Ever wondered why some people can lose weight on any diet while others struggle?
And what if I told you that chronic pain is more common than asthma and diabetes combined?
Today we're tackling two game-changing topics that could transform your health.
First, we'll dive into the surprising truth about exercise and chronic pain and why movement might be exactly what your body needs, even when it's the last thing you wanna do.
Then we'll break down a fascinating study that finally answers the age-old question, does it really matter whether you go high protein or high carb for weight loss?
Get ready for some myth-busting, evidence-based insights that might just change the way you think about health.
Let's get started.
And welcome back team to the Building Lifelong Athletes podcast.
Thanks for stopping by, I really appreciate it.
For those who don't know me yet, my name is Jordan Rennke and I'm a dual board certified physician in family and sports medicine.
And the goal of this podcast is to keep you active and healthy for life through actionable evidence and form education.
And we're talking about today it was just two different articles talking about macros for weight loss and exercise for chronic pain.
So let's drive in right away.
For this first study, we're gonna talk about chronic pain so we're gonna dive in right now.
Chronic pain is a common health problem that affects so many people.
It's defined as pain that lasts quote unquote longer than normal that we'd expect but it's usually about 12 weeks.
Once we get past that 12 weeks, that's when we expect we're kind of going into chronic pain.
And chronic pain affects a ton of people, approximately 20% of adults.
And this percentage is expected to increase as people get older.
And this actually makes it more common than asthma or diabetes, which is actually kind of insane to think about it.
And chronic pain is not just physical, right?
It also affects mental health, causing anxiety, depression, and trouble sleeping.
And this in turn can lower a person's overall quality of life.
And so this is something that we really care about 'cause it affects a lot of people.
And so when we're determining exercise for chronic pain or physical activity, we kind of have to break out what is exercise and what is physical activity.
Physical activity is any movement of the body that uses skeletal muscles that burns energy.
So literally just moving around, that's physical activity.
This can include activities from work, play, household chores, transportation, and leisure activities.
Whereas exercise is different.
Exercise is a specific type of physical activity that is planned, structured, and repeated with a goal of improving or maintaining physical fitness.
So that might seem pedantic saying, oh, why does it matter?
Well, it kind of matters because a lot of times the intensity is gonna change and there's differences, right?
There's gonna be many differences to how you're being physically active versus exercise.
And so there's obviously lots of ways to be physically active or exercise.
Going to the gym, having a structured program, asking for exercising, just simply taking a walk because you feel like it, that's probably physical activity.
And both are good, but it's important to understand that we do have some differentiating factors between the two.
It's important to differentiate the two because if you just do some physical activity, although being very good, we may not improve markers that we're looking for, right?
Things necessarily in terms of cardiovascular fitness, strength, and you know, depending on if it's gonna help with pain, which we'll kind of get to in a little bit.
But overall understanding there is a difference that just when people say, hey, do you exercise?
And say, oh, I go on walks, that's fantastic, but that's not necessarily exercising.
And so we wanna, my goal would be to get everybody into an exercise program.
So we are progressing, getting more fit, reaching our goals and improving health markers, which is the most important thing.
But the difference between exercise and physical activity is that exercise is intentional.
That's kind of how I think about it.
And so the article we looked at today, this was actually a Cochrane Review.
So this is a Cochrane Review, which is a comprehensive analysis of research on various topics.
They do huge deep dives into a bunch of different things, really, really great resources.
If you've never seen them before, please go check it out.
But this was a deep dive on physical activity and exercise for chronic pain.
And this review looked at studies involving adults with different types of chronic pain.
Things like rheumatoid arthritis or inflammatory arthritis, osteoarthritis, fibromyalgia and low back pain.
And overall, what did they find?
Well, they found that there was definitely some evidence that physical activity and exercise can reduce pain severity, but the evidence is actually kind of limited and the reductions in pain are usually small to moderate.
So that being said though, at the baseline for these people, most had either mild to moderate pain at baseline.
So if we take a step back here, we saw that we did see some trend towards improving pain, although the reductions in pain were usually small to moderate.
That being said, if people started with mild to moderate pain, we can't expect to have an enormous improvement in pain, if your baseline is just kind of, oh yeah, I have a little bit of pain.
And so overall, the people at a baseline had more mild to moderate pain.
And so we may not have that much room to begin with.
And you think about, if you have someone who has an horrible pain, you have a much bigger chance or you have more room to kind of improve their outcomes with exercise as opposed to someone who has only a little mild pain.
So that's just something to consider when I was reading this, something I would think about there.
They also did find more consistent evidence though that exercise improves physical function.
So they did find some indication that exercise improves pain, but what they found that pretty consistent is that exercise improves physical function, which is really no surprise, right?
But what this means is that people who exercise have better mobility and strength and quite a rest for fitness and all that fun stuff.
And that's really a huge part as well.
Like yes, pain is very important.
If you're in debilitating pain, you know how it can just take over your whole life.
It's all you think about.
It's all we want to improve pain.
But a lot of times people say when they're in pain, they can't do things, right?
And so if we can kind of bypass that, pain is very complicated.
There's many, many books and articles all about pain and how it's much more complex than what we think, but maybe you'll have some pain, right?
Odds are your product eliminate chronic pain entirely.
That's just probably where we're at.
But if we can kind of bypass that, deal with pain, maybe decrease it a little bit, but then improve our function, well then maybe we're hitting one of our goals.
So that's a really important thing when I say, and I see the results saying, "Hey, improve your function."
I think that's huge, right?
'Cause that's the thing people most time, if you dig down saying, "Hey, I don't live in pain."
Yes, pain is debilitating.
A lot of times they say, "It's pain that's preventing me from doing X or Y."
And if you exercise that helps you accomplish X and Y, and you maybe increase the pain or decrease pain a little bit, I think it's gonna be a net win for a lot of different people.
And on top of this, they also looked at the effects of exercise on psychological function and quality of life.
And overall, the results are kind of mixed here, but some studies did show some positive results.
They weren't necessarily showing negative results like exercising made it worse or any means, but it wasn't as clear cut that it definitely improved psychological factors or quality of life.
But once again, trending in the direction of probably helping, right?
If we're improving our function, we're probably gonna improve quality of life and all those things.
So that's really what.
And also importantly, this review found that exercise inventions are generally safe with very few side effects.
And this is kind of like my foot stomp point here, right?
We see this study saying, "Okay, maybe improving pain, improving function, maybe some psychological factors, quality of life."
All of these things are kind of good maybe, but with like no real side effects, to me that's just like, it's the Holy grail of intervention, right?
Let's talk about interventions and the next year, are there side effects exercise?
Yeah, you could absolutely have side effects exercise.
You get sore, you could pull a muscle, you could have a very, very, very rare issue of having a cardiac problem.
Once again, that's very unlikely to happen, but for all intents and purposes, this is about as much of a free lunch as we can possibly get.
Meaning that if you do exercise, the odds of something really bad happening are really low, but the odds of having something beneficial happen are pretty high.
And so we're having a huge, a lot to gain in this.
And this is one of those things where exercise may or may not help with pain.
Okay, let's say it doesn't.
Let's say it does not help with your pain at all, but it's not harmful, right?
It's still really important.
I would still recommend this to people.
And so that's just something to mention that is very safe here.
And what were the limitations of the study?
Well, as a Cochrane review, the input is only as good as what they give you, right?
And a lot of times, a lot of these papers had small sample sizes, which can make the findings a little bit less reliable.
Many of these studies also had short follow-up periods, which makes it hard to know if these benefits would last over a lifetime, right?
So most of them were around eight to 12 weeks, which is good.
And that's a pretty normal time for a study, right?
'Cause studies take a long time, so I'm not knocking that at all, but it's just hard to know, hey, it wasn't like, hey, if you're exercising for two years, what's the benefit?
So for me, I kind of look at it the other way.
If we're already seeing signal at eight to 12 weeks, I imagine that would continue, and over time it's gonna be even better.
And so that's kind of how my brain works, but we can't necessarily say that 'cause it's only over eight to 12 weeks.
And from a future research perspective, more research is definitely needed to better understand the effects of physical activity and exercise for chronic pain.
That's just kind of how it goes.
I can always say that more research is needed, but I'd love to see in future studies include more participants, which would be great.
And then a little bit longer, preferably longer than 12 months, that'd be awesome.
But once again, that's very, very challenging, and I'm not gonna say like, hey, you need to design studies better 'cause it's a lot to do, and it's a lot of work for researchers.
And so that's something I have to think about there.
And so overall, my takeaways from this study is that while exercise is not a cure for chronic pain, it can be a valuable tool for managing it.
There's tons of benefits to exercise or physical activity other than just pain, right?
We're improving physical function, maybe improving mental health, maybe better quality of life, all those things.
And like I said before, even if we have zero effect on pain, if exercise is nothing for pain, which I still think it does, we should still recommend it.
Because why?
Well, because it's safe and has so many other benefits.
And so at the end of the day, we're getting more fit.
We're able to do more things.
We're decreasing our risk for diseases, chronic disease, all these amazing things from exercise.
And if even if we get nothing on it, I'm still gonna recommend it.
So it's one of those things where, this didn't change necessarily change my practice saying, oh, like I'm gonna start providing exercise 'cause I do that all the time.
But it's just once again, another reason for why we wanna consider exercise so much.
And I think it does have an impact on pain.
So I think it's worth it from that regard as well.
But the key is finding an exercise that works for the patient, right?
So if I say, hey, you've got to do resistance training three times a week, or you've got to go start running, people are gonna be like, nah, man, I'm out.
So that's really the big thing is, you'll see things online, people being very myopic.
You have to do this, like this specific exercise and whatnot.
At the end of the day, I think the data, first of all, how do you study that, right?
There's various small sample sizes to start.
And then you add in different types of exercise.
You add in resistance training, endurance training, things like tai chi, yoga, Pilates, all that stuff.
How do you make signal from that noise in a review?
It's very challenging.
And so I always tell people, what do you like doing?
Like, let's start there, we'll do that.
And then yeah, if they start exercising, doing something, we kind of talk about the physical activity guidelines, talk about how we wanna get some resistance training there, some cardiovascular training, all that stuff.
But if someone's saying, hey, yoga is what I like to do, then let's do it, man.
Let's start there and then kind of work our way into it.
And so always finding something that works for the patient is gonna be the best.
And so overall, I do think that exercise helps with chronic pain.
It's not the end all be all, not gonna magically cure it, but I think that it's definitely worth it.
And I thought it was a cool article to talk about.
Next, let's move on to the article talking about macros for weight loss.
Obesity affects a large portion of the general population with 2.5 billion adults presenting as overweight and then 10% presenting with obesity.
And obesity, as most of us know, is a major risk factor for several chronic diseases, including type two diabetes, cardiovascular disease, and some cancers.
And dietary interventions play a key role in addressing obesity, though their effectiveness varies greatly among individuals.
There's an idea called Nutrigenics.
So Nutrigenics is the study of how genes interact with the diet, and it's a promising field that could lead to personalized dietary interventions for obesity management.
In this study, we're looking at the IMPROVE study.
So the IMPROVE study is a randomized clinical trial conducted from 2020, 2021 in the Attica region of Greece.
The study investigated the role of macronutrient composition and genetic predisposition in weight loss among 200 Greek adults with overweight obesity.
So there's a lot of words there.
When I say macronutrient, real quick, except mac, that is your fats, carbohydrates, and proteins.
So those are macronutrients.
And they're looking at what percentage of these macronutrients, how does that affect weight loss when looking at some patients who have a genetic predisposition to obesity and overweight?
That's what we're looking at.
The researchers aim to assess the effectiveness of a three-month dietary intervention with either a high protein or a high carbohydrate hypocaloric diet on weight loss and looking at body anthropometric things as well.
So what they're saying is they're gonna have one group with high protein, one group with high carbohydrate, both of them are gonna be hypocaloric, meaning in a caloric deficit, and they're gonna see what it does to body composition and weight loss.
And so how did they run the study?
Well, participants in this IMPROVE study were adults age 18 to 65 with a BMI above 25, which is generally that overweight category, right, without any uncontrolled health conditions.
So it's not necessarily people with hypertension or heart disease, but they are in that overweight category.
The study excluded pregnant or lactating women, individuals with diagnosed comorbidities that affect body weight in their diet, those taking weight loss supplements, and anyone participating in any other weight management research.
And so overall, they had a total of 202 participants they recruited, and their daily caloric intake was reduced by about 500 calories, targeting weekly weight loss of about 0.5 to one kilogram.
And so overall, this 500 calorie deficit, this is over the whole week.
And most people will say that that's a pretty safe, reliable, and reasonable rate of decrease, right?
So you don't wanna drop, you know, 1500 calories a week.
That's gonna be a lot, and you're gonna lose weight really, really fast.
And we know that's not necessarily great based on previous other podcasts.
So this is kind of a low and slow, you know, it's decent chunk, but it's nothing unreasonable.
And most people think this is a, you know, something that most people are, I've heard a lot before or can try for, and it's gonna help kind of go for about 0.5 or one kilogram per week was their random goal.
And then the participants were randomly assigned to either a high carbohydrate section.
So this is where they're consuming 60% of their calories through carbs, 18% protein and 22% fat, or a high protein group, which was 40% carbs, 30% protein and 30% fat.
And once again, they were both at a hypocaloric deficit.
And that's the biggest thing for me is they were in a calorie deficit, one at high carb, one at higher protein.
And then an online assessment tool was used to administer and monitor the dietary intervention.
And these participants provided information on their medical history, demographic details, lifestyle habits, and dietary intake at baseline and throughout the three month intervention.
And then healthcare professionals like dieticians, nutritionists regularly monitored their progress and made monthly adjustments to their hypocaloric diets.
So that's the biggest thing.
As you go down, if you're losing weight and you were sub 500 calories, you're decreasing that 500 calories, you are gonna burn less by having less body mass.
So they're gonna adjust how many calories they should be eating.
So that's what they did with the dieticians and nutritionists they kind of monitored it and then adjusted as needed.
They also took measurements including height, weight, waist and hip circumference.
They were taking a baseline in the three months and then a body composition analysis, including BMI, total kind of body fat, muscle and water percentage were conducted using a bioelectrical impedance analysis.
That's kind of when you think about you hold something or you stand on a scale and they kind of shoot electricity through you, you don't feel it, it's not painful, but they kind of determine body fat, muscle and water storage, it can be kind of cool.
And they're also taking blood samples, right?
So blood samples were collected at baseline and then again at the end of three months to analyze for different biochemical parameters and for the DNA genetic analysis of what they looked at.
And they were looking specifically for the effects of 10 specific gene variants known for their association with BMI, so meaning people who had these genetic variants that increase your chance of having a higher BMI, they're looking at that.
And the goal is to see if these variants played a role in how people responded to dietary inventions, meaning, "Hey, if you have these genes, maybe a higher carb diet is better or a higher protein."
So that was the overall goal of this study.
And what were the results?
Well, out of the 202 participants, 84, which, you know, 36 from the high carb and 48 from the high protein group completed the three month invention.
So I had a pretty big dropout rate there.
So 202 started, only 84 finished.
And these are the people that attended the final in-person meeting.
And pretty high dropout rate, like I mentioned, but it's okay.
And however, both groups experienced statistically significant weight loss with men losing a median of five kilograms and women losing a median of about six kilograms.
However, what they did find is there's no statistically significant differences in weight loss were observed between the high carbohydrate and the protein group.
So people lost weight, didn't matter if you're in the high protein or high carb group.
There was something done that was called imputation analysis, which is trying to fill the holes of all these dropouts.
So they're kind of doing some fancy statistical stuff.
And with this analysis, taking into account variables like age, sex, and physical activity, and baseline kind of body measurements, it confirmed a significant weight reduction in the overall sample.
And, you know, living alone was also associated with lower chance of decreasing weight compared to someone living with someone else.
So actually being isolated seemed to also be a high risk factor for not losing much weight.
And from a genetic analysis perspective, the genetic analysis using that 10, you know, BMI related snips is what we call them.
So essentially genes, risk markers, they did not show any statistically significant associations of weight loss in the post-intervention.
So in either the total weight loss group or in the different macro groups, it didn't matter if you had the genes or whatnot, they found no significant difference.
And so what does this actually mean?
Well, the improved study findings are, they're consistent with other large scale trials as well, such as the Pounds Lost and Diet Fit studies, which also reported similar weight loss results regardless of the macronutrient composition.
And this study once again highlights the effectiveness of hypocaloric diets for weight loss, irrespective of the macronutrient ratios, meaning it doesn't really matter what your preference is.
If you're in a hypocaloric diet, it's gonna work.
And the lack of significant genetic associations with weight loss in the study could be due to a limited number of snips that were analyzed or the sample size in general.
So they only looked at 10 and we only had 200 people.
So maybe there is something to that.
We definitely can't say there's no genetic component, as we know there probably is, but they couldn't find a signal in this specific study.
And overall for the strength limitations, the improved study is the first of a kind in the Greek population, which is cool and provides lots of valuable insights in the impact of dietary interventions on this specific demographic, right?
However, it's limited because it's so specific to a small sample size.
They're in Greece, can we extrapolate this to America or anywhere else?
There is challenges with long-term adherence with that intervention and that big dropout rate was something we really talked about as well.
But overall, what I think about this, well, overall the improved study demonstrated that hypocaloric diets, whether high in carbs or protein, lead to significant weight loss in these Greek adults in this group with overweight or obesity.
The study did not find any significant influence of the 10 investigated gene variants on weight loss.
And overall, this is pretty consistent with what we know, right?
From a dietary perspective, find a dietary pattern that works for you and go to work.
That's really the biggest thing.
If there is a difference in high protein, high carb, it's very small.
We couldn't pick it up here.
And I think the whole body of literature kind of supports that.
So you just have to step back for a second, right?
You'll see people on the internet talking about a bunch of different things.
You gotta get out of your algorithm.
The YouTube algorithm will suck you in sometimes.
You can think this is the only thing that exists.
But if you step back for a little bit, just look what happens, right?
We have this group of people saying, "Low carb changed my life."
You have this group of people saying, "Well, actually, whole food plant-based changed my life."
Low carb, very high fat diets.
Whole food plant-based, very low fat diets potentially.
And so we're having people on vastly different sides of the spectrum having lots of success.
Then what's the common denominator?
Well, it's probably that they got themselves into a hypocaloric diet.
They were losing weight and they improved all their biomarkers from most likely weight loss is the biggest thing.
So is there something to this that there could be a best diet for your genes?
Absolutely.
I am not writing that off by any means.
I think with AI coming, we'll be able to analyze data at a rate we wouldn't know previously or know how to do.
And so I think we'll probably find something to that.
But right now, all I know is that finding what works for you and getting that hypocaloric diet is gonna be the best long-term outcome.
And for some people, they just can't stay satiated or full on a whole food plant-based or the other way they just couldn't tolerate a low carb.
Whatever it is, you just gotta find what works for you.
And I hope that in the future, we're able to develop genetic tests and say, "Hey, based off of this, you'll tolerate this better."
I think it'd be awesome 'cause right now we're doing a lot of guessing and I hate that you try and say, "Oh, it didn't work."
You try and it didn't work and it can be very discouraging.
So I'd love to have that.
But overall, if I have you taking one thing away from this article specifically, it is that at the current time, there's no way to predict what's gonna be best for you.
But the most important thing for your success is getting into a hypocaloric diet, something you can sustain and stay on long-term that is by far and away the most important thing.
And there you have it, team.
Today, we explored two crucial topics that impact millions of lives.
We learned that exercise, while not a cure-all for chronic pain, is both safe and potentially beneficial for pain management.
Remember, even if it doesn't directly reduce pain, the improvements in physical function and overall quality of life definitely make it worth doing.
And for the great macro debate, well, the evidence is pretty clear.
Whether you prefer high protein or high carb, what matters most is finding a sustainable approach that works for you.
Both dietary patterns led to significant weight loss in this study, showing there's more than one path to success.
And if you found this information helpful, please take a moment to leave a five-star review on your favorite podcast, platform, or choice.
It really helps other people find this content.
And to stay up to date with the latest news, sign up for our newsletter so you don't miss any content.
But that's it for today.
Now get off your phone, get outside, and we'll see you next time. - Hi, this is Matt McRae, and I'm a medical physician at the University of Michigan.
I'm a medical physician at the University of Michigan.
I'm a medical physician at the University of Michigan.
I'm a medical physician at the University of Michigan.
