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Category Archives: Weight Loss
Depends on how you define “work.”
New Zealand researchers found significant long-term weight loss and improved cholesterol levels over six and 12 months with a low-fat vegetarian diet. Surprisingly, this was accomplished without restriction on calories and without an exercise component. Weight loss measured at six months was 27 lb (12.1 kg) and they only gained a little back by six months later.
The authors think the successful weight loss was from “… the reduction in the energy density of the food consumed (lower fat, higher water and fibre). Multiple intervention participants stated ‘not being hungry’ was important in enabling adherence.”
I scanned the article pretty quickly and don’t see that they referred to the diet as vegetarian. Here’s their test diet description:
We chose a low-fat iteration of the plant-based diet [7–15% if calories as fat] as this has been shown with previous research to achieve optimal outcomes, especially for heart disease and weight loss. This dietary approach included whole grains, legumes, vegetables and fruits. Participants were advised to eat until satiation. We placed no restriction on total energy intake. Participants were asked to not count calories. We provided a ‘traffic-light’ diet chart to participants outlining which foods to consume, limit or avoid. We encouraged starches such as potatoes, sweet potato, bread, cereals and pasta to satisfy the appetite. Participants were asked to avoid refined oils (e.g. olive or coconut oil) and animal products (meat, fish, eggs and dairy products). We discouraged high-fat plant foods such as nuts and avocados, and highly processed foods. We encouraged participants to minimise sugar, salt and caffeinated beverages.
Perfect diet compliance would make this a vegan diet. I didn’t catch it in the text of the article, but I’m guessing protein calories were 10–15% of the total, and carbohydrates were around 75%.
The researchers called their investigation the BROAD study. All study subjects were overweight or obese adults. A control group ate their regular foods. The intervention group eating the whole food plant-based diet numbered 33, including 7 with type 2 diabetes. All studies like this have people that drop out. I.e., they quit or otherwise get lost to follow-up. Of the intervention group, 75% lasted for six months, 70% stuck with it for the entire 12 months.
There weren’t enough diabetics in the study to make statistically significant conclusions, but the authors write, “Hemoglobin A1c reductions favoured the intervention and all intervention patients with a diabetes diagnosis improved while adherent, and two resolved their condition by HbA1c.”
I’d love to see these researchers repeat this study with 50–100 overweight or obese folks with T2 diabetes. Clearly, it’s a radically different diet than what I recommend for my patients with diabetes.
Steve Parker, M.D.
PS: For science nerds, here’s the study abstract:
Background/Objective: There is little randomised evidence using a whole food plant-based (WFPB) diet as intervention for elevated body mass index (BMI) or dyslipidaemia. We investigated the effectiveness of a community-based dietary programme. Primary end points: BMI and cholesterol at 6 months (subsequently extended).
Subjects: Ages 35–70, from one general practice in Gisborne, New Zealand. Diagnosed with obesity or overweight and at least one of type 2 diabetes, ischaemic heart disease, hypertension or hypercholesterolaemia. Of 65 subjects randomised (control n=32, intervention n=33), 49 (75.4%) completed the study to 6 months. Twenty-three (70%) intervention participants were followed up at 12 months.
Methods: All participants received normal care. Intervention participants attended facilitated meetings twice-weekly for 12 weeks, and followed a non-energy-restricted WFPB diet with vitamin B12 supplementation.
Results: At 6 months, mean BMI reduction was greater with the WFPB diet compared with normal care (4.4 vs 0.4, difference: 3.9 kg m−2 (95% confidence interval (CI)±1), P<0.0001). Mean cholesterol reduction was greater with the WFPB diet, but the difference was not significant compared with normal care (0.71 vs 0.26, difference: 0.45 mmol l−1 (95% CI±0.54), P=0.1), unless dropouts were excluded (difference: 0.56 mmol l−1 (95% CI±0.54), P=0.05). Twelve-month mean reductions for the WFPB diet group were 4.2 (±0.8) kg m−2 BMI points and 0.55 (±0.54, P=0.05) mmol l−1 total cholesterol. No serious harms were reported.
Conclusions: This programme led to significant improvements in BMI, cholesterol and other risk factors. To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise.
David Mendosa found a 2016 research report suggesting that cool temperatures may help with weight management by activating our brown fat, which burns more calories. Heat generated by brown fat is derived from glucose and triglycerides. Keep in mind as you read further that a comfortable environment temperature for a clothed human is about 23°C or 73°F. Those temps don’t stress our bodies by requiring us to either generate or dissipate extra body heat.
Researchers have discovered that when we get mildly cold, which they define as being cool without shivering, our bodies burn more calories. As a result, managing our weight can be easier.
This is the conclusion of a recent review that two researchers at Maastricht University Medical Center in the Netherlands published in the November 2016 issue of the professional journal Diabetologia. The title of their article, “Combatting type 2 diabetes by turning up the heat,” puzzled me at first.
The title confused me because the study is about turning down the heat in the room we’re in. But then our bodies compensate by turning up their internal heat production.
When our body does this, its energy expenditure increases, ratcheting up our metabolism. Being mildly cold revs up our bodies’ brown fat, which unlike white fat, burns calories instead of storing them.
It’s not quite clear how much cold exposure it takes to turn on your brown fat. From the link above:
Cold acclimation by intermittent exposure to a cool (14–17°C) [57–63°F], or cold (10°C) [50°F] environment resulted in significant increases in NST [non-shivering thermogenesis or heat production] capacity. A 10 day cold acclimation study with 6 hour exposure to 14–15°C [57–59°F] per day was enough to significantly increase NST by 65% on average. A 6 week mild cold acclimation study (daily 2 hour cold exposure at 17°C [63°F]) also resulted in an increase in NST together with a concomitant decrease in body fat mass. The latter two studies also revealed significant increases in BAT [brown adipose tissue] presence and activation. All in all, cold-induced BAT activity is significant in adults and parallels NST. The actual quantitative contributions of BAT and of other tissues (e.g. skeletal muscle) to whole-body NST are, however, not elucidated and await further studies. Furthermore, more information is needed on the duration, timing and temperatures to find out which treatments are most effective with respect to increasing NST.
Furthermore, cold exposure over the course of 10 days increased insulin sensitivity in T2 diabetics by 43%. Eight study subjects, probably in the Netherlands, were exposed to temps of 14–15°C [57–59°F] but I don’t know for how many hours a day. Increased insulin sensitivity should help keep a lid on blood sugar levels and reduce the need for diabetes drugs.
In case you’re elderly, obese, or have type 2 diabetes, be aware that the activation of brown fat by cold exposure is not as robust as in others.
On the other hand, I found evidence that higher ambient temperatures (above 23°C) [73°F] may also help with weight management, regardless of what brown fat is doing. Science is hard.
Steve Parker, M.D.
PS: Check out my books for more ideas on weight management.
I haven’t read the entire article, so probably can’t answer any of your questions. When you read “android fat” below, think “belly fat,” which is linked to poor health outcomes compared to non-belly fat.
OBJECTIVE: Abdominal fat accumulation after menopause is associated with low-grade inflammation and increased risk of metabolic disorders. Effective long-term lifestyle treatment is therefore needed.
METHODS: Seventy healthy postmenopausal women (age 60 ± 5.6 years) with BMI 32.5 ± 5.5 were randomized to a Paleolithic-type diet (PD) or a prudent control diet (CD) for 24 months. Blood samples and fat biopsies were collected at baseline, 6 months, and 24 months to analyze inflammation-related parameters.
RESULTS: Android fat decreased significantly more in the PD group (P = 0.009) during the first 6 months with weight maintenance at 24 months in both groups. Long-term significant effects (P < 0.001) on adipose gene expression were found for toll-like receptor 4 (decreased at 24 months) and macrophage migration inhibitory factor (increased at 24 months) in both groups. Serum interleukin 6 (IL-6) and tumor necrosis factor α levels were decreased at 24 months in both groups (P < 0.001) with a significant diet-by-time interaction for serum IL-6 (P = 0.022). High-sensitivity C-reactive protein was decreased in the PD group at 24 months (P = 0.001).
CONCLUSIONS: A reduction of abdominal obesity in postmenopausal women is linked to specific changes in inflammation-related adipose gene expression.
The Joslin diabetes blog has an interesting article on brown fat and its effect on metabolic rate and insulin sensitivity. Brown fat is just a type of body type different from the more plentiful white fat (which is actually more pale yellow). If there are other colors of body fat, I don’t know.
If you can “activate” your brown fat, it helps you burn more calories, which could be helpful if you’re trying to lose weight. It also improves insulin sensitivity: beneficial if you have type 2 diabetes or are prone to it.
“When brown fat is fully activated, it can burn between 200 and 300 extra calories per day. It is most successfully activated through cold exposure. A recent study of people with type 2 diabetes had volunteers sit in a 50 degree room for a couple of hours a day for 10 days in shorts and short-sleeved shirts.
“When I say cold, it’s not icy cold, it’s not like the winter in Boston,” she says. “It’s more or less like the temperature we have here in autumn. After this mild cold exposure, all ten volunteers with type 2 diabetes, as shown in that study, displayed increased brown fat activity and improved insulin sensitivity. This is very exciting.”
Dr. Tseng is working on understanding exactly what is happening on a cellular level to activate brown fat in the cold to see if she can create a drug that will mimic the effects. “Although cold works, it’s just not pleasant,” she says. “If you had to sit in a cold room for a few hours every day, perhaps not everybody could accept that.”
Another way to activate brown fat is exercise (at least if you’re a man or a mouse).
Steve Parker, M.D.
By “beat the other diet,” I mean it in terms of weight loss. Over four weeks, the paleo dieters lost an extra 2 kg (4.4 lb) compared to the other group. Click the link at bottom for full text of the study. Here’s the abstract:
Background: The Paleolithic diet is popular in Australia, however, limited literature surrounds the dietary pattern. Our primary aim was to compare the Paleolithic diet with the Australian Guide to Healthy Eating (AGHE) in terms of anthropometric, metabolic and cardiovascular risk factors, with a secondary aim to examine the macro and micronutrient composition of both dietary patterns.
Methods: 39 healthy women (mean ± SD age 47 ± 13 years, BMI 27 ± 4 kg/m2) were randomised to either the Paleolithic (n = 22) or AGHE diet (n = 17) for four weeks. Three-day weighed food records, body composition and biochemistry data were collected pre and post intervention.
Results: Significantly greater weight loss occurred in the Paleolithic group (−1.99 kg, 95% CI −2.9, −1.0), p < 0.001). There were no differences in cardiovascular and metabolic markers between groups. The Paleolithic group had lower intakes of carbohydrate (−14.63% of energy (E), 95% CI −19.5, −9.7), sodium (−1055 mg/day, 95% CI −1593, −518), calcium (−292 mg/day 95% CI −486.0, −99.0) and iodine (−47.9 μg/day, 95% CI −79.2, −16.5) and higher intakes of fat (9.39% of E, 95% CI 3.7, 15.1) and β-carotene (6777 μg/day 95% CI 2144, 11410) (all p < 0.01).
Conclusions: The Paleolithic diet induced greater changes in body composition over the short-term intervention, however, larger studies are recommended to assess the impact of the Paleolithic vs. AGHE diets on metabolic and cardiovascular risk factors in healthy populations.
None of my patients has ever lost 650 lb (295 kg), but I’ve no doubt that skin that has been stretched out for decades doesn’t spring back into place.
NYT has an interesting article on it:
“It has been more than six years since Paul Mason, who once weighed 980 pounds and could not move from his bed, pulled himself back to life with gastric bypass surgery and his own strength of will. But he still carries his past with him.
On Wednesday, Mr. Mason, who is 55 and now lives in rural Athol, Mass., took another important step in a process that has been long and uneven, marked by small triumphs and unexpected setbacks. He had the second of two surgeries to eliminate the excess skin that enveloped his body like a shroud. Fifty pounds of it was removed from his abdomen last year; this time, about 10 pounds’ worth was excised from his arms and hip in a multihour operation in Manhattan.”
In 2011, Prof. Roy Taylor and colleagues found they could “reverse” type 2 diabetes with a very low-calorie diet. How low? 600–800 per day for eight weeks. His program—often called the Newcastle diet—has achieved some prominence in the United Kingdom but I don’t hear about it much over here across the pond. The clinical study in support of the program was very small—only 11 participants: 9 men and 2 women (with an average BMI of 33.6). I’m sure hundreds, if not thousands, have tried it since then.
I’m not endorsing or recommending the Newcastle diet at this time. I haven’t studied it in detail. It probably requires careful medical and dietitian supervision. Prof. Taylor says:
Our research subjects found the diet challenging to stick to. Motivated people were selected, and support from the team was given frequently. Support from the families of the research volunteers was very important in helping them comply with the diet. Hunger was not a particular problem after the first few days, but the complete change in social activities (not going to the pub, not joining in the family meals etc.) was a challenge over the eight weeks.
The purpose of this post is simply to collect a few informational links for my own records and for my readers who want to know more.
- Basic info about the plan from Prof. Taylor
- Information for physicians
- Seminal scientific report
- Prof. Taylor’s Banting Memorial Lecture on Reversing the Twin Cycles of Type 2 Diabetes
- My post on theoretical underpinnings of the Newcastle diet
- Professor Taylor recently found that T2 diabetes reversal can persist for six months if the initial weight loss can be maintained (abstract in Diabetes Care)
The original program utilizes Optifast liquid meals (600 calories/day) plus vegetables for another 200 calories. Prof. Taylor notes that products equivalent to Optifast may be more readily available and just as effective, but I don’t know what those are. Ensure? Carnation Instant Breakfast? Boost? Jevity?
Very low calorie diets like this are often referred to as starvation diets or crash diets. Starvation diets can cause weakness and easy fatigue, headaches, dizziness, hair loss, gallstones, electrolyte (blood mineral) disturbances, palpitations, nutritional deficiencies, skin problems, gout, kidney failure, or worse.
Even if successful, transitioning away from the eight-week Newcastle diet better be done carefully or the diabetes will return. Prevention of weight regain is harder than losing weight.
Overweight and obese women who habitually drank diet beverages lost more weight if they substituted water for the diet beverage. Over the course of 24 weeks on a reduced calorie diet, the water drinkers lost an extra 1.2 kg (2.6 lb) compared to those who continued their diet beverage habit.
Furthermore, the researchers found that the water drinkers had healthier values on insulin levels, HOMA-IR (a measure of insulin resistance), and after-meal blood sugar levels.
I wonder if the sweet taste of diet drinks triggers an insulin release that inhibits fat-burning.
This was a small study with only about 30 in each experimental group. Whether similar results would be seen in men is unknown to me.
In the past, I’ve advised dieters it’s OK to drink diet drinks in moderation while trying to weight. I may have to revise my recommendations. On the other hand, if diet drinks help keep you happy and on a successful weight-loss journey, they may be helpful. The diet beverage consumers still lost 7.6 kg (16.7 lb) compared with 8.8 kg (19.4 lb) in the abstainers. But diets don’t work, right?
PS: I haven’t read the full text of the article; just the abstract.
PPS: Steven Novella at Science-Based Medicine blog concludes that low energy sweeteners probably help with weight control.
It’s common on any weight-loss program to be cruising along losing weight as promised, then suddenly the weight loss stops although you’re still far from goal weight. This is the mysterious and infamous stall.
Once you know the cause for the stall, the way to break it becomes obvious. The most common reasons are:
- you’re not really following the full program any more; you’ve drifted off the path, often unconsciously
- instead of eating just until you’re full or satisfied on a very-low-carb diet, you’re stuffing yourself
- you need to start or intensify an exercise program
- you’ve developed an interfering medical problem such as adrenal insufficiency (rare) or an underactive thyroid; see your doctor
- you’re taking interfering medication such as a steroid; see your doctor
- your strength training program is building new muscle that masks ongoing loss of fat (not a problem!).
If you still can’t figure out what’s causing your stall, do a nutritional analysis of one weeks’ worth of eating, with a focus on daily digestible carbs (net carbs) and calorie totals. You can do this analysis online at places like FitDay or Calorie Count .
How Does That Help?
What you do with your data depends on whether you’re losing weight through portion control (usually reflecting calorie restriction) or carb counting. Most people lose weight with one of these two methods. (Exercise alone is hardly ever effective for significant amounts of body fat loss.)
If you’re a carb counter, you may find you’ve been sabotaged by “carb creep”: excessive dietary carbs have insidiously invaded you. You need to cut back. Even if you’re eating very-low-carb, it’s still possible to have excess body fat, even gain new fat, if you eat too many calories from protein and fat. It’s not easy, but it’s possible.
Those who have followed a calorie-restriction weight loss model for awhile may have become lax in their record-keeping. The stall is a result of simply eating too much. Call it “portion creep.” You need to re-commit to observing portion sizes.
“Doc, I’m Doing Everything You Say and It’s Still Not Working. Help!”
A final possible cause for a weight loss stall is that you just don’t need as many calories as you once did. Think about this. Someone who weighs 300 lb (136 kg) is eating perhaps 3300 calories a day just to maintain a steady weight. He goes on a calorie-restricted diet (2800/day) and loses a pound (0.4 kg) a week. Eventually he’s down to 210 lb (95.5 kg) but stalled, aiming for 180 lb (82 kg). The 210-lb body (95.5 kg) doesn’t need 3300 calories a day to keep it alive and steady-state; it only needs 2800 and that’s what it’s getting. To restart the weight loss process, he has to reduce calories further, say down to 2300/day. This is not the “slowed down metabolism” we see with starvation or very-low-calorie diets. It’s simply the result of getting rid of 90 pounds of fat (41 kg) that he no longer needs to feed.