Individuals live longer and healthier (life with quality) when their body weight is being maintained within the normal range. Two significant components comprising the body weight are skeletal muscle mass (SMM) and body fat mass (BFM) – reduction of the former and increase in the latter are usually associated with aging. According to previous studies, strength training (ST) and low-calorie diet plans are proven strategies for promoting SMM gains and for reducing BFM.[3,4] Decreasing BFM with improvement in SMM is termed body recomposition. Improving body recomposition has been also proven to be beneficial in improving biological age. Biological age represents the actual age to which body of a person has aged while chronological age is the age of an individual which progresses at a fixed rate from birth – for an obese individual his biological age will be higher than the chronological age, and vice versa.
The first author has been experimenting with different diet plans and exercise regimens since 2012. The COVID-19 pandemic restrictions led to the temporary closure of all the fitness centers and the author had to take a break from exercises since April 2020. He continued to follow a structured diet plan [Table 1]. After the restrictions were lifted, he joined a new fitness center in February 2022. The diet was modified and exercises were charted [Tables 1 and 2] based on the first set of body composition scores [Table 3].
The body composition parameters were obtained in the evening after a fasting period of two hours (no solid and or liquid meals) using an electric scale and bioelectrical impedance device (InBody™ 270 [Figure 1]; Biospace Co., Seoul, South Korea) following the standardized procedures recommended by the manufacturer, and as mentioned in an earlier study. For evaluation, the author had to wear light workout clothing (shoes and any ornaments or electronic devices were removed), and the hands and feet were placed on the electrodes [standing position – Figure 2]. Before performing the evaluations, no strenuous physical exercises were undertaken. The reports [Figure 3 shows the last report, as a sample] were generated under one minute. Exercises were performed in the same fitness center. At home, all the meal portions were quantified and prepared by the author. Carbohydrate sources were mostly limited to potatoes, brown bread, and oats. Protein sources were restricted to two whole eggs per day for the low protein (LP) period; and in the normal protein (NP) period lean sources of meat such as chicken breast and fish (tuna, cobia, and shark), and peanut butter were further added on to the menu. Fat sources – Dry nuts (cashew, almond, pistachio, and walnut) were consumed and olive oil (extra virgin) was used for cooking. Plain salad (raw vegetables), apple cider vinegar, and green olives were part of daily diet. During the low-calorie period, the author experimented with a calorie count of 1400–1600/day, and the intermittent fasting duration was 14–16 hours. The author has been a nonsmoker and nonalcoholic; he has not been taking any medications/training stimulants, but consumes tea/coffee two times a day. He has no history of any chronic diseases. At the end of four months, he had lost more than eight kg of BFM, without losing any of the SMM.
In contrast to routine blood investigations, body composition analysis has always been a step ahead for determining the actual healthy physique of an individual. This is because through body composition analysis parameters such as SMM, BFM, percent body fat, and visceral fat level can be assessed (fairly accurate). When compared to dual-energy X-ray absorptiometry (DXA), a yesteryear's accepted methodology in assessing composition, InBody™ 270 machine gives an identical body composition report, minus the risk of radiation (of DXA).[8,9] Periodic assessment of composition is the only method to keep track of healthy progress (recomposition) of the physique of an individual. Body recomposition can be achieved [Table 3] through a low-carbohydrate (LC) diet plan. Moreover, insulin levels are improved when a LC ketogenic diet is followed. The benefits of LC ketogenic diet include changes in waist circumference [Table 3]. As part of a LC diet, BFM is reduced, but sometimes in conjunction lean body mass (which includes SMM) can also be lost. Therefore, in addition to ST [Table 2], an adequate protein intake (>1.0 g/kg/day) also has been recommended. This was why the diet got modified [Table 1] from LP to NP to ensure the preservation of SMM, when the balance had tilted midway [Table 3], in the disadvantage of SMM. For optimizing body composition, the role of adequate protein intake is very crucial. A chronic negative energy balance (via low-calorie diet) is a necessity to reduce BFM, whereas in general a positive energy balance is recommended for building SMM. However, similar to what has been demonstrated in this case report, body recomposition was demonstrated earlier in hypocaloric conditions.
The presence of dietary cholesterol (whole eggs) has been found as an effective method to increase testosterone levels in middle-aged strength-trained men when combined with LC diet plans. The author had a healthier lipid profile too, after incorporating dietary cholesterol. The visceral fat/hidden fat got reduced [Table 3] (and not just the BFM, which is mostly subcutaneous fat), thereby reducing the myriad of complications, which could be arising as a result of the same.
Perusal of the existing literature has shown this experimental and observational case report as one of its kind and the first of its kind in India, among the medical fraternity. Further cohort studies utilizing the InBody™ machine, on a larger sample size are warranted to answer research questions regarding body physiques. Once doctors (physicians, diabetologists, endocrinologists, and physical therapists) get actively involved in the forefront of such works, they will be facilitators in guiding a majority of individuals, not just to do away with lifestyle diseases, but to live proudly with a healthy physique.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
We express our gratitude to Shri. Jubair M and his team of trainers (Club Active Fitness Centre, Ernakulam, Kerala State) for the valuable insights regarding the working principles of InBody™ 270 Body Composition Analysis Machine at Club Active, and for providing the body composition reports which were used in this publication.
Our special thanks to Mr. Toxon Correya, the workout partner of the first author for capturing the photographs at the fitness center, which have been used as figures for this publication.
We are extremely thankful to our Principal of Amrita School of Medicine, Dr. (Col.) Vishal Marwaha since he has always encouraged us to think laterally and to explore the grey areas in research. Our team is indebted to Dr. K.N. Unni, Chairman of Amrita School of Dentistry and Head of Amrita Gymnasium Committee as he has always been instrumental in motivating fitness (diet and exercises) for students, faculty members, and staffs all alike – Sir always favor innovative investigations to tackle lifestyle diseases. The principal author expresses his heartfelt gratitude to Dr. VV Pillay, Professor, and Head of the Department of Forensic Medicine and Toxicology, for Sir's understanding and motivation toward the craze the author has in experimenting the effects of right lifestyle habits on body health parameters.
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