ourselves the errant expectation that who you will be is the product of a past action. It's foolhardy. Claiming today that you are doing cardio has no bearing on who you will be in five years. You are what you do, not what you did. You will be what you will do. Yes, a single decision can change trajectory. But the accumulated baggage on the current path determines the current status.
There is a more fulfilling explanation for the recidivism, because there are real physical and physiological reasons why most extreme rapid weight lost must be regained:
1.) Physics - Newton's Third Law
For every action, there is an equal and opposite reaction. Homeostasis, an equivalent idea, is this broad term. When applied in human biology it refers to our organism's internal checks and balances continually seeking to maintain roughly our exact tissue makeup. Simply put, our body works hard to be the same mass, the same composition, NO MATTER WHAT. Some in the fitness world have proffered the solution: "shock the body." Wrong. You absolutely never want to shock the body. Have you ever heard the saying, "you can sheer a sheep many times; but you can skin him only once"? If you sucker punch your body, you are going to get dragged into a street brawl that there's no surviving. You have to coax, cajole and embezzle your way to the top, just like the Rothschilds and Rockefellers. Take a penny a day. Don't get greedy and skin yourself. Empires aren't built on a lottery ticket. "Shock and awe" didn't work on Iraq. It's not going to work on human biochemistry.
2.) The Human Animal Is A Threat-Survival Machine
Every time you signal your body that it is under threat, keep in mind that it is the most resilient survival machine known to us. It is going to grow into a bigger animal so that it can better dominate the threatening environment. The deepest centers of our brain haven't the first clue whether we are losing weight rapidly because of war, famine, pestilence, some "well-intentioned professional" slicing up our innerds with cutting weapons... I mean surgical tools, or a "well-intentioned professional" enslaving us... I mean guiding our food choices on a reality show.
When we are under threat continuously and intensely we are either going to break while trying to become a bigger animal or we are going to actually become a bigger animal. Going back to Newton's Third Law, if the perception of threat is low, the survival desire to become a bigger animal will be equally low. If the perception is great, the survival desire will be great.
On the flip side, simply reducing your perception of stress reduces the survival need to become bigger. People with better management of stress tend to be leaner. There is data on this. Anecdotally, I can tell you that, from tens of thousands of clients and members, those who manage stress well have very little difficulty losing weight and maintaining. Clients who refuse to face the negativity and stress in their workplaces, relationships and personal habits fruitlessly adhere to one diet and exercise plan after another.
One of my case studies involved an older gentleman whose work and social responsibilities were taking an obvious toll on him. My first recommendation was to stop any overt exercise. Everything in his program for the first 12 weeks revolved around improving sleep, gaining a feeling of dominance in his mornings, streamlined simplicity during the workday and purposely eating white rice, sweet potatoes, ice cream, cereal, etc. before bed at night. I never allowed him to do a single workout until he effortlessly dropped 25lbs of body fat just by lowering his psychological burdens.
3.) Extreme Rapid Weight Loss Relies on Extreme Hormonal Imbalances
Optimal hormone balance will eventually result in optimal body composition. Besides being evident common sense, I've run the experiments. This approach requires more patience and a much greater understanding of why you're doing what you're doing; but then there is no maintenance transition. The client is already in maintenance mode before reaching her goal. It's so effective that a whole movement has cropped up in recent years among brilliant innovators and laypeople alike, known by or associated with a variety of monikers: quantified self; quantified medicine; citizen medicine; anti-aging and life extension science.
With extreme hormone imbalance, on the other hand, you enter a tailspin from which there may never be an exit. Thyroid will be suppressed. Stress hormones are ignited in order to break down fat, which reduces the amount of DHEA and total testosterone [T] that can be made AND weight loss commensurately increases sex hormone binding globulin [SHBG] which will bind to whatever little T is left and make the free T (the usuable testosterone) negligible. DHEA and T work on a tipping balance with cortisol, so without them, your stress hormones get little oversight. This itself is likely viewed by our bodies as an attack, the proper response to which is grow bigger and fatter.
Following the path of reductionism to understand why extreme weight loss is regained, we could go all the way down to cation exchanges, chemical affinities and alterations in the ability of receptor transposition across stressed cell membranes. Observing what's happening at the organ and hormone level and thereabouts, however, we have all the ammo we need for now. Marked suppression of testosterone plays a major role, as obese men and women already have supressed T prior to losing weight, thus having one less androgenic (e.g. - making one leaner) stimulus in the arsenal to start. The pituitary gets a good ribbing while you're at it; and I think we can fairly state that you will have shortened the life of your adrenals and kidneys with such intense demand, along with the liver attempting to keep up with the cholesterol, energy and steroidogenesis precursor demands. Insulin is controlled; so the pancreas possibly gets a break. Leptin and ghrelin are part of the short term explanation. But when looking for a cause of cumulative difficulty, most intriguing to me is LPL.
LPL, or lipoprotein lipase, is a marker for body fat regulation. As the name indicates, it's an enzyme involved in breaking down fat. When we break down a little fat, LPL is stable. When we drastically plummet our body fat, LPL skyrockets, as one would expect. The problem, however, is that LPL also signals its countermeasure: the restoration of fat. There's supposed to be a balance in the body. And when we take LPL off the charts, the signal for fat restoration is undeniably imbalanced. We don't know the exact mechanism yet. But the double whammy is that LPL stays elevated for many months after the lost weight and possibly several years. Hence, the signal to regain fat is equal or greater than the signal you sent to lose the weight in the first place.
Not enough is known about LPL-related receptors. However, it's a safe assumption that, like when any other compound gets introduced in massive quantities, the related receptors become desensitized. When the body receives caffeine all the time, caffeine doesn't work so well. When the body receives alcohol all the time, alcohol loses potency. When LPL is constantly elevated, fat loss doesn't happen. This in part explains why heavier individuals have higher LPL to begin with, despite not naturally losing weight more easily than thin individuals. The lipolytic (i.e. - breaking down fat) action of LPL is blunted. Simply put, with extreme elevation of LPL and other extreme changes during rapid weight loss, they become less effective. More simply, it becomes a lot harder to break down stored body fat. Though we'd hope the countermeasures' related receptors would also get burned out, that just doesn't seem to be the case when you follow individuals who've had extreme weight loss. Their systems become steadily and increasingly incapable of lipolysis while readily regaining fat with very little or no new stimulus.
What To Do
It is not super exciting to lose a half, one or even two pounds of fat every one to two weeks. It's also not exciting to practice scales in music. It's not exciting to practice conjugations in a foreign language. It's not exciting to make tiny contributions to your retirement fund. In general, worthwhile long-lasting accomplishments are the result of consistent and non-exciting work. We can't proxy the hare in place of the tortoise. Whatever excitement people have at the outset of their programs is perfectly fine, and, to a certain extent, ought to be encouraged. In order to help ourselves and our fellow man, however, we must reevaluate the weight loss journey. Rather than one of excitement, it has to be the natural outgrowth of optimal-health-engendering behaviors.
The most difficult part of the road will begin after the weight is lost. New "boring" behaviors must be implemented as an obligatory path to real maintenance. When people experience difficulty and relapse, it's not a character flaw. It's a natural response to hormone imbalance. At some point, when the excitement wanes, we must put the emphasis on optimal health and hormone balance. When we do, all of a sudden, "character flaws" magically disappear. I used to think that as people neared their goals, it was time for them to begin loosening the reigns. The fact is, instead, that's the very time people need to double down and commit to additional measures, whether it's increased guidance by trainers, nutritionists and coaches or supplemental hormone therapy and fitness community external accountability. In the end, people have to find a sustainable program that works.
If your weight loss relied on extreme hormone imbalance, the transition to maintenance should be two to four times the amount of time it took to lose the weight. If it takes three months to lose the weight, it's going to take six to twelve months to enter maintenance mode. The same could be said about the energy and financial resources committed.
Now, well into my second decade in the fitness industry, I've met with over 10,000 gym members, prospective members or coaching clients. All of them have experienced weight loss at some point for 4-12 weeks. Guess what: if you're an adult human in the Western world, you've experienced weight loss at some point for 4-12 weeks. That can't be the goal. It has zero staying power. The goal has got to be deep internal change, both physiologically and mentally. Monitor hormones. Do testing. Do a mental check as a way to get additional insight into hormone balance. If you consistently find yourself dwelling on disempowering thoughts, there's a good chance your T is across the board too low, your diurnal cortisol curve is suboptimal, and your physical capacity to be motivated is low. This isn't a character weakness. It's a neurological and endocrinological reality that won't be solved by increased threat and trauma. Address this. Return to realistic consistent fundamental healthy behaviors. Don't be a flash in the pan. Remember Newton's Third Law - you're only going to more strongly seek unhealthy rewards if you further traumatized yourself. Reach out to those who can help. Avoid those who judge and shame you out of their abject ignorance on the subject. Practice the skill of listening to yourself. Then, in 10+ years, be one of the real success stories.
Post script of hope:
For those of you who have incredibly suboptimal hormone balance, you can tip the scale in your favor. Even with the cards stacked against you, even with elevated LPL, even with zero thyroid function, even with immeasurably low T, DHEA, DHT, androstenedione, androstenediol, and whatever other challenge you face, you can do it. It can be done. Start with two things:
A.) Don't Guess. Test.
There are a lot of entry points here, but one of the weakest is the CBC/CMP. If you talk with your general health care provider about fatigue, inability to lose weight, lack of drive, and concerns about hormonal function, she will do nothing or pull a CBC/CMP. There has never been a more pointless set of labs for wellness than the CBC/CMP. This will tell you absolutely nothing useful unless you are in the throes of kidney failure or Dengue Fever. Don't be distracted by the 30 different values in the tests. They are telling you almost nothing about long term health. Just so you know, almost every time a doctor has said, "well, your labs look perfect," they are referring to this incredibly shortsighted set of tests which tell us little more than you are currently breathing and don't need IV fluids. It's a cheap set of tests for a reason. Perhaps it can be a starting point to determine that you aren't actually at critical impending risk of death. But it can only be a starting point.
If your health care provider is particularly motivated, she may run a thyroid screen. Again, unless you are way off the testing range, you're going to hear nothing more than, "you're in normal ranges." You could be at the dead bottom of normal T3, and, if they even bother to check TSH, you could be at the absolute top, and they are still going to tell you you're "normal." Even good endocrinologists won't usually add TPO into a thyroid screen. So, even if you do come up as hypothyroidic, or, if you're working with a fully evolved clinician who will use the term "borderline," we don't have an answer for one of the biggest culprits in causing suboptimal thyroid function without checking TPO.
That's to say nothing about the fact that your lab values change depending on time of day. Most health experts are oblivious to this. And steroidal hormones, though they can tell us a lot, are too complex for your general practitioner.
To get more than "good/bad," "normal/abnormal," look into wellnessfx, life extension lab testing, my former employer (Life Time Fitness) or go to an actual HRT specialist clinic. If that's too involved for you at this point, I'd encourage you to begin with testing your own blood sugar ( http://www.elev8wellness.com/wellblog/lose-15lbs-for-15-in-2015) and orthostatic blood pressure. From these, you can get a pretty good starting feel for what's going on. Until you regularly pull 85 or less on glucose, you aren't losing body fat even if you're losing weight. When you stand up and recheck blood pressure, if your systolic number doesn't go up 20 points, you are exhausted from the perspective of organ reserve, and a salivary diurnal cortisol test kit can confirm it.
Once you're ready to expand the testing roster, look into some fundamentals you can change right away, like B vitamins and vitamin D. The vast majority of non-Equatorial people are extremely deficient in vitamin D. The only way to get the dose right is check your levels at least quarterly. I have a colleague who is active and outdoorsy, spends a good part of the year in Central America, but discovered through testing that he had to supplement 15,000 ius per day year-round to be in optimal ranges. Generally, people take 500-2,000 ius per day and think they're changing the landscape. If you don't test, you don't know.
B.) Revise Your Idea of a Plan
When people say they want to lose 20lbs, for example, they create a "plan" to workout and diet a certain way. The reality, however, is that "plan" is actually a goal and you have no strategy on how to hit the goal. An actual plan includes how you will perform the behaviors. An actual plan is not a checklist of foreign behaviors that most likely you won't ever do.
One of my favorite questions to ask is, "on your worst week, when you're about to lose your job, your best friend dies, your health is compromised, you hurt your ankle, your car breaks down, you've been going to sleep too late, and there's a snowstorm outside, what is the greatest number of workouts you'll get in and the greatest nutritional compliance you will execute?" Whatever those numbers are, that is your realistic average execution going forward, because all that and then some is going to happen some day, possibly today. Make the plan based on that. Do not make a "plan" based on some Pollyanna week that's never even existed. The moment you face a non-Idyllic week, you will implode, unless you have worst case scenario plotting in place. Remember, we are looking for sustainable lifestyle, not imposed restriction.
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