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Ep. 418 Fat Loss Myths, Muscle Matters & Diet Break Strategies Explained with Dr. Bill Campbell


Today, I am thrilled to welcome Dr. Bill Campbell, a professor and director of the Performance and Physique Enhancement Lab at the University of South Florida and the creator of Body by Science, a review summarizing the latest and best research on fat loss and muscle-building. His research focuses on helping people optimize their physiques within a sustainable lifestyle. 


In our discussion, we tackle common misconceptions about fat loss and explore ways to measure body fat rather than lean mass. We look at the mechanisms that increase hunger and slow metabolism when body fat is too low, the effects of crash and yo-yo dieting, the menopause transition, and contributors to weight-loss resistance. We cover concerns related to muscle protection, protein needs, and lifestyle habits in strength training. Dr. Campbell also defines diet breaks, discusses his concerns about time-restricted and intermittent fasting when protein intake is insufficient, and shares some of his favorite supplements.


You will love this informative conversation with the delightful Dr. Bill Campbell.


IN THIS EPISODE YOU WILL LEARN:

  • Some common misconceptions surrounding fat loss

  • What are the most effective ways to measure body fat?

  • The average body fat percentages for men and women

  • How social media and fitness competitions have skewed our perceptions of body fat 

  • The benefits of fat-loss sprints as an alternative to crash dieting

  • Why women may struggle with weight loss resistance during menopause

  • Dr. Campbell clarifies the concept of anabolic resistance and explains the need for higher protein intake as we age

  • Why very short feeding windows are not ideal for building muscle

  • How diet breaks can help to control hunger 

  • The adverse effects of sleep deprivation

 

“The biggest harm to maintaining a lean body is a crash dieting mindset.”

-Dr. Bill Campbell

 

Connect with Cynthia Thurlow  


Connect with Dr. Bill Campbell 


Transcript:


Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.


[00:00:29] Today, I had the honor of connecting with the delightful Dr. Bill Campbell. He is a Professor and Director of the Performance & Physique Enhancement Lab at the University of South Florida and his research focuses on helping people optimize their physiques within a maintainable lifestyle. He also created Body by Science, which is a research review that summarizes the latest and best research focusing on fat loss and building muscle.


[00:00:54] Today, we talked about some of the biggest misconceptions and mistakes regarding fat loss, effective ways of measuring body fat versus lean mass, textbook averages of body fat, percentages of men and women and differentiating between essential body fat versus visceral body fat, the mechanisms that drive hunger and slowed metabolism when your body fat is way too low, the impact of crash dieting and yo-yo dieting, the menopause transition and what contributes to weight loss resistance, concerns related to protecting muscle, which really focuses in on strength training, adequate protein intake and lifestyle, his specific concerns surrounding time restricted and intermittent fasting if you're not getting adequate protein intake, defining what diet breaks are and lastly, lifestyle, which includes some of his favorite supplements and not surprisingly, one of them is creatine monohydrate. I know you will enjoy this conversation as much as I did recording it. 


[00:01:58] Welcome Dr. Campbell. Such a pleasure to have you on the podcast. It's taken a couple months to coordinate our calendars, but really looking forward to this discussion. 


Dr. Bill Campbell: [00:02:06] Yeah, me too. Thank you very much for the invitation. 


Cynthia Thurlow: [00:02:09] Yeah. So as a researcher, I'm curious, are there pet peeves or common misconceptions surrounding fat loss? Do you see information on social media or well-meaning social media influencers that extrapolate upon broad level concepts that you think are pet peeves for you?


Dr. Bill Campbell: [00:02:31] Yeah, I don't know about pet peeves, but there are things that I constantly see. And not to say I don't have a lot of pet peeves I do, [Cynthia laughs] but for research I have to always put myself, what if I wasn't a scientist? How would I think about things? And I would think no differently than the masses. Now I will say this, a major pet peeve I have is researchers who have conflicts of interest who don't disclose them. I'm always happy when scientists supplement their salary with selling supplements, books, programs, whatever. But in certain situations, there's a clear conflict with what they're researching and what they're selling. And again, that's perfectly fine. But when it's hidden that there's a pet peeve, since you asked.


[00:03:17] Let me move to just the what I call general population people doing. I'm a fat loss researcher, so this is my scope. So, they'll do X, Y or Z diet and it works for them. And they'll say, “Okay, this is the one that everybody should do.” And as a scientist it's like, “Well that worked for you. But so likely so would have eight other options had you stuck to that diet.” Or somebody will start taking a particular supplement and they'll go on a diet and they'll start an exercise program and they're getting better sleep. And then they'll say, “Man, since I've been sleeping, I have really lost all this fat.” So, sleep is important and sleep is important. Sleep is very high on my list. But when you have all of these different variables coming into the equation, a lot of people are just ignorant and they think, okay, they just latch on to one item and it's like, well, that wasn't the only thing. So, there's ignorance and pet peeves. 


Cynthia Thurlow: [00:04:20] Yeah, well, and it's interesting for listeners, whether they know this or not, there's some events if I speak to them, especially medical conferences, even podcast sponsors. I have to disclose up front, although I make it a habit of never discussing my podcast sponsors when I'm talking at a medical event. But I agree with you about the conflicts of interest and this is the power of the N of 1 as it pertains to if something worked for one person, that's great, but it doesn't per se mean that it works for everyone. And I think about one thing in particular. As a clinician, I have many friends that have had a lot of great success with ketogenic diets as an example, and ketogenic diets, if that works for you, that's great. 


[00:04:55] But if I look at the research on the gut microbiome and people that don't do well on a ketogenic diet, more often than not, it can have a lot to do with the composition of microbes in the gut microbiome. And so, there's many, many things that can impact success or lack thereof with a particular intervention. So, I 100% agree with you. Now, when we're talking about body fat and for women of a certain age, certainly it becomes probably more problematic or bothersome as we're navigating perimenopause and menopause because there are so many physiologic changes that are ongoing. One of the most common questions I receive is what's the most effective way to measure it? There are Bod Pods that are accessible for people, DEXA scans. From what I understand about DEXA scans, it can be hugely influential as to who is actually reading the scan to determine body fat percentages. As a scientist, what do you think is the most effective way of measuring body fat overall?


Dr. Bill Campbell: [00:05:54] Yeah, so I tend to now gravitate towards research-based devices. So those would be DEXA, Bod Pods, my lab uses InBody or BIA, the research grade. We also use ultrasound. So, those are the best devices on the market. But none of them are perfect. And you make a good point. I was recently working with somebody and they got a DEXA at one facility and then they went to a different facility and they thought, “Hey, why did I gain all this fat?” And I haven't been doing the things that would make me think that I have gained fat. And my answer was, you didn't gain fat, you switched DEXA machines, one. Two, there were different people that were doing the different technicians analyzing those scans, it's not just that you get on the table and it spits out a number. You have to adjust. I'll just call them the lines when you're doing this.


[00:06:49] So, you have a lot of variation. So, I tell people, let's make sure that whatever device you choose InBody, DEXA, Bod Pod, Skinfolds. So, let's just say it is a Skinfold or DEXA just make sure the person doing it is always the same person and that they are a well-trained individual. So, the next thing I say is you always want to do these under standardized conditions. So, the best thing, what we do in my research lab is in the morning after an overnight fast. And ideally you did not exercise the day prior. And then the next thing that I say is don't get hung up on whatever number you are. If you've been dieting, just look at changes. 


[00:07:33] Because if I lay down on a DEXA now or I did a Bod Pod or I did an InBody, my body fat might be 22 on one, 17 on another, and 19 on another. But if I dieted for six weeks and I lose fat, all three of them, regardless of what they said today, they're all going to show that I've lost fat. One might show I lost 2%, 3%. So just to be the most helpful, pick one device, stick with that device or technician if it's Skinfolds and put your focus on changes over time with that one device. Don't get too hung up on that it has to be a DEXA or it has to be an InBody. 


Cynthia Thurlow: [00:08:13] Yeah, I think that, you bring up so many good points that you want consistency between devices, between operators, if they're doing Skinfold testing. And when we're looking at the degree of body fat we have, obviously there's stages in our lives, obviously puberty for women, pregnancy and then menopause. Clearly if you're looking at research, these are times when you'll see women's body fat go up. But when we're looking at men and women, what is considered to be average, and I'm not talking about a fitness professional, I'm not talking about an athlete, but what is considered to be average now, and I know that we're heading into territory. I think the last statistic I looked at, it's 92 to 93% of Americans are not metabolically healthy. So, the body fat percentages are probably going in an upward trend. But when you're looking at the research, “What is considered to be normal?”


Dr. Bill Campbell: [00:09:07] Yeah. So, I base this on a standard called reference man and reference woman. So, these are textbook examples. So, reference woman has a body fat percentage of 27%. Reference man has a body fat percentage of 15%. Now, some context. These are young adults. They're not. They're probably in their 30ish. And I've done a lot of past research on bodybuilders and when I say 27% for a female, they just like, “Wow, that's crazy high.” But their reference point is a woman stepping on a fitness stage or a bodybuilding stage. And that is one that's not sustainable. That is somebody's body composition one or two days out of a year. So that's not a good comparison. But I know my fitness enthusiasts, they gravitate towards those as being norms and they are not.


[00:10:01] So 27%. What does that look like in terms of morphology? Well, that woman would not have abs. A reference male at 15% would not have defined abs at that level. And by the way, the reason reference woman has more fat than a male is because of essential body fat. So more natural fat in breast tissue around the reproductive organs that men don't have. So, the average and I'm not saying unhealthy, just average is often higher than what a lot of people think. 


Cynthia Thurlow: [00:10:34] Well, I think our perceptions get so skewed from what we see. If it's a fitness competitor, what we see online, what we see in the movies, those are people that it is their job to look a particular way. But I'm sure when they're not filming a movie or a series, they may look very, very different. And I think the other thing is you mentioned, the concept of sustainability. Those fitness competitors look like that one or two days out of the year. What is it about fat mass or body fat that makes it challenging to sustain it too low of a level over time?


Dr. Bill Campbell: [00:11:08] Yeah, that's a great question and essentially when you get your body fat to very low levels, essentially your body works in every domain it possibly can to fight against sustaining that. So, your drive to eat or your hunger levels go up, your metabolism goes down. So, you and your cues to food increase. You have again, it's the biology works against extreme lean levels. And now the opposite is also true as we approach like morbid obesity. The body will speed up metabolism to help prevent the body to keep gaining weight. So, if whatever extreme you put your body in, the body will naturally try to work back to homeostasis.


Cynthia Thurlow: [00:11:59] Does this play into why yo-yo dieting is ultimately over time so harmful? I think maybe listeners understanding that gaining and losing the same 10, 15, 20 pounds over time can negatively impact our metabolism over the long haul.


Dr. Bill Campbell: [00:12:19] Yes. And I would say, and I'm going to base this on research that we've done or basing it on other people's research, the biggest harm to maintaining a lean body or setting yourself up for failure is a crash dieting mindset. So, yo-yo dieting comes in with that. So, let me just get to the yo-yo dieting. The more dieting attempts somebody makes, especially if they're young, the greater the likelihood of being overweight or obese later in life. And I don't study childhood obesity, I haven't done that research. But this is particularly concerning to me. If a young child is becoming overweight or obese, the outlook on their future is not optimistic at all.


[00:13:12] And even if they diet and lose it again, you're saying yo-yo dieting or intentional weight loss efforts, those aren't good. So, that's the yo-yo aspect of this. So, predicts a not ideal future. And then the other thing is this crash dieting mindset. So, the worst thing that somebody can do is to starve themselves for extended periods of time where they lose a lot of weight and they're seeing success on the scale. But what's actually happening is they're losing a lot of lean mass and metabolism is being suppressed. And what happens then is that there's a condition called hyperphagia. As soon as your diet is over, you've lost all this weight. You have friends, relatives saying, “Oh, you look great, but you've starved yourself to that condition.” And hyperphagia is an extreme desire to eat.


[00:14:06] It is hunger levels that are literally off the charts. And what happens is as soon as your crash diet is over, you cannot maintain your current physique and you have something that leads to fat overshoot, which is where within a very short period of time, sometimes within a fraction of the time that it took you to lose this body fat, you have now gained more body fat than what you had before you started the diet. Now, I want to add one more caveat to this because I'm very much in the middle of a paradigm shift in some of my thinking on fat loss. I used to say constantly a slow rate of fat loss is ideal and that is true.


[00:14:50] But I'm now doing current research in my lab on, I'll just call it like fat loss sprints, where it's very aggressive for just a few days. But here's the key, it is not an extended. What's different between that and crash dieting is it's targeted for a few days of extreme behaviors, very low calories, but pretty high protein and high exercise volume, mainly aerobic or walking exercise. And if we look at, “Hey, what was the fat lost over a month?” Well, if they only spent four or five days doing this, it's still a relatively slow rate of fat loss. But we've chosen to just accelerate it in a very short window and then get out.


[00:15:32] So, there's a lot of nuance to this. And again, I wouldn't have said this two years ago, but I've seen early research and now we've done some of this work in my own lab. We haven't published all of this yet, which makes me think that this may be a better option. And we're currently doing this across the menopause transition in a case series study in women. 


Cynthia Thurlow: [00:15:50] Ooh. So, this is very much of interest to listeners, of course, because I feel like maybe if women didn't have challenges with body fat or feeling like they had weight loss resistance, perimenopause is where these things start to show up. And I feel like it really gets magnified into menopause and post-menopause. And so, talking about that research that you're referring to, what is it that is so unique about women in a low hormone state that makes them more susceptible to weight loss resistance and increases in body fat? 


Dr. Bill Campbell: [00:16:24] I'll start with answer that nobody's going to like. I don't know [laughs] and I don't think anybody knows for sure. And I don't know if you know this because I know we started communicating maybe two years ago, but I've shifted almost all of my research to studying weight loss resistance in menopausal aged females. I don't know if you knew that term. We're doing, I think, the largest survey study in women who have a fitness lifestyle that are going through menopause. Back to your question. Why? Well, the easy answer is the changing hormonal environment, particularly estradiol levels are lowered. I think that probably is the lowest hanging fruit that could be changed to help offset weight loss resistance. The other thing is inflammation. 


[00:17:12] So, a lot of people will have the opinion that going through menopause is essentially an inflamed state. And if you can address that, then you really help this weight loss resistance. So, I can't point to specific studies on the inflammation, but some of the experts in my space that I have a lot of respect for, that's what they think and let me just say the question you asked is the question that I am committed to at least spending the next 20 or 30 years of my professional life to try to answer. And you probably know this, there are many fitness professionals, researchers that don't even acknowledge the concept of weight loss resistance. I would say I was in that camp not too many years ago and then something very interesting happened. Wife experienced, my wife is now postmenopausal and she's given me permission to share this. But she gained weight during this phase of her life and she could not lose it. And guess who she's married to, a fat loss researcher. She's my guinea pig all throughout my career. I've put her on all my machines, devices and have her do crazy diet. For the first time, she couldn't lose weight. And then I'm like, I've heard hundreds and hundreds, if not now, thousands of other women claim this. Now I cannot deny she was down to, I think, we had her down to 1100 calories for several weeks and would not lose weight. 


[00:18:40] So, I don't know why. I think it's probably a hormonal transition, particularly estradiol and probably an inflammation state that maybe not even can be detected outside of the cell. Again, that's why I would love to say, “Yeah, this study, this study, this study.” I can't, at least not yet. 


Cynthia Thurlow: [00:18:56] Well, I think we all appreciate your transparency and love that you willingly share your personal experiences through your wife. I think that one of the things that I think definitely contribute to some degree of weight loss resistance is this loss of muscle mass. So, sarcopenia is not a question of if but when. And, I will still say, and I'll shout it from the mountaintops. Too many of us, myself included, did not appreciate or value in our 20s and 30s how important skeletal muscle mass is, how critically important is. So, as we're losing it, we are losing insulin sensitivity. I think it's multifactorial. I think there's many things that contribute. But I definitely think about, in that low estrogen state, high follicular stimulating hormone, we're much more catabolic. We're breaking down muscle pretty readily and unless we're actively working against it. 


[00:19:45] But you mentioned protein and I think protein for so many of us, I feel like, things come full circle, when I was first a clinician, fats are bastardized and eat more heart healthy grains and all that stuff and don't eat saturated fat and sure as heck don't eat butter. And the pendulum is swinging back towards protein-centric diets. And we know protein's helpful for satiety, it's helpful for amino acid composition. When you're working within your research, thinking about how important protein is, what are the things that you feel like women need to really understand about the benefits and it's not to suggest carbs are bad and fat is bad. But why is protein so important for us as we're getting older?


Dr. Bill Campbell: [00:20:28] So, the first thing just again, taking a broad approach to this. Throughout all of my weight loss studies that we've done in my lab, our primary goal is fat loss. But we devote every resource available to us to protect muscle. Every resource available, because fat loss at the expense of losing muscle mass is a recipe for gaining everything back and being in a worse situation. So, how do we protect muscle during a fat loss phase or just as we age? I'll get to protein, but the first thing is resistance training. So, if we are dieting, that's a catabolic stimulus on the body. So, where are areas in our life that we can impute an anabolic stimulus? Well, that's what resistance training does. And you don't have to love resistance training. Minimal amounts is very beneficial. 


[00:21:23] So you don't have to live in the gym, you don't have to go every day. And then the second thing is back to your question is an optimal protein intake. So, protein is anabolic nutrient. It is what builds skeletal muscle and like you said, it also makes you feel fuller and it helps maintain our metabolisms, especially when you pair it with resistance training. Now as we get through to midlife, what happens is what we used to eat with protein it would stimulate a given amount of muscle protein synthesis. Well, as we age and we get into our 40s, 50s and beyond, everybody, males and females experience something called anabolic resistance. And part of that explanation is that protein levels do not do what they used to do. So, we need to actually have more protein as we age to get the same anabolic stimulus that we did when we’re younger. 


Cynthia Thurlow: [00:22:19] Yeah, I think it's interesting. I have two athletic teeny boys and I will talk to them about how you could probably have a whiff of protein and that will stimulate muscle-protein synthesis versus I have to have 40, 50 g of protein because they laugh at me. They're like, “Why are you so fixated on how much protein you're consuming?” And I just remind them, I'm like, “I need a good bolus several times a day.” And perhaps this is a good tie into talking about the role of time-restricted eating, intermittent fasting, what are your thoughts, kind of broad concepts on this for middle-aged people? It doesn't necessarily have to be for women. 


[00:22:51] Now for full disclosure, I've built a whole platform talking about fasting, but I have started to find I need a wider feeding window to make sure I'm getting enough protein so that I'm building muscle. What do you feel like or where do you feel like time-restricted eating can fit into the program of weight training, adequate protein intake, can they exist concurrently is what I'm trying to say? Or is time-restricted eating putting us at risk for losing lean body mass? 


Dr. Bill Campbell: [00:23:20] I think I have the same perspective you do or where you've evolved with this. So, the potential harm of very short feeding windows is that you don't have a lot of protein distribution. So, let me give two different scenarios. If somebody's goal is to build as much muscle as they possibly can, that's their primary goal, then my advice would be consume about a gram of protein per pound of body weight or 0.75 g per pound if getting a gram per pound is too difficult. And this would be goal body weight. And then once you have that as your, “Hey, this is how much protein I want to aim to consume today.” If the goal is I want to build as much muscle as possible, you want to approximately evenly distribute that about or across 3 to 5 protein feedings throughout the day. 


[00:24:09] So, if your feeding windows only four hours, that's not very evenly distributed. So, for that person I would say that a time-restricted feeding or if we're going to call it intermittent fasting, that may not be the best approach for your stated goal. Now let's look at somebody else. This would describe me, I more struggle with gaining body fat and I'm actually, I mean I would like to build muscle, but I put more of my effort into losing fat or not gaining fat and a time-restricted feeding lifestyle works better for me. I'm not hungry in the morning, so I don't eat in the morning and then as I'm hungrier throughout the day, I'm able to get those calories. Two other caveats to this. 


[00:25:00] If somebody wants to just use a hybrid approach, have your feeding window, but just have protein when you wake up, that way you're getting this protein bolus or anabolic stimulus. And then the other thing, and this was a study that I'm referring to that was published early last year where they gave male and female subjects, a 100 g of protein in one sitting and previously a lot of the research suggested that a lot of this huge amount of protein like over 30 g was wasted. And what this study found was it's not wasted at all. The problem with those earlier studies, they stopped measuring muscle-protein synthesis three to four hours after ingestion, whereas this study went 12 hours. And what they found was 100 g had significant benefits to increasing muscle-protein synthesis. 


[00:25:52] So, now I think a great application of this for somebody who enjoys intermittent fasting, time-restricted feeding on your two ends of your feeding windows, have large protein boluses because we know that the benefits will carry during your fasted window. 


Cynthia Thurlow: [00:26:09] I think that's really significant. And it's interesting, being in this space, I was speaking out against OMAD a long time ago and we would get angry messages. People were angry, they were disappointed because there were people who had gone from maybe being obese to being a healthy weight by just doing one meal a day. And I would remind them I understand how that has allowed you to achieve your goals. But overtime, how much muscle mass did you lose? Because with a significant weight loss you are going to have some loss of muscle, you will have some loss of fat. The loss of muscle I think is potentially more catastrophic. And so, I just like to remind people that the average person cannot in four hours consume enough protein to be able to bolster. 


[00:26:50] Although I love that addition of that study where you get this 12-hour timeframe because that's oftentimes a concern is that people will say, “Well how can you have 60 g of protein in one meal? Aren't you concerned that your body can't use it?” I was like, “Oh, my body can definitely use it.” So, I think reassuring people that consuming higher protein diets does not then lead to losing out of the benefits of protein. 


Dr. Bill Campbell: [00:27:15] Yes. I want to add another thought that came up. A lot of your audience, I think you said is females that are plus 35, 30s, 40s, 50s. There's a few studies where, well, let me just be stereotypical for a moment. A lot of, especially women, they consume non-optimal amounts of protein, very limited amounts of protein. And in these few studies, and I'm thinking of 2 and then my lab did one in resistance trained young people, but these are in middle aged or even postmenopausal females when they were consuming very small amounts of protein. And the only change that researchers introduced was increasing protein intake. That was the only change. One of these was a dieting study, the other one was literally just eat more protein. The results were, and I'll just say like literally surprising to me. 


[00:28:09] They not only gained lean mass and there is zero exercise here, which I used to think you have to exercise to build muscle. Not at all. And they lost body fat. So, the way that I conceptualize this, the biggest improvements in health and body composition are when you have somebody that's starting with a very low amount and just increasing it, losing body fat even though they're eating more calories and gaining muscle mass without resistance training. So, I here to something called a protein anchored flexible dieting approach. But protein is the center of my research studies and my own personal, just how I view food for health. 


Cynthia Thurlow: [00:28:50] I love that protein anchor. I may have to borrow that and give attribution. 


Dr. Bill Campbell: [00:28:54] There you go, take it. 


Cynthia Thurlow: [00:28:56] [laughs] What do we do if someone, there's still this dieting mentality. People think they have to be on a diet almost, consecutively. But I know based on, some of the other interviews I've seen you speak on talking about diet breaks or you refer to it as non-linear dieting, what are the benefits? If someone's been either they've been in time-restricted eating, they've been at a caloric deficit for a period of time, how does you know this dieting break? How does this benefit us metabolically and otherwise?


Dr. Bill Campbell: [00:29:29] So, most of the research including the research from my lab and we did this in resistance trained women, diet breaks don't really help physiologically that they're not going to build more muscle, they're not going to cause more body fat as when calories are the same between somebody who never takes a break. But practically speaking, and data from my lab and from a lab in Australia, we both found the same thing with diet breaks, the psychological assessments of hunger and something called disinhibition. And I'll explain what that is. They both were significant findings in our studies. The reason these are important is because my study was six weeks, the Australian diet break study I think was 12 weeks. So they weren't that long. They weren't really long studies. 


[00:30:20] The Australian studies found that subjects who had diet breaks every few weeks, and let me define that you're on a diet, so you're reducing your calories and every few weeks you say, “Okay, I'm going to stop dieting this week for seven days and I'm going to go back to my maintenance calories.” So, that's an important delineation. You're not eating at a buffet, it's not a cheat day where you're eating anything you want, you're increasing your calories, which seems like a lot of extra calories since you've been dieting, but you're not overeating. What they found was that the diet break group had significant lower drive to eat and significantly lower hunger levels. What my lab found, we used some different psychological questionnaires, something called a three-factor eating inventory. What we found was that this inhibition scores were significantly improved. 


[00:31:09] And this inhibition means that you tend to lose control of what you will eat when you're in a social context or you have more anxiety or stress. So, the subjects in our diet break group had much better control over their subjective feelings of their hunger and their ability to not overeat during this study or at the end of the study. So, where this becomes impactful is it seems that diet breaks help you have better control over hunger. And over time, that is what will dictate diet success or fat loss success. So, if my study would have been extended, let's say for three months or the other study would have been longer, I think we would have started to see physiological differences that were not yet manifested because they were too short. 


[00:31:58] I will also say just in my own life, I will never, and I live my whole life dieting. I gain weight, I lose weight. Sometimes it's on purpose, sometimes it's not. And I'm a fat loss researcher. I love this stuff. But I will never put myself on a diet again that does not have a diet break. Typically, what I'll do is I'll diet Monday through Friday and I'll increase my calories on the weekends because I tend to eat more on the weekends. So, I'll design my diet strategy around my lifestyle. 


Cynthia Thurlow: [00:32:26] Do you think of diet breaks? Because sometimes I'll hear people use the term refeeds. Like they'll go through a period of caloric restriction and then they'll do refeeds whether it's a few weeks. I know I think for you it was defined as one to two weeks and that allows you to be more anabolic, which means you're building muscle. But I think for anyone that's listening, especially those that have been calorically restricted, they've been doing time restricted eating, maybe they've been doing fasting for 5, 10 years. I think there is benefit from liberalizing things and it could be that maybe it's a 100, 150 extra calories of protein. I'm not talking that you're going out every day and having like a brownie sundae, although I'm sure you could adjust your macros to do that accordingly. 


[00:33:08] [Dr. Bill Campbell laughs] But helping people understand, when we're talking about these diet breaks, it's not a cheat day. It's not a cheat week or two. It is liberalizing things enough where you're still benefiting your health, but allowing you to have a degree of comfort where, you mentioned the disinhibition, and I think that's really interesting that people who have a propensity for wanting to continue to eat are then satiated. And that's what we're really speaking to is that degree of satiation and sustainability. Because the reason why diets oftentimes fail is they're not sustainable long term. 


Dr. Bill Campbell: [00:33:40] Yes. The best diet is the one that you can adhere to. And that's why we talked earlier, ketogenic diets, I'm not a big fan because most people cannot adhere to them, but a certain segment of the population does very well on them. And I think that's a great choice for them until they get to where their goals are. And then again, if we start to see some nutrient deficiencies, “Hey, we want to address that.” Adherence sustainability is everything. 


Cynthia Thurlow: [00:34:07] Absolutely. And where does lifestyle fit in? If we're talking about things like sleep and stress, I mean, these are topics we talk about a lot. Where do those things as well as, do you have favorite supplements, are there ergogenic aids that you feel like are beneficial? looking at the research that have shown some consistent patterns that are of benefit to women in particular. 


Dr. Bill Campbell: [00:34:28] So, lifestyle to me, the lowest hanging fruit is sleep. Again, I study muscle and fat essentially. And multiple studies have shown sleep deprivation, whether it's a little bit each time for several weeks, a complete night of zero sleep, or four hours for two weeks, only getting four hours of sleep for two weeks. I'm just referring to different studies. It always has adverse consequences on our body composition. And in particular, we lose muscle mass when we're sleep deprived and we gain body fat. Now, some of that is because we're just eating more food, because disrupted sleep will elevate hunger. But one of the studies that I'm referring to, it actually caused a distribution of higher fat in the visceral region. So, think of that as where you do not want to store fat because now you're having more metabolic resistance. 


[00:35:24] Just it's the most unhealthy place to store fat is in your-- Now you need some, but we're talking about excess visceral fat, a lack of sleep actually caused a shift in where our body stored fat, which was very interesting. And this was the most controlled study I've ever read on sleep and used MRI to measure this. So, it was a very high-quality study. 


Cynthia Thurlow: [00:35:46] It's interesting. We had Sean O'Mara on a few months ago and he's the visceral fat guy. He loves to talk about it and wants everyone to get an MRI and talks about the dangers of this deep visceral fat, that it's not benign. I used to have patients that would tell me that as they got older, their inseam kept getting smaller and smaller and it was because their bellies were getting bigger and they were trying to fit their pants around their belly at the expense of their inseam. So, it was like Santa Claus. You think about Santa Claus' body habitus that was what was happening. 


[00:36:16] And I would remind them that that's the deep inflammatory, cytokine-rich, problematic fat as opposed to the fat that we as women generally complain about that we might have on our hips or our thighs, that's more subcutaneous and although pesky is not as inflammatory. Are there particular stimulants, supplements that you like to use or you've used in your research? Supplements are a hot topic on the podcast largely because I just always find it interesting to ask guests like what are the things that are part of your supplement stack or that you or your wife really find beneficial or you've used in your study work that you have found has been beneficial for body fat? 


Dr. Bill Campbell: [00:36:57] My career started as doing a lot of sports nutrition research or dietary supplement research, but I really don't take that many dietary supplements. I'll just say the ones that I take. I take creatine, protein, fish oil, and a multivitamin, multimineral supplement that's pretty much all I take. If I were, let's say I wanted to lose fat quickly, I would leverage caffeine. Caffeine is a really, I want to say it's powerful, but it's a modest fat loss supplement. It's not going to melt fat away, but it does everything you want it to do. But we have to be careful. We don't want to take it too late because then we're going to not sleep and then that's going to work against our efforts. So, yeah, and I'm trying to think right now my wife is my complete focus and hers by default is on HRT. So, we're going with the big movers in her physiology. But she takes a lot of the same multivitamin that I do. She does take fish oil, vitamin D, by the way. A lot of people are deficient in vitamin D and don't know it. So, in our multivitamin, it has vitamin D. I would also take vitamin D if it weren't already in my multivitamin. 


Cynthia Thurlow: [00:38:04] No, I love that. I love the simplicity. And we are very much pro HRT if that is for you. And I think for a lot of people it's easy to get oral progesterone. It might be more challenging to get transdermal estrogen as a starting point. Testosterone, I keep hoping that we're going to have FDA-approved testosterone for women. We aren't there yet. So, most women are either using teeny tiny portions of AndroGel, which is for men or they're having it compounded. But I think testosterone for most women in terms of body mechanics and body composition seems to be hugely impactful.


[00:38:47] Well, I've so enjoyed this conversation. I hope I can convince you to come back when we both have a little bit more time together. Please let listeners know how to connect with you outside of this podcast, how to learn more about your research and your work.


Dr. Bill Campbell: [00:38:51] Yeah. So again, thank you for inviting me. I know I should come back when we get our survey study, our menopause survey. 


Cynthia Thurlow: [00:38:58] Please do.


Dr. Bill Campbell: [00:38:59] That would be a great conversation to have. I'm easy to find them. I'm only really on Instagram, so my Instagram handle is @billcampbellphd. And I try to respond to every question, every DM, every comment, try to. I think I do a pretty good job. And I'll just say I am literally obsessed with menopause, fitness, HRT, exercise, diets in this phase of life. So, if anybody has questions. At this point, just like earlier, I don't know the answers to everything, but there is nobody more passionate about this space than me right now. Maybe you. 


Cynthia Thurlow: [00:39:37] [laughs] No. Well, thank you. This has been an interview that we've been trying to make happen for a while and I'm so glad to know that were able to make it happen and obviously have to have you back when your research has been completed on that survey. Because I think in many ways, you know, I've had Dr. Lisa Mosconi on the podcast and she said in 2016 she was appalled at the lack of research being done on women in perimenopause and menopause. So, thank you for the work that you do. It really does take an army to get things done. And I think the more that we can understand based on research, the more that we can advocate and inspire others to be able to take the best care of themselves possible. 


Dr. Bill Campbell: [00:40:17] Yes. Yeah. Thank you again for asking me the questions that I love to talk about. 


Cynthia Thurlow: [00:40:21] Awesome. 


[00:40:24] If you love this podcast episode, please leave a rating in review, subscribe and tell a friend. 



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