Wanted to update everyone on all that's been happening; so much to share! First, I've agreed to write a textbook on muscle hypertrophy, to be published by Human Kinetics -- one of the leading publishers on the science of exercise and nutrition. The book will be geared towards fitness p...
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August 17, 2014
Wanted to update everyone on all that’s been happening; so much to share!
First, I’ve agreed to write a textbook on muscle hypertrophy, to be published by Human Kinetics — one of the leading publishers on the science of exercise and nutrition. The book will be geared towards fitness professionals and university programs. I’m totally stoked to provide an evidence-based resource on a subject that has long relied on gym lore and bro-science. Estimated pub date is April of 2016.
I’ve also agreed to write a monthly column for Flex Magazine. The column will discuss science-based application of hypertrophy and fat loss practices. It’s a real kick for me to be a regular columnist for a mag that I grew up reading. My first column is slated for the November issue.
Research-wise, I’m currently finishing up a study on body comp changes associated with fasted cardio and another on muscle activation during different loading intensities in the bench press. During the fall I have multiple studies set to get underway including a training frequency study investigating muscular adaptations in split vs. total body routines, another comparing functional transfer between the squat and leg press, and yet another that will evaluate the effects of protein timing pre- versus post-workout on muscle hypertrophy in well-trained subjects. I look forward to sharing the results of these and other studies currently in review when they become available.
Okay, that out of the way, here are some links that I thought you’d find informative. As always, I appreciate your continued support.
• I recently lectured at the CanFitPro Conference in Toronto. While there, I got a chance to record a few interview segments for Omar Isuf’s YouTube channel. In this segment we discuss repetition ranges for maximizing muscle hypertrophy. Give this a watch and you’ll see why Omar lives up to his nickname, King of YouTube Fitness.
• I was interviewed along with my partner-in-science, Alan Aragon, on the We Do Science Podcast. Here Alan and I discuss the complexities of nutrient timing, delving into both the science and practical applications on the topic. Bonus discussion on a related topic: whether there is any fat loss benefit to doing fasted cardio. Click on Episode #8.
• I’ve appeared numerous times on Superhuman Radio; this segment might be my favorite yet. Here I discuss whether it’s possible to gain muscle simultaneously while simultaneously losing fat. Host Carl Lanore is consistently one of the best interviewers in the biz and he again shows why by asking all the right questions. l
• My friend and colleague Tom Venuto wrote an excellent post on delayed-onset muscle soreness and its relevance to muscular gains. The article covers the science in an understandable fashion, and provides solid take-home advice.
• Speaking of Tom Venuto, he wrote what I think is the most detailed review of my book, The M.A.X. Muscle Plan. Always an honor to receive praise from a true fitness pro such as Tom.
• In case you missed it, I recently published this study showing muscle activation during the leg press at 30% 1RM to failure produced significantly lower muscle activation compared to 75% 1RM. I also wrote an accompanying blog post where I break things down into consumer-friendly language and discuss the study’s implications.
• Finally, my good friend Bret Contreras wrote this terrific article that delved into the free-weights vs. machines debate. As mentioned earlier, I will be collaborating on a study examining this topic; Bret’s post provides excellent commentary on its complexities. While you’re at it, make sure to read through the references at the end of the article; it’s patently clear research doesn’t support the claims made by certain fitness pros.
August 13, 2014
There is compelling evidence that the onset of fatigue during resistance training results in an increase in motor unit activation, whereby the strength-oriented type II fibers are progressively recruited to sustain muscular contractions. Some have taken this to mean that any load, regardless of how light, will ultimately lead to full fiber recruitment provided that training is carried out to muscle failure (i.e. the point where you are unable to complete an additional rep with proper form).
Recently, my lab sought to test this hypothesis. Here is an overview of the study and its practical implications. The study, titled, Muscle activation during low- versus high-load resistance training in well-trained men, was just published ahead-of-print in the European Journal of Applied Physiology.
The purpose of the study was to compare muscle activation in the leg press at 30% and 75% 1RM when sets are carried out to muscular failure. Ten college-aged men were recruited for participation. Subjects were all experienced in resistance training, including regular performance of lower body exercise.
A within-subject design was employed where each participant performed both 30% and 75% 1RM conditions. Testing was carried out over two sessions. Subjects were initially tested to determine their 1RM in the leg press. They then returned to the lab at least 48-hours later for muscle activation testing of the quads (rectus femoris, vastus lateralis, and vastus medialis) and the hamstrings (biceps femoris) during heavy- vs. light-load training. The order of performance was counterbalanced whereby Subject 1 performed the high-load condition first, Subject 2 performed the low-load condition first, etc. In this way, we ensured that order of performance did not confound results. Fifteen minutes rest was provided between trials to ensure that previous fatigue was not a factor. We verbally encouraged subjects to perform each set to the point where they could physically no longer continue training with proper form.
Both mean and peak muscle activation was markedly and significantly greater during the heavy- compared to light-load condition (by 57% and 29%, respectively). Importantly, not a single subject displayed equal or greater activation during low-load training. These findings strongly suggest that training at 30% 1RM in a compound lower-body exercise is insufficient to recruit the entire motor unit pool for the target musculature.
It has been well-established that training to muscle failure causes an increase in motor unit recruitment. This outcome was in fact confirmed in our study, as EMG amplitude increased in both the high- and low-load conditions over the course of each set. However, the magnitude of these increases were substantially lower during light- versus heavy-loading. The take home message here (in conjunction with a recent study on the topic using single-joint lower body exercise) indicates that a minimum threshold exists to achieve activation of the full spectrum of fibers and that 30% 1RM is below this threshold. Thus, it can be inferred that some of the highest threshold motor units — those associated with the type IIx fibers — were not recruited during the low-load condition.
From an applied standpoint, it might seem that these findings show training at very low-loads is useless. After all, why would you train with a load that does not generate complete fiber recruitment, right?
Not so fast.
Understand that there are two aspects to maximizing muscle development: recruiting a fiber and then keeping it stimulated for a sufficient period of time (i.e. time under load). While the loading strategy used in the light-weight condition here (i.e. 30% 1RM) did not bring about full muscle activation, it did maintain tension in the lower-threshold motor units for an extended time period. This could be particularly important in optimizing development of the type I fibers that are highly fatigue-resistant. This lends credence to the hypothesis that training throughout the full spectrum of rep ranges is the best strategy for maximal muscle hypertrophy. I have a longitudinal training study currently in review that seems to support this hypothesis. More on that in the near future.
An interesting secondary finding of the study was that the hamstrings displayed only minimal activation during the leg press — much less than that seen in the quads. This refutes the claims by some fitness pros that single-joint exercise is unnecessary provided you perform compound lower body exercises. Our results clearly indicate that movements such as the leg curl, stiff-leg deadlift, and good morning are important components of a well-rounded resistance training program to ensure proper symmetry between the quads and hamstrings.
A limitation of the study is that we only assessed a single set at each condition. Thus, it is not clear whether accumulated fatigue from performing multiple light-load sets would ultimately bring about complete recruitment. This requires further study. But even if this turns out to be the case — which is far from a certainty — it would mean that you’d need to perform a lot of additional volume just to achieve similar levels of activation; at the very least, an inefficient training strategy.
I am in the process of finishing a follow-up bench press study looking at 80% vs. 50% 1RM in an attempt to determine the approximate minimum threshold necessary for complete muscle activation. This will provide important info to those who are unable to lift heavier weights due to medical conditions or other issues. Realize, though, that muscle activation (and hypertrophy for that matter) do not necessarily translate into optimal strength gains. My recent study showed that even moderate load training (~10 RM) is inferior to very heavy lifting (~3 RM) if absolute strength is the goal. I discussed that study in-depth in this blog post
On a side note, I’ll be discussing the ramifications of this study and others currently in progress at my upcoming seminar in Montreal next month. Hope to see you there!
Cook SB, Murphy BG, Labarbera KE. Neuromuscular function after a bout of low-load blood flow-restricted exercise. Med Sci Sports Exerc. 2013 Jan;45(1):67-74.
Schoenfeld BJ, Contreras B, Willardson JM, Fontana F, Tiryaki-Sonmez G. Muscle activation during low- versus high-load resistance training in well-trained men. Eur J Appl Physiol. 2014 Aug 12. [Epub ahead of print]
Schoenfeld BJ, Ratamess NA, Peterson MD, Contreras B, Tiryaki-Sonmez G, Alvar BA. Effects of different volume-equated resistance training loading strategies on muscular adaptations in well-trained men. J Strength Cond Res. 2014 Apr 7. [Epub ahead of print]
August 11, 2014
Science is ever-evolving. New studies are continually carried out to expand on previous research and thus shed additional light on topics of interest. The process can be likened to solving a puzzle, where more and more pieces are provided over time to ultimately fill out the complete picture.
Such is the case with a recently published study titled, Effect of timing of protein and carbohydrate intake after resistance exercise on nitrogen balance in trained and untrained young men. Briefly, the study employed a within-subject design where both an untrained group and a trained group performed regimented resistance training under two different protein-timing conditions. Training was carried out over two consecutive 11 day periods using a push/pull split (lower body on days 1, 5, and 9; shoulders, chest, and triceps on days 2, 6, and 10; back and biceps on days 3, 7, and 11). Subjects were placed on a regimented nutritional plan where they ate breakfast at 7 am, lunch at 1 pm, and dinner at 7 pm. During one of the 11-day training phases subjects consumed a protein supplement immediately after exercise while during the other phase they consumed the shake 6 hours post-workout. Importantly, training was carried out from 10 to 11 am each morning prior to lunch. The table below provides specifics on the study’s protocol.
The results were intriguing. In the untrained group, no differences in nitrogen balance were noted between timing strategies. Conversely, the trained subjects showed a significantly greater positive nitrogen balance when protein was provided immediately after training compared to delaying consumption by 6 hours.
Upon first hearing about the study I was ready to dismiss results because of the very long wait to consume the post-workout supplement. Considering that training was carried out 3 hours after breakfast and that training took an hour, that means the supplement was ingested 10 hours after breakfast. Simple logic dictates that’s not ideal if the goal is to maximize the anabolic impact of training.
Here’s the rub though: Subjects ate lunch 2 hours after the training bout and that meal contained ~30 grams of protein. So in essence, the study actually showed that delaying intake just a couple of hours after a training bout had a significantly detrimental effect on protein balance in experienced lifters.
With that as background, here are some things to keep in mind when drawing evidence-based conclusions. I’ll start by noting that the study was well-designed to assess the desired outcome measure (nitrogen balance). The author took good care to control all relevant variables, in particular food intake (diets were designed by a nutritionist and intake was strictly monitored). This provides good confidence that results were attributed to the independent variable — namely, timing of post-workout protein provision.
It is important to understand, however, that the study measured nitrogen balance over a 3 day training period — not long-term muscle growth. Now there is a correlation between *chronic* nitrogen balance and hypertrophy. The accretion of muscle proteins is predicated on a positive nitrogen balance, whereby protein synthesis exceeds protein breakdown over a given time-frame. However, it is misguided to extrapolate that an *acute* measure of nitrogen balance will necessarily translate into greater muscle hypertrophy over the course of weeks or months. To this point, recent research from Stu Phillips lab shows that acute measures of post-exercise protein synthesis do not correlate well with long-term increases in muscle growth.
In addition, the nitrogen balance technique itself has inherent limitations. Research has shown that the technique results in an overestimation of nitrogen intake and an underestimation of nitrogen losses. Moreover, its ability to accurately determine balance over short time frames has been called into question — and this study evaluated balance over a period of just 3 days. Finally, nitrogen balance comprises many bodily tissues and thus it is not clear if differences are specific to muscle fractions. Whether these factors had an impact on the present study is anyone’s guess. Therefore, results must be interpreted cautiously.
Bottom line is that the study provides some interesting insight for generating hypotheses. In the narrative review I co-authored with Alan Aragon, we discussed that the anabolic effects of a meal last a maximum of about 6 hours, and therefore speculated that this would be the outer limit as to how long you should wait to consume post-workout protein from the time of your last meal. The present study suggests waiting 6-hours between meals has a negative effect effect on protein accretion in trained subjects but not in untrained subjects. Whether this translates into reductions in long-term muscle mass is unknown and can only be determined from a longitudinal study that directly measures changes in muscle hypertrophy.
Fortunately, I am collaborating with Alan Aragon and Colin Wilborn a study set to begin in a few weeks that will investigate this very topic. Stay tuned!
Aragon AA, Schoenfeld BJ. Nutrient timing revisited: is there a post-exercise anabolic window? J Int Soc Sports Nutr. 2013 Jan 29;10(1):5.
Mitchell CJ, Churchward-Venne TA, Parise G, Bellamy L, Baker SK, Smith K, Atherton PJ, Phillips SM. Acute post-exercise myofibrillar protein synthesis is not correlated with resistance training-induced muscle hypertrophy in young men. PLoS One. 2014 Feb 24;9(2):e89431. doi: 10.1371/journal.pone.0089431. eCollection 2014. Erratum in: PLoS One. 210;9(5):e98731.
Mori H. Effect of timing of protein and carbohydrate intake after resistance exercise on nitrogen balance in trained and untrained young men. J Physiol Anthropol. 2014 Aug 6;33(1):24. [Epub ahead of print]
Rand WM, Pellett PL, Young VR. Meta-analysis of nitrogen balance studies for estimating protein requirements in healthy adults. Am J Clin Nutr. 2003 Jan;77(1):109-27.
Tomé D, Bos C. Dietary protein and nitrogen utilization. J Nutr. 2000 Jul;130(7):1868S-73S. Review.
August 2, 2014
The beauty of peer-reviewed research is that it’s self-correcting. Scientists publish papers and then the scientific community scrutinizes the methodologies and conclusions employed. When appropriate, criticism is levied on a study and discussion/debate ensues. This process should be welcomed by researchers; it’s what pushes science forward and enhances our understanding of a given topic.
As many of you know, an area of research that I’ve recently been pursuing is the effects of protein timing on muscle strength and hypertrophy. In 2013 I collaborated with my good friend and colleague Alan Aragon to publish a review on the topic titled, Nutrient Timing Revisited: is there a post-exercise anabolic window?. In short, our review concluded that while muscle is sensitized to anabolism in the post-workout period, current evidence does not seem to support the existence of a narrow “window of opportunity.” I discussed the practical implications of the review in a previous blog post.
The paper stirred a lot of controversy. After all, the concept of an anabolic window of opportunity for nutrient consumption had been somewhat of a sacred cow in the field. Until publication of our review it was widely taken as gospel that you had an hour or less to take advantage of this narrow window; if you missed the window, muscular gains would be compromised.
One of the staunchest proponents of the nutrient timing paradigm is Dr. John Ivy, a professor at the University of Texas and noted sports nutrition researcher. Dr. Ivy literally wrote the book on nutrient timing with publication of his popular text, “Nutrient Timing: The Future of Sports Nutrition” back in 2004 It therefore was no surprise that Dr. Ivy took issue with our paper in an article he published in the American Journal of Lifestyle Medicine.
I welcomed Dr. Ivy’s criticism of our paper. As stated, critical debate of research is what drives science forward. But debate is a two-way street. I felt his critique was heavily biased and that he cherry-picked research to substantiate his claims.
As such, I provided a point-by-point rebuttal to Dr. Ivy’s critique in this blog post. In an effort to be fair and balanced, I emailed Dr. Ivy and gave him the opportunity to write a response to my comments. I offered to post anything he wrote unedited on my blog; unfortunately he never responded to my offer.
Subsequently, I co-authored a meta-analysis on protein timing with Alan Aragon and another good friend and colleague, James Krieger, titled The effect of protein timing on muscle strength and hypertrophy: a meta-analysis. Results showed a small effect for protein timing on hypertrophy, but virtually the entire effect was explained by an increased protein intake in the timing group. I discussed the study in detail in this blog post.
This week Dr. Ivy took to the airwaves to levy criticism of our meta-analysis. Appearing on the Superhuman Radio Network, Dr. Ivy called our paper “flawed” and took several of our methods to task (the discussion of our paper comes in at about the 22 minute mark).
Suffice to say, it’s my view that Dr. Ivy’s criticisms lack merit. What follows is a point-by-point refutation of Dr. Ivy’s claims.
First, Dr. Ivy mentions that “good studies were eliminated from the analysis” In particular, he specifies two studies that didn’t make the cut because they did not provide enough protein for inclusion in the analysis. He goes on to states that “…these studies showed significant increases in strength and muscle mass, so I don’t know how you can say that the protein wasn’t effective.”
I’ll start by saying that meta-analysis is only as good as the data it analyzes. Thus, rigid inclusion/exclusion criteria must be established to focus the analysis on the topic at hand.
Our inclusion criteria mandated that studies had to provide subjects with at least 6 grams of essential amino acids (EAAs). This cutoff point was determined from research showing that a ~6 g dose is required produce a marked increase in net protein balance – double the magnitude compared to a 3 g dose. If we had allowed inclusion of lesser amounts of post-workout EAAs intake it could just has easily been claimed that any negative findings would be attributed to insufficient protein provision.
That said, Dr. Ivy makes a fair point here since some potentially relevant studies were omitted from analysis. So let’s look at the two studies he mentioned.
In perhaps the most heralded study by protein timing proponents, Esmarck et al. randomly assigned 13 elderly men (average age 74 years) to perform a resistance training protocol 3 days a week for 12 weeks. The only variation in the protocol was that subjects consumed 10 grams of protein (a combination of skimmed milk and soy protein) either immediately following or 2 hours after the exercise bout. Results showed that muscle cross sectional area and mean fiber area of the quadriceps increased by 7 and 22 %, respectively for the group that received protein immediately post-exercise while the group that delayed protein intake showed no increases in fiber hypertrophy. On the surface, these findings would appear to provide compelling evidence in support of a narrow anabolic window of opportunity. Nail-in-the-coffin evidence, right?
Not so fast.
It is highly curious that the delayed-intake group saw *no* gains in muscle growth over a period of 12 weeks regimented resistance training simply because they waited 2 hours to consume protein. Zero! Considering that virtually every resistance training study ever done shows significant hypertrophy in untrained subjects after 3 months of regular lifting, the results must be viewed with skepticism. Moreover, these results were achieved with a dose of just 10 grams of protein (including lower quality soy protein), which equates to ~3 grams of EAA –an amount that as mentioned promotes only half the increase in protein synthesis as our required 6 gram dose. Add to this the fact that elderly subjects tend to be protein insensitive and generally need a ~40 gram dose to fully stimulate muscle protein synthesis and the findings are even more suspect. I’ll also note that the study had a very small sample size (only 7 subjects in the immediate provision group and 6 in the delayed consumption group), limiting statistical power. All told, it’s hard to make a case that this is nail-in-coffin evidence in favor of protein timing.
The other study we omitted because protein intake fell below the 6 gram threshold was carried out by Holm et al., who evaluated the effects of protein timing in 29 postmenopausal women over 24 weeks of resistance training. After exercise, subjects consumed a supplement containing either 10 grams of protein or placebo in double-blind fashion. Results showed that group who received the protein dose after exercise displayed greater gains in lean body mass compared to the placebo group. Interestingly, MRI analysis conducted at the 12-week midway point showed no differences in hypertrophy between groups (unfortunately the MRI was not repeated at the end of the study so it can’t be determined whether results would have diverged over time). While on the surface this study does provide some support for a beneficial effect of timing, it is important to note that total daily protein intake was ~10 grams greater for the timed group, and this confounding variable could have been responsible for any differences in muscle mass as opposed to a direct impact from timing.
Dr. Ivy also neglects to mention that two other studies were ultimately omitted from our analysis because we were unable to obtain sufficient data to compute an effect size. One of these studies by Bemben et al. showed no differences from a timed dose of protein compared to a non-timed dose. The other study by Burk et al. actually found a superior response when protein was consumed early in the day and late in the evening as opposed to before and after a workout.
Considering all the above, it is a huge stretch to claim that our inclusion/exclusion criteria unfairly biased results. The two studies excluded because of low protein provision had substantial limitations that deserve real scrutiny, and when factoring in the other two studies excluded for lack of usable data the net effect is at best a washout.
Next, Dr. Ivy stated we included studies that were not truly looking at nutrient timing but rather looking at differences between supplements post-exercise. He states these studies didn’t eliminate supplements post-exercise they just used different types of supplements. To quote Dr. Ivy: “They used studies that did not restrict eating post-exercise. For example, they would use studies where one group was given a protein supplement and the other was given an isocaloric carbohydrate supplement.”
While Dr. Ivy’s basic point is true, I’m not clear as to what the beef is here? Our inclusion/exclusion criteria specified we’d include any and every randomized controlled study where at least one treatment group consumed a minimum of 6 g EAAs < 1 hour pre- and/or post-resistance exercise and at least one control group did not consume protein < 2 hours pre- and/or post-resistance exercise. It really doesn’t matter whether or not protein timing was the primary objective of the research hypothesis per se. As long as a study employed timing in the manner specified by inclusion/exclusion criteria, then it provides a valid basis for evaluating the effects of timing. If I'm missing something here I'd be happy to hear Dr. Ivy's rationale.
Dr. Ivy goes on to question our statistical methods. He states: “In a meta-analysis you do what’s called an effect size on each of the independent studies. There were certain studies like the one by Cribb and Hayes which have dramatic differences between the groups that had supplementation around the workout versus in the morning and evening. When I looked at the effect size I thought it would be huge but it wasn’t. So I’m not sure how they actually measured the effect size, which can affect the results as well.”
This is a curious comment as the statistical calculation of effect size is clearly stated in the methods section of our paper. The formula is plainly presented so that anyone can easily perform their own calculations. We’re certainly happy to address any discrepancies in statistical outcomes based on hard data that conflicts with we found. However, it’s unscientific to simply dismiss our findings because they don’t conform to individual expectations based on intuition.
Finally, Dr. Ivy insinuates that we included a lot of poor quality studies and states if you look at lean body mass gains in the “6 or 7 good studies” — the ones he considers to be “well controlled” – then a clear superiority emerges for protein timing.
While Dr. Ivy is certainly entitled to his opinion as to what represents a “good” study, I’ll note that we did a quality analysis using the PEDro scale. The average PEDro score of the studies was 8.7 (out of a possible 11) indicating a very high degree of quality. I have scrutinized the quality between studies showing an effect of protein timing versus those that did not, and see no major differences between the two. Again, if he feels that the pro-timing studies are of sufficiently higher quality than those showing no effect then he needs to provide specifics. It’s not enough to make a passing statement such as this without backing up claims with supporting evidence.
As mentioned in a previous post, I have a great deal of professional respect for Dr. Ivy. He is an esteemed researcher and has a long history of publishing quality studies. However, a researcher’s body of work doesn’t provide a mandate to accept his opinion as fact.
When scrutinizing research, it is imperative that we take an objective approach; personal bias should never enter into the analysis. If Dr. Ivy wishes to criticize our meta-analysis, he must do so in the context of the overall body of literature rather than with evidence that selectively supports his opinion. Otherwise, the critique comes across as a skewed attempt to discredit the study for the purpose of confirmation bias. I’ll again put the offer out there for Dr. Ivy to write a response, which I will publish unedited in its entirety.
I’ll conclude by noting that I will soon be collaborating on a protein timing study that should help to fill in some of the many gaps in the literature, with data collection set to begin next month. Neither I nor my co-authors have any stake in the topic. I’ll be happy to consider changing my opinion on the topic in the face of compelling evidence.
Bemben MG, Witten MS, Carter JM, Eliot KA, Knehans AW, Bemben DA. The effects of supplementation with creatine and protein on muscle strength following a traditional resistance training program in middle-aged and older men. J Nutr Health Aging. 2010 Feb;10(2):155–159
Børsheim E, Tipton KD, Wolf SE, Wolfe RR. Essential amino acids and muscle protein recovery from resistance exercise. Am J Physiol Endocrinol Metab. 2002 Oct;283(4):E648-57.
Esmarck B, Andersen JL, Olsen S, Richter EA, Mizuno M, Kjaer M. Timing of postexercise protein intake is important for muscle hypertrophy with resistance training in elderly humans. J Physiol. 2001 Aug 15;10(Pt 1):301–311
Holm L, Olesen JL, Matsumoto K, Doi T, Mizuno M, Alsted TJ. et al. Protein-containing nutrient supplementation following strength training enhances the effect on muscle mass, strength, and bone formation in postmenopausal women. J Appl Physiol. 2008 Jul;10(1):274–281
July 27, 2014
Here is episode #9 of the B&B Connection. Bret and I discuss some of our recent research collaborations as well as touching on the just-pubbed review I co-authored with Menno Henselmans. Here are links to a few of the studies discussed (two are not yet availabile — one is still in press and the another in review).
July 26, 2014
Few nutritional topics spark more debate than the efficacy of low-carb diets. It’s therefore no wonder that a recent meta-analysis titled Low Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis is currently stirring up quite a bit of controversy in internet forums and social media outlets.
In case you’re not aware, a meta-analysis involves pooling the results of studies on a given topic to achieve clarity on the body of evidence. Here is an overview of the study with my analysis of methods and findings as well as commentary on its implications:
An important component of a meta-analysis is the inclusion/exclusion criteria. Simply stated, this refers to what conditions must be met for studies to be included in the analysis. For this meta-analysis, researchers required that studies had the following constraints:
• Compared a “low-carb” diet (less than 45% of calories from carbs) to a “balanced” diet (45-65% calories from carbs) that were isoenergetic (same number of calories between groups) in randomized, controlled fashion
• Comprised overweight or obese subjects
• Included macronutrient breakdowns
• Spanned at least 12 weeks in length
• Contained at least 10 subjects in each group
For statistical analysis, the low-carb diets were stratified into “high fat” (containing greater than 35% lipid) or high protein (containing greater than 20% protein). The diets were then further stratified into those where subjects were type 2 diabetics or non-diabetic. This stratification allowed for sub-analysis in a manner that helped reduce the potential confounding.
At first glance it would be fair to question the fact that “low carb” was categorized as any diet containing less than 45% of total calories. However, percentages can be misleading. The only truly relevant number here is the total grams consumed from carbohydrate. Let’s take a look at how this factored in to the included trials.
For the high-fat, non-diabetic studies there was one true ketogenic diet (4% of total calories from carbs) and the others ranged between 26-38% total calories from carbs. Given that energy intakes varied from about 1500 – 1700 calories per day, this puts total carb intake at about 97 to 161 grams/day (discounting the one true keto study). On the lower end this would put most in ketosis while on the higher end it would not. Carb intake in the high-fat diabetic studies averaged 20% of total calories, which would almost certainly translate into a ketogenic state in these subjects. The “high-protein” studies were basically all “Zone” type diets using the 40-30-30 approach. In these studies the total carb intake would have been greater than 150 grams and hence not induce ketosis. Bottom line: The “high fat” groups could fairly be classified as low-carb for the most part (at least if you pool the means of these studies) while the “high protein” groups would be more appropriately placed in a balanced category.
Overall the inclusion criteria allowed for the ability to examine an important issue on the topic, namely the effects of carb intake when total calories are kept constant. As will always happen in such situations, a number of studies that can have relevance are ultimately excluded from analysis. The extent to which this impacts results cannot be determined and the entire body of literature should always be taken into consideration when drawing evidence-based conclusions for practical application to nutritional approaches.
A total of 19 RCTs met inclusion criteria encompassing 3209 participants. The duration of the studies spanned from 3 months to 2 years. In scrutinizing the methodology, the researchers appeared to have done a nice job collecting and analyzing data. Two different researchers were involved in the search and coding process. This serves as a double-check to help minimize the prospect of errors in data entry. They screened for various types of bias (i.e. selection, performance, detection, attrition, and reporting) and did report instances where these issues could have impacted results. The one thing I did not see mentioned was an attempt to re-code a random number of the studies to check for “coder drift” (a change in the interpretation of coding items over time). It’s unlikely that this significantly impacted results, but the possibility cannot be ruled out based on what is presented in the methods section.
There were no significant differences in any of the outcomes at any of the time-points measured; weight loss was similar between all of the diets as were health-related outcomes (blood pressure, blood lipids, fasting glucose). The forest plots highlight the disparity between studies, with no trend whatsoever for superiority of one diet over another. The evidence presented suggests that when calories are equated, there is no difference in weight loss or health-related markers regardless of carbohydrate intake.
The primary limitation of the analysis is the fact that participants did not fully adhere to prescribed macronutrient goals in a majority of trials, and adherence declined with longer time periods. Compounding matters further, self-reporting of food intake is historically inaccurate, particularly in those who are overweight and obese. Thus, the strength of evidence is compromised here, making it is difficult to formulate clear conclusions from the analysis.
On the other hand, what is reinforced from this data is just how difficult it is to stick with a diet – any diet – over the long-term. As the authors of the study point out, this is especially true in diets that exclude entire food groups such as low-carb diets (although it should be noted that adherence in the balanced diet was equally poor in the studies analyzed). With respect to weight loss, nothing is more important than dietary adherence; you can’t achieve results if you don’t follow the diet.
The other point to keep in mind is that the subjects were all overweight or obese. Thus, results cannot necessarily be generalized to a healthy, non-overweight population. Now I’d point out that those who are lean tend to be more insulin-sensitive compared to the overweight/obese, and therefore low-carb diet would seemingly have less utility for these individuals. This would be particularly true of those who are serious exercisers, as both aerobic exercise and resistance training enhance insulin sensitivity. Still, the relevance of findings to lean or athletic populations remains questionable.
This meta-analysis provides evidence that energy balance – not macronutrient composition – is what dictates weight loss, although findings must be interpreted with caution due to poor dietary adherence across protocols. Despite this inherent limitation, results seem to be consistent with current theory on weight loss. While ketogenic diets can be a viable approach for some, I’m aware of no evidence showing that they have a universal metabolic superiority over balanced diets provided calories and protein are equated between dietary strategies. In fact, the few studies that have investigated the topic under controlled conditions failed to show any such metabolic advantage:
• Johnston et al compared a ketogenic diet (33 g carbs) to a balanced diet (157 g carbs) in a sample of 20 sedentary overweight/obese men and women. Total protein and calorie consumption were held constant so the only thing that differed between diets was intake of carbohydrate. No differences were found in fat loss or markers of cardiovascular health. The big strength of this study was that all meals were individually prepared giving a high degree of confidence in the results. The study was limited by a duration of only 6 weeks and a small sample size.
• Soenen et al. conducted an eloquent study that included four isoenergetic groups of varying protein and carb content, including groups where protein was matched but carb intake varied. The study was carried out over a 12 month period with an initial 3-month phase where subjects consumed 33% of their maintenance calories followed by a 9-month phase where subjects consumed calories at 66% of maintenance. During the initial 3-month phase the low-carb group consumed 5% of calories from carbohydrate; during the second phase carb intake increased to 25% of total calories. The average total caloric intake was not disclosed, but given the percent carb values and the fairly substantial energy restriction, it would certainly appear that the subjects were in ketosis throughout the study duration. Results? Here is a direct quote from the authors: “The study showed irrefutably, that, despite the success all-over with all four diets, the answer is that it is the relatively high-protein content per se, that supports the even greater success, and not the relatively lower carbohydrate content.”
The primary take-home message here is that there is no universal “best” diet. There is compelling evidence that higher protein intakes (at least 1.5 g/kg and generally higher in those who are lifting weights) are beneficial for optimizing body composition and enhancing satiety. A certain amount of dietary lipid is also essential for proper health, particularly with respect to polyunsaturated fats. Otherwise your approach to nutrition is largely an individual choice that, within fairly wide limits, should be based on preference, goals and lifestyle. Most importantly, calories do count!
Naude CE, Schoonees A, Senekal M, Young T, Garner P, Volmink J. Low Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis. PLoS One. 2014 Jul 9;9(7):e100652
Johnston CS, Tjonn SL, Swan PD, White A, Hutchins H, Sears B. Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets. Am J Clin Nutr. 2006 May;83(5):1055-61
Soenen S, Bonomi AG, Lemmens SG, Scholte J, Thijssen MA, van Berkum F, Westerterp-Plantenga MS. Relatively high-protein or ‘low-carb’ energy-restricted diets for body weight loss and body weight maintenance? Physiol Behav. 2012 Oct 10;107(3):374-80
July 23, 2014
Recently, I collaborated with my friend and colleague, Menno Henselmans, to review the literature on the effects of rest interval length on muscle growth. I’m pleased to report that this review has just been published in the prestigious journal, Sports Medicine. If you’re into the science of hypertrophy, I encourage you to read the paper as we delve into all the relevant research on the topic. In the meantime, here is an overview of the take-aways with practical implications.
General resistance training guidelines recommend that rest intervals should remain relatively short to maximize hypertrophy. In a previous review, The Mechanisms of Muscle Hypertrophy and Their Application to Resistance Training I echoed these sentiments, suggesting that rest periods of 60-90 seconds would seemingly provide an optimal balance between mechanical tension and metabolic stress (primary mechanisms in the hypertrophic response) to enhance anabolism. It should be noted, however, that these recommendations were based primarily on a logical extrapolation of mechanistic data; there simply have not been a sufficient number of studies that have investigated the topic in a well-controlled fashion.
In what is the most comprehensive study on the topic to date Ahtiainen et al. found no differences in muscle cross sectional area between 2 versus 5 minute rest periods in a sample of well-trained men. The study had several strengths including a randomized crossover design (which substantially increases statistical power), the inclusion of experienced trainees, and the use of the gold-standard imaging modality, MRI, to measure muscle growth. The one issue here is that the 2-minute rest period employed by the researchers is longer than what is generally advised for hypertrophy-type training. The impact on metabolic stress diminishes with longer rest periods, and this conceivably could have had negatively affected anabolic signaling in this study.
The other study of note that attempted to investigate the effects of rest interval length on hypertrophy was carried out by Buresh et al, whereby 12 untrained individuals performed their workout with either 1 or 2.5 minutes rest between sets. This study actually showed superior results for hypertrophy in the arms and a trend for greater growth in the legs in the subjects using longer intra-set rest intervals. While these results may seem compelling, it should be noted that muscle cross sectional area was determined by anthropometric means (i.e. surface measurements) which can be quite unreliable and thus compromise accuracy. Further confounding matters is the small number of subjects (only 6 in each group) and the fact that subjects were inexperienced with resistive exercise. Thus, while the findings here are interesting they must be interpreted with caution.
So what practical applications can we derive from the literature? Based on current research, it seems highly doubtful that rest interval length has a substantial effect on muscle growth. Bottom line: It would appear that you can self-select a rest period that allows you to exert the needed effort into your next set without compromising hypertrophic results.
That said, the paucity of controlled studies on the topic make it difficult to draw concrete conclusions. Certainly we know that shortening the duration of rest between sets increases metabolic stress, which is known to stimulate muscle remodeling. We also know that well-trained individuals such as bodybuilders are able to sustain a high percentage of their repetition maximum with rest periods as short as a minute. Could the combination of these factors may provide an additional hypertrophic stimulus — albeit a small effect — over time in well-trained subjects? Could other factors such as increased hypoxia and cell swelling also contribute to such a response?
These are questions that require further research. I’m currently in the process of carrying out a study that will provide relevant answers. I hope to begin data collection before the year is out. Stay tuned.
Henselmans M, Schoenfeld BJ. The Effect of Inter-Set Rest Intervals on Resistance Exercise-Induced Muscle Hypertrophy. Sports Med. 2014 Jul 22. [Epub ahead of print]
July 6, 2014
In this post I want to delve into the specifics of a study I recently published in the Journal of Strength and Conditioning Research that investigated muscle activation in two popular hamstrings exercises: the stiff leg deadlift and the lying leg curl. While other studies have evaluated differences between these exercises in activation of the medial hamstrings (semitendinosus and semimembranosus) versus the lateral hamstrings (biceps femoris), our study is unique in that we also looked at activity in the upper and lower aspects of the individual muscles.
My interest in undertaking this work revolves around an emerging body of research showing that, contrary to popular belief, muscle fibers do not necessarily span from origin to insertion. Rather, many muscles are compartmentalized so that fibers terminate intrafascicularly (within the fascicle) with each subdivision innervated by its own nerve branch. This structure provides a mechanism by which different exercises can conceivably target different portions of a given muscle. It just so happens that several studies have shown that the hamstrings muscles are in fact partitioned in a manner that would potentially allow for such regional-specific activation. I thus decided to test this hyptothesis in the lab under controlled conditions.
What We Did
Ten young men were recruited to participate in the study. All of the subjects were experienced with resistance training, defined as lifting at least 3 times per week for a year or more. We employed a counter-balanced design where each subject performed both the stiff-leg deadlift and the leg curl. This design provides a high-degree of statistical power, thereby improving the possibility of detecting a significant difference if one in fact does exist. Testing took place over two sessions. In the first session we tested subject’s 8RM on both exercises. The second session involved assessing activation during performance of the movements at the subject’s 8RM.
Muscle activation was determined by a technique called electromyography (EMG). Electrodes were placed on the upper and lower aspects of the subject’s medial and lateral hamstrings; care was taken in placement to make sure that cross-talk between muscles did not confound results. The subjects then performed one of the exercises followed by a lengthy rest period and then performed the other exercise. The exercises were counterbalanced so that Subject 1 performed the leg curl first, Subject 2 performed the stiff-leg deadlift first, etc. This ensured that the order of performance did not confound results. All sets were performed at the subject’s 8RM to muscular failure.
What We Found
Activation of the upper hamstrings was similar between exercises. Interestingly, however, activation of the lower hamstrings, both medially and laterally, was significantly greater in the lying leg curl. The differences in activation of the lower hamstrings was stark, with the leg curl showing greater lower lateral hamstrings activity of ~170% and lower medial hamstrings activity of ~65% compared to the stiff-leg deadlift. The data for the lateral hamstrings was not unexpected; the short head of the biceps femoris does not cross the hip joint, so a knee-dominant exercise such as the leg curl would necessarily be the only way to directly target this muscle. However, the data for the medial hamstrings was somewhat surprising since both the semitendinosus and semimembranosus are biarticular muscles. Results suggest that the partitioning of these muscles may allow for greater regional-specific activation in their lower aspect.
The findings suggest that performing both a hip-dominant hamstrings exercise (such as the stiff-leg deadlift) and a knee-dominant exercise (such as the leg curl) are beneficial to maximize activation of the muscle complex. Given that muscle hypertrophy is predicated on recruiting as many motor units as possible in the target muscles and achieving high firing rates in these motor units for a sufficient length of time to fully stimulate the fibers, it stands to reason that greater activation achieved should lead to greater regional-specific muscle growth. Several recent studies have in fact shown this to be the case, with non-uniform hypertrophy correlating to the region of greatest muscle activation. However, the evidence to date remains correlational and more research is needed to draw cause-effect conclusions. In the meantime, the present study provides interesting insight into how different exercises elicit different responses in a given muscle and lends support to the potential benefits of varying exercise selection to optimize muscle development.
Schoenfeld BJ, Contreras B, Tiryaki-Sonmez G, Wilson JM, Kolber MJ, Peterson MD. Regional Differences in Muscle Activation During Hamstrings Exercise. J Strength Cond Res. 2014 Jun 24. [Epub ahead of print]
June 16, 2014
Been a little while since my last blog post. Here’s an update on what’s been going on:
• I just received acceptance from the Journal of Strength and Conditioning Research on study showing that you can target different areas of the hamstrings by varying exercise selection. The study evaluated muscle activation during performance of the stiff legged deadlift and the leg curl. We looked both at activation of the medial hamstrings (semiteninosus and semimembranosus) versus lateral hamstrings (biceps femoris), as well as the upper and lower aspects of the muscle. While previous studies have shown that the medial versus lateral hamstrings can be targeted, this is the first study to document differences in the upper and lower portions. Very interesting findings with novel practical implications. I’ll have lots more to say when the study is officially published, which should be soon.
• The internet has given rise to a legion of arm-chair scientists who have little appreciation for what it actually takes to carry out a research study. The upshot is rampant misinterpretation of data and absurd criticisms about study design, often based solely from reading the abstract. That’s why it’s refreshing to see when someone writes an insightful commentary on a study. Such is the case here, where Lyle McDonald provides an excellent critical analysis of my recent study comparing muscular adaptations in bodybuilding- vs. powerlifting-type training. The write-up shows keen insight into understanding the nuances of research methodology and the ability to draw applicable conclusions from the results. Really well done and worth the read.
• I have a number of speaking engagements coming up in the next few weeks. First, I’ll be at the ISSN Annual Conference in Clearwater Beach, Florida discussion how to periodize a muscle-building routine. Next, I’ll be at the NSCA International Conference in Murcia, Spain speaking on a new paradigm for hypertrophy training based on my recent research. Final stop is the NSCA National Conference in Las Vegas, Nevada where I’ll co-present with the incomparable Alan Aragon on practical applications for nutrient timing. If you’re attending any of these events, make sure to stop by and say hello.
May 24, 2014
You pretty much can’t pick up a fitness magazine these days without seeing an article on “functional fitness.” The promotion of the “functional fitness” concept was basically a reaction to popular bodybuilding-type programs that focused on structuring workouts by muscle groups such as the chest, back, shoulders, and legs. Functional fitness proponents countered that such routines did not address the complex interaction between muscles during human movement, leading to the catch-phrase: “Train movements, not muscles.”
On the surface the premise sounds logical.
In reality it’s a gross oversimplification of motor learning principles.
As I’ve previously written about, functional transfer through exercise exists on a continuum. Bottom line is that we need to stop thinking about exercises as “functional” or “non-functional” and realize that for most practical purposes all exercises can produce functional improvements depending on task requirements and the individual.
In this video, Bret Contreras and I discuss the nuances of functional training. We review the science on the topic, dispel some of the popular myths, and delve into practical applications for exercise selection.