Thursday, May 9, 2013

The "20 / 30 Principle" Sheds 15% Body Fat in 6 Months, Boosts Testosterone & Sexual Performance in Overweight Men. Plus: Six Signs You're Doing Too Much, Already.

One out of four men with newly diagnosed erectile dysfunction is under 40 (more)
You will probably remember the post about the increasing prevalence of erectile dysfunction in young(er) men on Facebook, the other day (learn more)!? As of now, one out of four patients who are newly diagnosed with erectile dysfunction are 40 years or younger. That's an alarming trend that certainly cannot be reversed by the use of adulterated OTC libido boosters with high amounts of pharmacological PDE-5 inhibitors that are not listed on the label (read more on the SuppVersity Facebook Wall and listen live to today's installment of the Science Round Up starting at 12PM EST!). With  30-40% of the overweight men not being able to achieve an erection of maintain it long enough to engage in sexual intercourse, it stands out of question that the root cause for the exploding numbers of impotent young men is diabesity.

Against that background it is only logical that Joan Khoo and his colleagues from the Department of Endocrinology at the Changi General Hospital, the Departments of Sports Medicine and Rehabilitative Services at the Changi General Hospital assumed that diet and exercise should be more than an alternative to drug interventions. The latter has in fact been established in numerous previous studies, already. In obese Australian men who lost an average of 10% of baseline weight from caloric restriction alone using meal replacements or a low-fat diet and in men after 2 years of weight loss using Mediterranean diet and exercise, for example, the test scores in the International Index of Erectile Function 5-item (IIEF-5) improved by ~20% (Khoo 2011; Esposito. 2004).

Exercise works, but how much exercise does it take?

What has been missing up to know is yet a study that would establish the amount of exercise that's necessary to boost the existing benefits of energy restriction. And guess what!? That's exactly what Khoo et al. set out to do - conduct a trial that would compare the effects of 24 weeks of ...
  • low volume medium intensity exercise training (<150 minutes/week) and
  • (relatively) high volume medium intensity exercise (>200m/w) training
on the body weight, waist circumference (WC), body composition, International Index of Erectile
Function 5-item (IIEF-5), International Prostate Symptom Scale (IPSS) (for LUTS), and 36-item Short Form Survey version 2 Instrument (SF-36) (for QoL) scores, plasma testosterone, sex-hormone binding globulin, glucose, insulin and lipids, and endothelial function (by Reactive Hyperaemia Index [RHI] using finger plethysmography) of 90 abdominally obese Asian men (BMI >27.5 kg/m²; WC>90 cm; mean age 43.6y), who ha not moved an inch all day long in the past years (average amount of "exercise" ~80 minutes/week).

Freedom of choice: Exercise when and where you want

The aerobic only *sigh* exercise program could be performed on whatever equipment / sportive activity the subject like - stationary cycling, treadmill, elliptical crosstraining, brisk walking, jogging, cycling, and swimming, all were eligible for 90–150 minutes/week - the subjects were free to chose and pick, but they had to record type and exercise duration and make sure that they would hit their target heart rates of 55–70% of their individual maximal heart rate (HRmax=220-age) on whatever they did.
Figure 1: Absolute (body composition) and relative changes (lipids, sex hormones & erectile function); after 6 months on the diet + low vs. high volume exercise regiment;LUTS = lower urinary tract symptoms; IIEF-5 = International Index of Erectile Function 5-item questionnaire; IPSS = International Prostate Symptom Scale; SF-36 PCS and MCS = 36-item Short Form Survey version 2 Instrument Physical Component Summary and Mental Component Summary scores (Khoo. 2013)
In combination with the obligatory reduction in energy intake (-400kcal/day; ~15-20% of their baseline intake) both groups made significant progress. In comparison to the -4.7kg of body fat the guys in the "high volume" group (I use the quationmarks to emphasize that I would not consider ~30min of exercise/day exorbitantly high, considering the fact that the this was cycling, walking or swimming at a relatively moderate intensity) lost in the course of the 6-months intervention, the -1.1kg of total fat mass the guys in the low volume group dropped do yet look pretty pathetic.

"Doing more" for total & free testostosterone!?

What are signs that you are already doing too much ?
  • constant fatigue that does not disappear, when you take a day off and get enough sleep (too much volume)
  • inability to fall asleep (too much high intensity work)
  • inability to sleep through (too much volume)
  • getting up to pee every 1-2h (too much volume, too few carbs vs. too much protein)
  • the 4am wake-up call = inability to sleep through (see above, fasting in the evening)
  • no fat loss despite caloric deficit (eating too little + high training volume)
  • losing muscle, not fat (too much volume, too much medium intensity cardio)
  • low sex hormones / drive, low thyroid function, high rT3 (too much volume, too much protein, too little fat & carbs, not eating enough)
If you want more insights, you can find them in the Athletes Triad Series.
If we take a look at a couple of other parameters the scientists evaluated, you will notice a clear dose-response relationship. Much contrary to the participants in the Rosenklide study, I wrote about in 2012, which had a much higher training volume and intensity, doing more did - within this narrow relatively low volume moderate intensity regimen - did thus really yield superior results. Even more, the dose-response relationship is almost linear: 2x more exercise, 2x more weight loss, 2x more fat loss, 2x greater reduction in insulin, 2x greater reduction in blood glucose.

For testosterone (>2x more) and free testosterone (almost 5x more), the benefits were even more pronounced and the difference between the ratio of fat and lean mass lost 6.7 for the high vs. 5.5 for the low volume group are certainly not to be scoffed at, either.

Still, we just have to go back to the counterproductive effects Rosenkilde et al. observed in their study (go back and learn more), to see that the 30 minutes of exercise per day are probably not the end of the flagpole, but a very happy medium beyond which previously untrained individuals, and experienced trainees who work out at a correspondingly higher intensity level, could hit a wall and spiral down into the abyss of chronic overtraining - especially when exercise habits like that are combined with a diet that does not only induce an energy deficit of 20% but does at the same time make it particularly hard for the body to use the energy it gets... yep, I am talking about the notorious high protein, low carb, low fat diets the scaremongerism on both sides of the low-carb vs. low-fat divide have made so popular (learn more).

Bottom line: Diabesity, erectile dysfunction and hypogonadism? The solution to this triad is there! It's not complicated, but it requires commitment, it requires discipline and it will cut your daily screen time by 30 min... if you or your overweight friends don't feel that this is worth it, let them waste their money and risk their health by jumping from one "quick fix" solution and diet (e-)book to the other. If not, write the numbers "20/30 x 6" on a DinA4 sheet and pin that to your or your friends' fridge to remind yourself or them that it takes a caloric reduction of 20% + 30min of moderate intensity exercise and the stubbornness to adhere to that protocol for 6 months day in day out (I guess 90% compliance would even be enough) to take a huge step on your way towards normalizing your body composition, glucose and lipid metabolism and endocrine and erectile function... and on a last note: I bet this works for overweight women with PCOs, as well.

  • Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D’Andrea F, D’Armiento M, Giugliano D. Effect of lifestyle changes on erectile dysfunction in obese men: A randomized controlled trial. JAMA 2004;291:2978–84.
  • Khoo J, Piantadosi C, Duncan R, Worthley SG, Jenkins A, Noakes M, Worthley MI, Lange K, Wittert GA. Comparing effects of a low-energy diet and a high-protein low-fat diet on sexual and endothelial function, urinary tract symptoms, and inflammation in obese diabetic men. J Sex Med 2011;8:2868– 75.