1.) no time under tension 2.) no true progressive overload 3.) strong belief in diet myths Time Under Tension Watch the tempo of someone who has built piles of muscle and you’ll notice that he’s long learned to embrace the discomfort of effort. Forget about the weight on the bar for a moment and watch how much time his muscles are withstanding the load. Now, watch a toothpick-limbed waif and you see this herky-jerky nonsense. Always. To this day, every guy I’ve ever met who “can’t seem to put on size” I GUARANTEE does not control weight while it moves WITH gravity. The eccentric tempo is 0 seconds. Deadlift drops to the floor. Bench press plummets to the chest. Squat catapults into the ground. There is no embrace of the effort. There is an explosive jerk, albeit weak, followed by nothing. The weight burps up from its place of resting and promptly hurtles itself back into the earth. To overcome this is going to take A LOT of ego check. Most guys who think they’re 300lb dead lifters should actually be using 110lbs. Guys who think they’re 225lb bench pressers are 65-85lb benchers. The good news is that in 3-6 months you’ll be using your prior weight, except with control and some actual muscle on your frame. Progressive Overload Skinny guy squats the 45lb bar. In a year he squats 200lbs. NO PROGRESSIVE OVERLOAD. Why? Because when he squatted 45lbs, he used his entire range of motion, controlled the weight, and managed it under muscular tension for almost 60 seconds. Now, with 200lbs, he does a 1/8th to 1/16th squat for about 8 seconds looking like an epileptic chicken. Progressive overload means MORE when comparing apples to apples. You can’t just put more weight on a bar. You can’t just fudge the accomplishment. OBVIOUSLY. Look at your limbs. They haven’t changed because you flee from effort. You run away from discomfort. You REDUCE tension and stress. And that is why you don’t progress. Check ego. Reference time under tension. Reduce the weight on the bar. And continue progressing the SAME movement in the SAME way. No more short-changing the range of motion and the duration of effort. This is most critical with regard to lower body training, because this is where the heaviest loads will be managed, therefore promoting growth hormone signaling, which we will cover shortly. Diet Every guy or gal who’s come to me complaining about an inability to build muscle is eating about 1/10th of what it took me to gain muscle and then whining about how much they’re eating. It’s actually stupid simple. If you aren’t growing, you aren’t eating enough. It doesn’t matter what you think is enough AT ALL. All that matters is what it takes. If you can’t grow at 4,500 calories per day, go to 6,000. If you aren’t packing on size at 6, go to 8. Elite endurance athletes LOSE weight eating 10,000 calories per day because their energy expenditure is so high: https://sportsmedicine-open.springeropen.com/.../s40798... . It really doesn’t matter at all what you think is enough. All that matters is what it takes. The inadequate eating is often paired with superstitions about carbohydrates. Carbohydrates exert almost zero impact on beneficial hormones (with the exception of the insulin increase during or after intense workouts, which still pales in comparison to the effect of being in a hypERcaloric state). Dietary fat inculcates better sex hormone balance. Also, dietary fat is significantly more dense (2.25 times more calories per gram) than carbs. Thus, when looking to fit in a greater energy intake, little guys are barking up precisely the wrong tree with carbs. Moreover, during rest, carbs will not produce any advantageous increase in lean tissue. Only protein and fats will promote the gain people want. Thus, generally, little guys are eating too many carbs WHILE eating insufficient amounts of overall food. Testosterone Is Not The Problem There is a heavy fixation on testosterone among many people without adequate education on physiology. You can see this crop up in limiting beliefs about muscle gain and in philosophically-errant arguments about trans athletes. Testosterone, albeit important, is ONE piece of a very complex puzzle. The person’s conversion rate to other hormones matters a lot more. An overstressed person with incredibly high conversion to estrone, dht, and cortisol will see a WORSENING of fitness if we increase his or her testosterone. What actually matters is RESILIENCE. For a few people, resilience improves with an increase in testosterone. But not for everyone, and certainly not in the same amounts or duration. And what matters most for growth of athletic capability is on-site (within the muscle itself) IGF expression. That is, this is promoted mostly through training intensely and consistently followed by RECOVERY. I have shocking case studies on this, wherein a very consistent lifelong natural athlete with low testosterone is built and shredded, whereas an obese and weak former athlete and long-time steroid user has high natural levels of testosterone. You read that right. The guy with no drug use has LOW T and great results from consistency. The guy with long time drug use (discontinued years ago) has HIGH T and no results due to lack of consistent discipline. Testosterone is an incredibly weak substance per molecule actually, while something like estrogen is much more potent. Women have two to forty times more testosterone than estrogen in their bodies. Amounts matter, but only in relationship to other physiological mechanisms. I’ve known super low stress guys who just seem to pack on piles of muscle (obviously, eating and therefore recovery increase). I’ve known super high stress guys who just get worse with even a tiny dose of anything we would expect to be anabolic. I have older female clients who add 1mg of testosterone cream per week and reverse osteoporosis. I have older male clients who add 75mg of testosterone per week and reverse heart disease, diabetes, prostate growth, and cognitive decline. I have known peers who take 1,000mg per week and get little more than a fluid increase (bloat) with no obvious long term advantage. I have known peers who add 200mg and gradually keep recovering and no longer getting injured. Only a small handful of people seem to be able to tolerate (let alone benefit from) high doses, and even among them I tend to see almost no improvement in athleticism after 2-5 years. Again, it’s going to come back to the top three: 1.) no time under tension 2.) no true progressive overload 3.) strong belief in diet myths Without addressing these, it really won’t matter much what other avenues someone explores. I’ve been in the fitness world long enough to see up close the 10-20 year outcomes. Some people have receptors built for it. Some people don’t. Some people have great conversion and tolerance. Some people don’t. What we always see is that it comes down to resilience. If stress management doesn’t improve, long term outcomes are not good, because the body won’t be able to handle time under tension, progressive overload, or distribute the increased food appropriately.
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First, watch the video above:
One week in Tampa I train with my good friend and one of the absolute top coaches in the business, Adam Bisek; and we ended up in the background of Derek Lunsford’s (super nice guy, btw) video shoot. The next, I grab a lift with my friend and former client, one of the best IFBB pro athletes in MN state history, Donna Randall. The next, I join my long-time buddy, Mike Duffy, an expert who’s trained with special teams. Next, I workout with another good friend and former business partner, an LEO who squatted 700lbs in high school. Whether it was last Fall in Europe or Winter in Ohio and Georgia, whether it’s with an elite coach/athlete or a novice/beginner/outsider, I get something out of every different interaction. Not everybody will hire an expert all the time for every single fitness decision. Ok. So start hanging out with friends and working out with them. Let’s normalize that. Sure, I get the advantage of owning a movement lab, Elev8wellness, where I gain 50 more hours of professional experience every week. And I have to be honest: I did make some of the most outrageous strength gains in private isolation without distraction. I have clients who in virtual workouts made more progress than I’ve ever seen gym-goers make. BUT that’s not applicable to most people. Most people’s interface with fitness is watching some influencer girl do bridges on her IKEA couch in her studio apartment. You need some active feedback. You need some interaction. Not ready for a professional coach? Totally fine. Just start making “workout lunches,” “gym coffees,” “lifting dates.” Let’s normalize it. Your friend who’s never been to the gym has the same or more experience than some of the top influencer accounts I’ve seen. We need to support each other in actual reality. And we can all use live input and feedback. I asked ChatGPT to list the requirements for people to gain as much muscle as possible; and it churned out the following ten-point list:
And actually, this list isn’t bad. In my personal experience going from around 160lbs as a full-grown adult in 2000 to as much as 290lbs in 2007, without even knowing it, I had followed this list more or less. Zero performance enhancing drugs. There are a few things I’d refine or add, however. With regard to progressive overload and nutrition, there is an extra layer of precision a person hellbent on gaining muscle would want to employ. It has three parts: 1.) Every single workout, every single week, you MUST lift more than the prior while gaining size. This is critical. It doesn’t have to be much. But it has to be. You have to FORCE the body to change. Think about it this way: if you are a bigger and stronger animal with more muscle, the stimulus to get to the next level must be greater than the stimulus which got you to the prior musculature. AND, when you’re eating more than you used to, there is no reason why you couldn’t lift more than you previously did when you had less fuel than you now have. Now, this could mean that you pay extra special attention to 2.5lb plates, extra attention to adding one single extra rep, buying a set of magnetic fractional weights even. Whatever it is, you MUST do more in a real, measurable, meaningful way. It does not have to be a lot more. But it has to be more. And a very small amount more each week run over the course of a year or years adds up to quite a lot actually. 2.) Every single week, you MUST eat more than the prior while gaining size. This dovetails with the prior point. If you’re lifting more, you need more food to repair. If you eat more, you’ll lift more. If you are a bigger animal, it takes more energy just to maintain. And you are hellbent on gaining size. So it better keep increasing. The ChatGPT list says 250-500 extra calories. That’s middling. Some people jump up 1,000 or more. You could add as little as 100. But the following week you will need ANOTHER 100. And so on. The degree of jump will contain risks and rewards. The smaller the degree of change, the smaller risk and smaller reward. But the week that passes with NO change confers NO reward. Remember that. 3.) You MUST be committed to gaining some body fat. There are a lot of influencers nowadays who look exactly the same as they did 5 or 10 years ago who talk about lean bulking. Can it be done? Sure. But the reality is that if you are truly going to take your body to your actual limit and push it to grow, you will need a progressive eating strategy to ensure recovery and growth. Inevitably, on the upswing, you’re going to overshoot your caloric need by some. This will result in body fat. If you’re super worried, what you could do is make the weekly jumps less dramatic, which will also reduce how dramatic the size and strength gains are. But it will also prevent too much spillover from happening. And that’s probably best anyway. Universally, we find that when body fat percentage rises too much, feed efficiency drops (a greater percent of the calories eaten do NOT go to muscle). Also, if you have too much excess fat to lose, you risk shedding too much lean tissue on the cut down. And this does happen a lot, even with the most devoted of dieters who train hard. And it’s a serious bummer, because people put in so much effort to end up not too far from where they started. Sadly, too many natural lifters chalk up this “going in circles” to the fact that they’re natural, when really it’s that they weren’t forcing the body to change enough, they didn’t stay big enough long enough (generating a new normal), and generally they’re overzealous on the cutdown (losing precious lean mass). AND they don’t sleep or recover enough. If someone isn’t getting surplus sleep, he simply isn’t serious about gaining muscle. If you demand from your body to lift more than it did the week prior for two years straight (100 weeks of 1-2% increases), and you’re not under-rested, when you cut down, you will have more muscle mass on the body than you did three years ago. A LOT MORE. That’s just a logical fact. The biggest mistake I see a lot of natural lifters make is that they so worry about gaining any amount of body fat that they’re eating too light from beginning to end, training at too low an intensity from beginning to end, and diet hard as hell on the cutdown, sometimes ending up even smaller than when they started years ago. When they add crap sleep to the equation, they may be smaller AND fatter than when they started. Possibly more pernicious than that, I’ve now seen a lot of influencers arguing that natural lifters can and ought to do outrageously lengthy and volume-filled workouts. There is no way any natural lifter is going to make progress with that on a cutdown. They’re just going to burn up lean tissue and possibly end smaller than before the bulking period. Go hard. Go slow. Be smart. Make everything persistently progressive. Gain a modest amount of body fat on purpose for a time. Get to a very low body fat percentage for a time. Get sleep. Repeat. One day in the early 2000s, at Naperville school district, students heaved and panted, crossing the finish line of their fastest mile runs in PE class. The gym teacher looked on with worry as the slowest girl in class rounded her next-to-last lap, dead last, with still the final length to go. To their credit, the other classmates cheered her on as she pushed the last leg of a clearly toilsome journey. The gym teacher’s moment of pride turned to a sinking heart as he watched the girl visibly slow down right at the final stretch where he’d hoped she would push herself.
All students wore heart rate monitors. The teacher reviewed the data. The slowest girl actually logged the highest average heart rate in the whole class. And that last stretch where he thought she’d given up? Her rate kept going highER. She had actually pushed harder than any other student. She had actually pushed hardER at the end. True story. Read “Spark” some time. This real-life study illustrates that a lot of “out-of-shape” people work harder and more intensely than a lot of “in-shape” people. But we let out external comparisons mislead us. All of us. The reality is that as important as intensity can be, consistency is king. None of the most ridiculously in-shape people I know work out maximally hard every set, every workout, every day. Their defining characteristic is simply that they don’t quit. Most of the people I’ve known who struggled immensely with fitness over the years have logged many punitive and outrageously hard workouts. But they aren’t consistent. In your fitness journey, be careful comparing outward performance to others or seeking painful intensity as a virtue. Merely, Just don’t quit. Toward the end of 2015 I noticed a marketing push by Jesse Itzler for his book “Living with A Seal”. I posted about it, which Jesse saw. He then contacted me directly and sent me a signed copy of his book a few months later. I was in disbelief as the return address was his actual home with his wife, Sara Blakely. At the time I liked the mental toughness of the unidentified “Seal” character in Jesse’s book; but even then I warned about how simply pushing hard can be bad methodology. Sure, for people stuck in the excuse-making mode, there is a lot to be learned there. Nevertheless, pushing insanely hard isn’t actually a method or a strategy for 99% of people, and it certainly doesn’t achieve fulfillment or balance. We have to be very careful about survivor bias. I didn’t wear a bike helmet or a seat belt as a kid. That I’m just fine doesn’t mean those are good tactics. I survived to tell the story. I too used to start my day between 2 and 4am, 7 days per week, and hammered out days which are unbelievable to people, FOR YEARS. That doesn’t mean it was a good idea for others. That doesn’t mean I was able to have balance with my family or maximize my time with loved ones who are no longer among us. It doesn’t mean I improved my long-term health prospects. It just means I survived. A year or two later, the mythical “Seal” whom Jesse had built up in his marketing push, book, and interviews came out of the shadows to reveal his true identity: David Goggins. Already known in some ultra-endurance circles, Goggins stepped out into the public eye, and meteorically he skyrocketed to fame and stardom. Again, there is a lot to be gleaned from Goggins’ messages about inaction, combatting it and combatting the desire to weakly shut down and give in to our lesser selves. The fact of the matter is that the Goggins mindset, though rare, is not singular. Lots of people push themselves and too hard, but they don’t survive to tell us how cruelty to their bodies was the right tactic. Through actual debilitating injury, sickness, or fractured relationships, they decide to reevaluate the idea. Goggins survived really dumb solipsistic training, outrageously imbalanced priorities, incredibly self-centered schedules. That doesn’t make it a good idea for others. It doesn’t make it a good idea for him. To his credit, he does say that what he does isn’t for everyone. To his credit, his primary message is that people have so much untapped potential they’ll never even know. But there IS a problem. First of all, we have still not helped the majority of people find a way to get involved in fitness which progresses them and stays with them over the long-term. So more “go hard until you puke, and then keep going” messaging isn’t really winning any converts or having a net positive impact on the world. The health and fitness statistics for the average populace keep worsening, sadly. We need more realistic and reasonable messages, not more from extremists. In fact, I have increasingly come to worry that watching other people do really hard physical feats may be worsening outcomes for all. Voyeurs and virtue signalers don’t do the hard work, by definition. We discovered some years ago that wearing a fitness tracker worsens outcomes: https://jamanetwork.com/journals/jama/article-abstract/2553448. That’s right. Wearing a FitBit or other tracker can make you fat, or at least REDUCE the amount of loss you would’ve had. One of the reasons is that wearing the device flips a virtue switch in the brain convincing the wearer that he or she has “done something” merely by wearing the device. Likewise, as fitness influencers have exploded into existence, the general populace has gotten more unhealthy at a FASTER rate than before. It’s likely that people watch someone like Goggins and think they “did something” by virtue of merely watching him or feeling his message resonate, without actually DOING anything. Second, there are just as many dangers on the other side of inaction, just as many or more dysfunctions that crop up in relationships, just as many or more dangers of being a monochromatic caricature of a successful person. People get lost in obsessions, even ones which started with good intentions and transformative drive. Now, don’t get me wrong. Yes, mostly people need to get off their butts and move, get off their phones and live, confront fears, not cower in the face of challenge, get up and DO. When things get tough, yes, harden up. Good. HOW do we get people to improve? Call me crazy; but I don’t think injuring themselves and burning up 6 hours per day on inefficient training methods is going to do it. We know that wearing trackers doesn’t do it. I don’t think that watching OTHER people do hard work gets it done either. Sustainable progress will keep coming back to moderate alterations. Developing consistency isn’t about shock, excitement, feelings of motivation, or punishing hours which most people just aren’t ever going to do. It’s about one positive step right now. And another after that. And in six months, five years, ten years, if people haven’t figured out how to reasonably balance their progress with the rest of their lives, they aren’t still stepping. In a given bout, in a given moment, the 40% rule or the Goggins tough love is apropos. But then the bills come, the work deadline drops, the end of quarter occurs, the family member dies, and life happens… and the regular people literally do not have the immense luxury of sitting back on their fame, fortune, book deal, cult of personality, and multi-million follower base of supporters. When you need to break the addiction to excuses, any guru will do. Goggins has no monopoly on it. Any tough love message will suffice. But you also have to acknowledge that you aren’t doing anything by simply listening to another tough love message, another pep rally moment, another podcast, another article, another reel. You have to actually go do the work. Moreover, when you are ready to stay consistent and balance your desired progress with the rest of your life, then scrap the gurus, keep a minimal weekly practice in place, recover, DO NOT push too hard, DO NOT embrace “no pain, no gain” mindsets. Just do. And just be consistent. There’s no way to do that if you truly drive yourself into the ground, into exhaustion, into dysfunctional solitude, into injury, into brokenness. People focus on reps. People focus on types of exercises. People will even talk a lot about form and technique. But the quality of the movement extends beyond all of these.
People will report reps to me as if anyone should care. What was the QUALITY of each rep? What was the range of motion? What was the time under tension? What was the degree to which you could connect with the intended muscles? Reps are A way to describe a performance. It is our jargon for moving a resistance down and up or up and down, from a start position through resistance to a certain distance and back to that start position. But someone can make an exercise easier and less effective BY PERFORMING MORE REPS, even with the exact same exercise with the exact same resistance, IF the range of motion is less, the activation of intended muscles is less, and the tempo is faster. Imagine someone squats with 100lbs on his back. He takes 5 seconds to descend into a full rock bottom squat (approximately 135 degrees knee flexion). He pauses for 3 seconds. He ascends over the course of 4 seconds. ONE REP. Full range. He can feel the hips and glute muscles working intently and intentionally. Quality. 12 seconds time under tension for a single rep. In a few months, imagine, he reports back 200lb back squats for 10 reps. Sounds good, right? But then we discover he doesn’t achieve more than 45 degrees knee flexion, and tempo is now .5/0/.5. Garbage quality. The entire set of 10 reps takes less time than the single rep used to. Time under tension is AT LEAST 2 seconds less than it was; and he never interfaces with the myofibril landscape to stimulate progress. He doesn’t feel his glutes working. He isn’t intentional with hips. He’s regressed, become weaker, and I can guarantee he can’t even manage 100lbs in the full squat anymore. This happens. I have observed it many times. People will speed up and shorten range and REDUCE engagement in order to create the impression that more was done. But it’s actually far less. People will attend group classes where a set of an exercise could be multiple minutes. They pause longer in low effort positions (knees locked or elbows locked). They shorten the amount of joint angle used. They REDUCE the overall work performed, all the while claiming they’ve done more. The human animal is an energy conservation machine. So it will literally do anything in order to exert less effort. This includes completing more reps or doing more of anything in order to APPEAR to be doing more, when, in fact, the effort and work performed is less. It is to satisfy the mind’s desired belief to be improving. I’ve seen the phenomenon with people in running or endurance programming. I’ve seen it with people in their own strength programs. I’ve fallen prey to it in my own lifts. In order to combat it, we need to periodically complete super slow reps. Especially power athletes, especially explosive athletes, especially people like me who are wired for more of the max strength tempos, we must from time to time train outrageously lengthy reps. For some clients, I’ve insisted they complete a 10 count on the descent and another on the ascent. Usually, we’ll pick a weight that’s 25-50% of what they’ve been doing. But it almost doesn’t matter at the beginning, because they soon discover there are all sorts of muscles and fibers and tissues and feedback they’ve perhaps never had before. We begin to strengthen sections of the movement they’ve always used momentum to avoid or shortened range of motion to avoid. And people will realize that they are being much more effective and working HARDER than ever before simply by implementing intentionality, slowing down, getting in touch with quality. You can integrate this into an existing program within the midst of a single set here and there. Or you can completely overhaul your full program by making every set like this. Simply grab a weigh or hop on a machine or set up for a body weight exercise; take the extra time and care to think about and feel which muscles or area of the body must be involved; and begin the movement, counting, “10, 9, 8, 7, 6, 5, 4, 3, 2, 1,” taking note the intended muscles are still intentional and the movement is quality, then begin to return to start position, “10, 9, 8, 7, 6, 5, 4, 3, 2, 1.” Don’t even both counting reps. This is more than enough mental bandwidth. It could be 2. It could be 5. But just keep the intention and the quality. The cholesterol hypothesis (or "lipid hypothesis") never rose past the threshold of "theory," as it never made useful predictions, nor did it ever get vindicated in reproducibility (the standard of science). Yet a lot of people treat it like a scientific law. In 2010 the Journal of The American Medical Association exposed how the benefit of statins is questionable and that major trials on the subject were influenced by money tied to statin manufacturers: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/416101. Numerous randomized controls trials prior to 2004 suffered scandals and conflicts of interest which led to regulations in hopes of more reliable studies thereafter. However, of the 29 major randomized control trials on the topic since, 27 DID NOT affirm the expectations of the lipid hypothesis: https://amjmed.org/a-reappraisal-of-the-lipid-hypothesis/. When the mainstream authorities place more rigid protections on the reliability of studies and you reach a fail rate of 27 out of 29, what we're talking about is no longer science. It is anti-science. It is pseudoscience. But it is not science.
Now, the problem isn't simply that observational studies consistently fail at substantiating the notion that cholesterol is the boogeyman. The problem is that the hypothesis was always untenable. Cholesterol is what makes all of human biology possible. It heals you. It is the building material for every cell membrane in the body. IF WE REMOVED EVERY SCRAP OF FREE CHOLESTEROL FROM THE BLOOD YOU WOULD NOT MEANINGFULLY CHANGE THE AMOUNT OF CHOLESTEROL IN THE BODY. There are 100 trillion cells in the body, each one wrapped in cholesterol. When you begin to run the math on a 180lb person, 12lbs of whom is blood, you begin to get a sinking sensation that we’ve wasted a lot of ink on the wrong tissue. That 12lbs of blood is about 54 deciliters. If that person has a cholesterol of 200 (as in 200 milligrams per deciliter), we are talking 11 grams of cholesterol in the entire bloodstream. Meanwhile, the other 168lbs of that person is 76,363 grams. Since the cytoplasm makes up almost 70% of a cell, we’ll leave only 30% for the membrane (40% of which is cholesterol). That’s 9,000 grams of cholesterol outside of the blood. Literally, you could zero out your blood levels of cholesterol or triple them and it wouldn’t change the content in the body by even one-half of one percent. After all, we know that people in prolonged fasts have temporary rises in blood serum measurements of cholesterol. Where did all the extra cholesterol come from if they aren’t eating? Ancel Keys, the University of Minnesota researcher responsible for this 1940s lipid hypothesis belief system, had his heart in the right place and was even a relatively intelligent guy. But he NEVER showed how cholesterol INDEPENDENT OF INFLAMMATORY STRESS (or, more specifically in his work it was HIGH BLOOD PRESSURE AND SMOKING) would constitute a risk. No one else has either. Of course, they could not. Heart disease is the accumulation of plaques, by definition. And these plaques are caused by inflammation. In fact, researchers have shown that inflammation begins to generate heart disease "even in the absence of traditional risk factors": https://pubmed.ncbi.nlm.nih.gov/22895665/. It is paramount that you as the reader understand the prior quote. While the body has unhealthy persistent inflammation, LDL (the "bad" cholesterol) can be low or in "healthy" ranges, and heart disease will still occur. That means that LDL cannot be solely or predominantly responsible in the development of atherosclerosis. Moreover, there are undeniable facts and known biological science which makes the lipid hypothesis impossible: - There isn’t actually evidence that eating dietary cholesterol has any adverse risk response in the body: https://www.mdpi.com/2072-6643/10/6/780... - Most heart attacks occur in people with normal or low cholesterol: https://www.uclahealth.org/.../most-heart-attack-patients... - When people fast for a week (NO FOOD), their bodies actually produces MORE cholesterol for a period of time: https://pubmed.ncbi.nlm.nih.gov/7569738/ - Lowering “bad cholesterol” to improve health is not supported by data: https://www.bmj.com/.../doubt-cast-on-wisdom-of.../ - And eating low fat, avoiding saturated fat, and emphasizing seed oils actually appears to increase risk of death (even when cholesterol drops) or AT BEST has zero positive impact on risk: https://www.minnpost.com/.../new-look-old-u-m-study.../ Physicians and clinicians I've coached and mentored since 2004 are mostly not up-to-date on their own publications altogether, particularly on this front. Anything involving nutrition science is just a minefield for them. However, I have noticed that it is changing little-by-little in recent years. Younger MDs and simply well-read intellectuals in medicine are gradually evolving to accept the preponderance of evidence. Old paradigms die hard, especially when they've been so gleefully (and thoughtlessly) embraced by the broader society. But they do die. Or so I hoped. The failure of the lipid hypothesis has been so spectacular in the past three decades that ideologues at the American College of Cardiology walked it back from "cholesterol is bad" to "LDL is bad" to "LDL-C" is bad. To be fair, that statement is less wrong than the prior ones, though none are scientific in nature. But in a British Medical Journal review of 68,094 people, we see that people with high LDL-C live as long or longer than those with low LDL-C: https://bmjopen.bmj.com/content/6/6/e010401. No matter how much anyone wants to believe the old lipid hypothesis, honesty at least compels an evaluation along the lines of "results vary." The ACC and its fellows have been involved in enough scandals with conflict of interest that we might disregard anything they say that ends in the purchase of drugs anyway. There do exist some studies showing that if we intervene to lower LDL-C in some people there may be reduced incidence of cardiac event. However, even in those studies, all we may be seeing is that getting healthier reduces risk, and if the same person gets healthier, that person will produce less LDL-C than was previously in that same person. We are not seeing that LDL-C is causal. We are also left with the very real possibility that statins (which are fundamentally antimicrobial drugs) help some people clear infections which were causing inflammation. Do some people have elevated LDL-C for no particular reason of detriment while others because of infection? If so, brief use of a statin in some people would be indicated. For what reason, other than profiteering, should anyone take an antimicrobial drug in perpetuity? Most concerning is that there are some new people pushing backward toward the lipid hypothesis. There is this trend where fitness personalities and influencers scan the summary or abstracts in PubMed and purport to be science literate. And it's at least as dangerous as when the scandalous studies with conflicts of interest were shaping our opinions, because these new individuals by themselves are commanding the amount of attention that large organizations used to. What I've noticed is that these guys and gals tend to not even read the full papers which often contain whole paragraphs that refute the influencer's position. And again, like we saw with Ancel Keys, I don't believe they're idiots or evil. Some are very smart, know a lot, and indeed appear to want to help improve health outcomes. However, they're all merely insufficient in their cognitive horsepower with regard to sussing through causality. And to be provocative and gain social media engagement they are agreeing with Ancel Keys’ failed hypothesis. One of the more popular fitness influencers even argues AGAINST discussion of mechanism. I want people to really think about this. There is a guy who is commanding the thoughts of at least a million people every day; and he won't allow discussion of HOW the process of heart disease occurs. He merely cherry picks epidemiology and observational outcomes to substantiate his ideology. And that might be just fine if people thought of him like a raving lunatic. But he is actually considered one of the more "science-minded" people in that sphere. He refers to himself as a "science ninja." A guy who won't entertain scientific mechanism, known causation, and counter-evidence, is THE SCIENCE NINJA. Laugh all you like. I did too. But when you have multiple people like this pontificating with religious zeal and altogether across platforms they are maybe shifting the thinking of hundreds of millions of people, we have a serious problem. For almost 100 years the public has been devotedly following lipid hypothesis thinking. Heart disease prevalence increased. Statin use exploded onto the scene. Heart disease prevalence and cardiac-related death increased. Even if the old paradigm had been true, clearly its interventions and communication is the opposite of effective. That is undeniable. Hell, forget the studies for a moment, and simply look around. Just when the real scientists were beginning to win the war and move authoritative opinion in the other direction, we've now got people making whole careers by trying to convince the public to believe completely refuted hypotheses and ineffective/counterproductive interventions. Beware. There are educated health professionals who still fear cholesterol. As a grown adult, I gained 130lbs, lost 70, netting a 60lb increase of muscle while decreasing bodyfat percent. I went to college at 160lbs. I did one of my last real bulks to 285 in Sept 2020, and I’m 240 now in March 2023.
People say, “if there’s no video, it didn’t happen.” But it’s really more like, “if you don’t KEEP reposting about it ad nauseam, and it doesn’t go viral, we all forget completely.” And I’ve come to see that forgetfulness as a convenient amnesia to ignore what’s possible. I have changed so drastically so many times over the years that I’ve met people who can’t believe I was ever small, others who can’t believe I was ever huge, others who can’t believe I showed up untrained for a marathon, others who can’t believe I did a zero-momentum muscle up at nearly 250lbs, and so many others who are likewise in mutually exclusive disbeliefs… WHILE OBSERVING THE VERY THING THEY SAY THEY CAN’T BELIEVE. This has taught me: 1.) people will believe the most convenient disempowering do-nothing narrative no matter what proof 2.) “that’ll never be me” has got to be the most popular lie on planet earth, except that people make it true through inaction There are people reading this right now who haven’t got one person who believes in them. But I believe in them. And once they believe in themselves, that’ll make two. If as a society we can begin to embrace possibility, we might make a strand of three or more. And three cords won’t so easily be broken. CBS news just ran a segment on how people struggle emotionally with retirement:
https://www.cbsnews.com/amp/news/preparing-emotionally-for-retirement/ In two decades of coaching I have walked dozens of clients through the transition from working, to retiring, to retired. And I’ve noticed their emotional struggle. It comes up so often that I now address it as part of my coaching. And I try to help many prepare for it, because they’re often still thinking about retirement as some fairytale moment. But it’s not. It’s harder. A lot harder. Finding meaning and purpose and joy can be really elusive for people who were thinking of retirement as a magical moment to “begin living.” And we also have to contemplate how physical capability plays a major role in how well the shift does or doesn’t go. Think of it this way: Slave until you’re nearly dead; and then, one day, get up every day to go through an unformatted/undirected day where you may have LESS meaning in your life. Add to that, you grind through the day with a battered body which is incapable of doing things it used to. That’s the 1950s to 1990s Western career/retirement model. Since large companies ceased to have retirement plans, pensions, or continued existence, my generation and younger have had to rethink the model anyway. Which is a very good thing. There are almost no stable companies which will keep you employed across a thirty year span without eliminating a division or your title. For most, promotion and reliable employment is a historical artifact. Frankly, even among the trust fund babies and ultra-successful young people I’ve coached, effectively “retired” young, I find they still have to discover a driving reason to make their weeks matter. The trips and the houses and the cars and the parties grow stale. Simply having free time doesn’t mean you fill it with meaningful moments. The time passes anyway. And often they feel a greater sense of disappointment than working people who at least know they provided for their families that week, tried (successful or not) to give input to their organization that month, and impacted somebody somewhere through sacrifice of their own. LESS growth as MORE time passes doesn’t feed the soul. Three years. That’s what I’ve found it usually takes. Retired people take about three years to get their footing, get a routine, and thrive or not. Intrinsically motivated people do it a little faster. Extrinsically motivated people flounder. Without the imposed structure of work weeks, some people really heartily struggle to create a framework in the week. And as week after week passes, they start to realize they’re merely counting minutes to expiry. It’s not inspiring or motivating. They still don’t write the book they always said they’d write. They still don’t climb the mountain they always said they’d love to climb. They still don’t read all the books they said they didn’t previously have time for. Time passes. Among the lucky ones, by the third round of holidays and birthdays, they at least nail down a balance. As the CBS article points out, surveys indicate depression hits around a third of retirees. But I’d argue the number is far higher. People are conditioned to say they enjoy retirement, even when they don’t. Ask the most negative complaining retired people, “how’s retirement?”, and within a fraction of a second they’ll retort, “it’s great; it’s wonderful; I love it.” Ask specifically how they’re finding more meaning and more joy, and the facial expression changes. The tone changes too. If they’re candid, the answers change and get murky. Culturally, we want to think of it as a grand time, even when it isn’t. The candor of people admitting the downside is rare. We shouldn’t take that to mean the downside of retirement is rare. When someone has social connections, weekly appointments, and some structure in retirement, he or she has better emotional footing. Yet, the fact remains that most people are pale physical shadows of what they could be and once were. And that means that even with all the extra free hours, the life lived is less. Unless… They also invest in their physical capability. The CBS segment was right to focus on how financial preparation is insufficient without emotional preparation. But what about physical preparation? Some of my retired clients have been very clear that they want to achieve physical accomplishments they never previously could do. And we get there. Some say they want to be able to keep crouching down so they can play with the grandkids. And we get there. Some soon-to-be retired clients say they want to be able to hit all the hard hiking trails STILL after retirement. And we get there. Some want to decrease risk of cognitive decline. And we get there. Some just want to reduce risk of osteoporosis or other physical decline. And we get there. When we train, we can be physically prepared for retirement as well. We can be fittER. Moreover, with physical training, we can retain structure and growth in our weekly schedule. That itself carries a a heft of emotional preparedness. And we shouldn’t easily forget it, because retirement CAN be a good thing. It just isn’t inherently. As such, it might also be wise to remember to live now. Don't wait. Don't wait to live. Don't wait to start improving. Don't wait to invest in your physical self. Don't wait to emotionally prepare. Don't simply wait for a time to arrive and find all you do at that moment is merely wait for the end. Under the age of 50, the chance of a man getting prostate cancer is about 1 in 500: https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/prostate-cancer-survival-rates/.
As his testosterone declines, markedly around this age, the chance skyrockets to 1 in 54. The next decade, as testosterone declines further, risk jumps to 1 in 19. Again, at the next decade, it nearly doubles to 1 in 11. And now, epidemiologists and statisticians agree that into old age the risk approaches 100%. That is, if you live long enough, as testosterone declines toward zero, risk rises to assurance. As a man, if you die of old age, you will die with prostate cancer. Not OF. But WITH. 100%. Perhaps even more interesting is that prostate cancer incidence is highest in Europe, then North America, then Australia: https://www.frontiersin.org/articles/10.3389/fpubh.2022.811044/full And of absolutely no surprise, the three regions where we’ve seen the most dramatic drop in testosterone levels over the past decades are these same places where prostate cancer incidence is highest. In fact, the RATE (1% per year: https://www.reuters.com/article/health-testosterone-levels-dc/mens-testosterone-levels-declined-in-last-20-years-idUKKIM16976320061031 ) of drop in population testosterone looks an awful lot like the RATE (3% per year: https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html) of increase in prostate cancer incidence. To be clear, the prevalence of prostate cancer is highest among males with low and/or declining testosterone. The phenomenon essentially didn’t exist in young men, until a society-wide trend developed starting around 1990, wherein a 2% per year increase in prostate cancer risk among 15-40 year olds came to be: https://pubmed.ncbi.nlm.nih.gov/31553489/ . With no need for conspiracy thinking, this dovetails extremely tightly with the decline in testosterone among the same populace during the same timeframe. Moreover, recent studies on men who are taking synthetic testosterone replacement therapy find they they have a lower risk of aggressive prostate cancer: https://ascopubs.org/doi/full/10.1200/JCO.2016.69.5304 Looking at 150,000 men on testosterone replacement therapy determined that risk of prostate cancer did not rise even with higher dosing: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199194 A study on 17,049 men indicated that the higher the testosterone and androgens, the LOWER the risk of all aggressive cancers, not just prostate cancer: https://aacrjournals.org/cebp/article/15/1/86/258197/Circulating-Steroid-Hormones-and-the-Risk-of Testosterone protects AGAINST prostate cancer, and a whole lot more. |
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