What were the main criticisms of 'The Game Changers' documentary?

The documentary was criticized for cherry-picking research, relying on anecdotal demonstrations, presenting false dichotomies (vegan vs. extreme Western diet), and disregarding dose-response relationships and distinctions between risk and relative risk, rather than providing robust scientific arguments for veganism.

Does foam rolling effectively increase range of motion?

Yes, a meta-analysis found that foam rolling is more effective than doing nothing and as effective as static stretching for acutely increasing range of motion. Interestingly, its impact appears to be larger in females than males, though the reason is unclear.

How does capillary density relate to muscle growth?

A study by Mauro et al., replicating earlier findings, indicates that higher skeletal muscle capillarization is positively associated with muscle hypertrophy, particularly in older adults. This suggests that oxygen delivery capacity may be a limiting factor for long-term muscle growth.

Can isometric training reduce muscle soreness after eccentric exercise?

Yes, isometric preconditioning (e.g., 10 sets of 3-second maximal isometric contractions) performed 48 hours before eccentric training can significantly reduce muscle soreness and accelerate recovery of maximal torque, consistent with the 'repeated bout effect'.

What is the impact of resistance training on mortality risk?

A systematic review and meta-analysis found that resistance training reduces mortality risk by about 21%. When combined with aerobic training, the protective effect doubles, leading to a 40% reduction in mortality risk over approximately nine years.

What are the primary health benefits of a ketogenic diet?

The most established benefit is for epilepsy management, particularly in cases resistant to conventional drugs. Other widely applicable benefits include weight loss and improved diabetes management, where reductions in weight and better blood sugar control are often observed.

How do you objectively measure ketosis?

Ketosis can be objectively measured in three ways: blood ketone meters (most accurate and immediate), breath monitors (for acetone), or urine strips (indicating ketones from hours prior). Blood meters are generally preferred for precise tracking, such as when experimenting with protein or carb intake.

Does high protein intake 'kick you out' of ketosis?

Research suggests that while higher protein intake might generally reduce ketogenesis, there is no strong concrete association between protein levels and blood ketone levels. Individual variability is significant, so personal testing is recommended to see its effect.

What micronutrient deficiencies are common on a ketogenic diet?

Ketogenic diets, due to their restrictive nature, commonly lead to potential inadequacies in calcium, fiber, iodine, iron, magnesium, potassium, sodium, and vitamins A, B1, B9, C, and D. A well-formulated multivitamin is often recommended as a 'band-aid' solution.

How does a ketogenic diet affect blood lipid profiles?

Long-term ketogenic diets, such as those in the Verta Health Study, show sustained drops in triglycerides and small increases in HDL, but also a sustained increase in LDL cholesterol. The overall metabolic impact requires careful consideration and discussion with a doctor, especially for individuals with a history of heart disease.

Is the ketogenic diet better for fat loss or muscle gain than other diets?

When calorie intake and exercise are matched, ketogenic diets do not appear to offer an inherent advantage for fat loss or muscle gain compared to traditional carbohydrate-inclusive diets. Measurement errors due to water and glycogen shifts on DEXA/BIA scans also complicate direct comparisons.

How does keto impact endurance performance?

For elite endurance athletes, low-carbohydrate diets generally tend to impair performance. However, for recreational athletes or very low-intensity, long-duration activities (e.g., long hikes), the impact may be less significant or even advantageous if it helps manage hunger.

Are ketone supplements effective for performance?

Current research on ketone supplements for exercise performance is in its infancy and largely mixed. Most studies indicate no substantial or positive effect, and side effects like gastrointestinal upset and nausea are common. More well-studied supplements are generally recommended first.

What factors should someone consider before starting a ketogenic diet?

Key factors include personal preferences (food enjoyment, sustainability), organizational skills (meal planning, tracking), a supportive environment (friends, family, social groups), and home environment (removing disallowed foods). It's crucial to be fully informed and discuss any medical conditions with a healthcare provider.

Key Moments

The Game Changers, Vegan Diets, Foam Rolling, and Keto with Michael Hull (Episode 24)

Stronger By Science

Education8 min read171 min video

Oct 31, 2019|10,676 views|217|82

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TL;DR

A deep dive into vegan diets, foam rolling benefits, and the nuanced world of ketogenic diets with Michael Hull.

Key Insights

The documentary "The Game Changers" promotes vegan diets with flawed evidence and cherry-picked research, similar to other sensationalist nutrition documentaries.

Foam rolling and static stretching are similarly effective in acutely increasing range of motion, with potential sex-based differences in efficacy for foam rolling.

Higher muscle capillarization is linked to better muscle hypertrophy, particularly in older adults, suggesting oxygen delivery as a limiting factor in muscle growth.

Isometric preconditioning can significantly reduce muscle soreness and accelerate strength recovery after eccentric training, an actionable strategy for new lifters or after a layoff.

Resistance training reduces mortality risk by 21%, and combining it with aerobic training doubles this benefit to 40%.

Ketogenic diets are effective for weight loss, epilepsy, and diabetes management, but adherence can be challenging, and long-term effects on blood lipids require careful consideration.

Protein intake on a ketogenic diet may not significantly hinder ketogenesis, showing high individual variability, and net carbs are a more flexible counting method than total carbs.

Keto diets do not offer an inherent advantage for fat loss or muscle gain compared to other diets and may impair endurance performance at elite levels, though strength appears unaffected.

Exogenous ketone supplements currently lack strong evidence for performance benefits and may cause gastrointestinal upset.

A CRITIQUE OF 'THE GAME CHANGERS' DOCUMENTARY

The documentary "The Game Changers" is reviewed as a highly biased, pro-plant-based documentary that uses cherry-picked research and anecdotal evidence to support its claims. It features a protagonist influenced by ancient gladiator diets and makes sweeping generalizations, such as linking animal product consumption to poor athletic performance. The hosts of the podcast point out the documentary's reliance on false dichotomies (vegan vs. unhealthy Western diet) and a complete disregard for dose-response relationships or distinctions between risk and relative risk. They also criticize its misrepresentation of protein's role in high-intensity exercise and its dismissal of protein quality.

MISGUIDED ARGUMENTS FOR VEGANISM

The documentary makes several questionable points, including extensively proving that humans are not carnivores and using the analogy of cows building muscle without eating meat, while omitting crucial details about ruminant digestion. Another key concern raised is the documentary's attempt to discredit established trade organizations that promote protein intake by comparing them to tobacco companies. The hosts particularly highlight a segment featuring a urologist discussing nocturnal erections in relation to diet, finding its relevance and scientific rigor highly dubious. The documentary fails to provide a robust, evidence-based argument for its claims, largely due to its sensationalist approach.

PLANT-BASED DIETS VERSUS DOCUMENTARY BIASES

Despite the critique of "The Game Changers," the hosts emphasize that their dismissal of the documentary should not be interpreted as dismissive of plant-based or vegan diets themselves. They affirm that well-formulated vegan diets can be remarkably healthful and fully support athletic endeavors. The issue lies with the documentary's unscientific methodology. For general health, they recommend being active, maintaining a healthy body composition, scaling calorie intake, and consuming plenty of vegetables and fiber. They suggest a Mediterranean-style diet as a sensible, well-researched option for overall health, rather than extreme dietary approaches.

MARATHON RECORDS AND TRACK & FIELD HISTORY

The discussion covers two recent marathon world records: Eliud Kipchoge's unofficial sub-two-hour marathon (1:59:40) and Brigid Kosgei's official female record (2:14:04). Kipchoge's feat, though not sanctioned, is acknowledged as an incredible athletic achievement. Kosgei's record, shattering a 16-year-old mark by over a minute, is highlighted for its impressive nature. The conversation also touches on the common misconception that records are always improving in every sport. Many track and field records from the 1990s or earlier still stand, particularly in power and short-distance events, partly due to less stringent drug testing in previous eras. This makes current record-breaking achievements, especially in tested sports, even more impressive.

POWERLIFTING ACHIEVEMENTS AT USAPL NATIONALS

USAPL Nationals saw several remarkable performances despite some lifters facing challenges. Bryce Lewis broke the 105kg world record with a 902.5kg total, a significant comeback. Samantha Calhoun set a world record in the 63kg class with a 511kg total, showing consistent progress. Mahailya Reeves, a 15-year-old, tied for second in the super heavyweight class with a 612.5kg total, ranking third all-time for drug-free women, demonstrating immense potential. Jamar Royster achieved a PR total and moved into the top 10 all-time in the 83kg class, despite not hitting his squat goals. The defensive lineman Chase Young, with an exceptional performance for Ohio State, is also mentioned as a standout athletic feat.

FOAM ROLLING AND RANGE OF MOTION BENEFITS

A meta-analysis on foam rolling's acute effects on range of motion found it to be more effective than doing nothing and similarly effective to static stretching. The actionable takeaway is that individuals can choose whichever method they prefer or find more enjoyable. Interestingly, the study suggested foam rolling might have a larger impact on range of motion for females compared to males (effect size of 0.95 vs. 0.35), a finding for which the authors offered no clear hypothesis, inviting future research.

CAPILLARY DENSITY AND MUSCLE GROWTH

A study in older adults revealed that low skeletal muscle capitalization limits muscle adaptations to resistance training. People with higher capillary density experienced significant hypertrophy, while those with lower density did not. This reinforces the idea that oxygen delivery could be a limiting factor in muscle growth. The hosts hypothesize that at a certain point, individual muscle fibers may become too large to be adequately supplied with oxygen, thereby limiting further growth. This suggests that training methods aimed at increasing capillary density, such as high-rep training with short rest intervals, might help advanced lifters overcome plateaus, a testable hypothesis for future research.

ISOMETRIC PRECONDITIONING FOR MUSCLE DAMAGE REDUCTION

Research shows that isometric preconditioning (e.g., ten 3-second maximal isometric contractions) can significantly reduce muscle damage, soreness, and aid faster recovery of maximal torque after eccentric exercise. This is particularly useful for untrained individuals or those returning to training after a layoff. Incorporating an easy isometric session before a challenging workout can mitigate the severity of delayed-onset muscle soreness. Trainers can use this strategy with new clients to ease them into resistance training, improving adherence and reducing initial discomfort, as part of the “repeated bout effect” phenomenon.

RESISTANCE TRAINING'S IMPACT ON MORTALITY

A systematic review and meta-analysis found that resistance training reduces overall mortality risk by approximately 21% over an average follow-up of 8.85 years. The benefits are almost doubled when resistance training is combined with aerobic exercise, leading to a 40% reduction in mortality risk. This highlights the substantial, independent health benefits of resistance training and the compounded advantages of a combined approach to physical activity. The hosts note a positive shift in the medical community's recognition of resistance training's importance alongside aerobic exercise.

INTRODUCING THE KETOGENIC DIET GUIDE

Michael Hull from Examine.com joins the podcast to discuss their new 250-page guide, "The Evidence-Based Keto: Your No-Hype Guide to the Ketogenic Diet." The guide was created to address widespread confusion and interest in ketogenic diets among their readers. Michael, with an academic background in exercise science and nutritional science, was a senior researcher on the project, which involved a large team and external experts to distill complex research into practical concepts. The guide aims to provide unbiased, evidence-based information, rather than advocating for or against the diet.

DEFINING KETOGENIC DIETS AND THEIR BENEFITS

A ketogenic diet is defined as one that produces ketones, primarily achieved by limiting carbohydrate intake to less than 50 grams per day, though individual variability exists. The most well-known benefits include its use as a medical intervention for epilepsy, particularly in drug-resistant cases, and its utility for weight loss and diabetes management. While keto can lead to significant weight loss and improved diabetes markers, Michael emphasizes considering the demanding lifestyle changes required before committing to such a rigorous diet. Blood ketone levels of 0.5 mmol/L or higher typically indicate ketosis.

PROTEIN INTAKE AND KETOGENESIS

Contrary to popular belief, Examine.com's analysis of 19 studies found no concrete association between higher protein intake and reduced blood ketone levels. While a general reduction in ketogenesis with very high protein might occur, individual responses are highly variable. Some individuals maintained ketosis with protein intakes as high as 2.1 grams per kilogram of body weight. For those closely monitoring ketosis, objective measures like blood ketone meters are most accurate, with breath monitors and urine strips offering less immediate feedback. Less objective signs, like 'keto breath,' are temporary markers of initial ketosis.

CHALLENGES AND ADHERENCE IN KETOGENIC DIETS

Adherence to ketogenic diets can be challenging. An unpublished meta-analysis showed similar dropout rates (around 24%) for low-calorie keto and non-keto diets. Long-term studies, like the "Diet Fits" study, revealed that participants initially assigned to very low-carb diets (20g/day) quickly increased their carb intake to around 100g/day within three months, indicating that maintaining strict ketosis long-term is difficult for many. The hosts also discuss the phenomenon of decreasing measured ketone levels over time, speculating whether it's due to increased carb intake or greater metabolic efficiency, with current long-term data leaning towards the former.

POTENTIAL DRAWBACKS AND HEALTH CONSIDERATIONS

One universal drawback of restrictive diets like keto is the increased risk of micronutrient inadequacies (e.g., calcium, fiber, magnesium, various vitamins). Careful planning or supplementation with a well-formulated multivitamin is often necessary. Regarding blood lipids, the Verta Health study showed sustained increases in LDL cholesterol alongside improvements in triglycerides and HDL, and significant weight loss. The net effect on cardiovascular risk remains debated, and individuals, especially those with pre-existing conditions, should consult doctors and monitor their biomarkers. Michael emphasizes that the decision to pursue keto should be contextual, considering opportunity costs compared to better-studied diets like the Mediterranean diet.

KETO AND EXERCISE PERFORMANCE

When it comes to strength performance, the current, albeit limited, research suggests that ketogenic diets do not significantly hinder or enhance strength gains. However, for elite endurance athletes, low-carbohydrate diets generally appear to impair performance, particularly at higher intensities. The efficacy for recreational athletes or very sub-maximal, long-duration activities is less clear. The optimal strategy for enhancing both strength and muscle gain likely involves a higher carbohydrate intake. The concept of 'keto adaptation' is still not precisely defined in research, leading to individual variability in how people experience performance on the diet.

Mentioned in This Episode

●Supplements

●Software & Apps

●Tools

●Companies

●Organizations

●Books

●Studies Cited

●Concepts

●People Referenced

Ketogenic Diet: Key Considerations

Practical takeaways from this episode

Do This

Limit carb intake to less than 50 grams per day (adjust for individual variability).

Measure blood ketone levels for most accurate assessment of ketosis; breath or urine strips for casual checks.

Count net carbohydrates (total carbs minus fiber) for more dietary flexibility and fiber intake.

Ensure high daily protein intake (1.6-2.3 grams per kg body weight) for muscle preservation/gain during exercise.

Maintain good exercise volume and intensity for body composition benefits.

Consider a well-formulated multivitamin to address potential micronutrient deficiencies (calcium, fiber, iron, magnesium, potassium, sodium, vitamins A, B1, B9, C, D).

Be aware of potential LDL cholesterol increases and discuss with a doctor, especially if you have heart disease history.

Align the diet with your individual preferences, organizational skills, support system, and home environment.

Avoid This

Do not rely on the 'Gladiator diet' or purely anecdotal evidence for primary nutrition decisions.

Avoid drastic caloric deficits if muscle mass preservation is a priority.

Do not over-interpret small body composition changes from DEXA/BIA scans on keto due to water/glycogen shifts.

Do not expect an inherent advantage for fat loss or muscle gain on keto compared to traditional calorie-matched diets.

Do not expect performance enhancement for elite endurance athletes; low-carb diets may impair performance at this level.

Do not assume keto is a cure-all for conditions like Alzheimer's or widespread cancers without substantial high-quality research and medical guidance.

Do not rely on ketone supplements for performance benefits unless willing to experiment with uncertain outcomes and potential GI upset.

Do not overlook micronutrient intake; restrictive diets increase risk of deficiencies.

Common Questions

No, the book 'Carnivore Diet: How to Cure Depression and Disease with Meat Only' was incorrectly attributed to Jordan and Mikhaila Peterson. It was a compilation of their online content, and Amazon eventually removed it due to incorrect authorship.

Topics

Health & Longevity Nutrition & Diet Human Performance Muscle Hypertrophy Fat Loss Endurance Performance Diet Adherence Vegan Diets Micronutrient Deficiencies

Mentioned in this video

Media

The Game Changers

A documentary promoting plant-based diets, criticized by the hosts for cherry-picking evidence, using anecdotal demonstrations, and presenting false dichotomies.

Stronger by Science Podcast

The podcast hosting this episode, discussing nutrition, training, and recent research.

Terminator 2: Judgment Day

A film directed by James Cameron, sarcastically compared to 'The Game Changers' for its production quality.

Books

Carnivore Diet: How to Cure Depression and Disease with Meat Only

A book discussed for its controversial cover and claims, which was falsely attributed to Jordan and Mikhaila Peterson, and later removed from Amazon.

The Evidence-Based Keto: Your No-Hype Guide to the Ketogenic Diet

A 250-page guide produced by Examine.com, co-authored by Michael Hull, offering unbiased, evidence-based information on the ketogenic diet.

People

Jordan Peterson

A public figure whose name was incorrectly attributed as an author to the 'Carnivore Diet' book mentioned.

Mikhaila Peterson

Jordan Peterson's daughter, also incorrectly attributed as an author for the 'Carnivore Diet' book. She is known for promoting the carnivore diet and once challenged another expert to a race between their children.

Eliud Kipchoge

Kenyan long-distance runner who achieved the first sub-two-hour marathon, although not an official world record due to race conditions.

Usain Bolt

Jamaican sprinter whose athletic achievements are compared to Jesse Owens to illustrate the impact of technology on sports.

Jesse Owens

American track and field athlete mentioned to highlight how advances in sports technology (like shoes and tracks) impact performance over time.

Andrew Jones

Cardiovascular researcher known for beetroot juice research, who led Nike's Breaking2 project to achieve a sub-two-hour marathon.

Brigid Kosgei

Kenyan long-distance runner who broke the female marathon world record by over a minute, beating a 16-year-old record.

Paula Radcliffe

British long-distance runner whose 16-year-old female marathon world record was broken by Brigid Kosgei.

Bryce Lewis

Powerlifter who broke the world record in the 105 kilo class at USAPL Nationals, totaling 1989.6 pounds.

Samantha Calhoun

Powerlifter who set a new world record in the 63-kilo class at USAPL Nationals, totaling 1126.5 pounds.

Mahailya Reeves

A 15-year-old powerlifter who exhibited incredible strength, benching 330-370 lbs and squatting over 500 lbs, tying for third-best drug-free female total of all time.

Bonica Brown

A dominant powerlifter who Mahailya Reeves competed against and lost to at Nationals, described as a 'monster'.

Jamar Royster

Powerlifter who squatted 305 kilos (672 lbs) and achieved a PR total, placing him in the top 10 all-time in the 83-kilo class.

Chase Young

Defensive lineman for Ohio State, praised for an 'absolute problem' game with 6 tackles, 5 for a loss, 4 sacks, and 2 forced fumbles.

Ndamukong Suh

A dominant defensive player in college football, mentioned as a comparison for Chase Young's performance.

Nate Diaz

MMA fighter whose victory over Conor McGregor was illogically used by 'The Game Changers' documentary to argue against eating animal products.

Conor McGregor

MMA fighter whose loss to Nate Diaz was misused by 'The Game Changers' documentary to support plant-based diets.

James Cameron

Film director, mentioned as the producer of 'The Game Changers' documentary, leading to a sarcastic comparison of the documentary to Terminator 2.

Arnold Schwarzenegger

Actor appearing in 'The Game Changers' documentary, earning the film a bonus 'bag of popcorn' in the host's review.

Kamal Patel

The CEO of Examine.com, who recruited Michael Hull after seeing one of his blog posts.

Michael Hull

Senior Researcher at Examine.com and co-author of 'The Evidence-Based Keto' guide, interviewed for his expertise on ketogenic diets.

Zach Bitter

An ultrarunner who set the 100-mile world record on a low-carb diet, practicing a cyclical approach to carbohydrate intake based on training intensity.

Companies

Amazon

The online retailer that eventually removed the 'Carnivore Diet' book due to false authorship attribution.

Nike

Sports apparel and equipment company that funded the 'Breaking2' project aimed at achieving a sub-two-hour marathon.

Examine.com

A website focused on evidence-based nutrition and supplement information, where Michael Hull works as a Senior Researcher.

Organizations

WADA

The World Anti-Doping Agency, whose formation in 1999 significantly changed drug testing in the Olympics and impacted athletic records.

Ohio State Football Team

Their defensive lineman, Chase Young, had an exceptional performance against Wisconsin's offensive line.

Wisconsin Football Team

Their offensive line was acknowledged for a great game previously but struggled against Ohio State's Chase Young.

McGill University

Where Michael Hull completed his master's degree in nutritional science.

George Mason University

Where Michael Hull completed his undergraduate degree in exercise science with a minor in nutrition.

Concepts

Heisman Trophy

Chase Young's performance led to calls for his inclusion on the Heisman shortlist, despite defensive players rarely winning.

Repeated Bout Effect

The collection of physiological adaptations that protect against performance decrements and soreness after training, which can be initiated with low-intensity training or isometrics.

Ketogenic Diet

A diet characterized by very low carbohydrate intake, leading to the production of ketones for fuel, discussed in detail for its benefits, drawbacks, and applications.

Lactate threshold

A physiological marker in endurance exercise, discussed in the context of how keto might affect it, potentially decreasing VO2 max but increasing lactate threshold.

Multivitamin

Recommended as a 'band-aid' solution for ketogenic dieters to address potential micronutrient deficiencies due to restrictive food choices.

isometric training

A training method involving holding muscle contractions without movement, which can precondition muscles and reduce soreness from subsequent eccentric exercise.

resistance training

A form of exercise that, according to a meta-analysis, reduces mortality risk by about 21%, and when combined with aerobic training, can reduce it by 40%.

Whole30 diet

A popular dietary program, which Michael Hull reviewed in a blog post that led to his recruitment by Examine.com.

DEXA Scan

A body composition measurement tool whose accuracy can be impacted on a ketogenic diet due to rapid changes in water weight and glycogen stores.

Studies & Research

Wilk et al.

A systematic review and meta-analysis titled 'Acute effects of foam rolling on range of motion in healthy adults' which found foam rolling to be as effective as static stretching, possibly more so for females.

Mauro et al.

A study titled 'Low skeletal muscle Capillarization limits muscle adaptations to resistance training and older adults' finding a correlation between capillary density and muscle hypertrophy, especially in older adults.

Snyder et al.

An older study that found similar results to Mauro et al. regarding capillary density and muscle hypertrophy in older adults.

Barreto et al.

A study titled 'Protective effect conferred by isometric preconditioning against slow and fast eccentric exercise induced muscle damage' which found isometric preconditioning reduces soreness and speeds recovery from eccentric exercise.

MacDougall

A key paper that observed similar muscle fiber sizes in previously untrained lifters after six months of training, compared to experienced lifters.

DIETFITS Study

A large trial (608 participants) comparing low-carb and low-fat diets, which found that participants randomized to low-carb eventually increased their carb intake significantly, indicating challenges with long-term adherence to very low-carb.

Verta Health Study

A two-year ketogenic diet study (300 diabetes patients) that showed sustained improvements in weight loss and some health markers, but also an increase in LDL cholesterol.

Framingham State Food Study

A long-term study that examined dropout rates across high, moderate, and low-carb diets, finding similar attrition rates regardless of carbohydrate intake.

Tools & Products

Foam rolling

A self-massage technique found to acutely improve range of motion, similarly to static stretching, and possibly more effectively in females.

Bioelectrical Impedance Analysis

Another body composition measurement tool, also prone to inaccuracies on a ketogenic diet for similar reasons to DEXA.

Supplements

Glycine

An amino acid with a mildly sweet taste, jokingly suggested as an ingredient for 'carnivore diet desserts'.

Ketone supplements

Supplements that provide exogenous ketones, primarily studied for exercise performance but with limited and mixed research; generally considered in their infancy.

Software & Apps

Nutrition as I Know It

Michael Hull's personal blog where he wrote a review of the Whole30 diet that caught Kamal Patel's attention.