Barbell Shrugged - [DEXA Scans] How to Test, Analyze, and Optimize Body Composition w/ Alan Kenny, Anders Varner, Doug Larson, and Travis Mash #736

Episode Date: February 28, 2024

Alan Kenny is a performance nutritionist with over 10 years experience supporting teams, athletes and executives to optimize their health. Holding a degree in Exercise Science and a Masters in Sports Nutrition, Alan has also lectured at University level in Ireland and currently heads a performance lab in an executive medical clinic in Vancouver, Canada. His work here is focused on optimizing health over a person’s lifespan using modern tools such as blood-work analysis, VO2 and DEXA scans. He also runs his own virtual nutrition consultancy and acts as a nutrition consultant for the University of British Columbia Sports Medicine Clinic, where he sees people to assess their dietary habits and body composition/bone density through DEXA and nutrition consultations. Alan has also previously worked as Head of Science & Education EMEA at Glanbia Performance Nutrition, the parent company of industry leaders in the Sports Nutrition Supplementation category such as Optimum Nutrition and BSN. When not working, he can be found playing soccer, doing BJJ or exploring the great outdoors that Vancouver offers with his wife and two young daughters.   Work With Allen Kenny Website: www.alankennynutrition.com Instagram - @akennynutrition Linkedin Anders Varner on Instagram Doug Larson on Instagram Coach Travis Mash on Instagram Alan Kenny - Preventum: Personalized Health Care | LinkedIn

Shrug family, this week on Barbell Shrugged, Alan Kinney is coming into the show. We're going to be talking about DEXA scans, body composition, nutrition. What's super cool is we make all of our clients, but I didn't say we make them. All of our clients want to get a DEXA scan. It's the most comprehensive way to understand body composition, body fat percentage, muscle mass, bone mineral density, any imbalances that you're going to have that we need to be able to get into and fix through training, visceral fat, kind of the organ fat that everybody's really terrified of that you can't really see in the mirror. But I have never taken a deep dive into how to analyze those reports, what's important, what's not.

And Alan is going to be here today, walking us through why DEXs are so important, what you can gain from them, the information that you need to understand in seeing your report and really why they're so useful and why we make all of our clients get them, even though we've never done a super comprehensive deep dive into that specific thing. So super fired up to have him here as well as like every week, you can head over to rapidhealthreport.com. That's where Dan Garner and Dr. Andy Galpin are doing a free lab lifestyle and performance analysis that everybody inside Rapid Health Optimization will receive. You can access that free report over at rapidhealthreport.com. Friends, let's get into the show.

Welcome to Barbell Shrug. I'm Andrew Garner, Doug Larson, Alan Kenney. Today on Barbell Shrug, we're going to be digging into DEXA scans, which is awesome because we've never actually done a show on DEXA scans, even though every single one of our clients takes one. And Alan, you were saying pre-show here that you do over a thousand of these a year. What is the background that has led to analyzing a thousand DEXA scans a year? That's a lot. Yeah. I mean, between the couple of clinics I work at, I'm head of performance in a medical clinic in Vancouver in Canada, and I'm a sports nutrition consultant in a sports medicine clinic

at the University of British Columbia. And yeah, as a baseline measure for all of the patients we see, some people will do more than one a year, but DEXA would form a large part of, I guess, our body composition assessment and metabolic profile. So I've probably seen the good, the bad and the ugly in terms of what happens with DEXAs. My background is in nutrition. I've done maybe like the equivalent of a kinesiology, undergrad degrees of exercise science, and then a master's in sports nutrition. So really day to day, I'm working with clients to assess their um basically assess their dietary habits assess their body body composition look at their blood work look at their like

stress test vo2 all that sort of stuff and just build a profile on someone as a start point and then kind of just go from there and really i see yeah i see dexa being misused I think and a lot of um the things I see online oh we can I totally want to dig into that point about the misuse of it but before we get there let's cycle all the way back out like what are DEXA scans what are they used for like what's what's the the intent and then I definitely want to hear how they're misused yeah so essentially for anyone that's unfamiliar DEXA is a form of x-ray. It's a very, very mild, low dose of radiation. And so way less radiation than someone would be exposed if they had a typical mammogram or chest x-ray. Typically, I tell people it's less than if you flew coast to coast in North America.

So we're exposed to more radiation on a flight like that. And really what it does is it measures, I guess, three tissues in the body very effectively. It measures fat mass, it measures bone, so bone mineral density, and then fat-free mass or lean mass, which is kind of everything else. So from a body composition standpoint, it's the most accurate way to measure body composition. So it'll give you a very accurate body fat percentage, total lean mass, things like that. But bone density as well as another type of scan that usually happens on the same scanner. And that's a measure of really a marker indicator for osteopenia, which is bone thinning leading all the way to like osteoporosis. And really, that's where a lot of the value i find index that is because it's

what happens then is it's it's taking it from being like a fitness assessment to really like a health assessment and i feel like then i can comfortably prescribe maybe exercise the things that we would do anyways but it has a bit more meaning when it's coming from a more of like a clinical assessment essentially yeah so in your setting primarily you're doing it for bone density reasons as opposed to body composition reasons. I'm primarily doing it for body composition. Now it does give a read for bone density, but you cannot use it as a diagnostic tool unless you do a specific scan of the spine and the hips. Now we can run that scan as well, but typically the average person who comes in as a first introduction to DEXA will use it as a body composition assessment. And that will measure

lean mass and muscle and fat distribution. We do offer like bone density scanning too. I guess the reason for the split in that is typically bone density scanning is usually like an insurable health marker that runs through like a hospital setting because that's the pathway. Now you can do it privately and you just kind of bring that data to your doctor and kind of, you have to be proactive with it on that side, or you can wait until you're like 65 when it's recommended. And usually it's too late, like a lot of other health things. So. Yeah. Um, one of the, one of the readings that, uh, is very hard to get in any other, um, kind of like body fat testing machine is visceral fat. Um, which is in my

opinion, kind of like one of the largest indicators of like health. Um, I'd love if you could dig into kind of like, um, visceral fat, um, where things go wrong, what are healthy numbers when people are kind of analyzing their report, etc? Yeah, so visceral fat essentially is the intra abdominal fat. And really, it's an indirect measure because it's it's it's read off what's what's left in that abdominal cavity. And so it's an indicator for a lot of metabolic disease, higher risk for cardiovascular disease, type 2 diabetes, et cetera. Typically, I want people to have less than 500 gram of total visceral fat or less than a pound is another one.

And you can go by surface area either. But there's risk categories that are stratified based on those numbers. Honestly, I've seen people as high as 3,800. I've never seen anyone over 4,000 because I think the machine has an issue reading it. We don't know why visceral fat deposits. We don't have a great answer to why exactly it deposits compared to other fat or how can we target visceral fat. we know anecdotally speaking that like sugar intake and alcohol intake high alcohol intakes are typically associated with higher visceral fat and it just comes out of the body the same way we would use our loose body fat essentially and and really

it's another indicator for like that typical skinny fat person where i've seen people that maybe have a healthy bMI to the naked eye, look relatively healthy, but then have this like super high visceral fat. And typically it's a lifestyle, poor lifestyle habits that have kind of led to that visceral fat depositing there. Again, I can't, unless we have ultrasound that we can use to confirm, but very highly correlated with things like fatty liver, if you've got elevated visceral fat as well. So I find that to be, like you said, just that key number that really drives into people's brain where it's like, holy crap, my visceral fat is X. Okay, I'm like, okay, I'm going to do something

about this. And like a body fat number, we can always say, well, bioelectrical impedance, maybe not that accurate, or maybe it was a bad day, a bad week, where it's kind of like when you do the DEXAT, you've got this objective data point that's very much defined on that date. And you can't lie to it. And you can't really lie. It almost removes the need to have this entire consultation where it's like, it's kind of like, it is what it is. And then if we do another one in six months, what we've done in those six months is captured here. So it's just kind of like it really brushes away a lot of the kind of stuff that we tell ourselves. And it just is what it is. Yeah.

When you look at the report, I'd love to know kind of like what your eyeballs, kind of the checklist that you go through. It's obviously got tons of data on there. But what are the things that you kind of find the most valuable in the order that you're analyzing things? Yeah. So I think the primary one that people want to know and want to come see me for is really like body composition, total fat mass, body fat percentage. Now I'm more probably fixated on total fat mass because that's like a very direct measure. And that's a number that can come up and down because you can have a low body fat percentage, but not be optimized. Like people that are super skinny and they don't have much muscle kind of low body fat, but they're not optimized in terms of how you would maybe want

to look or perform. So total fat mass is one. And really then from that, it will calculate someone's resting metabolic rate. Now it's an indirect calculation because it's based off lean mass, but it's a pretty accurate number. From that, then I can calculate based on someone's activity, their calorie number for a specific body composition goal, like gaining weight, losing weight or maintenance, whatever it may be. then i'm looking at total lean mass just to see where someone is at with that number if someone's got a high level of muscle mass that they carry because you have got people that maybe are overweight but they've got good lean mass so in that sense when we reduce body weight i'm kind of happy to trade off some muscle mass and I'm not too concerned. And

I just, they've got muscle that they can afford to give up in the pursuit of fat loss. Say the other number, I guess that is tied into that as relative skeletal muscle index. And that's, I think, I believe it's called like appendicular lean mass in the States. And, and really what that looks as is muscle distribution, how much muscle has a person got kind of in their arms and legs compared to the rest of their body and compared to their height. And that that's a measure that's used to indicate basically if someone has sarcopenia, for example. So if someone is low on that, they can have sarcopenia, which is usually age induced muscle loss, but we see it in younger people too. So if somebody like I see sarcopenic obesity as well,

where someone has like high body fat, low muscle, and then you're like, where do we begin? But it tells me then like, maybe if I want to, if someone wants to modify their body, if you want to go up or down, relative skeletal muscle index and lean mass will kind of indicate where I'm best starting that intervention. If we want to go down a weight first, if we've got wiggle room there, or if we want to go up. The other one then is bone mineral density. And that's just a measure of bone density compared to typically a T-score is compared to like a healthy 30-year-old. And that's a measure for osteopenia, osteoporosis. Again, to diagnostically confirm osteoporosis, you do need to do the hip and spine one but if someone is low bone density you can kind of get a global measure and then

you can inform like vitamin d and calcium and strength training and things like that because i do see a lot of people with low muscle mass low muscle mass low bone density and then again exercise and strength training in particular is really the prescription. So then I feel like a lot of times if we don't have access to that information, it's hard to make exercise and strength training be very prescriptive. Most people know they should do it. But if you're telling someone like, look, you've got low muscle, you've got low bone, your likelihood of having a fracture later in life, which will probably twofold increase your chances of dying in the next 12 months after that are high. If you want to walk upstairs, put on your socks, put on your shoes when you're older, really you need muscle mass and strength.

Shark family, I want to take a quick break. If you are enjoying today's conversation, I want to invite you to come over to rapidhealthreport.com. When you get to rapidhealthreport.com, you will get to rapidealthreport.com, you will see an area for you to opt in in which you can see Dan Garner read through my lab work. Now, you know that we've been working at Rapid Health Optimization on programs for optimizing health.

Now, what does that actually mean? It means in three parts, we're going to be doing a ton of deep dive into your labs. That means the inside out approach. So we're not going to be guessing your macros. We're not going to be guessing the total calories that you need. We're actually going to be doing all the work to uncover everything that you have going on inside you. Nutrition, supplementation, sleep. Then we're going to go through and analyze your lifestyle. Dr. Andy Galpin is going to build out a lifestyle protocol based on the severity of your concerns. And then we're going to also build out all the programs that go into that based on the

most severe things first. This truly is a world-class program. And we invite you to see step one of this process by going over to rapidhealthreport.com. You can see Dan reading my labs, the nutrition and supplementation that he has recommended that has radically shifted the way that I sleep, the energy that I have during the day, my total testosterone level, and my ability to trust and have confidence in my health going forward. I really, really hope that you're able to go over to rapidehealthreport.com, watch the video of my labs, and see what is possible. And if it is something that you are interested in, please schedule a call with me on that page. Once again, it's rapidealthreport.com and let's get back to the show. Yeah. Wait, so where do you typically start with people that have high body fat percentages and low muscle mass? Do you guys have a standard for that?

It depends on the person and their training age essentially now if if all things were equal and someone needed to gain muscle and lose body fat and it wasn't like a major like crisis levels i would typically want them to cut first and lose body fat first because for me the habits you learn to lose body fat are will last longer even when it comes to gaining weight. Whereas if you tell someone to gain weight, you can get away with a lot of crap and you can eat poorly and you can kind of still see results. Whereas I think if you learn the good habits that are involved in terms of maybe doing a short period of tracking your calories and modifying your macros and monitoring your weight and stuff, then that kind of stands to you when it comes to adding muscle as well.

Now, if it's someone that's like super low muscle mass, super low bone density, I'd probably have them strength train and add weight first because the added muscle mass will help the metabolic rate down the road in terms of like, because I've seen someone last week with a resting metabolic rate of 900 calories.

Land like, Joe, you both carry a lot of muscle mass, your resting metabolic rate might be like 16 1700 calories or more so it's like that person then to it's very easy for that person to gain weight because their calorie burn is so low um and i think there's a lot of talk out there about metabolism and all these different things but like your metabolic rate is primarily determined by how much lean mass you have that's the biggest thing you know um so yeah it depends on a person's training age and it depends on how bad the numbers are but if it's not too bad i'd go down first and if it's really bad i'd go up first

regarding the report that ancient men anders mentioned earlier like what all is on that report it's it's radically more than if you did biological impedance or some other body fat um body composition testing modality like you get your 12 body fat and that's the only number you have it's not broken out by body part or visceral fat versus uh intermuscular fat or a subcutaneous fat rather like what all is on that report yeah so i think the first thing that people see visually is you see an image of your body and it really puts pay to the whole like oh big boned people like when you look at a thousand dex's everyone has more or less the same size

bones that are then length and and fat is very much visually showed as like a yellow on on a on the screen so people get this really visceral reading of their body fat, and it's a kind of shocking. And it does give an indicator for bones as well. But again, we don't diagnostically do but you can see like scoliosis and some various things like that. Or sometimes people see leg length. In terms of the actual numbers and data you get, you will get total body weight, obviously body fat percentage, percentile, bone mineral density, you will get a resting metabolic rate, you will also get things like an android gynoid ratio, which is like, basically waist to hip region in terms of where you're

storing your body fat, you will also get a breakdown of each limb in terms of how much muscle mass and how much how much lean mass and how much fat mass is on each limb you also get a breakdown in terms of like left to right uh left to right arm left to right trunk left to right leg and i have seen cases where there's maybe rotational athletes or people that have had previous injuries and that have immobilized the legs and they've atrophied a lot of muscle mass in that leg. And then you can talk to people then about single leg strength training and doing different things like that. And, and then as you move down the report, and you're also going to get that

relative skeletal muscle index, which is really like muscular distribution. And, and really, if I if if I've never met someone, if I have that number and that number is maybe closer to a 10 kilogram square or kilogram per meter squared for me, if it's male, I know that that person like strength trends and kind of has got a decent frame closer to a seven for females. But if it's low, like I said, it's kind of sarcopenic. They're the major kind of numbers or data points that we get from it. Yeah. You mentioned earlier kind of taking calcium and vitamin D. How do you, how do you, obviously those ones related specifically to bone, bone mineral density. Are there other supplements that you, you kind of draw a conclusion from, from looking at the report? And I guess this kind of parlays with something to what you mentioned

before that caught my attention before the show, mentioning that you feel like you can many times get more information out of a DEXA scan than somebody doing kind of like the standard doctor blood work. I'd love for you to dig into kind of like the real health side of it? And then how does that play into supplementation? Yeah, so I think in how we assess someone overall, is we kind of break the body down into different departments, essentially, and the DEXA forms one part of like our metabolic body composition assessment, we also have like a cardiovascular screen, also do like a musculoskeletal, which would be like muscle mass, like low RSMI or low bone density. And then kind of cellular health would be like internal health.

The reason I say a DEXA is probably more often valuable than some of the blood work we do is because there's always more nuances in terms of blood work. Like it's hard to give direct answers for a lot of things. Now, vitamin D is easy because you just check vitamin d supplement with vitamin d it's a very like direct measure it goes up and it's like okay bingo whereas things like dyslipidemia or ldl and triglycerides there's a hell of a lot more involved so a person can kind of walk away and kind of think oh well i'll try a few things whereas a deA is like your body fat is 30 kilograms. That's dead weight your body is carrying around. It's not contributing to your metabolic rate. It's kind of just like

a very direct measure. Vitamin D and calcium are two of the obvious ones when we have lower bone density. There are some specific bone builder supplements, and usually they'll have K2 and phosphorus in there as well. The other supplements that I guess would come out of like a DEXA scan would be like protein, which isn't really a supplement, but protein powder, if people aren't using, it's just an easy way to support lean muscle mass, creatine potentially as well, if someone's on the lower end of muscle mass. But yeah, I guess it has to be used in conjunction with some of the other stuff. Like really, if someone has impaired fasting blood sugars and HA1C and insulin things, and then you've got the high visceral fat and the metabolic stuff, you're kind of like,

OK, this is a person that we need to work on their metabolic health, whereas someone else might be fine on DEXA, but they might have dyslipidemia and elevated blood pressure and poor cardiovascular health. And then the other category of people that I really see a lot of is just simply low muscle, low bone. I see a lot of maybe middle-aged females that haven't trained, haven't done anything. And that's a risk factor, you know. And again, it's easy for them because it's so obvious what needs to happen. The other kind of category of people separate to a health perspective is I work with a lot of athletes, but particularly endurance athletes.

And they're already like tracking so many things. But a lot of those carry low muscle mass. Some of them have poor bone density, particularly ones that have chronically been underweight for years, like you've got the relative energy deficiency in sport and that's kind of that can pull from bone density. And so I think everyone should have a DEXA scan, whether it's an annual event, even just to get an insight on your bones and stuff. I think the issue with the maybe online discourse is DEXA has probably been reduced to like a way to measure body fat. And people will argue, well, it's $200 to measure your body fat. I can just do that on a scale and it might be in the ballpark, but you're not going to get bone density. You're

not going to get muscle distribution. And once someone knows their bone density is suboptimal, it's not going to go to optimal, no matter how much strength training we do. Our aim is really to keep it there and prevent the decrease um which is expected muscle mass and bone decrease you know we typically peak at about 30 and then it's unless you do something i just always say to people to use it or lose it you know yeah um one of the things that i really like looking at on dexascan reports is the imbalances side to side and i would imagine um on the when you're working with athletes, depending upon their sport,

I think tennis is one that always comes to mind, specifically athletes that are using just one side of their body all the time or rotating the same way like golfers do. Where do you start to see those? What percentages or just how do you read that when you're kind of developing training programs to write some of those things, knowing that like, a tennis player is always going to have like, a million more reps with their right arm. I remember the first time I actually like,

noticed this in real life, I was watching Andy Brodick live and looked at his right arm. And I was like, Oh my gosh, that guy is so shredded. Like it just veins coming out of his forearm. And then you look at his left arm and it was like regular, it looks so depressing. Like it's like just nothing there. Um, but when do you start to feel like those ratios, uh, really come into play, um, or those imbalances and, and how do you kind of move forward and um fixing them it's like those arm wrestler guys as well you see that and honestly it's it's not usually a major issue you're expecting to see maybe a couple of percent potentially and and that would be normal and

uh anything more than that like if you had a five to ten percent difference would be something that would potentially impact things and like you said tennis and golf particularly are ones that, um, yeah, overuse on one side. Um, and again, like it's, it's kind of like from a metabolic standpoint or anything like that, it's not going to be an issue. I think where that becomes an issue is in the training room and potentially puts them at an injury risk or anything like that. For the average person, it's not necessarily a major concern. It's honestly, it's kind of rare enough to see significant changes one side to the other, unless someone has gone through like, I have a client who ruptured his Achilles and was in a boot for like six months. So then he lost muscle mass on his left leg. I mean, really,

the main outcome for me is like, oh, it's a, it's a way to encourage single leg strength training, which I would encourage everyone anyways, but now I've kind of got a reason to do that. So, and I think that the other thing as well with the DEXA is it is just one unit of, of measure and it's an objective measure. And I feel like sometimes people don't even do anything with the info like it is still going to boil back down to what are you going to do with this info and then are you going to actually modify your behaviors based on this info and that's really where a lot of the challenge lies okay can you can you speak to the the accuracy uh both in how how accurate it actually is and also the accuracy across many months.

How consistent is it? How reliable is it compared to hydrostatic weighing, skinfold calipers, bod pods, and any other method you could use for assessing body composition? Yeah, I think DEX is universally accepted to be about like a 1% potential margin of error. And they are a very, like you have to calibrate the machine regularly. Like we calibrate it most days. And it kind of will prompt you to calibrate the machine if it hasn't been done in two days. You won't be allowed to scan someone without running a machine calibration.

I think like margin of error for um bioelectrical impedance and stuff like that might be like three to four percent and skin folds are like skin folds are potentially very accurate with the under the right conditions if someone is good at doing it and it's the same person each time and obviously in a team sport setting like realistically you're not going to run uh 20 to 50 guys through a dexa scan on the same day so like skin folds then can be a very quick and easy way to do that so it's not going to always work in each setting and the other thing then i would say about that is um the other thing to kind of really make dexa scanning be accurate is you have to do it under the same conditions if possibly.

So typically there's a protocol in terms of like fasting, like an overnight fast, no excessive training the day before. I would also say things like not using sauna or doing something that's going to induce excessive sweating because really your water intake will impact your lean mass. So if you do a DEXA scan and then you drink a liter of water, you're going to have a kilogram more lean mass if you retest. So that's another mistake that people can kind of make. So ideally people would do DEXAs under the same conditions as they've done previously. Now, when you're running a business and stuff, it's kind of, it's not always easy to

have everyone just do a morning fasted scan. So there are protocols for like an afternoon scan where you just minimize intake, stay hydrated, and maybe keep a track like of what you've eaten on that day. So you could retest under the same conditions. So yeah, I guess there's less user error, essentially. The user error is high on things like skin folds and stuff if it's across different people. And it's hard to skin fold people that have like very high amounts of body fat and bigger bodies it can just be harder to get those readings so yeah i mean if it's a it is a pretty commonly ready readily available tool i would say

and i would say that people should seek it out there's dexes everywhere and and like even if it's a once-off thing and then you want to use your own scale or a different measure to kind of like track it over time, then it will correlate highly with that. I would say that Dexa typically reads, because it's x-ray technology, it would read all of the body fat. So people are often surprised at their body fat. 99% of guys that come in, if if i ask them what do you think your body fat is they're usually like five points lower than the reading because it's high it reads high because it's higher than kind of finding everything it really does read high if you go get new calipers and you're 12 your dexa scan is gonna gonna tell you something that's not 12 i I found the leaner I am though, the more, the more accurate it is.

Like I used to fight MMA and I would, I would cut for fights and I'd be in great shape, you know, pre-fight and whatnot. And if I was like 6% on calipers, then generally the DEXA was right around 6% also. But if I was walking around at something like 12%, then usually it was like 14 or 15%. It was always a few, a few points more, but whenever I was lean,

it was, it tended to be more in line with what my calipers would show yeah for sure i i think yeah we all we all wanted to read lower than it is but i think honestly people have a misconstrued idea of what a healthy body fat is or what people expect to be like everyone is like i want to be single digit body fat but really most people outside of like elite professional athletes aren't single digit body fat but really most people outside of like elite professional athletes aren't single digit body fat you know and even some of them are like high single digits high single digits and that's excellent you know but um yeah if you're single digits on a dexa you are yeah yeah it's been a couple months of uh caloric deficit yeah an extreme caloric deficit in the in my case like it was five percent on a dexa was like the lowest i ever got but that was like

like cutting cutting weight for many weeks trying to lift weights competing at 94 kilos which is 207 and then fighting welterweight at 170 i was making these big swings back and forth uh but you mentioned the the calipers earlier. They're kind of tough on bigger people, especially if they're really big. The calipers don't even get over the skin folds, that type of thing. I used to be in corporate fitness for a period of time over the summers when I was in college.

It was company policy that if a very large person came in and wanted their body fat tested, we told them the calipers were broken just so they didn't have the embarrassment of the calipers not fitting over the skin folds yeah it just didn't work so we always did bi-lactoimpedance with them you know we were supposed to tell them that the calipers were broken we couldn't just tell them they were too big for it they were like just lie to them yeah okay whatever you want yeah are there limitations to it like uh like should high school athletes be

in there i assume that um and then we've talked so much about kind of like osteopenia osteoporosis is it is it something that just your your average um like high school athlete um or is there really more value to it as you start to get older um when maybe the bad decisions stack up a little bit more and you need to go learn the truth about where your body composition's at. Yeah, I think like the only limitation from like a bone density standpoint for like anyone really under the age of 30 is kind of like, well, it's still kind of meant to be increasing. So it's hard to give a definitive judgment on someone's bone density when we don't know where it's going to get to um and typically that's only after the age of 30 um same with like

muscle mass lean mass and stuff like that most of the normative data that we have is kind of like um correlated with age and it's usually like 21 plus and stuff i've seen it be very useful though for like kind of high school athletes and that from a lean mass perspective, essentially. And I mean, the outcome isn't necessarily going to change much for them. It's going to be like, but I find that because it's a health measure, you just have a bit more validity or credibility in terms of those recommendations, because it's like, well, here's an exact specific number. Here's why you need to eat that amount of protein. And but I mean mean those guys if they're training hard are going to shoot up in muscle mass anyway so your readings aren't in a truer sense whereas i feel like when someone is 30 plus that's who they are and they're not going

to like change naturally too much apart from deteriorate yeah um yeah if we were to kind of uh because you aren't just someone that analyzes DEXA scans, but also provide nutrition guidance along the way. I would love to hear kind of even going back to the beginning of like the checklist on how you read and analyze reports. What, how do we take that information and then turn it into a nutrition plan for someone? Yeah, I think that's really important to, I guess, have the right person review the things. And I know you do this as well, because again, you can go to a DEX and a tech might just give you a scan and hand you a report

and you leave, but you don't have that. That's what they do most of the time. Yeah, it's silly. It's just not actionable information then really. I mean, typically my starting point will be to define a specific calorie number for someone. Now, again, I will want someone to track their calories. Now, I will want them to do that for the minimum amount of time needed to learn what they need to learn. The same way if I drop into a city, I need a map, But after a week or so, I don't need that map anymore. So like, that is the be all start point. Because again, people don't have, or people will say, oh, tracking calories is bad or kind of like unhealthy. But it's like the goal of tracking is to not track. But you have to have a ballpark range. You have to have an idea of that, particularly if you

want to modify your body composition. So I will use the resting metabolic rate along with their activity level to calculate that number. Secondary to that is really from a body composition standpoint is defining a protein number. Now, usually maybe like 1.6 gram per kilogram. I like to just give people a range from 1.5 to 2 grams per kilogram body weight. So because I feel like that's an easy one for them to calculate. So if someone's 80 kilograms, I'll say like hit 120 to 160 a day. Most people don't know how many grams of protein they consume in a day. So you're starting at that. Like, um, based on that, then a carbohydrate intake will be dictated by the demands on their body. I would typically follow a form of like a training day, non-training day split, uh like blood sugar and insulin and stuff will also have a play a role in carbohydrates

kind of recommendations. But we'll have a specific number based on what they do. Now, if someone's very active and they're doing endurance activities, they'll be on the higher end. If someone's just kind of weekend warrior and doing a few exercise sessions, they can afford to be a little bit lower. And then kind of fat will make up the difference in a sense. We want to hit a minimum number, but we don't want to overdo it on fat

purely because of the grams of calories per gram. If you have adhered to the first principle of modifying your calorie intake, you can't really go too far wrong with fat. And that's kind of like your core baseline. So I like to think of it like a video game where you can kind of unlock more levels now once you unlock more levels you can get a little bit more detailed in terms of like um really detailed like private blood work doing all those biochemistry things and looking at health systems and stuff but you kind of have to earn the right to be doing that if you're wanting to do that first and you haven't really addressed your sleep stress or eating takeout

four times a week or having like 1500 calories worth of alcohol a week it's that's kind of where we focus our attention um and yeah then it's like kind of test retest i would typically want someone to do another dexa maybe like four months from now and i feel like if you do two in quick succession it's more valuable than doing like one per year. Now, maybe you do two and then you don't do another one for a year or something, because then you've got this really specific time period where you can see what's happened. And I've seen. I guess like sometimes people may if someone loses eight kilograms, most of the research would say they might lose a quarter of that in lean mass. So they might lose six kilos fat, two kilos lean. But with the right training and with an adequate protein intake, you can pretty much make that

all be fat or you can reduce that ratio. And I've also seen where someone might lose eight kilograms of fat or eight kilograms weight, and it's like four and four. And that's not like a good ratio, because like I said earlier, you're driving your metabolic rate down, which makes it easier to gain weight in the future, essentially. And then it's just tracking a bit of kind of trial and error, figuring out where people go. And usually the thing with the DEXA is usually everything is logical, explainable, actionable. We're just not the most logical of creatures at times.

You know, like most of the time when we combine a DEXA with a nutrition consult, it's kind of like, it's obvious what people are doing that's not right. It's just, for the most part, people just eat willy nilly. They don't track anything. They have no idea how much they weigh. They have no idea how much protein they consume. And it's like, add a bit of structure to that and you soon see results. And I would say that the majority of people tend to be active enough to be whatever weight they kind of want to be. They just over consume on calories. And if you have someone with a 2500 calorie maintenance amount, if I drop 15% off that it might be like 2200 calories. So it's like you're only finding 300 calories a day realistically to drive fat loss. And that might be two glasses of wine or six squares of chocolate.

Are there any times or situations where people shouldn't use DEXA scans? I mean, or detrimental? I mean, the big one would be pregnancy, like we wouldn't do it if anyone is pregnant. It is a small dose of radiation. I would also deter people from doing them too regularly, like in terms of the actual radiation dose, like one or two per year is perfectly fine. And really doing them more often in shorter time periods doesn't really tell you that much more. Some of those numbers that I talked about earlier are kind of like hard to really significantly change over a short period of time. Lean mass and fat mass,

you can see big changes, but you would see that on a normal scale or true pictures are how you look with your clothes off anyways. Yeah. So like if someone does any other types of scanning regularly, if someone is in some treatment for some other thing and they're exposed to radiation, those would be the other kind of factors or considerations. And pregnancy, yeah. What's like the best number two choice there? Oh, for just body composition testing?

Yeah. What's like the second best? I mean, I would just skinfold someone if I don't DE't Dexa them or if, if they're not in a position to do Dexa, I would skinfold them. Um, if it's someone that's kind of away, um, yeah, I mean, bioelectrical impedance, some of those scans now are better than they used to be. And if it's, if the person uses the same scale under the same conditions, then they're going to get a read on it anyway. So it's not going to be like haywire, super high, super low, and they'll get a read on it. When may things show up in there that would classify as medical and not something that is like a nutrition or training problem?

I think the big one on that is the bone density aspect, because that's a clinical condition like osteopenia is a T score of minus 1.5 osteoporosis is a T score of minus 2.5. And if someone is as low bone density, I will their leader and do a separate private scan. And we look at the spine and the hips to get an actual diagnostic image of their bone density. Or you can do that usually through a hospital radiology clinic as well. And they are kind of, because that's a treatment pathway and they might go on medication and stuff for that. Or SMI being low would be one factor that would indicate that. But again, the treatment for that is really lifestyle nutrition the strength training and

like we don't have treatments really for like building muscle mass you can get into i guess like hormones and different things like that that that can impact that but um like we don't have like a clinical treatment for that other than and we have in our clinic we have a gym essentially which is kind of like a modern approach i guess to health care in a sense where it's like a lot of people don't want to go to a gym or haven't been and they're like where do i begin so we will train people and see them and just kind of get the ball rolling and then kind of get them comfortable in that setting rescan them be like look you're strength training you're supporting bone density and muscle mass is in a better place. And now you can kind of go out into the world of what we like to talk about

normally, which is like maximum strength training, muscle mass and different programs and such. But I guess I deal with two P two types of people. One are the people who come to see me in the clinic and the university and they're, they've elected to come and see me and they've kind of made a decision to view this.

And they're in a position where they're wanting to like optimize what they do but then i also see people who i kind of see maybe every year and i look at their decks every year and some of them are like i don't want to do the decks i don't want to be told i don't like so those the motivation and those people is kind of like different and i don't want to take one because i think that i'm a body fat percentage that i'm comfortable with and then i see the dex scan number and i go that's too high then i have to go reduce my calorie intake which is no fun yeah i know we we all we cut ourselves all the time like i i gain like i have the truth hurts yeah like i i have a 10 week old at the moment and like my exercise

and stuff hasn't been great and i've gained a couple of kilos and in my head i kind of tell myself i think i'm stronger though maybe it's maybe it's muscle but it's it's not you know what i mean gotta be we all just caught ourselves all the time and i'm avoiding getting on it i'll i'll do it if i i'll have like a jujitsu competition or something at some point coming up and i'll want to cut weight and i'll do it if I have like a jujitsu competition or something at some point coming up and I want to cut weight and I'll do it then. And you can use it that way very easily. But other than that, I'm avoiding getting on it right now. But I've done it enough to know.

And I think that's the trick with any of this stuff, like the tracking, the monitoring. You have to do it to be in charge, kind of put yourself in the driver's seat. Whereas I feel a lot of people feel like they're just in the backseat of a car. They're just going year to year, gaining five pounds. I still have people come to me and say, I gained 15 pounds during the pandemic. It's like four years ago. So it's like we just kind of go on this autopilot and just keep going. And yeah, we add weight here and we're not measuring or doing anything.

Whereas if you do a little bit of upfront work, put yourself in the driver's seat, then you can loosely manage these things. And then you, like, you don't need to do it, Dexter, because you've got to read on what it was at some point. Yeah. I'd love to know, have you ever, I know there's like radiation involved with it,

so you don't probably want to be in there like every 20 minutes, just seeing how accurate the data is. But have you done like multiple testing, either like once a day for a week, just to see how the data comes back, how similar it is? Typically not for the radiation purposes. And like, the only things that really impact it mostly are like water intake and hydration status. So sometimes we might have someone come and they're doing blood work and they're fasted because they're doing blood work and like fasted.

You can drink water, you know, like where a lot of people don't even drink water. And then like they might do a DEXA scan and have like a low lean mass compared to what they usually have. And it's kind of like wondering why, but that's, I guess lean mass is an indirect measure. Essentially. There's a lot of components of lean mass. So I'm not as like, I would focus my attention on fat mass in the scan because nothing else will contribute to fat mass. It's just fat mass. So that's a more accurate reading within the DEXA. Um, no, I haven't seen, like, it'd be hard to get someone to volunteer for that. There probably is some research

where they've got some students to do it, but I'm not, like, too familiar with it. Throw the young kids in there. They'll be fine. Yeah. Here's, like, $50 and expose yourself to radiation. There's a couple extra meals at the dining hall. Yeah, but I mean, the radiation

is low. It's less than a flight. It's not a concern typically. And for how valuable the test is, I would say everyone should do one and just kind of see what you get. And then it's very actionable. That's the key thing. And then you can always test and recheck

and you just kind of read on what people do. And it just honestly, as a nutritionist, now I'm in a luxurious position where I have all this information at hand. But now if someone rang me up and said, I want to like do a nutrition plan or sometimes people are like, oh, will you send me a meal plan?

I'm like, well, based on what, where do we begin? Like you kind of, you have to have a start point and you may as well have an accurate start point rather than in previous years, you work with someone and you get them in better shape and you know you're improving their internal health but when it's not captured, it's hard.

I know you do a good job with that but obviously all the things you do in Rapid and stuff is very detailed so it's like you're capturing everything. Fantastic, dude. This was a lot of fun. I appreciate coming on the show. Where can people find you

and they wanted to work with you? Yeah, so thanks for having me. Alan Kenney Nutrition is my website. If people are in Vancouver or BC, I see people in person at the University of British Columbia Sports Medicine Clinic. I work with people online as well.

So I do a lot of remote work, a lot of work with athletes, endurance athletes, Instagram, aka Nutrition. Fantastic. Doug Larson. All right, Alan, dude, appreciate you coming on the show.

This is really fun. This is my reminder to go get a DEXA scan because it's been way too many years since I've had my last one. I was actually just talking about with my wife just maybe a day or two ago.

So it's on my to-do list. Dude, appreciate you coming on the show. You can find me on Instagram, Douglas E. Larson. And I'm Anders Varner, at Anders Varner. We are Barbell Shrugged, Barbell underscore Shrugged. Make sure you get over to rapidhealthreport.com. That's where Dan Garner and Dr. Andy Galvin are doing a free lab lifestyle and performance analysis

that everybody inside Rapid Health Optimization receives. You can access that free report at rapidhealthreport.com. Friends, we'll see you guys next week.