The most effective fitness program incorporates these important elements
MY NUMBER-ONE DIET FOR FAT LOSS is the ketogenic diet. My number-one exercise program for fat loss is helping patients combine strength training (which targets fast-twitch fibers) with some explosive bursts of energy.
When people start the ideal protein ketogenic diet, I recommend incorporating a walking program. Depending on the person’s physical condition, I may have to wait weeks to months to start strength training. The strength-aerobic workout targets both fast-twitch and slow-twitch muscle fibers. I combine the best of both diet and exercise modes to build muscle, increase strength and burn fat, with the result of improving total-body composition. Fat loss and exercise are just one part of my strategy to help people create longevity.
I have a full-time weight loss coach in my office. We use bioelectric impedance analysis (BIA) to get a baseline body composition. We can deal with people among the highest body mass indexes (including those who classify as obese). It may take a long time to get overweight and/or obese people to burn calories from exercise that translate into many calories being burned at the end of the day. Not only that, some people, with or without obesity, are really efficient at hanging onto their fat stores, especially visceral fat.
BIA is a good patient engagement tool. I measure body fat percentage and total body water, then break it down into extracellular and intracellular water amounts, fat-free weight (so I know approximate skeletal muscle weight), and phase angle, which is a measure of cell membrane health. BIA allows me to see the influence of my programs and patient compliance.
I have experimented long enough to know that the ideal protein ketogenic diet alone will reduce harmful fat that helps reduce patients’ musculoskeletal inflammation and pain. My goal is to reduce pain so I can introduce exercise to build muscle and reduce frailty as we age. The higher the muscle mass, the greater the longevity. Combining both diet and exercise gives us predictable results. Heavy strength training targets the fast-twitch fibers and helps build muscle. Endurance-based training targets slow-twitch fibers and fat loss.
My solution: Train patients to work out with some moderate-heavy weightlifting and do some explosive exercises. My target is having the heart rate in a zone between 60 and 70% of your overall maximum heart rate. Heavy weightlifting means different things to different people. People that need fat loss are often deconditioned. I have criteria to measure where a person is at for exercise programming.
Number 1: I need patients to tell me they are ready for movement beyond walking. Next, I need them to demonstrate that they can own their body weight and I use the Bunkie Tests for this. Once these goals are achieved, they can progress to their favorite workout class or I offer to train them with band workouts; then they can progress to dumbbells or kettlebells. I still use a Tabata-type tempo recommendation of 20-30 seconds on/rest for 10-15 seconds, which is long enough to transition from one move to another. I want patients to build up to approximately 30 minutes of exercise. Many can only start with three to five minutes of a workout.
Here’s a typical 30- to 35-minute workout a patient may be doing along with the ketogenic diet program. These exercises can be done with body weight, bands, kettlebells, free weights or any combo:
- Warm up for 4-5 minutes with a march in place (high knees) while moving the arms overhead or making arm circles.
- Do the following sequence of exercises: Squats, kettlebell swings. Bent-over rows, kettlebell swings. Deadlifts, kettlebell swings. Lunges, kettlebell swings. Cleans, kettlebell swings. Chest presses, kettlebell swings. Clean to press, kettlebell swings.
- Repeat to desired time.
Kettlebell swings can be replaced with a sprint, jumping jacks or anything they like that is going to get the heart rate up to 70-80% of your max heart rate. It may feel explosive and take the breath away in the beginning, but after a while they are usually in that sweet spot of 60-70% of max heart rate.
I’m happy to write different programs of exercise for five to seven days a week. The movements are designed to hit fast-twitch muscles, which have the greatest potential for size and strength gains, use energy to contract the slow-twitch fibers and are not boring.
Diet + Exercise + Tempo = I’m combining lots of benefit
The “tempo” of the lifting exercises is at a slow but steady tempo from start to finish. I’ll use the “kettlebell tempo squat” as an example. This is simply a kettlebell squat (one kettlebell held with both hands or one kettlebell held in a one-arm clean position) in which you take two seconds to lower the weight and two seconds to lift the weight—all without pausing at the top or the bottom of the exercise. One important point: You’ll have to lower the load—a lot—for these tempo moves. Too much weight and you’ll still be focused on your fast-twitch fibers, which won’t give you all the benefits of this combo approach.
For the past few years, I have recommended blood flow restriction (BFR) cuffs for those who are ready for “next” levels. Imagine having cuffs around the upper inner thighs when doing the kettlebell squat; the legs are under constant, low-level compression tension. The cuff reduces the blood flow to your working muscles, depriving them of oxygen for an extended period of time. With less oxygen, your muscles react by creating more mitochondria. The more mitochondria you have, the more energy you can produce, ultimately the more energy you can produce, the harder and the longer you can exercise.
Keto + exercise + BFR = the brain likes being in ketosis (diet), and mitochondria like to use body fat (exercise).
BIA results demonstrate that diet and proper exercise helps improve body composition.
If a patient has extra time at the end of each workout, I include short bursts of intense walking or sprinting (again, it depends on the patient). These are all-out power exercises you do for about 10 to 20 seconds, recover your breath (about 60 to 120 seconds) and then do again.
Rules I have learned from having a (ketogenic) weight loss program:
- I’m okay with slower weight loss to lose fat while keeping your muscle mass.
- Being on the ketogenic diet has an expiration date. If you notice prolonged fatigue or loss of energy, loss of strength, gut microbiome issues, if immunity goes down, hair loss or loss of periods, it may be time for a 10- to 21-day break.
- Some people need an entire range of vitamins and minerals.
- Measure bone density more frequently than you are currently doing. I recommend my young adult patients measure bone density with a DEXA sooner than later.
- When patients get a digestive problem like constipation, fix it!
- Any diet should contain a wide variety of healthy, whole foods.
- Watch out for hormonal changes.
- Optimize sleep. If you have trouble sleeping, fix it!
- Allow people an occasional piece of chocolate or slice of pizza. Don’t take away all the joy of eating.
- Continuous glucose monitors (CGMs) are a good thing and I encourage the use of them, so patients become knowledgeable about personal glucose levels for foods, beverages and movement time.
- Consuming foods with a high glycemic load causes hormonal responses that alter a person’s metabolism.
- Patients need help reinforcing the importance of figuring out time to just breathe and meditate.
I love helping patients figure out how to lose weight, burn more calories, decrease inflammation that decreases muscle and joint pain, improve posture and create healthy aging, all with our wholistic and biohacking approaches to diet + strength-aerobic principles.
JEFFREY TUCKER, DC, is in private practice in Los Angeles, Calif. Sign up for his newsletter at drjeffreytucker.com.