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.

 

Change Your Diet, Change the World

Car wreck
Did a bad diet cause this?

At the beginning of 2016, some speeding lunatic on the 405 took out the car on her left and me to her right, before spinning out and removing the entire front of her own vehicle.  She totaled all three of us, shut down three lanes of the 405—which made her very popular with all her fellow drivers—and I had to lay to rest my beloved Scion TC of 11 years.

Later that day, the Uber driver picked me up to take me to Hertz.  “How has your day been?” he asked.  Huh.  “I’ve been better…but at least I’m alive.”  I told him about Speeding Lunatic and he told me about the psychopath doctor who had assaulted his fellow Uber driver that week.  “You know what I think it is,” Mr. Uber offered, “and people think I’m crazy for saying this…it’s the food.”  Amen!

No, I don’t have a PubMed study directly linking assaults on Uber drivers to artificial sweeteners, but something is clearly wrong with the energy of this country.  And while I don’t think changing the food supply will entirely solve the problems of internet trolls, corporate corruption, police brutality, mass shootings, or the terrifying joke that is the state of our political system, I do believe it is foundational to getting us out of the cluster you-know-what we find ourselves in.

As an example, our food supply is highly estrogenic.  From soy to plastic containers, endocrine disruptors are everywhere (don’t get me started on personal care products).  Soy lecithin is in everything as an emulsifier to make your sauces, dressings, and chocolates creamy and smooth.  And so many of your beverages and prepared foods are packaged in plastic which leaches estrogen.  Little by little, all of this adds up to enough to hinder your brain.  I’m not kidding.  There are tons of studies you can find on PubMed linking impaired cognitive ability to phytoestrogens.

Now Estrogen Brain may or may not have contributed to Speeding Lunatic’s brain fog that morning.  Point is, there are a LOT of things out there making us sick in all kinds of ways and my Uber driver hit the nail on the head—so much of it is in our “food.”  I can’t even call it food.  Artificial sweeteners and emulsifiers unbalance gut flora.  Did you know most of your neurotransmitters are produced in the gut?  Yes, gut health determines your state of mind!  Soy (unless it’s non-GMO) and plastics slow down cognitive function.  Genetically engineered super gluten, pesticides and herbicides, and products from hormone-treated and grain fed animals are all highly inflammatory.  These things make people chronically sick.  Sick people don’t feel well.  This makes them angry and do stupid things.

No, cleaning up our eating habits alone will not solve all our problems but it’s a start.  The start.  Cooler heads will not prevail until we are thinking clearly, and clear thinking starts with what we put into our bodies.