The Journal of the American Medical Association (JAMA) published a study in 2012 on peoples’ dietary habits and overall energy expenditure. The study compared three diets—low fat, low GI (Glycemic Index*,) and low carbohydrate. A daily intake, respective to each diet, was distributed among calories derived from fat, protein and complex and simple carbohydrates. The overall effect of the low-carbohydrate diet revealed that the fewer carbohydrates in the diet, the higher the resting and overall expenditure of calories. The low-carb diet consisted of 60% dietary fats, 40% proteins and 20% of combined complex and simple carbohydrates.

Dr. David Ludwig’s of Boston Children’s Hospital, the lead researcher, reported that the subjects expended “300 more calories a day on the low-carb diet than they did on the low-fat diet and 150 calories more than on the low-glycemic-index diet.” As Dr. Ludwig explained, “When the subjects were eating low-fat diets, they’d have to add an hour of moderate intensity physical activity each day to expend as much energy as they would effortlessly on the very-low-carb diet.” (NY Times. Sunday Review. June 30, 2012.)

The findings reported that a strategy to reduce glycemic load rather than dietary fat may be advantageous for weight-loss maintenance and cardiovascular disease. (JAMA June 27, 2012, Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. Ludwig, Et. Al)

Essentially, the nutritional composition of the types of food we eat, not the general amount of calories consumed, can trigger the predisposition to gain weight or get fat. Fewer carbohydrates consumed keep us leaner. Fat and protein are mandatory for muscle and brain fueling and hormonal balance. Carbs are great and necessary for quick energy and breakdown of food. According to Ludwig and his team, what matters is the quantity and quality of the carbs eaten and their effect on insulin. Insulin is a hormone that regulates the absorption of sugar (glucose) by cells. When excessive calories are consumed, particularly those found in simple carbohydrates, the cells get more glucose than they need. Glucose that is not used by the body’s cells accumulates as fat resulting in weight gain.

Why is this research particularly valuable in treating eating disorders

Eating fat does not make you fat. AND, restrictive eating or not eating for many hours slows metabolism as the body’s natural response is to conserve the food ingested. A sluggish metabolism causes quick weight gain.

“Excessive weight gain occurs when fat cells suck up and store too many calories, leaving too few for the rest of the body. Low fat, low calories diets don’t solve this basic problem and can make matters worse. Faced with caloric deprivation, the body gets into starvation mode and fights back. Hunger and food cravings rise and metabolism slows—the perfect recipe for weight regain and disordered eating habits.” (Ludwig, David.  Always Hungry? Conquer cravings. Retrain your fat cells & lose weight permanently.  2016. Hatchett Book Group. NY)

Further supporting Dr. Ludwig’s research, a fairly large separate study was conducted of 2768 participants suggesting that low-carbohydrate diets might provide an alternative approach for weight reduction without worsening metabolic risk factors. (American Journal of Epidemiology. 2012 Oct 1; 176(Suppl 7): S44–S54. (Tian Hu, Et. al.  Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials)

Both studies suggest that lower fat diets generally will increase weight as compared to people who consumed a diet rich in unsaturated fats and higher protein. Eating throughout the day, beginning with a solid breakfast, supports metabolism. As a result, calories are sufficiently burned. Metabolism is not slowed thereby avoiding the ubiquitous “yo-yo” dieting syndrome.

What is the message to eating disorder sufferers?

Not eating fat and restriction of food or waiting many hours between eating is counterintuitive to the body’s physiological and biological needs. Because we cannot see the internal processes, does not mean that they are not occurring. 

People with eating disorders tend to disregard their internal psychological processes and cues and project their needs, feelings and relationship issues on to food and their bodies. It is “easier” to have an eating disorder than identify that there is something or some things going wrong internally or interpersonally. Acknowledging depression and anxiety are perceived more negatively than the rigor of restriction and pursuing the perfect body. There is hope of relief through the attainment of the perfect body and envy of others for being able to control intake. Feeling envied by others often provides a temporary elixir to an eating disorder sufferer.

Genetics plays a role in health and longevity. Whether or not someone’s particular genetic makeup plays a role in the development of an eating disorder is yet to be proven. Having a predisposition to anxiety or depression stacks the deck for an eating disorder. Maintaining a healthy lifestyle combats depression and anxiety. A significant component of a healthy lifestyle is healthy eating.
 
Eating disorder sufferers struggle to accept that their psychological and relational issues underscore, or at least run parallel to their symptomatology. Those who seek to live or who have been raised by the principles that a sound mind, healthy body and healthy relationships provide a better support  to a stable life will likely stave off an eating disorder in the future.

Eating alone at a restaurant recently, I listened in on a conversation between two women discussing the merits of their respective diets in their efforts to lose weight. Both women chose a salad for their lunch with no-fat dressing on the side. Each ordered a very rich dessert when their meal was finished. Perhaps they might have felt more satisfied and full had they ordered a meal rich in fat and protein thereby avoiding the high saturated fat and simple carbohydrates in the desserts? Perhaps they simply did not know what their bodies need to be healthy and how to maintain a body weight they can accept and appreciate. Judgment or fact on my part?

The issue was not the choice of meals. Perhaps both women wanted to simply enjoy a salad and two rich deserts. The conversation detailed their efforts to lose weight and being “bad” as they were eating the desserts. Guilt over pleasure? Might both have an eating disorder?

Clearly, there is no better way to access a patient’s truth than to help them in the process of becoming authentic. In authenticity comes clarity  of thought in understanding one’s motivation and intent.

For some people, not knowing what makes them tick enables an eating disorder to develop in response. What cannot be articulated or felt CAN, however, be expressed via an eating disorder.

In any case, having accurate information is necessary to educate the general public as well as patients with eating disorders. (i.e., how do calories derived from different food sources affect the body and how the metabolism works are essential to understand in dismantling weight myths and eradicating irrational thoughts.) Physiological and biological processes run parallel to the processes of  the mind. Both are necessary to address in the deciphering what drives one’s proverbial bus. 

As I finish this blog at an airport in Mexico, two women are sitting next to me eating pizza discussing the calories in the pizza and how they are blowing their diets. To be continued…

Best,
Judy Scheel, Ph.D., LCSW, CEDS 
  

* Low Glycemic Index diet: daily intake of fewer carbohydrates in total, and those carbs that are included are slow to be digested—i.e. beans, non-starchy vegetables.

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