As soon as I saw the name of Dr. Bryan Walsh's program, I cringed. Here we go again, I thought, another wanker making excuses for people who won't control what they eat or get off their asses and go to the gym.

After talking with Dr. Walsh for a few hours, I still hate the title of his program. I bet you will too. Okay, brace yourself. Here it is:

Fat Is Not Your Fault

Ug. Listen, I've been fat, and it was totally my fault! Who is this guy telling people that fat ain't their fault? Whose fault is it? Someone giving them intravenous Twinkie infusions in the middle of the night?

Then again, I knew that many respected nutrition gurus refer to Dr. Walsh as their "go-to guy" when they run into a client that just can't seem to lose fat. And I knew this naturopathic physician worked with physique competitors and athletes and was no stranger to bodybuilding.

It was time to sort this out. I contacted Dr. Walsh and turned on my digital recorder.

T Nation: Fat is Not Your Fault? Are you outta your mind?

[laughing] I don't blame you. The title gets people's attention, and that's what I want to do. There's some truth to the title, which I'll get into, but first I need to make something very clear.

This is not for people that sit around eating Ding Dongs all night while watching reruns of Dancing With The Stars and then wonder why they look like crap. It's not for people who try taking Alli hoping it will help them lose weight while they walk around the mall sipping on a frappuccino.

A good physique takes effort and if you're not willing to do that I don't really want to hear about it. Diet and exercise always come first. Period.

T Nation: That sounds better than "Fat is not your fault." So what the heck are you talking about then?

Okay, let's say you decided to take up gardening. The two things necessary for a plant to grow are sunshine and water. So you go down to Home Depot, buy a couple plants and start taking care of them. But after a few weeks, they don't grow.

So you give them a little more sunshine and extra water, but they still don't grow. You add fertilizer. No dice. You even sing to them. They don't budge.

Then one morning you wake up and see your son squirting Windex on your plants, thinking he was watering them for you. Is that your fault? No. Things happen. You didn't know about it, but now that you do – and this is a major point – it is your responsibility!

Just like there are two things to make a plant grow, we need two things to lose weight – diet and exercise. But a plant will only grow to the degree that it has healthy soil. When it comes to fat loss, we are the soil. The health of our physiology dictates our response to diet and exercise.

T Nation: Okay, but who's squirting Windex on our physiology? I'm still not convinced.

I'll give you a few examples. Firstly, there are plenty of studies showing that certain chemical compounds – some pesticides for example – cause animals to gain weight.

For example, they'll have two groups of mice eating the exact same diet. One group receives exposure to a certain chemical and they'll gain weight versus the other group. In fact, cattle farmers used to knowingly give their herd some of these chemicals because they gained weight on it. It's illegal now, but they used it because it would fatten up their cattle and bring them more money.

If you think you don't have any of these chemical exposures, you need to start doing more research. They are everywhere and it's well documented.

Another example: Fairly recent research has shown that certain bacteria in the gut can actually cause you to extract more calories from your food than you're ingesting. It's a little hard to wrap your head around that concept, but it appears these bacteria are metabolizing food in such a way that you end up absorbing even more calories from your food.

Lastly, there was a small study done in Europe that looked at food sensitivities in obese individuals. IgG food sensitivity tests were done on people and they were told to avoid those foods for the duration of the study. Every single person ended up losing weight, despite the lack of exercise. The researchers concluded that the elimination of food sensitivities may be a treatment for obesity. That's huge.

So simply using these examples you might have chemical exposures, abnormal bacteria in your gut, and food sensitivities. If so, I guarantee losing weight will be more difficult for you than someone who doesn't have these issues.

T Nation: Hmm, I see your point, but give me some real world examples that could relate to the general public. I mean, how many people have pesticide exposure that will actually stop them from losing weight?

More than you think, but I'll give you some more concrete examples based on biochemistry.

There are a host of things that will impact someone's ability to lose weight, but there are four "deal breakers" that'll make anyone's fat loss program not work.

The number one nutrient in the body is oxygen. Don't believe me? Try holding your breath for ten minutes and then we'll talk. To put it in very basic biochemical terms, if your body can't produce ATP, it can't repair tissues. It can't recover from injury and every cell of your body will be working sub-optimally.

In any biochemistry class you learn that when glucose goes from the citric acid cycle, to electron transport, to the oxidative phosphorylation pathway, 36 ATP are produced. But that's in an optimally functioning body. That's a best-case-scenario textbook version of the process.

In reality, two things are necessary for ATP production – oxygen and glucose. If either one of those are impaired for any reason, 36 ATP won't be produced. Multiply that times a trillion cells and it'll make a big difference.

Editor's note: As we're sure Dr. Walsh knows, ATP can also be produced without any oxygen at all in the process known as anaerobic glycolysis. It's very inefficient–2 ATP compared to 36–but it happens a lot. We wanted to point this out in case any smarty-pants first-year biochem students got their dander up from presumably catching an error in Dr. Walsh's discussion of the oxidative phosphorylation pathway.

If a cell isn't working correctly, you can forget about optimal function, including muscle gain or fat loss. Medically, this is referred to as anemia, but we see subclinical versions of this all the time, meaning it's not diagnosable, but oxygen deliverability is impaired.

T Nation: Interesting. Tell us more.

Fat loss is about physiology. Diet and exercise are an attempt at altering physiology, but if your body isn't working properly, diet and exercise won't have the effect you're looking for.

That's why I call it Fat Is Not Your Fault – fault and responsibility are two very different things. For example, if you run out of gas because you weren't paying attention it's your fault. But if you run out of gas because the gauge was broken and you didn't know it, it's not your fault. It is, however, your responsibility.

T Nation: Good analogy. What are the other deal breakers?

Adrenal physiology, blood sugar balance, and gastrointestinal function, including liver function.

T Nation: Okay, hold on a minute. Before we get into all that, I'm wondering when someone should start to look into these physiological systems? Some people are just unrealistic. They lose three pounds a week on a diet and think it's not fast enough and that something must be wrong with them. Building your best body takes time.

Completely. If it's taken you six months to get out of shape, you're not going to get it back in a couple of weeks. People need to put in some solid effort and a reasonable amount of time to see any reliable results. And if that doesn't work, tweak the program a few more times. We're all different and it can take some tweaking to get the diet and exercise program that works for us dialed in.

But if you've legitimately tried a few different diet and exercise programs – and I'm not talking about the "Somersizing" diet – maybe you should start considering that your physiology is out of whack.

T Nation: So you see real people following truly good training and nutrition programs for a considerable amount of time and still getting no results?

You'd be surprised at how many. This whole concept became more solidified for me when some very big names in the industry started sending me their clients. These are experts I'd personally go to if I needed the best diet and exercise info, and they're sending me people saying they don't know what else to try.

T Nation: So what's the first step in diagnosis?

The first thing to do is look at your symptoms. A lot of people have gastrointestinal symptoms and think it's normal. Some women have a bowel movement every few days and think that's normal. Guys think ripping farts all day long is normal male behavior.

Sorry, but you're wrong. A normal person doesn't break wind on command, and it shouldn't smell like your neighbor is repaving his driveway when you do.

I could go into a lot more detail on all of these, but you'd be sitting here all day.

T Nation: So nutshell it for us.

Okay, I already talked about oxygen deliverability to cells. If you can't get adequate amounts of oxygen into your cells, nothing will work correctly. Hormones, brain function, fat loss... forget about it. This is fundamental. Oxygen is the most important nutrient in the body.

Next is blood sugar. If you think you don't have a blood sugar issue, you might want to think again. You want to know the first step towards diabetes? Low blood sugar. You see, when blood sugar starts to get out of control, the pancreas produces insulin. Your body is really good at lowering blood sugar, but it does so with elevated insulin levels.

Blood sugar issues are rampant today, even in people who eat right and exercise. The problem with blood sugar issues are two-fold. One, like I said earlier, if you don't have glucose and oxygen in a cell, that cell won't function correctly. If you have insulin resistance (metabolic syndrome) or the opposite, hypoglycemic tendencies, glucose isn't getting in the cell.

The other problem is that in men, insulin raises estrogen levels. Insulin also simulates cortisol production via interleukin-6. We've seen hypoglycemic tendencies cause pretty significant insulin and hormonal problems in both men and women.

T Nation: What about adrenal issues?

Most people totally misunderstand them. Dysfunctional adrenal hormone production will affect fat loss in a number of ways. Most people probably know about the effects of high cortisol, but low cortisol can screw you up too. Adrenal issues are far more present, and more damaging, than people realize.

T Nation: How about the last thing you mentioned, gastrointestinal dysfunction?

If your guts don't work, nothing will. Some old timers have suggested that "death begins in the colon." There's some truth to this statement.

A lot can go wrong with your gastrointestinal system, which has systemic effects on the rest of your body. Food sensitivities, abnormal gut barrier function, fungal or parasitic infections, dysbiosis... any of those things have the potential to completely wreck other systems of your body, including cortisol production, inflammation, hormone balance, immune function, etc.

T Nation: Okay, so which of the four problems – oxygen delivery system, blood sugar management system, adrenal or digestive system – is most common?

That's tough. We see all of them a lot in our practice. In women, oxygen deliverability is more common than in men, but just about everyone has adrenal issues as well as gastrointestinal issues.

It's hard to choose one because they are all tightly interrelated. For example, let's say someone has a gut issue – an infection for example. This is a stress to the body, which will increase cortisol, which then increases blood sugar. Increased blood sugar raises insulin levels, which increases a cytokine called interleukin-6, which increases cortisol, and thus the vicious cycle continues.

Or, let's say it starts with stress and elevated cortisol. It could be overtraining, or a stressful event, or even, theoretically, stimulant use. Elevated cortisol decreases stomach acid, making you more prone to a GI infection, which leads to the cascade above. Or even if that doesn't happen, cortisol decreases SIgA in your gut – your body's protective gut lining – which makes you more prone to food sensitivities, which can lead to elevated cortisol and insulin, etc.

Regardless of what type of diet or exercise program you're following, this will completely hinder your results. You may lose 15 pounds in two months, but you'll have to work your ass off for it because you're fighting against physiology – and you may have been able to lose even more body fat if things were working properly.

That's why these are the top four things we always start with in our practice because any one of them will make the rest of your body not work properly.

T Nation: As muscleheads who train like maniacs, are there particular problems we should be on the lookout for?

A couple of things. One, eating the same thing day in and day out can cause food sensitivities. These are really common nowadays. You don't want to do that, trust me.

Two, adrenal-related issues depending on how hard you train. Also, I've never seen any research on it, but the rampant stimulant use nowadays is likely causing a negative impact on adrenal physiology.

And I know "overtraining" is talked about a lot, but it can be very real and it does exist. I don't know statistics, but there are people who have severely impacted adrenal function and don't know it. It's very rare that we see a normal adrenal panel come back to us.

T Nation: Okay, so let's say my diagnosis is that my cells aren't receiving adequate amounts of oxygen. First, what caused that? Second, what's the fix?

It depends. Most commonly it's due to low iron and or low folic acid/B-12. However, these might be low due to hypochlorhydria – or low stomach acid – causing an inability to fully absorb nutrients.

Low iron in men is likely due to a bleeding issue, such as from your gastrointestinal system (i. e. an ulcer). In women it's far more common. But do not take iron without getting good lab work! Iron is the most toxic, most inflammatory metal to the body. Forget all this talk about mercury, lead and aluminum – iron is very toxic. Again, find a good doctor and get tested first.

Low B-12/Folate is another common cause of oxygen deliverability issues and is most often caused by absorption issues in the gut. If you don't have adequate stomach acidity, this could be an issue. Also excessive alcohol intake can deplete some B vitamins. The fix for this is easy – take B vitamins, but still believe in getting tested first. If you're not assessing, you're guessing.

T Nation: Imbalanced blood sugar levels would seem easier to spot. It's usually just a crappy diet, right?

I wish it were that easy. While yes, that's partly true, do you know the main role of cortisol? It's to elevate blood sugar. It's a glucocortocoid.

So you can be eating a pristine diet and following a killer exercise program thinking you have balanced blood sugar, but if you have something causing high cortisol, you'll likely have blood sugar issues as well. Nothing to rush off to the doctor for, but something that can be hindering your progress. Your training program alone could be causing elevations in cortisol leading to elevations in blood sugar despite your diet and exercise program.

I think people need to get tested but have it read from a functional perspective. Do you know that when you get blood work done, your results are compared to sick people? This actually pisses me off quite a bit.

The reference ranges for blood work are a bell curve analysis of people that normally get their blood work done. In other words, sick people. When's the last time you woke up in the morning and said, "You know, I'm feel fantastic today. I think I'm going to get my blood work done."

No, it's people who are sick that are going to the doctor and getting blood work done. So when you go get blood work and it's within the reference range, what it's really saying is, "You have the same results as 95% of the people that go to the doctors." But who's going to the doctor? People with diabetes, heart disease, cancer, etc.

So anyhow, I think people need to get tested and go to a doctor that knows what he's talking about. That's really the only way to know. Symptoms can help, but aren't that reliable. Especially in guys.

T Nation: Okay, same question for adrenal issues. What's the most common cause and how do we fix it?

The most common pattern we see in our practice is low adrenal function. But that's probably because people with high cortisol won't be seeing a doctor anytime soon – they are too wired to be bothered.

Elevated cortisol causes what I call the "wired and tired" effect – people that are wiped out but can't slow down because their mind is racing, especially when they're trying to get to sleep. So as much as low cortisol is what I see most of, elevated cortisol is probably a pretty big problem today. Again, people need to be tested.

But determining the cause of the adrenal problems is tough. Your adrenal glands respond to stress, and virtually anything can cause stress – mental/emotional stuff, not enough sleep, poor diet, food sensitivities, a gut infection, you hate your wife, your job sucks, elevated blood sugar... You name it, it can stress out your body.

In terms of how to fix it, it depends on what's going on. Elevated cortisol needs high dose phosphytidyl serine to help lower it, as well as help regenerate hippocampus cells. Cortisol damages the hippocampus, which is the very thing that manages the HPA axis in the first place.

And I don't care what the literature says, you need at least 2 grams of PS a day to regulate cortisol and help regenerate hippocampal cells. Also, adaptogenic herbs can be helpful in regulating the HPA axis. Things like rhodiola, ashwaganda, some of the ginsengs, maybe a little vitamin C, pantetheine and glandular support.

Someone with low cortisol levels needs some additional support. PS can be helpful in these people, not because of its impact on cortisol, but because of its impact on the hippocampus. But more importantly, licorice root extract will help elevate cortisol levels. However, people with high blood pressure might not want to take it – it can elevate blood pressure.

Adaptogenic herbs will be helpful here and someone might even need low doses of DHEA and pregnenalone depending on how depleted they are. But again, get tested first.

T Nation: Now, how do we fix the gastrointestinal system issues you mentioned?

People have known forever that the gut plays a critical role in health, fat loss, muscle gain, etc. But five years ago if you said it, you were laughed right out of the gym. Now you get these muscleheads that say, "Dude, you think I should start taking probiotics?"

Anyway, gut health is huge. This is an easy one to catch because everyone knows the symptoms. In fact, everyone else in the same room as you probably knows you're having symptoms. So this one is the easiest to spot.

In terms of the fix, it depends on what the problem is. If you have food sensitivities, you need to go on an elimination diet for a few weeks. If you have some type of infection, you should get tested to see what it is, what it's sensitive to, and kill it. If you have decreased mucosal barrier function, you need to avoid whatever is causing the problem, and take things to support its reconstruction.

And as I've said a few times already, I'm a big fan of testing. The GI Effects test from Metametrix is one of the best gut function tests on the market.

T Nation: Okay, this is good info, but my worry is that many people will glom onto one of these conditions and blame it for their lack of progress, when in truth they're just not as strict with their diets and training plans as they'd like to think. Have you run all these tests on someone and told them, "Nope, no problems. You just eat too damn much, fattie."

Totally. But usually I don't need a test to know that. You can get a pretty good idea just by asking questions. One good one is, "What are the three healthiest foods you eat?"

They say, "Um , whole wheat pasta, organic bran muffins, and organic cereal with rice milk." Riiiiight. Then we have a talk about diet.

Some people are really tough to figure out though. But it basically boils down to one of a few things – hormone balance, adrenal health, gastrointestinal function, liver function, and blood sugar balance.

T Nation: I still hate the title of your program, Doc, but thanks for the interview and the intriguing info!

NOTE:For more info on Dr. Walsh and his Fat Is Not Your Fault program, click HERE. T Nation doesn't endorse all the concepts in this product, but we do find many of Dr. Walsh's ideas interesting.