'Bizzy Diet' Sheds 2% Body Fat (2kg) in Only 3 Weeks, Study in 51 Women (BF 25%) Shows - W/ and W/Out 'FitMiss Burn'

The "Bizzy Diet" works, the supplements that are suggested in the program at BB.com are useless, though.

You know that I am a fan of supplement companies that try to support the often hilarious claims on their product labels with science. Against that background, I feel there's nothing wrong with MusclePharm sponsoring, ah... I mean "funding" a recent study by researchers from the University of... ah, I mean, from Bodybuilding.com and the Ohio State University (Kendall 2017) - and that's not just in those (not exactly rare cases) when said research proves that their "thermogenic" powerhouse is actually a hilariously underdosed barrel burst.

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In the study at hand, the corresponding supplement is MusclePharm's FitMiss Burn "thermogenic fat burner" for women. A product that contains an undisclosed amount of Guarana Seed Extract (Paullinia Cupana), (22% Caffeine) Caffeine Anhydrous (100mg), Pyroglutamic Acid, Green Tea Extract (40% EGCG) (Camellia Sinensis)(Leaf), Papain, Yerba Mate (Llexparaguariensis)(Leaf), Yohimbine HCl, of which all have some scientific back-up as fat-burners alongside the other ingredients you can see in the graphical summary of the study results I created in Figure 1:

Figure 1: Graphical summary of the results; no sign. inter-group differences for Bizzy Diet (alone) vs. BD + FitMiss Burn.

In view of the fact that there's research backing almost all of the other ingredients, as well, it may seem surprising that the those of the fifty-one apparently healthy women between the ages of 18 and 35 years volunteered to participate in this randomized, double-blind, placebo-controlled study, who have been randomized to receive the product didn't see any benefit from their two capsules of FitMiss Burn, right?

Exercise characteristics in the three groups of young women during the 3-week study period (Kendall 2017)

Why did the control group see almost identical improvements in body composition? That's a good question. After all, the 14 women in the control group were "instructed to maintain their normal dietary habits" (Kendall 2017) and trained significantly less (see Figure on the left), ate more food and less protein over the course of the three-week study. Well, the explanation for this "phenomenon" lies within our naive trust in the accuracy of DXA scans and studies with small group sizes. With standard deviations that are two-times larger than the relative pre-/post-changes in body composition, we simply have to rely on the scientists' statistical analyses and those reveal that: (a) the diet groups lost sign. more body fat and (b) had a sign. different lean mass trajectory (lost or maintained vs. gained) compared to the control group... let's be honest, that's not a phenomenon.

Well, that's true, but if you scrutinize the label you'll realize that the total amount of active ingredients, i.e. 1,450 mg per serving (2 capsules per day) simply cannot contain caffeine, green tea, yerba mate, yohimbine, glucomannan, white kidney bean extract... to allow for all of them to have measurable effects. After all, the studies I previously alluded to used...

• at least 200mg of caffeine (usually alongside other ingredients),
• more than 500 mg green tea extract (e.g. Nagao 2007), and
• the human equivalent of 7g of yerba mate (e.g. Arçari 2009)

which would already exceed the total weight of the proprietary ""Energy & Focus Complex" in the product... and we haven't even talked about the "Appetite Reduction & Fat Metaboliser" blend from which we'd need 2x1g per day of glucomannan (e.g. Salas-Salvadó 2008), 7.5-30g of guar gum (Pittler 2004), and much more of all other key ingredients.

Figure 2: Original grocery list for the "Bizzy Diet 21-Day Fitness Plan" (Bodybuilding.com | download PDF)

Well, now that it's clear that the supplement didn't work and couldn't work, let's take a closer look at the "Bizzy Diet" (you can learn more about the diet at bodybuilding.com): Basically, we're looking at a high calorie (1,000kcal/d) version of a low-carbohydrate protein-modified fast.

Over the course of the three-week study period the women had to cut their habitual food intake to 1,000kcal, cut out almost all carbs, eat every 3h (this is probably an irrelevant rule of the diet, but will certainly keep you "bizzy" ;-) and 'gorge' on eggs, bacon, tuna, broccoli and the other foods the meal plan on bodybuilding.com suggests - is it any wonder that the (almost overweight) ladies went from ~27% to ~25% DXA-assessed body fat on that diet? Not really.

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Why did you even discuss the study at hand? I know that some of you may now ask yourselves just that: Why? Well, the answer is simple: Firstly, I want you to scrutinize the labels of the supplements you buy and not be fooled by "proprietary blends" - in cases like the one at hand, it doesn't matter if the amount of the individual ingredients is undisclosed: even a first-grader will be able to see that they're underdosed if the label lists 20+ ingredients and the total weight of active ingredients is below 2000 mg (or less).

And secondly, I want you to understand how powerful dieting is: I mean, the 2% reduction in body fat the ladies in the study at hand achieved with their 1,000kcal protein- and nutrient-rich low-carbohydrate diet is worth reporting, isn't it?

References:

• Arçari, Demétrius P., et al. "Antiobesity Effects of yerba maté Extract (Ilex paraguariensis) in High‐fat Diet–induced Obese Mice." Obesity 17.12 (2009): 2127-2133.
• Kendall, Kristina L., et al. "A Randomized, Double-Blind, Placebo-Controlled Trial to Determine the Effectiveness and Safety of a Thermogenic Supplement in Addition to an Energy-Restricted Diet in Apparently Healthy Females" Journal Of Dietary Supplements (2017) - Ahead of print.
• Nagao, Tomonori, Tadashi Hase, and Ichiro Tokimitsu. "A green tea extract high in catechins reduces body fat and cardiovascular risks in humans." Obesity 15.6 (2007): 1473-1483.
• Pittler, Max H., and Edzard Ernst. "Dietary supplements for body-weight reduction: a systematic review." The American journal of clinical nutrition 79.4 (2004): 529-536.
• Salas-Salvadó, Jordi, et al. "Effect of two doses of a mixture of soluble fibres on body weight and metabolic variables in overweight or obese patients: a randomised trial." British Journal of Nutrition 99.06 (2008): 1380-1387.

Macros & Calories Don't Count? Better Food Choices Make Diet More Than 10x More Effective for PCOS Sufferers

Normal-weight women can have PCOS, too. Recently, Macruz et al. did DXA scans on young women with PCOS and a normal BMI and found increased truncal and leg fat compared to healthy controls in a similar age (12–39 years) and BMI range (at least 18.5 but below 25 | Macruz. 2017). More evidence that weight alone doesn't explain PCOS.

PCOS is by no means an issue only obese women suffer from. Yes, obesity is and will always be the #1 risk factor for developing the polycystic ovarian syndrome (PCOS = a condition in which a woman's levels of the sex hormones estrogen and progesterone are out of balance; this leads to the growth of ovarian cysts (benign masses on the ovaries); PCOS can cause problems with a women's menstrual cycle, fertility, cardiac function, and appearance), but eventually it seems as if both occurred in response to the same hitherto not fully elucidated triggers.

In that, it is unquestionable that a woman's diet plays a minor part in the development of PCOS. Accordingly, scientists all over the world are currently trying to determine the optimal diet for people like the 60 overweight or obese patients with PCOS who participated in a recent study from the Kashan University of Medical Science in Iran (Foroozanfard 2017).

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The study was designed to evaluate the effects of the Dietary Approaches to Stop Hypertension (DASH diet) on weight loss, anti-Müllerian hormone (AMH) and metabolic profiles in women with polycystic ovary syndrome (PCOS). To this ends, the scientists conducted a randomized controlled clinical trial among 60 overweight or obese patients with PCOS. Patients were randomly assigned to receive either a low-calorie DASH (N=30) or control diet (N=30; designed to mirror the traditional Iranian diet) for 12 weeks. What is particularly interesting is that both diets had identical macronutrient compositions: 52-55% carbohydrates, 16-18% proteins, and 30% total fats.

Table 1: Constituents of the DASH and control diets in the study; data are presented for a calorie intake of 1800 kcal/day - (b) at least 3 servings of whole grains in the DASH diet; (c) low-fat (lower than 2%) in the DASH diet; (d) 4 servings of lean meat in the DASH diet and 2 servings in the control diet (Foroozanfard 2017).

However, the DASH diet was designed to be rich in fruits, vegetables, whole grains, low-fat dairy products, and low in saturated fat, cholesterol and refined grains (cf. Table 1). Both diets were equicaloric. Physical activity was monitored and identical in both groups. To further promote the comparability between the study arms, all subjects were...

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[...] provided with 7-day menu cycles that were individually planned using a ‘calorie count’ system. To facilitate the compliance to the diets, participants were given and instructed an exchange list. 

[...] Compliance with the consumption of diets was controlled once a week through phone interviews. The compliance was also double-monitored by the use of 3- day dietary records completed throughout the study. 

[...] To control for dietary intakes of subjects throughout the study, the dietitian was calling the participants to resolve their probable problems" (Foroozanfard 2017).

The significant difference in the study outcomes you can see in Figure 1 are thus a function of the foods and not the macronutrient composition or the total energy intake of the women.

Figure 1: Anti-Müllerian hormone and metabolic profiles at baseline and after the 12-week intervention in women with polycystic ovary syndrome; p-values indicate stat. significance of the inter-group difference (Foroozanfard 2017).

More specifically, there was almost no change in glucose management in the control, but significant benefits in the DASH group; a further increase in the hallmark features of PCOS, i.e. anti-Müllerian hormone (AMH) and the free androgen index (FAI), but a significant decrease of these indices in the DASH group; and no change and a small improvement in heart-healthy NO and inflammation, respectively, in the control, but a huge increase in NO and decrease in inflammation (MDA) in the DASH diet group.

The detailed micronutrient breakdown shows that one of the reasons of the health benefits could be an increased intake of potassium, magnesium & co - eventually, that's yet not enough to explain the benefits of making better food choices - 'cause food ≠ macros.

Improving your health by eating healthy ≠ weight loss! Despite the impressive inter-group differences in all relevant health markers that were assessed in the study, the weight loss in both groups was identical, with the subjects' BMI dropping by -1.2±0.7 and -1.6±0.5 kg/m², respectively. That goes against the mantra that the best diet was always the one that produced the greatest weight-loss. Especially in people who are battling inflammation and insulin resistance, major health improvements can be achieved without concomitant weight loss... OK, usually you would expect anthropometric changes like a reduction in waist circumference as well as body and esp. visceral fat (Ehsani 2016; Orio 2016), but, unfortunately, these parameters were not assessed in the study at hand | Comment!

References:

• Ehsani, Behnaz, et al. "A visceral adiposity index-related dietary pattern and the cardiometabolic profiles in women with polycystic ovary syndrome." Clinical Nutrition 35.5 (2016): 1181-1187.
• Foroozanfard, Fatemeh, et al. "The effects of DASH diet on weight loss, anti‐Müllerian hormone and metabolic profiles in women with polycystic ovary syndrome: a randomized clinical trial." Clinical Endocrinology (2017).
• Macruz, Carolina F., et al. "Assessment of the body composition of patients with polycystic ovary syndrome using dual‐energy X‐ray absorptiometry." International Journal of Gynecology & Obstetrics (2017).
• Orio, Francesco, et al. "Obesity, type 2 diabetes mellitus and cardiovascular disease risk: an uptodate in the management of polycystic ovary syndrome." European Journal of Obstetrics & Gynecology and Reproductive Biology 207 (2016): 214-219.

'Training on Cycle': Hitting the Weights Frequently (5x/WK), Alone, Very Unlikely to Trigger the 'Female Athlete Triad'

The squat was not part of the training regimen in the study at hand - that's bad because it would certainly have made the workout more intense and might thus have affected the results.

If you don't remember what it was, I suggest you (re-)read the classic 'SuppVersity Athlete Triad'-Series (read it)... and if you don't have the time to devour those classics, here's the gist: While it is often accompanied by eating disorders, the athlete triad can also arise in periods of either low energy availability or high training loads. Next to an ongoing decline of physical (and eventually also cognitive performance), the main features of the female athlete triad are amenorrhoea / oligomenorrhoea (no, or a disturbed menstrual cycle, respectively), and - in the long(er) run, i.e. after months and years - an often highly significant decrease in bone mineral density (osteoporosis and osteopenia).

As et al. point out in their latest paper, the female athlete triad "has shown to be related to both training intensity and duration" (Wikström-Frisén. 2016). It is thus a threat for endurance athletes, strength athletes and gymrats alike; and a very similar effect can be observed in men when they're overtraining - even though, their fertility is not threatened as easily.

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"Intensive exercise-associated disorders, such as the female athletic triad, generally originate from hypothalamic dysfunction failing to initiate a normal hypothalamic-pituitary-ovarian function. This is leading to a decrease in pituitary secretion of luteinizing hormone (LH), and follicle-stimulating hormone (FSH), which in turn limits ovarian stimulation and estradiol production" (Wikström-Frisén. 2016).
In spite of everything we know, evidence pertaining to the effects of increased resistance training load on the athlete triad is scarce. The aim of the scientists from the  Umeå University in Sweden was thus to investigate potential exercise-related negative consequences on components in the female athlete triad following high-frequency leg resistance training.

So far, so good. What is new, or at least almost new, in this 2nd paper by Lisbeth Wikström-Frisén et al. addressing the issue of what I previously called tongue in cheek "training on cycle" (read my 2015 article of mine) is that the subjects' training regimen were periodized according to different parts of the menstrual/OC cycle. Practically speaking, the participants, all of whom had regular menstrual cycles (at pre-test 27.9 ± 1.9 days), or were taking oral contraceptives (OC cycles of 28 days), and had previous experience of leg press and leg curl resistance training, were randomized into either one of two periodized training groups or a control group:

• one training group were allocated to high-frequency training (5 times per week) during the first two weeks of the menstrual/OC cycle (group 1), and 
• the other training group to high-frequency training during the last two weeks of the menstrual cycles (group 2), 
• the controls trained at a low frequency (3 times per week) during the whole cycle. 

During training, all participants performed leg resistance training according to current recommendations in order to achieve strength gains. The completed number of leg training sessions were logged and was equivalent in the three groups (group 1 = 41 ± 4.0, group 2 = 41 ± 4.8, control group = 42 ± 4.4).

Figure 2: While the relative changes (pre- vs. post-test) clearly indicate that training intensely in the latter phase of the menstrual cycle appears to have the most favorable effect on the women's hormonal profiles, none of the visible inter-group difference reached statistical significance - probably because of the rather small(ish) study size (N = 59 in three groups of 19, 19, and 21 subjects, respectively) as well as large inter-individual variation (Wikström-Frisén 2016).

At post-test, the participants reported how they perceived their leg training program during the four consecutive menstrual/OC cycles. Their perceptions were categorized on a three-graded scale; 1 = positive, 2 = neither positive nor negative, 3 = negative. The analysis revealed "a significant difference in regards to how the training was experienced, χ2(2) = 11.552, p = 0.003" with a significantly more positive perception of the leg training in the "on-cycle" group #1.

Figure 2: For those of you who are interested only in the takeaway messages, here are the implications of this (Study 2 / 2016) and the previous paper by Wikström-Frisén et al. (Study 1 / 2015) in a comprehensive form.

Now, the way you feel about your workouts is unquestionably important. The objectively measured hormonal response in Figure 1, however, is unquestionably a more objective measure of the training load or overload ... unfortunately, the lack of statistical inter-group differences (in spite of visible differences in the relative changes of the hormonal marker), doesn't allow for any definite conclusions on what's "best" hormone-wise (it's not even clear how to define "best" in this context, by the way). Nevertheless, the study does provide an important new insight, a result Wikström-Frisén et al. summarize as follows:

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"The results are in contrast to endurance training where negative exercise-related consequences are common when increasing the training load (Warren 2001). 

Thus, we observed no evidence that the high frequency periodized menstrual/OC cycle based resistance training resulted in exercise-related negative consequences which could contribute to a suppression of LH, FSH, and further decrease of the estradiol production (Meczekalski 2000)" (Wikström-Frisén 2016).

This conclusion is corroborated by the lack of changes in body composition and/or bone mineral density, but should still be taken with a large quantity of healthy skepticism.

Figure 3: Relative changes in lean mass (DXA data), measures power and strength (torque) in 59 trained women in response two weeks of frequent leg-training in the first or second two weeks of their estrous cycle (Wikström-Frisén. 2015).

After all, the long-term results of the 5-days-a-week approach to leg training cannot be accurately predicted based on these findings from a 4x28-day study and the higher motivation and previously detected performance increments (see Figure 3, from Wikström-Frisén 2015; learn more in my previous article about this study from 2015) speak in favor of a (maybe non-hormonal) advantage of training more intense in the first two weeks.

Read my analysis of the previous paper on this matter | learn more

So, how do I train, now? While the paper and hand suggests that it does not matter when you plan to increase the volume, a previously discussed study by the same researchers found that leg resistance training performed during the first two weeks of the menstrual/OC cycle will additionally improve physical performance in women (Wikström-Frisén 2015), the authors recommend to periodize accordingly: if you want to increase the training frequency, do it in the first two weeks of your menstrual cycle, ladies - your performance and, as the study at hand shows - your training experience will benefit! Comment on Facebook!

References:

• Meczekalski, Blazej, et al. "Hypothalamic amenorrhea with normal body weight: ACTH, allopregnanolone and cortisol responses to corticotropin-releasing hormone test." European journal of endocrinology 142.3 (2000): 280-285.
• Warren, M. P., and N. E. Perlroth. "The effects of intense exercise on the female reproductive system." Journal of Endocrinology 170.1 (2001): 3-11.
• Wikström-Frisén, Lisbeth, Carl Johan Boraxbekk, and Karin Henriksson-Larsén. "Effects on power, strength and lean body mass of menstrual/oral contraceptive cycle based resistance training." Journal of Sports Medicine and Physical Fitness (2015).
• Wikström-Frisén, Lisbeth, Carl J. Boraxbekk, and Karin Henriksson-Larsén. "Increasing training load without risking the female athlete triad: menstrual cycle based periodized training may be an answer?." The Journal of sports medicine and physical fitness (2016).

Dieting Down to ~10% Body Fat for Women: Contest Prep Study - Deficits, Muscles, Hormones and the Yo-Yo Effect

This would unquestionably be at the lower end of contest BF% levels (avg. 12%) the women in this study achieved,

The number of studies on fitness and bodybuilding competitions is limited. Probably you will remember my previous discussions of the paper/s by Rossow, et al. ("Natural bodybuilding competition preparation and recovery: a 12-month case study." | 2013) Kistler, et al. ("Case Study: Natural Bodybuilding Contest Preparation." International Journal of Sport Nutrition and Exercise Metabolism", 2014), and Robinson et al. ("A nutrition and conditioning intervention for natural bodybuilding contest preparation: case study" | 2015). And yes, three is not just the number of studies that I've covered at the SuppVersity, it's also the number of decently recent studies dabbling with dieting down for a contest in one of the "physique sports".

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Speaking of fitness, ... you probably already guessed it: There's study #4 by Juha J. Hulmi, et al. (2017). The study that was conducted by researchers from Finland and Estonia has the telling title "The Effects of Intensive Weight Reduction on Body Composition and Serum Hormones in Female Fitness Competitors" and was, as its authors point out, designed at least partly in response to the "worries about the potential negative consequences of popular fat loss regimens for aesthetic purposes in normal weight females have been surfacing in the media" (Hulmi. 2017).

Since longitudinal studies investigating these kinds of diets are lacking, Hulmi et al. studied the effects of a 4-month fat-loss diet in 50 (initially) normal weight females competing in fitness sports. This means we are dealing with a large-scale observational study, not an experimental study in which parameters such as the daily or weekly caloric deficit, the protein intake or related variables were set by the researchers. Rather than that, the 27 females (27.2 ± 4.1 years | 15 newbies, 12 women who had competed before) who dieted for ~4 months, and their 23 (27.7 ± 3.7 years) peers, who were acting as weight-stable controls, managed their diet and exercise regimen as they saw fit (note: with only 3 dropouts from the diet group and 6 from the control group the adherence was pretty good).

Figure 1: The experimental design of the study. Two representative participants are shown from each group. The pre to mid time period lasted ∼20 weeks during which the participants decreased their energy intake and the amount of exercise, whereas the controls maintained their activity levels and nutrient intake. The mid to post period lasting ∼18 weeks was a recovery period with increased energy intake back toward the baseline levels in the diet participants, whereas the controls maintained their energy intake and exercise levels (Hulmi. 2017).

You can take a glimpse both the design and the results in Figure 1. The subjects' body composition was assessed on separate test with the DEXA test being done on empty (that makes the test more reliable, because it's not going to be tricked by overstocked glycogen levels). The exercise performance tests, on the other hand, took place after the subjects' had a standardized breakfasts, because the dieters would otherwise have underperformed due to their low energy intake in the later phase of the dieting period - a period during which the subjects maintained not identical, but similar resistance training and cardio regimen (quoting from the FT | my emphasis):

• Resistance training: Split routines were used for resistance training by all competitors in the diet group meaning that they focused on single muscle groups per session as is often the case also in bodybuilders (Hackett et al., 2013). The main muscle groups trained included thighs, hamstrings, buttocks, chest, shoulders, arms, upper and lower back, calves, and abdominals. Dividing training into separate body parts per session did not differ significantly throughout the training. At baseline the 3-, 4-, 5-, and 6-split training was used by 3, 10, 13, and 1 of the 27 participants, respectively, while the same numbers were during the diet on average 5, 8, 14, and 0 and during the recovery period 7, 8, 12, and 0. In addition, the competitors also practiced their posing routines. Training sessions lasted between 40 and 90min. 
• Cardio: Aerobic training for the participants was almost uniquely either high-intensity interval training (HIT) with a bicycle, cross trainer or other gym equipment or both HIT and steady-state low to medium intensity aerobics (usually walking/running or with cross trainer). During the competition week the participants did not report doing HIT, but instead lower intensity aerobics. Typical HIT-exercise was 10–25 min in total including high intensity 15–45s intervals with 30–60s of recovery between the sets. Steady state lower intensity aerobics was typically 30–60 min in duration. Part of the females completed their aerobic training mainly together with their resistance exercise workouts while most of the participants completed also separate aerobic workouts, especially during the diet.

As the authors point out, there was a tapering period (learn more) during which total training load is typically slightly decreased and carbohydrate and total energy intakes are increased toward the baseline levels, in the last week of the contest prep.

Why would you taper before the competition? A competitor would probably answer that he, or, as in this case, she, did not "want to come in flat". Accordingly you taper, i.e. reduce the training intensity and (re-)introduce carbs into your diet to restore muscle glycogen and get rid of the "flat" look of which Hulmi et al. argue that it will "occur with low carbohydrate diets as ∼2.7g of water per each gram of glycogen is stored in skeletal muscle" (Hulmi. 2017).

Speaking of the subjects' energy deficit. The latter was - as it is currently in vogue - achieved almost solely by a drastic reduction in carbohydrate intake while keeping protein intakes high and fat intakes moderate. You can see the result in form of a diet that lacked, during contest prep/dieting, ca. 20% of the habitual energy intake of the subjects in my plot in Figure 2 reduced (see Figure 6 for data on the energy balance, i.e. calories in vs. calories out from exercise = cardio + weights).

Figure 2: Energy intake expressed as protein, carbohydrates and fats rel. to body weight (g/kg | Hulmi. 2017).

With these dietary changes and the increase in aerobic exercises aka "cardio", the subjects achieved body fat reductions of ~12% and a ∼35–50% decrease in fat mass (DXA, bioimpedance, skinfolds, P < 0.001) during the dieting phase.

Table 1: Tabular overview of the exercise levels in the diet and control groups; learn more about METs (Hulmi. 2017).

As you can see in Table 1, the latter, i.e. the aerobic workload did indeed increase significantly, while the subject's maintained their resistance training volume fairly stable [ 4.7 ± 0.7 (diet group) and 3.9 ± 1.9 (controls) METs] - until the tapering week, which may now give you the false impression that volume and/or intensity were reduced during the dieting phase:

• lower body muscles were trained during the diet 1.4 ± 0.5 times per week, and 
• upper body muscle groups were trained 1.1 ± 0.3 times per week, 

as part of the previously hinted at split design. That allowed for 4.9 ± 2.9 extra cardio sessions per week (that's an increase of +27% | P < 0.05) that came mostly from an increased amount of steady state aerobics "in several subjects" (I interpret this as "the majority increased the steady-state, only a few the HIIT volume). During the recovery period, the subjects' cardio frequency dropped down to 2.3 ± 1.9 times per week - both, cardio and resistance training were yet never skipped completely.

Figure 3: Changes in body composition; for fat and lean mass I used the average of all three measuring methods, i.e. DXA, body impedance and skinfold; * p < 0.05 and *** p < 0.001 (Hulmi. 2017)

The fact that the women kept training after the contest is important, when it comes to the interpretation of the actual study results, which include the following observations:

• 

  Figure 4: Changes in hormone levels; surprisingly, the cortisol levels (not shown) did not change - not even non-significantly at any time-point; *–*** is significant (p < 0.05–< 0.001) difference to Pre and #–### is significant (p < 0.05–< 0.001) difference between the groups in the change (Hulmi. 2017).

  a weight reduction of -12% of their initial weight and a loss of 35-50% body fat according to DXA, bioimpedance, and skinfold measurements -- the exact figures are -23.1 ± 5.6 to -12.7 ± 4.0% (DXA), from -19.7 ± 4.2 to -11.6 ± 3.9% (bioimpedance), and from -25.2 ± 3.0 to -18.3 ± 2.7% (skinfolds) -- in this context it may be worth mentioning that the women lost abdominal fat in particular, with the DXA scan indicating a -60% reduction in visceral fat 
• a small decrease in lean mass (bioimpedance and skinfolds) and in vastus lateralis muscle cross-sectional area (ultrasound) were observed in diet (P < 0.05) -- in that, it is certainly interesting that the scientists found that some competitors even managed to gain lean mass during the contest prep
• the total bone mass decreased by −1.3 ± 1.8% (DXA) in the competitors, 
• the subject's leg strength, measured as the isometric maximal strength and explosive strength of their leg extensors remained unchanged during dieting, their bench press performance, on the other hand, declined,
• a sign. changes in the hormonal system with decreased serum concentrations of leptin, triiodothyronine (T3), testosterone (P < 0.001), and estradiol (P < 0.01) coinciding with an increased incidence of menstrual irregularities (P < 0.05), 
• the surprisingly small (and non-significant) changes in mood-related parameters of which only the subjects' vigor showed a significant decline during the pre-contest phase,
• the normalization of all body weight/composition parameters and all hormones except T3 and testosterone which did not fully recover during the 3–4 month recovery period

Whether or not the small reduction of T3 is enough to produce what people refer to as "metabolic damage" is not clear. On the one hand, the small reduction in fT3 you can also see in Figure 5, would suggest that at least some of the subjects' (N=1...27) metabolisms were running slower than before.

Figure 5: Active thyroid hormone (fT3) concentration at baseline (pre), before the contest (mid) and after recovery (post). The number at the x-axis depicts participant numbers ordered based on the pre-value (Hulmi. 2017).

On the other hand, the subjects' body weight did not yo-yo back up to levels sign. above those they had before the contest, one may assume that this was not the case. After all, all women ate just as much as before the contest and did even less, not more cardio. This, in turn, translates into a 16% increase in their energy balance in the recovery (vs. baseline, see Figure 6) phase.

Now, the question is: What can we learn from this study? If you're looking for information about the "best contest prep diet" or the "ideal workout, volume or intensity for your contest prep training", you will be disappointed to hear that a study with a single dieting group that did not even intend to compare different approaches to contest prep cannot help you to answer these unquestionably important questions (note: since "best" is always individual, I'd say you cannot answer them with certainty, anyway).

Figure 6: It is important to note that the subjects' energy balance was 16% above baseline during the recovery phase when the difference between their energy intake and total ex. induced expenditure was 1471.82 kcal (vs. 1209.60 kcal at baseline). And still, they did not become fatter, but simply returned to their previous body fat levels; the figures beneath the bars indicate the daily energy balance calculated based on data from Hulmi et al by subtracting the exercise-induced energy-expenditure (cardio + weights) from the dietary intake(s).

What the study can tell us - and that's, when all is said and done, eventually even more important - are that (a) using a relatively large caloric deficit (-22.5% as calculated for Figure 6) women can shed up to 50% body fat without losing sign. amounts of lean mass if they force their bodies to keep the muscle by strength training and fuel the protein synthesis that's responsible for conservation of muscle tissue with adequate protein intakes (previous studies on starvation diets show lean mass decreases of 6-28% | Keys. 1950; Dulloo. 1996); (b) the endocrine changes in form of reduced leptin, estradiol, testosterone and T3 levels, as well as the regularity of your menses will recover without medical intervention (albeit with a delay for fT3 and testosterone in some, but not all subjects); (c) there's no classic yo-yo effect which would imply a body fat super compensation during the recovery phase (otherwise the women would have ended up with more fat than before the competition), when the restoration of a pre-contest energy content and the concomitant decline of the subjects' exercise-induced energy expenditure in response to the reduced volume of 'cardio' (ca. 36%) | Comment!

References:

• Dulloo, Abdul G., J. Jacquet, and Lucien Girardier. "Autoregulation of body composition during weight recovery in human: the Minnesota Experiment revisited." International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity 20.5 (1996): 393-405.
• Hulmi, Juha J., et al. "The effects of intensive weight reduction on body composition and serum hormones in female fitness competitors." Frontiers in Physiology 7 (2017): 689.
• Keys, Ancel, et al. "The biology of human starvation.(2 vols)." (1950).

Gain DXA-Confirmed 3% Lean Mass Within ~12h, Glycogen Loading Does the Trick | Plus: Training on 'The Pill' & More...

The first December 2016 research update with studies that are relevant for both, women and men. I mean, who wouldn't want to get sign. more muscular in hours? I guess those who know that this is just an often overlooked measuring error.

Have you ever wondered about the accuracy of your DXA data? It's supposed to be "the gold standard", but you've learned only recently in the SuppVersity Facebook News that this is only the case if you measure at the same time of the day, identical hydration and - as a more recent study shows - even identical glycogen stores. What? Yes, that's right! You can make DXA-confirmed 3% gains in lean mass within hours. Simply by glycogen loading.

You're not interested in body fat data? Well, this is your lucky day. Today's installment of the short news will also discuss the latest study on the interaction between oral contraceptive and the adaptive response to exercise (Schaumberg. 2016).

Looking for more cutting edge exercise and supplementation science?

Vitargo, Red Bull, Creatine & More | ISSN'15 #1

Pump Supps & Synephrine & X | ISSN'15 #2

High Protein, Body Comp & X | ISSN'15 #3

Keto Diet Re- search Update | ISSN'15 #4

The Misquantified Self & More | ISSN'15 #5

BCAA, Cholos-true, Probiotics & Co | ISSN'15 #6

That's still not for you? Well, there's also the interaction between glucose, fructose and gastric emptying, which is of "urgent" (keyword: diarrhea vs. fastest glucose uptake) importance for endurance athletes (Shi. 2016).

• Diarrhea vs. fastest glucose uptake - How the glucose / fructose ratio can make all the difference (Shi. 2016) -- In their latest study, scientists investigated the effect of beverage osmolalities, carbohydrate (CHO) type and CHO concentration on gastric emptying in euhydrated subjects at rest.
  
  To this ends, the scientists measured the gastric emptying of water (W), and compared it to four glucose beverages containing either 2, 4, 6, or 8% glucose (2G, 4G, 6G, and 8G, respectively) and four sucrose (= 50% glucose + 50% fructose) beverages containing identical percentages, i.e. 2, 4, 6, or 8% of sucrose (2S, 4S, 6S, and 8S) in eight healthy subjects using the modified George double-sampling technique (Beckers. 1988).
  

  

  Figure 1: Mean gastric residual volume and gastric emptying rate in with standardized drinks with different carbohydrate sources (glucose or sucrose = 1:1 glucose : fructose) and volume (Shi. 2016).

  The scientists did not find significant differences in the gastric secretion volume among beverages across time and practically less relevant differences for the gastric residual beverage (GRBV) volume. What is interesting for you, on the other hand, is the scientists' observation that the gastric emptying rate (GER) was negatively correlated to the calories emptied (r=0.84) - and that the effect was more pronounced for glucose than for sucrose.
  
  

  

  Bad Fructose? Increased Glycogen Synthesis, Reduced Glycemia, Higher Glucose Oxidation | more

  What does that mean? Well, the answer is simple. Shi et al. provide more evidence of and a "novel" mechanism for the superiority of glucose + fructose mixes as intra- and post-workout shakes. Especially at high energy content, i.e. high levels of glucose and fructose in the drink, they are simply processed faster. Accordingly, it is not surprising that studies show benefits, not detrimental effects of adding the allegedly bad fruit sugar to a sugary intra- or post-workout shake. You can learn more about this in "Bad Fructose? Increased Glycogen Synthesis, Reduced Glycemia, Higher Glucose Oxidation" (more) and "Post-Workout Glycogen Repletion - The Role of Protein, Leucine, Phenylalanine & Insulin" (more).
  
  On the other hand, the risk of getting diarrhea may increase with each extra-gram of fructose in your intra- or post-workout beverage. The "optimal" 2:1 ratio for glycogen recompensation, I discussed in the previously cited article from 2013.
• Manipulation of Muscle Creatine and Glycogen Changes DXA Estimates of Body Composition (Bone. 2016) -- As the authors of the previously referred to study say dual x-ray absorptiometry (DXA) protocols are thought to provide a reliable measurement of body composition. In fact, however, their study shows that the accuracy will largely depend on the muscle glycogen content upon measurement (not so much on the level of creatine, though).
  
  How do they know? Well, the researchers had eighteen well-trained male cyclists (the training status is important, because the results may well differ for untrained or only recreationally active subjects) participate in a parallel group application of creatine loading (n=9) (20 g/d for 5 d loading; 3 g/d maintenance) or placebo (n=9) with crossover application of glycogen loading (12 v 6 g/kg BM/d for 48 h) as part of a larger study involving a glycogen-depleting exercise protocol. Body composition, total body water, muscle glycogen and creatine content were assessed via DXA, bioelectrical impedance spectroscopy, and standard biopsy techniques.
  

  

  Figure 2: Percent changes in leg lean and fat mass vs. baseline following glycogen depletion and creatine and glycogen loading with and without creatine (Bone. 2016).

  Their results confirm glycogen, as the primary determinant of ostensible gains. In fact, glycogen loading, both with and without creatine loading, resulted in substantial increases in estimates of lean body mass (mean +/- SD; 3.0 +/- 0.7 % and 2.0 +/- 0.9 %) and leg lean mass (3.1 +/- 1.8 %and 2.6 +/- 1.0 %) respectively. Cool? Well, the only bad news is that the DXA scan's body fat analysis will be messed up even more (+4.5% of body weight for the whole body, albeit - due to interpersonal differences - not statistically significantly) - in the end, you would thus always be told that you failed to achieve lean gains.
• Oral Contraceptive Use Dampens Physiological Adaptations to Sprint Interval Training (Schaumberg. 2016) -- Dampens? Yes, this means "the pill" will impair your fitness gains - in this case maximal oxygen uptake (VO2peak) and peak cardiac output (Qpeak), but there is good news, too... before we get to that, however, we should take a brief look at the study design.
  
  The scientists studied women taking oral contraceptives (OC | n=25) or experiencing natural regular menstrual cycles (MC; n=16) who completed an incremental exercise test to assess VO2peak, PPO, and Qpeak before, immediately after, and four weeks following 12 sessions of SIT. The SIT consisted of 10, one-minute efforts at 100-120% PPO in a 1:2 work:rest ratio.
  Now, the bad news I've already revealed is that the OC group saw a significantly reduced increase in VO2peak (OC +8.5%; MC +13.0%; p=0.010) and Qpeak (OC +4.0%; MC +16.1%; p=0.013), but the good news is...
  • the peak power output (PPO) increased to a similar extent in both groups (OC +13.1%; MC +13.8%; NS), and
  • intriguingly, the OC group showed more sustained training effects in VO2peak (OC -4.0%; MC -7.7%; p=0.010) on the follow up 12 weeks later
  Eventually, SIT did thus (i) improve peak exercise responses in all recreationally-active women, with (ii) women on OC responding significantly worse, yet (ii) more sustained (when the women seized training) than those with natural menstrual cycles.
  
  Therefore, the authors conclusion that "OC use should be verified, controlled for, and considered when interpreting physiological adaptations to exercise training in women" (Schaumberg. 2016) is obviously right - during detraining, on the other hand, it could be an advantage to be on oral contraceptives (needless to say that the adaptation conserving effects would have to be proven in a future study in which MC women would be put on OC after SIT).

Yes, I do suggest that it may be beneficial to drink these two and another two cups of coffee w/ lots of sugar after your workout - if you are an athlete, at least -- "Post-Workout Coffee Boosts Glycogen Repletion by Up to 30% and May Even Have Sign. Glucose Partitioning Effects" | more

So what's the verdict here? I guess there's no clear verdict on the headliner study. We will need a follow up to investigate whether a woman's "gains" (in this case in the conditioning department) can be conserved if she starts taking oral contraceptives during de-training. What we do know without another study, however, is that taking oral contraceptives during a training period will impair the normal physiological adaptation to sprint training.

And what about the other studies? Well, I guess if you can stomach it (and as of now, nobody complained), the previously discussed 2:1 glucose:fructose ratio is probably the "optimal" natural sugar supplement for your workout.  And if you want to measure your results, you better make sure you did not change your carb intake or had a glycogen depleting workout before doing a DXA scan | Comment!

References:

• Beckers, E. J., et al. "Determination of total gastric volume, gastric secretion and residual meal using the double sampling technique of George." Gut 29.12 (1988): 1725-1729.
• Bone, et al. "Manipulation of Muscle Creatine and Glycogen Changes DXA Estimates of Body Composition." Medicine & Science in Sports & Exercise: Post Acceptance: November 28, 2016 - doi: 10.1249/MSS.0000000000001174.
• Schaumberg, et al. "Oral Contraceptive Use Dampens Physiological Adaptations to Sprint Interval Training." Medicine & Science in Sports & Exercise: Post Acceptance: November 28, 2016 - doi: 10.1249/MSS.0000000000001171.
• Shi et al. "Effect of Different Osmolalities, CHO Types, and [CHO] on Gastric Emptying in Humans." Medicine & Science in Sports & Exercise: Post Acceptance: November 28, 2016 -doi: 10.1249/MSS.0000000000001176.