All Diets Work…and that’s the Problem

Dieting Advice Confusion-meter!

Which Diet is Best? All…and none.
Photo: Stuart Miles at FreeDigitalPhotos.net

All research starts as good ideas.  And then research validates if those ideas are, in fact, any good.  Many ideas can be proven to achieve similar effects, in this case, weight loss or improved health. In other words, there’s more than one way to skin a cat…or lose 20 pounds and improve cardiovascular disease risk.

Company spokespeople cite the “latest” research about their diet and how it’s the best and how no one else’s compares.  I politely respond, b*llsh*t.  Ask a dietitian, or even trainer, how many times they’ve heard: “What’s the best way for me to eat to lose weight, or get healthier?”  Like we’re supposed to magically have the answer…not even the research proves a single “holy-grail answer.”  (beyond eat better and move more).  But we need to have an answer, because we’re the experts.

So here’s an answer; let’s prove that all diets work, even ones that blatantly contradict each other in approaches:

*Note: This list is long.  If you want to skip to the punch line, hit Page Down a few times.

Similar weight loss between a high-protein, low-fat & high-carbohydrate, low-fat diet: http://ajcn.nutrition.org/content/81/6/1298.full

Both low-fat and low-carb diets led to 15 pound weight loss: http://jcem.endojournals.org/content/89/6/2717.short

When total calories are held constant, low-fat and low-carb diets yield similar weight and body fat loss (better insulin, but worse blood lipids in high protein group): http://ajcn.nutrition.org/content/90/1/23.abstract

Weight loss was similar between a high-protein and high-carbohydrate group after an initial 3 months of calorie restriction (better blood pressure improvement in high protein group): http://ajcn.nutrition.org/content/90/5/1203.abstract

Just cutting fat out of the diet works: http://ajcn.nutrition.org/content/53/5/1124.full.pdf

Low-fat, high-fiber diet predicts long-term weight loss and decreased Type 2 Diabetes risk: http://link.springer.com/article/10.1007%2Fs00125-006-0198-3?LI=true

Low-fat diets improve cardiovascular disease risk factors: http://circ.ahajournals.org/content/86/1/1.full.pdf

Lower carbohydrate diets lead to weight loss: http://phdres.caregate.net/curriculum/pdf-files/nejm2k3-2074.pdf

Zone (40/30/30), Atkins (low-carb), Ornish (low-fat) and LEARN (lifestyle-behavior change) all resulted in weight loss.  Atkins had best results in 12 months: http://jama.jamanetwork.com/article.aspx?articleid=205916

Those who have achieved significant long-term weight loss tend to consume a low-fat, low-calorie diet (~23% of calories from fat): http://europepmc.org/abstract/MED/9550162

Low-fat, low-carb and Mediterranean diet groups all lost weight, low-carb and Med groups did better: www.fammed.usouthal.edu/JournalClub/Journal%20Club%2032609/WtLossWithLowCarbMediterraneanOrLowFatDiet–NEJM.pdf

A lower-fat diet led to weight maintenance in postmenopausal women over 7.5 years compared to a 4 pound weight gain in the control group: http://jama.jamanetwork.com/article.aspx?articleid=202138

Those following a moderate fat Mediterranean diet had better adherence to the diet than low-fat diets.  Average weight loss after two and a half years: 7.7 pounds. http://europepmc.org/abstract/MED/11673773/reload=0;jsessionid=KaU6kHUz52R7Ig82Xxw1.20

Just eating less foods high in fat leads to weight loss, but restricting calories AND fat does better (plus self reported exercise): http://europepmc.org/abstract/MED/8281220

Consuming a reduced-calorie diet across a range of nutrient levels [protein (15 to 25%), fat (20 to 40%) and carbs (35 to 65%)] 424 participants lost a similar amount of weight independent of nutrient composition.  Interestingly, 40% of the weight was regained within 2 years, independent of groups as well: http://ajcn.nutrition.org/content/95/3/614.abstract

Meal Replacements work, better than food-based diets initially (28 vs. 20 pounds lost in first 16 weeks)…until the meal replacements stop (12 pound vs. 2 pound REGAIN in the following 24 weeks).  www.biomedcentral.com/content/pdf/1475-2891-9-11.pdf

Dairy IS effective for weight loss:

Dairy IS effective for reducing inflammation: http://ajcn.nutrition.org/content/91/1/16.long

Dairy IS NOT effective for weight loss:

Soy IS effective for weight loss:

Soy and Inflammation:

Whole Grains PROMOTE health and weight loss:

Whole Grains and Inflammation:

Paleo Diet Improves Weight and Health Biomarkers:

Intermittent Fasting is as Effective for Weight Loss as Consistent Calorie Restriction

More Frequent Meals Lead to Better Control of Appetite and Weight:

Recap – Here’s the summative review:

All diets work, but the results last ONLY if you stick with them – if your “diet” becomes the true meaning of the word: your permanent eating habits.  Some interesting statistics from the studies above:

1.   Poor long-term adherence to most diet recommendations: The average dropout rate of participants in these studies were usually somewhere between 25 to 50% with most studies lasting less than 6 to 12 months.  Imagine that many people dropped out of your school or quit your job…makes you think people don’t want to be there.

2.   Modest long-term results: And studies that lasted longer than a year resulted in modest average weight losses around 5 to 10 pounds.

3.   Only 33% use better eating AND exercise for weight loss: In a comprehensive look of over 32,000 people in 1998, nearly one-quarter of men and 38% of women reported trying to lose weight.  Unfortunately, only one-third of the people trying to lose weight were actually trying to eat better AND exercise more:  http://europepmc.org/abstract/MED/15165656

4.   When food is more than just fuel: Few of these dietary interventions take into account people dealing with issues of emotional eating.

This article is one of the best reviews I’ve seen of weight loss for obesity and metabolic syndrome (pre-diabetes, cardiovascular disease, etc.) and their conclusion quote describes the situation well:

“As shown in this review, there are many dietary strategies focused on macronutrient distribution or micronutrient and food-enriched manipulation for the treatment of obesity and features of MetS features. However, the real challenge is to find the appropriate approach for maintaining body weight loss and preventing subsequent relapse, while simultaneously reducing cardiovascular risk factors.

The ideal diet should be personalized to each patient and should include those dietary factors that imbue healthy and satiating dietary habits that are beneficial not only for effective weight loss, but are also good for body-weight maintenance as well as for reducing cardiovascular risk. Thus, a currently available diet may be one that has a moderate protein content (30%), high monounsaturated and omega-3 FAs, low-GI carbohydrates (40%), and includes adequate quantities of fiber, isoflavones, calcium, and antioxidant minerals.  Since adherence to healthy dietary patterns can be difficult, meal replacement and dietary supplements should be considered as effective strategies for weight loss, weight maintenance, and treatment of MetS. Several factors such as genetics, physical activity, psychopathological conditions, obesity type, gender, age, or yo-yo cycles may influence the outcome of any dietary intervention. They should be taken into account as much as possible when dietary advice is prescribed for body weight management.”

From: Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance (2010) by Itziar Abete, Arne Astrup, J Alfredo Martínez, Inga Thorsdottir, and Maria A Zulet

It’s still a matter of calories in vs. calories out…even if you choose not to count them.  The rub is, the equation is always changing on both sides depending on your base metabolism (which tends to decrease if you’re chronically undereating – to be discussed in further posts), your exercise levels and, of course, your eating habits.

Remember the question from earlier about the best diet to lose weight?  Here’s a better answer:

There are 10,000 ways to lose weight, but only one of them matters: the one that works for you.

Thoughts on Meal Frequency, Calorie Restriction & Weight Loss

4 Empty Dishes: From All Day or Dinner?

Is this from all day, or just dinner?
Image(s): FreeDigitalPhotos.net

America sure likes its dinner.  While other countries view lunch as the biggest meal of the day and dinner as a “don’t go to bed hungry” snack, our busy schedules don’t give us a chance to breathe or eat until 6, 7, 8 PM.  And then the feast is on!

I’ve talked to a number of people whose daily eating habits sound like riding a roller coaster:

  • Wake up not very hungry – Maybe a piece of toast and some coffee
  • Busy all day – A couple pieces of fruit or a light salad or small soup for lunch
  • 3 PM – Crash, consume nearest edible (or questionably edible) thing in sight.  Sugar kick to get through the rest of the day
  • 7 PM – Sugar kick crash, starving, not wanting to cook or think about anything than the nearest opportunity for warm food in mouth.  Usually results in eating second portions faster than most people eat their first or purchase of foods that appeal to us regardless of whether it’s nutritious.  Pizza, Chinese, Thai, huge plateful of pasta and meatballs, maybe a mini-salad or a couple pieces of broccoli.  Hey, at least there’s shredded cabbage somewhere in my lo-mein!
  • 9 PM – Another evening snack, usually something sweet because we’re used to having something sweet after dinner
  • 10 PM – Go to bed
  • Wake up not very hungry.

I wonder why we’re not waking up very hungry.  Maybe it’s because we eat two-thirds or more of our calories in the hours immediately before we go to bed.  Calories are designed to fuel our activity, right?  So what are we fueling at 7 and 9 PM?  A rousing, challenging eight hours of sleep (or so we hope).

There’s been a big debate over how to “ideally” fuel our body for weight loss with ideas ranging from:

  • Does eating small frequent meals really increase your metabolism?
  • Should we always be restricting calories?
  • Is intermittent fasting better?  (Intermittent fasting involves significantly reducing food consumption or fasting for a day or so followed by regular eating)
  • Should we cut out a particular nutrient group (i.e. carbs) or follow a particular diet to optimize weight loss?
  • Is three meals a day enough?
  • What time should I stop eating before bed?  7 PM?  2 hours before?

You can argue for or against any of these until you are blue in the face…and there’s research to back all of them up.  But why should we care unless:

  1. It fits into your lifestyle
  2. It gets you results
  3. You can continue to do it for the long haul

We are the product of our habits, so if we make changes, lose weight and then return to our old habits, I can guarantee you that you’ll return to your old weight.  So I took a step back and considered, what do we know and what have I seen in my experiences.

What we know:

  • We lose weight when we burn more calories than we consume
  • Our blood sugar is most stable when we are fueled consistently throughout the day.  Unstable blood sugar is associated with headaches, fatigue, irritability, trouble concentrating and more not so fun things.
  • Athletic performance is better when we fuel before and after it
  • Non- and minimally processed foods (i.e. fruits, veggies, whole grains, lean protein, healthy fats) tend to be higher in nutrients (vitamins, minerals, water, fiber) and lower in calories
  • Carbohydrates are an ideal source of energy, particularly for the brain and muscles
  • Protein provides the foundational building blocks of lean mass, transport proteins, hormones, chemical messengers, enzymes and many other molecules in the body
  • Fat helps protect and regulate a number of our body’s functions including hormones, inflammation, cell membranes health and efficient conduction of the neurological system.  It also provides access to essential fat-soluble vitamins: A, D, E and K.
  • Intermittent fasting is about equivalent to consistent calorie restriction for weight loss results when people performed both options consistently
  • Consistent calorie restriction leads to a decrease in metabolism, usually resulting in stubborn plateaus

What I’ve seen:

1.   The more frequently we eat throughout the day:

  • The more it forces us to think about what we eat and the meal and/or snack planning that goes with it.  Most homemade foods will be more nutritious and lower calories than eating out.
  • We don’t have the time to eat crappy because we’ve usually planned and are eating meals every few hours.  So we’re rarely starving.
  • We have more stable blood sugars, so we’re less likely to be ravenously hungry.  We tend to make better decisions about food when we’re not ravenously hungry.
  • The better and more energized we feel throughout the day.  The better we feel, the better we can handle stress.  The better we can handle stress the less we want that brownie/cookie/ice cream to comfort us.
  • The more likely we are to fuel ourselves pre- and post-workout so we get better workouts and burn more calories during them.
  • The less starving we are at dinner so we end up having smaller dinners.  And lo and behold we start getting hungry in the morning.

2.    There is not particular time to stop eating before bed (i.e. 7 PM).  Ideally aim to have your last meal a couple hours before bed.  That means if you have dinner at 7 PM but don’t go to bed until midnight, you should be planning a small, balanced snack around 10 PM.

3.    A great way to keep your metabolism high during calorie restriction is to stay active, particularly with a resistance training component (weights, bodyweight, etc.).  It helps maintain your lean body mass which is your main calorie burner.

4.   During periods of calorie restriction, give your body more calories every few days to keep your metabolism from dropping.   In other words, have a bit more food every fourth or fifth day if you are mindfully eating less.  You can consider it a cheat meal, cheat day or just eat more of the same healthy foods you’re eating normally.  The key is not to go insane and eat a whole pizza pie, a tub of ice cream, etc.  Enjoy a burger and fries.  Have a couple slices of pizza.  Enjoy a serving of your favorite dessert.  The goal is to have about 20-25% more calories on those days.

5.   While I’m personally not a fan of the intermittent fasting approach because it seems to be contrary to the idea of “consistency”, it could be an option if avoiding food for a day doesn’t make you feel like crap and if it doesn’t make you go overboard the day after.  ****Be aware not eating for an entire day can have a lot of side effects: watch out if you have diabetes, are sensitive to changes in blood sugar, are on medications, have thyroid issues, etc.  In other words, DO NOT make drastic changes like this until you speak with your doctor or appropriate medical professionals about it.  And please be sure to drink water!

Don’t just take my word for it.  Consider for yourself:

Consider your current meal habits.  Write down what you eat and when.  Also track your energy levels throughout the day.  Is it usually after going a long time without food?  Ideally you should be eating a small, balanced meal (carbs, fat, protein) every 3 to 4 hours.  About the same amount of food, evenly spaced throughout the day.  While that’s a perfect world, start considering how you can make a small shift in that direction.

Another good way to check and see if you’re fueling your body well throughout the day is charting your hunger levels:  write down what your hunger level is throughout the day on a scale of 1 (starving) to 10 (stuffed).   Aim to be around 3 to 7 all day.  When we get too low, we tend to go overboard with eating and then end up too high (think how much we eat when we’re starving…then we’re stuffed because we ate faster than our body could digest and signal us to stop).

Some ideas:

  • If you know you crash at 3 PM, start planning/bringing a healthy snack with you.
  • If you know you always stuff yourself at dinner and are never hungry in the morning, purposefully eat slower (I guarantee you won’t starve if you eat slower) and only to about 80% fullness at dinner for a week and see if your appetite at breakfast changes.
  • If you’re skipping meals, eat something…anything!
  • If you know you’re eating too little at a particular meal, try adding one more thing.
  • Make it a point to fuel yourself pre- and post-workout.
  • If you’ve been very strict with your eating and you’ve plateaued, consider adding in a day of increased caloric intake.  If you’ve been at a very stubborn plateau, consider actually increasing your caloric intake for a few days in a row.  You’d be amazed as to how that can renew your metabolism.

Give one of the ideas a shot, what’s the worst that can happen?  Alternatively, what’s the best that can happen?

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