#242 - AMA #44： Peter's historical changes in body composition with his evolving dietary, fasting, and training protocols
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Summary
In today's episode of the Ask Me Anything (AMA) Podcast, I'm once again joined by Nick Stenson to discuss the changes that have taken place in my nutrition and exercise over the past 12 years, and how that has impacted my body composition.
Transcript
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hey everyone welcome to a sneak peek ask me anything or ama episode of the drive podcast
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i'm your host peter atia at the end of this short episode i'll explain how you can access
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the ama episodes in full along with a ton of other membership benefits we've created
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or you can learn more now by going to peter atia md.com forward slash subscribe so without
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further delay here's today's sneak peek of the ask me anything episode
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welcome to ama number 44 i'm once again joined by nick stenson in today's episode we do something
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a little bit different i recently had a dexa scan and some blood work done and i decided that we
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would go back and look at the past i don't know 10 to 12 years of my dexa scan results through a
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variety of changes that i've made but specifically with respect to nutrition and exercise so we focus
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really on how my nutrition and exercise has changed over the past 12 years and how that has impacted at
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least one metric for the purpose of this discussion which is body composition so as our subscribers
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you have told us that you find great value in patient case studies and we figured for this time
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let's use peter as the patient so when this ama we go through my dexa reports for the past 12 years
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or so along with my most recent blood test and we talk about all of the changes that have taken place
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so when i went into ketosis for a prolonged period of time came out of ketosis spent a lot of time doing
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time restricted feeding spent a lot of time doing periodic prolonged fasts high protein low protein all
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sorts of things we also talk about the evolution of my training when i was primarily an endurance
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athlete versus now when i'm primarily strength training but obviously still doing what i consider
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an appropriate amount of endurance training so while this is a bit of a different episode my hope is
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that you'll find a lot of insight in here because even though we're using me as a case study a lot of
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what i talk about is i believe applicable to all of you because i know it's applicable to all of my
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patients and these are the types of discussions that i have with my patients every day as we review
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their dexa scans and of course their blood work now if you're a subscriber and you want to watch the
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full video of this podcast which is actually going to be pretty helpful because we are showing a lot of
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the images and the percentiles of changes in things like body fat visceral fat almi ffmi those sorts of
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things by all means make sure you check out the video of this podcast which you can find on the show
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notes page if you're not a subscriber you can watch a sneak peek of the video on our youtube page so
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without further delay i hope you enjoy ama number 44
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peter welcome to another ama how you doing i'm doing well but you look awfully cold it is negative
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degrees right now it's not good it's that time of year i feel like we've got nothing but snow
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for the past two weeks so it's just a matter of survival at this point there's nothing you can do
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i mean i know you miss it and that's kind of why you want to go back to canada is just
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the weather so it's fair but you can always come to minnesota can come live out here i think the
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whole time i was growing up in canada i kept wondering why did people live there prior to
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the industrial age like prior to heat and things like that like did it not occur to them that hey
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i could just walk south for a couple of months and i'll be in a place where yeah it's hotter in the
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summer but like i don't risk dying in the winter anyway well on that note we're going to do a little
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something different for this ama we kind of had a little something else planned and then recently
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in the past week you've gotten some labs and dexa results back and you found them really interesting
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and we were talking about them internally so we kind of decided to pull an audible and instead kind
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of talk through those because i think what we've heard from our audience is whenever we can do case
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studies and see like real world results and then how people tweak it they've always found that really
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helpful and this time the patient's going to be you so hopefully it's even more interesting and
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on the cold which we'll get to in a second i think the rate you're going you could survive in the cold
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a lot longer than you maybe could have 10 years ago ouch ouch i think what we're going to do is we're
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just going to kind of get into it it's going to be a little more old school kind of question and answer
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and going along the way but i think what would be helpful is a few amas ago a handful probably at this
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point we talked about dexa and we went through kind of how you think about that and then also
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what you do with patients and so what you have is you have a spreadsheet of dexas that you've done over
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the past 11 years and kind of how your body has changed throughout that time and i think what we'll
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do is we'll use that as an anchor to talk about like the various things and what you've seen from
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yours because i know in that time you've done a lot of different things from exercise to nutrition
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nutrition to everything else and i think it will be a good point to walk through that so do you want
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to just share your screen kind of pull up before i do that i'll just kind of give a bit of the
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background so growing up when my main thing was boxing obviously weight that's a very very weight
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driven sport especially if you're not a heavyweight which i was not i was a middleweight
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every ounce of non-essential tissue you carry into the ring is problematic so we relied on calipers at
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that time for body composition and as anybody who's either had a caliper test done or certainly
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done one or seen it understands it's not the most objective standard and it's highly dependent on the
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skill of the individual doing the test that said a person who really knows what they're doing with
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calipers is awfully good and pretty accurate fast forward to you know my 30s the next time i was
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paying attention to this sort of thing that's when i was doing hydrostatic testing so you would
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go to places that weighed you while dry and then weighed you underwater under the conditions of full
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exhalation and the ratio of those two weights your buoyant weight versus your knot and the use of
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archimedes principle would basically allow them to deduce how much of your weight was fat that turned
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out to be a pretty inaccurate way to go about doing things because again if for no other issue highly
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dependent on basically how much air is left in your lungs at the point of exhalation so i think it was
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probably 2011 so almost 12 years ago i sort of switched over to dexa scanning and for all intents and
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purposes dexa is the gold standard and we've talked about what that is so i'm not going to go into it but
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basically it's a type of x-ray that scans your body that effectively divides tissue into the following
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buckets very accurately bone fat other so the other is mostly muscle but of course it's also your organs
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and things like that so we look at dexas in a number of ways it's very good at giving total body fat
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because it's very accurate at measuring fat so total body fat divided by total body weight
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is your body fat percentage and as we've talked about that's the thing that most people care about
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when they get a dexa scan when our patients get dexa scans and we are really adamant that our patients
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get dexa scans at least once a year i think this is a very important thing to be doing when i run through
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the results with them i always say the same thing of the four things we're going to talk about today
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the least interesting of these is your body fat the three other things that we talk about are your
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visceral fat which is one of the compartments of fat that is outside of the subcutaneous stores
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that's the areas where we want to store fat if we're going to put excess energy away we want it to
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be in subcutaneous pockets of fat as our capacity to store fat there gets stretched we begin to spill
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over into other places we talk about this and i write about this in the book as the bathtub so
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everybody has sort of a different size bathtub that's their genetic capacity to store fat in the
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safe subcutaneous space the water coming in the bathtub is what you're eating the water leaving the
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bathtub through the drain is the energy expenditure you will either be net accumulating or net losing
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water in that bathtub but if you get to the point where you exceed your bathtub's capacity to hold
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water and you start to spill over really bad things happen nobody likes to have even a small amount of
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water on their floors and god forbid in their drains and heating ducts and that's what's basically
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happening when you start to see visceral fat when you start to see intrahepatic fat you know nafaldi
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is the earliest stage of that when you start to see peripancreatic fat perinephric fat pericardial
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fat all of these things are really problematic highly inflammatory and effectively what i would
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call the fourth pillar of disease so for example if you're talking about ascvd we talk a lot about
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apob blood pressure smoking we don't want to forget the inflammatory effect of those fat sources so that
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becomes the second thing we care a lot about third thing we care a lot about is bone mineral density
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so we care about a person's z scores and t scores recall from the podcast we did on that
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the z score is your age sex matched bmd for your lumbar spine and your hips the t score is comparing
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you to a 30 year old we use the t score to make the diagnosis of osteopenia if that's one standard
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deviation below the mean or osteoporosis if you're i believe two and a half standard deviations below
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the mean fourth thing we look at are the metrics the two metrics of muscle mass which are a l m i and f f m i
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appendicular lean mass index and fat free mass index these are two different methods to triangulate on
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the same sort of thing which is basically how much muscle mass do you have for your height so the a l m i
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is calculated by looking at the lean mass in your arms and legs in kilograms dividing that by your
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height in meter squared the f f m i takes the total fat free mass in your body and divides that by your
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height in meter squared obviously f f m i is a much bigger number than a l m i the absolute numbers aren't
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what matters what matters is where do you show up on the nomogram for your age and your sex and we want
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our patients to be north of the 75th percentile for a l m i and f f m i based on the data we've shared
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previously okay so with all that said i have kept a spreadsheet for better part of 12 years where i
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log my dexa data and you know it'll be interesting to go through some of that now so again let me just
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set the context because i think what we'll do when we go through this so people that are just listening
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to this i think i'll do my best and nick you'll do your best we'll we'll try to talk about the numbers
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but the reality is this is one of those things where it's probably helpful to be watching a screen when
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we talk about this stuff we're going to kind of talk about what was happening in my life at each
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of these time points how did things change because really there's a bunch of variables there's the
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passage of time more than a decade there's many changes in nutrition from very strict types of diets
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to fasting to completely unrestricted eating and then obviously there's dramatic changes in the type
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of exercise that's been going on there those are really the fundamental three changes anything else
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before we jump into this one thing i was going to say is i think anyone listening won't be surprised
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that you keep a spreadsheet of data of like across different health metrics and it's something that
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you do beyond just dexa but i've heard you talk a lot about it and i know with patients internally you
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create kind of a trend sheet which is like let's do a lot of work to up front get all their historical
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labs so then we can see how does this number compare historically as opposed to looking at
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this number isolating and so as much of a pain as it is for people whether it's dexa or even labs
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you put a high value in being able to look at something like this where you can say let's look
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at historically let's monitor changes as opposed to like i got a dexa i'm just going to look at it this
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time i got my blood run let me look at what it is now and then not focus on everything else correct
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yeah and there are companies that do this kind of stuff i mean we kind of build our templates in
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house i'm not i guess later i'll show kind of our in-house template for how we present the data
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and then if obviously you just have kind of like a table that records the historical data so you kind
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of present the current data in sort of graphical form and then include that along with all the
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historical data in tabular form so you can see the trends but yes i mean i think you know trends
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matter you're treating what you see but you're mindful of the trends okay so let me do a little
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screen share here and pull up the dexa data so what you're looking at here is a relatively
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straightforward spreadsheet that simply records the data as they've been laid out going back to
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may of 2011 what's interesting is that was the first dexa scan i ever had and i did it the same
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day that i had a hydrostatic dunk test so i had been maybe every year doing a hydrostatic dunk test
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and on that particular day and maybe it was the day before but it was pretty i think it was the same
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day i had a hydrostatic dunk test and it said something like 16 body fat and i was like well i
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sure don't look like i'm 16 body fat and then i decided to go and splurge for the dexa because at the
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time and there probably is still a significant difference in price so i went to the dexa scan and it was like
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no you're actually 9.3 which was kind of more in line with what i felt like i was and that was
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basically the last time i ever did a hydrostatic test now why again was there such a discordance
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between them i don't know maybe i'm someone who can't get a lot of air out of his lungs
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and therefore wasn't giving a good enough underwater weight relative to above water weight but
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regardless that's where i was call it 12 years ago so as you can see just to orient you to the
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columns body weight at the time was just under 180 pounds and then what's being spit out is
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what the dexa scan is really good at telling you it's able to tell you how much lean mass you have
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so that's basically muscle and organs call it 156 pounds how much fat mass 16.8 pounds
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the mass of bone mineral content seven pounds and then fat free mass which as you can see is just
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the sum of lean mass and bone mineral content 163 pounds so body fat is calculated at 9.3 percent now
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unfortunately this is back when i lived in san diego and i was doing these at san diego state
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university or something and they just didn't have the software at the time they weren't spitting out
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vat so i don't have vat recordings furthermore they probably gave segmental information on their
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reports but i wasn't paying attention to it so when i you know a couple years ago started paying
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attention to almi and ffmi didn't have the data i even called them up and they didn't have the reports
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so back then all i could tell you was what my fat mass index was and again i don't really pay that
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much attention to that metric but i do record it and what my fat free mass index was and we'll talk
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about that but i don't have almi until 2014 okay so what can i say looking at those numbers so a body fat
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of nine percent and i would have been 38 years old so i'm going to pull up my table of what that is so
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that's low right that's sort of below the third percentile so that's really lean
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and for an ffmi of 23.4 at that age it's above the 97th percentile that's the highest line on the
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nomogram so what was i doing at the time i guess that's the more important question so that's back
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in an era where i was swimming a lot and that was kind of my main thing like pool swimming i was kind
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of done with open water marathon swimming i was lifting weights like crazy and doing a little bit
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of cycling as kind of cross training and i was on a carb restricted diet but not a ketogenic diet so
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this was right before i started a ketogenic diet in fact this is the month i went on a ketogenic diet
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was may of 2011 so i was pretty carb restricted for a year before that okay so fast forward to the
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end of that summer i'm now i don't know whatever two three months into a ketogenic diet i go and repeat
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the test i've lost weight so i've gone from you know 180 pounds down to call it 172 and a half pounds
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lost about seven pounds some of that is lean so let's say i went from 156 down to 152 and a half
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so lost about three and a half pounds of muscle but lost about four pounds of fat bmc doesn't change
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and so body fat's actually gone down a little bit to seven and a half percent but also my fat free mass
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index has gone down a little bit to 23 obviously still plenty high just for reference at that age my
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goal would be to make sure that my fat free mass index is above about 19 that would be kind of the
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75th percentile real quick that's the 75th percentile for ffmi is what you want your patients at above 75
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or above yeah when there's discordance between the almi and the ffmi we tend to prefer the almi because
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it's we actually have more data for almi it's also a slightly more pure measurement why because in
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your limbs you really only have muscle fat and bone so the almi truly tells you about what its name
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suggests the appendicular lean mass index it is the index of muscle mass in arms and legs the fat free
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mass index i guess i need to be a little more clear is also true to its name but the reality of it is it
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is somewhat confounded by the organs so while we do that because it includes the musculature of the
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torso and things like that you'll sometimes see percentile discordance and in fact you see that in
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me we'll see that when we get to more recent data that i'm slightly discordant between those two my fmi
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tends to represent me at a higher percentile than my almi probably because i just have scrawny little
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arms okay so as we march through 2011 2012 and 2014 so you can see all of those tests
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those are all my keto days so what am i doing during this period of time well from 2011 to 2012
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i now transition into cycling so you see this change in my exercise where i am now spending just
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as much time exercising but now it's on a bike maybe even slightly more time so i'm still you know
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lifting weights but not quite as much but i'm on a bike five days a week two of those days are really
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really long days saturday sunday and then there's three weekdays where they're probably still 90
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minutes to two hours i'm still on a ketogenic diet and again i've talked about that a lot probably
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documented that i'm sure i've written about it someplace not really experiencing any downside
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of a ketogenic diet other than you know the restriction that obviously comes from it and you
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can see at one point this isn't my lowest weight my lowest weight was about 164 pounds but my lowest
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weight captured on a dexa was in october of 2012 and that was 167.5 pounds now by that point my lean
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mass was down to about 145 pounds so that's you know like 11 pounds less than the initial test in
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april pardon me in may of 2011 my body fat percent was like what nine and a half percent and my almi
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sorry we're still not calculating that but my ffmi is still about 22 so again as i talked about i sort
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of decided at the end of or at the middle of 2014 that summer that i was just kind of done with a
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ketogenic diet i think all my metrics of health were really good blood markers were great my performance
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was great it takes a while to adapt i want to be really clear it took three months to just even get
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over the cliff of maybe it got over the hump i should say of feeling kind of miserable when i
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exercised and i would say it took me 18 months to get to the point where i couldn't distinguish
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between being on and off carbohydrates but there's no question that it's just a very restrictive way to
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eat and so in the middle of 2014 is when i started to experiment with fasting real quick when you were on
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the ketogenic diet do you have an idea of how much protein you are having during that time compared
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to now because i know you talk so much about protein being so important and seeing your lean mass drop
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like 11 pounds from may of 2011 to february of 2014 it actually dropped six pounds were you getting as
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much protein as you are now you think thank you for listening to today's sneak peek ama episode of the
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