The Hardest Client I'll Ever Have to Train

In this week's episode of the Enterprise Fitness Podcast, we take you behind the scenes of a live event that we had, the Elite Results Bootcamp. We present on a number of different topics from training, nutrition, but more importantly, how we get the elite results we do here at Enterprise Fitness. So check it out and let's jump in.

Today I basically want to talk about— yeah, you'll likely be the hardest client that I'll ever have to train. And I just want to talk today about someone that came in As someone very timid, didn't want to speak to anyone, with virtually no prior training knowledge and a myriad of mental and physical issues, and to the present day where he's now turned into someone who's part of the furniture at Enterprise, someone we all love, someone who's really come out of his shell, and a real gym junkie of sorts, and someone that has fallen in love with the process, and someone that I've established a fantastic relationship with, someone that's really pushed me to become a much better version of myself as a trainer. So just a brief rundown of what we'll go through today. So there will be a little bit of storytelling because context is important here, okay? I'm just going to go through his overall medical history, look at the surgeries he's had done growing up, look at his physical mental conditions, the symptoms of these things, how they affect his exercise, and the approaches that I've taken to these things regarding his programming, his nutrition, and also his supplementation. Okay, so Lachlan wanted this to be called the Lachlanography, but I said no, you're the client with everything wrong, but I'll see if I can work it in somewhere else. So here we go, it's a bit of background information on Lachlan. So he came to me about 25— well, not about, he was 25 years old, and he weighed about 124 kilos, which was the highest that he had gotten to at that period in time. He was a classic case of your COVID kilos, and he was maintaining around the 110 kilo mark prior to increasing his weight prior to coming here, okay. Physical activity at that point, he was confined mostly to just walking, and this will make a lot more sense when we go through his surgery history and why he was more or less limited to just this when he did walk. And he has been doing physical therapy and osteo 3 times a week fairly consistently for majority of his life due to these conditions that he's had, but he's someone that has typically been quite sedentary as he is an avid gamer, and it's not unusual for him to go more than 6 hours sitting at a time. Okay, looking at his nutrition, he's a classic case of your binge eater. Okay, so just eating everything in sight, not much of a structure to what he was eating as well. The irony of this is that he actually had okay nutritional education. Again, as a result of these conditions that he has, which we'll cover in more detail going forward, there are specific nutritional approaches that he's had to, that he had to make that helped to alleviate the symptoms of these issues. So in that sense, he actually already had some, some decent background information, but things like calories and macronutrients are something that he hadn't really acted on yet until he walked through the door at Enterprise. Looking at his sleep, fairly regular and late hours, again, mostly as a result of his gaming. Now, most people need around that 7 to 9 hour range to get a good night's sleep. Lachlan is a rare case of someone where if he doesn't get 9 hours, he's cactus. Okay, that was something that he already knew and something that he conveyed to me when he came here. So Lachlan's goals at the start at least were a little bit hard to, to quantify. I was a little bit newer of a trainer at the time, and I probably could have done a little bit of a better job at quantifying things like a fat loss goal. But what he conveyed to me from the start was as long as he's improving in any one of these 4 metrics, then he's happy. And the reason why I presented this as a wheel is because these are all relatively interchangeable and they all tie in with each other, okay. So if he's improving mobility, the reality is he's probably going to be reducing pain and strength. If there's fat loss, it's going to be reducing pain, okay. So they all tie into each other, and this was my centerpiece when looking at improving and measuring any metric of progress. So looking at his surgical history, we're going to go through all the procedures that he's received, how it affected him, and this will set the groundwork for the approaches and modifications that I had to make from, especially from a programming perspective. So Lachlan was born with a right clubfoot. So you'll see that that clubfoot is typically where a foot is bent in like that. Lachlan's was a little bit spicier. Lachlan's foot was a full 180, okay, so one was looking at you, the other was looking for you, okay. So when he was born, he had his right foot foot deliberately broken and corrected into the right place, and it was placed in a plaster cast for 6 months. Straight after that, he had his first foot reconstruction with that same foot. Okay, so his ankle was fused as a synovial joint around that ankle never truly formed in his gestation period. Okay, and since then he has constantly had custom orthotics and braces, especially when he was younger, just to encourage his foot to grow in the correct alignment and allowing him to— for his gait to be normal. He grew up with a twisted shin bone as well, so what this resulted in was frequent knee dislocations, especially because the muscle, the ligaments around his knee had been atrophied. So he had metal plates drilled into the growth plates, and this actually automatically twisted his legs back into the correct alignment as he hit puberty. So this is all by 11. 8 years later, he has a triple ankle fusion, so his hind foot and his midfoot are fused together as he had early onset arthritis, and basically he was in constant pain walking everywhere. So this was one of the approaches they took of simply looking to alleviate some of the pain that he was constantly in. 2 years later, he underwent a full knee reconstruction in his right knee. Okay, so this was replaced— all the ligaments in his knee were replaced with artificial ligaments again because they were quite atrophied and they weren't showing any signs of getting better. And a year later, he had a couple toes fused and some additional tendon work. So this is everything that Lachlan has had to endure all by the time that he's 22, and this is before we get into the psychological and other stuff as well. So again, looking at the conditions now, same thing here, talk about— I'll give a brief description of each of these conditions, and later on I'm going to talk about the relationship that each of these conditions have with exercise, if they have a relationship with nutrition, how they can be improved, and also the correct supplementation approach. With these things. So Lachlan was diagnosed with autism, or back then he was diagnosed with pervasive developmental disorder, okay, or PDD as it's better known. Symptoms of this include impaired social interaction, impaired verbal and non-verbal communication, as well as a difficulty relating to people and events and difficulty with changes in routine or surroundings. And this was quite prevalent when he walked into the door for the first time, okay. It was very hard for him to make eye contact with anyone, and conversations with him were, were the bare minimum. In fact, he actually came in with his mum the first time, and it was his mum that did all of the talking. So the reason why this is important, and just a bit of extra context I wanted to provide here, is anyone that's diagnosed with a condition like autism, they're diagnosed under the Diagnostic and Statistical Manual of Mental Disorders, or DSM. Okay, so Lachlan was diagnosed under the DSM-IV. Okay, about 20 years ago now, and this was when pervasive developmental disorder was its own diagnosis. Okay, since then it's been updated to the DSM-5, and PDD, along with a couple of other disorders like Asperger's, have now been rolled into autistic spectrum disorder. Okay, all under one thing. Um, so this just provides a little bit of context so that if you guys have a client that's diagnosed with autism or they're diagnosed with, say, Asperger's, they are now the same diagnosis is now it's expressed as just a spectrum, okay? But they are the same thing, okay? So what's the approach in this case? I like to— I like an ability, not a disability focus, okay? So this isn't exclusive to Lachlan. This should apply to any client that you have walk through the door, okay? So this is focusing on everything that they can do rather than focusing on what they can't do, okay? So I'm I treated him like anyone else when looking at, when sitting down with his initial consult, when going through his screening on the floor and not conveying anything to him that were any of his limitations, okay? And just a lot of positive reinforcement ultimately. Patience as well, okay? Especially with someone with the physical and mental limitations that he has, it's gonna take a lot longer for him to, and it did take a lot longer for him to understand a lot of what I was telling him to learn these movement patterns, okay? Some clients are going to pick this up quicker than others, okay? So patience from your end is going to set a really good foundation for your client to be a lot more receptive to everything that you say. And that ties into basic personability as well, okay? So building a relationship with your client, in my opinion, is, is half the battle, okay? So learning what they like learning about their interests and just focusing from the second they walk into the door. Gym environments are intimidating even for me still, okay? So imagine someone who's never walked into a gym before, someone who's as overweight as perhaps Lachlan was, okay? Making them comfortable in, in your environment is again going to set the groundwork for long-term progress going forward. And this was especially important with Lachlan. So Lachlan was also diagnosed with ADD. Okay, so this one is a lot more common. It's a chronic condition that involves inattention, hyperactivity, and impulsiveness. So this can be one or a combination of both. There are typically two types of ADD, and that's those who are inattentive or distractible, those who are impulsive or hyperactive. In Lachlan's case, it was a combination of the two. So I would describe him as someone that was distractible and impulsive. Lachlan, in ADD terms, was— is classified as someone that's an in dumper. So rather than your more common case of someone with ADHD who's very quite frenetic or jittery, um, and this is quite common, some of you may have even had a client of this sort, Lachlan, the symptoms weren't as physical. It was more from a dialogue perspective. So if Lachlan got onto a topic of something that he's passionate about, it's not unusual that I'm stuck there for 3 to 5 minutes just nodding along, listening to his conversation. You cannot break his conversation, okay? You have to let him speak. So this ties back into just the patience of the client, and if they do have a specific mental condition, not providing too much pushback against them and just working with what you've got, okay? Fibromyalgia is probably the one condition that affects him the most, as this is a chronic condition that causes widespread pain. So symptoms of this are musculoskeletal pain and tenderness, impairments to sleep, and thus general fatigue. And Lachlan's definition of it was just, it feels like you constantly have flu symptoms. So Lachlan lives with pain 24/7. It's something he's learned to do. And it's something that we work to manage, okay? Exercise is actually the best remedy for fibromyalgia. However, if you're already experiencing symptoms, then exercise on top of that, or being run down, can exacerbate your symptoms, okay? There are no cure. However, symptoms are manageable, primarily through things like exercise. Sleep apnea, something he has as well. So this is a sleep disorder in which breathing repeatedly stops and starts throughout the night. Something that's a little bit more common here, okay. Symptoms, excessive daytime sleepiness, and as a result, headaches in the morning and difficulty concentrating throughout the day, okay. Again, this is just providing some context as to what he has, of which he has a lot. Restless leg syndrome, something that's a little bit more common, and he's actually probably about the third or fourth client that I've had with this, okay? So restless leg syndrome involves uncontrollable urges to move the legs primarily at night when people are sleeping, okay? This is theorized to be attributed to the dopaminergic system function. Fuck, I said that well for the first time. So evidence suggests that the dopaminergic system is associated with the development of restless leg syndrome, okay? These neurons that run this system are responsible for smooth and purposeful muscle activity. And so there is abnormal activity with these neurons. This is what causes involuntary movements, hence why they believe that this is what's responsible for restless legs. Vasovagal syncope is a little bit more common, okay? So have you ever had a client, or even yourself, or anyone that cuts their finger on something and they see their blood and they start to get a little bit woozy, okay? Well, that's what vasovagal syncope is, okay? So it's just a sudden drop in heart rate or blood pressure that's caused by a stressful trigger, okay. The most common remedy for this is actually a high salt diet, okay. It's the most common and effective treatment, okay, when someone experiences a drop in their blood pressure. So once upon a time, Lachlan was eating a low sodium diet. Lo and behold, this is why he had this, okay. So he was brought up to a normal sodium level, but his blood pressure actually didn't change. So Lachlan has a chronically low blood pressure, which is often the opposite issue that a lot of people have. And so he's since been advised to continue to bring up his sodium levels, and it's just something that we've monitored since. Okay, so let's look at his programming now. Here I'm going to talk about approaches that I've taken from the start with this programming. I'm going to break it into different periods, things that are approaches that I took in the first 6 months, approaches I've taken after, the differences between some of his earlier programs and some of his later programs, and again how the conditions are affected or improved by exercise. So looking at his training split and his volume distribution, I found that a full body split worked very well for Lachlan very early on. Reason being, due to things like his fibromyalgia, there's a great, uh, high degree of unpredictability with whatever pains or soreness that he would walk in with. Okay, so if he walks in one day and his legs are in so much pain that he can't do any lower body work, well, if he's programmed for a lower body session, then I have to swap the whole session, that whole session is rendered useless. Okay, so I found that if I programmed a full body split for him, there's only about 2 or 3 exercises that I need to swap out. Okay, so just work better for Lachlan. So even examples of this are just simply providing alternative exercises, even if it isn't swapping upper or lower body movements fully out. So an example of, of this is just say offering the alternative of a kneeling leg curl or a 45-degree back extension. Extension. So that way it's still an exercise that's targeting the posterior chain, but it's just different enough that if he's perhaps experiencing, experiencing some pain in his hamstring, can swap it out and it's like for like enough. A 2:1 pull-push ratio is definitely something that I think is underutilized across a lot of clients, but in Lachlan's case, given that there was a lot of postural, for lack of a better term, damage that was caused by long sedentary periods. Providing 2 pull exercises, i.e., rows or pulldowns, for every push motion, i.e., dumbbell press, is something that I look to administer to people when I have the aim of posture correction. And that's something that has been fairly constant with, with Lachlan's, with Lachlan's programming. Looking at his volume distribution, this isn't too different to what I would program for most people. So 15 to 20 sets for priority groups like his posterior chain or his back work. Other larger groups, 10 to 15. So this could be things like his chest, and then more accessory movements had about 6 to 10 sets devoted to them. His first 6 months involved primarily a unilateral focus since he was born with permanent— or he developed permanent atrophy in the right side of his body as a result of all the surgeries that he had. This isn't a photo of him, but this is how his legs look, okay? So his right leg is virtually half the size of of the other leg, okay? That said, his upper body is relatively similar in size and strength as he hasn't had any surgical procedures on his right side of his body in the upper body. So unilateral lower body movements made up the majority of his lower body movements that are programmed for him, okay? So examples of these, step-ups, single leg extensions, and single leg curls, at least prior to when we had the kneeling leg curl, we only got about earlier this year, uh, with— were staples in his program for a fair while and even still get thrown into the rotation now as well. Following on from this, he actually built up a fairly decent, uh, foundation of strength, um, and as a result of his physical therapy, he actually has fantastic mind-muscle connection and proprioception. So with bilateral movements, simply cueing a right leg emphasis with his movements was actually— has actually been enough for him to get a good stimulus out of these movements. So an example of this is with an RDL. I simply provide the cue of just focus on working with your right leg as much as possible, making the conscious effort to feel each leg working evenly, because otherwise he has a tendency obviously to work more with his left leg, which is stronger. He actually has a very good ability to do that. And so since then, we've been able to load up pretty decently on things like trap bar deadlifts, Romanian deadlifts, and even squats. And he moves as well as anyone within the mobility that he has. His fused right ankle is what poses the biggest limitation from an exercise selection and programming perspective. Reason being is that he virtually has no ankle dorsiflexion in his right leg. So there was— there has been limited direct calf work that we are able to do, as any uneven foot distribution does bother his foot a lot. Um, since he has all of these screws and all the reconstructions that he's had in his foot. So examples of this are calf work, like a seated or a standing calf raise, where your foot is centered on one specific part of the foot, so there's no even foot distribution. Or even just simply elevating his feet on things like the rubber mats or the rubber wedges are things that we found bothering his feet. Okay, so here you can see him doing safety bar box squats, and yes, there's a lot of limited ankle dorsiflexion, but we just work with what we can and take him, take him through as much range as we can whilst keeping his foot flat on the ground. And that's what works best for him and allows us to maintain some consistency between his exercises and be able to witness some progressive overload, which is going to be the goal with anyone at the end of the day, right? That said, there are some adjustments I've been able to make with other exercises. So things like loading off his feet in any exercise that requires significant dorsiflexion or toe flexion. So examples of these are like push-ups or planks where I can actually suspend his feet up and he can execute these exercises as you normally would. So what does it look like when this is put into practice? I'm not going to go into too much detail here, but I'll just point out the key parts. So this is an example of a lower body session in the first phase that I gave to him. Remember, I only changed to full body split about 2 or 3 phases in. But you can see that there's a bias towards a lot of single leg movements here, like step-ups, single leg curls, single leg extension, building some foundational posterior chain strength with things like thrusts. Looking at his mobility series, a focus on glute activation, ankle mobilization, and ab activation as well, as this was something that he conveyed to me was a weakness of his, um, by his osteo. An upper body session— this isn't too different to what I would administer to a lot of people in their first phase, but again, it comes with the aim of posture correction. Okay, so there's a bit more of a bias towards posterior exercises, modifications that have made to things like his incline dumbbell press is with a rotating grip, so just looking at getting a bit more length through his pectoral muscles. Okay, looking at his most recent program, so you can see the— it has since changed to a full body split. So at the moment, his job requires some manual labor, so zurcher squats are something that I'm doing with him at the moment as there's something that I've found have been able to load really heavily on, and they have really good carryover to, say, picking up heavy things, which is what, what is involved in his work at the moment. Limitations in his QL, so hip shift has been something that he's been experiencing in squat or hinging movements, so things like an offset farmer's carrier, things that I'm having a play around with. It was a limitation that I myself had, and these accessories have worked well for me. So giving them a crack with him. Just touching on his Romanian deadlifts as well there, when I talk about him being able to maintain symmetrical recruitment of both of his legs, we found that 8 is the magic number for him. So once he is doing more than 8 reps, that's when that fatigue, that cognitive fatigue starts to set in, and that's when he's working a lot more with one side. So that's a more lower focus session. A more upper focus full body session. I got him on the bench press. He's actually— a goal of ours, of goal of ours was to do chin-ups for the first time. That's something that he's been able to do quite recently, so clusters have been the next progression. But otherwise, nothing too out of the ordinary here. So I'll encourage you to have a look through these in your own time, and if you have any questions having a look at them, feel free to ask me outside of this presentation. So looking at the relationship that ADD and exercise have with each other. Okay, there aren't— I couldn't find too much research looking at recommendations on training modality, so what kind of exercise is best for ADD. That said, there are studies that show that exercise improves the symptoms of ADD independent of other treatments. So when all other variables are kept constant and exercise is introduced into the mix, symptoms are improved. There's also research to show improvements in neurotransmission and cognitive performance. So for those with ADHD who have attentiveness issues or issues with their working memory, there's evidence to suggest that exercise can serve to benefit these things. Fibromyalgia has a very long relationship with exercise, and there are— there is a lot of research on different training modalities. So strength training has been shown show improvements in overall well-being, large pain reduction, fewer tender points, and even reduction in depressive symptoms as well. Moderate intensity aerobic training has also shown to have improvements in overall well-being and improved physical function. So what's the approach here? Ideally, you want to train all energy systems. Okay, so mostly it's going to be mostly anaerobic work that you're doing in here. But it is not unusual, they'll throw in a little bit of conditioning work at the end of Lachlan's sessions. Again, I never— there's an unpredictable nature to how fatigued he's going to be at the end of his sessions, or if he begins to experience any kind of soreness. So I don't program any conditioning work to him ongoing. But again, it's not unusual that I'll throw in some battle ropes or some farmer's carry or even some prowler at the end of his sessions just to get a little bit of aerobic stimulus, especially because due to his conditions, he's not able to do things like running. So when his fibromyalgia symptoms are high, just focus on what can be done. So there are even days where he can't come in at all, okay, head to toe, he's just in crippling pain. So if he can walk, he can walk. And he even has these little desk pedals that he has under his seat where he can just pedal on the spot when he's gaming. So I go, shit, if you can do that, do that. And again, how can we implement this to your clients? Always focusing on what they can do rather than what they can't do, okay. Mark often has the adage of, "Not all or nothing, always something." Okay, and this applies to everything.

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Looking at his nutrition now. Okay, so I'll talk about the approach I took with him. At the start, looking at establishing maintenance, establishing calories, tools that we've used along the way, roadblocks that we've encountered along the way, and again, the relationship that any nutritionist has with any conditions that he has. So looking at his nutritional approach from the start, when determining maintenance with someone that says overweight and with the conditions that Lachlan has, body composition is important. So when I put his details into the maintenance calculator that I usually use, it comes up, it spits out an estimated maintenance calories of about 3,000, okay? But this doesn't distinguish between lean mass and fat mass, okay? So if this is a 125-kilo rugby player, the reality is his maintenance calories are probably gonna be even higher. But for someone as overweight as Lachlan, there's gonna be a smaller amount of lean mass. So the reality is it's probably a little bit lower than this. And again, someone with conditions like Lachlan, for example, fibromyalgia, are typically associated with a downregulated basal metabolic rate, okay? So what's the approach that we take here, or what's the approach that I took back then? There's no specific maths to estimating what someone's maintenance is going to be if, when you're factoring things like both body composition and whatever conditions that they have, but I came up with the educated guess of 2,600 at the time. So I would have thought it would have been a couple hundred calories lower. Again, is there any science to this? Not necessarily. Okay, but when you're doing these things, you'd rather undershoot it than overshoot it, especially in the context of fat loss. Okay, you'd rather have their calorie set a little bit lower and see that needle move a little bit more aggressive at the start rather than not see it move at all. Okay, we want to think about what's going to create buy-in with the, with the client in their initial couple of weeks here. And then I used percentages back then, so going into a pretty aggressive 30% deficit that had him at about 1,800 calories. So how does this compare to what I would do if Lachlan walked into the door now. I would more or less go about, take the same approach when having an estimated guess with body comp and factoring in his conditions. So let's call it 2,600. But I'd like to bring a bit more, a bit more maths into the equation. So we know that to burn a kilo of fat, we need to burn 7,700 calories, okay? If we're proposing a rate of 1 kilo of fat loss per week, that means they need to be in a deficit of 7,700 calories a week, okay? If we divide that by 7, that gives us the daily deficit that we need to be in, and that's 1,100, okay? Subtract that from his estimated maintenance calories, that gets us 1,500. So am I saying that all the mistake that I made was that I didn't set his calories low enough at the time? No, not at all, okay? The needle still moved at 1,800, and it would now. What this method allows me to do is it allows me to ultimately use maths to see exactly, to look at his rate of fat loss compared to my proposed rate of fat loss. Okay, so let's say he's dropping 1.2 kilos of fat per week and I want him to drop 1 kilo. It allows me to pop that back into the equation to calculate backwards and I can retrospectively determine his true maintenance. Okay. So again, it's not about the fact that— Shush. It's not about the fact that I didn't put his calories low enough, okay? But it just takes a little bit of guesswork out of it and allows me to use a bit of maths to determine his maintenance. I know this sounds probably a little bit confusing, but I won't talk about it too much more because Amy and Tyrone are gonna talk about this a lot more when they talk about their presentations on fat loss and on comp prep. So tracking is something that I did implement with Lachlan, uh, down the track, um, just because I wanted to see exactly what he was eating, um, and just so he could learn the, the cost of some of the foods that he was having, so he could, um, see exactly, yeah, how much he was having and the, the measurements of the, of the foods that he was weighing how true they were and how much they actually aligned with the calorie and macro targets that I set with him. The paradox of tedious tracking. The biggest pushback that I'll get from people when I pitch tracking to them, even it's just for a couple of days or for a week, is that, oh, it's too tedious, okay, it's so much work, it takes too long. What I have found, what I found with Lachlan, what I found with other people as well, is once they get through the initial stage stages of working their way through the app, understanding how tracking works, um, perhaps putting in recipes and foods into the database, and they ultimately establish— get that ball rolling and establish that routine of tracking, it actually ends up saving them time in the long term. And perhaps this is something that you guys may have found with your clients as well. It ends up saving them time with regards to making food choices as they, they can track something that's already, already in their database or a recipe that's already in their database. So that is something that I will say to them when I get that, that kind of pushback, okay. Lachlan was no exception and it's something that works well for him now on the odd occasion. But again, it was just more establishing that knowledge of calories since I like to treat calories as your budget for the day, okay. So the conversation I'll have with clients if they want to have a meal or a food of plan is if you want to spend the calorie equivalent of buying one of those red things from across the road, yeah, it's going to cost you a little bit more. I mean, you're not going to have a lot more to spend throughout the day, okay? But if that's what you're going to enjoy and you can stay within especially your calorie and your protein target for the day, that's what's going to allow your client to have something that they enjoy and still see sustainable progress, okay? Again, it's not about an all-or-nothing mindset. So looking at setting macros for someone as overweight as Lachlan, I'm not gonna go closer to the 2 times body weight per, 2 grams per kilo of body weight. Reason being, you're not gonna give someone like Lachlan 250 grams of protein straight off the bat. That's gonna be too much for virtually anyone, okay? Again, this is distinguishing, it's about distinguishing how much lean mass someone has on them, not just their body weight. So somewhere around the 1.2 to 1.5 gram per kilo range is going to be optimal for someone like Lachlan. And whatever absolute protein target you set with them is likely not going to change too much in the context of fat loss. So what I mean by that is Lachlan's protein was set to around 170 grams of protein at the start, and that has actually stayed about the same. Since, reason being, as Lachlan's body weight has dropped, this ratio goes from 1.2 more to 1.5 more to 1.8 since his body weight is dropping, okay? So the relative, the ratio is actually increasing without me having to make any adjustments to his protein. Fats, I like to keep around the 0.6 to 0.8 range, and I like this to, I like to maintain this ratio, okay, as he's dropping. So I like to maintain 0.6 to 0.8, so that means his, the absolute number of grams of fat that he's gonna have prescribed is going to decrease. As his weight decreases as well, okay? In the context of long-term progress, are carbs and fats going to be relatively interchangeable for someone like Lachlan or for a fat loss client if it means sustainable progress? Sure, okay? There is research to suggest that any eating fats above 0.5, 0.6 grams per kilo of body weight doesn't serve much of a purpose, okay? But if giving a little bit more fats to your client at the expense of carbohydrates, especially for someone like Lachlan that is going to have a poor ability to metabolize carbs anyway, if that's what's going to result in longer-term progress and allow them to accommodate for foods that are going to be a little bit more palatable to them, then by all means, right? It's about what they can sustain over a long period of time. If you give them what you determine is the perfect nutrition plan and it's something that they can't stick to or they only stick to for for a week, you haven't done your job properly. Okay, so sustainability is going to be the North Star that I like to relate everything to. So again, when this is put into practice, I'll encourage you guys to have a look at this and let me know if you have any questions surrounding it. But this isn't too foreign to what I would prescribe to most people in the way of meal timing, the general framework of allowing the option of a protein, a fat, and a carbohydrate source. So as long as they're adhering to this general framework, I like to provide as much variety as possible, okay? So they have their protein sources to choose from, they have their fat sources to choose to cook with, and they have their carb sources to cook with as well. Okay, so the gut conundrum. So there was a period at which Lachlan was experiencing constipation and/or loose stools for 2 months, and his weight was plateauing around the 108 to 109 range. And honestly, I was stumped. I tried everything. I sort of went with my, my, my usual checklist that I'll go through: drinking enough water, has your magnesium, has your sleep, has your stress, you're obviously exercising. And we introduced supplementation 'cause I don't think he was taking magnesium at the time. And this only provided temporary results in the way of relieving his constipation, although weight wasn't changing too much. And sometimes you just need some luck to go your way. So Lachlan went to Japan around this time for 4 weeks on holiday. And when he came back, the problem was solved. Okay. And I was like, what the hell? Okay. So we went through everything. We said, what did you do that was different? He goes, I have no idea. Okay. He came back, he had a meal with raw vegetables and we were back to square one. And so from here we were able to determine that the one variable that changed that we reintroduced when he got back and that was gone when he went to Japan was raw vegetables. Okay. And that was just what we found didn't work for him. So since then he blanches and steams his veggies and we're happy as Larry. Okay, so what approach would I take if we were, if we were back there? Look, there's probably, I don't feel like there's much I could have done differently to what I did. The approach I usually take is just focusing on eliminating or adjusting one variable at a time. So if someone is having digestive issues, okay, let's look at removing gluten from their diet if they don't have already, or let's look at removing dairy from their diet. Okay, change one variable at a time so you can see the exact association between the presence or not, or the non-presence of that thing and the effect it has on the client, rather than changing a million things at once. Or remove everything altogether and then reintroduce one thing. So if they reintroduce one thing and the problem reoccurs, then we know that it can be attributed to that thing. So may have— we may have gotten there in the end, it may have just taken us a little bit longer until we said, okay, let's try eliminating raw vegetables, but you know, sometimes luck goes your way and we got there. Okay, I typed in IBS into Google Images and it autocorrected to ibis, so I just figured I'd put an ibis in. So he does have IBS, but it's not as present as it used to be. So he does have a history of parasites, especially when he was younger. Things like FODMAP diets, gluten-free and dairy-free diets did help a lot more. When he was younger, but since his parasites are at manageable levels and these aren't things that we have to be as strict with, especially things like a low FODMAP diet, we still have an affinity towards gluten-free and dairy-free diets. But if it's on the odd occasion where he's having a meal that has those things, then I'm not throwing my arms up in the air. Okay. So food exposure therapy is the approach that they'll often take with people who are experiencing parasites. And they're just going to monitor their eosinophil levels. So eosinophil is just a type of white blood cell that's inversely related to the presence of parasites. So I have low levels equal parasites here, and that's correct. It says high levels of eosinophils equal parasites in your booklet, but that's wrong. This is right.

Ibis.

Looking at his supplementation, I'm going to look at the supplementation approach that I've taken with him since he walked in here and the and talking about the supplements that he already was taking when he came in here and for each of the conditions that he has. So the vitamin D chronicles of Lachlan. He was deficient with vitamin D in his childhood, so they administered liquid, liquid vitamin D. No increase. They upgraded to an IV infusion of vitamin D. It was only a slight increase. When they introduced Calcium supplementation alongside vitamin D, that was a substantial increase. Yay. Okay. Reason being calcium supplementation is gonna be the carrier of vitamin D and it's going to aid with absorption of vitamin D. Okay. So if someone's vitamin D levels are still not increasing, even after you've been supplementing with vitamin D in the long term, then calcium can be something that you look at. That said, he was lactose intolerant and wasn't having a lot of calcium fortified food when he was younger. And this isn't the case anymore now. So that had a lot to do with why he was low in vitamin D and obviously why he wasn't getting that much calcium in either. So looking at the present day, his vitamin D is at a more manageable level and he just tops up with a multivitamin at the moment. Fortunately, he gets his bloods done quite regularly as well, so it's a good, um, it's good to have those frequent touch points. And he just, uh, since he's not as lactose intolerant anymore and doesn't have has a lot more calcium-fortified food, his calcium intake has increased, and he also makes more of a conscious effort to get a bit more sunlight exposure as well, which doesn't hurt. So looking at magnesium, I began to supplement with the TriMag Active Muscle from Designs for Health once we got that in. So magnesium is responsible, as Mark would have told a lot of you guys, for over 300 functions in the human body. A couple of the main ones are energy production, production, cardiovascular health, and skeletal muscle health. The reason I went with the Trimag Active Muscle, since we have so many different magnesium supplements, is that it's formulated with 3 different magnesium compounds: glycerophosphate, magnesium aspartate dihydrate, and the big one for me is magnesium citrate. Okay, so what's so special about these 3? 3 of these compounds are 3 of the most bioavailable forms of magnesium that you can get, so they're best absorbed by the body, but citrate is the big one for Lachlan since magnesium citrate helps with bowel movements since it draws water out of the intestine and helps to soften stools, okay? So when he often experiences constipation as a side effect of his, any of the medications that he takes, this is something that I've found to work very well for him. That said, before magnesium citrate, and also there are a lot of fibromyalgia benefits associated with magnesium as well, which I'll touch on in a little bit. But before magnesium citrate, we had magnesium oxide, okay? And with this, we performed what Lachlan coined as the ghetto magnesium trick, okay? I don't know if that's politically correct, but we're gonna run with it anyway. It's never stopped me in the past, okay? So magnesium oxide essentially has the same effect as magnesium citrate. So it draws water out of the intestine, works to soften the stool. So why wouldn't we just use magnesium oxide instead of magnesium citrate, especially when magnesium oxide is a lot more accessible? Well, it has far poorer bioavailability, okay? So it has 0% solubility in water compared to about 50-odd percent for citrate, and only about 55% solubility in stomach acid. I couldn't find any specific figures on magnesium citrate solubility in stomach acid, but it was quoted to be very high, okay. So why do companies choose to supplement with oxide instead of citrate? Cheap, cheap, okay, it's just that simple. If anyone knows who that pink guy is, we can be friends. Looking at electrolytes, these are the electrolytes that we stock here, and electrolytes are going to be responsible for things like muscular and energy recovery, circulation, and detoxification. Supplementation. Okay, so this has been a staple in Lachlan's supplement stack. The reason I go with these is because they have the same ratio of sodium to potassium ratio in his body. Okay, and in doing so, it means I'm not going to inflate his sodium levels too much, which is already, if we remember from before, he's already making a conscious effort to do. Okay, because he's trying to bring his blood levels constantly up. That said, we're still monitoring his blood level, blood pressure levels. And electrolytes also serve to auto-regulate your blood pressure. So that means if your blood, it can regulate it either way. If your blood pressure is too low, it can help to bring it up. If it's too high, it can help to bring it down. Okay, so something super handy for someone like Lachlan that has the rare case of having chronically low blood pressure as opposed to high blood pressure. So that said, something that you can administer with clients that have a high blood pressure, wouldn't hurt to do so. And also helps to relieve bloating and fluid retention. As a result of a lot of the medications that Lachlan takes, it's not unusual that he can put on 2, 3, 4 kilos in just water retention, okay. Again, it's something that we factor in when we're looking at his scale weight, but if it's something that we can minimize with, with appropriate supplementation, then it's something that we'll make an effort to do. And this obviously is going to help to alleviate symptoms that are attributed to IBS and his medications, as I mentioned. So looking at the supplementation approach that we can have with ADD, so he already takes Vyvanse, which is quite common for people with ADD, as this is a stimulant that's prescribed for people with ADD symptoms. It is generally safe to work out on. The only repercussion is for people with high blood pressure— well, he's got low blood pressure, so it's all good. If anything, it actually serves to benefit him because it can help to bring his blood pressure a little bit higher when when we're, when we're training. Potential side effects are going to be anxiety, diarrhea, nausea, or dizziness if someone does have higher blood pressure when they take this when they train. Fibromyalgia supplementation, vitamin D deficiency is often reported in people with this condition, okay? And when we look at the association between vitamin D and bone health and bone density, this shouldn't really come as surprise. Vitamin B12, or even just B vitamins, B vitamins overall, are reported to have— reported to be deficient in people with fibromyalgia as well, especially vitamin B12. And there is research to show positive effects of B12 supplementation in people with this condition. Magnesium as well, as I touched on before. This is theorized to have a good relationship with fibromyalgia as well. As deficiency in magnesium means that you have an increase in substance P levels, and substance P levels are what is attributed to elevated pain levels. So this is the proposed mechanism of fibromyalgia, because remember, they don't have a cure for it at the moment. Chronic sleep deprivation also equals intracellular magnesium deficiency, okay? So if someone's not sleeping due to fibromyalgia, they're going to be deficient in magnesium, okay? And if they're deficient in magnesium, then it's going to feed into these, um, feed into this. So you just get this vicious cycle, okay? So is it a chicken or the egg thing? Well, we don't know, but the appropriate approach here is just going to be to supplement appropriately with ideally all of these things if they need them. I don't supplement vitamin B12 with him at the moment, um, because his vitamin B12 levels are at adequate level at the moment as per his bloods, but he does supplement with a level of B vitamins within his multivitamin. So looking at supplementation for sleep apnea, our good friend vitamin D once again. Okay, so those who are deficient in vitamin D have the same comorbidities as those that have sleep apnea. And again, vitamin D deficiency is reported in people that have been referred for sleep apnea. So what we can see from here is vitamin D is a great thing to supplement for anyone that has any of these conditions, let alone all of them for someone like Lachlan. So vitamin D is essential for your dopaminergic system function, which if you remember is what's theorized to be the proposed mechanism of restless leg syndrome, okay. And again, vitamin D levels are inversely associated with restless leg syndrome. Now we know that correlation doesn't equal causation, but again, it's probably gonna be a safe approach to supplement with vitamin D if someone has this condition as well. On top of this, Lachlan already supplements with gabapentin, okay? So this is an epileptic drug that's used to treat people with, they often get seizures. So it can be used for people with ADHD. As well. It's prescribed in Lachlan's instance as an anticonvulsant, so this is going to decrease abnormal excitement to the brain, okay. It is typically unsafe to take with exercise, okay, so if someone is taking this for ADHD or restless leg syndrome or anything else, it is a consideration to make. That said, for Lachlan's context, because he takes it for his restless leg syndrome, he's taking it at night, okay, so it's safe for him to exercise during the day to still take this later on in the day. So the results is jorts. So Lachlan came in one day wearing jorts and I absolutely flamed him for it. It was the most hilarious thing ever. Just bullied him all session basically. And I said, okay, okay, if he gets under 100 kilos, I'll wear jorts to your next session. Okay, lo and behold, he got under 100 kilos and I'm a man of my word. And thus this picture was born. Okay. So the results thus far is that he's dropped from 124 to 93 kilos, and we're still working on dropping this even further and just setting bite-sized goals of— it's more or less been in 5-kilo increments. So we're looking at getting under 90 kilos at the moment and hopefully looking at getting to what would be his proposed healthy weight range. So we anticipate that to be just under, say, the 85-kilo mark. Okay, but we're obviously constantly making these adjustments as we go. Okay, so he's reporting less pain, which if you remember was one of his, his biggest things to focus on, one of his biggest metrics of progress. So he's just reporting less overall pain throughout his body throughout the day and pulling up a lot better from his sessions as well. Less IBS symptoms since we've made the appropriate changes regarding food and supplementation. Increased strength as well. So the only strength goal we've really had at the moment that's quite onto fireball was being able to do chin-ups, which we have been able to do. And we've since set the goals of being able to get to a 1.5 bodyweight trap bar deadlift and a bodyweight bench. So we've been having a lot of fun with that. We're working towards that at the moment. And his relationship with exercise has also improved. So again, he was someone that came in who was very timid about exercise and very apprehensive about it, as it's something— it was something that he hadn't done a lot of before, something that he was very self-conscious about doing, especially as he had to sit out on a lot of PE growing up in high school. But the biggest change with Lachlan has just been the change in his confidence, and he's just a completely different person to when he walked through the door for the first time. He was totally in his shell. You could barely get two words out of him. I could barely get two words out of him, let alone if anyone else tried to greet him. Or say hello to him, and you, you go to the present day and we've got someone that everyone— who loves to talk to everyone when he comes in, who just brightens up the room. Any of the team here at Enterprise will often see me in tears of laughter within 5 minutes of him walking in. He's someone that I have a great relationship with, great relationship with. He's someone that's made me a much, much better trainer. He's an absolute joy to have around, and he's someone that I'm proud to have as a client and proud to have as a friend. Thank you very much. Um, uh, looks like we've got a couple of minutes, so happy to take any questions if we have any. How long have you trained? About 18 months now, so I think it was about March last year, so a little bit longer actually. Yeah, shoot. How did you find the solution to the sleep apnea problem? Sleep apnea is something that he always has, so that's a chronic condition, okay? It's just something that it has to be managed, okay? So it's not something— he doesn't have it to a very large extent. He's not someone that has to have the machine hooked up to him, but he was just often experiencing— he was sometimes waking up in the middle of the night, but it wasn't to the extent— it's not to the extent to which it's it's a risk to his health in the same way it is for a lot of other people where they need to wear that machine, otherwise they're gonna suffocate in their sleep. So the approach is there, managing any other things that are gonna help him sleep a little bit better and supplementing with appropriate things like vitamin D. And he obviously supplements with, I think the gabapentin actually helps with that as well, if I'm not mistaken. Yeah, does that answer your question? Anyone else? Ethan? 100%. It's a very good question. This was an ongoing conversation between him and I and his doctor. So any questions I had to him, he would convey to his doctor. But it was actually things like the electrolytes, for example, were things that he already knew as well with regards to just being tentative about his— making sure his sodium levels aren't going any higher and things like that. When— so it's just, it was just an ongoing conversation, um, and yeah, it was just some— there were just questions that he would pass on to his doctor. Um, so the approach that I'd suggest anyone to take with a client is basically to do the same thing, or even just ask your client for, say, the doctor's details, and you can even just relate directly with them. It's not often 100%. Um, yeah, so the doctor's cleared it. Um, and yeah, just something that is constantly monitored. But yeah, if you have any, um, reservations surrounding it, always, always take it up with them. Absolutely. Anyone else? Beautiful. I think that'll do us.

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