What, Me Worried?! A Metrics of Stress Case Study

Alfred_E._Neumann

Last week a client of mine came in whose numbers were seemingly inexplicably up.  I hadn’t seen him for quite a while and since he is usually 6-7% body fat it, he was quite dismayed by the numbers which had popped up to 12%.  He said he’d been eating the same and exercising as always and couldn’t understand how he could be up.  So I asked him what had been going on since I’d last seen him and he told me he was finalizing his divorce.  This on top of his day gig of running a billion-dollar private equity firm.  I gently suggested that his numbers may be attributable to stress.  “What?!” he snapped.  “I’m NOT STRESSED!”  Umm, okay, if you say so…”

I explained to him that with skinfold calipers, we can get inflated numbers because when we’re stressed the adrenals are overworked.  The adrenals maintain fluid balance so when they’re doing overtime we end up with some edema.  Of course, if stress is chronic, elevated cortisol also contributes to accumulation of body fat as well.

Some people handle their stress very well but may not be aware of how it’s affecting them physiologically.  This is where metrics can be invaluable for showing a client where he/she’s at and can be the factor in motivating them to change their behavior.

Kathy's Chart

My client Kathy is an excellent example of how important metrics can be.  If we take a look at her body composition chart you’ll see she made great progress but not without a few blips along the way.  This is real life.  But what’s so fantastic about Kathy is that she tracked all her food and exercise, and she wore a FitBit all day.  Since she was following everything to the letter most of the time, if one variable was out of whack, we were able to isolate it as the culprit.

So on Kathy’s chart we can see she was doing fine until Week 5 when her menstrual cycle showed up.  This is pretty common and will affect body composition due to water retention from increased inflammation.  It’s interesting to note that this was not a factor for the rest of her chart.  This isn’t surprising since one of the benefits of getting blood sugars under control is reduced inflammation, which in turn will reduce premenstrual symptoms.  We also see blips in weeks 21-24 due to overtraining, which is a subject we’ll address in another entry.

Of more interest for our discussion of psychological stress, however, are Weeks 11-15.   Kathy had done amazingly well, plummeting from 29% to almost 12% body fat.  Until the month of April killed us and she popped up as high as 17%.  Why?  Well, a job opportunity came up that Kathy really wanted.  She really, really, really wanted this gig.  And in April the interview process started.  A lot of people don’t believe me when I say stress may be the cause of elevated “body fat” numbers—whether from actual body fat or water retention.  But in this case, we had some amazing data because Kathy was wearing a FitBit the whole time.  So I asked her for some random screen captures of her heart rate during those weeks.

 

You can see that April 7 is our baseline day before she found out about this job opportunity.  Her heart rate throughout the day never really peaks past 100 until her evening exercise class where she topped out in the 130’s.  The second week her heart rate (not counting the evening exercise elevation) spikes past 100 twice and BPM’s are closer to 100 throughout the day.  The third week—and she’s in the thick of the interview process by now—heart rate spikes past 100 4 times and a little higher between spikes as well.  The fourth screenshot she surpasses 100 BPM 5 times and heartrate is considerably elevated between spikes.  And the fifth screen shot is the day of the final interview.  Her heart rate is almost 150 while NOT exercising!

KathyFitBit1
Baseline Heart rate under 100 except during exercise in the evening.
KathyFitBit2
Kathy just found out about job opportunity. Heart rate starting to peak past 100 during the day.
KathyFitBit3
Job interview process has started. Heart rate spiking past 100 at more points.
KathyFitBit4
Well into the interview process.
KathyFitBit5
Final interview. Heart rate is almost 150 during the actual interview!

This story, at least, has a happy ending.  Kathy got the job and she made a full body composition recovery two weeks after.  I was thrilled that she had the metrics for the month because they show:

  • That even GOOD stress (she really wanted that job!) can still affect the body adversely. Over-stimulation of the sympathetic nervous system still taxes the adrenals.  Sometimes clients say they are stress-free because it’s not negative stress as we’ve just seen, eustress—good stuff—still has a physiological effect.

 

  • Over stimulation of the sympathetic nervous system (stress) really does affect you physically! And skinfold calipers, though old school, are a great way to observe the adverse effects stress can have on your body composition.  Wild fluctuations in body comp can indicate fluid imbalance due to adrenal and lymphatic overload.

Just telling my clients that stress will make them fat or, in the short term, appear so is often too abstract for them to prompt behavioral changes.  They’ve heard stress does these things to the body—“yeah, yeah, yeah.”  But metrics make all of this tangible.  With a few simple tools—a heart rate monitor and caliper measurements–you can observe the effects of sympathetic nervous system overdrive on the body.  Simple metrics can be a great motivator to make big lifestyle changes.

kathy
Story with a happy ending: Kathy at her new job!

 

Adrenals, Schmenals! Part 1

For years, my acupuncturist would take my pulse and say, “What’s going on with your adrenals?  You shouldn’t get up so early and run around the basketball court for an hour and a half at 6 AM.”  To which she would add, “That’s okay, my adrenals are shot, too.”  Yeah, yeah, yeah, adrenals, schmenals.  Stress can be a very abstract concept.

Some clients handle their stress quite well.  They’re accustomed to dealing with a certain level and that becomes their new norm.  But they may not realize that it’s affecting their physiology, regardless.  So you can tell the client that they’re stressed and they may even admit it, but what exactly does being “stressed” mean in terms of how it’s affecting your body?  This is where hormone testing (along with caliper testing) can be helpful in convincing the client to change their behavior.

Cortisol
The numbers don’t lie.  And in my case (above), they weren’t pretty either.

Cortisol, if you haven’t heard, is a stress hormone produced by the adrenal glands.  It wasn’t until I saw my own results, that I realized how high my cortisol levels were—ahem…OFF THE CHARTS!!!  And guess when it was the highest?  At 6 AM when I was on the basketball court.  I started sleeping in from there on out and moved my workouts to midday and the afternoon.  Prior to testing, I only had a vague notion of how under sleeping and overtraining were affecting my health.  It wasn’t until I saw just how bad it was (OFF THE CHARTS!) and that it was a real, tangible, measurable thing that I changed my behavior.  I lost 8 pounds of water immediately.

If you have a sneaking suspicion that you may be pushing too hard on all cylinders and would like to know where you stand, you might just want to give stress hormone testing a whirl.  Having some solid numbers on which to base decisions can sometimes move you faster towards better health.

Food Quality Part 2: The Highlight Reel

Screen Shot 2018-04-21 at 4.18.52 PM

Last week, I introduced you to my client David and presented his body composition chart.  While the caliper numbers go into a formula for body fat, remember such reactively inflated numbers are usually the result of inflammation due to food intolerances or impurities.  When I mention “body fat,” I am referring to body fat but also the fluid that can be measured with the calipers.

Let’s take a look at some of the highlights of David’s chart.  The follow-up’s have been condensed to fit everything on one chart.  So if I refer to a follow-up number, know that several weeks may have passed prior to that follow-up during which body composition remained the same.   These status quo weeks are not shown on this chart.

  1. At the start of this run, David was coming off a lot of work stress. This reduced his hydrochloric acid production, which disrupted his pH balance.  A gut protocol of botanical supplements got his digestion back on track and immediately brought us to less than 8% body fat.
  2. There is a spike at follow-up 7. A few years ago, David had done a food intolerances test which revealed a high intolerance to dairy.  When he went back to a whey protein powder he still had a reaction and spiked up  in body comp from the 7’s to almost 9% body fat.
  3. Not wanting to throw away the entire tub of protein he’d just bought, he took used the whey powder half the time and substituted the other half with a vegan powder and his numbers immediately came back down.
  4. We had a slight pop up at follow-up 9 when David had a protein bar several times that week. When he looked up the ingredients, turns out it had whey protein in it.
  5. The week of follow-up 11, he finally completely cut out the whey powder and reached what was at that time, a record low in the high 6’s.
  6. At follow-up 12, David forgot about the moderate intolerance he’d had to almonds. This is further proof that even if you lay off a food for which you have an intolerance, you still may not be able to eat it every day.  In this case, David’s numbers spiked almost two full percentage points.
  7. Follow-up 16 illustrates why I’m such a stickler for obtaining Certificates of Analysis for supplements. Turns out that David thought he’d try another protein powder—not one of the two that I recommend.  He spiked almost two full percentage points.  Why?  When we looked at the ingredients, I won’t name brand names, but despite listing a bajillion “organic” ingredients, this powder also contains erythritol and guar gum.  These can be very highly inflammatory to the gut and may have contributed to the spike.  But we also don’t have a COA for this product and, therefore, don’t know what levels of heavy metals may be present.  Metals are a very common problem for vegan powders and not also cause inflammation  but disrupt fat burning as well.
  8. I was so proud of David during the week of follow-up 21. He finally gave up gluten!  His mother is Swedish so giving up bread was a big deal and I’d been working on him for years on this.  As you can see this was a record low and got us into the 5% range.
  9. Things were going quite swimmingly until follow up 22. David’s percentage jumped a one and a half points.  Since he rarely eats out it was easy to pinpoint the steak salad he’d had the day before.  I asked if it was grassfed.    Hmm…
  10. The next spike came about a month later. This time he zoomed from 6.5% all the way past 10%!  The culprit was a non-grassfed burger.  This was the second time that a grainfed burger obviously didn’t agree with David.  Sure enough, three months later we redid his food intolerances test which revealed a moderate intolerance to corn gluten.  Technically, there is no gluten in corn but this is the name for a processed form of corn that used to feed livestock.

Phew!  And these were just the highlight excerpts of David’s charts, you can see that not knowing how your body reacts to certain foods and additives can seriously hinder not only your body composition progress but your overall health as well.  The spikes on these charts are indicators of inflammation and we all know the litany of detrimental effects caused by inflammation.  So the next time you’re about to ignore the quality of your food, think about this highlight reel and remember this seemingly insignificant variable is actually the most important one.

 

 

 

Food Quality Part 1: “Little things make big things happen.”—John Wooden

John_Wooden
Coach Wooden: “There are no big things, only alogical accumulation of little things done at a very high standard of performance.”

These days my biggest pet peeve is when people reflexively dismiss the importance of food quality.  My initial approach to the subject is often met with rolling eyes and a knee-jerk assumption that I’m some sort of food Nazi.  We’ve been incorrectly brainwashed for so long to think that calorie intake and maronutrient ratios are the only things that matter and that the effect of food quality is only minimal.  The exact opposite is true.  Instead of counting calories and calculating ratios all day, you get much more bang for buck simply by cleaning up your food sources.

I understand.  Talk of organic produce, heavy metal contamination, endocrine disrupting pesticides, damaging additives, food intolerances, and inflammatory grains is very abstract.  Yeah, yeah, yeah, it sounds good but what effect do all those things really have?  Well, as Coach Wooden would say, those little things add up to something very big.

This is when data is really necessary.  Tangible numbers enable clients to see the results of their actions and convince them to change their behavior.  One of my favorite examples to show new clients David G’s chart.  David’s been a client of mine for about 8 years now.  He comes in once a week and has kept strict records of his diet and exercise for the entire time.  I don’t require that kind of dedication from all my clients but it’s awesome because his consistency week in and week out make working with him a fantastic science experiment.  He’s so good at keeping all the variables in place that if his numbers pop up, we can usually pinpoint the one thing that made things go wonky.

The irony is that David didn’t initially believe in the validity of food quality either.  But after spending so much time watching macronutrients and calories and still not understanding why numbers would go up or down, he decided to play around with food sources.  As you’ll recall from my post about body composition, the calipers are an excellent tool for measuring inflammation.  If there’s a food intolerance, impurity, or additive causing inflammation, it will result in water retention that is picked up by the calipers.  While the inflated number is water and not fat, 1) the bloat looks like fat and nobody wants that and 2) prolonged inflammation will result in metabolic disorders that will result in body fat accumulation as well as water retention.

From his chart, you can see how sensitive David’s body comp is to even slight changes in his diet.  Next week we’ll discuss each event in more detail.

Screen Shot 2018-04-21 at 4.18.52 PM 

The Russians Used Pencil: Measuring Body Composition Part 2

Calipers
Skinfold calipers: sometimes Old School really is better.

The Lowly Caliper Measures More than Body Comp

Last week, we looked at the shortcomings of methods for measuring body fat.   I’ve always leaned on calipers but in recent years I’ve started to like them for the very reason they are criticized.  Detractors will say that because when you measure with calipers, you are measuring everything under the skin.  Yes, fat, but this also includes water.  Critics will say this means that calipers aren’t accurate.  Not for measuring body fat, perhaps.  But the fact that they measure water under the skin makes them an invaluable tool.

Why?  Any stressor—lack of sleep, alcohol, high blood sugar, psychological stress, toxins, lack of sunlight, antigens, overtraining—will tax the adrenals, causing inflammation.  Since the adrenals are responsible for water balance, any sudden, significant increase in a skinfold measurement can likely be attributed to the adrenals working overtime.  Calipers actually help me pinpoint which foods and lifestyle factors cause inflammation in a client.  So the very thing that’s always been cited as the major shortcoming of the calipers actually make them a more informative tool than the other measurement methods.  Blood and cortisol tests would be too cost prohibitive to run on a weekly basis.  With calipers, though, I’ve been able to determine food intolerances and training thresholds conveniently and cost effectively from week to week.

While some love to poo poo the fact that calipers don’t give an accurate fat measurement because they don’t account for edema, water retention from inflammation is often more of an aesthetic issue than actual body fat is!  Get rid of the bloat and clients are already happier with their appearance.  And, of course, chronic inflammation leads to metabolic disorders, elevated cortisol, and increased body fat.  So even if the calipers are not measuring precisely only body fat all the time, they can provide invaluable clues as to what is causing inflammation.

The Russians Used Pencil: Measuring Body Composition Part 1

Ultrasound
This state-of-the-art ultrasound machine mostly collects dust in my office.

I once explained to a client of mine, who is a brilliant astronomer, why I prefer using old school skinfold calipers over my $2000 ultrasound machine—or a $20,000 DEXA machine, for that matter.  He said, “You know, NASA spent thousands of dollars developing a pen that would write in space.  The Russians?  They used pencil.”  This is exactly how I feel about methods for measuring body composition.

Every now and then I get into a bit of a scuffle with trainers over this.  I’ve seen thousands of clients in my practice and come across many methods of measuring composition, and at the end of the day I stand by the claim that Old School, as with many things—hollow body guitars, tube amps, stick shifts, film cameras, and pencils in space—is still the best way to go.

It’s also important to remember that all methods of body composition have inherent flaws and different methods yield very different results.  DEXA and ultrasound tend to be consistent with each other but will spit out much higher body fat percentage numbers than hydrostatic weighing, the BodPod, or calipers.  The most important thing is that a method is consistent with itself.  From there we look for trends.  Remember in science class when they explained accuracy vs. precision?

In this case, accuracy can only truly be known if we were to examine you as a cadaver.  Since this isn’t terribly convenient (and probably not desired), we settle for precision.  If methods are consistent and performed precisely, then trends in measurements should tell us whether or not a treatment plan is heading in the right direction.  And never, ever discount how you feel in your clothes or appearance.  You’d be surprised how many people have told me how great they feel and how many clothing sizes they’ve lost, and yet, they still run into my office crying (literally) when the machine tells them otherwise!  Never let a machine override your common sense or the glaringly obvious.

An Overview of Methods for Measuring Body Composition

  • While DEXA (dual energy x-ray absorptiometry) may be our new gold standard, the problem lies in human error.  Well, more like human laziness.  I’ve had many clients go for a DEXA scan, lose 3 or 4 pant or dress sizes, only to re-measure a year later and be told they’re fatter—considerably fatter—than they were before they lost the sizes.  This is impossible.  So where did the doctor’s office go wrong? Apparently, the machine needs to be recalibrated daily but most offices don’t do this.  They can let the machine go uncalibrated for weeks or even months!  If you do a DEXA scan make sure your facility has calibrated the machine the day of your test and get proof! Human laziness aside, DEXA is also not particularly practical for the size of the machine, cost, and exposure to radiation.
  • Bio Impedance Analysis is my least favorite of all body composition methods. While some scales are better than others—and certainly better than handhelds—I’ve never seen this method achieve satisfactory consistency with itself.  I used to work at a fitness club where we had a $4000 BIA machine.  I can’t tell you how many clients cried in my office over the numbers they got from that machine when they had, in fact, significantly improved their composition.  The machine was so finicky, if you breathed on it or shifted your weight or, most important, popped on it at anything less than fully hydrated, you would get a crazily inflated number.  Essentially, BIA measures the resistance to an electrical signal from one hand and/or foot on a sensor to the other hand/foot.  Since water is a conductor of electricity, if you are dehydrated even in the slightest, you will end up with an inflated number.
  • Hydrostatic weighing used to be our gold standard and while it has always been consistent with the BodPod and caliper numbers, it’s not particularly convenient to have a water tank or even a tub in the office. Nor is it fun for the subject to frequently slip into their bathing suit exhale all air from their lungs and then dunk themselves underwater…over and over again until they can maintain the required stillness.  Unless you’re experienced at drowning, most find it particularly unpleasant.
  • The BodPod results are consistently consistent with hydrostatic weighing and calipers, and, even more important, it’s consistent with itself. But like hydrostatic weighing, the Pod takes up considerable space, is not portable, and is wildly expensive.  It also doesn’t measure specific areas of the body so you cannot pinpoint problem spots or determine how fat is distributed.
  • Ultrasound is my second favorite method. It’s a convenient handheld device that is non-invasive, portable, and fairly consistent with itself.  It’s great for assessing visceral fat which lies under a layer of muscle.  Skinfold measurements can’t get to visceral fat.  This seems to be the preferred method of Tim Ferris.  But as someone who measures clients weekly, it is not as sensitive to small increments of change as the calipers.  And like the calipers it is subject to more error depending on the pressure applied by the wand to the site being measured.  The margin of error for precision because of this is actually much greater than it is with the calipers.  It’s easier to find a consistent measurement site and let the caliper spring do the work than it is to apply the exact same wand pressure to a site.  And while your main objective may be to measure only body fat, I find the calipers are actually pretty handy for assessing other things as well.  But like the calipers, ultrasound does enable you to see how fat is distributed throughout the body.
  • Which brings us to good ol’ skinfold calipers. Yes, they’re primitive but they’re still my go-to.  And I’m not the only one.  My friend who works with a fifth of the NFL, various college teams, and a huge Rolodex of professional athletes uses the same retro-green Lange calipers that I do.  He’s the only person I know who’s gone through more pairs than I have.  Yes, caliper numbers are subject to inaccuracies but I’ve found them to be more reliable than any other method in the hands of an experienced professional pincher.

Troubleshooting Caliper Measurements

  • Site consistency. The measurer needs to have reliable landmarks to measure and hit them every time.
  • Separation of fat from muscle. Most sites require some kind of flexing and relaxation of the muscles in the area to help separate fat from muscle.  Too often—almost always—I see trainers just grab people and measure.  This happens at the highest levels of professional athletics, by the way.  I’ve had NBA players report back to me with horror at the lack of technique often involved in team measurements.
  • Multiple measurements Most trainers will only take one measurement.  I take at least three for every site.  All should be within a millimeter of each other and if there are outliers, take more measurements until they are consistent!

Next week, we’ll discuss an even more important function of calipers as a tool for measuring inflammation.

 

 

All or Nothing is an Excuse to do…NOTHING

Sinatra
“All or Nothing at All” is only great if you’re Ol Blue Eyes.

When Sinatra crooned “All or Nothing at All” with Tommy Dorsey’s band, it was romantic.  Hey, I fell for it, too, and like many of my clients, applied the same OCD principle to other areas of my life.  Until I finally realized…it wasn’t working.  I’ll admit, a certain amount of obsessive compulsion makes the world go around.  It fuels the kind of persistence needed to make things happen.

But for people who are obsessive compulsive about their obsessive compulsion, it’s just not a very good long game strategy.  “All or nothing” is another term for perfectionism, and perfectionism is a really just an excuse to do nothing.

I can’t tell you how many times I’ve had clients blame their bad results on perfectionism.  They have one little slip-up and instead of getting right back in the saddle, they use their perfectionism to justify a landslide.  So one Oreo turns into twenty.  One chip turns into the whole bag.  One French fry becomes the entire plate. “You see, I’m an all or nothing kind of person”, they brag, as if it’s some kind of badge of honor.  It’s not.  It’s an honorable sounding reason to be lazy.  You’ve already set yourself up for failure because who can be perfect all the time for the rest of their lives?  No one.

This is such a common issue among my Type A clients who think they’re taking a macho stance.  “I’m so intense, I can’t do anything unless I do it all the way.”  It seems like an admirable creed until you realize over the course of a lifetime, it’s not sustainable.  It can work for a six-week training camp leading up to fight night, but who can train like that day-in-day-out, for weeks, months, years, decades?

And when applied to exercise, “all or nothing” can be dangerous.  On the one hand, people will often use it as an excuse not to exercise.  If they can’t do a full hour, forget it—not worth the trouble.  Or if they can only do 3 days instead of 5, there’s no point in doing 3.  So if they can’t do it “all the way,” hey, guess what?  They don’t have to do a damn thing!  We all know what kind of metabolic and structural issues this leads to.

While lesser known, the flipside to “nothing” is overtraining, and it can be just as harmful.  Earlier in the year the American Journal of Medicine published an article on several cases of rhabdomyolysis, a life threatening condition involving muscle breakdown due to over-exercise—in this case, spinning.  In my practice, I see a laundry list of other more common consequences of overtraining as well.  Dysbiosis—an imbalance of gut bacteria—is especially common in endurance athletes.  It can lead to GI distress, metabolic and immune dysfunction, not to mention adverse effects on body comp.  Over-exercise is a stressor to the body, which results in soaring cortisol levels, structural breakdown of muscle and joints, depressed immunity, and mood disorder.  So what’s so sexy about going all out all the time?

As I mentioned before, “all or nothing” has its place.  It’s good for short term goals, fight camps, bursts of inspiration.  But smart athletes have an off season.  And they don’t give up when a wrench gets thrown in their plans either.  Imagine if one of my fighters quit training camp because he didn’t get his morning run in one day.  For my recovering obsessive compulsives—and God knows I’m one of them, too—let’s take that Type A mentality and channel it towards something productive.  All my most successful clients have done this.  Train smarter, not harder.  Work hard at being more forgiving of mistakes while staying the course.  Be obsessive compulsive about not being obsessive compulsive.