Ep 376 - Weight Loss Resistance

[MUSIC] What's up everybody, welcome back to Iron Culture. It is me, Eric Trexley-Droy is always by B, Dr. Eric Helms, in the flesh. We traveled to the other side of the world. You went like, I don't know, 20 feet. I don't know how far Australia or New Zealand is from Australia. But we are here in the down under, as they call it. Everyone calls it that here I've noticed. >> Mm-hm. >> It will be upside down. >> Yeah. >> And we are here for the SNA annual conference. We flip-flop. Every other year we do it in America. Next year we do it in Australia. So last year we were in Texas. And now we are here in Gold Coast, Australia. Helms, how we doing? >> Good. It's nice that we get to trade who is jet lagged each year. >> Yes. >> Yeah. So we'll see you like, man, it seems like Trex and Helms are never both on at the same time. >> Yeah. >> So. >> Yeah, it's interesting. I am on day one of, you know, I got in yesterday, was able to stay awake until a reasonable bedtime and then woke up naturally like three minutes before my alarm. So I think I've done everything as well as I possibly can. I don't feel tired, but I do feel disoriented and I really did not appreciate it. I don't know how you got used to this, but I feel like I woke up today in like several people vaguely asked if I could like hop on a call tomorrow. And I was like, I have no idea what tomorrow means. Because I got this message at one in the morning and I don't know what day you're living in. I'm living in a totally different day. So I've had like three people try to schedule things with me today and I've just given up. I've just said, whatever, put it on a calendar and we'll make it work. So I don't know how you got used to that, but I hate it very much. >> Oh, don't make it the hack? Yes, I do the hack. >> Cool calendar. Yes. First step is you just operate in the time zone of the person you want to work with. And what you do is when you make the calendar invite, you select the time zone and the location of them and you schedule it. But the first step is you have to go to your settings and make sure that your calendar is set for wherever you physically are. >> Okay. For example, if someone from Norway, shout out to Stan Larson, says, hey, Eric, I want to jump online and talk to you about my awesome study on lean back like extensions. And I would say, of course, Stan, I would love to talk to you about that. And I go, how does, and here you do a little bit of homework, like what time is it currently in Norway, right? And you go, okay, well, that's crazy. So for example, New Zealand Norway, we're looking at one of our evenings and one of our mornings because we're on the opposite side of the planet. And I was like, hey, how does, can you make a 9 PM meeting your time work? And then I say that they want, and I to check that, I just 9 PM on the seventh and then it'll pop up for, once you schedule it, it'll show up where it is for you. Okay. Yeah. >> I did not do any of that. I just immediately became overwhelmed. It said I give up. I'll accept whatever conflicts happen, just make it happen. So, but yeah, I'm excited to be here nonetheless, really good group, a lot of good talks. And in this episode of Iron Culture Helms, I'm going to talk about my presentation, which is about why it's actually extremely rare to be resistant to weight loss. So in the fitness space, so often we have people who say, I'm an outlier. For me to actually lose weight, I need to diet on like 1100 calories. And even then it's pretty touching go. And Helms, you're familiar with the concept of statistics. >> The concept, yes. >> Yes. So, it turns out everyone can't be an outlier. >> That kind of defeats the purpose. >> Because I'm familiar with the concept of statistics, I understand conceptually how that would remove the concept of outliers. >> Yes. >> So, basically what I'm going to talk about in my presentation, I'm going to give like the cliff notes high level summary in this episode. I'm going to talk about when you work with someone in the fitness world. And honestly, people who are fitness enthusiasts, they hear this from people out in the wild, and their regular life, right? Your uncle, your aunt, whoever. I'm going to talk through some of the things that kind of muddy the waters and lead people to that conclusion when it's more than likely not actually the case, right? And so, basically, when we talk about being an outlier who is highly resistant to weight loss, essentially what that boils down to, we're talking energy balance. And we're talking about people who think there's that classic figure in the Ponsor Energy Expenditure Paper from 2021, where they look at total daily energy expenditure on the Y-axis and then fat free mass on the X-axis. You could do it for resting metabolic rate, you could do it for total energy expenditure. But basically, it's people saying, "I fall way below the pack for people that are my body size," right? And what's really interesting is, I really, I refer back to that total energy expenditure figure all the time. And what's interesting is there's this giant gap at the bottom where there's like a very clear basement effect for adults, right? And so, the reality is, not many people are falling into this zone that a lot of people think they're falling into, right? Because no one ever thinks it's on the energy inside of the equation. They say, "I know I'm eating 1200 calories a day. I'm not losing a pound. I'm not having changes in body composition. I'm just stagnant." And it implies a level of energy expenditure that needs to fit in this giant empty space where we don't see a lot of people fitting, right? That particular figure, doubly labeled water data, really high quality gold standard data from like 9,000 people from age zero to 95, right? And so, if a lot of people were falling in that dead zone, we probably would have found them, right? So, what I'm going to talk about in my presentation in this episode is number one, the most obvious thing you want to look at when someone says, "Hey, I'm a huge outlier. I'm resistant to weight loss. We have to look at energy intake, right?" And it's not quite as simple as just assuming everyone is lying. And it's not quite as simple as assuming everyone just simply doesn't know how to track, right? Of course, a great way to under-report your calorie intake is by lying or by having absolutely no idea how to track your intake. That is true. But it's not always the case when we have somebody who is under-reporting their energy, right? So, there's a really cool paper by Lichtman and colleagues. I'm sure you've seen this before. I think it was back in the early 90s, if memory serves. But they basically brought in a sample of people who self-reported as being resistant to weight loss. See, Blue said, "I've tried dieting before. It never works. It's terrible, et cetera." And they compared them against a control group. And so, one of the first things they looked at was, well, maybe they're outliers in terms of their energy expiapature, right? So, they looked at total daily energy expenditure. They looked at resting metabolic rate. These people were indistinguishable from the control group. Like, you could never in a million years pick out which data point belonged to which group, just absolutely no difference on the expenditure side. Then they looked at energy intake. And they did a really cool graph. It was like two bars for each person in the weight loss resistant group, again, self-reported. The first bar was their energy expenditure. The second bar was stacked bars. It was their reported energy intake. And then the energy intake that they were consuming, but not reporting. Right. So, it was the stacked bar. And what you, they have it on a per-subject level. And every single person in this group was under-reporting their energy intake. Some people buy a moderate amount. And some people buy an extreme amount. But it was not unusual to see a discrepancy of a thousand calories a day. So people who were saying, "I eat 1200 calories per day." And then you look at it's like, "Dude, you're at 2600 calories per day." Right. And so, that alone in that case can really cover a lot of ground in terms of feeling resistant to weight loss. But what I thought was really cool about that paper was they also looked at some more like eating psychology items and like, you know, perceptual items. So they did like an eating inventory with some questionnaires. And I think what was really telling about it was that the actual experience of eating was fundamentally different in the folks who were resistant to weight loss self-reported. So for example, things like how they reported their hunger, how they reported bison-hibition as it pertains to eating. And there's like, you know, there's all these different survey and questionnaire tools looking at, you know, kind of more behavioral aspects of eating and perceptual aspects of eating. And those really differed between group A and group B. And so that study highlights a lot of times the lowest hanging fruit when someone says "I'm resistant to weight loss" is definitely not on the expenditure side. It's going to be on the intake side. And it actually is going to take some time to sit down with somebody and do a real meticulous interview talking through their intake. Because you're going to have to not just overcome issues of accuracy and honesty, but also perception. different. They actually sat down these two groups into the controlled test meal and reliably, the people who were weight loss resistant in a single meal where they know they're being observed, under-reported their intake. And the folks who were in the control group actually over-reported their intake. They're like, "Yeah, I think I ate 900 calories. They only ate 800." But the people who were weight loss resistant, it was the other way around. They reported a number that was actually considerably lower than they consumed. And again, you're not getting away with a lie there. Like, there's a genuine difference in your perception of intake, right? And probably something to do with your education on nutrition. Oh yeah. Yeah. There's a knowledge-based difference and potentially also a perceptual-based difference. Because it's not just we look at it. I mean, it's not the way a dietician would do it where they've taught all these tools, "Oh, this is a portion size, a deck of cards." You know, my thumb is a tablespoon. I'm going to visually look at that. How is that cooked? Cognitive, cognitive. A lot of what I think people do is they go, "I felt pretty hungry after the meal was over. I was probably in a deficit. I think X amount of calories is a large amount." So it was less than that. Right. Exactly. Yeah. So it takes a lot of work, right? To kind of build up that skill of being able to, I mean, first of all, just have the kind of library of information, this cooking method versus that cooking method, this serving size versus that serving size. So there's a lot to overcome when it comes to helping people with no background in nutrition or fitness get to really accurately reporting calories. And so obviously, when you're a coach, that's the lowest hanging fruit is to look at that and just say, "We need to at least go through tracking 101 to make sure that we are in the ballpark if we're going to try to get an estimate of total energy intake." Right. So I think that's number one is just what I call user error from like the, if you're like developing a tracking product. But there's other stuff as well, right? So a lot of folks know this by now, but like labeling it, I think every country has their own kind of rule of thumb in terms of how close is close enough. You have to have some variants built in. And last I checked if memory serves in the US, it's like plus or minus 20% with your calorie labeling. And so that's not nothing, right? So 200 calories could be 100 to 60. It could be 240. 2,000 calories could be 1600. It could be 2,400. Now, the nature of labeling error is you don't expect it to always be biased in one direction and a maximal, right? So it's not like every company is going through and saying, "Oh, we can remove 20% great." Right. So you expect there's going to be some overages, some underages. I don't think that's a word, but I'm going for it. Underges works. Okay. Yeah. So you don't have to be confused with underages. That does not work. No. Don't do that. Overages, underages. Yes. So you expect it to kind of wash out. You don't expect it to actually be minus 20% across the board. But one place where things do get skewed is prepackaged multi-ingredient like frozen meals to go and definitely restaurants as well, right? So in mass, several issues ago, Lord knows when. I'm very disoriented from the jet lag. I talked through a study where they looked at these kind of multi-ingredient frozen dinners. You know the kind where you get like, there's like a little pasta portion and a meat portion and little potatoes over here. And those were more than 20% in a lot of cases. There were several of those that were much more close to the like 30% under reporting relative to the true values. So the way I always explain this to people that I'm kind of consulting one on one is like, we know what's in potato. Like we're pretty good at estimating the energy content of a potato, especially if we know how much it weighs. But when you're getting this kind of multi-ingredient three-course meal put together, you know, with questionable quality control over the exact serving sizes and the exact mixture, there's a lot of error that comes into play there. And then Helms obviously, when you get into restaurant meals, all bets are off, right? So in that in that paper, they're like, yeah, these frozen meals, not unusual to see 20% become 30% or 35% restaurant meals, they were literally, they were off by 100%. And then when you start to add in, they also looked at like, they looked at some meals that had some side dishes that were basically like free that came with the meal. And once they added all that stuff in, some of them were report, some of these meals had 240% of the calorie content that was actually reported, right? 2.4 times what are this? Exactly. Yeah. And so in many cases, you know, when you're working with somebody who, who basically self-reports as being, you know, resistant to weight loss, a lot of times what you really need to do is, number one, do that educational piece in terms of tracking. It doesn't mean they have to track their calories as the intervention, but it does mean if we're going to say, hey, I'm doomed because dieting doesn't work for me. It probably is worthwhile to actually establish a baseline number, even if daily tracking isn't going to be the path forward. Maybe it is, maybe it isn't. But the other thing I think is to, if someone's really dead set on this idea that resistance is futile, I cannot make this work. I'm doomed to have a period of time where we say, let's in terms of food selection, let's get back to the basics, right? I'm not saying you can never step in a restaurant again, but if you're eating a considerable percentage of your meals at a restaurant and you're telling me that 1200 calories is not working for weight loss, I'm very skeptical of what's happening at the restaurant, not because of you, but because of the restaurant, right? And I don't want to beat up on them because, I mean, they're trying. They're trying. You know, you're working, you know, you're a cook, you're a chef, you're working the, you know, you're a lying cook. You're not out there with the little scale measuring out every little bit, you know, you throw a dash of oil in the pan, you got, you just got to make it work. 90 calories, boom. Exactly, yeah. So, so definitely. Can I have one other way that I think, and I have no data to back this up, but I really do think it is a thing and it makes sense from the way the systematic error would swing. When you do get people who start to really focus on dieting and diet foods, I think when you are a company that is selling diet foods, you're competing against how much protein can I make this label go up and how many, how many different ways can I get the calories to go down? Yeah. So, you're looking at creative use of sugar, alcohol, fiber, and potentially other things that will drive the, the total amount of weight of the project, basically volumetrics, right? Yeah. And there's been enough instances where we've seen people, you know, put in a report on, we talked about with like the David Food Barnes, even though that wasn't a valid critique. Yeah, but it's an example where how many times have diet foods or protein bars had to go back and, and, okay, we were cheating the label too much. It's actually 50 calories higher. Yeah. So, I think when people start to consume a tremendous amount of diet foods, even when they have been educated, I think it's not common at all to, they're going to chase the thing that is too good to be true. Yeah. And if it looks like it's too good to be true, it's probably too good to be true. Yeah. I remember there was these, these, these these interesting Turkish wraps that we were getting at a grocery store that was in in California way back in the day. And we were just going off the macro labels and it had an unbelievably low fat and carbohydrate content. And it was supposed to be like kind of the spider wrap thing, guaranteed you. It was like half of what it actually was. Yeah. And how many times have I seen like kind of, if it's your macronator kind of focused people who are, they're not eating the basic foods, right? They're incorporating a lot of these things in weight loss stalls. And the first thing I think is well, well, you know, there's these sodium in these and maybe it's the sugar out holes and it's bloating in and like I actually think that you went from at the start of this diet eating a reasonably well balanced normal quote unquote, calorie-stricted diet with fruit vegetables, lean meats and some low fat dairy. And now you're getting a whole bunch of diet products that are maybe collectively 20% higher than you think. Yeah. And yeah, we've seen this if you've been in the game for a while. Cookies, brownies, ice creams. We've seen it enough times. Like you said, if it's too good to be true, if it looks too good to be true, it probably is. And this, there's even a sign felt episode about this with the fat free yogurt that wasn't fat free. So like, I may be misremembering the details. It came out in the early 90s. So you gotta give me a break on that. But in any case, you just, you really got to be careful with again, eating out at restaurants really frequently. Some of these diet foods that maybe are kind of strategically trying to really work that margin of error that they're allowed to work with and perhaps going beyond what they're allowed to work with. Definitely. And then the other thing you can talk about here, which now we're getting way into the the weeds of this section of just ambiguity about absorb calories. But we've talked about this before. Then you can start factoring some of the little minor details. Thermic effective food, non-digestible carbohydrates or residual. resistant, or digestion resistant carbohydrate fiber intake of the diet. And so in a previous mass article, you basically laid out the extremes of the case and said, like, if we wanted to look at like a western diet, highly refined carbohydrate sources, minimal fiber, a little bit lower on the protein, low on resistant starches, that's the extreme on one end. The other end we're going, you know, resistant starches, higher fiber, more protein, we can carve out a gap of about 300 calories if we're looking at two different diets that are labeled as being in the 24, 125, 100 calorie range. Yeah, and there were a few things in that that I could have included, but I couldn't quantify well, so it wasn't enough data. There's a classic study where they take the same sandwich, but once processed in the TES, at least the acute TES response to that meal, it was notably lower. And I don't think that's been well shown in, like, say, ket and HALS data, but there are some indications that not only would the TES be higher because of the higher protein, higher fiber diet in the non-processed, hyper-crazy bodybuilder diet, not that crazy, but the TES might be systematically lower than even the protein in the fiber would indicate in the processed diet. So I think there are scenarios where you could be looking at 20% differences, you know, and it wouldn't be too crazy. Yeah. Which for the average person is 400 calories, right? Yeah. So if you're looking for, again, this person says, I should be dieting on 2400 calories, but I'm 1200 below that and I'm still not losing. If you're looking for thousands of calories, look at the major tracking errors, look at the lack of tracking education, look at really rampant, constant eating out at restaurants, but you can still find on the order of hundreds of calories when you start digging in more to specific food choices, those diet foods, some of these differences with, you know, the process, highly refined carb sources versus resistant starches, fibers, and higher protein. So there's calories to be found there, but rarely is that like the single culprit where we say that's it, right? So the next thing I talk about in my presentation is just kind of clearing up some confusion about certain medical considerations, you know, because a lot of times you'll hear someone who says, I can't lose any weight. I'm only eating a thousand calories a day. I'm hypothyroid. It's because I'm hypothyroid because maybe I have PCOS and there's a lot of content out there about PCOS and weight loss. And the last thing I'm going to do is say anything that detracts from the realness of those medical conditions, right? Hypothyroid is real. You know, PCOS, there's a lot going on in PCOS. I actually just saw a paper the other day where I think they're trying to make a push to rename it to make it more metabolically centered rather than more cyst related. Yeah. It is very much, it gives people a misperception of what the actual clinical qualifiers are. And it's not necessarily dependent these days on having multiple cysts around. So yeah. So yeah, it's not to take away from any of the realities of what those medical conditions entail, but as someone who studies energy expenditure, I have a responsibility to make sure I'm not going to go waste $200,000 studying something that doesn't need to be studied or that has been studied and doesn't actually bear fruit when you look at it rigorously. So for example, when we look at hypothyroid, does that, you know, just having low thyroid hormone reduce your basil or resting metabolic rate? Typically, yes, but it's important to understand the magnitude that we tend to see in the research. It's usually, it's rare that we see that being more than like a 10% reduction of resting metabolic rate. And there's two important things to note about that. Number one, I literally, you know, go back to that, that figure, again, showing that huge cloud of data of, you know, energy expenditure against fat-free mass. And when you actually go in and say, let's say I had an average energy expenditure and I knocked my basil metabolic rate down 10%, invariably, you find you're still pretty much in the thick of the data. And what we also tend to find, there's a nice paper a couple years ago that looked at correlations between several different thyroid hormones and seeing how it correlated with weight, body composition, characteristics, metabolic characteristics, and low thyroid generally did correlate with lower basil metabolic rate, but did not actually correlate with body weight or body fat percentage. And so that's not to say that your, that hypothyroid won't affect your basil metabolic rate, but the impact is relatively modest in magnitude and doesn't seem to reliably translate to higher body weights or higher body fat percentage across the board. And I mentioned there are two caveats. That's one of them. The other caveat is if you are managing your hypothyroidism well with medication, it generally will bounce you back up to right about where you would be if you did not have a hypothyroid condition. So usually that complication is a real medical complication, but in terms of moving the needle dramatically and energy balance or making you weight loss resistant, that generally doesn't seem to be how it pans out. Same thing too. There's the etiology of how you get to having low thyroid, I think also matters. There is a paper and right now my brain is remembering zinc, but it could be iodine. That if someone has a substantial deficiency and they replenish it, you can see on the order of hundreds of calorie increase. And this is not necessarily due to a hormonal issue, it's due to a micronutrient deficiency. Right. That is probably going to cause other issues throughout the body. So that is probably a little different than having an isolated pathological issue with a certain part of your hormonal system versus having a chronic malnourishment issue that is leading to you being microditive deficient and correcting it. Yeah. I think there's a classic paper of like it's close to 500 calorie increase and energy expenditure when they gave people who were deficient, this mineral. Yeah. So how you present and what people do about it and whether or not the clinician is actually kind of crossing their teeth and dodging their eyes makes a difference as well. Yeah. And I do like in fitness people ask all the time, should I be going with the pink Himalayan salt? Should I be good? You know, all these questions about like specialty salts and like generally speaking, I'm like bro, just go with the normal iodized salt because it's nice to get that iodine in your diet and it tastes like salt and it's cheap and it's great, right? You don't need the like extra negligible amount of these random minerals like you'd rather get the iodine, right? And the pink Himalayan salt actually has less iodine. Yeah. To believe it or not. Yeah. So you want the iodized salt most of the time. Now I will say, yeah, there's a great addition there and so yeah, if you have, you know, if you suspect that if you're showing symptoms having low thyroid, then obviously you should check with a clinician for a variety of reasons, right? And you should try to manage that. It may be related to, you know, iodine deficiency is a common cause of a variety of different other causes for hypothyroidism, different routes to managing that based on the etiology or, you know, how it's coming about. So do treat that. But don't expect that that is going to be the game changer that fundamentally changes your body composition, right? Now with PCLS, so far, you know, there's been a number of studies that do compare resting or basal metabolic rate in PCLS patients versus controls and there does not seem to be a consistent difference in those comparisons. Again, that doesn't detract from any of the other realities of, you know, the symptoms, the course of treatment from PCLS. Very, very real condition. Is it the impact on satiety and hunger? Exactly. And so that's kind of what I, what I talk about in my presentation is these are the two things that you hear about is my energy expenditure is low because of thyroid hormone or PCLS. In reality, when you want to look at the medical conditions that really have a huge impact and really move the needle in terms of body composition, it's the ones that impact appetite, not the ones that impact expenditure. You know, the funny thing is if you think about the widespread, common things that we consume or do that have moved the needle a bit on energy expenditure, they rarely move the needle independently on body weight and society. So cigarettes and nicotine, cigarettes specifically have a dual effect on energy expenditure as well as appetite suppression. And when you look at some of the BLI and body weight correlations in societies where you have kind of pre and post cigarette consumption, consumption, I don't know if that's right, where do you consume cigarettes? Sure. Inhale. I'll ask my wife, she studies cigarettes, if she used to. Yeah, I would be curious to get her take, but you can see that. But then caffeine, appetite suppression isn't, the data isn't that strong on it. But it's pretty reliably does at least increase short-term energy expenditure. Everyone in the world is drinking way more caffeine than they probably should. But then GOP1s come around and go. Yeah, absolutely. Yeah, and so, you know, there's medical conditions, you know, hereditary conditions where if you're born with, you know, anomalies related to grellen or leptin, you can read all these case studies about it and you will literally see kids who are four years old who have extremely severe obesity, right? And so, like, you know, these medical conditions, thank God, they're extremely rare. They're brutal to manage. Like, if you have a child who has, you know, massive, excessive grellen production, just the hereditary condition or God forbid has, you know, dysfunctional leptin receptors. Basically, you know, these parents, their kids are starving, subjectively. They feel like they are starving. And so the parents are in this impossible condition of, if I don't feed my child, they're miserable. If I do feed my child to the extent that they want, I'm harming their health. Right? And so these are just tragic conditions. I mean, they are really brutal on the families. And you know, it's one thing like, if you're born with a leptin, with just the inability to produce leptin, we can work with that. Like, we can actually give, you know, exogenous leptin and try to treat that. But, deficiency in leptin receptors, there's just not really anything you can do. You know, I've actually been curious to get you to take on this. Now that you've moved into Duke and you look a little more evolutionary in biology, my first thought is, you know, it makes sense that those would have survived into the modern era because when food is scarce, the bottleneck is not. Well, I'm always hungry, so I keep eating. It's like, yeah, well, kind of everybody is most of the time. You're just a guy who suffers a little bit more all the time with a gal. Yeah. You get food and you get food. You eat as much can, but we're sharing it in the tribe. And then you're just, that's all there is. And we're all like, yeah, we're unhappy to you. But would you like, yeah, I'm more unhappy than you. But you don't gain the weight because there's not enough calories. Right. And you have to like move to get them. Yeah. So it kind of is a self limiting thing, but not to the point where you can't pass on your genius. Exactly. Yeah. And so luckily, you know, if you put together all, you know, all the different hereditary conditions impacting Grelan regulation, leptin regulation, their receptors, et cetera, we're talking so far below one percent of the population. Right. So these are extremely rare. And if you have them, you found out by the time you're four years old, right? They are very substantial. But all that is to say, you know, a lot of times we get this misconception that there's a lot of very prevalent medical conditions that are reducing metabolic rates and causing substantial obesity and resistance to weight loss in reality. It's usually the stuff that impacts appetite. And that includes medical conditions and also medications. Yes. But it's almost always the intake side of the equation that's being impacted by those. Would you be comfortable with saying that if a condition impacts energy regulation, that that's when there's a problem because I think people see stuff related to energy expenditure and they get caught a little bit in that kind of calories and calories out, maybe like level one fallacy. But most of the time, we regulate our energy intake based upon our energy expenditure. Unless we are dysregulated. Yeah. So if you have some type of lowering of energy expenditure, you typically also have a lowering of energy intake. Yeah. Even though that's even in modern society where, you know, I would say in Western society for non-active people who are not intentionally trying and they don't have genes that are specifically or epigenetics that are specifically obesity resistant, they're going to slide towards being heavier. But I think the relative surplus that they're going to sit in is probably going to be the same. And some of the data indicates what we're like gaining like a quarter of a pound per year, something like that. People put us, you know, we're unfortunately in a classification aligned with obesity for BMI by the time we're in our middle age, right? Yeah. So, yeah, I don't know if that's an easy way of saying it. Like, hey, it's, it can't be an energy expenditure, but energy regulation. Yes. Yeah. And usually, you know, again, when we start looking at that dysregulation, the kind of simple diagnostic element is, well, the dysregulation is that you are eating more than you should be relative to your expenditure. So we express it on the intake side, but yeah, it's the mismatch, that dysregulation that ultimately leads to overconsumption, right? Now, the other thing, I don't want to talk about too much in this podcast episode due to time and due to the fact that I'll be canned, I'll put my cards on the table. I don't know a lot about it, but you can't do this talk without at least tipping the cap and acknowledging lipidema, right? Ah, yeah. So, you know, this is good that you're not going to go into this extensively, because I have, I think, one other, I don't know, have a few friends at the same way as the points that you've made, but something that we should talk about that I actually think is far more problem than people realize, but we can do it after that as kind of like, hey, another really important note, especially for coaches and why they see disconnects with the literature. Yeah. Well, I mean, now I'm curious. So what is it? Okay. So, we started recording, but would you agree, because we both need deep in this literature, since the very first time we collaborated in 2014 and we wrote a paper or like, we wrote a piece, I should say, that basically modeled why you see such a huge difference in energy intake throughout contest prep when you're at the peak of your metabolic positive adaptation and peak of your metabolic negative adaptation and people are looking at when they're in their highest surplus to their lowest deficit and like, oh my god, I almost have to calorie intake and going, that's actually not that abnormal. That's at most one standard deviation from what you would anticipate based upon group means. Yeah. Here's the thing is that the vast majority of the fundamental adaptive thermogenesis data and weight loss data that we have built our understanding on with the field sits on, great data. Some of the best, I would say, nutrition science research and human physiology research that was done in the 80s and 90s, really, really good lab groups does not include resistance training. I would say 95% of it, not including resistance training. So our understanding of energy regulation and energy expenditure is based upon models where that's not occurring. So when we look at all this fantastic, highly reliable data onto doubly-label water with huge sample sizes, what people are doing in practice, coaches and well-read athletes or clients, is they're going right. So that's probably my energy expenditure. And I know the 3500 calorie rule or even maybe I've read Kevin Hall's paper. I know it's not exactly that, but I can model it also based on people not lifting weights. So what I should expect to see is X amount of scale weight change if I'm where I'm at. Yeah. But I think people just don't realize how common and I would almost say the norm in your typical person who starts lifting weights that body decomposition is. Oh, sure. Yeah. So when you have people who are capable of putting on muscle and especially if they're genetically gifted and they go on a pretty novel program, it is not uncommon at all to see almost no scale weight change when they're actually in 400 to 600 calorie deficits. Yeah. And this is normal to be expected. And I think a lot of coaches struggle with that because we had this long resistance against meaningful body decomposition happening outside of your beast beginners or people on antibiotics, right? That's kind of the constant mantra. And I think there's far more caveats and nuance to that than what people realize. So if you have not done this as a coach, you may not relate to this, but something that I do very frequently when I have athletes who are not appearing to lose scale weight, but I'm seeing positive visual changes is I ask them to start doing measurements. So for example, thigh, waist, chest, for depending upon the category, I might be focusing on hips and thigh, I'm a waist and chest for say like a bikini competitor or a female physique competitor. I'll throw an arm measurement for a guy and I might get like one other waist measurement higher or lower, right? And I have seen, if you do some of the conversions that are out there, you can figure out based on how big is the person on tall land and what type of volume changes do we see in different places. And I've quite literally seen people who would be calculated to be losing a kilogram every couple weeks. So we're talking more than a 500 calorie deficit and only the losing an average on the scale weight over that period of maybe 200 grams. So they look, they would actually be if they just did the math and only thought about weight and assumed weight was fat. They would be in that zone where no one exists. Yeah. But they're not. They aren't a deficit and if you looked at the fat mass losses, they're there. But what is happening is they're quite literally gaining like a fair amount of lean tissue. Or there are that plus other factors that are driving scale weight to be a slower loss than it actually is. So as their fat mass is going down, their fecal mass is going up. Yeah. You know, like one thing that happens to me is I have a pretty, I don't know if talk about this before. But people just, they don't really appreciate what it means. Like if you go from, if you go to half of your frequency of bowel movements, that you've actually increased the weight of your food because you're eating more fruits and vegetables and fiber as meals by say 50%. What is going on for those three days when you happen to have a meal? taking a shit, you know, you should be gaining that. And if you're not losing that, that means the amount of like poo and fecal and GI tract slowing accumulation that you have is about equal to what you should be losing. - Yeah. So those conversations I think are really important to contextualize clients who get very, very weak focused. And sometimes I have seen clients who are just shocked when they had done the measurements. Yeah. They might be losing very small amounts of weight, but actually in the kind of deficit that you wouldn't anticipate when the math does work out. - Yeah. - No, it's an important point. The energy balance method does not use weight as a multiplier. It uses fat mass and fat free mass. And if you're trying to mentally, nobody puts the term on it that way, but when someone says, well, I'm supposed to have lost this much weight. It's like, well, no, the math you're doing in your head, we have to separate that out in the compartments and we have to really state our assumptions about how each of them are changing. So yeah, you can definitely find yourself in that situation where the scale is not responding how you expect and then you have to dig in and do some more detail. And I mean, one other complication, especially now that you've opened the box of training effects. I've talked about this a million times on podcasts, but I was prepping back in the days like 2014-ish, I think, 2011-ish, somewhere in that range where everybody was doing multiple windgates, France, beaten the hell out of ourselves on cardio. And I've always been a volum addict. So I'm pushing the resistant training volume way too high, just nonsense volumes. Tons of sprint work day in and day out, stressed 'cause the show's coming up. And I made a diet change and literally nothing is happening on the scale. And I'm not recomping. Like I'm a reasonably advanced body builder at that stage. I'm prepping, I'm nine weeks out. - Yeah, you have no testosterone. - Yeah, you're not slightly. - Yeah, my test is 130. And so I was pretty young. I'm kind of proud of myself for putting the pieces together 'cause this was, I think this was actually before grad school. So I didn't really know that much, but I was like, I wonder if I just chill for a few days, what would happen? And what do you know? I just stayed out of a gym for 72 hours. And every bit of weight loss that was supposed to be happening, but not happening happened. Just immediately scale weight plummeted and stayed down. And so you do have to consider if you're stressed out as hell pushing every angle of your training frankly far beyond where you ought to be, just in terms of intensity and frequency and volume. Sometimes you're just running sky high cortisol levels, it can impact water retention to some degree. And so that's another thing that has to come into the picture. - We often use the WD, we do diet break, the same week, you know, like cortisol is hilarious stuff. When you're just like doing this clients, do like extreme hand pictures. And it's like, they look like a jump to an alley. I'm like, yeah. Yeah. This person just needs to look, you're okay, you're not training, you're not doing cardio and you can get in two full body sessions and we're eating at maintenance for a week. Yeah, and like just reset it to the degree that at least your shredded butt will allow. - Yeah, yeah. So just to recap, tracking errors on the diet side, whether it's because of the restaurant, because of the company that makes the food, telling you that it's low calorie brownies, but they're not low calorie brownies, whether it's just not being that good at tracking yet, a lot of stuff going on there, little bit going on in terms of the actual absorbable calories from the diet, could be some modest changes in, or differences in resting metabolic rate from hypothyroid related conditions, but they don't seem to really make a massive impact on weight gain, weight loss outcomes, especially if they're being managed well medically. The one thing I was gonna get to is lipidema, right? And so lipidema, if you've not heard of it, if you Google it, you'll know it when you see it, right? You've probably seen people who have lipidema. It is a medical condition that frankly, we just don't know a lot about it. It's very surprising to me how little we seem to know. Maybe I'm an idiot, maybe everyone else knows about it, and I don't, but whenever I try to look into it, I don't get the detail level that I'm looking for in those answers. But in any case, lipidema, it is predominantly, like the major clinical presentation is a lot of fat storage, disproportionate fat storage in the legs, in the lower body, and there's what they call a cuffing effect, which is, you've ever seen, it's like right at the ankle, the fat storage just stops, and it almost kind of has like a cuff or like overhang of the foot. And sometimes in more advanced lipidema, you'll start seeing it in the upper body, and again, around the elbow, around the wrist, you'll see that cuffing effect. And what's going on, it's the best of my understanding with lipidema is there is a degree of fibrosis occurring. There's a little bit of a little bit of a fibroidic, you know, what's the term that they use? The adipocytes themselves seem to be having this kind of fibiotic, it's almost like scar tissue that's forming. And in parallel with that, there's a lot of extra retention of lymph fluid and interstitial fluid. And so what's really frustrating about it is people that do have lipidema, let's say, for example, they have disproportionate fat storage in their legs, they may start a diet, and they're losing weight, and they're losing arm fat and chest fat and belly fat, but the actual size and kind of visual presentation of their legs is not changing at the same pace as what they're seeing with their upper body. And part of that-- - Correct, if I'm wrong, there's issues that fast-grorization of the tissue as well. - I believe so because of the fibrosis. - Yeah. And so what's happening to the best of my understanding, number one, that fibiotic scar tissue for lack of a better term that's forming is not gonna be lost from the deficit, right? That's not fat. - The fibiotic element. - It's maintaining the structure of the fat. - Exactly, even if you're getting triglycerides out of the fat cells. - Exactly. The fluid retention, the related deal with that is what, it seems like people try to go with different kind of massage therapies and compression therapies, but it's not a deficit. That's gonna get that fluid out of the legs. And the thing I can't get a lot of clarity about, I would imagine because of how that fibrosis impacts just the function of the adipocyte, I would imagine that it is, and like you mentioned, issues with vascularization, I would imagine it's also harder to liberate the triglycerides from those fat cells. So for a variety of reasons, this is definitely a scenario. And you gotta bring it up when you're talking medical stuff and resistance to weight loss. It is a localized resistance to mass loss of the legs. And again, part of it is fluid retention, part of it is fibiotic scar tissue, and part of it may in fact be a regional challenge in terms of actually liberating those triglycerides. - We're talking true stuff in fat. - Exactly, yeah. - And it's one thing to talk about, oh, energy balance is what regulates everything, but if your body can't actually access that energy, it's kind of a closed system in and of itself. - Right. - We're not getting it. - Yeah, and the thing I'd be curious about, and I don't say this to like trivialize it, I'm genuinely fascinated to understand how these adipocytes function. I'd be really curious to see, you know, if someone just got absolutely shredded, what happens at the adipocyte level? Do you eventually tap into that lipid because it's the only lipid left, or do you start to get in a situation where it's so hard to access because of how that fibiotic, you know, the vascular stuff, the fibiotic stuff, do you start actually breaking down lean mass instead of the adipocyte, or instead of the lipid? - I would probably postulate, yes. And you can see other examples of this in certain species that have evolved to always kind of carry like a little bit of a fat area in certain spots. - Yeah. - Like we both love our tats. - Oh yeah. You know, when you have male cats, especially if they've been neutered, they tend to develop a little belly pouch. - Yeah. - Yeah, and that belly pouch is not just skin, it does have a little bit of fat tissue in it. And this is a little unhappy to hear, but you know, one of our cats had always had one of these fat pouches and he had to go through B.A. of cancer and he actually went through chemo, but he got very, very, very skinny during that time period. He still had it. Yeah. And the good news is that he did, you know, the chemotherapy worked, and that I'm passing away from something else, very late in my, almost 19. But when he was at his smallest and the largest threat to him was actually not eating enough, he still had the little fat pouch. Yeah. You know, so this is someone who, someone, this is a cat who could have, you know, starved to death and still had like it. - Good, good, good. - You know, so yeah. There you go. - So yeah, so you gotta throw that out there, but with lipidema, that's a real thing. And again, unfortunately right now, it looks like the treatment for lipidema as far as I can tell is, it does seem to, for whatever reason, coincide a lot with obesity. I don't understand why, but in any case, the treatment there, this is legitimate, again, regional, localized true resistance to fat loss. And the treatment seems to be, I've heard of attempts to do surgical-- treatment to remove some of these Phybrotic adipocytes and like I said for for dealing with a fluid retention compression massage things like that, but that is one, you know very substantial barrier when if you if you have you know advanced lipidema and you say I want shredded legs That's gonna be a yeah a real tough battle right and and that's something you have to acknowledge in this conversation so Fortunately, that's not a super super super common thing and it's rarely you know usually when people say hey I'm resistant to weight loss you know a lot of times it's someone who they're storing fat all over the place and they're like hey Why do I weigh 240 pounds and I can't lose weight on a thousand calories and that's not lipidema right? That is something totally different to combination of probably many of the other factors prior to this one exactly now The ones the other thing I talk about in my presentation I'm not gonna get too into the weeds on it in the podcast here just because I've done it to death and I'll probably revisit these topics soon with a more Dedicated update on where I'm at with it because it's when I study but metabolic adaptation exercise energy Compensation we've talked about them on the show basically you Establish a deficit either through doing more exercise or you know cutting down on the dietary side The body has opportunities to adapt right there are ways that we can Turn down the knob on some physiological processes And in and some behaviors right some of that non-volutional movement and things like that to try to cut down on the ATP budget You know and if we're using less ATP throughout the day Then we have to break down less fat in order to fuel you know that that energy cost so One thing that's really interesting about that the thing I will talk about is the fact that when you go back to that figure I keep mentioning with you know total daily energy expenditure against fat free mass What's really interesting about that to me is the asymmetric variance in those numbers when you look up at the high end of total daily energy expenditure It's all over the place you you have this the data just totally fans out There's a lot of variants up there some people are you know kind of high some people are really high some people are extremely high when you look at the other side It's just flat. There's not a lot of variants at the low-end and the reason for that in my opinion is that a lot of our ATK costs are non-negotiable you can only adapt so much for example Sodium potassium pumps. Yeah, you can't live without them and the ATP cost simply is what it is like your heart does need to beat Yeah, your heart needs to beat You do have to keep certain balances of electrolytes otherwise you do die right so Sodium potassium pumps non-negotiable and you can't barter It just takes the ATP that it takes same thing with muscle contraction if you want to detach Myosin from actin and do more cross-bridge cycling you're gonna have to pay up. Yeah, and that's ATP, right? And so yeah, trouble my son doesn't take a day off when you're when you're dieting exactly Yeah, and so so I think what's really interesting about that is yes We can adapt but it's finite No one in the world that studies metabolic adaptation or exercise energy compensation treats it as if we can Somehow go out there and find an adult who weighs 170 pounds Who's burning 300 calories a day? It's not going to happen right and so The thing that's really fascinating to me you look at the biggest loser study is say this is some of the greatest in magnitude greatest metabolic adaptation we've ever seen They're burning 2900 calories a day Right yeah, at the end of the competition when they're in their most adapted state similar to me I when I went to a grand tens of lab and you would have seen all this and the documentary you paid close attention he You know six compartment model resting energy expenditure ventilated hood and then plotted my RMR Against every equation that existed and I was lower than all of them Yeah, and I at the time I was like like 180 pounds ish and I had a energy A an RMR of 1700. Yeah, so like Then I start training, you know, we're still gonna be clock and like I think we calculated one time We thought my my baby is calories of 2100. Yeah, so I mean, it's not fun to be on a an 1800 calorie diet when that's only You know when you're six foot and you compete as a light heavyweight bodybuilder, but it's still not 300 calories, right? Right exactly. I run down. I'm hanging out, but I'm still on the same seal the same floor is a lot of other people Yeah, on that plot, so yeah Absolutely. Yeah, and then of course the Minnesota starvation experiment we diet Adult men full grown men down to about 115 pounds on average The average body fat of course its body fat measured in the 1940s. So take with a grain of salt Well, if you see the pictures, you know, this is accurate. Yeah, if you see the pictures Yeah, the average body fat in the group was I think under 6% body fat And so these these are guys when you see the pictures literally when your knees are thicker than your quads Like that actually was happening in this cohort and still we find that at the very lowest You know their energy expenditure was in the like 6,600 1700 calorie per day range, right? So again, these people still would be losing weight on a 1200 calorie diet and also why the hell would you want them to be losing weight? Right, so it's really informative to look at some of these extremes and say well if 1200 calories was in Still going to get them losing weight from that state an adult man 15 pounds and I can see not just some of your ribs every rib. Yeah, even at the peck level. Yeah Really, John I encourage people to look at the photos from that because it is really just a fascinating piece of science history But in any case metabolic adaptation exercise energy Compensation are they part of the picture? Yes, but it pains me to say this as someone who spent way too much time studying these things in my life They're not the biggest Contributor by any means a lot of times it really comes down to these massive tracking errors It comes down to big mismatches in appetite and just Misperceptions or misreporting of how many calories are coming in The one thing I do want to acknowledge briefly is even though we kind of go through and just knock out It's not this. It's not this. It's not this. It's worth noting that Experiences differ when it comes to how resistant to weight loss you are. So if we treat as a spectrum some people They you know make one little change to their diet. It's new sailing other people They have to have a more iterative process. It seems like there's more friction for them. That is reality Right, there's twin studies looking at weight loss induced my exercise and Among twins a high correlation indicating strongly there's a genetic component and Some people in the same intervention with very well controlled energy intake You know on the same exercise those some people lose eight kilograms in the study some people lose two kilograms in the study Right there's been studies with metabolic adaptation where they do find the more you adapted based on drop in resting metabolic rate It maybe it took you longer to get to the the target of weight loss or maybe it was a fixed time of weight loss and you lost less weight During that timeline, but When you look at the details of those studies. I'm thinking of a series of studies by Martins and colleagues What you find is not nearly as devastating as that sounds now It's like it's 20% longer or something like that Yeah, but in most cases that like there is one cool I like tell they did one study where they they were dieting to a target and the question was how long does it take? And in most cases the people who are really feeling it with metabolic adaptation It was like you had to diet three more weeks, right? Or in one case like think that average weight loss in a study with a fixed timeline was like 14 kilogram Very successful weight loss study and the people who are really struggling really lagging behind They lost 11 kilograms instead of 14 and it's like bro you lost 11 kilograms That's not weight loss resistant person, you know, especially when the averages 14 right? Yeah, so these things are a piece of the equation, but yeah, I will say I think that that when you apply that to the extremes It can feel pretty wild because So for example, there are people who can get shredded in four months and there's people who If they want to maintain a fair amount of muscle mass on the part they're more like seven months Yeah, and now we're almost doubling a timeline, but I think there's a big difference between you've got 40 kilograms of fat to lose and you lose 11 or 14 or you have 15 kilograms to lose and you have to lose all of them Right, yeah, and you know like the the the pace of weight loss becomes very slow at the end Because we're dealing more than absolute issue and how much can you liberate and you get in time period without muscle mass loss? Yeah, so that is something that I've I've had Acceptance-based therapy is only way to get there. It's like hey, like do you value this your goal of getting there and can you Disassociate yourself from what is normal? Because you got to do what you got to do and if you can accept that it doesn't actually feel that much worse Yeah, and that's something I think why I like getting away from and you've talked about your own experience of this I think when you are someone who is in that kind of maybe two standard deviation below most people or three even and that Mathematically you do exist. Yeah Like putting your macros on the internet don't do it. Right. We come because you're gonna feel like worse than you actually feel. Yeah, I know. When people, when I talk about my diet and what I do, and other people who are like, yeah, I'm six foot, I competed 180 pounds this or I'm, I would. Oh my God, I could not live on a 1800 calorie diet. I'm like, that's because you're, my 1800 calorie diet feels like 2500 calories for you. And you're thinking about what it would be like to be 700 calories lower. And I agree, 1100 calories is really, really hard. And I wouldn't want to do that either. But that's kind of a relative equivalent thing. Yeah. And Burdo was starving out there on 3000 calories. He's trying to get, you know, 10 kilos of myod doing. It's just, yeah, it's different in different bodies, you know? Exactly, yeah. And the thing to impress upon people, I think just to close here is, when it comes to weight loss resistance, what we really should be thinking about is weight loss friction. It exists, it differs and it's on a spectrum. So the question is not, am I resistant to weight loss as if it's a dichotomous? These people can lose weight, these people can't. Or resistant to fat loss, I should say. These people can lose it, those people can't. It's really, where do I fall on this spectrum of how much friction I'm going to experience? When we put together all the physiological elements that put some extra friction in place, when it comes to where do I fall on that spectrum of appetite regulation of my wire to be a little hungrier than most, right? So when it comes to expenditure, when it comes to adaptation of that expenditure, when it comes to the way our appetite is regulated relative to our expenditure, there is variance in these different characteristics. And so of course, we'd all like to be on the, a particular end of that spectrum in many cases. But we have to think of that as a spectrum, have to think of it as a collection of traits, and have to deal with the reality of, for some of us we're going to be lower than the mean, for some of us we're going to be higher than the mean. Most people should be closer to the mean than like super far away from it. And the final-- - Two thirds of people I would think would be within-- - Assuming it's normally distributed, yeah. - Which it might not be, because you've talked it's kind of asymmetric. - Well, yeah, so it's probably not normal if we're looking, especially at the total energy expenditure side rather than, you know, basil, for example. - Yeah, basil probably, I bet it's normally-- - Probably closer, yeah. But in any case, you know, we have to just kind of like you said, acceptance-based therapy, kind of say, not everyone's going to have the same experience, but everyone has a number. There is always a number you can get to that will get you moving in that direction you want to go, and how that feels is going to be, how it feels, and where it settles is going to be where it settles. But when we go out and scour the research, looking for the truly weight loss or fat loss, resistant individual outside of some of these, you know, kind of fringe cases we talked about with localized-- - Yeah, like the non-clinical weight loss is the resistant person. - Exactly. We haven't found it yet, right? Everyone's got their number, and the goal with weight loss, if you're a practitioner working with a client is, how do we find your number, get you there sustainably, and kind of support you through that process of getting you down to where you are trying to get? And if I might to test your model for the audience, there are some GLP1 trials that have participant level information or the range reported that have reported no one not losing weight. - Yeah, some of the small trials. - Yeah, and yeah. - Yeah, there was a study with 1.3 million subjects that was looking at, it was like a weight loss intervention where they had all these different support groups that need, and they found of the people who met a certain threshold of attendance, and again, this is a very low touch intervention. This is not an injection. - It rests. - Come and talk about what you're doing. - Yeah. - Even among that low touch intervention of the people who actually attended a bunch of the events, 75% in this study lost at least 5% of their body weight. So like-- - Yeah, I think the GLP1 is probably more, of a direct test of what you're stating because-- - Press. - Yeah, it is directly going, it's putting you into the physiological state of, I just ate two kilograms of broccoli, and I feel like that all the time. - Yeah, you know what I mean? - Exactly, yeah. - No, on the pure physiology and appetite regulations, I absolutely. But yeah, so when you start looking at opportunities to kind of stress test this idea, it really does start to fall apart, right? So the goal is how do I, in the most sustainable, health promoting way possible, implement the changes I need to implement in order to get things moving at a pace I can live with. It may not be the pace you want, but the pace you can live with, right? And so, yeah, man, your results may differ, mileage may vary, but the process is what it is, and it is available to all. Also, yeah. Folks, that's us looking at ourselves, and that's you looking at us. I just want to say thank you for continuing this sport iron culture. This is a cool opportunity where we're getting to speak to each other live, which creates a different dynamic that I, I found I actually like, it feels more of a natural conversation. We're going to be listening together, and let me ask you a question, Tracks. Did you bring your lifting straps? - I did not. - Well, it's a smart thing he didn't, because the only way that the elite FTS straps would fail is if you left them on Australian and you couldn't use them again. So smart move, I wouldn't bring such high quality lifting gear to a place where I could lose it forever. And if you were interested in getting something that you would purposely leave at home, just at the risk of potentially losing it, because it's just that good of quality, head over to elite FTS and use the code MRR10. At checkout, that's mass research review 10. And why is it called mass research review 10? Oh, that's right. This is Iron Culture presented by Mass. And if you're interested in learning more about these topics, Tracks has written a tremendous amount on energy regulation, that loss resistance and ways to deal with that. So if you're someone who wants to actually see those citations, understand those applications, and look at actually, we've got half of the studies you referenced in this talk, head over to massresearchery.com. And with that, I would say thank you, and we'll be probably doing one more episode recorded here live at Surface Paradise in Gold Coast at the SNA Conference of 2026. (upbeat music)