Women Have a Much Harder Time Losing Body Fat Than Men, But Both Benefit From Doubling Their Protein Intake!

Image 1: Looks good, tastes good, is good - and contrary to zinc, ingesting 2x the RDA will help you lose body fat, instead of setting you up for insulin resistance.

Enough of useless (ALA, zinc) and useful (glutamin) supplements for at least 24h! Let's get back to what really counts: Training? No, not today,.. the other thing! The one, which is actually to be supplemented - your diet! Believe it or not - even after all those years, I am finding time and again that the food you put into your mouth has much more pronounced effects on the ways you look feel and perform than any of the countless useless and useful supplements. Accordingly and in response to the futile notion of "calories in vs. calories out" and the bomb-calorimeter representation of the human metabolism as a simple furnace, the past couple of years have seen an increasing public and (as of late) scientific interest in the effects varying macronutrient compositions will have on your ability to shed weight and, more importantly, to keep it off in the long run.

Submitted on December 30, 2011 and published in the latest issue of the Journal of Nutrition & Metabolism (9:55) the results of a "randomized clinical weight loss trial" comparing more or less isocaloric (-500kcal/day) weight loss regimen in 130 (58 male, 72 female) overweight middle-aged (40-56) subjects (BMI  =  32.5  ±  0.5 kg/m²) provide further insights into the real-world effects of  prescribed minimal protein intake levels on the outcomes of a 4 months weight loss and 8 months weight maintenance intervention (Evans. 2012).

RDA = 0.8g/bw vs. 2x RDA = 1.6g/bw protein - Round 1: Education & Adherence

In many of the previous posts on this issue (e.g. "High Carb vs. High Fat for Obese Type II Diabetics and What Really Happens, When Science Meets Real Life"), adherence or even an appropriate awareness of what "high protein" actually means turned out to be one of the main culprits as far as the significance of respective data is concerned (Krebs. 2012). In this respect, the subjects in the study by Evans et al. who were supported by a pretty extensive educational and support program that included

• the provision of electronic food scales and instruction on how to weigh and record food servings at all meals (logs were monitored for compliance on a weekly base!)
• a specific diet program with detailed instructions from a research dietitian including the menus, food substitutions and portion sizes
• an obligatory weekly 1 h meeting at the weight management research facility, where they received dietary counseling, had the ability to pose questions and instructions referring to the minimum of 30 min of walking 5 d/wk

constitute a positive exception from the average "study participant" who receives a handout with instructions and a clammy handshake for his/her willingness to step on the scale twice within a given time-frame.

Figure 1: Energy intake (total) from different macronutrients (left) and relative reduction compared to basesline in the 4-month weight loss and the subsequent 12 months "maintenance" period (based on Evans. 2012)

Based on the activity logs, the average amount of exercise was less than 100min/wk and not different between the two treatment groups. As far as the drop outs are concerned, there was yet a trend for lower drop out rates of the male participants in the protein compared to the carbohydrate group (9/28 vs. 18/30). 

Figure 2: Adherence to the prescribed macronutrient ratios was similarly "good" for men and women in both the high carbohydrate and high protein arm of the study (based on Evans. 2012)

The overall adherence to the prescribed nutrient ratios, i.e. 15% protein, 55% carbohydrates and 30% fat in the high carbohydrate and 30% protein, 40% carbohydrates and 30% fat in the high protein group was similarly good (the deviations were smaller than one standard deviation) among both men and women; and still, the net results of the study appear somewhat disappointing - at least if you make the all too common mistake of judging the outcome of an already intrinsically mislabeled "weight loss" intervention solely by the figures on your scale, which were, for the subjects in the study at hand, identical for both groups (PRO:-10.7  ±  6.8 %, CARB:-10.1  ±  6.2 %, expressed relative to body weight at baseline).

Feminists beware! Life is not fair...

A closer analysis of the data does yet reveal that despite an overall greater reduction in calorie intake in the high protein group (-31% vs. -22% in the weight loss phase and -27% vs. -16% in the maintenance phase) and slightly but statistically non-significantly greater body fat loss in the male participants on the high carbohydrate diet at the end of the maintenance phase, the "net" effect on the lean to fat mass ratio in men and women speaks in favor of increased protein intakes during phases of reduced energy intake.

Figure 1: It is obvious that compared to baseline the loss in body fat (expressed relative to baseline, left) was significantly more pronounced in the male compared to the female participants; the favorable effects of the high(er) protein diet on the lean to fat mass ratio (4% and 6% greater improvements) is yet of even greater importance for the ladies.

There is yet no denying that middle-aged women are - irrespective of their diets - having a substantially harder time losing body fat than men of the same age. In view of the fact that this is at least partly mediated by their significantly lower lean body mass to fat mass ratio (1.3 in women vs. 2.2 in men), the aforementioned protein sparing effects of "high" protein diets are of even greater importance for female dieters than for their male peers (cf. figure 3, right) - unfortunately, even the latter rarely rarely spare a thought about that, when their short-sighted and often likewise overweight Dr. tells them "you got to lose weight, if you want to see your grand children graduate, buddy!"

... and if you want sexual equality you got to lift weight and eat your meat ;-)

Against that background the results of the recently published exercise-only trial by Washburn et al. come to mind (cf. "Strength Training Ain't For Women -  Really!?" and Washburn. 2012). In the study at hand, The absence of at least a minimalist strength training regimen, as it was employed in the Washburn study, could in fact be one of the major reasons for the small overall effect size Evans et al. observed in their "walk in the park if you will" study. Eventually, the preservation of an already low amount of lean tissue mass is one thing, increasing the latter and thusly building the metabolic advantage of greater lean muscle mass, based on which the male study participants shed roughly 15% more body fat within the 12 month than their female peers is yet another one, of which I can hardly repeat often enough that it will not turn Angels into Divas over night (see image 2). And while you can easily regain 2 pounds of fat you lost, you will have to acknowledge that the lean mass you have either never built or lost over years of mainstream dieting, won't come back easily (cf. Beavers. 2011).

Image 2 (unkown Facebook source): Strength training and a high protein diet don't turn Angel's into Divas over night - what a pity ;-)

Bottom line: Regardless of whether you are a woman or a man, an angel or a diva, Homer Simpson, Peter Griffin, or Stanley Smith (cf. "Stocktaking, Goal Setting, -Tracking & -Resetting to Achieve a Healthy Weight & Shed Excess Body Fat"), greasy steaks, eggs, fish, dairy and a gym membership will not just have a much more pronounced impact on the outcome of your next diet, than all the diet products and books your money can buy, as an elementary part of your new lifestyle they will also lay the foundation of your future health - and what's even better: You will have more than enough extra years to spend all the money you would otherwise have spent on all those gimmicks, false promises, useless supplements and defacing cosmetic surgeries! Now you tell me eating a high(er) protein diet and spending time in the gym instead of the office was uneconomical ;-)

References:

1. Beavers KM, Lyles MF, Davis CC, Wang X, Beavers DP, Nicklas BJ. Is lost lean mass from intentional weight loss recovered during weight regain in postmenopausal women? Am J Clin Nutr. 2011 Sep;94(3):767-74. Epub 2011 Jul 27.
2. Evans EM, Mojtahedi MC, Thorpe MP, Valentine RJ, Kris-Etherton PM, Layman DK. Effects of protein intake and gender on body composition changes: a randomized clinical weight loss trial. Nutr Metab (Lond). 2012 Jun 12;9(1):55.
3. Krebs JD, Elley CR, Parry-Strong A, Lunt H, Drury PL, Bell DA, Robinson E, Moyes SA, Mann JI. The Diabetes Excess Weight Loss (DEWL) Trial: a randomised controlled trial of high-protein versus high-carbohydrate diets over 2 years in type 2 diabetes. Diabetologia. 2012 Apr;55(4):905-14. 
4. Washburn RA, Kirk EP, Smith BK, Honas JJ, Lecheminant JD, Bailey BW, Donnelly JE. One set resistance training: effect on body composition in overweight young adults. J Sports Med Phys Fitness. 2012 Jun;52(3):273.

Sunlight, L-Tryptophan & Vitamin B6 With Breakfast Increase Serotonin and Wakefulness During the Day and Melatonin and Restful Sleep at Night

Image 1: For these kids the high tryptophan + B6 breakfast would be useless unless they already got their 10min+ of direct sun exposure this morning

A recently published study that was conducted by a team of international researchers led by Miyo Nakade from the Gakuen University in Nagoya, Japan (Nakade. 2012), concludes that sunlight exposure and vitamin B6 and l-tryptophan intake with breakfast could be profound modulators of circadian rhytmicity in young children (N=816, age = 2-6 years). The results the researchers published in the latest issue of the Journal of Physiological Anthropology clearly suggest that the increased production of serotonin from l-tryptophan and the vitamin B6 metabolite pyridoxal 5’-phosphate (also known as PLP or p5p) exerts beneficial effects on the morningness-eveningness (M-E) score - a measure for the natural and highly desirable difference in wakefulness in the morning and sleepiness in the evening, the disturbance of which is among the emerging correlates of metabolic diseases, such as diabetes, obesity and abnormal lipid metabolism.

[C]hildren showed a tendency to be more morning-typed if they ate breakfast with
a high estimated Trp content. This study also confirmed a similar trend with estimated Vi-B6
content. Among essential amino acids, the Trp content in food is quite small, and thus it is
necessary to make a special effort to consume a sufficient amount in one’s diet.

That those foods with specifically high tryptophan content are, as so often, eggs, meats, and fish is something I probably don't have to tell you - just as I don't have to tell you that soybeans, and other soy products, which also contain significant amounts of tryptophan should not constitute a major part of your diet; regardless of whether you are a man or a woman.

Sunlight must not be hidden behind curtains or seen just through the windows your car

Interestingly, all the vitamin B6 and tryptophan in the world appears to be of little use, if you get too little sun-exposure (Rosenthal. 1997). And, now listen up!, they can become disturbed when you sleep with black out curtains and use an alarm clock to wake you up (Harada. 2003) - in how far these effects are mitigated, or even reversed (i.e. using black-out curtains = beneficial) in people who would otherwise be constantly exposed to unnatural light-exposure (e.g. a street lantern right before your window) would require further investigation, though.

Figure 1: Distribution of early birds (low M-E score on the x-axes) and late risers (high M-E score) among the study population (data calculated based on Nakade. 2012).

Anyways, as you can see in figure 1 the effect of the curtains was statistically significant, but not as pronounced as the scientists' emphasis in their report would have it. There are tendencies for more morning types (lower M-E scores) in the children sleeping without blackout curtains, yes. And there are no real evening types in the children sleeping without blackout curtains, but the broad majority falls into the same 18-23 M-E score range on the 7-28 early bird to long sleeper scale Nakade et al. employed.

Vitamin B6 and inflammation: Although this is only indirectly related to the topic of circadian rythmicity and wake-sleep patterns, it is quite intriguing that vitamin B6 is still touted as an anti-inflammatory agent. And though even very recent population based studies confirm that there is in fact an inverse relation of low plasma vitamin B6 and its active metabolite pyridoxal-5-phosphate (PLP) are inversely associated with the "overall inflammation" score in the US population (Sakakeeny. 2012), another recent study by Ulvik et al. clearly suggests that these associations are corollary, at best (Ulvik. 2012). In their trial, the results of which have been published in the May issue of the American Journal of Clinical Nutrition, Ulvik et al. administered 40 mg pyridoxine hydrochloride per day to patients with stable angina pectoris. Contrary to their expectations, this practice did neither replete the low vitamin B6 levels, nor sooth the inflammation. On the contrary, the rapidly metabolized vitamin B6 appeared to preserve or even increased the expression of inflammatory markers.

What's good in the morning won't hurt at night

With tryptophan being a serotonine precursor and vitamin B6 a necessary co-factor in its synthesis, it may come as a surprise that both, and the sunlight induced serotonin synthesis boost can boost "morningness" and make you more alert. After all, you will probably have read on the label of various dietary supplements that tryptophan is supposed to make you sleepy, right? What those labels don't tell you is that the exposure to sunlight and not the shear availability of precursors and co-factors, let alone the position of the hands on your clock modulate its destiny. And determine whether the tryptophan will get you going, as it obviously does in the children with the highest breakfast intake of tryptophan and vitamin B6 (cf. figure 2), or helps you fall and stay asleep at night.

Figure 2: M-E index relative to group mean in high / low tryptophan & vitamin B6 breakfast intake groups (data calculated based on Nakade. 2012)

That both is possible and obviously works quite fine, is thus the main message of this study, the results of which Nakade et al. interpret as direct evidence for the potential usefulness of

[...] a higher Trp and Vi-B6 intake [to] promote the synthesis of serotonin via light stimulation in the morning and have a natural sleep-inducing effect when converted to melatonin at night [and thus] help prevent a phase delay in young children’s circadian clocks and promote their morningness against the effects of the 24-h commercialization of society.

Against the background, that similar improvements have been observed in 35 middle-aged/elderly (aged 55-75 year) volunteers who consumed a tryptophan enriched  (+30mg per serving) cereal at breakfast and dinner for three weeks by Bravo et al. (Bravo. 2012). And since there is no effect without "side effects", I guess I better mention that the Spanish researchers also observed significant increases in

Table 1: Tryptophan content of various foods (in g per 100g, 2nd column), ordered by tryptophan per protein content (3rd column; data based on Wikipedia)

• sleeping time,
• sleep efficiency, and
• immobile time

as well as concomitant decreases in

• sleep latency (almost 25%!),
• wake bouts,
• total activity, and
• sleep fragmentation index

If you take into consideration that their subjects' total antioxidant capacity levels and mood improved, as well and that the treatment elicited a -50% decrease in state anxiety and a significant drop on Beck's Depression Inventory Index, both of which returned to their initial value, when the treatment was seized, it should be obvious that you better make get out in the sun, immediately after you made the right food choices (and no, I am not talking about tryptophan-enriched breakfast cerals, here) at breakfast and watch the sunset after dinner ;-)

References:

1. Bravo R, Matito S, Cubero J, Paredes SD, Franco L, Rivero M, Rodríguez AB, Barriga C. Tryptophan-enriched cereal intake improves nocturnal sleep, melatonin, serotonin, and total antioxidant capacity levels and mood in elderly humans. Age (Dordr). 2012 May 24.
2. Harada T, Matsumura A, Takeuchi H: Effects of the usage of a blacked-out curtain on the sleep-wake rhythm of Japanese University students. Sleep Biol Rhythms 2003, 1:179–181
3. Nakade M, Takeuchi H, Taniwaki N, Noji T, Harada T. An integrated effect of protein intake at breakfast and morning exposure to sunlight on the circadian typology in Japanese infants aged 2-6 years. J Physiol Anthropol. 2009 Sep;28(5):239-45. 
4. Nakade M, et al. Can breakfast Tryptophan and Vitamin B6 intake and morning exposure to
   sunlight promote morning-typology in young children aged 2-6 years? Journal of Physiological Anthropology 2012, 31:11
5. Sakakeeny L, Roubenoff R, Obin M, Fontes JD, Benjamin EJ, Bujanover Y, Jacques  PF, Selhub J. Plasma Pyridoxal-5-Phosphate Is Inversely Associated with Systemic Markers of Inflammation in a Population of U.S. Adults. J Nutr. 2012 May 23.
6. Rosenthal N, Schwartz P, Tumer E, Nalm S, Matthews J, Hardin T, Barnett R, Wehr T:
   The psychobiology of SAD and the mechanism of action of light therapy. Biol Psychiatry
   1997, 42:57S.
7. Ulvik A, Midttun O, Ringdal Pedersen E, Nygård O, Ueland PM. Association of plasma B-6 vitamers with systemic markers of inflammation before and after pyridoxine treatment in patients with stable angina pectoris. Am J Clin Nutr. 2012 May;95(5):1072-8. 
8. Wikipedia contributors. Tryptophan. Wikipedia, The Free Encyclopedia; 2012 May 26, 00:42 UTC [cited 2012 May 27]

Low Volume + High Intensity is the Best "Health Investment" Obese Babyboomers Can Make! Plus: Doing More "Cardio" Than 3x30min Can Make Sense to Maximize VO2max

Image 1: It's not too late to do something for your health. Just make sure you or your loved ones back the right horse - and this si not the nag trotting along the race track in what it believes was the "fat burning zone" ;-)

If you are, as I would hope, a regular here at the SuppVersity. I do not have to tell you that "cardio", and I am using this term here to refer to exercise that is in fact (and not just supposedly) heart healthy and will help you improve your conditioning, does not, or, I should say should not consist of doing hours of steady state aerobic exercise in the "fat burning zone". A question I do yet often get (and rightly so!) is how much is enough and what is too much? And while I stick to my experience based recommendation that 2-3x HIIT sessions at 15min are plenty (assuming you also lift weight), I don't want to deny you the latest results of a recently published study by scientists from the Duke University (Duscha. 2012), which could shed some light on the "optimal" dosage of the "classic" steady state variety of "cardio training" for the not-so athletic part of the population - I know this ain't you, but maybe your aunt or uncle ;-)?

Important message #1 - "Any exercise is better than none!"

"Another study with obese subjects?", you may now say - and yes, it is, but let's look at it this way: By 2030 50% of you, my dear American friends, will be obese (USA Today. 2011). And if the government didn't keep pushing the "demarcation line" up every year, you would already have passed the 50% mark by now (I guess, we Germans are not much better though ;-). The 163 obese subjects (age: 40-65, mean: 52y; BMI: 25-35kg/m², mean: 30kg/m²; bodyfat: 33.5%) in the Duke study are thusly very well representative of (at least) one out of three of your formerly babybooming neighbors and maybe even some of your relatives.

Figure 1: Outline of the study protocol (left) and adherence of the subjects in the individual groups to the prescribed form of exercise (created based on information from Duscha. 2012)

As my mini-overview of the study design in figure 1 goes to show, the subjects were randomized to one out of three exercise groups which different in both the weekly volume, as well as the average intensity of the exercise sessions. As you can imagine, the subjects were in pretty bad shape at the beginning of the study, which is why the first three of the 9-months study period were spend "accommodating" the study participants to their respective jogging (high intensity) or walking (low intensity) regimen, on which they then remained for the subsequent 6 months.

Image 2: I am not particularly fond of heart rate monitors, but especially for people who are just starting to work out for the first time in their lives, they can actually be a valuable tool.

Progress comes from providing new stimuli: Whether you are obese or lean, a professional athlete or a sedentary couch potato. If you want to make progress you got to expose your body to new stimuli on a regular basis. And as I have mentioned this in several previous blogposts, already - taking the stairs can be a very powerful new stimulus for someone whose farthest "walk" of the day takes him from the couch to the fridge. Even for really big losers, it does yet not take too long until taking the stairs comes quite handy and the importance of continuous progression the subjects in the study monitored by the means of a heart rate monitor, is obligatory - not to train in a non-existent fat-burning zone, but to make sure that a) you are still demanding enough of yourself to make progress and b) that you are not at the point where running faster and running longer becomes counter-productive.

From an epidemiological point of view, the first, and probably most important result of the 6-months exercise intervention, probably is that no matter what you do, you will benefit from getting your ass of the couch! Now, given the fact that most people consider doing that "inconvenient" and thusly refuse to do it, the 2nd most important result of the study is that despite the fact that the subjects had already been hand-picked for "high adherence" from a cohort from the Studies of Targeted Risk Reduction Interventions Through Defined Exercise, the subjects  in the low volume + high intensity exhibited a 4% and 6% greater adherence to the exercise regimen than their peers in the "classic low intensity" group and the high volume + high intensity group, respectively.

Important message #2 - "More is not always more"

Although adherence is one of the most commonly overlooked, yet crucially important determinants of how successful any dietary and/or exercise intervention may be, an adherence rate of across-the-board >80% is more than just "above average" and goes to show you that the subjects were highly motivated to get in better shape. If we now assume that your aunt, uncle, mom or dad was one of them, the question still remains, which of the regimen would be the "best" for her/him to do?

Figure 2: Relative increases in Peak VO2, citrate synthase activity and capillary density after 6 months on training regimen with different volume / intensity; text quotes the conclusion (data calculated based on Duscha. 2012)

If you take a look at the relative increases in VO2Max, citrate synthase (a marker of mitochondrial health and fatty acid oxidation capacity) and density, it appears quite obvious that "more" and "harder", as in high volume + high intensity, would be the way to go - at least if increased conditioning and building a bigger metabolic engine are your relative's main concerns.

Figure 2: Cost-benefit analysis (expressed relative to low volume + low intensity group) for increases in Peak VO2, citrate synthase activity and capillary density after 6 months on training regimen with different volume / intensity (data calculated based on Duscha. 2012)

And while this may be the case, if we just rely on absolute increases, the image looks slightly different, when we plot those against the effort (for figure 1 I used the workload, but the graph looks identical, if you plot it relative to the time the subjects spent training). In fact, the cost-benefit analysis in figure 2 reveals that contrary to what the data in figure 1 suggested, VO2Max and citrate synthase do not improve to an equal extent with the increase in volume in the high volume + high intensity group: While you get a whopping and very worthwhile additional increase in VO2Max from doing 175min/week of high intensity exercise (vs. 114min/week; note: these are the actual, not the prescribed values), the additional hour results in a comparatively mediocre +33% increase in citric acid synthase - or put another way: If you invest +58% more work, you get a very "profitable" +128% in VO2max, whether the extra work is worth the +33% increase in citric acid synthase, which could as well be a simple result of the increased energy consumption and the correspondingly increased turnover rate of the citric acid cycle is yet questionable.

Bottom line: 3x a week 30-40min = plenty, but...

If we wanted to summarize the results of our analysis and turn it into some wise-ass advice you can give to your obese friends and/or relatives this could sound like this: "Look, it does not take much! Three times a week 30 minutes of exercise is plenty and this type of exercise is matched to your individual capacity. You will be puffing a little, but I promise the results are well worth it. It will not only improve your conditioning, but also help you build a bigger metabolic engine that will help you shed that pouch today and keep you healthy into the old ages, in the future".

Image 3: For the babies of the babies, intensity is even more important than for their formerly babybooming granddads and -mothers

And what about my kids? In case you missed the piece on HIT exercise for obese boys from February, 14th, 2012, I highly recommend you read up on that, if you are wondering what type of exercise your daughter/son, granddaughter/-son, niece or nephew could (or should) do to avoid the same fate as 17% of her/his obese peers, who are destined to develop diabetes and heart disease in later life. For them, even more so than for your uncle, aunt, mom or dad, intensity holds the key to success - cf. "HIT the Cravings - Eat Less, Improve Your Health & Lose Weight"

What is important though, is that you keep an eye on your protégé(e) and switch her/him over to a more explosive combination of resistance training and HIIT, when the 30-40 minutes of "classic" aerobic training are no longer demanding. If you fail to do that and your mentee just keeps escalate the dosage, the only one who will benefit from that is Gary Taubes, because it would prove his theory that "exercise does not help with weight loss" and what's worse, according to a decently written editorial in the latest issue of the British Journal of Sports Medicine there is "emerging evidence" of "a potential link between life-long intensive endurance competition and acquired cardiac pathology" (Wilson. 2012) - yet another reason to make sure not to forget to make the switch, before you or the babyboomer you take care of becomes a marathon junkie!