Fizz, fizz, plop, plop?

Dear Doctor Ninja,

I’m a 27 year old woman who is trying to lose weight. I switched from regular soda to diet soda, but I’m worried about some news that the sweetener in the diet soda will make my gut health worse. I like the flavor of soda and the fizziness, and the diet soda keeps from from drinking the regular stuff, but I also worry, since gut health seems to be so important.


G. Utrot

Personally, I think the jury is still out on what artificial sweeteners do to the bacteria in your gut in terms of whether the changes that seem to have been reported have any impact on you. And while there are some diseases and conditions that are directly caused by problems with gut flora, they’re not generally ones that can be fixed through diet alone.

The answer to your question lies more in the realm of what it takes to dislodge your dieting sanity. If diet soda is what makes the difference between sticking to your diet and achieving weight loss, and if weight loss is your major goal, then I say, take the theoretical hit (and I do think it’s theoretical) and lose that weight. If diet soda is something that’s just, “nice to have” and you can stick to your diet whether you have it or not; AND the theoretical risk bothers you that much, then consider something else that might be just as refreshing or fizzy that might be sweetener-free.

There’s also the idea that switching is the first step to “quitting”, if that’s also a major goal. Tastes are changeable. You can condition yourself out of a soda habit, just as much as you can condition yourself into one. The benefit of a diet soda is that it allows you to quit or reduce on your own terms without having to worry about the calories. Not everyone can go from full-sugar soda to plain water in one giant step.

The decision you made the day you switched from regular soda to diet isn’t carved in stone. You can choose to taper off diet soda in favor of other non-caloric drinks when it feels time and you can do it as fast or gradually as you want; if ever.

Disappointment, or error?

Dear Doctor Ninja,

I am a reasonably fit 57 year old male. Nearly three years ago, I had a DEXA scan that revealed I had about 500g of visceral fat. It didn’t seem critical that I lose it, but I thought it would definitely be good if I reduced it. Between the scan and November last year, I hiked 1000km over four separate hikes, rode my bicycle a lot, became a vegetarian and generally reduced drinking alcohol. In November last year, I started an intensive 12-week workout program, which included five weight-training workouts and one aerobic workout every week. I also didn’t have an alcoholic drink for 100 days. Then I had another DEXA scan. I felt sure that my visceral fat level would have dropped. Instead, it was 160g more, causing me to exclaim mutha-ninja! Would you have any advice on the best ways to reduce visceral fat?


Fujibayashi Nagato

First off, congratulations on making some great lifestyle changes that seem to be working for you!

Before I get into your question, I think it’s important to note a number of reasons why you might have been disappointed in your perceived lack of progress.

In an ideal situation, if you wanted to know how effective your 12-week program was going to be, you would have done a DEXA scan before you started. Since it’s been 3 years and a bit since your DEXA, we really don’t have a good idea of what your visceral fat has been doing. Were you possibly even higher than 660 grams 12 weeks ago?

The other consideration is the nature of the DEXA scan itself. Again, in an ideal situation, you would have a DEXA scan with the same scanner, as different scanners use different algorithms to calculate the various tissue masses. You didn’t mention if this was a whole-body DEXA scan or a single-level one, which can also affect things, particularly if your previous scan was one and your latest scan was the other.

Even measurements with the same machine carry measurement error though. Fat mass variation between scans of the same person (with no change in body composition) can be in the 150g range, which means that an increase of 160g of visceral fat from your previous scan 3 years ago could be due to just the variation in the machine, as opposed to an actual meaningful increase in visceral fat.

You can’t reduce your visceral fat to 0. The average amount of visceral fat in healthy 20-30 year old males likes somewhere in the 400g range. You’re not 20-30 years old anymore, so the average amount of visceral fat in a healthy 50-60 year old male is expected to be higher as visceral fat tends to increase as we age, even if our waistlines don’t.

Visceral fat is contrasted from the fat that sits under the skin (the fat you can pinch, also called subcutaneous fat). It’s the fat around your organs. Visceral fat plays an essential role in organ health as both a source of energy as well as padding; it’s only when visceral fat is in _excess_ that it becomes a problem. Its accumulation is directly related to fat accumulation in general. There’s no known effective way to directly target visceral fat without making changes in other fat stores.

Fat, in general, does not accumulate when there’s no difference between the energy you’re spending vs the energy you’re eating. So the best ways to prevent visceral fat accumulation, or to reduce it, are the same ways to lose fat in general, which come down to controlling the “energy in vs energy out” equation. While there are still many small controversies about which diet is best and whether there can be ways of trying to get around this energy balance requirement, it still seems to bear out that it’s the main linchpin of the matter. How you choose to manipulate energy balance (whether through vegetarianism, or carnivorism) depends mostly on the priorities you have on what, of many factors, play into whether you can stick to an eating style or not. “Diets” are mostly mind-tricks that we use to allow us to execute a habit of eating within energy balance—some people need different or stricter rules than others.

There’s no ‘U’ in diet. But there is an ‘I’

Dear Doctor Ninja,

I’m a 33 year old female. I started a new diet this year, and I’ve lost a bit of weight already. It feels like I lose the same 15 pounds every year no matter which one I try. I’m starting to wonder which diet would be best for me to lose the weight permanently. There are so many articles on so many diets, that I don’t know how to choose! Help!

F. Ifteen

There are a couple of things that almost all diet-type science folks agree upon:

  1. If you’re not eating enough food, and don’t have a medical condition, weight gain is nearly impossible. And by nearly impossible, they mean that if it were to happen—that someone gained substantial amounts of weight while eating not enough food that could ONLY be explained by their food, that it would be a publishable case report in a very prestigious medical journal and you wouldn’t be hearing about it on a blog first because the news would be THAT big.

  2. A diet that cannot be followed by an individual, can’t produce results.

After that, it turns into a shitshow.

But, if we consider the these two things, a diet that will cause weight-loss really just has one purpose:

To give you a set of eating “rules” that you can stick to, that allows you to not eat enough food.

Not eating enough food is not the same as being hungry. And hungry is a state of mind that is driven not only by what’s in your tummy, but also when you’re used to eating, how much you’re used to eating, who else is eating with you, or at the same time as you, how certain foods make you feel, what memories certain foods evoke, and what food means culturally to you and what your beliefs around what the function of food is, apart from just calories. And more.

Diets aren’t made for everyone (one might even argue that they’re not made for any one). They make assumptions about what people will and won’t tolerate. For some people, eating three meals per day, no matter what is in those meals is mandatory. For other people, feeling full is more important than eating three meals a day. The range of priorities that we each MUST have in order to feel satisfied (or at least not angry) about our food is as wide as the number of diets available to us.

Thinking about what’s important to you when it comes to food and then picking the diet that respects those values is more important than picking a diet that is “scientifically best” (as though there was such a thing) and changing yourself to fit it.

The diet you pick is like picking who to date. You have a certain set of core values that you won’t give up for anyone. A compatible partner respects or even shares those values. Likewise, all relationships require some degree of compromise. But that compromise doesn’t involve changing who you are fundamentally. Your relationship with your diet shouldn’t be an abusive one.

And just like we outgrow some relationships, we can outgrow our diets. The diet that you partner with that enables you to lose those 15 pounds might not be the diet that enables you stay at your new weight, because at your new weight, some values can change. The good news is that breaking up with your old diet doesn’t have to be full of angst. You don’t even have to text it.