Ketogenic Diets: Fat-Filled Lies Won’t Make You Slim (or a Better Athlete)

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How do you turn your body into a fat burning machine, run faster than Usain Bolt, recover from exercise immediately and wake up each day bursting with energy? According to some people, the ketogenic diet is your answer (learn the basics of this diet here). This high-fat, moderate protein diet that is practically void of carbohydrates forces your body to use fat for energy. LeBron James supposedly tried it and offensive lineman decided to give it a shot after an ex-NFL center and O-line coach LeCharles Bentley recommended it. However, the offensive lineman and LeBron weren’t actually following a ketogenic diet. Though these athletes didn’t really know what they were following (no worries LeCharles, I’m sure your nutrition advice is on par with me coaching the O-line), people who actually follow it swear by it. Could this be an unconventional path to weight loss and better health? Unfortunately, the ketogenic diet craze has been fattened with misinformation.

Here is what I am covering in this post:

  • Eat Fat, Lose Fat? Does the ketogenic diet make you lose weight?
  • How does this diet impact muscle?
  • The ketogenic diet and athletic performance.
  • The issue with ketogenic research studies.

I am not covering “training low” or low carbohydrate  / non-ketogenic diets in this article.

Eat Fat, Lose Fat?

During the first several days on a ketogenic diet your weight will take a nosedive. Carbohydrate is stored in the form of glycogen in liver and muscle. Each gram of carbohydrate is stored with 3 – 4 grams of water. Decrease your carbohydrate intake, use glycogen and you’ll lose water weight very quickly. Weight loss, even if from water, can motivate people driven by the number on the scale. Given that adherence is the number one predictor of weight loss when on a diet, we can’t discount psychological effect of the number on the scale going down.

What happens if you stay on the diet? A group of NIH researchers admitted seventeen overweight or obese men to a metabolic ward and placed them on a high carbohydrate baseline diet for four weeks followed by four weeks on an isocaloric ketogenic diet (this diet contained the same amount of calories as the high carbohydrate baseline diet). The men lost weight and body fat on both diets. The ketogenic diet did not lead to greater fat loss as compared to the high carbohydrate diet and in fact body fat loss slowed during the ketogenic diet and subjects lost muscle (1). Time to chuck the “carbohydrates make you fat” books in the recycling bin.

What about other studies showing ketogenic diets help athletes lose body fat and maintain performance? These studies were not actually using a ketogenic diet protocol but instead were high fat, high protein, low carbohydrate diets. Also, none of the studies measured if the study subjects were actually in nutritional ketosis (2, 3, 4).  See the section on The Issue with Ketogenic Research Studies for more information on this topic.

Ketogenic diet and weight

Regardless of the studies indicating the ketogenic diet will not lead to greater weight loss and could result in a decrease in muscle mass, I know I would lose weight on it only because I’d get sick of eating. If faced with eating a fatty steak with melted butter on top for dinner followed by spoonfuls of oil for dessert, I’d rather not eat.

Muscle Up with the Ketogenic Diet?

The ketogenic diet isn’t high enough in protein for maximal muscle gains. Using the lower end of fat intake on a classic ketogenic diet (80% of calories), one could consume 15% of calories from protein (112 grams) on a 3,000-calorie diet. Protein requirements are at least 1.2 – 1.8 grams of protein per kilogram bodyweight (or 0.55 – 0.82 grams per lb. bodyweight) per day if training and eating a diet with enough calories to maintain weight. Protein needs go up if you are cutting calories to spare the breakdown of muscle tissue when dieting. On this diet, 112 grams of protein equals just under 1.3 grams of protein per kg bodyweight for a 200 lb. person and even less for anyone who weighs more.

In addition to inadequate protein intake, “the ketogenic diet reduces many of the signaling molecules involved in muscle hypertrophy (growth),” states Dr. Antonio Paoli, M.D., B.Sc., Associate Professor and Vice Dean of the School of Human Movement Sciences, University of Padova. Without getting too technical, even with sufficient calorie intake, the ketogenic diet suppresses the IGF-1 / AKT / mTOR pathway (5). Using ketones for energy slows muscle breakdown. However it doesn’t stop this process (5).

The Ketogenic Diet and Athletic Performance

Once fully adapted to a ketogenic diet, athletes can supposedly rely on a seemingly endless supply of body fat for energy. No need for carbohydrate gels, beans, gummies and sports drinks every 15-30 minutes during long runs, rides or triathlons to sustain energy levels. Fewer calories consumed may make it easier for some people to stay within their total daily calorie needs (though if you are training that much staying within your calorie requirements shouldn’t be difficult).

Trading carbs for fat seems like a huge benefit for athletes, particularly endurance athletes who train and compete for several hours at a time (6). In addition to utilizing body fat, fat actually produces more energy (ATP) (5). However, fat is a slow source of fuel (see graphic below), the human body cannot access it quickly enough to sustain high-intensity exercise and therefore, this diet is really only (potentially) applicable to ultra-runners and triathletes competing at a relatively moderate to slow pace.

In a ketogenic diet study examining athletic endurance, researchers had subjects cycle at a snails pace (equivalent to a heart rate of about 120 beats per minute for anyone 20-30 years old or 115 for a 40 year old) until they became exhausted before and after 4-weeks on a ketogenic diet. There were no differences in the amount of time they were able to cycle before getting tired prior to or after the four-week ketogenic diet (7). In studies examining high fat diets (not ketogenic and ketones weren’t measured) and endurance performance, study subjects relied on more fat as opposed to carbohydrate during low intensity exercise, yet there was no clear performance advantage on the higher fat diet (8). A recently published study examined 20 elite ultra-marathoners and Ironman distance triathletes. Some were habitually consuming a traditional high carbohydrate diet while the other group was following a ketogenic diet (slightly adjusted macronutrient ratios yet they were in ketosis as measured by blood ketone levels). As expected, those following a higher fat diet used a greater percentage of fat for energy while the higher carbohydrate diet group used more carbohydrate for energy during a 180 minute submaximal running test (I’d call that leisure running intensity). There was no difference in calories burned over the course of the run. Both groups had the same level of perceived exertion and there was no test to determine performance differences between groups (9).

If there’s no performance benefit and we know carbohydrates work, why follow this diet? If your primary goal is weight loss, it doesn’t matter if you use more fat than carbohydrate while exercising (SN: can we please stop talking about the fat burning zone) as long as you’re burning more total calories over the course of the day. Plus, in the interest of (if you are not an ultra endurance athlete) jack up the intensity and burn as many calories in a short period of time as possible. Unfortunately, a ketogenic diet won’t help you do that – when relying on fat for fuel, the intensity of your exercise will drop – the body simply can’t access fat (a slow source of energy) quickly enough to sustain high-intensity exercise. Instead, carbohydrates are necessary for high intensity activity.
ketogenic diet and sports

The Issue with Ketogenic Research Studies

Here’s the issue with many ketogenic research studies and media reports based on them: in most cases, the study subjects were not actually following a ketogenic diet – they were following a higher fat, high-protein low carbohydrate diet (10, 11, 12). Each person’s carbohydrate and protein limits needed to stay in ketosis vary and therefore, measuring ketones through blood or urine is the only definitive way to determine if you are in ketosis. Complicating matters more, low carbohydrate diets (including ketogenic diets) lead to a substantial drop in carbohydrate content, and associated water stored with it, in muscle. This change overestimates the drop in lean body mass as measured by DEXA.

ketogenic and low carbohydrate diets

There are no modifications, higher protein intakes or “on again, off again” (where you go on it one day and off it the next) to this diet. You must be in a state of nutritional ketosis or you will need to decrease carbohydrate and protein intake even further to get into nutritional ketosis and rely on ketones for energy.

Is There Any Benefit?

Ketogenic diets help decrease incidence and severity of seizures in epileptic patients (this is what the diet is intended for). Also, ketogenic diets may be beneficial when implemented soon after a traumatic brain injury (including concussion) (13). In addition, scientists are examining if this diet is beneficial for diseases that affect the brain such as Alzheimer’s.

If you want to lose weight, the ketogenic diet is not superior to a reduced calorie diet. Also, unless you are an ultra endurance athlete who just loves dietary fat, hates eating at social occasions and can put up with the potential side effects from this diet it isn’t for you.
Now where is the O-line? I’ve got some coaching to do…

References

1 Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016 Jul 6. [Epub ahead of print]

2 Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk M, Zydek G. The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients 2014;6(7):2493-508.

3 Rhyu HS, Cho SY. The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors and cytokines of Taekwondo athletes. J Exerc Rehabil 2014;10(5):326-31.

4 Paoli A, Grimaldi K, D’Agostino D et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts. JISSN 2012;9:34.

5 Paoli A, Bianco A, Grimaldi KA. The ketogenic diet and sport: a possible marriage? Ex Sports Sci Reviews 2015.

6 Volek J, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci 2014;2:1-8.

7 Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism 1983;32(8):769-76.

8 Burke LM, Kiens B. “Fat adaptation” for athletic performance: the nail in the coffin? J Appl Physiol 2006;100(1):7-8.

9 Volek J, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt pm, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic characteristics of keto-adapted ultra-endurance runners. Metab Clin Exp 2016;65(3):100-110.

10 Tinsley GM, Willoughby DS. Fat-Free mass changes during ketogenic diets and the potential role of resistance training. Int J Sport Nutr Exerc Metab. 2015 Aug 12. [Epub ahead of print]2 Rouillier MA, Riel D, Brazeau AS, St. Pierre DH, Karelis AD. Effect of an Acute High Carbohydrate Diet on Body Composition Using DXA in Young Men. Ann Nutr Metab 2015;66:233-236

11  Paoli A. The ketogenic diet and sport: a possible marriage? Ex Sci Sports Sciences Rev 2015;43(3):153-62.

12  Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am Society Clin Nutr 2008;87(1):44-55.

13 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel (2011). The National Academies Press, Institute of Medicine. Washington DC. 2011 http://www.nap.edu/read/13121/chapter/15

 

The Ketogenic Diet Craze: Fat-Filled Lies, Part 1

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ketogenic diPicture this: a thick, juicy, tender eventeak grilled to perfection with melted butter glazed on top, gently dripping down the sides. Lying next to the steak there’s a side of dark green asparagus sautéed in coconut oil and dusted with a sprinkle of sea salt. Could a diet loaded with fat help you lose diet-resistant body fat that’s been taunting the seams of your dress pants and poking through buttons on your shirt? Will eating fat turn you into an all-star athlete? This is part 1 of a 2 part series on the ketogenic diet.

Here is what I will cover in this blog post:

  • What is the ketogenic diet?
  • Adverse health effects.

Here is what I will cover in tomorrow’s blog on this topic:

  • The issue with ketogenic research studies.
  • Is the ketogenic diet superior for losing fat?
  • How will the ketogenic diet affect muscle?
  • How will the ketogenic diet impact athletic performance?

What is the Ketogenic Diet?

For nearly a century, epileptic patients have used ketogenic diets to control seizures when common medications provide no relief. Scientists aren’t sure why following a ketogenic diet decreases the incidence and severity of seizures but it works.

The ketogenic diet contains – 80-90% of calories from fat, 15% from protein and 5% from carbohydrate (1, 2). Food choices may include heavy cream, bacon, eggs, non-starchy vegetables, mayonnaise and sausage while fruits, starchy vegetables, breads, pasta, cereal and other carbohydrate-rich foods are not allowed.

During the first several days on a ketogenic diet, your body’s limited supply of carbohydrate stored in liver and muscle tissue decreases dramatically. As a result, you will feel like you have mono – exhausted, with headaches and easy exercise will feel like you’re climbing Mount Everest (3). Once your stored carbohydrate has dwindled, ketones, formed from the breakdown of dietary fat, become the primary source of energy for brain and body. Ketogenic means “ketone forming.” It takes at least seven days to reach nutritional ketosis and several weeks to fully adapt to the diet (12). If you aren’t in nutritional ketosis (as measured by blood, urine or breath ketones; ketone levels > 0.5 mmol/L), then you aren’t following a ketogenic diet, you are on a low carbohydrate diet.

Adverse Health Effects from the Ketogenic Diet

Much of the research on adverse effects comes from studies in epileptic children since they have been on the diet for long periods of time. These studies show soon after starting a ketogenic diet, blood cholesterol levels and artery stiffness increase (4, 5). High total and LDL cholesterol are risk factors for cardiovascular disease (diseases of the heart and blood vessels). When arteries are stiff, they cannot expand as well in response to changes in blood pressure. Think of this like a garden hose when you turn up the water pressure, your hose either expands or the water bursts out of the space between the faucet and the hose. When arteries cannot open widely to accommodate increases in blood flow, blood pressure increases leading to microscopic tears on artery walls, development of scar tissue and the perfect surface for plaque buildup (6). Blood cholesterol levels returned to normal in patients who went off the diet and in those who stayed on it, they returned to normal after 6 to 12 months. Artery stiffness returned to normal after 24 months on a ketogenic diet.5 Studies in obese patients suggest ketogenic diets improve blood sugar and blood cholesterol levels over time, either due to the diet, weight loss from the diet, a combination of the two or carbohydrate restriction (7, 8). Lose weight, regardless of what you eat and blood cholesterol, blood pressure, inflammation, blood sugar and many other disease risk factors will improve.

Ketogenic diets are typically low in calcium, vitamin D, potassium, magnesium, folic acid and fiber. There are several potential consequences associated with consistently low intake of each of these micronutrients including softening of the bones, decreased bone density, muscle damage, muscle weakness or spasms, and abnormal heart rhythm. However, with careful planning, a fiber supplement, multivitamin and under the guidance of a physician who may prescribe potassium and sodium supplements (blood sodium could drop to dangerously low levels while on this diet), nutrient needs can be met. Also, to prevent constipation when on a ketogenic diet, a fiber supplement may be necessary along with more water / fluid intake then you are used to.

Here are some other potentially bad side effects from following a high fat diet:

  • Harm to your Brain. Studies in mice show a high fat diet, even when followed for as little as two months leads to chronic inflammation, sedentary immune cells in the brain – these cells typically act like janitors picking up trash and infectious compounds but when they become sedentary they stop doing their job, leading to cognitive impairment (9).
  • Mad Bacteria in Your Gut. A diet with no probiotics (healthy bacteria) and low in prebiotics (certain types of fiber that the healthy bacteria much on for food keeping them happy) will likely change the composition of bacteria in your gut so you have more harmful and less beneficial bacteria.
  • Leaky Gut. High saturated fat meals increase bacterial toxins (endotoxins) in the intestines and intestinal permeability. In other words: leaky gut (10, 11).
  • Free radicals in overdrive? If you can’t eat a number of colorful foods including blueberries, beets, corn, oranges, and more, chances are you won’t get a wide array of antioxidant compounds to quench free radicals (compounds that are important for good health but can wreck your body when they aren’t tamed by antioxidants) as well as other plant-based compounds that keep your arteries, muscles and other parts of your body healthy.

Are the side effects and potential negative side effects worth it if you can lose weight on this diet? Stay tuned for tomorrow’s post on how the ketogenic diet impacts body fat and athletic performance.

References

1 Freeman JM, Freeman JB, Kelly MT. The ketogenic diet: a treatment for epilepsy. 3rd ed. New York, NY: Demos Health; 2000.

2 Paoli A, Bianco A, Damiani E, Bosco G. Ketogenic Diet in Neuromuscular and Neurodegenerative Diseases. BioMed Research International 2014, Article ID 474296, 10 pages, 2014.

3 White AM, Johnston CS, Swan PD et al. Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: a pilot study. J Am Diet Assoc 2007;107(10):1792-6.

4 Tanakis M, Liuba P, Odermarsky M, Lundgren J, Hallböök T. Effects of ketogenic diet on vascular function. Eur J Paediatr Neurol 2014;18(4):489-94.

5 Coppola G, Natale F, Torino A et al. The impact of the ketogenic diet on arterial morphology and endothelial function in children and young adults with epilepsy: a case-control study. Seizure 2014;23(4):260-5.

6 Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovascular Disease 2012;1(4):1-10.

7 Dashti HM, Mathew TC, Hussein T, Asfar SK, Behbahani A, Khoursheed MA, Al-Sayer HM, Bo-Abbas YY, Al-Zaid NS. Long-term effects of a ketogenic diet in obese patients. Exp Clin Cardiol 2004; 9(3): 200–205.

8 Volek JS, Feinman RD. Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005;2:31.

9 Hao S, Dey A, Yu X, Stranahan AM. Dietary obesity reversibly induces synaptic stripping by microglia and impairs hippocampal plasticity. Brain Behav Immun 2016 Jan;51:230-9.

10 Mani V, Hollis JH, Gabler NK. Dietary oil composition differentially modulates intestinal endotoxin transport and postprandial endotoxemia. Nutr Metab (Lond) 2013; 10: 6.

11 Lam YY, Ha CW, Campbell CR, Mitchell AJ, Dinudom A, Oscarsson J, Cook DI, Hunt NH, Caterson ID, Holmes AJ, Storlien LH. Increased gut permeability and microbiota change associate with mesenteric fat inflammation and metabolic dysfunction in diet-induced obese mice. PLoS One 2012;7(3):e34233.

12 Paoli, A, Grimaldi K, D’Agostino D, Cenci L, Moro T, Bianco A, Palma A. Ketogenic diet does not affect strength performance in elite artistic gymnasts. J Int Soc Sports Nutr 2012;9:34.

Count Macros, Eat Doughnuts & Get Ripped

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If you’re counting macros (grams of protein, carbohydrate and fat), are you stuck with a boring diet full of egg whites, chicken, brown rice and broccoli or, can you indulge in doughnuts and other foods typically considered “off limits” and still get ripped? A recent study from the University of South Florida examined both approaches. I think you’ll be happy with their results.
Doughnuts and macros

Macros Study: Flexible vs. Rigid Dieting

In this study,  27 resistance trained men and women (this is huge because many studies use untrained subjects – the kind that have never seen the inside of a gym so almost any intervention is guaranteed to produce results) about 25 years of age were placed on either a Rigid or Flexible 10-week diet phase based on macros and a 25% decrease in calories:

  • Rigid Macro Counting (termed “exclusive” in the study) included a pretty basic diet (given they were 25-year-olds on a limited budget) including foods such as eggs, egg whites, protein shakes (they were given preparation instructions), oats, berries, 99% lean turkey breast, chicken breast, fish (they were given specific options), brown rice, potatoes, choices of different vegetables, oils (added if need be to increase fat intake).
  • Flexible Macro Counting (termed “inclusive” in the study) –  the study subjects could eat whatever they wanted as long as it fit their macros. They were given no food restrictions and could therefore incorporate more variety into their diet.

All continued on their regular training program.

Results

Both groups lost weight and body fat  with no differences between groups in weight loss, body fat mass loss and body fat % decrease. However, in the 10 week post diet, the flexible diet group gained a significant amount of fat-free mass compared to the rigid group (+1.53kg vs. -0.59kg respectively) though there was no difference, between groups, in resistance and aerobic exercise (I suspect the rigid group when crazy shoveling in junk food but the study didn’t collect food records +  most people lie on food records anyway when they feel ashamed about what they ate). No other changes were noticed in the 10 week post diet phase.

Take Home Message

Does this mean you can go gangbusters on gummy bears and doughnuts? Not exactly.  After all, if you’re cutting calories it’s pretty difficult to incorporate high calorie foods that aren’t very filling unless you don’t mind the distraction of hunger pangs later the day. However, it does mean you might need to loosen up a little on rigid dieting. As stated by study author, Bill Campbell, PhD, CSCS, FISSN, Associate Professor – Exercise Science, University of South Florida. “If you are the type of person that has cravings for certain foods, you may be able to consume them in limited quantities during a diet phase within the flexible dieting strategy – this is very appealing for some dieters. Others prefer to have a meal plan created for them with specific foods that they are to consume during their diets – in this case a rigid/exclusive diet is more appealing,” states study author,

If you’re interested in more information about macros, physique and fitness nutrition, follow the study authors on social media:

Bill Campbell on instagram: billcampbellPhD and Facebook

Lorin Conlin, IFBB Bikini Pro, MS Research Assistant – Physique Enhancement Laboratory, University of South Florida on instagram: @laurinconlin and Facebook: FB page Laurin Conlin IFBB Pro

Yikes! Are there Antibiotics or Hormones in Your Milk & Dairy Foods?

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milk

Are antibiotics and hormones used in dairy cows contributing to the obesity epidemic, early puberty and antibiotic resistance? Before going down that road, we have to first we have to first ask if there are any antibiotics or hormones in milk and dairy products.

In this blog post I will cover:

  • Why are antibiotics given to cows?
  • Antibiotics are not in milk, here’s why.
  • Why are growth hormones given to cows? Are there any hormones in my milk and dairy food?
  • What are the cows Eating?

Why are Antibiotics given to Cows?

Antibiotics are used on farms to treat animals who are sick just like you would give an antibiotic to your child if he or she gets sick or take one yourself. There is no reason for dairy farmers to give antibiotics to cows who are not sick. Doing so costs additional money,  serves no clear purpose and arbitrarily giving animals antibiotics could contribute to antibiotic resistance. Now imagine you are a farmer and your life depends on the health of your cows – would you want to run the risk of antibiotic resistance and your cows getting sick with fewer treatment options?

Some antibiotics are also used for animal growth. The FDA is phasing out this practice so medically important antimicrobial drugs (antibiotics) will no longer be allowed to enhance growth or feed efficiency. In the future antibiotics will only be allowed to treat, control or prevent disease and of course require a prescription from a licensed veterinarian. Regardless of whether or not the antibiotic is used for growth or treatment of disease, no traces of antibiotic residues are allowed in milk or dairy products.

Antibiotics are Not in Milk, Here’s Why.

Any cow that gets an antibiotic is milked separately from the rest of the herd and the milk is thrown out. That milk will never be sold or consumed. All antibiotics have a different period of time before all traces of the medication leaves the body (whether we are talking about a cow or a human). Once this period is up and the cow is completely healthy again, the farmer tests her milk. Milk cannot be sold until it is completely clear of all drug residues. Whether organic or conventional, all milk is tested several times before making it to market. It is tested on the farm and at the milk processing plant. Any milk that tests positive for any medication residue, including antibiotics, is thrown out (1).

According to national Milk Drug Residue Data Base compiled for the years 2013 to 2014, 0% of milk tested positive for drug residues. In 2015, the FDA’s Center of Veterinary Medicine surveyed 1,918 raw milk samples (before pasteurization) from across the country. Samples were tested for residues of 31 drugs including the antibiotics, NSAIDs (ibuprofen etc.) and an antihistamine. They found 99% of sampled milk was free of any drug residues. Keep in mind the 1% of milk with residues must be thrown out – it cannot be sold (1, 2).

Cheese and yogurt are made from milk and therefore, there are no antibiotics in your cheese or yogurt either.

Growth Hormones in Dairy Cows

Growth hormones are approved for use in dairy cows to improve milk production. Greater milk production means fewer environmental resources used to raise cows for milk. Bovine somatotropin (bST; also called bovine growth hormone or rBGH) is perhaps the most well recognized growth hormone used on dairy farms. bST is “a protein hormone produced in the pituitary gland of animals, including humans, and is essential for normal growth, development, and health maintenance.” Very little bST is used in dairy cows and there is no test that can distinguish between cows treated with bST and naturally occurring bST (3). Humans do not have receptors for bST and therefore it is passed through your body intact without being absorbed (4). As a result, there are no known side effects or health issues associated with consuming dairy from cows treated with bST. IGF-1 (insulin like growth factor 1) concentrations are slightly higher in cows treated with bST. However, the human body synthesizes IGF-I and drinking 1.5 L of milk is equivalent to an estimated 0.09% of the IGF-I produced by adults each day (5, 6, 7, 8).

USDA organic dairy products are “produced without antibiotics fed or administered to the animal at any point in its life” (9). There are no meaningful nutrition differences between organic and conventional dairy products. I covered that topic in this post.

What are the Cows Eating?

Cows’ diets also vary depending on many of the same factors that influence your food choices. However, unlike humans, all cows have the benefit of seeing a nutrition expert (like dietitians, animal nutrition experts are specialists). Many consumers also have questions about how cows are fed. Cows are fed nutritious diet to ensure health of cow and nutrition of milk. Typical feed mixtures may include haylage (grass with a higher water content), corn silage, sugar beet pulp and a protein mineral mix.

Rest assured, your dairy products are safe. In fact, the dairy product that says it is made with cows not treated with antibiotics is the exact same as the one from a cow that may have been treated with antibiotics. Both contain no antibiotic residues. Growth hormones used in dairy also pose no known threat to human health. The human body does not even recognize the main hormone used in cows. So, regardless of what milk, yogurt, or cheese you choose, all have been produced and extensively tested to ensure they are safe for human consumption.

This post was written as part of my ongoing sponsored partnership with U.S. Farmers & Ranchers Alliance. All opinions expressed are my own and per the usual, took me hours to research and double check my facts.References (if not cited via a hyperlink in the text of this post)

References

1 Questions and Answers: 2012 Milk Drug Residue Sampling Survey. FDA.

2 NATIONAL MILK DRUG RESIDUE DATA BASE FISCAL YEAR 2014 ANNUAL REPORT October 1, 2013 – September 30, 2014 http://www.fda.gov/downloads/food/guidanceregulation/guidancedocumentsregulatoryinformation/milk/ucm434757.pdf

3 Bovine Somatotropin (BST) http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm055435.htm

4 Bovine Somatotropin. National Institutes of Health, Technology Assessment Conference Statement. December 5-7, 1990. https://consensus.nih.gov/1990/1990BovineSomatotropinta007html.htm

5 Joint FAO/WHO Expert Committee on Food Additives (JECFA). 1998. Toxicological evaluation of certain veterinary drug residues in food; Summary and conclusions. 50th report of the Joint FAO/WHO Expert Committee on Food Additives. World Health Organization, Geneva, Switzerland.

6 Collier RJ, Bauman DE. Update on human health concerns of recombinant bovine somatotropin use in dairy cows. J Animal Sci 2013; 92(4): 1800 – 1807. https://www.animalsciencepublications.org/publications/jas/articles/92/4/1800

7 Recombinant Bovine Growth Hormone. http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/recombinant-bovine-growth-hormone                  

8 Report on the Food and Drug Administration’s Review of the Safety of Recombinant Bovine Somatotropin. Food and Drug Administration. http://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm130321.htm

9 Stacy Sneeringer, James MacDonald, Nigel Key, William McBride, and Ken Mathews. Economics of Antibiotic Use in U.S. Livestock Production, ERR-200, U.S. Department of Agriculture, Economic Research Service, November 2015. http://www.ers.usda.gov/media/1950577/err200.pdf

 

 

Full Fat or Low Fat Dairy?

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If you are totally against low-fat dairy, it’s time to take a closer look at the research. After listening to this dairy debate and watching the finger pointing, I started searching through the literature for an answer to this question “does dairy fat increase LDL cholesterol and risk for cardiovascular disease?” Then I came to my senses. No one eats dairy fat. Unless you’re a food scientist, you aren’t separating the fat from milk or full-fat yogurt and eating it or adding it as an ingredient to your recipes. However, we do eat cheese and yogurt and drink milk. The array of compounds in each of these foods influences how they affect your cholesterol and risk for heart disease. So, I revised the question to: “how does full fat cheese, yogurt and milk impact cholesterol and risk for heart disease?”

Here’s what I’ll cover in this article:

  • Why people are up in arms about saturated fat – saying it is either good or bad;
  • How does full fat cheese, yogurt and milk impact cholesterol;
  • What should you do with this information?

Dairy Fat isn’t the Only Factor

The research on dairy generally follows the research on saturated fat: the replacement strategy matters. For instance, it isn’t a good idea to take cheese out of your diet and replace it with a highly refined carbohydrate (not a good move for blood fats). Butter isn’t better than liquid oil. Butter raises LDL cholesterol. Some research suggests dairy fat might raise the large, less artery clogging LDL cholesterol compared to small dense LDL. However, “less artery clogging” does not mean “not artery clogging” and this area of the science needs more work before we can draw firm conclusions. Also, there are a few differences based on the type of food (milk, cheese, yogurt, butter); cheese reigns.

dairy and cheddar cheese

-> Cheese does not raise LDL as much as butter (accounting for total fat in each). In fact, several studies show cheese appears to have a “relatively minor” impact on LDL cholesterol or no impact at all. This could be due to the calcium content, which leads to the excretion of some fat or, fermentation may have an effect. Cheese stands out in the research.

-> Yogurt appears to have less of a cholesterol raising effect than expected. However this research is inconsistent possibly due to differences in the type of bacteria in the yogurt (aka probiotics). I recommend choosing one with “live and active cultures.”

– > Milk – when consuming the same amount of fat from whole milk or butter, both raise LDL to the same extent. Milk contributes substantially less total fat per amount consumed compared to full fat yogurt and butter. Cross-sectional studies suggest milk consumption doesn’t raise coronary artery disease risk, however, this may reflect lower total fat intake from milk compared to butter.

-> Cottage cheese –  this incredible food is oftentimes forgotten yet an excellent addition to your diet. I couldn’t find any studies on cottage cheese, however, the highest fat cottage cheese I could find  (4% milk fat) contained 5 g total fat per serving so we can expect the impact cottage cheese may have a lower impact compared to whole milk.

What Should You Do with this Information?

If your LDL is high, choose skim, 1% or low fat milk. Opt for a good quality yogurt with naturally occurring probiotics. As far as cheese goes – I’d take out all of the other offending foods and work on other aspects of heart health before ditching the cheese (unless your LDL is very high) and cottage cheese. However, always follow the dietary advice of your registered dietitian since there are many variables that should be taken into consideration.

What about the trans fats in dairy? They are good for you right? No. In large amounts, the trans fats in dairy have the same impact as those found in partially hydrogenated oil (not good for cholesterol, cardiovascular disease risk etc.). However, we don’t eat dairy trans fats in significant quantities (they make up very tiny amounts of dairy fat and beef fat).

Take Home Points

In general, dairy foods help lower blood pressure plus there is emerging evidence about the positive role dairy foods may play in metabolic syndrome. What about dairy fat? Consider the whole food and your diet overall so you can make the right choices based on your personal risk factors for cardiovascular disease. Also, keep in mind there are many factors that influence cardiovascular disease pathology, some of which are unrelated to cholesterol.

References

Tholstrup T, Hoy CE, Andersen LN, Christensen RD, Sandstrom B. Does fat in milk, butter and cheese affect blood lipids and cholesterol differently? J Am Coll Nutr 2004;23:169–76.

Hjerpsted J, Leedo E, Tholstrup T. Cheese intake in large amounts lowers LDL-cholesterol concentrations compared with butter intake of equal fat content. Am J Clin Nutr 2011;94:1479–84.

Biong AS, Muller H, Seljeflot I, Veierod MB, Pedersen JI. A comparison of the effects of cheese and butter on serum lipids, haemostatic variables and homocysteine. Br J Nutr 2004;92:791–7.

Nestel P. Effects of Dairy Fats within Different Foods on Plasma Lipids. J Am Coll Clin Nutr 2008, 27(6): 735S–740S.

Thorning TK et al. Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial. Am J Clin Nutr 2015.

Labonté MÈ et al. Dairy product consumption has no impact on biomarkers of inflammation among men and women with low-grade systemic inflammation. J Nutr 2014;144(11):1760-7.

Sjogren P et al. Milk-derived fatty acids are associated with a more favorable LDL particle size distribution in healthy men. J Nutr 2004;134(7):1729-35.

Hodson L, Skeaff CM, Chisholm WA. The effect of replacing dietary saturated fat with polyunsaturated or monounsaturated fat on plasma lipids in free-living young adults. Eur J Clin Nutr 2001; 55(10):908-15

Soerensen KV et al. Effect of dairy calcium from cheese and milk on fecal fat excretion, blood lipids, and appetite in young men. Am J Clin Nutr 2014;99(5):984-91.

Grebe A, Latz E. Cholesterol crystals and inflammation. Curr Rheumatol Rep 2013;15(3):313.

 

 

Is Saturated Fat Good for You?

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Though largely driven by misinterpretation of the science and cherry-picked population studies, the “Butter is Back” movement comes with very persuasive sound bites followed by arrogant punctuation marks. No wonder so many people hopped on board the bandwagon while looking back, pointing fingers and shouting “health professionals have been misleading us for decades!” Yet the flawed reasoning behind the pro-saturated fat movement comes with a hefty price tag – you could be making food choices that, over time, will increase your risk for cardiovascular disease and type 2 diabetes.

Here’s what I’ll cover in this article:

  • Why is there so much confusion about saturated fat?;
  • The science behind saturated fats, cardiovascular disease (diseases of the heart & blood vessels) and type 2 diabetes;
  • Best food choices for heart health.

Why is there so Much Confusion about Saturated Fat?

There are a few reasons for the confusion about saturated fat (fat that is solid at room temperature such as butter, shortening, coconut oil and the fat on meat) and misinterpretation of the science. First off, some people group all saturated fatty acids (saturated fatty acids make up saturated fat) together as a team. However, there are several types of saturated fatty acids. Some raise LDL cholesterol (the kind that contributes to clogged arteries and is a risk factor for cardiovascular disease) as well as HDL cholesterol (“good” cholesterol, the kind that removes bad cholesterol; SN: drugs that increase HDL do not lower risk of heart disease so there is some considerable debate regarding the role of HDL), others don’t raise LDL cholesterol and some we aren’t quite sure about. Secondly, using population-based studies alone to draw conclusions about saturated fat intake and heart disease is misguided.  These studies are not designed to determine cause and effect (that’s the job of well-designed clinical trials) plus, there are inherent issues with the methods used in many of these studies.  Nutrition research is not easy, especially in humans living their life (those not in a metabolic ward where all factors are controlled and measured including diet and physical activity).

Lastly, some research studies (and the media) take the results way out of context. So, here’s the lowdown based on sound science:

The Science Behind Saturated Fat, Cardiovascular Disease and Type 2 Diabetes

  • There is no dietary requirement for saturated fat. Your body can make all of the saturated fatty acids it needs.
  • Foods high in saturated fat typically increase total, HDL and LDL cholesterol. However, the impact dietary saturated fat has on increasing LDL-cholesterol (the kind that contributes to clogged arteries and an inflammatory cascade in arteries) may depend on the amount of polyunsaturated fat (PUFAs) in your diet (as well as the type of saturated fatty acids consumed).
  • In general, replacing saturated fat with polyunsaturated fat (and monounsaturated fat though there is less evidence for monounsaturated fat) reduces LDL and total cholesterol, both risk factors for cardiovascular disease.
  • saturated fat and cholesterolOverweight, obesity and insulin resistance may reduce the beneficial effects (lowered LDL cholesterol) generally noticed from a reduction in saturated fat intake. *If obese or overweight, losing excess body fat (regardless of the type of diet used to lose the weight) has powerful effects on lowering risk for cardiovascular disease, some cancers, and type II diabetes.
  • Food contains a complex mixture of compounds that may affect cholesterol and cardiovascular disease risk (it is not just the fat). The food “matrix” matters.
  • Many factors impact how a food affects cholesterol and blood lipids (fats) including fats eaten at the same time, overall diet, and carbohydrate intake (and type of carbohydrates consumed – high fiber vs. foods high in added sugar with few other nutrients).
  • There are individual, genetic differences in response to saturated fat intake – your cholesterol might shoot up after eating a diet containing a diet high in the type of saturated fatty acids that raise LDL cholesterol and I might be able to get away with this diet without a problem (blame your genetics or consider it an opportunity to open your taste buds to foods containing less saturated fat; particularly the kind that is artery clogging).
  • Certain saturated fatty acids, or a diet high in saturated fat, may increase risk for type 2 diabetes.

Best Choices for Heart Health

If you are overweight, focus on losing excess body fat. Even small amounts of fat loss will improve health and risk factors for cardiovascular disease. If you have high total and LDL cholesterol, swap foods high in saturated fat for foods high in polyunsaturated fat (liquid oils, nuts, seeds, olives, avocados). Minimize your intake of foods high in added sugars and refined, white flour, carbohydrates. Instead, choose higher fiber carbohydrates as often as possible.

Don’t get sucked into the media headlines written by journalists who could sell ice to an eskimo. Butter isn’t back (for good health anyway). The bulk of your fat intake should still come from foods that are higher in polyunsaturated and monounsaturated fats. However, food is a complex matrix of compounds and therefore, some foods higher in saturated fat may have little to no impact on cholesterol and therefore fit into your diet while contributing to your vitamin and mineral needs and providing plant-based compounds important for good health.

References

Tholstrup T, Hoy CE, Andersen LN, Christensen RD, Sandstrom B. Does fat in milk, butter and cheese affect blood lipids and cholesterol differently? J Am Coll Nutr 2004;23:169–76.

Nestel P. Effects of Dairy Fats within Different Foods on Plasma Lipids. J Am Coll Clin Nutr 2008, 27(6): 735S–740S.

Hodson L, Skeaff CM, Chisholm WA. The effect of replacing dietary saturated fat with polyunsaturated or monounsaturated fat on plasma lipids in free-living young adults. Eur J Clin Nutr 2001; 55(10):908-15

Soerensen KV et al. Effect of dairy calcium from cheese and milk on fecal fat excretion, blood lipids, and appetite in young men. Am J Clin Nutr 2014;99(5):984-91.

 

Sourdough – Safe for Gluten Sensitivity?

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There’s something special about sourdough bread. Made through a slow process that begins with simple ingredients, warm water and flour, yeast and bacteria feast on the flour’s carbohydrate, producing carbon dioxide gas and bubbles that expand the dough. Each batch may tastes a little different depending on the flour and water used as well as the environment the starter is made in. My favorite sourdough bread, the kind that is made over the course of several days, has an alluring pungent, slightly sour taste. This long fermentation process leads to more complex flavors while also creating bread that is easier for those with gluten sensitivity to digest. I shared the science behind sourdough in this segment on Fox TV:

What is Gluten?

Gluten’s stretchy fibers give dough it’s rubberband-like elasticity allowing it to stretch when pizza dough is tossed in the air like a frisbee. Gluten-rich dough traps air and water during the baking process so bread rises with delicate ease, producing light and fluffy baked goods. Without wheat (and therefore gluten, which is produced when wheat flour is mixed with water), gluten free items require a blend of flours, starches and additives yet they still can’t replicate the texture of gluten-containing baked goods.

In people with celiac disease, an autoimmune digestive disease, repeated exposure to gluten damages villi, fingerlike projections in the small intestine that help us absorb nutrients from food. Over time, a decrease in nutrient absorption can lead to anemia, osteoporosis, miscarriages and other complications. The University of Chicago Celiac Disease Center website lists over 300 symptoms associated with celiac disease though anemia is the most common symptom in adults. The only available treatment is a strict gluten free diet – which helps reverse intestinal damage over time. Gluten sensitivity is not an autoimmune disease but instead a vague medical condition without a uniform definition or diagnostic test at this time. People with gluten sensitivity report various symptoms triggered by the ingestion of gluten-containing foods including abdominal pain, bloating, and constipation or diarrhea. Though gluten sensitivity is real, someone who thinks they have sensitivity may actually be reacting to something other than gluten (another protein or the starches – see below under Is it the Gluten?)

Sourdough bread

The Science behind Sourdough

Standard yeast leads to a fast fermentation process. This ramps up production speed and it is also foolproof so companies can produce batches of bread at warp speed. Sourdough bread is made slowly, over time, letting the yeast work it’s magic to deliver an array of flavors as well as bread that is easier to digest. In one study, sourdough bread made with selected sourdough lactobacilli and long-time fermentation resulted in bread with gluten levels of 12 parts per million (ppm), which qualifies for gluten-free (anything below to 20 ppm is gluten free). A long fermentation process allows bacteria and yeast adequate time to feed on proteins and starches breaking them down into more digestible parts. Yet sourdough also boasts a lower glycemic index than many other types of bread (including white bread) and therefore it doesn’t lead to a quick spike in blood sugar levels.

In 2011, a small study conducted in Italy tried giving volunteers with celiac disease a small amount of specially prepared sourdough bread. The bread was fermented until the gluten was broken down to more easily digestible parts. The subjects in the study reacted well to the sourdough, with no changes in intestinal villi and no detectable antibodies typically found when a celiac disease patient eats a gluten containing food. According to the study authors, the bread “was not toxic to patients with celiac disease.”

In another study, conducted over 60 days, baked goods made from hydrolyzed wheat flour, manufactured with sourdough lactobacilli and fungal proteases, was not toxic to patients with celiac disease. Though these studies are groundbreaking, it is far too soon for celiac disease patients to try this at home. For sourdough bread to be an option for those with celiac disease, a uniform production process would need to be established to ensure the end product is gluten-free.

For those with Gluten Sensitivity, Is it Really the Gluten?

Some people may experience bloating and flatulence in response to FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). FODMAPs are a type of carbohydrates that are not well absorbed in the small intestine and are present in bread along with a number of other foods (other grains, some vegetables and fruits). In some people the problem may be FODMAPs, not gluten. The long fermentation process reduces FODMAPs.

How to Make Sourdough at Home

Sourdough starter begins with flour and water that sits for several days while being fed intermittently with both flour and water allowing bacteria (lactobacilli) and yeast to grow and multiply creating live cultures. These microorganisms are what makes the dough ferment similar to the way milk ferments to become yogurt. Check out these recipes to make your own sourdough bread: Healthy Aperture, the Perfect Loaf.

If you run into problems making sourdough check out this page for troubleshooting.

 

 

Are Low Carbohydrate Diets Best for Weight Loss?

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If you haven’t been bombarded with advertising for low carbohydrate foods, diets, plans and crazed anti-carbohydrate friends and coworkers in the past few years, you must be living on a remote island somewhere (taking any visitors?). The anti-carbohydrate, pro-fat crowd (including keto, Paleo, and Whole 30 – aka Paleo reinvented) devotees might be onto something. But that “something” isn’t a miraculous cure for obesity. Should you trade your low fat, higher carbohydrate diet for full fat foods and “bread” made from cauliflower and mozzarella cheese? It’s time to look past the media headlines to the latest research on low fat vs. low carbohydrate diets.

In this article I’ll cover:

  • the latest research on lower carbohydrate diets;
  • what this research means for you; and
  • a sidenote on the insulin hypothesis.

Should you switch to low carbohydrate vs. high carbohydrate foods?

The Latest Research on Low Carbohydrate Diets

In an attempt to determine which diet is best for weight loss, one of the latest studies collected and analyzed studies on low fat and low carbohydrate diets. A systematic review and meta-analysis, which combines the results of several studies, compared intervention studies > 1 year in length where participants were placed on low fat diets, low carbohydrate diets, other high fat dietary interventions or they continued eating whatever they wanted (their typical diet). Low fat diets ranged from  < 10% of calories from fat to < 30% of calories from fat. The diet interventions used ranged from providing instructions at the start of the study and expecting participants to follow the diet plan to regular counseling sessions with dietitians, food diaries and cooking lessons to actual feeding studies where participants were given most of their overall food intake (with the last approach the most well-controlled). Some studies coached participants to cut calories while others, including those put on low-carbohydrate Atkins-style diets, were told to eat until they were full without worrying about calories.

They analyzed results from 13 trials that examined weight maintenance as well as studies that didn’t include weight loss as a primary goal. In these studies low-fat and high-fat diets lead to a similar amount of weight loss. Low-fat diets were superior only when compared to the subjects’ normal diet – in other words actually going on a diet led to greater weight loss than not dieting (no surprise there). The tiebreaker came from an analysis of 35 weight loss trials, 29 of which were conducted using adults who were overweight, obese, or had type II diabetes. Overall, there was no difference between low-fat and high-fat diet interventions. Low-fat diets led to greater weight loss compared to groups who didn’t diet. However, higher fat diets were the clear winner (according to the headlines), leading to significantly greater weight loss after a year than low fat diets. Before tossing out your steel cut oatmeal, whole-grain bread and fresh Summer fruit, let’s take a closer look at this data. It was pulled from a comparison between low-fat diets and high-fat diets that varied by more than 5% of calories. So did low carbohydrate, higher fat diets really win or was it because subjects cut calories? Is it easier to cut calories on low carbohydrate, high fat diets? Participants on low carbohydrate diets lost about 2.2 pounds more weight after one year versus those on a low-fat diet. A 2.2-pound difference in weight loss after one year on a diet isn’t very impressive, especially considering many of the subjects were overweight or obese to begin with.

The End of Higher Carbohydrate, Low-Fat Diets?

Based on these results the authors suggest low-fat diets shouldn’t be the go-to recommendation for weight loss. However, the results of this study are mainly applicable to overweight, obese and type II diabetics – the primary populations examined in these studies. We can’t take the authors conclusion that low carbohydrate, higher fat diets are better if you are looking to lose a few pounds for a beach ready body. What works for an obese adult or type II diabetic will not necessarily work for an active adult who wants to get a 6-pack. Secondly, previous research shows low carbohydrate diets tend to produce greater weight loss, initially, than low fat diets (some of this is water weight since carbohydrates store 3-4 times their weight in water in the form of glycogen in muscles and the liver and your glycogen stores will start dropping when you drastically lower your carbohydrate intake) yet after a year, weight loss is equivalent between both diets. Other research shows weight loss over the first six months on a diet is the main predictor of both weight loss success and sticking to a diet over the long-term. Greater weight loss initially = better adherence = better success over time.

Long-term Success

What’s more disappointing than the paltry 2.2-pound difference between the low-fat and high-fat diets after one year is the total average weight loss in the studies designed for weight loss – a mere 8.25 lbs. after 1 year. Instead of declaring low carbohydrate, higher fat diets a clear winner over low fat, higher carbohydrate diets (especially considering the 2.2 pound difference), we should be asking why it’s tough to stay on a diet, any diet? Why aren’t study participants losing more weight? I don’t have the answer to these questions and leading weight loss researchers don’t seem to have a complete picture right now either.

If you want to lose weight, choose a lower calorie diet primarily based on high quality foods or create your own plan that fits into your lifestyle and is one you can stick with it. There are many diets that could, potentially, work for you. If you want to try a low carbohydrate diet for a while, by all means go for it (especially if you need to see that number on the scale move pretty quickly)! If cutting carbs sounds like being in detention, then skip that approach! I’m giving you permission to alter your plan as often as you need to based on changes in your lifestyle (some research papers actually suggest doing this and I am a huge fan of this approach), motivation, and results.

Conceptually, low carbohydrate diets are very easy. You don’t have to worry about portion sizes, log calories, count points or determine if you have to eat less at dinner to make up for a lunchtime splurge. Decision-making is boiled down to: it contains carbs and therefore off my diet or it is low in carbs and the carbs it does contain are high in fiber so I can eat it. Just don’t buy into the hype that low fat, higher carbohydrate diets are the only way to lose weight or that these diets are better, over the long term, than other dietary approaches that also cut calories.

References

Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Epub before print. 29 October 2015.

Greenberg I, Stampfer MJ, Schwarzfuchs D, Shai I; DIRECT Group. Adherence and success in long-term weight loss diets: the dietary intervention randomized controlled trial (DIRECT). J Am Coll Nutr 2009;28(2):159-68.

Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W, Bowman JD, Pronk NP. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 2007;107(10):1755-67.

Hall KD. Predicting metabolic adaptation, body weight change, and energy intake in humans. Am J Physiol Endocrinol Metab 2010;298(3):E449-66.

Hall KD, Sacks G, Chandramohan D, Chow CC, Wang YC, Gortmaker SL, Swinburn BA. Quantification of the effect of energy imbalance on bodyweight. Lancet 2011; 378(9793).

Rosqvist F, Iggman D, Kullberg J, Cedernaes J, Johansson HE, Larsson A, Johansson L6, Ahlström H, Arner P, Dahlman I, Risérus U. Overfeeding polyunsaturated and saturated fat causes distinct effects on liver and visceral fat accumulation in humans. Diabetes 2014;63(7):2356-68.

 

 

 

Can You Lose Fat and Gain Muscle at the Same Time?

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Eat fewer calories than you burn each day and you’ll lose weight. There’s one major issue with this time-tested approach: you’ll probably strip away more than just body fat. Weight loss, especially fast weight loss, achieved after crash dieting or drastically slashing calorie intake, leads to a decrease in muscle mass and subsequent drop in metabolism. A slower metabolism means your body needs even fewer calories to maintain your new weight (weight loss alone = fewer calories needed to carry around a smaller body, add muscle loss and your calorie needs drop even more). In addition, with less muscle you won’t be able to push yourself as hard during workouts (and therefore burn as many calories). This can put you on the fast track to yo-yo dieting, weight loss and regain. There’s a much better approach and a recently published study highlights how you can lose body fat and gain muscle at the same time.

crash dieting leads to muscle loss

In this article I’ll cover:

  1. How dieting can slow your metabolism;
  2. The latest evidence on losing fat and building muscle at the same time;
  3. Why researchers didn’t use a low carbohydrate diet;
  4. How you can keep the weight off.

How Dieting Slows Your Metabolism

When you eat fewer calories than you need each day, your body is forced to pull from its backup supply, body fat and muscle, to maintain your energy (calorie) needs. Some people lose a substantial amount of muscle when dieting, 30% or more, of their initial muscle mass. In addition to a decrease in muscle mass and slower metabolism, lower calorie diets decrease the intracellular signaling necessary for the synthesis of new proteins in muscle. Plus, muscle tissue may be less sensitive to protein when you’re dieting. In other words, it’s really tough to build muscle when dieting to lose weight. Based on these physiological changes, there’s an age-old theory suggesting it’s impossible to gain muscle and lose fat at the same time. However, scientists from McMaster University in Canada found it is not only possible but also, doable even when losing a substantial amount of body fat in a relatively short period of time.

Building Muscle While Losing Body Fat

In the McMaster University study, young overweight recreationally active men (prior to the study they exercised 1-2 times per week) were placed on an intense four-week diet and exercise program. Their diet contained 40% fewer calories each day than needed for weight maintenance. All meals were prepared and provided to participants during the study. The men were randomly selected for one of two diet groups:

  Higher Protein Group

 

Lower Protein (Control Group)

 

Total daily calorie intake 15 calories per pound of lean body mass 15 calories per pound of lean body mass
Macronutrients 35% protein, 50% carbohydrate and 15% fat 15% protein, 50% carbohydrates, 35% fat
Total daily protein intake 1.09 grams of protein per lb. body weight (2.4 grams of protein per kg) 0.55 grams of protein per lb. bodyweight (1.2 grams of protein per kg) – 2x the RDA (0.8 g/kg) for protein

 

Per meal protein intake 0.22 grams of protein per lb. of body weight

 

0.10 grams of protein per lb. of body weight

 

Dairy shakes 3- 4 / day including one after exercise (depending on body weight; higher protein, lower carbohydrate shakes compared to the Lower Protein Group)

 

3- 4 / day including one after exercise (depending on body weight; lower protein, higher carbohydrate shakes compared to the Higher Protein Group)

 

Training Program
Supervised workouts consisted of full-body resistance circuit training twice per week and high intensity interval training six days per week. In addition to their structured exercise program, all participants were instructed to get at least 10,000 steps per day as monitored by a pedometer worn on their hip.

Resistance Training Circuit
2 times per week
3 sets of 10 reps at 80% 1 RM with the last set of each exercise to failure
No rest between sets
1-minute rest between each circuit

Sprint Interval Training
1 time per week
Four to eight 30-second bouts on a stationary bike (participants started with four sets and progressed to eight sets)
4 minutes rest between bouts

Modified High Intensity Interval Training
1 time per week
10 bouts of all-out sprint for one minute at 90% VO2max
1-minute rest intervals at 50% VO2max

Time Trial
1 time per week as fast as possible until approximately 250 calories were burned

Plyometric bodyweight circuit
30-second rest between exercises

Results
Both the lower protein and higher protein groups lost weight with no significant difference between groups. Men in the higher protein group gained 2.64 lbs. of muscle and lost 10.56 lbs. of body fat while men in the control group gained little muscle (0.22 lbs.) and lost 7.7 lbs. of fat. Both groups improved all but one measure of strength in addition to aerobic and anaerobic capacity. There were no differences between groups in strength, power, aerobic fitness or performance at the end of the study.

In this study, a higher protein, reduced calorie diet combined with a high intensity circuit-training program including interval training and sprints helped participants build muscle. In addition to their total protein intake, participants in the higher protein group also consumed more protein per meal (approximately 49 grams per meal) than those in the lower protein group (approximately 22 grams per meal).

Why Didn’t They Cut Carbohydrates?

Low carbohydrate diets are not only popular, but they may lead to greater weight loss (in overweight and obese individuals), initially, than higher carbohydrate, low fat diets (some of this is water weight). However, when giving up carbohydrates you also sacrifice something else, intense training. Carbohydrates are the primary source of fuel used during high-intensity exercise because your body can readily access and utilize them for energy. Fat is a slow source of energy and therefore, your body cannot access and use fat quickly enough to sustain high intensity training. In this study, both groups of participants consumed 50% of their calorie intake from carbohydrate. If the study authors cut carbohydrates, the participants wouldn’t make it through their high intensity training program that was specifically designed to take off fat and increase muscle mass.

Keeping the Weight Off

Consider a program like the one used in this study a short-term jumpstart. It isn’t sustainable over a long period of time. The transition to a longer-term approach after weight loss should include a gradual increase in calorie intake while maintaining a higher protein diet (at least 0.55 grams of protein per lb. of body weight to maintain muscle while considerably more, along the lines of 1.09 – 1.41 grams of protein per lb. of body weight may be necessary to continue building muscle during periods of reduced calorie intake). This gradual increase in calorie intake is important because substantial weight loss results in a slower metabolism even if you maintain or build muscle during your jumpstart weight loss program. It isn’t entirely clear why this happens and the drop is greater than scientists can predict based on a decrease in muscle mass. Even if you build some muscle, this won’t rev fire up your metabolism to make up for a drastic decrease in body weight.

One pound of muscle burns a measly 5.9 calories per day at rest while a pound of fat burns 2 calories per day at rest.

Greater weight lost while dieting means an even greater drop in metabolism – something dieters must account for so they can maintain their new weight.

In addition to slowly increasing calorie intake and consuming a higher protein diet, each meal should contain at least 25 – 30 grams of protein. We don’t know the exact amount of protein per meal needed to maximally stimulate muscle building.

Your exercise regimen should continue to include resistance training and you’d be wise to continually vary your training program. Be sure to move each day as well. Research shows many people naturally adjust to greater amounts of aerobic exercise by decreasing their activities of daily living. They exercise intensely at the gym and then sit the rest of the day. Circumvent this by using one of the many devices that counts steps each day. Also, consider doing more work around your house including cleaning, mowing your lawn, gardening, and washing your car. Get moving and stay moving all day long.

If you want to get rid of your love handles while building a six-pack at the same time, combine an effective resistance training and high intensity interval-training program with a reduced calorie, higher protein diet. Your diet and exercise program does not need to be as rigorous as the one in this study. Instead, you can adjust the McMaster University approach to fit your lifestyle, though your results may take more time. Once you reach your goal weight, slowly transition your training program and diet to an approach you can live with.

References
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;68:375–88.

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 2006;36(3):239-62.

Heymsfield SB, Gonzalez MCC, Shen W, Redman L, Thomas D. Weight Loss Composition is One-Fourth Fat-Free Mass: A Critical Review and Critique of This Widely Cited Rule. Obes Rev 2014; 15(4):310–321.

Deurenberg P, Weststrate JA, Hautvast JG. Changes in fat-free mass during weight loss measured by bioelectrical impedance and by densitometry. Am J Clin Nutr 1989;49(1):33-6.

Johannsen DL, Knuth ND, Huizenga R, Rood JC, Ravussin E, Hall KD. Metabolic Slowing with Massive Weight Loss despite Preservation of Fat-Free Mass. J Clin Endocrinol Metab 2012; 97(7): 2489–2496.

Ravussin E, Bogardus C. Review Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilization. Am J Clin Nutr 1989; 49(5 Suppl):968-75.

Phillips SM. A Brief Review of Higher Dietary Protein Diets in Weight Loss: A Focus on Athletes. Sports Med 2014; 44(Suppl 2): 149–153.

Longland T, Oikawa SY, Mitchell CJ, Devries MC, Phillips S. 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;103:738-46.

Heydari M, Freund J, Boutcher SH. The effect of high-intensity intermittent exercise on body composition of overweight young males. J Obes 2012;2012:480467.

Areta JL, Burke LM, Camera DM, West DW, Crawshay S, Moore DR,Stellingwerff T, Phillips SM, Hawley JA, Coffey VG. Reduced resting skeletal muscle protein synthesis is rescued by resistance exercise and protein ingestion following short-term energy deficit. Am J Physiol Endocrinol Metab 2014;306:E989–97.

Pasiakos SM, Vislocky LM, Carbone JW, Altieri N, Konopelski K, Freake HC, Anderson JM, Ferrando AA, Wolfe RR, Rodriguez NR. Acute energy deprivation affects skeletal muscle protein synthesis and associated intracellular signaling proteins in physically active adults. J Nutr 2010;140:745–51.

Hector AJ, Marcotte GR, Churchward-Venne TA, Murphy CH, Breen, von AM, Baker SK, Phillips SM. Whey protein supplementation preserves postprandial myofibrillar protein synthesis during short-term energy restriction in overweight and obese adults. J Nutr 2015;145:246–52.

Murphy CH, Churchward-Venne TA, Mitchell CJ, Kolar NM, KassisA, Karagounis LG, Burke LM, Hawley JA, Phillips SM. 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:E734–43.

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How Much Protein Can Your Body Use from One Meal?

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Steak is a high protein meal

How much protein can your body digest and use at a time? If you you eat the right amount of protein at every meal you’ll supposedly hit the sweet spot – maximum muscle growth and satiety (fullness) without wasting food or money. General guidelines based on short term trials and one cross-sectional study suggest adults need regular meals including 25 – 45 grams of protein per meal to maintain or build muscle mass and maximum strength (1, 2, 3). However, it is possible that more protein per meal may be beneficial in some instances while the per meal amount might not matter very much in others. Your body can and will digest all of the protein you eat in a sitting (it might take a while) and it doesn’t just discard any excess that isn’t used to build structures in the body.

In this article I’ll cover:

  1. Why should we focus on a “per meal” dose of protein?
  2. What happens to “leftover” protein;
  3. What influences protein requirements;
  4. How you can estimate your protein needs.

Does the Amount of Protein Per Meal Matter?

In a really cool study conducted by well-known protein scientists, the minimum amount of protein per meal found to maximally spike muscle growth was 0.11 grams per lb. of body weight in younger adults and 0.18 grams per lb. of body weight in older adults (over 71 years of age) (2). Older adults need more protein due to a decline in muscle response to protein intake that occurs with age. In addition to a minimum, there is an upper limit of protein intake; anything beyond this threshold dose will not be used to build muscle. For example, one study examined 4 ounces of beef containing 30 grams of protein compared to 12 ounces of beef containing 90 grams of protein. The larger serving did not lead to a greater increase in acute muscle protein synthesis compared to the 4 ounce serving (4). So now we know we need some protein, but not 90 grams in one sitting. However, we still don’t know what the minimum upper limit is, beyond which higher intakes do not lead to increases in muscle mass or muscle functioning over time (5).

More evidence for a per meal dose came from a short-term study that found an even pattern of high quality protein at each meal (30 grams per meal; 1.2 g/kg for the day) as opposed to a skewed pattern (10 grams at breakfast, 15 g lunch and 65 g at dinner; 1.2 g/kg for the day) may be best for maximally stimulating muscle building in young adults (1).

Despite the evidence in favor of an even distribution of protein intake throughout the day, a short-term study in older, resistance trained adults given 2x the RDA – 0.68 grams of protein per lb. bodyweight (1.5 grams per kg) per day in an uneven or even pattern (see chart at the end of this article) or the RDA of 0.36 grams of protein per lb. bodyweight (0.8 grams per kg) per day again in an uneven or even pattern found the pattern of intake didn’t matter. Consuming 2x the RDA, regardless of whether it was consumed in an uneven or even pattern, led to a significantly greater increase in muscle protein synthesis compared to consuming 1x the RDA. The pattern of protein intake didn’t matter, possibly due to age-related decline in muscle response to protein intake,  greater total daily protein intake or some other factor (6).

What Happens to Excess Protein Intake?

There is no long-term storage site for amino acids, the building blocks of protein. After eating a thick juicy steak, creamy bowl of split pea soup or sizzling soy fajitas, your body digests the protein and absorbs the amino acids, using them to build new structures, including muscle. When excess protein is consumed, more than the body needs at that point in time, the rest is used for energy or  converted to body fat. The nitrogen (from amino acids) is combined with other compounds to form urea, a harmless waste product, which is processed by the kidneys and excreted in the urine.

What Influences Protein Requirements?

Though 90 grams in one sitting may be more than necessary for muscle, science has yet to figure out the exact threshold beyond which there is no benefit for muscle. This is a complicated question as there are many factors that influence a person’s daily protein needs as well as how much protein a person may need at each meal. These include but are not limited to: age, training status, total daily calorie intake (if dieting total protein needs are higher), overall amount of protein consumed each day; the type (anti-nutrients?), quality and leucine (or EAA) content of the protein consumed at each meal, other nutrients consumed at meal time, training program, lean body mass, health status and goals.

How Much Protein Do You Need at Each Meal?

Given the research to date, does a per meal does matter?

If you are dieting, yes.

If you don’t get at least 0.55 grams protein per lb. body weight (1.2 grams per kg), yes.

If you eat plenty of protein every day and a decent amount at regular meals throughout the day, it might not matter that much, or at all.

For now, stick to the general guideline of at least 25 grams per meal (the amount of an average female’s palm worth of chicken, turkey, red meat, fish). You may need more, per meal, to maximize muscle growth and repair  if:

  • You are older (relative term since we don’t know exactly what age qualifies as “older). Aim for 1.0 – 1.5 grams of protein per day (7) and regular meals with a good amount of protein per meal. If you have chronic kidney disease, follow the advice of your RD and MD.
  • You eat primarily vegetarian proteins.

Many factors influence a person’s nutrition needs. If you want to maintain or gain muscle mass and strength, concentrate on your total daily protein intake (at least 0.55 grams of protein per lb. of bodyweight; 1.2 grams per kg) followed by how much you consume at each meal. There is no one-size-fits-all ideal protein intake per meal and the body doesn’t just “waste” protein that isn’t used for muscle building. For now, research suggests 25 to 45 grams per meal is a good general guideline. More may be better for muscle. Less may be necessary if you have chronic kidney disease.

Table: Quantity of dietary protein intake, but not pattern of intake, affects net protein balance primarily through differences in protein synthesis in older adults (select data and average leucine intake calculated)

Amount Pattern Meal Protein (grams) Protein as a % of total calories Average leucine intake per meal (calculated)
1x RDA Uneven Breakfast 11.1 8 0.89
Lunch 14.9 8 0.89
Dinner 47.8 12 3.56
Total 73.7 10 4.45
Even Breakfast 22.3 15 1.63
Lunch 21.5 9 1.63
Dinner 22.0 9 0.81
Total 65.8 11 4.07
2x RDA Uneven Breakfast 18.1 15 0.80
Lunch 24.3 12 1.60
Dinner 78.4 22 4.79
Total 120.8 19 7.99
Even Breakfast 38.0 25 2.98
Lunch 36.5 17 2.98
Dinner 37.9 18 2.23
Total 112.4 19 8.2

References

1 Mamerow MM, Mettler JA, English KL, Casperson SL, Arentson-Lantz E, Sheffield-Moore M, Layman DK, Paddon-Jones D. Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults. J Nutr. 2014 Jun;144(6):876-80.

2 Moore DR, Churchward-Venne TA, Witard O, Breen L, Burd NA, Tipton KD, Phillips SM. 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.

3 Loenneke JP, Loprinzi PD, Murphy CH, Phillips SM et al. Per meal dose and frequency of protein consumption is associated with lean mass and muscle performance. Clin Nutr 2016 Apr 7.

4 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):1582-6.

5 Deutz NE, Wolfe RR. Is there a maximal anabolic response to protein intake with a meal? Clin Nutr 2013;32(2):309-313.

6 Kim IY, Schutzler S, Schrader A, et al. Quantity of dietary protein intake, but not pattern of intake, affects net protein balance primarily through differences in protein synthesis in older adults. Am J Physiol Endocrinol Metab 2015;308(1):E21-8.

7 Paddon-Jones D, Campbell WW, Jacques PF, Kritchevsky SB1, Moore LL, Rodriguez NR, van Loon LJ. Protein and healthy aging. Am J Clin Nutr 2015 Apr 29.