Tag Archive for: calories

The Cause of Obesity

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On Tuesday, I said that I couldn’t get past the word disease in the statement from CDC Head of Disease Prevention and Health Promotion: “Obesity is a disease caused by many factors, including eating patterns, physical activity levels, sleep routines, genetics, and certain medications.” While we can agree that there may be a genetic or medication contribution to obesity, there is only one real cause.

The definition of disease is a disorder of structure or function in a human, animal, or plant, especially one that has a known cause, and a distinctive group of symptoms, signs, or anatomical change. There’s no question that obesity has anatomical changes that result in symptoms.

But understand the numbers of obesity. Not everyone is massively oversized; the average height for a man in the U.S. is 5’9” and over 202 pounds to be considered obese, while for the average height of a women is 5’4” and over 173 pounds. There are many people who can hide that weight well. My point is that it’s not the largest individuals who are tipping the scales in the increase in obesity; it’s all of us above normal weight contributing our share.

The disorder part of the definition is one that is clear.

The Cause of Obesity

The cause of obesity is the systematic overconsumption of calories, usually taking years, if not decades, to manifest itself.

The Evidence for the Cause

There are two examples I’ll cite, both related to World War II. The first was the Minnesota Starvation Experiment. Male conscientious objectors had to lose 25% of their body weight in six months. They were normal weight when the study began, and their caloric intake was adjusted weekly to maintain the required weight loss. The result was a linear loss of 25% of their weight in six months.

This one is extreme but applies nevertheless. No one walked out of concentration camps overweight after being liberated—no one. They were systematically starved until they no longer had the energy to work.

In both cases, there was not a change in structure or function; the people were simply starved. The result was weight loss. There’s no change in structure or function when we systematically overeat. However, once we’re overweight and obese, there are changes in the structure and function of our bodies that must be dealt with. But it still comes down to this: a calorie is a calorie. No matter what genetics we have or what medications we take or how little we move, we won’t get fat if we don’t overeat.

The Bottom Line

We are obese because we consistently eat too many calories. We can reduce our weight if we systematically eat less. Yes, there are challenges to overcome because of those structure and function changes caused by chronically overeating. You just have to find the way to reduce your caloric input that works for you. Eat less. Eat better. Move more.

I frequently am asked which calorie-counting app is best, and I don’t have an answer. Do you? Have you found one that’s easy to use? Drop me an email and let me know which app you like and why. I’ll give them a try and let you all know which ones perform best.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/obesity/data/prevalence-maps.html

Diet: It Just Doesn’t Matter

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Long-time readers probably know I love using quotes from movies. One of my favorites is a Bill Murray line from the movie Meatballs. Although it’s part of a much longer rant, the key phrase is, “It just doesn’t matter!” That’s what I want you to remember from the study that examined the percentage of energy nutrients in the paleo diet. They found a significant difference in the range of nutrients, but the ranges are wide enough to incorporate the ketogenic diet as well as the Mediterranean diet.

Looking at the diets of hunter-gatherers in different parts of the world showed that the types of carbohydrates were dependent on what was available. In some cultures, digging up root vegetables and tubers was critical to the diet. But eventually, we learned to grow and process grains, and now we have an abundance of refined carbohydrates such as breads and pasta, often to our detriment.

What are the lessons?

Personalization

In one of the many commentaries I read on the merits and downfalls of the paleo diet, one researcher said this:

Ultimately, the best way to eat for your health is the change you can keep up with. Most people know what they need to do: limit calories, eat fruits, vegetables, whole grains, and lean proteins. The challenge is how to do it. There are lots of ways people can achieve this. The key is figuring out which is best for you as an individual that you can keep up with.

That uses a whole lot more words, but the message is the same as always: eat better.

When It Comes to Weight, It’s All About the Calories

Whichever way you decide to eat—and there are many ways to eat a healthy diet—losing weight is always going to be about how many calories you eat versus how many calories you expend. You can eat the carnivore diet, which is essentially all meat, although I wouldn’t recommend it. Or you can become a vegan. You can follow the DASH diet that I talked about a couple weeks ago, or you can eat the paleo diet. It just doesn’t matter. As long as you control the number of calories you eat, you can get to and maintain a normal body weight.

I believe you have to have vegetables and fruit as the foundation of your diet, but there’s a difference between maintaining a normal body weight and sustaining a healthy lifestyle. What we eat does matter. But quality aside, as always, it is and it will always be about the calories. Nothing else matters in controlling what you weigh. Eat less.

And if you can, eat better.

What are you prepared to do today?

        Dr. Chet

Reference:https://doi.org/10.1016/j.ajcnut.2022.12.003

Is Summer Paleo Diet Time?

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Now that we’re past Memorial Day, we’re officially in the summer season. For many people, that typically means they grill more than at other times of the year—I know that I do. It also seems like we favor more vegetables and fruit. In a way, it seems to mimic the paleo diet approach: we eat foods closer to nature before planned agriculture became common. I can’t say we’re hunter-gatherers because we mostly shop at the same grocery stores, but we may buy foods closer to the source due to the prevalence of roadside stands and farmers markets. With all the fresh food available, we also may eat fewer grains and starches, which also fits the paleo profile.

Or does it? Researchers at Simon Fraser University decided to examine the premise behind the paleo diet in terms of proportion of protein, carbohydrate, and fat. The current paleo diet approach consists of 19-35% protein, 22-40% carbohydrate, and 28-58% fat. While the range of percentages in each energy category are wide, it does focus on much higher protein and much lower carbohydrate, especially refined carbohydrates.

In a recently published paper, researchers at Simon Fraser University examined the percentage of energy nutrients in the diet of ten hunter-gatherer societies and in different locations. They derived the following percentage of energy nutrients: 14%–35% protein, 21%–55% carbohydrate, and 12%–58% fat. The percentages were significantly different—they incorporated a wider range in each nutrient category.

Are these differences meaningful in the real world? I’ll let you know on Saturday. Meanwhile, time to grill some burgers and veggies.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1016/j.ajcnut.2022.12.003

Lessons from the Starvation Study

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The analysis of data in the Minnesota Starvation Study was immense—1,385 pages in two volumes—but I found two fascinating quotes from interviews with the subjects and lead author Dr. Ancel Keys. Let’s begin with a quote from one of the subjects in an interview 40 years later.

Lesson 1: How You Know You’re Restricting Food Too Much

“I don’t know many other things in my life that I looked forward to being over with any more than this experiment. And it wasn’t so much . . . because of the physical discomfort, but because it made food the most important thing in one’s life. . . food became the one central and only thing really in one’s life. And life is pretty dull if that’s the only thing. I mean, if you went to a movie, you weren’t particularly interested in the love scenes, but you noticed every time they ate and what they ate.”
Harold Blickenstaff, Study Subject

If you try to restrict calories, and you’re obsessed with food all day long, you’re restricting calories too much. For most of us, lowering our intake 10% to 15% by making better choices should not be that noticeable. Yes, it takes a little time to get used to eating a different way, but it shouldn’t create an obsession with food.

Lesson 2: Post-Weight Loss Honeymoon Period

“Enough food must be supplied to allow tissues destroyed during starvation to be rebuilt . . . our experiments have shown that in an adult man, no appreciable rehabilitation can take place on a diet of 2,000 calories a day. The proper level is more like 4,000 calories daily for some months. The character of the rehabilitation diet is important also, but unless calories are abundant, then extra proteins, vitamins, and minerals are of little value.”
Dr. Ancel Keys, Lead Scientist

Caloric restriction is used to lose weight as well as to try and attain the many benefits of long-term caloric restriction. Eventually you reach a point of unity; you achieve your goal weight and that’s where you maintain.

But if you’ve ever reached a weight loss goal, chances are you’ve tempted fate: you experiment to find out if you can eat a little more of your favorite foods. You add little at a time, and you don’t see the scale move—at first. But eventually, the honeymoon period ends and you begin to gain back the weight. It’s happened to me several times. Be aware that it will happen to you. Remember, it’s always about the calories. Keep that in mind and you’ll abandon that weight permanently.

The Bottom Line

One more item from those interviews 40 years later: to a man, the subjects all said they’d do it again. In spite of the deprivation they went through, they knew the knowledge gained was important. I think it speaks to their character to know they would make those sacrifices again.

These two quotes provide us with guidelines. Keep them in mind so you know when you may be overdoing restricting or eating. We’re after the long-term benefits, so keep adjusting until you make it your way of life.

What are you prepared to do today?

        Dr. Chet

Reference: J. Nutr. 135: 1347–1352, 2005.

The Right Meal Plan for You

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“On Day 1 of semistarvation, February 12, 1945, the men sat down to a meal that included a small bowl of farina, two slices of toast, a dish of fried potatoes, a dish of jello, a small portion of jam, and a small glass of milk.”

This was a quote from the Minnesota Starvation Experiment to give an example of the meals the subjects ate during the six-month study. In our carbs-obsessed society, that’s just about the worst meal imaginable. Remember, the purpose was to lose 25% of their body weight in six months. They could eat only the foods that would be available during WWII; the non-combatants in the areas where the war was fought had been semi-starved for years, and we had to know how to begin to feed them so they didn’t get sick from overconsumption.

When I said it’s all about the calories, I really meant it. If you’re ready to try calorie restriction, eat exactly what you’re eating now but reduce it by 11% to 15%. It’s also a great time to eat better with more vegetables and fruit and less fried food, but it’s not mandatory. The Right Meal Plan is one you’re willing to maintain for the rest of your life.

I’ll cover a couple more lessons from the Minnesota study on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J. Nutr. 135: 1347–1352, 2005.

Semifinal Thoughts on the CALERIE Study

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In case you’re thinking, “Wow, I can’t believe he’s still talking about this one study”—I know! I don’t typically spend this much time reviewing a single study, but this one answered a lot of questions about the benefits of cutting calories. Even with 60 publications so far from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) clinical trial, there’s still a lot more info to come and two big questions still to be answered.

More Results from the CALERIE Study

In this first controlled study of calorie restriction in healthy humans, researchers found that:

  • Fasting insulin decreased
  • Triglycerides, total cholesterol, and LDL-cholesterol decreased
  • HDL-cholesterol increased
  • Glucose tolerance increased
  • Working memory improved
  • Inflammation markers such as C-reactive protein and TNF-alpha decreased

As more data is examined and new analytics are discovered to test more variables, I’ll be bringing you more results that may help you be healthier.

What We Don’t Know

The most important thing we don’t know yet is whether calorie restriction is an effective way to lose weight and whether all those great benefits would still apply. By definition all diets restrict calories, but this is not a diet; this is changing your lifestyle to maintain a calorie restriction of 11% to 15% for a long time, preferably for life. If you want to maintain the benefits, such as better insulin control and reducing the risk of heart disease, you never stop.

The other question is whether one type of eating style would be more effective than others to sustain the diet and its effects. Mediterranean? Keto? Vegan? We still don’t know for sure, but my opinion is that it doesn’t matter—it should be one that you can live with long term using the healthiest foods you can afford.

The Bottom Line

The CALERIE Study has demonstrated specific health benefits for calorie restriction of 11% to 15% for normal weight people. I think it will apply to overweight people as well. In the next few weeks, I’m going to drop my caloric intake by 12.5%, and I’ll keep you posted on how you can do it as well.

What are you prepared to do today?

        Dr. Chet

Reference: Nutrition Reviews 2020: Vol. 79(1):98–113.

How Calorie Restriction Affects Your Metabolism

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Resting metabolic rate (RMR) is the number of calories you use while at rest—just lying around doing nothing. It’s the calories your body uses to operate your internal organs and your brain, etc. From the second you open your eyes, the calories you burn are considered activity-related calories.

The concern in trying to restrict calories as in the CALERIE Study is how that will affect RMR. Will it be proportional or will RMR go down too much, leaving you feeling too tired to do anything?

Researchers examined the data in a subset of normal-weight subjects over a year, looking at tissue losses and metabolic adaptations that contributed to the reduction in RMR. In other words, which organs or systems were impacted the most to lower RMR? They calculated the differences before and after the secondary study to see what changed, and found that the RMR was reduced by only 101 calories per day.

There’s more to come from the CALERIE study. One thing for sure is that a small reduction of 12% to 15% in calories every day can do you a whole lot of good—no special diets necessary—without losing your get up and go.

What are you prepared to do today?

        Dr. Chet

Reference: Int J Obes (Lond). 2022 Feb 18. doi: 10.1038/s41366-022-01090-7.

Can Cutting Calories Improve Your Mood?

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In research like the CALERIE study, there’s a tendency to focus on physical changes but what about mood, depression, and quality of life (QOL)? Did researchers find changes in those variables as well? Let’s take a look. While the two-year span of the data analyzed varied slightly from other phases of the study, physiological results were virtually identical to the other phases I’ve talked about in previous Memos.

Testing Procedures

For those readers familiar with the assessment tools typically used in measuring psychological variables, here’s a list of the instruments they used.

Mood: Beck Depression Inventory-II [BDI-II] and the Profile of Mood States [POMS]

QOL: Rand 36-Item Short Form and Perceived Stress Scale

Sleep: Pittsburgh Sleep Quality Index [PSQI]

Sexual function: Derogatis Interview for Sexual Function Self-report

Results

For simplicity’s sake, I won’t use numbers to report the results, because unless one is familiar with the scale for each assessment it wouldn’t be meaningful. Every following relationship was statistically significant or correlated. Compared with the ad libitum (AL) group, the caloric restriction (CR) group had significantly improved mood, reduced tension, and improved general health and sexual drive at month 24. Sleep duration had improved by month 12 and was sustained through month 24.

Greater percent weight loss in the CR group at month 24 was associated with increased vigor and less mood disturbance, improved general health, and better sleep quality. The researchers concluded that there was no negative impact of CR on psychological variables in normal-weight people.

I have a tendency to put more faith in measurable variables such as blood pressure or heart rate than inventories and questionnaires, but the results demonstrated that all measures moved in a positive direction when restricting calories: better perception of mood, health, QOL, more and better sleep, and even sexual vigor. There are indications that CR may be beneficial even in people who are normal weight.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2016 Jun 1;176(6):743-52.

Saving Muscle While You Reduce Calories

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Several studies have been published from the CALERIE study data with even more interesting revelations, so I’ll review several over the next few Memos. I’ll start with changes in body composition in those who restricted calories (143 subjects) and those who continued to eat normally (75 subjects), often called ad lib or ad libitum. Remember, the purpose of the study was to achieve a 25% reduction in calorie intake and sustain it for two years in subjects who began at normal BMI.

The caloric restriction (CR) group achieved only an 11.9% decrease in CR over two years but still showed significant changes:

  • 16.7 pounds decrease in weight compared with a one pound gain in the ad libitum (AL) group
  • A decrease in waist circumference of 2.4 inches versus a 0.5 inch increase
  • Fat mass decrease of 11.9 pounds compared with a 1.1 pound gain
  • A 4.4 lb. decrease in fat-free mass compared with no change at 24 months
  • Although the CR subjects lost some fat-free mass, the loss of fat exceeded the expected proportional loss found in the typical weight loss program of 50% fat mass and 50% fat-free mass

That’s the surprising result: the study showed that a moderate reduction in calories did not abnormally impact the proportion of muscle loss to fat loss: fat loss exceeded muscle loss. Rather than protein intake, the calories used in activity contributed to sustaining muscle mass—exercise helped maintain muscle.

We’ll examine another paper from the CALERIE Study on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Am J Clin Nutr 2017;105:913–27.

It’s All About the Calories!

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One of my long-held beliefs is that where weight is concerned, it’s all about the calories—and I’m happy to say that this study reinforces my belief.

But when I’m wrong, I’ll tell you. Case in point: as I continued to examine the CALERIE trial, it became apparent I had made a mistake in the number of subjects and the percentage of caloric restriction. One paper reported 11% caloric restriction over two years, another 15.9%, and a third 14.1%; I referred to that one in Tuesday’s Memo on caloric restriction and immunity. This was a five-year data collection study that began in 2007 and finished in 2012. Different papers covered different time periods, and the data set used was appropriate for the time period examined; there were additions and dropouts until two years before study ended in 2012.

The Purpose of the Study

The primary purpose of the study was to develop a program that would help people maintain a 25% decrease in calories by using technology and a continuous support system. They also had a variety of physiological, psychological, and genetic factors to examine. That’s why data from 15 years ago are still being examined today.

There is one more thing we need to know. This was not a weight loss program; all the subjects were normal weight. They wanted to find the level of caloric restriction that would provide benefits but not cause problems with the immune system, such as the rodent studies found at 40% caloric restriction.

I think they succeeded; 25% caloric restriction was too much in free-living people, but 10% to 15% caloric restriction was doable with no issues in body composition, psychological factors, or several other variables they have reported on such as the decrease in an enzyme that sabotages the immune system as in Tuesday’s Memo.

It’s About the Calories

There were no special diet plans recommended. Subjects were provided support on how to reduce calories along with strategies to use if their interest started to wane over the entire two years. One of the researchers commented when interviewed that perhaps there will be a more effective diet between Mediterranean, keto, or some other way of eating.

No, there won’t.

I’m more convinced than ever: it’s all about the calories. I think people should choose to eat the healthiest foods they can afford so they get the optimal types of fat, phytonutrients, and other factors. But it was, it is, and it will always be about the calories—for weight loss if you’re overweight, for improved health if you’re normal weight, or both.

What are you prepared to do today?

        Dr. Chet

Reference: SCIENCE. Feb 2022. 375(6581):671-677