Ketogenic Diet: Burning Fat Or Burning Out?

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In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:

  • About 45% said “It has its benefits, but they don’t outweigh the risks”
  • About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
  • About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”

So what does the science say?

First, what is the ketogenic diet?

There are two different stories here:

  • Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
  • Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.

Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.

The ketogenic diet works by forcing the body to burn fat for energy: True or False?

True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.

See: The Ketogenic Diet: One Decade Later | Pediatrics

Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:

Source: Dietary Therapies for Epilepsy

The ketogenic diet is good for weight loss: True or False?

True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:

❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.

Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞

~ Dr. Shadan Khdher et al.

Read in full: The Significant Impact of High-Fat, Low-Carbohydrate Ketogenic Diet on Serum Lipid Profile and Atherosclerotic Cardiovascular Disease Risk in Overweight and Obese Adults

On which note…

The ketogenic diet is bad for the heart: True or False?

True! As Dr. Joanna Popiolek-Kalisz concluded recently:

❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.

Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞

~ Dr. Joanna Popiolek-Kalisz

Read in full: Ketogenic diet and cardiovascular risk: state of the art review

The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?

True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:

❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.

Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞

~ Ibid.

The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?

False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.

That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:

  1. At first, the body is running out of glucose, and so naturally feels weak and tired.
  2. Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
  3. Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.

Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:

  • Bad breath
  • Weight loss
  • Appetite loss
  • Increased focus and energy
  • Increased fatigue and irritability
  • Digestive issues
  • Insomnia

The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.

Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:

The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia

The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?

True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.

One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.

Other things are more specific to the keto diet, such as the problems with the kidneys:

The Relationship between Modern Fad Diets and Kidney Stone Disease: A Systematic Review of Literature

However, kidney stones aren’t the worst of the problems:

Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure

We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:

❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞

~ Dr. Ida Heikura et al.

A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise

Want a healthier diet?

We recommend the Mediterranean diet.

See also: Four Ways To Upgrade The Mediterranean

(the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)

Enjoy!

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  • Our ‘food environments’ affect what we eat. Here’s how you can change yours to support healthier eating

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    In January, many people are setting new year’s resolutions around healthy eating. Achieving these is often challenging – it can be difficult to change our eating habits. But healthy diets can enhance physical and mental health, so improving what we eat is a worthwhile goal.

    One reason it’s difficult to change our eating habits relates to our “food environments”. This term describes:

    The collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status.

    Our current food environments are designed in ways that often make it easier to choose unhealthy foods than healthy ones. But it’s possible to change certain aspects of our personal food environments, making eating healthier a little easier.

    Unhealthy food environments

    It’s not difficult to find fast-food restaurants in Australian cities. Meanwhile, there are junk foods at supermarket checkouts, service stations and sporting venues. Takeaway and packaged foods and drinks routinely come in large portion sizes and are often considered tastier than healthy options.

    Our food environments also provide us with various prompts to eat unhealthy foods via the media and advertising, alongside health and nutrition claims and appealing marketing images on food packaging.

    At the supermarket, unhealthy foods are often promoted through prominent displays and price discounts.

    We’re also exposed to various situations in our everyday lives that can make healthy eating challenging. For example, social occasions or work functions might see large amounts of unhealthy food on offer.

    Not everyone is affected in the same way

    People differ in the degree to which their food consumption is influenced by their food environments.

    This can be due to biological factors (for example, genetics and hormones), psychological characteristics (such as decision making processes or personality traits) and prior experiences with food (for example, learned associations between foods and particular situations or emotions).

    People who are more susceptible will likely eat more and eat more unhealthy foods than those who are more immune to the effects of food environments and situations.

    Those who are more susceptible may pay greater attention to food cues such as advertisements and cooking smells, and feel a stronger desire to eat when exposed to these cues. Meanwhile, they may pay less attention to internal cues signalling hunger and fullness. These differences are due to a combination of biological and psychological characteristics.

    These people might also be more likely to experience physiological reactions to food cues including changes in heart rate and increased salivation.

    Two young women sitting on a couch eating chips.
    It’s common to eat junk food in front of the TV.
    PR Image Factory/Shutterstock

    Other situational cues can also prompt eating for some people, depending on what they’ve learned about eating. Some of us tend to eat when we’re tired or in a bad mood, having learned over time eating provides comfort in these situations.

    Other people will tend to eat in situations such as in the car during the commute home from work (possibly passing multiple fast-food outlets along the way), or at certain times of day such as after dinner, or when others around them are eating, having learned associations between these situations and eating.

    Being in front of a TV or other screen can also prompt people to eat, eat unhealthy foods, or eat more than intended.

    Making changes

    While it’s not possible to change wider food environments or individual characteristics that affect susceptibility to food cues, you can try to tune into how and when you’re affected by food cues. Then you can restructure some aspects of your personal food environments, which can help if you’re working towards healthier eating goals.

    Although both meals and snacks are important for overall diet quality, snacks are often unplanned, which means food environments and situations may have a greater impact on what we snack on.

    Foods consumed as snacks are often sugary drinks, confectionery, chips and cakes. However, snacks can also be healthy (for example, fruits, nuts and seeds).

    Try removing unhealthy foods, particularly packaged snacks, from the house, or not buying them in the first place. This means temptations are removed, which can be especially helpful for those who may be more susceptible to their food environment.

    Planning social events around non-food activities can help reduce social influences on eating. For example, why not catch up with friends for a walk instead of lunch at a fast-food restaurant.

    Creating certain rules and habits can reduce cues for eating. For example, not eating at your desk, in the car, or in front of the TV will, over time, lessen the effects of these situations as cues for eating.

    You could also try keeping a food diary to identify what moods and emotions trigger eating. Once you’ve identified these triggers, develop a plan to help break these habits. Strategies may include doing another activity you enjoy such as going for a short walk or listening to music – anything that can help manage the mood or emotion where you would have typically reached for the fridge.

    Write (and stick to) a grocery list and avoid shopping for food when hungry. Plan and prepare meals and snacks ahead of time so eating decisions are made in advance of situations where you might feel especially hungry or tired or be influenced by your food environment.The Conversation

    Georgie Russell, Senior Lecturer, Institute for Physical Activity and Nutrition (IPAN), Deakin University and Rebecca Leech, NHMRC Emerging Leadership Fellow, School of Exercise and Nutrition Sciences, Deakin University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Uric Acid’s Extensive Health Impact (And How To Lower It)

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    Uric Acid’s Extensive Health Impact (And How To Lower It)

    This is Dr. David Perlmutter. He’s a medical doctor, and a Fellow of the American College of Nutrition. He’s a member of the Editorial Board for the Journal of Alzheimer’s Disease, and has been widely published in many other peer-reviewed journals.

    What does he want us to know?

    He wants us to know about the health risks of uric acid (not something popularly talked about so much!), and how to reduce it.

    First: what is it? Uric acid is a substance we make in our own body. However, unlike most substances we make in our body, we have negligible use for it—it’s largely a waste product, usually excreted in urine.

    However, if we get too much, it can build up (and crystallize), becoming such things as kidney stones, or causing painful inflammation if it shows up in the joints, as in gout.

    More seriously (unpleasant as kidney stones and gout may be), this inflammation can have a knock-on effect triggering (or worsening) other inflammatory conditions, ranging from non-alcoholic fatty liver disease, to arthritis, to dementia, and even heart problems. See for example:

    How can we reduce our uric acid levels?

    Uric acid is produced when we metabolize purine nucleotides, which are found in many kinds of food. We can therefore reduce our uric acid levels by reducing our purine intake, as well as things that mess up our liver’s ability to detoxify things. Offsetting the values for confounding variables (such as fiber content, or phytochemicals that mitigate the harm), the worst offenders include…

    Liver-debilitating things:

    • Alcohol (especially beer)
    • High-fructose corn syrup (and other fructose-containing things that aren’t actual fruit)
    • Other refined sugars
    • Wheat / white flour products (this is why beer is worse than wine, for example; it’s a double-vector hit)

    Purine-rich things:

    • Red meats and game
    • Organ meats
    • Oily fish, and seafood (great for some things; not great for this)

    Some beans and legumes are also high in purines, but much like real fruit has a neutral or positive effect on blood sugar health despite its fructose content, the beans and legumes that are high in purines, also contain phytochemicals that help lower uric acid levels, so have a beneficial effect.

    Eggs (consumed in moderation) and tart cherries have a uric-acid lowering effect.

    Water is important for all aspects of health, and doubly important for this.

    Hydrate well!

    Lifestyle matters beyond diet

    The main key here is metabolic health, so Dr. Perlmutter advises the uncontroversial lifestyle choices of moderate exercise and good sleep, as well as (more critically) intermittent fasting. We wrote previously on other things that can benefit liver health:

    How To Unfatty A Fatty Liver

    …in this case, that means the liver gets a break to recuperate (something it’s very good at, but does need to get a chance to do), which means that while you’re not giving it something new to do, it can quickly catch up on any backlog, and then tackle any new things fresh, next time you start eating.

    Want to know more about this from Dr. Perlmutter?

    You might like his article:

    An Integrated Plan for Lowering Uric Acid ← more than we had room for here; he also talks about extra things to include in your diet/supplementation regime for beneficial effects!

    And/or his book:

    Drop Acid: The Surprising New Science of Uric Acid―The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health

    …on which much of today’s main feature was based.

    Take care!

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  • 6 Daily Habits To Keep Your Brain Young & Sharp

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    Without brain health, we do not have health. So here are six ways to keep it in order:

    Food for thought

    The six areas to focus on are as follows:

    1. Physical exercise: as we at 10almonds sometimes say, what’s good for the heart is good for the brain (because the brain is only as healthy as the circulation feeding it). For this reason, the recommendation here is for physical exercise that improves heart health—so, walking, running, swimming, dancing, etc.
    2. Healthy diet: shocking nobody, this is important too. Specifically, a diet rich in fruits, vegetables, and healthy proteins and fats is important—partly for the heart benefits that give indirect benefits to the brain, and partly because the brain is built of stuff and so we have to consume that stuff in order to rebuild it (omega-3s features strongly here, for instance). Remember to hydrate, too! The body can’t do anything without water.
    3. Good sleep: yes, the famous 7–9 hours sleep per night, and yes, even at your age, whatever that might be. This is important for memory consolidation, cell repair, toxin removal, and more. Sleep deprivation, on the other hand, leads to cognitive decline and brain shrinkage.
    4. Mental stimulation: ideally, engaging those parts of the brain you most wish to protect (e.g. language, memory, or whatever is most important to you).
    5. Social interaction: this one gets underestimated a lot, but it’s important to have meaningful conversations (not just polite smalltalk from a small menu of stock phrases), and that these should be two-way, i.e. involving both listening/reading and speaking/writing. Ideally, all four of those, which for most people means online and offline social interactions.
    6. Stress management: because chronic stress damages brain cells and accelerates cognitive decline, it’s important to manage that; practices like mindfulness meditation go a very long way and make a big difference.

    For more on all of these, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    The Physical Exercises That Build Your Brain ← this is different from just exercising for one’s heart and thus the brain by extension, and rather, is specific exercises that strengthen specific parts of the brain.

    Take care!

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  • How to be kind to yourself (without going to a day spa)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    “I have to be hard on myself,” Sarah told me in a recent telehealth psychology session. “I would never reach my potential if I was kind and let myself off the hook.”

    I could empathise with this fear of self-compassion from clients such as Sarah (not her real name). From a young age, we are taught to be kind to others, but self-kindness is never mentioned.

    Instead, we are taught success hinges on self-sacrifice. And we need a healthy inner critic to bully us forward into becoming increasingly better versions of ourselves.

    But research shows there doesn’t have to be a trade-off between self-compassion and success.

    Self-compassion can help you reach your potential, while supporting you to face the inevitable stumbles and setbacks along the way.

    What is self-compassion?

    Self-compassion has three key ingredients.

    1. Self-kindness

    This involves treating yourself with the same kindness you would extend towards a good friend – via your thoughts, feelings and actions – especially during life’s difficult moments.

    For instance, if you find yourself fixating on a minor mistake you made at work, self-kindness might involve taking a ten-minute walk to shift focus, and reminding yourself it is OK to make mistakes sometimes, before moving on with your day.

    2. Mindfulness

    In this context, mindfulness involves being aware of your own experience of stress or suffering, rather than repressing or avoiding your feelings, or over-identifying with them.

    Basically, you must see your stress with a clear (mindful) perspective before you can respond with kindness. If we avoid or are consumed by our suffering, we lose perspective.

    3. Common humanity

    Common humanity involves recognising our own experience of suffering as something that unites us as being human.

    For instance, a sleep-deprived parent waking up (for the fourth time) to feed their newborn might choose to think about all the other parents around the world doing exactly the same thing – as opposed to feeling isolated and alone.

    It’s not about day spas, or booking a manicure

    When Sarah voiced her fear that self-compassion would prevent her success, I explained self-compassion is distinct from self-indulgence.

    “So is self-compassion just about booking in more mani/pedis?” Sarah asked.

    Not really, I explained. A one-off trip to a day spa is unlikely to transform your mental health.

    Instead, self-compassion is a flexible psychological resilience factor that shapes our thoughts, feelings and actions.

    It’s associated with a suite of benefits to our wellbeing, relationships and health.

    Massage therapist massaging woman's back
    A one-off trip to a day spa is unlikely to transform your mental health.
    baranq/Shutterstock

    What does the science say?

    Over the past 20 years, we’ve learned self-compassionate people enjoy a wide range of benefits. They tend to be happier and have fewer psychological symptoms of distress.

    Those high on self-compassion persevere following a failure. They say they are more motivated to overcome a personal weakness than those low on self-compassion, who are more likely to give up.

    So rather than feeling trapped by your inadequacies, self-compassion encourages a growth mindset, helping you reach your potential.

    However, self-compassion is not a panacea. It will not change your life circumstances or somehow make life “easy”. It is based on the premise that life is hard, and provides practical tools to cope.

    It’s a factor in healthy ageing

    I research menopause and healthy ageing and am especially interested in the value of self-compassion through menopause and in the second half of life.

    Because self-compassion becomes important during life’s challenges, it can help people navigate physical symptoms (for instance, menopausal hot flushes), life transitions such as divorce, and promote healthy ageing.

    I’ve also teamed up with researchers at Autism Spectrum Australia to explore self-compassion in autistic adults.

    We found autistic adults report significantly lower levels of self-compassion than neurotypical adults. So we developed an online self-compassion training program for this at-risk population.

    Three tips for self-compassion

    You can learn self-compassion with these three exercises.

    1. What would you say to a friend?

    Think back to the last time you made a mistake. What did you say to yourself?

    If you notice you’re treating yourself more like an enemy than a friend, don’t beat yourself up about it. Instead, try to think about what you might tell a friend, and direct that same friendly language towards yourself.

    2. Harness the power of touch

    Soothing human touch activates the parasympathetic “relaxation” branch of our nervous system and counteracts the fight or flight response.

    Specifically, self-soothing touch (for instance, by placing both hands on your heart, stroking your forearm or giving yourself a hug) reduces cortisol responses to psychosocial stress.

    Middle-aged man hugging himself
    Yes, hugging yourself can help.
    http://krakenimages.com/Shutterstock

    3. What do I need right now?

    Sometimes, it can be hard to figure out exactly what self-compassion looks like in a given moment. The question “what do I need right now” helps clarify your true needs.

    For example, when I was 37 weeks pregnant, I woke up bolt awake one morning at 3am.

    Rather than beating myself up about it, or fretting about not getting enough sleep, I gently placed my hands on my heart and took a few deep breaths. By asking myself “what do I need right now?” it became clear that listening to a gentle podcast/meditation fitted the bill (even though I wanted to addictively scroll my phone).The Conversation

    Lydia Brown, Senior Lecturer in Psychology, The University of Melbourne

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Get Fitter As You Go

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    Dr. Jaime Seeman: Hard To Kill?

    This is Dr. Jaime Seeman. She’s a board-certified obstetrician-gynecologist with a background in nutrition, exercise, and health science. She’s also a Fellow in Integrative Medicine, and a board-certified nutrition specialist.

    However, her biggest focus is preventative medicine.

    What does she want us to know?

    The Five Pillars of being “Hard to Kill”!

    As an athlete when she was younger, she got away with poor nutrition habits with good exercise, but pregnancy (thrice) brought her poor thyroid function, other hormonal imbalances, and pre-diabetes.

    So, she set about getting better—not something the general medical establishment focuses on a lot! Doctors are pressured to manage symptoms, but are under no expectation to actually help people get better.

    So, what are her five pillars?

    Nutrition

    Dr. Seeman unsurprisingly recommends a whole-foods diet with lots of plants, but unlike many plant-enjoyers, she is also an enjoyer of the ketogenic diet.

    While keto-enthusiasts say “carbs are bad” and vegans say “meat is bad”, the reality is: both of those things can be bad, and in both cases, avoiding the most harmful varieties is a very good first step:

    Movement

    This is in two parts:

    • get your 150 minutes of moderate exercise per week
    • keep your body mobile!

    See also:

    Sleep

    This one’s quite straightforward, and Dr. Seeman uncontroversially recommends getting 7–9 hours per night; yes, even you:

    Mindset

    This is key to Dr. Seeman’s approach, and it is about not settling for average, because the average is undernourished, overmedicated, sedentary, and suffering.

    She encourages us all to keep working for better health, wherever we’re at. To not “go gentle into that good night”, to get stronger whatever our age, to showcase increasingly robust vitality as we go.

    To believe we can, and then to do it.

    Environment

    That previous item usually won’t last beyond a 10-day health-kick without the correct environment.

    As for how to make sure we have that? Check out:

    Our “food environments” affect what we eat. Here’s how you can change yours to support healthier eating

    Want more?

    She does offer coaching:

    Hard To Kill Academy: Master The Mindset To Maximize Your Years

    Take care!

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  • Rethinking Exercise: The Workout Paradox

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    The notion of running a caloric deficit (i.e., expending more calories than we consume) to reduce bodyfat is appealing in its simplicity, but… we’d say “it doesn’t actually work outside of a lab”, but honestly, it doesn’t actually work outside of a calculator.

    Why?

    For a start, exercise calorie costs are quite small numbers compared to metabolic base rate. Our brain alone uses a huge portion of our daily calories, and the rest of our body literally never stops doing stuff. Even if we’re lounging in bed and ostensibly not moving, on a cellular level we stay incredibly busy, and all that costs (and the currency is: calories).

    Since that cost is reflected in the body’s budget per kg of bodyweight, a larger body (regardless of its composition) will require more calories than a smaller one. We say “regardless of its composition” because this is true regardless—but for what it’s worth, muscle is more “costly” to maintain than fat, which is one of several reasons why the average man requires more daily calories than the average woman, since on average men will tend to have more muscle.

    And if you do exercise because you want to run out the budget so the body has to “spend” from fat stores?

    Good luck, because while it may work in the very short term, the body will quickly adapt, like an accountant seeing your reckless spending and cutting back somewhere else. That’s why in all kinds of exercise except high-intensity interval training, a period of exercise will be followed by a metabolic slump, the body’s “austerity measures”, to balance the books.

    You may be wondering: why is it different for HIIT? It’s because it changes things up frequently enough that the body doesn’t get a chance to adapt. To labor the financial metaphor, it involves lying to your accountant, so that the compensation is not made. Congratulations: you’re committing calorie fraud (but it’s good for the body, so hey).

    That doesn’t mean other kinds of exercise are useless (or worse, necessarily counterproductive), though! Just, that we must acknowledge that other forms of exercise are great for various aspects of physical health (strengthening the body, mobilizing blood and lymph, preventing disease, enjoying mental health benefits, etc) that don’t really affect fat levels much (which are decided more in the kitchen than the gym—and even in the category of diet, it’s more about what and how and when you eat, rather than how much).

    For more information on metabolic balance in the context of exercise, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Take care!

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