Cutting Calories but no Progress

As of 12/09/23 the natural bodybuilding subreddit has 240k members and is ranked Top 1% by size. In comparison, the White Coat Investor subreddit has only 55.9k members and is ranked Top 5% by size. The natural bodybuilding subreddit is up there with r/bogleheads (Top 1% ranked by size, 330k members) and r/medicine (Top 1% ranked by size, 460k members). I bring this up bc r/naturalbodybuilding is one of the premier place lifters flock to for dieting and training advice on building muscle and losing fat most effectively. Yet, as you will see below, it's full of midwit infused misleading advice. I am going to systematically go through a couple posts related to this thread below. Where do you go for good advice on dieting and training? Sadly, you will have to sift through a bunch of bullshit until you find someone who is competent, intelligent (intelligent enough they surpass the midwit valley), and has first person experience. Mind you, this critique below is only on this 1 topic. Don't even get me started on the fuckery that ensues on threads related to injuries.

OP:

"This phase seems to be going nowhere

I'm about 4 weeks into a cut and I've seen minimal movement on the scale and in body measurements. When I started this phase I was coming from 2900-3200 cals/day, went down to 2700 the first week, then 2500 the following, and then 2200-2400, and at 2100-2200 now. The scale went from 235 down to 230 in the first 2 weeks, but just bounces between 232-230 for the past 2 (trying to get to 220 by mid Jan). Biggest difference I've seen is my lifts are more of a struggle bus now. For instance, I was pushing a 255x6 flat bench, the week after I struggled with 245x8. My squat suffered from 295x7 -> 275x5 -> 225x8.

I expected the lifts to be less strong, but not this fast. And then to not even move what should be fat loss on the scale. I don't understand what I'm likely doing wrong with this. I hit my macro targets mostly (~210p, ~65f, ~206c), I get 6.5 hours of sleep on average during the week, maybe 8 or 9 on the weekends. To me it seems there's nothing left I could change to make this smoother and go in the direction I envisioned; I'll take whatever basic constructive criticism that can be provided."

Answers followed by my commentary below:

"It's possible you are burning fat but oddities of water retention and other factors of weight are masking that. Can't say for sure." —Oddities of water retention, often due to cortisol and overall stress, rarely ever show up at the beginning of the diet especially when the person isn't even near single digit body fat

"You should be getting a consistent 7-8 hours of sleep." —Plenty of the best bodybuilders of all time got by on 5 hrs of sleep. Also, the leaner you are the less sleep you need.

"you should be trying to hit 8 hours, even if 9 is harder. If you’re waking up at 04:30, that means being asleep by 20:30. It’s hard to know why that’s practically impossible for you without knowing the outline of your day (hours worked, responsibilities, routine etc). I will say that in working a shift pattern, I was getting to bed by 20:00 in order to be up at 04:00. You can get used to it fairly quickly if you don’t turbo the caffeine to compensate for poor sleep and get stuck in a cycle." —Lol. 8-9 hours of sleep. Good luck balancing making a lot of money outside of bodybuilding, maintaining a good romantic relationship, and raising a family. Going to sleep by 20:30 or 20:00?!?!?! Holy shit. Do you have a LIFE?

"Nothing is gonna happen in 1 month of cutting." —This is false. When you start a cut from a high body fat , BW should be dropping quite precipitously starting week 1. Heck, the BW should be dropping precipitously starting DAY 1.

"Go back to maintaining for a month and than restart.." —Uhh. Why?

"If you are advanced aim for a 200-300 deficit." —You're suggesting he cut kcals too fast. But what is his true maintenance? Better question. What is his maintenance RANGE?

"For reference I lost 8 kg over 9 months last year from 18-20 to 9-10 bf%." —1.96 lbs per month is way too slow. Many natural bodybuilders can get shredded from 12-14% bodyfat in ~14-16 weeks.

"Did you maintain weight for a couple weeks before you went for a deficit?" —There's something to be said for maintaining BW for a while after a bulk before cutting so you can solidify the gains but this isn't the reason why he's not losing BW. If anything, by not maintaining BW for a while after bulking, the BW should drop FASTER when he starts a cut bc the body is more willing to give up the BW (fat and lean tissue)

"I'd take your lifts. Drop the weight by 25%." —As long as rep range is reasonable, should not decrease weight lifted. More likely to lose muscle.

"But your cal cut is insanely drastic. Which means your bulk was 1000-2000cals unnecessarily high when you only needed 500 extra. Or your really stressing yourself out and messing your hormones into an unfavorable fat burning ratio." —Tell me you don't understand the metabolism without telling me. Again. What is his maintenance RANGE? Answer that question first.

"It should be +300-500 cals or -300-500 cals in either direction." —Says who? And what if refeeds are incorporated?

"At this point you might be better off just doing maintenance cals to start. Maintaining your strength on all exercises for a month just to prove you're actually at maintance and have proper recovery. And just cut cals by 50-100 every consecutive week until maintaining lifts feels more difficult. Then sit here until your weight stops dropping. Then add one more rest day and repeat." —Dude. Are you aiming to get lean in this lifetime or the next?

"And that's my whole motivation in telling you to go back to maintance calories and do as I described so you can get your cortisol down raise your T back up and most importantly fix your fat burning resting metabolic rate before starting your cut the right proper way because with what your describing with how dramatic of a calorie cut you've made with minimal results. You've crashed your resting metabolic rate which will result in muscle loss that'll be replaced with fat. Because your body thinks it's in survival mode now." —Lol. metabolic damage boogeyman.

"Also I don't think it was mentioned, are you even doing cardio? Please don't tell me the answer is 0. Yes you can fuck yourself up with excessive cardio. But trying to cut with no cardio is stupid. If your protein is sufficient and your not crashing your metabolism with ridiculous calorie jumps then cardio will actually accelerate your cut without burning muscle.

Even going from 0 cardio to 30 mins of LISS cardio walking on a treadmill with target HR of 130 BPM would literally turn your 300 cal deficit on when it wasn't working previously." —Overrated. Constrained TDEE.

"It's too soon to be judging the effectiveness of anything and you're making dramatic cal cuts week after week based on not enough time to let it work." —Again, should be able to see scale BW moving precipitously by day 1, definitely week 1.

"Nobody can tell you how and when exactly the strength loss is because it effects our leverages a little differently and with how the fat comes off, where it comes off." —OP just started his diet, only lost 5 lbs, nowhere near lean. Should have lost zero strength. Nocebo through and through.

"I calculate my tdee to be around 3200 (~2100 BMR + ~1100 active energy)." —These calculators are notoriously inaccurate.

Diet Fatigue

You’ll generally be able to find out if it’s diet fatigue causing significant water retention and masking fat loss by simply implementing a refeed and taking daily kcals significantly over upper threshold of maintenance (at least 500-1000 kcals). And really. These refeeds won't do what they are intended to do unless the kcals are significantly over maintenance. Don't be afraid of the BW spike. Even on paper a 1000 kcal surplus results in negligible fat gain. I find the tighter the window you can do the refeed in the better. The day after the refeed you can capitalize on the additional reserves and transiently increased RMR by dropping kcals moderately lower than your base dieting days. If it is diet fatigue, once you jump back on your low days (assuming your low days are low enough and not just lollygagging at just slightly below maintenance), you should drop below baseline in like ~3 days.

Diet fatigue does contribute to water retention. Water retention masking fat loss isn’t necessarily a bad thing in and of itself. But diet fatigue ALSO increases risk of muscle loss. So water retention is a good proxy for risk of muscle loss.

The 500-750 kcal rec Mike talks about is actually a good rule of thumb for bodybuilders (you’re not a fat mess). Accounting for the fact that BW loss isn’t purely fat loss, it translates to about 2 lbs of BW loss per week which is as fast as you should shoot for unless you just don’t care about preserving muscle.

Bound and Free Glutamate—Cook your Proteins

Wrt fat loss, you often hear the advice that you should avoid hyperpalatable foods. However, people express less hunger and more mental fullness after eating better-liked versions of a food. You should only avoid hyperpalatable foods to the extent they generally (not always) offer a poor ROI wrt gram weight volume and calories. Put another way, if a food/dish has a very high ratio of gram weight volume to calories, you SHOULD maximize how good it tastes.

Wrt satiety, satiation, and fat loss umami is very important because the more you can capitalize on umami, the higher the satiety (between meals) you can achieve. A reasonable counter to this is that increasing umami will result in a person eating more within a meal (satiation). My answer is if you don't capitalize on umami within a meal, you are going to experience much higher cravings and hunger throughout all your waking hours (tbh it might even interrupt your sleep). So, my strategy around this is to maximize umami within a meal (which can often times only be achieved with savory animal proteins like beef, chicken, salmon, whole eggs.) and capitalize on VOLUME with a high ***gram*** weight volume per calorie carb source. If you can surpass a threshold of 1,000-1,300 grams of food for a meal, you will likely be able to achieve satiation (within meal fullness).

“Umami taste is increased by the presence of IMP and GMP, and IMP is found in relatively high qualities in meat and ​fish (for example, IMP has a concentration of 286 mg/100 g in tuna).

The effect of MSG on palatability is not universal across foods: MSG does not enhance liking for sweet taste or for liking of the flavour of sweetened foods. MSG enhancement of flavour appears to require some existing umami-like element to be present.”

—Flavor, Satiety and Food Intake (Institute of Food Technologists Series)

There's a lot of hype around sashimi, medium rare steaks, and tartare. However, the mere presence of protein in animal proteins does not necessarily result in significant umami taste. Harnessing most of the umami taste in animal proteins requires the breakdown of protein tissue through hydrolysis, which typically only happens after the protein is actually cooked.

For 100 grams of raw beef, there are 33 mg of free glutamate and 2,846 mg of bound glutamate. Only "freed" glutamate produces umami taste. If beef is only cooked medium rare, you are leaving out a lot of umami bc only the outside of the steak is cooked. In contrast, if you fully cook 96/4 ground beef (and add just enough liquid to it while cooking to maintain moisture and avoid the beef from drying out), you will release that other 2,846 mg of bound glutamate to enhance umami. That is an ~85x increase in umami just by fully cooking beef. A bonus is you have also just increased gram weight volume of the dish with the added liquid, which is now also infused with the freed glutamate from the beef.

For 100 grams of raw salmon (sashimi), there is only 20 mg of free glutamate. To "free" up the other 2216 mg of bound glutamate so that it can actually contribute to umami taste, you need to cook it. That is a ~110x increase in umami taste just by fully cooking the salmon. Sous vide wild salmon at 120 degrees for 45 min-1 hour. Trust me.

Refeeds, Numbers, Formulas, Calories-in-calories-out

In general, do you need to be in a calorie deficit to lose bodyfat? Yes. 

Is it as simple as "3500 kcals is 1 lb of fat loss?" No. 

Does the magnitude of the deficit lead to a rate of BW and fat loss that you would expect based off simple formulas and calculations? No. In fact, my experience is that especially after a massive refeed/cheat, a larger deficit (like 1600 kcals/day instead of 1800 kcals/day intake) gets me back to baseline (and below) way faster than what calories-in-calories-out would predict. 

And for the grand finale...see below:

Q: I have read numerous threads in this site, trawled through other forums and websites but can't find a discussion or answer to the following:

Please correct me where I am wrong as I am keen to learn more on this...

Thermodynamics is essentially at play with calories in and calories out. We cant create energy out of nothing but we can transfer it. Therefore weightloss (ideally fat loss) comes about via being in a deficit.

Hypothetical example: If a person has a maintenance intake of 2500 calories per day , the only way to ensure this person can Skipload and still lose weight is to create a calorie deficit over the 6 days that is greater than the calorie intake over and above 2500 during the Skipload day.

E.g maintenance = 2500 cals x 7 = 17500 cals per week.

Implement a 800 cal deficit for the first 6 days = 1700 cals per day.

The Skipload day needs to be less than 2500(maintenance) + 6 x 800( our daily deficit).

I know the Skipload is not a numbers based protocol but I havent seen it discussed how people approach the first 6 days and still ensure the weekly deficit and it is this I am interested in.

Look forward to hearing thoughts and discussion on this."

Skip's answer: 

"Great question but one that a lot of people don't like the answer to because it isn't as black and white as the numbers. In fact, if we go by JUST the numbers, it simply cannot work, and yet it does.

Though skiploads change from person to person, there are plenty of people who can load for 3 meals over 6 hours and this is a pretty average skipload time. At any given time in the last 20 years of doing what I do, roughly 50% of my clients will be loading at 6 hours. However, there are others who will load at 12 hours or more. Even if you take a look at any other trainer who might allow a cheat meal every now and then, that one cheat meal will also surpass any caloric deficit for the week, if you are approaching it strictly by the numbers. So, what is really going on?

The best I can do is give you my opinion based on doing this for almost 20 years (started in 2002).

Here are a few points that are important in understanding how it works:

Calories in and calories out doesn't work in a situation like this. It can't. Anyone who says it can or that it does, is just plain wrong. As I said before, the numbers prove this. Otherwise, there is no way anyone would get lean, let alone ripped to shreds. Calories in and calories out is a rudimentary way to understand WEIGHT loss. What we are doing with skiploading—as bodybuilders—is not as simple as weight loss. It is about body fat loss and either maintaining muscle or even gaining muscle at the same time. This is where hormones comes into play, timing comes into play, etc. I know a lot of people disagree with this but my response to them is, "explain how skiploading works as well as it does." They can't do that. Let me take that back; they will TRY to explain it, but it makes no sense and isn't logical.

One of the things that is crucial to successfully getting lean while skiploading is the fact that you need to be glycogen-depleted. This alone will help to cause super-compensation from skiploading. Without getting into numerous paragraphs to explain this, it's a situation with insulin sensitivity, replenishing glycogen stores, and amping the metabolism. Kind of a 2-steps-forward-one-step-back concept.

On it's own, the above doesn't explain why the numbers don't work. It needs a second part and this is the caveat to the entire thing and it is and will be argued ad nauseam:

The body can and will get to the point where it cannot fully digest all of the food ingested. For a short skipload, this likely doesn't apply. For longer skiploads, it absolutely can. Look at it this way and anyone who has experience with long skiploads will back this up: you will get to the point where food coming in has to basically push food out the other end. The food either moves through the system quicker and/or the volume of food is so large that it can't process and assimilate all of it. People who have experience with very long skiploads will report more pale-colored feces later in the skipload. This is because the amount of food overwhelms the liver's ability (and the gall bladder) to provide enough bile salts. When there isn't enough bile salts, the body cannot break down fats as easily or efficiently. Those fats pass through the digestive system not being fully digested and assimilated. In short, this means these calories do NOT count because they weren't digested to be counted as a unit of energy. Most people believe that as soon as you eat something, the calories count. They certainly don't count if you throw them up or they move through your body without being fully digested.

The next question should be obvious: why would someone eat so much food if it isn't all digested? The reason is because when you are very depleted, you can either guess at the amount of food you need and hope you are right, or you can saturate your system with calories knowing that you are maximizing the amount of food your body is able to process. The latter means that your only limitation is what your body can handle—digest, assimilate, and use.

When you put together these 2 "caveats" above, you have a situation where you are maximizing glycogen storage, maximizing recovery, and maximizing the amount of calories that your body can use during the skipload. The more calories you get in, the more "gas" you are pouring on your metabolic fire for the following week when you go back to regular dieting. Yes, you can overdo the skipload, so there is a point where it is too much and body fat can be stored. This is why the skiploads start small and you build into larger skiploads over time. It is also why it is important that someone with a lot of experience with skiploading is dictating how long and how much to load. Someone like, say, me. 

To circle back to the point of the caloric deficit and the numbers not working, even without all of the calories "counting" from the skipload, there will still be an extremely large amount of calories that cannot be explained away with numbers (in reference to x amount of a caloric deficit). The explanation that I have given is the best I can do right now. It would take a lot more knowledge and a lot more science to get into the exact reasons, but I am confident that my opinions above explain probably 90% of what is going on. The other 10% will be explained by someone else who is smarter than I am and probably much younger than I am. I say younger because I don't think there is going to be a black and white explanation for why or how it works for a while. I think we have to learn more about the relationships between food intake and hormones to know the exact reasons why it works."

Satiety and Satiation Part 3

Links to Part 1 and Part 2

Using specific examples of a typical bodybuilding diet, I’m going to show you exactly why the experience of dieting down involves much more suffering than is necessary from a food enjoyment, satiety, and satiation perspective.

If you're a natural male lifter trying to diet down very lean (and this is assuming you have put on a good amount of overall muscle mass firts), chances are you will have to dip kcals down to sub 2k. Let's use 1800 kcals as an example. I'll set protein at 165 grams (1 gram per pound of LBM). Set fat at 50 grams. You're left with 690 kcals to play with in the form of carbs. If you're eating a reasonable and optimal 4 meals per day, you're likely going to cluster these carbs peri-workout. It'd probably look something like 300 kcals worth of carbs pre-workout and 300 kcals worth of carbs post-workout. When dieting hard in a deficit and carbs are low, you should have some carbs peri-workout. You don't necessarily need this many grams of carbs pre and post-workout but eating less than 300 kcals worth of the typical bodybuilding bro carb source is such a low volume of food that it's a tease and just leaves you feeling very deprived. Even so, when you're dieting hard, 300 kcals worth of even the typical bodybuilding bro carb source isn't all that satiating, even if you pair with a lean protein. And after those 2 meals, you're left with pretty much just protein and veggies for the other 2 meals—which sucks. 

Let's use oatmeal as an example. 300 kcals of oatmeal is 80 grams of dry oats which is 1 cup. You prepare with 1.75 cups of water which is 414 grams. You pair with a lean protein source, likely 150-200 grams worth. At most, you're looking at 690 grams for the whole meal. This is for a meal that clocks in at around 500 kcals. Oatmeal is already lacking in texture (baby food texture), so you won't enjoy it that much. So you're likely not going to add even more water. 

Let's compare this to 32 grams of puffed kamut + 800 cc cold water + 4 grams TN chocolate flavor pack + 161 grams chicken breast. That is about 1,000 grams for the whole meal. 1,000 grams for 300 kcals. Way more satiating and crosses that 800-900 gram threshold. And if I eat this meal both pre and post-workout, out of the 690 kcals worth of carbs I can play with for the day, I still have 490 kcals left to play with for my other 2 meals. Hell, I could do puffed kamut AGAIN for those last 2 meals and STILL have 290 kcals left of carbs to play with. 

I'm not really going to cover cream of rice, white rice, brown rice, bread, pasta. They are even worse from a satiety and satiation aspect compared to oatmeal. 

I already talked about why puffed products are very suboptimal choices. Air doesn't make it into your stomach. And 300 kcals of something like Quaker Rice Cakes is only 78 grams of food. 

Fruits and veggies. Let's use broccoli and strawberries as examples. 100 kcals of broccoli is 300 grams. 100 kcals of strawberries is 300 grams. My puffed kamut concoction is 113 kcals and 836 grams. Further, I don't know about you but my palate gets pretty bored after eating 100 kcals worth of strawberries, blueberries, broccoli, cauliflower, etc.—even if I haven't achieved satiation yet. At the very least, it would prefer to have a starchy carb source (e.g. puffed kamut). If volume was the only thing that mattered for satiation, then we could just chug liquids. Unfortunately, that's not the case. It's hard to override that innate desire to actually experience chewing and swallowing starchy carbs. 

Protein ice cream. This is actually not a bad option from a volume standpoint. However— and this is really getting into personal preference—my reasoning for not really eating protein ice cream on low days is while I do like sweets, I also have a craving for savory foods. Veggies don't really cut it for me. It is very difficult to find or put together high volume savory carb sources. So I tend to like to keep my protein sources in my 4 meals savory (egg whites + whole eggs, chicken breast, beef, salmon). Keeping your protein sources savory allows you to capitalize on the IMG + MSG umami synergy that increases satiety. I am satiated for much longer with a puffed kamut + wild salmon meal compared to a protein ice cream meal even when kcals are controlled for. 

Pay attention to your cravings, satiation, and satiety. Pay attention to them before, during, and after meals. Like for me I typically crave both sweet and savory in a meal—which is why puffed kamut (with 800 cc cold water + TN chocolate flavor pack) and a savory protein source work so well. Even if I were able to reach the point of satiation volume wise, if the meal only consisted savory foods or only consisted of sweet foods, my cravings would still be there; and I would be quite hungry very soon after the meal. 

Intermittent fasting. If you eat less than 4 evenly spaced out meals per day, it's suboptimal from a protein bolus frequency standpoint for maximizing hypertrophy/LBM retention. If you make 1-3 of those meals just protein, it's just a tease. Is it worth it to suffer for those 1-3 meals or to just be hungry the majority of the day so you can have 1-2 large meals per day where you actually achieve satiation? YMMV, but not for me. I'd rather be satiated all 4 meals of the day—pretty much throughout the entire day.

Also, many of the most productive people I know train in the AM shortly after waking up. Acknowledging you should have carbs and protein around your workout, with intermittent fasting are you really going to structure your day so that you're not going to eat or only have protein meals the rest of the day? It significantly constrains your options if you eat out at night as well—and social gatherings involving food are typically going to take place at night. With the way I have my diet set up, I am not only satiated but I have also only consumed ~1100 kcals by the time my last meal comes around, which gives me a lot of leeway/freedom to eat out at night. 

Keto products. How many calories your body digests and absorbs from these products will vary. Take the kcal values on the nutrition labels with a huge grain of salt. Whenever I incorporate products like these into my diet, my BW responds in a way that suggests I’m eating more than my logged kcal intake. For example, if 1800 kcals puts me in a mild deficit, just subbing in 1 pint of “240 kcal” Nick’s Ice Cream (total kcals for the day tallying up to 1800 kcals) will take me out of that deficit and result in BW stall. I’ve experienced the same with other keto products like Aunt Millie’s bread and Quest bars. 

Satiety and Satiation

Satiation is what signals us to stop eating a meal.

Satiety is how satisfied we are in between meals.  It is a longer-term phenomenon that occurs when we obtain enough of the all the essential nutrients like the vitamins, minerals, amino acids, and fatty acids we require.  Thus, we don’t search for more or as much food for a longer time.  

From this article:

"The average person eats between three and five pounds of food per day. In a pamphlet entitled Low-Energy-Dense Foods and Weight Management: Cutting Calories While Controlling Hunger, the CDC writes, “Research shows that people eat a fairly consistent amount of food on a day-to-day basis. This finding holds true whether the amount of food contains many or few calories.”  —Take the ceiling here which is 5 lbs of food per day. That is 2267.96 grams of food per day (eaten at lib to comfort). It's reasonable to assume the average person eats somewhere around 3 meals per day. That is around 756 grams per meal. So, if you're dieting down and dieting hard, each of your meals should hit a minimum threshold of 800-900 grams to achieve satiation. Since you'll be in a calorie deficit and likely hungrier when meal time comes around, you should err a tad higher. I'd say 1300 grams is a reasonable minimum threshold for maximizing satiation. 

Let me emphasize that this is GRAMS of food. What this means is puffed products alone aren't very effective. This includes rice cakes and popcorn (Greg Doucette LOL). Air from puffed products don't make it into your stomach (gastric stretch mediated satiation). Liquid does though. See below.

From this article:  

"Protein seems to have a greater effect on satiety than the other macronutrients. A minimum of 20g of protein per meal seems to be the sweet spot." —It's optimal if protein source is savory to capitalize on the synergy of IMG + MSG (enhance with MSG sauce like Maggi sauce), which further enhances satiety. Monosodium glutamate (MSG) has been shown to increase satiety when combined with protein. Inosine 5'-monophosphate acts synergistically with MSG when tasted, is present in high-protein sources, and may potentially further enhance satiety. For satiation (triggers you to feel full during the meal), it's hard to beat the bang-for-buck you get with carbs and water. More specifically, you should prep the carb source in a way where you are ingesting a high volume of liquid without your brain really registering that it is largely liquid you are ingesting. Yes, you essentially want to trick the brain. Refer to study below: 

"In general, the water content of foods is a critical determinant of energy density; it has a larger effect than other ingredients such as fat or fiber. We saw in the previous experiment that adding water to a food increased the effect of the food on satiety. It is of both practical and theoretical interest to determine whether the addition of water affects intake simply by increasing the volume in the stomach, or if an increased volume of food affects satiety through sensory and cognitive influences. For example, a food with added water will look bigger and will likely cause greater stimulation of oropharyngeal mechanisms. One way to separate these influences is to test subjects with the food and water consumed separately and to compare the effects with those when the food and water are mixed together. In a recent study, we developed a chicken, rice and vegetable casserole containing 1128 kJ and weighing 263 g (Rolls et al. 1999b). The base of this casserole was undiluted cream of chicken soup; thus water could be added to the casserole to make a soup. The casserole and soup had exactly the same ingredients except for the additional 356 g of water in the soup. In a third condition, the casserole was served with a glass of water equivalent to the amount of water that had been added to make the soup. When the women in the study ate lunch 5 min after finishing the preloads, the water affected how much was eaten, but only when it was incorporated into the casserole to make a soup. The women ate similar amounts when the casserole was served with and without a glass of water. When they consumed soup, however, they felt fuller and less hungry and consumed ~27% less energy compared with intake at lunch after the casserole. The subjects did not compensate at dinner for this reduction in lunch intake. This study showed that water had to be incorported into a food, thereby increasing its weight or volume, to influence satiety."

"Food volume is important in the satiety response and may be more important than specific macronutrient content." — More accurately this is for satiation, not satiety. 

From this study:

"The effect of mastication on food intake was stronger insofar as more trials found a significant effect of mastication on food intake. Overall 10 of 16 experiments which measured energy intake found a significant effect of chewing on ad libitum intake. The first to demonstrate this was Lavin et al. [24,33] who showed that sucrose containing preloads consisting of a chewable candy (pastilles) reduced energy intake at lunch compared to the same energy provided as a semi-solid (jelly) or as a drink. The pastilles took 10 min to chew, the jelly 5 min to eat and the drink 2 min to consume. Thus the conditions differed in both chewing effort and oral transit time. Nevertheless, despite showing no effect on appetite, participants reduced intake of a pasta and bread test meal following the pastilles compared to water and the sucrose drink preload. It can be concluded that prolonged chewing reduced intake at the lunch." —Food texture/bite is important for both satiation and satiety. This is why oatmeal sucks. Cream of rice sucks even more. Stop eating baby food. Puffed kamut is the winner. 

Read my puffed kamut reddit post. Over 700 upvotes ok?

https://www.reddit.com/r/1200isplenty/comments/rnty20/puffed_kamut_is_king_for_satiety_300_kcals_kashi/

32 grams of puffed kamut (slightly nutty and buttery flavor) with 800 cc of cold flavored liquid and 4 grams of TN flavor pack. Really, True Nutrition's Chocolate Flavor Pack is the best for this. I've tried this with Skinny Syrup and Almond milk—it's not as enjoyable. Just with 113 kcals, you've already hit 836 grams for 1 meal!!! Refer to what I talked about above wrt 800 grams minimum threshold for satiation per meal. Puffed kamut eaten the way I recommend is very unique in that puffed kamut is actually firm with a slightly chewy texture (unlike other puffed products such as popcorn). What I notice is that because of this firm and slightly chewy texture, I naturally want to drink the cold flavored liquid IN BETWEEN bites. This is essentially prepping the food in a way where I am eating the carb source with a lot of liquid but my brain not realizing that I'm just ingesting a bunch of liquid. This is not at all the same as having a cup of liquid to drink separately. Remember, we are trying to trick the brain here. You wouldn't enjoy ramen if the noodles and broth were separated into two different bowls. This is very similar to how vegetables and fruits help you achieve satiation without you even noticing that they are over 85-90% water. 

By the way, 32 grams of puffed kamut is 4 grams of fiber. Fiber slows digestion and contributes to satiety. If you eat 32 grams of puffed kamut 4 times per day, that's 16 grams of fiber. Pretty good eh? 

"Participants enjoyed their meal less when asked to prolong chewing by 30 s for each mouthful." —Yes, mindful eating with no distractions is good. But you don't want to purposefully slow someone down. 

"Sham feeding models have shown that oral stimulation affects circulating ghrelin concentrations." —Again, food texture is very important. Stop eating baby food like oatmeal and cream of rice. 

From this study:

"This study assessed the impact of liquid whey protein dose manipulation on subjective sensations of appetite and food intake in a cohort of athletes. Ten male athletes who performed both resistance and aerobic (endurance) training (21.2 ± 2.3 years; 181.7 ± 5.7 cm and 80.8 ± 6.1 kg) were recruited. In four counter-balanced testing sessions they consumed a manipulated whey protein supplement (20, 40, 60 or 80 g protein) 1 hour after a standardised breakfast. Subsequent energy intake was measured 3 hours after the protein supplement using an ad libitum test meal. Subjective appetite sensations were measured periodically during the test day using visual analogue scales. All conditions resulted in a significant decrease in ratings of hunger (50-65%; P < 0.05) at the time of supplement consumption. However, there were no significant differences between the conditions at any time point for subjective appetite sensations or for energy consumed in the ad libitum meal.  Increasing whey protein supplement dose above 20 g did not result in a measurable increase in satiety or decrease in food intake." —Again, 20 grams protein minimum to maximize satiety (between meals), not necessarily satiation (carbs with high volume liquid—but prepping in a way so your brain doesn't register you're just ingesting a bunch of liquid—are the key here)

Read Marty Kendall's article here. It's very good:

"Although low energy density foods might make you feel full in the short term, our analysis suggests that you might search for food again before too long.  While low energy density foods provide some essential vitamins and minerals, they don’t supply the complete array of nutrients you need, particularly the amino acids selenium and zinc.

Consider how a big bowl of watery soup may leave you feeling full immediately after you eat it. However, there’s a good chance you’ll be hunting for some more energy dense foods in only a few hours.  

Conversely, low energy density veggies alongside a lean steak may keep you from thinking of food for many more hours.  So while this meal provides more calories, it’s likely to bring you satiation and satiety for long and short-term satisfaction that will allow you to eat less.

The table below shows a selection of these parameters ranked by the most to least substantial effect each has on satiety based on our analysis of 125,761 days of data from 34,519 Optimisers.  For example, we tend to consume 55% fewer calories each day when we move from a diet with a low percentage of total calories from protein (protein %) to a very high protein % diet.  Energy density comes in at number 19 on this list of parameters that positively affect satiety. "—Did you read that? For satiety (not satiation), energy density comes in all the way down the list at number 19!!! All you IIFYM fans should focus on the QUALITY of your diet especially if you are dieting hard in a calorie deficit. What ranked ABOVE energy density? Protein, potassium, methionine, valine, diet quality, cystine, isoleucine, phenylalanine, lysine, histidine, threonine, tyrosine, phosphorous, tryptophan, cholesterol, folate, calcium, niacin (B3). 

"Protein % has a highly statistically signficant impact on energy intake throughout the day.  Moving from 22% to 44% protein reduces energy intake independently by around 33%." —People will eat through kilos of food and thousands of extra calories to meet their protein minimum. Eat at least 1 gram of protein per pound of LBM. 

"Moving from lower to higher intakes of potassium, calcium, fibre, and sodium per calorie also correspond with a lower calorie intake. " —Yes, sodium. Salt your food to taste! 

"The multivariate analysis shows that some of the satiety benefit previously attributed to protein is actually due to other micronutrients."

"If you want to improve your satiety across the day, it’s better to focus on foods and meals with a higher nutrient density to ensure you get the protein, vitamins, and minerals you require at the expense of minimal energy." —Remember, this is for satiety. For satiation, biggest bang for buck is carb + discreet liquid. 

"The lists below illustrate what nutrient-dense foods look like.  As you can see, they still have a fairly low energy density, but a high nutrient density to ensure you get everything your body requires from the food you eat." —Go to the link above if you want the actual table. I'll just highlight some good options: asparagus, broccoli, cauliflower, zucchini, green peppers, whole egg, egg whites, pork, beef, crab, cod, shrimp, salmon, haddock, tilapia. I would also add chicken and turkey. 

Now, what is the optimal meal frequency? I recommend every ~4 hours which incidentally falls right in line with the recommended protein bolus frequency to maximize hypertrophy.  You can certainly eat protein alone but the downside is without carbs you likely won't be able to hit the ~800 gram meal threshold for satiation. Why every ~4 hours? Carbs are shown to have the highest acute satiety until the 150 min mark, when protein takes over. After 3 hours, carbs return Ghrelin levels to baseline fasting levels. 

Here are some other satiation tips. You should start thinking about incorporating liquid to elevate your dishes. Not only will the liquid contribute more volume to your dish, it will also make the dish taste better. 

Similar to how puffed kamut's firm and slightly chewy texture makes it ideal to be eaten with a lot of flavored liquid (and conversely would be way too dry and chewy when eaten alone)—there are many other dishes/foods that bodybuilders typically eat that would benefit from adding liquid. 

96/4 lean ground beef. What is the most common complaint of lean ground beef? It's dry. When you cook 96/4 lean ground beef, you should add water so that you are essentially simmering the meat. When you're done cooking the meat, transfer it to a bowl WITH the simmered liquid (which is now also infused with the meat flavors, herbs, spices, seasoning you used). Before eating, add a couple drops of maggi sauce and eat it like you would kind of like a stew. You will notice that the broth tastes pretty damn good. Veggies like broccoli and cauliflower also complement lean ground beef. Veggies are over 85-90% water and offer a nice counterbalance to any additional dryness of the lean ground beef. One of my meals is 96/4 lean ground beef, broccoli, cauliflower, and puffed kamut (with 800 cc cold water + TN chocolate flavor pack). It's an absolute satiation and satiety bomb for only 380 kcals. I can go up to 5 hrs without eating after that meal. 

Blueberries. What is the most common complaint of blueberries? They are too tart. You should submerge FRESH blueberries in a bowl of cold water and add 8 drops of ez-sweetz (sucralose). Eaten this way, blueberries taste much better. And you've just added additional volume to your meal. 

Why not just add Splenda/Stevia packets without the liquid? Those aren't 0 calories (they are suspended in maltodextrin and dextrose which are not zero calories)

Why FRESH blueberries and not frozen? Water makes up 70-90% of the weight of most fruits and vegetables. It and other substances are stored in the rigid cell walls which support the structure and texture of the product. When you freeze a fruit or vegetable, you are freezing the water contained in the cells. As the water freezes, it expands, and ice crystals cause the cells walls to rupture. This causes the texture to be much SOFTER when it is thawed than when it was raw. Rapid freezing and vitamin C mitigate this but not nearly enough. Just buy fresh blueberries. Same thing with broccoli and cauliflower. Don’t buy frozen or precut (once broccoli and cauliflower are cut, quality degrades much faster) broccoli and cauliflower. Buy the whole crowns/heads. Texture after cooking is much better. Remember, TEXTURE is a big factor wrt satiation and satiety. Although blueberries are slightly more calorie dense compared to strawberries and watermelon, I still find FRESH blueberries a superior fruit from a texture standpoint bc the skin is significantly more firm and chewy.

Always have your meals with a cup/bottle of water with you. Let's say one meal is salmon and puffed kamut. You eat the salmon and are thirsty after. Drink water after before diving into the puffed kamut. Remember, we are capitalizing on adding volume to your meals in a way where the whole meal experience is elevated. This is such a no brainer recommendation but I feel like it's worth mentioning bc people often forget this. I am in no way recommending you to force liquid into your meals/dishes—only add if it elevates the dish/meal. Why not a flavored drink or diet pop during the meal? YMMV but I find flavored drinks mask the flavors of whatever I'm eating. I do drink diet pop but I typically drink it either after a meal or in between meals. 

Lastly, learn to cook your proteins right. Stop eating dry ass chicken breast. If you have to, buy a sous-vide or an air fryer. Once you've had lean chicken breast cooked sous-vide at 142 degrees for 1 hour, you will find all other chicken served at restaurants inferior. Ditto with wild salmon cooked sous-vide at 120 degrees for 45 minutes. And you will appreciate just how many unnecessary calories restaurants add to their dishes when you could achieve BETTER flavor (herbs, spices, MSG sauce, g hughes) and texture saving hundreds of calories. 

Make your food taste damn good. Maximize satiety and satiation. And other than the social aspect, you really won't feel like you're missing out by not eating out—even when you're dieting hard and getting shredded. 

Keto Friendly Products and Sugar Alcohols

How many calories your body digests and absorbs from these products will vary. Take the kcal values on the nutrition labels with a huge grain of salt. Whenever I incorporate products like these into my diet, my BW responds in a way that suggests I’m eating more than my logged kcal intake. For example, if 1800 kcals puts me in a mild deficit, just subbing in 1 pint of “240 kcal” Nick’s Ice Cream (total kcals for the day tallying up to 1800 kcals) will take me out of that deficit and result in BW stall. I’ve experienced the same with other keto products like Aunt Millie’s bread

Bulking and Surpluses

As a natural, unless you are a rank beginner, you will not put on muscle in a calorie deficit, calorie maintenance, or short surplus. 

It doesn't matter how good your training routine is. Past the newb phase, a calorie surplus needs to be in place for you to actually put on significant muscle. 

Stop asking dumb questions like "Can I bulk for 1 week then cut for 1 week?" While it may make sense on paper, it won't work out in the real world. Pretty much all naturals who have built a significant amount of muscle past the newb phase have gone on prolonged bulks where BW significantly increased over a span of months to years. Those who try these short bulks just end up spinning their wheels. 

For an effective muscle building phase, you should be in a moderate daily calorie surplus; you should gain at least 20-25 lbs over at least 6-8 months; BW should go up at a reasonable rate like 1 pound per week. 

What if you're too fat to put on 20-25 lbs? Then get lean and create a clean slate first.

Dieting Hard and Satiety

Wrt fat loss, it is common to hear "you should gradually reduce calories. Otherwise, if you cut calories too fast, you will have nowhere to remove calories from once your metabolism adapts and fat loss stalls." This is bullshit. And it's a variation of the "metabolic damage" boogeyman. When people heed this advice, what usually ends up happening is they end up in this limbo "dieting" phase where no progress is made—because they end up not cutting enough calories which lands them in the maintenance range. This is such a common problem that many physique athletes will set aside 16-20 weeks for prep but they actually won’t make any meaningful progress until the last ~8-10 weeks when they realize they are behind and they need to cut kcals asap.

Assuming same BW and body composition, once kcals are below the lower threshold of maintenance, metabolism does not continue to downregulate. Obviously, metabolism rapidly adapts to kcal intake down AND up within the maintenance range. That's why maintenance is a ***range***.

It is much more productive to approach fat loss with the mindset of "I'm going to set my calories at a deficit and range which GUARANTEES I will be progressing every week, that the bodyweight WILL be decreasing every week, and I will use refeeds to pump the brakes (e.g. if already pretty lean, losing more than 1 lb per week)." Unless you're a rank newb, as a natural you will NOT put on muscle in a calorie deficit or maintenance. What this also means is you generally are also not losing any fat if BW is not going DOWN every week. 

How aggressive should this deficit be? I can't give you absolute hard criteria but let's play around with a scenario:

Bodybuilder's lower threshold of maintenance is 2,000 kcals. If they employ the typical strategy to gradually reduce calories from an offseason kcal intake of 3,000-3,500 kcals, they likely won't start seeing **consistent** fat loss until they get down to 1800 kcals. If he uses a more aggressive approach, what is a safe kcal intake from a LBM preservation standpoint?

1,000 kcals/day? Probably too aggressive even with refeeds. 

1,400-1,600 kcals/day? Likely just fine, especially with refeeds deployed at the optimal time with optimal amounts/kcals/carbs. 

You probably should have 4 meals per day.

You probably should emphasize peri-workout nutrition. 

From a satiety perspective, I think it's ideal to set up your diet (e.g. food choices, volume per meal) so that you can achieve pretty good satiety through the entire day with a final total daily kcal intake that is significantly BELOW the "safe" kcal intake. It gives you the freedom to add food to get back up to the "safe" kcal intake from a baseline of already being pretty satiated throughout the day. 

When in a significant calorie deficit/low kcal intake, you will generally experience much less olfactory/palate fatigue and your taste buds will be highly sensitive to flavors—even from foods that others would consider "plain and boring." If pure junk such as donuts is like 10/10 enjoyment, and your experience of "plain and boring" food is 7-8/10 enjoyment, I would capitalize on this—especially if you pick the right foods and can hit a volume threshold to achieve satiation at each meal. 

My go to is puffed kamut + TN flavor packs. Oh and leave the pure junk for refeed days, which will be quite frequent if you’re in an aggressive deficit.  

Here is what my baseline "satiated all day" diet looks like. I will typically add kcals towards the end of the day to get the kcals from 1440 kcals back up to ~1650-1750. If I plan to eat out at night and I want to keep it a low day (not refeed), I will substitute that meal for meal 4; with a leeway to hit 1600-1800 kcals, that leaves me 500-700 kcals to play with. 

Let's say I eat out my last meal of the day and want to really enjoy myself but not turn it into a full on refeed/binge. I go into that last meal having already eaten 3 meals that tasted great, left me satiated, and conferred good satiety throughout the day. I have only eaten 1100 kcals. Let's say that last meal is like 1800 kcals which puts me at 2900 kcals for the day. Since the upper threshold of my maintenance is around 2700 (lower threshold of maintenance is 2000), I'm going to barely put on any bodyfat. And I'll get right back to baseline or even below with ~1 low day.

I'll walk you through exactly why I have my diet set up like this. And for more details, you can refer to my other two articles on satiety. Here. And here. I really can't stress this enough. A lot of lifters want to maintain a very lean physique year round but end up having to settle with being soft bc they can't psychologically handle their poorly constructed calorie limited diets. Pick the right foods, construct the diet optimally, and you will find staying very lean year round or dieting down pretty easy. 

Goal here is satiety all my waking hours, hitting satiation ceiling all meals, enjoying all meals (aka TASTES GOOD), eliminating cravings. None of this intermittent fasting bogus. I hit the satiation ceiling with all 4 of these meals. I look forward to all these meals and enjoy all of them. Don't be fooled by the low calories/meal. When it comes to satiation, GRAMS of total food volume is way more important. Again, if you doubt this, read my satiety articles linked above. 

Couple servings of fruits and veggies to hit micros. Out of all protein sources. I feel broccoli and cauliflower pair best with lean ground beef.

I stick with savory protein sources every meal bc of IMP + MSG umami synergy which enhances satiety (between meals). This IMP + MSG umami synergy is only possible with savory protein sources—so ditch the shakes and anabolic ice cream. I put a couple drops of maggi sauce (MSG) on every savory protein source (soy sauce and aminos are good options as well). Btw, the umami in eggs is only in the egg yolks, NOT egg whites. When dieting hard, if you don't consume enough micronutrients and vitamins, you will feel hungrier throughout the entire day. And when it comes to micronutrients, it is hard to beat salmon, egg yolks, and beef. I use my sous vide to cook my chicken breast at 142 degrees for 1 hr and salmon at 120 degrees for 45 min-1hr. Texture is impeccable and even fine dining restaurants can't touch what my sous vide can do. 

I use puffed kamut as my STARCHY carb source every meal bc it is unrivaled for satiation (within meals). You need to hit an 800-900 gram volume threshold for a meal to even skirt the lower bounds of satiation. I kid you not. Puffed kamut is a satiation bomb. And read carefully, I am not sponsored by puffed kamut. I have nothing to gain by promoting this carb source. I don't even have a damn cookbook to sell you bc the way I prepare my puffed kamut is easy and idiot proof. I use 32 grams (100 kcals) worth of puffed kamut each meal bc when paired with a savory protein source, it allows me to hit that satiation ceiling. I don't recommend more than 100 kcals worth of puffed kamut per meal bc I feel it is overkill from a volume standpoint. If you need more carbs/kcals, I would recommend sticking to simpler and more calorie dense carbs after. No need to abuse the volume. I eat the puffed kamut like a cereal with 800 cc of cold water + 4 grams True Nutrition Chocolate Flavor pack + couple drops of ez-sweetz sucralose. By itself, puffed kamut is nutty and slightly buttery but it is NOT sweet. Whatever liquid you pair with puffed kamut needs to be sweet and needs to have a somewhat strong FLAVOR (like chocolate). 

A common rebuttal I get is "Aren't you just adding as much water/liquid as you want to your meals then? I can do the same with vegetable soup and oatmeal." No, this is not the same thing at all. The goal is to find a carb source that LENDS itself to adding liquid so that it ends up being ideal to eat from a texture and flavor standpoint, and hopefully the entire meal ends up surpassing that 800-900 gram satiation threshold. To really drive my point home, let me expand on this. If I eat puffed kamut dry, it is terrible and very dry. If I eat puffed kamut with greek yogurt, it is also too dry. If I eat puffed kamut with only 300-400 cc of cold liquid, I run out of liquid before I have finished the puffed kamut—and it is too dry. In fact, the way I landed on 600-800 cc of cold liquid as the ideal amount is the first time I ate 100 kcals worth of puffed kamut in cereal form, I only added an amount of liquid that I would use for a 300 kcal bowl of Honey Nut Cheerios. It wasn't until I started eating the bowl of puffed kamut that I realized it needed way more liquid to TASTE GOOD. So I kept titrating the liquid volume up until I found the volume (600-800 cc) where eating the bowl of cereal was enjoyable, tasted good, and I finished the cereal about the same time as I finished the liquid. So, it really ISN'T about adding as much liquid as I want to a food. Otherwise, I'd just grab 32 grams of oats and fill the bowl to the brim, or crumble rice cakes into a bowl and fill the bowl with water. And by the same token, that is why I recommend 600-800 cc of liquid per 100 kcals of puffed kamut and not 1600 cc. Bc 1600 cc of liquid would make the dish too watery. 

There's countless threads online of people dieting down that go something along the lines of:

"Hey I eat a lot of high volume vegetables, fruits, soups and while the volume expands my stomach, I still don't feel satisfied after the meal."

It's because when it comes to satiety and satiation, it's not just about volume. Otherwise, we could just chug water when dieting down without psychological deprivation. Our brains want to FEEL like we've eaten a sufficient amount of STARCHY carbs. And I honestly cannot find another starchy carb source with the characteristics and texture of puffed kamut. If you don't believe me, you can simply experiment and compare with oatmeal. Keep adding water to 100 kcals worth of oatmeal until you hit the threshold where you inevitably start telling yourself "Wow this is just watery ass oatmeal and doesn't really taste that great at all. Dieting sucks." That threshold will be far far below 800-900 grams. 

Vegetables and fruits do not even come close to rivaling puffed kamut. We are evolutionarily wired to crave starchy carbs—and the texture of starchy carbs. And if you ever have a bowl of puffed kamut like I described above, by the third bite you will know what I mean. If you've been dieting hard on baby food texture oatmeal or cream of rice, you will be asking yourself "Wow, this is the texture (firm, chewy) I've been craving and missing out on. And how the hell is this only 100 kcals? This definitely hits that "I want starchy carbs" craving." 

I know I touched on this above but I'll just emphasize here how important a savory protein source is for me to achieve satisfaction each meal. YMMV but even with how voluminous my prepped puffed kamut is, how good it tastes, and how much it stretches my stomach—my brain still craves that umami protein source in each meal. And it's not until that first bite of savory eggs, chicken, beef, or salmon hits my mouth that it hits my brain—"Yes, this is what is missing from the meal." 

Shoulder Pain

I find that subacromial pain as it relates to bodybuilders often responds differently (natural history, management) compared to other common overuse injuries such as patellar tendinopathy (hack squats), golfers elbow (straight bar curls), triceps tendinopathy (skullcrushers). With the other common overuse injuries listed above, unless changes are made to exercises, angles, stance, grip, handles, technique, volume, intensity, frequency the pain is generally not going to go away (poor natural history). I will add that I generally prefer to manipulate angles/stance/exercises before volume, intensity, frequency. For example, smith squats are generally much more comfortable on the knees; overhead rope extensions attached to low pulley is generally much more comfortable for the elbows; ez-bar curls are generally much more comfortable for the wrists and elbows. 

I find subacromial pain interesting bc it often warms up and desensitizes after a couple sets—at the very least much more so compared to other overuse injuries. It is also often not clear and obviously predictable what angles/exercises provoke the pain. And even when you can pinpoint what angles/exercises provoke the pain, it often leads you scratching your head "Why those specific angles/exercises?" For example, a lifter may report incline barbell presses are most painful but overhead presses and dumbbell laterals feel just fine.

Nonetheless, while the shoulder pain may linger for quite a while (months), it's not unusual that the pain will improve markedly and clear up even if you train right through it. So, in comparison to other insidious onset overuse injuries, I generally have a much higher threshold to meddle with exercises, angles, volume, intensity, frequency. Instead, if pain is tolerable and especially if the pain warms up and desensitizes after a couple sets, I usually have no reservations recommending bodybuilders train through the pain. And I offer reassurance that while it may take a couple months, I anticipate the pain will improve markedly or clear up. 

I am confident you are generally not doing any damage to the rotator cuff muscles by training through the pain. Read this:

"Narrative challenges to the subacromial impingement theory have been published,17,1923 arguing that the anatomy, pathology, poor relationship between imaging and symptoms, and equivalent outcomes obtained with other interventions, such as exercise, even in the presence of a type 3 acromion, compellingly dispute the relevance of the acromion as initially hypothesized.

Lewis17,19,22 also hypothesized that the benefits of the surgery may be due to the potential benefits of a placebo effect. A substantial body of clinical research now suggests that the reported outcomes of many elective orthopaedic surgical procedures may be attributable to such a response.8,10,26,29,30

The findings of the recently published Can Shoulder Arthroscopy Work (CSAW) study1 have substantially confirmed these earlier hypotheses. In this randomized 3-group trial, acromioplasty was reported to be no more beneficial than investigational arthroscopy and no intervention at 6-month and 1-year follow-ups. Although pressured saline would have been introduced into the shoulder in the investigational arthroscopy group, it was designated as a placebo, as no bone or soft tissue was removed. These findings substantially challenge the rationale behind the proposed biomechanical benefit of subacromial decompression surgery and may herald the end of the era for this procedure. At the very minimum, they should challenge surgeons, health funding bodies, insurance providers, clinicians, the media, and those contemplating surgery to reflect on the published literature."


"However, there is a fairly large “elephant in the room” here: if surgery can be a placebo, exercise could be a placebo as well, or both interventions may only be mapping the natural course of the condition as the patient's symptoms regress to the mean."

To extend on the excerpt directly above, and I emphasize the part about favorable natural course of the condition (albeit long course), as long as a lifter is on a well-rounded hypertrophy routine with rows/pulls in different angles, presses/pushes in different angles (including overhead presses), laterals, rear delt flies I generally do not recommend isolated rotator cuff exercises. You can't help but to recruit the rotator cuff muscles if you're on a well rounded hypertrophy routine and I'd argue that isolated cuff work is superfluous for this specific population. 

This does not extend to post-ACL reconstruction rehab where leg extensions should be performed. But what I just wrote in the prior sentence also does not extend to what exercises are most effective for quad development—heavy squat variations. That's for another post though. 

"Finally, what should we call this condition? Impingement is inappropriate; an aberrant acromion is not pushing down onto the underlying tissues."

This editorial was published in 2018 and they suggested the term "rotator cuff-related shoulder pain." If we are honest about the uncertainty and evidence wrt insidious onset shoulder pain, the most specific we can get is a term like "subacromial pain." We actually can't confidently say the pain is arising from the rotator cuff. And just like "impingement" foments unnecessary fear wrt any type of arm activity above 90 degrees, "rotator cuff related shoulder pain" or "rotator cuff tendinopathy" foments unnecessary fear that there is damage/irritation to the rotator cuff muscles. We actually can't confidently say that. I have no problems saying that anterior knee pain from hack squats is patellar tendinopathy, elbow pain from skullcrushers is triceps tendinopathy, medial elbow pain from straight bar curls is wrist flexor tendinopathy (golfers elbow) because the provoking factors, conditions, and response to interventions are way more straightforward and predictable (e.g. If a lifter experiences a lot of anterior knee pain from hack squats, the pain will often improve markedly with a squat variation where they can kick their hips back slightly such as smith squat, or hack squat with a small foam roller nudged right under the shoulder pads flush against the back pad)—I can't say the same about insidious onset subacromial pain. See below.