Tag Archive for: weight loss

It’s Still All About the Calories

/in /by

The keto vs. Mediterranean diet study was interesting for a variety of reasons. The researchers deserve a lot of credit for even attempting to try a study of this magnitude; 40 subjects may not seem like a lot, but to provide food via delivery together with instructions on preparation is very expensive and labor intensive. It should be noted that a portion of the study took place during the lockdown phase of COVID-19; that delayed some testing, but to their credit, the subjects affected continued the particular diet they were on for the two weeks until testing could be scheduled. Here are my thoughts on the results.

Blood Lipids

  • Subjects on the keto diet showed a greater decrease in triglycerides (TG) than those on the Mediterranean diet.
  • On the other hand, those on the Mediterranean showed a greater decrease in LDL-cholesterol than did the keto diet subjects.

While the researchers discussed it at length, I don’t think it was relevant. All subjects began with average fasting TG in the normal range. While both diets decreased TG, that the keto diet reduced it slightly more isn’t earth shattering when you start at a normal reading.

The same holds true for the LDL-cholesterol. Yes, the Mediterranean diet reduced it while the keto diet increased it, but the net was 6 mg/dl over the initial readings. What could have been concluded was that neither diet reduced LDL-cholesterol by an amount that was clinically meaningful.

The Microbiome

There were no tests of the changes in the microbiome under each diet reported—at least not yet. Subjects had a definite decline in fiber intake, especially when they provided their own food in the keto diet. The Mediterranean diet saw an increase in fiber intake when subjects provided their own food.

Why mention this at all? The microbiome controls the initial processing of nutrients. In addition, the immune function begins in the gut. While the keto diet may have provided some benefit related to HbA1c, at what cost? We simply don’t know. What we do know based on other research is that the lack of fiber changes the probiotic content of the microbiome.

The Bottom Line

The data showed that the subjects averaged 200 to 300 fewer calories per day regardless of diet and maintained the reduction over both diets. They ate better, they ate less, and they lost weight.

I think this study was important because it leaves us with better questions to ask in the future, such as: how would health measures be affected if subjects reduced calories another way? It also proves what I’ve been saying for years. The average weight loss after the study was 13 to 17 pounds, and that was maintained during the follow-up period. This was not a weight loss study, yet regardless of the initial diet, the subjects lost weight. I’ve said it before and I’ll say it again: regardless of the type of diet, it’s still all about the calories.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN doi.org/10.1093/ajcn/nqac154

Three Ways to Really Reduce Your Cancer Risk

/in /by

In the last Memo before Spring Break, I said I’d cover ways to reduce your risk of getting cancer that really work. Every cancer website has lists, ranging from 10 to 15 recommendations. I’m going to give you my top three ways to reduce the risk of cancer of the items you can control. You can’t control your age or your genetic risk factors, but there are many elements of your health you can control if you work at them.

I’m not including smoking cigarettes or other tobacco products. That’s a no-brainer and shouldn’t even be mentioned, because no one should smoke. (I’m not saying that from my perch on Mount Olympus; I smoked when I was young and foolish, and quitting was one of the best decisions I ever made.)

Dr. Chet’s Top Three Ways to Prevent Cancer

  1. Eat more vegetables and fruits every day and the wider the variety, the better. They don’t have to be organically farmed; you just have to eat eight to ten servings per day. That seems like a lot, and I’m not perfect at it, but you get a new chance every day. Here’s a tip: weigh your produce instead of measuring it. Find out what constitutes a serving in grams or ounces. You may find out that a large banana is actually two servings. Do supplements matter? Yes, but the important point is to eat the fruits and veggies first, then add a multivitamin as backup.
  2. Exercise for 30 to 45 minutes per day. The fitter you are, the lower your risk of cancer. It doesn’t all have to be aerobic; yoga and strength training count as well.
  3. Reduce your weight until you achieve as close to a normal BMI (under 25) as you can; you’ll find all the info you need in the Body Mass Index article on the Health Info page at drchet.com, including how to adjust your target for your body type. We talked about caloric restriction in February, and that’s a way to slowly reduce your weight. My theory is that the older you are, the more movement matters, so if you are doing well at Numbers 1 and 2, you’re well on your way to accomplishing Number 3.

Those may sound very familiar: Eat less. Eat better. Move more. The reason these are my top three is that they reduce inflammation in different ways.

On Thursday, I’m going to cover a study on the relationship between a test for inflammation and cancer.

What are you prepared to do today?

        Dr. Chet

Lessons from the Starvation Study

/in /by

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

/in /by

“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

/in /by

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.

Can Cutting Calories Improve Your Mood?

/in /by

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

/in /by

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!

/in /by

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

Your Holiday Eating Plan

/in /by

Over the years, the topic of “How should I eat during the holidays?” comes up over and over. We all want to try to avoid gaining the five to ten pounds during the weeks from Thanksgiving through New Year’s. Depending on your activity levels during the past year and a half with COVID restrictions, you may already be dealing with some extra weight. I think there are two parts to the solution of preventing weight gain during the holiday season.

Increase or Begin to Exercise

In my experience working with people, the holidays are so busy they stop doing what can help deal with stress and extra calories: exercise. Even a 20-minute interval session (found in the Basic Health Info section on drchet.com) can do wonders for relieving stress, and that may help you eat less when those extra calories are available. Or when it all gets to be too much, declare it’s time for your walk and take off.

Exercise isn’t designed to burn a lot of calories unless you really work out strenuously or work out for hours, but it helps keep your metabolism going: you use up your short-term fat storage, and your muscles continue to use energy to recover. It’s an effective way to help prevent weight gain.

Have an Eating Plan

The most important way to eat during the holiday is to have a plan. Strategize. You know when the holiday foods, treats, and goodies are going to be available; decide how you’re going to approach them. Here are the three most popular ways people have said they use.

To Here and No More
Many people decide in advance what and how much they will eat whether at parties or holiday meals. Maybe someone makes the best taquitos you’ve ever eaten and you want to have several. That’s fine. Skip other calorie-laden treats such as the cookies you’re not crazy about and opt for calorie-free drinks instead of calorie-heavy alcohol. Hosts will never be offended when you turn down a drink because you need to save room for the stupendous taquitos.

Another example: Paula and I almost never make cookies other than for the holidays—and when we make them, we’re going to eat our share. Baking days include a lot of soups and salads rather than heavier meals to at least partially make up for all the cookie calories.

Be wary of two things: sugar and salt. Both make you crave more so when you set a limit, you have to stick to it.

Just One Meal
Let’s face it: like Thanksgiving, most holiday gatherings center around one meal. Eat everything you want but in smaller quantities. This is similar to the first approach, but involves more foods you might only get at the holidays: oyster stuffing, gravy with mashed potatoes, or Mom’s special dessert. Eat the foods you love but in reasonable quantities. You can eat more lightly the day before and day after to compensate.

Stay the Course
You’ve worked hard to get your weight to where you want it to be, so you decide to stick to your meal plan. Adjust it to account for the holiday foods but don’t deviate. All foods count; stick to what has worked for you.

One more point: forgive yourself if you fall off the plan. It happens. Put it behind you and get a fresh start the next day.

The Bottom Line

The idea of holiday gatherings is to enjoy the company of others, and part of the celebration is food and drink. Decide on an eating plan, stick as close as you can to your workout plan, and you may not have to start the year by resolving to lose what you gained over the six weeks of the holiday season.

What are you prepared to do today?

        Dr. Chet

The Bottom Line on Fasting

/in /by

In the past four Memos, I’ve focused on explaining fasting. The questions I left you with on Saturday were: “Is it worth it to fast? Is it effective? Is there science to support it?” The answer to all three is yes. I think it can be summed up in one quote from the reference.

“In response to starvation, mammalian cells enter either a non-dividing or a low-dividing state and invest energy resources in cellular protection against various insults.”

While the statement is complicated, it means that metabolism is decreased. That allows the body to shift energy sources from glucose to fat metabolites such as ketones. The body focuses on reducing the production of proteins that can be destructive, such as inflammatory hormones, thereby protecting cells. It also helps improve the immune system so it functions better. The stress of reducing food intake in a controlled fashion helps cells function better.

The research review is available for free; it goes into more detail but demonstrates that fasting is beneficial when used properly. The bulk of the research is on the two- to-five-day fast with fewer than 1,000 calories on the fast day; I’ll use a two-day version before my knee replacement next week to help my body prepare. Just be sure to check with your physician before you fast if you have any metabolic issues such as diabetes or if you take medications, both of which can be impacted by restricting food.

Wednesday is the final scheduled Insider call of 2021. This may be the time to join to help you achieve your health goals in 2022. Hope to see you (or hear you) at 9 p.m. Eastern Time.

What are you prepared to do today?

        Dr. Chet

Reference:Trends Endocrinol Metab. 2018 April; 29(4): 271–280.