A Physician's Guide to Bodybuilding

I recently wrote an article for New York Muscle Radio.  I started listening to this podcast a couple months ago and they are at the forefront of practical and scienctifically based approaches to bodybuilding. They have interviewed renowned luminaries in the fitness and nutrition industry such as Lyle McDonald, Skip La Cour, Jeff Willet, Mike Tuchscherer, John Hansen. After reaching out to compliment them on their valuable contribution to the fitness community, they invited me to write an article for their website. Here is the article below.


A Physician’s Guide to Bodybuilding

10 years ago, there was an ethos in the bodybuilding community that championed an all consuming focus on diet and training at the expense of other life priorities. In recent years, we have witnessed a new ethos where bodybuilding should be integrated into a trainee’s life so that balance is maintained.  This definition of balance is ultimately an individual one and what is most salient is that the individual can be at peace with their priorities when life as a whole is taken into context.  

More than just aesthetics and scratching that vanity itch, bodybuilding has been a wellspring of many qualities such as determination, consistency, stoicism, precision, and incisiveness for me.  However, anything in excess can become a detriment.  I hail from a time when it was considered the norm to:

1. Eat every 2-3 hours for fear of catabolism and to stoke the metabolism

2. Only consume meals consisting of carbs and fats or protein and fats because the combination of carbs and fats in a single meal would presumably lead to immediate body fat accumulation irrespective of caloric intake

3. Perform 2 hours of cardio per day to achieve fat loss

4. Run myself into the ground with training because it presumably correlated with more potential gains

5. Restrict myself to performing cardio on an empty stomach in the AM and apart from weight training

I am currently 27 years old and a Resident Physician.  I became enchanted with bodybuilding when I was 18 years old as a freshman in college.  After I received my undergraduate degree at 22 and as the impending years of medical training loomed closer and closer, I knew that in order to reconcile my two passions of becoming a physician and bodybuilding, it was imperative I streamline the process.  Thanks to eminent drug-free individuals (Matt Ogus, 3DMJ, Chris Jones, and the ilk) who spearheaded a more science based approach to bodybuilding and a personal willingness to experiment and course-correct along the way, my approach to bodybuilding was distilled considerably as I ruthlessly eliminated the superfluous. As of today, I have competed once in a bodybuilding contest, dieted down a total of 6 times with 5 of those times occurring through my medical training, and have not missed a single scheduled training session since I embarked on this journey 9 years ago.  In the following paragraphs, I would like to offer some practical advice on how to integrate bodybuilding into your life from the perspective of a physician who maintained this pursuit through medical school and am currently continuing to do so through residency. 

First and foremost, learn the first principles of nutrition and training.  Without this foundational knowledge, you will be relegated to a shotgun approach to bodybuilding that will consequently leave you expending efforts that not only fail to yield measurable results but also could be potentiallycounterproductive. I would highly recommend you continue educating yourself regularly through videos, articles, podcasts, and status updates on a regular basis from sources such as 3DMJ, Matt Ogus, Chris Jones, Brad Schoenfeld, New York Muscle Radio, Omar Isuf, Jeff Nippard, etc.  By understanding first principles, you can take a more nuanced approach to bodybuilding fulfilling the checklist of what actually matters. Among the myriad of training routines out there, it all boils down to progressive overload and getting stronger in a rep range of anywhere from 4-20 repetitions with the basics (deadlifts, pull-ups and/or pull-downs, row variations, chest press variations, chest flies, crunches, bicep curl variations, tricep extension variations, calf raise variations, squats, machine squats and/or leg presses, overhead presses, lateral raises, shrugs). For nutrition, tending to caloric intake first and macronutrients second will go a long ways in steering your progress towards fat loss or building muscle. 

I cannot stress enough the value of hiring a coach if one has the financial means to do so.  Time is your only non-renewable asset in life and a coach can potentially save you years of self-experimentation by streamlining the process. I have personally worked with two coaches for 4 out of the 9 years I have been training. I can also say without a shadow of a doubt that working with these coaches expedited the learning process in a magnitude that self-experimentation could never even hold a candle to.  Another overlooked merit of coaching but profoundly valuable nevertheless is the peace of mind that accompanies working with a coach.  Hiring a coach will allow you to squash perpetual self-doubt, make more rational rather than emotional decisions, and allocate your cognitive reserves towards other activities to cultivate eclecticism. 

When seeking a coach among the glut of respectable coaches out there, it behooves the trainee to appraise what credos he/she upholds.  If you do not respect or admire the coach as an overall person, the relationship will be off to a rocky start and portends disillusionment and disappointment.  Coaching involves much more than just assigning macronutrients, training, and cardio recommendations.  With how all encompassing bodybuilding is, especially when dieting down, emotions must be taken into account.  While I may ruffle some feathers here, I believe that an individual seeking to balance bodybuilding with a demanding career should seek a coach who has firsthand experience of the same conundrum.  While I am not insinuating that those who coach as their primary profession have no insight into the adversities of a client in a high-octane profession, it is more probable that a coach with a demanding career will be able to empathize.  Case in point, compared to a coach who has a career on the side, a coach who coaches online and works from home as their sole profession would probably not bat an eye when recommending a client perform 1.5-2 hrs of cardio per day, not to mention splitting it up from weight training.  

I frequently work with clients who have issues fitting training into their schedule while juggling a career and family on the side.  A force multiplier habit for me, and what I tend to recommend, is to train in the early AM around 4:30-5:30 AM at a gym near their job location and shower at the gym after.  The time you shave off by adopting this habit is almost unparalleled. This affords you the opportunity to circumvent the nuisance of AM rush hour traffic by training at a gym near work, to train in an empty gym so that waiting for benches, dumbbells, machines, squat racks, and platforms is abolished, and to avoid an extra drive home just to shower.  I would like to preempt the uproar about the pains of training so early in the morning by conceding that I used to strongly advocate that training without a couple meals in me would be a severe handicap.  Ironically, after being consigned to this as my only option through my clinical years in medical school, I noticed that I was actually slightly stronger training in the AM.  If you cannot train on a full stomach, train on an empty stomach and eat after in your car.  If you need to eat before training to avoid hunger pangs, have something lighter so that a distended stomach does not interfere with training. After the initial adjustment period of a couple days, I am confident that that you will agree theupsides of training early in the AM outweigh the downsides considerably especially in light of other life obligations. 

Cardiovascular exercise does not need to be performed in a separate session apart from weight training.  If you are incorporating cardio into your routine, perform it after your weight training session so that energy for weight training is not sapped.

Acknowledge the law of diminishing returns.  Depending on your routine, after a certain point, longer training sessions do not correlate with more gains.  My weight training sessions last approximately 1 hour and I train 5 days a week.  Drop sets and training past failure should be used judiciously, if at all. Cardiovascular exercise is a great tool for fat loss but taken to excess can be a detriment. I find that when I start exceeding 30-40 minutes of cardio per day, the benefits plateau considerably and recovery is impeded.

With the advent of flexible dieting, there has been a burgeoning of admiration for variety and novelty. This is certainly preferable to restricting yourself to traditional bland bodybuilding foods. However, I personally find that novelty should be tempered.  Not only does an unfettered quest for variety lead to decision fatigue where you expend your limited cognitive reserves on questions like “What should I eat next?” that could be used for other more fruitful activities, it also precludes you from establishing a routine that can save you precious time.  I personally prepare all my meals every morning at 4:00 AM and it takes 20-25 minutes.  I consume around 4 meals/day and while each of these 4 meals is different, I maintain consistency with the foods I use throughout the week.

Avail yourself of pre-cooked meat that can be bought in bulk at stores like Costco.

Establish routines and avoid multi-tasking when activities require higher order cognitive demands.  Routines allow you to go on autopilot to accomplish mundane tasks more efficiently and conserve cognitive reserves for activities that offer more return on investment for that input of cognitive effort.  Resist the impulse to check social media when studying or reading about more complex topics. Refrain from checking your phone while training that not only unduly prolongs your training session but also detracts from the flow experience of full psychological and physical immersion in training. 

Lastly, learn to detach yourself from your emotions and just execute the plan. Motivations and emotions are ephemeral.  There will be days when fatigue will set in like an ominous fog.  These are exactly the times when you need to cultivate stoicism and just get the job done.  If there is one thing I have learned on this journey in the past couple years, it is that unskilled thoughts such as self-pity, anger that others can not sympathize with the sacrifices attendant to training and dieting, and rumination on aspects that are out of your control only perpetuate a barrier that makes it less likely you will follow through on achieving your goals.  It probably is not a coincidence that today I consider it an immense blessing rather than a sacrifice that I even have the opportunity to bodybuild. The glass is always half full. 

Whether you incorporate some or all of these tips into your life, I hope this article has at least inspired confidence that the pursuit of bodybuilding and a demanding profession are not mutually exclusive.  In fact, they can serve to complement each other if pursued intelligently.