Tuesday, June 3, 2014

Calorie Shifting (-45%) Beats Calorie Reduction (-55%): Four Meals, Spaced 4h Apart Induce Greater Hunger(!) & Body Weight Reduction Than More Restrictive Regular Dieting

4x4 are those the optimal numbers?
Alright, if you have 500,000kcal worth of fat to lose, you'd sure as hell lose it faster if you're running a kcal deficit of 55% vs. 45%, right? Yeah, I know. As a SuppVersity reader you're smart enough to question the validity of this simple mathematical question and I have to admit that this is in fact one of the major weaknesses of the study at hand. However, let's postpone the criticism to the conclusion and simply assume it would be obvious that someone cutting back by 55% would lose more fat or at least more body weight than someone who consumes only 45% less calories.

Let's further assume this "someone" was an obese and overweight (BMI ≥ 25), nonsmoking adult (age 26-50 years) woman who has been selected from two clinics related to Weight Loss and Weight Gain Unit, Shohaday Tajrish Hospital and Private Clinic in Esfahan between April 2010 and September 2012.
You can learn more about meal frequency at the SuppVersity

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Int. Fasting & Exercise
Now, if you took 74 of these women and randomly allocated them to either the 45% or the 55% arm of the study, you would expect to see a weight loss advantage for the latter, right? Right.

But what if there was another twist to the study? A twist that says: "Eat 4 times per day for eleven days and make sure you leave at least 4h of time to digest between those four meals. Then, eat regular for three days and repeat!" Ha? What would happen?
Figure 1: Relative weight and fat loss after 12 weeks of dieting and after 4 week follow up (Davoodi. 2014)
Surprised? Well honestly, I would not have expected to see a difference like the one in Figure 1, either. Eventually, the study at hand which was conducted to test whether you can tackle some or all of the following downsides of classic weight loss interventions, i.e. non-adherence due to being  hungry, metabolic shutdown reduced physical activity, by nutrient timing provides more compelling evidence to a truth some people in the health and fitness industry have been propagating for decades: Timing matters!
Figure 2: Reduced hunger and no drop in resting metabolic rate - still asking for the reasons?
It matters not only because the subjects in the "eat 4 times a day at fixed 4h intervals"-group lost significantly more body weight. It matters above all, because...
  • their "resting metabolic rate tended to remain unchanged" during the CSD phases,
  • their plasmaglucose, total cholesterol, and triacylglycerol reductions were greater, and
  • their geeling of hunger actually decreased over the course of the 4-week study
Now, all that is certainly fantastic. What's not so fantastic, though, is the minor "flaw" in the study design of which I've already pointed out in the introduction that it is based on the (imho) false believe that increases in caloric deficits in the 40%+ region would yield improved weight loss results.
No, no and no! Don't be stupid! Eat to satiety and fast or stay fat forever! Frequent meals will hamper not improve dietary T2DM treatment. Eating four times a day with 4h+ between the meals, on the other hand, is a promising approach to dieting.
Bottom line: Due to the extra -15% deficit in the "regular" diet group, the study at hand fails to "prove" the sole influence of meal timing on weight loss and improvements in glucose and fatty acid metabolism. That's a pity, but it does not mean that we could not conclude that "meal timing", or as I would rather like to call it "meal spacing" is an important and effective strategy to improve your weight loss results - I mean, on which -45% energy restricted diet does your hunger decrease over time?

So how can we conciliate the results of the study and hand with those of the "Many Small Meals Suck" (read it) study from  a couple of weeks ago? Well, easy! We're dealing with four, not 6 meals and they were spaced 4h, not just 2h apart. This + the fact that the women were  obese or overweight, but not diabetic could explain the difference.
  • Davoodi, Sayed Hossein, et al. "Calorie Shifting Diet Versus Calorie Restriction Diet: A Comparative Clinical Trial Study." International journal of preventive medicine 5.4 (2014): 447.