The Truth is . . . Caloric Restricted Exercise Won’t Work
This post isn’t going to win me any friends . . . in fact, mentioning this topic a few days ago has already angered a number of them and resulted in an online tongue lashing by a few others. However, I can’t resist. And, based on some very persuasive data and personal experience, I don’t care.
Truth is truth . . . it doesn’t change no matter how you spin it, or attempt to fit it into your paradigm. The problem is what we have accepted in the last 40-50 years as “the scientific truth about getting healthy” is far from truth. By getting healthy, I’m implying the application of main-stream methods accepted to lose weight, reduce cholesterol, improve blood pressure and reduce your risk of heart disease and diabetes.
For the last 40 years we’ve been told that the only way to get and live healthy is to restrict our calories. This main-streamed advise continues even today in our USDA 2010 Dietary Guidelines. And, if you ascribe to this futile dogma propagated since the 1970’s, then you’ll know that the “only acceptable way” to do this is to “eat less fat” (because fat is the most caloric dense of the macro-nutrients, right?) and to “exercise more” (because that’s how we burn calories, right?!) Well, that’s what I thought, too. And that is the health prescription I doled out to my-self and to all of my patients for the first 8 years of my practice.
Interestingly, most of them, including myself, took that prescription of a caloric restricted diet of 1200-1500 calories per day and exercise 3-6 days a week for 30-60 minutes and ran with it. Personally, I restricted calories to 1200-1500 per day and began running triathlons. I performed cardiac monitored running, swimming and cycling for an hour a day during the week and 2 hours on the weekend. I lifted weights 2-3 days per week as well. Guess what it got me? Fat.
It raised my triglycerides by 100 points, elevated my LDL-C and increased my waistline by 3 inches. Yes, I gained weight. But, hey, my doctor was happy because my HDL-C went up by 4 points.
I saw this identical pattern with 3/4ths the patients in my office. A fourth of my patient’s (the group without any genetic insulin resistance) saw weight loss and improvement in their cholesterol profiles, but the rest didn’t. I had the exciting opportunity to introduce the saddened and discouraged 3/4ths of my patients to STATIN drugs and blood pressure medications. My average patient’s gained 2-3% of their body fat each year. Those that exercised like fiends were lucky if their weigh gain just stabilized.
What I saw in my office over a period of eight years was that exercise and caloric restriction didn’t work. But I couldn’t say that, because that goes against everything your 8th grade health teacher taught you. It contradicted your neighborhood dietitian, and it spat in the face of the food pyramid and the USDA Guidelines. The Government wrong? Never. . . . Speaking contradictory of the calorie-in/calorie-out exercise dogma was heresy, right? Contradict, Dr. Ornish, wouldn’t be heard of?!!
If I’ve learned one thing in my medical career, it is this: “Don’t be afraid to question everything” – even Dr. Dean Ornish, the USDA and the American Heart Association. And, fascinatingly, I’m not the only on that did.
Three Massive Studies did just that . . . question whether this exercise and caloric restriction dogma really works. This is what applying exercise and caloric cutting did for almost 67,000 people between 1972 and 2010 – little to nothing.
WHAT?!! Nothing?! You can’t be serous?
The first of these trials was the MRFIT (Multiple Risk Factor Intervention) Trial. It started in 1972, looking at 12,866 men with high risk for heart disease and followed them over seven years. All of them were placed on caloric restricted low fat diets and encouraged to exercise. It demonstrated that low fat diets and exercise FAILED to reduce weight or stop coronary artery disease in 100% of the cases. Don’t believe me? Read it for yourself (JAMA. 1982; 248 (12):1465-1477).
The second of these trials was the Women’s Health Initiative (WHI). This study started in 1991 and followed 48,835 women (yes, that’s a small city of women) for eight years. They didn’t believe the MRFIT results apparently, so they had a low fat (caloric restricted) arm and a control arm [the SAD diet (Standard American Diet)]. The women on the low fat arm lost a whooping 0.4 kg over the 8 year period (JAMA. 2006 Jan 4;295(1):39-49). 0.4 kg, really!?? That’s almost an entire pound of weight loss over 8 years. Quick, call Barnes & Noble so we can package that diet and sell it on Opra!! (Oh, wait, the news media was a little embarrassed by the findings and never really mentioned them.)
Lastly, if research on 60,000 men and women wasn’t enough to demonstrate what most primary care physicians seen in their offices daily, we had to do the Look AHEAD Study (Action for Health in Diabetes). This study started in 2001 and was supposed to run for 13.5 years. It studied 5,145 Type II diabetic patients with intensive lifestyle intervention. These patients were placed on intensive caloric and fat restriction of 1200-1800 calories per day with exercise and behavioral counseling. It was so unsuccessful, that they stopped the trial at 9.6 years – cause it wasn’t working.
The patients did lose some weight through Look AHEAD . . . an average of 6% of their body fat (That means you would have lost 15.6 lbs over 9 years if you weighed 260 lbs. Successful? . . . NOT). What made this trial worse is that it didn’t improve risk for coronary artery disease and people didn’t live longer (N Engl J Med 2013; 369:145-154). They just got the exciting chance to eat cardboard for 9 years of their lives. Sad. Very sad.
So, what does all this mean? Exercising your brains out at an expensive gym every morning won’t do much more than help you loose 1% of your body fat. It won’t increased your life span and it won’t decrease your risk of heart disease, despite what Dr. Ornish said. If you like spending $40 per month just to stare at sweaty fat bodies jumping up and down in spandex, by all means, please keep going to the gym. But I’d much rather spend that $40 on a nice rib eye steak at a restaurant staring at my wife. But, the benefits of saturated fat . . . that’s for another post.
Don’t get me wrong. I love lifting weights. I love riding my horse. I truly enjoy working in my yard. I even enjoy riding my bicycle. But I do these things now because they bring me peace, decrease my stress, and allow me to connect with nature. Believe me, there’s nothing natural about a 250 pound man in spandex staring at himself in a mirror repetitively lifting 30 pound bars of iron. But, we won’t go there.
My friends, and a few of my patients, get their knickers in a wad trying to decry the fact that I’m giving people a reason not to go running. Maybe I am. To be honest, there’s really only one reason I want to run, . . . and that’s when I’m being chased by a bear. But what good does it do to guilt a person into participation in an activity that isn’t really benefiting their health or help them lose weight, unless they really truly enjoy the activity for the sake of the activity?
Our health is not based upon a caloric scale of inputs and outputs. We are hormonal machines. We gain or lose weight and we gain or lose muscle based on powerful hormone signals, specifically insulin. Simple carbohydrate restriction has profound effects upon our weight, blood pressure, cholesterol and inflammatory states. Until we each come to grips with the fact that the food we eat triggers hormone responses in our bodies, we will continue down the path of diseases of civilization. Hippocrates summed it up when he said, “Let food be thy medicine, and let medicine be thy food.”