Health Benefits Cutting 297 Calories A Day

Bob Crowther (68) highlights a July 11, 2019 article in THE LANCET - a two year study examining the effects of calorie restriction on cardiometabolic risk factors in healthy adults.   

Adho Mukha Svanasana

Downdog (2015)

 BACKGROUND

US Centers for Disease Control and Prevention
About 610,000 people die of heart disease in the United States every year - or, 1 in every 4 deaths

METABOLIC SYNDROME
A Cluster Of Metabolic Disorders 
[American Heart Association]

Medical diagnosis can be met when three or more of the following biomarker measurements are observed in an individual - increasing cardiovascular risk:

1 - Abdominal Obesity: waist circumference greater than 40 inches for men, greater than 35 inches for women

2 - Triglyceride: blood serum fat level of 150 milligrams per deciliter of blood or higher

3 - HDL Cholesterol: high density lipoprotein cholesterol values of less than 40 mg/dL in men, 50 mg/dL in women

4 - Blood  Pressure: systolic pressure (top number) of 130 millimeters  of mercury or greater; diastolic pressure (bottom number) of 85 mm Hg or greater

5 - Fasting Glucose: blood sugar levels at, in excess of 100 milligrams per deciliter

[Underlying causes of metabolic syndrome include overweight and obesity, physical inactivity, genetic factors, getting older]

2015 - 2020 US Dietary Guidelines

Recommended 

Daily Calorie Consumption Estimates

[Varies On Age, Height, Weight, Physical Activity]

Adult Women: 1600 - 2400

Adult Men: 2000 - 3000

YET
Pew Research Center Analysis
(Bob Curley)

. The average daily caloric intake for Americans rose 23% from 1970 to 2010

. In 2010, the average American consumed 2,481 calories

Evaluating Health Benefits

From
 CALORIE REDUCTION 

Anahad O'Conner of the New York Times reported on the Kraus investigation, its significant and noteworthy findings:

. it "was the first major clinical trial to examine the effects of caloric restriction in a group of middle-aged or younger adults who were either normal weight or just slightly overweight but not obese.

. The goal of the trial was to look at whether caloric restriction could influence healthy aging and disease."

[Kraus findings build on hypothesis that it's not just weight loss that leads to these improvements, but some more complex metabolic change triggered by eating fewer calories than what's expended. (Samiha Khanna)]

Authors

Prof William E. Kraus, MD (Duke University)
[There were 11 Co-Authors]

Article Title

2 years of calorie restriction and cardiometabolic risk (CALERIE): exploratory outcomes of a multicentre, phase 2, randomised controlled trial

[This study by Kraus, colleagues used data from CALERIE = Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy]

Journal 

THE LANCET Diabetes & Endocrinology

 (July 11, 2019)

Funding
(55 Million)

National Institute on Aging and National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Duration Of Study

May 8, 2007 to February 26, 2010

Involving

3 Clinical Centers in the USA

Participant
 Details

Healthy, Lean to Overweight 
Average Age Men & Women (38), Range: 21- 50 

Body Mass Index (BMI)
Average Baseline (25.1), BMI Range: 22.0 to 27.9 

BMI Defined

[= person weight in kilograms (kg) divided by height in meters squared]

Obese Individual Has A BMI of 30, Higer

Participant Pool

218 Individuals Selected, Randomly Assigned 
[238 Were Assessed, Some Eliminated Based On Concerns About Physical Or Mental Health] 

Participant Ethnic Backgrounds
 76% White, 15% African American
 9% Asian, Native American or Pacific Islander



Study Design

Experimental and Control Groups Composition

Experimental Group - 143 individuals were assigned to a 25% caloric restriction diet, 117 participated for 2 years:

• Initially 44 Men, 99 Women 
• Ate 3 Meals/Day Prepared At 3 Clinical Centers For First Month To Understand What A 25% Reduction In Calories Looked Like 
• Choice Of Six Meal Plans Made Available (Cultural Preferences)
• Received Individual, Group Behavioral Counseling For First Six Months On Basics Of Calorie Restriction, Learned To Cook Low Calorie Meals

Control Group - 75 individuals began, 71 completed full 2 years:

• Initially 22 Men, 53 Women
• 'Ad Libitum': Continued Usual Diet  
• Received No Behavioral Counseling
• Met With Researchers Every Six Months 

 Cardiometabolic Risk Factors Evaluated

Baseline data of known biomarkers impacting health span (for cardiovascular and metabolic risk factors including diabetes) were obtained for both groups:

1. Blood (Systolic, Diastolic) and Renal Pressure Values
2. Cholesterol (LDL Cholesterol, Total Cholesterol to HDL Cholesterol Ratio) ... LDL often referred to as 'bad' cholesterol
3. Metabolic Syndrome Score (based on data about abdominal circumference, blood pressure, cholesterol, triglycerides, glucose)
4. Glucose Homeostasis (Measures of Fasting Insulin, Glucose, Insulin Resistance, 2h-Glucose)
5. Inflammation: High Sensitivity C-reactive Protein (hs-CRP) linked to heart disease, cancer and cognitive decline

FINDINGS

Major Cardiovascular & Metabolic Health Benefits 

[Experimental Group]

"Calorie restriction caused a persistent and significant reduction from baseline to 2 years of all measured conventional cardiometabolic risk factors"

• Cut 297 Calories A Day: Average Calorie Reduction (from 2,467 to 2,170) After 2 Years [Over First Six Months, Cut Calories by 20%]
• This Was A 11.9% Reduction, Not The 25% Goal Sought
• Lost About 10% Weight [On Average, 7.5 kg (= 16.5+ pounds)]
• Decrease in Fat Mass Loss (71%), Did Not Change Protein Intake, Ate Slightly Fewer Carbohydrates

AND

• Lower Total Cholesterol, LDL Cholesterol Values - decreased significantly after one year; change was maintained at two years

• 24% Less Blood Serum Triglycerides (Fats)

• Improved Blood Pressure (Systolic, Diastolic) - lowering evident as early as six months, reached statistical significance by one year and persisted for the duration of the study

With Significant Improvement In:

• hs-CRP values (Less Inflamation)
• Insulin Sensitivity Index (Reduced Risk Of Type 2 Diabetes)
• Metabolic Syndrome Score (Lower Risk Of Heart Disease, Diabetes, Stroke)

Also Noted:

• Increase In Micronutrients (Vitamins A, K and Magnesium) 
• Better Sleep, Increased Energy, Improved Mood
• No Significant Increases In Hunger Or Food Cravings

[Control Group]

Mean Reduction Calorie Intake: 0.8% 
Increased Weight: 0.1 Kg (= 0.22 pounds)

Dr. Kraus noted the Control Group participants did not see any of these health benefits of the Experimental Group during the same 2 Year span

Towards Eliminating 297 Calories A Day

Kraus: "It's not hard to achieve that amount of calorie restriction." "That's essentially an after-dinner snack." ... Identify a non-essential component of your diet you can easily skip. (Anahad O'Conner, A. Pawlowski)

What 297 CALORIES Looks Like

(Anahad O'Conner, Susie Neilson, Bob Curley)

. A large bagel, a few chocolate cookies, a small Starbucks Mocha Frappuccino

. About six standard-size Oreos (cookies)

. A ham and cheese croissant at Starbucks (320)
. A regular cheeseburger at McDonald's (300)
. A grab-size bag of potato chips (274)
. A small order of french fries at McDonald's (230)
. A Snickers candy bar (280)

Nutrition experts point out that it's more important to focus on what kind of foods you're eating as opposed to overall calories. (Bob Curley)

Madelyn Fernstrom

(NBC News, Health and Nutrition Editor)

"The calorie-restriction diet can take a lot of mental focus and discipline to maintain, but it can be achieved by eating a variety of low-calorie fruits and vegetables, fiber-rich starch, lean plant and animal proteins, and heart-healthy fats." (A. Pawlowski)

 INTERPRETATION OF DATA

"2 years of moderate calorie restriction significantly reduced multiple cardiometabolic risk factors in young non-obese adults." 

" These findings suggest the potential for a substantial advantage for cardiovascular health of practicing moderate calorie restriction in young and middle-aged healthy individuals, and they offer promise for pronounced long-term population health benefits."

"The extent to which their metabolic health got better was greater than would have been expected from weight loss alone" 

The authors recognized calorie restriction could reduce the "ravages" of cardiovascular disease, diabetes and obesity, possibly boosting  longevity. (A. Pawlowski)

QUOTES, PERSPECTIVES
 On Various Topics

 Kraus On Calorie Reduction:

• "We expected there to be [some] improvement on cardiometabolic factors because of weight loss.' ... "But ... we didn't expect the degree of improvement we saw." (Susie Neilson)

• " ... the magnitude was rather astounding. In a disease population, there aren't five drugs in combination that would cause this aggregate of improvement (Anahad O'Connor)

• "Caloric restriction in this study improved [the biomarkers for metabolic syndrome] dramatically early, and maintained improvements in all five of these parameters rather remarkably."  & Modestly cutting calories "improved even normal biomarkers to be supernormal. Clearly caloric restriction is going to reduce risk of obesity and diabetes among those at greater risk, but it also may actually impact individuals who have minimal risk, so it has broad application over a wide population potentially." (Bob Curley)

Also

• On Why Calorie Restriction Would be So Beneficial: "That's the million dollar question. Its something we really don't know."

• "It's not just due to weight [change]. There is something else about restricting calories that seem to have benefits on cardiometabolic factors that we don't really understand." (A. Pawlowski) 

• Kraus speculates: "We could be resetting the baseline in normal people so it will be longer until they get certain diseases" adding an evaluation of study participants in 10 years was a way to see if there was a legacy effect (see Becky Upham section on Calorie Restriction: The New Fountain Of Youth? and comments on the Diabetes Prevention Program informing Kraus thinking)

Kraus On Study Design 
Using Younger, Mostly Normal-Weight Population

"We designed this study on the basis of the results we've seen in animal trials where calories have been restricted." 
In most cases, the earlier you start the calorie restriction, the greater its effects on the life span and health span.
Health span is the period between the start of the intervention and the start of the disease 
Kraus and his team also wanted to see what benefits, if any, calorie restriction could have for people who weren't overweight (Becky Upham)

&

Susan B. Roberts, Sr. Scientist (Co-Author)
U. S. Department of Agriculture Human Nutrition Research Center on Aging
 Tufts University (Boston)

About Experimental Group

They tended to eat less fat than the control group ... "At the same time they had big increases in vitamin K and magnesium intakes" (markers of a generally healthy diet) (Becky Upham)

"They were eating more healthy foods ... Things like nuts, whole grains, green vegetables and legumes." (Anahad O'Conner)

Editorial Commentary On Study

Frank Hu, MD, PhD Director Of Nutrition
 (Harvard T.H. Chan School of Public Health)

Combining calorie restriction with other strategies like intermittent fasting, a low carb diet or the Mediterranean diet could help people stick with a healthy lifestyle that ensures a lean body over the long term - "the optimal way to promote longevity" (A. Pawlowski)

"Calorie restriction may be a useful tool for better health and weight loss, but it's unclear whether the changes in the new study will ultimately translate into longevity and reductions in chronic disease." ... Hu questioned whether caloric restriction would be practical for most people given that "we are living in an obesogenic environment with an abundance of energy-dense, nutrient-poor foods that are cheap, accessible and heavily marketed." (Anahad O'Conner)

Whether these findings could have real-world application is unclear. Although participants in the study were highly motivated and the intervention was intensive, many people couldn't comply with the goals of the study." (Becky Upham)

1

"Because individual food choices are shaped by the food environment the long-term sustainability of calorie restriction and its benefits on bodyweight can be easily undermined."

2

"Therefore, improving the food environment by making healthy food choices more accessible, affordable, and the norm while reducing the accessibility of ultra-processed and highly palatable foods is essential to supporting healthy food choices."

3

"To this end, policy solutions including sugar taxes, financial incentives producing and purchasing healthy foods, food labelling, and better regulation of food marketing are needed to improve the global food environment." (1,2,3 Jacqueline Howard)

Another Viewpoint

Dr. Subbarao Myla, Director Cardiac Cath Labs
Hoag Memorial Hospital Presbyterian
(Newport Beach, California)

He noted the study was "well designed" ... adding: "it would be interesting to see what happens to the contestants in this study two years after the study ended, if they sustained these habits or not"

Myla was interested in expanding the small trial sample size 'to determine whether similar results would emerge among a larger and more diverse group of people over a longer period of time'

He added: "The study did not address measures of activity which is very hard to control for. Weight loss is best supplemented and sustained by increasing activity." (Jacqueline Howard)

Speculation
An Unresolved Question Of Interest

Dr. Krause asks: could decreasing calorie intake extend life of humans as done with other animals?  
[Calorie restriction has been shown to increase the life span of various organisms and reduce their rate of cancer and other age-related ailments. (Anahad O'Conner)]

" The question is does caloric reduction extend life span or health span - the period between birth and when people develop diseases. ... In all organisms, caloric restriction seems to effect both, while exercise affects health span but not life span." (Bob Curley) 

Future Analysis

Kraus:
"We have collected blood, muscle, and other samples from these participants and will continue to explore what this metabolic signal or magic molecule might be." (Samiha Khanna)

Other next steps for research would be to combine caloric restriction used in this study with other lifestyle interventions, such as modest physical activity (Becky Upham)

Another
 Perspective 
David Sinclair, Professor Of Genetics
(Harvard Medical School)

On Caloric Restriction And Aging
(Susie Neilson)

... the study demonstrates a significant problem with using caloric restriction to improve human health: It's really hard to maintain, even for motivated people. Of the 143 participants who originally began the restricted diet, 26 dropped out before the two years were up. (Small sample size was a limitation of the study.)

"You can't expect the elderly or frail to do this severe dietary regimen. We need alternatives, be they intermittent fasting or medicines that mimic calorie restriction."

 Sinclair is working to understand how caloric restriction works on a molecular level so that he and others can come up with medications that confer the same benefits without the pain and difficulty.

The goal of any caloric restriction research is the reduction - any maybe elimination - of aging-related diseases.

"Aging isn't considered a medical condition - it's just too common. Hopefully, in the near future, we won't accept it."

"That's what calorie restriction offers: It compresses the period of sickness. People one day will hopefully live into their 90s in a healthy way and pass away more quickly and [less] painfully than we do now."

Sources (Reporters, Organization)

 Anahad O' Conner (NYT), Bob Curley (Healthline), Jacqueline Howard (CNN health), Samiha Khanna (DukeHealth), Susie Neilson (npr), A. Pawlowski (TODAY DIET & FITNESS), Becky Upham (Everyday Health)

 STUDY REFLECTS MY EXPERIENCES

I too achieved significant improvements, reducing cardiometabolic risk factors, over several years: positive health outcomes similar to those participants in the Experimental Group described by Kraus and colleagues in their two year trial.

 [During one year I lost 13.2 pounds (10.3% body weight) and, while intentionally eating more, successfully maintained my weight in the 120's at the end of the following 12 months] 

Complementing this lifestyle focus on making better and more informed nutrition choices, I continued my daily yoga sessions - whole body physical asanas contributing to maintaining and enhancing my mobility.

Walking and hiking at times have further contributed to my current health status.

Trader Joe's and Whole Foods continue to be sources of many nutrient-rich and diverse food selections including frozen fruits and vegetables.

I have enjoyed adding whole black figs to the various small home prepared meals.

Whole Black Fig

(Trader Joe's)

Knowledge of some family medical history, potential genetic risk factors have continued to inform my decisions and behaviors over many years.

[My dad was diagnosed with late onset diabetes and later experienced metastasis of colon cancer; my mom was diagnosed with congestive heart failure, had a stoke leading to partial paralysis.] 

Eating better, moving daily, reducing sources of stress and ones genetics all undoubtedly have contributed to many welcomed health status updates enjoyed as a senior - including my recent (June) colon evaluation I remained awake to witness.  

It's encouraging knowing lifestyle choices can, do have significant positive consequences.

I look forward to reading future observations from studies by Dr. Kraus and his colleagues.

Your reaction(s) my comments are welcomed.

#BobCrowther #Nutrition #Yoga