Weight loss: What science says really works

Carole has been trying to lose weight for the past two years. She has tried weight watchers,  all number of different supplements but without any significant success. She has a very stressful family and work life leaving little time for exercise and has problems sleeping.

In 2014, 20.2% of Canadians aged 18 and older, roughly 5.3 million adults, were classified obese. (1) In 2013, it was estimated that Canadians spend nearly 7 billion dollars on weight loss products and programs. (2) There is much hype what works for weight loss but what does the current scientific research say.

What is best Diet for weight loss?

In a scientific paper recently published in the Lancet looking at the effectiveness of different diets for long-term weight loss, the researchers concluded that when compared with diets, the evidence does not support low-fat diets over other diets for long-term weight loss. (3) Other findings included:

• Low-carbohydrate diets led to significantly greater weight loss than did low-fat interventions.
• Low-fat diets did not result in differences in weight change compared with other higher-fat diets.
• Higher-fat weight loss diets led to significantly greater weight loss than low-fat interventions.

These findings go some way to dispelling the idea that low-fat diets are an effective intervention for long-term weight loss. On the contrary, it appears that a high fat, low carb is a better approach based on current evidence. This conclusion is backed up by findings from a study looking at the effect of a Mediterranean, high-fat, low carbohydrate diet, which found it had a significant impact on weight loss. (4)

What about exercise?

There is a commonly held belief that you need to do exercise to lose weight but is this true. When looking at the scientific data increasing exercise without any other changes has a modest effect on weight. (5) However, moderate exercise combined with other lifestyle interventions clearly had a significant influence on weight. (6)

Does sleep affect weight?

There is robust scientific research to show that poor sleep has a negative effect on overall health as well as weight. (7) A review paper found that reduced sleep duration is a causal factor of weight gain. (8)

What about stress?

While stress has a negative impact on health, there is only weak evidence that it causes weight gain. (9)

In conclusion

Lifestyle factors such as poor diet, sleep and lack of exercise can cause weight gain. When considering a weight loss program, the evidence points to one that includes a Mediterranean high-fat, low carb style diet, moderate exercise, and adequate sleep. While there is only weak evidence that stress alone causes weight gain it would be foolish to ignore because of the negative effects stress has on health. (10)

Disclaimer

This article in not intended to provide medical advice, diagnosis or treatment.

Nutritional supplements and your health

Nutritional supplements (NS) are a hot topic in the Canadian media at the moment. Both the FifthEstate and Marketplace aired programs looking at the effectiveness and quality of NS sold in Canada. After watching the information presented it would certainly make you question whether NS should be effective and safe part of improving maintaining your health.

Do NS help?

In clinical practice, it is important to look at what evidence there is to show that something works. This can come in two forms, scientific research, and clinical observation. When looking at the scientific data it is commonly agreed among researchers that the best source to derive any truly meaningful evidence that something works is from research papers that review and analysis the data from some studies. These are called systematic reviews with meta-analysis  (SRMA). When looking at the most recent SRMAs looking at Vitamin and mineral supplements, the conclusions are varied between NS may give benefit, no benefit or even harm to health. Table 1 below shows a summary of the latest SRMAs. I have used some NS throughout the vast majority of clinical practice, beginning in 1997. From my observations of my clients, which have come to me already taking NS I would have to agree with scientific data that results are mixed. When prescribing any NS are am a big believer in using some form of testing to determine whether to recommend a client takes something. When adopting this approach in the majority cases, I have seen both objective and subjective benefits.

The case for food and exercise

While I have seen some remarkable results from prescribing supplements, these benefits have been limited to resolving specific problems and not overall health. From my 18 years of clinical practice, the most effective therapeutic approach I have observed has been from diet and exercise modification. This observation is pretty much in line with the scientific data from the most recent SRMA’a on the effect of diet and exercise on overall health. Diet and lifestyle modifications may have benefits in the management of Alzheimer's, Chronic Disease, Diabetes, obesity, visceral fat and overall health. Table 2 below shows a summary of the latest SRMAs looking at the effect of diet and exercise on health. There seems to be a particularly heavy weight of evidence suggesting that consuming more fruits and vegetables and incorporating exercise can have benefits for overall health.

In conclusion

I see NS very much in the same light as drugs they are simple solutions used to try and solve complex problems. Humans are complex beings and as such you need complex solutions to prevent and resolve health issues. Real food provides that complex solution, and this is born out from my clinical observations and current scientific research. If you are searching for that magic pill you are probably going to be disappointed.

Table 1

Supplement	Conclusions
Multivitamin and minerals	There is no evidence to support the use of vitamin and antioxidant supplements for prevention of cardiovascular diseases.
	There is sufficient evidence to substantiate the role of dietary multivitamin/mineral supplements for the decreasing the risk of age-related cataracts.
	Unlike observational epidemiological studies, this meta-analysis of RCTs suggests that there is no clinical evidence to support the efficacy of vitamin and antioxidant supplements in the prevention of esophageal cancer.
B Vitamins	B vitamin supplementation, when used for primary or secondary prevention, is not associated with a reduction in MACE, total mortality, cardiac death, MI, or stroke.
	A meta-analysis of 10 RCTs showed a borderline significant increase in the frequency of overall cancer in the folic acid group compared to controls.
Vitamin D	Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.
	The effect size for Vitamin D in depression demonstrated in this meta-analysis is comparable with the effect of anti-depressant medication, an accepted treatment for depression.
Calcium	Increasing calcium intake from dietary sources or by taking calcium supplements produces small non-progressive increases in BMD, which are unlikely to lead to a clinically significant reduction in risk of fracture.
	Calcium supplements with or without vitamin D modestly increase the risk of cardiovascular events, especially myocardial infarction, a finding obscured in the WHI CaD Study by the widespread use of personal calcium supplements. A reassessment of the role of calcium supplements in osteoporosis management is warranted.
Chromium	Data from RCTs show no effect of chromium on glucose or insulin concentrations in nondiabetic subjects. The data for persons with diabetes are inconclusive. RCTs in well-characterized, at-risk populations are necessary to determine the effects of chromium on glucose, insulin, and Hb A1c.
Zinc	Zinc supplementation has favorable effects on plasma lipid parameters. Zinc supplementation significantly reduced total cholesterol, LDL cholesterol, and triglycerides. Therefore,  it may have the potential to lessen the incidence of atherosclerosis-related morbidity and mortality.
Antioxidants	Treatment with beta carotene, vitamin A, and vitamin E may increase mortality.

 Table 2

Diet	Conclusion
Diet and Exercise	Moderate-quality evidence from the present network meta-analysis suggests that D + E can be highly recommended for long-term obesity management.
	Results suggest that an aerobic exercise program, without hypocaloric diet, can show beneficial effects to reduce visceral adipose tissue.
Mediterranian Diet	The Mediterranean diet was associated with better glycemic control and cardiovascular risk factors than control diets, including a lower fat diet, suggesting that it is suitable for the overall management of type 2 diabetes.
	The Mediterranean diet in children may prevent asthma or wheeze.
Fruits and Vegetables	Sub-types of vegetables, such as root vegetables or green leafy vegetables may be beneficial for the prevention of diabetes while total FVI may exert a weaker overall effect.
	Green leafy vegetables may help prevent bladder cancer.
	This meta-analysis showed several inverse associations between fruit and vegetable intake and prospective improvements in anthropometric parameters, and risk of adiposity.
	This critical review of the associations between the intake of vegetables and fruit and the risk of several chronic diseases shows that a high daily intake of these foods promotes health.
	The evidence reviewed provides additional support for increased consumption of a wide variety of vegetables, in particular, dark-green leafy, cruciferous, and deep yellow-orange ones, and a wide variety of fruits, in particular, citrus and deep yellow-orange ones. Continued attention to increasing fruit and vegetable consumption is a practical and important way to optimize nutrition to reduce disease risk and maximize good health.
Exercise	Decreased physical activity were particularly strong predictors of incident AD.

9 steps to a healthier you!

Martine 44, works for Stats Canada. She is married with two children, Samantha 13 and Gordon 11. Both play high level soccer which means that both her husband Graham and her are kept extremely busy ferrying them both to practice sessions and games. This combined with a demanding job and shouldering much of the home work, as her husband works late, Martine has little time for exercise, socializing, or pursuing her hobby of painting. 

Her full life has also meant that her diet has suffered since she has little time in the mornings except to grap her cup of coffee from Tim Hortons and a bagel. Lunches are often a quick sandwich and  while suppers often consist of some form of processed protein and frozen vegetables. By the time supper is finished and cleared away, Martine is usually exhausted and usually collapses in front of the TV with a glass of wine, which can often turn into 2 or 3. She manages to get to bed by about 11.30 most nights but usually takes about an hour before she goes to sleep. She sleep well but getting up for a work day has become increasingly hard as does not feel rested. 

Her energy picks up after her coffee but after lunch she is usually tired. Over the last year she has put on nearly 20lbs, has started to suffer from seasonal allergies and has been catching colds on a regular basis. 

On a recent visit to her doctor, Martine was horrified to find out that she had high blood pressure and cholesterol were high, her fasting blood sugar indicated that she was pre diabetic, and she had blood markers for autoimmune hypothyroidism (Hashimoto's)

Like thousands in Canadian today, the demands of career and family life has meant that Martine has taken her good health for granted and she has now become part of the alarmingly growing statistics of sick Canadians:

• In 2008/09, almost 2.8 million Canadians (6.8%) were living with diabetes.
• Almost 16,000 Canadians die each year as a result of a heart attack.
• 6 million Canadians (1 in 5) suffer from high blood pressure, representing 19% of the population.
• Obesity among Canadians tripled between 1985 and 2011 and it is estimated that about 21% will be clinically obese by 2019.
• Approximately, 2 million Canadians are affected by an autoimmune disease.

Up until she had started having children Martine had always been extremely fit, and full of energy and life. With this disturbing news she looked and felt 54, not 44, and was determined to get back her health but how?

To understand how Martine can take back her health we need to understand the fundamental reason why her health is failing -  mismatch!

Our bodies have not adapted to the diet and lifestyle we have in the modern world today. When animals are taken out of their natural habitat and caged into a zoo they become less healthy and they have a shorter life span. Zoologists have recognized this for sometime and as such have tried to recreate the animals diet and environment as much as possible. Our bodies are still much adapted to the diet and environment we lived in as hunter gatherers and like animals that are have been caged in a zoo, our bodies are caged by our modern diet and lifestyle.

To help Martine get back her health like in the zoos she needs to recreate, as much as possible, that ancient diet and lifestyle.

Here is a brief outline of the 9 steps Martine needs to take in order to get back her healthier self:

• Just eat real food and avoid food toxins.
• Nourish your body with the right foods.
• Think about the quality of the food and drink you consume.
• Get better sleep.
• Manage your stress.
• Get moving!
• Start enjoying yourself more!
• Get back into nature.
• Spend more time with the people you like and love!

If you can relate to Martine and some or all of her health issues then start to think about the above steps and about how you can begin to integrate them into your life. Over the next 9 weeks, I will write about each in more detail with details on why these steps are so important and practical tips on how to implement them.

Finally

I hope you found these ideas useful. More importantly, I hope you do something with them.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.

Nutrition, Nutrition, Nutrition

One of my favourite programs I used to watch in the UK was a property buying show called Location, Location, Location. The show was hosted by two realtors who who competed to find buyers a new home. When looking for a new home one of the most fundamental factors that determined whether the buyers liked the property was it's location.

Although I am an Osteopath one of the first things I look when somebody comes to me with a physical problem, especially if it is chronic, is their persons nutrition. For me if there's something off with their diet then it needs to be corrected for any physical therapy is going to really help.

Without getting too controversial

If you suffer from physical pain there are some obvious dietary factors you need consider:

1. Do you drink enough water?
2. Do you eat fresh fruit and vegetables everyday?
3. Do you limit your intake of processed food?

If you answered "no" to all three of these questions then then your body will not be happy. A good analogue I use with my clients is to imagine that their body is a high performance sports car. If you fill your car up with 87 then after not too long your car is not going to run as well and eventually you will be visiting your dealer who will tell you to start using 93. In the same way your body will respond much better to water than coffee, or fresh food than processed.

So, if you are suffering try making some basic nutritional changes and see what happens. You might be surprised.