Survival of the Strongest
From bone density to muscle mass, your body composition metrics tell an insightful story about your longevity. Plus, my DEXA scan wake up call.
True story. I’ve never owned a scale.
As a petite, Asian woman, weight never posed much of a concern for me. During my New York days, I hovered around 118 — give or take a few non-consequential pounds in either direction. My size 26 jeans never changed, although the percentage of stretch and waist height definitely increased over the years. Hip huggers no more.
The only time I packed on the pounds was the year I decided to train with the boys — swinging kettle bells, crawling with sand bags on my back and pulling a heavy as sh*t sled, that made me want to vomit. I put on a whooping 8 pounds during my time at Peak Performance, a private gym best known for toning athletic Sports Illustrated models and transforming actors into ripped Spartan warriors (for the film 300).
My trainer said I had the perfect weight lifter’s body — compact with lots of power. Although my butt looked great, annoyingly I couldn’t zip up my Catherine Malandrino dresses because my lats were getting too wide. After a kickboxing injury sidelined me, I decided to forgo my intense training to return to Pilates.
Fast forward fifteen years — hitting the big 5-0 never felt better, thanks to a quick pivot at 47 to manage my blood sugar and optimize my sleep. Perimenopause wasn’t slowing me down, but I knew I couldn’t ignore the impact of declining hormones on my long term health.
When I read Dr Peter Attia’s book Outlive (which honestly is a marathon in itself), I learned all of his patients do a DEXA body composition scan as part of his Medicine 3.0 longevity protocol.
Confident my consistent efforts over the years would deliver me a good result, I marched into the closest BodySpec location to get my DEXA scan — ready to see what I was made of. Literally.
Thin, active people are assumed to be healthy. But, as we all know, looks can be deceiving.
My results were definitely a blow to my health optimized ego.
34% body fat? Seriously, where?
Low muscle mass. Albeit evenly balanced on each side of my body.
Average visceral adipose tissue. The fat around my organs in my abdomen.
Above average bone mineral density. In a nice safe range.
Immediately I emailed BodySpec’s customer service to have them walk me through my detailed report. Perhaps some context would make me feel better.
“Your results show that you are tracking with the average of our customers in your age range,” she said in a consoling voice.
To this over-achieving Chinese student, all I heard was the word average. “I’m sorry but, did you just give me B-minus?”
What is a DEXA Scan?
The gold standard of diagnostic imaging scans, DEXA stands for Dual-energy X-ray Absorptiometry (also abbreviated DXA). It’s a machine that measures the composition of the human body by tissue type, amount and distribution.
1/ Body Fat
Includes subcutaneous fat (fat under the skin) and visceral fat (fat around the organs) to evaluate body composition and risk of obesity-related conditions.
Optimal ranges vary based on age and sex. The report shows fat mass and fat percentage across arms, legs, trunk, stomach and hips.
2/ Lean Tissue
Includes muscles, organs, bones and connective tissues to assess muscle health and distribution throughout the body and monitor gains or losses of mass over time to prevent sarcopenia.
Optimal ranges vary based on age and sex. The report shows lean tissue and lean tissue percentage across arms, legs, trunk, stomach and hips.
3/ Bone Mineral Density (BMD)
Analyzes the mineral density of bones in various regions including the spine, hips and wrists to identify areas of low density, evaluate bone health and prevent bone loss and fractures due to osteoporosis.
You get a Z-Score, which is a general overview and relative age-matched comparison of your bone strength. A score of -1 or higher, your bone is healthy while -2.5 or lower, you might have osteoporosis. Note: this is not a bone density exam which needs a medical professional
4/ Visceral Adipose Tissue (VAT)
Specifically the fat around the organs in the abdominal cavity which is inflammatory and associated with the increased risk of cardiovascular disease, diabetes and other metabolic disorders.
Your number should be as low as possible with a target of zero VAT.
Are You Skinny Fat?
Turns out the number on the scale or your BMI aren’t important metrics after all because they are not good predictors of health. Obesity does put you at a far greater risk across the board but you can also be underweight and heading towards chronic disease. Confusingly, it’s possible to be overweight yet have metabolic markers in optimal range.
According to Dr Gabrielle Lyon, founder of the Institute of Muscle-Centric Medicine and author of, Forever Strong, “muscle is the organ of longevity,” and apparently, I could use more of it.
While I was a healthy weight, my body composition results suggested I was “skinny fat,” a state of having higher body fat due to declining muscle mass and strength. It’s a percentage after all, so as one goes down, the other goes up.
“The current obesity epidemic is not an epidemic of being over-fat, but being under-muscled. Loss of muscle leads to rises in cortisol, insulin, stress hormones and blood sugar levels. These issues can occur quietly, without significant gains in weight, which is why it’s vital to measure these markers of your internal health.”
— Dr Gabrielle Lyon
Low muscle was likely contributing to my challenges with glucose metabolism and lipid regulation, despite my best efforts at a protein-rich, blood sugar-friendly diet.
Muscle is what they call “metabolically expensive,” meaning it requires a lot of energy, even when at rest. It effectively pulls glucose out your bloodstream when you use it. It's the reason why doing 20 squat jumps or walking after a meal can rapidly lower your blood sugar. The more muscle you have, the more glucose you can burn.
Other reasons why muscle is critically important
Movement + Strength
You need it for literally every single daily activity from walking to carrying groceries to playing sports
Stability and Balance
It keeps you steady, maintains posture, prevents injuries and helps to prevent a fall
Bone Health
Strong muscles exert force on bones when you move which stimulates bone growth and density
For those that need added incentive to build muscle, I’d add to this list: LOOK AND FEEL BETTER NAKED.
Strong Foundations
Osteoporosis seems like a disease for really old people, but here’s a wake-up call — the stats are staggering for those around 50. Hello, 50!
Unfortunately the disease is silent until you break a bone and, by then it might be too late. We fall because we have diminished muscle mass, strength, power and balance, which makes us unsteady and slows our reaction time. We fracture because we have weaken bones that cannot withstand the impact.
A sobering statistic from Dr Peter Attia that I’ve mentioned before is that 30% of those over 65 years of age who break a femur or hip will not survive the fall.
In the United States, an estimated 10 million people age 50 years and older have osteoporosis. Most of these people are women, but about 2 million are men. Just over 43 million more people — including 16 million men — have low bone mass, putting them at increased risk for osteoporosis.
— Health.gov
Who is most at risk for osteoporosis?
Post-menopausal white and Asian women
Small frames under 125 pounds
Those with eating disorders (malnutrition)
Men with low testosterone levels
Smokers
Heavy drinkers (more than two drinks per day).1
🚨PSA: Women can lose up to 20% of their bone density within 5 to 7 years following menopause, which is why they are at greater risk for osteoporosis. About one in two women over the age of 60 will experience at least one fracture due to osteoporosis.2
Build Your Body Armor
There is an extensive list of strategies for building muscle and bone which I’ll cover in a follow up post, but here are a few to get you started.
1/ Lift Heavy Sh*t
While we need to maintain muscle endurance (low weight, many reps), the focus later in life should be on muscle strength (high weight, low reps). According to Stacy T. Sims, the renowned exercise physiologist and nutrition scientist, “building true strength is a matter of increasing the maximum force your muscle can produce in a single contraction — how much you can lift or move in one shot.”
Heavy resistance training can help improve bone mineral density by strengthening corticol bone, which makes up 80% of your skeleton.
Biohack: Studies show using a whole body vibrating Power Plate, like the ones at PlateFit in LA, can improve bone mass in women under 653.
2/ More Protein (like, a lot)
As we age or as a result of reduced physical activity, we develop anabolic resistance, the diminished ability to build new muscle tissue in response to exercise or protein consumption.
Therefore we need to compensate by increasing our intake of protein to 1g per pound of body weight with the goal of 30g of protein each meal.
My preferred protein sources are turkey, chicken, eggs and fish. Other options are Greek yogurt, cottage cheese and nuts (but they are higher in carbs and fat).
3/ Eat Calcium-Rich Foods
Vegetables are great for your bones especially kale, collard greens, broccoli, cabbage and okra
Other good sources of calcium include dairy, tofu and nuts
4/ Supplement Wisely
Vitamin D: Many of us are deficient as it’s difficult to get it from our diet or from sun exposure. Depending on your bloodwork levels, supplementing with up to 5000 IUs of D3/K2 can help us absorb calcium from food and protect our bones.
Creatine Monohydrate4 has proven effective at increasing gains from strength training by increasing the amount of water in your muscles. Adding 3-5g of creatine powder to your workout smoothie can help build muscle mass.
5/ Check Your Hormones
For both men and women over 40, getting a baseline understanding of your hormones (such as estrogen and testosterone) can help determine whether declining levels could be accelerating the loss of muscle mass or bone density.
Hormone replacement therapy can be explored with you doctor to slow this degradation.
🚨 PSA: Insurance only covers bone density scans at 65 years of age and older. Another sign our healthcare system does not prioritize preventative medicine. Do not wait. Go out-of-pocket or use your HSA/FSA to get a DEXA scan TODAY. These four metrics can provide a good baseline for tracking preventative progress from diet and fitness as well as the risk for chronic diseases like sarcopenia, osteoporosis and other metabolic issues. Use code5 CELIA for a discount on your first scan at BodySpec ($50/scan) in Los Angeles, San Francisco, Seattle, Dallas or Austin.
While it’s not too late for me to improve my results, I wish I could go back in time to the moment I veered away from strength training. It’s not to say Pilates and yoga don’t have their merits in a fitness regimen. However I realize now the immense benefits I could have reaped from prioritizing muscle and bone building during my younger years.
Stay tuned for a follow up post delving deeper into my body composition journey. I’ll be discussing how to mitigate the impact of menopause on factors like lean muscle, bone density and fat distribution. I’ll be experimenting with nutrition, dedicated resistance training and other innovative modalities and doing additional scans to track progress.
Consider getting a DEXA scan, and join me for the ride! 💪🏼
xCelia
The take-away: Life is a long game, if you are lucky. Play to win by fortifying your body now with strong muscles and bones to carry you to the end. The benefits will give you a competitive advantage and sturdy defense against the challenges of aging so you can thrive.
All writing is for informational and entertainment purposes only and is not a substitute for medical advice, diagnosis or treatment.
PLOS One: Whole Body Vibration Treatments in Postmenopausal Women Can Improve Bone Mineral Density
Not an affiliate link but I have partnered with BodySpec to create an educational class about menopause and its impact on body composition.
Bone density is the new aspirational lifestyle.
Finally my decade long obsession with Crossfit shows its merit! I so love this research, Celia, and the Dexa scan has been on my list; 2024 may just be the year I finally do it. I have Peter Attia's book (audible, thankfully) but yet to start. I envision it's a summer listen.