Yesterday (May 2nd), in the New York Times, an article appeared that somewhat colorfully described the all-too-common theme of regaining weight after a “diet” program. The title was “After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight.”

In a nutshell, this article followed several individuals who had gone through the Biggest Loser contest, one of which was the grand champion. The “take home message” for the casual, uninformed reader is that weight loss programs are doomed to fail; you are doomed to be fat; there’s no point in trying because then you’re going to be chronically hungry and gain all the weight back anyway.

It would be TRAGIC to be left with that interpretation. This blog entry is an attempt to remedy that possibility.

Danny Cahill, the New York Times reported, was the Season 8 winner of the well-known television show, The Biggest Loser, and he lost from 430 lbs to an astonishing 239 lbs in seven months. He described “getting his life back.” In spite of his best efforts, however, he has regained 100 pounds. According to the article in the New York Times, “In fact, most of that season’s 16 contestants have regained much if not all the weight they lost so arduously. Some are even heavier now.”

Kevin Hall, a research scientist at the National Institute of Diabetes and Digestive and Kidney Diseases federal research center, decided that it would be an interesting project to follow these people and see what happened. That study, entitled “Persistent Metabolic Adaptation 6 Years After ‘The Biggest Loser’ Competition, was just published in Obesity Biology and Integrated Physiology and represents the data accumulated over the last six years. Here are some of the findings from the study, mixed with some extra biographical information from the New York Times, and a contextual framework to understand them:

  • Mr. Cahill’s metabolism has decreased. It has been determined that he has to eat 800 calories LESS per day for a typical man his size just to maintain his weight. That’s the equivalent of a little over two hours on a treadmill per day just to burn that amount of calories off. Or, alternatively, he could eat 800 less calories per day. That’s the equivalent for most of us of missing one entire meal per day.
  • 13 of 14 contestants studied over six years regained their weight. Four contestants are even heavier now than before the competition.
  • The weight gain was associated with SLOWER METABOLISM.
  • The show’s doctor, Dr. Robert Huizenga, was quoted as advising contestants on the show to exercise “at least nine hours a week and monitor their diets.” Realistically, in today’s fast-paced, re-engineered, down-sized, optimized, right-sized world, people just aren’t going to have time to do that.
  • Recently, 14 of the 16 contestants went to the NIH for three full days of testing, where it was determined that their metabolism had slowed significantly.
  • Not only had their metabolism gone down, but also so had their levels of leptin. Leptin is a hormone that tells you, “you’ve had plenty.” You can imagine what the results of a drop in that hormone would be. Four other hormones were identified as well that had also had their levels changed.>/li>
  • In another study at the University of Melbourne, lead author Dr. Proietto commented: “The body puts multiple mechanisms in place to get you back to your weight. The only way to maintain weight loss is to be hungry all the time.”

Getting back to Mr. Cahill – how did he lose all that weight? Answer: in an extreme fashion. He had to quit his job to accommodate his daily routine (well documented in the New York Times article):

  • Up at 5 a.m.
  • Run on treadmill for 45 minutes
  • Breakfast – “one egg and two egg whites, half a grapefruit and piece of sprouted grain toast”
  • Run on treadmill for another 45 minutes
  • Rest 40 minutes
  • Bike ride nine miles to a gym
  • He took electrolyte tablets to make up for all of the electrolytes he was losing through sweating.
  • Work out for 2 ½ hours (?!?!) at the gym.
  • Shower, ride home, eat lunch – grilled skinless chicken breast, one cup of broccoli and 10 asparagus spears.
  • Rest for one hour
  • Drive to the gym for another round of exercise.
  • His goal was a negative 3500 calorie deficit per day. If Mr. Cahill had not achieved his goal, he would go back to the gym after dinner.
  • He was so intense that if that didn’t do it, he would run in his neighborhood until midnight when his calorie counter would reset.

I have two thoughts: incredible admiration for Mr. Cahill’s dedication, and absolute incredulity at the physiological and hormonal stress of this type of regimen – not to mention the total stupidity of this for a long-term solution.

OK. What can we learn from this?

Is it that notable and admirable dedication to weight loss for a period of time will ultimately be doomed because the body will go about “finding” the calories it “lost”? Or are there more subtle answers?

Here are my thoughts:

    • The type of extreme exercising and fasting that Mr. Cahill did was, on the one hand, the ONLY way he could have lost as much weight as he did and emerge the clear winner at the end of the season. On the other hand, not only is this not sustainable over the long term (he had to quit his job to do it), but it will clearly put the body in “starvation” mode with potential devastating consequences for years after, if not the rest of his life, if steps are not taken to rehabilitate his metabolism.It should be remembered that our bodies are the result of millions of years of slow, steady, evolution. Back when our ancestors were roaming the earth with hair on their bodies and clubs in their hands, it was evolutionarily adaptive to be able to hang on to every last calorie in times of famine or lack of food. That has continued to the present time. It is almost axiomatic that if you put a patient on a starvation diet (recall Oprah Winfrey and her liquid protein diet and size 7 jeans which she never fit into again) they will gain it all back, and usually more to spare on top of it.

      So, for weight loss that can be maintained, don’t assault your body with this extreme amount of exercise or extreme calorie deprivation. Just like the Tortoise and the Hare, “slow and steady wins the race.” In general, I advise my patients to never try to lose more than one, and at the very most, two pounds per week. More than that is not sustainable… as The Biggest Loser contestants found out.

    • The impact on the adrenals and sex hormones of this extreme exercise and dietary protocol was not considered. The level of activity that Mr. Cahill, as well as other contestants on the show, engaged in was extreme. It was like running from the saber-toothed tiger for 10 hours a day. Your adrenal glands (that sit right on top of the kidneys and push out stress hormones when needed) were not designed for that. Over time, when you exercise to that level, you exhaust your adrenal capacity. When that happens, there are two downstream effects. The first is that your body simply cannot handle stress and you have no energy: you have to DRAG yourself out of bed in the morning. The second thing, and more insidious, is that you actually lose some of your sex hormones, including testosterone and estradiol. (There are easy tests for both of these possibilities that are painless, and involve just spitting in four tubes over a day’s time and sending them off for analysis. We do it all the time for patients here at CWI).
    • Testosterone, which hormonally contributes to burning visceral adipose fat (the worst kind on your body, wrapped around your abdominal “viscera”), is produced in one of two places, depending on your sex. In males, it’s produced in the testicles (most people know that!), but it is also produced by downstream reactions to adrenal hormones, particularly DHEA. Low adrenal function = lower levels of testosterone. In women, the situation is very similar, except testosterone is produced in the ovaries in a woman, as well as downstream from the adrenals. The consequences of exhausted adrenals in both sexes are the same: low testosterone. Which equals more fatigue, and less burning of fat. And also less muscle mass. Not good.
    • Potential hypothyroidism – it is unclear to me if adequate attention was paid to the thyroid axes of these people. Of concern to me is the potential lack of trace minerals in their extreme weight loss diets. Iodine is required to make thyroid hormone. Selenium is required to convert thyroid hormone to the active form – Liothyronine. If you don’t have enough Liothyronine (or “T3”) floating around in your blood, your body’s thermostat is not going to be set high enough to burn calories. And you won’t get adequate amounts of Selenium from your food. There is an epidemic of both selenium and iodine deficiency in this country. Typically the only way to get an adequate amount is to supplement.
    • Sarcopenia – or, the dangers of “binge exercising” and extreme dieting. From my friend, Lisa Bell, RN, MBA and former personal fitness trainer, I learned the somewhat colorful term “binge exercising.” That is what all of these people did: extreme amounts of exercising in a comparatively short period of time. And significant calorie restriction. There are two problems with this:
      • With the “binge exercising,” you never adequately build your muscles. Bill Phillips, in his excellent book, Body for Life, talks about his interview with the exercise physiologists at the Karolinska Institute. As a result of those conversations, he advises alternating upper and lower body exercises, and separating the original period of exercise and a return to that body group by four to five days. He points out that the entire idea of muscular hypertrophy is that you damage the myofibrils in the muscles by overloading them. It takes, as Phillips notes, several days to repair the damage and basically hypertrophy and plump up the muscle. If you are binge exercising and hitting the same muscle groups day after day, you damage the muscles but never truly let them recover and plump up.
      • Combining this binge exercising with a low calorie diet – even if it is reasonable in protein content – can produce sarcopenia – or, a general wasting of muscles.
      • It is not surprising that these contestants, after undergoing such an extreme weight loss and radical program resulting in muscle as well as fat loss, would regain weight so quickly after beginning the “refeeding” process. They have broken down some of their muscle mass that could burn the calories more optimally.
      • I have no idea if there was great attention paid to the amount of protein in their diet. The recommended protein requirement for body builders trying to build large amounts of muscle is at least one gram of protein per pound of body weight per day. The people in this program, with the stresses that they were putting on their bodies and muscles, probably needed a similar amount, if not higher. I wonder if they were getting enough.
      • Coupling binge exercising, micronutrient deficiencies, idiotic exercising schedules and inadequate protein intake produces a recipe for disaster: a disaster which is delayed until the trophy is rewarded, the Klieg lights are turned off, and the winners leave the stage. The disaster occurs in the aftermath of this ill-advised program.
    • Antioxidants. Your mother taught you to “eat your fruit and vegetables.” Well, all right, maybe back in the Wally and June Cleaver days your mother taught you that. But there is a lot of evidence that the levels of carotenoids in your blood are actually related to your blood sugar control and your risk of metabolic syndrome – a pre-diabetic condition. Indeed, in the work of Holt et al. [Nutrition Research. 2014 Sept 6 – “low skin carotenoid concentration measured by resonance Raman spectroscopy associated with metabolic syndrome in adults”], it was found that a skin carotenoid score of less than 25,000 (or 1.5 MICROgrams of carotenoids per ml of blood serum) was associated with metabolic syndrome (a pre-diabetic condition) with an odds ratio of 3.71 with a 95% confidence interval. Translation: if your skin carotenoid score (which we measure here at Cady Wellness Institute) is less than 25,000, you’ve got about a FOUR FOLD increased risk of metabolic syndrome. Not good numbers.
    • Finally, there is the concept of epigenetics. Dean Ornish, in an absolutely brilliant demonstration of the difference in genetic expression of prostate cancer genes as a function of dietary and lifestyle interventions, conclusively showed that a significant difference in genetic expression could be achieved: cancer genes were switched off; healthy genes were switched on. [Ornish, Dean et al. Proc Natl Acad Sci USA 2008 June 17; 105(24):8369-8374]. Dr. Joseph Chang, Ph.D., the chief scientific officer of Pharmanex, has shared with me in a private conversation that “what we eat – our food – talks to our genes.” Indeed, Pharmanex has a line of supplements and a rational weight reduction program that actually resets the genes in the fat cells to a more youthful expression where you burn more fat and store less fat. (If you want to see some of the research in the area of gene expression, just go to Google Images and type in “gene heat map” and knock yourself out. ☺ )

The “genetic conversation” that was going on in the bodies of The Biggest Loser contestants would go like this, with their genes doing the talking: “You’re not getting enough calories to keep you in caloric balance. You haven’t been getting them, you’re not getting them, and there’s no evidence that you’re going to get them. You have convinced us that there is famine in the land. Therefore, it’s time for us to lower the old thermostat and help you hang on to every little morsel of calories and energy you can, because if you don’t, you’ll die.” And so it is done.

So let’s wrap this up. What can we learn?

        • Extreme dieting and exercising can produce extreme weight loss in the short term, but ultimate failure in the long term. It doesn’t have to be this way.
        • In any weight loss program, great care needs to be taken in terms of supplying the body with adequate amounts of protein, antioxidants, and trace mineral nutrients.
        • Exercising should be reasonable and rational, and based on sound physiological concepts. What was done to these people on The Biggest Loser was not reasonable.
        • The body’s incredible ability to adapt should not be overlooked. If you starve it, it will go into starvation mode. And you will fight it, and fight it, and fight it, and not win.

As a result, here are my specific recommendations for reasonable weight loss and optimal health:

          1. Insure an adequate consumption of fruits and vegetables. Use an antioxidant supplement. (You will not get enough from your diet.)
              Insure an adequate amount of trace minerals. (You will also not get these from your diet. You will need to supplement. We use tests at CWI that can determine your adequacy or inadequacy of basically all relevant nutrients to within 1%.)

            1. Insure an adequate amount of protein. It is critical. For anyone doing even a moderately intensive diet and exercise program, a good rule of thumb is thirty grams of protein three times daily, going up to even forty or fifty grams of protein three times daily if you are a larger person. (This will also keep you from being hungry and, thus, decrease your desire to eat junk and empty carbs.)
            2. A rational exercise and fitness program. Bill Phillips suggests 20 minutes of High Intensity Interval Training on three staggered days of the week – say, Tuesday, Thursday, and Saturday – and staggered exercising of muscle groups on Monday, Wednesday, and Friday. On Monday of the first week, for example, it would be upper body; on Wednesday, lower body; on Friday, upper body. The cycle would then repeat the next week, but with an inverted order: lower body on Monday, upper body on Wednesday and lower body on Friday. And you take Sunday off. You can even have a “cheat day” on Sunday – again, it’s a way to keep from telling the body, and your genes, that “There is starvation in the land.”
            3. There are supplements available, and dietary programs which are rational, that we offer at Cady Wellness Institute. But you don’t have to consult with us or even consider using these if you can use some common sense concepts from what I’ve just shared with you.

Just like the notorious “Women’s Health Initiative Study” was interpreted in the media as “don’t use hormones in women because it gives them heart attacks and strokes” (when the REAL interpretation should have been – “don’t use horse pee estrogen and fake progesterone in post-menopausal women whose blood vessels haven’t seen a decent amount of estrogen in over a decade”)… just don’t take all the hoopla over this latest news story as “you’re gonna gain it all back anyway, so why try?” That would be tragic.

Inscribed on the Temple of Apollo at Delphi, there is a saying: “mhden agan.” It means, literally, “nothing in excess.” Aristotle, in his Rhetoric, attributed this concept to Chilo, one of the Seven Ages of ancient Greece.

For those of us who are trying to lose weight, or those of us who are helping people in doing so, the combination of the historical conception of a great sage of ancient Greece all the way up to the integration of the most modern concepts of medicine seem to me to point the way forward.

Good luck in your endeavors!

Louis B. Cady, M.D.
Cady Wellness Institute
Newburgh, Indiana

May 4, 2016