How to preserve bone and mass on a low calorie diet.
Potential Pitfalls of Calorie Restriction
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
One of the most consistent benefits of calorie restriction is blood pressure improvements in as short as one or two weeks. Blood pressures can sometimes even be normalized in a matter of weeks, and blood pressure pills discontinued. Unfortunately, this can work a little too well, and cause something called orthostatic intolerance, which can manifest as lightheadedness or dizziness upon standing—which in severe cases can cause fainting. Staying hydrated can help.
What about loss of muscle mass? In the CALERIE trial, 70 percent of the lost body weight was fat, and 30 percent lean body mass. So, they ended up with an improved body composition: 72 percent lean mass, compared to 66 percent in the control group. Though leg muscle mass and strength declined in absolute terms, relative to their new body size, they generally got stronger. Is there any way to preserve even more lean mass, though, particularly among older individuals who naturally tend to lose muscle mass with age?
Increased protein intakes are commonly suggested, but most studies fail to find a beneficial effect on preserving muscle strength or function whether you’re young or old, active or sedentary. For example, researchers randomized overweight older men and women to a normal-protein diet—4 grams for every 10 pounds of body weight, or a high-protein diet—about 8 grams per 10 pounds, during a 25-percent calorie restriction. That doubling of protein intake had no discernible effect on lean body mass, muscle strength, or physical performance. Most such studies found the same lack of benefit. But, put them all together, and one can tease out a small advantage, about a pound or two difference over an average of six months. Unfortunately, high-protein intake during weight loss has been found to have profoundly negative metabolic effects; for example, undermining the benefits of weight loss on insulin sensitivity. Lose 20 pounds, and you can dramatically improve your body’s ability to handle blood sugars, compared to a control group that maintained their weight. Lose the exact same amount of weight, but on a high-protein diet, getting about an extra 30 grams a day, and it’s like you never lost any weight at all.
Though you can always bulk back up after weight loss, the best way to preserve muscle mass during weight loss is exercise. The CALERIE study had no structured exercise component and, like after bariatric surgery, about 30 percent of the weight loss was lean mass. In contrast, that proportion was only about 16 percent in The Biggest Loser contestants, chalked up to their vigorous exercise program. Resistance training even just three times a week can prevent more than 90 percent of lean body mass loss during calorie restriction.
The same may be true of bone loss. Lose weight through calorie restriction alone, and you experience a decline in bone mineral density in fracture risk sites, such as the hip and spine. In the same study, though, those randomized to lose weight with exercise didn’t suffer any bone loss. The researchers conclude: “Our results suggest that regular [exercise] should be included as part of a comprehensive weight loss program to offset the adverse effects of [caloric restriction] on [the] bone.“ You can never argue with calls for increased physical activity, but even without an exercise regimen, the “very small” drop in bone mineral density in the CALERIE trial might only increase a 10-year risk of osteoporotic fracture by only about 0.2 percent. The benefits of calorie restriction revealed by the study—improved blood pressure, improved cholesterol, improved mood, improved libido, improved sleep—would seem to far outweigh any potential risks. The fact that a reduction in calories seemed to have such wide-ranging benefits on quality of life led commentators in the AMA’s Internal Medicine journal to write: “The findings of this well-designed study suggest that intake of excess calories is not only a burden to our physical equilibrium, but also [to] our psychological well-being” as well.
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- Nicoll R, Henein MY. Caloric Restriction and Its Effect on Blood Pressure, Heart Rate Variability and Arterial Stiffness and Dilatation: A Review of the Evidence. Int J Mol Sci. 2018;19(3).
- Florian JP, Baisch FJ, Heer M, Pawelczyk JA. Caloric restriction decreases orthostatic tolerance independently from 6° head-down bedrest. PLoS One. 2015;10(4):e0118812.
- Lu CC, Diedrich A, Tung CS, et al. Water ingestion as prophylaxis against syncope. Circulation. 2003;108(21):2660-5.
- Most J, Gilmore LA, Smith SR, Han H, Ravussin E, Redman LM. Significant improvement in cardiometabolic health in healthy nonobese individuals during caloric restriction-induced weight loss and weight loss maintenance. Am J Physiol Endocrinol Metab. 2018;314(4):E396–E405.
- Das SK, Roberts SB, Bhapkar MV, et al. Body-composition changes in the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE)-2 study: a 2-y randomized controlled trial of calorie restriction in nonobese humans. Am J Clin Nutr. 2017;105(4):913-927.
- Racette SB, Rochon J, Uhrich ML, et al. Effects of Two Years of Calorie Restriction on Aerobic Capacity and Muscle Strength. Med Sci Sports Exerc. 2017;49(11):2240–2249.
- Cava E, Yeat NC, Mittendorfer B. Preserving Healthy Muscle during Weight Loss. Adv Nutr. 2017;8(3):511–519.
- Backx EM, Tieland M, Borgonjen-van den Berg KJ, et al. Protein intake and lean body mass preservation during energy intake restriction in overweight older adults. Int J Obes (Lond). 2016;40(2):299-304.
- Kim JE, O'Connor LE, Sands LP, Slebodnik MB, Campbell WW. Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis. Nutr Rev. 2016;74(3):210–224.
- Smith GI, Yoshino J, Kelly SC, et al. High-Protein Intake during Weight Loss Therapy Eliminates the Weight-Loss-Induced Improvement in Insulin Action in Obese Postmenopausal Women. Cell Rep. 2016;17(3):849–861.
- Sardeli AV, Komatsu TR, Mori MA, Gáspari AF, Chacon-Mikahil MPT. Resistance Training Prevents Muscle Loss Induced by Caloric Restriction in Obese Elderly Individuals: A Systematic Review and Meta-Analysis. Nutrients. 2018;10(4):423.
- Knuth ND, Johannsen DL, Tamboli RA, et al. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin [published correction appears in Obesity (Silver Spring). 2016 Oct;24(10):2248]. Obesity (Silver Spring).
- Villareal DT, Fontana L, Weiss EP, et al. Bone mineral density response to caloric restriction-induced weight loss or exercise-induced weight loss: a randomized controlled trial. Arch Intern Med. 2006;166(22):2502-10.
- Romashkan SV, Das SK, Villareal DT, et al. Safety of two-year caloric restriction in non-obese healthy individuals. Oncotarget. 2016;7(15):19124–19133. doi:10.18632/oncotarget.8093
- Ravussin E, Redman LM, Rochon J, et al. A 2-Year Randomized Controlled Trial of Human Caloric Restriction: Feasibility and Effects on Predictors of Health Span and Longevity. J Gerontol A Biol Sci Med Sci. 2015 Sep;70(9):1097-104.
- Martin CK, Bhapkar M, Pittas AG, et al. Effect of Calorie Restriction on Mood, Quality of Life, Sleep, and Sexual Function in Healthy Nonobese Adults: The CALERIE 2 Randomized Clinical Trial. JAMA Intern Med. 2016;176(6):743–752.
- Martin CK, Bhapkar M, Roberts SB. Healthy Behaviors Potentially Due to Calorie Restriction-Reply. JAMA Intern Med. 2016;176(11):1724.
Image credit: Thought Catalog via unsplash. Image has been modified.
Motion graphics by Avocado Video
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
One of the most consistent benefits of calorie restriction is blood pressure improvements in as short as one or two weeks. Blood pressures can sometimes even be normalized in a matter of weeks, and blood pressure pills discontinued. Unfortunately, this can work a little too well, and cause something called orthostatic intolerance, which can manifest as lightheadedness or dizziness upon standing—which in severe cases can cause fainting. Staying hydrated can help.
What about loss of muscle mass? In the CALERIE trial, 70 percent of the lost body weight was fat, and 30 percent lean body mass. So, they ended up with an improved body composition: 72 percent lean mass, compared to 66 percent in the control group. Though leg muscle mass and strength declined in absolute terms, relative to their new body size, they generally got stronger. Is there any way to preserve even more lean mass, though, particularly among older individuals who naturally tend to lose muscle mass with age?
Increased protein intakes are commonly suggested, but most studies fail to find a beneficial effect on preserving muscle strength or function whether you’re young or old, active or sedentary. For example, researchers randomized overweight older men and women to a normal-protein diet—4 grams for every 10 pounds of body weight, or a high-protein diet—about 8 grams per 10 pounds, during a 25-percent calorie restriction. That doubling of protein intake had no discernible effect on lean body mass, muscle strength, or physical performance. Most such studies found the same lack of benefit. But, put them all together, and one can tease out a small advantage, about a pound or two difference over an average of six months. Unfortunately, high-protein intake during weight loss has been found to have profoundly negative metabolic effects; for example, undermining the benefits of weight loss on insulin sensitivity. Lose 20 pounds, and you can dramatically improve your body’s ability to handle blood sugars, compared to a control group that maintained their weight. Lose the exact same amount of weight, but on a high-protein diet, getting about an extra 30 grams a day, and it’s like you never lost any weight at all.
Though you can always bulk back up after weight loss, the best way to preserve muscle mass during weight loss is exercise. The CALERIE study had no structured exercise component and, like after bariatric surgery, about 30 percent of the weight loss was lean mass. In contrast, that proportion was only about 16 percent in The Biggest Loser contestants, chalked up to their vigorous exercise program. Resistance training even just three times a week can prevent more than 90 percent of lean body mass loss during calorie restriction.
The same may be true of bone loss. Lose weight through calorie restriction alone, and you experience a decline in bone mineral density in fracture risk sites, such as the hip and spine. In the same study, though, those randomized to lose weight with exercise didn’t suffer any bone loss. The researchers conclude: “Our results suggest that regular [exercise] should be included as part of a comprehensive weight loss program to offset the adverse effects of [caloric restriction] on [the] bone.“ You can never argue with calls for increased physical activity, but even without an exercise regimen, the “very small” drop in bone mineral density in the CALERIE trial might only increase a 10-year risk of osteoporotic fracture by only about 0.2 percent. The benefits of calorie restriction revealed by the study—improved blood pressure, improved cholesterol, improved mood, improved libido, improved sleep—would seem to far outweigh any potential risks. The fact that a reduction in calories seemed to have such wide-ranging benefits on quality of life led commentators in the AMA’s Internal Medicine journal to write: “The findings of this well-designed study suggest that intake of excess calories is not only a burden to our physical equilibrium, but also [to] our psychological well-being” as well.
Please consider volunteering to help out on the site.
- Nicoll R, Henein MY. Caloric Restriction and Its Effect on Blood Pressure, Heart Rate Variability and Arterial Stiffness and Dilatation: A Review of the Evidence. Int J Mol Sci. 2018;19(3).
- Florian JP, Baisch FJ, Heer M, Pawelczyk JA. Caloric restriction decreases orthostatic tolerance independently from 6° head-down bedrest. PLoS One. 2015;10(4):e0118812.
- Lu CC, Diedrich A, Tung CS, et al. Water ingestion as prophylaxis against syncope. Circulation. 2003;108(21):2660-5.
- Most J, Gilmore LA, Smith SR, Han H, Ravussin E, Redman LM. Significant improvement in cardiometabolic health in healthy nonobese individuals during caloric restriction-induced weight loss and weight loss maintenance. Am J Physiol Endocrinol Metab. 2018;314(4):E396–E405.
- Das SK, Roberts SB, Bhapkar MV, et al. Body-composition changes in the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE)-2 study: a 2-y randomized controlled trial of calorie restriction in nonobese humans. Am J Clin Nutr. 2017;105(4):913-927.
- Racette SB, Rochon J, Uhrich ML, et al. Effects of Two Years of Calorie Restriction on Aerobic Capacity and Muscle Strength. Med Sci Sports Exerc. 2017;49(11):2240–2249.
- Cava E, Yeat NC, Mittendorfer B. Preserving Healthy Muscle during Weight Loss. Adv Nutr. 2017;8(3):511–519.
- Backx EM, Tieland M, Borgonjen-van den Berg KJ, et al. Protein intake and lean body mass preservation during energy intake restriction in overweight older adults. Int J Obes (Lond). 2016;40(2):299-304.
- Kim JE, O'Connor LE, Sands LP, Slebodnik MB, Campbell WW. Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis. Nutr Rev. 2016;74(3):210–224.
- Smith GI, Yoshino J, Kelly SC, et al. High-Protein Intake during Weight Loss Therapy Eliminates the Weight-Loss-Induced Improvement in Insulin Action in Obese Postmenopausal Women. Cell Rep. 2016;17(3):849–861.
- Sardeli AV, Komatsu TR, Mori MA, Gáspari AF, Chacon-Mikahil MPT. Resistance Training Prevents Muscle Loss Induced by Caloric Restriction in Obese Elderly Individuals: A Systematic Review and Meta-Analysis. Nutrients. 2018;10(4):423.
- Knuth ND, Johannsen DL, Tamboli RA, et al. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin [published correction appears in Obesity (Silver Spring). 2016 Oct;24(10):2248]. Obesity (Silver Spring).
- Villareal DT, Fontana L, Weiss EP, et al. Bone mineral density response to caloric restriction-induced weight loss or exercise-induced weight loss: a randomized controlled trial. Arch Intern Med. 2006;166(22):2502-10.
- Romashkan SV, Das SK, Villareal DT, et al. Safety of two-year caloric restriction in non-obese healthy individuals. Oncotarget. 2016;7(15):19124–19133. doi:10.18632/oncotarget.8093
- Ravussin E, Redman LM, Rochon J, et al. A 2-Year Randomized Controlled Trial of Human Caloric Restriction: Feasibility and Effects on Predictors of Health Span and Longevity. J Gerontol A Biol Sci Med Sci. 2015 Sep;70(9):1097-104.
- Martin CK, Bhapkar M, Pittas AG, et al. Effect of Calorie Restriction on Mood, Quality of Life, Sleep, and Sexual Function in Healthy Nonobese Adults: The CALERIE 2 Randomized Clinical Trial. JAMA Intern Med. 2016;176(6):743–752.
- Martin CK, Bhapkar M, Roberts SB. Healthy Behaviors Potentially Due to Calorie Restriction-Reply. JAMA Intern Med. 2016;176(11):1724.
Image credit: Thought Catalog via unsplash. Image has been modified.
Motion graphics by Avocado Video
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Title
Potential Pitfalls of Calorie Restriction
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
This is the follow-up to The Benefits of Calorie Restriction for Longevity.
For more on calorie restriction see:
- The Benefits of Caloric Restriction without the Actual Restricting
- Caloric Restriction vs. Animal-Protein Restriction
- Caloric Restriction vs. Plant-Based Diets
- Diet and Caloric Restriction for Longevity—The Monkey Trials
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