#135 | What's your Healthy Fat %? | Vyvyane Loh MD

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If you look around you can see that body fatness is a bigger problem now than it used to be.  Officially the statistic is approximately 45% of Americans are obese measured by BMI. But if we measure body fat as a percentage of total body weight, the metric is closer to 90 percent. because of the many people who don’t look obese but have high fat combined with low muscle mass. What's even more concerning for wise athletes is that the level of body fatness that is unhealthy varies dramatically between people because the location of the fat is what matters. Some people have a very low threshold for fatness before they start to experience metabolic problems that are associated with obesity including higher rates of Cancer, t2d, and CVD.  So what is my threshold for unhealthy fat? What is yours?

Today on episode 135, Dr Vyvyane Loh joins the show to explain what is happening to our bodies and why, and thankfully she shines a bright light on the pathway to metabolic health and athletic longevity.  Dr Loh is board certified in internal and obesity medicine, and she runs a medical practice helping people of all shapes and sizes to solve metabolic health challenges. And she has answers to my questions on how to know if this applies to you, and how to avoid the excessive catabolism that comes from sitting too much, over weighting endurance exercise, eating too little protein, intermittent fasting, frequent dieting, and more. 

Bullet points

• People generally think their body fatness is lower than it really is.   The “pinchable” fat under the skin isn’t the problem. Fat can be hidden under the abdominal wall and in organs: muscles, heart, lungs, liver, pancreas …wherever your body could put it after your “under the skin” (subcutaneous) fat storage filled up.  
• Note: Ectopic (abnormal place) fat includes visceral (in the abdomen) fat
• Obesity measurements based on weight miss the key point. It’s the amount of ectopic or "out of place" fat that drives metabolic illness.  And each person has a different amount of healthy fat storage before the unhealthy storage begins. So the amount a person weighs can be misleading if the fat increase is offset by muscle and bone losses, and for people who have very low healthy fat storage. In fact, muscle and bone losses on top of fat increases is an even bigger problem even though BMI is “normal”.  
• Obesity definition — body fat %
  • Men: 25% or higher
  • Women: 35% or higher
• If you are using a bio-impedance device add 10-15 points (men) or 20-25 points (women). Use Dexa “body scan” to get an accurate reading. Very low radiation. 
• You can’t get an accurate assessment with body fat photo comparisons or bio impedance or using blood markers of inflammation 
• The key: find your body fat % and where is the fat located
• Dexa breakdown
  • Fat mass
  • Lean mass (muscle, organs, protein in bone, water)
  • Mineral mass of bone
• A dual-energy X-ray absorptiometry (DEXA) scan can measure bone mineral density and body composition, including lean mass, fat mass, and muscle mass. Lean mass is made up of everything that isn't bone mineral or body fat, including organs, skin, connective tissue, and water. However, DEXA scans don't show body water as a separate component.
• People lose 3-8% of muscle mass per decade of aging
• On top of that loss, “catabolic crises” cause additional muscle (and bone) loss. Illness, injury, surgery.  Also weight loss is a catabolic crisis. 
• Catabolic crises
  • “Aging”
  • Injury & Illness
  • Yo-Yo dieting (30% of weight loss comes from lean mass but weight regain is nearly 100% fat)
  • Excessive endurance exercise 
  • Intermittent fasting and extended fasting
  • Losing muscle mass leads to less space to put the excess calories eaten. Now the extra calories have to go to fat storage which eventually becomes dysfunctional and inflammatory. This inflammatory state accelerates the muscle and bone loss, as well as the diseases of “aging”. 
• Solution
  • Resistance training is key: 3 full body sessions per week
  • Metabolic conditioning: HIIT (“talk test” & “high exertion”) two 30 (maybe 45 minutes) minute sessions per week (3 / week of only doing 2 resistance training session per week
  • Some endurance exercise is okay but do less low intensity if exercise time is constrained. Dr Loh says 1 slow endurance exercise day per week
  • Mobility day — no exercise for except mobility work
  • Protein: 120-150g per day divided into 30-35g per meal. Animal sources. 
  • Don’t skip meals. Breakfast protein is important to break the catabolic 
  • Sleep is critical. Work on circadian rhythm. Muscle builds during sleep. Low sleep makes hunger worse. 
  • High BP that is resistant to medication means sleep apnea is a likely problem. 
  • Creatine can help
  • Fish oil is good
  • Stay away from antioxidants right after workouts; wait 6 hours after workouts 

Related info and episodes:

• Episode 132 | Measuring Metabolism
• Episode 129 | Optimal Human & Bone Health
• Episode 127 | Great Bones

More Dr Vyvyane Loh info:

• tulaversity.com - Dr Loh's Coaching platform
• vyvyanelohmd.com - Dr Loh's website
• Dr Loh's podcasts -- for medical professionals and laypeople who want details
• Courses/info-metabolic-health-practitioner-certification-program-level-1
• Dr Loh's YouTube Channel - for laypeople

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