ASK THE DOCTOR
May 2012 - Vol. 35 No. 6
YOUR QUESTIONS ANSWERED
by Mauro DiPasquale, MD | mauro[at]metabolicdiet.com
To download Dr. Mauro's latest Elite Performance Newsletter, go to:www.eliteperformancenewsletter.com
DEAR MAURO: I have talked to you in the past and ordered products from you many times and am very pleased with the results of your products and your knowledge of them. I am going on my fourth year of serious bilateral epicondylitis (tennis elbow). Over fifteen different specialists have all told me that it is something that I am going to have to deal with the rest of my life. I do not believe this; I have learned a little about what they are telling me and feel that if I can repair the fascia I believe that will fix the problem.
Do you think that building the muscle by taking your GHboost, TestoBoost, and Metabolic will make things worse or do you think that building muscle will do more harm then good? I have been told that building excess muscle will aggravate the problem and make the problem worse. The damage was made from excessive work and damage, creating scar tissue and inflammation. The last time that I took this I felt almost symptom free for several months, but slowly fell back to my old symptoms.
I just talked to my family doctor; I went for a yearly physical and he told me that everything came back good. My arms have been bothering me a little bit more than usual because of exams at school. I do have a note keeper to help me out with notes and reviews in class. I was wondering if you had time to look at the CDs that I sent you. Would you like me to go for any other testing that might help you? Your advice and or opinion on this would be greatly appreciated.
LES: I had a look at the two discs and I really can't see anything that would make them come to the conclusion that it's unfixable and that you have to live with the bilateral epicondylitis.
Certainly a combination of supplements would help with the main one being Joint Support at this point (for info on Joint Support go to http://mauromd.com/store/product.php?id_product=102), although later on you could add GHboost, TestoBoost and Metabolic, which would work with the Joint Support by helping you strengthen the musculoskeletal structures in and around the elbow joints.
I would also look into Ming Chew's methods that involves treating the fascia to resolve various musculoskeletal problems—see http://www.mingmethod.net/about.htm. In his book, Ming recommends my Joint Support and also states it's what he himself uses. He's been very successful in treating athletes who didn't have any success with anything else that they'd tried.
Hope this helps,
DEAR MAURO: I have a personal diet question. Here is what I am currently doing; I wanted your thoughts. Again!
- I get up at 6 a.m. and take my MVM, EFA+ and MRP LoCarb and some Amino as well.
- I train in the morning, an hour or so after I get up, three times a week. I then take my Resolve, GHboost and Amino prior to working out; no carbs.
- I train my ass off for around 2 hours twice a week—lots of sets with low reps, usually 3–5 lately. I use Power Drink through the workout. The other day I go light and do mostly 5 to 8 reps, not as many sets.
- After the workout I take Amino and GHboost and then another MRP LoCarb about an hour later.
- A few hours after that I eat some meat, usually beef, and some cheese.
- Around 2 p.m. I have a can of tuna with miracle whip and usually green beans and cheese again.
- For supper I usually have a steak, 12–16 ounces, with a vegetable and a salad; take my MVM and EFA+ here as well.
- Around 9 p.m. more cheese and half a cup or so of almonds.
- Before bed I use your GHboost and TestoBoost, with 2 scoops of Myosin Protein.
I do this pretty solid for almost two weeks and then carb spike usually for about a day or a day and a half. Shifting the low carb and high carb days this way seems to work best for me.
I attached some pics from this morning's workout. Right now I am 5-foot-9 and 218 pounds after carb load this weekend.
I want to get leaner but keep my muscle and strength, and then compete in the 198-pound class, giving me almost four months to get to where I want.
I'd like to know your thoughts on the diet, and on how to get my weight to just under the 204-pound mark a week or so before competing.
I have to tell you that the last few times I did it all this way, my totals stayed about the same. So I'm open to diet, supplement and training suggestions. Thanks, Doc, your input means a lot!
DAVE: You're looking pretty good in those pictures, but I can see that you're carrying around 15-percent body fat, give or take a few percentage points. That means that if you're aiming to get under 8-percent body fat you can definitely get down to under 204 by just losing body fat and no "functional" muscle (I'll explain how you may lose muscle mass, but the muscle mass you lose won't be functional mass; that is it won't be muscle mass that will affect your strength). As far as your diet regimen and supplements, you're doing fine. It's obvious you've been experimenting with the diet as per my Anabolic Solution for Powerlifters (see http://mauromd.com/store/product.php?id_product=156) and the food list I pointed you to for the low carb phase of the diet at http://mauromd.com/store/product.php?id_product=156, which is the way to go in order to find out the best mix for you. This is something I've always said about my phase shift diets; you get the chance to try different approaches on a regular basis until you find what works best, and even that may change as your body composition changes.
You're following a traditional way of getting ready for a competition and it works. In fact in my books, whether for powerlifters or bodybuilders, or for any competitive athlete, I've always suggested going through the same route that most people traditionally do, that's to first do a bulking phase, followed by a cutting phase up to contest time. In between the two there can be other phases, and sometimes a zig zag of phases, bulk, followed by cutting, then a strength or static phase, then bulk, then cutting, etc. The variations are many and again it's a matter of experimenting.
Having said that over the last several years I've had a lot of power athletes and bodybuilders trying an approach that's in a reverse order in order to maximize body composition and strength and for some it's worked better than the more traditional approach. Since the approach is different for bodybuilders compared to powerlifters and other athletes who are looking to maximize muscle strength at a certain weight class, I'll outline the approach you should use since you're trying to maximize strength AND muscle mass, but not the same muscle mass as bodybuilders are looking for, per pound of body weight.
The bulk up and then trim down approach is what most strength athletes (especially those in weight classes where you want to maximize muscle mass and strength per pound of body weight) and bodybuilders use. However, I've had a number of lifters and other athletes go the other way—first they drop weight and get cut (by following the Cutting Phase in my Anabolic Solution for Powerlifters), and then they slowly add the weight back on, while at the same time increasing workout intensity. The new bulk up phase, in which you don't actually bulk up but just gain muscle while keeping body fat levels within a percentage point of what it was at the end of the weight loss/cutting phase.
As far as the training for this approach, you basically follow some of the information I sent you three weeks ago about muscle hypertrophy (I've copied part of that email below so you won't have to go back to find it—see Excerpt from previous email). In the first phase, in which you slowly drop weight and body fat, you're looking to increase both myofibrillar and sarcoplasmic hypertrophy to keep muscle mass. In this stage you're using relatively light weights and doing less overall sets and many more overall reps, expending more energy in the process, with the energy coming from the burning up of body fat. It's been shown in several studies that slower weight loss impacts less on the loss of muscle mass, but I believe if you keep protein levels high you don't need to lose any functional muscle mass or strength—see abstracts below.
The end result is that you'll lose body fat and maintain muscle mass, although strength won't go up since you're not increasing myofibrillar hypertrophy very much (and you definitely won't lose any since you don't lose myofibrillar hypertrophy as quickly as hypertrophy of the rest of the sarcoplasm) compared to hypertrophy of the rest of the sarcoplasm. Not to worry, however, because that muscle strength will increase in spades when you start increasing your weight while at the same time changing your training to using heavier weights, more sets and less reps. In this phase you'll get a dramatic increase in the myofibrillar part of the sarcoplasm, and strength, with a mild to moderate decrease in the rest of the sarcoplasm. That means that your muscle fibers will be lean and mean compared to a bodybuilders muscle, with less size but more strength per pound of body weight.
This method is trickier than the usual bulk up and then cutting, but it can result in more "quality" muscle and strength per pound of body weight, with the same body fat level or even a lower body fat level than if you followed the traditional bulk up and cut down regimen. I used this method over a much longer term when I dropped down to the 132-pound class, getting down to about 4-percent body fat, and then slowly climbing to the 148, 165, 181, and 198-pound class, keeping body fat levels low all the way up to the 181-pound class. Although I even lifted in the 198-pound class, that wasn't part of the experiment as I did a traditional bulk up phase to 212 pounds and then cut back to 195 pounds to compete in that class. Doing it that way wasn't as productive as slowly working my way up after dropping down.
Bodybuilders would actually reverse the two phases as far as training, but not the basic lose weight and body fat first, and then bulk up your muscle while keeping body fat levels low. Bodybuilders are looking to maximize muscle mass but not strength so that for them the end result is maximum sarcoplasmic hypertrophy versus maximum myofibrillar hypertrophy. That means doing what needs to be done to maximize hypertrophy which means working on maximizing the part of the sarcoplasm that contains everything but the muscle myofibers, which can overshadow the hypertrophy secondary to mostly increasing the myofibrillar part of the sarcoplasm. To do that they lose weight in the first phase but use heavier weights, more sets and less reps. In this phase they'll lose weight and muscle size until they get to the body fat level they want. Then in the second phase as they gain weight they do a more typical bodybuilding routine, which results in dramatic increases in muscle size over the time period. Since as I mentioned above, myofibrillar hypertrophy sticks around longer than hypertrophy of the rest of the sarcoplasm, the myofibrillar hypertrophy gained in the first phase sticks around when the dramatic increase of non myofibrillar sarcoplasm expands, resulting in a maximum muscle size, but not maximum strength, per pound of body weight.
The cutting phase should be slow and done over at least eight weeks. The bulking phase also has to be slow and usually best if longer than the cutting phase, so you're looking at ten weeks or more—see the abstracts below for some backing for this. If you want to try this approach, and given this time line, which is not written in stone, mind you, and it may be that down the line you may be able to shorten the process and get the same results, then four months may be too soon. Certainly you could do it in five or six months, and I can help you through it. If you want to see some sample supplement regimens followed by other athletes, have a look at http://www.mauromd.com/det-articles-89-Nutritional-Supplement-Regimens-for-Athletes.php.
The bottom line is by this process of losing weight and body fat first, and then gaining it back again slowly, you're gaining in contractile proteins so that at the weight you want to be a week before competition you actually may have the same level of muscle hypertrophy as you do now, but the hypertrophy will be tilted to an increase in contractile proteins over the rest of the sarcoplasm that makes up muscle cells—you'll actually have more contractile protein, and thus greater strength, even though your body composition may not be all that different the other times you've been a week out from competition, although I would expect that this time out you'll have less fat and more functional muscle.
Another factor in the increase in strength through this process may lie in the androgen receptor. As you lose weight androgen receptors may increase in numbers and binding in order to retain muscle mass. The changes in the androgen receptor may persist when you begin training heavier even though you're increasing weight. This would result in more favorable body composition and increased strength once you're ready for competition.
I'll be working on a comprehensive article on this method, also explaining muscle hypertrophy types, effects on the androgen receptor, and much more. When it's done I'll be posting it on my new master site www.MauroMD.com.
Let me know what you think.
Excerpt from previous email:
First of all, even though there is some controversy on this issue, you can consider the muscle cell as being comprised of two main parts the sarcoplasm (basically all that's inside the muscle cell and bound by the sarcolemma, which is the cell membrane) and the myofibrils contained in the sarcoplasm (see my accompanying drawing showing normal muscle, then muscle with mainly myofibrillar hypertrophy and then muscle with mainly hypertrophy of the rest of the sarcoplasm). The myofibrils are the actin-myosin pairings we're all familiar with and which is the contractile machinery of the muscle cells. Myofibrillar protein is comprised not only of the myosin and actin, but also other proteins including titin, tropomyosin, troponin, protein C, and even some mitochondrial proteins.
The rest of the sarcoplasm is what is needed to keep the muscle cell healthy and make these contractions happen, including myoglobin, the nucleus, golgi apparatus, sarcoplasmic reticulum, intramuscular triacylglycerol droplets, glycogen granules, mitochondrial elements, ATP, and enzymes that drive cell metabolism and located mainly in mitochondria, sarcoplasmic reticulum, and lysosomes (although these enzymes can spill out of these areas). Sarcoplasmic proteins are mostly enzymes participating in cell metabolism. However, if the organelles within the muscle cells are broken, this protein fraction may also contain the metabolic enzymes localized inside the sarcoplasmic reticulum, mitochondria and lysosomes.
For more info on the sarcoplasm, have a look at http://en.wikipedia.org/wiki/Sarcoplasm. Here's is part of what Wikipedia has to say: The Sarcoplasm of a muscle fiber is comparable to the cytoplasm of other cells, but it houses unusually large amounts of glycosomes (granules of stored glycogen) and significant amounts of myoglobin, an oxygen binding protein. The calcium concentration in sarcoplasma is also a special element of the muscular fiber by means of which the contractions takes place and regulates.
Other than the fact that it contains mostly myofibrils, its contents are otherwise comparable to those of the cytoplasm of other cells. It has a Golgi apparatus, near the nucleus, mitochondria just on the inside of the cytoplasmic membrane or sarcolemma, as well as a smooth endoplasmic reticulum organized in an extensive network.
Athletes in weight classes shouldn't be looking for bodybuilding type of muscle hypertrophy, which consists not only of whole sarcoplasm hypertrophy (less myofibrillar hypertrophy than hypertrophy of the rest of the sarcoplasm) but also increased vascularity from the capillary level up, and more intramuscular fat, but rather increased strength without excessive hypertrophy, less vascularity and intramuscular fat, and thus limited weight gain. As such, the weight training part of their training regimen should consist of a basic core strengthening powerlifting type of routine, heavier weights, lower reps, and longer rests between sets. This type of training emphasizes myofibrillar hypertrophy with less hypertrophy of the rest of the sarcoplasm, and increased strength. A bodybuilding routine with lighter weights, more reps per set, and shorter rests between sets, leads to more muscular hypertrophy, and greater weight gain due to increase in the whole sarcoplasm even though myofibrillar growth, and thus strength gains, aren't as great.
When talking about other athletes in weight classes, including MMA athletes such as your friend, it's always been my mantra that for athletes in weight classes, you build strength, but limited hypertrophy in the weight room and skill and endurance doing your sport. And the diet you follow determines how much body fat and thus weight that you drop in a certain period of time. As well, I've always felt that the weight training be done before skill training on the days you weight train, and that the two training sessions be separated by several hours if possible.
By following this kind of training schedule, you can maximize muscle fiber types that are most suitable for the sport. While it's known that individual muscles are a mixture of three types of muscle fibers (type 1, type 2a and type 2b/x), but their proportions vary depending on the action of that muscle, it's my feeling that the type 2 b/x fibers that heavy training increases the most, can enhance their oxidative capacity and thus be as functional for aiding endurance as type 2a fibers, but maintaining their ability for maximal explosive strength above what can be achieved by the type 2a fibers.
While my athletic prowess was mostly as a world class powerlifter for almost two decades, I also wrestled and did gymnastics (specializing in the rings), competing in both at the university level. When I trained ultra heavy with reps that didn't go above three and about eight sets after a few sets of warm-ups I found that I didn't get much muscular hypertrophy, but I got stronger, which is what I needed in both sports—for wresting because of weight classes and the rings because weight mattered when doing the iron cross and other strength routines. That's because at that point my weight training was used to enhance the growth of the muscle fibers rather than the rest of the muscle cell, and thus there was little expansion in muscle size and weight. I carried the experience gained from my dieting and weight training (which consisted of mainly the three lifts and some assistance exercises) into powerlifting, which I concentrated on from the late 1960s on.
ABSTRACTS ON WEIGHT VS. STRENGTH
Int J Sport Nutr Exerc Metab. 2011 Apr;21(2):97-104.
Effect of two different weight-loss rates on body composition and strength and power-related performance in elite athletes.
Garthe I, Raastad T, Refsnes PE, Koivisto A, Sundgot-Borgen J., Norwegian School of Sport Sciences, Oslo, Norway.
ABSTRACT—When weight loss (WL) is necessary, athletes are advised to accomplish it gradually, at a rate of 0.5-1 kg/wk. However, it is possible that losing 0.5 kg/wk is better than 1 kg/wk in terms of preserving lean body mass (LBM) and performance. The aim of this study was to compare changes in body composition, strength, and power during a weekly body-weight (BW) loss of 0.7% slow reduction (SR) vs. 1.4% fast reduction (FR). We hypothesized that the faster WL regimen would result in more detrimental effects on both LBM and strength-related performance. Twenty-four athletes were randomized to SR (n = 13, 24 ± 3 yr, 71.9 ± 12.7 kg) or FR (n = 11, 22 ± 5 yr, 74.8 ± 11.7 kg). They followed energy-restricted diets promoting the predetermined weekly WL. All athletes included 4 resistance-training sessions/wk in their usual training regimen. The mean times spent in intervention for SR and FR were 8.5 ± 2.2 and 5.3 ± 0.9 wk, respectively (p < .001). BW, body composition (DEXA), 1-repetition-maximum (1RM) tests, 40-m sprint, and countermovement jump were measured before and after intervention. Energy intake was reduced by 19% ± 2% and 30% ± 4% in SR and FR, respectively (p = .003). BW and fat mass decreased in both SR and FR by 5.6% ± 0.8% and 5.5% ± 0.7% (0.7% ± 0.8% vs. 1.0% ± 0.4%/wk) and 31% ± 3% and 21 ± 4%, respectively. LBM increased in SR by 2.1% ± 0.4% (p < .001), whereas it was unchanged in FR (-0.2% ± 0.7%), with significant differences between groups (p < .01). In conclusion, data from this study suggest that athletes who want to gain LBM and increase 1RM strength during a WL period combined with strength training should aim for a weekly BW loss of 0.7%.
J Strength Cond Res. 2006 Aug;20(3):643-53.
The effects of protein and amino acid supplementation on performance and training adaptations during ten weeks of resistance training.
Kerksick CM, Rasmussen CJ, Lancaster SL, Magu B, Smith P, Melton C, Greenwood M, Almada AL, Earnest CP, Kreider RB., Center for Exercise, Nutrition and Preventive Health Research, Department of Health, Human Performance and Recreation, Baylor University, Waco, TX 76798, USA.
ABSTRACT—The purpose of this study was to examine the effects of whey protein supplementation on body composition, muscular strength, muscular endurance, and anaerobic capacity during 10 weeks of resistance training. Thirty-six resistance-trained males (31.0 +/- 8.0 years, 179.1 +/- 8.0 cm, 84.0 +/- 12.9 kg, 17.8 +/- 6.6%) followed a 4 days-per-week split body part resistance training program for 10 weeks. Three groups of supplements were randomly assigned, prior to the beginning of the exercise program, in a double-blind manner to all subjects: 48 g per day (g.d(-1)) carbohydrate placebo (P), 40 g.d(-1) of whey protein + 8 g.d(-1) of casein (WC), or 40 g.d(-1) of whey protein + 3 g.d(-1) branched-chain amino acids + 5 g.d(-1) L-glutamine (WBG). At 0, 5, and 10 weeks, subjects were tested for fasting blood samples, body mass, body composition using dual-energy x-ray absorptiometry (DEXA), 1 repetition maximum (1RM) bench and leg press, 80% 1RM maximal repetitions to fatigue for bench press and leg press, and 30-second Wingate anaerobic capacity tests. No changes (p > 0.05) were noted in all groups for energy intake, training volume, blood parameters, and anaerobic capacity. WC experienced the greatest increases in DEXA lean mass (P = 0.0 +/- 0.9; WC = 1.9 +/- 0.6; WBG = -0.1 +/- 0.3 kg, p < 0.05) and DEXA fat-free mass (P = 0.1 +/- 1.0; WC = 1.8 +/- 0.6; WBG = -0.1 +/- 0.2 kg, p < 0.05). Significant increases in 1RM bench press and leg press were observed in all groups after 10 weeks. In this study, the combination of whey and casein protein promoted the greatest increases in fat-free mass after 10 weeks of heavy resistance training. Athletes, coaches, and nutritionists can use these findings to increase fat-free mass and to improve body composition during resistance training.
Med Sci Sports Exerc. 2010 Feb;42(2):326-37.
Increased protein intake reduces lean body mass loss during weight loss in athletes.
Mettler S, Mitchell N, Tipton KD., School of Sport and Exercise Sciences, University of Birmingham, Birmingham, United Kingdom.
ABSTRACT—PURPOSE: To examine the influence of dietary protein on lean body mass loss and performance during short-term hypoenergetic weight loss in athletes. METHODS: In a parallel design, 20 young healthy resistance-trained athletes were examined for energy expenditure for 1 wk and fed a mixed diet (15% protein, 100% energy) in the second week followed by a hypoenergetic diet (60% of the habitual energy intake), containing either 15% (approximately 1.0 g x kg(-1)) protein (control group, n = 10; CP) or 35% (approximately 2.3 g x kg(-1)) protein (high-protein group, n = 10; HP) for 2 wk. Subjects continued their habitual training throughout the study. Total, lean body, and fat mass, performance (squat jump, maximal isometric leg extension, one-repetition maximum (1RM) bench press, muscle endurance bench press, and 30-s Wingate test) and fasting blood samples (glucose, nonesterified fatty acids (NEFA), glycerol, urea, cortisol, free testosterone, free Insulin-like growth factor-1 (IGF-1), and growth hormone), and psychologic measures were examined at the end of each of the 4 wk. RESULTS: Total (-3.0 +/- 0.4 and -1.5 +/- 0.3 kg for the CP and HP, respectively, P = 0.036) and lean body mass loss (-1.6 +/- 0.3 and -0.3 +/- 0.3 kg, P = 0.006) were significantly larger in the CP compared with those in the HP. Fat loss, performance, and most blood parameters were not influenced by the diet. Urea was higher in HP, and NEFA and urea showed a group x time interaction. Fatigue ratings and "worse than normal" scores on the Daily Analysis of Life Demands for Athletes were higher in HP. CONCLUSIONS: These results indicate that approximately 2.3 g x kg(-1) or approximately 35% protein was significantly superior to approximately 1.0 g x kg(-1) or approximately 15% energy protein for maintenance of lean body mass in young healthy athletes during short-term hypoenergetic weight loss.