True Alternate Day Fast Beats Classic Dieting: Max. Fat, Min. Muscle Loss, No 'Metabolic Damage' in 32 Wk Human Study

This is exactly the way your plate will look during true alternate day fasting.

This study is not just about alternate day fasting aka ADF. It is about "true alternate day fasting" - What is that? Well, it's not an official medical term, yet, but if you hadn't read about "alternate day fasting" regimens at the SuppVersity before, you'd probably think that an "alternate day fast" would be a full fast as in "not eating anything" every 48h - like in "Monday, don't eat; Tuesday, eat regularly, Wednesday, don't eat; Thursday, eat regularly..." As of now, only a handful of rodent studies tested (quite successfully, though) these "true alternate fasting" regimen, while human studies often used reduced, but never no energy intakes on the fasting days.

That's until now, though! Scientists from the University of Colorado Anschutz Medical Campus randomized decently healthy, but obese adults BMI 30 kg/m², age 18-55) to either (a) a zero-calorie ADF (n = 14) or chronically energy reduced (CR | -400 kcal/day, n = 12) diet for 8 weeks. Outcomes were measured at the end of the 8-week intervention and after 24 weeks of unsupervised follow-up.

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What is important to understand is that the study diets were not designed to produce comparable energy deficits. Now, at first sight, this may sound stupid, but eventually, this and the 24-week unsupervised follow-up make the study more practically relevant with respect to the actually relevant research question: Is ADF better than a standard-of-care weight loss diet (moderate daily CR)? The existing difference between the two diets which had identical macronutrient profiles (55% carbohydrate, 15% protein, and 30% fat) is described as follows:

• CR participants were provided a diet that produced a -28% (that was more than intended) deficit from estimated energy requirements (considered a standard-of-care weight loss diet at the time the study was designed). 
• ADF participants were provided a diet but instructed to fast on alternate days. On fed days, they were provided a diet estimated to meet estimated energy requirements, which was supplemented with ad libitum (as much as they wanted) access to five to seven optional food modules (200 kcal each). ADF participants were permitted to eat as much as they wished on fed days, but were not encouraged to eat all food provided. On fast days, ADF participants were instructed to begin their fast after the evening meal the preceding day, and to consume only water, calorie-free beverages, and bouillon/stock cube soup. 

The subjects' individual daily energy and macronutrient intakes were calculated based on food return
using PROnutra software (Viocare Technologies Inc., Princeton NJ). Estimated energy deficits were calculated by subtracting estimated daily EI from estimated daily energy requirements.

Table 1: Mean daily energy and macronutrient intake on fast and fed days over 8 weeks in ADF (Catenacci. 2016); corresponding data for weeks 9-32 not available.

What about adherence? At least for the first 8 weeks, the subjects' adherence was - within the limits of accuracy values from a non-metabolic-ward study have - excellent. 44.4 kcal/day, that's almost nothing and not really that surprising. After all, studies have shown that, eventually, many people feel it's easier to simply eat nothing than to eat in moderation or less than would be necessary to be satiated. Which leads me to my personal experience (N=1 + friends) that confirms: one of the biggest strengths of any intermittent fasting regimen (ADF or classic IF) is that they are easier to adhere to than regular diets with identical calorie refeeds; and thus eventually back to the study which found the previously hinted at benefits in form of maximal fat, minimal muscle loss and no changes in resting metabolic rate (RMR) only after the not as tightly controlled 24-week weeks of unsupervised follow-up - the real-world part of the study, as I would like to call it.

When the scientists say that the subjects in the fasting (ADF) group "achieved a 376 kcal/day greater energy deficit" (Catenacci. 2016) we thus have every reason to be skeptical of the accuracy of this value. Providing a range of 200-500 kcal would probably be more "accurate" - and if we further assume that the real value is on the lower side, it's also not surprising that "there were no significant between-group differences in change in weight (mean +/- SE; ADF 28.2 +/-  0.9 kg, CR 27.1 +/-  1.0 kg)" (ibid.)

Figure 1: Changes in body composition (%) during the initial tightly controlled 8 weeks and at the end of the subsequent "real-world" uncontrolled 24 weeks, i.e. at the end of the 32 weeks (Catenacci. 2016).

With that being said, who cares if the relevant real world results, i.e. the reduction in fat mass and the ill effects on lean mass after the 24 weeks of unsupervised follow-up speak a clear language: ADF kicks CR's ass, or, in non-acronym English, if you simply don't eat every other day, this is a highly effective real-world compatible weight loss tool, one that will have sign. better effects on your body composition (fat to lean mass ratio) than regular dieting where you reduce your energy intake by the same X% every day!

Figure 1: Absolute (see below for explanation) advantage in changes of body composition in the ADF group (left) and changes in resting metabolic rate (in kcal/d) in the controlled early and uncontrolled follow-up (Catenaccio. 2016).

And the best is yet to come: Not only did the subjects in the ADF group lose more fat and less muscle (the values in Figure 2, left are absolutes, i.e. the fat mass values are extra percent body fat loss, while the lean mass value is an extra percent gained in the latter 24 weeks, the "real-world" phase), the subjects in the ADF group also experienced sign. increases in BDNF, the brain-derived neurotrophic factor, which decreased in the CR group who thus could not longer benefit of its beneficial effects on brain health and its ability to regulation the subjects' energy balance (Xu. 2003; Bariohay. 2005; An. 2015); and these effects on the energy balance, respectively the resting metabolic rate (RMR), show: Unlike the subjects in the CR group, the ADF subjects didn't suffer the statistically significant RMR decrease of -111.6 +/- 36.9 kcal/day reduction we see in the CR group (ADF: -16.2 6 +/- 36.6 kcal/d).

Against that background, it is also not surprising that the study at hand suggests that ADF dieting is also less likely to cause / promote the dreaded yo-yo effect: With the total fat mass (%) declining and the lean mass (%) inclining only in the ADF, yet not in the CR group where the body composition kept deteriorating in the 24 weeks of unsupervised follow-up, I previously called "the real-world phase".

Chronic Energy Deficits Make Athletes Fat - The Longer You Starve, the Fatter You Get. No Matter What the Calories-in-VS-Calories-Out Equ. Says - With true alternative day fasting (this is what the study at hand suggests but only future studies will prove), the dreaded decline in RMR and increase in body fat (in the study at hand that's +1.2 kg total and +0.8kg trunk fat in the CR group) hopefully won't happen.

The subjects lost only 2.4% body fat, why's that so exciting if they started at >40%? Well, what is exciting is that even though the ADF diet was clearly not optimally designed (e.g. way too little protein on both fasting and feasting days), there was a fundamental difference in the diets' effects on the subjects' body composition during the "real-world test", i.e. the 24 weeks of unsupervised. A difference that tells you a lot about which regimen is going to yield the better results for the majority of you and your clients: the alternative day fast.

Follow-up studies will now have to (a) identify the underlying mechanism that explains the ADF advantage (of which I personally believe that it is mostly an increased adherence to ADF | remember: the best diet won't help you lose weight if you can't adhere to it), and (b) modify the fasting regimen (e.g. protein modified fast with say 150g protein on the fasting day + the little fat and carbs that come from the protein source and optional veggies) and/or the macro-nutrient profiles on the feasting days and in the CR group from being simply stupid (namely 55% carbohydrate, 15% protein, and 30% fat) to a ratio that would promote fat loss and lean mass retention | Comment on Facebook!

References:

• An, Juan Ji, et al. "Discrete BDNF neurons in the paraventricular hypothalamus control feeding and energy expenditure." Cell metabolism 22.1 (2015): 175-188.
• Bariohay, Bruno, et al. "Brain-derived neurotrophic factor plays a role as an anorexigenic factor in the dorsal vagal complex." Endocrinology 146.12 (2005): 5612-5620.
• Catenacci, Victoria A., et al. "A randomized pilot study comparing zero‐calorie alternate‐day fasting to daily caloric restriction in adults with obesity." Obesity 24.9 (2016): 1874-1883.
• Xu, Baoji, et al. "Brain-derived neurotrophic factor regulates energy balance downstream of melanocortin-4 receptor." Nature neuroscience 6.7 (2003): 736-742.

High(er) Dose Fish Oil (3g EPA+DHA per Day), an Effective Thermogenic for Older Women - 187 kcal/Day Higher RMR

This study is different from the average "fish oil is good for you" study and that's both refreshing and revealing. Speaking of "fresh" you got a 50/50 chance you buy fresh, not rancid fish oil.

I am not exactly a fan of fish oil supplementation, but I am neither ignoring the few gems among the bazillion of "fish oil is good for you" papers. Samantha L. Logan's and Lawrence L. Spriet's latest paper in the open access journal PLOS|ONE looks as if it was one of those gems. A gem that suggests that 3g of DHA + EPA per day (2 g/d EPA, 1 g/d DHA, to be precise) will not just lower the triglyceride levels of community dwelling older, healthy women by 29%, but also (a) increase their lean mass by 4%, (b) boost their functional capacity by 7% and (c) bump up their resting metabolic rate by 14%, their energy expenditure during exercise by 10%, and the rate of fat oxidation during rest and low-intensity cycling by 19% and 27%, respectively.

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What? Yep, now I got your attention, right? Well, the objective of the study was to evaluate the effect of fish oil (FO) supplementation in a cohort of healthy, community-dwelling older females. Now, in contrast to your average fish oil study, the scientists did not restrict themselves to measuring the effects on blood measures of insulin, glucose, c-reactive protein, and triglycerides, though. Their primary study outcomes included the effects on the subjects' metabolic rate and substrate oxidation at rest and during exercise as well as on body composition, strength and physical function.

For the study, twenty-four healthy females (66 ± 1 yr) were recruited and randomly assigned to receive either 3g/d of EPA and DHA or a placebo (PL, olive oil) for 12 wk. Exercise measurements
were taken before and after 12 wk of supplementation and resting metabolic measures were made before and at 6 and 12 wk of supplementation.

Figure 1: Relative changes in metabolic parameters at rest and during 30 min of exercise (Logan. 2015).

As you already know and can now see in Figure 1, the fish oil supplementation significantly increased the subjects' resting metabolic rates, energy expenditure during exercise and the rate of fat oxidation at rest and during exercise. What is kind of funny, though, is that the scientists either misreported the actual values or miscalculated the changes, because I used the data from their study to calculate the relative differences in Figure 1 and as you can easily see those are significantly different from the values reported in the introduction - values I copied directly from the abstract.

So, how did this work? As of now we don't really know that. It is most likely that EPA and DHA modulate energy metabolism by activating one or several PPAR receptors, which may then trigger increases in the levels several protein (FAT/CD36, FABPc, UPC3) and enzymes (acyl-CoA oxidase, CPTI) which control the mitochondrial fatty acid oxidation. Additional effects on PGC-1α, which is involved in regulating the genes involved in energy metabolism, as well as in mitochondrial biogenesis and function may augment the metabolic effects of the long-chain omega-3s. Effects of which we do yet not know how they are affected by and whether they require the incorporation of DHA and EPA into the cell membrane - obviously significantly more research is necessary.

Now the reason I am not going to spend time to find out, whether I or the researchers have made a mistake is that the statistically significant increase in resting metabolic rate for example amounts to 7kcal per hour, if the actual value is 2-5% lower or higher that's absolutely irrelevant. Since the same can be said for the other values, I think we all should be able to cope with any potential deviation from the actual data in the following overview I've compiled based on the (hopefully accurate) data from the tables in the full text of the study graphically in Figure 2.

Figure 2: Graphical overview of the absolute increase in energy expenditure and fat oxidation (Logan. 2015).

In conjunction with the marginal, but significant increase in lean mass, which does by the way only partially explain the increase in energy expenditure, these changes are not just statistically, but practically relevant - that's something even I, as a fish oil critic, have to admit ;-)

So, fish oil is a metbalic activator? Well, at least in this particular group of subjects, there's no debating that the 3g of combined EPA + DHA per day triggered statistically significant and as the data in Figure 2 shows even potentially practically relevant increases in energy expenditure at rest and during exercise.

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As the authors highlight, though, "[f]uture research should also aim to test a greater number of participants and include a longer period of supplementation (ie. 1 yr) to determine whether the increase in metabolic rate results in changes in more robust changes in body composition" (Logan. 2015). In view of the complaints of their subjects who had difficulties stomaching the 5g of total fish oil that were required to achieve the desired dose of EPA + DHA, the scientists also argue that future studies have to investigate solutions that reduce the digestive issues (gastrointestinal discomfort) and whether you even need 3g of EPA + DHA or lower dosages would have the same effect... well, and obviously, it would be interesting to see if similar results could be observed in younger and / or male subjects | Comment on Facebook!

References:

• Logan, Samantha Louise. Physical Activity and Nutrition as Modifiable Lifestyle Factors for Healthy Aging in Older Adults. Diss. The University of Guelph, 2013.

Weight Loss, 'Metabolic Damage' and the Magic of Carbs? Human Study Probes Effects of Carbohydrate Content, GL & GI on Diet-Induced Suppression of Resting Metabolic Rate

Will slimming down from a 120 cm to a 60 cm waist always ruin your metabolic rate and set you up for weight regain or can high GI protect you from yoyoing?

Broscience tells us: "Carb up to preserve your resting metabolic rate." And in fact, there is some scientific evidence that suggests a link between high(er) carbohydrate intakes and increased thyroid function. The same amount of T3 will trigger a sign. higher stimulation of lipolysis and fat oxidation, for example, on high vs. low carb diets (Mariash. 1980). Low carb diets, on the other hand, lead to significant reductions of the active thyroid hormone and increases in the 'thyroid receptor inhibitor' rT3 - even in healthy individuals and if the energy intake is standardizes (Serog. 1982; Ullrich. 1985). So, is broscience right? Well, overfeeding studies show a similar increase in T3 in response to protein, fat and carbohydrates (Danforth Jr. 1979). So refeeds should work, irrespective of their carbohydrate content...

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As you can see, it is hardly possible to confirm or reject the "carb up to prevent metabolic damage" (=prevent the diet induced over-proportional reduction in resting energy expenditure) hypothesis based on the existing evidence. A recent study by J. Philip Karl and colleagues who tried to determine "the effects of diets varying in carbohydrate and glycemic index (GI) on changes in body composition, resting metabolic rate (RMR), and metabolic adaptation during and after weight
loss" (Karl. 2015), however, may yet take us one step further towards rejecting or confirming this commonly heard of idea.

Figure 1: Overview of the key parameters of the study design and dietary composition (Karl. 2015).

In said study, Karl et al. randomly assigned adults with obesity (n = 91) to one of four diet groups for 17 weeks. As you can see in Figure 1, the diets all subjects were provided with differed in percentage energy from carbohydrate (55% or 70% | Figure 1, top-right) and GI (low or high, Figure 1, bottom-right) but were matched for protein, fiber, and energy. The study design itself comprised 5 phases:

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"Phase 1 was a 5-week weight maintenance phase in which weight maintenance energy needs were determined by adjusting provided energy intake to maintain stable weight. Mean Phase 1 energy intake was 12.2 MJ/day with 48% energy provided as carbohydrate, 16% as protein, and 36% as fat. Following Phase 1, participants were randomized by the study statistician to their Phase 2 dietary assignment using computer-generated randomization. The four diets differed in carbohydrate content (55%, ModCarb or 70%, HighCarb of total energy) and dietary GI (less than 60, LowGI or 80, HighGI), and were provided for 12 weeks at 67% of the weight maintenance energy intake determined in Phase 1. 

Participants were allowed to increase their energy intake during Phase 2 by requesting additional, randomization-appropriate foods from the metabolic kitchen if too hungry to be adherent. Phase 3 was a 5-week weight maintenance phase during which food was provided according to randomization. Energy intake during Phase 3 was prescribed to support weight maintenance at the new, lower body weight, and was predicted from body weight and energy intake measured at the end of Phase 2, with adjustment for self-reported physical activity. Phase 4 was a 12- month follow-up period during which participants selected and pre pared their own meals after being provided with instructions on fol lowing the diet to which they were randomized" (Karl. 2015)

To assess the effects of this sequence of induction (weight maintenance), and weight stabilization phases, the body weight, body composition, RMR, and metabolic adaptation (measured RMR vs. predicted resting metabolic rate = RMR) of the middle aged study participants (49-64 years) were measured before and after all phases of the study.

Figure 2: (A) Weight loss and (B) percentage of total weight loss attributable to fat mass and fat free mass while consuming provided-food diets differing in glycemic index (GI) and percent energy from carbohydrate (55%, ModCarb and 70%, HighCarb) for 17 weeks (n = 79). Values are mean 6 SEM. Weight loss analyzed by repeated measures ANCOVA, body composition by two-factor ANOVA. a,bMain effect of time; asignificant decrease from baseline (P < 0.001), bsignificant difference from Phase 2 end (P < 0.001). No diet effects (main effects or interactions) for any comparisons. GI, glycemic index; HighCarb, 70% energy from carbohydrate; ModCarb, 55% energy from carbohydrate (Karl. 2015).

Interestingly, the analysis of this data revealed no significant inter-group differences in terms of any of the relevant study outcomes. Yes, you read me right: This means that neither the GI, nor the GL, nor the carbohydrate content of the diet had statistically significant effects on weight loss, body composition, RMR, or the metabolic adaptation aka "metabolic damage" due to weight loss.

Figure 3: Measured resting metabolic rate as a function of predicted metabolic rate (Karl. 2015). Note: If there was no "metabolic damage", the solid line which represents the ideal body-weight dependent decline of energy expenditure and the dashed line which represents the actual ratio of the measured to the predicted RMR should be congruent.

While there were no inter-group differences and neither the amount or the type of carbohydrates had an effect on the reduction of the metabolic rate, there is still one interesting result you can see in the right graph in Figure 3. Said graph depicts the ratio of the measured to the predicted metabolic rate during the 5-week weight maintenance phase. If you look closely, you will realize that it suggests that having a high predicted RMR, i.e. being heavier, being taller and being more muscular, is associated with a non-significant decline of the non-predicted reduction of the energy expenditure (=metabolic damage) and thus a narrowing of the gap between the solid and dashed line.

"Solid and dashed? I don't get it!"

You're asking how I can support this hypothesis? Well, the dashed line that represents the true ratio of the actual to the predicted RMR approaches the theoretical one (the solid line) for higher RMR values. If this was more than a trend, it would suggest that two things: (a) Losing less weight and thus maintaining a higher predicted metabolic rate protects against metabolic damage (that would be useless). And (b) being tall and muscular and thus having a naturally high(er) predicted RMR can protect you from suffering metabolic damage when you lose weight.

Unfortunately, it's not possible to tell which (if any) of the two options is correct. If I had to make an educated guess, though, I would say it's a combination of both: The weight change of an average 5.5 kg did not wary too much and was withing 95% confidence intervals of [-7.1 kg, -4.6 kg]. In conjunction with individual physiological qualities of people with higher baseline RMRs, it could still explain the narrowing of the gap between predicted and true RMR after dieting.

Figure 4: Changes in body composition (absolute value in kg) after 20 weeks and after weight loss phase 2 (Karl. 2015).

Bottom line: As Karl et al. point out, "neither low-GI relative to high-GI diets nor moderate-carbohydrate relative to high-carbohydrate diets showed differences with respect to effects on changes in body composition or resting metabolism during weight loss when confounding dietary factors were tightly controlled in a study providing all food for 22 weeks" (Karl. 2015).

This does not just go against the mainstream assumption that low GI and/or low(er) carbohydrate diets facilitate weight loss, fat loss and weight maintenance (see data in Figure 4 for an overview of these parameters, it also contradicts the initially mentioned broscientific assumption that carbohydrates, in general, and high GI carbs, in particular, have a protective effect against the unexpected diet-induced reduction of basal energy expenditure many people know as "metabolic damage". If there's anything of which the study at hand suggests that it could protect you from such unexpectedly large decrease in RMR, it's not high GI carby, but rather an already high(er) baseline RMR (see Figure 3).

And what does that tell us? Right! Since a high predicted RMR is a function of (a) being male, (b) being tall, and (c) being muscular, all three attributes may protect you from diet-induced "metabolic damage" | Let me know your thoughts and comment on Facebook!

References:

• Danforth Jr, Elliot, et al. "Dietary-induced alterations in thyroid hormone metabolism during overnutrition." Journal of Clinical Investigation 64.5 (1979): 1336.
• Karl, J. Philip, et al. "Effects of carbohydrate quantity and glycemic index on resting metabolic rate and body composition during weight loss." Obesity 23.11 (2015): 2190-2198.
• Mariash, C. N., et al. "Synergism of thyroid hormone and high carbohydrate diet in the induction of lipogenic enzymes in the rat. Mechanisms and implications." Journal of Clinical Investigation 65.5 (1980): 1126.
• Serog, P., et al. "Effects of slimming and composition of diets on VO2 and thyroid hormones in healthy subjects." The American journal of clinical nutrition 35.1 (1982): 24-35.
• Ullrich, Irma H., Philip J. Peters, and M. J. Albrink. "Effect of low-carbohydrate diets high in either fat or protein on thyroid function, plasma insulin, glucose, and triglycerides in healthy young adults." Journal of the American College of Nutrition 4.4 (1985): 451-459.

High Protein Diet & Weight Maintenance - Same or Different Benefits? High Metabolic Rate, Increased Satiety, Improved Body Composition Confirm: "You Better Eat Your Protein!"

Scientists ask: High protein for weight loss only or also during maintenance phases?

"Relatively high-protein diets are effective for body weight loss, and subsequent weight maintenance," that's the first half-sentence from the abstract of the latest study from the Maastricht University, Maastricht (Martens. 2014). A sentence that continues with a reference to an important limitation of the contemporarily available evidence: "It remains to be shown whether these diets would prevent a positive energy balance."

Therefore, Martens et al. conducted a study that investigated the effects of high vs. low protein diets during weeks of body weight stability [unfortunately, no RDA group (0.8kg/day) ;(].

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In that, the researchers objective was to determine fullness, energy expenditure, and macronutrient balances on a high-protein low-carbohydrate (HPLC) diet compared with a high-carbohydrate low-protein (HCLP) diet at a constant body weight, and to assess whether effects are transient or sustained after 12 weeks.

Figure 1: Comparison of the relative contribution of protein, carbohydrates and fat to the total energy intake (Martens. 2014).

As you can see in Figure 1, the "high protein diet" is not exactly as "high" as many of you may have expected. With only 35% of the total energy of approximately 2,000kcal (on average) and a mean body weight of 66kg, the total protein intake relative to body weight was "only" 1.89g/kg protein.

The changes in body composition did not reach statistical significance, but the way the protein balance went from 4.1 ± 18.8 g/day to −16.4 ± 11.1 g/day within just one week and stagnated at −11.9 ± 14.1 g/day on the low protein diet clearly suggests that eating a diet that contains only 0.38g/kg body weight protein won't be able to sustain the amount of lean mass you need to function properly.

Compared to the low protein diet, where only 5% of the daily energy requirements were covered with high protein foods and thus only 0.38g protein per kg body weight, that's yet still plenty of protein and enough to have significant effects on the

• total energy expenditure (TEE) (P = 0.013), 
• sleeping metabolic rate (SMR) (P = 0.040), and 
• diet-induced thermogenesis (DIT) (P = 0.027) 

of the male and female study participants. Most importantly, the total energy expenditure was maintained only in the high protein diet group (HPLC), while it significantly decreased throughout the intervention period in the high carbohydrate (HCLP) diet group (wk 1: P = 0.002; wk 12: P = 0.001).

Figure 2: Metabolic effects of high vs. low protein diets (baseline vs. 12-week in % | Martens. 2014)

Similarly, the protein balance varied directly according to the amount of protein in the diet, and diverged significantly between the diets (P = 0.001); and last but not least, unsurprisingly the fullness ratings were significantly higher in the HPLC vs. the HCLP diet group at wk 1 (P = 0.034), but not at wk 12.

Figure 3: High vs. low protein diets have opposite effects on hunger, fullness, satiety and desire to eat w/ measurable effects on body comp. that may become sign. after more than 12 weeks (Martens. 2014).

Bottom line: The study at hand provides the missing evidence that high protein diets have similar beneficial effects during weight maintenance phases as they do during weight loss phases.

Most importantly, a high protein intake of (in this case) 1.89g/kg protein will help you to maintain a high energy expenditure and keep you from eating more than you need, due to its beneficial effects on hunger, fullness, satiety and the desire to eat you can see in Figure 3. What? Ah, yes! There were also decrease and increase in fat and lean mass of 3% and 1%, respectively. These changes in favor of the high protein diet did not reach stat. significance over the course of the 12-week study, but are likely to become sign. after longer periods | Comment on Facebook!

References:

• Martens, E. A., et al. "Maintenance of energy expenditure on high-protein vs. high-carbohydrate diets at a constant body weight may prevent a positive energy balance." Clinical Nutrition (2014).

Calorie Shifting (Refeeding) for Max. Fat Loss: Classic Body Building Principle Has Overweight Women Lose 8kg of Pure Fat in 42 Days - 2.6x More Than Calories In vs. Out Predicts

Want to lose that blubber in a minimal amount of time? Diet like a bodybuilder and don't forget to refeed, Ladies!

Calorie shifting? What's that? Don't worry. I have been asking myself the same question, when I first read the title of a recent paper from the Shaheed Beheshti University of Medical Sciences and Health Services and as it turned out, I was well aware of the principle, but didn't know scientists would call the classic diet - refeed cycles bodybuilders have been using for ages "calorie shifting".

The principle is as simple as effective. You're dieting for 11 days and "refeeding", i.e. eat ad-libitum for three days. The intention is to achieve a temporary deficit that's large enough to induce significant weight and fat loss in spite of the potential of temporary over-indulgence on the refeeding days.

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Common sense and years of practical experience inform us that this way of dieting works, but scientific evidence is yet scarce. The latter obviously cannot be said of the beneficial effects of using moderate amounts of caffeine on a diet to (a) increase the oxidation of fatty acids and (b) stabilize your energy levels. Against that background it appears smart that thirty of the sixty overweight or obese, but otherwise healthy women (aged between 26- 45 y) with sedentary life styles, who were selected to participate in the study at hand followed a calorie shifted diet (CSD) and supplemented with 5mg/kg of caffeine on both the calorie reduced and the ad-libitum days of their diet.

Figure 1: Overview of the three 4-week phases of the study and the respective energy intake.

As you can see in Figure 1 there was a hardcore dieting phase (phase 1 + 2 | day 1-14 + 15-28), in the course of which the subjects consumed ~800kcal less than on their regular diets and a 4-week normalization phase (phase 3 | day 29-42).

"All subjects were instructed to consume their meals (containing determined calorie) only at 4 set of meals every day and avoid any other intake at other times of day. The time for each of these meals was optional and they were free to consume in any hour, but the time interval between meals could not be less than 4 hours (e.g. 8-12-4-8)." (Davoodi. 2014a)

The subjects had to follow their 55% carbohydrate, 25% protein, 20% fat diets "to the T" for the previously mentioned 11 dieting days which were followed by 3 days of self-selecting food and energy intake. The 11-3 day-cycles were repeated 3 times (for 42 days) and followed by a whole follow-up period, in the course of which subjects received a diet containing 55% carbohydrates, 20% protein and 25% fat that was designed to match their individual energy requirements.

Calorie shifting beats the crap out of regular dieting by preserving the dieters' RMR (Davoodi. 2014b)

Is calorie shifting superior to regular calorie restriction? Yes, it does! As I've pointed out in the introduction, there are only few studies investigating the effects of diet / refeeding cycles, but a previous study by the authors of the study at hand (Davoodi. 2014b) shows overweight women lose significantly more body fat on a calorie shifting vs. regular diet; and, more importantly, kept the fat off during the weight maintenance phase - probably due to the conservation of their resting metabolic rate, which goes hand in hand with slightly reduced hunger scores and a higher rate of satisfaction with the diet.

The study design is not too difficult to understand, right? A significant reduction in calorie intake for 11 days that should suffice to strip 3.1kg of pure fat off the overweight physique of the study participants (assuming that you need a deficit of 7,000kcal to lose 1kg of body fat) if they didn't overeat on the ad-libitum days.

Figure 2: Body weight and body fat levels in % of baseline (Davoodi. 2014a)

And surprise! In this case the "optimistic" calories in vs. calories out calculation is actually not optimistic enough. Instead of the calculated 3.1kg of body fat, the ladies lost 8.04 kg of pure fat! That's 2.6x more fat than you would predict based on the stupid in vs. out calculation!

Caffeine promotes fat loss, but not using it may benefit body composition

Yes, you read me right. Take another look at the data in Figure 2. While the weight in the caffeine group dropped faster, the weight / body fat loss (a proxy of changes in body composition) in the group who abstained from caffeine was significantly more favorable.

Figure 3: Ratio of fat to weight loss - higher values = more favorable changes in body composition.

While the extreme difference in the first week could still be an outlier, there is a non-negligible trend towards more favorable changes in body composition in the "non-caffeinated" dieters (see Figure 3).

It is important, thought, to point out that this advantage occurred only during the active weight loss study. During the one-month follow up the addition of caffeine during the dieting phase inhibited the minor body fat rebound of 0.78kg and may - according to Davoodi - be what triggered the additional 1.54kg body fat loss, they observed during the maintenance follow up (Davoodi. 2014b)

Figure 4: If the fat loss alone was not impressive enough for you, what about the absence of a fat rebound?

Bottom line: While the caffeine-disadvantage comes as a surprise and is difficult to explain (could be an increase in cortisol that blunts fat loss, specifically in the obese) the overall message of the study at hand is clear: the good old bodybuilding diet / refeed regimen works and it works extremely well in overweight and obese women...

I mean: Can you remember another study, where the subjects lost almost 30% of their body fat and did not experience a weight rebound (in the caffeine arm, they even kept losing fat, see Figure 4) after a 42 day weight loss intervention? I can't and I have read my share of scientific papers | Comment on Facebook!

References:

• Davoodi, Sayyed Hossein, et al. "Caffeine Treatment Prevented from Weight Regain after Calorie Shifting Diet Induced Weight Loss." Iranian Journal of Pharmaceutical Research 13.2 (2014a): 707-718.
• Davoodi, Sayed Hossein, et al. "Calorie Shifting Diet Versus Calorie Restriction Diet: A Comparative Clinical Trial Study." International journal of preventive medicine 5.4 (2014b): 447.