Best Way To Reduce Risk Of Breast Cancer

What Does The American Cancer Society Say About Reducing Breast Cancer Risk? 

Author: Dr. Stephen Chaney

breast cancerBreast cancer is a scary disease. The American Cancer Society tells us:

  • 281,000 women will be diagnosed with invasive breast cancer in 2021.
  • 43,000 women will die from breast cancer in 2021.
  • The good news is that both prevention and treatment of breast cancer have gotten much better:
    • The 5-year survival rate is 90%.
    • The 10-year survival rate is 84%.
    • For women over 50 the death rate has decreased by 1%/year between 2013 and 2018 (mainly due to recognition that hormone replacement therapy is a risk factor for breast cancer).
  • The bad news is:
    • The cost of breast cancer treatment can range from $50,000 to over $180,000.
    • The side effects of breast cancer treatment can be brutal.
      • For example, there is an effective treatment to prevent breast cancer recurrence for some forms of breast cancer, but many women discontinue the treatment after a few years because of the side effects.

So, wouldn’t it be wonderful if there were some simple changes you could make that would dramatically reduce your risk of developing breast cancer in the first place? There are lots of options for reducing your risk of developing breast cancer, but which one(s) should you choose?

  • Dr. Strangelove and his friends are only too happy to recommend their favorite potion, food, or diet.
  • There are long lists of foods you should avoid if you want to reduce your risk of breast cancer.
  • There are also lists of harmful chemicals in cleaners and other household products that you should avoid.

It can become confusing. It can become overwhelming. It would be easy to just throw up your hands and say, “I give up. I don’t know what to do.”

You may be thinking, “Why doesn’t someone simplify things by identifying the top few lifestyle changes that are most effective for reducing my risk of developing breast cancer?”

It turns out someone has. Today I will share two recent studies that have identified the top 6 strategies for reducing your risk of breast cancer, and I have ranked them from 1 to 6 in order of effectiveness.

What Is The Best Way To Reduce Risk Of Breast Cancer?

AwardThe first study (RM Tamimi et al, American Journal of Epidemiology, 184: 884-893, 2016 was designed to identify the major modifiable risk factors for invasive, postmenopausal breast cancer (The term “modifiable risk factors” refers to those risk factors that are under your control.

The study utilized data collected from the Nurses’ Health Study between 1980 and 2010. During that time 8,421 cases of invasive breast cancer were diagnosed in 121,700 postmenopausal women in the study. The study looked at the effect of nonmodifiable and modifiable risk factors on the development of invasive breast cancer in these women.

  • Nonmodifiable risk factors included current age, age at which menstruation began, height, age of first birth, number of births, weight at age 18, family history of breast cancer, and prior benign breast disease.
  • Modifiable risk factors included weight change since age 18, alcohol consumption, physical activity level, breastfeeding, and postmenopausal hormone therapy use.

Here were the results from the study:

  • All the risk factors included in this study accounted for 70% of the risk of developing invasive breast cancer in postmenopausal women.
  • Modifiable risk factors accounted for 34.6% of the risk of developing invasive breast cancer in postmenopausal women.

When they analyzed the effect of modifiable risk factors on the risk of developing invasive breast cancer separately:

  • 44 pounds of weight gain since age 18 increased the risk by 50%.
  • Postmenopausal hormone replacement use increased the risk by 35%.
  • More than one alcoholic beverage/day increased the risk by 32%.
  • Low physical activity increased the risk by 7%.
  • Lack of breastfeeding increased the risk by 5%.

What About The Effect Of Diet On Breast Cancer Risk?

You may be wondering, “What about the effect of a healthy diet on my risk developing invasive breast cancer?” Unfortunately, the study I described above completely disregarded the effect of diet on breast cancer risk.

However, the second study (MS Farvid et al, International Journal of Cancer, 144: 1496-1510, 2019) I will discuss today partially addresses this issue. It uses the same database as the first study and looks at the effect of fruit and vegetable consumption on the risk of developing invasive breast cancer.

When this study compared high versus low intake of fresh fruits and vegetable on the risk of developing invasive breast cancer:

  • Women eating >5.5 servings/day of fruits and vegetables had a 11% lower risk than women consuming ≤2.5 servings/day.
  • Women consuming >2.5 servings/day of fruit had a 9% lower risk than women consuming ≤0.5 servings/day.
  • Women consuming >4.5 servings/day of vegetables had a 9% lower risk than women consuming ≤0.5 servings/day.

While all fresh fruits and vegetables contributed to this effect:

  • The most protective fruits were berries and cantaloupe & melons.
  • The most protective vegetables were yams & sweet potatoes, green leafy vegetables (such as kale, mustard greens, and chard), and cruciferous vegetables (such as Brussels sprouts).

The authors concluded, “Our findings support that higher intake of fruits and vegetables, and specifically cruciferous and yellow/orange vegetables, may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors.”

Now we are ready to answer your question, “Which lifestyle changes are most effective for reducing your risk of developing breast cancer?” If we combine the two studies and rank order the modifiable risk factors, it would look like this.

#1: Minimize weight gain during your adult years.

#2: Don’t use postmenopausal hormone replacement therapy unless absolutely necessary.

#3: Drink little or no alcohol.

#4: Eat a healthy diet with lots of fresh fruits and vegetables.

#5: Be physically active.

#6: Breastfeed when possible.

What Does The American Cancer Society Say About Reducing The Risk Of Breast Cancer?

American Cancer SocietyThe advice of the American Cancer Society is remarkably similar. Here are their recommendations:

  1. Get to and stay at a healthy weight.

After menopause, most of your estrogen comes from fat tissue. Having more fat tissue increases the amount of estrogen your body makes, raising your risk of breast cancer. Also, women who are overweight tend to have higher levels of insulin. Higher insulin levels have also been linked to breast cancer.

If you are already at a healthy weight, stay there. If you are carrying extra pounds, try to lose some. Losing even a small amount of weight can also have other health benefits and is a good place to start.

3) Be physically active and avoid time spent sitting.

Current recommendations are to get at least 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week. Getting to or exceeding 300 minutes is ideal.

In addition, you should limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment. This is especially important if you spend most of your working day sitting.

3) Follow a healthy eating plan.

A healthy eating pattern includes a variety of vegetables, fiber-rich legumes (beans and peas), fruits in a variety of colors, and whole grains. It is best to avoid or limit red and processed meats, sugar-sweetened beverages, highly processed foods, and refined grain products. This will provide you with key nutrients in amounts that help you get to and stay at a healthy weight.

4) It is best not to drink alcohol.

Research has shown that drinking any alcohol increases the risk of breast cancer. If you choose to drink alcohol, the American Cancer Society recommends that women have no more than 1 alcoholic drink on any given day. A drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of hard liquor.

5) Think carefully about using hormone replacement therapy.

Studies show that HRT using a combination of estrogen and progestin increases the risk of breast cancer. This combination can also lead to increased breast density making it harder to find breast cancer on mammogram.

Talk with your doctor about all the options to control your menopause symptoms, including the risks and benefits of each. If you decide to try HRT, it is best to use it at the lowest dose that works for you and for as short a time as possible.

The Bottom Line

Breast cancer is a scary disease. The good news is that detection and treatment of breast cancer has improved over the past decade. The bad news is that treatment is expensive, and the side effects can be brutal.

There are lots of options for reducing your risk of developing breast cancer, but which one(s) should you choose?

  • Strangelove and his friends are only too happy to recommend their favorite potion, food, or diet.
  • There are long lists of foods you should avoid if you want to reduce your risk of breast cancer.
  • There are also lists of harmful chemicals in cleaners and other household products that you should avoid.

It can become confusing. It can become overwhelming. It would be easy to just throw up your hands and say, “I give up. I don’t know what to do.”

You may be thinking, “Why doesn’t someone simplify things by identifying the top few lifestyle changes that are most effective for reducing my risk of developing breast cancer?”

It turns out someone has. Today I will share two recent studies that have identified the top 6 strategies for reducing your risk of breast cancer, and I have ranked them from 1 to 6 in order of effectiveness in the article above.

For more details about these studies, my ranking of the top 6 strategies for reducing your risk of breast cancer, and the American Cancer Society recommendations, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

A Vegan Diet And Weight Loss

Is A Vegan Diet The Secret To Permanent Weight Control?

New Year DietThe new year is here, and you, like millions of other Americans, have decided this will be the year to get your weight under control. But how to do that is the question.

You have tried lots of diets over the years. You have given up sugar, then high-fructose corn syrup, then carbs in general. You have eliminated whole food groups from your diet. You have restricted your eating to between noon and 4 PM. You have eaten cabbage on Tuesdays and grapefruit on Thursdays (Just kidding about that one, but some fad diets are almost that bizarre).

You lost weight at first, but none of those diets were sustainable. You started adding back your favorite foods. Then the pounds you lost came back – and brought their friends with them.

At this point you may be desperate. You may be tempted to try one of those “magic” supplements that promises to rev up your metabolism and make those pounds melt away. Resist that temptation! Those supplements are either dangerous or worthless – sometimes both.

Or you may be tempted to sign up for one of those expensive diet programs that sends you low calorie versions of all your favorite junk foods. Don’t waste your money. You don’t really need more highly processed food in your diet. And you aren’t learning healthier food choices.

But what if…

…you could rev up your metabolism just by eating a healthy diet?

…you could lose weight naturally without counting calories or reducing portion sizes?

…you could keep most of the weight off permanently?

The study (H Kahleova et al, JAMA Network Open.2020; 3(11): e2025454) I will review today says there is diet that does all of these things. It is not the latest, greatest fad diet. In fact, it has been around for years. It is called the vegan diet.

How Was The Study Done?

Clinical StudyThis was a small, but very well-designed, study. It enrolled 244 obese (average BMI = 33), middle aged (average age = 54) subjects (87% female, 48% white). They were randomly assigned to a vegan diet or control diet and followed for 16 weeks.

The control group was told not to change their diet and exercise routine.

The vegan group was also told not to change their exercise routine. In addition, they were given printed materials and attended weekly classes that provided detailed instructions and cooking demonstrations to help them follow a vegan diet.

The vegan diet consisted of fruits, vegetables, whole grains, and legumes with no animal products or added fats. 75% of the calories came from carbohydrate, 15% from protein, and 10% from fat.

The diets of both groups were assessed by a 3-day dietary recall at the beginning of the study and 16 weeks later, at the end of the study. In addition, dietitians made unannounced telephone calls at random times during the week and weekends to assess the participant’s adherence to the diet.

In the vegan diet group, mean intake of carbohydrate and fiber increased, while intake of fat, protein, and cholesterol decreased. There was no significant change in intake in the control group.

The other parameters measured at the beginning of the study and week 16 were:

  • Body composition:
    • Weight and BMI (a measure of obesity).
    • Fat mass and lean muscle mass.
    • Belly fat.
    • Fat stores in liver and muscle (accumulation of fat stores in the liver and muscle is associated with insulin resistance).
  • Parameters of blood sugar control and insulin resistance:
    • Fasting blood glucose and hemoglobin A1c levels were measured.
    • Insulin secretion and blood glucose levels were measured during a 3-hour oral glucose tolerance test. Insulin secretion was used as a measure of insulin resistance, and blood glucose levels were used as a measure of insulin sensitivity (Note: This is a very simple explanation of complex calculations.)
  • Lipid Levels:
    • Total cholesterol.
    • HDL and LDL cholesterol.

A Vegan Diet And Weight Loss

Vegan FoodsThe study results were impressive:

  1. The vegan group lost 14 pounds, while the control group lost only 1 pound. There were two reasons for the greater weight loss in the vegan group:
    • The vegan group decreased their caloric intake by almost 500 calories per day. This was most likely due to the lower caloric density (calories per serving) of plant foods.

In other words, the vegan group consumed fewer calories without focusing on weight loss or portion size. They ate until they were full and consumed fewer calories in the process. Isn’t this what everyone wants from a weight loss diet?

    • The thermic effect (calories burned due to digestion) of the food they ate increased by 14% in the vegan group. This is because it requires more energy to digest foods when your digestive system has to break down the cellular matrix found in unprocessed plant foods.

In other words, the vegan group burned more calories every day just by eating healthy foods. No other diet can promise this.

2) Fat mass decreased by 10% (9 pounds) in the vegan group but was unchanged in the control group

3) Lean body mass (muscle mass) decreased by 1 pound in the control group and 4.6 pounds in the vegan group. There are two important observations here:

    • All the weight loss in the control group came from muscle.
    • 33% of the weight loss in the vegan group came from muscle. This is the only negative outcome from this study and is likely due to the decreased protein intake in the vegan group. Previous studies suggest this loss of lean body mass could be prevented by increasing the protein content of the diet with a plant-based protein supplement.

4) Belly fat decreased by 15%, liver fat was decreased by 31%, and muscle fat was decreased by 19% in theBelly Fat vegan group. All three parameters were unchanged in the control group.

    • This is perhaps the most significant observation from these studies since these are the three deadliest forms of fat in our bodies. Any diet that significantly reduces these forms of fat is likely to dramatically improve our health.
    • These parameters have not been measured in most studies of other weight loss diets, so we have no idea whether other weight loss diets have this effect.

5) Fasting blood glucose decreased by 11%, insulin resistance decreased by 40%, and insulin sensitivity increased by 22%. These parameters were unchanged in the control group.

    • Note: While insulin resistance and insulin sensitivity are opposite ways of measuring the same phenomenon, they were measured in different ways in this study. That is why the percentage change was different for these two parameters. The important thing is that both parameters changed by a significant percentage in a direction that reduces the risk of type 2 diabetes.
    • These data show that just 16 weeks on a vegan diet is sufficient to significantly reduce the risk of developing type 2 diabetes. Previous studies have shown that a vegan diet can reverse type 2 diabetes for many people.

6) Total cholesterol decreased by 11% and LDL cholesterol decreased by 16%. Both parameters were unchanged in the control group.

Is A Vegan Diet The Secret To Permanent Weight Loss?

As I said, the results of this study are impressive. But you have probably heard similar claims for other diets like keto, paleo, etc. To put this into context for you I am going to discuss “The Truth (about weight loss diets) Nobody Talks About” and The Questions (about weight loss diets) Nobody Asks”.

truth signThe Truth Nobody Talks About: Why are there so many conflicting claims about weight loss diets? They can’t all work, or can they? Here is the truth nobody talks about.

If you just focus on short term weight loss and improvement in health parameters like cholesterol and blood sugar levels, the very low fat vegan diet and the very low carb keto diet give virtually identical results.

That statement is true for any restrictive diet, but I chose the vegan and keto diets because they are as different as any two diets can be. That means you can forget all the scientific-sounding mumbo-jumbo about why each diet is best and focus instead on what they have in common. Here is what they have in common.

  • They all compare themselves to the typical American diet. The American diet is high in saturated fat, high in sugar, high in refined carbs, and high in junk foods. Almost any diet is better than the typical American diet!

Unfortunately, none of these diets compare themselves to each other, so we don’t know which is best. We just know that all of them are better than the typical American diet.

  • All of them are whole food diets. Any diet that cuts out sodas, junk foods, and highly processed foods will result in weight loss and better health.
  • All of them are restrictive diets. Some restrict sugar. Others restrict fat. Some eliminate particular foods. Others eliminate food groups. Some restrict the time of day you can eat. When you do any of these things you are forced to focus on what you eat.

And when you focus on what you eat, you lose weight. That is why diets that force you to count calories, count carbs, or keep a food journal are successful.

Don’t misunderstand me. Although the vegan and low carb diets have not been directly compared in clinical trials, vegan diets may have some unique benefits that other diets do not. For example, this study shows that:

  • Because of the low caloric density of unprocessed plant foods, you can eat more food and consume fewer calories on a vegan diet. You don’t get this benefit from low carb diets. They are high in fat and have, therefore, a high caloric density.
  • Digestion of unprocessed plant foods increases your metabolic rate. This benefit also doesn’t exist for low carb diets. They contain less unprocessed plant foods than a vegan diet.
  • Belly fat, liver fat, and muscle fat are all decreased in just 16 weeks with a vegan diet. This may occur for other diets. But most studies of other diets have not looked at these parameters, so we don’t know if they have this benefit.

QuestionsThe Questions Nobody Is Asking: Since all these diets result in short-term weight loss, there are two questions we should be asking.

  1. Which of these diets are healthy long term? Numerous studies have shown people who consume vegan diets and other primarily plant-based diets for 10, 20, or 30 years weigh less and have a lower incidence of heart disease, diabetes, and some cancers than people who consume the typical American diet.

Although the Atkins diet has been around for more than 50 years, there is still no evidence that the Atkins diet or other meat-based low carb diets are healthy long term. I have summarized these studies in my book, “Slaying The Food Myths”.

2) What happens when you get tired of the restrictions in these diets and start adding back a few of your favorite foods? If you start with a vegan diet and add a little dairy, eggs, and meat to it, you end up with a semi-vegetarian diet. People following a semi-vegetarian diet weigh less and are healthier than people consuming the typical American diet.

Keto diets are high in meat and saturated fat. If you add carbs, even healthy carbs, to that diet, you end up with the typical American diet, which is characterized by weight gain and poor health.

Vegan BurgerOne Final Thought: Big Food has noticed that many Americans want to eat vegan but still crave the taste and convenience of their favorite foods. Big Food has been only too happy to oblige with a wide selection of highly processed “vegan” foods. Avoid these foods like the plague!

I have discussed the shortcomings of the “vegan” burgers found in your local supermarkets and fast food restaurants in a recent issue of “Health Tips From the Professor”.

The biggest problem with all these “vegan” food substitutes is that they are highly processed foods. The benefits of a vegan diet come from eating unprocessed plant foods. None of us need more highly processed foods in our diet.

Of course, it isn’t just vegan food substitutes. Any hope that the Atkins diet might have been healthy evaporated with the advent of “Atkins” processed foods. Now I am starting to see the same trend with “keto” and “paleo” foods.

The Bottom Line 

The new year is here, and you, like millions of other Americans, have decided this will be the year to get your weight under control. But how to do that is the question.

You have tried lots of diets over the years. You have given up sugar, then high-fructose corn syrup, then carbs in general. You have eliminated whole food groups from your diet. You have restricted your eating to between noon and 4 PM. You have eaten cabbage on Tuesdays and grapefruit on Thursdays (Just kidding about that one, but some fad diets are almost that bizarre.

You lost weight at first, but none of these diets were sustainable. You started adding back your favorite foods. Then the pounds you lost came back – and brought their friends with them.

But what if…

…you could rev up your metabolism just by eating a healthy diet?

…you could lose weight naturally without counting calories or reducing portion sizes?

…you could keep most of the weight off permanently?

We know people who eat a vegan diet for 10, 20, or 30 years weigh less and are healthier than people consuming the typical American diet. Could the vegan diet be the diet you have been looking for?

The study I review this week was designed to answer this question. The investigators randomly assigned obese, middle-aged Americans, to follow either a vegan diet for 16 weeks or to continue eating their typical American diet.

The study results were impressive:

  • The vegan group lost 14 pounds, while the control group lost only 1 pound. There were two reasons for the greater weight loss in the vegan group:
    • The vegan group decreased their caloric intake by almost 500 calories per day. This was most likely due to the lower caloric density (calories per serving) of plant foods.

In other words, the vegan group consumed fewer calories without focusing on weight loss or portion size. They ate until they were full and consumed fewer calories in the process. Isn’t this what everyone wants from a weight loss diet?

    • The thermic effect (calories burned due to digestion) of the food they ate increased by 14% in the vegan group. This is because it requires more energy to digest foods when your digestive system has to break down the cellular matrix found in unprocessed plant foods.

In other words, the vegan group burned more calories every day just by eating healthy foods. No other diet can promise this.

  • Fat mass decreased by 10% (9 pounds) in the vegan group but was unchanged in the control group
  • Belly fat decreased by 15%, liver fat was decreased by 31%, and muscle fat was decreased by 19% in the vegan group. All three parameters were unchanged in the control group.
    • This is perhaps the most significant observation from these studies since these are the three deadliest forms of fat in our bodies. Any diet that significantly reduces these forms of fat is likely to dramatically improve our health.
    • These parameters have not been measured in most studies of other weight loss diets, so we have no idea whether other weight loss diets have this effect.
  • Fasting blood glucose decreased by 11%, insulin resistance decreased by 40%, and insulin sensitivity increased by 22%. These parameters were unchanged in the control group.
    • These data show that just 16 weeks on a vegan diet is sufficient to significantly reduce the risk of developing type 2 diabetes.
  • Total cholesterol decreased by 11% and LDL cholesterol decreased by 16%. Both parameters were unchanged in the control group.

For more details and a more in-depth comparison of the vegan diet with other popular diets read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Is Losing Weight Getting Harder?

Why Is Weight Loss More Difficult Than It Used to Be?

Author: Dr. Stephen Chaney

If you are one of the millions of Americans who set a New Year’s goal of losing weight and eating healthier, you are to be congratulated.

However, if you are like many Americans, you are probably asking yourself “Is losing weight getting harder, or is it just my imagination?”

If you are asking yourself “Is losing weight getting harder than the first time I went on a weight loss diet?”, the answer to that question is a clear yes. It has to do with the perils of yo-yo dieting.

But here is the question that most of you never thought to ask: “Is losing weight getting harder than it was for my parents and grandparents?”

If this study (RE Brown et al, Obesity Research & Clinical Practice, 10: 243-255, 2016) is correct, the answer to that question is also yes.

How Was The Study Done?

Clinical StudyThe authors used data from The National Health and Nutrition Examination Study (NHANES), which is conducted by the CDC on an ongoing basis. For those not familiar with this program, here is a description of the NHANES program from the CDC website.

“The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States.

The survey examines a nationally representative sample of about 5,000 people per round, with 2-year data sets available for analysis. These people are located in counties across the country.

The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel.

All participants visit the physician. Dietary interviews and body measurements are included for everyone. All but the very young have a blood sample taken and have a dental screening. Depending on the age of the participant, the rest of the examination includes tests to assess various aspects of health. In general, the older the individual, the more extensive the examination.

Health interviews are conducted in respondents’ homes. Health measurements are performed in specially-designed and equipped mobile centers, which travel to locations throughout the country. The study team consists of a physician, medical and health technicians, and dietary and health interviewers.”

In short, the NHANES dataset represents a valuable source of data for this kind of study in that it provides a 2-year snapshots of the health and nutritional status of the American population over many decades.

The authors of this study looked at the association between total caloric intake and diet composition with BMI (body mass index a measure of obesity) at 2-year intervals between 1971 and 2008. There were 36,377 US adults in this part of the study.

Because physical activity was only part of the NHANES dataset between 1988 and 2006, the correlation of physical activity with BMI was measured at 2-year intervals between 1988 and 2006. There were 14,419 adults in this part of the study.

Is Losing Weight Getting Harder?

Question MarkThe study showed:

  • Between 1971 and 2008 total caloric intake, carbohydrate intake, and BMI increased between 10% and 14%.

Nobody was surprised by this result. Americans are eating more calories and more carbs (primarily refined carbs and sugar) than we did 30 years ago. It’s no wonder we weigh more.

  • Between 1988 and 2006 physical activity increased a whopping 47-120%.

This result was a little surprising. It raises the question: “Why isn’t all this extra physical activity paying off in keeping our weight under control.

However, when the authors compared people who had the same diet (same caloric intake and same amount carbohydrate) and same physical activity with their BMI over the years they found a very surprising result.

  • When they compared people eating the same diets in 1971 and 2008, the group in 2008 weighed 10% more! And this wasn’t a single data point. There was a relatively linear increase in weight between 1971 and 2008 for people consuming exactly the same diet.
  • When they compared people with the same amount of physical activity in 1988 and 2006, the group in 2006 weighed 5% more! Once again, there was a relatively linear increase in weight between 1988 and 2006 for people performing exactly the same amount of exercise.

In other words, people weigh significantly more today than they did 20 or 30 years ago, even if they follow the exact same diet and exercise plans. Nobody saw this one coming.

That means it is harder to maintain a healthy weight today than it was just a few decades ago. You may have suspected this, but now you know for sure. Life isn’t fair!

The authors concluded: “Factors other than diet and physical activity may be contributing to the increase in BMI [in this country] over time. Further research is necessary to identify these factors and to determine the mechanisms through which they affect body weight.”

In other words, the real question is: “Why is weight loss more difficult than it used to be?”

Why Is Weight Loss More Difficult Than It Used To Be?

WhyThe short answer is, “Nobody knows for sure”. However, the authors raised several possibilities.

  • We are increasingly exposed to persistent organic pollutants (such as pesticides, flame retardants, and chemicals in food packaging) that accumulate in our bodies and may affect how our bodies process food and store fat.
  • The use of prescription drugs has risen dramatically since the 70’s and 80’s. Antidepressants, for example, are now one of the most commonly prescribed drugs in the US, and many antidepressants have been linked to weight gain. However, it’s not just antidepressants. Allergy medications, steroids, and pain medications can also cause weight gain.
  • Just looking at caloric intake and diet composition (% carbohydrate, fat, and protein) obscures other major changes in our diet over the last few decades. We are eating more meat, more highly processed foods, and more artificially sweetened foods. Highly processed foods and artificial sweeteners have both been linked to weight gain.
  • Our microbiome (gut bacteria) appears to be changing as well. Meat, highly processed foods, and artificial sweeteners have all been shown to influence which gut bacteria inhabit our intestines. We also know gut bacteria can influence our tendency to gain weight.

In short, a lot of things have changed over the past few decades. And these changes may be making it more difficult for us to lose weight. Some of these things, like diet and the influence of diet on our microbiome, we can control. Other things may be beyond our control.

The Bottom Line 

A recent study has looked at the effect of diet and physical activity on BMI (a measure of obesity) over the past few decades.

When the authors compared people who had the same diet (same caloric intake and same amount carbohydrate) and same physical activity with their BMI over the years they found a very surprising result.

  • When they compared people eating the same diets in 1971 and 2008, the group in 2008 weighed 10% more!
  • When they compared people with the same amount of physical activity in 1988 and 2006, the group in 2006 weighed 5% more!

In other words, people weigh significantly more today than they did 20 or 30 years ago, even if they follow the exact same diet and exercise plans. Nobody saw this one coming.

That means it is harder to maintain a healthy weight today than it was just a few decades ago. You may have suspected this, but now you know for sure. Life isn’t fair!

For more details and to learn why it is harder to lose weight now than it was a few decades ago read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Which Weight Loss Diet Is Best For You?

Tips For Choosing A Diet That Works

Author: Dr. Stephen Chaney

New Year DietDiet season starts in just a few days! Like millions of Americans you will probably be setting a goal to lose weight. But which diet should you choose? Vegan, Paleo, Keto, 360, Intermittent Fasting, low-carb, low fat – the list is endless.

And then there are the commercial diets: Meal replacements, low calorie processed foods, prepared meals delivered to your door – just to name a few of the categories.

You can choose to count calories, focus on portion sizes, or keep a food journal.

And, if you really want to live dangerously, you can try the latest diet pills that claim to curb your appetite and rev up your metabolism.

The advertisements for all these diets sound so convincing. They give you scientific-sounding mumbo-jumbo to explain why they work. Then they talk about clinical studies they say prove their diet works.

If you are like most Americans, you have already tried several of these diets. They worked for a while, but the pounds came back – and brought their friends with them.

But, as the saying goes, “Hope springs eternal in the human breast. Surely some diet you haven’t tried yet will work for you.

There is such a diet. But it will require a change of mindset. It will also require effort. There is no magic wand that will chase the extra pounds away forever.

If you are searching for the perfect diet to start the new year, let me be your guide. Here are:

  • 4 tips on what to avoid and…
  • 6 tips on what to look for…

…when you are choosing the perfect diet.

Tips For Choosing A Diet That Works

Things To Avoid:

Avoid1) Endorsements

Endorsements by your favorite athlete or public person are paid for. They don’t necessarily represent their opinion. Nor do they assure you that they follow that diet or use that diet supplement.

Endorsements by Dr. Strangelove and his buddies can be equally misleading. They usually tell you that the medical establishment has been lying to you, and they have discovered the “secret” to permanent weight loss and the “Fountain of Youth”.

Recommendations of the medical and scientific communities usually represent a consensus statement by the top experts in their field. I would choose their advice over Dr. Strangelove’s opinion any day.

2) Testimonials

Most of the testimonials you see on TV or in print are either paid for or are fake

Testimonials by your friends can be equally misleading. We are all different. What works for your friend or your trainer may not work for you.

For example, some of us do better on low-carb diets, and others do better on low fat diets.

[Note: Some DNA testing companies claim they can sequence your DNA and tell you which diet is best. However, as I reported in a recent article in “Health Tips From The Professor”, independent studies show that DNA testing is of no use in predicting whether low-carb or low-fat diets are better for you.]

3) Diets Based on “Magic” Or “Forbidden” Foods or Food Groups.

I have often said we have 5 food groups for a reason. Each food group provides a unique blend of nutrients and phytonutrients. And each plant food group provides a unique blend of fibers that support the growth of different types of friendly gut bacteria.

The bottom line is that each of us does better with some foods than others, but there are no “magic” or “forbidden” foods that apply to everyone.

4) “Magic” Diets.

Magic WandI have written perhaps the first diet book, “Slaying The Food Myths”, that doesn’t feature a “magic” diet that is going to make the pounds melt away and allow you to live to 100. Instead I recommend a variety of healthy diets and suggest you choose the one that fits you best.

However, I understand the allure of “magic” diets. Dr. Strangelove claims the diet will be effortless. He gives you some scientific-sounding mumbo-jumbo to convince you the diet is scientifically sound. Then he cites some clinical studies showing the diet will cause you to lose weight and will improve your health parameters (things like cholesterol, triglycerides, blood sugar, and blood pressure). It sounds so convincing.

Before you fall for Dr. Strangelove’s latest “magic” diet, let me share two things that may blow your mind:

    • The studies are all short-term (usually 3 months or less).
    • When you rely on short-term studies, the very low-fat Vegan diet and very low-carb Keto diet give you virtually identical weight loss and improvement in health parameters!

Those two diets are as different as any two diets could be. That means we can forget all the scientific-sounding mumbo-jumbo as to why each of those diets work. Instead, we should ask what these two diets have in common.

The answer is simple:

#1: The clinical studies are comparing “magic” diets to the typical American diet. Anything is better than the typical American diet! It is high in sugar, refined carbohydrates, saturated fat, and highly processed foods. No wonder the “magic” diets look so good.

#2: The diets are whole food diets. Anytime you eliminate sodas, fast foods, and highly processed foods, you will lose weight.

#3: The diets eliminate one or more food groups. Whenever you eliminate some of your favorite foods from your diet, you tend to lose weight without thinking about it. I call this the cream cheese and bagels phenomenon.

  • If you are following a low-fat diet, it sounds great to say you can eat all the bagels you want. But without cream cheese to go with the bagels, you tend to eat fewer bagels.
  • If you are following a low-carb diet, it sounds great to say you can eat as much cream cheese as you want, but without bagels to go with your cream cheese, you tend to eat less cream cheese.

#4: Because they eliminate many of your favorite foods, “magic” diets make you focus on what you eat. Whenever you focus on what you eat, you tend to lose weight. That is why food journals and calorie counters are effective.

#5: Finally, whenever you lose weight, your health parameters (cholesterol, triglycerides, blood sugar, and blood pressure) improve.

Things To Look For In Choosing A Healthy Diet For The New Year

Look For1) Choose whole food diets. Avoid sodas, fast foods, and highly processed foods.

2) Choose primarily plant-based diets. These can range from Vegan through semi-vegetarian, Mediterranean, DASH, and Nordic. All are healthy diets. I have discussed the evidence for this recommendation in my book “Slaying The Food Myths”. Here is a brief summary.

When we look at long term (10-20 year) studies:

    • Vegetarians weigh less and are healthier than people consuming the typical American diet.
    • People consuming semi-vegetarian, Mediterranean, and DASH diets are healthier than people consuming the typical American diet.

If you look at low-carb diets:

    • People consuming plant-based low-carb diets weigh less and are healthier than people consuming the typical American diet.
    • People consuming meat-based low-carb diets are just as fat and unhealthy as people consuming the typical American diet.
    • The Atkins diet low-carb diet has been around for more than 50 years, and there is no evidence it is healthy long-term

3) Choose diets that include a variety of foods from all 5 food groups. I have discussed the rationale for that recommendation above.

4) Choose diets that consider meat as a garnish, not a main course.

5) Choose diets that feature healthy carbs and healthy fats rather than low-carb or low-fat diets.

6) Think lifestyle, not diet. If you choose a restrictive diet so you can achieve quick weight loss, you will probably be just as fat and unhealthy next December 31st as you are this year. Instead, choose diets that teach healthy eating and lifestyle changes that you can make a permanent part of your life.

Tips For Keeping The Weight Off

Yo-Yo You know the brutal truth. Around 95% of dieters regain everything they lost and then some within a few years. You have probably gone through one or more cycles of weight loss and regain yourself – something called “yo-yo dieting”. You may even be asking yourself if it is worth bothering to try to lose weight this year.

Rather focusing on the negative statistics of weight loss, let’s look at the good news. There are people who lose the weight and keep it off. What do they do?

There is an organization called the National Weight Control Registry that has enrolled more than 10,000 people who have lost weight and kept it off. The people in this group lost weight on almost every diet imaginable. However, here is the important statistic: On average people in this group have lost 66 pounds and kept it off for 5 years.

The National Weight Control Registry has kept track of what they have done to keep the weight off. Here is what they do that you may not be doing:

  • They consume a reduced calorie, low fat diet.
  • They get lots of exercise (around 1 hour/day).
  • They have internalized their eating patterns. In short, this is no longer a diet. It has become a permanent part of their lifestyle. This is the way they eat without even thinking about it.
  • They monitor their weight regularly. When they gain a few pounds, they modify their diet until they are back at their target weight.
  • They eat breakfast on a regular basis.
  • They watch less than 10 hours of TV/week.
  • They are consistent (no planned cheat days).

Which Weight Loss Diet Is Best For You?

I have covered a lot of ground in this article. Let me summarize it for you.

If you are thinking about popular diets:

  • Primarily plant-based diets ranging from Vegan to Mediterranean and Dash are associated with a healthier weight and better health long term.
  • If want to lose weight quickly, you may want to start with the more restrictive plant-based diets, like Vegan, Ornish, Pritikin or semi-vegetarian.
  • If you do better with a low-carb diet, my recommendation is the low-carb version of the Mediterranean diet.
  • If your primary goal is rapid weight loss, you could also start with one of the healthier of the restrictive low-carb diets, like the Paleo or the 360 diet. I do not recommend the Keto diet.
  • No matter what diet you start with, plan to transition to the primarily plant-based diet that best fits your lifestyle and food preferences. This is the diet you will want to stick with to maintain your weight loss and achieve better health long term.
  • Plan on permanent lifestyle change rather than a short-term diet. Otherwise, you are just wasting your time.
  • Eat whole foods. Big Food keeps up with America’s favorite diets and is only too happy to sell you highly processed foods that match your favorite diet. Avoid those like the plague.

If you are thinking about commercial diets featuring meal replacement products:

  • Look for meal replacement products that:
    • Do not contain artificial sweeteners, flavors, or preservatives.
    • Use non-GMO protein. A non-GMO certification for the other ingredients is not necessary. For a more detailed explanation of when non-GMO certification is important and when it is unnecessary, see my article in “Health Tips From the Professor”.
    • Have stringent quality controls in place to assure purity. “Organic” and/or “non-GMO” on the label do not assure purity.
  • Look for programs that can provide clinical studies showing their diet plan is effective for weight loss and for keeping the weight off. Many programs have short-term clinical studies showing they are effective for weight loss, but very few have longer-term studies showing the weight stays off.
  • Finally, look for programs that teach permanent lifestyle change. This should include guidance on exercise and healthy eating.

I do not recommend most commercial diets that feature prepared low-calorie foods “shipped right to your door” as a major part of their program. The foods are highly processed. Plus, they include all your favorite unhealthy foods as part of the program. Even if they include lifestyle change as part of their program, they are undermining their message with the foods they are providing you.

I would be remiss if I didn’t mention that Weight Watchers is highly recommended by most experts in the field. Weight Watchers emphasizes journaling and counting calories, which is a plus because it makes you focus on what you are eating. They also have a good lifestyle program and support that can help you transition to permanent lifestyle change if you are willing to put in the effort. However, I don’t recommend their prepared low-calorie foods. They are no better than foods provided by the other commercial diet programs.

The Bottom Line 

Weight loss season is upon us. If you plan to lose weight and/or adopt a healthier diet in the coming year, you are probably trying to decide which diet to try this year. In this issue of “Health Tips From The Professor” I give you:

  • 4 tips on what to avoid when selecting your diet.
  • 6 tips on how to choose your perfect diet.
  • 7 tips on how to keep the weight off.

Then I put all this information together to help you choose the best diet, the best meal replacement product, and/or the best commercial diet program.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Can DNA Testing Help You Lose Weight?

How Does DNA Testing Work Best?

Genetic TestingGenomics (DNA testing) is hot. You are being told that if you just knew your genes, you could lose weight successfully, be healthier, be happier, leap tall buildings in a single bound (Actually, I haven’t heard the last claim, but it’s about the only claim that genomics marketers haven’t made). Which of these claims are true, and which are just hot air?

The experts agree that the benefits of DNA testing have been greatly oversold. As I said in a recent article on DNA testing, the idea that genes control our destiny is no longer considered valid. There are 3 reasons for this. I will start with the scientific term for each and then give you the non-scientific explanation.

  • Penetrance simply means that the severity of most gene mutations is influenced by our genetic background. Simply put, the same mutation can have a significant effect in one individual and a trivial effect in another individual.
  • Epigenetics refers to modifications of the DNA that influence gene expression. These DNA modifications are, in turn, influenced by diet and lifestyle.
  • Microbiome refers our gut bacteria. In many cases, our microbiome has just as much influence on our health as our genes. And our microbiome is influenced by diet and lifestyle.

Now you know the complexity of DNA testing, it is easy to see why experts feel that it is premature to use DNA testing to predict the best diet for either weight loss or health.

As an example, one recent study used DNA testing to predict whether study participants were more likely to lose weight on a low-carb or low-fat diet. The participants were then randomly assigned to low-carb and low-fat diets. At the end of 12 months:

  • There was no significant difference in weight loss for those on low-fat and low-carb diets. This has been reported in multiple previous studies but is an inconvenient truth that most low-carb enthusiasts tend to ignore.
  • DNA testing offered no predictive value as to whether a low-carb or low-fat diet was more effective for weight loss.

However, DNA testing may have one benefit that is overlooked by many experts. What if the DNA test results motivated people to do better? After all, most diet advice is generic. People feel it may or may not apply to them. Does personalized diet advice based on their genetic makeup motivate people to stick with the diet better?

Some studies have suggested that people may follow personalized diet plans based on their DNA more faithfully. However, most of those studies have been short-term.

That is why I have chosen today’s study (J Horne et al, BMJ Nutrition, Prevention & Health, 2020) to discuss. It is a very well-designed study and it lasted for a full year.

How Was The Study Done?

Clinical StudyThis was an extremely well-designed study. In fact, it was so well designed that it probably needs the “Results are not typical” designation the FDA requires when some diet companies make claims about weight loss success. Here are the details:

  • The study participants were highly motivated, college educated, middle-aged (average age = 55), obese (average weight = 216 pounds) Caucasian women who had a positive attitude about their ability to change what they ate. In case you weren’t counting, there were four characteristics of this group that might be considered atypical for the average American.
  • The participants volunteered for a highly structured weight loss program called the “Group Lifestyle Balance”, or GLB, program.
    • Participants were given a detailed calorie-controlled nutrition plan at the beginning of the program.
    • They were asked to track their daily food and beverage intake for the first 2-3 months of the program.
    • In the second week of the program participants were educated on how to count and track calories and nutrients such as total fat or saturated fat.
    • There were weekly meetings with dietitians the first 3 months and monthly meetings for the remainder of the 12-week program to provide the guidance and support needed to stick with their nutrition plan.
  • The plan also incorporated a behavior change program called Theory of Planned Behavior (TPB) that evaluates and influences attitudes, subjective norms, and behavioral control that are key to behavior change. During the regular meetings:
    • The participants were informed about of the health benefits associated with a healthy lifestyle.
    • They were educated on positive mindsets and mindfulness.
    • They were taken through a stepwise, goal setting approach designed to positively impact behavioral change.

In short, this is a gold standard diet program that provided the nutritional support needed to stick with the diet program and the psychological support needed to change eating behavior. Unfortunately, this is also atypical. Very few diet programs provide this level of support.

Everyone in the study participated in this program. However, the participants were divided into two groups.

  • Both groups were advised to follow a standard calorie-controlled, moderately low-fat (25% of total calories) nutrition plan.
  • In addition, the second group was put on a plan that was either high protein or low saturated fat (<10% of total calories) based on their DNA test results.
  • The nutritional support was identical except that the second group was told that their nutrition plan was specific for them, based on their DNA analysis.
  • The dietary intake of both groups was assessed with a 3-day dietary recall (2 week days and 1 weekend day) at baseline (before the program began) and at 3, 6, and 12 months to assess the participants adherence to their diet plan.

Can DNA Testing Help You Lose Weight?

Happy woman on scaleI hate to disappoint you, but the short answer to this question, is no. Both groups lost the same amount of weight, which is not surprising considering the comprehensive nature of the diet program that both groups were enrolled in.

However, the group given advice based on their DNA test were more motivated to stick with their personalized nutrition goals. Specifically:

  • Long-term adherence to reductions in saturated fat intake was significantly greater in the group that was told their diet plan was personalized based on their DNA analysis.
    • The control group reduced their saturated fat intake by 12% at 3 months, but only by 4% at 6 months, and 2.5% at 12 months.
    • The group with the personalized diet plan reduced their saturated fat intake by 14% at 3 months, 18% at 6 months, and 22% at 12 months.
  • Long-term adherence to reductions in total fat intake was also significantly greater in the group that was told their diet plan was personalized based on their DNA analysis.
    • The control group reduced their total fat intake by 18% at 3 months, but only by 4% at 6 and 12 months.
    • The group with the personalized diet plan reduced their total fat intake by 11% at 3 months, 13% at 6 months, and 16% at 12 months.
    • It is important to remember that both groups had been advised to reduce their total fat intake to 25% of calories and had received nutritional and psychological support to achieve that goal. The only difference was that the second group had been told that advice was based on their DNA test.

The authors of the study concluded: “Weight management interventions guided by nutrigenomics can motivate long-term improvements in dietary fat intake above and beyond gold-standard population-based interventions.”

How Does DNA Testing Work Best?

DNA TestingThere remain significant concerns about the validity of personalized weight loss advice based on DNA testing. However, this and other studies suggest that DNA testing may provide one valuable asset for weight loss programs. It appears that people are more likely to stick with a program they believe has been personalized for them.

There are, however, several caveats to this conclusion.

  • Participants in this study received nutritional and psychological support throughout the 12-month program. We don’t know how well participants would have stuck with the program if they had not been continually reminded that the program had been personalized for them.
  • Participants in this study were well-educated, highly motivated, Caucasian women. We don’t know whether these results apply to men and to other ethnic and socioeconomic groups.
  • This study only looked at personalized diet advice based on DNA testing. Some studies suggest that other methods of diet personalization may also improve adherence.
  • Personalization can be misused to recommend unhealthy dietary changes. It is not enough to follow personalized diet advice. You also need to ask whether it is healthy dietary advice.

For example, DNA test results consistent with reduced carbohydrate intake are sometimes used to recommend unhealthy diets that eliminate one or more food groups rather than low-carb versions of healthy diets like the Mediterranean diet.

The Bottom Line

There remain significant concerns about the validity of personalized weight loss advice based on DNA testing. However, DNA testing may provide one valuable asset for weight loss programs. Some studies have suggested that people are more likely to stick with a program they believe has been personalized for them.

However, most of these studies have been short term. A recent study asked whether the improvement in motivation lasted for 12 months.

Two matched groups of well-educated, highly motivated women were enrolled in a “gold-standard” weight loss program that provided both nutritional and psychological support for 12 months.

Both groups were given a diet plan that restricted total calorie intake and advised reducing fat intake to 25% of total calories. However, based on their DNA test results one group was given a personalized diet plan that also advised them to reduce their saturated fat intake to less than 10% of total calories.

  • The group receiving personalized diet advice did a better job of reducing both saturated and total fat intake and maintaining that change for 12 months compared to the group that just received a set diet plan.
  • These results suggest that personalization of diet advice may improve long-term adherence to healthy dietary changes.

The authors of the study concluded: “Weight management interventions guided by nutrigenomics can motivate long-term improvements in dietary fat intake above and beyond gold-standard population-based interventions.”

There are, however, several caveats to this conclusion.

  • Participants in this study received both nutritional and psychological support throughout the 12-month program. We don’t know how well participants would have stuck with the program if they had not been continually reminded that the program had been personalized for them.
  • Participants in this study were well-educated, highly motivated, Caucasian women. We don’t know whether these results apply to men and to other ethnic and socioeconomic groups.
  • This study only looked at personalized diet advice based on DNA testing. Some studies suggest that other methods of diet personalization may also improve adherence.
  • Personalization can be misused to recommend unhealthy dietary changes. It is not enough to follow personalized diet advice. You also need to ask whether it is healthy dietary advice.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Intermittent Fasting Work?

Will Intermittent Fasting Help You Lose Weight?

Author: Dr. Stephen Chaney

intermittent fastingIf you are like millions of Americans, one of your New Year’s resolutions is to lose weight. Now your dilemma is how to accomplish that. You have tried various diets before – Atkins, paleo, keto, Whole 30, etc. You lost some weight, but it came right back. You are looking for something new, something different from anything you have tried before.

What about intermittent fasting? It’s hot right now. It’s probably different from what you have tried in the past. It doesn’t require radical changes to what you eat. Some of your friends are singing its praises. Could this be the one that solves your weight problem forever?

A Primer On Intermittent Fasting

professor owlLet’s start by defining intermittent fasting and reviewing what we already know about it. There are several variations of what the mass media refers to as intermittent fasting, but the two most popular versions are:

  • Time-restricted fasting which limits daily intake of food to a 4 to 12-hour period. The most popular version of this restricts food intake to 8 hours followed by 16 hours of fasting.
  • Intermittent fasting in which there is a day or more of fasting or decreased food intake between periods of unrestricted eating. The most popular version of this allows 5 days of unrestricted eating followed by 2 days of fasting.

A major review (Di Francesco et al, Science, 362: 770-775, 2018) of time-restricted and intermittent fasting was published a little over a year ago. At the time that review was published, there were lots of studies comparing time-restricted fasting with continuous caloric restriction. I summarized those findings in a previous issue of “Health Tips From the Professor” last January.

Here is a brief summary of the key findings from that review:

  • If you read the blogs about time-restricted fasting, you will come across all sorts of metabolic mumbo-jumbo about ketone bodies, adiponectin, leptin, IGF-1, and blood glucose levels. It sounds so convincing. Don’t get sucked in by these pseudo-scientific explanations. At this point they are mostly speculation.
  • Although there is no conscious effort to control calories, time-restricted fasting result in an inadvertent reduction in food intake by restricting the time allowed for eating and by eliminating late night snacking. This reduction in caloric intake is likely responsible for most of the weight loss associated with intermittent fasting. When you control for calories, there is no difference in weight loss between time-restricted fasting and continuous caloric restriction (your typical reduced calorie diet).

However, at the time the review was published, far less was known about the relative benefits of intermittent fasting and simple caloric restriction. Since that time, two studies have rigorously compared the effectiveness of intermittent fasting and continuous caloric restriction on weight loss. I review those studies below

Will Intermittent Fasting Help You Lose Weight?

The first study (YM Roman et al, International Journal of Obesity, 43: 2017-2027, 2019) was a systematic review and meta-analysis of 9 clinical studies comparing intermittent fasting with continuous caloric restriction. Total caloric reduction was controlled and was the same for both intermittent fasting and continuous caloric reduction.

The studies ranged from 12 weeks to 52 weeks with most of them in the 20 to 30-week range. This meta-analysis found:

·       There was no difference between intermittent fasting and continuous caloric restriction in terms of weight loss, waist circumference, or body fat loss.

·       Loss of lean body mass, on the other hand, was greater for intermittent fasting than for continuous caloric restriction.

The authors concluded: “Since it is ultimately fat mass loss that improves health indices, and not the loss of muscle, the significantly greater loss of lean mass in the intermittent dieting group versus the continuous dieting group is concerning and needs to be further assessed.”

I would add, it is also concerning because lean mass muscle burns calories faster than fat mass. Loss of lean muscle mass could lead to a lower metabolic rate. That would make maintenance of the weight loss more difficult.

The second study (ML Headland et al, International Journal of Obesity, 43: 2028-2036) compared intermittent fasting versus continuous calorie restriction for 12 months in a group of 332 healthy overweight or obese adults. Again, total caloric reduction was the same for the two groups. In this study:

·       There was no significant difference between intermittent fasting and continuous caloric restriction for weight loss, body fat loss, and lean body mass loss. [Note: The retention of lean body mass in this study differs from the loss of lean body mass reported in the previous study. Additional studies will be required before we become overly concerned about potential loss of lean body mass with intermittent fasting.]

·       There were also no significant differences between the groups for blood levels of glucose, total cholesterol, triglycerides, HDL, and LDL.

Does Intermittent Fasting Work?

does intermittent fasting workThese studies make it clear there is no “magic” associated with either time-restricted or intermittent fasting.

·       If either time-restricted or intermittent fasting allows you to reduce your daily caloric intake by restricting the time that you are eating, you will lose weight and keep it off. However, if you compensate for the fasting periods by consuming additional calories when you are eating, all bets are off.

·       In clinical studies that restrict calories to the same extent in the various diets, neither time-restricted nor intermittent fasting results in greater weight loss than continuous caloric restriction (your typical reduced calorie diet).

o   In addition, neither time-restricted nor intermittent fasting results in better improvement in blood parameters (glucose, total cholesterol, triglycerides, HDL, and LDL) than continuous caloric restriction.

·       Intermittent fasting may result in greater loss of lean muscle mass than continuous caloric reduction. If confirmed by subsequent studies, this would be concerning.

This also means:

·       If you happen to read the blogs about time-restricted or intermittent fasting, you can forget all the metabolic mumbo-jumbo about ketone bodies, adiponectin, leptin, IGF-1, and blood glucose levels.

o   At this point this metabolic information comes mostly from animal studies. Its application to humans is purely speculation.

o   Since time-restricted and intermittent fasting offer no advantage over continuous caloric restriction, there is no evidence that changes in any of those metabolic markers has any effect on weight loss in humans.

Finally, you need to ask whether time-restricted and intermittent fasting are something you can maintain in the real world.

·       Your friends are unlikely to be on the same schedule. It won’t be easy to fit your diet around socializing, travel, and holidays.

The Bottom Line

There are several variations of what the mass media refers to as intermittent fasting, but the two most popular versions are:

  • Time-restricted fasting which limits daily intake of food to a 4 to 12-hour period. The most popular version of this restricts food intake to 8 hours followed by 16 hours of fasting.
  • Intermittent fasting in which there is a day or more of fasting or decreased food intake between periods of unrestricted eating. The most popular version of this allows 5 days of unrestricted eating followed by 2 days of fasting.

The latest studies make it clear there is no “magic” associated with either time-restricted or intermittent fasting.

·       If either time-restricted or intermittent fasting allows you to reduce your daily caloric intake by restricting the time that you are eating, you will lose weight and keep it off. However, if you compensate for the fasting periods by consuming additional calories when you are eating, all bets are off.

·       In clinical studies that restrict calories to the same extent in the various diets, neither time-restricted nor intermittent fasting results in greater weight loss than continuous caloric restriction (your typical reduced calorie diet).

o   In addition, neither time-restricted nor intermittent fasting results in better improvement in blood parameters (glucose, total cholesterol, triglycerides, HDL, and LDL) than continuous caloric restriction.

·       Intermittent fasting may result in greater loss of lean muscle mass than continuous caloric reduction. If confirmed by subsequent studies, this would be concerning.

Finally, you need to ask whether time-restricted and intermittent fasting are something you can maintain in the real world.

·       Your friends are unlikely to be on the same schedule. It won’t easy to fit your diet around socializing, travel, and holidays.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Why Do Most Diets Fail?

How To Lose Weight And Keep It Off

New Year DietTomorrow is the official start of another dieting season. Millions of Americans will be making a New Year’s Resolution to lose weight. The top three reasons for these weight loss resolutions are:

1)    Reduce disease risk (73%). After all, we are being told those excess pounds increase our risk of diabetes, heart disease, cancer, and just about every other disease known to man.

2)    Improve self-esteem (61%). Some of this may be due to the social stigma associated with obesity, but many people simply want to improve the image they see in the mirror every morning when they get out of the shower.

3)    Boost energy (49%).

Those are all good reasons for losing weight. But before you make your New Year’s resolution to embark on another weight loss journey, you should ask yourself “Do weight loss diets work?” If you look at the statistics, they aren’t very encouraging:

1)    45 million Americans go on a weight loss diet every year.

·       50% go on fad diets.

·       They spend $33 billion on weight loss products.

·       90% regain almost all the weight. That’s called the yo-yo effect.

·       On average, Americans gain 11 pounds on every diet yo-yo.

o   They might as well have thrown that $33 billion to the wind.

2)    228,000 Americans get gastric bypass surgery.

·       80% regain almost all the weight.

o   Their digestion and their health will never be the same.

As if those statistics weren’t bad enough, the obesity epidemic gets worse year after year (see the graphic on the Obesity Epidemicright). Americans keep getting fatter. What we are doing clearly isn’t working.

You are probably saying to yourself: “I know that, but this year I’m going to try a new diet.” As the saying goes “Hope springs eternal in the human breast”, but is it realistic to think this time will be different?

Let me share a quote from a book and TV series called “The Weight Of the Nation” by John Hoffman & Dr. Judith Salerno”:

“First we blamed fat – low fat diets didn’t work! Then we blamed carbs, eggs, red meat, dairy, white flour, sugar, juices, sodas, high-fructose corn syrup, & partially hydrogenated fats. One by one, we replaced the evil food du jour…and watched our collective waistlines grow.”

In other words, they are saying it’s not just low-fat diets that don’t work. None of the popular diets work long term. I come across lots of people who tell me the Atkins weight-loss diet works best for them. That would be convincing if they were slender, but they aren’t! They gained it all back and then some. Now that the keto diet has been around for a few years, I am starting to see the same pattern there as well.

Clearly, the problem isn’t losing the weight. Any diet can help you lose weight. The problem is keeping the weight off. Let’s look at why this is.

Why Do Most Diets Fail?

WhyTo understand the answer to this question, let’s start with another quote from “The Weight Of the Nation”: “Our bodies were designed to store fat in times of plenty and retain fat in times of famine”

Essentially, the authors were saying when our ancestors were hunters and gatherers, there were times when food was abundant, and times when food was scarce. In order to survive, our bodies had to store energy in its most efficient form when food was abundant and hold on to those energy stores as long as possible when food was scarce.

Fat provides more than twice as many calories per gram as either carbohydrate or protein. Additionally, our ability to store carbohydrate is limited. And we don’t really have protein stores. All the proteins in our body have essential functions. However, our ability to store fat is unlimited. Now you understand why fat is the preferred energy store in times of plenty and our bodies try to hold on to it as long as possible in times of famine.

With that perspective in mind, there are three reasons why most diets fail:

1)    Most dieters are looking for rapid weight loss (at least 2-5 pounds/week). That is a problem because “Our bodies were designed to…retain fat in times of famine”. When we lose weight quickly, our bodies interpret that as famine. Our bodies respond by decreasing our metabolic rate so we can hold on to those fat stores.

The solution to this problem is to set more reasonable weight loss goals. If we keep the rate of weight loss in the 1-2 pound/week range (0.5-1 pounds/week is even better), we can largely avoid this famine response. You should ask yourself, “What’s the rush?” After all, the average American only gains 1-2 pounds/year. Why do we need to get rid of that excess weight in just a few weeks?

2)    Most dieters are looking for significant weight loss (more than 20 pounds). That is a problem because our bodies are designed to retain fat stores, not protein stores. When our bodies sense a famine they burn our protein stores (lean muscle mass) to spare as much of our fat stores as possible. The longer the diet (famine) lasts, the more muscle mass we lose.

That’s a problem because muscle burns calories much faster than fat. The more muscle we lose, the more our metabolic rate decreases. It gets harder and harder to lose weight, and eventually we reach a plateau. Most people get discouraged at that point and go off their diet.

That’s where the other part of the quote from “The Weight Of The Nation” kicks in: “Our bodies are Yo-Yo with Boydesigned to store fat in times of plenty”. Once again, it is fat we store, not protein. Most people never regain the protein stores they lost, so their metabolic rate remains low. They regain most of the weight they lost, and then some. This is the origin of the yo-yo effect.

There are two solutions to this problem:

·       Increase your resistance exercise and your intake of protein with high levels of the essential amino acid leucine. I have covered this in a previous issue of “Health Tips From The Professor”.

·       Set more reasonable weight loss goals. It is possible to lose more than 20 pounds without losing muscle mass. We just need to think in terms of reaching those weight loss goals in years rather than in months. Once again, remember it took us years to gain the weight. Why not think in terms of years to lose the weight?

3)    Most dieters think in terms of diets rather than lifestyle change. Diets have an expiration date. Then most people just drift back to “the way they really live”. Lifestyle change, on the other hand, is permanent. Once we change to a healthier lifestyle, we no longer need to focus on weight loss. The weight comes off automatically.

To better understand the power of lifestyle change let’s look at something called “The National Weight Control Registry”.

How To Lose Weight And Keep It Off

Happy woman on scaleRather than focus on the abysmal statistics for long-term weight loss, doctors Rena Hill and James O Wing decided to focus on the characteristic of people who manage to keep their weight off. They founded something called “The National Weight Control Registry” and invited people who were successful at keeping the weight off to participate in their program.

Currently, the National Weight Control Registry is tracking over 10,000 individuals who have lost 30 pounds or more and have kept it off for long periods of time. They use detailed questionnaires and annual follow-up surveys to study the behavioral and psychological characteristics and the strategies of weight loss maintainers.

When you look at how they lost weight, they are a very diverse group:

·       They lost weight on every possible diet – from vegan to keto to just plain crazy.

·       50% lost weight on commercial diet programs. 50% lost weight on their own.

·       Some lost weight quickly. Some lost weight slowly.

When you look at weight maintenance, you realize that the dismal weight maintenance statistics don’t have to apply to you. The good news is:

·       On average, people in The National Weight Control Registry have lost 66 pounds and have kept it off for 5 years or more.

·       12-14% of them have maintained a weight loss of 100 pounds or more for 5 or more years.

·       Even better, once they maintained their weight loss for 2-5 years, it became easy.

They no longer had to battle hunger and a sluggish metabolism. They no longer had to think about the lifestyle changes they were trying to maintain. Their new lifestyle became what they did automatically, without even thinking about it. Their weight loss had become permanent.

By now, you are probably wondering how they do it. Here are the top 7 characteristics of those who are successfulhealthy living at keeping the weight off:

1)    They consumed reduced calorie, low-fat, healthy diets.

2)    They had internalized their eating patterns. It had become how they ate every day without even thinking about it.

3)    They monitored their weight regularly. This allowed them to make adjustments whenever they saw their weight start to creep up.

4)    They ate breakfast on a regular basis.

5)    They got lots of exercise (on average, about 1 hour/day).

6)    They watched less than 10 hours of TV/week. If you were wondering where you would find the time to exercise an hour/day, this is probably your answer.

7)    They were consistent. They had no planned “cheat days”. This doesn’t mean they were purists. They still allowed themselves to eat some of their favorite unhealthy foods on an occasional basis. They just didn’t set aside regular times when they planned to “pig out”.

There was one other interesting observation from this study:

·       Those who used meal replacement shakes as part of their weight loss, focused more on diet and included meal replacement shakes as part of their maintenance program.

·       Those who lost weight on their own, also followed healthy eating habits, but put a bit more emphasis on exercise to keep themselves on track.

·       Both approaches were effective.

The take-home message of the National Weight Control Registry is clear. There is no magic diet that guarantees you will keep the weight off. The “secret” to keeping the weight off is a healthy eating pattern and a healthy lifestyle.

In short, if your resolution is to lose weight next year, don’t focus on the diet you will follow to lose the weight. Instead, focus on the healthy lifestyle you will follow to keep the weight off.

Of course, you will be most successful if the diet you are following to lose weight incorporates the healthy lifestyle you plan to follow to maintain your weight loss.

What Role Do Habits Play In Weight Loss?

Habits-Old-vs-NewFinally, I would like to share a recent study (G Cleo et al, International Journal of Obesity, 43: 374-383, 2019) that puts the whole issue of weight loss and weight maintenance in a different perspective. This study looked at the role that habits play in weight loss.

In short, the study enrolled 130 participants who wanted to lose weight. All the participants were told this was a weight loss study, but none of the participants were given detailed diet and exercise recommendations to follow. The study had a 12-week intervention phase followed by a 12-month follow-up phase. The participants were divided into three groups.

1)    Group 1 received no advice during the intervention phase. This was the control group.

2)    Group 2 focused on breaking old habits. During the intervention phase they were sent daily tests suggesting new habit patterns. These were suggestions like “Drive a different route to work today”. None of the texts had anything to do with diet or lifestyle.

3)    Group 3 focused on creating new healthy habits. They were given a list of 10 healthy habits. During the intervention phase they were asked to log how many of these habits they implemented each day. The 10 healthy habits were:

#1: Keep to a daily meal routine.

#2: Choose reduced fat versions of foods.

#3: Walk off the weight (aim for 10,000 steps/day).

#4: Pack a healthy snack (Choose healthy options such as fruits, nuts, or low-fat yogurt).

#5: Read labels.

#6: Be cautious with your portions.

#7: Break up your sitting time (Stand for 10 minutes every hour).

#8: Think about your drinks (Choose water instead of sodas and fruit juices).

#9: Focus on your food (Slow down. Don’t eat while watching TV).

#10: Don’t forget your 5 servings of fruits and vegetables a day.

The results were:

·       People in both habit change groups lost significantly more weight than people in the control group.

·       People in the habit change groups continued to lose weight for 12 months after the intervention ended.

·       Weight loss was essentially identical in the two habit change groups.

The last observation is particularly interesting. Remember that one of the habit change groups was simply focused on breaking old habits, yet people in this group did just as well as people who were taught healthy lifestyle habits. This implies that people already know about healthy lifestyle habits. They just don’t know how to break their old habits. Once they become comfortable breaking old habits, they find it easy to adopt healthier lifestyle habits.

In short, change your habits, change your lifestyle. Change your lifestyle, control your weight.

What Does This Mean For You?

why-do-most-dirts-failI covered a lot of information in this article. Let me sum it up by giving you my top 10 tips for losing weight and keeping it off.

1)    You don’t need to achieve your “ideal weight”. Losing 5-10% of your body weight may be enough.

2)    Ditch diets. Focus on lifestyle change.

3)    Slow and steady wins the day.

4)    Change your habits, change your weight.

5)    Long-term weight loss is possible.

6)    Low-fat, healthy eating patterns are best.

7)    Once you have internalized healthy habits, they become automatic.

8)    If you stick with a healthy lifestyle long enough, keeping the weight off becomes easy.

9)    Focus on all the healthy food choices you have, not what you have to give up. There is a cornucopia of great tasting, healthy foods to choose from.

10)  Never say never. Allow yourself to enjoy your old favorite foods on occasion. Just don’t make it a habit.

The Bottom Line

I cover a lot of information in this article. Let me sum it up by giving you my top 10 tips for losing weight and keeping it off.

1)    You don’t need to achieve your “ideal weight”. Losing 5-10% of your body weight may be enough.

2)    Ditch diets. Focus on lifestyle change.

3)    Slow and steady wins the day.

4)    Change your habits, change your weight.

5)    Long-term weight loss is possible.

6)    Low-fat, healthy eating patterns are best.

7)    Once you have internalized healthy habits, they become automatic.

8)    If you stick with a healthy lifestyle long enough, keeping the weight off becomes easy.

9)    Focus on all the healthy food choices you have, not what you have to give up. There is a cornucopia of great tasting, healthy foods to choose from.

10)  Never say never. Allow yourself to enjoy your old favorite foods on occasion. Just don’t make it a habit.

For more details on how to lose weight and keep it off, read the article above. In fact, if you plan to lose weight in the coming year, you should really read this article first.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

 

A Low Carb Diet and Weight Loss

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Choosing the Best Weight Loss Diet

Calories Rule

Author: Dr. Stephen Chaney

 

weight loss dietChoosing a weight loss diet?

Next week you’ll be making your annual New Year’s resolution that this will be the year that you finally lose those extra pounds and keep them off!

The good news is that you will have lots of choices for losing that weight. The bad news is that most of those choices are bogus!

You see each diet book and Internet marketer will have a “magic formula.”

  • Sometimes it will be a “magic” diet composition – low fat diets, low carb diets, high protein diets – or don’t eat protein and carbohydrates together.
  • Sometimes it will be a “magic” food – grapefruit, cabbage soup, acai berries or chocolate.
  • Sometimes it will be a villainous food or food group to avoid – sugar, grains, or dairy.

All these diets are hyped with a lot of scientific sounding mumbo jumbo and many of them have short term studies that seem to show that they work. But whenever well designed scientific studies have been performed that compare these diets at equal calorie levels and look at weight loss over two years or more, there is not a dime’s worth of difference between them.

With Weight Loss Diets, Calories Rule

weight loss diet calories ruleDespite all the hype that you will hear, weight loss is dependent on the difference between calories in and calories out.

Don’t misunderstand me, I recognize that the calorie equation is not identical for everyone. For example, in a recent issue, “Does Genetics Determine Weight,”  of “Health Tips From The Professor” I talked about a study that put all of the subjects in a metabolic ward where every aspect of calorie intake and calorie expenditure were controlled. They then restricted calories by the same percent for everyone for 6 weeks. The subjects with “thrifty genes” lost 5% of their body weight. Subjects with “spendthrift genes” lost 12% of their body weight.

  • The good news is that everyone lost weight. Calories rule!
  • The bad news is that some people lost weight more slowly than others. Life isn’t fair.

The problem, of course, is that we don’t live in a metabolic ward. We have trouble keeping track of the calories we eat and overestimate the calories we burn. That’s why fad diets are so popular. They promise you won’t have to track calories. You don’t have to watch what you eat. You won’t need to exercise. All you need to do is eat the foods they tell you are OK and avoid the foods they tell you are bad.  This is not how to choose a weight loss diet.

I have a news bulletin: There is no “magic diet formula,” no “magic diet composition” and no “magic diet food.”  Did you really think that someone had repealed the laws of thermodynamics?

Once you understand and accept that the difference between calories in and calories out is the most important determinant of successful weight loss, you can start to understand the key principles of successful weight loss.

 

Choosing The Best Weight Loss Diet

 

choosing best weight loss dietHere is a quick guide to choosing the best diet:

Principle #1: The diet doesn’t have to be weird to be successful.

In fact, the diet is most likely to succeed if it includes foods that are familiar to you.

If you’re a “meat and potatoes” guy, a vegetarian diet is not likely to be successful for you (Some of my friends refer to that kind of diet as “rabbit food”). If you are a vegetarian, a meat-based low-carb diet is not likely to be appealing.

More importantly, we are all different. Some of us will lose weight successfully on one diet. Other people will be more successful on a different diet. That means that the diet that worked so well for your friend might not work at all for you. You will need to experiment a bit to find the best diet for you.

And, before you ask me, your body type or blood type has absolutely nothing to do with which diet is going to work best for you.

Of course, you will need to make some changes to your diet. You will want to drop unhealthy foods from your diet and include some foods that are new to you. The first foods to go should be sodas (both sugar-sweetened and diet), junk foods, and fast foods. In their place add water or herbal tea, fruits, vegetables, and whole grains. That change alone can be worth at least 2-5 pounds in your first month.

You will want to think about what you are eating and make conscious choices about which foods are helping you fulfill your goals of losing weight and which are not.

Principle #2: The diet should be one that is healthy in the long run.

I’m particularly talking about the popular high fat, low carbohydrate diets here. It is clear diets high in meat and fat – particularly saturated and trans fats – are associated with increased risk of heart disease, diabetes, cancer and inflammatory diseases.

Plus, high fat diets just don’t work well for long term weight control. Fat has more calories than carbohydrate. This is not rocket science!

Just in case you don’t believe me, you just need to consult the National Weight Control Registry. The National Weight Control Registry was established in 1994 and has tracked the weight loss strategies of over 5000 people who have been successful at keeping their weight off long term.

While those people lost weight using every diet in the books, the vast majority of them who were successful at keeping their weight off long term followed a low calorie, low-fat diet to maintain their weight loss. Of course, I am not referring to a low-fat that contains a lot of sugar and refined carbohydrates. That kind of diet is part of the problem. I am referring to a plant-based low-fat diet with lots of fruits, vegetables, legumes and whole grains.

Principle #3. Don’t forget the other part of the calorie equation. That’s right, I’m talking about exercise.

While you burn some calories every time you exercise, the real value of exercise is that it increases lean muscle mass – and lean muscle mass burns more calories than fat.

Again, if you consult the National Weight Control Registry, you will find that virtually everyone who has been successful at keeping the weight off exercises on an almost daily basis.

Helpful hint: The handy exercise monitors on your Fit Bit, smart phone, and exercise machines overestimate energy expenditure by as much as 50%. Decrease those numbers accordingly when you are estimating your calorie balance for the day.

Principle #4: Don’t start if you don’t intend to finish. Once again, the National Weight Control Registry puts that in perfect perspective.

Almost everyone who was successful at keeping the weight off long term had stopped thinking of it as a diet. It had become a way of life. It was how they ate. It was the exercise that they liked to do on a daily basis. It no longer required any conscious effort. It no longer required any will power.

This is perhaps the most important weight control principle of all:

When you make your resolutions this New Year, don’t make a resolution to change your weight. Make a resolution to change your life.

 

The Bottom Line

 

Forget the hype. There is no “magic diet formula”, no “magic diet composition” and no “magic diet food.” While the calorie equation is different for each of us (see article above for details), weight loss always requires that calories out be greater than calories in. Calories rule!

Here are four simple principles to keep in mind when selecting the best diet to lose weight next year.

#1: The diet doesn’t have to be weird to be successful.

#2: The diet should be one that is healthy in the long run.

#3: Don’t forget the other part of the calorie equation, i.e. exercise.

#4: Don’t start if you don’t intend to finish.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

3 Weight Loss Scams To Avoid

Weight Loss, Wealth Loss, Or Health Loss?

Author: Dr. Stephen Chaney

 

weight loss scamsP.T. Barnum once said “There’s a sucker born every minute”.  Those words were never truer than in the weight loss industry and weight loss scams.

You’ve seen the ads: “Lose 4 pounds/week of belly fat”; “Lose 40 pounds in two weeks”; “burns off fat effortlessly”; “The pounds just melt away”. It’s hard to believe that people actually fall for those ads. Yet they do.

The problem is that weight loss is hard. You have to change your lifestyle – eat healthier, exercise more, give up some of your favorite foods. Even worse you can’t just make those changes for a few weeks or a few months. Those lifestyle changes need to be permanent if you wish to achieve lasting weight loss.

That just doesn’t fit with the American psyche. After all, our doctors and the TV ads promise us a “pill for every ill”. If you think that way, it is only logical that there should be a pill for weight loss.

 

Unfortunately, the unscrupulous supplement manufacturers are only too happy to fill that expectation. They don’t care whether their products actually work or whether they may actually kill you. They just want to make a quick buck.

 

Here are the 3 weight loss scams making headlines today.

3 Weight Loss Scams to Avoid

 

Fake Weight Loss Marketing Schemes

weight loss scams to avoidThe first 2 weight loss scams fall into the category of ones that lighten your wallet. In a recent press release the FTC recently charged two Florida-based supplement manufacturers of concocting elaborate, but completely fraudulent, marketing schemes to sell their weight loss products– one containing forskolin and another containing white kidney bean extract.

The schemes started with the marketers hacking people’s email accounts and sending messages touting the fake products to all of their contacts. The messages were worded in such a way that the email appeared to be a recommendation of the product coming from a trusted friend or family member.

The emails were linked to fake “news websites” that were designed to look like they were put up by an independent consumer reporter who had reviewed and endorsed the product rather than by the product manufacturers. These web sites featured glowing testimonials from consumers who had supposedly lost significant weight using those products. Of course, the fake “news websites” contained links that took consumers to websites where they could purchase the products.

In the complaint they filed in court, the FTC said “these weight loss claims are false and lack scientific support”.  In plain English, the FTC was saying that the testimonials were made up and there was no scientific evidence that the products actually worked.  The fake “news websites” also said that the products were endorsed by Oprah and a television show called “The Doctors.”   The FTC said that both of those claims were also false.

And, if all of this weren’t enough, the defendants in these two cases then approached people who had legitimate health and weight loss blogs with large followings and offered them affiliate status if they would feature links to the fake “news websites” the defendants had constructed. In plain English, affiliate status means that the owners of the blogs receive a commission whenever someone started from their blog and clicked all the way through to one of the defendant’s sites and bought a product*.

The FTC is seeking an immediate injunction that would shut down these fraudulent marketing schemes and prevent the companies from selling fake products that don’t work.  I hope the FTC is successful at obtaining the injunction against both companies, and I hope it happens quickly. Unscrupulous manufacturers like this need to be put out of business.  Please, be careful to avoid these kind of weight loss scams.

*Just so you know, I have also been approached by companies offering “Health Tips From the Professor” affiliate status for marketing their products.  I have chosen not to do that.  I don’t want to become like so many other popular health blogs that seem to be more about marketing than about health.  I will not feature any product I don’t believe in on my site.  Integrity is more important than money.

 

Weight Loss Products That Might Actually Kill You

weight loss drugThe third of the weight loss scams is of the more dangerous kind – one that might even kill you.

The FDA recently sent a warning letter to a marketing company called The Ultimate Weight Loss Company claiming that 3 of their weight loss products that were labeled as containing bee pollen actually contained two undeclared drugs that the FDA has banned for consumer use.

The first undeclared drug in their products is a compound called phenolphthalein, which was widely used in laxative drugs. It was also widely used in weight loss products because its laxative effect also causes water loss from the body – giving the appearance of rapid weight loss. However, research in the 90s suggested that it also increased the risk of several cancers.  Laxative and weight loss drugs containing phenolphthalein were subsequently withdrawn from the market and the FDA currently classifies phenolphthalein as an unapproved drug.

The second undeclared drug in their products is a compound called sibutramine. Sibutramine suppresses appetite and increases metabolic rate. It was the active ingredient in a weight loss drug called Meridia, which was initially approved by the FDA in 1997.

The problem is that, like many drugs that increase metabolic rate, sibutramine also increases heart rate. While that is relatively benign for some people, it can cause arrhythmia, heart attack and stroke in anyone with a weakened cardiovascular system.

A large clinical study published in 2010 (James et al, New England Journal of Medicine, 363: 905-917, 2010) showed that Meridia significantly increased the risk of heart attack and stroke in subjects with preexisting heart disease. Shortly after that the FDA declared that it caused an unacceptably high risk of heart attack and stroke, and it was withdrawn from the market. The FDA currently classifies subutramine as an unapproved drug as well.

Of course, some of you are probably saying to yourself: “My heart is fine. If this drug suppresses my appetite and revs up my metabolism, where can I get it?”  My response is: “Not so fast. Here are a few statistics you should know”:

  • 47% of Americans are at risk for heart disease, and many don’t know that they have a problem until they drop dead from their first heart weight loss drugs killattack.

Unfortunately, the combination of phenophthalein and sibutramine are still used in fraudulent weight loss products because they work. These two drugs together might actually give you 10 pounds or more of weight loss in the first couple of weeks. They might also kill you.  They are certainly weight loss scams to avoid.

In their warning letter to The Ultimate Weight Loss Company the FDA said that their products pose “a threat to consumers because sibutramine is known to substantially increase blood pressure and/or pulse rate in some patients and may present a significant risk for patients with coronary artery disease, congestive heart failure, arrhythmias, or stroke. This product may also interact, in life-threatening ways, with other medications a consumer may be taking”

The problem is not just that the weight loss products manufactured by this company contained unapproved drugs that are dangerous. The problem is that those compounds weren’t on the label.  The label claimed the products contained bee pollen.  The consumer had no way of knowing that the products might be dangerous.

Even worse, as soon as the FDA shuts down this company, another one will pop up somewhere else. The combination of phenolphthalein and sibutramine is one of the  weight loss scams that turn up time after time.

How Can You Protect Yourself From Weight Loss Scams?

It is definitely “buyer beware” in the weight loss industry. Unscrupulous manufacturers and weight loss scams abound. You have learned from this article that:

  • You can’t trust testimonials. They are often fabricated.
  • You can’t trust before and after pictures. They can be photoshopped and purchased over the internet.
  • You can’t trust endorsements by celebrities or doctors. Endorsements can be bought and sold, and sometimes they are just fabricated.
  • You can’t trust claims about “proven results.” They often aren’t backed by real science.
  • You can’t even trust product labels. Some products contain dangerous ingredients that aren’t even on the label.
  • You can’t even trust the FDA and FTC to protect you. They are doing their best, but two new scams pop up for every one they shut down.

So what can you do to keep from being ripped off or endangering your health?  Here are my top 4 recommendations for avoiding weight loss scams.

  • Don’t be taken in by claims of rapid weight loss, effortless weight loss, or “magic” ingredients. The experts tell us weight loss should not exceed one or two pounds per week and should include lifelong lifestyle change. If the ads claim anything else, run in the other direction.
  • There are no “magic” foods or “magic” combinations of protein, fat and carbohydrate.  It also doesn’t matter whether the diet is Paleolithic age or space age. Weight loss simply requires calories in to be less than calories out.
  • Look for clinical studies published in peer reviewed scientific journals showing that the weight loss program actually works.
  • Choose companies that have established a reputation for quality and integrity over a period of decades, not just a few months or a year or two. Weight loss scams come and go. Good reputations take a long time to develop.

 

 

The Bottom Line

Weight loss scams have been in the headlines recently.

  • The FTC recently announced legal action two companies selling weight loss products containing forskolin or white kidney bean extract. According to the FTC the companies were using a “fraudulent marketing scheme” and the weight loss claims for their products were “false and lacked scientific support”.
  • The FDA recently announced legal action against a company selling three weight loss products which they claimed contained bee pollen, but which actually contained two unapproved and dangerous drugs that can cause heart attack and stroke in susceptible people.

In both cases the products seemed legitimate. They seemed safe. When you read the details of the FTC and FDA cases it becomes apparent that:

  • You can’t trust testimonials. They are often fabricated.
  • You can’t trust before and after pictures. They can be photoshopped and purchased over the internet.
  • You can’t trust endorsements by celebrities or doctors. Endorsements can be bought and sold, and sometimes they are just fabricated.
  • You can’t trust claims about “proven results”. They often aren’t backed by real science.
  • You can’t even trust product labels. Some products contain dangerous ingredients that aren’t even on the label.
  • You can’t even trust the FDA and FTC to protect you. They are doing their best, but two new scams pop up for every one they shut down.

In the article above you will find my top 4 recommendations for avoiding weight loss scams.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Health Tips From The Professor