Category: Overall Health

Health is hard to define but it features dietary patterns centered around real food, is personally sustainable and enjoyable, and leads to great body composition.

Visceral Fat – The Core Value of a DEXA Scan

I’ve been getting a regular body composition measurements by DEXA Scan since December 2018 with a goal of less than 15% body fat and optimal visceral fat. At my latest scan, February 12, 2022, Rafi the tech who has witnessed our entire journey, made the comment:

Welcome to the 1% club. You’re in rarified air my friend.

Rafi, Composition ID Arlington VA

It took me a bit to internalize this. Looking closely at my DEXA I realized it means, after a starting point at the 57th percentile for my age as compared to the USA NHANES Database, I’m now at the 1st percentile for my age! This is pretty shocking to me but represents years of work to improve my diet, add strength training, and really dial in a way of eating that got me to 15% body fat! (What is NHANES ?)

DEXA Body Scan report showing total body fat, fat free mass, and comparison to USA NHANES database.
My Body Composition Over Time – As Compared to NHANES

A key take away is that the DEXA Body Composition Scan can be a very powerful tool to identify problems in body composition. Critically, it also can provide the motivation needed to continue adjusting diet and lifestyle. If you are serious about your health, you must ignore weight and BMI, and instead focus on body composition. To illustrate DEXA I’ll share some key parts of the report for me.

Visceral Fat – The Most Important Measure?

What upset me the most at my first DEXA scan was how many pounds of body fat I was walking around with. I think it was the psychology of the the number — 50 lbs! It was really the wrong number to focus on but it stuck in my head and initially became my “why”.

However, it was really the number on the last page which should have been the focus. That number was 2.41 lbs of visceral fat. Why? Visceral fat is the fat buries way under the skin. It’s the fat that lives in and around your organs. It’s the fat that disrupts the function of your internal organs. In short, its the stuff that will cause painful chronic disease and ultimately kill you off early.

DEXA is a great tool to track Visceral Adipose Fat. In my case I've dropped from 2.41 lbs to 0.65 lbs in 3 years.
Three Years of Visceral Adipose Fat Data

After I got over the “omg 50 lbs!” shock from my initial scan I realized that, more than anything, I needed to get my VAT down to less than 1 lb as quickly as I could. Less than 1 lb seems to be the key for minimizing risk of heart attacks and chronic disease.

Three years after my initial scan I’m well below 1 lb now. Rafi explained that while you can go lower, and some people are at 0 lbs, the ability to go that low may depend a lot on genetics. So getting to 0 may be the best but it also may not be practical or even possible.

Fat Distribution – Subcutaneous vs Visceral Fat

I’m not even sure I need to say much about this part of the DEXA Scan report. Look at the red coloration in my 2018 scan and you can clearly see the visceral fat where my organs live. Then see the 2022 scan where virtually all the remaining fat is clearly subcutaneous (under the skin) and far less important to metabolic health. You do need some amount of fat to live so this will never be zero.

DEXA can clearly show you where visceral fat vs subcutaneous fat lives on your body.
A Picture Speaks a Thousand Words (Fat Distribution)
Chart of the percentage body fat over time. Makes it real easy to see which dietary choices are working and which aren't.

Here is another graphic that’s been motivating to me. Using this chart I was able to easily understand which dietary changes I’ve made helped, and which didn’t. Early on (circa 2018-19) it was simply keto and low-carb but eventually I hit a plateau. Most recently (circa Fall 2022) I changed to carnivore’ish but with a focus on increased protein and decreased dietary fat. See the huge change October 2021 (20.6% body fat) to February 2022 (15.4% body fat).

Bone Mineral Density – Haven’t Found the Magic

Another feature of DEXA is tracking bone mineral density. In my case its trending the wrong way and I haven't quite figured out how to reverse it.
Bone Mineral Density – The one area I’m still trying to figure out.

The one area of my DEXA Body Composition report that continues to frustrate me is bone mineral density. I’m told I’m still in positive territory so that’s good. However, my BMD has steadily dropped over time. I had thought that the increase in protein would have reversed this trend. So far it has not. Supposedly strength training can help to reverse this. But I’ve been increasing the amount I can lift steadily to no avail. So this is still a work in progress as I look to identify what part of my diet may need a change.

If You Care About Health – Track Your Body Composition

There are several different options available for tracking body composition. Two of the better known are DEXA and Bod Pod. Regardless of what you choose be consistent and track your progress. Doing so once a quarter is a good starting point though you can go more often if you think there is value. Expect to pay out of pocket and if you think its expensive consider the future costs of monthly medication you will avoid if you get body composition in line.

Combine tracking of body composition along with select blood markers to understand and rapidly improve your health.

Are Aches, Pains, and Diabetes Really Inevitable as You Age?

(Before) David & Hillary 2015
Port Renfrew, British Columbia

While the focus of Gout DiY is obviously about curing gout, lets set that aside for the moment. Quite often my wife and I have people who have known us for a while approach and ask what we’ve been doing. We both look strikingly different from years ago.

We’ve both spent a number of years re-imagining what health could look like for us. As a result we’ve been experimenting with diet and exercise, informed by less well known doctors and researchers. For my wife it was initially about prevention of Alzheimer’s. For me it was about sustainable weight loss and curing my gout without medication.

We’ve had to be willing to ignore the mainstream health guidance, learn what our own bodies really needed, and track the results that matter. Those results are not about weight alone. Instead its about body composition and key blood markers that reinforce and provide the necessary motivation to continue forging ahead.

This is what we did. Admittedly, there have been internal struggles to give up the bad habits so common in society today. We’re a work in progress and there are slips as well as intentional splurges. But we pay attention to how our bodies feel when we slip and get back to plan quickly.

The changes we’ve made to our diet and lifestyle have led to massive improvements. We’ve both lost a large amount of body fat, weigh less now than we did in high school, yet have more skeletal muscle. A number of skin conditions, aches, and pains have also resolved.

Aches, pains, diabetes progression, and other chronic health issues are NOT inevitable but it’s up to you if you want to make the change necessary to train for the Centenarian Olympics.

Truly Changing Diet and Lifestyle

Easing In to a new Diet and Lifestyle
We stopped going out to eat (for the most part), eliminated processed carbs and grains, and increased dietary fat. This step got our bodies used to burning fat for fuel and reduced the blood sugar swings that drive being hangry between meals. We found the low-carb/keto recipes from DietDoctor.com to be hugely helpful. We also started walking regularly 30-60 minutes a day.


Regularly Measure Body Composition and Bloodwork
About every 3 months we get a DEXA body scan done to monitor changes to visceral fat, overall body fat, lean mass, and bone density. In the Metro DC area Composition ID is a great option. We also regularly (every one to three months) check HbA1c, Fasting Glucose, and Blood Lipids — especially the Triglyceride to HDL-C ratio. OwnYourLabs.com allows you to purchase these tests yourself and they are quite inexpensive.


Intermittent Fasting
We eliminated snacks and shifted to an eating window of 8 hours. This left 16 hours between our last meal of the day and our first meal the following day. This helped improve blood sugars further and allowed some of our body fat to be burned (this only happens when insulin drops and glucose from sugar or cabs keeps insulin up).


Refinements to Accelerate Health Improvements
Threw out all vegetable oils and shifted fats in our diet to Olive Oil, Coconut Oil, Butter, and Beef Fat. Eliminated most/all fruits and increased protein from meat. Added strength training 3 x week for 15-20 minutes each time. Reduced our eating window further to between 1 and 4 hours depending on the day.


Protein First, Fat for Fuel, and Carbs as Desired
We took inspiration from Dr. Ted Naiman and increased protein to 40% (higher some days) by calories with a goal of at least 1 gram per pound of desired body weight, no more than 1 gram of fat per pound of desired body weight, carbs are only coming from a small serving of vegetables if we want them, normally less than 60 grams per day.


Strength Training to Failure
We started doing indoor bouldering at a local gym three times a week and increased emphasis on lifting weights, as heavy as we can, doing enough repetitions each set to go to failure (here’s a way to start simple and at home)


The Future (Not There Yet)
We expect at some point to reach a body composition we are happy with. Ideally we are shooting for 20% body fat (my wife) and 15% body fat (me). At that point we expect to (a) allow for greater energy in our diet — a combination of more fat and carbs from whole foods (mainly vegetables) so that we maintain body composition and (b) continue to strength train with a goal of increasing muscle mass as long as possible and then maintaining it as we continue to age.


We fully recognize this is not a path everyone is willing to take. However, we found it to be the only approach where we aren’t constantly hungry and were able to make significant change to our body composition. As a result we’ve massively improved our long term health outlook. If you aren’t happy with the trajectory of your health maybe its time to try something different.

Before (2017 – Wuyishan, Fujian, China) and After (2022 – SportRock, Sterling, Virginia)
National Health and Nutrition Examination Survey
U.S. NHANES Databases

The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. It combines interviews and physical examinations.

Though started in the early 1960’s, beginning in 1999, the survey became a continuous program that has a changing focus on a variety of health and nutrition measurements to meet emerging needs. The survey examines a nationally representative sample of about 5,000 persons each year.

The interviews include a wide variety of topics and informs public policy. A substantial problem with this is the use of Food Frequency Questionnaires (FFQs) and then linking the poor/bad data resulting from them to health outcomes.

The problems with FFQs are many and include poor individual recall of foods eaten as well as a tendency to over-report frequency of foods perceived to be “healthy” and under-report those perceived to be “unhealthy”.

Perhaps as bad are the questions asked. For example, they do not account for foods eaten together (e.g. red meat and a bun with processed sugar), they don’t ask about packaged foods at all, and they don’t ask about foods with added sugar with the sole exceptions of sweetened beverages or soda.

(GoutDiY’s Opinion) Any study making claims about foods and health outcomes based on NHANES is virtually useless.