You Can Build Muscle and Stay Lean—But Only If You Do This First

Hard Time Building Muscle AND Staying Lean?
(Hint: How You Look Today Is the Result of How You Ate Two Days Ago)
Recently, a good friend gave me some honest feedback after I gained about 20 pounds. He mentioned that a few months earlier, I looked “show-ready”—but my face looked gaunt in not so many words. He didn’t need to spell it out entirely; I’ve always known that it shows in my face first when I lose weight.

Let’s be real: I pride myself on staying lean for physical, emotional, and a little ego boost. But I’ve had to grapple with the trade-off between rocking an 8-pack and having a face that looks older (thanks, skin-thickening post-45). I’ve also seen this pattern in many patients—it’s not often talked about but quietly noticed.

So, how can I gain muscle while still staying lean but not gaunt-looking in the face?

Step 1: The Kitchen Always Comes First
If you’ve worked with me, you know my mantra: Heal your fasting insulin first. Ideally, fasting insulin should be under 3. Why? Elevated insulin starts a cascade of problems—chronic inflammation, fat storage, glycation (aging skin!), fatty liver, high cholesterol, low mood, and kidney decline, to name a few. What is the fastest way to achieve this? Replace all carbs with non-starchy veggies. It’s simple, effective, and tackles these dysfunctions head-on.

Step 2: Add Complex Carbs back (Strategically!)
Once your fasting insulin is under control and your body composition is dialed in—specifically, less than 20% android fat as measured by a DEXA scan—it’s time to reintroduce carbs. Not just carbs, though—complex carbs, and not at every meal. Why? Because your muscles need carbs to grow. The trick is to find that 'sweet spot' where you build muscle while staying lean and avoiding the gaunt, “extra-lean” look that can age your face.

How I Did It
When I moved from 172 pounds to 192 pounds to build muscle, I increased my carb intake from less than 50 grams daily to around 250–300 grams daily. I didn’t just add carbs indiscriminately. Instead, I followed a flexible pattern:

• High-carb days: 3–4 days of higher complex carbs.

• Low-carb days: 2 days back to just non-starchy veggies.

• Repeat the cycle while assessing results in the mirror

The Mirror Test
A golden rule I’ve learned: How you look in the mirror today reflects how you ate not yesterday but the day before. Use this feedback loop daily. After your morning routine, look in the mirror and adjust your carb intake accordingly. Are you filling out with muscle and maintaining a lean look? Excellent—keep going. If you notice extra fluff, dial the carbs back. This approach isn’t one-size-fits-all. Your age, activity level, muscle-to-fat ratio, and body type (mesomorph, ectomorph, etc.) will influence your optimal carb intake. But with intentional adjustments, you can strike a balance between staying lean, looking more youthful in your face, and building muscle.

Grateful to be your physician guide.
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Kevin Hoffarth MD, IFMCP
Author: Functional Medicine: The New Standard
Owner: BioFIT Medicine, Austin TX