Calorie Restriction Without Counting Calories - A 6 Cup Salad, Eggplant Lasagna, a 27 ounce Green Smoothie, & Fruit for Lunch & Dinner
"I didn't think calorie restriction worked in humans until I started working with people who'd been doing it for years.
They are among the healthiest people I've ever known. Their heart function is similar to people 15 years younger, they have very low levels of inflammation and very few get cancer."
-Dr. John Holloszy, M.D., lead CALERIE investigator, Washington University, St. Louis, Missouri-
"In terms of cardiovascular diseases - the No. 1 cause of death: 4 out of 10 people die of it in the U.S. and Europe - we know that they (Calorie Restriction Society members) will not die of cardiovascular death."
"..every day doctors are publishing hundred of papers on circulation research and medications that are lowering blood pressure or cholesterol by a small bit. And here we have such a powerful intervention that is basically cleaning out the arteries."
"I don't know why anyone would take drugs when they could do something like this."
-Dr. Luigi Fontana & Dr. Susan Roberts, Washington University & Tufts University, investigators for the NIH-funded CALERIE Study-
9/21/10 update: Bill Clinton's CNN interview. Why he's eating plant-based. His stent wasn't going to cure his cardiovascular problems. He wanted a long-term solution. Click here.
Update 9/25/10: Click here for my latest post about Bill Clinton's Diet and Wolf Blitzer's Interview with Drs. Esselstyn & Ornish.
Back to October 11, 2009 - Revisiting the CALERIE Study
One of my all-time favorite posts was almost a year ago--about the CALERIE Study that's been ongoing at Washington University in St. Louis (a shout-out to Wash U!), Tufts University in Boston, and the Pennington Biomedical Research Center in Baton Rouge.
I was totally intrigued by these 132+ people who were cutting their calories by 25%, eating a nutrient-dense diet, and getting super healthy all at the same time. But, honestly, it sounded like a whole lot of measuring, weighing, calorie counting, and constant hunger. Back then I didn't seriously think it was something I could ever do it.
Fast forward to June 18, 2010 when I decided to up the ante on my plant-based diet, and take Dr. Caldwell Esselstyn's challenge to cut out oils, nuts, and avocados from my already healthy diet. That was 3 months ago--my 4 week "experiment" is over, but I'm still going strong with this eating lifestyle. (update Aug. 2012: Still going strong with the plant-based no-added-oil diet, 2+ years later & cannot see ever changing)
Weight-loss is always a huge motivator. I got on the scale today and I was 121 pounds--unbelievable for me--and that's with plenty of muscles, I'll have you know! Down 10 pounds in 13 1/2 weeks, and I'm not counting calories or depriving myself one bit. (update Aug. 2012: I've stabilized at around 118 pounds, with plenty of lean muscles & a pretty flat belly & I eat a lot!)
I love how my clothes fit--I love that my blood pressure is consistently low normal--that my resting pulse is around 56--my cholesterol is just fine, I've got plenty of energy, the toxic belly fat is almost gone, as well as my extra tush cushioning--and guess what? I didn't set out on this diet to lose weight. I figured I was fine just the way I was--at 131 pounds--OK for a sixty-year old. (Update Aug. 2012: Now age 62.5 at 118)
I set out on this path for the same reason that Lisa Walford did. She's the 55 year-old daughter of the late Dr. Ray Walford, one of the first researchers to look at the benefits of caloric-restriction. Lisa has followed a 25% calorie restricted diet for over 20 years and at 4 foot 8 inches, she weighs in at a diminutive 80 pounds, and eats around 1500 calories a day. If Lisa wasn't trying to lose or gain weight--her "set point" would be 95 pounds and she'd be consuming 2000 calories a day.
"Personally, I don't do it in hopes that I live longer. I do it so that I can liver better now! If I do live longer, it'll be a nice bonus." Lisa Walford
My Unintentional Calorie-Restriction Experiment
Without intending to, it turns out that I'm following many of the precepts of calorie restriction, as well as the guidelines of the CALERIE Study (the Comprehensive Assessment of the Long Term Effects of Reducing Intake of Energy).
- Sticking to the most nutrient-dense foods like fruits, vegetables, whole grains, and legumes--although the CALERIE study is not vegan or vegetarian.
- Eating foods that are filling, appealing, low in calories, and nutrient-rich.
- Eating lots of fiber--at least 50 grams a day (for me) without counting grams or even trying. Fiber is key to keeping satisfied and full--and it likely activates the satiety receptors in the lower intestine. My husband is a huge fan of eating a big bowl of high-fiber cereal (Uncle Sam's & Ezekiel's) with oat milk as a dessert, or when he craves a snack.
- I've easily cut my calories by 25% just by eliminating the high calories of oil, avocados, chocolate, sugar, and nuts. I'm consuming around 1400-1600 calories of very filling, nutrient-dense & high-fiber foods without counting a single calorie.
- Why I wasn't losing weight on a plant-based diet. To maintain my previous weight of around 131 pounds I was eating around 2000-2200 calories a day, and exercising around 5 days a week. Sure, I had been eating mostly plant-based since March 2008--but I still used olive & canola oils, salad dressings, ate avocados, nuts, nut butters, chocolate, and didn't scrutinize labels for added fat. I never lost a pound.
- Eliminating high-calorie-low-nutrient foods. By just cutting out the added oils in my food and in my cooking, eliminating nuts (except for small amounts of walnuts in recipes), avocados, vegan mayo, my beloved Terrapin Ridge Chipotle sauce, my favorite Whole Foods prepared deli vegan fare, hummus with tahini, and chocolate--I've naturally cut my calories to about 1400 a day without counting a calorie, or missing a thing! Believe me, I never thought I could cook without oil, or live without nuts.
- I eat whenever I'm hungry and as much as I want.
If you had the chance to stay healthy and lean as you aged--free from the diseases of aging, like diabetes, cancer, and cardiovascular diseases--and all you had to do was cut out 25% of your daily calorie intake--would you do it?
Oh--and if you could also fit into cool clothes, drop to your high school weight, & enjoy super energy? Would you be willing to do it?
Why Is Calorie Restriction on My Mind Right Now?
A few weeks ago I picked up the Sept/Oct issue Natural Health and zeroed right in on their cover story "Eat Less, Live Longer" by Catherine Guthrie. And then I watched the 2010 Milken Institute panel, "The Science of Longevity", that featured my favorite calorie restriction expert from Washington University, Dr. Luigi Fontana. I highly recommend viewing this video if you ever have 70 minutes to spare. Right!
August 2012 Update: I just watched the 2012 Milken Institute Panel, "Getting to 100: Your How-To Guide" with Dr. Luigi Fontana & others. Excellent 1 hour presentation. That summary will appear in a future post.
If you aren't seeing the 2012 Milken Institute video on your screen, click here.
Here's what I learned from the 2010 Milken Institute:
1. Your body has a natural set point weight. That's the weight your body would naturally gravitate to if you weren't trying to lose or gain weight. If you want to lower your calories by 25%--you first need to know how many calories you typically eat to maintain your "natural set point" weight.
2. Short-term pleasure vs long-term benefits. To make this work, you have to be willing to sacrifice the short-term pleasure of chocolate cakes for the long-term benefit of good health. Easier said than done. It's also not just a calorie-cutting game--it's eating the most nutrient-dense foods possible. Otherwise you end up malnourished.
3. Why does calorie restriction confer good health? Most researchers in the field believe it's because low-calorie nutrient-dense foods stave off oxidative stress, which is the damage caused by free radicals--a natural byproduct of the body's metabolism. Catherine Guthrie offers an elegantly simple explanation of the process.
"Think of free radicals like the carbon dioxide produced when you burn gas driving a car.
By restricting the amount of calories entering the body, cellular engines are forced to be more efficient (hybrid vs SUV), and the entire body hums like a well-oiled machine. More efficient cellular engines mean less metabolic waste and fewer free radicals spewed into the body.
Since free radicals (and inflammation) play a role in nearly all age-related diseases, especially cancer, heart disease, and diabetes, the result is healthier aging."
4. Caloric restriction slows aging. According to Dr. Luigi Fontana, caloric restriction is the most powerful tool we have to slow aging, and reduce disease. All the cardiac risk factors are reduced significantly, type 2 diabetes is reduced to zero, arteries are clean, and cancer causing hormones are down-regulated. Right now the average life span in the U.S. is 80 years. The average health span is 50 years--after that it's doctor visits, prescriptions & treating disease. We need to bridge that gap. Fontana's latest article on "Extending Healthy Life Span--From Yeast to Humans" is published in Science 2010 Apr 16;328(5976):321-6. Click here.
5. Animal protein & cancer. Reducing the amount of animal protein we eat to 10% of calories eaten reduces risk factors for prostate, breast, and colon cancers, and neurodegenerative diseases. Animal protein increases IGF-1, a growth factor associated with these diseases. (Fontana) Click here to read more.
6. A Flat Belly Means a Healthy Body. BMI is a crude way to measure health. Waist circumference is better. A flat belly means you are eating just the right amount of calories you need. Yikes! A round belly means you are eating too much. (Fontana)
7. If you have a family history of cancer, eating a high animal protein diet is not a good idea. (Fontana)
And now for the original post from Oct. 11, 2009. It will explain a lot.
"In terms of cardiovascular diseases - the No. 1 cause of death; 4 out of 10 people die of it in the U.S. and Europe - we know that they (Calorie Restriction Society members) will not die of cardiovascular death."
"... subjects have cholesterol around 160, blood pressure around 100 over 60, high HDL, low triglycerides and very low levels of inflammation."
"...every day doctors are publishing hundreds of papers on circulation research and medications that are lowering blood pressure or cholesterol by a small bit. And here we have such a powerful intervention that is basically cleaning out the arteries."
"I don't know why anyone would take drugs when they could do something like this."
If you had the chance to stay healthy and lean as you aged--free from the diseases of aging, like diabetes, cancer, and cardiovascular diseases--and all you had to do was cut out 25% of your daily calorie intake--would you do it? Oh--and if you could also fit into cool clothes, drop to your high school weight, & enjoy super energy? Would you be willing to do it?
We know that careful calorie restriction--eating a nutrient-dense-low-calorie diet--works in rodents and those University of Wisconsin rhesus monkeys--but will it work for humans who are constantly tempted by cheeseburgers, pizzas, office parties, and dinners out with friends? (Read about the Rhesus Monkey 20 year follow-up here)
According Dr. Susan Roberts, one of the principal CALERIE investigators, when it comes to animals, "They don't just live longer, they are healthier. They actually aged biologically slower. Their hair has gone gray less quickly. Their hormones have stayed at their youthful profile and their immune function has stayed good."
I'd heard for years about too-skinny "calorie-restriction groupies" who were out to beat death with a miserably low-cal boring diet. It held no appeal for me. I love food too much!
But, I've got to tell you, after reading about the National Institute of Aging's ongoing calorie-restriction experiment known as CALERIE (Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy)--I'm rethinking this whole calorie-restriction scene! This is not excruciating or boring at all! And since I started on my "veganish" adventure in March of 2008--I'm not that far away from the CALERIE model already!
Take a look at Jon Gertner's fascinating story, "The Calorie-Restriction Experiment" in the October 11, 2009 New York Times Magazine, here.
Honestly, I'd describe it as Weight Watcher's on steroids--with help from physicians, dietitians and counselors. There's even room for an occasional Uno's pizza, Haagen Dazs ice cream bar, bratwurst, or beer.
The first participants are finishing up their 2-year trial and the results are promising.
What is the CALERIE Study?
- Since it's virtually impossible to follow people over a lifetime to find out if restricting calories by 25% would slow aging, drastically reduce diabetes, cardiovascular diseases, and cancer--CALERIE aims to follow a select group (right now there are 132 enrolled) for two years to find out if the biomarkers for aging can be modified when calories are restricted.
- The study will measure if inflammation, insulin levels, blood pressure, core body temperature, and body weight can be lowered simply by reducing calories by 25%.
- Where are the sites? Tufts University in Boston; Washington University in St. Louis; Pennington Biomedical Research Center in Baton Rouge.
- Who is eligible? 20-50 year olds who are healthy and not too fat or too thin--having a BMI of 22-27.9. Participants also have to be motivated, organized (they have to measure & record every morsel they eat for 24 months), have stable jobs with little travel, and a supportive family.
What's the Diet Like?
- So, do you think you know how many calories you eat every day? Think again. Most participants guessed wrong. Using a high-tech lab technique that involves swallowing water with rare isotopes, the researchers are able to figure out precisely how many calories each participant is typically consuming. Then they cut it down by 25%.
- Liz Ewen, a molecular biologist, was eating 2,226 before CALERIE--now she's at 1,670. Dr. Jeff Peipert, an OB-Gyn, was consuming a whopping 3,300 a day pre-CALERIE--now he's at just under 2,500.
- For the first 28 days participants get all their meals & snacks cooked for them and at no cost--based on their individual calorie counts. This gets them accustomed to portion sizes and adjusted to eating the kind of foods that will keep them filled and satisfied. And this food isn't spartan: Mediterranean-style fish with Greek-style potatoes, or Farfalle with Pesto & Diced Chicken, for example. After 28 days--they buy and prepare their own food--with regular help and guidance from dietitians and a support group.
- The Key to eating 25% less: eat foods that are nutrient rich and high in fiber, like vegetables, fruit, high fiber cereals, and soups. Aim for foods that weigh as much as what you were eating before the diet--but lower in calories--to keep you full and satisfied. Favorite food for keeping hunger at bay: apples. Everyone in CALERIE has become a big fan of apples.
- The 4 Rules for Eating Less: Eat Foods That Are Filling, Appealing, Low in Calories, Nutrient Rich!
- Dr. Susan Roberts of Tufts says, "If you don't change your diet to a high-satiety diet you will be hungry, and you will fail." Fiber One, the breakfast cereal, or Nature's Path Organic Smart Bran--both with soluble & insoluble fiber, "have a unique effect in helping calorie-restriction subjects feel fuller, probably because they activate certain receptors in the lower intestine."
To see some of Dr. Roberts' satiating snack recipes in my previous post click here: "The Instinct Diet Helps Us Combat Our Hard-Wired Food Cravings - And Satisfy Our Cravings for Something Spicy, Salty, Crunchy, & Chocolate"
- CALERIE tip: Save up calories if you have a special occasion or celebration coming up. Want a bratwurst or Haagen-Dazs? Save up those calories. Decide what's more satisfying--170 calories for a gin & tonic, or a 190 calories for a Haagen Dasz ice cream bar.
- Surprisingly, no one complains of raging hunger. But most everyone felt hungry for the first few weeks. When I joined Weight Watchers years ago to lose pregnancy weight I felt exactly the same way. But then you just get used to less calories and learn to eat more filling foods.
- The hardest (& most annoying) part is getting used to measuring the food, preparing the food, and keeping track of the calories.
Why is CALERIE Working For Most of Its Participants?
- There's accountability.
- You have to submit a weekly food diary.
- Attend weekly weigh-ins
- Once or twice a week you must attend individual counseling sessions
- Group counseling sessions give participants an opportunity to swap strategies and get support from fellow dieters.
- There's a battery of medical tests every 6 months. Cognitive tests. Blood tests. Bone-mineral density tests. Measurements of resting metabolism, respiratory output, and internal core temperature.
- Most participants met their weight loss goals. They were told to expect to lose about 15% of their weight during the first year. After that initial drop they would plateau to "weight stability".
- Doug Hansen started out at 198 pounds and dropped to 168--near his plateau--after 6 months. Jeff Peipert began at 174 pounds--dropped to 151 after 52 weeks--and was projected to plateau at 147 pounds.
- Benefits. For example: Peipert's blood pressure started out at 130 over 80. Now almost a year into CALERIE, he's at 110 or 115 over 54. At age 49 his weight is what he weighed in high school. Same for Brad Beggs. He is down to wearing a size medium shirt--a size he hasn't worn since high school. And Beggs adds, "I've never gotten so much pleasure in my life."
Dr. Jeff Peipert, a Washington University CALERIE participant
1. 18 holes of golf
2. Biking 8 miles back & forth to his office just to pick something up
3. Cutting his 1 acre lawn
4. Pulling out tree roots with his son for over an hour
5. 40 minute after-dinner walk with his wife.
6. This "calorie-incinerating machine" was wondering why he felt particularly hungry the next day, resulting in his eating a bowl of cereal in the middle-of-the-night. Both my husband & I have definitely noticed the huge uptick in our appetites the day after long work-outs. It makes sense to us.
Is Calorie-Restriction Possible for the Average American?
- The Naysayers: Dr. John Holloszy, a Washington University lead investigator thinks 99% of Americans can't stick with it. Other doctors think calorie-restriction requires too much individual effort--too much in medical resources--too much in counseling. Dr. Robert Krikorian, a neuropsychologist who happens to be a long-time follower of a calorie-restriction diet himself-- thinks that most people won't pay attention to how much they eat--and they would refuse to keep up the organizational requirements necessary for such a diet.
- The Boosters: Many doctors involved in CALERIE are surprised & encouraged at the high level of compliance with the diet.
- The Participants: All of the subjects that Times writer Jon Gertner spoke with intended to continue with calorie-restriction when the trial ended. Liz Ewen likened it to Weight Watchers (& I agree). Given the right online tools, some sort of infrastructure, group meetings, and dietitians available for support, Ewen thinks it's suitable for many people. "It's really not much more than embarking on a diet that teaches you how to eat normal foods but make better choices!"
- Some of the first of the group to finish: Most of "first finishers" plan to keep up the diet--but switch to estimating the calories, rather than counting them precisely. Josh McMichael finished up with CALERIE in September. In the few weeks since ending the program he gained eight pounds--but it's now mostly gone. "I tried the new massive burgers at Burger King," he said. "Twice. Wasn't worth the side effects. I think I've gotten over things like that. For the most part."
- Dr. Luigi Fontana of Washington University in St. Louis. "My perception right now is the effects of calorie restriction are multiple, so I think it is highly difficult to find one, or two, or three drugs that will mimic such a complex effect." And although he isn't optimistic that calorie restriction will gain traction in the general public, he does believe an important common sense lesson will be learned from the experiment:
"Eating less is better than eating more, especially if it's a nutritious mix of whole grains, fruits, vegetables and the like. The evidence is overwhelming now that it will improve your health and will improve your chances of living healthier and probably longer."
- Dr. Susan Roberts of Tufts University in Boston: Roberts thinks the study will have greater effects than the average clinical trial. "I don't know why anyone would take drugs when they could do something like this--calorie-restriction," said Roberts.
The Healthy Librarian Weighs in on Calorie Restriction
For my money, the folks in the CALERIE study are following a plan that seems very similar to:
- Dr. Joel Fuhrman's Eat for Health: Lose Weight, Keep It Off, Look Younger, and Liver Longer
- Dr. Susan Roberts' (a CALERIE lead investigator) Instinct Diet
- Dr. Caldwell Essestyn's Prevent and Reverse Heart Disease
- The Weight Watcher's diet plan
Easiest way to cut calories: ditch added fats, like butter, margarine, mayo, cooking oils, salad dressings, desserts, high-fat dairy like cheese & ice cream, and the after-dinner snacking.Foods highest in nutrient density:
*Dr.Fuhrman’s Aggregate Nutrient Density Index
Top 30 Super Foods Score
1. Collard, mustard, & turnip greens 1000
2. Kale 1000
3. Watercress 1000
4. Bok choy 824
5. Spinach 739
6. Brussels sprouts 672
7. Swiss chard 670
8. Arugula 559
9. Radish 554
10. Cabbage 481
11. Bean sprouts 444
12. Red peppers 420
13. Romaine lettuce 389
14. Broccoli 376
15. Carrot juice 344
16. Tomatoes & tomato products 190-300
17. Cauliflower 295
18. Strawberries 212
19. Pomegranate juice 193
20. Blackberries 178
21. Plums 157
22. Raspberries 145
23. Blueberries 130
24. Papaya 118
25. Brazil nuts 116
26. Oranges 109
27. Tofu 86
28. Beans (all varieties) 55-70
29. Seeds: flaxseed, sunflower, sesame 45
30. Walnuts 29
Drugs or Diet? I find it interesting that the only cure for celiac disease (the inability to digest gluten) is to follow a gluten-free diet. There are no pharmaceutical or surgical cures. People with celiac who want to get better just follow a gluten-free diet.
Yet, when it comes to the diseases of aging, like Type 2 diabetes, some cancers, and cardiovascular diseases--most physicians find that the majority of people are unwilling to follow a diet even if it promises to free them from these diseases. Oh well!
Do you think such a diet is ready for Prime Time? Would you be willing to give it a try?