Fine Tuning Your Diet for Improved Body Composition

Practical and Effective Advice with Dr. Eric Trexler

Dr. Michael Ruscio: Hi, everyone. Today I spoke with Dr. Eric Trexler about sleep and about how to dial in your diet for optimal body composition. That may seem like a trite, vague, maybe even an “I don’t really care about that” topic which I fully understand. However, I think we struck an optimal balance between how can we try to help people realize eating behaviors that are thwarting their body composition on the one hand, but also making sure we don’t tell someone to just blindly cut your calories or kind of encumber them with tracking, which can seem difficult, arduous, and painstaking. There are definitely some great pearls here, and there’s also a great answer to the question of age-associated weight gain, meaning, is it just something that as you age, that your metabolism slows and you gain weight? And no, there’s actually a very empowering ray of hope there. And also, a few nuggets about sleep.

But really, if you’re trying to optimize your body composition and you’ve got some body fat that you’re not happy with, I was really happy with how this conversation came together. It provides some simple, actionable, insightful, and empowering techniques that you can employ to:

• Improve your diet
• Potentially see blind spots in your diet

It may be a healthy diet, but for whatever reason (will help you identify those in the body of the podcast today) it is thwarting your ability to get to a better body composition.

Dr. Trexler is an accomplished academic. He’s published over 40 papers, so he’s certainly no slouch, and he also coaches people. He has a foot in both academia and publications and also in real-world practice. He brings a very balanced and experienced perspective to the conversation today. With that, we will jump in with Dr. Eric Trexler.

Episode Intro

DrMR:  Hi everyone. Welcome back to another episode of Dr. Ruscio Radio. Today I’m here with Dr. Eric Trexler, and we’re going to be digging into strategies for weight loss, but also emphasizing how important quality sleep is, to make sure that you can hit your weight loss goals. I see a decent amount of overlap here. There are also more questions that I have regarding weight loss. The more experts I speak with, we’ve spoken with Stephan Guyenet, we’ve spoken with Chris Gardner, we’ve spoken with Mike Nelson, they all give us these great insights and I’m hoping that we can gain a further granularity regarding some of these insights today as we talk with Eric. So, Eric, welcome to the show.

Dr. Eric Trexler: Yeah, thank you for having me.

DrMR:  Can you tell people a little bit about your background before we get rolling here?

DrET:   Absolutely, yeah. My first experience with weight loss came as a wrestler. I wrestled in high school and obviously weight manipulation is a big part of that. I think that really fueled my interest in how we can manipulate body composition. I ended up doing an undergraduate degree in Exercise Science, and then a master’s, and then a Ph.D. in Human Movement Science. That program is very interdisciplinary, so my lab group did a lot of interventions looking at how different exercise and nutrition interventions affect performance and body composition. So weight loss was certainly a part of many of those studies. Outside of that I’m also a pro drug-free bodybuilder. Based on that background, after I finished my Ph.D., now I work with a company called Stronger by Science. We put out a lot of educational material and I also work with a lot of clients one-on-one.

DrMR:  Awesome. And you’ve published a number of papers, correct?

DrET:   Yeah. I think at this point, over 40 peer-reviewed papers, mostly dealing with some exercise or sport nutrition intervention.

DrMR:  That’s awesome. Knowing how hard it is to publish one, that’s commendable being at 40. Good for you.

DrET:   Yeah, I appreciate that. There were times during my Ph.D. where I was like, “Is it good for me?” There were plenty of late nights. But it was a really productive environment, where it was, “Just sink your teeth in and just study and study and study.” It was a really productive time for sure.

DrMR:  Well, one of the things I appreciate about those who published is they tend to be less heretical. When you do publish, you have to go through peer review, you have to cite your argument. So it tends to make people slightly less biased, hopefully less dogmatic and a bit more measured in their arguments. Hopefully, being measured in their argument is a by-product of looking at data that supports and refutes a position, thus safeguarding against that dogma. With weight loss, obviously this is an area where there’s lots of dogma. Certainly, I’ll admit when I was earlier in my career, I got swept up in some of that. When I was getting into this in college, that was when, at least in the circles I was running in, the low-carb train to weight loss town was the train.

I would’ve made these statements that calories don’t really matter, it’s all about the carbs. Of course, we know now that it’s not quite that simple. What I’d like to do is put on the board what my current understanding is, and then allow you to nitpick that. Let me know where I might want to amend my thinking, because certainly I don’t profess by any stretch to be a weight loss expert. But we’ve interviewed a few, and there seems to be this really important goal of caloric balance. But I also don’t think it’s quite as simple as just caloric balance. This is one of the things that I think Christopher Gardner’s work, especially his DIETFITS Trial suggested. Food quality seems to be a big driver of calories. With poor quality food, you pack on the calories very easily. So we might want to amend that to say food quality first, and that takes care of calories to a good extent. Then from there, we can refine one’s diet, especially making sure that they’re not overindulging on a certain food type that they tend to have a hard time satiating. Like with me, I can pack on healthy fats very easily so I have to be careful with that. As I’ve evolved my diet, I’ve had a monitor calories but it wasn’t necessarily the first thing that I went after. Is that generally true? Would you modify that?

DrET:   This is interesting because I think we probably come from two very different backgrounds in terms of the perspective where we’re viewing the question from. So, if I were to go back to my roots, which is the natural bodybuilding world, and say that food quality matters first, and then management of calories is second, or something along those lines. I don’t mean to twist your arguments by paraphrasing.

But that would get me a lot of negative feedback. But, I don’t disagree with what you’re saying. The reason is the perspective. I come from a natural bodybuilding world where if I were tell somebody, “Every single day, I need you to eat these many grams of carbs, these many grams of protein, these many grams of fat,” the client will do it. So at that point, we’re not worried about if we make these qualitative food swaps, might we influence the calorie intake number? Usually, the background I come from, the general paradigm is to, right out of the gate, manage the calories manually.

So from that perspective, I would say it’s the same approach, but inverted. We would say the most important thing is the number of calories, the energy balance. But the question is, how do we get there? And you could get there by very carefully managing food intakes and weighing everything and tracking everything really diligently. But, if I didn’t come from a bodybuilding background and I worked with more general population folks who don’t want to weigh and track and meticulously document every calorie, then I would have the same exact understanding of the literature, but I would phrase it more the way you do. I would say, “Let’s make some qualitative food swaps,” and in the process of doing that, we are going to affect our caloric intake. If we really need to get down to the granular details later, we can.

So I think we see it the same way, but it’s just a matter of, who is this information for? At the end of the day, it is about managing caloric intake from my perspective. But the question is, do you do that manually with meticulous tracking? For some populations, that’s absolutely a non-starter. If you try to go that route, you’re going to fail.

But for other populations, absolutely. It’ll work. You mentioned Guyenet. So I’m sure he would agree with us on that, but most of his work is focusing on how do we deal with some of the brain-related effects. In terms of how do we make change in caloric intake more feasible and palatable and successful with some of the neurobiology going on with dieting? There are a million ways to look at it. Everyone’s trying to make sure we’re positively affecting energy balance, to make sure that caloric intake is appropriate for the goal in mind. But the question is, from what paradigm do you view it? And what do you view as the most important parameters that we need to adjust? Does that make sense?

DrMR:  Yeah. And I agree. And I think part of the different ways in which we approach this come from the populations that we deal with. You’re probably getting most direct to the outcome, which is just measure. For me, especially given that we’re in a clinical setting with people who oftentimes will have IBS, that’s overwhelming them, and they have bigger fish to fry, so to speak, in trying to figure out what foods won’t flare their IBS, and the calories come second to that. So fully agreed though, that the end goal is the same. Likely, we just frame this based upon the populations that we’re used to working with.

DrET:   Absolutely. Yeah, because you could go into your clinic and because it’s a different population, you could say, “Hey, I’ve got the perfect diet for you. It’s this many carbs, this much fat, this much protein,” every single day. And there’s a low likelihood that that’s going to be a successful approach for you to take, based on the population. With some of my clients, I’ll say, “Yeah, we could get down to that, but we don’t need your diet to be that granular in terms of details. We can make this a lot easier on ourselves.” So there are times that even for me with the population that I work with most frequently, I’ll still say, “We probably don’t need to weigh and track every single morsel. Let’s make some big picture qualitative changes.” That’s going to work just as well for those goals. It sounds like you work a lot with people who have a very specific GI-related specifications. So the entire paradigm from which I’m coming basically assumes you’re a healthy person who doesn’t mind weighing and tracking everything.

Tracking Calories

DrMR:  Sure. And that’s where I’m hoping to glean some insights. If I had to try to generally describe our population, well, there’s people on different spots of the spectrum, some people may be just starting their journey of, “Boy, my gut’s a mess, I’m trying to recover.” Other people, hopefully, thankfully have gotten to the other end of that, “My gut used to be a mess, and now I can eat a wide array of foods. But I’ve got this annoying five, seven, 10 pounds, and I’m trying to get that off.” What I’d really love to be able to do is provide them with an approach that’s not too arduous. This is where I see maybe some utility in short-term tracking with some goals, help someone re-calibrate, figure out where they are over-eating or where they are off. I think that’s where dipping into your brain and the approach that you take, might help re-align people. Now, maybe my assumption is fundamentally flawed, and people need constant re-alignment. But how would you generally speak to that?

DrET:   I think you’re on the right track for sure. I think you’re correct. The whole idea that some short-term tracking is an instructive exercise, that is absolutely true. It’s also absolutely true that if you do that short-term tracking, and you glean some insight from it for the population you work with, you probably don’t need to be tracking in perpetuity. Now, if you were preparing bodybuilders to get on stage, you probably ought to track. You either have to track or you track it once and basically stick with the diet you’re eating every single day. But that’s not a particularly fun way to do long-term weight loss and successful weight maintenance.

I think what’s really important for that type of approach is this short-term tracking period is extremely helpful. You learn a lot about how many calories actually taken in, in a given day or in a given meal. It’s almost like when someone is having some financial issues with their budget, and you say, “Well, let’s actually do a really thorough accounting of where your paycheck goes every month.” All of a sudden they have this revelation of like, “Oh my God, I can’t believe I’m overspending on eating out this much on a monthly basis.”

It’s the same thing with tracking, where people will say, “Oh my God, did you know salad dressing has this big an impact?” And you go, “Yeah, of course it does.” So a lot of times there can be these light bulb moments. It has to be enough time that you’re really going to get their true dietary habits. What I mean by that is, on a one-day food log, you can be on your best behavior for a day. That’s not going to do it. You want to get to that point where they have to really settle into a normal dietary intake. So at least a few weeks in a row, of consistent tracking.

I don’t like to do the three days a week thing, because what you’ll find is for those three days that they track, their intakes look very different from the other four. So I like to make it a long enough period of time to get a really good pattern, and a consistent enough, consecutive days in a row, so that they can’t have these fluctuations where they get it together and they under-eat for the days they track, and then they compensate on the other days.

So it’s very instructive. It helps them realize on a typical day, “Where am I getting calories from? And where could I make really easy cuts that would meaningfully affect my overall energy balance?” I think it’s awesome to give people that learning experience, and then, from there you say, “Okay, now we have a good understanding of our typical caloric intake. We can identify some calories throughout the day that we frankly don’t mind losing.” It’s one of those things where you can make little cuts here and there and all of a sudden you’ve knocked 250 calories out of your daily diet.

And so from that point, the client has an understanding of carbs, fats, and protein, the relative amount they’re getting in, their total caloric intake, and at that point you can start saying, “Okay, now let’s take a look at what we should reduce. Should it be fat? Should it be carbs?” Typically, protein, if anything, is going to be under eaten in my population. I’m talking about people who are trying to build and retain muscle. In the general population, protein needs aren’t quite as high. But at that point, once you have that instructive lesson in place, you can start saying, what exact macro-nutrient parameters should we be tweaking? And what are the qualitative steps we’re going to do to induce that quantitative change, right?

DrMR:  And I really hope that for the people who are saying, “Well…” I picture in the office, a patient who will be saying, “Well, I just can’t lose that last five to 10 pounds. And I’m eating good,” and that whole kind of narrative. I really hope they will consider taking up tracking because as someone who prides himself on eating pretty darn healthy, it was a pretty eye-opening experience for me. You do see, but only after the tracking period, areas ripe for improvement. As one example, this is obviously not something that would be conducive to weight loss, but I like to have a few drinks on the weekends.

And when I started tracking my weekends, that is where I really saw I went off the rails. And typically the way this would look is, I’d have a few beers and then we’d end up having dinner at Cheesecake Factory, or wherever, and even a salad there is, I think, starting at 1,300 to 1,600 calories. And then I’d have an entree after that and I’d say, “Wow, I ate 4,800 calories today.” When I’m typically trying to get, let’s say 2,700.” I would make some simple changes where I started drinking tequila on the rocks instead, which I think, a glass of tequila has maybe 60 calories, whereas a beer has 160. You multiply that times three or four, that makes a big difference. You don’t use a salad dressing at the dinner that you eat out, and that can cut down 400-500 calories right there.

Then also for me, I really noticed that, and sorry Eric, to be sharing all this personal stuff, but I’m trying to find connecting points with our audience here. Also, I found that… And I think there’s probably a decent amount of people in our audience who are doing this, I was way over-eating fat. And as I started tracking, I started realizing I could be eating more protein and I was eating a lot more fat. To be honest, it’s because a lot of the higher healthy fat foods are easier to make than cooking protein, at least in my observation. So I really hope you reach people because it sounds like a pain, but if you can discover those areas where you’re off and then you can course-correct, and you don’t have to do this forever, and as Eric had just commented.

DrET:   Yeah, one of the things that, especially if I’m working with somebody who doesn’t want to actually weigh and measure and track all their intakes, one of the easiest places to cut is fat, for sure. Just by being mindful of those things, we can cut a really significant amount of calories out of a diet, and they don’t even notice. When you start cutting carbohydrates, all of a sudden you’re cutting handfuls of actual food volume out of the diet. You can look at your plate, and when it has 40 fewer carbs on it, that plate looks different, when you look at it. There are fewer spoonfuls of food traveling toward your mouth in that meal.

A lot of times with fat, we don’t even notice it. We’re not hungrier, we don’t get lethargic. Within reason, obviously, we need some dietary fat. Whenever there’s excess fat in the diet, a lot of times we can lose that and barely even notice. The point you brought up about weekend eating is extremely true, because we talk about consistency with dieting. It really is incredible when you think of the amount of sacrifice that goes into trying to reduce your daily intake, by let’s say, 250 calories a day. Then to look at how in the blink of an eye, on the weekend, you could eliminate that entire caloric deficit.

I really believe that that is a key contributing factor to why a lot of people say, “But 98% of the time I’m 100% perfect. And I never seem to successfully lose weight. There’s this extra amount of weight that won’t come off.” I really think it’s during that 2% of your week that you’re eating that way, but the magnitude of over-eating that can occur can really put a dent in all the effort you’ve had the week prior.

DrMR:  Yup. I’ve lived through that, but to speak to the person who might be going, “Ah, well what point is it if I can’t have any fun?” You can still have fun. It’s just you learn how to be more strategic with the fun that you have. There’s a whole menu of things you can indulge in. You can start to figure out what indulgences will not put you 4,000 calories over, and instead, may only put you 1,000 calories over. And that can be the difference between, “Okay, I’ve got nice abs now,” or, “Nope, I’m still complaining about not being able to lose the weight.”

DrET:   This is another place where the financial analogy works really well. So you wouldn’t look at your monthly budget and say, “I have a fixed amount of spending I can do. I’m just going to spend recklessly because I don’t like having constraints on it.” Obviously you wouldn’t intuitively make that decision. So you wouldn’t say like, “Oh, I can’t have elaborate ski trips to Utah several times throughout the winter. This sucks. I’m going to go off the plan.” You’d just say, “Maybe a quick trip to West Virginia might be a little bit more affordable, right?”

DrMR:  Great analogy.

DrET:   Yeah. I love skiing, unfortunately, I can’t spend my entire winter out in like a beautiful Chateau in Utah or California. So instead of that, every now and then I’d drive up to West Virginia. It takes a while to drive there, but it’s still a fun weekend.

DrMR:  Sure. No, it’s a fantastic point.

What About Fasting?

DrMR:  Trying to keep in mind an audience that cares but maybe isn’t going to go to that full extent of tracking everything, they still want to leave that little door open for some fun. Do you find intermittent fasting or fasting as a suitable approach for offsetting, “Okay I blew it on Saturday night. Maybe I’ve learned how to have a reasonable blowout, but I still went over. Now I’m employing a strategy of just having dinner on Sunday as a health-promoting, but also a good way to offset what I’ve done on Saturday night.”

DrET:   Now, I’m going to ask a follow-up question. When you say intermittent fasting, there’s time-restricted feeding, and then there’s the having entire days of your diet where intake is somewhere between zero and 25% of your normal caloric intake. So which are we referring to?

DrMR:  Well, I guess that’s a good question to get more granular on this. The way I’ve personally been doing this, and I advise those that I see in the clinic is, if you’re trying to offset something that happened earlier in the week, usually it’s the weekend, it’s Friday night, it’s Saturday night, I’ll recommend skipping meals on Sunday, and making that a partially-fasted day. Just having one meal, also being mindful that you don’t make that one meal so massive that you just end right back up at normal.

DrET:   It’s a meal, not a challenge, basically.

DrMR:  That’s one approach. I guess another approach would be just people consistently skip breakfast, and I guess, they’re all viable. What are you finding seems to be the most well-endorsed by people?

DrET:   When it comes to intermittent fasting, there are these two different strategies that sometimes share the same term. Which is why I try not to get too bogged down in semantics, but in this case I think it is two distinct approaches. So I find it really unfortunate that one borrowed the term from the other, because now it’s hard to separate them. I think both are viable. So let’s start with time-restricted feeding. Usually what people will do with this strategy is condense all of their caloric intake for the day within maybe a four to eight-hour period, okay.

If you have a single meal, one to three meals, you can squeeze them into that four to eight-hour period. And a lot of people find that they enjoy that pattern of eating because when they’re not eating, they can just forget about food. They don’t have to have several small meals throughout the day that remind them exactly how little they’re allowed to eat on their current diet. What they find is there’s also a satiety benefit, where they don’t seem to struggle as much with hunger when they’re on this time-restricted feeding window.

A good friend of mine, Grant Tinsley, is a researcher at Texas Tech. He’s done a few studies with time-restricted feeding. It seems to be a completely viable option. So I have no issues with it. Looking at intermittent fasting, usually what people will do is there are three main strategies people use.

• Alternate-day fasting
• 5:2 fasting, where they eat normally for five days a row and then have two consecutive fasting days
• Two fasting days interspersed throughout the week on non-consecutive days

Now, with this approach, a fasting day usually means that you’re either going to not eat any calories or at the most, you’ll have maybe 25% of your normal caloric intake. So if you’re on a 2,000 calorie diet, that’d be for the whole day, you would only have like 500 calories, at most. There’s been three meta-analyses on those different strategies, within the last couple of years. And what those studies tell us is intermittent fasting is a viable strategy that doesn’t seem to be inherently better or worse than normal caloric restriction.

The difference is, if you find that you are way more adherent, and compliant with the diet when you do intermittent fasting rather than a typical daily caloric restriction, then clearly one of these is going to be better for you. So, a common misconception of people who are getting into, “I want to start implementing research into my habits,” is a lot of times we forget we’re looking at averages. So when there are factors that influence our ability to stick to one of these strategies, that becomes meaningful information.

So to directly answer your question, I do think that type of strategy can be useful, viable and effective. However, the big caveat is obviously that this has to be done on a case-by-case basis because you have to consider the individual’s personality type and their history. My main concern is, I don’t like getting clients into a mindset where we have very large intakes, and then very restrictive periods. I don’t want to get on this back and forth, and back and forth because it leads us to some potentially problematic habits that start getting into binging and purging cycle.

So as long as you trust that the client can handle that, I don’t see any major issue with it. But it is something that, whenever you start to see that pattern developing, you have to keep it in the back of your mind. Are we promoting some of these cycles that might be more extreme than we’re comfortable with?

DrMR:  Sure, that’s a great point to not push someone into extremes on both ends, where you really blow it out, and then you really fast, maybe excessively to offset that. That’s a fantastic point. And that’s where I think the tracking can be helpful because that can help someone to hopefully not go as far off the rails when they do deviate, and therefore not need to maybe fast so deeply in order to offset themselves.

DrET:   Definitely.

DrMR:  Something else that seems to be helpful for people is focusing on protein. This is something that Mike Nelson shared. He said that he’ll start having people do either some time-restricted feeding or intermittent fasting as one strategy that seems to be fairly high in its acceptance. Then also focusing on increasing protein intake as easier recommendations that people who aren’t ultra-motivated will comply with. Would you agree with that? Would you modify that at all?

DrET:   First of all, love Mike. Really great guy. I agree. I think those are two very feasible strategies that can be adopted quite easily. Again, the whole point here is we’re trying to figure out… I don’t want to put words in Mike’s mouth, but it sounds like what we’re trying to do is get a client to, almost accidentally, reduce their caloric intake. Let’s find some strategies, move some things around. Let’s not get too focused on it, but we’re still trying to move that main number. And I think time-restricted feeding and intermittent fasting, absolutely. The research indicates those are effective ways to get that number to nudge a little bit subconsciously without directly telling them, “Hey, you’re on a calorie-restricted diet.”

Now, theoretically, some people might be able to really overeat in those feeding periods and negate the benefit, but I think the averages would tell us that’s an effective strategy, and protein is so satiating. I do agree with Mike that that is a good strategy, and the benefits of being on a high protein diet are very multi-faceted. There are many reasons that an increase in protein intake would generally be an advisable strategy for, really, a wide range of goals. So those are two very easy things right off the bat.

The main hurdle with the protein is that, preparing good sources of protein can be a bit cumbersome, in terms of meal preparation. But even if that’s a hurdle, you can start somebody out by even making the easy step a little easier and saying, “Let’s find a protein supplement that you like. And let’s start there and eventually you’ll get tired of it and then we’ll start cooking more.”

DrMR:  Well, you’re so dead on with the protein preparation challenge, and that’s another reason why I think I, and I’m assuming a lot of our audience, may overeat healthy fats. If I come home, and it’s been a long day, and I’m trying to just cobble together a dinner, I can have three to five eggs. I can have a block of cheese, I can have an avocado, and it’s like boom, there is a ton of fat in there that goes down very easily, and I can very easily over eat. But now I’m forcing myself just to take that extra five minutes, really, to put two fillets of salmon into the oven and cook that on… I’ll do a frozen fillet if I wanted to get this done quickly, at 425, for 15-20 minutes and then oftentimes it’s done. So you can find hacks to make it not that difficult, but you’re totally right, that the fats oftentimes require no preparation. And that’s why I think people either tend to overindulge on carbs or on fats, is because they’re easier to prepare than the protein.

DrET:   Oh, yeah. Carbs and fats, they’re just sitting there in your pantry or your refrigerator, basically ready to go. And the protein takes a little more effort. And I always joke with people, I get it. There was actually about a two year period, I would say maybe a year or two, where I was essentially an ovo-lacto vegetarian because I was just too lazy to cook meat. The process of getting it and thawing it and then… The meal prep for me was just a non-starter, so I would eat some eggs, I would eat some dairy, and I would get my protein that way. And for people who meal preparation is a big barrier, that is a viable strategy to get them started on a high-protein diet.

What is a Good Caloric Target?

DrMR:  So we see this structure emerging whether there’s a number of interventions someone can make that may not even require them to track, some fasting or intermittent fasting or calorie-restricted feeding, trying to optimize for protein intake. And if someone needed to go a step further, they could start tracking. One of the questions, albeit likely no one-size-fits-all answer, that I’m trying to give people guidelines for is, what’s a good caloric target? Mary Sue is now doing 2,000 calories a day. At the end of a week, can she fully judge if that is too high or too low for her? And how quick can someone read the feedback and make adjustments? And then also, how big should the adjustment swing be? If 500 calories at a time, I know there’s a lot there. But curious if people are going to go to that next step, how do they navigate that?

DrET:   Yeah, it’s a good question, and obviously we’ve got equations where a person we could put in there, biological sex, and height, and age, and all that stuff, and it’ll spit out a number and say, “Here’s your calorie number.” But in reality, there is some variation between people in terms of their resting metabolic rate, but the thing that really varies between people is their non-exercise activity. So just depending on how, generally active you are throughout the day, that can have a huge influence on your energy needs. So what I prefer to do, obviously, if I have no idea where I’m starting, I’ll use a predictive equation. There are several validated predictive equations out there. And I’ll say, “Okay, here’s a good place to start. But what we ought to do, at least while we’re getting this target set, why don’t we do a morning weight every day?”

And I obviously for some people with disordered eating histories, that might be a non-starter, but assuming that’s not a barrier, let’s get a morning weight with standardized weighing protocols.

• Wake up, use the restroom, get your body weight, wearing minimal clothing. And basically what we’re doing is titrating caloric intake.
• We’ll adjust the caloric intake upward or downward, as necessary, based on the trend seen.
• We determine how far we need to go to reach a maintenance level.

And so from there, it’s almost like a titration lab in chemistry class, right? We just add a little or reduce a little, and try to figure out, what is the caloric intake that’s required to be weight stable? So it’s a little bit of guess and check, but for most people, they either want to be gaining, or I would imagine most listeners are more interested in losing weight than gaining weight. Sometimes bodybuilders saying, “Hey, I got to gain all this weight.” But most general population, people either want to maintain or lose weight.

So let’s say you’re going to use this strategy and a client says, “I don’t have time to stay weight stable for three weeks. I want to start losing weight now.” You can do the same titration procedure, but instead of trying to titrate at a linear flat-line for their current stable weight, what you can do is say, “Okay, we want to begin losing 1% of your body mass per week.” And you start with a caloric intake that you think is low enough to achieve that. And if you start deviating from that projected trend line, you say, “Oh, we’re losing way more than that on a weekly basis,” then you increase calories, because obviously you’ve undershot it. If you notice that weight is not moving as quickly as you wanted, then you drop some calories out.

And to directly answer your question, how many calories?

• Usually I only move calories by maybe a couple hundred at a time. I usually like to keep the adjustments fairly manageable.
• The obvious exception to that is some people who, based on their personality type, just say, “Put me on a diet, leave me alone and we’ll adjust it in four months.” In that case, I’d say “Okay, well, let’s try to shoot low enough that we’re going to have sustained weight loss throughout the course of this, whatever predetermined period it is.”

How Sleep Affects Weight Loss and Body Composition

DrMR:  Now, two questions in one here, to segue us over to sleep. Are there some people that even when they’re executing correctly, they don’t lose weight. And is one of the most common causes of that resistance poor sleep?

DrET:   Well, there certainly are people that you give them a particular caloric intake, and weight loss doesn’t seem to match your expectations. And sleep can contribute, but it contributes in fairly indirect ways. Normally, when weight loss is not progressing at the rate we would expect, and let’s assume that adherence is perfect, so we’re not worried about things that contribute to overeating or cheating on the diet or anything like that. If we assume adherence is perfect, usually what can happen, some people have what we call a fairly adaptive metabolic rate. And their total energy expenditure as you reduce calories, it actually goes down a little more than it should.

Now that’s extremely critical to know. This is an area that I’ve published some research on. This is not unavoidable, and it’s not like there are no ways around this barrier, okay? It is a speed bump. It is not a brick wall. So some people, their metabolic rate and their energy expenditure adapt a little more than we thought it would, but there is a limit. It won’t just continue going down, and down, and down. So for them, we just have to make an additional adjustment. And then things tend to go in the right direction.

DrMR:  Oh, sorry. Is that adjustment having them get a little more daily activity in? Is it eating a little bit less? Is it both? Something else?

DrET:   Yeah. It really depends on what is going to be most tolerable at that time. So you might even give the client an option and say, “Okay, well we need to adjust this energy balance. We could do that with more activity, or we could do it with less intake. Which will be preferable for you?” And people vary a lot. For me, when I compete in bodybuilding, I really don’t mind just barely eating. I just really hate doing cardio, so I don’t. When I turned pro in bodybuilding, I did no cardio during that contest prep, which for bodybuilding is pretty atypical. But I was like, “Whatever, I’ll keep cutting the calories lower. It doesn’t really bother me that much.”

But some people are the opposite. They say, “No, let’s do cardio. I can’t lose any more food from my diet” So usually when there’s some metabolic adaptation going on, it’s real, but a lot of people think it’s insurmountable. Like, “Oh, my metabolism changed. That’s it. It’s not going to work.” And in reality, all it means is we need to make a slightly bigger adjustment than we thought, and it completely circumvents the issue.

But there can be times, to answer the question about sleep, where sleep does give us some challenges in the weight loss process.

• Poor sleep can affect someone’s ability to train effectively for their exercise component of weight loss.
• It can make you sluggish and subconsciously lower your activity level in subsequent days.
• It can also affect your ability to regulate your emotions. You can be more susceptible to negative emotions, stress, anxiety, and the issue on the dieting side of things is stress and anxiety, and for a lot of people, it can increase the likelihood of overeating.

DrMR:  Yeah.

DrET:   So it could be affecting energy expenditure, it could be affecting our ability to adhere to the diet, it could be affecting our performance in the gym, which obviously affects body composition. And what’s really interesting is there is some human research showing that two groups of people going through pretty similar weight loss programs, but one of them having some sleep restriction, they lost similar amounts of weight. But the group with restricted sleep lost more lean mass and less fat mass. And that’s one of those things that obviously would be disadvantageous for most people’s goals.

And then finally, one last thing to add here, sleep certainly has an impact on a wide range of hormone levels. And a lot of times some of these hormonal fluctuations can influence fluid retention. There are times where people that are overly stressed during weight loss, whether that’s coming from sleep restriction as a stressor, or psychological stressors, or physical stressors like exercise, excessive exercise, sometimes that can actually mask fat loss. And what I mean by that is, we’re still technically in a caloric deficit in this particular example. However, because fluid retention is increasing as fat mass is decreasing, we look down at the scale and we’re not seeing a budge in the direction we’re hoping for.

This is why sleep becomes important thing is it can affect our ability to train, our activity level, our energy intake, and our ability to even interpret our progress in terms of the number on the scale. So multifaceted effects that make it really challenging. So sleep, when dieting is critical. And unfortunately when people push dieting really far, one of the things we see is disrupted sleep.

How to Improve Sleep?

DrMR:  What do you do for people who are seeing sleep problems? One of the things that I’ve seen to be effective in a certain presentation is, especially if someone’s going too low-carb, getting them on carbs for some people can be very helpful, and then having people eat frequent meals throughout the day, and some people who are just fasting too much, this seems to be a consequence. So essentially just repleting the individual oftentimes, at least in those who I see with carbs, or with some calories, now that might be, if you go too far, antithetical to weight loss. But yeah, just curious how you’re getting around this.

DrET:   Yeah. So there are certainly dietary inputs that can affect this. And it actually makes a great deal of sense. So I’ve talked to people who have done some rodent studies, where they restrict the feed of the rodents. And they actually paradoxically become more active during the caloric restriction, because they have this natural urge that, “I shouldn’t be sleeping now. I need to run around in my cage and try to forage for food,” right? So what we do see is, it’s hard to go to sleep and get quality sleep when you’re going to bed hungry. There might be an evolutionary link there. But in any case, they’re dietary things that can affect our ability to get good, long, quality sleep. Certainly going to bed hungry is not a great option, and getting more specific, you generally want the meal that proceeds bed to be at least a couple hours before actually going to bed. But if there’s a higher relative contribution of calories from carbohydrates and protein, that’s generally good.

The research currently would indicate that you don’t want to have a really high-fat meal as your pre-bed meal. So that does line up with some of your observations about getting some of that carbohydrate back into the diet. I’ve heard anecdotes of people on ketogenic diets who notice that their sleep becomes a little bit disrupted, or they just don’t sleep as much as they used to. So you’re definitely not alone in those observations, there’s some research to back that up. So there’s the pre-bed meal, and there’s the fact that obviously you don’t want to go to bed hungry, and there are a lot of factors you can control that aren’t actually dietary in nature.

• A large contributor is caffeine intake. A lot of people underestimate how long caffeine remains in your system after you ingest it.
• The half-life of caffeine generally is estimated to be five to six hours. If you have a big dose of caffeine, even early in the afternoon, that can still be affecting sleep that you’re trying to get many hours after that dose.
• Regulating caffeine intake and its timing is one of the first things I address with my clients in sleep-related matters.

And in a surprising proportion of cases, just dealing with the caffeine issue fixes it. If we say it like, “Okay, no more coffee at three in the afternoon. That’s got to be gone.” A lot of times that’ll do it. So getting your caffeine shifted earlier in the day, and if that doesn’t work, lowering the dose, and in some cases, just getting rid of it.

DrMR:  Is your cut off about noon?

DrET:   I’d say that’s the easiest cut-off. Depending on their typical waking time and sleeping time, noon is usually a really easy rule. I’d say the first step would be none after noon, and then if that’s not working, maybe let’s just get rid of it altogether for a little bit and see if that works. And then if that’s still not doing it, then I proceed to some of these other things that are not diet-related, but do have big impacts on sleep.

DrMR:  Got you. Okay.

DrET: Some of the strategies here are:

• Maintain a regular sleep and wake cycle. Waking up at the same time every day, and going to sleep every day. It’s very tempting to try to sleep-in on weekends, and maybe stay up later on weekends, but the literature would indicate it’s much more favorable from a physiological perspective, to try to maintain normal times.
• Try to align those times relatively closely with light and dark cycles. It’s not always practical depending on the exact sunrise and sunset times. But generally speaking, when the sun comes up, wake up. And then when you’re tired at night, go to bed.
• Avoid light near bedtime, particularly blue light. That’s light anywhere in the blue wavelength spectrum. Avoiding that close to bed within two to three hours of bedtime is ideal. And you’ve probably seen people now have glasses that filter out those blue wavelengths of light. Some digital devices can now be set to do this automatically.
• Have a regular pre-bed routine to help you wind down at night. Maybe it’s reading, taking a warm bath or a shower, anything you can do to relax.
• Control your actual bedroom environment. Make sure your bedroom is dark and quiet and cool is really effective, and restricted only to sleeping. Make sure your bed is not used to study and watch TV and do all of these other things.

It’s really is helpful to establish some of these habits, and to really treat bedtime and waking time as a normal daily habit. It’s a process, right? So you get ready for bed, you remove yourself from screens and artificial light, you start your wind-down routine and it’s like clockwork.

A couple other things that get people, and these are coming back to the diet-related things or kind of diet-related.

• Nicotine use can be very disruptive of sleep  So if you are using nicotine and having sleep issues it may be the cause. There’s also many health-related reasons associated with nicotine products so that you’d probably want to scale back anyway.
• Alcohol use near bedtime. Sometimes alcohol makes you sleepy so many believe it aids sleep. But it actually reduces a sleep latency, resulting in falling asleep quickly but overall poor sleep quality, especially later in the night. It’s more likely that you’ll wake up prematurely, and be unable to get back to sleep. It results in lower quality sleep with a shorter overall duration.
• If waking up to urinate is an issue, you might want to think about tapering your fluid intake down over the late afternoon and evening hours. This is especially true for bodybuilders or those drinking copious amounts of water.
• There are some dietary supplements that can facilitate good sleep if everything else has failed. I do prefer to leave them as a last resort because I think these other more behavioral approaches and nutritional approaches are a little more palatable and generally more conducive to establishing good, healthy behaviors.

DrMR:  Yup. No, fully agreed. And I think the supplements can’t fully undo many of these lifestyle variables anyway, so they should really be looked at as something you stack on top of the lifestyle foundations.

DrET:   Absolutely. Yeah. So there are a few supplements out there that help. The one that everybody knows about is Melatonin and for good reason.

• Melatonin plays a huge role in regulating sleep and wakefulness.
• People often fail to take the correct dosage of Melatonin. The dosages on these products are usually far higher than they need to be. If you go to the store and see Melatonin dosed at 10 grams for some products, and you probably only need closer to 0.3.
• Start as with a dosage as low as you can find at the store basically and work up from there as needed.
• Before you make any changes related to supplementation, it’s never a bad idea to check with your doctor and make sure you don’t have any medical issues or medications that might interact.

DrMR:  Sure. Is there a second one that you like? And like you said, there’s a handful out there. I’ve just caught wind of these bioactive milk peptides that seem to have at least some preliminary evidence behind them from a very quick check. I’m curious about your thoughts on those or any others that you like.

DrET:   Yeah, I haven’t seen those yet as it pertains to sleep. So that’s interesting. I’ll have to look into that. A few that come to mind, magnesium, if your dietary intake is low, if you’re correcting a low magnesium intake, that can help with sleep a little bit. Valerian root an hour before sleep can be helpful, and glycine can also be helpful. Usually like a three-gram dose an hour before sleep can be helpful as well. So those are the four that are toward the top of my list. And really anything that has a relatively calming or sedative effect, people will put it on the shelf in the sleep section and say like, “Yeah, here’s a sleep supplement.” So that’s by no means a comprehensive list, but those are the ones that you can least look at the research literature and find studies that say, “Right here, there is some legitimate evidence to believe that this would facilitate a good night of sleep.”

Why You Can’t Eat Like You Did When You Were A Kid

DrMR:  Sure. No, it makes complete sense. I want to ask you about where people can find you online next, but I want to make sure not to overlook this question. Oftentimes people will say, “Well, when I was younger I could eat whatever I wanted.” And my thinking is there’s two predominant things that drive that, but I haven’t fact-checked this, so I’m curious what your opinion is. One, your metabolic rate slows as you age, at least as I understand it. And two, I’m assuming that people are more prone to be active and are more active when they’re younger, and they become more sedentary as they age, so there’s this compounding effect, which suggests you can’t and shouldn’t eat as much when you are 38 as when you were 18. Is that the main two issues at play here or are there other things that are causing this perceived issue?

DrET:   Yeah. I believe those are the two main ones and I think the second one is far more impactful than the first, okay? So does resting metabolic rate go down as we age?

• Yes, by a very small amount. It’s really not a large magnitude of a change.
• The more significant change as we get older is non-exercise activity. It’s a huge contributor to our energy expenditure throughout the day.
• If you compare two people, same size, same biological sex, everything about them is the same except their day-to-day activity habits, maybe one works a strenuous job, the other one doesn’t. We can see that non-exercise activity between those two individuals can differ by up to 1,000 or even 2,000 calories a day.

DrMR:  Wow.

DrET:   So, yeah. The amount of change in resting metabolic rate we see as we age is a drop in the bucket compared to the potential ramifications of going from being a very active young individual who plays sports during their leisure time and is walking around school and campus all day, versus 10 years later when we’re stuck behind a desk, eight, 10 hours a day, and we go home and are generally sedentary. I don’t use those terms in a judgmental way, because I literally do not move anymore. It’s horrible. Like right now, I work from home. There are days where I’m like, “I’m not sure if I’ve actually moved yet today.”

So I’m not at all judging, but seriously, even for me, just going from being a grad student to someone who works from home, and not walking around campus to go to meetings and collect data in the lab and things of that nature, my energy expenditure has plummeted. And I’ve had to adjust my diet accordingly. So that is really, in my opinion, the primary contributor.

DrMR:  Yeah. And it’s such a fantastic point because I think it takes the culpability off of, “Oh, I’m just gaining weight because I’m getting older,” which I’ve never found to be a very compelling reason. And it puts the onus back on the individual to be a little bit more active. And a lot of this connects back to, I think, just good lifestyle practices to make sure… What’s the recommendation that some bodies are issuing?

• Make sure you get a small amount of activity every 45 minutes. Think of a college lifestyle, which is you have a class, you get up, you walk for a few minutes and then you’re in another class and you walk for a few minutes, and then you have to walk to your car. At a lot of universities, your parking lot was far from where all the classes were. Or you walk to the dorms.
• Try to move a bit more, replicating the daily tasks of living you once used to naturally do.

So yeah, I think it’s really important to underscore that because sometimes I think people get a little bit cynical if they don’t like what’s happening to their body, and then it leads to this said non-tactfully, this almost pseudo-self-hatred, when really there may not be anything at all wrong with you. But it’s not the hardest thing in the world, as long as your work situation isn’t one that doesn’t allow you to set a timer and say, “Okay, every 45 minutes I’m going to walk once around the building or I’m going to do a little short activity break.”

And it sounds like that can be pretty powerful, and I believe there’s a decent amount of evidence showing that non-exercise activity, as you just alluded to, does seem to track pretty tightly with weight or BMI or whatever measure the researchers are tracking. Is that correct?

DrET:   Absolutely. Yeah. If you look at all the literature pertaining to who successfully maintains meaningful weight loss for extended periods of time, it’s people with really high daily energy expenditures. You don’t have to be training for a marathon, you just have to be active. And you mentioned the idea of putting the onus back on the person. And my whole thing is, and I’m sure you agree with this 100%, I don’t look at it as what do we blame for this challenge, but more importantly, who do we empower to change it?

If you believe that it is an unavoidable passing of time that has caused you to now struggle with your weight, that gives you no power to change it. And that’s really the first step of the battle is realizing not, “It’s my fault for being here,” but more importantly, “I’m empowered to actually make meaningful steps to change this.” And sometimes people look at it as pushing blame on people who are struggling. And I say, “No, I’m doing the greatest thing you could possibly do for this person, telling them, “You, as you are right now, the exact person you are, are fully capable of making this happen.” And if that’s not good news, I don’t know what it is.”

Episode Wrap-up

DrMR:  Yeah. That’s a great optimistic note for us to close on. Will you remind people again of your website or anywhere else you want to point them online?

DrET:   Absolutely. Yeah. So you can find me online. My Instagram handle is @Trexlerfitness, and you can find me at strongerbyscience.com where we have articles and books and products and we have a podcast every Thursday as well.

DrMR:  Awesome. Well, I really appreciate it. This has been, in my mind, educational but also an empowering call, which I think is really important around the topic of weight loss because sometimes I think people do feel a little bit defeated. And hopefully we provided the audience with some tips ranging from simple all the way through pretty calculated. And I’m confident this will give people some implementation strategies for moving their body composition in a better direction. So thank you, Eric. I really appreciate it.

DrET:   Yeah, thanks for having me.

What do you think? I would like to hear your thoughts or experience with this.

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