The difference between calorie restriction and fasting – Fasting 27
by Jason Fung | posted in: Calories, Fasting, Health and Nutrition | 97

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Perhaps one of the most common questions we get is what the difference is between calorie restriction and fasting. Many calorie enthusiasts say that fasting works, but only because it restricts calories. In essence, they are saying that only the average matters, not the frequency. But, of course, the truth is nothing of its kind. So, let’s deal with this thorny problem. deathvalley

The weather in Death Valley, California should be perfect with a yearly average temperature is 25 Celsius. Yet, most residents would hardly call the temperature idyllic. Summers are scorching hot, and winters are uncomfortably cold.

You can easily drown crossing a river that, on average, is only 2 feet deep. If most of the river is 1 foot deep and one section is 10 feet deep, then you will not safely cross. Jumping off a 1 foot wall 1000 times is far different than jumping off a 1000-foot wall once.intermittentvscontinuous

In a week’s weather, there is a huge difference between having 7 grey, drizzling days with 1 inch of rain each and having 6 sunny, gorgeous days with 1 day of heavy thundershowers.

It’s obvious in all these examples that overall averages only tell one part of the tale, and often, understanding frequency is paramount. So why would we assume that reducing 300 calories per day over 1 week is the same as reducing 2100 calories over a single day? The difference between the two is the knife-edge between success and failure.

The portion control strategy of constant caloric reduction is the most common dietary approach recommended by nutritional authorities for both weight loss and type 2 diabetes. Advocates suggest that reducing daily caloric consumption by 500 calories will trigger weight loss of approximately one pound of fat per week.

The American Diabetes Association’s main dietary recommendation suggests to “focus on diet, physical activity, and behavioral strategies to achieve a 500–750 kcal/day energy deficit.” The ‘portion control’ advice to reduce calories has been fairly standard since the 1970s. This reduction is average calories should be spread consistently throughout the day, rather than all at once. Dieticians often counsel patients to eat four, five or six times a day. There are calorie labels on restaurant meals, packaged food, and beverages. There are charts for calorie counting, calorie counting apps, and hundreds of calorie counting books. Even with all this, success is as rare as humility in a grizzly bear.

After all, who hasn’t tried to portion control strategy of weight loss. Does it work? Just about never. Data from the United Kingdom indicate that conventional advice succeeds in 1 in 210 obese men and 1 in 124 obese women (4). That is a failure rate of 99.5%, and that number is even worse for morbid obesity. So, whatever else you may believe, constant caloric reduction does NOT work. This is an empirically proven fact. Worse, it has also been proven in the bitter tears of a million believers.

But why doesn’t it work? For the same reason the contestants of The Biggest Loser could not keep their weight off – metabolic slowdown.

Starvation Mode

The Biggest Loser is a long running American TV reality show that pits obese contestants against one another in a bid to lose the most weight. The weight loss regimen is a calorie-restricted diet calculated to be approximately 70% of their energy requirements, typically 1200-1500 calories per day. This is combined with an intensive exercise regimen typically far in excess of two hours daily.

This is the classic ‘Eat Less, Move More’ approach endorsed by all the nutritional authorities, which is why The Biggest Loser diet scores third on the 2015 USA Today’s ranking of best weight loss diets. And, it does work, in the short term. The average weight loss that season was 127 pounds over 6 months. Does it work long-term? Season two’s contestant Suzanne Mendonca said it best when she stated that there is never a reunion show because “We’re all fat again”.

Their Resting Metabolic Rates (RMR), the energy needed to keep the heart pumping, the lungs breathing, your brain thinking, your kidneys detoxing etc., drops like a piano out of a 20 story building. Over six months, their basal metabolism dropped by an average of 789 calories. Simply stated, they burning 789 calories less per day every day.

As metabolism drops, weight loss plateaus. Caloric reduction has forced the body has shut down in order to match the lowered caloric intake. Once expenditure drops below intake, you start the even more familiar weight regain. Ba Bam! Weight is regained despite dietary compliance with the caloric restriction and even as your friends and family silently accuse you of cheating on your diet. Goodbye reunion show. Even after six years, the metabolic rate does not recover .

All of this is completely predictable. This metabolic slowdown has been scientifically proven for over 50 years. In the 1950s Dr. Ancel Key’s famous Minnesota Starvation Study placed volunteers on a ‘semi-starvation’ diet of 1500 calories per day. This represented a 30% caloric reduction from their previous diet. In response, their basal metabolic rate dropped about 30%. They felt cold, tired, and hungry. When they resumed their typical diet, all their weight came right back.

Caloric restriction diets only work in the short-term, before basal metabolism falls in response. This is sometimes called ‘starvation mode’. Daily calorie restriction fails because it unerringly put you into metabolic slowdown. It’s a guarantee. Reversing type 2 diabetes relies upon burning off the body’s excess glucose, so the daily calorie-restricted diet will not work.

The secret to long-term weight loss is to maintain your basal metabolism. What doesn’t put you into starvation mode? Actual starvation! Or at least the controlled version, intermittent fasting.

Fasting triggers numerous hormonal adaptations that do NOT happen with simple caloric reduction. Insulin drops precipitously, helping prevent insulin resistance. Noradrenalin rises, keeping metabolism high. Growth hormone rises, maintaining lean mass.

Over four days of continuous fasting, basal metabolism does not drop. Instead, it increased by 12%. Neither did exercise capacity, as measured by the VO2, decrease, but is instead maintained. In another study, twenty-two days of alternate daily fasting also does not result in any decrease in RMR.

Why does this happen? Imagine we are cavemen. It’s winter and food is scarce. If our bodies go into ‘starvation mode’, then we would become lethargic, with no energy to go out and find food. Each day the situation gets worse and eventually we die. Nice. The human species would have become extinct long ago if our bodies slow down each time we didn’t eat for a few hours.Zaunder1

No, instead, during fasting, the body opens up its ample supply of stored food – body fat! Yeah! Basal metabolism stays high, and instead we change fuel sources from food, to stored food (or body fat). Now we have enough energy to go out and hunt some woolly mammoth.

During fasting, we first burn glycogen stored in the liver. When that is finished, we use body fat. Oh, hey, good news – there’s plenty of fat stored here. Burn, baby burn. Since there is plenty of fuel, there is no reason for basal metabolism to drop. And that’s the difference between long-term weight loss, and a lifetime of despair. That’s the knife edge between success and failure.

Fasting is effective where simple caloric reduction is not. What is the difference? Obesity is a hormonal, not a caloric imbalance. Fasting provides beneficial hormonal changes that happen during fasting are entirely prevented by the constant intake of food. It is the intermittency of the fasting that makes it so much more effective.

Intermittent Fasting vs Calorie Restriction

The beneficial hormonal adaptations that occur during fasting are completely different from simple calorie restriction. The reduction of insulin and insulin resistance in intermittent fasting plays a key role.

The phenomenon of resistance depends not only upon hyperinsulinemia, but also upon the persistence of those elevated levels. The intermittent nature of fasting helps to prevent the development of insulin resistance. Keeping insulin levels low for extended periods of time prevents the resistance.

Studies have directly compared daily caloric restriction with intermittent fasting, while keeping weekly calorie intake similar. A 30% fat, Mediterranean style diet with constant daily caloric restriction was compared to the same diet with severe restriction of calories on two days of the week.harvie1

Over six months, weight and body fat loss did not differ. But there were important hormonal differences between the two strategies. Insulin levels, the key driver of insulin resistance and obesity in the longer term, was initially reduced on a calorie restriction but soon plateaued. However, during intermittent fasting, insulin levels continued to drop significantly. This leads to improved insulin sensitivity with fasting only, despite similar total caloric intake. Since type 2 diabetes is a disease of hyperinsulinemia and insulin resistance, the intermittent fasting strategy will succeed where caloric restriction will not. It is the intermittency of the diet that makes it effective.

Recently, a second trial directly compared zero-calorie alternate-day fasting and daily caloric restriction in obese adults. The Caloric Reduction as Primary (CRaP) strategy was designed to subtract 400 calories per day from the estimated energy requirements of participants. The ADF group ate normally on eating days, but ate zero calories every other day. The study lasted 24 weeks.catenacci1

What were the conclusions? First, the most important conclusion was that this was a safe and effective therapy that anybody could reasonably follow. In terms of weight lost, fasting did better, but only marginally. This is consistent with most studies, where, in the short term, any decent diet produces weight loss. However, the devil is in the details. The truncal fat loss, which reflects the more dangerous visceral fat,was almost twice as good with fasting as opposed to CRaP. In fat mass %, there is almost 6 times (!) the amount of loss of fat using fasting

The other big concern is that fasting will ‘burn muscle’. Some opponents claim (without any evidence) that you lost 1/4 pound of muscle for every single day of fasting you do. Considering I fast at least 2 days a week, and have done so for years, I estimate my muscle percentage should be just about 0%, and I shouldn’t even have enough muscle to type these words. Funny how that didn’t happen. But anyway, what happened in that study? The CRaP group lost statistically significant amounts of lean mass, but not the IF group. Yes, there is LESS lean muscle loss. Maybe it has to do with all the growth hormone and nor adrenalin being pumped out.

Lean mass % increased by 2.2% with fasting and only 0.5% with CRaP. In other words, fasting is 4 times better at preserving lean mass. So much of that old ‘fasting burns the muscle’.

What happens to basal metabolism? that’s what determines long term success. If you look at the change in Resting Metabolic Rate (RMR). Using CRaP, basal metabolism dropped by 76 calories per day. Using fasting, it only dropped 29 calories per day (which is not statistically significant compared to baseline). In other words, daily caloric reduction causes almost 2 1/2 times as much metabolic slowdown as fasting! So much for that old ‘Fasting puts you into starvation mode’.catenacci2

Fasting has been used throughout human history as a tremendously effective method of controlling obesity. By contrast, the portion control strategy of daily caloric restriction has only been recommended for the last 50 years with stunning failure. Yet, conventional advice to reduce a few calories every day persists and fasting is continually belittled as an outdated, dangerous practice akin to blood-letting and voodoo. The study reports that “Importantly, ADF was not associated with an increased risk for weight regain”. Holy S***. That’s the Holy Grail, Man! The whole problem is obesity and The Biggest Loser is WEIGHT REGAIN, not initial weight loss.

Weight regain differed during fasting vs CRaP. The fasting group tended to regain lean mass and continue to lose fat, while CRaP group gained both fat and lean mass. Part of the issue was that the fasting group reported that they often continued to fast even after the study was done. Of course! It is easier than they though, with better results. Only an idiot would stop. One of the very fascinating things is that ghrelin (the hunger hormone) goes up with CRaP but does NOT during fasting. We’ve known forever that dieting makes you hungrier. It’s not a matter of willpower – it’s a hormonal fact of life – the ghrelin goes up and you are hungrier. However, fasting does not increase hunger. Fascinating. No wonder it’s easier to keep the weight off! You’re less hungry.

Calorie restriction diets ignore the biological principle of homeostasis – the body’s ability to adapt to changing environments. Your eyes adjust whether you are in a dark room or bright sunlight. Your ears adjust if you are in a loud airport or a quiet house.

The same applies to weight loss. Your body adapts to a constant diet by slowing metabolism. Successful dieting requires an intermittent strategy, not a constant one. Restricting some foods all the time (portion control) differs from restricting all foods some of the time (intermittent fasting). This is the crucial difference between failure and success.

So here’s your choices:

    Caloric Reduction as Primary: less weight loss (bad), more lean mass loss (bad), less visceral fat loss (bad), harder to keep weight off (bad), hungrier (bad), higher insulin (bad), more insulin resistance (bad), perfect track record over 50 years unblemished by success (bad)
    Intermittent Fasting: More weight loss, more lean mass gain, more visceral fat loss, less hunger, been used throughout human history, lower insulin, less insulin resistance.

Almost every medical society, doctor, dietician and mainstream media will tell you to use choice #1. I prefer to tell people to take choice #2.
Are You An Under-Eater? 8 Signs You’re Not Eating Enough

on June 2, 2015 by Chris Kresser 355 comments
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Could an inadequate calorie intake be the root cause of your health problems? Find out how to recognize the signs of under-eating.

This is a guest post written by staff dietitian Laura Schoenfeld, MPH, RD.
Woman Sad about Dieting

In our modern society with its seemingly endless supply of fast food and junk food, it seems obvious to most why we’re dealing with an obesity epidemic. Cheap, low quality food surrounds us, and there’s not enough time in the world to exercise away all the excess calories that exist in our food supply.

However, those of us in the Paleo and ancestral health community seem to have a different problem altogether. It’s one that I’ve seen in dozens of clients, as well as most of our participants in our online adrenal fatigue program.

This problem is chronic under-eating.

Yes, I said under-eating, not overeating. While most people would find it hard to believe that many of the health problems people experience when going Paleo is from a lack of calories and appropriate macronutrients, I’ve seen it in my private practice countless times; clients who were experiencing mysterious, nagging symptoms that suddenly disappeared when we evaluated and corrected their daily food intake.

I’ve even seen clients who couldn’t lose weight that were suddenly able to after increasing their food intake. Quite the opposite of the “calories-in-calories-out” mentality!

    Are you an under-eater? Learn the most common signs and symptoms of a too-low calorie intake! #Paleo

Could something as simple as under-eating be causing your health problems? Could inadequate food intake be the reason why your Paleo diet suddenly isn’t working for you anymore? Is your “rapid weight loss” diet plan the reason your jeans are getting tighter instead of looser?

Below are the top 8 signs and symptoms I see in my clients who are chronically under-eating. Read on to discover if you might simply need some more food to start feeling better today!
Your Weight Isn’t Budging

This is one of the most paradoxical symptoms of someone who is under-eating, and it often goes hand-in-hand with overtraining. You might be surprised to hear that I’ve never had a weight loss client who was actually overeating. In fact, many of my clients come to me on extremely low calorie diets (around 1000-1200 calories per day) combined with 6-7 days per week of intense exercise like Crossfit or long distance running.

For good reason, they are extremely frustrated that their weight isn’t changing; for some of these clients, their weight has actually been increasing since they dropped their food intake and started working out more. Many of these clients are also eating a very low carbohydrate diet with the goal of losing weight quickly.

We’ve been trained to believe that the body is a machine and we can input and output our calories in a way that will cause weight loss, so it’s understandable why these clients would expect to see weight loss from a significant caloric deficit like that. But the fact is, they simply can’t lose the last 15-30 pounds no matter how little they eat. Why is this?

While a slight caloric deficit can lead to sustainable weight loss (think 300-500 calories per day), much larger deficits induce changes in your body’s metabolism in order to keep your body in a homeostatic balance. Your body does not like major, drastic changes, and it will make modifications to your thyroid, adrenal, and sex hormones in order to reduce your overall caloric output.

This includes reducing active thyroid hormone, shutting down sex hormone production, and raising stress hormones like cortisol. (1, 2, 3, 4, 5) Chronically elevated cortisol leads to both leptin and insulin resistance, a disastrous hormonal state that can keep body weight high. (6, 7)

These hormonal changes can lead to stalled weight loss and body fat retention, along with many other negative health effects that go beyond weight loss resistance. So if you’ve been eating much less and exercising much more in a futile attempt to lose weight, consider whether this strategy has been working for you.
You Can’t Get Pregnant

Scientists have known for a long time that low calorie dieting and inadequate body fat can lead to infertility and amenorrhea in women. (8) One of the most commonly seen manifestations of this problem is known as hypothalamic amenorrhea, which is hallmarked by menstrual irregularity or amenorrhea and low energy availability, with or without an eating disorder. (9) Menstrual irregularity doesn’t necessarily mean a missed period, it can simply mean a woman is having an anovulatory cycle, meaning there is no egg released during the ovulatory period.

Hypothalamic amenorrhea caused by chronic caloric deprivation is also associated with physiological changes like hypothalamic-pituitary-adrenal (HPA) axis overactivity (also known as adrenal fatigue) and disturbances in the hypothalamic-pituitary-thyroid axis (also known as euthyroid sick syndrome).

I’ve worked with many clients who recovered their period after returning to a normal caloric intake. I’ve even had one patient who was finally able to get pregnant when she switched to a higher calorie ancestral diet, after her doctors told her she’d always be infertile.

So if you’ve been struggling to get pregnant and you have a history of dieting and exercising for weight loss, it’s possible that your low-calorie diet is preventing you from getting pregnant.
Your Blood Sugar Is On A Roller Coaster

While many people blame excessive carbohydrate consumption for wild blood sugar swings, you might be surprised to learn that inadequate calorie consumption can cause just as many issues with blood sugar control. The most common issue that comes from chronic under-eating is hypoglycemia, or low blood sugar.

Hypoglycemia is defined as blood sugar below 70 mg/dL, though some people experience symptoms at higher blood sugar levels. Common symptoms include hunger, shakiness, anxiety, dizziness, sweating, weakness, confusion, and changes in mood.

Under-eating can easily cause hypoglycemia, especially when combined with exercise. (10) And because many people feel better eating sugary foods when they’re hypoglycemic, this can lead to the common cycle of high and low blood sugar swings that cause chronic dieters to overeat or binge on junk foods.

This is yet another reason that the most sustainable diet for weight loss provides adequate calories to keep your hormones and blood sugar even-keeled.
Your Mood Is Totally Unpredictable

Have you ever heard the term “hangry” before?

This urban slang refers to the state of anger and irritability resulting from being hungry. And even though it’s a made up term, there’s actually scientific evidence for the existence of this volatile emotional state caused by inadequate food intake. (11)

As I mentioned earlier, not eating enough food can lead to hypoglycemia, or low blood sugar. Since the brain requires blood sugar to function optimally, when it starts to drop, one of the first cognitive processes that suffers is self-control. (12) And your ability to exert self control allows you to control your attention, regulate your emotions, cope with stress, resist impulsivity, and refrain from aggressive behavior.

So if you’re always on a short fuse, or your mood is constantly swinging between cheerful and irritable or anxious, you should make sure that you’re not severely under-eating before making any other significant changes to your diet and supplement or medication routine.
You Can’t Fall Asleep (Or Stay Asleep)

Insomnia and other sleep disturbances are one of the top health complaints my clients come to me for help fixing. This is especially common in peri-menopausal women who seem to be especially prone to poor sleep despite generally good sleep hygiene and a health conscious lifestyle.

Oddly enough, one of the first symptoms that changes when I get my clients eating a more calorically appropriate diet is a significant improvement in sleep duration and quality. Even if they weren’t necessarily waking up hungry, many of my clients find that an increased calorie intake (especially from carbohydrates) can lead them to fall asleep faster and stop waking up at night.

One reason for this likely comes from the improved blood sugar control that arises from an appropriate calorie and carbohydrate intake. As your blood sugar drops overnight, your liver must release its stored glucose (in the form of glycogen) to keep your blood sugar steady.

If you’re constantly under-eating, and especially if you’re overexercising on top of that, your liver won’t have the glycogen stores it needs to keep your blood sugar stable, and your body must release stress hormones like cortisol and adrenaline to promote gluconeogenesis, the process of creating new glucose. If these stress hormones elevate high enough, they can actually wake you up in the middle of the night.

Making sure you’re eating enough overall and including a carb and fat-dense bedtime snack 1-2 hours before going to sleep can help keep your blood sugar stable overnight, leading to more restful, uninterrupted sleep.
You’re Chronically Constipated

There are a few reasons why chronic under-eating can cause constipation. The most obvious is that feces is made up of waste matter from the digestion of food, so if you’re not getting enough food, your stool won’t have much bulk to it.

The less obvious, but more likely reason that under-eating can lead to constipation is due to the effects of undernutrition on thyroid hormone. As I discussed previously, under-eating causes a down regulation of T3, the active thyroid hormone. This can lead to a condition called euthyroid sick syndrome, where T3 is low, reverse T3 is high, and TSH and T4 are often normal. This means your body develops hypothyroidism symptoms without necessarily showing any change in the typical thyroid function markers that most doctors check.

Constipation is a very common symptom of hypothyroidism, as active thyroid hormone helps stimulate peristalsis in the gut, keeping digestion humming along smoothly. When T3 drops, gut motility slows, and this can lead to chronic constipation. So if you’re only having a bowel movement every couple of days, check your caloric intake and make sure you’re not under-eating.
You’re Always Cold

Caloric restriction is known to cause a drop in body temperature. (12) While some calorie-restriction proponents suggest that this is a sign of expected longevity, my clients’ (and my own) experience dictates that this is not a comfortable way to live on a daily basis. Whether or not this extends our lifespan, who wants to constantly feel frigid on a daily basis? Not me, and I’d bet not you either.

A lowered body temperature can be due to a decrease in thermogenesis, since your body needs a certain amount of ingested calories to create heat, as well as due to the hormonal changes that come from caloric restriction, such as thyroid hormone reduction and HPA axis disruption. Low insulin can also lead to low body temperature, so some people on a very low carbohydrate diet will experience this symptom as well. (13)

I may be sounding like a broken record at this point, but if you’re always cold, even in the summer time, it’s highly likely that you’re not getting enough to eat.
You’re Losing Hair By The Handful

Hair loss is one of the first signs of nutritional deficiency, whether that be calories, protein, or both. It is exacerbated by the hormonal changes that develop from chronic under-eating, including a drop in sex hormones like progesterone, testosterone, and estrogen. (14, 15) Hair loss is another common symptom of hypothyroidism, which as you’ve learned can develop from long term calorie restriction.

Hair loss is one of the most rapidly improved symptoms we saw in our students in our online adrenal fatigue program, where one of the modules is focused on ensuring participants are getting adequate amounts of nutrient dense foods. Even in our test group of 30 participants, there were several people who remarked how their hair had stopped falling out within weeks of making the diet changes. (It’s incredible how quickly the body can respond when its caloric needs are finally met.)

If your hair is falling out at a scarily fast rate, you need to take a hard look at your diet. Consuming a calorically appropriate, protein-rich, nutrient-dense whole foods diet should be the first step for anyone who wants to stop hair loss in its tracks.
How Much Should You Be Eating?

Determining exactly how many calories you need to be eating on a daily basis for optimal health and weight control is tricky. Many factors come into play, including your physical activity, stress levels, sleep adequacy, history of chronic disease, and more. It’s impossible to know exactly how many calories your body needs on a daily basis, but there are some ways to estimate what you should be eating.

A quick and easy way to roughly estimate your “basement” calorie target – the lowest amount of calories you should ever be eating – is to multiply your ideal body weight by 10. A woman who is 5’ 5” has an “ideal” body weight of around 125 pounds, so she should not eat less than 1250 calories per day. Use this calculator to determine your “ideal” body weight. (Note: this calculator does not take into account frame size or muscle mass – that’s why I put “ideal” in quotes.)

It’s important to note that this quick estimate is a “sedentary” formula, meaning it does not take into account any physical activity beyond sitting and standing. If you’re exercising regularly, you’ll need to add at least 200-400 calories on top of that number. That same 5’5” woman might burn around 300 calories or more from a 30 minute run, taking her minimum calorie needs up to 1550 calories per day, assuming she doesn’t do any other exercise that day.

Different workouts will burn different amounts of calories. A Crossfit WOD can burn 12-20 calories per minute on average, so a WOD that takes 20 minutes could burn 240-400 calories. (16) If you’re aiming for a high step count, 10,000 steps burns around 300-500 calories, give or take depending on body size and gender.

These are just examples of common exercise types in the Paleo community, and the point is to be aware that if you’re a highly active individual, your calorie needs will go up by several hundred calories per day above the “10 x ideal weight” formula.

Another common factor that will raise your caloric needs if you are a breastfeeding woman. Many of my female clients are shocked to hear that breastfeeding can raise your caloric expenditure by 500 calories per day or more. (17) So breastfeeding women need at least 300 calories per day above and beyond other women who are not breastfeeding, and that’s only if they have extra weight to lose postpartum.

So what does this calorie target exercise look like in practice? Using myself as an example, my “ideal” body weight is about 140 pounds, and I usually burn around 400-500 calories via exercise per day, so I try not to eat below 1800 calories, especially on heavier training days where I may eat more like 2000-2200 total. Your mileage may vary, but it’s a pretty easy place to start from, and you can tweak up and down as necessary as your health and weight fluctuates.

As you can see, determining caloric needs can get somewhat complicated, especially with the goal of weight loss thrown into the mix. When I work with clients, my goal is to get them on the least restrictive, most calorically-appropriate diet possible. It’s amazing to see the health improvements that come from a simple increase in caloric intake when someone has been chronically under-eating.

If you need help figuring out the right calorie intake for you, let me help you to determine the best diet to keep you feeling and looking your best, without unnecessary restriction or starvation dieting. Sign up for a 1 hour comprehensive case review and we’ll get you started on a diet that’s completely tailored to your individual needs.

Remember, eating too little is just as unhealthy as eating too much. Find the right amount of food intake that works best for you, and don’t be afraid to experiment with eating more if your health isn’t where you want it to be!