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Category Archives: Weight Loss
British Medical Journal: Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance
When you read “total energy expenditure” below, it may make more sense if you substitute “calories burned per day.” If you burn your food calories, they don’t end up as stored fat on your body,
“In this controlled feeding trial over 20 weeks, we found that total energy expenditure was significantly greater in participants assigned to a low carbohydrate diet compared with high carbohydrate diet of similar protein content. In addition, pre-weight loss insulin secretion might modify individual response to this diet effect. Taken together with preliminary reports on activation of brain areas involved in food cravings and circulating metabolic fuel concentration, results of the current Framingham State Food Study (FS)2 substantiate several key predictions of the carbohydrate-insulin model. Regardless of the specific mechanisms involved, the study shows that dietary quality can affect energy expenditure independently of body weight, a phenomenon that could be key to obesity treatment, as recently reviewed.”
Body proteins are good. You can’t blame them for making you fat. It’s adipose tissue making you fat. That’s what you want to lose when you lose weight, not body proteins.
I wrote recently about a vague “milk diet.” I sought details and found a few in the reference below. The authors write like there’s only one milk diet; I’m skeptical. In fact, at my prior post the milk diet was “a variable combination of full cream or semi-skimmed milk and unsweetened yoghurt.” The study under the microscope today used milk only, probably whole milk.
This was a frustrating study to review. The experimental protocol is complicated, the researchers altered way too many variables, and didn’t hint at how how much weight the dieters lost until the last sentence of the research report. Oh, sure, they gave rates of weight loss during days 2–4, days 1–13, days 13–22, weeks 4–13, and in week 24. But I refuse to calculate total weight loss over those time frames for four different experimental groups.
The goal of the authors was to determine the composition of weight loss on two different very low calorie diets (VLCDs). Would there be differences in fat loss and lean tissue loss? Lean tissue would include muscle, organs, bone, water, etc. Lean tissue is also called fat-free mass. Remember, that’s not the tissue you want to lose when you’re trying to lose excess weight. So measurement of nitrogen loss, a surrogate for protein and lean tissue loss, was the major focus of the study. How do you gauge nitrogen loss? You measure it in urine and feces of the inmates in a hospital metabolic ward.
When I was researching the literature in preparation for writing my first edition of Advanced Mediterranean Diet, I remember reading many studies of very low calorie diets (VLCDs). Offhand, what I remember is that they’re potentially dangerous, compliance is poor, symptomatic gallstones are more common, and they’re only a short-term “solution” because rapid weight regain is a huge problem. VLCDs typically provide 200–800 calories per day.
How Was the Study Done?
All research subjects were women in England. Metabolically healthy except for obesity. Seventeen of the original 22 completed the study. Average age was 33 (range 20–50), average BMI 42, average weight 115 kg (253 lb). They were randomized to eat one of two very low calorie diets:
- Cambridge Diet: 330 cals/day, 33 g protein, 42 g carbohydrate, 3 g fat, plus vitamins and minerals specified in the article
- Milk Diet: 1,200 mls (41 fl oz) of milk daily (780 cals). The milk provided 46 g protein, 56 g carbohydrate, and 46 g fat. Plus supplementation with 60 mg iron, 750 micrograms vitamin A, 7.5 micrograms vitamin D, 1 mg thiamine, 0.5 mg riboflavin, 7.5 mg niacin, 15 mg vitamin C
Unclear whether this milk was from cows, goats, sheep, water buffalo, or yaks. Unclear whether full fat, skim, or some % reduced fat. I’ll assume they used cow milk. Whole milk from a cow is 3.25% fat. Five cups a day (1200 ml) would provide 730 calories, 40 g protein, 65 g carbohydrate, and 40 g fat. The iron, thiamine, and riboflavin in this much milk is very similar to those items used in the Milk Diet above. I got too bored to check the other micronutrients. The point being, if you wanted to emulate the Milk Diet above, drinking 5 cups (1200 ml) of whole milk daily plus a vitamin supplement (and iron?) would get you in the ballpark.
Nor do the researchers describe the Cambridge Diet. Best I can tell, in 1986 it was a commercial diet composed of powder mix, meal bars, and liquid meals. It’s still available, no doubt in different formulations.
Five women in each group agreed to have their jaws wired shut. Wow. This is how they came up with the aforementioned four experiments groups: Cambridge or Milk Diet, jaws wired or not.
The first three weeks were in an inpatient metabolic ward, the next 20 weeks in the outpatient setting, and a final week back in the metabolic ward. I’ve simplified it a bit so you don’t get too lost in the weeds.
All dieters were offered £60 if they completed the entire 24-week protocol.
- From the last sentence of the report, it looks like the Cambridge Dieters lost 21.9 kg (48 lb) and Milk Dieters lost 17.9 kg (39 lb), not a statistically significant difference between the two.
- No patient had to withdraw from the trial due to side effects.
- “Tests of vitamin status showed little of significance.”
- No difference between the diets in terms of hemoglobin, plasma urea, sodium, potassium, triglycerides, cholesterol, glucose, and glucose tolerance test, and “the values were almost all within the normal ranges.”
- “It is concluded that the Cambridge Diet (330 kcal) causes greater N loss [body protein loss] in relation to weight loss than the milk diet (800 kcal)….”
- “Since we have strong reason to doubt that the patients were strictly observing the prescribed diet as outpatients it is dangerous to draw conclusions about the effects of these diets on weight loss and body composition. The most that can be said is that there is no significant difference between the weight loss observed among those who were trying to keep to Cambridge Diet and those who were trying to keep to milk. However, those who had their jaws wired lost significant more weight than those who did not.”
After the start of this trial, a UK government report suggested that VLCDs should provide at least 500 cals/day and 50 g protein for men, and 400 cals/day and 40 g protein for women. The Cambridge Diet was reformulated to comply with the guidelines.
Can you imagine living only on five cups of milk a day plus a vitamin supplement for 20+ weeks? I gotta admit I’m sorta tempted to try it, but not for 20 weeks. One of my problems with prolonged liquid diets is: what effect does that have on your teeth? We have teeth to chew. Do teeth shift out of place if not used as designed? I’ve never seen it discussed in the scientific literature.
Did nutrient deficiencies “force” dieters to be noncompliant. I don’t know. Sometimes we may need to trust our bodies to help us make the right dietary decisions.
I’ve only reviewed two milk diet studies in these pages. Not many study subjects involved. Nevertheless, at first blush, it looks like a milk diet is relatively safe and effective over several months in otherwise healthy folks. If you were to do it, I’d get the blessing of your personal physician, and probably take a vitamin supplement daily. I bet only menstruating women need an iron supplement.
Sometimes I think diets with too much variety are harder to stick with. Too much temptation. The simplicity of a milk diet appeals to me. Five cups a day. That’s it, nothing else. Don’t even think about it.
Many folks on a weight-loss journey hit a “plateau phase” where they’ve stopped losing weight but are still far from goal. I wonder if a temporary milk diet—one or two months?—is a good option for getting back on track.
Reference: Garrow, J.S., et al. Inpatient-Outpatient Randomized Comparison of Cambridge Diet Versus Milk Diet in 17 Obese Women Over 24 Weeks. International Journal of Obesity (1989) vol. 13, pages 521-529.
I recall a milk diet to treat stomach ulcers in the mid-20th century. Tagamet changed that!
I’ve been reading scientific articles on low-energy liquid diets for weight loss and diabetes remission, and ran across a reference to a milk diet. I found impressive results in a 16-week study.
This was a small randomized trial that enrolled 45 very fat folks — BMI 41-47, average weight 122 kg (268 lb), mostly women — and assigned them to one of three diets:
- Control: conventional balanced diet of normal foods providing about 800 calories/day and at least 36 grams of protein.
- Milk: “variable combination of full cream or semi-skimmed milk and unsweetened yoghurt,” about 800 calories/day. BTW, a cup (240 ml) of whole milk has 150 calories.
- Milk Plus: same as the milk diet plus “unlimited amount of a single food selected by the patient on each day of the week. Of these seven extra foods, three were a fruit or vegetable, two were a high protein food, and two were a “favourite” food. The seven foods were repeated on the same day of successive weeks.” (If you understand this, you’re smarter than me, which wouldn’t be unusual.) Average calories were 1,350/day.
The researchers figured these adults were eating about 2,500 calories/day at baseline. Diabetics were excluded.
The Milk group lost the most weight. Eleven of the 14 participants completed the 16-week study, with an average weight loss of 11.2 kg (24.6 lb). Constipation was the only “serious” side effect reported. The authors admitted that deficiencies in some vitamins and iron might be a problem, but cited a similar but longer trial (24 weeks) that found no such deficiencies.
Eleven of the 17 in the Milk Plus group persevered for the whole 16 weeks. Average weight loss was 8.2 kg (18 lb).
Nine of the 14 in the Control Group were able to put up with it for the duration. Average weight loss was only 2.6 kg (5.7 lb). I suspect they had a bit of a compliance problem. When you weigh 268 lb, a 5.7 lb loss isn’t much.
“Analysis of compliance (not reported) showed that it was similar for the two milk diets but much lower for the conventional diet.”
The researchers opine that…
- “Patients are more likely to respond to a simple diet which they have not tried before than to advice on conventional diets.”
- “Probably the best strategy is to rotate diets,…[to prevent compliance from falling].”
I wonder how well the Milk diet would work for someone who weighs 205 lb (93 kg) and just wants to lose 25 lb (11.4 kg).
I wonder how important are the exact proportions of “full cream or semi-skimmed milk and unsweetened yoghurt.”
As with all diets, weight regain will be a problem after the 16 weeks.
The Milk diet might be a good temporary option for someone who wants to lose more excess weight but has hit a weight-loss plateau in their current regimen.
I’m skeptical about the nutritional adequacy of the Milk diet.
My Advanced Mediterranean Diet is actually two diets, making diet rotation easy. And I tell you the secrets to prevention of weight regain!
Reference: Summerbell, C.D., et al. Randomised controlled trial of novel, simple, and well supervised weight reducing diets in outpatients. British Medical Journal, 317: 1487-1489. November 28, 1998.
It’s refreshing to see a vegetarian diet study that specifies which type of vegetarian diet was used.
Followers of two different healthy diet patterns showed similar reductions in weight, body mass index and fat mass after 3 months, found researchers from the University of Florence, Italy in conjunction with Careggi University Hospital, Florence.
The lacto-ovo vegetarian diet was however more effective in reducing ‘bad’ low-density lipoprotein cholesterol whereas Mediterranean diet followers saw a greater reduction in triglycerides.
“After 3 months of dietary intervention, both lacto-ovo vegetarian and Mediterranean diets were effective in reducing body weight, body mass index, and fat mass, with no significant differences between them,” commented study first author Professor Francesco Sofi.
Seniors who want to lose weight should hit the weight room while they cut calories, a new study suggests.
Older folks who performed resistance training while dieting were able to lose fat but still preserve most of their lean muscle mass, compared with those who walked for exercise, researchers report.
“The thought is if you lose too much lean mass, that this will exacerbate risk of disability in older adults,” said lead researcher Kristen Beavers, an assistant professor of health and exercise science at Wake Forest University in Winston-Salem, N.C. “Our findings show if your treatment goal is to maximize fat loss and minimize lean mass loss, then the resistance training is probably the way to go.”
We’ve know for a while that resistance training helps preserve muscle mass in younger folks during weight-loss programs. I’ve always figured the principle applied to older folks, too. It’s good to have proof. Average age of these study participants was 67.
P.D. Mangan makes an argument for high-protein diets for those hoping to shed pounds of fat:
In humans, data collected from 38 different trials of food consumption that used widely varying intakes of protein, from 8 to 54% of energy, showed: “Percent dietary protein was negatively associated with total energy intake (F = 6.9, P < 0.0001) irrespective of whether carbohydrate (F = 0, P = 0.7) or fat (F = 0, P = 0.5) were the diluents of protein. The analysis strongly supports a role for protein leverage in lean, overweight and obese humans.”
In obese humans, substitution of carbohydrate with protein leads to far greater weight loss, nearly twice as much.
In a human trial, decreasing the percentage of protein in food from 15% to 10% led to increased calorie intake of 12%. However, increasing the protein percentage from 15 to 25% did not affect calorie intake, which shows that humans may target a certain amount of protein, and eat no more or less when they get it.
There’s more at the link.