Today’s blog assesses the research that has specifically compared any kind of fasting regime (intermittent-calorie-restriction) to the typical dieting approach (constant-calorie-restriction) on weight loss.

While there are multiple studies of intermittent fasting in the literature most have not looked at weight loss as an outcome (most are studying biomarkers of cardiovascular disease or longevity), and many have no control or comparison group. So, we have only three studies in the published literature that have actually compared weight loss between constant-calorie-restriction and intermittent-calorie-restriction groups.[i]^,[ii],[iii]

In all three studies the outcome was the same: No significant differences in weight loss, or changes in body composition.

The Bottom Line: Intermittent Fasting isn’t a magic bullet for weight loss. Granted (as long as overall calorie-restriction is equal), it is just as effective as other approaches to calorie restriction. Fair enough, however, there’s no data on anyone using Intermittent Fasting for weight maintenance.

If you are considering trying intermittent fasting, I suggest the following questions:

1. Will Intermittent Fasting be easier to follow than other forms of calorie restriction for me, and why?
2. Can I see myself using this as permanent lifestyle change?
3. If not, how do I propose to maintain my weight loss?

There's an endless number of wackadoodle diets out there, and they mostly work—for as long as you are able to follow them. In the long run however, permanent lifestyle changes are needed in order to maintain one's weight loss. That's why I advocate beginning with the end in mind. If you approach weight loss as a lifestyle change you will essentially be practicing the same behaviors (needed for weight maintenance) during the period you are losing weight. It's boring, it's not new, but it is realistic.

All the Best!
-Dorene

PS--if you like this blog you may also like my book: The NEW Healthy Eating & Weight Management Guide.

i] Harvie MN, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int J Obes 2011;35(5):714-727.

[ii] Hill JO, et al. Evaluation of an alternating-calorie diet with and without exercise in the treatment of obesity. Am J Clin Nutr 1989;50:248-254.

[iii] Arguin H, Dionne IJ, et al. Short- and long-term effects of continuous versus intermittent restrictive diet approaches on body composition and the metabolic profile in overweight and obese postmenopausal women: a pilot study. Menopause. 2012 Aug;19(8):870-6.

Federal law requires that the Nutrition Facts label accurately reflects the nutritional profile of the food product. The bakery has to fix its mislabeling problems before the FDA will lift the injunction. In order to comply the company can either change the label, reformulate the food-items, or both.

You may have never thought about questioning the accuracy of a Nutrition Facts label. The truth is however, that we all depend on the honesty of businesses to accurately label their food products. Why? Because according to Federal regulations, “There is no required oversight of Nutrition Fact information for packaged food BEFORE [emphasis added] distribution for sale.” [i]

What’s more, it’s FDA’s Food Safety division that is tasked with nutrition label oversight, a division that has long been under-funded and must prioritize its resources based public health risk. Mislabeling issues that pose risk include foods that fail to label known allergens (i.e. peanuts, eggs, shellfish, etc.), or certainly if they claim to be sugar-free (and therefor appealing to diabetics). Mislabeling that makes products appear to have less calories, fat, carbs etc. (errors that don’t pose a health risk), are unlikely to get FDA attention.

It should be no surprise then that more often than not it’s a consumer, or consumer watchdog investigation, that brings a potentially mislabeled product to the attention of the FDA.

You’ll notice that Butterfly Bakery had a detailed warning from FDA almost two years ago--time enough one would think to get things right. I saw a similar situation in 2001 with a cookie company is Bellingham WA (Baker’s Breakfast Cookie; Erin Baker's). Several independent laboratory analyses showed that their cookies were mislabeled and actually had 100- to 200-calories more (per cookie) than the labels said. Needless to say the cookies were flying off shelves and the company could barely keep up with demand. The problem with Baker’s labels was twofold: the cookies weighed a half ounce more than they were supposed to (3.5 instead of 3 ounces), and the calories-per-serving (3 ounce cookie) was also understated by around one third. Two years after Baker's was first informed of their mislabeling problems (and after reformulating and relabeling their cookies) their labels were found to still be significantly off in analyses the Seattle Times had done (the two types of cookies analyized still had 40% more calories than the label claimed). Today Erin Baker’s cookie’s labels have the lowest calories by weight (per gram/ounce) of the dozens of cookies I checked on www.calorieking.com. [See Calories of Baking Ingredients for more insight on calories in baked goods.]

Over the past 20 years only a handful of studies have looked at the accuracy of food labeling.  While most labeling is accurate, it's not too hard to find problems.

Most recently (2010) researchers reviewed 29 restaurant entrees/side-dishes and 10 grocery store frozen foods. The study focused on items labeled as low-calorie. “The measured energy [calorie] values of the restaurant foods averaged 18% more than their stated values. So a 500-calorie entrée would actually ring in at 590-calories. However, some individual restaurant items contained up to 200% of stated values and, in addition, free side dishes increased provided energy to an average of 245% of stated values for the entrée they accompanied.” The measured calorie content of the supermarket-purchased meals was greater than stated values, but only by 8%.[i]

Understated item weights—automatically lead to understated calories for single serving baked goods (cookies, muffins and brownies). This may well be the most common mislabeling issue. “Nearly one third (6 of 19) of the sampled packages weighed at least 1 ounce more than was stated on the label” in a small 1995 study of single-serving baked products.[ii]

Since these kinds of items run between 100 and 150-calories per ounce the error introduced when you’re trying to accurately track your calorie intake is frustrating—especially if it’s an item that you are eating regularly.

Federal law allows a food item’s actual weight to exceed what’s stated on the food label by 20% (allowable range: 99% to 120%). Legislators believed that companies would naturally stick closely to the stated weight (as a matter of cost savings).  

In another small study researchers analyzed 20 national brand foods, 12 regional brands and 8 locally produced products. The national brands averaged just 2.18% more calories than stated in their labels. Regionally distributed foods averaged 25.2% more energy than labeled and the locally produced items averaged 85.4% more energy than stated.[iii]

Based on this limited data it seems likely that you can generally trust the nutrition information on national brands—their actual content tends to be very close to what the labels say. This makes sense in that big operations, with quality controls (that carefully watch expenses) produce these items.

On the flip side, inaccuracy is higher in regionally produced and labeled brands and worse still in locally labeled foods likely because their production operations (like restaurants) are more human-labor and less mechanized.

So what’s a consumer interested in accurate calorie counts to do?

1. Be skeptical—if the calorie count on a food item seems too good to be true it very well may be! Compare it to other similar foods (www.calorieking.com).
   
   
2. If you buy single serving baked goods weigh them (using a digital kitchen scale) to see if the actual weight matches the label. If it’s over the labeled weight than it’s more than one serving. Next check to see if the calories per serving are plausible: divide the stated calorie amount by the serving size (usually this is in grams). Muffins and cake should be about 3.5 calories per gram (so about 100 calories per ounce). Cookies or brownies should be about 4.9 calories per gram (so about 140 calories per ounce). [1 ounce = 28.35grams]
   
   
3. In restaurants make sure you account for all extra sides, beverages, bread etc. in addition to the calories of the entrée.
   
   
4. Practice makes you a better estimator when you need to be. The more you weigh, measure and track your intake the better you will be at accurately estimating portion sizes. Most of the error in tracking calorie intake comes from underestimating the portion size, or forgetting things (sides, snacks or beverages, etc.).

Your questions or comments are welcome!
-Dorene

Of Further Interest: Some Media reports of mislabeling

2013 – How Accurate are chain restaurant calorie counts? [added 27APR13]

2013 – Potato chips mislabeled Gluten Free…

2013 – Mislabeled fish a national problem

2011 – With Faulty Food Labeling, Who's Minding the Store?

2010 – Nutrition Label Accuracy

2008 – Nutrition Bars (Energy Bars, Fiber Bars, Protein Bars, Meal Replacement Bars, Snack Bars and Whole Food Bars).

2005 – Consumer.lab.com Reports on Nutrition Bars: Highlights Major Differences, Inaccuracies, and Urges Consumers to "Know Your Bar".

2003 – Seattle Times – Cookies’ true calories may dismay diligent dieters.

2003 – Heart Associatioin Praised for 'Laura's Lean Beef' Crackdown

2002 – Woman Seeks $50 Million in Damages Caused by Mislabeled Fat Content.

2002 – Can you judge a bar by its wrapper? J Am Diet Assoc. 2002;102(2):180.

2002 – Low-Carb Bars Aren’t What You think They Are

2001 – Sixty percent of nutrition bars fail to meet claims in Consumerlab.com tests—“Low Carb” Bars Often Loaded with Carbohydrates; excess sodium and Saturated Fat also found.

2001 – I Scream, You Scream… Our Position: It’s Too Bad That The Ice Cream Was Too Good To Be True. Orlando Sentinel; June 20, 2001.

1996 – The Case of the Missing Calories. Vegetarian Times. 1996 Oct. pg. 32-34.

1996 – FDA found food labels mostly accurate

1992 Consumer Reports – Lowfat frozen desserts: better for you than ice cream? 1992;57(8):483-487.

1992 CBS This Morning – Special segment: Study of soft-serve frozen dessert. Diaz A. CBS September 19, 1992.

1989 New York Times – Soft-serve desserts: how low in calories? Burros M. NYTs August 9, 1989:C-1.

[i] Urbain LE, et al. The Accuracy of Stated Energy Contents of Reduced-Energy, Commercially Prepared Foods. J Am Diet Assoc. 2010;110:116-123.

[ii] Young LR, et al. Food labels consistently underestimate the actual weights of single-serving baked products. J Am Diet Assoc. 1995;95(10):1150-51.

[iii] Allison DB, et al. Counting Calories—Caveat Emptor. JAMA 1993;(270):1454-56.

There are multiple possible time frame variances among these protocols, including:
a) limiting eating to the same 8-hours daily,
b) an alternating pattern of under- and over-eating days,
c) having two fasting days per week and eating normally the other 5 days,
d) having regular splurge days (in the middle of stretches of calorie restriction), and on and on.

Some authors even suggest you can splurge and eat as much as you want of whatever you want, on the non-fasting days and still lose weight. That’s the kind of promise that causes diet books to fly off shelves!

Traditionally, fasting has been considered primarily the act of willingly abstaining from all food, drink, or both, for a period of time. Alternately—and what is recommended by most these diets—is eating only sparingly (just 500 to 600 calories) on “fasting” days, and sometimes eating only certain kinds of foods on “fasting” days.

History - Fasting of course has been around for centuries, and is commonly used at different times of the year in religious observances. Various kinds of fasting regimes (i.e. "juice fasts," etc.) are sometimes advocated in alternative medicine. Within the field of weight management very-low-calorie “liquid diets” are often referred to as “fasting” as well.

The roots of this new genre of "fasting" diet seem to spring from longevity research showing that long-term calorie restriction (eating only about 75% of normal) improves health and lengthens lifespan. While it’s true that long-term calorie restriction does wonders for worms, flies, yeast and mice, in fact there’s almost no research on humans in this area.

Many of these diet book authors tout a magical metabolic shift to “burning fat” as a result of these plans. Such a shift however is the natural result of calorie restriction in general, and not the method of under-eating used to create a calorie deficit.

Your body is an energy burning machine. Carbohydrate, fat and protein (and alcohol) are fuel sources to your body, which is always burning BOTH carbohydrate and fat (and even a small amount of protein). The ratio of carb:fat oxidation varies depending on multiple factors, including: a) when your last meal was, b) what you ate (balance of carbs/fat/protein), c) have you been sitting on the couch, or did you just finish a 5K, d) whether you’re currently in energy “deficit” or “overage,” and myriad other biological-based nuances.

How does your body decide what fuel to burn? Upon ingestion it preferentially increases the oxidation of fuel(s) it has the least ability to save/store for later use. The first two of those fuels are alcohol and protein. Next is carbohydrate; although you are able to store some carbohydrate (as glycogen) in your muscles and liver, your body still increases oxidation of carbohydrate as it becomes available.

So in the end, upon ingestion/digestion, your body preferentially burns fuel in this order: Alcohol>Protein>Carbohydrate>Fat

Note that we are also burning a small smount of protein (relative to CHO and FAT) all the time. The protein which is being oxidized is believed to be the quantity available--over and above--that currently needed for other physiological requirements. The greater the percentage of energy from protein (or total protein) we ingest, the more protein gets oxidized this way.[viii]

Remember however, that you’re also always burning a ratio of carb:fat. Fat oxidation simply reduces when the oxidation of other fuels increases. So by default your highest level of fat oxidation occurs on an empty stomach (when you’re relaxed on the couch or sleeping) after the other fuels have been cleared.

Ultimately the only way to reduce your fat stores (excess body fat) is to sustain a long-term energy deficit which forces your body to continue to draw on stored fat for energy. It doesn’t matter what type of calorie-restriction scheme is employed to get there (at least not from an energy metabolism perspective; overall health is another important conversation). [For a more thorough discussion of human energy metabolism see: When is a Calorie Not a Calorie?]

Another claim the authors of these regimes make is that their methods prevent your metabolic rate from having the usual (normal) drop associated with sustained energy restriction. The notion they present is that by alternating calories on different days you trick/confuse your body so that it doesn’t notice the ongoing/overall calorie-restriction. It’s a great claim, but there’s NO data supporting it. In fact the only studies in the medical literature that have actually looked at rotating calories between various levels found neither an enhanced weight loss effect, or any beneficial effect on metabolic rate.[i],[ii],[iii]

The suppression in metabolic rate related to calorie restriction is strongly tied to the magnitude of (sustained) calorie restriction. Inexplicably, suppression of metabolic rate doesn’t happen to everybody.[iii] So these studies [i, iii] finding no difference (in RMR changes) between groups eating the same total weekly calories, but one group alternating between high and low days, suggests that it’s harder than we think to outsmart Mother Nature!

What should be obvious is that the real challenge people have with diets is that they’re hard to follow for very long! Any (reduced calorie) diet will lead to weight loss IF you stick to it. The question we should be asking is, “are these intermittent/alternate day fasting regimes easier to follow than other diets?” I don’t find any evidence, or hypothetical reason, to suggest that that might be the case.

Of six published human trials on intermittent fasting and alternating calorie diets in the medical literature only one tracked hunger[ii], three tracked resting metabolic rate (RMR)[i, ii, iii], and two tracked fuel oxidation[i, ii]. A couple studies only looked at markers of cardiovascular health (in addition to weight loss).[iv],[v],[vi]

In the trial that tracked hunger [ii], the authors wrote: “Hunger increased on the first day of fasting and remained elevated” (for the 3 week study). This study had two “fasting” days a week, and 5 normal eating days (no overeating). That arrangement set participants up for a weekly weight loss of a bit more than a pound, which overeating days would quickly have eroded. I think it’s fair to say that if you’re hungry ALL the time, the diet won’t be easy to stick to.

In the same study, “RQ did not change significantly from baseline to day 21.” RQ (respiratory quotient) measures the balance of carb:fat oxidation. Fat oxidation in the study did finally increase on day 22 by 15g/d. As I said earlier however, that shift is the natural result of calorie restriction in general, and not the method of under-eating used to create a calorie deficit. In the study by Hill (which included a comparison group), there was no difference in weight or body fat losses between the constant or intermittent calorie-restriction groups.

Ignoring the elephant in the room?

Despite lots of misinformation and mythology to the contrary weight loss comes down to “calories-in/calories-out” as noted in the first sentence of the recent position paper from the American Society for Nutrition, “Human physiology complies with the first law of thermodynamics…”[vii]

Nevertheless, it's also true that there is always somebody that does well on a particular diet. That’s what leads to the well known “results not typical” advertising disclaimer required by the FTC on the inspiring testimonials that are the backbone of weight loss advertising.

Things worth thinking about:

One of the concerns professionals voice about some of these regimes is that they may actually encourage binging and/or disordered eating by over selling the notion of overeating days.

Another concern is that some of these regimes seem to encourage an unhealthy (anything goes) diet on non-fasting days. It should be obvious that the quality of what you eat becomes MORE (not less) important if/when you’re consuming less total calories. Furthermore, such eating would probably obliterate any calorie deficit created on fasting days. That might explain why I saw more than a few (book) reviewers complaining of no weight loss after several weeks.

Having worked with patients in medically-based fasting programs I know that many people initially do very well. Compliance to any diet however is generally short-lived (because our environment and busy lives don't naturally support restricted eating plans). Non-compliance (cheating) usually starts early and continues to escalate until people throw in the towel. Unfortunately they usually blame themselves instead of the silly diet they were trying to follow.

The Bottom Line: If you want success with your weight and health the tried and true approach is to learn how to eat in a healthy way and in healthy amounts. My best advise is to start where you are at, and look for "easy changes" to improve the quality of your diet. Forget "going-on-a-diet," instead approach it as a lifestyle change. It would also help a lot to understand more about how your body works. Here are some links that can help you get started:

• The Game of Weight Loss has Rules
• 5 Things You Need to Know about Protein for Healthy Weight Loss
• Manage Yourself to Success!

All the Best!
-Dorene

PS--if you like this blog you may also like my book: The NEW Healthy Eating & Weight Management Guide.

[i] de Groot LC, et al. Adaptation of energy metabolism of overweight women to alternating and continuous low-energy intake. Am J Clin Nutr 1989;50(6):1314-23.

[ii] Heilbronn LK, et al. Alternate-day fasting in nonobese subjects: effects on body weight, body composition and energy metabolism. Am J Clin Nutr 2005:81:69-73. 

[iii] Hill JO, et al. Evaluation of an alternating-calorie diet with and without exercise in the treatment of obesity. Am J Clin Nutr 1989;50:248-254.

[iv] Varady KA, et al. Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults. Am J Clin Nutr 2009;90:1138-1143.

[v] Klempel MC, et al. Intermittent fasting combined with calorie restriction is effective for weight loss and cardio-protection in obese women. Nutriton Journal 2012;11:98.

[vi] Harvie MN, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int J Obes 2011;35(5):714-727.

[vii] Hall KD, et al. Energy balance and its components: implications for body weight regulation. Am J Clin Nutr 2012;95:989-94.

[viii] Stubbs JR, et al. Carbohydrates and Energy Balance. Annals New York Academy of Sciences. 1997;819:44-69.

Related blog added 11-APR-13 - Diet Book Review: The Fast Diet

“We all talk to ourselves. We may not want to admit it, but all thinking human beings have a constant stream-of-consciousness chatter going on,” says psychologist Stephen Gullo PhD. That stream-of-chatter essentially programs you for either success or failure.

The good news is that you can take control of your internal dialog so that it is programming you for success. Changing your thinking so that it supports you instead of sabotages you is called cognitive restructuring.

Cognitive Restructuring is a proven behavioral strategy for successful weight control based on the premise that distorted or dysfunctional thinking strongly influences a person’s behavior. It involves identifying distorted thinking (self-defeating, false, and irrational beliefs) and replacing them with more rational, constructive thoughts and beliefs.

Examples of Negative and Sabotaging Self-Talk:

False Beliefs: The interesting thing about false beliefs is that they provide convenient excuses for failure.

• “I’ve ruined my metabolism with yo-yo dieting—my body is broken.” Unless you have severe undiagnosed hypothyroidism, your metabolism does fall in the normal range for your gender, age and weight. If you doubt this have your RMR measured so you can stop doubting it.
• “I’m destined to be heavy due to family genetics.” Genetics do play a role in a variety of areas that can affect your weight, including the tendency to overeat, and be physically inactive. But biology is not destiny. If fact, your choices about what you eat and how much you move ultimately determine your weight. You are still in control.
• “I haven’t found the right doctor/pill/nutritionist/diet—nothing works for me.” The underlying error is that responsibility for changing is put outside of yourself rather than being owned by you. By the same token when you’ve had success you’ve also given the credit to the (fad) diet instead of to your own hard work. In reality all the diet did was trick you into eating fewer calories—YOU did all the work! When you own responsibility for your weight you also—correctly—give yourself the CREDIT for your success.
• “I can’t wait for this diet to be over—I’m tired of watching what I eat.” The underlying error is thinking that temporary changes might have permanent results. Additionally, you may be telling yourself how unfair things are, and how deprived you feel.
• “Food is my friend.” Food—and especially problem trigger foods—are not friends, treats, rewards nor comfort. What have these foods really done for you? In fact they have cost you happiness, quality of life, and self esteem by creating a never ending struggle with your weight. Trigger foods are more like enemies. Any food that you can’t control is controlling you, and needs to be dealt with accordingly.

Unrealistic Expectations:

• “I want to lose 40 pounds for my class reunion (wedding, anniversary, before summer, etc.).” You didn’t put the weight on overnight and it comes off even slower than you put it on. Expecting otherwise is unrealistic and a set-up for disappointment and failure. The smartest approach is small—and therefor achievable—goals. That way you have more frequent celebrations of success, and you know you CAN lose the next 5 pounds.

Self-Critical & Defeatist Thinking:

• “It’s too hard, I have no self-control, I will never lose weight.” You are simply programming yourself for failure. Your mind will dutifully find all kinds of evidence to support what you tell it—so if you keep saying, “I have no self-control,” you’ll never have any self-control.
• “Poor me, I’m deprived, it’s not fair!” The truth is that you CAN have anything you want whenever you want. You can’t however do that AND be trim (and that truth applies to everyone). This kind of self-pitying, self-indulgent, self talk keeps you stuck. Worse, the end point of this type of thinking can be highly destructive—leading to a binge cycle that spirals you out of control.
         Turn deprivation thinking on its head—the reality is that by over-indulging in certain foods you have deprived yourself of a healthy weight and appearance, self-regard, peace of mind, and ultimately left you feeling unhappy and out of control. How many years have your handful of trigger foods tricked you into perpetually feeling frustrated and miserable?
         Finally, add in some perspective: real deprivation is a child going to bed hungry because he/she literally doesn’t have enough food to eat.

Basically, any change efforts are bound to fail if you don’t also change the internal conversation that you sabotage yourself with. You can continue with a negative, pessimistic, defeatist and often self-demeaning internal dialog (and keep spinning your wheels)—or you can take control with an upbeat, winning attitude that supports success.

Examples of Supportive and Constructive Self-Talk. Change your thinking and weight loss will naturally follow:

• “Losing and maintaining weight, or gaining weight, is under my control.”
• “It’s not a treat if it keeps me fat.”
• “Avoiding trigger foods is not deprivation, it’s liberation!”
• “Managing my home environment makes a winning day easy!”
• “Planning trumps willpower!”
• “I CAN have everything I need; and what I don’t need I don’t want.”
• “I am mastering the skills necessary for success.”
• “I’m in charge now—food no longer controls me.”
• “A craving is just a feeling that passes quickly when I ignore it.”
• “I CAN have everything I need; and what I don’t need I don’t want.”
• “I can master the skills necessary for success. I just need to take it one step—and one day or hour—at a time.”
• “Weight management depends on skills that I am mastering.”
• “Every time I say, 'no, thank you,' I say 'yes' to my health and happiness.”
• “I CAN have that, but I CHOOSE not to.”
• “Good food is body fuel, body nourishment, but not entertainment. Treats are for special occasions, not every day.”
• “A real treat is buying smaller clothes.”
• “Eating doesn’t solve my problems, it adds to them!”
• “With each ‘no, thank you’ I gain more control, self-reliance, and self esteem.”

How to Replace Sabotaging Self-Talk with Constructive Self-Talk:

1. Start by tuning in and listening to your internal dialog so that you can begin to identify your “flawed thinking” and in each case write a constructive/supportive statement—or belief—that counters it.
        Don't worry if this seems difficult or awkward at first—after all you're in  the habit of not fully tuning into it consciously. Like most new habits, it will take a little practice.
2. Create a personal set of 3 x 5 cards with your constructive statements and read them a minimum of twice each day. The more often the better! Keep adding to your collection of supportive statements—every time you catch your internal dialog going negative, write a new supportive counter statement.
3. It’s also helpful to listen to yourself speak each of your new constructive beliefs and statements. An easy way to do that is to leave yourself a message on your cell phone (or voice recorder) that you can listen to several times a day.
4. Immediately read or listen to your cards whenever you find yourself tempted to slip. Make sure you memorize some supportive one-liners too. The more you read—and listen to—your new constructive beliefs and statements, the faster your “new thinking” will be internalized. Essentially, what you are doing is waging an internal PR campaign that reprograms you for success!

It’s Up to You. Of course this all depends on your really wanting to change. If deep down you are not actually ready to give up being pessimistic, defeatist, and self-critical you’ll make excuses for not identifying and fixing your sabotaging self-talk. That’s okay—it just means you’re not yet ready to leave this self-defeating (crazy as it sounds) comfort zone. There are always costs as well as benefits to changing. Know, however, that serious success with your weight—the kind that lasts—will require dealing with any unsupportive self-talk that holds you back. You can and will be successful as soon as YOU decide to be!

Best,
-Dorene

PS--This blog is excerpted from a new section of the latest edition of my book, The NEW Healthy Eating & Weight Management Guide.

While a sham diet will likely deliver on some early weight loss it won’t be because of the reasons claimed in the diets’ marketing literature or book cover. The real disservice to you however is the misinformation that you’re fed that actually ends up being an impediment to any long-term success with weight control.

Spotting sham diets can save you money on the books, supplements, and programs that deliver them, as well as not waste your time and energy going in the wrong direction. And don't forget your health... sham diets frequently ban whole categories of foods that in fact are essential to good health.

So what exactly will tip you off to a sham weight loss diet? You’ll find that they all consist of the following four key components:

1. The “magical breakthrough” is to impress you with the notion that this “new expert/guru” has figured out what no-one has been able to—so you’ll buy their book, or sign up for their program (after all, they do know you are looking for a magic bullet).

2. A secret combination of eating the "right things, in the right way” (and the flip side of this—the notion that “calories don’t count”). The purpose of this “secret formula” is to convince you to follow a eating plan of what usually amounts to 1,200- to 1,400-calories, that will produce significant early weight loss. However, the weight loss is due to simple calorie restriction (and the extra water losses associated with calorie restriction), not to the magic of “eating the right things in the right way.”

3. Leveraging the illusion of quick early weight loss—to keep you hooked in. After all, they said the scale would drop, and voila!—boy did it! The problem is your early weight loss is ALWAYS more water than body fat. They just don’t bother mentioning that it’s mostly water—in fact they’re counting on you not knowing that.

4. The monotony of restricted eating: The short list of allowed foods, and all the rules around what to eat and when ensures you will soon lose your appetite for the foods that are allowed. That fact, in turn, guarantees that your calorie intake stays low basically fooling you into doing what you would likely otherwise balk at.

I’ve specifically used the word “sham” to point out that the reasons FAD diets work are very different than what each fad diet claims. Now I have a question for you. Can you find a single fad diet out there that doesn’t fit the above criteria? If you actually look and listen carefully, no, you’ll find the pattern in each and every one.

Look, if you want success with your weight and health then you need to learn how to eat in a healthy way and in healthy amounts. My best advise is to start where you are at, and look for "easy changes" to improve the quality of your diet. Forget "going-on-a-diet," instead approach it as a lifestyle change.

If you choose to follow the (you name it) fad diet you will lose weight (due the low-calorie eating plans you’ll be following and nothing else). You will surely also drive yourself crazy trying to jump through all the silly magic hoops.

So why not save your money and your sanity? The reality is that there is no magic. All there is is eating less and moving more, and you are the best author of how to do that in your life!

Best,
-Dorene

PS - Here's a couple gimmickless programs you might want to consider:
Weight Watchers online
SparkPEOPLE
Diet.com

You might also want to check out my book (no shams, no magic, just the facts): The NEW Healthy Eating & Weight Management Guide.

Subscribe to Dorene's BeyondDiets Blog by Email!

The authors of the editorial concluded “nobody really knows” where the ‘8 x 8’ recommendation (64-ounce daily target) got started,ⁱⁱ and, “there is no single study—and therefor no single outcome—that has led to these recommendations.” The implication was that there is no wisdom behind drinking eight glasses of water a day. Really?

Did we just “throw out the baby with the bath water?" The short answer is yes! True there isn’t a specific study that the recommendation can be traced back to--but that's true for pretty much all nutrition guidelines! So, let us consider what we do know:

The latest Institute of Medicine (IOM) report on Water and Electrolytes (2004)ⁱⁱⁱ (which "establishes nutrient recommendations on water, salt and potassium to maintain health and reduce chronic disease risk") designates an “adequate intake” (AI) for males (3.7 liters) and females (2.7 liters). These amounts are for total daily fluids (not exclusively water), and it’s expected that 20% of the value comes from food. (The IOM is part of the National Academy of Sciences, a nongovernment nonprofit science organization that addresses health and health care.)

The IOM AI (for the most part) simply balances what we naturally lose in fluid each day. A sedentary 150-pound man loses about 3 quarts of water daily, while a sedentary 120-pound woman loses about 2.5 quarts—through urine, sweat, stools, and evaporation. The full IOM report includes over 360 references including "water-balance" studies, and U.S. survey data (where the median fluid intake was an important end-point).

The IOM report notes that fluid requirements vary widely among individuals: individual fluid needs vary with body weight and gender, but also increase dramatically with activity level, increasing ambient temperatures, and with higher humidity levels. This tells us that active people, and those in warmer climates may have higher requirements than the AI, while folks who are sedentary, or live in colder climates may have lower requirements than the AI.

Long story short, however, is that the IOM recommendation for FLUID intake is not all that different than the seemingly discredited recommendation for “8 glasses of water a day” (although it need not be all from water).

In fact, the IOM AI guideline is actually higher—take a look (this is 80% of the AI, as 20% is expected to be taken in from food):

So how much water, and what else, should we be drinking? A “proposed guidance system” for beverage consumption was published in the American Journal of Clinical Nutrition in 2006^ivauthored by six top research scientists in the nutrition field, including Harvard’s Walter Willett.

The recommendations from this group of experts are that the majority of our fluid intake be from water, unsweetened tea or coffee. They were cautious regarding artificially sweetened beverages, writing that, “FDA-approved noncaloric sweeteners are considered safe, although other than FDA surveillance data there is [actually] no evidence from long-term studies in humans… [regarding safety].”

Here’s their proposal to guide the American people on fluid intake. These categories add up to 98-fluid ounces/day (which is equivalent to 80% of the 3.7 liter IOM AI for men).

Level 1 — Water, 20-50 fluid oz/day.

Level 2 — Unsweetened tea and coffee, 0-40 fluid oz/day (can replace water, however caffeine is a limiting factor </= 400mg/day ~32 fluid oz coffee/day).

Level 3 — Low-fat or skim milk, and soy beverages, 0-16 fluid oz/day.

Level 4 — Artificially sweetened beverages, 0-32 fluid oz/day.

Level 5 — Caloric beverages with some nutrients, 0-8 fluid oz. 100% fruit juice/day, 0-1 alcoholic drink/day for women, and 0-2 alcoholic drinks/day for men (one drink = 12 fluid oz beer, 5 fluid oz wine, or 1.5 fluid oz distilled spirits), and 0 fluid oz of whole milk per day.

Level 6 — Calorically sweetened beverages, 0-8 fluid oz/day.

The bottom line:

• The idea of getting 8 glasses of FLUIDS per day is not out of whack with expert guidance.

• Water still reigns as the fluid of choice, while unsweetened tea and coffee are strong second-placers (they’re both rich in health-promoting antioxidants).

While I didn't cover the details today, adequate hydration has been shown to improve both cognitive and physical performance, and may be a factor in avoiding bladder and colorectal cancers and other health issues.

And finally, the IOM did not set an upper limit for fluid intake as problems from excess water intake are not generally seen in healthy people with the exception of endurance athletes (who need to drink electrolyte replacements, not just water). See more on "water intoxication" (hyponatremia) here.

All the Best!
-Dorene

Related: Is what you're drinking helping or hindering your weight loss efforts?

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Researchers recently did a meta-analysis of 23 studies that looked at the effect of THREE common overeating triggers: alcohol, lack of sleep, and TV.[i]

They found alcohol to have the strongest effect on food consumption, followed by sleep deprivation, and then television-watching. The effect of alcohol was double that of sleep deprivation, which was double the effect of watching TV.

When we drink alcohol, our intentions to "eat well" often go out the window. When we haven’t had enough sleep (whether getting up without a good nights sleep, or staying up past when our body needs rest) we often feel hungry (or mistake being tired for hunger). Watching TV means seeing lots of food ads—while sitting with our hands free—which can lead to evenings of mindless munching.

A complicated mix of hormones and brain chemestry...

It turns out that all three behaviors (although through different pathways) lead to an increase in circulating ghrelin (a hormone that stimulates appetite).  So, there is a biological underpinning behind our diminished resolve when these lifestyle factors are in play. The scenario could be characterized as: biologically unnecessary appetite stimulation paired with a heightened response to environmental food cues, which results in overeating.

The authors of the review study conclude that, "sleep deprivation, alcohol consumption, and television watching promote increases in acute caloric consumption.” The authors further postulate that these lifestyle patterns are not merely correlated with obesity, “but likely contribute to it by encouraging excessive eating."

Obviously not everyone eats in front of the TV, and many people indulge in alcohol only occasionally. Those folks don’t have a problem-to-solve. It’s when these types of habits become a lifestyle that they become important factors in adding and maintaining extra pounds.

Actionable Advice:  If you think you have either of these lifestyle habits going on, then 1) limiting TV time and 2) limiting the number of episodes per week you indulge alcohol, should be obvious goals. Avoiding being sleep-deprived is more complicated, but trying to arrange your schedule to get a full 7- to 8 hours of sleep per night, is a good place to start (or adding a regular nap to make up some of the difference).

Additionally, a not so obvious action to take is to utilize stimulus control. Stimulus control means managing your environment so that you don’t have to rely solely on willpower to eat in a way that supports your healthy weight goals. We know stimulus control works and this new information actually helps explain why. (For more information on stimulus control see the links below.)

All the Best,
-Dorene

Related topics:
Stop Fighting Losing Battles with Food!
What Happens to Your "Good Intentions?"
White Knuckles & Willpower

References:
[i] Am J Clin Nutr doi: 10.3945/ajcn.112.039750

On the other hand, most of us know someone who lost a chunk of weight and did keep it off. So what made them special? How did they beat the (purported) odds?

The fact is the so often repeated 95% figure, can be traced back to a 1958 research review paper[i] by Albert Stunkard. However, the data from Stunkard’s review was never applicable to the general population.

Part of the reason the 95% myth has been so intractable is that there has been almost no research on weight-loss maintenance that is applicable to the general population.

Would you believe that 1 in 6 US adults has maintained a weight loss of at least 10% of their body weight for at least a year? In fact, data collected on 14,000 US adults between 1999 and 2006, showed that about 17% had kept off an average of 42-pounds for a year or longer. (This data is from a random US adults sample--NHANES).[ii]

This data is reminiscent of the National Weight Control Registry (NWCR) data, which is not a random sample, but is where most of what we believe we know about successful weight loss/maintenance comes from.

In 1993 researchers started an ongoing study—The National Weight Control Registry (NWCR)—to identify the behaviors associated with long-term successful weight-loss maintenance. In 1997 the first report on the study was published in the American Journal of Clinical Nutrition. The study group (786 individuals) had lost an average of 66 pounds and kept it off for an average of 5 years (16% of them had maintained for 10 years).

Most of the dieters had been overweight since childhood. Almost all, 91%, said they had tried and failed to keep weight off in the past. Many reported previously losing and regaining as much as 270 pounds! This time they were stricter with their diets and exercised more vigorously. About half, 57%, initially got help from a weight management program or a health professional.

The NWCR now includes over 10,000 subjects and 31 research papers[iii] have been published to date illuminating key behaviors that successful “losers”—the Masters of Weight Control—have in common.

1. Track your progress. 74% of the Masters used food and activity records while they were losing weight, and 50% continue to track calories during maintenance. Also, 69% report weighing themselves at least weekly.

2. Get moving. The men and women in the study reported weekly physical activity levels equivalent to 4 miles walking per day for their respective body weights. Additionally, 62% report watching fewer than 10 hours of TV per week—the national average being 28-hours.

3. Turn off the TV. 62% of men and women in the study also reported watching fewer than 10 hours of TV per week—the national average is 28-hours.

4. Structure and consistency. Participants report eating breakfast 6.3 days per week, and 4.7 meals/snacks per day. Furthermore, they also report maintaining a consistent eating pattern across weekdays, weekends, and holidays and special occasions.

5. Eat breakfast. Participants report eating breakfast 6.3 days per week.

6. Eat more fruits and vegetables. Emphasizing fruits and vegetables is one of the main methods Masters use to add volume to their meals, while also keeping their calorie intake low.

7. Skip the fast food—Masters eat fast food less than once a week.

8. Become a manager and problem-solver. Masters have learned to problem-solve how to respond to cravings and stressful situations, and have learned to control problem foods. Not bringing them home is the foundation of ending the struggle with problem foods.

9. No man (or woman) is an island. Masters have become skillful in developing support relationships and have learned to be assertive about their needs. Not surprisingly, most report increased general quality of life, moods, mobility, self-confidence, health, and energy.

10. Practice makes perfect. Weight loss maintenance gets easier over time; after 2 years the chance regaining is reduced by 50%. In fact, most Masters report that maintaining weight is EASIER than taking it off.

The Bottom Line:
You can lose weight and keep it off, and don’t let anybody try to tell you otherwise. It will take patience, won't be the result of fadish dieting, and will require permanent lifestyle changes.

All the Best,
-Dorene

Related topics:
The Game of Weight Loss has Rules
Manage Yourself to Success!

[i] Stunkard AJ, et al. Arch Intern Med 1958;103:79-85.

[ii] Kraschewski JL, et al. Int’l J Obesity 2010;34(11):1644-54.

[iii] National Weight Control Registry – Research findings

Gary Taubes—author of Why We Get Fat: and What to Do About It—attempts to make the argument that obesity is the result of a “fat storage defect” which carbohydrates purportedly encourage through the secretion of insulin. Taubes theory hinges on the notion that some calories (carbohydrates) are more fattening than others (protein or fat).

Three reasons why Taubes’ theory fails:

1. Taubes ignores a consistent body of literature that shows “a calorie is a calorie.” At this point there are numerous well done studies that have compared diets of varying levels of protein, carbohydrate and fat that find no statistical difference in weight loss WHEN CALORIES ARE CONTROLLED (kept at the same level for each diet type).[a]^,[b]^,[c],[d]^,[e],[k] Additionally, studies comparing low glycemic index (or glycemic load) diets to other weight loss diets find no difference when calories are kept at the same level for each diet type.[f] Furthermore, even when calories are not controlled any early statistical differences between diets are short-lived—dissappearing by six months. 

2. Taubes’ theory ignores huge pieces of the human energy metabolism picture.[g]^,[h] Human energy metabolism is a complex system that constantly adjusts what substrates (carbohydrate, fat, protein or alcohol) it’s using (for energy) based both on what we provide it (eat and drink), as well as one’s current energy needs. More precisely we’re always burning a combination of these substrates, so it’s the ratio that changes.

Storing fat is the normal response to excess available energy from any substrate. However fat stores are also drawn upon between meals making the net change (in fat stores) zero over the course of a day—UNLESS energy intake has exceeded energy needs. Therefor, looking at energy balance in anything less than a 24-hour time frame is pointless.

When energy from carbohydrate or protein is taken in, the oxidation of protein and carbohydrate increases—as the body “knows” it has little ability to store either of these substrates (especially protein). At the same time, the body will preferentially store fat (hopefully for later use) as it has the unlimited ability to store fat. Likewise, since the body has no ability to store alcohol, it will also always be oxidized preferentially, even before protein or carbohydrate.

All these energy substrates are interconnected—the ingestion or oxidation of each affects the oxidation or storage of the others—in one of nature’s most elegant automatic feedback systems.

Taubes’ argument overlooks this big picture—total energy metabolism—by paying attention only to “deposits” (the storage of fat). This argument is like saying that your bank balance is only affected by deposits. If only it were so! As if that wasn’t specious enough, Taubes goes further into the weeds, essentially suggesting that $20 in five dollar bills (carbohydrate) adds more to your account (fat-deposits) than $20 in one dollar bills (protein), or $20 in ten dollar bills (fat).

This basic argument has long been the notion behind popular and fad diets of the low-carb, high-protein, and low-glycemic index approaches to weight loss.

While it is true that the Thermic Effect of Food is higher for protein than for carbohydrates or fat, those differences don’t add up to enough calories to be of practical significance, especially on reduced calorie diets.

3. Taubes’ theory would require reconsidering a law of physics. Earlier this year, a consensus statement came out of an American Society for Nutrition (ASN) conference where obesity researchers from a variety of backgrounds (biophysics, exercise science, human nutrition, physiology, etc.) formally agreed that the human body complies with the First Law of Thermodynamics. The bottom line the ASN Consensus Statement[i] translates to is that—as far as human energy metabolism is concerned—“a calorie is a calorie.” The jury isn’t out, to suggest otherwise is to suggest that a law of physics needs to be reconsidered. No serious researcher supports such nonsense.

While "a calorie is a calorie," what comprises a healthy diet is another conversation. And on that front, at least three well done studies point to higher cardiovascular risk and mortality rates for persons following indiscriminate high-protein/low carbohydrate regimes. Atkins is an example of an indiscriminate-low-carb diet, while South Beach—which emphasizes lean protein, unsaturated fats, and whole unprocessed foods—is not. Data from Harvard’s Nurses and Male Health Professionals Health Studies show that those following low-carb diets rich in PLANT proteins were 43% less likely to have died over 20-plus years of follow-up as those following low-carb diets rich in animal proteins.[j]

The Bottom line: Looking at a snapshot of metabolism (i.e. what happens only in the few hours after eating) overlooks the “rest-of-the-story.” Making claims about human metabolism based on a snapshot is like claiming to know a jigsaw puzzle picture from 2% of its pieces.

Taubes isn’t the first armchair theorist with an intelligent sounding but specious theory—and won’t be the last.

For example, as I mentioned earlier, carbohydrate oxidation automatically increases after eating carbohydrate. The same is true for protein. Not so for fat however, which is why Covert Bailey PhD (author of Fit or Fat) jumped to the conclusion that dietary fat was more fattening (than carbohydrate or protein). Bailey’s “theory” is another example of the hazards of theories based on just a couple puzzle pieces! The low-fat craze that Bailey kicked off in the 90’s didn’t solve anyone’s weight problems, and most agree at this point that the indiscriminate avoidance of (healthy) fat in favor of the indiscriminate intake of sugar and processed carbohydrates was a health boondoggle.

Despite what Taubes and other authors of popular diets would have you believe there is no magic way of eating that unlocks the mysteries of weight loss (or gain). Weight management and a healthy diet don’t require a PhD—just some common sense.

All the Best,
-Dorene

Additional references added: Sept. 1, 2012

For reliable information on healthy eating, and healthy weight loss, see my book The NEW Healthy Eating & Weight Management Guide.

Related topics:
The Game of Weight Loss has Rules
Can You Spot a Sham Weigth Loss Diet?

[a] De Souza RJ, et al. Am J Clin Nutr 2012;95:614-625.

[b] Foster GD, et al. N Engl J Med 2003;348(21):2082-90.

[c] Sacks FM, et al. N Engl J Med 2009;360:859-873.

[d] Mozaffarian D, et al. Ann Intern Med 2010;143:147-57.

[e] Dansinger ML, et al. JAMA 2005;293:43-53.

[f] What is the relationship between glycemic index or glycemic load and body weight?

[g] Stubbs R, et al. Am J Clin Nutr 1995;62:316-329.

[h] Stubbs R, et al. Am J Clin Nutr 1995;62:330-337.

[i] Hall KD, et al. Am J Clin Nutr 2012;95:989-94.

[j] Lagiou, P, et al. BMJ 2012;344:e4026.

[k] What is the optimal proporton of dietary fat, CHO and protein to lose weight if overweight or obese?