Making Lifestyle Recommendations Based on Fat Loss, Not Weight Loss with JJ Virgin

JJ Virgin, CNS, BCHN, EP-C, joins Integrative Practitioner Content Specialist, Avery St. Onge, to discuss why building skeletal muscle to increase insulin sensitivity, improve metabolic function, and support fat loss is more effective than the standard approach to weight loss.

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Transcript

Avery St. Onge: Hello everyone and welcome to the integrative practitioner podcast. You're on the go resource where we bring you closer to top industry experts through exclusive interviews with leaders in integrative medicine. I'm Avery St. Onge, content specialist of integrative practitioner, and today we're talking about the problems with the standard approach to weight loss and why practitioners should instead be focusing on fat loss by helping patients build quality muscle that improves their insulin sensitivity and metabolic function.

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For today's episode, I'm joined by triple board-certified nutrition expert JJ Virgin. In addition to founding the mindshare collaborative, a premier community for health and wellness influencers and entrepreneurs, JJ is a TV and media personality public speaker and author of four New York Times bestsellers including the Virgin diet and JJ Virgins Sugar Impact Diet. Welcome, JJ, thank you so much for joining me on the podcast today.

JJ Virgin: I am thrilled to be here. 

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Avery St. Onge: Okay, so can you just give me a brief overview of what you will be discussing at the symposium?

JJ Virgin: I would love to I am talking about my favorite all time subject, I've literally been fascinated with weight loss for 40 years, so much so that over the course of 40 years, I've been unpacking, like what gets in the way of you losing weight, what causes you to gain weight identified all these different factors. And I had an epiphany a couple of years ago that actually, you know, I always like to go back to the basics and go ask the question, well, what if this was, what if this was easy? And what I realized back then is we've actually been looking at this all wrong. And that the reality is we need to stop focusing on losing weight, that that is actually creating the problem. And obviously, something's not working. If we now have over 70% of the population that's overweight, or obese, and over 40% of population that's obese, and those numbers are just, you know, exponentially increasing. So if we have more knowledge than ever, and things are not going in the right direction, what's going on? And could it be that it's because we've actually been looking at the long wrong metrics all the way along? So that's what I'm going to be talking about, and what should we be looking at? And then what should what to actionable from that?

Avery St. Onge: Okay, my next question is actually three questions, really. So can you tell me what has been the standard approach to weight loss? How did we get here? And where did we go wrong. 

JJ Virgin: So standard approach to weight loss is to weigh someone in look at their weight, but not what the weights made up of. So that's, that's a big problem number one, looking at the weight but not what the weights made up of, and then doing what we need to do to lower that weight. Now, here's the challenge with that, if I wanted someone to lose weight, and this actually happened, I was on the Dr. Phil show for two years working on his weight loss challenges. And this actually happened during the show, it's one of the ways that a group of them won one of the competitions we had two groups and at the end of the month, whichever group collectively lost the most weight was going to get to go to Canyon Ranch. Right so the one group what they did the day before was they did what you would do if you were gonna go say into a you know, lower your weightlifting your boxing class to be able to go in and box at a lower weight. The day before, they didn't eat, they didn't drink. They did slow, steady exercise all day long and then they put themselves into their rooms puts put in their bathrooms they put towels under the doors, they cranked up the showers to full heat and they sweated. And that group collectively won by a half a pound total overall. And yeah, but but they won the contest, they totally did exactly what we were asking lose the most weight? Well, how could you lose the most weight? Well look at how much her body weight what two thirds or body weight is made up of water, just dehydrate yourself or lose more muscle. Alright, so, which is not what we want to do. That's, that means that you could lose the weight but actually make yourself worse, not better. Right? So that's the first part is oh, you know, how do we get so wrong? Well, way back when, you know, we weren't able to look at the two different compartments, what what's fat mass, what's fat free mass, and ultimately, pulling out fat free mass and go what skeletal muscle mass. And so we've just been basing all of our recommendations, eat less, exercise more on looking at how we can lose the most weight. And that, ultimately, is where we've gotten ourselves into trouble. Because if you flipped that you said, You know what, instead of trying to lose weight, I want to improve what that weights made up of? You know, it'd be like, I just want to lower cholesterol. Well, do you really want to lower cholesterol? Or do you want to change? What's going on with that cholesterol so that you don't have those small dense little particles going in there? And you've got more of the big fluffy? It's the same with weight? Do you really want to lose weight? Or do you want to hold on to rebuild skeletal muscle that changes everything in your health, while you're dropping fat and really focusing specifically on fat that's visceral adipose tissue. So so that's the shift, and I equate it to, to what we used to look at with total cholesterol because it's, it's so similar. Whereas nowadays, we never look at total cholesterol as the metric we unpack that. And then look at other risk factors alongside it needs to be the same here.

Avery St. Onge: So what do you propose should be the metrics instead of just simply weight?

JJ Virgin: Yes. So here's what I would happen. And it's still happening because I had to go have a surgery recently. And boy, they went in and they checked my weight. And I'm like, What are you looking at this for? Right? You know, what, what are you trying to find from this number? It's just because it's standard of care. What if we could go in and every doctor, you know, ideally, you would be getting an a DEXA scan twice a year, because that's going to be the best indicator. But at least at the doctor using some kind of a higher quality, bioimpedance scale, that segmental that can look at not just your body fat, but where that body fat is located. And then not just fat free mass, but go deeper into looking at skeletal muscle mass, because ideally, what we're really trying to do is we've got the body segmented into two parts really fat, and fat, free mass, everything else. But then you have to unpack it further and go, Okay, body fat. While we might not like having body fat on our hips and thighs, that is not the body fat, that's problematic. It's the problematic, it's the visceral adipose tissue that's problematic. And so we'd want to unpack those. And then we'd also want to look at, at both fat free mass, but really, what can What's the thing that's changing in fat free mass, you know, originally DEXA scans were used for to look at bone health, but the challenge is you're looking at bone mineral density on a DEXA scan. It's a lagging indicator. Just like when we use a CGM to look at blood sugar. It's a lagging indicator of insulin resistance. So if we fix insulin sensitivity, likely we fix blood sugar, if we fix our muscle mass, we fix bone density. So what we really need to be looking at is skeletal muscle and visceral adipose tissue. And then the other thing that we can do there like Simplot home things is someone can do as simple as a waist to height measurement. Because one of the big indicators, you know, we say if you're losing weight, but not losing your waist, you're making yourself worse, not better, we can easily get skinny arms and legs and hold on to our belly fat or visceral adipose tissue. And it's problematic. So if we're looking at blood sugar and insulin sensitivity, if we're looking at that waist measurement, if we can look at fat mass and fat free mass, and specifically within that VAT, fat and skeletal muscle, and then we can also look at, hey, what's your how strong are you? Like, I think another thing I'd love to see in a medical offices is using a hand grip dynamometer they're like 20 bucks, and seeing how you correlate to everyone else in your age because we know that poor grip strength is associated with higher IQ all cause mortality, mortality because it's a great indicator of overall body strength. 

Avery St. Onge: And according to those measurements, how do you then personalize a nutrition plan, especially in comparison to a nutrition plan, which is usually just, you know, less calories more exercise in terms of when when you're measuring just weight. 

JJ Virgin: And you know, diet and exercise are interesting because like, diet could be keto, it could be intermittent fasting, it could be vegetarian, you know, it's got all these different things in similarly exercise could be, you know, you're just doing cardio, maybe you're just going walking, right, so we've really got to unpack within both of those and go, Okay, these, like I look at exercise is a drug, right, so give the right dosage of the right thing. And diatas tools use the right one for what you're trying to achieve. There are some specific things in diet, though that are fairly universal. And one of the things that we know as you age is starting probably around the age of 30. Is is in a lot of it's because of hormone shift, we start to be reliant on the ability to trigger mTOR to build muscle and hold on to muscle. And that is, is triggered by two things. One is triggered by an amino acid, leucine being at a high enough level 2.5 to three grams, from dietary protein. And two, it's triggered by resistance training. And we need both of those things. But we've got to have the dietary protein, the essential amino acids and the leucine specifically, in order to build muscle. So the first thing that I would say is, as we age, we don't need less protein, we need more, the RDA is probably half of where it really should be the protein researchers out there, and I'll cite Dr. Stu Phillips out of Canada, because I think his work is so great. Here I've translated over to pounds, because we're not in kilograms in the States. But basically, point seven to one gram per pound of target body weight is probably where we should be. And we are consuming about half that is the RDA. But then you look at the average female as they age, and they're eating somewhere from in the 40 to 65 grams of protein overall, and generally eating the majority of their protein in the evening. Which means if you need that two and a half to three grams of Leucine from dietary protein to trigger mTOR, to build muscle to go through muscle protein synthesis, and you probably aren't getting that much until maybe your evening meal, you're in muscle protein breakdown all day long, you're catabolic, which is going to lead to this sarcopenia or frailty, that is really the epidemic. You know, we talk about osteoporosis, but that's secondary to having poor muscle mass and poor muscle quality. So that's now I don't remember the question I just went off on that rant about was how do you create personalized nutrition? So here's the reality, we've got three macronutrients. Two are essential one is not we have to have protein, we have to have fat, we can live without carbohydrates, but I think we're better off with them, especially for the fiber. So when you look at those you have protein which is could be used for fuel, but really should be your building. It's it's your repair, recovery, building macronutrients and then you have your energy macronutrients protein, fat and carbs. So you first start and I like to say eat protein. First, you're going to build your diet around having optimal protein at your two to three to four meals a day. And then you are going to fill in the rest with healthy fats. And carbs really is you can bring you can shift those the diet you want to avoid as a low protein, high carb high fat diet, it's an obesogenic formula. But once you've got your protein at each meal optimized, then you can play around with do I feel better, higher carb lower fat? Or do I feel better, higher fat, lower carb, you can obviously do higher carb higher fat with optimal protein because the metrics don't work, right. But you can play around with it. I like to build it and going let's get the essentials in first build around protein, eat it first. Add in non starchy vegetables. I always used to joke that you could put a bunch of nutritionists and doctors in the room and the one thing they'd agree on is vegetables. Now certain vegetables are villainized too. And I'm like the poor consumer must be going What the heck do I eat? Should I just live on like, you know, protein shakes? Like what do I do here?

I really love the whole idea. And I think Deanna Minix work on this has been amazing of have and same with Dr. Kara Fitzgerald. So Dr. Deanna minich, Dr. Kara Fitzgerald are the two people I'm leaning into here to look at plants and the poly phenols and gut microbiome and how important they are that with a little bit of fruit, probably two servings, getting some great healthy fats because you're eating high quality protein from animals because you are what you eat, ate, and then you can build the rest. You know, basically on preference on what makes you feel the best. So that's how I would build it. And I'm a big believer of using a tracking app to start first to start as an audit. Because the research is pretty darn clear that we overestimate what we are underestimate, rather, what we eat by somewhere between 25 and 40%. So you know, and I found this myself, I was like, you know, olive oil is good, and all of a sudden, you're like, Oh, that was a lot of olive oil, you know, and, hey, too much healthy foods, not healthy, you're gonna go into a calorie excess. And if you are trying to lose body fat, that won't happen in a calorie excess, even if it's calorie excess, from, you know, like, avocado, right, or blueberries, it's still gotta go somewhere, and likely, it's going to be stored as fat. So I believe I'm a big believer in doing this, using a tracking app for the first month, the research is really clear that people who do that have more success. And it's just like all these great tools that we can use now for tracking, it's just a great way to, to know where you're at. And if you're really, if you're really doing these things. And, you know, I think back to all the years of working in weight loss, where we didn't have access to tracking apps like we do now. And I just wonder how many of those people that felt like they were weight loss resistant, actually just weren't dialing in their nutrient levels the way they should.

Avery St. Onge: It's interesting that you're talking about protein, because I feel like the narrative especially recently, has been like, actually, Americans get plenty of protein. But you're saying that, that estimate of how much the average amount of protein or like, the minimum amount of protein that is recommended is actually way lower than it should be? 

JJ Virgin: So it's interesting looking at that, I think part of the problem is the RDA is wrong. Or already, I don't know if it's Ira anymore, it's what we have is the recommended daily intake, each is really the minimal, it's the minimum will to avoid disease. So if you're looking at it going, Oh, we're getting more than that. The reality is for women, they're actually not the average woman. But the, you know, the recommendations are wrong. So that's the bigger challenge. And again, it can all go back to that anabolic resistance. And you know, we eat protein for the essential aminos. And when we look at muscle, and being able to go through muscle protein synthesis, the trigger is from one specific amino acid. This is the work of Dr. Donald layman, who discovered that it was somewhere two and a half to three grams of Leucine were needed to trigger muscle protein synthesis, because it triggered mTOR. And this is something that you want to be able to turn on and turn off. You know, you want to be able to throughout the day, we're going through muscle protein turnover, just like we're going through bone turnover, you know, our body is breaking down and building up breaking down and building up. And we've got to be able to do that if we're breaking down more than we're building up. We are now setting ourselves up for sarcopenia for frailty, which I think is the biggest risk factor like little silent risk factor we have going on out here is this, you know this, what we're calling now normal weight, obesity, this skinny fat, which is really just being having low muscle mass. And if you're not able to measure it, how would you know? And the story I'll give you that's so interesting is you know, last year I I went and took my husband, we went and got DEXA scans, and I've done one at 39. Now I was doing one again at 59. And I have a segmental bioimpedance scale at home as well. Those are not as accurate as going and getting a DEXA. Well, my husband looks great, he works out he eats healthy. However, he was 25% body fat, which is high for a male. And men only have like three to 5% of central fat he should have been as apt for what he was doing, how athletic he was. And for his health. I would like to have seen him at 12 to 18%. And we were both kind of shocked about it. He was a skinny fat, which we've now improved. He's gone from 25% down to 11% over a year and a half it's been you know, a dream but he without that information, we wouldn't have known and lowered all of his cardiovascular risk factors which is pretty interesting because the research is pretty clear when you go and start he he was a little bit phoning it in at the gym. He wasn't quite as like I'd always look at him at the gym going are you just at the gym doing your email? What are you doing? But I was like keeping my mouth shut because it's like it's his gym time. But this got him fired up because you know now we had the information and I gave him a program to do that was very actionable. And he saw the shifts. But one of the cool shifts Besides increasing is like, he literally looks better than he's ever looked at his life at 58 years old. And but the other thing was, you know, he'd family history of heart disease, and he'd always had some concerning cardiovascular markers that are all improved. And now he's in the, you know, optimal ranges. So, you know, if we're not looking, we wouldn't know. And, you know, while while you might say, Oh, I just, you know, I look like I need to maybe lose a little weight. I've had client after client that it wasn't that they needed to lose any weight, they needed to put on muscle and lose fat. And I always like to focus on putting on the muscle first. And one of the cool things is, is if all you did was dietarily shift, increase your protein, likely for most people, that means doubling it, and we kept everything else constant to start, that alone would help them start to lose body fat, because of the thermic effect of the protein beside it being besides being so satiating, but also because it's going to help them now build muscle mass or increase lean mass, they combine that then an add in resistance training, and now sudden they've got, you know, more metabolically, higher quality, muscle, slow, more metabolically active, it's helping them become more insulin sensitive, they'll start to also lose body fat, and it's just this beautiful shift that's doesn't like if someone's been trying to lose weight forever, they feel like they're battling it, you know, they step on the scale, they should, it should have gone down, it went up, this is a way bigger way to to give them some control, and help them start to track progress. Because they feel better, they feel stronger, they have better energy. Right?

Avery St. Onge: Right. This all makes so much sense. I am just thinking about like, especially for people in maybe their their mid life, women are so much under the assumption that it's a low fat, low calorie diet is the way to go. So how do you walk patients through this? You know, how do you convince them that it's not about, you know, eating less and running five miles a day or whatever? Like, how do you actually make that shift and make them commit to it? 

JJ Virgin: Yeah, and I think the most interesting thing, especially with women, I'm glad you brought up women, is women for so long, have tried to make themselves smaller and weigh less, right. And they have lived on lower carb, lower fat, higher carb, or they'll try the Keto thing quite often, that's not working well for them, because they've got adrenal stuff going on as well, that creates its own host of problems. So there's that. But the reality is, they know that it's not working. And so if all you did, I always like to do one thing at a time. And especially one thing that gives you a quick win, right? And what I know about this is for a quick win, is that one of the things that you start to see quickly, when someone is shifting protein is that literally they'll notice that they're not hungry. If you're hungry, and you're on it, which most people go okay, I'm gonna go on a diet, what's the first thing you expect to be hungry? unsatisfied? 

Turns out there is a hypothesis. It's called a hypothesis now, but it's been proven enough by these two locus scientists out of Australia called the protein leverage hypothesis turns out that if you're eating a low protein, higher carbohydrate fat diet, you will actually overeat in an effort to get the essential amino acids that you need. Part of the reason we may be hungry on a on a diet. But if all we did to start with shift, the amount of calories you're eating, shift some of those calories away from either carbs or fat and over to protein. Just that alone, keeping calories the same if you were in a maintenance stage before will trigger some weight loss because of the thermic effect of protein. It requires 25% of that calories roughly, to go through the digestion assimilation metabolism process contrasted with almost 0% from fat and maybe 5% from carbs. So you get you get a quick win. And you're not hungry. No one wants, you know, you look at in someone could eat a big pasta dinner, and then all of a sudden someone comes by with dessert and they're like, sure. Let's contrast that with if you were sitting down, you ate a big steak, and then they rolled through and said, Hey, you want some wild salmon? Here's a big piece of that. And you'd be like, Oh, no, I'm full. Like, you know, you just wouldn't do it. So you're full. You're feeling better. You're not feeling bloated, you eat a bunch of carbs, you feel bloated, you eat some protein, you just feel full and satiated for hours. So you start to do that. Then you start to add in I see the bigger fear with women is generally around weight training, resistance training, and it's still this fear that I'm going to get bulky and that muscle is like metabolic spanks that holds everything and tighter. And it's it's a small effect, but it's a small effect that accumulates over time as to how much it's going to support a better metabolism, you know, because muscle is very metabolically active that muscle protein turnover. And adding, adding a pound of muscle could impact your metabolism anywhere from 10 to 30 calories a day. But you know, you add 1010 pounds of muscle over a year that's significant. And so and it's a it's a metabolic sponge as well, like I always call it the sugar sponge, because when you're eating carbohydrates, if you've been active and you've got quality muscle, those carbohydrates will go back and get stored as glycogen in the muscle. So you have them there for your next exercise if you've depleted them.

So when you look at it, muscle is the one I have more challenge convincing someone to do, because they're afraid they're gonna get bulky. But the reality is, you know, gosh, I spent a couple decades working with women in resistance training. And I always say I've never once seen a woman get bigger lifting weights, because again, the metabolic Spanx of holding everything and tighter. And I had one woman Vicki who came to me and she wanted to lose 10 pounds. But her BMI at the time was like 21, she didn't need to lose weight whatsoever. She needed to change what that weight was made up of. I think she was like 25% body fat. We got her to 18% over a year, she dropped 10 pounds of fat, she put on 10 pounds of muscle, she dropped to clothing sizes couple inches off of her way, she looked like an entirely different person. And at the end of the year, like I'm thinking she must be jumping up and down. Like she's going to be like JJ, you're my hero, this is the greatest thing ever. And she she's disappointed because she didn't lose 10 pounds. I know. So it is a mindset. That's why I say we've got to stop looking at weight.

Just as one component, we need to get people into use to using a biome pain scale at home, looking at the relative change over time getting really clear on on on identifying total body water as this metric we're improving because muscles are going to have more water. And I'm even one of the big recommendations I make alongside protein is creatine. And women are afraid to take that because they're like, I'm going to gain weight, I'm going to sit and I say you're going to have more water in your muscles, you're going to hold more fluid in your muscles, which is excellent, because you're going to be able to work out harder, you're going to have some better phosphocreatine impact when you work out first little bit. And they're just so scared about that. I don't know what's gonna, you know. So it this That, to me is the bridge we have to cross. That's the biggest challenge that I that I have. And I every single day it comes up on social media, and I'm just like, Wow, holy smokes, right.

Avery St. Onge: I know that that makes a lot of sense too. Because with weight, there's so much shame attached to that, that I feel like if someone gets on the scale and sees that number, you know, first of all, they don't know exactly what to do. But there's also so much shame that they're kind of stuck in frozen, but with it broken down. It's just so nice to see like 25% body fat. Okay, I know what to work on. Exactly, right. And then you say, well, well, the scale weight didn't actually change but holy smokes, I dropped 3% body fat and put on some skeletal muscle, I'm going in the right direction. The scale doesn't tell you if you're going in the right direction. The bioimpedance side of it will and you have to take the trends because again, it's based on total body water with one day you're dehydrated. Like I knew those Dr. Phil challengers had done what they've done, because I actually had a segmental bioimpedance scale that I was using on the show I brought to the show, they didn't ever talk about body fat because they wanted the drama of the weight. But I saw on the scale, because when you deplete your total body water, it looks like your body fat went up, right? Because the more water you have, the more muscle you have. And the less water you have, the more the more resistance you have to that bioimpedance wave and the higher they'll predict your body fat, so I knew what they'd done. I can see it, but I couldn't report on it because that's not good for TV.

I really want to get out of this shame around a scale. And if we instead start to look at what the scales may be, you know, what is this made up of? And like, okay, what are the actual things we need to do? It's very different, right? It's a very different conversation than this ridiculous, just scale thing that somehow has gotten to be like a mean, you know your mean evil twin that shames you when you get on it?

Avery St. Onge: Definitely. Well, those are really all the questions that I have for you. I won't make you you know, discuss your entire presentation. But before I let you go, do you have anything else that you'd like to add?

JJ Virgin: Yeah, I'm very excited to present this. Because it's funny, as I was putting this together, I thought this, I'm thrilled that you guys are so innovative, that you're willing to look at this and go, Alright, maybe what's currently being prescribed is not is not right. And my whole goal is that exercise actually, I was for years, I started as an exercise physiologist, and, and then I always felt like exercise was just a sign a redheaded stepchild over there. And you know, not that exciting, I feel like exercise is really now coming to the forefront because you can't talk about muscle without talking about exercise. So my goal with listening with with talking about this is that we can easily start to look at exercises, as you know, first line therapy and people will understand how to actually prescribe it because I think that's part of the challenge is exercise could mean going for a walk to some people doing a yoga class, or doing powerlifting. So how do you know what to recommend? And then how do you know what to recommend that's going to be effective and safe. So I'm excited that I get to do this and that you guys are on board with it. So thank you. No, definitely, of course. Well, thank you again, JJ, for joining me and I look forward to your presentation. Thank you.

Avery St. Onge: Thanks for listening. We'd like to thank Scott Holmes and Kevin MacLeod for providing us with our theme song. Be sure to visit our website integrative practitioner.com or send us an email at IPE [email protected]. Remember to like and subscribe to our show. We'll see you next time.

Editor's note: Transcripts are autogenerated.