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Calorie Counter: Why "Calories In, Calories Out" Hypothesis May Not Be Telling You the Whole Story

Dr Arun K Chopra

Ship Shape May 19, 2019

We discussed some limitations of the “Calories In, Calories Out” hypothesis here last week, which suggested that assiduously counting one's calories does not help in fat loss or weight maintenance.   Are we really looking at the “Death of the Calorie”, as suggested by a recent cover story of The Economist's 1843 Magazine?   Do calories matter at all? Of course, they do! But not in the way most people think.   Calories In   Let's look at why calories are thought of to be critical for weight loss/gain in the first place. If we were to give a group of people food prepared with a pre-decided calorie and nutrient content (ratio of carbs: fat: proteins), and control everything else (i.e., work done, calories spent, etc.) without allowing for any extra food, one is unlikely to observe much difference in the weight lost or gained in the short term (within a few days or weeks).   However, there is now sufficient data available that proves that different foods are handled by the body differently. While carbohydrates are quickly digested (within 2-3 hours, with lesser calories burnt), proteins and fats take much longer (about 8-12 hours, with many more calories burnt in the process).    This implies that net calories gained from eating foods is different from a simple addition of all calories consumed.     Further, the gut responds differently to different foods. The hormones that signal satiety (a sense of fullness after a meal) are secreted most profusely in response to fat consumption. Therefore, one feels fuller earlier and for a longer duration while consuming a fatty meal vs. a carbohydrate-based meal.   There is data available which proves that the net calorie intake in a day is lower if the fat content is higher than the recommended 30% of all calories (perhaps closer to 40-50%). And that’s how calories indirectly kick in - if we consume more fat and protein compared to carbs, we eat lesser (total calories in a day) and crave food less than if we consume >50-55% calories from carbs (which is the norm in most parts of the World today).   Over the long term, a difference of 100-300 calories per day in the food intake and the extra work done in digesting fats and proteins is responsible for the greater weight loss and fat loss that’s seen with low carb diets.   Also, the real world is not like a controlled study. Here, there are meetings, deadlines, sleepless nights, travel, parties, and much more, which makes it much harder to ensure portion control. The easy digestion of carbs encourages frequent snacking, often leading one to consume unnecessary calories. Carbohydrates are also known to activate brain reward mechanisms, that lead to the pleasurable experience associated with intake of high-calorie, especially high sugar foods, that one craves repeatedly, which is why people get addicted to desserts and colas.   Is it then not better to eat foods that provide early satiety, that we can eat to fullness, not feel hungry or cranky all the time, rather than eating a measured proportion of food that leaves one dissatisfied?   Calories Out   The other side of the equation is exercise. Undoubtedly one of our healthiest activities - exercise, goes a long way in maintaining health and fitness. It also helps in weight maintenance, when accompanied by a good diet. However, despite being intuitive, it comes as a surprise that in the absence of a healthy diet, exercise alone does not help in weight loss, especially as one ages. A study published in 2006 showed that even regular runners would gain weight year on year, unless they increased their running distance by about 3 km per week for men, and nearly 5 km for women.   This suggests that people running in their 20s would need to run marathons every week in their 50s in order to avoid gaining weight - a very impractical idea. The only exception could be elite athletes, who can burn over 1000 calories in their workouts.     Another problem is the apparent lack of energy or disinclination to exercise that many people face after a few weeks of diet control. Again, the carbs in our diet make everything else (fats and proteins) unusable for providing energy - carbohydrates get digested first while all the other calories get stored as body fat. This means that one has to eat still more to find the energy to exercise or eat less and feel lethargic all the time. Also, as one grows heavier by eating more, the appetite increases further, and a vicious cycle ensues.   Thus, our appetite appears to be a function of what we eat, as is our ability to exercise.   Conclusion: A healthy diet is better than calculating CICO and getting frustrated.   In summary, calories do matter, but different foods are metabolized differently by the body, and thus have variable effects. If you are watching your calories, please watch your food choices first. Moving towards healthy foods may avoid the need for any rigorous portion control or calorie count, which is nearly impossible to achieve in any case. Eating healthy also improves our exercise capacity, making the circle complete.   This is a recurring column published every Sunday. Click here to view my other articles on health, nutrition and exercise.    (We are now on your favourite messaging app – WhatsApp. We strongly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

Count Your Calories: Is "Calories In, Calories Out" A Weight Loss Tip or a Myth

Dr Arun K Chopra

Ship Shape May 12, 2019

The Amercian doctor and author LH Peters in what was perhaps the first ever book on nutrition Diet & Health: With Key to the Calories proclaimed:   “You may eat what you like… but count your calories!”   Published in 1918, and the first one to sell over a million copies, Diet and Health led to a mathematical understanding of obesity - the so-called CICO hypothesis (Calories in-Calories out).   A relatively simple concept which is easily understood by most:   One gets fat if one eats more and/or exercises less than is needed according to one’s height and age.   In order to lose weight, all that one needs to do is to reverse this equation i.e. exercise more and eat less. This seemingly simple process has been followed, and is still sworn to by millions of individuals worldwide in a bid to lose fat and become fit. However...mostly in vain.     Studies over the last century have shown consistent results. Most serious dieters lose 5-10 kg in the first 3-6 months, after which their progress plateaus, followed by a slow regain of the lost weight (roughly 90% of the dieters regain at least half of their lost weight within 2 years; many of them even more). As most succumb to inertia, leading to lethargy and overconsumption, they remain overweight/obese. It would be worthwhile to ask why efforts of millions of humans and countless scientists failed to crack this seemingly straight forward task?   As Sherlock Holmes said to his friend Dr. Watson, “…when you have excluded the impossible, whatever remains, however improbable, must be the truth.” This might leave us with an uncomfortable truth - there must be something wrong with the CICO hypothesis.   A Calorie (or a Kilo calorie-kcal, or 1000 calories-cal) is a unit of heat-defined as the amount of energy needed to raise the temperature of 1 liter of water by 1° C. Wilbur Atwater calculated the energy content of foods in the late 19th century, and reached the conclusion that the energy content of carbohydrates and proteins is approximately 4 kcal/ g, while that of fat is 9 kcal/g. The average American adult was thought to need about 2000 cal/day for females and 2500 cal/day for males. The average calories needed to be burnt to lose 1 lb weight was estimated around 3500 cal (~7700 cal for 1 kg). This led itself to an easy interpretation - eat 500 calories less per day, remain active, and one should lose 1 lb per week (or 1 kg every fortnight).   This should be easily achievable by any dedicated dieter, and obesity should be rare. The facts, however, are mind boggling. Obesity has multiplied over 3-fold in the last 40 years, diabetes by 4-fold, and heart diseases have become mankind’s biggest scourge in this period. So, what are we missing?   What Are the Problems with Calculations of Calories Consumed?   The calorie concept does not differentiate between nutrients themselves, meaning that the calories from sugar, butter and meat have the same response once digested. However, we now know that while carbs are easily digested within 2-3 hours, proteins take over 6-8 hours, and fats even longer (8-12 hours). This means that not only does one remain full for a longer period after a protein and/or fat-based meals, but also burns more calories in digesting them as well. This shows that eating and digesting are more complex compared to the simple math given above.   The calorie concept also does not differentiate between the sources of nutrients, assuming all to have similar effects when eaten. For instance, all carbs are treated similarly, whether simple sugars, starchy vegetables like potatoes, or fiber-rich salads. While sugars are digested easily and lead to an early peaking of blood sugar levels, potatoes are metabolized much more slowly, even though ultimately even they get converted to simple glucose molecules. And fiber is indigestible, so has practically no calories (as the few calories that the food containing high fiber releases are used up in digesting them).   It also does not account for the effects of cooking upon foods. Chopping and cutting food items simplify the work of digestion, as does cooking, by breaking down food into an easily digestible form, making the calorie content higher. Simply cooling a food after cooking and reheating it lowers its calorie content somewhat, making it very difficult to count the exact amount consumed.   What Are the Problems with Calculating Calories Burnt?   The other side of the CICO hypothesis is fraught with similar complications. Excluding young athletes, one cannot exercise enough to lose weight consistently or even keep it off, if one is not watching one’s diet. For instance, it would take an average adult 3-4 hours of brisk walk to burn the calories contained in a scoop of ice cream, a piece of chocolate, or the friendly samosa.     For a normal healthy adult who is not into heavy running or weightlifting, the maximum amount of energy is consumed in unconscious non-exercise related activities like digesting food, regular working of the organs, especially the brain, and minor home and work-related activities.   The calories used in different exercises are dependent upon a lot of factors-age, body weight, current level of fitness and ambient temperature, among others. It is notoriously difficult to estimate the calories burnt in any activity, and the digital monitors on treadmills don’t really help.   Metabolism acts differently in different people, which is why some people rarely gain fat, while others struggle to lose it despite eating much less. This upholds genetic factors (some of which are under research presently) which determine how many calories are taken up and how many are passed out undigested.   Hence even if the CICO is a valid hypothesis, it is a rather complex calculation with many imponderables. If one were to eat the equivalent of just 20 calories extra per day, one would gain about 1 kg every year, everything else remaining the same. Also, one rarely sees the predicted results within expected time. Eating 500 calories per day less than usual for 1 month doesn’t bring about a weight loss of 2 kg, hardly 1 kg or so. And most people feel tired, often listless, lacking in energy and the drive to exercise, and dream about splurging on their favorite dessert; which they do, sooner or later. And that too lasts a few months; soon there is a plateau followed by a slow regain.   So, do calories not matter at all? Of course, they do. But not in the way people think!   More on this next week.   This is a recurring column published every Sunday. Click here to view my other articles on health, nutrition and exercise.    (We are now on your favourite messaging app – WhatsApp. We strongly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

Can A Social Beverage Save Your Life: The Good, The Bad, and The Ugly Side of Alcohol

Dr Arun K Chopra

Ship Shape Mar 03, 2019

Alcohol is commonly perceived as a "social beverage" - a friendly drink to lighten up your mood, relieve tension, induce sound sleep, and to top it all...protect one from heart attacks! Could you have asked for more!   Alcohol has been part of our culture for nearly 5000 years (described as Sura in the Vedic period). According to the WHO Global Status Report on alcohol and health 2018, nearly a third of the population of the world (age 15 years or more) - a mind-boggling 2.35 billion people (about 39% of males, 25% of females) consume alcohol. This is nearly twice the population of India. Just slightly more, about 2.4 billion are abstainers, while just over 2/3 of a billion are former drinkers who have now quit. Over a quarter of the world’s population between 15 -19 years, and 1/3 to over 1/2 of the 20-24 year old group, currently drink.   Studies conducted across the globe have common findings - low to moderate drinking protects against heart attacks, and probably diabetes as well. Only high drinkers (> 4 drinks per day for men, > 3 drinks for women) have higher mortality, largely due to alcoholic liver diseases (fatty liver, cirrhosis, etc.) and rare higher volume drinkers risk the chance of a heart failure (alcoholic cardiomyopathy).     The common thread is the presence of a J-shaped curve, i.e., low to moderate drinkers are less prone to some diseases than always abstainers (non-drinkers). The risk rises once people start consuming high volumes of alcohol daily - the most consistent evidence being found for heart attacks or occurrence of Coronary Artery Disease (CAD). It would be interesting to note that some of the diseases apparently less likely in low-volume drinkers are deafness, hip fractures, common cold, dementia, cancers and even cirrhosis liver.   This concept came about from the so-called French Paradox. The French consumed large amounts of saturated fats and smoked regularly, yet had a much lesser risk of CAD than other populations. Wine was postulated to be one of the possible causes for this unexpected finding.   Guidelines have consistently permitted (even endorsed) low-volume alcohol consumption regularly as a protective measure against heart attacks (Coronary artery disease or CAD), while stopping short of recommending never drinkers to start drinking, as the data wasn’t solid enough. Red wine has been noted to have the maximum data, probably due to the presence of a compound called resvetarol, and some other compounds.     All-in-all, the overriding belief has been one of tangible benefits with modest regular consumption of alcohol, apart from its positive social implications.    No wonder, a recent study conducted by AIIMS, New Delhi, reported alcohol as the most common drug used for substance abuse. Nearly 15% of the adult Indian population were regular drinkers, 1in 5 being addicted to or dependent on it.   Independent analysts, however, found these conclusions problematic. Subjects reporting self-consumption generally tend to under-report the amount of alcohol consumed. Moreover, data on patterns of drinking and binge drinking are often missing, and several health problems associated with alcohol tend to be ignored (uncontrolled blood pressure, accidents, inter-personal violence, depression, etc.). Many studies had been pooling previous drinkers who gave up drinking, often due to diseases, in the same group as never-drinkers, further confounding the analysis.     Recently however, a shift has been noted. Since it is a little tricky to collect data on huge numbers of individuals (hundreds of thousands, followed up over several years, in different age groups) to conclude benefit or harm with social drinking, combining results of multiple studies with similar design is a common statistical method used in clinical Medicine (meta-analysis and systematic review). This provides a rather unique look into the outcomes of millions of individuals from different parts of the world.   A major such analysis in 2016 on nearly 4 million individuals found no evidence of a survival benefit with alcohol. Next year, they analysed the impact on CAD events, and failed to find solid evidence of a positive effect on nearly 3 million subjects. This analysis found a protection against heart attacks in Whites over the age of 55 with low to moderate consumption, but none in individuals < 55 years of age, or in Asians.   So, to drink or not to drink, that is the question!   This was the background for the largest ever study on alcohol in 2016. Funded by a neutral organisation (Bill & Melinda Gates Foundation), the investigators reported on the outcomes associated with alcohol consumption in 28 million individuals from 195 countries and territories (in age group 15 years to 95 and above) from 1990-2016 by the Global Burden of Disease (GBD) 2016 Alcohol Collaborators in August, 2018.   They found that alcohol was associated with a disturbing 2.8 million deaths in 2016 vs 5.5 million associated with smoking, making it the seventh largest contributor to disease and mortality. Further, in the age group 15-49 years, it was the leading risk factor for disease burden worldwide, including 12.2% of all male deaths and 3.8% of female deaths. Apart from alcoholic liver disease, its regular consumption also increased the risk of uncontrolled hypertension, strokes (clot formation or bleeding inside the brain), tuberculosis, road accidents and several types of cancers. Data for interpersonal violence was missing, and may further increase the morbidity than what is reported here.   Some protection against heart attack was found in females > 50 years of age, and males > 60 years. This showed a J-shape curve, with the maximum benefit being for low-volume drinkers, consuming < 1 standard drink per day (10 g of ethyl alcohol). However, this benefit was offset by the much greater increase in risk of the above mentioned diseases, ultimately leading to no beneficial effect.   The investigators concluded that the net amount of alcohol correlating with minimum risk of disease or mortality is zero. As guidelines continue to uphold the cardio-protective effects of alcohol, a revision is urgently needed to correct this fallacy and prevent a big chunk of preventable diseases, just as for smoking.   In summary, alcohol is not the panacea it is often made out to be. Occasional social drinking, < 1 drink per week may be acceptable and even beneficial for the heart. Regular drinking is not better for heart attack prevention, and in fact, increases the risk of multiple other health issues, totally reversing all the putative cardiac benefits.   This is a recurring column published every Sunday. Click here to view my other articles on health, nutrition and exercise.    (We are now on your favorite messaging app – WhatsApp. We strongly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

Understanding The Myth Behind Converting Fat into Muscle

Dr Arun K Chopra

Ship Shape Jan 27, 2019

Our body comprises different organs and tissues...each having their unique role in its normal functioning. Apart from brain, heart, lungs and abdominal organs, readers may be familiar with two types of tissues - lean tissue (i.e. skeletal muscles and bones) and body fat. Perhaps I don't need to emphasise that lean tissue is good, and fats not so much. However, body fat is not all bad – some fat is needed for insulation against cold, while females need more fat for normal hormonal function aside from needs of pregnancy and lactation.   The amount of body fat desirable depends on age and gender - about 12-20% for healthy adult males and 16-25% for healthy adult females, rising with age.   However, with nearly one third of the population being overweight or obese, there is a large chunk of population trying to lose fat and build muscle to be fit.   That begs the question, can fat be converted into muscle?    Well, sorry to break the bubble but:   The conversion of fat into muscle is physiologically not possible.   In general, the body finds it easier to progress in one direction at a time - both during anabolism or catabolism. That means when you eat less but don't exercise, you will lose both muscle and fat. Similarly, if you exercise intensely and eat more with intention of "bulking up", you would gain both muscle and fat.    As discussed earlier, with heavy exercise, lean tissue constitutes about two-third of the gained weight, with one-third being fat. The latter may be minimised, of course, using professional help with diet and drugs/supplements - neither available nor desirable for most normal adults. Moreover, unregulated consumption of supplements do enhance risk of liver and kidney damage.    But this is not writ in stone. It’s indeed possible for obese individuals to eat sensibly, cut down on high-calorie refined foods and exercise regularly to lose fat and gain some functional muscle.     At this point, an important concept needs to be understood. Whether one is overweight, underweight or fit, the body is in a state of equilibrium. We provide a stimulus to the metabolism, using dietary modifications and exercise, which is followed by change until we reach a new equilibrium...commonly known as a plateau. Another stimulus is now needed to trigger further change in the desired direction. Either in the form of diet evaluation, or progression of exercise? Perhaps you need to increase your number of reps? Or lift a heavier weight? Or even slow down? Don't hurt yourself - but change should be your only constant which achieving your planned objectives.   There is a reason for the popular gym saying: everything works, for about 3 weeks; after that, you need to change. Hence, if one continues to eat and exercise the same way, day after day, one stops losing fat and building muscle after a few weeks: a change in the routine is again required.   Our cravings for certain foods, extremes of weather, social events and work pressures distract us from our goals, and need to be figured in and accounted for. Be patient, be steady, and don't lose focus.       This is a recurring column published every Sunday under the title: A Guide to Exercise.   (We are now on your favourite messaging app – WhatsApp. We highly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

Why is Protein a Diet Essential For Muscle Growth and Bodybuilding?

Dr Arun K Chopra

Ship Shape Jan 20, 2019

Proteins are well known as the building blocks of muscle. They are made up of amino acids, which are divided into Essential and Non-essential. Non-essential does not suggest unimportant. Its rather a medical term implying they can be synthesised in the body, while the Essential ones can’t.   Hence, Essential amino acids must be consumed as part of one’s diet, as their deficiency hinders effective muscle growth.    Further, proteins have the same calorie content as carbs (about 4kcal/g) but are much harder to digest. Nearly a third of their calories are consumed merely in digesting them. This means consuming proteins keeps us full for longer, and imposes a lighter calorie burden on the system, resulting in weight loss and muscle building, if supported by proper exercise.   Yes, muscle growth is a function of two inputs - proper nutrition AND exercise, both alone being inadequate for the best results.   Speaking of the nutrition part...for years debates have raged around two aspects:   1. How much protein is required daily, for building muscle? 2. Are meats the only good source of protein?   How Much Protein?   The first question is harder to answer than commonly believed. The Recommended Dietary Allowance (RDA) say that for a normal, healthy adult (read sedentary individual), about 0.8-1 g/kg of body weight is enough. This translates to around 56 g/day for an adult male weighing 70 kg and 46 g/day for a 59 kg female. Even this amount is hard to source in average Indian vegetarian diets.   Moreover, much higher intakes are recommended for inducing optimal muscle growth.   For those who practice regular strength training, the requirement stands at around 1.5-2 g/kg of body weight. These are recommended for professionals and not the average gym enthusiast, who could do well with c.1 g/kg, with a reasonable upper limit of 1-1.5 g/kg daily.   Bodybuilders supposedly need even higher intakes, with different authorities recommending 1-1.5 or even upto 2 g/lb body weight (1 kg=2.2 lb), meaning an intake of upto 2.2-4.4 g/kg body weight. This kind of consumption is obviously impractical, except for professional athletes, who typically consume 4,000-6,000 kcals per day via 6-7 divided meals. Note: This is NOT recommended for weekend enthusiasts and needs professional advice - which this series of articles does NOT claim to be. Consult your Dietician.   The very idea of heavy protein intake for muscle building has been questioned. Coach Wade, the author of Convict Conditioning, rightly questions this guideline - having witnessed convicts achieve massive gains in strength and muscularity, despite being on relatively restricted prison diets, and being limited to bodyweight exercises and few fixed weights.   Having said that, a healthy protein intake along with willpower certainly helps build muscle and prevent muscle breakdown, especially while trying to lose fat in order to achieve definition.   The Best Sources of Protein   Now to the second question. The best source of protein comprise: eggs, meats (red and white), fish, milk and nuts. These deliver the most healthy and complete proteins having all Essential amino acids.   Also, as you can notice, these are largely non-vegetarian sources. Does that mean that vegetarians can't have enough protein or become strong?     Absolutely not! But non-vegetarian foods definitely have their advantages with respect to muscle building. For starters, they contain complete proteins with all the Essential amino acids. They also have a much greater protein content per gram, containing 50-90% of their calorie content as protein, compared to 13-20% of total calories in vegetarian sources.   Conversely, most vegetarian sources lack a few of the Essential amino acids. The only vegetarian source of complete protein is: soy, buckwheat and quinoa. Other healthy vegetarian sources are nuts (almonds, walnuts, cashews, pistachios, pecans, peanuts), tofu and tempeh (from soybeans), lentils (daals), chickpeas and beans like kidney and black beans (also called legumes), green peas, spirulina, oats, wild rice, chia seeds, nut butters, and vegetables like broccoli, spinach and asparagus. Fruits contain only small amounts, the maximum being found in guavas, berries and bananas.     Its not practical to eat only quinoa or soy all day long, one has to improvise. For instance, daal and rice both have incomplete proteins, but daal-chawal together have all the Essential amino acids. For reassurance, some of the most impressively muscled Bollywood stars – John Abraham, Vidyut Jamwal, Sonu Sood and Shahid Kapoor are vegetarians. Around the time he was shooting for Dangal, Aamir Khan became a vegan as well.   Further, in India there are 3 types of vegetarians – vegans, lacto-vegetarians (a diet that includes vegetables as well as dairy products) and ovolacto-vegetarians (a vegetarian who does not eat meat, but does consume some animal-derived products such as eggs and dairy).   Obviously, it is much easier for the latter two groups to imbibe the required amount and quality of proteins - eggs and milk/dairy are some of the richest and best sources.   Eggs contain very high quality proteins. The PDCAAS score (a marker of protein quality) is 1 for egg protein and whey. One large egg has about 6.3 g proteins, about 3.75 g being in the white. Soya is another excellent source of proteins. Notably, it also contains phyto-oestrogens, making it unsuitable for consumption in substantial amounts by males.   Milk also has IGF-1 (Insulin like growth factor-1), which is also very helpful in bulking up. So, next time someone says she is a hard-gainer, tell her to drink two glasses of whole milk daily and exercise: she will be surprised.    Protein Supplements   Anybody aiming for >1-1.5 g/kg daily intake of proteins has to take supplements. They broadly come from 3 sources - whey and casein derived from milk; albumin from egg whites; and soya. Whey and casein can be consumed by lactovegetarians. The former is better for muscle building (more anabolic), while casein is slowly digested and so is better for preventing muscle breakdown (anti-catabolic).     A lot of controversy exists about the role of protein supplements. Proteins are digested by the kidneys, hence there is no problem with consumption of reasonable amounts of proteins (1-1.5 g/kg body weight) if kidney function is normal. However, when professional bodybuilders take huge amounts of proteins (2-4.4 g/kg) along with drugs/supplements of questionable quality (as proteins are very expensive), chances of damaging the liver and kidney are high.   Thus, one should preferably consume natural foods rich in proteins rather than large amounts of whey or other supplements; if one has to, then 30-40 g of whey or other supplement protein is a reasonable amount per day.   In summary, proteins are very important for building muscle. A healthy consumption is even more important for strength trainees. While meats, eggs and dairy are the best sources of complete proteins, it’s quite possible to consume healthy proteins as a vegetarian (even as a vegan), and become strong and muscular.   Next week, we shall try Understanding The Myth Behind Converting Fat into Muscle.   This is a recurring column published every Sunday under the title: What is Nutrition.   (We are now on your favourite messaging app – WhatsApp. We highly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

10 Must-Have Books on Avoiding Obesity, Good Nutrition, and Diet Plans

Dr Arun K Chopra

Ship Shape Jan 13, 2019

Akin to the previous article, which suggested some must-have books to begin resistance training, this one discusses some valuable books on nutrition. Reading these will provide you with an insight into the root causes of obesity, i.e. food and habits which are likely to promote it), while simultaneously offering some effective tools to deal with it.    As discussed earlier, it is easy to design a diet and lose some weight in the initial few months. The trouble is in maintaining progress. Multiple well-designed and meticulously conducted studies have demonstrated that weight loss tends to plateau even in the most committed individuals over 6-12 months, and is inexorably followed by weight regain over the course of the year after. Hence, two years after an enthusiastic beginning, most people (>90% in several studies) are back where they started from. A depressing scenario, indeed!     Those who have been following this series from the beginning know that it’s possible to lose weight and keep it off too, provided some rules are followed. While one can learn a lot about the impact of different food items and nutrients on weight just by revising the Ship Shape articles on nutrition, some of you may want to delve deeper for a fuller understanding of this rather complex subject.   Please bear in mind that a lot of the information in the earlier articles is from scientific medical journals and text-books, which are a little too complex to be followed by the lay man. I shall thus be presenting a list of books that can be read by anyone, not just doctors or science students.   The Root Causes of Obesity and Lifestyle Diseases   1. Why We Get Fat: And What to Do About It, by Gary Taubes   This is one of the landmark books that examine the history and causes of weight gain in the last 50 years. With data from scientific studies in populations that have stayed away from civilisation, as well as rat studies, it presents at length the insulin model (simply put, the carbohydrate model) of obesity, with compelling data on why calories don't matter, that is, fat is not burnt by the body unless insulin levels in the blood are low. He also recommends a regular intake of all kind of meats, while avoiding refined carbs completely (including wheat and wheat products) – two major diet controversies today.   2. Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health, by William Davis, MD   This one is by a cardiologist, who also believes that modern wheat is to be avoided in order to be healthy and fit. The data on two pieces of whole wheat bread raising the blood sugar more than two tablespoons of pure sugar comes from this text. With the recent wave of going gluten free, especially among athletes and sportspersons, a look at this very informative book is warranted.   3. The Obesity Code: Unlocking the Secrets of Weight Loss, by Jason Fung, MD   Dr Fung is a nephrologist with special interest in diabetes and obesity, and also supports the insulin model, i.e., the carb-based model of obesity. He also presents the history behind the data leading to guidelines restricting fat intake, and their loopholes. While the book has been criticised for quoting blogs in addition to medical journals, he was one of the early researchers to implicate refined carbs more than fats in obesity. Finally, he suggests a diet pattern that enables us to avoid getting fat, or lose weight if we need to.   4. Eat Fat Get Thin, by Mark Hyman, MD   Another book presenting the background of the demonisation of fats by studies conducted in the 1940s-60s, and their formal restriction to prevent obesity and heart disease in subsequent dietary guidelines. It discusses the impact of fats on metabolism, explaining at length why fats do not cause obesity.   5. The Case Against Sugar, by Gary Taubes   A thorough discussion on how sugar and refined carbs have helped usher in obesity and lifestyle disease. While it has been criticised by authorities as being biased, the amount of data on sugar that was relatively ignored in the 80s and 90s is shocking. There is no doubt that these items should be minimised in our diet, as this book will undoubtedly convince you.     What and How Should One Eat?   6. Food: WTF Should We Eat: The No-Nonsense Guide to Achieving Optimal Weight and Lifelong Health, by Mark Hyman, MD   A book that discusses the nitty-gritty of diet, it talks about all individual food groups (e.g., meats, eggs, dairy, fruits and vegetables, etc.), and provides guidance on what items can be consumed ad lib, what are to be limited and what is to be avoided. He suggests his version of an ideal diet-the “Pegan diet”, a synthesis of the Paleo and Vegan diets (discussed earlier), designed to keep one near ideal body weight and full of energy. Perhaps one of the most useful texts if one wishes to plan one’s own diet.   The two books discussed above (3 and 4) also give useful information about what to eat and when to.   Small, Frequent Meals or Intermittent Fasting?   7. Intermittent Feast, by Nate Miyaki   A to-the-point discussion on the benefits of eating a more natural diet (akin to Paleo) while minimising refined foods (carbs or fats) with natural proteins and fats. Carbs can be increased by people who exercise heavy regularly, while fats need to be emphasised by sedentary individuals, who gain weight rapidly if they eat excess carbs. Overall, the recommendation is to avoid refined foods and keep the meal frequency low (he strongly recommends a satisfying dinner, and light snacks during the day).     8. The Warrior Diet: How to Take Advantage of Undereating and Overeating, by Ori Hofmekler   An Israeli ex-Army officer, he has evolved his own techniques for Maximum Muscle, Minimum Fat by using The Anti-Estrogenic Diet and finally, The Warrior Diet (incidentally, all 3 are titles of books he has written on nutrition and fitness). He also reiterates the remarkable benefits of intermittent fasting-feasting as in the above book, especially for people who are physically active.   9. Better than Steroids by Warren Willey, DO   This is a book for bodybuilders, or those who perform heavy exercise regularly. Rather than using steroids or other supplements of doubtful value, Dr Willey outlines how one can achieve similar results with healthy food combined with exercise. He gives detailed plans regarding calorie intake and adjusting meals according to exercise plans and goals.   For Those Who Want Quick Fat Loss   10. New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great, by Westman, Phinney and Volek   The original Keto diet – the Atkins’ diet is discussed here. Replete with details of the Induction and Maintenance phases, full of practical meal recipes and plans, this is a must-have for those planning a short phase of the Keto diet. While there are concerns about its health implications for long-term use, there is no doubt about keto diet's fat-loss efficacy.   Among these books, the most useful books to understand the cause of obesity are Why We Get Fat: And What to Do About It and The Obesity Code. The most helpful one for designing a healthy and balanced diet is Food: WTF Should We Eat? Better than Steroids is more useful for athletes, sportspersons and bodybuilders. Wheat Belly is an essential read if one wishes to go gluten-free, or is gluten sensitive.   That’s it then-the complete low-down on the sources for the secrets of nutrition, fat loss and muscle gain.   You can buy the book by clicking on its title in the article. You would be re-directed to Amazon where you can place your order. Happy reading :)    This is a recurring column published every Sunday under the title: What is Nutrition.   (We are now on your favourite messaging app – WhatsApp. We highly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

15 Must-Have Books to Start Exercising

Dr Arun K Chopra

Ship Shape Jan 06, 2019

One of the toughest things about starting resistance training is to learn how to do the individual exercises accurately. As alluded to earlier, venturing head on into weightlifting is not the best idea. One must start gradually, learn the proper form of the exercises and then progress slowly but steadily.   Hence, we have two major challenges at hand.   To learn the proper form of these exercises To plan the workouts, their days, and sets/duration, etc.   We shall look at the first one today.   Resistance training can be done in several forms - bodyweight training or callisthenics, weightlifting with free weights and/or machines, and dumb bells/kettle bells. Let’s look at some great resources for these.   Bodyweight Exercises   The best way to start resistance training is to learn bodyweight training. It’s easier to learn. There is little, if any investment needed and the chances of injury are also less. Further, there is nothing more efficient than learning to move one’s body in space effectively.                                  1. Convict Conditioning by Paul “Coach” Wade   This is one of the best resources to learn about body weight exercises. Learn it from people who have nothing to develop their strength, except their hands and feet, and sheer will power – convicts. This wonderful book outlines the history of bodyweight strength training (with multiple photos), and the techniques to master the big 6 basic exercises – push-up, pull-up, squat, bridge, hanging leg raises and the handstand. Not just this, it gives the means of progression to elite standards in these (though the last couple of elite levels in the one-arm pull-up or one-legged squat are probably unrealistic). Still, it’s one of the best books to get started on the subject.   2.  Never Gymless by Ross Enamait   Another great text on a wide variety of body weight exercises, their variations and progressions. Also, it looks at the use of simple tools to make these exercises easier, or harder, as per requirement, for instance ropes, boxes, etc. More to the point, but perhaps, not as inspirational as Convict Conditioning.   3. Raising the Bar by Al Kavadlo   For those who want to do the pull-up and can’t, or think pull-up is the only exercise you can do on a bar, is this little gem from one of the finest practitioners of Callisthenics, The Kavadlo brothers have written several books on the subject. Here, he outlines the steps to master these difficult exercises, as well as how to make slow, but steady progress. To see the results, check out their “human flag” photos. You can see four progressions for the pull-up here.   Weightlifting   Bodyweight training has enough juice to last a lifetime. However, there are many who want to lift heavy weights. While Schwarzenegger and Bill Pearl do give cursory descriptions of hundreds of strength exercises in their huge volumes on weightlifting, these are not the best sources for learning the proper form. For that, the classic text is Starting Strength.   4. Starting Strength by Mark Rippetoe and Lon Kilgore   Perhaps the best book to master the big 5 - the bench press, overhead press, squat, dead lift and power clean. While he does spend pages on apparently simple aspects like positioning of the feet, where one should look and the different types of grips, at the end, one does come out much wiser. However, my favourite part is the Foreword. Rippetoe dedicates the 2nd edition to his teacher, Philip S. Colee, who passed away with cancer. He writes,   You have not witnessed determination until you have seen a man wearing an oxygen bottle do deep squats for sets of five across…(the metastatic cancer) was not going to prevent him from living his remaining days as he saw fit-he taught many of us here at the gym what was possibly the most valuable lesson…no matter what your personal circumstances might be (the universe is unconcerned with such details), you get out of life exactly what you have contributed to the effort. It is my honour to have been his student. He will be missed.   Strongly recommended.   5. Strength Training Anatomy Workout by Delaware and Gundill.   This is a useful text which shows good anatomical photos of various muscles, and outlines of several exercises with barbell and dumbbells. Should ideally come after one has learnt the basics from Starting Strength.   6.  Exercise Technique Manual for Resistance Training by the National Strength and Conditioning Association (NSCA)   A useful resource, it encloses two DVDs showing correct and incorrect exercise techniques.   However, Olympic lifts (snatch, clean and jerk) are much more technical and more injury prone than the power lifts (squat, bench press, dead lift). Hence these are best learnt from a coach, especially in the younger age group. As one ages, it’s much harder to master these rapid jerky movements, and much more likely to cause injury.   Kettlebells   7. Enter the Kettlebell by Pavel Tsatsouline   Pavel is the Russian strength coach who introduced Kettle bells to the West. This is one of his finest books in mastering the difficult art of handling the “gym in the palm of one’s hand”. Many of his books have been criticised for being overpriced and too brief; this isn’t one of them. It contains detailed descriptions of the major kettle bell exercises – the swing, the Turkish get up, the clean, the press and the snatch. Embellished with tips and tricks from the master himself, this book is a must-have for all kettlebell enthusiasts.   8. Kettlebell RX: A Complete Guide for Athletes and Coaches by Jeff Martone   This is the other complete guide to learning the above-mentioned exercises and more. A Martial Artist and a trainer of repute, Martone is well known for his feat of performing get ups with a female athlete clinging to his forearm, instead of holding a kettlebell, highlighting the strength these exercises can build over time. While this book is more structured and systematic than Pavel’s, the two are probably complementary.   Other Useful books for Strength Training   9. Never Let Go by Dan John   A well-known strength coach, Dan John specialises in writing practical, no-nonsense guide books on strength training. Subtitled “A Philosophy of Lifting, Living and Learning”, this one is full of useful insights. Dan John’s inspiring writing is sure to fire up the newbie as well as the seasoned athlete.   10. Practical Programming For Strength Training by Mark Rippetoe   Another book by the author of Starting Strength, this one teaches us the tough art of programming - the term used for cycling of workouts, or simply, taking two steps back, in order to take three steps forward. As one starts plateauing which is inevitable within 6-12 months (probably even sooner) of starting strength training, programming is critical to progress.   11. Strength and Physique (3 slim volumes) by James K Chan   A police officer and a martial artist, Chan shows how to build strength, fitness and bulk by using the right exercises and the right schedules. While these books are printed privately (hence lack proper page numbers), they pack a lot of useful information for designing your own workouts, should you choose to exercise in your home.   12. Body By Science by Doug Mcguff and John Little   The best for the last. This is a complete text book for fitness, strength and fat loss. It discusses the metabolism at length, followed by a description of 5 major exercises (both machine based and using free weights) that are crucial to building whole body strength. It also packs in detailed chapters on HIIT and fat loss.   Highly recommended.     Further Reading   13. The Complete Keys to Progress by John McCullum   An old-school guide to strength training. If one starts to lose enthusiasm or novelty, this is the go to resource for finding inspiration and variety.   14. High-Intensity Training the Mike Mentzer Way by Mike Mentzer, with John Little   The detailed work on HIIT protocols, as applied to strength training.   15. Power to the People by Pavel Tsatsouline   His detailed exposition on using just two basic exercises (dead lift and the side press) for two workouts a week for maximal strength and fitness.   What Should One Start With   I suggest Convict Conditioning or Starting Strength as the first text, depending upon preference for body weight training or weightlifting. The NSCA Manual is also useful due to the DVDs showing correct and incorrect exercise forms. Those preferring kettle bells can start with either Pavel or Martone, both are excellent.   Once you have eased into a routine of regular exercise, Dan John and James Chan give you more variations, as well as philosophy (especially Dan John and McCullum). Raising the Bar will serve well for conquering the one-arm pull, the muscle-up and other enviable, impossible to perform bar exercises.   As Pavel says, “Power to You!”   P.S. One can refer to Athlean-X to understand the correct posture for the exercises mentioned through the article.   You can buy a book by clicking on its title in the article. You would be re-directed to Amazon where you can place your order. Happy reading :)   This is a recurring column published every Sunday under the title: A Guide to Exercise.   (We are now on your favourite messaging app – WhatsApp. We highly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

The Dark Side of Exercise and Nutrition: Workout Injury, Fatigue, Steroids, Supplements and More

Dr Arun K Chopra

Ship Shape Dec 30, 2018

Over the past couple of months, we have discussed the all-encompassing benefits of a healthy diet and exercise. As the year comes to a close, think it is now time to take a look at the darker side of things.   A primary concern while exercising is that of injuring oneself. This has been discussed in several previous articles on running, weightlifting, using kettle bells, etc. Let’s address all of these in one place.   Nearly half the people who run regularly end up injuring themselves over the course of a year. These injuries can be anywhere - feet, ankles, knees, hips, back or neck. There is also the risk of road traffic accidents if one is running on the roadside instead of on a track or in a park.     Herein lies the importance of a coach - to learn the proper stance, develop the right stepping, using the right footwear for individual needs, and most importantly-the right way to stretch fatigued muscles. Most injuries can be prevented by these, and doing proper warm up and cool down, which are essential for any strenuous exercise.   Another common concern is that of a sudden cardiac arrest during or immediately after a long run. This has also been discussed at length earlier. To reiterate, in healthy and fit individuals who exercise regularly, the risk of such an unfortunate accident is very low, and rises only to a very minor extent while exercising. Conversely, regular exercise significantly lowers the risk of sudden collapse during the rest of the day (a risk which is much higher in sedentary individuals). It’s important to be aware of this. This is also why it’s recommended that any person starting on a strenuous exercise program, especially after the age of 30, undergo a medical check-up prior to beginning. Notably, males are much more likely than females to suffer such events.   One is also prone to injury while weightlifting, though surprisingly, less so than running. However, trainees often suffer muscle pulls, which need time to heal, and muscle soreness and stiffness, which are mostly benign and self-limiting. One needs to differentiate between muscle soreness occurring soon after unaccustomed or heavier exercise, delayed onset muscle soreness and muscle pulls or worse still, tears. While the first two will settle with appropriate rest and decrease (but not disappear) with experience, muscle pulls may need physiotherapy and avoidance of exercises stressing the injured muscles till they heal. However, some soreness is normal after a heavy bout of exercise, and the muscle need not be avoided unless the situation worsens.     Muscle tears need professional opinion from an orthopaedic surgeon or ideally a sports medicine specialist. Even more important is to find out why the muscle was injured - was it was due to an improper technique, or inappropriately high weights? Needless to say, that the predisposing factors need to be addressed. Proper training for learning techniques is even more important for exercising with kettle bells, as rapid, jerky movements with a weight are more likely to cause injury.   Resistance training mandates following proper exercise techniques, and realising that slow and steady is the only way to gain. It’s been said that we overestimate what we can achieve in a year, but underestimate what we can in a decade. This is particularly true for weightlifting. Growing from 30s to 50s, a feeling of improving youth and fitness that is imparted is a most satisfying reward. The ancillary benefits of sticking to lifting heavy weights regularly are many, not least of which is developing an iron will to persist in the face of adversity.   One is usually prepared for pain and injury when initiating an exercise program; it’s the desire for rapid progress and unrealistic goals that causes greater harm. After the initial honeymoon period of rapid increase in strength and fitness, one reaches a plateau within 3-6 months of regular exercise, depending upon one’s initial fitness levels. At this stage, a coach is most crucial in guiding a trainee regarding programming-a term signifying taking a couple of steps back before moving 3 steps ahead. Even so, progress is slow and hard to find. The obvious solution at this stage is shortcuts: the use of supplements and/or drugs to augment performance.     These have been in use for decades now: Arnold Schwarzenegger was candid enough to admit that in his time, they used drugs to boost performance as they didn’t know better. However, others like legendary cyclist Lance Armstrong admitted to using them with full knowledge, managing to fool authorities for years, before finally coming clean a few years back. It’s important to understand supplements for what they are, along with their long-term consequences.   Whey protein is safe upto reasonable limits - 30-40 g per day can be easily digested and tolerated by a healthy young athlete aiming to fulfil her protein requirements. Other safe products include multi-vitamins and some minerals within recommended doses. Limited amount of creatine and glutamine powders may enhance strength and hasten recovery, respectively, and may be consumed under medical supervision. However, these are expensive and often come from unreliable sources.   Nothing beats a healthy diet, regular exercise and a solid will, as far as a normal adult aiming for fitness is concerned.   Steroids and other performance boosting drugs are a strict NO-NO; these harm the body in numerous ways and people might suffer lasting consequences for years even after giving them up. Youth in their pursuit of strength or a six-pack should not get carried away. They should persevere with their efforts and avoid taking short cuts - an endeavour that is fraught with permanent risks.   In summary, exercise is a life-changing endeavour, with multifarious benefits. It has to be a lifestyle change, rather than a compulsion and should not be muddied with drugs or supplements for rapid gains.   This is a recurring column published every Sunday under the title: A Guide to Exercise.   (We are now on your favourite messaging app – WhatsApp. We highly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

Ship Shape Podcast: Nutrition, Exercise, Health Tips, and Healthcare Policy

Dr Arun K Chopra

Ship Shape Dec 27, 2018

    In conversation with Nikhil Arora and Sharath Toopran  of Transfin. for an hour long discussion on:   The Bare-Bones (slurrp!) of Good Nutrition   I begin by addressing some recurrent queries posed by my patients - Why do we crave fats? Why do we regain the lost weight? Is veganism the way to go? How healthy is red meat?   I go on to talk about the basics of nutrition, discussing how the moderate consumption of any nutrient is the most optimum and how to engineer a 'balanced diet'.   Fitness 101   We move on to discuss exercise and fitness. What have we gotten wrong about fitness and exercise? Where do we begin from? What are some cost-effective alternatives to the gym? How do we think of diet and exercise in parallel?    What's Wrong with India's Healthcare?   Lancet, an acclaimed medical journal recently spoke of the rising risk of physical violence on doctors. I talk about how and why a reputed profession has come under attack in the recent past.   Hope you enjoy listening in. I may do this again in the future, so do drop in any questions or clarifications on nutrition and fitness that you may like me to address in the Comment section below.    For a deep dive into some of the topics we have discussed in this podcast, visit my profile on Transfin. here.   Also will recommend you to go through my 5 Most Popular Articles for a better understanding of how nutrition and exercise work:      Combining Exercise with Healthy Diet for Weight Loss, Bodybuilding, Endurance and More     Why HIIT is the Ultimate Resistance Training Routine     Intermittent Fasting vs. Frequent Small Meals     Your Guide To An Effective Keto Diet     Fixing The Healthcare Industry in India       (We are now on your favourite messaging app – WhatsApp. We highly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)

Diet and Exercise: Identifying the Right Amount of Calories For Weight Loss, Bodybuilding, Strength, Endurance and More

Dr Arun K Chopra

Ship Shape Dec 16, 2018

Last week, we briefly discussed how to calculate the caloric requirement and macronutrient intake of an active individual. It is suggested the reader reviews the article before we take a deeper dive into the topic.    Basal Metabolic Rate (BMR) or the energy spent when the body is at rest is highly dependent upon age and gender. As discussed earlier, progressive muscle and bone loss begins in normal adults after the age of 30. Apart from decreasing strength and causing problems in mobility, along with body and muscle ache, it also slows down the BMR, resulting in the creeping weight gain (0.5 kg per year). Use of simple formulas to calculate one's BMR may help as shortcuts, but remain just those, which is not ideal for serious athletes. Therefore, use of the Harris Benedict equation is the most recommended.  As established earlier, it is notoriously challenging to estimate burnt calories while exercising, or those consumed while eating. Therefore, a fine tuning of the diet plan should be guided not just by math, but also by the outcome.   Are you achieving your goals?  Fat loss, muscle gain, athletic gains, or even a combination of these?   Let's revisit the examples given last week.   A 30-year old female needs about 1,300 calories every day to maintain her BMR. One can add another 250 calories if she walks briskly for 45 minutes daily and is generally active. This means about 75 g of good quality proteins, 180-200 g of carbohydrates and 55 g of fat, if she is happy with her current weight and fitness levels.   However, if she wishes to lose fat, she should consider decreasing the total calorie intake by about 200 calories, most of them being refined carbs or added sugar. This would mean a reduction in carbs to 140-150 g per day. On the other hand, if she wants to gain lean mass, she should consider starting strength training and adding another 200 calories per day (approx. 25 g extra proteins and 25-30 g extra carbs and remaining fats). Another 250 calories can be consumed pre or post-workout for best results. These are not counted as part of the daily calorie intake as we have not calculated the caloric burn due to NEAT and EPOC. One can use the apps mentioned last week (HealthifyMe and Cronometer) for the needful. But this is just the beginning. The most important step is to monitor the progress.   If she is losing fat as per her goal, the plan continues; if not, she needs to re-evaluate the calories consumed, or reduce carbs further by 25 g per day.   If she is unable to gain strength as in the second example, she can consider adding 25 g carbs to her diet. Either way, reviewing the weight and strength gains (or losses) every week is important for deciding the next week’s plan.   A 35-year old male athlete who wishes to maintain his weight needs 2,300 calories every day. If he exercises regularly, he would do well to start with 100-125 g proteins, 250-300 g carbs and 70-80 g fats.   If he wishes to lose fat, he should reduce his carb consumption by 50-75 g and monitor his progress. If he wishes to gain strength/lean mass, adding 25 g proteins and 25-50 g carbs would help. Again, weekly weighing and measurements are mandatory for maintaining progress.   Here, it is important to mention why we are mostly meddling with the carb intake. Carbs are the easiest to digest, taking about 2-3 hours only, while proteins take 8-9 hours and fats even longer, with more calories expended in the process. Hence, a carb meal is digested within 2-3 hours, leaving a person hungry again, as is commonly seen in malls and cinema halls after enjoying colas and popcorn. On the other hand, the same amount of calories eaten as nuts, milk, cheese, chicken, fish or eggs take nearly three times as long to get digested, leaving a person full for much longer.   This also implies that the net calorie gain in a carb meal is higher than a protein/fat meal, which are commonly consumed together in all the above foods. Thus, a 300 calorie snack will differ in its impact upon the body depending on what food the calories come from. This is what is meant when it’s said that calories do matter in weight gain/loss, but not in the way most people think.   Hence, a person exercising for fat loss and fitness goals, should cut down on carbs (to around 40% of total calories) and consume higher proteins and fats, while one aiming for strength gains and not fat loss can go higher to 50-60%. However, a minimum amount of fat (about 20% of total calories) is essential for getting fat soluble vitamins and a minimum amount of carbs (about 30-40%) are needed for maintaining bowel movements. One must also ensure adequate intake of vitamins and minerals through fruits, vegetables and salads. Proteins are to be kept at 1-1.5 g/kg per day if one is seeking general fitness, and about 2 g/kg if one is lifting heavy weights or practising HIIT protocols.   How to Measure Progress?   Ideally, an athlete should get a body composition analysis. This may be impractical, as the best methods are dual energy X-ray absorptiometry (DEXA), a special type of X-ray that measures bone mineral density and under-water weighing - both not suitable for regular use except in elite athletes.   Practical methods include using Bodpod machines (available for gym and home use, not very expensive; simple, not very reliable but can tell whether one is progressing in the desired direction) and callipers for measurements. Jackson-Pollock formulas are useful for 3, 4 or 7 point skinfold thickness measurements and give more reliable body fat estimates.   Weekly or fortnightly measurements are useful if one is sincerely following a goal. This is important because one can never only gain muscle even if one undertakes rigorous strength training. Usually muscle and fat are gained in a 2:1 ratio at best (means 2/3 of gained weight is muscle, 1/3 is fat). This means one has to watch the fat and manipulate exercise and diet to lose fat intermittently.   All the while, strength and fitness gains are of utmost importance, and should not be forgotten in trying to lose fat or gain muscle. Strength gains which come at the expense of general health (using supplements indiscreetly, incurring injury while trying unrealistic lifts) or fat loss with a feeling of general weakness is of no use ultimately.   A pre-requisite to follow the above - Motivation   No program can begin or continue without it. Initially gains come fast and one is energised. Within weeks and months, these plateau, following which progress is slow and hard to earn. This is the time when most fitness enthusiasts begin to feel frustrated and become irregular in their schedule, starting the slide downhill. This is why most people manage to lose weight or exercise regularly for 3-6 months, but then start regaining weight. This is the time to realise that a healthy lifestyle is its own reward, and will bring benefits if one is persistent.   This is a recurring column published every Sunday under the title: A Guide to Exercise.  [Listen in to understand some broad thumbrules around good Nutrition and Fitness from Dr Chopra.] (We are now on your favourite messaging app – WhatsApp. We highly recommend you SUBSCRIBE to start receiving your Fresh, Homegrown and Handpicked News Feed.)