Evidence-Based Practice in Exercise & Nutrition: Common Misconceptions and Criticisms

Published in Evidence-Based Practice in Exercise & Nutrition | Exercise Biology March 03 2017

Introduction: Evidence based practice or EBM is an area that I have always been passionate about.In fact, speaking to the late David Sackett (the father of EBM) about EBM on a few occasions is something that I will always cherish. Without an EBP approach, scientific research in health and fitness is pretty much useless. Even if you are not a doctor or a fitness professional, if you are remotely interested in your health or fitness or nutrition, you should have a basic understanding of EBP. In the article below, I am collaborating with my friend and colleague Brad Schoenfeld, Ph.D. to answer some of the common concerns and questions about EBP. Brad has a strong practical and research background, which is not commonly seen in the fitness field. 

We (Anoop Balachandran, Ph.D. & Brad Schoenfeld, Ph.D.) are glad that more and more people are demanding and applying evidence in the exercise and nutrition field. That been said, there remains a lot of misunderstanding and misconceptions about an evidence-based Practice (EBP). In this article, we will address some of the common misconceptions and criticisms of EBP. Here we go:
 
1. Why do we need EBP? Why can’t we just use anecdotal evidence or expert opinion?
In fact, we’ve used anecdote or expert opinion as ‘evidence’ to treat people throughout the history of medicine. But this approach clearly didn’t work well as shown by hundreds of examples of medical mistakes we made in the past. For example, smoking was ‘good’ for heath until studies showed otherwise; bloodletting was the standard medical treatment for almost 2000 years by the foremost doctors of the West, and so forth. In short, EBP evolved because anecdotal evidence or expert opinion were not producing ‘results’.

You can read more about it here:Why We Need an Evidence-Based Approach in the Fitness Field

2. So what is EBP/EBM?

The definition of EBM (Evidence Based Medicine) by David Sackett reads: “EBM is a systematic approach to clinical problem-solving that allows integration of the best available research evidence with clinical expertise and patient values”. This principle can be applied across many scientific disciplines, including exercise and nutrition, to optimize results.

2. What is evidence?

Many people wrongly assume that the term “best available evidence” in EBM/EBP is limited to research-based evidence. In fact, evidence can be obtained from a well conducted randomized controlled trial, an unsystematic clinical observation, or even expert opinion. For example, the evidence could come from a controlled trial, your favorite fitness guru, or a physiological mechanism. However, the critical point is that the importance or trust we place on the evidence differs based on the type of evidence. We will talk more about this as we talk about the evidence hierarchy.

3. What about values and preferences?

Every patient or client assigns his/her own values, preferences, and expectations on outcomes and decisions.

For example, some might place a high value on muscle growth, whereas others would value their general health as most important. Some would value building their upper body muscles more than their lower body muscles. Others may value the social aspect of working out at a gym more than the muscle and strength gains.

And rightly so, these personal decisions have no wrong or right and should be listened to and respected. The job of a fitness professional is to help clients achieve whatever goals they desire; we cannot impose our own values no matter how contrasting beliefs and opinions maybe.

4. What about clinical expertise? And what is the ‘art’ of EBP that people always talk about?

Clinical expertise is what many refer to as the art of EBP. So, does the art of EBP mean applying what has worked for your clients? Clearly not.

Clinical expertise involves basic scientific knowledge, practical expertise, and intuition to:

  • diagnose the problem (for example, why can’t this person squat deep, how to correct exercise technique, why he/she is not gaining strength or losing weight.),
  • search for the relevant research evidence (how many sets to gain muscle for an advanced trainee, or which exercise targets specific muscles) and critically analyze the research evidence for methodological issues (was the study in beginners, was the outcome measured relevant)
  • understand both the benefits, the risks involved, and other alternative approaches to the goal (a Crossfit type workout might be motivating and improve general cardiovascular endurance, but has a high risk of injuries)
  • alter the program based on the client feedback and results (reducing the number of sets or modifying the exercise (angles, ROM and do forth) for an older person or someone with pre-existing shoulder injuries• .)
  • Listen and understand clients value and preferences, clearly communicate the risk, cost, benefits in a simple manner, and use a shared decision approach to come to a decision


And this is called the art of evidence-based approach. As you can see, it forms an integral part of EBP and no amount of research can replace it. Likewise, no amount of clinical expertise can replace research evidence.

5. What is the evidence hierarchy? And why are RCT’s (Randomized Clinical Trial) at the top of the pyramid?

An evidence hierarchy is one of the foundational concepts of EBP. And there are three important points to keep in mind:
evidence based exercise and nutrition

  • First, as shown, the different types of evidence are arranged in an orderly fashion. As we go up the hierarchy, the trust or the confidence we place in the study results go up too. RCT’s are the most valid research design, as they allow the ability to infer causality. And expert evidence is the least trustworthy and occupies the bottom position. Meta-analyses- a collection or a group of RCT’s-are generally considered the highest form of evidence, as they synthesize the entire body of literature on a given topic and quantify the results based on a statistical measure of practical meaningfulness. Meta-analyses can be particularly important in exercise- and nutrition-related topics, as the sample sizes are often small and thus pooling the data across studies provides greater statistical power for inference.
  • Second, it is important to note that depending on the quality of the study, an RCT can be downgraded, too. A poorly designed study will never provide a high level of evidence, and in fact can impair the ability to draw proper evidence-based conclusions. The hierarchy therefore is not set in stone.
  • Third,  there is always evidence. So the best available evidence is what is available and need not come from an RCT (Randomized Controlled Trial). But based on the type of evidence, our confidence in the results and our recommendations will differ accordingly.

 
6. What if there are no RCT’s? How do I evaluate a program or diet?

First, as mentioned before, there is always evidence. If there are no RCT’s, you simply move down the evidence hierarchy. But as you go lower in the hierarchy, uncertainty about the validity of the evidence goes up as well. Second, you also must compare the benefits, risks, cost, scientific plausibility, and other alternative programs before making recommendations. Below are a few examples where the absence of an RCT does not preclude recommendations.

  • Example 1: If a client comes with a new program that uses 5 lb weights to increase strength, we know from basic science that without load progression, muscle and strength gains will be nil. Such a program would go against the most fundamental theory of muscle growth. So you can make a strong recommendation against the program, even without an RCT.
  • Example 2: Recently, the Ebola virus vaccine was used before conducting an RCT. How is that possible? Here is a classic example of weighing the benefits, risks, alternative approaches, and making a strong recommendation with weak evidence. In this case the risk is death, the benefit is obvious, and there are no alternative approaches. Thus, the risk/reward strongly favored giving the vaccine. And 99% of the informed patients would agree with the recommendation.
  • Example 4: An observational study shows that eating meat raises cancer. Considering observational studies are lower in the hierarchy no matter how well the study is conducted, recommendations cannot be more than just suggestions.


What if there are no studies and my client wants to try a new program?

As previously noted, if a person understands the uncertainty due to the lack of studies or weak evidence, availability of alternative programs that fit his/her goal, the cost, and risks, he/she can make an informed personal choice. Keep in mind that majority of the questions in exercise and nutrition are of weak evidence. In fact, it is the same for the medical field too. But what is important is to clearly know and convey what your recommendations are based on.

7. There are a lot of factors like genetics, diet, motivation that can influence your results. A study hence…

Many people are unaware that in a randomized controlled trial, the randomization serves a crucial purpose: The randomization ensures that both the known variables and unknown variables that can affect muscle growth or strength are equally distributed into both groups. That is, if there are unknown genetical factors that can drive muscle growth, it is highly likely these genetically gifted individuals will be distributed evenly. This is the reason why RCT are considered to be the gold standard to study cause and effect. Hence, the results of the study can be pinned to the intervention or treatment

8. There are numerous problems with scientific study. So you cannot use the results of a study to train your clients?

Yes. But one of the basic steps in EBP is to critically analyze the study: If the study has methodological issues or has a different population than your client, you downgrade the evidence accordingly and lower your strength of recommendations.

9. Most of the studies in bodybuilding/strength training are on untrained individuals. 

Yes. And rightly so, caution should be used when extrapolating recommandations to trained individuals. Exercise science is a relatively new field and studies in trained individuals are small in number, but accumulating. Generalizability (i.e. the ability to apply findings from a study to a given population) must always be taken into account when using research to guide decision-making.

10. I don’t care about “why” it works or the science behind. All I care about are results.

As previously mentioned, EBP evolved to get better results. It didn’t evolve to explain how or why a treatment works. There are 1000’s of life saving treatments and drugs where the underlying mechanism(s) are just unknown.

11. Studies are looking at an average of the sample. There is a lot of individual differences. 

Yes. In fact, n=1 studies occupy the top of the evidence hierarchy because it applies to the specific individual in question. But these are hard and almost impossible for certain outcomes like muscle growth or disease prevention. There are two concerns with so-called trial and error method that is often talked about.

  • First, even if you gain benefits with a certain program, in many cases, it is extremely hard to figure out what was the variable that made the difference. Was it the specific exercise, the change in diet, the placebo effects, genetics, or some unknown variable?
  • Second, it may not be clear if you are indeed making an improvement depending on the outcome. For example, gains in muscle come very slowly for trained individuals (like years for a several pounds). Hence, you will have to run a program for a few years to see if it works or not. However, controlled research often uses measures that are highly sensitive to subtle changes in muscle mass, and thus can detect improvements in a matter of weeks.


12. The program worked for me!

What was the outcome measure? Strength, muscle growth, weight loss? What are you comparing against? Against your previous results?  What was the magnitude of the benefit? Without knowing answers to these questions, the meaning of the word ‘worked’ is unclear.

Further, if it indeed worked, we still don’t know what made it work, or if it will work for someone else. So your personal anecdotes are often fraught with problems and unfortunately mean very little. And importantly, just because something “worked” doesn’t mean that another approach might not work better.

13. This X supplement was shown to increase muscle growth in an animal study. Should I use it?

Research in animal models is almost at the bottom of the evidence hierarchy. It is very weak and hence the uncertainty is high, and deserves no greater than a weak recommendation. Although animal models can serve an important purpose in preliminary research, evidence based practice should rely primarily on human studies when developing applied guidelines.

I saw a supplement study which showed a statistically significant weight loss. Can I use that supplement for my client?

No, you also have to look at how much weight the subjects lost. The term “significance” is a function of the probability of results occurring by random chance; it is not necessarily related to the magnitude of the effect. Provided a large enough sample size, results of a study can be statistically significant even with just a 1 lb weight loss over a 1 year period. This is known as ‘clinical significance’.

Would you take a supplement to lose 1 lb in a year? Depending on the cost, the burden of taking a pill every day, and how much you value weight loss, you may or may not.

14. EBP does not consider a science-based approach.

EBP does consider a science-based approach. A science-based approach provides strong evidence when the program or treatment violates fundamental principles or universal laws. For example, homeopathy.

However, EBP does not support evidence just based on biological plausibility or mechanistic evidence. For example, if a new diet tells you to eat as much as you want to lose weight, it goes against fundamental laws of thermodynamics. You do not need an RCT to make strong recommendations against this diet

15. “This house believes that in the absence of research evidence, an intervention should not be used” This was the motion of a debate which took place at the end of the recent PhysioUK2015 Conference in Liverpool.

As you know by now, EBP does not rely on RCT’s. To quote the famous saying in EBP: “There is always evidence”. It is an unfortunate misrepresentation of EBP/EBM to assume that without RCT’s, a treatment cannot be recommended. For example, smoking has perhaps the greatest detrimental effect on health of any social habit, and health-based organizations universally recommended against its use. But we do not even have even a single RCT on smoking!

Effects of smoking are from observational studies. But since the magnitude of harm is very high, it upgraded in the evidence pyramid. Once again, this shows why the hierarchy is not set in stone.

16.‘Parachute use to prevent death and major trauma related to gravitational challenge’. This is the title of the paper published in BMJ. The paper satirically argues that parachute use has not been subjected to rigorous evaluation by using RCTs’ and therefore has not been shown to save lives. Critics of EBP have used this as a criticism of EBP and the reliance of RCT’s.

EBP has always maintained that RCT’s are not required when the magnitude of benefits is very high.

For example, insulin injection for diabetes, Heimlich maneuver, and anesthesia are all examples of treatments where the magnitude of benefit is very high, and hence RCT’s are not required nor asked for. 

17. I do not have enough knowledge to critically analyze studies.

There are a few resources in the field of exercise and nutrition that critically appraises the evidence for you. They are www.alanaragon.comwww.strengthandconditioningresearch.com and www.weightology.net

In closing, we hope the article has helped you better appreciate and understand this simple framework called evidence based practice or evidence based medicine. EBP is currently the best approach we have to make decisions related to health, fitness or strength and conditioning.

A good EBP practitioner should have a strong understanding of both the practical and the scientific aspects of exercise and nutrition; and more importantly, an untiring commitment and empathy to your clients and their values and preferences.

The Reason You’re Not Losing Weight

BMI BMR calculator

Original article by Lyle McDonald, if you don’t follow his work already, you should. https://bodyrecomposition.com/

Although I have other pieces ready, I wanted to follow up my Dumb Shit Fitness Professionals Say #1. And I wanted to do that by showing what being helpful is. To whit, I’ve redone that stupid “Eating like an Asshole” thing to be correct and useful rather than a piece of trash. So now let me show you the real reasons you’re not losing weight.

Here it is, probably the closest to an Infographic I’ll ever make.

Real Reasons You're Not Losing Weight

Click it to make it bigger for saving. There’s a full size version at the end of the article.

Now let me examine the real reasons you’re not losing weight.

Reasons You’re Not Losing Weight: Myths

First let me look at some of the common myths to explain why you’re not losing weight. This can’t even begin to be comprehensive so I’ve just chosen some of the more representative ones.

Insulin

The idea that insulin was the cause of obesity or could prevent weight loss can be traced to Gary Taubes. Who, after 5 years of “dedicated research” drew a stupid conclusion that people still believe to this day. That conclusion being that insulin levels, rather than calorie intake caused obesity. Tim Noakes, who used to be a forward thinking physiologist, is a more recent convert to the cult. Which is simply sad.

The idea here is that high insulin causes obesity and/or just lowering insulin will cause fat loss/prevent obesity. Therefore, goes the logic, just stop eating carbohydrates to lower insulin and obesity is solved. The idea isn’t even new, only the nonsensical rationale.

And it’s wrong. Modulating insulin levels from the low to high range just doesn’t impact on much. There is also the fact that protein raises insulin just fine and we know it doesn’t cause weight gain. And factually fat can store itself without raising insulin at all. The whole idea is crap.

Related: What Is the Glycemic Index?

Meticulous work by Kevin Hall has shown the insulin hypothesis to be garbage. Quite in fact, at least one of his studies was funded by a low carb group called NuSi. It still found a negative result which must have been a real kick in the nuts.

Not that it matters. Taubes has stated that “No evidence will change my mind.” That’s not science. That’s gurudom. Because research apparently only mattered until he had his first book deal. And then nothing would change his mind.

Which isn’t to say that for people with insulin resistance, lowered carbohydrate diets may not be better in many ways. But there’s no magic effect on body weight outside of any impact on food intake.

Eating Carbohydrates

This is just an extension of the previous topic. Since carbohydrates raise insulin, so the logic goes, eating carbohydrates either causes weight gain or prevents weight loss. And it’s untrue. In a calorie controlled situation, high and low-carbohydrate diets cause about the same weight loss.

Some will point out that bodyweight drops rapidly when carbohydrates are removed from the diet. And that it goes up similarly when they are reintroduced. But this is just water going on and off of the body. It doesn’t mean anything.

Related: What Are Carbohydrates?

Eating Sugar

An extension of the previous topic, people who will eat carbohydrates in their diet think of sugar as the devil. There are various arguments here but they usually go back to insulin. Which is funny because the insulin response to sugar is lower than to many “good” carbohydrates. It’s glycemic index is lower than potatoes.

And there is nothing inherently evil about sugar in this regard. Quite in fact, years ago I stated that if someone got sufficient protein, they could eat nothing but table sugar and lose fat. Imagine the response.

Except that people have done this. So we had one guy do The Twinkie Diet and another who did the Ice Cream Diet. And they both worked fine in terms of causing weight loss. Am I saying to do this? No, of course not. It simply makes the point: sugar intake does not explain why you’re not losing weight.

Sugar cannot magically prevent weight loss. Quite in fact, when calories are controlled, replacing some complex carbs with sugar has no impact on weight loss.

Eating Some Specific Food

Just another extension of the above. Sometimes rather than broad categories of foods, people think a specific food is why they’re not losing weight. Usually it’s their own pet trouble food. Or one that they stopped eating at some point and finally lost weight. Aha, they conclude, that food stops weight loss. Except that what happened was that not eating that food made them eat less.

Gluten is a common one here and I’m sure there are a lot of these if you take the time to look. Dairy is one that gets trotted out a lot in various circles. What’s hilarious about this one is that study after study shows that dairy improves fat loss on a diet. Not only is the myth untrue, it’s completely backwards.

Not Clean Eating/Doing a Specific Magic Diet

A further extension of the above is the idea that if you’re not following some specific magic diet, you will be prevented from losing weight. Here, the perfect diet is the one that whomever you’re talking to is on.

Take your pick: clean eating, Paleo, carnivore, IF, IIFYM (not really a diet), etc. Whatever worked for them is the right diet. If you’re not losing weight, you just need to switch to their magic diet. I mean, it worked for them!

The simple fact is that this can’t be true. On any diet you name, some do great, some are ok and some fail. If there were a single correct magic diet we’d know what it is. I mean, we do: it has to have sufficient protein and create a deficit.

Beyond that, the difference in results between diets is minimal. What mostly matters is that people can adhere to it in the long term. And I was saying that over 15 years ago.

Starvation Mode

Ok, starvation mode. This one has been around for decades. The basic idea being that if you do certain things the body will go into this mode and “hoard calories and store fat.” Various ideas tend to follow from this.

One is that if you miss breakfast, your body will go into fat storing mode. This idea came out of animal research and it’s nonsense. For an animal missing a single meal is a huge deal. For humans it’s irrelevant. Also, the Intermittent Fasting data shows it’s untrue.

A similar idea is that if you don’t eat every 3 hours you go into starvation mode. Same thing, came out of animal research. In humans, meal frequency has no measurable impact on energy expenditure.

What’s even funnier about this one is that it’s actually reversed. In humans, fasting completely for 3-4 days actually RAISES metabolic rate.

Metabolic Damage

And then there is the idea of metabolic damage, that you can do permanent damage to your metabolism through extreme dieting. It’s been around for years in one form or another with entire books about “fixing it” out there.

Related: Is Metabolic Damage Real?

At a conceptual level, to explain starvation mode or metabolic damage, you’d have to explain how people living in food ravaged countries are all emaciated. Didn’t their bodies go into starvation mode? No, because it’s not a thing.

Which isn’t to say that there aren’t endless metabolic adaptations to fat loss. Energy expenditure absolutely goes down, appetite goes up and there’s more. But that’s not damage. And it’s not storage mode. And none of the adaptations can cause someone to GAIN FAT if they are in a deficit.

Slow Metabolism

The idea of a slow metabolism causing someone to gain weight or as an explanation for why you’re not losing weight is decades old. It still gets thrown around as an explanation. And, well, it’s not true.

Outside of some rather severe disease states, the idea of a low metabolic rate just isn’t a thing. Invariably when someone online claims such and goes and gets their metabolic rate measured, it’s stock normal.

Related: What Determines How Many Calories I Burn in a Day?

Quite in fact, as people’s bodyweight (well lean body mass) goes up, so does their resting metabolic rate. It’s simple, to a point, bigger people burn more calories.

LBM Metabolic Rate Relationship

Certainly there is variability at any given bodyweight as you can see in the graph. For any given weight there may be relativly higher or lower values. LBM only explains a majority of BMR, not all of it. Even here variations in BMR don’t predict weight gain.

Which isn’t to say that total daily energy expenditure may not be lower in overweight individuals due to lower activity levels. But this is not a “slow metabolism” so much as low activity. Usually the issue is in Non-Exercise Activity Thermogenesis with NEAT being low.

Related: What is Non-Exercise Activity Thermogenesis?

There are a couple of reasons for this. One is that heavier individuals often don’t move around much. No, I’m not playing the “gluttony card”. It’s just physics. But part of it is that there is a biological driver on activity levels, it lives in the dopamine system. And it’s just as likely that a deficit here predisposes individuals to move less, allowing them to gain weight.

But by and large there is no such thing as a slow metabolism.

Low Thyroid

Which brings me to the idea of people having low thyroid hormone levels. This one must date back to the 50’s or 60’s when nobody knew nothin’ about nothin’. I think they sort of assumed that low thyroid caused obesity and they handed out thyroid drugs like candy. Which caused all kinds of fun tachycardia and muscle loss.

Funfact: DNP is safer than thyroid medications.

Which isn’t to say that some people aren’t truly hypothyroidal in a clinical sense. That still can’t stop weight loss although it makes it harder. Energy expenditure is down and water retention is common which can mask weight loss. But people with true hypothyroidism have lots of other symptoms. Factually, in most cases this is not an explanation.

Endless Other Myths

And that is seriously just touching the surface of the topic. People repeat the endless myths and they refuse to die. So of course people are confused.

Especially when lazy ass “Fitness Professionals” tell them to “Do their own research” rather than pointing them to better information. Because they’d rather be judgmental and call them an asshole for not knowing what they can’t know.

Reasons You’re not Losing Weight: Realities

With some of the common myths covered, let’s move to the realities of the topic. Some actual reasons you’re not losing weight. Again, I can’t be comprehensive and will only hit on the big ones.

Underestimating Your Food Intake

In all honesty, this is usually the explanation for why people can’t lose weight. Simply, they are eating more than they think. Research shows that people may underestimate their food intake by 20-50% at least. That is, what they think they are eating is 20-50% less than what they are actually eating.

Literally everybody misreports their food intake. Lean people, overweight people, active people, inactive people are all terrible at estimating their food intake. Even registered dieticians are bad at it.

Among other things, this is why epidemiology is crap. The food reports are garbage. Because everybody sucks at this.

Related: Is Self-Reported Food Intake Accurate?

And in a weight loss context, this means that people who think they are only eating 1200 calories may be eating 1800. And that’s why they can’t lose weight. There are all kinds of TV shows where they find someone who says they have a broken, slow metabolism. Who say they don’t eat very much. And they add up the daily food and it’s like 8,000 calories or more. People are terrible at his.

The modern world has simply broken our concept of portions and calorie amounts. They will do these on the street things and ask people how many calories in a large pizza. People will say 400 when it’s more like 4000.

And, going back to metabolic damage, THIS is why those people reporting gaining fat on low calories were doing nothing of the sort. They were simply underreporting their food intake. And we told Layne this. And he went to the guru well of ad hominems and bullshit to avoid the truth.

Hilariously Layne is now sharing stuff on Instagram about how you’re not losing weight because you’re underreporting your food intake. But when metabolic damage seminars were on the line, science didn’t matter. It only matters now so he can pretend he didn’t sell people lies for 5 years to buy a mansion (and afford moving to Australia). Isn’t that right?

Overestimating Your Calorie Expenditure

Coming right out of the above is the fact that most people overestimate how many calories they are burning through exercise. And that overestimation is in the same realm as the calorie underestimation if not worse.  In one study, lean women and men though they were burning 3-4 times as many calories as they actually were.  Think about this, they thought a 300 calorie exercise bout burned 900-1200 calories.

And a lot of this is due to people being told that this is the case.   You’ve got all these exercise programs telling people “You’ll burn 900 calories per hour.”  Or reading that they’ll burn 1000 calories in a 45 minute exercise class.  And in reality it’s more like 450 for a larger man and 300 for a smaller woman.

Yes, a trained endurance athlete can burn 15 cal/minute but they’re working. That’s 900 calories an hour. Most people are lucky to get 10 cal/minute and many will burn less.  That’s, at best, 600 calories per hour.  And weight training factually burns jack shit for calories. A solid hour of training might be 400-450 for a larger male and 250-350 for a smaller female. Gardening burns more.

And when you combine underestimated calories with overestimated activity levels, it’s a double whammy. You think you’re eating 1200 calories and you’re eating 1800. You think you’re burning 900 calories in exercise and you’re burning 450. And that deficit that should exist is now a surplus.

Your Diet is Too Restrictive and You End up Bingeing

Another common problem is, in general terms, not adhering to the diet. In fact, this can explain many weight loss stalls outright. But it can go further when people are trying to follow super extreme diets and end up losing control and bingeing more often than not.

So, assuming their food intake is what they think it is, they shoot for 800 calories per day.  They actually achieve that before blowing up and eating 2500 calories one day.  At which point they go back to trying to restrict calories as hard as possible, which leads to another binge.  And over the full week they end up being at about a net zero result.

Note: I am well aware of approaches like ADF and ICR and calorie cycling for athletes.  I’ve only been writing about them for 2 decades  That’s not what I’m talking about here and you know it.

And when you ask this person their calorie intake, they don’t want to talk about the binges. So they say they are eating 800 calories (really 1200) and are not losing weight. But you don’t hear about the 2500+ calorie days.  Which then leads you to conclude that they must be metabolically damaged or something.

Note: Yes, I have a Rapid Fat Loss diet based around very low calories. It’s different for specific uses. And research actually shows that rapid initial fat loss is better in the long-term. But it’s usually best for short periods of time.

The Rapid Fat Loss Handbook: A Scientific Approach to Crash Dieting

In any case for many people targeting a higher calorie level is better in the long term.  So they target 1400 calories per day or whatever and actually stick to it rather than bouncing low and high.

Your Rigid Eating Attitudes are Doing More Harm Than Good

This ties into the previous topic and the idea of rigid and flexible dieting (I prefer flexible eating).  Rigid dieting attitudes refer to conceptualizing food as good/bad or thinking in black and white.   In contrast, flexible eaters recognize shades of gray.

And study after study after study shows that flexible eating attitudes are superior to rigid ones overall.  Certainly, some get away with rigid eating approaches, usually athletes with an extreme goal. But for most it fails.  You can see this in droves in the clean eating community.  For every one person who makes it work, you can find dozens who fly off the rails.  They binge constantly, suffer enormous mental stress. Many end up with eating disorders.

Related: What is Flexible Dieting?

Adopting more flexible eating attitudes, even if you don’t use the flexible strategies, is a key to long term success.

You Are Offsetting a Week’s Dieting on the Weekends

This is one I do see a lot of fitness professionals bring up fairly frequently.   Usually by folks who would never share the “You’re eating like an asshole” tragedy to begin with.  But this is a very real issue and problem.

Although it’s changing in the modern world, we have traditionally had a Monday through Friday work week and weekends off.  And what happens to dieters is that they are strict about their diet during the week but let things go on the weekend.

Their daily structure is changed, they have family or personal obligations, most social events revolve around food.  And it’s easy to undo a week of proper dieting (assuming you’re not underreporting your food) with a weekend of overindulgence.

Short-Term Water Retention

I’ve been writing about the issue of water retention “masking” weight and fat loss for longer than I can remember.  It’s one of those things that can happen on a diet where various mechanisms may be involved.  I’ve typically focused on cortisol here.

Cortisol is a stress hormone that can impact on water retention (Cushing’s disease is an extreme version).  And when you combine mentally stressed dieters with hard dieting and exercise you often get chronic elevations in cortisol.  And with that can come water retention.

The practical impact of this being that true weight and fat loss may be “masked” by water retention.  If someone is losing one pound per week of fat but holding 3-4 pounds of water weight due to cortisol, they may not see measurable fat loss for a month.

I’d mention that despite arguments that this is “only a theory”, starvation water retention has been known about for decades. As they stated in the excellent book The Great Starvation Experiment.

Henry, along with many others, saw his weight loss begin to plateau around the 20th week of starvation. Unlike Willoughby and Plaugher, their stalled weight losses were entirely explicable and did not put them under suspicion of cheating. Henry and the other men were suffering from edema. The condition was, as Keys would put it, one of the chief “stigmata” of starvation.

Edema was a puffy swelling caused by retained water in the body. It occurred chiefly in the ankles and knees but also in the face. Every morning, each subject found the side of his face that he had slept on swollen. Henry had a severe case. His legs were like elephant feet, virtually the same diameter all the way down from the knees to his toes.

It became uncomfortable and then impossible for him to cram his feet into his normal shoes. When he pressed a fingertip against his shins, the indentation stayed, as if he had pressed his finger into clay. He would at times amuse himself by making a row of indentations run up his leg like buttons on a shirt.

It’s a very real thing.  Just like metabolic damage was very much NOT a real thing.

Menstrual Cycle Variations in Weight (Women Only)

In addition to the normal diet related water retention that can occur, women have to deal with the menstrual cycle. While it varies between women, bodyweight can swing up and down week to week.  For women, trying to compare weight every week is a non-starter.  Instead, they have to compare Week 1 of the cycle to Week 1 of the next cycle.

The Menstrual Cycle

This phenomenon can make it look like a woman isn’t losing weight.  But it’s simply water shifts across the month masking actual progress.  It goes without saying, but I’ll say it anyway, that I discuss this in detail in The Women’s Book Volume 1.

Other Actual Reasons

And that’s just a sampling of the actual research and reality based reasons you’re not losing weight.  Like with the myths, there are others but the above tend to be the big ones in my experience.

And they are the ones that fitness “professionals” should be educating you about rather than calling you an asshole for not knowing what you don’t know.  Because as professionals, or even active people who want to see people be healthy, you should either be helpful or shut the fuck up.

This is your obsession, or your career.  Rather than being a judgemental prick because someone has been misled by endless bullshit, EDUCATE them.   Start by showing them my graphic.

So Here’s My Graphic

So here’s the full size version of the graphic I put together.  Please feel free to download it and share it.  It will hopefully do a fuckload more good than the one calling people an asshole for not knowing what they can’t possible know.

Do note, it has my logo on it.  And it is COPYRIGHTED. 

You can download it, share it, etc.  But if you do, leave my logo and name on it.  I will know.

Real Reasons You're Not Losing Weight

Sleep Quality

13 Tips for Improving Your Sleep Quality. Practice these cutting-edge sleep strategies to help improve everything from your brain function to your gym performance.

published on bodybuilding.com Oct. 2020

Everyone knows how wonderful it feels to wake up after a refreshing sleep, but you may not know just how critical getting a full night of sleep is to your health and to achieving optimal mental performance.

In his 2014 TED Talk, neuroscientist Jeff Iliff explains that sleep and sleep quality are essential to maintaining brain function. The intense electrical activity undertaken by the brain consumes one-quarter of the body’s entire energy supply. Consequently, clearing waste from the brain is a major challenge. The clear cerebrospinal fluid meets that challenge, flushing waste from throughout the brain and moving it into the blood; however, this only happens in the sleeping brain—never when you’re awake.

How can you improve your quality of sleep? These tips are based on current neuroscience and can help you train yourself into getting more, higher quality sleep.

Tip 1: Get The Right Amount Of Sleep

No one prescription for sleep duration applies to everyone all the time. Still, for most people, 7-9 hours per night is optimal. Finding your own sweet spot for sleep may involve trial and error. The goal is to wake up feeling refreshed, without the need for caffeine or other stimulants, and to feel alert throughout the day. The demands you place on yourself during the day may affect how much sleep you need at night.

Tip 2: Go Dark

The darker your sleep environment, the better. Humans evolved to sleep in total darkness, without the constant humming of electric lights or the emanations of blue light from electronic devices.

Aim to keep your electronics dark when you sleep. If you can’t, cover your eyes with an eyeshade. If light seeps through your windows, try blackout shades.

Sleeping with an eyeshade.

Tip 3: Create A Transition Time

After sunset, dim all the lights in your house so you don’t artificially wake yourself at the wrong time. Install dimmer light switches if you can.

Avoid using electronics before bed. If you want or need to watch an electronic screen at that time, wear blue-light-blocking glasses or use a night light setting that’s amber rather than blue.

Finally, create a daily routine as you transition from waking to sleep. Read using light that isn’t blue, listen to a podcast or an audiobook, or listen to soothing music.

Tip 4: Cool Off

In order to initiate sleep, reach deeper levels of sleep, and stay asleep, your body must be cool and able to control its own temperature. Sleeping in a cooler room with linens to cover your body is the best means to this end. The National Sleep Foundation recommends an ambient temperature of 60-67 degrees for optimal sleep.

Tip 5: Keep It Down

Most people don’t need complete silence to sleep, but they do need to avoid loud, startling noise. If necessary, wear soft foam earplugs to bed, or use a box fan or white noise machine while you sleep.

Putting in ear plugs.

Tip 6: Choose A Comfortable Mattress And Pillows

This can take trial and error; a mattress that’s perfect for someone else may be terrible for you, and vice versa.

Tip 7: Stick To A Schedule

Going to bed at the same time every night should be part of your routine, even on weekends. This allows you to harness the power of your body’s circadian rhythms. Daily exposure to sunlight in the morning also helps anchor your body’s biological clock.

Tip 8: Avoid Regular Napping

If you get all the sleep you need at night, your body and mind will feel sleepy at bedtime and alert during the day. If you nap regularly, your body learns that it’s OK to get tired during the day and there’s no need to get all the sleep you need at night.

If your schedule is unusual and you really need routine naps or to catch up occasionally on the weekend, take them. Just make sure you nap for less than an hour.

Taking a nap on the couch.

Tip 9: Exercise Early In The Day

The more mentally and physically active you are during the day, the better you should sleep at night. Performing intense exercise within a few hours of bedtime can disrupt your sleep. And although it may be tempting when you’re busy, never skip sleep to work out.

Tip 10: Try Blue Light Therapy

If you tend to suffer a midday slump, blue light therapy can help pick you up. Alternatively, head outside and get some natural light, preferably with a brief but brisk walk.

Tip 11: Keep A Journal Or List

For many people, it’s the long list of undone tasks that keeps them awake, the constant thought-churning that stops their mind from relaxing. To counteract that process, keep a journal or list of tasks. Once you’ve jotted down everything, your mind can stop juggling all the information, allowing you to sleep.

Tip 12: Support Your Sleep With Proper Nutrition

Caffeine-containing foods and drinks are among the top sleep disruptors. Foods high in saturated fats cause less slow-wave sleep and more sleep fragmentation.

Pouring a cup of coffee.

On the flip side, eating foods high in fiber throughout the day contributes to deeper slow-wave sleep.

You’ll certainly find that a good night’s sleep improves your workouts.*

No matter what you’re eating, avoid eating too much of it within two hours of going to bed. Big meals can disrupt sleep and cause indigestion. Using alcohol and nicotine within six hours of bedtime can also disturb your sleep.

Tip 13: Take A Sauna Or Hot Bath

People use saunas to relax and recover from intense physical activity, and for numerous other purported health benefits. If you can’t use a sauna, take a hot bath. Once you leave the heat, your core temperature will drop, helping you sleep.

*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Jeff Nippard

Jeff Nippard – YouTube

Description

Hello everyone! I’m a Canadian natural pro bodybuilder and internationally-qualified powerlifter with a BSc in biochemistry/chemistry and a passion for science. This channel is dedicated to providing science-based training and nutrition information and journaling my own fitness journey. I’ve been training for 15 years. I hope you enjoy my videos!

ATHLEAN-X™

ATHLEAN-X™ – YouTube

Description

Welcome to ATHLEAN-X™ on YouTube! This is where you can find all the latest FREE workouts, nutrition and training advice to get you on your way to a healthy, leaner, more muscular, athletic body by training like an athlete.

Learn from the physical therapist and strength coach Jeff Cavaliere, exactly what he does with his professional athlete and celebrity clients. Put the science back in strength to build muscle, keep your muscles and joints healthy and to improve your overall athleticism.

If you want to look like an athlete…you’ve got to train like an athlete! Now you can with the ATHLEAN-X™ workouts here on YouTube!

Send Pro Athlete / Celebrity Training Requests to: mediarelations@athleanx.com

Rules of Conduct: This channel is for those looking to learn. Period. No racism/hate speech. No inciting/spreading drama. No advertising or self-promotion of any kind.

Squat University

Squat University – YouTube

Description

Squat University is the ultimate guide to realizing the strength to which the body is capable of. The goal with each and every video is to help you move better in the gym (and in life) decrease your body’s aches and pains & help you reach your true athletic potential!

Dr. Aaron Horschig is the founder of SquatUniversity.com. A physical therapist, coach, speaker, and author of ‘The Squat Bible’, works with athletes of all competitive levels and backgrounds get out of pain & find their true strength.

Renaissance Periodization

Renaissance Periodization – YouTube

Description

Renaissance Periodization was founded with the understanding that science is the surest path to the truth, and in this field, to results. Our approach is the rigorous application of scientific principles to nutrition and training. Everything we do is built on a foundation of peer-reviewed literature and experimentally-confirmed theory. At Renaissance, formulas, calculations, and literature reviews replace gurus, hunches, and attachments to tradition.

Countless hours of research and development have been put into every product and service we offer, and all of our products and services are constantly updated to integrate the accumulation and refinement of knowledge in the scientific community.

We have been featured on Forbes, Men’s Health, Shape and many more top publications around the world! We have helped hundreds of thousands of clients around the world reach their goal.

Shredded Sport Science

Shredded Sports Science – YouTube

DescriptionFitness.

Comedy. Social Media Satire.

This is Shredded Sports Science by James Linker I hold multiple academic Sports Science Degrees, additional fitness certifications and endless Dad jokes.

Exercise Science Videos This channel does not give specific lifting tutorials or specific programs to follow. This channel presents scientific evidence based information in an analytical manner that you must think critically about. Giving benefits and disadvantages for certain fitness concepts that you may apply or not. I do not tell you what you ‘must’ do.

Comedy Videos Any comedy videos concern the information of a person. My intention is to dispel myths, educate this community and make people laugh, not to direct traffic towards another channel. Thank you

DIET ADJUSTMENTS DURING THE LOCKDOWN

As lockdown measures are imposed throughout the world, all of our daily routines have been well and truly shaken up. Our activity levels, eating schedules and nutritional habits are likely to change considerably in the weeks and months to come. We need to consider how to redress this balance, how to not lose sight of our goals of weight loss, maintenance or anything else.

Calorie intake

For any weight-based goal, the dietary adjustment we need to consider most of all is tempering our calorie intake based on our new energy expenditure. The calories we harvest from the foods and fluids we ingest are used to produce energy. Or, when our energy needs are met, calories are stored in our blood stream, muscles, fat tissue and so on. Once energy is produced and used, it is lost. It cannot generally be recycled. 

This means that we can alter our bodyweight by manipulating the balance of energy coming into the body, and energy being used for movement and supporting bodily functions. As we are now advised to stay at home, without access to gyms and fitness facilities, our energy expenditure has, most likely, reduced. We now need our calorie intake to match our new normal daily energy expenditure.

The quickest way to adjust our food intake based on our activity to work out our basal metabolic rate (BMR) (i.e. how much energy we burn at rest) and then multiply it based on how our activity level has changed. One rough way to calculate your BMR is to multiply your bodyweight in kilograms by 22 for men, and 20 for women. Next, you multiply your answer by one of the following activity multipliers to get your daily maintenance calorie needs:

Multiply by 1.0-1.2 if you are now sedentary

Multiply by 1.3-1.4 if you are now lightly active

Multiply by 1.5-1.6 if you are now moderately active

Multiply by 1.6-1.7 if you are now very active

Multiply by 1.8-1.9 if you are now extremely active

Being ‘moderately active’ generally means you are doing 10,000 steps a day, and three 90-120 minute weightlifting sessions a week. Keep in mind that these estimates are based on population averages, and the rough BMR calculation works best for people with average weights and fat percentages. Nonetheless, this calculation should give you a good idea of how much you need to consume to stay on top of your weight.

Food environment

A grandiose term for how easily food is accessible to you day to day. Your food environment encompasses the visibility of foods, how easy the foods you have at home are to eat (i.e. do they need cooking first?), their palatability and how calorie dense they are.

Our food environment is typically spread across at least two locations, at home and at work, and can have a huge impact on our desire and likelihood to eat foods. Hall wrote in a 2018 paper that although the continued rise of obesity cannot be pinned on a single cause, “it seems clear that the food environment is likely the primary driver”. 

One of the most widely cited studies examining the impact of food environment was published in 2006 by Wansink et al. This four-week study exposed 40 secretaries to four different food environments within their workplaces – a clear or opaque bowl of chocolate placed on their desk or two metres away from them. When the chocolate was closer, and more visible, participants consumed much more over time. Participants also reported that the chocolates were harder to resist, kept attracting their attention and invaded their thoughts much more when they were closer to them, and more visible.

Wansink et al.’s (2006) study shows that if we want to avoid overeating and poor nutritional choices, we need to control the availability of foods in a way that makes it harder to get hold of and eat highly palatable and calorie dense foods. Instead, we need to make it easier and more enjoyable to access and consume healthy, nutrient dense foods – especially if our goal is weight loss. We can do this in three ways:

  1. Avoiding buying and storing foods that we know we will overeat – typical examples include cookies, pizza, crisps, fizzy drinks and so on
  2. Keeping bowls and food displays filled with fruit and vegetables to make it more likely that you reach for them instead of calorie dense snacks
  3. Buying as few pre-packaged and pre-made foods as possible – instead stocking up on single ingredient foods that require preparation and cooking before they can be eaten

Food experimentation 

We all have a lot more time on our hands, so make the most of it by trying new meal prep methods, recipes, flavours, textures and so on. In doing so, we build up our self-efficacy with food preparation and build up an arsenal of healthy, time-friendly options to choose from when the lockdown is alleviated. 

One of the most valuable tools a meal prepper can have in their kitchen is a slow cooker, and there are hundreds and thousands of healthy meal recipes you can find online. Before long, you will find options that make dieting easier, and more enjoyable – freeing you up to spend less time actively cooking, and more time enjoying a wider variety of dishes.