Friday, June 6, 2014

Exercise for Weight Loss - Clear Your Calendars



Recently, I was looking for articles on how exercise effects weight loss (or not) and finally found one on PubMed that actually controlled for diet and different levels of calorie exertion over a fairly long time period.  I wanted to share with you the trial, the researcher's take-aways and what the results really state.

Aerobic exercise alone results in clinically significant weight loss for men and women: Midwest Exercise Trial-2


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630467/


Researcher summary

EEEx at 400 or 600 kcal/session resulted in a significant reduction in weight compared to controls.




My summary

1)200 kcal difference over 10 months resulted in a 0.4 pound weight loss difference. That is zero point four. Think about it. Nearly 43,000 (thousand) additional calories supposedly "burned".

2)For 600kcal group, individuals had to burn approximately 12,772 calories to lose one pound, which is the equivalent of exercising 21 days to "burn off" a pound.

3)For the 400kcal group, individuals had to burn 8,866 calories to lose one pound.

4)Compliance in the program, even when compensated was only around 67%

5)If the data trend continued (which I doubt it would), if you'd like to lose an additional 2 pounds, you'd have to be in a new research group that exercises 5 days a week for 10 months, with a 1,600kcal/day expenditure. That's akin to running (approximately) 15 miles a day. Keep in mind, these are obese or overweight patients.

For those 2 pounds, that is 3,225 miles, or a leisurely RUN from Miami, Florida to Seattle, Washington.  Google estimates that would take a 'few' hours (I don't think Google uses running estimates though):







6)A few interesting tidbits:

600kcal women (n=18) - 17% gained weight.
400kcal women (n=19) - 26% gained weight.

600kcal men (n=19) - 21% gained weight.
400kcal men (18) - 28% gained weight

It seems for a large portion of the individuals in the study, even those with relatively high continuous energy expenditures gained weight, though the impact was lessened a bit with added exercise.

The researcher's conclusions: "400 or 600 kcal/session resulted in a significant reduction in weight compared to controls...Absence of a significant increase in weight loss between the 400 and 600 kcal/session groups suggests compensation in components of energy balance and warrants additional investigation that could lead to targeted interventions" - ahh like, increasing exercise does squat because your body is under duress and adjusts accordingly?

Important item the study doesn't cover:

Followup > exercise regime stopped. What happened to patient weights?

Thursday, February 13, 2014

Low Carb Diet - For Weight Loss

 

You want to lose weight.  Problem is, as Gary Taubes mentioned in his latest New York Times piece, nutrition and weight loss can be downright confusing.  When we envision healthy food attributed to weight loss, we think about low-fat foods, smaller portion sizes and plenty of fruits and whole grains.  I’m here to tell you that while the main purveyors of our recommended daily intake of food are well-intentioned, they’re dead wrong!  These entities include the USDA (US Department of Agriculture), AHA (American Heart Association) and ADA (American Diabetes Association).  


What we are led to believe is a "healthy" dietary staple - 100% whole grain.


FULL DISCLOSURE:  I’m not here to sell anything.  I simply know what works from experience, research of clinical trials, journal articles and texts - and hundreds (if not thousands) of anecdotal evidence.  This type of evidence comes from individuals who have experienced success on low-carbohydrate programs.  This is a quick how-to, not comprehensive in any way.  I fully recommend reading about this starting now – from books I’ll recommend at the end.  The Internet also allows for access to thousands of clinical trials, journal articles and communities which makes learning about health and nutrition possible like never before.

A quick note:  when I refer to “diet”, this means what you eat on a day-to-day basis as opposed to a temporary way to lose weight.


The Basics of a Low-Carbohydrate Diet



WHO:  Who is “LC” low-carbohydrate for? 

This article assumes you want to lose weight.  You may want to lose it because you’ve accumulated weight slowly over the years…or quickly.  You may have been pregnant and cannot shed the pounds.  No matter what the reason, this is for you.  The only exceptions are for those who cannot properly metabolize fat, have hypercholesterolemia or a few other medical conditions.  If you have questions, ask your doctor – HOWEVER take what they say with a grain of salt.  Let me know their reasoning for dissuading you.



WHAT:  What is LC, exactly?

Low-carbohydrate is only part of the equation.  When you eat low-carbohydrate, your new best friend is fat.  Wait, what?  You’ve probably heard that ingesting fat is bad – that it clogs your arteries and stokes your body full of fatty deposits.  This is not the case.  Dietary fat enters the blood stream as a fatty acid – able to move about without ‘clogging’ anything up.  Did you know that ingesting carbohydrate actually builds up fat in your blood higher and for a longer duration than fat? 
Low-carbohydrate is a high fat diet.  It is not high protein.  Why not protein?  Protein is a GREAT thing!  It provides your body with amino acids, glycerol and wait for it…glucose! Before we get to why you should not have too much protein in your diet, let me tell you what your nutrients should be comprised of:  75% fat 25% protein.  Waaaait a minute, where are the carbs?  Carbohydrates are not a necessary nutrient for humans.  This can be cited in nutrition textbooks.  Often, you’ll hear individuals say you won’t have energy without glucose and will crash.  This is where protein comes in.

Protein, once ingested breaks down into amino acids.  These are further synthesized into other elements, including glucose.  So, if you were to look at someone who never ingested a dietary carbohydrate, you’d note their glucose levels were at a normal (not hypoglycemic) level.    More on the why glucose matters when we get to that section…

Eating LC, you’ll be ingesting butter, cream, coconut oil, olive oil, palm oil, nuts, avocado, coconut, poultry, beef, pork, fish, seafood, eggs, broccoli, lettuce, tomato, cauliflower, kale, and much, much more.  Foods to avoid without question are:  fruit juice, regular sodas, cereal, pasta, bread (all grains), added sugar, high sugar fruits (bananas, grapes, apples) and starchy vegetables, aka root veggies like potatoes and carrots.   




WHEN:  When do I do this?  For dinner, on the weekend?

Low-carbohydrate high fat (LCHF) is a lifestyle change.  If you’ve begun to gain weight, you have a metabolic issue.  Sometimes this happens early on in childhood – but for others it occurs later in life.  Keep in mind, issues with metabolism don’t necessarily mean you’ll get fat.  There are plenty of TOFI (Thin Outside Fat Inside) individuals walking around right now stating they can eat anything they want.  Plenty of thin individuals are also diagnosed with type II diabetes or drop dead from a heart attack. 

Initially, when you are out to lose weight, there are no cheat days.  Once your weight is lost, you can either incorporate a few items on the no-no list, or have a cheat day every now and then.  Just remember that you are eating to improve your health and maintain your weight loss!




WHERE:  You work, have kids and are constantly on the go.  How is this possible?

One of the biggest challenges to eating healthy is that it takes convenience out of your meal time and snack equation.  What we have learned throughout human history as a species is how to adapt.  Prepare your meals (and for your meals) and snacks ahead of time and you’ll be half way there.  You’ll be spending more time in the kitchen though – which is a good thing!  You can actively have your family participate in meal preparation.  When you make dinners, make them big – have leftovers for future dinners or take them for lunch. 





WHY:  Why should I choose low-carbohydrate high fat over low-fat plant-based diet? 
Low-carbohydrate high fat is based on scientific principles.  Essentially, being overweight or obese means you store too much fat, right?  You have specific cells in your body that store fat.  This fat is called a triglyceride.  It is a special bond between glycerol and three fatty acids.  This bond keeps the stored fat from being released from your fat cells.  The more of this stored fat you have in your cells, the fatter you are. 

How did this stored fat get inside my cells?

The main regulator of when fatty acids in the blood are directed to fat cells is the hormone insulin.  Normally, when we eat healthy foods, our blood sugar aka glucose is hovering in the normal range.  However, when we ingest any type of carbohydrate, our bodies convert this quickly to glucose – raising our body’s concentration.  High levels of glucose are toxic to our bodies.  It creates free radicals by oxidizing cells.  Because of this, insulin’s job is to get rid of the excess glucose.  A lot of that excess glucose is converted to fatty acids.  Insulin pushes some to locations in the body that need it (i.e. muscles) and any extra is pushed into fat cells for storage.  If you decide to have a carb-laden meal, such as a giant plate of pasta and a side of garlic bread, much of those fatty acids will literally make you fatter.  As we age, this process becomes more detrimental as our aging bodies do not work like they did when we were younger.





How can I get this stored fat released?

The process is like this:  

  • Limit the ability of insulin to push fatty acids into cells for storage. 
  • Change your metabolism to use something other than glucose.

How does one change their metabolism and what else can my body use for fuel?  I thought we need glucose?  This leads us to the next section.


How:  How do I change my metabolism?

There is a metabolic state called ketosis.  Most people have never even heard about it, but everyone experiences it - normally while asleep.  When you sleep, you will eventually enter a fasting state - which kicks in ketosis.  This occurs when your glycogen stores are depleted (from not eating).  Individuals who eat even high amounts of carbohydrate in their diet will experience a mild state of ketosis by the morning.

What happens in ketosis?  Ketones are produced to fuel your brain and other parts of your body.  They are produced by the breakdown of internal and dietary fat.  Notice I said internal - THIS IS YOUR FAT! 

The main ketones are Beta-hydroxybutyrate (BHB) and Acetone.  Acetone is volatile and so is excreted through the breath (hence, when early adopters of ketosis have 'bad breath').  However, as time passes BHB is the major ketone produced.  

A molecule of beta-hydroxybutyrate

If you're in ketosis, it means that you're doing a great job in limiting your carbohydrate intake (and successive glucose response).  It also means your insulin will be in check and allow the faster release of stored fat for conversion to ketones. 



Frequently Asked Questions
:

1)Do I need to exercise?  Will it help me lose weight faster?


The short answer is a definite no.  I don't normally quote the American Heart Association, but according to the AHA and ACSM (American College of Sports Medicine)'s 2007 Physical Activity Guidelines, they quote:
 

"It is reasonable to assume that persons with relatively high daily energy expenditures would be less likely to gain weight over time, compared with those who have low energy expenditures. So far, data to support this hypothesis are not particularly compelling."

In a nutshell,  they're saying even those with a high amount of DAILY exercise cannot even maintain their weight (they gain weight over time).  


2)I've heard ketosis is dangerous to the kidneys and liver?
This is a common concern, but misguided.  Some early models of a low-carbohydrate diet was based on high protein.  Too much protein is counter-intuitive for weight loss, as discussed previously.  It can also be toxic and damage organs.  We can look back to isolated cultures in population studies to note the reliance on the fattiest meat. 


3)Isn't ketoacidosis dangerous?

There is an important distinction between ketosis and ketoacidosis.  This is the amount of blood ketones circulating in the body.  Ketoacidosis only affects type I diabetics and results in extremely high levels of blood ketones.  Think of it as an extreme of ketosis...as there is an extreme of glycolysis (metabolic state when ingesting carbohydrates).  See the different approximate levels of blood ketones here:  http://lowcarbconvert.blogspot.com/2012/07/am-i-in-ketosis.html


4)Is the Atkins diet different? 

The Atkins diet bases the weight loss phase, or induction phase on ketosis.  It is high fat, low-carbohydrate and moderate protein.  However, later phases allow for inclusion of more carbohydrate, which makes the lifestyle sustainable for a wider swath of individuals due to convenience.  During the later maintenance phases, individuals may or may not remain in ketosis. 


5)How long will it take me to enter ketosis and lose weight?  What should I expect?

Some people may take a matter of days, others may take weeks.  Individuals may take longer due to sex, current metabolic state, genetics, and adherence to eating correctly. 

You should expect rapid weight loss.  The first week or two, you will lose water weight only as your kidneys flush out the carb bloat.  You can lose around 5% of your weight in water.  You may feel sluggish, foggy in the brain, have a headache, become constipated and become irritable.  This is usually attributable to dehydration.


6)Any tips?

Drink extra water, especially when first beginning.  If you drink caffeine, drink an extra 8oz glass of water for every beverage.  Ingest a teaspoon of salt every few hours, especially before you enter ketosis.  This will ward off headaches, some sluggishness and brain fog.  Some people claim drinking broth works well, but most has a small amount of sugar in it, which you should avoid. 

If you want to kickstart ketosis faster, begin with a 24 hour fast.  Fasting is alike ketosis in that they share many of the same metabolic pathways.  Keep in mind, fasting is NOT starvation.  Starvation will hold onto fat stores - you want to release them.  Starvation will also lower energy expenditure, making you sluggish.  Refer back to the link I provided showing blood ketone levels - they are much higher when fasting. 


7)Do I need to take any nutritional supplements?

This is again something you have to determine on an individual basis.  If you include enough sodium in the food you ingest, you won't need to include extra salt.  Get some blood tests which test for levels of vitamins in your bloodstream.  Get your iron checked.  Normally, you don't need any supplements if you eat enough nutritious meats (organ meats included) and vegetables/low-sugar fruits.



The Books You Need to Read
Note:  Some of these books, you can initially borrow from a library if you plan to breeze through them.  However, several may be worth owning.  Books are in suggested reading order. 


1. 
"Why We Get Fat, And What To Do About It" by Gary Taubes.
http://www.amazon.com/Why-We-Get-Fat-About/dp/0307474259/ref=sr_1_1_title_1_pap?s=books&ie=UTF8&qid=1392389642&sr=1-1&keywords=why+we+get+fat

2.  "The New Atkins for a New You, The Ultimate Diet for Shredding Weight and Feeling Great" by Dr. Eric Westman, Dr. Stephen Phinney and Jeff Volek.
http://www.amazon.com/New-Atkins-You-Ultimate-Shedding-ebook/dp/B0038NN3B4/ref=sr_1_3?s=books&ie=UTF8&qid=1392390004&sr=1-3&keywords=atkins+diet+revolution

3.  "Good Calories, Bad Calories:  Fats, Carbs, and the Controversial Science of Diet and Health" by Gary Taubes. 
http://www.amazon.com/Good-Calories-Bad-Controversial-Science/dp/1400033462/ref=sr_1_1_title_1_pap?s=books&ie=UTF8&qid=1392390132&sr=1-1&keywords=good+calories+bad+calories