The doc weighs in on meal frequency, calorie counting, and the use of Clomid for boosting testosterone.
Meal Frequency Confusion
Q: Some diet experts say that having six small meals a day is outdated. Many recommend three (or fewer) meals instead. But what if I feel uncomfortably stuffed when trying to cram all my calories into three meals? Is there any harm in continuing to eat smaller, more frequent meals if I'm not gaining fat from it?
A: I understand your frustration. This industry seems to constantly be stuck in a never-ending cycle of black and white advice. One minute something is in vogue and the next it's not. I will tell you definitely and without hesitation that eating small frequent meals is NOT outdated and is a fantastic strategy for many people.
Part of the reason you're getting the message to avoid small frequent meals is a newfound appreciation for less-frequent eating. We now have plenty of substantial research telling us that there are many different eating regimes that work and have benefits.
A quick perusal of the last several years of research will reveal that one meal a day (OMAD) style of eating can work great for some. Different time restricted feeding schedules such as the 16-8 approach – which involves fasting for 16 hours a day by avoiding breakfast – can deliver great results.
A more recent study showed skipping dinner may be superior to skipping breakfast. Varied fasting regimes, like the the 5-2 plan, where you eat normal during the weekdays and then consume little to no food on the weekends, can be beneficial.
All of these studies have created excitement. New information typically generates a novelty bias for a bit. It's common to overemphasize the new and underappreciate the old, but it doesn't make a whole lot of sense since new things haven't been tested by time. Usually, the tried and true is better than the fresh and new.
I address all of this to hopefully help allay your concerns and clear some confusion. The current consensus in the nutrition research is still that calories matter most. Sure, we now know hormonal influence are working with calories to impact things like hunger, mood, cravings, and energy, but in the end we must attend to the calorie levels of the individual diets we choose.
There are two things required for sustained fat loss:
- A calorie deficit
- Metabolic hormonal balance
The calories drive the weight loss and the hormones push that weight loss towards fat loss and sustainability. You need both. Quality and quantity are equally important. It's impossible to separate the two.
The question of eating frequency comes down to the individual. We're all different. We're unique in our genetics, psychology, and personal preferences. We should honor that. What all that research above says is, there's more than one way to skin the calorie and hormone cat. Ultimately, it's about finding what works for you.
Try telling the bodybuilding world from 1960 to 2000 that small frequent meals weren't ideal. You'd be laughed at and mocked. The small frequent meal approach works fantastically well, but it's not the only way. Some people do better with different eating frequencies.
My advice? Keep doing exactly what you're doing so long as that regime keeps these things in check: sleep, mood, hunger, energy, cravings (SHMEC), and so long as you're attaining or maintaining your desired body composition. Why would you change?
One final hint here. The metabolism is an adaptive system. You want to keep it flexible and healthy. You can do that by keeping it guessing and changing up your eating frequency at times.
So, you may benefit even more if, from time to time, you experiment with less frequent eating. It's the same for those less frequent eaters. They're far better off deviating occasionally to a more frequent eating pattern.
In the end, you should always return to what works best for you. Remember, research is a tool for averages not individuals. The research can get you in the ballpark, but you'll need to tweak and adjust to get it just right for you.
Clomid for Boosting Test?
Q: Steroid-using bodybuilders use the drug clomid, an anti-estrogen, to help restore testicular function after a cycle, but I've heard of doctors prescribing it as a form of TRT – to boost natural T levels. Does that work?
A: It absolutely works and works incredibly well. There are more than a couple studies showing its benefit. I now consider it my first line therapy for low testosterone after trying to correct with diet and exercise.
I used to suggest HCG for this, but clomid is cheaper and more effective – it raises T and has a nice effect on the estrogen to testosterone ratio, where HCG may worsen that ratio in some. It also has a very good safety record with virtually no negative side effects reported in studies and no negative impact on PSA and hematocrit levels.
Clomid is cheaper than either HCG or testosterone. The typical dose is 12.5 to 50mg per day. I usually start my patients at 25mg per day and then retest all blood values after 6 weeks, adjusting dosing as needed.
One caveat: Clomiphene (clomid) does not have a great track record for sexual symptoms (i.e. erectile function). Little known fact, neither does testosterone have an automatic benefit in this realm. Some of my patients have seen a worsening of erections as testosterone rises. While we're not yet sure why some respond positively and others don't, the estrogen to testosterone ratio may be playing a role.
The final thing to know is that clomiphene works by interaction with the hypothalamic, pituitary gonadal axis and the adjustment of the signaling hormones FSH and LH. For this reason, the hypothalamus and pituitary need to be functioning well for the medication to work. If it doesn't work, it's an indication the site of dysfunction isn't the testes, but rather the brain.
Do I Have to Count Calories?
Q: Let's say that you're in a "eat more exercise more" season and you're fueling up in order to improve performance and increase gains. Is there a way to avoid overeating without having to count calories? Or is it just a "go by how you feel" and "adjust as you go" thing?
A: The intuitive approach to eating can work great IF you've had enough experiences in the trenches of weighing, measuring, and adjusting your food. Intuition is not magic; it's a natural consequence of experience and practice. If you don't have the experience and practice, you can't possible develop intuition.
Based on that, you can definitely use the "go by how you feel" approach. I like to use a combination of subjective and objective measures. The subjective measure I use is called HEC (hunger, energy, cravings) or SHMEC (sleep, hunger, mood, energy, cravings).
These are acronyms I came up with to help my clients have a window into their hormonal functioning/balance. If your HEC or SHMEC is in check, your hormonal system is likely balanced and the approach you're using is going to be far more sustainable. The objective feedback comes from body composition results.
Here's something to consider: Those eating low calories and burning a lot of calories (dieters) and those eating a ton of calories and burning none (couch potatoes) both suffer from HEC/SHMEC being out of check. That's because both of these metabolic states, when taken to the extreme, are a stress to the system.
What does the metabolism do when it encounters a significant stress? It tries to get back to balance. It does so by making you move less (less energy, less motivation) and eat more (increased hunger and cravings). Remember, most stressful things the body encounters will turn on our ancient survival software – the starvation response.
Now that you understand, you have a tool to know if you're going too far with things. Be aware also that the EMEM (eat more exercise more) system of eating can easily move into an EMEL (eat more exercise less) regime if you're not careful.
There are several things we know that can keep a lid on the compensatory mechanisms of the metabolism. First, make sure you're balancing any training with plenty of rest and recovery. Athletes train hard, eat plenty, and spend a lot of time resting and recovering. You should do the same. Control those stress hormones. They're highly correlated with increased food-seeking behavior.
Another trick is to raise your calories the smart way. What a lot of people do is go for burgers, pizza, nut butters, and guacamole. These foods make it easier to increase your calories, but they also make you eat more at the current meal and crave the same kinds of foods at future meals.
This is why I'm not a fan of cheat meals and refeeds done with highly palatable hedonistic foods. Keep your food choices on the blander side. The combination of salt, sugar, starch, fat, and alcohol will light up the reward centers in your brain like the Rockefeller Center Christmas tree.
Use these three tips:
- Read the hormone signals (HEC and SHMEC).
- Pay attention to rest, relaxation, and recovery.
- Keep to a more bland diet.