What Needs to Shift?

Whether you're trying intermittent fasting, lifting weights, or eating ‘better’, there's one question that haunts every health journey: Are my efforts actually working?

I learned this lesson in 2018 ⏳.

There I was, playing by all the rules — lifting weights four times a week 🏋️‍♂️, eating extra calories like it was my job 🍽️, watching those numbers climb 📈.

Looking good on paper, right?

But one question kept nagging at me: was I actually building muscle, or just getting really good at gaining fat?

My search for answers led me to DEXA scans (Dual-Energy X-ray Absorptiometry)—essentially a type of X-ray that maps out the muscle, fat, and bone in your body and shows you how much you have of each.

And as it turns out, I wasn't alone in this search for clarity.

Enter Dr. Ali Abdaal, a physician-turned-YouTuber who appeared what most of us would consider "normal healthy". The kind of physical build that wouldn’t raise an eyebrow at most medical check-ups.

Normal BMI? ✅

Fits in slim-fit shirts? ✅ 

Energetic? ✅ 

Could probably rock a meditation app sponsorship? ✅ ✅ 

But when he decided to get his first DEXA scan, it revealed something his YouTube camera never could: dangerous levels of visceral fat quietly accumulating around his organs ⚠️. ¹

The eye-opener was yet to come.

Fast forward six months of what he thought was "crushing it" — cutting calories, "dieting," and doing plenty of general exercise 🏃‍♂️. After losing 3 kg, he returned for another DEXA scan, expecting praise. Instead, he learned that most of his weight loss came from muscle, not visceral fat 🚨.

It's like decluttering your house by throwing out the furniture while keeping all the junk.

The DEXA scans transformed his approach in two ways. First, it showed where he stood compared to the population—concerning levels of visceral fat despite his "normal" appearance and BMI. Then, as he tried to fix this, the follow-up scan revealed a crucial, but common mistake: his "weight loss" was actually muscle loss ⚠️.

This precise feedback led to a shift in his strategy: more resistance training 🏋️ and higher protein intake to preserve muscle while targeting fat loss. When he returned for his third scan, the new strategy showed progress: same weight on the scale, but 1.5kg of fat replaced with muscle 🎯.

DEXA scans serve two key roles: showing where you stand compared to others in your age category, and tracking whether your strategy is actually moving you toward your goals.

What DEXA Reveals 🔍

Over 15-30 minutes, the scan uses two low-dose X-ray beams to create a detailed map of your body composition:

• 📊 Body Fat: Shows your total body fat percentage and, how much visceral fat you're carrying around your organs—that key longevity marker we discussed last week.

• 💪 Muscle Mass: Tells you how much muscle you have and where you rank compared to others your age and gender—showing whether you've built enough muscle mass or have serious work to do, as we explored in Issue #2.

• 🦴 Bone Density: Measures your bone strength and density—critical information since bone loss often goes unnoticed until it's too late.

Just like an MRI or blood work, you won't interpret these results alone. The facility that performs your scan or your healthcare provider will walk you through what your numbers mean and what to do about them.

Radiation Reality Check ☢️

Like all X-ray-based imaging, DEXA scans use a small amount of radiation. Every day, doctors order chest X-rays to rule-out pneumonia 🫁, and women over 40 get routine mammograms for breast cancer screening.

We barely blink at these procedures because we understand their life-saving value. ❤️‍🩹

Yet, mention DEXA scans, which use less radiation than either, and some people raise their eyebrows. Why? We tend to overestimate risks we don't fully understand.

Let's put this in perspective with some numbers that might surprise you:

• A single cross-country flight ✈️ delivers double the radiation exposure of a DEXA scan.

• A standard mammogram? That's 20 times more radiation. 📊

• Living close to sea-level (i.e. Boston) for a year? ⚓ You're casually absorbing 150 DEXA scans worth of radiation just vibing by the harbour.

The benefits of understanding your body composition, bone health, and visceral fat levels come with radiation exposure so minimal, worrying about it is like fretting about a water gun while swimming in the ocean. 🌊

The real risk isn't the radiation—it's making years of health decisions based on incomplete information.

Who Else Is Talking About it?

Want to know what to expect from your first DEXA?

Host Amelia Phillips (exercise scientist and nutritionist) shares her experience while she and Brendan Barry (exercise physiologist) walk through the practical details—from what happens during the scan to costs, frequency recommendations, and other nuances of the process.

Your Next Move

Getting your first DEXA scan might feel like a blind date with science—but unlike a date, this isn't about looking good. It’s about having an honest conversation with your body.

Think of it as opening a treasure chest: you might strike gold (more muscle than you thought! 💪), uncover hidden threats (that sneaky visceral fat ⚠️), or discover structural weaknesses (bone mass 🦴) that need reinforcing. Share this treasure map with your longevity physician or trainer to chart your course forward. ⛵

Schedule Your First Date With DEXA 📅

• Book that baseline scan now (yes, even if you're not where you want to be — that's the whole point) ✅

• Go first thing in the morning, fasted, and well-hydrated for consistent results. ☀️

• Dress code: simple workout clothes are perfect 👕 (no metal — save the bling for later)

• Time commitment: 15-30 minutes ⏰

Time Your Check-Ins Wisely ⏳

Like any good story, pacing matters.

• Sweet spot: Every 6-9 months (enough time to see real change, but not so long you've wandered off course). 📊

• Between scans, your bathroom scale becomes your daily teammate. While DEXA confirms whether you're making the right changes, your scale helps track progress along the way. 📈

Keep Perspective

No DEXA scanners in your area? Don't let that stop you.

• The fundamentals haven't changed: lift heavy things, eat plenty of protein, rest, repeat.

• Your scale and mirror might not provide the complete story in 4K, but they're still better than flying blind.

Remember: your results happen in the kitchen and gym—the scans simply help calibrate those efforts and ensure you're on the right path. Even without a GPS, you can still reach your destination.