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If you are trying to lower calorie intake for better weight loss, you will probably ask a question at some point: is it better to cut fat or carbohydrate calories? This is what this articles is about and I start with probably somewhat surprising answer. Actually, two answers because they are different for diet in general and diet for weight loss and exercise:

For general nutrition, cut down on carbohydrate first, especially refined sugars and starch products. It is very likely that you are overeating particularly these kinds of carbohydrate, which have proved to be most detrimental to human metabolism.

For weight loss and exercise, it does not matter if you cut down on fat or carbohydrate or both, as long as you:

• Supply essential fatty acids as 1-2 serving of unsaturated fats (oils);
• Supply sufficient protein to maintain and build muscle: preferably, at least 1 grams protein per kg body weight.

Lets get into detail on how I arrived to this answer.

The 2010 nutritional guidelines by US government call or the following proportion of energy (calorie) intake for adults:

Carbohydrate	Protein:	Fat:
45–65%	10–35%	20–35%

As we can see, this diet is biased in favor of carbohydrate. Is this something that is based on research or something that merely reflects our habits?

Talking about out real habits, take a look at the graph of soft drink consumption here(from here):

The soda sales in US have pretty much hit the ceiling but in developing countries, which strive to live by “western” standards, sweet water sells pretty well. Coca Cola spends about 10% of its 12 billion profits on advertisement and it goal is to double business by 2020, mostly by growing in developing world.

In soft drinks sold in US, carbohydrate comes in a form of HFCS – high fructose corn syrup. It is a mixture of sweet simple sugars glucose and fructose obtained by chemically processing corn. Fructose is very sweet, it is sweeter than regular sugar (sucrose), which is one reason for using HFCS. Another reason is price – HFCS is cheap because US companies get subsidies to grow corn, or else cheaper foreign sugar made of sugar cane would put them out of domestic market.

Not only we mostly replace water with soft drinks, but we have also created negative image for water consumption. Many people think that tap water is somehow inferior in quality to bottled water, which is a misconception. About half of bottled water sold is nothing but a regular tap water. If you go to any fast food place, you will be offered a huge 24 or 32 oz brightly colored cup for soft drink (free refills, of course). If you ask for water, you well be offered a tiny inconvenient 8 oz cup. Not enough for a hot Texas day! 32 oz cup of soft drink is, by the way, 4 servings – about 400 calories with absolutely no essential nutrients.

The map of soft drink consumption in US is a pretty good overlap with a map of obesity and heart disease. Here is my article about that. This is not surprising since every known metabolic marker is affected by high carbohydrate consumption. Glucose tolerance is reduced, “bad cholesterol” (smaller LDL) rises, good cholesterol (HDL) drops, and fats (triacylglyceroles) also rise. Yes, you are reading this right – high carbohydrate in diet raises fat level in blood. This leads to diabetes, obesity and elevated risk of heart disease.

There are generally three problems with carbohydrate rich foods:

• Too high on calories. Just an example: a 4 oz chocolate muffin has 8g protein and 360 calories. 4oz of pork have 28g protein and 280 calories.
• Too high in simple sugar (glucose), causing a blow to your metabolism by messing up glucose balance. Note that starch is also glucose but connected in a chain: in your stomach and small intestine, it is digested and absorbed into blood as glucose.
• Too low on essential nutrients. Companies are trying to get around this by adding things like vitamin C and labeling it “Vitamin Water” but it does not make no difference – it still over 100 calories, and still no protein. You can easily get you daily dosage of vitamin C from real fruits and vegetables, like onions and oranges. The problem of course is that real stuff is not as sweet and that is why so many people prefer varous forms of sweet water labeled as “juice”.

Fat, especially fat from meat and diary products (solid, or saturated fat) has been getting negative publicity. It is easy to convince people that fat is bad if you tell them that fat is what makes them “fatter”. So many people are looking for “zero saturated fat” products and often replace them with foods rich in carbohydrates. Our body can easily convert fat to carb and carb to fat in a snap. What really matters is the total amount of consumed calories. Unused calories from either source will be saved as fat, mostly in abdominal area.

In 2010 analysis, some prominent experts in a field, Ronald Krauss and colleagues, have reached a conclusion that there was “no significant evidence that dietary saturated fat is associated with an increased risk of cardiovascular disease”. However, increasing consumption of polyunsaturated fat is independently associated with reduced risk of cardiovascular disease. The take home message: you can have nutrition rich in saturated fats (meat, diary products, eggs), but be sure to also include products rich in polyunsaturated fats: fish and plant foods. Replacing saturated fat with carbohydrate is a bad idea.

All above is described for diet unrestricted in calories and for those who do not take steps to include exercise and/or increase their activity level. For an individual with an average genetic makeup, eating as much as you want and not exercising will result in a slow weight gain, slow muscle loss, and all chronic diseases that come with it. This will happen regardless of what you are eating. Under those conditions, lowering carbohydrate to a minimum, reducing saturated fats, and increasing unsaturated fats is a good idea, but it will only slow down the process of slow decrease in fitness. With these diet modifications, expect better weight control and about 30% decrease in the risk of cardiovascular disease.

But things are a little different when calories are restricted. When calories are down to about 70% (1400 kcal), both low fat / high carb and high fat / low carb diets worked about equally well. Low high fat / low carb diet showed slightly more of weight loss (9.2% vs. 7%). In both diets, cardiovascular markers were also improved: lower fat (triacylglycerol) level, higher “good cholesterol” (HDL) and lower “bad cholesterol” (small LDL).

So the take home message is:

it is not the particular fat to carbohydrate ratio that matters, but the total amount of consumed calories.

With calorie restricted diet alone, both loss of fat tissue and loss of muscle tissue will occur, accompanied by a decrease in metabolic rate – body’s ability to burn food into energy. This is described in more detail here. For both weight loss and increase in fitness level, diet needs to be combined with an exercise regime and an increase in low-level and moderate-level activity. When combined with exercise, very different types of diets give significant improvement in all health parameters, but high protein / low carbohydrate diet allows for better muscle gain and better fat loss.

Here is an example of how diet and exercise combinations worked for obese women (average weight 94 kg, BMI 34.9) over 14 weeks:

Regimen	Diet	Waist size change, cm	Body mass change, kg
Exercise + 1200 kcal diet	63% protein, 7% carb	Decrease by 6.3	Decrease by 5.6
Exercise + 1200 kcal diet	50% protein, 20% carb	Decrease by 6.7	Decrease by 6.5
Exercise + 1200 kcal diet	15% protein, 55% carb	Decrease by 5.7	Decrease by 4.0
Exercise only, no diet	Normal	Decrease by 5.1	Decrease by 0.2
No exercise, no diet (control)	Normal	Increase by 8.2	Increase by 1.4

(from Kerksick, 2009).

I marked best results I bold. Clearly, limiting calories, keeping protein high and carbohydrate low gives best results for weight loss in combination with exercise. Also note two other things: 1) No exercise, no diet group got significantly fatter over 14 weeks and 2) Exercise only also gave small, but visible improvement.

In summary, for exercise and weight loss, the total amount of calories and amount of protein is more important than a fat to carbohydrate ratio. As long as you keep calories low, weight loss will occur. High protein, on the other hand, will facilitate muscle gain.

Whether you are focusing on lowering carbohydrate or lowering fat, there is a couple of things to remember:

• Refined sweet sugar (sucrose and HFCS) is extremely unhealthy and mess up metabolism. It should be avoided at all cost.
• Daily need for essential fatty acids must be met. This can be easily done with 1 to 2 servings of regular cooking oils such as canola oil and vegetable (soybean) oils. There is no scientific basis for providing more than necessary amount of omega-3 fatty acids in a form of supplements (flax seed, fish oil, etc.).
• It helps to increase protein to above the recommended daily amount to retain and build muscle: 1 gram per kilogram body weight or more. If you are more into muscle building (“bodybuilding”), then go up to 2 grams per kilogram, or 1 g per pound. You cannot overeat on protein – whatever is not used as building material will be used as energy source.

When you decide to limit calories there is a practical consideration though: most animal protein sources are rich in fat calories and low on carbohydrate. This means that if you build your diet around these products, you will quickly max out your calories, and there will be little or no space left for carbohydrate products. This is exactly how I build my diet – around meat, eggs, milk, poultry and fish. I really do not mind dumping most carbohydrate. My staple food is meat, mostly trimmed pork, and eggs – two per day. I call is a “caveman’s diet”. My full article about it is here.

I personally use a “carbohydrate avoidance strategy” – for me, this is the easiest way to limit calories. This means no sugar in the house, no soft drinks, no sweet stuff, no bread, grains limited. But there is an advantage to it also – I can enjoy an occasional sausage (200 kcal) or a beer (another 200 kcal). I do get some carbohydrates from vegetables though – mostly potatoes. I found that this approach works great and is very easy to maintain, I only need to buy a few very basic foods in a grocery store.

Advanced reading:

Saturated fat, carbohydrate, and cardiovascular disease.
Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Am J Clin Nutr. 2010 Mar;91(3):502-9.

Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.
Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Am J Clin Nutr. 2010 Mar;91(3):535-46.

Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects.
Tay J and others. J Am Coll Cardiol. 2008 Jan 1;51(1):59-67.

The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?
Astrup A and others. Am J Clin Nutr. 2011 Apr;93(4):684-8

A randomized trial of a hypocaloric high-protein diet, with and without exercise, on weight loss, fitness, and markers of the Metabolic Syndrome in overweight and obese women.
Meckling KA, Sherfey R. Appl Physiol Nutr Metab. 2007 Aug;32(4):743-52.

Effects of a hypocaloric, low-carbohydrate diet on weight loss, blood lipids, blood pressure, glucose tolerance, and body composition in free-living overweight women.
Meckling KA and others. Can J Physiol Pharmacol. 2002 Nov;80(11):1095-105.

Effects of a popular exercise and weight loss program on weight loss, body composition, energyexpenditure and health in obese women.
Kerksick C and others. Nutr Metab (Lond). 2009 May 14;6:23.

Many people think that it is possible to effectively manage body weight with low calorie diet only and absolutely no exercise or little physical activity. They believe that by simply switching from coke to diet coke or from red meat to chicken breast or eating some kind of “omega-3” supplement they can lose weight and be healthy. This is one of the most common myths about weight loss. The market is full of products that help you “burn fat”.

Sugar-blocking brownies… Wow!
Very often, attempts to shed pounds with diet only either fail miserably or weight is quickly regained after diet regime is stopped. Here is why: with low calorie diet only, you will lose both fat and muscle. Because muscle burns most calories in your body, dieting only will cause a decrease in your energy producing capacity, or metabolic rate, and therefore a decrease in your endurance, fitness and strength. When you start cutting down your calorie intake, the first thing your body does is shutting down energy usage in order to save energy. Stop your diet for a while and quickly regain all those pounds lost and even put some extra!

Muscles are you body’s power machines – they burn food you eat into energy. It is the physical activity and exercise that maintains oxygen supply and energy production ability of your muscles in top shape. No exercise = slow loss of muscle = burn less food into energy = gain weight = become less fit. This process will be happening naturally as you age, no matter what you eat. This weight gain is not merely an increase in fat tissue – it is more a conversion of muscle mass into fat mass.

The best results for both weight loss and maintaining your metabolic rate are achieved when low calorie diet and exercise regime are combined together, which is shown on the diagram below.

Exercise only regime (bottom right) is still a better choice than going low calorie diet only. Exercise only will not necessarily result in a net weight loss, but if done correctly, it will result in losing fat mass while building up muscle. This alone will make you a whole lot fitter, even with no net weight change. When you are exercising, even minor adjustments to your diet, such as just cutting down on soft drinks, will have noticeable effect – because now you body is more limited for energy. Your muscles have a lot more blood flowing through them and burn a lot more calories, during exercise and after exercise, and even when you sleep. Reduce energy supply by a little – and observe a significant weight loss.

Every form of physical activity counts – light activity (standing and walking), moderate activity (brisk walking, bicycling), aerobic exercise and resistance exercise. Whether you can put in an extra 10 minutes of jogging, do an extra set of yoga, park at the far corner of a parking lot to have a little walk, or stand at your office job – do it. They all work through somewhat different mechanisms, but they all are good for you. Just like there is no “magic” organic food, there is also no single “magic” exercise. All forms of physical activity are great, but the best ones are the ones you enjoy!

If you do not maintain a necessary level of physical activity as you age and, your metabolic rate will gradually decrease. At the same time, as you advance in your career, your job usually becomes more sedentary. (Few people still flip burgers in their forties). That is why most people, as they progress from their 20s to their 50s, gain weight. This slow weight gain is detrimental to health. In one study reference below, individuals with high weight gain (22 lbs) between ages 20 to 50 years had 4-5 times higher risk of chronic disease (cardiovascular and diabetes) than folks who did not gain weight (from Haffner,2006):

Some people may say that this reasoning is wrong, because they know a lot of people who do not exercise and are lean in their 40s, 50s, and 60s. This is true, because your energy balance and weight also depends on your genetic makeup. I have two objections to this. First, this is a minority of people – most people do gain weight as adults. It is a fact. Just think of your last college reunion. Did many people look as fit as they did in their 20s? Second, even though these people are lean it does not mean that they are also healthy. They are fitter that overweight folks, but nowhere nearly as fit as the lean folks who also exercise. I had a lean friend of mine who thought he was healthy. He even played tennis sometimes. He died from a heart attack, at age 52.

Scientists can never figure out exactly what diet is right. Few years ago, they were recommending reducing fats. Then cooking oil became the culprit. Then there was talk about virtues of fish oil, flax seed oil, vitamin pills, and so on. We are always looking for an easy in-the-bottle solution, which requires no effort on our side. There is still “fat versus carbohydrate” argument going on right now, with neither side winning. Most of these recommendations later did not confirm, and even when effects were significant, they were relatively small (which is one reason why they are hard to prove). The only food that is consistently proven to be very unhealthy is simple (sweet) sugars, because they tend to mess up your blood lipid and glucose profile.

The level of physical activity and fitness are by far stronger predictors of mortality and risk of chronic disease (cardiovascular, diabetes) than the exact composition of food you eat. In various studies, effects of physical activity and fitness level on reducing risk of cardiovascular disease and all cause death were measured into 2 to 3 fold. And there is no disagreement on this in the scientific community; only research on mechanisms of how physical activity improves various functions of human body.

So, if you were thinking that you could significantly improve your health by somehow mixing just the perfect amount of protein, fiber, omega-3 fatty acids, and vitamin pills, while still comfortably sitting in your chair most of the time, keep dreaming. When we were apes and prehistoric humans, we were not spending days cooking and mixing perfect food – we were spending most of our time trying to find, catch or kill it. And our body was happy with whatever we could obtain.

Do not get my message wrong though. I have a whole chapter on nutrition here. Nutrition is very important and can prime your body to flourish, but good nutrition alone does surprisingly little. Combine it with some exercise – and see your body respond immediately and robustly!

The importance of diet is overstressed, while physical activity and sleep regime in underestimated. The reason for this is simple – foods are easy to advertise and sell and require no effort on your sideother than spending some extra bucks. And most people want something with no effort. That is why the market is flooded with all kind of nutrition and food supplement products.

Some of those products are certainly good. Free-ranging eggs and vegetables from Whole Foods are definitely higher quality and better choices than same products from cheap Mexican stores. But they do no magic. Exercise and physical activity requires significant effort on your side and it is harder to sell to you. If you noticed, most exercise products on the market aim to decrease your time and effort invested in exercise, such as “get flat abs in 10 minutes a day” or “get perfect abs with no crunches”” and so on.

These strategies might work for some people who are lucky to have a perfect genetic makeup. They are primed to burn energy and have a significant response even to a small amount of exercise.

For the vast majority of us magic will not happen. So instead of trying to decrease your exercise time, come up with clever and creative strategies to increase it and integrate physical activity in your daily routine whenever possible. Not just vigorous exercise, but also light and moderate physical activity, such as simply standing and walking instead of sitting. When I started in 2012, my personal goal was about 30 minutes of aerobic and 30 minutes of resistance exercise on most days as well as doing my regular activities at work and at home while standing and walking.

So the bottom line is:

Whether or not you want to go on a low calorie diet, do exercise.

Recent research study says that those who exercise even tend to earn more money. When you are physically fit, you will perceive yourself differently, and the world will perceive you differently. Whether you are trying to lose weight, maintain normal weight, increase strength and endurance, reduce risk of most diseases, extend your life or do it all at the same time – do exercise!

References

Relationship of metabolic risk factors and development of cardiovascular disease and diabetes.
Haffner SM. Obesity (Silver Spring). 2006 Jun;14 Suppl 3:121S-127S.

Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review.
Fogelholm M. Obes Rev. 2010 Mar;11(3):202-21.

Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men.
Lee CD, Blair SN, Jackson AS. Am J Clin Nutr. 1999 Mar;69(3):373-80.

Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men.
Wei M and others. JAMA. 1999 Oct 27;282(16):1547-53.

This article is about how human body balances its energy intake and energy expenditures, and its relevance for weight loss and exercise.

First, we need to realize that human body does not like change — it has multiple compensatory mechanisms to oppose change and keep things at balance: weight, temperature, blood glucose level and so on. This is called homeostasis. But at the same time, our organism needs to adapt to changes to increase its chances of survival. When we want to lose fat, we need to push metabolism out of its comfortable equilibrium state and make it undergo change.

Energy balance like any balance is made of input, or intake, and output, or expenditures.

Energy input is food that you eat. All macronutrients can be used to produce energy. Carbohydrate (glucose) is the default energy source, then fat, then protein. When energy input changes, human body will attempts to balance out by doing the following in this order:

• Adjust you appetite to make you eat more or less. It you try to diet, first thing that happens it that your appetite will increase, so that you return to a normal level of food consumption. But let us assume you have iron will, then the next thing your body is going to try is:
• Adjust energy production, or metabolic rate. For example, if you eat less, your body will slow down its energy production so you can run longer on smaller amount of calories. You will tend to be more tired, less active — those are manifestations of lower metabolic rate. If you eat more, on the other hand, your body will attempt to burn that extra food by increasing metabolic rate.
• Tap into or make more reserves in a form of fat. If it not possible to balance out energy with metabolic rate and appetite, your body will deposit or use fat for energy. Fat is our long-term energy storage.

When energy output changes — for example, if you force you body to produce more energy through exercise, it will also attempt the same things but in slightly different order:

• Adjust energy production, or metabolic rate, to meet energy needs. If you exercise, your metabolic rate will increase and this increase will even persist after exercise, because now your muscles have increased oxygen supply and are metabolically more active.
• Adjust appetite. It you do not take precautions at this point, you will also start feeling hungrier — your appetite will increase and you will eat more to meet higher energy needs. But let us assume you have good will power, and are not eating more, then your body will have to:
• Tap into or make more reserves in a form of fat. If it not possible to balance energy output by adjusting energy intake and metabolic rate, your body will use or make reserves in a form of fat.

Note that in relation to metabolic rate, food intake and exercise work in the same direction: increasing either one will increase metabolic rate. But in relation to fat storage they work in opposite directions. Increasing food intake will facilitate more fat storage, while increasing exercise will facilitate fat loss.

If we put both energy intake and energy expenditures on a graph, the equilibrium area is where intake and output are about the same. This is the stable weight zone. Within this zone, human body can adapt to changes in energy intake and / or energy output by adjusting its metabolic rate and appetite without having to change the amount of stored fat:

Stable weight zone does not mean any particular amount of stored fat; it means a zone where amount of fat is not changing. Where you are exactly in the zone depends on your genetic makeup and environmental factors. On this graph, points A and B illustrate two different people, or the same person in two different environments. Person A runs at low metabolic rate — he eats little but also spends little. Person B runs at high metabolic rate — he eats a lot, but also spends a lot through physical activity. Both are at stable weight, but could be at any weight — normal, overweight or underweight.

For weight loss, you need to push your body away from stable weight zone into the weight loss zone — where energy expenditure is way more than energy intake. In this area (upper left), your body is at its limit of adjusting metabolism and will have to start using its fat reserves.

Weight gain area is where output is less than input (bottom right). Significant part of US adults does slowly gain weight and become overweight or obese, so those folks belong to this bottom right corner.

This model describes the middle part of the human population, and takes into account its spread in genetic makeup. Some people never get fat no matter what they eat. They are in a stable weight zone, but close to the border with a weight loss zone. Other folks gain weight very easily even with moderate diet — they are borderline weight gain zone.

Lets see how this model relate to real world. In an experiment below, various diet combinations with exercise were tested on their effect on different parameters, including body weight, body composition and metabolic rate. This was a 14 week experiment on obese women. Below, I highlighted numbers that I used:

HED is for high-energy diet (2600 kcal) high carbohydrate + exercise;
ND is no diet (normal diet) + exercise;
LCMP is a low calorie (1200 kcal) low carbohydrate diet + exercise;
CON is a control — normal diet and no exercise.
REE is metabolic rate, or resting energy expenditures.

Numbers in the table show change over 14 weeks: decrease is negative, increase is positive number.

Lets put numbers on the graph where they belong. Metabolic rate is in red (kilocalories per day); weight change is in blue (kg):

In the middle, with normal diet and exercise or normal diet /no exercise, there is very little weight loss or gain, the body is able to adjust to this relatively small change in activity by adjusting its metabolic rate, and possibly appetite and food intake. (The kind of exercise used in this particular experiment was relatively modest.) Metabolic rate is a bit higher with exercise as compared to no exercise, as expected.

On the right, subjects given high calorie diet and exercise still did not show much weight change, but look at the metabolic rate increase! Actually, it went up by about 1/6th of the total energy intake. Here, human body shows that it would increase its metabolic rate and energy intake rather than start burning its fat.

In the top left corner, however, when low calorie (1200 kcal) diet was given in combination with exercise, significant weight loss did occur, 6.5 kg. There was little change in metabolic rate. What happens here is that increasing energy output and decreasing energy intake push metabolic rate in opposite directions (see above), so the net change is very small. Or think this way: exercise has compensated for a drop in metabolic rate due to reduced diet. But decreasing energy intake and increasing output both push fat reserves toward using them — that is why significant weight loss was observed.

I hope I explained everything clearly. The take home messages are:

For weight loss, you must push your metabolism out of its comfort stable weight zone.

This is best achieved by a combination of calorie-reduced diet and exercise!

Reference:

Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women.
Kerksick C and others. Nutr Metab (Lond). 2009 May 14;6:23.

When we talk about healthy metabolism, how do we know that it is healthy or messed-up? Doctors and scientists do certain tests to look at metabolic markers that are discussed at the bottom of the page. But you do not have to visit a doctor to know if your metabolism is working right. There are simple ways to tell if things are good at home using minimal equipment.

Measure your aerobic fitness level

Aerobic fitness level, or aerobic power, is the single best description of your health, because it is the most direct measure of what your metabolism is capable of. It is your body’s ability to output energy (mechanical force and heat) by burning chemical energy sources using oxygen. Your aerobic power depends on many things:

• ability of your heart to effectively move blood through your body,
• ability of your lungs to provide oxygen,
• ability of vascular system and blood to deliver oxygen to cells,
• your muscle mass,
• blood flow through your muscles,
• ability of your muscles to burn food into energy using oxygen.

Scientifically, aerobic power is measured as your maximum rate of oxygen consumption under maximum exercise load on a treadmill or similar machine and when you reach your maximum heart rate. It is called VO2max and is expressed in liters per minute (L/min) or milliliter pres minute per kg of body weight (mL/(min*kg).

But you can get and quick estimate of your aerobic power without all that equipment. Aerobic respiration fully kicks in after about 2 minutes of high intensity exercise. The time you can maintain aerobic energy production after 2 minutes is a pretty good estimate of your aerobic metabolism.

So the test is: determine how much time you can run. Not sprinting, but not jogging either – run at about half maximum pace. This will get your heart rate close to its maximum.

• under 2 minutes. You have almost no aerobic power left in you. You metabolism is in very bad shape. Expect big problems.
• 2 to 10 minutes. You are just one step above very unfit. You need to take serious steps to become fitter, otherwise things will get worse pretty soon.
• 10 to 30 minutes. You are at average fitness level.
• 30 minute to one hour. You are very fit.
• More than one hour. You belong to the elite club of very healthy people. Just keep living the way you always did, because whatever you have been doing was right.

I see people objecting to this measure because it does not take into account age and sex. As far as gender – yes, females get a little slack. Lower every number by 15%. As far as age, common sense tells us that these numbers should be lower for older people since older people are known to be less healthy. But think about it: the fact that most people do not take necessary steps to maintain their body healthy is exactly the reason for such an expectation. After all, we know many examples of people who did take those steps and could run marathons in their 60s. So you cannot be “healthy for your age”.

You are either healthy or unhealthy. If you are old and have little aerobic power left, face the truth: you are not “normally unfit” for your age, you are simply unfit.

You level of aerobic fitness is the most reliable predictor of your health. Fact number 1: lean and unfit men have double the risk to die of any cause than lean, fit men. Fact number 2: lean and unfit men were higher mortality risk than obese (high BMI, see below), fit men.

Measure your resting heart rate

Another quick and easy measure of your metabolism is your resting heart rate. The more efficient your cardiovascular and respiratory systems at bringing oxygen to cells, the less often your heart has to pump blood through your body. Sit comfortably for five minutes, then count your pulse.

• Under 50 beats per minute Congratulations! You are as healthy as a human being can be. Your aerobic metabolism is at the athlete’s level. Continue living the way you always did.
• 50 to 60 bpm You are very healthy. Keep maintaining your healthy lifestyle.
• 60 to 70 bpm. You are normally healthy.
• 70 to 80 bpm. You are in average health category, but the trend is bad. Time to start thinking about including more exercise and general activity in your lifestyle, or things will get worse over next few years.
• 80 to 85 bpm. You are in poor cardiovascular health category. Start taking necessary steps now or expect big problems pretty soon.
• Above 85 bpm. You are extremely unhealthy. Time to go write a will, because every day could be your last one.

Here are a few facts about heart rate: 1) for every 10 bpm increase, your risk of death from any cause is up 25% (45% if you have a history of heart disease); 2) If your bmp is above 84, your risk of death is 80% up relative to normal range (159% if you have a history of heart disease).

Are you overweight ?

Being overweight or obese is a manifestation of improperly functioning metabolism.

Most often, you weight is assessed using Body Mass Index, or BMI. For adults, BMI is your body mass in kg divided by your height in meters squared:

BMI = mass(kg)/heigh(m)2

The following are BMI ranges:

<18.5: low

18.5–24.9: normal

25–29.9: overweight

>30: obese

BMI can be somewhat misleading, however, because it does not take into account what part of your body weight is muscle and what part of it is fat. A lot of athletes would actually be overweight by this measure.

So a better quick measure of your obesity level will be to look at specifically the amount of fat your body is storing. There are ways to do it precisely, but for a quick assessment just look at the mirror.

Can you grip a handful of belly fat at about your bellybutton level? Most of extra fat your is deposited at the abdominal area of your body. If yes, then you are most likely in the overweight category.

Look at the trend of your weight change. Has your weight been pretty stable in the last 10-20 years? If yes, that is good news, because it means that your energy metabolism is properly balanced and you are in the stable weight zone.

If your weight has been slowly increasing over last few years, even if it is by a couple of pounds per year, your metabolism is out of balance. Your energy intake (food) is way above your energy expenditures and you are in the weight gain zone.

See my article here about energy balance. Fat gain is actually the last thing your body is going to do to balance out its energy intake and output, after all other options are exhausted. So being in the weight gain zone means that your metabolism is seriously messed up. Here is a fact: those who gained 15 kg (about 30 pounds) in adulthood have 5.5 higher risk of developing diabetes compared to those who kept their weight stable. Those who lost 10 kg (20 pounds) had about twice lower risk of diabetes. It is always better to be closer to a weight loss zone. Here is a graph of this research (from Haffner, 2006):

Being obese is bad, but being obese and physically unfit (see my aerobic fitness test above) is a lot worse. Obese/unfit is absolutely the worst category. Expect 3 times higher risk of death from any cause and elevated risks for most chronic diseases and cancer.

Determine your body composition: fat content

Relatively cheap devices are out there to measure fat content in your body precisely. They work by measuring electrical resistance of your body. Fat is better insulator than muscle, so if you know resistance, you can calculate fat content (height, weight, age are also taken into account) Some of them measure total body resistance through feet, some through hands, both do a good job.

Fat content is a much better measure than BMI, because it really is a measure of your body composition, not just total mass.

Below are guidelines for fat content (normal fat content is highlighted):

Note that these “recommended ranges” are simply based on the spread of population for fat content, they just show how BMI is related to fat content at different ages. It does not mean that these numbers are your targets or indicators if good health. Given what we know now about weight gain in adulthood (see above), the recommendation I can make is: stay lean or even get leaner as you age. You can maintain and build up muscle and burn fat successfully at any age using a combination of aerobic and resistance exercise, and limiting your calories in food.

Scientific (medical) metabolism assessment

Glucose tolerance

This is a very common metabolic measure when your body’s ability to metabolize glucose is measured. You are given 75 g of glucose, about the same amount as two cans of Coca-Cola, and then your blood level of glucose and insulin is monitored over 2 hours. Insulin is your body’s response to glucose – this hormone tells muscle and liver cells to absorb and metabolize it.

The faster your body can bring glucose level back to normal and the less insulin it needs to accomplish the goal, the better is your glucose control mechanisms. Higher insulin response means that your cells are more resistant to insulin, which is a signature of type 2 diabetes. Your response will look something like this (from Hamburg, 2007):

On this picture, black squares are people who spent 5 days totally inactive resting in bed (But not sleeping! Sufficient sleep time improves glucose response).

Lipid profile

Lipid profile, or lipid panel, or simply “cholesterol” is determined primarily to assess the risk of cardiovascular disease. Lipid profile can also be used for assessment of conditions such as atherosclerosis and diabetes.

Lipid profile includes determination of several markers, some of which are signs of good, healthy metabolism, and others are signs of problems. The table below summarizes markers of lipid profile:

	Abbreviation	Good health	Bad health
Fat, triglyceride, or triacylglycerol	TG, TAG	low	high
Apolipoprotein B	ApoB	low	high
High density lipoprotein, “good cholesterol”	HDL	high	low
High density lipoprotein to total cholesterol ratio	HDL to total	high	low
Low density lipoprotein; small dense particles; “bad cholesterol”	Small LDL, or sdLDL-C	low	high
Low density lipoprotein; medium particles	Medium LDL	low	high
Low density lipoprotein; large particles	Large LDL	high	low

There is still an argument going on about what markers on this list are most reliable predictors of problems. Most agree on using HDL to total cholesterol ratio as a marker of good health (low risk of CVD) and small LDL-C as a marker of bad health (high risk of CVD).

Most people are not familiar with all these subtleties about “good” and “bad” cholesterol and think that cholesterol and fat are the culprits. This story has gotten a lot of publicity, as can be inferred from a variety of products labeled “zero cholesterol” and “zero saturated fat”. Consuming more cholesterol with food will not necessarily mess up your blood lipid profile, just like consuming more fat will not necessarily make you fatter.

Our body has about 30 grams of total cholesterol and is able to make cholesterol at a rate of about 1 g per day. If you eat more cholesterol with diet, your body will shut down production of its own, provided that your metabolism is working properly. 1 gram of cholesterol is the amount contained in about six eggs.

What will indeed mess up your lipid profile most are these four things in this order:

• Insufficient physical activity
• Over-consumption of calories in any form
• Insufficient or irregular sleep time
• Large amount of refined carbohydrate in diet (sweet sugars and starch)
• and influences that will improve your lipid profile are the ones opposite to listed above.

Blood pressure

High blood pressure may either be a sign of poor salt and water metabolism, poor kidney function, or poor cardiovascular system function. I will not go into more detail on this here, because there are a lot of resources available. I will just mention that using combination aerobic-resistance training, it is possible to significantly reduce your blood pressure.

References:

Effect of changing heart rate during treatment of hypertension on incidence of heart failure.
Okin PM and others. Am J Cardiol. 2012 Mar 1;109(5):699-704.

All-cause and cardiovascular mortality in relation to changing heart rate during treatment of hypertensive patients with electrocardiographic left ventricular hypertrophy.
Okin PM and others. 2010 Sep;31(18):2271-9.

Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index.
Dympna Gallagher and others. Am J Clin Nutr September 2000 72: 694-701

Relationship of metabolic risk factors and development of cardiovascular disease and diabetes.
Haffner SM. Obesity (Silver Spring). 2006 Jun;14 Suppl 3:121S-127S.

Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers.
Hamburg NM and others. Arterioscler Thromb Vasc Biol. 2007 Dec;27(12):2650-6.

The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?
Astrup A and others. Am J Clin Nutr. 2011 Apr;93(4):684-8

Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men.
Lee CD, Blair SN, Jackson AS. Am J Clin Nutr. 1999 Mar;69(3):373-80.

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