Only 30 Grams of Protein Per Meal?

10 Jun

Only 30 Grams of Protein Per Meal?

Tim Skwiat, MEd, CSCS, Pn2

This is a really good—and important—question, and it’s one that we hear quite frequently, albeit it in a number of different ways. It can be best summed up like this: “I heard that you should only consume 30 grams of protein per meal, and anything beyond that is wasted. Is that true?”

When asked this question, prominent protein and amino acid researcher Dr. Donald Layman (Professor Emeritus in the Department of Food Science & Human Nutrition at the University of Illinois) said:

“It is one of my biggest pet peeves in the area.”1

 The short answer is: While there may be a limit on how quickly the body can absorb protein, this is presumption is not true, and there is really no evidence to indicate that 30 grams is the “magic number” that should be consumed per meal.

However, I wouldn’t be satisfied providing you a short answer—particularly without supporting evidence—and I hope that you wouldn’t be either.

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A good starting point for some background on this question and the benefits of a high-protein intake is understanding the difference between protein “need” and “optimization,” which you can learn about it the following article:

Why Is Optimizing Protein Intake So Important?

For starters, as is outlined in that article, there are a host of metabolic advantages associated with a higher protein intake.2 Higher protein diets have been shown to:

  • Accelerate fat loss and spare calorie-burning lean body mass when following a reduced-calorie diet.
  • Prevent weight regain and contribute to long-term weight maintenance.
  • Optimize 24-hour muscle protein synthesis and facilitate the maintenance or building of calorie-burning lean muscle mass.
  • Boost metabolic rate.
  • Preserve metabolic rate after weight loss.
  • Increase satiety and improve appetite control.
  • Improve carbohydrate metabolism and glycemic regulation.
  • Increase calcium absorption.

As described in the section Establishing the ‘New Normal,’ a high-protein diet would involve an intake upwards of 0.8 – 1 gram of protein per pound of body weight per day. Thus, you can see that body weight is one of the factors that may dictate how much protein is consumed per meal. With that in mind, a 200-pound man and a 150-pound women would have significantly daily protein needs. If the 30-gram rule were in play, then each would have to spread their protein intake out over the appropriate number of meals (i.e., 7 and 5, respectively). However, the available evidence—both scientific research and real-world experience—tells us that, when it comes to body composition, meal frequency doesn’t matter when other variables (e.g., food choices, portion sizes) are controlled.

In one randomized controlled crossover trial published in The American Journal of Clinical Nutrition, researchers compared the effects of reducing meal frequency on a variety of health indicators in healthy, normal-weight adults. The study involved two 8-week treatment periods, during which time the participants consumed all of the calories (and protein, which was about 80 grams per day) needed for maintenance in either 3 meals per day or 1 meal per day.3

At the end of the study, the researchers found no effect of meal frequency on heart rate, body temperature, or the majority of blood chemistry variables. What they did find, however, was that the reduced meal frequency (i.e., 1 meal per day) result in a significant improvement in body composition marked by reduced body fat and modestly increased lean body mass, which one might have expected to drop.

In another randomized controlled crossover trial published in The American Journal of Clinical Nutrition, researchers from the University of Amsterdam provided further evidence that reduced meal frequency (a form of intermittent fasting) has no negative effect on lean body mass even when consuming an entire day’s worth of protein (80 – 100 grams) in a single 4-hour period.4

In a study published in The American Journal of Clinical Nutrition, French researchers a single protein feeding was more effective (in terms of protein synthesis) than four balanced protein feedings among a group of healthy older women.6 In a separate study published in The Journal of Nutrition, the same French researchers found no difference (in protein synthesis or breakdown) when healthy young women were given 0.77 grams of protein per pound of body weight per day either in one feeding or spread across four feedings.

Please see the section of the article above titled Show Me the Data for a litany of studies demonstrating that high-protein diets accelerate weight and fat loss and spare lean body mass.

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The general consensus is that most folks will probably do best with 3 – 4 meals per day, spreading out their protein intake relatively evenly across those meals (rather than a “skewed” intake of protein). Please see the Balanced Bites section in the article cited above for more information.

As you’ll see in that section, researchers have made per-meal suggestions for protein intake based on maximizing muscle protein synthesis (MPS). In other words, a per-meal protein amount of about 0.18 grams of protein per pound of body weight optimally stimulates MPS and ingestion of protein beyond that amount does not appear to have any further impact on MPS.7,8 These findings have been similar among healthy young folks regardless of the type of food (i.e., protein supplements or whole food), whether at rest or after exercise, and regardless of fitness level.9–12

With that being said, a key finding to point out here is that the amount of protein needed to maximally stimulate MPS in healthy older men is substantially higher than the amount needed by healthy younger men. In other words, in addition to body weight, age also appears to be an important contributing factor when determining protein needs.

While larger amounts of protein can indeed be consumed and digested, they do not appear to further stimulate MPS, but they are oxidized at a higher rate, resulting in the production of urea.11,12 As Professor Layman has said on a number of occasions, “The notion that [protein] oxidation is bad I think is totally misleading.”1 As an adult, the body strives for balance/homeostasis, and increased protein oxidation concomitant with a higher intake is reflective of that (i.e., nitrogen balance). That being said, if we can swing the equation in favor of positive nitrogen balance while still consuming more protein, that may be worth discussing, which we will below.

Before moving on, one important thing to note is that these findings are based off acute protein-only feedings. In other words, it’s unknown how mixed meals may influence MPS.

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With these MPS findings in mind, it’s plausible that the notion that the body can only “use” 30 grams of protein per feeding may have been born. However, if you go back to the article cited above, you’ll see that there are myriad benefits and metabolic advantages to high-protein diets beyond stimulating MPS.

For instance, high-protein diets increase satiety and improve appetite control.13,14 High-protein meals boost satiety, which means that protein-dense foods are much more likely to make you feel full and satisfied.13 What’s more, diets rich in high-quality proteins improve appetite control and reduce cravings, as well as reduce daily food intake.15

All foods that you eat requires calories to be burned in order to digest, absorb, and assimilate their nutrients. This is referred to as the Thermic Effect of Feeding (TEF). There is a general consensus in the scientific literature that protein stimulates TEF to a greater extent than other macronutrients (e.g., carbohydrates, fat).16 In fact, protein-rich foods are estimated to boost metabolic rate by as much as 30%, whereas as fats and carbohydrates are typically estimated to be in the 5 – 10% range.13

In other words, protein-rich foods have the greatest TEF, boosting the metabolism THREE to SIX TIMES more than carbs or fats.

This means that you burn more calories each day when you consume a high-protein diet, and it also means that protein-rich foods provide less metabolizable energy (than carbs or fats).17 This latter point is important to note. Going back to the section above about MPS, this means that “extra” protein that is oxidized provides less energy (i.e., calories) than carbs or fats, and as a result, the calories from protein are less likely to be stored as fat.

This leads to another great question. If you’re not eating protein, what else will you eat?

Along these lines, Professor Steve Simpson formulated the protein leverage hypothesis, which essentially posits that protein can reduce the intake of other nutrients (e.g., carbs, fats) due to a homeostatic mechanism based around a protein “seeking” behavior.18 In other words, protein is the driving force for appetite, and our bodies are programmed to eat toward a protein target.

Professor Simpson describes, “Interestingly, if protein in the diet is diluted, even by a small amount by extra fat and carbohydrate, the appetite for protein dominates and they will keep eating in an attempt to attain their target level of protein.”

A number of randomized controlled trials have tested Professor Simpson’s protein leverage hypothesis, and they have found that lower protein intakes are associated with the consumption of more snacks between meals and greater daily caloric intake than higher-protein diets.19,20

Further, in a recent meta-analysis (a high-level statistical analysis of the current body of research) published in the journal Obesity Reviews, a research team from the University of Sydney (including Professor Simpson) found that the amount of protein in the diet was negatively associated with total daily caloric intake. In other words, higher protein diets were associated with lower caloric intake, and lower protein intakes were associated with higher caloric intake, thus strongly supporting the the protein leverage hypothesis in lean, overweight, and obese humans.

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One of the factors that may contribute to limiting how quickly the body can digest and absorb protein is saturation of the digestive enzymes responsible for the breakdown of protein (i.e., proteolytic enzymes). You see, the body has a limited number of digestive enzymes—which decline as a result of aging, environmental pollution, stress, processed foods, irradiated foods, not consuming enough raw foods, genetically modified food, and cooking methods—and that means the body can only digest protein at a certain rate.

Let’s take whey protein for example. Under normal circumstances, the maximum rate of absorption of whey protein is 8 – 10 grams per hour.21 Could the addition of proteolytic enzymes (i.e., enzymes that digest proteins) enhance the rate of absorption? That’s a great question, and it’s precisely one that researchers set out to answer in a recent study published in the Journal of the International Society of Sports Nutrition.22

In the study, on two separate occasions, a group of 41 healthy men drank a whey protein shake (containing 42.5 grams of protein)—first without any additional digestive enzymes, and then on a separate day, with the added proteolytic enzymes. The researchers measured the participants blood and urine at various points afterward (30 minutes, 1 hour, 2 hours, 3 hours, 3 ½ hours, and 4 hours) to assess the levels of amino acids (i.e., the building blocks of protein), which represents how much protein has been absorbed (in the blood) and the amount of nitrogen excreted (in the urine).

After drinking the whey protein shake by itself, the participants’ blood levels of amino acids (representing absorption) peaked after 4 hours, about 30% greater than baseline. After the participants drank the whey with added digestive enzymes, their levels of amino acids also peaked at 4 hours, however, in this case, they had increased by as much as 127% relative to baseline.

Over the course of the 4-hour time period, the addition of the protease enzymes led to a 3.5 TIMES greater increase in amino acid absorption.

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Remember that the researchers also measured the amount of nitrogen excreted in the urine as well. This measure is a rough approximation of whether our muscles are in a state of balance (i.e., nitrogen in equals nitrogen out), growth (i.e., positive nitrogen balance), or breakdown (i.e., negative nitrogen balance). The researchers found that when the participants consumed the whey with the addition of proteolytic enzymes, they excreted less nitrogen, indicating a positive nitrogen balance and a more favorable environment for recovery and muscle growth.

This research indicates that protease supplementation significantly increases the rate of absorption of whey protein in liquid form. Thus, the researchers speculate that the rate-limiting step in the digestion process may be saturation of the body’s endogenous proteolytic enzymes.

One of the reasons that I point this out is because BioTrust Low Carb (my personal protein supplement of choice and what I recommend to my clients) contains a patented, research-backed specialized blend of proteolytic enzymes called ProHydrolase®, which has been shown to substantially increase the rate of digestion of the proteins found in BioTrust Low Carb. Based on the findings from the study above, this increased rate of digestion likely means greater blood levels of amino acids (i.e., absorption) and less urinary nitrogen excretion (i.e., positive nitrogen balance).

[Another side benefit of ProHydrolase and enhanced protein digestion is the mitigation of GI discomfort (e.g., nausea, bloating, gas, cramping) associated with inadequate digestion of proteins.]

Researchers from Deerland Enzymes recently assessed the impact that ProHydrolase had on the breakdown of the proteins in BioTrust Low Carb, and the results were nothing short of amazing. Two samples of BioTrust Low Carb were tested for protein breakdown—one sample with ProHydrolase and one without. After just 15 minutes, 20% of the initial protein with ProHydrolase was already digested. After 60 minutes, 96% of the protein had been broken down with the addition of ProHydrolase. The protein samples without ProHydrolase showed little to no breakdown at all time points measured, which is consistent with the rate of digestion described in the study above.

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The section above indicates that the body has a certain capacity to digest proteins limited by the amount of endogenous proteolytic enzymes. So, you may be asking yourself whether supplementation with digestive enzymes may be a good idea with other protein-containing meals to maximize protein absorption and utilization. This is a very good question, and while we can’t say for certain, it does seem to be a plausible conclusion.

In general, orally administered digestive enzyme products containing proteases have very few side effects. Issues tend only to arise in cases of hypersensitivity (i.e., allergic reaction) to the source of the enzymes, which may be bovine-, porcine-, or plant-based (e.g., fungal, papaya, pineapple).23

As you already know, the body has a finite number of endogenous proteolytic enzymes for protein digestion. Further compounding that, there are a number of additional factors that can affect the body’s natural digestive enzyme production and supply, including (but not limited to) aging, environmental pollution, stress, processed foods, irradiated foods, not consuming enough raw foods, genetically modified food, and cooking methods.

The notion that we’re born with a finite number of enzymes during our lifetime, stems from research conducted by Dr. Edward Howell, a noted pioneer in the field of enzyme research, who coined the Enzyme Nutrition Axiom, which states:

“The length of life is inversely proportional to the rate of exhaustion of the enzyme potential of an organism. The increased use of food enzymes promotes a decreased rate of exhaustion of the enzyme potential. Another rule can be expressed as follows: Whole foods give good health; enzyme-rich foods provide limitless energy.”24

Thus, age is inversely correlated with enzyme production, as the organs responsible for producing digestive enzymes become less efficient. This is particularly interesting to note because evidence suggests that suggests that older folks tend to be less sensitive to a specific dose of protein. In other words, whereas 20 grams of protein may be sufficient to stimulate muscle protein synthesis in healthy, young folks, it may take significantly more protein (e.g., up to 40 grams) to elicit the same response in older folks.25 While there are likely to be a number of factors in play, some speculate that the body’s supply of proteolytic enzymes (or lack thereof) may play a contributing role.

Further, food choices also affect the body’s ability to produce digestive enzymes. Dr. Howell discusses this at length; in fact, he states, “The increased use of food enzymes [e.g., supplemental enzymes, raw foods] promotes a decreased rate of exhaustion of the enzyme potential.”

For instance, raw, whole foods provide food enzymes, which help promote their digestion. Cooking methods (e.g., heating) destroys food enzymes, and by the same token, processed foods are void of said food enzymes. Certain micronutrients (e.g., magnesium, zinc, iron) are also required for optimal enzyme function. Via dietary displacement, if someone is eating predominantly nutrient-sparse foods, that means s/he is also eating fewer nutrient-dense foods, which contribute these vital nutrients for enzyme production.

Another factor that may affect digestive enzyme supply is stress. Stress initiates the sympathetic branch of the nervous system—the “fight or flight” response—which works in direct opposition with the parasympathetic nervous system, also known as the “rest and digest” branch of the nervous system. The parasympathetic division stimulates digestion whereas the sympathetic branch typically inhibits it.

The digestive system is densely innervated by both branches of the nervous system, and the sympathetic nervous system exerts a predominantly inhibitory effect upon GI muscle and provides a tonic inhibitory influence over mucosal secretion.27 When the parasympathetic branch of the nervous system is activated, digestive enzymes are released; on the other hand, when the sympathetic nervous system is activated saliva production is reduced and many digestive system functions are slowed or stopped.

With all of this in mind, supplementation with a high-quality digestive enzyme product (containing ample proteases) may be a good idea for many folks who are looking to optimize protein absorption.

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Take-Home Points

  • There doesn’t appear to be a “magic number” for protein to which we need to limit ourselves on a per meal basis.
  • Factors that seem to be most important are body weight and age. Protein intake can be calculated on a daily (0.72 – 1g per pound of bodyweight), and it’s a good idea to spread this out over 3 – 4 meals (at least 0.18g per pound of body weight).
  • On a per meal basis, muscle protein synthesis (MPS) may be optimized at 0.18g of protein per pound of body weight.
  • However, are numerous metabolic advantages and benefits to consuming a high-protein diet beyond muscle protein synthesis, including improved satiety, increased metabolic rate, and positive dietary displacement (i.e., eating more protein-rich foods means eating less “other stuff”).
  • The body’s ability to digest protein may be limited by its endogenous production and supply of proteolytic enzymes. Choosing a protein supplement with a blend of proteolytic enzymes appears to be an effective solution to increasing protein absorption and augmenting nitrogen balance.
  • There are a number of factors that may impact the body’s supply of digestive enzymes, including age, stress, food choices, whether food is cooked or raw, and environment. Supplementation with digestive enzymes may be a safe, effective strategy to decrease the rate at body’s natural supply is exhausted as well as enhance protein digestion and absorption.

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References:

  1. Lennon D. Donald Layman, PhD – Leucine Kinetics, mTOR Activation & the Anabolic Response to Protein. http://sigmanutrition.com/episode123/.
  2. Pasiakos SM. Metabolic Advantages of Higher Protein Diets and Benefits of Dairy Foods on Weight Management, Glycemic Regulation, and Bone: Benefits of higher protein…. J Food Sci. 2015;80(S1):A2-A7. doi:10.1111/1750-3841.12804.
  3. Stote KS, Baer DJ, Spears K, et al. A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. Am J Clin Nutr. 2007;85(4):981-988.
  4. Soeters MR, Lammers NM, Dubbelhuis PF, et al. Intermittent fasting does not affect whole-body glucose, lipid, or protein metabolism. Am J Clin Nutr. 2009;90(5):1244-1251. doi:10.3945/ajcn.2008.27327.
  5. Jakobsen LH, Kondrup J, Zellner M, Tetens I, Roth E. Effect of a high protein meat diet on muscle and cognitive functions: a randomised controlled dietary intervention trial in healthy men. Clin Nutr Edinb Scotl. 2011;30(3):303-311. doi:10.1016/j.clnu.2010.12.010.
  6. Arnal MA, Mosoni L, Boirie Y, et al. Protein pulse feeding improves protein retention in elderly women. Am J Clin Nutr. 1999;69(6):1202-1208.
  7. Moore DR, Churchward-Venne TA, Witard O, et al. Protein Ingestion to Stimulate Myofibrillar Protein Synthesis Requires Greater Relative Protein Intakes in Healthy Older Versus Younger Men. J Gerontol A Biol Sci Med Sci. 2015;70(1):57-62. doi:10.1093/gerona/glu103.
  8. Morton RW, McGlory C, Phillips SM. Nutritional interventions to augment resistance training-induced skeletal muscle hypertrophy. Front Physiol. 2015;6. doi:10.3389/fphys.2015.00245.
  9. Cuthbertson D, Smith K, Babraj J, et al. Anabolic signaling deficits underlie amino acid resistance of wasting, aging muscle. FASEB J Off Publ Fed Am Soc Exp Biol. 2005;19(3):422-424. doi:10.1096/fj.04-2640fje.
  10. Symons TB, Sheffield-Moore M, Wolfe RR, Paddon-Jones D. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc. 2009;109(9):1582-1586. doi:10.1016/j.jada.2009.06.369.
  11. Moore DR, Robinson MJ, Fry JL, et al. Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Am J Clin Nutr. 2009;89(1):161-168. doi:10.3945/ajcn.2008.26401.
  12. Witard OC, Jackman SR, Breen L, Smith K, Selby A, Tipton KD. Myofibrillar muscle protein synthesis rates subsequent to a meal in response to increasing doses of whey protein at rest and after resistance exercise. Am J Clin Nutr. 2014;99(1):86-95. doi:10.3945/ajcn.112.055517.
  13. Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr. 2004;23(5):373-385.
  14. Westerterp-Plantenga MS, Nieuwenhuizen A, Tomé D, Soenen S, Westerterp KR. Dietary Protein, Weight Loss, and Weight Maintenance. Annu Rev Nutr. 2009;29(1):21-41. doi:10.1146/annurev-nutr-080508-141056.
  15. Leidy HJ. Increased dietary protein as a dietary strategy to prevent and/or treat obesity. Mo Med. 2014;111(1):54-58.
  16. Westerterp KR. Diet induced thermogenesis. Nutr Metab. 2004;1(1):5. doi:10.1186/1743-7075-1-5.
  17. Boirie Y, Dangin M, Gachon P, Vasson MP, Maubois JL, Beaufrère B. Slow and fast dietary proteins differently modulate postprandial protein accretion. Proc Natl Acad Sci U S A. 1997;94(26):14930-14935.
  18. Simpson SJ, Raubenheimer D. Obesity: the protein leverage hypothesis. Obes Rev Off J Int Assoc Study Obes. 2005;6(2):133-142. doi:10.1111/j.1467-789X.2005.00178.x.
  19. Gosby AK, Conigrave AD, Lau NS, et al. Testing Protein Leverage in Lean Humans: A Randomised Controlled Experimental Study. Morrison C, ed. PLoS ONE. 2011;6(10):e25929. doi:10.1371/journal.pone.0025929.
  20. Martens EA, Lemmens SG, Westerterp-Plantenga MS. Protein leverage affects energy intake of high-protein diets in humans. Am J Clin Nutr. 2013;97(1):86-93. doi:10.3945/ajcn.112.046540.
  21. Bilsborough S, Mann N. A review of issues of dietary protein intake in humans. Int J Sport Nutr Exerc Metab. 2006;16(2):129-152.
  22. Oben J, Kothari SC, Anderson ML. An open label study to determine the effects of an oral proteolytic enzyme system on whey protein concentrate metabolism in healthy males. J Int Soc Sports Nutr. 2008;5(1):10. doi:10.1186/1550-2783-5-10.
  23. Lorkowski G. Gastrointestinal absorption and biological activities of serine and cysteine proteases of animal and plant origin: review on absorption of serine and cysteine proteases. Int J Physiol Pathophysiol Pharmacol. 2012;4(1):10-27.
  24. Howell E. Enzyme Nutrition. Penguin Group US; 1995. http://lib.myilibrary.com?id=717976. Accessed April 20, 2016.
  25. Breen L, Phillips SM. Nutrient interaction for optimal protein anabolism in resistance exercise: Curr Opin Clin Nutr Metab Care. 2012;15(3):226-232. doi:10.1097/MCO.0b013e3283516850.
  26. Browning KN, Travagli RA. Central nervous system control of gastrointestinal motility and secretion and modulation of gastrointestinal functions. Compr Physiol. 2014;4(4):1339-1368. doi:10.1002/cphy.c130055.

 

Why Is Optimizing Protein Intake So Important?

23 May

Why Is Optimizing Protein Intake So Important?

By Tim Skwiat, MEd, CSCS, Pn2

When it comes to improving overall health, performance, body composition, appetite control, and satiety, there is arguably not a single more effective, well-established dietary factor than optimizing one’s protein intake. Research has shown that consuming diets higher in protein are not only safe for otherwise healthy individuals, they may provide a host of benefits. Higher protein diets may:

  • Accelerate fat loss and spare lean body mass while following a reduced-calorie diet.
  • Attenuate weight regain and contribute to long-term weight maintenance.
  • Optimize 24-hour muscle protein synthesis and facilitate the maintenance or building of muscle mass.
  • Boost metabolic rate.
  • Preserve metabolic rate after weight loss.
  • Increase satiety and improve appetite control.
  • Improve carbohydrate metabolism and glycemic regulation.
  • Increase calcium absorption.

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Establishing the ‘New Normal’

While the Institute of Medicine (IOM) has established a recommended dietary allowance (RDA) of protein intake at 0.8 grams of protein per kilogram of body weight per day (or, about 0.36 grams of protein per pound of body weight), research illustrates quite clearly and convincingly that an increase in dietary protein intake to at least TWICE (i.e., ≥ 1.6g/kg or 0.72 g/lb) that of the IOM recommendations may be “metabolically advantageous,” particularly for individuals looking to improve body composition (e.g., lose fat) as well as older adults (who are likely to lose muscle mass as they age) and physically active folks (e.g., athletes, military personnel, recreational exercisers).1

The International Society of Sports Nutrition’s (ISSN) Position Stand on Protein states that “protein intakes of 1.4–2.0 g/kg/day [0.63 – 0.91 grams of protein per pound] for physically active individuals is not only safe, but may improve the training adaptations to exercise training.” Further, the ISSN states, “While it is possible for physically active individuals to obtain their daily protein requirements through a varied, regular diet, supplemental protein in various forms are a practical way of ensuring adequate and quality protein intake for athletes.”2 Further, the American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada support higher protein intakes in this range to optimize body composition and performance.3

According to a study published in the Proceedings of the Nutrition Society, renowned protein researcher Dr. Kevin Tipton from the University of Sterling suggests that a high-protein diet may be defined by as much as 35% of total daily caloric intake.4 What’s more, in a breakthrough study published in the journal Applied Physiology, Nutrition, and Metabolism, researchers revealed the RDA (Recommended Dietary Allowance) for protein has underestimated protein requirements by as much as 30 – 50%. Using a novel, validated scientific method, researchers have established that folks should be consuming as much as 35% of their total daily caloric intake from protein. Along these lines, researchers posit that one can optimize protein intake by eating 1.5 – 2.2 grams of high-quality protein per pound of body weight per day.5

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Show Me the Data

High-protein diets have been shown to accelerate fat loss and spare lean body mass while following a reduced-calorie diet. In one study published in the Journal of Nutrition, researchers from the University of Illinois found that women consuming 0.72 grams of protein per pound of bodyweight (about 125 grams per day or 30% of their total daily caloric intake) for 10 weeks had a 66% better ratio of fat to lean body mass loss compared to the “normal” protein group (who consumed half the amount of protein). This means the high-protein group lost MORE fat and LESS muscle—despite consuming the EXACT same amount of calories.6

Interestingly, when the same group of researchers, led by Dr. Donald Layman, combined exercise (5 days of walking plus 2 days of strength training), the effects of the high-protein diet were amplified. Over the course of 16 weeks, the folks combining a high-protein diet (about 30% of calories per day) with exercise lost 43% more fat than the “normal” protein group, who consumed the same number of calories and followed the same exercise program. Even more, compared to the normal protein group that dieted without exercise, the high-protein plus exercise group lost 75% more fat over the course of the 4-month study.7

In a recent randomized control trial published in The American Journal of Clinical Nutrition, researchers from McMaster University found that men combining a reduced-calorie high-protein diet (about 1 gram per pound of body weight per day) with a strenuous exercise program lost over 10 pounds of fat in 4 weeks—37% more than the low-protein group eating the same number of calories and performing the same exercise routine. What’s more, the high-protein group gained over 2.5 pounds of muscle­—despite heavy calorie restriction—while the low-protein group experienced no change. That’s the holy grail of body composition: Fat loss PLUS muscle gain!8

In a recent randomized control trial, a group of researchers from UCLA, led by Dr. Lorraine Evangelista, found that study participants consuming a high-protein diet for 12 weeks lost 77% more weight and dropped more than TWICE as much body fat than the standard protein group.9 In another recent randomized control trial, a group of German researchers, led by Dr. Marion Flechtner-Mors, found that folks consuming a high-protein diet for 12 months lost over TWICE as much weight as the standard-protein group.10

In yet another randomized control trial conducted at the University of Navarra in Pampalona, Spain, a research team led by Dr. Idoia Labayen found that obese women consuming a high-protein diet (about 30% of daily caloric intake) for 10 weeks lost nearly 10 MORE pounds (or, 92% more weight) and 88% more fat than the standard-protein group—once again, despite both groups eating the exact same number of calories.11

In another recent study, researchers from the University of California-Davis, led by Dr. Sidika Karakas, found that overweight women consuming a high-protein diet lost THREE times more weight and over SIX times more fat than the standard-protein group despite sticking to the same amount of reduced calories.12

One of the most objective analyses of the effects of an intervention (like high-protein diets) is something called a meta-analysis, in which researchers gather all of the studies on a particular topic and perform a highly sophisticated statistical analysis. Along these lines, in a meta-analysis of 24 weight-loss studies published in the American Journal of Clinical Nutrition, researchers from the University of South Australia found that high-protein diets led to significantly greater losses in body weight and body fat and spared losses in lean body mass and reductions in metabolic rate, which are common with standard-protein, reduced-calorie diets.13

The study authors concluded that, compared to standard-protein diets, high-protein diets (between 25 – 35% of total daily caloric intake) provide benefits for weight and fat loss and for mitigating losses in lean body mass and resting metabolic rate.

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No One-Trick Pony

What’s more, high-protein diets help attenuate weight regain and contribute to long-term weight maintenance. That’s right, not only have high-protein diets been shown to lead to greater fat loss and improvements in body composition during dieting trials, researchers have also found that high-protein diets increase compliance and long-term weight management.14 In a study published in the New England Journal of Medicine, researchers found that after dropping over 20 pounds during an 8-week weight loss trial, folks consuming a higher protein diet (25% of daily caloric intake) maintained body weight over the next 12 months whereas individuals consuming a standard-protein diet regained some of the weight lost.15

As mentioned above, high-protein diets also help preserve metabolic rate after weight loss.16 A common concern and consequence of standard-protein, reduced-calorie diets is a significant decline in metabolic rate, which frequently leads to weight regain. However, studies have shown that high-protein diets may conserve metabolic rate, and therefore, prevent weight regain. In one study published in the Journal of the American Medical Association, researchers found that metabolic rate was conserved to a significantly greater extent in folks who consumed a higher protein diet (30% of total calories) compared to individuals who consumed a lower protein diet (20% of total calories).17

One way by which high-protein diets may improve weight-loss outcomes is through increased satiety and improved appetite control. High-protein meals boost satiety, which means that protein-dense foods are much more likely to make you feel full and satisfied.18 What’s more, diets rich in high-quality proteins improve appetite control, as well as reduce daily food intake.19 In a recent study published in the Nutrition Journal, researchers from the University of Missouri found that consuming higher protein, dairy-based snacks (e.g., yogurt) improved satiety, appetite control, and limited subsequent food intake when compared to higher fat and higher carbohydrate-based snacks.20

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Balanced Bites

Many people tend to follow a skewed pattern of protein intake throughout the day. In other words, they might have a carbohydrate-dense breakfast (e.g., oatmeal, cereal, bagel) that contains just a few grams of protein, and at lunch, they may have a salad, sandwich, and/or soup that contain less than 20 grams of protein. Then, at dinner, they tend to have a large meal with their largest portion of protein for the day.

In fact, many people consume as much as 50% of their daily protein intake at a single meal in the evening.21 Contrary to this common pattern (referred to as a “skewed” intake of protein), research shows us that a “balanced” intake of protein throughout the day appears to be optimal to take advantage of the many beneficial attributes of protein.

For instance, in a study published in The Journal of Nutrition, researchers found that balancing protein intake over the course of three meals (about 30 grams of protein per meal) significantly increased muscle protein synthesis (by 25%) when compared to a “skewed” protein intake typical of the American diet.22

Why is this so important? Maximizing protein synthesis is paramount to looking, feeling, and performing your best regardless of your age or goals, and it’s especially important for improving body composition, optimizing metabolism, improving carbohydrate tolerance, avoiding age-related declines in muscle mass and metabolic rate, improving performance, and optimizing physical function.

In a separate study published in the American Journal of Physiology, researchers from McMaster University discovered equally impressive findings when they compared a balanced to a skewed protein intake combined with calorie restriction (i.e., dieting). In general, dieting results in a marked decrease in muscle protein synthesis, which typically leads to muscle loss. In fact, losses in lean mass may account for as much as 25% of the weight lost.23,24

The researchers found that a skewed protein intake combined with calorie restriction led to significantly greater reductions in muscle protein synthesis. In other words, a balanced protein intake “rescued” much of the normal decline seen in protein synthesis with dieting. Even more, they found that combining resistance training with a balanced protein intake completely rescued the decline in protein synthesis seen with energy restriction and skewed protein intake.25

As far as how much protein to eat, the research suggests at least 30 grams per meal (3 – 4 meals per day) as a starting point. More specifically, researchers suggest that about 0.18 grams per pound of bodyweight per meal seems to be optimal.26

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Take-Home Points

  • Optimizing protein intake is a well-established nutrition priority for looking, feeling, and performing your best.
  • Studies show that higher protein intakes accelerate fat loss, preserve lean body mass, promote recovery and performance, increase satiety, improve appetite control, reduce cravings, improve glycemic control, preserve metabolic rate, and attenuate weight regain.
  • The evidence suggests that an optimal protein intake may be between 0.7 – 0.9 grams of protein per pound of bodyweight per day as a starting point.
  • Research also suggests that a balanced intake of protein (versus a skewed intake) throughout the day may be optimal to maximize muscle protein synthesis. Based on the current body of research, an intake of around 0.18 grams of protein per pound of bodyweight per meal may be a good starting point.
  • Combining resistance training with an optimal protein intake appears to be superior (for body composition, health, performance) than a higher protein intake alone.
  • High-quality sources of protein are likely best and include: lean meats, poultry, fish/seafood, and wild game (preferably pasture-raised, wild, organic, etc., when appropriate); eggs (preferably pasture-raised); dairy (e.g., Greek yogurt, cottage cheese; preferably organic); protein supplements. [Note: Many protein studies use milk-based protein supplements (e.g., whey, casein), which are considered superior due to their protein quality (e.g., leucine content) and are often used to establish key baselines.]

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References:

  1. Pasiakos SM. Metabolic Advantages of Higher Protein Diets and Benefits of Dairy Foods on Weight Management, Glycemic Regulation, and Bone: Benefits of higher protein…. J Food Sci. 2015;80(S1):A2-A7. doi:10.1111/1750-3841.12804.
  2. Campbell B, Kreider RB, Ziegenfuss T, et al. International Society of Sports Nutrition position stand: protein and exercise. J Int Soc Sports Nutr. 2007;4(1):8. doi:10.1186/1550-2783-4-8.
  3. Rodriguez NR. Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. J Am Diet Assoc. 2009;109(3):509-527. doi:10.1016/j.jada.2009.01.005.
  4. Tipton KD. Efficacy and consequences of very-high-protein diets for athletes and exercisers. Proc Nutr Soc. 2011;70(02):205-214. doi:10.1017/S0029665111000024.
  5. Pencharz PB, Elango R, Wolfe RR. Recent developments in understanding protein needs – How much and what kind should we eat? Appl Physiol Nutr Metab. April 2016:1-4. doi:10.1139/apnm-2015-0549.
  6. Layman DK, Boileau RA, Erickson DJ, et al. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. J Nutr. 2003;133(2):411-417.
  7. Layman DK, Evans E, Baum JI, Seyler J, Erickson DJ, Boileau RA. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. J Nutr. 2005;135(8):1903-1910.
  8. Longland TM, Oikawa SY, Mitchell CJ, Devries MC, Phillips SM. Higher compared with lower dietary protein during an energy deficit combined with intense exercise promotes greater lean mass gain and fat mass loss: a randomized trial. Am J Clin Nutr. 2016;103(3):738-746. doi:10.3945/ajcn.115.119339.
  9. Evangelista LS, Heber D, Li Z, Bowerman S, Hamilton MA, Fonarow GC. Reduced body weight and adiposity with a high-protein diet improves functional status, lipid profiles, glycemic control, and quality of life in patients with heart failure: a feasibility study. J Cardiovasc Nurs. 2009;24(3):207-215. doi:10.1097/JCN.0b013e31819846b9.
  10. Flechtner-Mors M, Boehm BO, Wittmann R, Thoma U, Ditschuneit HH. Enhanced weight loss with protein-enriched meal replacements in subjects with the metabolic syndrome. Diabetes Metab Res Rev. 2010;26(5):393-405. doi:10.1002/dmrr.1097.
  11. Labayen I, Díez N, González A, Parra D, Martínez JA. Effects of protein vs. carbohydrate-rich diets on fuel utilisation in obese women during weight loss. Forum Nutr. 2003;56:168-170.
  12. Kasim-Karakas SE, Almario RU, Cunningham W. Effects of protein versus simple sugar intake on weight loss in polycystic ovary syndrome (according to the National Institutes of Health criteria). Fertil Steril. 2009;92(1):262-270. doi:10.1016/j.fertnstert.2008.05.065.
  13. Wycherley TP, Moran LJ, Clifton PM, Noakes M, Brinkworth GD. Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2012;96(6):1281-1298. doi:10.3945/ajcn.112.044321.
  14. Layman DK, Evans EM, Erickson D, et al. A Moderate-Protein Diet Produces Sustained Weight Loss and Long-Term Changes in Body Composition and Blood Lipids in Obese Adults. J Nutr. 2009;139(3):514-521. doi:10.3945/jn.108.099440.
  15. Larsen TM, Dalskov S-M, van Baak M, et al. Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance. N Engl J Med. 2010;363(22):2102-2113. doi:10.1056/NEJMoa1007137.
  16. Soenen S, Martens EAP, Hochstenbach-Waelen A, Lemmens SGT, Westerterp-Plantenga MS. Normal protein intake is required for body weight loss and weight maintenance, and elevated protein intake for additional preservation of resting energy expenditure and fat free mass. J Nutr. 2013;143(5):591-596. doi:10.3945/jn.112.167593.
  17. Ebbeling CB, Swain JF, Feldman HA, et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA. 2012;307(24):2627-2634. doi:10.1001/jama.2012.6607.
  18. Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr. 2004;23(5):373-385.
  19. Leidy HJ. Increased dietary protein as a dietary strategy to prevent and/or treat obesity. Mo Med. 2014;111(1):54-58.
  20. Ortinau LC, Hoertel HA, Douglas SM, Leidy HJ. Effects of high-protein vs. high- fat snacks on appetite control, satiety, and eating initiation in healthy women. Nutr J. 2014;13:97. doi:10.1186/1475-2891-13-97.
  21. USDA Agricultural Research Service. Energy Intakes: Percentages of Energy from Protein, Carbohydrate, Fat, and Alcohol, by Gender and Age, What We Eat in America, NHANES 2009–2010.; 2012. http://www.ars.usda.gov/Services/docs.htm?docid=18349.
  22. Mamerow MM, Mettler JA, English KL, et al. Dietary Protein Distribution Positively Influences 24-h Muscle Protein Synthesis in Healthy Adults. J Nutr. 2014;144(6):876-880. doi:10.3945/jn.113.185280.
  23. Weinheimer EM, Sands LP, Campbell WW. A systematic review of the separate and combined effects of energy restriction and exercise on fat-free mass in middle-aged and older adults: implications for sarcopenic obesity. Nutr Rev. 2010;68(7):375-388. doi:10.1111/j.1753-4887.2010.00298.x.
  24. Areta JL, Burke LM, Camera DM, et al. Reduced resting skeletal muscle protein synthesis is rescued by resistance exercise and protein ingestion following short-term energy deficit. AJP Endocrinol Metab. 2014;306(8):E989-E997. doi:10.1152/ajpendo.00590.2013.
  25. Murphy CH, Churchward-Venne TA, Mitchell CJ, et al. Hypoenergetic diet-induced reductions in myofibrillar protein synthesis are restored with resistance training and balanced daily protein ingestion in older men. Am J Physiol – Endocrinol Metab. 2015;308(9):E734-E743. doi:10.1152/ajpendo.00550.2014.
  26. Moore DR, Churchward-Venne TA, Witard O, et al. Protein Ingestion to Stimulate Myofibrillar Protein Synthesis Requires Greater Relative Protein Intakes in Healthy Older Versus Younger Men. J Gerontol A Biol Sci Med Sci. 2015;70(1):57-62. doi:10.1093/gerona/glu103.

 

Detox Diets and Cleanses: Health Boost or Recipe for Disaster?

4 Jan

Detox Diets and Cleanses: Health Boost or Recipe for Disaster?

By Tim Skwiat, MEd, CSCS, Pn2

There’s no doubt about it, the promises of detox diets and cleanses are alluring:

  • “Jump start your weight loss”…
  • ”Eliminate impurities”…
  • ”Drop 21 pounds in 10 days”…
  • ”Expel toxins”…
  • ”Revitalize and re-energize your body”…
  • ”Whisk away polluting nasties”…
  • ”Fast, easy weight loss”…
  • ”Purify the body”…
  • “Lose weight like the celebrities”…
  • ”Flush away toxins”

But do these plans work? Can they provide the health boosts they guarantee? Are they the perfect recipe that the proponents would like you to believe? Or, are they a recipe for disaster and self-sabotage, contributing to a vicious cycle and reinforcing poor eating habits and relationships with food?

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One of the most challenging aspects of assessing the various detox diets and cleanses, which are typically characterized by severe food and energy (i.e., calorie) restriction, is that you’d be hard-pressed to find a specific scientific definition of either, which are typically interchangeable terms.

In the Detox Dossier, an investigation by the Voice of Young Science (VoYS) into 15 different products and special diets that are widely promoted as detoxes, a group of researchers found that no two companies use the same definition for “detox.”1,2 Not only that, the VoYS found that no program or company could name the supposed “toxins” targeted by its detox, and the proponents provided little—and in most cases, no—evidence to back up detox claims.

The VoYS concluded, “No one we contacted was able to provide any evidence for their claims, or give a comprehensive definition of what they meant by ‘detox.’ We concluded that ‘detox’ as used in product marketing is a myth. Many of the claims about how the body works were wrong and some were even dangerous.”

In other words, there’s virtually no agreement on what a detox diet is, and what’s more, not even the creators of these detox diets can verify what toxins they aid in eliminating nor provide any evidence that they actually “work.”

Along those lines, while the detox industry promotes “purification,” “cleansing,” and “elimination,” it’s incredibly important to point that the human body has evolved highly sophisticated mechanisms for eliminating toxins. The liver, kidneys, gastrointestinal system, skin, and lungs all play a role in the excretion of unwanted substances, without chemical intervention. For example, the liver and kidneys both serve as exceptionally effective “detox” organs, converting toxic chemicals into less harmful ones and promoting the excretion of unwanted chemicals.

In its Debunking Detox Leaflet, the VoYS echoes the above: “Your body is capable of removing most potentially harmful chemicals you will encounter in your daily life. The human body has evolved to get rid of unnecessary substances through your liver, kidneys, and colon. It isn’t possible to improve their function without medical assistance.”3

The VoYS is not the only group of health professionals that’s out to set the record straight on the topic of detox diets. The Dietitians Association of Australia have also heavily criticized several popular detoxes, which can result in the loss of healthy gut bacteria and electrolytes.4

Dietitian Melanie McGrice says, “The problem with fad diets is that they’re all about restrictive eating patterns that you can’t stick to over the long haul and may even undermine your health. What you lose on these detox diets is usually fluid, healthy gut bacteria, electrolytes—all the things to keep your body healthy—rather than fat. And you don’t need to go on a severe detox because your body has an inbuilt detox system: the lungs, liver, and kidneys working every minute of the day.”

In a study published in the Journal of Human Nutrition and Dietetics, researchers Professor Hosen Kiat, Head of Cardiology at Macquarie University Hospital and the Australian School of Advanced Medicine, and Dr. Alice Klein from the Cardiac Health Institute conducted a thorough review of the currently available research to assess whether there was any clinical evidence to support the use of detox diets for weight management or toxin elimination. They concluded, “Although the detox industry is booming, there is very little clinical evidence to support the use of these diets. To the best of our knowledge, no randomized controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans.”5

The researchers also identified a number of concerns and potential health risks. For instance, detox diets typically involve severe calorie restriction and nutritional inadequacy. Professor Kiat said, “In assessing one detox diet we found that, based on the average person’s minimum daily energy requirement, it does not meet daily protein requirements for anyone who weighs more than 23 kg [i.e., 50 pounds].”

The take-home point is that there’s no medical evidence indicating that specialized detoxification programs are needed to rid the body of toxins. With that being said, just because the body is equipped with the machinery it needs to “cleanse” and “detoxify” itself and to do so remarkably well, that does not mean that exposure to pollutants, pesticides, food additives, etc., is not a big deal. That point should not be lost; however, it is to say that these approaches do not appear to be effective solutions or quick fixes in that regard.

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As mentioned above, another reason that folks turn to these drastic approaches is to promote weight management. As Professor Kiat and Dr. Klein’s extensive review demonstrated, there’s very little clinical evidence to support this.5 But there’s much more to the story to consider.

While these popular diets help control energy balance, detox diets typically involve severe energy restriction and nutritional inadequacy, which can lead to protein and vitamin deficiencies, electrolyte imbalances, lactic acidosis, as well as decrements in performance (mental and physical), hormonal imbalances, hair loss, and much, much worse. (Yes, even death.)

Even more, this type of approach lends itself to weight cycling, which may be more commonly recognized as “yo-yo dieting.” Numerous studies have provided evidence that weight cycling increases one’s risk of insulin resistance, type 2 diabetes, and cardiovascular disease.6–8 While very-low-calorie diets (VLCD) like these may lead to significant short-term weight loss, VLCDs do not lead to greater long-term weight loss compared to more moderate reduced-calorie diets.9

For those folks who find themselves resorting to this vicious cycle, it’s important to mention that long-term calorie restriction has been shown to lead to significant reductions in metabolic rate that rival that of life-threatening malnutrition and starvation.10 In other words, chronic dieters—who are often the type to gravitate toward extreme approaches such as detox diets and cleanses—are at risk of a drastically reduced metabolic rate that significantly exceeds what would be predicted by age, sex, and body composition.

It’s also noteworthy to point out that a significant percentage of the short-term weight loss associated with VLCDs is fat-free mass (e.g., muscle mass, glycogen, body water), not body fat. This disproportionate loss in fat-free mass (FFM) is one contributor to a decreased metabolic rate, as FFM comprises the metabolically active tissues of the body, and may also predispose one to weight regain.11,12

When talking about extreme energy restriction, such as the case with the majority of these programs, it’s also important to discuss metabolic adaptation (i.e., adaptive thermogenesis), which refers to the decrease in energy expenditure beyond what can be explained by a loss in FFM.13 In the face of dangerously low energy supplies and stores, this form of energy conservation, which is characterized by reductions in key hormones (e.g., leptin, thyroid hormone, insulin, catecholamines), is a biologically meaningful survival mechanism.10,14,15

However, most people who engage in these restrictive diets generally aren’t trying to get themselves ready for some sort of apocalypse involving a food shortage. Rather, they tend to be using them as a vehicle to optimize body composition, health, and/or performance, and considering that studies show that metabolic adaptation is proportionate to the degree of energy imbalance, this shouldn’t be viewed favorably. Not only are intense energy-restrictive diets tough to maintain, they trigger the body to suppress its resting metabolic rate (RMR) by as much as 20%.9,16

Another fundamental concept to consider is that a crucial component of effective weight management plans and an overall healthy lifestyle is regular physical activity. Rarely do detox diets or cleanses promote exercise, and considering that many of these programs severely restrict caloric intake, not enough calories are being consumed to fuel physical activity. This is important for a number of reasons, one of which is that adding exercise to a weight loss program tends to help spare FFM.17–19

A key objective during weight loss is to reduce body fat while minimizing loss of FFM to promote optimal overall health, metabolic function, cardiovascular health, and physical functioning. This is why an emphasis should be placed on fat loss as opposed to weight loss.

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Some might consider highly-restrictive plans like these (i.e., detox diets, cleanses) as “quick fixes,” but truth be told, they’re not really fixing anything. In fact, as outlined above, they’re quite possibly making things worse. With reductions in RMR (via reduced FFM and adaptive thermogenesis), one is putting him/herself at a greater predisposition for weight regain.

This is particularly true because these plans do little to teach folks how to eat or help them overcome individual limiting factors (e.g., creating a healthy food environment, preparing healthy food choices, cultivating a healthy relationship with food). Not only that, programs like these that heavily restrict both calories and specific foods and food groups make folks more prone to oversconsumption of high-calorie, highly palatable foods via metabolic adaptation and through the activation of hedonic pathways.20 Severe restriction increases appetite (via “hunger hormones”), as well as the activity of hunger and food reward centers. That’s right, “junk food” becomes even tastier, and an even greater amount of it is craved by the body to satisfy its “needs.”

It’s indeed plausible that one could feel better during a detox diet or cleanse. With that in mind, it’s important to point out where some of these plans may go “right.” This most likely is a result of dietary displacement, which simply means replacing less-healthy options with healthier ones. On one hand, if the detox increases one’s consumption of vegetables and fruits, then s/he is going to be bringing in copious amounts of micronutrients, fiber, and phytonutrients, all of which can have a beneficial effect on healthy, body composition, metabolism, feelings of wellbeing, and energy levels.

Conversely, dietary displacement also takes into account you are not eating when following one of these detox diets. If one’s diet resembles anything like that of the typical Western diet, then these types of programs will substantially reduce the overconsumption of energy and processed foods, and that means reductions in calorie intake, sugar, refined grains, and added fats and oils (i.e., industrial vegetable oils).

Research shows that the typical Western diet leads to increased incidence of obesity, metabolic syndrome, oxidative stress, chronic inflammation, cognitive dysfunction, and various chronic diseases and forms of cancer.21–24 Simply by process of elimination, one may look and feel better. That’s not to say that a detox diet is a “good” plan; rather, this highlights how poor typical eating behaviors truly are.

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Rather than resorting to an extremist approach that does nothing to promote good nutrition behaviors, teach you how to eat, encourage a healthy relationship with food, or promote a healthy food environment, focus on making changes that support long-term healthy habits. Not only do you not have to suffer and deprive yourself through dramatic restriction, you can enjoy great-tasting whole foods and fully support your health and body composition goals.

In the grand scheme of things, your health, fitness, performance, and body composition are contingent on your entire body of “nutrition work”—not an individual food or special diet. In other words, there’s no “magic bullet.” Instead of viewing foods in isolation as “good” or “bad” or thinking you need to “go on a diet,” think about weight management and “deep health” as the product of practicing healthy eating habits, creating a positive food environment, and choosing high-quality, nutritious foods in appropriate amounts relative to your goals and activity levels regularly and consistently over time. Good nutrition takes practice, and just like getting better and mastering anything in life, it’s about progress—not perfection.

Start where you are and make small changes that you are ready, willing, and able to take on; focus on mastering those new behaviors, one step at a time.

Helpful next steps:

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References:

  1. Voice of Young Scientists. THE DETOX DOSSIER. Sense About Science; 2009. http://www.senseaboutscience.org/data/files/resources/48/Detox-Dossier-Embargoed-until-0001-5th-jan-2009.pdf.
  2. Sense about Science. Debunking detox. Sense Sci. January 2009. http://www.senseaboutscience.org/pages/debunking-detox.html.
  3. Voice of Young Scientists. Debunking detox leaflet. January 2009. http://www.senseaboutscience.org/data/files/resources/49/Detox-leaflet-Final-Embargoed-until-050109remargin.pdf.
  4. NewsMail. Dietitians reveal the three worst diets for your health. January 2014. http://www.news-mail.com.au/news/dietitians-reveal-three-worst-diets-your-health/2132566/.
  5. Klein AV, Kiat H. Detox diets for toxin elimination and weight management: a critical review of the evidence. J Hum Nutr Diet Off J Br Diet Assoc. 2015;28(6):675-686. doi:10.1111/jhn.12286.
  6. Li Z, Hong K, Wong E, Maxwell M, Heber D. Weight cycling in a very low-calorie diet programme has no effect on weight loss velocity, blood pressure and serum lipid profile. Diabetes Obes Metab. 2007;9(3):379-385. doi:10.1111/j.1463-1326.2006.00621.x.
  7. Waring ME, Eaton CB, Lasater TM, Lapane KL. Incident Diabetes in Relation to Weight Patterns During Middle Age. Am J Epidemiol. 2010;171(5):550-556. doi:10.1093/aje/kwp433.
  8. Olson MB, Kelsey SF, Bittner V, et al. Weight cycling and high-density lipoprotein cholesterol in women: evidence of an adverse effect. J Am Coll Cardiol. 2000;36(5):1565-1571. doi:10.1016/S0735-1097(00)00901-3.
  9. Tsai AG, Wadden TA. The evolution of very-low-calorie diets: an update and meta-analysis. Obes Silver Spring Md. 2006;14(8):1283-1293. doi:10.1038/oby.2006.146.
  10. Weyer C, Walford RL, Harper IT, et al. Energy metabolism after 2 y of energy restriction: the biosphere 2 experiment. Am J Clin Nutr. 2000;72(4):946-953.
  11. Müller MJ, Bosy-Westphal A, Kutzner D, Heller M. Metabolically active components of fat-free mass and resting energy expenditure in humans: recent lessons from imaging technologies. Obes Rev Off J Int Assoc Study Obes. 2002;3(2):113-122.
  12. Faria SL, Kelly E, Faria OP. Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg. 2009;19(7):856-859. doi:10.1007/s11695-009-9842-6.
  13. Camps SGJA, Verhoef SPM, Westerterp KR. Weight loss, weight maintenance, and adaptive thermogenesis. Am J Clin Nutr. 2013;97(5):990-994. doi:10.3945/ajcn.112.050310.
  14. Heilbronn LK, de Jonge L, Frisard MI, et al. Effect of 6-Month Calorie Restriction on Biomarkers of Longevity, Metabolic Adaptation, and Oxidative Stress in Overweight Individuals: A Randomized Controlled Trial. JAMA. 2006;295(13):1539. doi:10.1001/jama.295.13.1539.
  15. Rosenbaum M, Leibel RL. 20 YEARS OF LEPTIN: Role of leptin in energy homeostasis in humans. J Endocrinol. 2014;223(1):T83-T96. doi:10.1530/JOE-14-0358.
  16. Knuth ND, Johannsen DL, Tamboli RA, et al. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obes Silver Spring Md. 2014;22(12):2563-2569. doi:10.1002/oby.20900.
  17. Garrow JS. Exercise in the treatment of obesity: a marginal contribution. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1995;19 Suppl 4:S126-S129.
  18. Redman LM, Heilbronn LK, Martin CK, et al. Effect of calorie restriction with or without exercise on body composition and fat distribution. J Clin Endocrinol Metab. 2007;92(3):865-872. doi:10.1210/jc.2006-2184.
  19. Stiegler P, Cunliffe A. The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss. Sports Med Auckl NZ. 2006;36(3):239-262.
  20. Greenway FL. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes. 2015;39(8):1188-1196. doi:10.1038/ijo.2015.59.
  21. Heinonen I, Rinne P, Ruohonen ST, Ruohonen S, Ahotupa M, Savontaus E. The effects of equal caloric high fat and western diet on metabolic syndrome, oxidative stress and vascular endothelial function in mice. Acta Physiol Oxf Engl. 2014;211(3):515-527. doi:10.1111/apha.12253.
  22. Lutsey PL, Steffen LM, Stevens J. Dietary Intake and the Development of the Metabolic Syndrome: The Atherosclerosis Risk in Communities Study. Circulation. 2008;117(6):754-761. doi:10.1161/CIRCULATIONAHA.107.716159.
  23. Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81(2):341-354.
  24. Kanoski SE, Davidson TL. Western diet consumption and cognitive impairment: Links to hippocampal dysfunction and obesity. Physiol Behav. 2011;103(1):59-68. doi:10.1016/j.physbeh.2010.12.003.

The Skinny on “Skinny Fat” (Normal-Weight Obesity)

16 Nov

Tim Skwiat, MEd, CSCS, Pn2

There’s a common misconception that body weight is a reliable and accurate depiction of health. However, the number on a scale says very little about one’s level of fitness, body fatness, fat storage patterns, and levels of lean body mass.

Typically, an “ideal” or “normal” weight is calculated as a ratio of body weight to height. The most commonly used tool is called the Body Mass Index (BMI), which is a person’s weight (in kilograms) divided by his/her height (in meters) squared (i.e., kg/m2). Using this ratio, the BMI separates folks into the following categories:

  • Underweight (BMI < 18.5)
  • Normal weight (BMI 18.5 – 24.9)
  • Overweight (BMI 25 – 29.9)
  • Obese (BMI > 30)

Hence, the notion of “normal” weight is born, but as mentioned above, there are many limitations associated with the BMI and using this avenue to assess health and fitness. Along those lines, recent research suggests that where folks store body fat—even if they fit into the “normal weight” category—may drastically increase their risk of disease and death.

In a study published in the journal Annals of Internal Medicine, a group of researchers led by Dr. Francisco Lopez-Jimenez, director of preventive cardiology at the Mayo Clinic, examined 14 years worth of data including over 15,000 study participants to determine the potential connection between “normal-weight obesity” and the risk of cardiovascular disease and death. They found that folks who are “normal weight” but store an excessive amount of fat in their mid-sections were more than twice as likely to die from cardiovascular disease compared to “obese” people whose body fat was more equally distributed throughout their bodies.1

It’s not like obese folks have a reduced risk of morbidity and mortality either. In fact, as you might imagine, traditionally defined obesity is a substantial, independent risk factor for cardiovascular disease, and it’s associated with diabetes, high blood pressure, sleep apnea, and a host of metabolic issues.2 This research suggests that “normal-weight obesity” appears to be even worse than that.

To put the increased risk of disease and death into perspective, Dr. Lopez-Jimenez said, “Being normal weight with mid-section obesity is comparable to smoking a half to a full pack of cigarettes daily.”

While the effect of “normal-weight obesity” on mortality has gained a significant amount of attention, it shouldn’t come as a complete shock. Previous research has shown that abdominal obesity is associated with a “constellation of metabolic abnormalities,” including:3,4

  • High triglycerides
  • Low levels of “good” cholesterol (i.e., HDL)
  • High levels of apolipoprotein B (which is considered a better predictor of cardiovascular risk than the more commonly used LDL5)
  • Small, dense LDL and HDL particles (small, dense particles are considered more detrimental than large, fluffy particles6)
  • Unhealthy levels of inflammation
  • Insulin resistance
  • Poor carbohydrate tolerance and metabolism
  • Leptin resistance

A number of important lessons and practical applications can be gleaned from this research and information. For one, it’s possible to be “normal weight” and “metabolically obese,” which Dr. Lopez-Jiminez and colleagues4 have defined as having:

  • Normal BMI
  • High visceral fat
  • High body fat percentage
  • Low muscle mass
  • Reduced insulin sensitivity
  • High blood sugar
  • High triglycerides
  • Reduced HDL cholesterol

Secondly, using a ratio of body weight to height (i.e., BMI) can be a relatively poor indicator of health and fitness. With that in mind, it’s important to use other measurements to determine health risk. While body composition testing (i.e., ratio of fat to lean mass) is arguably the most accurate means to discern health status, using waist circumference and waist-hip ratios may be alternative options.7–9

In general, women who have a waist circumference greater than 35 inches and men whose waist measurement is 40 inches or more are considered to have “central obesity” and be at “substantially increased” risk for cardiovascular disease and metabolic complications. With that said, according to the World Health Organization (WHO), women with a waist circumference greater than 31.5 inches and men with a waist circumference greater than 37 inches are at an “increased” risk for metabolic complications.10

Some research suggests that waist-hip ratio may be an even better predictor of health risk than waist circumference. According to the WHO and other professional health organizations, abdominal obesity is defined as a waist–hip ratio of 0.85 for females and 0.9 or more for men, and folks that fit into these categories are considered to be at “substantially increased” health risk because of their fat distribution.10,11

There appears to be a number of factors that contribute to excessive storage of belly fat. While genetics play a role, there are several modifiable lifestyle and behavioral factors, well within your control, that can be addressed to prevent the accumulation of and/or reduce the amount of existing visceral fat.

Exercise. A sedentary lifestyle, an overall lack of physical activity, and low levels of fitness are associated with abdominal obesity. As mentioned above, it should be noted that “normal-weight obesity” is typically associated with lower levels of muscle mass. This is often described as being “skinny fat.”

Fortunately, a number a studies have examined the impact of exercise on visceral fat, and while the exact amount (i.e., volume) and intensity is still be investigated, a substantial body of evidence suggests that a combination of resistance training and aerobic conditioning (including moderate and intense cardiovascular activity) may be optimal to reduce/attenuate abdominal obesity.12–15 The additional advantage to including resistance training is that it is the primary means by which to increase muscle mass, and it is also very effective at improving carbohydrate tolerance and insulin sensitivity.16,17

According to the American College of Sports Medicine (ACSM), a combination of moderate- to high-intensity exercise performed for a total of at least 250 minutes per week (i.e., 5 – 6 days of 45 – 60 minutes of exercise) is associated with significant weight loss.18

Nutrition. Not surprisingly, nutrition behaviors and food intake appear to have a direct impact on central obesity, and what’s more, studies that combine regular physical activity with diet interventions (i.e., resistance and/or aerobic exercise PLUS a reduced-calorie diet) result in even more significant reductions in visceral fat than either individually.12,19 As cited above, poor insulin sensitivity and carbohydrate tolerance coincide with excessive abdominal obesity, and there’s evidence to suggest that diets rich in refined carbohydrates (e.g., sugar-sweetened beverages) may selectively promote the storage of belly fat.20,21 In addition, excessive consumption of saturated fats also appears to be linked to visceral fat storage.22

Perhaps overtly obvious, long-term energy excess (i.e., overconsumption of calories) also leads to increases in overall body fatness and increases in abdominal obesity, and along those lines, research suggests that reduced-calorie diets (regardless of macronutrient composition) are effective at decreasing abdominal obesity.23,24 With that said, there is evidence that higher-protein (i.e., > 0.5 grams of protein per pound of body weight per day), “controlled carbohydrate” (i.e., <40% of calories from carbohydrate) reduced-calorie diets may be more effective at reducing visceral fat.25–28

Stress management. Excessive stress or the inability to cope with stress may also be a contributing factor to central obesity. You may be familiar with the “stress hormone” cortisol, which appears to have a direct connection to fat accumulation, and in particular, abdominal fat. Studies have shown that folks with high waist-hip ratios tend to have poor coping skills and secrete more cortisol when faced with a stressful situation. This suggests a relationship between cortisol and abdominal fat accumulation, and additional studies have identified a similar association between cortisol concentrations, coping skills, chronic stress, and excess belly fat.29,30

There are a number of potential explanations for the stress-cortisol-visceral fat connection. For instance, the enzyme (HSD) that “activates” cortisol from its inactive form (i.e., cortisone) is more prevalent in visceral fat than subcutaneous fat tissue.31 What’s more, visceral fat tissue has greater blood flow and four times as many cortisol receptors (compared to subcutaneous).30

It’s worth noting that there are a number of factors that can contribute to the stress equation—and subsequently, influence the release of cortisol—including psychosocial stressors, food intake, sleep quality and quantity, exercise, and more. Thus, it’s a good idea to examine your overall “stress web” to identify how various domains (e.g., physical, mental, emotional, environmental, financial, spiritual) may contribute to your overall stress levels (i.e., allostatic load).

While stress management can be tricky, yoga, meditation, mindful breathing (i.e., deep belly breathing), healthy levels of physical activity, optimizing sleep, purposeful relaxation, managing finances, and cultivating healthy relationships can all contribute to maintaining healthy stress levels. What’s more, there are certain herbs called adaptogens (e.g., Rhodiola Rosea; Relora®, which is a combination of Magnolia bark extract and Phellodendron bark extract) that may be helpful in reducing cortisol, improving stress levels, and promoting resilience.32,33 Also, phosphatidylserine may blunt cortisol release, reduce stress, and help promote an optimal hormonal status.34

Supplementation. In addition to the suggestions above, there may be additional nutrients that have a beneficial impact on central obesity. Of course, any dietary supplement that can promote a negative energy balance (e.g., increase energy expenditure, reduce calorie intake) has the potential to reduce visceral fat. There is also some evidence that supplementation with conjugated linoleic acids, fatty acids found in small amounts in dairy and meat, may preferentially reduce abdominal fat (i.e., waist circumference) in populations with central obesity.35,36

Take-Home Points

  • Using one’s body weight (and therefore, the scale) as the primary end point for assessing health and fitness may be unreliable and inaccurate.
  • “Skinny fat” (i.e., normal-weight obesity), which is characterized by a relatively high body fat percentage, excess visceral fat, and low levels of muscle mass, may put one at significantly greater health risk than folks who are “fat and fit” (i.e., metabolically healthy but overweight/obese).
  • While using the scale is one way to assess progress, consider using other measurements (e.g., body composition testing, circumference measurements, waist-hip ratios) to paint a more comprehensive picture of levels of body fat, fat storage patterns, and levels of lean body mass.
  • In addition to some factors that may be out of your control (i.e., genetics), there are a number of behavioral factors, well within in your control, that you can modify to reduce visceral fat or attenuate the risk of developing it in the first place.
  • Consider your current physical activity patterns, nutrition behaviors, and stress management tactics and how those areas may be playing a role in your health and fitness. If you could work on just one of those areas, which would it be? More specifically, what’s one thing that you might consider doing more of in one of these domains?

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References:

  1. Sahakyan KR, Somers VK, Rodriguez-Escudero JP, et al. Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality. Ann Intern Med. November 2015. doi:10.7326/M14-2525.
  2. Poirier P. Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113(6):898-918. doi:10.1161/CIRCULATIONAHA.106.171016.
  3. Despres J-P. Body Fat Distribution and Risk of Cardiovascular Disease: An Update. Circulation. 2012;126(10):1301-1313. doi:10.1161/CIRCULATIONAHA.111.067264.
  4. Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. The Concept of Normal Weight Obesity. Prog Cardiovasc Dis. 2014;56(4):426-433. doi:10.1016/j.pcad.2013.10.003.
  5. Walldius G, Jungner I. Apolipoprotein B and apolipoprotein A-I: risk indicators of coronary heart disease and targets for lipid-modifying therapy. J Intern Med. 2004;255(2):188-205.
  6. Toft-Petersen AP, Tilsted HH, Aarøe J, et al. Small dense LDL particles – a predictor of coronary artery disease evaluated by invasive and CT-based techniques: a case-control study. Lipids Health Dis. 2011;10(1):21. doi:10.1186/1476-511X-10-21.
  7. Ahima RS, Lazar MA. The Health Risk of Obesity–Better Metrics Imperative. Science. 2013;341(6148):856-858. doi:10.1126/science.1241244.
  8. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004;79(3):379-384.
  9. Welborn TA, Dhaliwal SS, Bennett SA. Waist-hip ratio is the dominant risk factor predicting cardiovascular death in Australia. Med J Aust. 2003;179(11-12):580-585.
  10. World Health Organization. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation, Geneva, 8-11 December 2008. Geneva: World Health Organization; 2011.
  11. Ilanne-Parikka P, Eriksson JG, Lindström J, et al. Prevalence of the metabolic syndrome and its components: findings from a Finnish general population sample and the Diabetes Prevention Study cohort. Diabetes Care. 2004;27(9):2135-2140.
  12. Dutheil F, Lac G, Lesourd B, et al. Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE randomized trial. Int J Cardiol. 2013;168(4):3634-3642. doi:10.1016/j.ijcard.2013.05.012.
  13. Slentz CA, Bateman LA, Willis LH, et al. Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT. Am J Physiol Endocrinol Metab. 2011;301(5):E1033-E1039. doi:10.1152/ajpendo.00291.2011.
  14. Schmitz KH, Hannan PJ, Stovitz SD, Bryan CJ, Warren M, Jensen MD. Strength training and adiposity in premenopausal women: strong, healthy, and empowered study. Am J Clin Nutr. 2007;86(3):566-572.
  15. Irwin ML, Yasui Y, Ulrich CM, et al. Effect of Exercise on Total and Intra-abdominal Body Fat in Postmenopausal Women: A Randomized Controlled Trial. JAMA. 2003;289(3):323. doi:10.1001/jama.289.3.323.
  16. Moore DR, Tang JE, Burd NA, Rerecich T, Tarnopolsky MA, Phillips SM. Differential stimulation of myofibrillar and sarcoplasmic protein synthesis with protein ingestion at rest and after resistance exercise. J Physiol. 2009;587(Pt 4):897-904. doi:10.1113/jphysiol.2008.164087.
  17. Hansen E, Landstad BJ, Gundersen KT, Torjesen PA, Svebak S. Insulin sensitivity after maximal and endurance resistance training. J Strength Cond Res Natl Strength Cond Assoc. 2012;26(2):327-334. doi:10.1519/JSC.0b013e318220e70f.
  18. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults: Med Sci Sports Exerc. 2009;41(2):459-471. doi:10.1249/MSS.0b013e3181949333.
  19. Idoate F, Ibañez J, Gorostiaga EM, García-Unciti M, Martínez-Labari C, Izquierdo M. Weight-loss diet alone or combined with resistance training induces different regional visceral fat changes in obese women. Int J Obes 2005. 2011;35(5):700-713. doi:10.1038/ijo.2010.190.
  20. Maersk M, Belza A, Stodkilde-Jorgensen H, et al. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr. 2012;95(2):283-289. doi:10.3945/ajcn.111.022533.
  21. Stanhope KL, Schwarz JM, Keim NL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119(5):1322-1334. doi:10.1172/JCI37385.
  22. Rosqvist F, Iggman D, Kullberg J, et al. Overfeeding Polyunsaturated and Saturated Fat Causes Distinct Effects on Liver and Visceral Fat Accumulation in Humans. Diabetes. 2014;63(7):2356-2368. doi:10.2337/db13-1622.
  23. de Souza RJ, Bray GA, Carey VJ, et al. Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial. Am J Clin Nutr. 2012;95(3):614-625. doi:10.3945/ajcn.111.026328.
  24. Bradley U, Spence M, Courtney CH, et al. Low-Fat Versus Low-Carbohydrate Weight Reduction Diets: Effects on Weight Loss, Insulin Resistance, and Cardiovascular Risk: A Randomized Control Trial. Diabetes. 2009;58(12):2741-2748. doi:10.2337/db09-0098.
  25. Miyashita Y, Koide N, Ohtsuka M, et al. Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity. Diabetes Res Clin Pract. 2004;65(3):235-241. doi:10.1016/j.diabres.2004.01.008.
  26. Skov AR, Toubro S, Rønn B, Holm L, Astrup A. Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1999;23(5):528-536.
  27. Due A, Toubro S, Skov AR, Astrup A. Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2004;28(10):1283-1290. doi:10.1038/sj.ijo.0802767.
  28. Noakes M, Keogh JB, Foster PR, Clifton PM. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr. 2005;81(6):1298-1306.
  29. Moyer AE, Rodin J, Grilo CM, Cummings N, Larson LM, Rebuffé-Scrive M. Stress-induced cortisol response and fat distribution in women. Obes Res. 1994;2(3):255-262.
  30. Epel ES, McEwen B, Seeman T, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000;62(5):623-632.
  31. Morris KL, Zemel MB. 1,25-dihydroxyvitamin D3 modulation of adipocyte glucocorticoid function. Obes Res. 2005;13(4):670-677. doi:10.1038/oby.2005.75.
  32. Olsson EM, von Schéele B, Panossian AG. A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 2009;75(2):105-112. doi:10.1055/s-0028-1088346.
  33. Talbott SM, Talbott JA, Pugh M. Effect of Magnolia officinalis and Phellodendron amurense (Relora®) on cortisol and psychological mood state in moderately stressed subjects. J Int Soc Sports Nutr. 2013;10(1):37. doi:10.1186/1550-2783-10-37.
  34. Starks MA, Starks SL, Kingsley M, Purpura M, Jäger R. The effects of phosphatidylserine on endocrine response to moderate intensity exercise. J Int Soc Sports Nutr. 2008;5(1):11. doi:10.1186/1550-2783-5-11.
  35. Risérus U, Berglund L, Vessby B. Conjugated linoleic acid (CLA) reduced abdominal adipose tissue in obese middle-aged men with signs of the metabolic syndrome: a randomised controlled trial. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2001;25(8):1129-1135. doi:10.1038/sj.ijo.0801659.
  36. Risérus U, Arner P, Brismar K, Vessby B. Treatment with dietary trans10cis12 conjugated linoleic acid causes isomer-specific insulin resistance in obese men with the metabolic syndrome. Diabetes Care. 2002;25(9):1516-1521.

Habits of Highly Effective Nutrition Plans

5 Nov

Habits of Highly Effective Nutrition Plans

Tim Skwiat, CSCS, Pn2

While there are quite a few effective nutrition programs out there, there’s not necessarily a single, universal “best” option. In fact, in a recent article published in the prestigious Journal of the American Medical Association, researchers compared various popular diets differing in macronutrient composition, and they found that differences in weight loss and metabolic risk factors were small (i.e., less than a couple of pounds) and inconsistent.1

What they did find, however, was that the single-most important factor influencing weight loss and improvements overall health (i.e., disease-risk outcomes) was adherence, or the ability of folks to stick with a program and consistently meet program goals for diet and physical activity. This led for the researchers to “call for an end to the diet debates.”

In the POUNDS Lost study, published in the New England Journal of Medicine, researchers compared four different diets (with varying amounts of carbohydrates, proteins, and fats), and they found that “reduced-calorie diets result in meaningful weight loss regardless of which macronutrients they emphasize.”2

With all of that being said, there are some common themes—criteria, if you will—amongst the most effective nutrition plans, including:3

  • They raise awareness and attention.
  • They focus on food quality.
  • They help eliminate nutrient deficiencies.
  • They help control appetite and food intake.
  • They promote regular exercise and physical activity.

While there may be no universal “best” diet, there may be a best option for you, and that’s what’s most important. How can you begin to find what works best for you? The following Habits of Highly Effective Nutrition Plans is a great place to start.

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Habit 1: Eat slowly and mindfully. For fat loss, there are two habits that you’ll need to master, and speaking generally—when combined with good food quality and done consistently—these two simple tools are typically enough for almost all clients to lose fat:

  • Eat slowly.
  • Eat until 80% full (i.e., just until satisfied; no longer hungry, but not “full”).

Slow eating provides a host of benefits:

  • Slow eating helps you “check in” and be present, pay attention, and sense into the cues that your body is sending you, why you’re eating, etc.
  • Slow eating allows you to sense into your body’s internal hunger/satiety cues.
  • Slow eating creates awareness of food textures, tastes, and smells.
  • Slow eating enhances digestion.
  • Slow eating doesn’t depend on controlling what you eat. It can be done any time, anywhere, and no matter what’s on your plate or who’s around, you can always eat slowly.
  • Slow eating makes you and your body the boss. You don’t have to rely on eternal cues and control methods (e.g., calorie counting, weighing/measuring food, points, etc.), and relinquishing external control gives you more real control.

Slow eating also ties into another extremely important component of how to eat: Learning appetite awareness. This is key to distinguishing when you feel that want to eat, need to eat, and have eaten enough (or too much). This ties into the concept of eating until 80% full, which you can track using this handy 80% Full Food Journal. Incorporating an Appetite Awareness Tracker along with the aforementioned food journal can be quite helpful in this regard as well.

If you can master the art of eating slowly and mindfully and learn to sense into (and listen to) your physical cues, you will be well on your way to improving your health, body composition, and vitality. You’ll be a nutrition ninja!

Extra Credit ==> Mindful Eating: HOW Do You Eat?

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Habit 2: Eat protein-dense foods with each meal. When it comes to improving body composition (e.g., losing fat, building/retaining muscle), optimizing protein intake may be one of the single most important dietary and lifestyle changes that one can make. Protein-dense foods increase satiety (i.e., feeling of fullness) and thermogenesis (i.e., boost the metabolism), and high-protein diets have consistently been proven to be effective at improving body composition (e.g., fat loss), preserving metabolic rate, and improving overall health (e.g., better blood lipids, blood sugar management, insulin concentrations).4–6

Increasing protein intake means moving from “surviving” to “thriving” and from “adequate” to “optimal.” Ideally, you should aim to consume a portion of protein-dense foods with each meal. Generally speaking, one palm-sized portion of protein is equivalent to approximately 20 – 30 grams of protein, and we recommend that:

[If you like to “count,” then a good rule of thumb is probably somewhere around 0.18 grams of protein per pound of bodyweight per feeding.]

Your best protein options include:

  • Lean meats, poultry, fish/seafood, and/or wild game (preferably grass-fed, pasture-raised, organic, etc., when appropriate)
  • Eggs (preferably pasture-raised, which is distinct from free-range and cage-free)
  • Lean dairy, especially Greek yogurt (with live cultures) and cottage cheese (preferably grass-fed, pasture-raised)

As noted above, there are a number of beneficial outcomes associated with a higher protein intake, and most experts tend to agree that folks can optimize protein intake by consuming about 0.7 – 0.9 grams per pound of bodyweight per day. This can be tricky, and this is why a protein supplement like BioTRUST Low Carb is “foundational” for the overwhelming majority of folks.

Bonus recommendation ==> Branched-chain amino acids, which play an intricate role in muscle building and recovery (particularly leucine), reduce muscle breakdown, and help regulate blood sugar levels. BCAAs are particularly useful during exercise, and they may also be especially applicable when protein needs aren’t being met (e.g., fasting, not enough protein at a given meal). What’s more, there’s some evidence to suggest that BCAA supplementation may be especially important (to help maintain muscle and metabolic rate) for older folks, whose protein absorption mechanisms may not be as effective.7

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Habit 3: Eat vegetables with each meal. Mom and grandma were right: Veggies are good for your health and your body composition. Studies show folks who eat more veggies tend to do a better job of losing fat and keeping it off. What’s more, a diet high in vegetables helps balance the body’s pH, which is important for both bone and muscle strength. Vegetables have a high nutrient-density and low energy-density, which means that you can consume a relatively large volume comparative to their calorie content. (See Move More, Eat MORE for more on this.)

While vegetables are also packed with important micronutrients (e.g., vitamins and minerals), they are also loaded with important phytochemicals that are necessary for optimal physiological functioning. These same plant chemicals often serve as anti-oxidants that combat oxidative stress, one of the most important factors mediating the deleterious effects of aging.8–10

Vegetables can essentially be prepared any way that you like (and it’s a good idea to include some healthy fats to maximize absorption of key nutrients),11–13 and while there’s not a limit on the number of non-starchy vegetables that you can include, the following is a good starting point:

Generally speaking, the more color (and the more varieties of colors) means the greatest array of beneficial phythonutrients, and it’s a good idea to consume a variety of vegetables each day. To optimize health, you may consider trying to include at least one serving of each of the primary colors each day:

  • Greens: Various lettuces, spinach, kale, arugula, Brussels sprouts, broccoli, asparagus, zucchini
  • Reds: Tomatoes, red bell peppers, red cabbage
  • Oranges: Carrots, orange bell peppers, various squashes, pumpkin
  • Whites: Onions, garlic, parsnips, cauliflower, yellow squash
  • Purples: Eggplant, purple cabbage, beets

For more examples, please see the World’s Healthiest Foods list.
Bonus recommendation ==> Supplement with a greens powder, which contain vegetables, fruits, grasses, etc., that have been distilled into powder form. While not necessarily a substitute for eating whole vegetables and fruits, greens powders are a good option to add to smoothies, when traveling, and for folks who struggle with adding vegetables to each meal.

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Habit 4: Carbohydrate intake should match activity levels. For fat loss, most people will do better by reducing carbohydrate intake, but it doesn’t mean that a low-carb diet is necessary. Rather, a controlled-carbohydrate diet seems to work best. Generally speaking, most people will do best with some carbs, with appropriate adjustments made for activity level, goals, and body type. In other words, the more active you are, the more smart carbs you’ll need; on the other hand, sedentary folks, especially those who are trying to lose fat and/or have more endomorphic body types, typically need fewer carbohydrates.

While there is often debate about low-fat versus low-carbohydrate diets and whether or not there are any metabolic advantages (there doesn’t seem to be any given the data at this time), there is some evidence to suggest that an individual’s insulin sensitivity status may influence the outcome of a reduced-calorie diet.14 For instance, in a study published in the journal Diabetes, Obesity and Metabolism, researchers found that folks with poor insulin sensitivity lost less weight on a low-fat, high-carbohydrate diet compared to more insulin sensitive folks (as well as compared to folks who followed a high-fat, low-carbohydrate diet, regardless of insulin sensitivity status).15

Why? Adherence (or lack thereof): Folks with a poor insulin sensitivity status had a much more difficult time sticking to the low-fat, high-carbohydrate diet, and as a result, they were much less likely to lose weight. Why did they have trouble sticking to it? It’s hard to say for certain, but we can speculate that their less-than-stellar carbohydrate metabolism induced a sequence of hormonal and metabolic changes that increases hunger and energy intake (after consuming a low-fat, high-carbohydrate meals).

Overall, when it comes to choosing smart carbs, the emphasis should be placed on whole, minimally-processed foods that are slow-digesting and high in fiber. Some folks find that consuming the majority of these carbs after exercise is best for body composition and recovery. When carbohydrates are added to meals (not necessarily every meal), the following is a good starting point:

Again, carb intake should be proportionate to activity levels, and particularly when the goal is fat loss, a portion may not be included at each feeding. For advanced folks, focusing on including carbs in the hours after exercise may be optimal. When you do choose to add carbs to a meal, the following are the best choices:

  • Colorful, starchy vegetables (e.g., sweet potatoes, purple potatoes, winter squashes)
  • Colorful fruits (e.g., berries)
  • Other sweet/starchy fruits and vegetables (e.g., bananas, plantains, potatoes)
  • Legumes (e.g., lentils and beans)
  • Whole, intact grains (rather than foods made from processed flours), including whole or steel-cut oats; wild, brown, or red rice; quinoa, amaranth, or buckwheat groats; sprouted grains; kamut or spelt grains; maize; millet; and barley
  • Other whole grain products (e.g., sprouted grains)

Bonus recommendation ==> Managing blood sugar and insulin concentrations are key to optimizing body composition, health, and performance. Supplements like IC-5 can help improve carb tolerance, insulin sensitivity, and metabolic flexibility, which are key players in weight management.

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Habit 5: Eat healthy fats daily. Don’t fear the fat! Despite a bad rap, fat does NOT make you fat. In fact, healthy fats from whole foods play important roles in manufacturing and balancing hormones. They also form our cell membranes and brains and nervous systems. They also transport important vitamins and minerals.

Healthy fats are critical for recovery and repair and supporting mental health and feelings of wellbeing. Fats slow gastric emptying and the release of glucose into the bloodstream (i.e., reduce the glycemic response), and furthermore, studies show that consuming fats can reduce the amount of food eaten in subsequent meals.

Generally speaking, the following are good starting points for portion sizes:

The key is to balance fats, and a variety of healthy fats usually does the trick:

  • Raw nuts (e.g., walnuts, almonds, cashews, etc.) and nut butters (e.g., almond butter)
  • Raw seeds (e.g., pumpkin seeds, chia seeds, hemp seeds)
  • Olives and extra-virgin olive oil
  • Avocado
  • Butter (preferably from grass-fed cows, e.g., Kerrygold)
  • Fresh coconut, coconut milk, and extra-virgin coconut oil
  • Cold-pressed, extra-virgin oils (e.g., walnut, macadamia nut, avocado, hemp, pumpkin, flax)
  • Fatty fish (e.g., wild salmon, mackerel)

Bonus recommendation ==> Supplement with omega-3 fatty acids, which, for the overwhelmingly majority of folks, will be “foundational.” For more on why this (i.e., fish oil) is such an important supplement, please refer to the following article:

The Benefits Of Omega-3 Fatty Acid Supplementation

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In sum, for most people who are eating 3 – 4 meals per day, the following is a good starting point:

  • 1 – 2 palm-sized portions of protein
  • 1 – 2 fist-sized portions of vegetables
  • 1 – 2 thumb-sized portions of healthy fats
  • 1 – 2 cupped-handful portions of carbohydrates can be added as needed (i.e., not every meal), depending on activity levels, goals, and body type.

With all of that being said, this is just a starting point. Remember to practice the first Habit, which emphasizes how you eat. Tune into your internal cues (e.g., satiety, appetite) to gauge what works best for you. In other words, find and do what works (for you). Focus on food quality and emphasize building a solid foundation of high-quality nutrition, done consistently.

Depending on where you are in your journey, you might start with something small, like adding a fish oil supplement to help balance your fat intake and reduce inflammation. From there, you might want to make sure that you consume a portion of lean protein at each feeding. Once you’ve nailed that, you might make sure that you’re consuming some colorful vegetables and/or fruits with each feeding.

In other words, take it one step at a time and focus on working on one change or new habit. Direct all of your time and energy into something that you are ready, willing, and able to do. Master that task or habit, and then take that next step. As Robert Collier said, “Success is the sum of small efforts, repeated day in and day out.”

Many find this step-like, habit-based approach to be far more tolerable, and more importantly, successful for long-term behavior change and weight management. However, some folks need or desire to make bigger changes, faster (e.g., athletes making weight, preparing for an event). In these cases, it’s important to understand that you’ll need to tolerate a greater amount of discomfort and disruption to your routine. Worry not, we’re here to support and encourage you every step of the way.

Notice and name what you do well and where you need help. Are there certain challenges that you face? The more awareness (here’s that mindfulness thing again) that you have of your habits, behaviors, and triggers, the more proactive that you can be in your approach to good nutrition. Remember, good nutrition (and being healthy) is not about perfection; it’s about improvement. It’s about the process—the journey. It’s about making the best, wise choices, as often as possible. It’s about living with purpose and getting up each day being your “best self,” with integrity. It’s about chasing health and wellness.

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Bonus resources:

Additional references used for this article: 16,17

References:

  1. Pagoto SL, Appelhans BM. A Call for an End to the Diet Debates. JAMA. 2013;310(7):687. doi:10.1001/jama.2013.8601.
  2. Sacks FM, Bray GA, Carey VJ, et al. Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. N Engl J Med. 2009;360(9):859-873. doi:10.1056/NEJMoa0804748.
  3. Berardi J. Paleo, vegan, intermittent fasting…Here’s how to choose the best diet for you. Precis Nutr. http://www.precisionnutrition.com/best-diet.
  4. Paddon-Jones D, Westman E, Mattes RD, Wolfe RR, Astrup A, Westerterp-Plantenga M. Protein, weight management, and satiety. Am J Clin Nutr. 2008;87(5):1558S – 1561S.
  5. Soenen S, Martens EAP, Hochstenbach-Waelen A, Lemmens SGT, Westerterp-Plantenga MS. Normal protein intake is required for body weight loss and weight maintenance, and elevated protein intake for additional preservation of resting energy expenditure and fat free mass. J Nutr. 2013;143(5):591-596. doi:10.3945/jn.112.167593.
  6. Westerterp-Plantenga MS, Nieuwenhuizen A, Tomé D, Soenen S, Westerterp KR. Dietary protein, weight loss, and weight maintenance. Annu Rev Nutr. 2009;29:21-41. doi:10.1146/annurev-nutr-080508-141056.
  7. Casperson SL, Sheffield-Moore M, Hewlings SJ, Paddon-Jones D. Leucine supplementation chronically improves muscle protein synthesis in older adults consuming the RDA for protein. Clin Nutr Edinb Scotl. 2012;31(4):512-519. doi:10.1016/j.clnu.2012.01.005.
  8. Floyd RA. Antioxidants, oxidative stress, and degenerative neurological disorders. Proc Soc Exp Biol Med Soc Exp Biol Med N Y N. 1999;222(3):236-245.
  9. Betteridge DJ. What is oxidative stress? Metabolism. 2000;49(2 Suppl 1):3-8.
  10. Fernández-Sánchez A, Madrigal-Santillán E, Bautista M, et al. Inflammation, Oxidative Stress, and Obesity. Int J Mol Sci. 2011;12(12):3117-3132. doi:10.3390/ijms12053117.
  11. Unlu NZ, Bohn T, Clinton SK, Schwartz SJ. Carotenoid absorption from salad and salsa by humans is enhanced by the addition of avocado or avocado oil. J Nutr. 2005;135(3):431-436.
  12. Brown MJ, Ferruzzi MG, Nguyen ML, et al. Carotenoid bioavailability is higher from salads ingested with full-fat than with fat-reduced salad dressings as measured with electrochemical detection. Am J Clin Nutr. 2004;80(2):396-403.
  13. Goltz SR, Campbell WW, Chitchumroonchokchai C, Failla ML, Ferruzzi MG. Meal triacylglycerol profile modulates postprandial absorption of carotenoids in humans. Mol Nutr Food Res. 2012;56(6):866-877. doi:10.1002/mnfr.201100687.
  14. Pittas AG, Roberts SB. Dietary Composition and Weight Loss: Can We Individualize Dietary Prescriptions According to Insulin Sensitivity or Secretion Status? Nutr Rev. 2006;64(10):435-448. doi:10.1111/j.1753-4887.2006.tb00174.x.
  15. McClain AD, Otten JJ, Hekler EB, Gardner CD. Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status: Research Letter. Diabetes Obes Metab. 2013;15(1):87-90. doi:10.1111/j.1463-1326.2012.01668.x.
  16. Berardi, J, Andrews R. The Essentials of Sport and Exercise Nutrition. Second Edition. Precision Nutrition; 2013. http://www.precisionnutrition.com/cmd.php?Clk=5266221.
  17. Berardi J, Scott-Dixon K. Precision Nutrition Level 2 Certification: Master Class. Precision Nutrition; 2014. http://www.precisionnutrition.com/pn-level-2-vip.

All About Probiotics

15 Oct

By Tim Skwiat, MEd, CSCS, Pn2

What Are Probiotics?

According to the International Scientific Association for Probiotics and Prebiotics (ISAPP), probiotics are defined as “living microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”1

The digestive tract alone contains roughly 100 trillion bacteria. To put that into perspective, we have 10 trillion cells that make up our bodies. In other words, the bacterial ecosystem that makes us who we are outnumbers our cells on the order of 10 to 1. From a DNA perspective, the genes of the microbes that inhabit our bodies exceed the amount of human DNA we each have by a factor of 100.

small world

Cani PD, Delzenne NM. Pharmacol Ther. 2011;130(2):202-212.(2)

Building and maintaining a healthy gut flora—which involves optimizing the balance of “good” to “bad” bacteria—is critical to digestive system health and function, overall health, immune system function, mental health and wellbeing, metabolism and weight management, respiratory (i.e., lungs) and integumentary (i.e., skin) systems, and more. When the gut flora is at a healthy balance, it provides immense support to digestive function, immune system, metabolism, skin health, mental wellbeing, and more.

However, when the gut is unbalanced and unhealthy, a number of issues can ensue. In fact, research suggests that having inadequate levels of healthy bacteria in your gut may contribute to over 170 different health issues, including weight gain and difficulty with weight management, as well as digestive-, skin-, and mental wellbeing-related issues. Along these lines, there are many common factors that can upset the balance of gut bacteria, including:

  • Aging
  • Environmental factors
  • Food choices (e.g., Certain artificial sweeteners like sucralose have been shown to reduce the levels of beneficial bacteria in the gut and negatively alter the gut flora.11)
  • Stress
  • Medications (e.g., antibiotics12)
  • Smoking

In other words, a modern lifestyle—characterized by poor food choices, stress, and antibiotics, as well as factors outside of your control like nutrient-deplete soil, environmental toxins, and pollutants—can wreak havoc on the gut flora. The great news that there is a solution to an unhealthy gut, and you can begin restoring your gut health by supplementing with high-quality probiotics.

western living

Adapted from Schippa S, Conte M. Nutrients. 2014;6(12):5786-5805.(5)

This leads us into a discussion of how probiotics may be helpful. In the GI tract, probiotics serve a number of important functions, as they:

  • Support a balance of healthy bacteria in the gut
  • Keep pathogenic bacteria from settling and growing
  • Help digest and absorb nutrients and support a healthy GI tract
  • Help regulate and support a healthy immune system
  • Produce key nutrients (e.g., B & K vitamins, short-chain fatty acids)
  • Keep the system moving
  • Help metabolize chemicals and phytonutrients
  • Synthesize polyamines
  • Produce coagulation and growth factors
  • Promote a healthy balance of cytokines
  • Regulate secretion and use of intestinal mucus
  • Help regulate blood flow to internal organs
  • Provide gut barrier reinforcement
Hill C, Guarner F, Reid G, et al.(1)

Hill C, Guarner F, Reid G, et al.(1)

A Lesson in ProBiology

Symbiosis refers to a “mutually beneficial relationship between two different organisms living in close approximation.” Pertinent to the conversation on probiotics, humans have evolved intimate symbiotic relationships with gut microbes. In fact, human beings can be considered “superorganisms” as a result of their close symbiotic associations with the gut microbiota.3 Optimal human health and homeostasis revolves heavily on this symbiotic relationship, which entails maintaining a healthy balance of bacteria in the gut.

Along these lines, dysbiosis refers to microbial imbalances on or within the body. In other words, dysbiosis describes the state of an unhealthy imbalance of bacteria in the gut flora, characterized by excessive levels of pathogenic bacteria, inadequate amounts of commensal and probiotic bacteria, and/or reduced bacterial diversity. Fundamentally, gut dysbiosis destroys the symbiotic relationship between humans and microbes; in fact, gut dysbiosis has been linked to numerous human health issues, including obesity.4–9

This is leads into why probiotics are critical to restoring gut health and fortifying the gut microbiome. By their very definition, probiotics are non-pathogenic, healthy bacteria that confer a clear beneficial effect on the host (i.e., humans). Supplementation with these commensal bacteria—which supply essential nutrients and defend against pathogens—helps restore a normal, healthy microbiome. Beyond restorative and reactive measures, probiotics help to prevent a normal, healthy individual from acquiring dysbiosis in the future.

In both cases, probiotics promote probiosis (i.e., an association of two organisms that enhances the life processes of both) and support and fortify the symbiotic relationship between humans and gut microbes.

The symbiotic relationship between humans and gut bacteria. Commensal bacteria supply the host with essential nutrients and defend the host against opportunistic pathogens. They are involved in the development of the intestinal architecture and immunomodulatory processes (i.e., healthy immune system function). On the other hand, the host provides the bacteria with nutrients and a stable environment.(10)

The symbiotic relationship between humans and gut bacteria. Commensal bacteria supply the host with essential nutrients and defend the host against opportunistic pathogens. They are involved in the development of the intestinal architecture and immunomodulatory processes (i.e., healthy immune system function). On the other hand, the host provides the bacteria with nutrients and a stable environment.(4)

What Does This Mean for You?

Building and maintaining a healthy gut flora—which involves optimizing the balance of “good” to “bad” bacteria—is critical to digestive system health and function, overall health, immune system function, mental health and wellbeing, metabolism and weight management, respiratory (i.e., lungs) and integumentary (i.e., skin) systems, and more. When the gut flora is at a healthy balance, it provides immense support to digestive function, immune system, metabolism, skin health, mental wellbeing, and more.

However, research suggests that having inadequate levels of healthy bacteria in the gut may contribute to over 170 different health issues (including weight gain and difficulty with weight management), and a modern lifestyle characterized by stress, processed foods, sugar, artificial sweeteners, antibiotics, nutrient-deplete soil, and environmental toxins can wreak havoc on the gut flora and disrupt the natural balance of healthy bacteria.

With that in mind, I would consider a high-quality probiotic (recommendation: BioTrust Pro-X10) “foundational” for nearly everyone to support optimal levels of probiotics, establish and maintain a healthy balance of bacteria in the gut, promote a healthy digestive system, and support a robust immune system. Along with probiotic supplementation, you can also fortify your gut by eating plenty of traditionally fermented foods:

  • Kefir, yogurt
  • Sauerkraut, pickles, and other properly fermented vegetables
  • Miso, tempeh
  • Kombucha
  • Red wine

Establishing optimal gut health is a balance between what’s there and what’s not there. Along those lines, it’s also advised to be mindful of and reduce exposure to the controllable factors (e.g., diet, stress, medications) that may negatively impact the composition of the microflora, gut health, and every other aspect of human health and function mentioned above.

References:

  1. Hill C, Guarner F, Reid G, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514. doi:10.1038/nrgastro.2014.66.
  2. Cani PD, Delzenne NM. The gut microbiome as therapeutic target. Pharmacol Ther. 2011;130(2):202-212. doi:10.1016/j.pharmthera.2011.01.012.
  3. Li M, Wang B, Zhang M, et al. Symbiotic gut microbes modulate human metabolic phenotypes. Proc Natl Acad Sci. 2008;105(6):2117-2122. doi:10.1073/pnas.0712038105.
  4. Martín R, Miquel S, Ulmer J, Kechaou N, Langella P, Bermúdez-Humarán LG. Role of commensal and probiotic bacteria in human health: a focus on inflammatory bowel disease. Microb Cell Factories. 2013;12(1):71. doi:10.1186/1475-2859-12-71.
  5. Schippa S, Conte M. Dysbiotic Events in Gut Microbiota: Impact on Human Health. Nutrients. 2014;6(12):5786-5805. doi:10.3390/nu6125786.
  6. Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: Human gut microbes associated with obesity. Nature. 2006;444(7122):1022-1023. doi:10.1038/4441022a.
  7. DiBaise JK, Frank DN, Mathur R. Impact of the Gut Microbiota on the Development of Obesity: Current Concepts. Am J Gastroenterol Suppl. 2012;1(1):22-27. doi:10.1038/ajgsup.2012.5.
  8. Turnbaugh PJ, Hamady M, Yatsunenko T, et al. A core gut microbiome in obese and lean twins. Nature. 2009;457(7228):480-484. doi:10.1038/nature07540.
  9. Zhang H, DiBaise JK, Zuccolo A, et al. Human gut microbiota in obesity and after gastric bypass. Proc Natl Acad Sci U S A. 2009;106(7):2365-2370. doi:10.1073/pnas.0812600106.
  10. Ridaura VK, Faith JJ, Rey FE, et al. Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science. 2013;341(6150):1241214. doi:10.1126/science.1241214.
  11. Abou-Donia MB, El-Masry EM, Abdel-Rahman AA, McLendon RE, Schiffman SS. Splenda alters gut microflora and increases intestinal p-glycoprotein and cytochrome p-450 in male rats. J Toxicol Environ Health A. 2008;71(21):1415-1429. doi:10.1080/15287390802328630.
  12. Jernberg C, Lofmark S, Edlund C, Jansson JK. Long-term impacts of antibiotic exposure on the human intestinal microbiota. Microbiology. 2010;156(11):3216-3223. doi:10.1099/mic.0.040618-0.

Move More, Eat MORE

7 Oct

By Tim Skwiat, MEd, CSCS, Pn2

When it comes to fat loss, it’s quite common to hear the adage, “Move more, eat less,” which stems from the fundamental principle of physiology, nutrition, and metabolism that states:

In order to lose weight, one must consume fewer calories than s/he burns—on a regular basis, consistently over time.1

Simply put, this is saying that a calorie deficit is necessary (over time) for meaningful fat loss. As simple and straightforward as that is, it’s neither easy nor particularly useful. Just ask anyone who’s attempted to lose weight through a reduced-calorie diet (i.e., eat less). For the overwhelming majority of folks, it’s not sustainable. In fact, researchers estimate that fewer than 25% of folks who lose weight are successfully able to keep it off for at least a year.2

While human physiology complies with the first law of thermodynamics, the “move more, eat less” axiom takes into consideration only a narrow aspect of the weight management equation. That is, there’s more to the story than the “numbers game” (i.e., counting calories) including a variety of environmental and behavioral factors.3

In other words choice to eat food can be sparked by metabolic need, hedonic drive (i.e., the “food reward system”), or a combination of the two. In today’s world, we no longer eat only when we’re “metabolically hungry.” Instead, we are driven to eat even when we’re not truly hungry and despite having vast energy reserves (i.e., body fat).

More and more, obesity researchers are investigating the impact of hedonic drive and other factors, which involves cognitive, reward, and emotional aspects, and may include choosing to eat based on food environment, food addiction, stress relief, boredom, and mood elevation.4

For example, think about a time when you ate (or drank) something because you felt that you “deserved” it, whether that was after a tough workout or a stressful day at the office. You weren’t necessarily hungry, but you made up your mind that you “earned” that reward. Another example of hedonic eating is susceptibility to food environment cues. Think back to a time when you ate something “because it was there.” Ever happen to you?

All of that is meant to create awareness that the “Move more, eat less” approach to fat loss, while “accurate,” may not be all that utilitarian or encompassing. In other words, from a well-educated fitness professional, it’s not very articulate or useful advice. However, there is truth to it, but does it tell the whole story?

Move More, Eat More

It’s no secret that most people could stand to move more. Generally speaking, research suggests that lack of physical activity is a significant determinant of the overall rise in obesity amongst adults and adolescents.5,6 Not surprisingly, people who are “normal weight” typically engage in more moderate and vigorous physical activity compared to overweight and obese folks.7

With little to debate about the energy expenditure portion of the equation, what about eating more? That seems to violate the law of thermodynamics and the age-old proverb about eating less, right?

Yes and no. Again, there’s no discounting the energy balance equation; the current body of scientific research suggests that this is necessary to lose fat. However, eating fewer calories (which can be viewed as “eating less”) doesn’t necessarily have to mean eating less food. In fact, studies show that it’s possible to eat significantly more food and lose substantially more fat.

That is, you don’t necessarily need to rely on the “numbers game” to achieve and maintain your ideal body composition. You see, research suggests that people may not limit what they consume based on calories alone. Specifically, feeling full (i.e., satiety) is a major reason that people stop eating. In other words, rather than the calorie content of food, the volume (i.e., weight, amount) of food that is consumed at a meal is what makes people feel full and stop eating.8

In fact, research strongly suggests that how much you eat daily is regulated by the weight of the food rather than by a certain number of calories. Researchers from Penn State have posited that “energy density is a key determinant of energy intake in that cognitive, behavioral, and sensory cues related to the volume or weight of food consumed can interact with or override physiological cues associated with food intake.”9

Energy density is defined as the relationship of calories to the weight of food (i.e., calories per gram). Foods like oils, bacon, butter, cookies, crackers, junk food, fast food, etc., are generally considered “high-energy-dense” foods (i.e., 4 – 9 calories per gram by weight); on the contrary, nearly all fresh vegetables (and fruits) are considered “low-energy-dense” foods (i.e., 0.0 – 1.5 calories per gram, by weight), as they tend to have a high water content and be a very good source of fiber, two important factors reducing energy density. Fiber itself has a relatively low-energy density, providing only about 1.5 – 2.5 calories per gram.

Along those lines, researchers have found that when folks consume low-energy-dense foods, they feel satisfied earlier and those feelings of fullness persist for relatively longer periods of time—despite reductions in calorie intake. In other words, diets rich in low-energy-dense foods like fruits and vegetables allow folks to eat more total food, which leads to greater feelings of satiety, all while reducing calorie intake.10 By definition, that’s eating more (overall food) and less (calories). Bingo!

In one study published in the American Journal of Clinical Nutrition, researchers from the University of Alabama allowed participants to eat as much food as they wanted (think all-you-can-eat buffet) over the course of 5 days, and their menu options alternated from low-energy-dense to high-energy-dense foods. On the low-energy-density diet, the folks ate only about HALF of the calories (1570) that they consumed before feeling full compared with the high-energy-density diet (3000 calories).11 Satiety (i.e., fullness and satisfaction) and food acceptance ratings were not different across days, meaning that they didn’t stop eating because they didn’t like the food.

In another study published in the American Journal of Clinical Nutrition, researchers from the CDC found that men and women (over 7,000 of them) who consumed a diet rich in low-energy-dense foods consumed between 275 – 425 fewer calories per day than did those folks who opted for more high-energy-dense foods; not only that, the men and women eating more low-energy-dense foods consumed upwards of 14 MORE ounces of food per day (that’s almost a pound).10 Not surprisingly, the folks who ate more low-energy-dense foods like vegetables had healthier body weights (i.e., lowest prevalence of obesity).

A number of other studies have confirmed these findings: Diets rich in low-energy-dense foods like vegetables, fruits, broth-based soups, high-fiber foods, foods with high water content, etc., promote satiety (i.e., feelings of fullness and satisfaction), reduce hunger, and decrease overall calorie intake.

What’s more, long-term studies have shown that low-energy-dense diets also promote weight loss. In fact, studies lasting longer than 6 months demonstrate that folks who eat more low-energy-dense foods experience THREE TIMES greater weight loss than people who simply opt to reduce calories.12

In a study published in the American Journal of Clinical Nutrition, researchers from Penn State University found that overweight women who focused on increasing their intake of low-energy-dense foods (i.e., fruits and vegetables) lost nearly 25% more weight over the course of one year compared to women who were instructed to follow a reduced-calorie diet alone. The women who focused on eating more fruits and vegetables ended up consuming MORE food (despite consuming fewer calories) and experienced greater satiety. The researchers concluded, “Reducing dietary energy density, particularly by increasing fruit and vegetable intakes, is an effective strategy for managing body weight while controlling hunger.”13

With all of that in mind, it should be a bit more clear how you can eat less and more at the same time to support your body composition goals by centering much of your food intake around low-energy-dense foods. This is not only an effective strategy for improving appetite control and reducing caloric intake. You see, what these low-energy-dense foods lack in calories more than make up for in their nutrient density, as they are packed with fiber, essential micronutrients, and important phytochemicals that act as potent antioxidants.

Examples of low-energy-dense foods:

  • Nearly all fresh vegetables and fruits
  • Colorful, starchy vegetables and fruits (e.g., bananas, potatoes, squash, yams)
  • Broth-based soups
  • Beans and lentils
  • Dairy (e.g., Greek yogurt, cottage cheese, milk)
  • Minimally-processed whole grains (e.g., quinoa, maize, amaranth, oats, rice, barley, sprouted grains, spelt, etc.)

Another Hunger Buster

Speaking of satiety, the discussion would not be complete without mentioning dietary protein, which is a nutrition all-star for a number of reasons, including its impact on appetite control.

In general, protein-rich foods result in a greater sense of satisfaction than fat- or carbohydrate-rich foods, and when you eat protein-dense meals, they tend to decrease calorie intake in subsequent feedings. In other words, protein-rich foods and protein-dense meals help you feel fuller, longer.14

Not only that, dietary protein exerts a significantly higher “thermic effect” than fats or carbohydrates, and high-protein meals are associated with increased thermogenesis. Simply put, a higher protein intake increases energy expenditure and boosts the metabolism.15

Even more, high-protein diets help build and maintain lean body mass and preserve metabolic rate, both of which are frequently compromised when dieting for fat loss.16 High-protein diets also tend to lead to significantly greater fat loss, and as a result, markedly better improvements in body composition.

As a matter of fact, when researchers from the University of Illinois compared the effects a high-protein diet to a standard reduced-calorie diet, they found that those folks who consumed more protein experienced a 62% greater ratio of fat loss—even though both groups consumed the same number of calories. 17

The researchers concluded, “This study demonstrates that increasing the proportion of protein to carbohydrate in the diet of adult women has positive effects on body composition, blood lipids, glucose homeostasis and satiety during weight loss.”

Despite the benefits on body composition, metabolism, and appetite, most folks don’t consume enough protein, and eating lean protein at each meal—a key habit of highly effective nutrition plans—along with low-energy dense foods can be tricky. That’s why a high-quality protein supplement tends to be foundational for optimizing overall health, body composition, and performance.

Because protein supplements are typically mixed with water or low-calorie liquid (e.g., unsweetened almond milk), they are inherently low-energy-dense options. For instance, the protein supplement recommended above mixed with 8 ounces of unsweetened almond milk has an energy density of about 0.6 calories per gram.

What’s also neat about a protein supplement is that it provides an opportunity to “sneak” in more low-energy-dense vegetables and fruits. For instance, you can add a couple of handfuls of spinach and some berries to make a great-tasting, nutrient-dense, low-energy dense protein smoothie.

As mentioned above, certain forms (e.g., cottage cheese, Greek yogurt, milk) of dairy are low-energy-dense and protein-dense, and a number of studies have demonstrated that dairy consumption may contribute to increases in lean body mass along with losses in body fat (i.e., improved body composition).18–22

Some folks do take issue with dairy, and in many cases, mild discomfort (whether real or perceived) can be alleviated by gradually increasing consumption and/or through use of digestive enzyme supplementation. While most digestive enzyme supplements in this category tend to only supply the lactase enzyme—which is necessary for the proper breakdown of the sugar lactose found in milk—it’s a better idea to consider a full-spectrum product that also includes proteolytic enzymes to help with the digestion of the proteins (e.g., whey, casein) found in milk, as they may also contribute to digestive discomfort.

Note: The majority of lean protein sources (e.g., beef, poultry, seafood, eggs, wild game, etc.) classify as “medium-energy-dense” foods, but they are still exceptional food choices and provide extraordinary nutrient density. As cited above, there are numerous advantages behind consuming protein-rich foods and a high-protein diet beyond the energy density discussion.

Move More, Eat More 2.0

Another interesting application of the “Move more, eat more” concept is what Dr. John Berardi has long advocated and described as G-Flux.23 The concept behind G-Flux, or energy flux, is that there is a multitude of benefits associated with a concomitant increase in both energy expenditure and calorie intake, including:

  • Improvements in body composition
  • Increased metabolic rate
  • Better recovery from and adaptations to exercise
  • Improved health
  • Greater nutrient density and improved micronutrient delivery

In general, when one increases activity (e.g., exercise), s/he burns a certain number of calories. Likewise, any time that you eat, your body expends energy (i.e., thermic effect of feeding) to digest, absorb, and assimilate the nutrients contained in food. With that in mind, there should be a predictable increase in energy expenditure when folks increase both physical activity and food intake.

What’s particularly interesting is that research suggests that these “high energy flux” states result in an unexpected and significant increase in the number of calories burned. In other words, when folks simultaneously increase physical activity and food intake, they tend to show significant increases in resting metabolic rate and burn even more calories than would be expected.24,25 Pretty nifty trick, and even more evidence of the “Move more, eat more” slogan.

What’s also interesting to note is that many folks tend to subconsciously increase non-exercise activity levels when they consume more calories. In other words, researchers have found that some people innately burn off more energy—through fidgeting, maintaining posture, daily activities—in response to overeating in order to preserve leanness and avoid gaining body fat.26 Thus, eating more can actually facilitate moving more, which enhances energy flux and body composition.

Take-Home Points

  • When it comes to fat loss, “Move more, eat less” makes sense, and it’s based on fundamental principles of human physiology. Although many researchers argue that there are other factors in play, an imbalance of calories consumed versus energy expended best describes how body weight changes.27 With that said, this common axiom is overly simplistic, and it doesn’t take into account other important factors (e.g., environment, hedonic compensation) that may influence food intake and eating behaviors.
  • “Move more, eat more” means that you can actually eat a substantially larger volume of food (i.e., low-energy-dense foods), which leads to greater satiety, fewer calories consumed, and greater overall nutrient intake.
  • Especially when starting a fat loss program, begin with the highest possible calorie intake. This leaves the most room for progression along the way. Dramatic reductions in food intake result in significant decreases in energy expenditure (e.g., reduced thermic effect of feeding, decreased cost of physical activity, reduced resting metabolic rate, and metabolic adaptations).28,29
  • Try not to get too caught up in the “numbers game.” While calories in versus calories out may be a rational scientific explanation, it’s virtually impossible to estimate the number of calories that you expend during activity or over the course of the day. Calorie counting can be a futile process, as labels and reporting may lead to estimates with a 30% margin of error. What’s more, without sophisticated equipment, it’s not feasible to accurately assess the number of calories absorbed.
  • When you’re encroaching on a plateau, experiment with the G-Flux concept—simultaneously increase physical activity and food intake. Done progressively, in most cases, folks tend to see rapid improvements in body composition and performance. In the worst cases, they remain at the plateau, and even then, they tend to add some muscle.
  • When you’ve reached your ideal body composition, consider the G-Flux approach as well to help facilitate a higher calorie intake. Once you’re able to maintain a stable weight at the higher energy intake, gradually decrease physical activity.

References:

  1. Hall KD, Heymsfield SB, Kemnitz JW, Klein S, Schoeller DA, Speakman JR. Energy balance and its components: implications for body weight regulation. Am J Clin Nutr. 2012;95(4):989-994. doi:10.3945/ajcn.112.036350.
  2. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341. doi:10.1146/annurev.nutr.21.1.323.
  3. Greenway FL. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes. 2015;39(8):1188-1196. doi:10.1038/ijo.2015.59.
  4. Berthoud H-R. Metabolic and hedonic drives in the neural control of appetite: who is the boss? Curr Opin Neurobiol. 2011;21(6):888-896. doi:10.1016/j.conb.2011.09.004.
  5. Martínez-González MA, Martínez JA, Hu FB, Gibney MJ, Kearney J. Physical inactivity, sedentary lifestyle and obesity in the European Union. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1999;23(11):1192-1201.
  6. Pietiläinen KH, Kaprio J, Borg P, et al. Physical inactivity and obesity: a vicious circle. Obes Silver Spring Md. 2008;16(2):409-414. doi:10.1038/oby.2007.72.
  7. Spees CK, Scott JM, Taylor CA. Differences in amounts and types of physical activity by obesity status in US adults. Am J Health Behav. 2012;36(1):56-65.
  8. Holt SH, Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods. Eur J Clin Nutr. 1995;49(9):675-690.
  9. Rolls BJ, Bell EA. Intake of fat and carbohydrate: role of energy density. Eur J Clin Nutr. 1999;53 Suppl 1:S166-S173.
  10. Ledikwe JH, Blanck HM, Kettel Khan L, et al. Dietary energy density is associated with energy intake and weight status in US adults. Am J Clin Nutr. 2006;83(6):1362-1368.
  11. Duncan KH, Bacon JA, Weinsier RL. The effects of high and low energy density diets on satiety, energy intake, and eating time of obese and nonobese subjects. Am J Clin Nutr. 1983;37(5):763-767.
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