At the end of the day:
Calorie Restriction
equals
Calorie Restriction.

See the article below from Dr. Arya Sharma, who is one of the world’s top medical obesity specialists.

Dr. Sharma is highly respected by obesity researchers, health professionals. His opinions are based on many years of extensive obesity research as well as many years of practical experience with obese patients. 

Alternate Day Fasting Is No Better Than Any Other Fad Diet
                   by Dr. Arya Sharma,  July 11, 2017

It seems that every year someone else comes up with a diet that can supposedly conquer obesity and all other health problems of civilization.

In almost every case, the diet is based on some “new” insight into how our bodies function, or how our ancestors (read – hunters gatherers (never mind that they only lived to be 35) ate, or how modern foods are killing us (never mind that the average person has never lived longer than ever before), or how (insert remote population here) lives today with no chronic disease.

Throw in some scientific terms like “ketogenic”, “guten”, “anti-oxidant”, “fructose”, or “insulin”, add some level of restriction and unusual foods, and (most importantly) get celebrity endorsement and “testimonials” and you have a best-seller (and a successful speaking career) ready to go.

The problem is that, no matter what the “scientific” (sounding) theories suggest, there is little evidence that the enthusiastic promises of any of these hold up under the cold light of scientific study.

Therefore, I am not the least surprised that the same holds true for the much hyped “alternative-day fasting diet”, which supposedly is best for us, because it mimics how our pre-historic ancestors apparently made it to the ripe age of 35 without obesity and heart attacks.

Thus, a year-long randomized controlled study by John Trepanowski and colleagues, published in JAMA Internal Medicine, shows that alternate day fasting is evidently no better in producing superior adherence, weight loss, weight maintenance, or cardioprotection compared to good old daily calorie restriction (which also produces modest long-term results at best).

In fact, the alternate day fasting group had significantly more dropouts than both the daily calorie restriction and control group (38% vs. 29% and 26% respectively). Mean weight loss was virtually identical between both intervention groups (~6 Kg).

Purists of course will instantly criticize that the study did not actually test alternative-day fasting, as more people dropped out and most of the participants who stayed in that group actually ate more than prescribed on fast days, and less than prescribed on feast days – but that is exactly the point of this kind of study – to test whether the proposed diet works in “real life”, because no one in “real life” can ever be expected to be perfectly compliant with any diet. In fact, again, as this study shows, the more “restrictive” the diet (and, yes, starving yourself every other day is “restrictive”), the greater the dropout rate.

Unfortunately, what counts in real life is not what people SHOULD be doing, but what people actually do.

The question really is not whether or not alternate-day fasting is better for someone trying to lose weight but rather, whether or not “recommending” someone follows an alternate-day fasting plan (and them trying to follow it the best they can) is better for them. The clear answer from this study is “no”.

So why are all diets the same (in that virtually all of them provide a rather modest degree of long-term weight loss)?

My guess is that no diet (or behavior for that matter) has the capability of fundamentally changing the body’s biology that acts to protect and restore body fat in the long-term. Irrespective of whether a diet leads to weight loss in the short term and irrespective of how it does so (or how slow or fast), ultimately no diet manages to “reset” the body-weight set point to a lower level, that would biologically “stabilize” weight loss in the long-term.

Thus, the amount of long-term weight loss that can be achieved by dieting is always in the same (rather modest) ballpark and it is often only a matter of time before the biology wins out and put all the weight back on.

Clearly, I am not holding my breath for the next diet that comes along that promises to be better than everything we’ve had before.

My advice to patients is, do what works for you, but do not expect miracles – just find the diet you can happily live on and stick to it.

Dr. Arya M. Sharma, MD, PhD, FRCPC is a medical doctor and university professor of medicine and obesity research.  His research focuses on the evidence-based prevention and management of obesity and its complications.

He has authored and co-authored more than 350 scientific articles and has lectured widely throughout the world on the etiology and management of obesity and related cardiovascular disorders. Dr. Sharma is regularly featured as a medical expert in national and international TV and print media and maintains a widely read obesity blog at www.drsharma.ca.

I have been observing and experimenting with various forms of Intermittent Fasting since early 2006, which was BEFORE the best-selling intermittent fasting books… including… JUDDD, ADF, EatStopEat, 5/2, and EOD ... were published.  And BEFORE the concept of Intermittent Fasting as a diet became famous on the internet.

This past 12 years, I’ve closely watched many diet “experts” talk about the latest fasting research, while providing their own anecdotal evidence.   I’ve seen both of these offered as evidence to prove the "expert's"  own opinions about the subject. 

As an attorney, I’ve been trained to notice when people improperly characterize evidence, especially when they misstate evidence or misquote a witness in order to prove a point they are trying to make.

This is something that is commonly done by diet “experts”.  Unfortunately even medical doctors whose overall medical expertise and opinions I tend to respect, sometimes engage in this type of Behavior, and apply valid scientific research incorrectly in order to support “a hypothesis with zero proof, which is really no more than that expert’s own wishful thinking.”

For example, even Dr. Jason Fung, who appears to be a very dedicated, well-educated, and experienced medical expert specializing in the area of Diabetes, …(and who is extensively quoted here in the Fasting Blog Category section of DietHobby as an intermittent fasting expert) … sometimes improperly characterizes research evidence in order to prove points which appear to be merely based on his “wishful thinking” due to the lack of valid supporting evidence.

One of Dr. Fung’s hypothesis is that people cannot lose weight by using “calorie restriction”, but that they can lose weight by using “Intermittent fasting”, and he claims that there is a very big difference between these two behaviors.  As evidence for this principle, he often compares scientific Research about Biggest Loser Contestants, who he labels as “Calorie Restricting”, versus scientific Research about Gastric Bypass Participants, who he labels as “Fasting”.

Of course, the main problem with the Comparison is that BOTH of these weight-loss methods are based on Calorie Restriction in that Post-gastric bypass, participants do not “Fast”.  They do not go without eating. After weight-loss surgery they eat small amounts of food daily.  First, they ingest liquid food, then soft food, and then go on to firm food. 

During the first year after my own open RNY gastric bypass, 25 years ago, my experience was similar to what everyone else commonly reports.  I ate between 300 and 600 calories per day … which was as much food as my body would tolerate at the time.  I did not fast.  I did not consciously “restrict calories”,  but instead focused on eating only the amounts and kinds of food that would prevent me from lying on my bed with dry heaves.  I did not fast. My surgery restricted calories for me.

Since both of these forms of eating behavior leading to weight-loss were based on Calorie Restriction, Dr. Fung misstated the evidence which he provided as proof for his hypothesis.  As a result, his hypothesis lacks proof.  This reduces it back to his own personal “wishful thinking”.   Over the past several years, Dr. Fung has failed to address or provide any explanation for this error, even though I have seen it pointed out to him on several different occasions.

I find it interesting that Dr. Fung also relies heavily on Dr Krista Varady’s past scientific research on Intermittent Fasting to prove that Intermittent Fasting is superior to Calorie Restriction… although in her own words .... Dr. Varady says that Intermittent Fasting is a form of "Calorie-Restriction".

 When Dr. Varady was interviewed about this recent research study which is the subject of Dr. Sharma’s article, she said:

“I really thought people would have an easier time and lose more weight on the [intermittent fasting diet] and I was shocked they lost the same amount,” says study author Dr. Krista Varady, an associate professor of nutrition the University of Illinois at Chicago and author of the book The Every-Other-Day Diet. “The take-home message for me is that this diet isn’t for everyone.”

"I don't think there's anything magical to the diet at all," she said of alternate-day fasting. "I think it's just another way of tricking people into eating less food or helping people to kind of monitor how much food intake there is or how much food they're taking in."

You can find the complete study in my previous article: “Fasting is No Better For You Than Regular Calorie Restriction - new Scientific Study”.

The Best Online
Calorie Calculator,
According to Science.
But it might not work for you.

Another free online calorie calculator, the Body Weight Planner, is now available to the public after several years of being used as a research tool for scientists at the National Institutes of Health. This one is noteworthy because its algorithms were validated in several controlled weight loss studies in human beings, and because it takes into account a person's slowing metabolism.
 
Kevin Hall, a scientist at the NIH's National Institute of Diabetes and Digestive and Kidney Diseases, created the tool.

Dr. Hall says the 3,500-calorie rule is accurate only if a pound of human fat is burned in a lab.  However, unlike a lab, the body is not a static environment, and instead adapts when a person changes their diet and exercise.

As a person diets and loses weight, the body slows the metabolism in an effort to conserve energy. As a result, eating 500 fewer calories a day leads to slightly less weight loss as time goes on.

Instead of 3,500 fewer calories, over 12 months, a person will need to eat 7,000 fewer calories to burn a pound of fat.

Dr. Hall said that the biggest flaw with the 3,500-calorie-rule is that it assumes weight loss will continue in a linear fashion over time. "That's not the way the body responds. The body is a very dynamic system, and a change in one part of the system always produces changes in other parts.”

He admits that dieters may be “bummed out” by news that they must double their efforts at reducing calories. “But we believe it's better to have an accurate assessment of what you might lose, that way you don't feel like a failure if you don't reach your goal.”

Dr. Hall added that very few people seem to be able to keep losing weight after 12 months.

The BWP calculates how many calories a day a person should eat to achieve their weight loss goals in a certain time (for example, to lose 10 lbs within a year).  The link can always be found here in DietHobby, under RESOURCES, Links, Body weight Calculator - NIH (Timeline Projections).

The NIH bills the planner as a cutting-edge tool that will empower people to take their health into their own hands, but research on the success of such calculators and trackers is mixed.  Although the federal government is to be praised for its official nod toward the utility of trackers and calculators,  human beings themselves are not “simple machines” who operate on a calories in, calories out basis.
 
The assumption is that calories in and calories out are independent of each other.  That is, if you reduce Calories in,  Calories out are not affected.  However, this is untrue.  

DietHobby contains many posts talking about how hard it is to get an accurate ongoing count of  “Calories in”, but getting an accurate ongoing count of “Calories out” is far more difficult.  Most everyone makes an erroneous assumption that the “Calories out” number stays constant.

“Calories out” is not under our conscious control.  There are many metabolically active tissues, including brain, kidneys, heart, liver, etc whose activity is very difficult to measure. There are numerous hormones and enzymes and genetics involved in our individual metabolic processes…and some of these are still undiscovered. 

We make the incorrect assumption that our only variable that changes is the energy we spend in voluntary exercise or activity.  This is also not true.  Basal Energy Expenditure is not stable and can change up or down 50%.  Reducing Calories In reduces Calories Out. They are not independent of each other.

This isn’t news to anyone who has ever seriously tried to lose and maintain weight. A London research study released in July 2015 that tracked 278,982 participants, using electronic health records from 2004 to 2014 estimated that for people with a 30-35 BMI (Stage 1= obesity), an obese man’s chances of reaching a normal body weight (<25 BMI) were 1 in 210 for men, and 1 in 124 for women. For the severely obese-people with a 40+ BMI (Stage 2+ =severe obesity+), only about 8 percent of obese men and 10 percent of obese women were able to lose five percent of their body weights.  Almost all of the participants who achieved weight loss regained it within five years. 

At my highest weight, 24 years ago at age 47, my personal BMI was 52.9  (Stage 4=super-obesity). I have been at-or-near a "normal" BMI for the past 10 years. See ABOUT ME.
 
Calculators can't provide prescriptions for weight loss or protections against regain. They don’t apply equally to every single individual, and are merely averages ... standardized guidelines. The problem is that not all metabolisms, circumstances and eating habits are standardized.
 
For example, if a professional athlete walked at 3 miles per hour speed for a half hour, that athlete would burn calories totally differently than an average non-athlete who was the same exact weight.
 
Many factors are at play when it comes to how people consume and burn calories. Environment matters, for example. Also, everything from stress, to genetics, to cultural influences plus more, can affect an individual’s dietary habits and exercise levels.
 
Emerging research shows that even gut bacteria affects a person's ability to absorb calories. For instance, food may be absorbed as three calories in a lean person and seven calories in an obese person simply because of differences in how gut bacteria breaks down the meal.
Therefore, it is unreasonable to expect ANY calculator to give everyone a full and accurate game plan.

In the video below, Dr. Hall demonstrates how the calculator works by using his own weight loss goals as an example:

Hall, a 44-year-old man who wants to lose 20 pounds off his 5’10, 180-pound frame, is going to have to eat about 2,300 calories per day, provided he sticks to his resolution to walk his dog in the mornings three times a week. Once he reaches his goal weight, he’s going to have to maintain that weight loss by keeping up his dog-walking activity level and eating about 2,600 calories a day.

NOTE: originally posted on 12/1/2015.  Bumped up for new viewers.

The issue of Projections about the Rate of Weight-Loss has been on my mind for a very long time, and so this article is going to be quite long and detailed.  Those who bear with me and press on through, might learn some helpful information, or at least be exposed to something other than empty promises.

The Diet Industry knows that people want to lose their excess fat ASAP, and that people also want to spend as little time possible on a weight-loss Diet.  It takes advantage of that fact by using the diet-of-the-moment’s maximum 1st week weight-loss number as a marketing tool. 

Typical is: “Lose 15 pounds in 7 days”; or 10 pounds or 7 pounds, etc.  We see that ploy used continually in the media.  It is almost impossible to look at any magazine display rack in a supermarket checkout line without seeing a similar Headline.

What is implied by this claim is that the number of the first week’s weight loss is a prediction of weight-loss for the subsequent weeks. Marketing claims: “10 pounds in 1 week”.  People think, “Wow, If I stick to this Diet for just 5 weeks, I can lose 50 pounds.” 

Then, when they don’t experience that rate of weight-loss, they feel disappointed. Upon expressing their disappointment to the medical doctor, the nutritionist, the diet guru, the group leader, the program counselor, or whoever, the most common response is: “YOU didn’t follow the diet correctly.”  People are blamed for their weight-loss failure; while the Diet Industry gets the credit for their weight-loss success.

This is universal. I’ve never seen or participated in ANY diet program that didn’t follow that line of thinking, and during the past 60 years …from adolescence on… I’ve been involved with a great many of them.  I have personal experience with a great many diets and diet programs, and I’ve closely watched the experiences of many hundreds of other people as they dieted.

People WANT TO BELIEVE the claims of rapid weight-loss that they hear, and they desperately hope that they will personally experience rapid weight-loss by following their latest Diet-of-choice.   Some of these rapid weight-loss claims are based on lies; some are based on ignorance; some are based on personal experience together with poor memory; and a few are based on the real results of very unusual people. There are those who make these incorrect rapid weight-loss projections in good faith; who stubbornly hold onto an unreasonable Belief by stubbornly ignoring the overwhelmingly-vast-weight-of-the-evidence stacked up against it. However, the fact is that almost all of those claims are false, and the rest of them are based on factors that don’t apply the the majority of dieters. 

Almost everyone on a Diet, including me, is curious about their own potential rate of weight-loss.  

Here are a few facts to consider.  Typically… all other things being equal…, males lose weight faster than females; younger people lose faster than older people; larger people lose faster than smaller people; fatter people lose faster than thinner people; athletic people lose faster than sedentary people; people who have gained weight after maintaining a lifetime of “normal” weight lose faster than people who’ve been fat for a long time.  When people become lighter, their bodies require less fuel to function, and therefore after successfully dieting, they must continually eat less than they did to maintain their old weight. 

In addition to the facts mentioned above, different people of the same age and same size naturally have different metabolic rates. The two main formulas that cite Metabolic rates, and list weights and calories together, are the Harris-Benedict formula and the Mifflin formula.  These are similar in that their numbers are based on AVERAGES… which means that there are many people ABOVE that number, and many people BELOW that number. The standard deviation of the Harris-Benedict formula is about 14%, and it is not uncommon for people to be 14% above or 14% below that Average number.  Also, the studies include  “Outliers” which are people who are situated away or detached from the main body and differ from all other members of a particular group.  An Outlier has a metabolic rate very much higher or very much lower than the rest of the Group.

It is important to understand that the calculators, charts, graphs and predictions we see online are based on the Averages used in the above-mentioned formulas, and although they are a good place to start, they may not apply exactly to you personally.  AND, even if they apply to YOU personally, it doesn’t mean that they will apply to EVERYONE personally.

I’m going to show you how this works by sharing about ME, personally.  In order to better understand, it would be helpful if you read or re-read the article: ABOUT ME.  Next read or re-read the article: How Fast…How Much…Weight Lost After Gastric Bypass?  This article contains a detailed chart of my rate of weight-loss during the year immediately after my RNY gastric bypass 24 years ago.

The rate of weight-loss that I experienced during the year following weight loss surgery is extremely valuable information because there can be NO QUESTION of whether or not I was “faithful to the diet”.  I had no other physical option, as my body would not allow me to eat in any other way.  No normal “cheating” was possible, and even a very tiniest amount of extra food resulted in severe physical discomfort, i.e. vomiting and/or other painful symptoms.

It is also important, because my diet after a gastric bypass was an extremely low-calorie diet, from less than 300 daily calories to a maximum of around 600-800 daily.  So, ….other than a total water fast… no other diet exists which would cause a faster rate of weight loss for me.

Here is a summary of my numbers (see the chart mentioned above for details).
Start: 271 pounds; End: 161 pounds.

Information from the first 7 months or so is the most relevant for this article.

Before WLS weighed 271
The first week: … week one I lost 17 pounds.
Start of week 2, weighed 254 pounds
Weeks 2-6 (5 week period) I lost 14 lbs for a 2.8 lb average loss per week.
Weeks 7-12 (6 week period) I lost 15 lbs for a 2 ½ lb average loss per week.
Weeks 13-18 (6 week period) I lost 16 lbs for a 2 ½ lb average loss per week
Weeks 19-24 (6 week period) I lost 15 lbs for a 2 ½ lb average loss per week
Weeks 25-30 (6 week period) I lost 14 lbs for a 2 ⅓ lb average loss per week
End of week 30, weighed 180 pounds.

In the weeks that followed, my body was able to tolerate more food, and my weight loss began slowing to a standstill.  Although this information is not all that relevant to this current article, I include it to satisfy those who might be curious.

Start weight 180 
Weeks 31-36 (6 weeks) I lost 3 lbs = ½ lb average loss per week
Weeks 37-42 (6 weeks) I lost 7 lbs = 1 lb average loss per week
Weeks 43-48 (6 weeks) I lost 5 lbs = ½ lb average loss per week
weight 167
Weeks 49-54 (6 weeks) I lost 1 lb = 1/6 lb average loss per week
Weeks 55-60 (6 weeks) I lost 2 lbs = ⅓ lb average loss per week
Weeks 61-64 (4 weeks) I lost 3 lbs = 3/4 lb per week
Final low weight 161.

So, regarding projections about my own future rate of weight-loss, the  information about myself shows that in the 7 or so months immediately following a RNY gastric bypass, which forced me to eat in a very low-calorie manner …. my average rate of weight loss was about 2 ½ pounds per week.

I am still female, and still 5 ft 0 in tall,
however, at this time……
I am 24 years older. I am physically much less active. Instead of being obese between 254-180 pounds, I am now a “normal” weight - 123.  All of these factors make a difference in my metabolic rate. It is now lower. My body now, simply does not need as many calories as it did before.  Because of this, it is unlikely that any type of diet … other than a total water fast… would cause an ongoing weight loss as high as that previous 2 ½ pound weekly average.

There are very few people who have kept exact and detailed long-term records of their weight-loss histories, or had the same diet experiences. So while my information is relevant to me, personally, it might not be all that helpful to others. Keeping all of that past personal information in mind, now I’m going to move on to share about making personal projections for my FUTURE rate of weight-loss on a very-low calorie diet.


This is an visual of my current weight maintenance graph.

My ultimate goal is to keep my weight within my “normal” BMI range.  At times this involves some rather serious dieting.  Currently, I am doing some more experimentation with “The 5-Bite Diet”, which is a very low calorie diet which mimics the volume of eating immediately after a Gastric Bypass.  This morning the scale said that I weigh 123 pounds.

In the next examples, I’m going to be using the Body Weight Planner Tool.  For my detailed discussion of this tool, read or re-read Body Weight Calculator -Timeline Projections. Remember, the numbers in this tool are based on AVERAGES, and people are commonly both Above and Below these Averages.

  Now, I’m going to use the Body Weight Planner Tool to run some calculations in order to see what a “reasonable” timeline projection of my rate of weight-loss would be if:

(1) I went on a “Total Water Fast”;  or 
(2) I followed the 5-bite diet eating only 2 Snickers bars or their equivalent daily (500 calories); or
(3) I followed the 5-bite diet eating only 1 Snickers bar or it’s equivalent daily (250 calories).

This following information is for those people who might be interested in learning how to use this Calculator to find out what a “reasonable” timeline projection might be for their own personal rate of weight-loss.  BTW, in order to force the tool to go under a 1, 000 calorie diet, you have to use the button “Switch to Expert Mode”. 


Scenario One….. A Total Water Fast.

In this example, I use my own numbers, to see how long it would take for me to lose from 123 pounds to a 105 pound goal on a total water fast. 

Notice the graph gives my total daily energy equivalent (TDEE) as 1,110 daily calories.  It says that after I reach 105 pounds that TDEE will drop to 1058 daily calories. In actuality, from my detailed 10 year history of personal records, my actual TDEE is a couple of hundred calories lower than  Average. 

According to this calculator, it would take 32 days of a total water fast for me to reach 105 pounds.



 Above is a graph of that same information.  Note, however, that immediately upon reaching 105 pounds, and starting to eat 1058 calories, there is a projection of an immediate up bounce, due to the increased weight of food/water/salt/waste. This projected up bounce is almost 8 pounds, leaving the final weight result 113.6 pounds.

Scenario Two….. 5-bite diet - 2 snickers bars per day (500 cal)

In this example, I use my own numbers, to see how long it would take for me to lose from 123 pounds to a 105 pound goal on a perfect 5-bite diet of 2 snickers bars or 500 calories per day.  All of these graphs will give me the same TDEE info.

According to this calculator, it would take 95 days of 2x5-bites (2 snicker bars=500 calories) for me to reach 105 pounds.



Above is a graph of that same information.  Note, however, that immediately upon reaching 105 pounds, and starting to eat 1058 calories, the projection of an immediate up bounce, due to the increased weight of food/water/salt/waste is less. This projected up bounce is about 4 pounds, leaving the final weight result 109 pounds.


Scenario Three….. 5-bite diet - 1 snickers bars per day (250 cal)

In this example, I use my own numbers, to see how long it would take for me to lose from 123 pounds to a 105 pound goal on a perfect 5-bite diet of 1 snickers bar (250 calories) per day.  All of these graphs will give me the same TDEE info.

According to this calculator, it would take 55 days of 2x5-bites (1 snicker bars=250 calories) for me to reach 105 pounds.


Above is a graph of that same information.  Note, however, that immediately upon reaching 105 pounds, and starting to eat 1058 calories, the projection of an immediate up bounce, due to the increased weight of food/water/salt/waste is less. This projected up bounce is about 6 pounds, leaving the final weight result 111 pounds.

  What does all this mean?
First, undoubtedly, it it means that I am a compulsive record keeper, who is obsessed about my weight.

Second, the information in the above pictures does not apply universally. It is applicable ONLY to me personally…. and even then… only to the “average” person whose height, weight, sex, age, and activity level numbers match my own. 

Next, the tool I’ve demonstrated can be used by anyone who wants to input their own numbers, and play the game of “how many calories = how fast a weight loss”.

Finally, my wish and hope is that everyone who is interested in their own rate of weight loss, will not simply take the amazingly erroneous weight-loss projections of any “Expert, including any Medical Doctor” as Truth, and then blame themselves for failing, when even despite their very best efforts, their bodies do not meet those impossible-and-unreal rapid-weight-loss standards.

NOTE:  Originally posted in January 2016. Bumped up for new viewers.