What do we know about the genetic influences for individuals with extreme visceral fat excess and what additional guidance/recommendation should be provided to these patients?
As a result doing body composition assessments via DXA for many of patients, I am noticing a non-insignificant number of patients with visceral fat at the 99% percentile for their demographic profile relative to about the 60-80th percentile for the total fat index. Some questions I worry have not been adequately addressed or answered thus far by the current research: 1. What are the genetic influences that lead some individuals to significantly over produce visceral fat? 2. What is the fraction of influence on visceral fat from diet versus genetics? 3. Should we be doing additional hormonal testing in these patients (i.e. lower threshold to screen for testosterone deficiency in males) Should we have a lower threshold to offer testosterone supplementation (https://pubmed.ncbi.nlm.nih.gov/34089171/)? --> From https://ncbi.nlm.nih.gov/pmc/articles/PMC8089287/, semaglutide was associated with visceral fat reduction by 27%. From https://diabetesjournals.org/diabetes/article/72/Supplement_1/758-P/149195/758-P-Changes-in-Liver-and-Abdominal-Fat-in, visceral fat decreased by 36% 4. Beyond using semaglutide and tirzepatide for these patients when appropriate, emphasizing the benefits of exercise + caloric deficit for reducing visceral fat, and advising to minimize intake of ultra processed foods, what else should we be recommending? --> These patients are much greater risk for health complications and thus I feel more aggressive therapy and more comprehensive guidance is needed. I would love for you to do episode or AMA on this topic
Huel
I typically train first thing in the morning in a fasted state. I used to follow the training session with a whey protein shake, but after I started wearing a CGM I noticed that the shake caused a sizeable glucose spike. I have since switched to using Huel Black as my post-workout meal. I like the macros and one serving has 40g of protein. I've seen mixed reviews from dieticians on the product (the most credible concern seems to be too much Omega-3). Have you given these "nutritionally complete" powdered meals any thought?
heart rate recovery
In the studies, HRR was calculated as the difference from peak heart rate and the heart rate one minute later during which time the individual walks at 1.5 mph. Why use walking at 1.5mph instead of rest for the 60 second interval? It would be far easier to reproduce the study method if rest was used.
Spine health: More lost after the episode with Stuart McGill
Good thing: learned how to not destroy my spine Bad thing: I know what not to do, but I don't know what to do. What are alternatives to deadlifts that would: a) get us the same benefit as deadlifts b) without the huge downsides of deadlifts ?
Asymptomatic High Uric Acid
Hey, sorry for a second question on this topic, but I'm just going back over the results of this large cohort study in Sweden: https://www.ahajournals.org/doi/10.1161/JAHA.122.027089#d1e814 and wondering if our recommendations for optimal Uric Acid levels are way off the mark. This is compounded by the slight increased risk of AF in people who do large amounts of exercise so in the 'healthy' population, should we (clinicians) be more aggressive when addressing Uric Acid levels across the board?