On this board, I will track my weekly progress, diet, nutrition, and exercise. I would also like to research a number of topics that are top of mind for me in my mid 30s including:
Sleep apnea
Ozempic and GLP-1 agonists
Testosterone replacement therapy (TRT)
Insulin resistance
Dopamine optimization
Weight (7d avg): 186.4lbs/84.5kg, from peak -13.3lbs/-6.1kg
RHR (7d avg): 62.0bpm
Calories In (7d avg): 2057kcal
Exercise (7d avg): 550kcal
Net Deficit (total): -1500kcal
2x4x500m row: 1:51.0, 1:51.3
As I began to recover from my surgery, I began thinking about my long-term fitness goals. While getting lean and healthy in my mid 30s was still feasible, what would my capability be like in my 40's, 50's, and 60's. Muscle loss becomes a larger factor as we age. Less time and energy means less exercise leading to loss of bone density and mobility.
This is why I found it so important to continue to challenge myself on this weight loss journey. To create personal benchmarks and also learn how to optimize my nutrition and exercise. Experimenting is easier now and the gains are build on themselves.
Peter Attia: Testosterone Replacement Therapy
TRT has been a growing topic of interest as an intervention not just for people with specific hormonal disruptions but simply as a health promoting measure for men in their later years. Joe Rogan and the manosphere of health influencers have put TRT in the forefront of many men's minds including myself. What I'd like to understand is how much reduced free testosterone would warrant TRT and the potential risks and benefits if used correctly.
Total testosterone can be understood in three broad categories:
Free testosterone (1-4%): bio-available to the body to be used
Albumin bound testosterone: loosely bound, held as a reservoir
Sex Hormone Binding Globulin (SHBG) bound testosterone: tightly bound for hormone regulation
These three types in sum are your total testosterone and what is most often measured in clinics. However, free testosterone is the only measure that is generally considered valuable for deciding on TRT. Most labs will use a calculated free testosterone (cFT) rather than measure free testosterone due to the complexities of direct measurement. That being said, many guidelines still use total testosterone to determine cutoffs despite free testosterone being a more accurate measure.
As an example, normal amounts of total testosterone are shown in this study:
Our final analytic cohort contained 1,486 men. Age-specific middle tertile levels were 409-558 ng/dL (20-24 years old), 413-575 ng/dL (25-29 years old), 359-498 ng/dL (30-34 years old), 352-478 ng/dL (35-39 years old), and 350-473 ng/dL (40-44 years old). Age-specific cutoffs for low testosterone levels were 409, 413, 359, 352, and 350 ng/dL, respectively.
When making the decision on whether TRT is right for you, its best to consider these factors and the impact some lifestyle changes like exercise can make not just on your total testosterone, but also how it may liberate additional free testosterone from your other bounded reservoirs.
This 2017 study reviewed the impact of various exercise types on elderly men's testosterone levels:
TT was significantly increased following HIIT (~17%; P < 0.001) with most increase occurring during preconditioning (~10%; P = 0.007). Free-T was unaffected by conditioning exercise (P = 0.102) but was significantly higher following HIIT compared to baseline (~4.5%; P = 0.023). Cortisol remained unchanged from A to C (P = 0.138). The present data indicate a combination of preconditioning, and HIIT increases TT and SHBG in sedentary older males, with the HIIT stimulus accounting for a small but statistically significant increase in free-T.
Weight (7d avg): 186.9lbs/84.8kg, from peak -12.8lbs/-5.8kg
RHR (7d avg): 59.4bpm
Calories In (7d avg): 1686kcal
Exercise (7d avg): 500kcal
Net Deficit (total): -2300kcal
2x5x500m row: 1:51.0, 1:49.6
I saw a continued steady decline in my weight 2 weeks after my sleep apnea surgery. Recovery was slow but continual. Though I had hoped to be mostly recovered 2 weeks in, I was just starting to be able to eat normally again throughout the week. My decreased diet meant exercising was difficult. But as soon as I was able to increase my calories I was able get back to my gym routine.
One additional goal I had for this weight loss challenge was getting my resting heart rate down closer to where I was a few years prior, in the low 50s. As I entered my mid thirties, my RHR seemed to go up 1 bpm every year. It's difficult to say what caused this but I was very interested in seeing what I could do to get it back down.
Anecdotally, the more weight I lost and more exercise I got, the better my RHR. However, getting sick or recovering from surgery caused my RHR to rise within a few days. There's 3 categories I'm interested in when considering RHR impacts: weight loss, exercise, and illness.
A meta-analysis from 2019 found an associated -9bpm with large median weight loss of 43kg. This ranged from 20% to 30% weight loss. In a 1 year controlled trial , RHR decreased by 4bpm with a 5-10% decrease in weight. There are several other confounding factors including diet and exercise that could also impact RHR, but generally weight loss seems to have a consistent effect.
Easily the most well studied factor for improving RHR, a large systematic review and meta-analysis published in 2018 showed -5.2bpm from all types of sports, -6.0bpm from endurance training, and -2.5bpm from strength training. Notably, studies showed -7.2bpm from yoga specifically. These adaptations took several weeks to see drops, but I see impacts from my Fitbit within a few days of high aerobic activity.
I always see a spike in my RHR when I get sick and it can be quite discouraging. I try to keep my spirits up by reminding myself its temporary. A national US study looking at the relationship between body temperature and heart rate found a HR increase of 7bpm for every increase in T of 1.0°C or 1 .8°F. Diseases like COVID-19 saw increases of 1.8% for females and 3.4% for males on initial onset.
Weight (7d avg): 188.8.2lbs/85.6kg, from peak -10.9lbs/-4.9kg
RHR (7d avg): 56.6bpm
Calories In (7d avg): 1014kcal
Exercise (7d avg): 267kcal
Net Deficit (total): -6300kcal
3k run: 19:12 min
This week started the day after my sleep apnea surgery. Because of the palate and tonsil reduction, eating solid foods was quite painful, especially after the first 2 or 3 days after the anaesthesia wore off. Eating was so painful, that I began to feel nauseous simply thinking about eating. In turn, this meant I could only take in a little over 1000 calories a day. My exercise also decreased, the small amount of cardio barely offsetting the general lack of movement from the days I stayed in bed. However, the did weight did fall off during this time period, dropping 3.7lbs (1.7kg) in a week.
But I knew this wasn't all fat I was dropping. More likely the reduction in food likely meant I was dropping water weight as I was both salt and carbohydrate depleted. The body stores carbohydrates as fuel in the form of glycogen and as stated in this article from the American Journal of Clinical Nutrition:
Glycogen is stored in the liver, muscles, and fat cells in hydrated form (three to four parts water)
That means while in a calorie deficit, especially when carbohydrates are limited, your body depletes its glycogen stores and the water it holds; one of the reasons ketogenic diets see such immediate weight loss within the first two weeks of dieting.
Ketogenic diet users can expect to lose up to 4.5 kg of body weight in the first 2 weeks or even sooner. For the most part, this is due to reduced water retention in the body, which in turn is mainly attributable to low carbohydrate supply, which is intrinsic to this particular diet....It is generally assumed that 1 g of glycogen is associated with at least 3 g of water (2.7 to 4 g). Assuming a 1:3 ratio, a loss of 500 g of glycogen will be accompanied by a loss of approximately 1500 g of water. Thus, the combined effect will be 2 kg of lost body weight. In addition, insulin is known to affect sodium retention in the kidneys, so a reduction in insulin concentration (as observed with the KD) will reduce sodium retention, which in turn leads to increased water excretion by the kidneys
Weight (7d avg): 192.5.2lbs/87.3kg, from peak -7.2lbs/-3.3kg
RHR (7d avg): 56.9bpm
Calories In (7d avg): 1714kcal
Exercise (7d avg): 680kcal
Net Deficit (total): -4000kcal
6x500m row sprints: 1:49.6
Deadlift: 402lbs (PR/PB)
For the past few years, I've heard about the risks of Obstructive Sleep Apnea (OSA), a growing concern shared by a number of podcasters and health influencers. The prevalence of the disease as reported in the Lancet:
we estimated that 936 million (95% CI 903-970) adults aged 30-69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399-450) adults aged 30-69 years have moderate to severe obstructive sleep apnoea globally. The number of affected individuals was highest in China, followed by the USA, Brazil, and India.
This is a staggering percentage of people, a billion adults, or about 25% of the global adult population. The percentage goes up with age and for men. I thought it best to get it checked out.
After a night with a take home sleep test, my ENT went over my results. Apnea-Hypopnea Index (AHI) is the primary metric for diagnosing and classifying severity of sleep apnea. Effectively AHI measures the number of times you stop breathing or breath shallowly per hour, averaged over the course of your sleep time. While this metric has come under scrutiny as painting too simplistic a picture as discussed by the European Sleep Research Society and this article in the journal Sleep, it still remains the standard for diagnosis.
The AHI standard as stated is:
<5 events/hour = normal
5–15 = mild
15–30 = moderate
≥30 = severe
My score ranged from 11 to 15, classifying me on the cusp of mild to moderate OSA. Even scarier, by blood oxygen saturation dropped to 82% in some instances during my sleep, putting me at higher risk for stroke. As I put on weight over the last few years, I began experiencing days with brain fog. I wondered if managing my OSA could prevent this and potentially help me lose weight. And so I signed up for a surgery that day for a week later.
As I went through the surgery and recovery process, I had so much more to learn and understand about OSA, which I'll touch on in future posts.
On a side note, I hit a personal record for deadlifts. A cool 402lbs, a number I was never sure I would hit. It was important for me to track my deadlift over this challenge as it provided a strength baseline. I did not want my weight loss to dramatically reduce my strength, so testing was a valuable way to see how my calorie deficit and weight loss were impacting my lifts.
Weight (7d avg): 193.2lbs/87.6kg
RHR (7d avg): 56.7bpm
Calories In (7d avg): 1986kcal
Exercise (7d avg): 825kcal
Net Deficit (total): -2000kcal
6x500m row sprints: 1:50.2
Notes:
As noted in my prior week, 3 months is a long time for sustained weight loss. And vacation time or life events happen. How do we build a a resilient routine that can handle some off days? My 7d weight average actually went up this week, even though my calorie counting showed I was still in a deficit. A reminder that these are estimates.
I was curious about the impacts of cortisol on weight loss. This 2010 study examined the impact of low calorie dieting on cortisol levels and no surprises
Restricting calories increased the total output of cortisol
The study concluded that stress from low calorie dieting could be counter productive to the goals of dieting. The stress hormone cortisol is of course notorious for driving weight gain. A study isn't required to show the value of vacations in reducing stress and cortisol, but here's one anyway.
Weight (7d avg): 192.6lbs/87.4kg
RHR (7d avg): 56.3bpm
Calories In (7d avg): 1757kcal
Exercise (7d avg): 800kcal
Net Deficit (total): -4300kcal
11x500m row sprints: 1:49.5
Deadlift/Squat: 355lbs/260lbs
Notes:
No matter the best laid plans, life will come. One reason I pursued a 91 day challenge, 3 months of consistent effort, was to balance life's many ups and downs with your long term goals. You will never be able to live exactly to the routine you've set, or if you do, you risk losing out on a lot of opportunities or changes that life has to offer.
Making cardio a consistent element in this challenge helped me keep my RHR lower while increasing the average amount of calories burned. It's been chic recently to dismiss traditional cardio in favor of things like walking or cross training but in my mid thirties I feel its still a component that should be celebrated along side weight lifting. The feelings of accomplishment and "number go down" joy add a lot of flavor to your daily routine.
Weight (7d avg): 194.0lbs/88.0kg
RHR (7d avg): 56.0bpm
Calories In (7d avg): 1800kcal
Exercise (7d avg): 600kcal
Net Deficit (total): -3300kcal
5k Row Split: 2:11.7
Deadlift/Squat: 315lbs/245lbs
Notes:
I didn't see much progress the first two weeks as I settled into a new routine. That was partly because of the existing momentum of my body before beginning this challenge. Day 0 I started around 197lbs but moved to 201lbs by day 3. While I was saturating my creatine levels, saw fluctuating water retention, and managed other day to day shifts, this weight increase was a reminder that daily weight measurements are not valuable in understanding your long term progression.
My week 3, the weight started steadily falling and I was down 6lbs from my highest weight since beginning. The increased cardio also led to a healthy drop in my RHR, which was mentally really important to me. My cardio baseline is more important to me than my waist line, and seeing my heart get healthier was a big part of why I want to lose weight.
I also made sure to take my foot off the pedal a little bit and not be too aggressive with my cut. My mantra through this challenge is to make consistent progress that can be maintained for life.
One major reason I started this challenge was to see whether I could lose weight at my age as or near as effective as people losing weight on GLP-1 Agonists like Ozempic, Wagovy, and Mounjaro. It felt like everywhere I looked, someone was trying these seemingly miracle cures and dropping a massive amount of weight, including people I knew personally.
I am generally apprehensive to try pharmaceuticals, especially ones that felt too new and too much of a miracle cure. But I read more about GLP-1 Agonists, I wanted to stay open minded about their value in the market and for health while also being clear eyed about the potential side effects.
As described in 'Glucagon-like peptide-1 receptor: mechanisms and advances in therapy' , GLP-1 is a naturally occurring hormone in the body that is usually secreted in response to nutrient intake. This hormone does a number of things, but primarily triggers hunger satiety. Semaglutides like the brands described above mimic this hormone and largely drive weight loss through appetite suppression. Although the drugs were originally created for people with type II diabetes, trials on obese and overweight populations showed these drugs were wildly effective for those adults as well. This study saw a mean weight loss of -14.9% vs -2.4% against placebo in 68 weeks.
The impact of these drugs seem remarkable and anecdotally people say it truly reduces the "food noise" for them. Alongside of the weight loss are significant benefits in cardiovascular health, skeletal muscle-related diseases, obesity management, and neurodegenerative conditions as described by Zhikai Zheng et al. Though it's not clear to me how much of these additional benefits are equivalent to other means of weight loss or reversal of metabolic diseases.
So my last major question is about the risks of these drugs? This meta-analysis of 23 studies showed the:
The meta-analysis revealed that the adverse event associated with semaglutide is gastrointestinal in nature (nausea and vomiting). No significant differences were observed between semaglutide and comparator groups...Semaglutide appears to have a favorable safety profile across diverse patient populations and treatment durations, supporting its continued use in the management of type 2 diabetes mellitus and obesity
I remain cautious as this drug still needs long term studies before we can draw conclusions on its long term impacts especially for non-diabetic individuals. However, at this point it does seem these drugs are as "miracle drug" as I've seen.
Weight (7d avg): 197.7lbs/89.7kg
RHR (7d avg): 57.0bpm
Calories In (7d avg): 1514kcal
Exercise (7d avg): 667kcal
Net Deficit (total): -4800kcal
5k Row Split: 2:11.9
Deadlift/Squat: 350lbs/260lbs
Notes:
Starting off on diets, I usually find my body recomposition is on a one to two week delay. Net, I didn't see any weight drop for my 7d average versus the week before, even though I was fairly aggressive in cutting back on calories. Usually, it takes time for my body to readjust with water weight and creatine, so I wasn't worried about the results just yet.
My goal heading into this 13 week challenge was to manage my aggression on the diet. This was a marathon, not a sprint and I knew success was reliant on me making marginal adjustments to ease into weight loss. That meant honing on the routines that ground me into consistency like:
eating most of my calories for breakfast with filling foods like oatmeal
skipping dinner or having something very light
avoiding alcohol, sweets, and snacks
I've never had too much of an issue with getting workouts in, but adjustments to my training to get a bit more cardio in would also benefit me.
