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25 pound weight loss difference over a 5-year period using meal replacements

by Jeff S. Volek, Ph.D., R.D.

The potential use of meal replacements to assist in weight management has been examined in several studies. Meal replacements can include shakes, powders or bars that replace a normal meal. They are easy to use, require little if any preparation, and most importantly provide structure to the daily eating plan.

It is estimated that as many as 15% of adults are using meal replacements as a strategy for losing weight. In the longest study to date, 5 years, overweight subjects who consumed a meal replacement shake lost weight (about 10 pounds) compared to a group of control subjects who gained about 15 pounds over the same time period. Other controlled studies of shorter duration have shown that meal replacements can assist in weight loss. The value of meal replacements is the structure of having a prepared meal, which can provide the needed motivation to reduce calories and enhance weight loss.

Reference: Obesity Rev, 6: 229-234, 2005.

 

Both diets lost 13-15 pounds, but one actually gained muscle

Diets very low in calories can induce rapid weight loss, but much of it could be muscle loss. Italian researchers compared two types of very low calorie diets, one low enough in carbs to induce ketosis (ketogenic diet), and another with enough carbs to prevent high levels of ketosis (non-ketogenic diet).

Both diets contained the same total energy (500-700 kcal/day). The ketogenic diet consisted of 1.2 to 1.5 grams of protein per kilogram of body weight (84 to 105 grams of protein for a 154-pound person) and only 6 grams of total carbohydrate. The nonketogenic diet consisted of 0.9 to 1.1 grams of protein per kilogram of bodyweight (63 to 77 grams of protein for a 154-pound person) and up to 30 grams of total carbohydrate.

After 3 weeks, weight loss was similar between the two groups (about 13 to 15 pounds). However, the non-ketogenic diet that was lower in protein and higher in carbs lost more than 7 pounds of lean body mass, whereas the ketogenic diet that was higher in protein and lower in carbs showed a gain of 4.2 pounds lean body mass.

These findings indicate that very low calorie diets can be implemented for a short period of time and result in substantial weight loss. However, there is significantly better protection from loss of lean mass when the diet has higher levels of protein and is lower in carbohydrate to induce ketosis. Ketones are known to inhibit protein breakdown, and emerging evidence has linked elevated ketones to greater satiety and improvements in several cardiometabolic risk factors.



Dr. Jeff Volek is a registered dietitian and Full Professor in the Department of Human Sciences at The Ohio State University. He has published 270 articles examining health and performance effects of low-carbohydrate diets and other dietary supplements including seminal work on creatine, carnitine and whey protein.

Caffeine has been described as the World’s most popular drug. That’s right, technically caffeine is considered a drug since it stimulates the brain and has mood-altering and metabolic effects. But it’s also considered a nutrient found naturally in coffee, tea and chocolate. What can you reasonably expect from ingesting caffeine? The answer may surprise you. Here’s a sampling of research findings to give you a sense of what caffeine intake does to the body.

Caffeine improves endurance performance
Going back more than 3 decades, studies consistently show that caffeine ingested before endurance exercise causes a modest performance enhancement. For example, in one recent study caffeine ingested one hour before exercise resulted in a 5% improvement in endurance performance.1 The performance boost was evident when caffeine was given as a supplement or coffee, suggesting the
source of caffeine is not important.

Caffeine improves high intensity and strength performance
Caffeine is not just for endurance athletes. Australian researchers examined the effects of ingesting caffeine or placebo 1 hour before 60 minutes of cycle sprints with short rest periods.2 The dose of caffeine was 6 mg/kg body weight (about 450 mg based on a 165 pound person), which is equal to about 2-3 cups of brewed coffee. Compared to placebo, caffeine intake resulted in a 7-8% increase in peak power and total work.

In another study, moderately trained men completed as many bench press repetitions as possible with a load equal to 60% of their one repetition maximum.3 Subjects consumed 5 mg/kg body weight of caffeine (about 375 mg) or placebo 1 hour before exercise. Subjects completed 20.4 reps after placebo and 22.4 reps after caffeine. Participants also reported that they felt more vigorous and less fatigued in the caffeine condition.

Caffeine reduces muscle soreness
In another study, subjects performed 4 sets of 10 bicep curls followed by a fifth set to exhaustion.4 Subjects consumed 5 mg/kg body weight of caffeine (about 375 mg) or a placebo one hour before the test. Subjects performed 18 reps after caffeine compared to only 12 reps after placebo. Despite completing more work during the caffeine trial, muscle soreness 2 and 3 days after exercise was significantly reduced compared to placebo. Caffeine was also associated with a significantly lower rating of perceived exertion during exercise.

Reduces exercise pain perception
A common finding in many caffeine and exercise studies is the perception that exercise
is easier when taking caffeine, which was confirmed in a recent experiment designed to show the effects of caffeine on perceived pain during a task that elicited discomfort.5 Healthy college students performed a grip task that consisted of holding on to a metal block with their arm extended. They were instructed to resist dropping the weight. During one trial they chewed gum containing caffeine and during another identical trial they were provided gum with no caffeine. Subjects were able to hold on to the metal for an average of about 100 seconds, during which time they rated the level of pain to be significantly less during the caffeine (3.5) versus the placebo (4.8) trial (0 = no pain, 5 = moderate pain, 10 = worst possible pain).

Caffeine mildly speeds caloric and fat burning at rest and during exercise
Several studies have shown that caffeine ingestion mildly increases caloric expenditure (aka, thermogenesis) on the order of about 10% for the few hours after ingestion. What’s more interesting is that caffeine intake specifically doubles fat turnover and increases fat burning by 24%.6 Caffeine intake also increases the use of fat during exercise, an effect that is associated with significant sparing of muscle glycogen and improved endurance performance.7

Less weight gain over 12 years
In a massive study that followed nearly 60,000 adults over a 12 year period, it was found that people who increased their caffeine intake the most had less weight gain than those who decreased caffeine intake, even after adjusting for energy intake.8 The effects were small, but are consistent with the known metabolic effects of caffeine.

Used appropriately, caffeine is safe
In large systemic reviews, moderate coffee consumption is associated with reduced risk of type-2 diabetes and heart failure.9,10 There is also no evidence that moderate caffeine ingestion before exercise leads to dehydration, ion imbalance, or any other serious adverse effects.

A large range of caffeine doses have been studied, but most positive effects can be achieved with 100-200 mg, or less if combined with green tea. Effects vary from person to person so you may need to find the right dose that works for you. Caffeine levels peak 30–120 minutes after ingestion and thus it makes sense to consume it 30 to 60 minutes before exercise. Since caffeine is a stimulant, don’t use it before going to bed. Caffeine does result in a physical dependency, but not an addiction. Thus, if you are a regular caffeine user and you miss your morning cup of coffee, it is completely normal to experience mild withdrawal symptoms like headache and drowsiness. If you have high blood pressure, heart abnormalities, sleep disorders or any other medical condition, or if you are under the age of 18, you should check with your physician before using caffeine.



References
1. Hodgson AB, Randell RK, Jeukendrup AE. The metabolic and performance effects of caffeine compared to coffee during endurance exercise. PLoS One. 2013;8(4):e59561. doi: 10.1371/journal.pone.0059561. Epub 2013 Apr 3.
2. Schneiker KT, Bishop D, Dawson B, Hackett LP. Effects of Caffeine on Prolonged Intermittent-Sprint Ability in Team-Sport Athletes. Med Sci Sports Exerc. 2006 Mar;38(3):578-585.
3. Duncan MJ, Oxford SW. The effect of caffeine ingestion on mood state and bench press performance to failure. J Strength Cond Res. 2011 Jan;25(1):178-85.
4. Hurley CF, Hatfield DL, Riebe DA. The effect of caffeine ingestion on delayed onset muscle soreness. J Strength Cond Res. 2013 Nov;27(11):3101-9.
5. Bellar D, Kamimori GH, Glickman EL. The effects of low-dose caffeine on perceived pain during a grip to exhaustion task. J Strength Cond Res. 2011 May;25(5):1225-8.
6. Acheson, K. J., Gremaud, G., Meirim, I., Montigon, F., Krebs, Y., Fay, L. B., Gay, L. J., Schneiter, P., Schindler, C. & Tappy, L. (2004) Metabolic effects of caffeine in humans: lipid oxidation or futile cycling? Am J Clin Nutr 79: 40-46.
7. Spriet, L. L., MacLean, D. A., Dyck, D. J., Hultman, E., Cederblad, G. & Graham, T. E. (1992) Caffeine ingestion and muscle metabolism during prolonged exercise in humans. Am J Physiol 262: E891-898.
8. Lopez-Garcia E, van Dam RM, Rajpathak S, Willett WC, Manson JE, Hu FB. Changes in caffeine intake and long-term weight change in men and women. Am J Clin Nutr. 2006 Mar;83(3):674-80.
9. Huxley R, Lee CM, Barzi F, Timmermeister L, Czernichow S, Perkovic V, Grobbee DE, Batty D, Woodward M. Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis. Arch Intern Med. 2009 Dec 14;169(22):2053-63.
10. Mostofsky E, Rice MS, Levitan EB, Mittleman MA. Habitual coffee consumption and risk of heart failure: a dose-response meta-analysis. Circ Heart Fail. 2012 Jul 1;5(4):401-5. doi: 10.1161/CIRCHEARTFAILURE.112.967299. Epub 2012 Jun 26.

Glutamine has many benefits during hard training. Because glutamine can support the immune system as an important source of fuel and decrease infections, it may prevent or lessen the severity of infections after intense bouts of exercise, which can weaken immunity. This can enable you to recover quickly and train more often.

Because it is a precursor for glucose/glycogen formation and can improve insulin sensitivity, it may provide an additional precursor for glucose formation and offset the negative effects of excess fat.

Since the gastrointestinal tract is the primary site of glutamine utilization, supplemental glutamine may prevent the loss of glutamine from other organs, especially muscle, thus sparing muscle protein. Clearly, glutamine would be beneficial to strength athletes who require large amounts of muscle mass, as well as to athletes who can be at risk for overtraining.

Clinical studies have resulted in glutamine being classified as a conditionally essential amino acid in critically ill patients and it may also be conditionally essential for athletes.

 

Dosage Guidelines: Supplemental glutamine in the range of 10 grams per day will protect your body's physiological systems during hard training.

 

Whey protein reduces body fat and increases lean muscle

 

If you use whey protein, I have great news for you. Results of a recently published analysis of several trials supports the use of whey protein for improving body composition. The authors examined 14 studies that included a total of 626 individual participants. The studies varied considerably in design which allowed different usage patterns to be analyzed.

 

Here were some of the key findings. In studies that used whey as a supplement without other dietary modification, the loss in body fat was 1.2 pounds. In studies where whey protein replaced other calories in the diet, the loss in body fat was 8.2 pounds. In studies where subjects supplemented with whey protein and performed resistance training, there was a significant increase in lean body mass of 5 pounds.

My research team recently completed the largest and longest study examining the effects of whey protein in combination with resistance exercise.2 We showed that after 9 months of resistance training, subjects who supplemented with whey showed significantly greater increases in lean body mass (7.3 pounds) than subjects who supplemented with carbohydrate (5.1 pounds) or soy protein (4.0 pounds).

The available evidence supports the use of whey protein reducing body fat and increasing lean body mass, especially if whey replaces other calories in the diet and you combine it with resistance exercise.

References: Miller PE, Alexander DD, Perez V. Effects of whey protein and resistance exercise on body composition: a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2014 Apr;33(2):163-75.

Volek JS, Volk BM, Gómez AL, Kunces LJ, Kupchak BR, Freidenreich DJ, Aristizabal JC, Saenz C, Dunn-Lewis C, Ballard KD, Quann EE, Kawiecki DL, Flanagan SD, Comstock BA, Fragala MS, Earp JE, Fernandez ML, Bruno RS, Ptolemy AS, Kellogg MD, Maresh CM, Kraemer WJ. Whey protein supplementation during resistance training augments lean body mass. J Am Coll Nutr. 2013;32(2):122-3

The essential amino acid leucine continues to be the focus of research, especially in regards to examining the effects of adding supplemental leucine to meals and protein drinks. Whey protein is naturally high in leucine making up about 10% of the amino acids. Thus, a 20 gram serving of whey protein delivers about 2 grams of leucine. While this is an effective dose of leucine, current findings suggest it may not be optimal.
 
In one study, adults at least 60 years of age consumed 20 grams of whey protein with a small amount of added leucine (3 grams total) or a control milk product matched for calories. 1 They performed a bout of resistance exercise on one leg 15 minutes before ingesting the drinks so they could measure rates of muscle protein synthesis just due to the drink (by examining the rested leg) and in response to exercise (by examining the exercised leg). They found that consuming the leucine-enriched whey drink resulted in a 47% increase in muscle protein synthesis, whereas the milk drink had a much smaller impact (10%). The increase in muscle protein synthesis in the exercised leg was also higher in the leucine-enriched whey drink (28%) versus the milk drink (3%). These results support the use of whey protein with added leucine as superior to a traditional milk product for stimulating muscle protein synthesis in healthy older subjects.

In a different study, researchers examined whether adding leucine to a drink low in total protein was beneficial. 4 Active men were randomly assigned to ingest one of five whey protein isolate supplements after resistance exercise:
• 25g whey (3g leucine),
• 6.25g whey (0.75g leucine),
• 6.25g whey + extra leucine (3g leucine total),
• 6.25g whey + extra leucine (5g leucine total),
• 6.25g whey + extra BCAAs (5g leucine total).
 
They all drank a 241 calorie beverage with 5.6g of fat from coconut oil and 23g of carbohydrate (sucrose) for the whey only group, and 35g of carbohydrate for the other groups to match energy levels across all groups. During the first 1.5 hours after ingestion, all groups experienced similar, significant increases in muscle protein synthesis. From 1.5 to 4.5 hours after ingestion, the group who received 25g of whey experienced the highest rate of muscle protein synthesis (~267%). Interestingly, the group who received 6.25g of whey protein + extra leucine (5g leucine) also experienced a high level of muscle protein synthesis (~220%) despite containing about half the amount of total amino acids. The other groups came in a close second.
 
The results provide evidence that adding extra leucine to low (suboptimal) protein meals can significantly improve the anabolic effect on muscle. Practically, this means if you want to consume one-fourth the amount of whey and add a teaspoon of extra leucine powder you can get the same benefit as consuming a full 25 grams of protein from whey. 

References
1. Luiking YC, Deutz NE, Memelink RG, Verlaan S, Wolfe RR. Postprandial muscle protein synthesis is higher after a high whey protein, leucine-enriched supplement than after a dairy-like product in healthy older people: a randomized controlled trial. Nutr J. 2014 Jan 22;13(1):9.
2. Churchward-Venne TA, Breen L, Di Donato DM, Hector AJ, Mitchell CJ, Moore DR, Stellingwerff T, Breuille D, Offord EA, Baker SK, Phillips SM. Leucine supplementation of a low-protein mixed macronutrient beverage enhances myofibrillar protein synthesis in young men: a double-blind, randomized trial. Am J Clin Nutr. 2013 Nov 27. [Epub ahead of print]

Citrulline improves exercise performance by 10-21 percent

Supplementation with citrulline, an amino acid metabolite, may have several beneficial effects on health and performance. Citrulline is naturally produced in the body during the urea cycle and nitric oxide synthesis. Citrulline may play a role in vascular dilation, removal of ammonia, energy production, and even protein synthesis. Here’s a recap of two very recent studies that investigated supplementation with citrulline in humans. 

Resistance-trained men performed two series of exercise tests after supplementing with citrulline malate (8 grams) or a placebo. Tests were separated by one week. Compared to placebo, performance was significantly greater after citrulline supplementation as evidenced by greater chin-ups (13%), reverse chin-ups (21%), and push-ups (10%).
Based on work in malnourished rats that showed feeding them a citrulline-enriched diet increased protein synthesis, researchers set out to test whether this effect could be observed in humans. Healthy men and women were provided a low-protein diet (8% of total calories) for 3 days to induce a slight protein deficit. After this period, subjects ingested either citrulline or an equal amount of non-essential amino acids over the next 8 hours while measures of protein synthesis were determined. The rate of muscle protein synthesis was 22% higher after citrulline ingestion. There were no differences in anabolic hormones. This is the first study to show that citrulline specifically stimulates muscle protein synthesis in the fasted state in healthy people on a low-protein diet.

These studies open the door to new roles of citrulline supplementation to enhance muscle building and performance.

Reference: J Diet Suppl. 2015 Feb 12. Clin Nutr. 2015 Jun;34(3):449-56. ..
CLA helps manage weight CLA, or conjugated linoleic acid, has a growing body of evidence demonstrating its ability to reduce body fat. In a study, 63 people tending toward overweight or obesity took 1,700 mg of CLA per day, or a vegetable oil placebo, in about 7 ounces of sterilized milk. After 12 weeks, while there were no changes for placebo, the CLA group had lost body weight, improved body mass index score, had less total fat and fat under the skin, a lower percentage of body fat, and a smaller waist-to-hip size. The higher the body mass index at the start of the study, the larger the improvement in all measures.
Reference: Nutrition; 2012 May; Vol. 28, No. 5, 559-65
CLA can reduce body fat and prevent holiday weight gain The holiday season is often a time for weight gain for many people. In one study involving 49 overweight, but otherwise healthy adults aged 18-44, supplementing with CLA (conjugated linoleic acid) for six months from July to December reduced body fat and prevented weight gain during the holiday season from November to December. Subjects were randomized to receive either 3.2 grams/day of CLA or a placebo. After six months, those who took CLA had reduced their body fat by 2.2 pounds, while those who took the placebo had no change. Moods significantly improved for those taking CLA as well, compared to baseline reports. Between the two groups, there were no significant changes in resting metabolic rate, physical activity, dietary intake, insulin resistance, blood lipids, markers of liver function or general markers of inflammation. However, for the CLA group, there was a significant decrease in the biomarker of endothelial dysfunction, thought to be a key element in the development of atherosclerosis or hardening of the arteries. Considering that existing research shows even small increases in weight over the holiday period contribute to overall weight gain by adults, and considering 65% of adults in the U.S. are overweight or obese, the results of this study are promising. Reference: International Journal of Obesity: 2006; Vol. 31, No. 3, 481-7.
Seniors stronger with selenium, creatine and CLA Seniors with higher selenium levels had stronger muscles than those with lower levels, and older adults who took creatine and CLA along with exercise had stronger, leaner muscles and less fat compared to placebo, in two new studies. In the selenium study, doctors noted that muscles need selenium to function properly, but that there are no studies on how selenium affects muscle strength. Researchers examined 891 men and women aged 65 or older who had taken part in the “Chianti” community-based study in Tuscany, Italy.
Scientists measured blood-plasma levels of selenium and found that on average, selenium levels were 24% below the minimum doctors believe is necessary to produce enough selenoproteins, the antioxidant enzymes that keep muscles healthy. Researchers also measured hip flex strength, hand grip strength and knee extension strength, and found that participants with the highest selenium levels—those in the top 25%—were 41% more likely to have strong hips and 48% more likely to have strong hand grip and knee extension compared to participants with the lowest selenium levels, who were in the bottom 25%. In the creatine/linoleic acid study, researchers recruited 19 men and 20 women, aged 65 or older, who had supervised resistance exercise training twice per week for six months while taking 5 grams of creatine monohydrate plus 6 grams of conjugated linoleic acid (CLA) per day or a placebo. Scientists measured walking, balance, sitting, standing and stair climbing and found that both groups improved, but that the creatine/CLA group had greater muscle endurance, stronger knee extensions, more lean muscle (fat-free) mass and had lost more fat than the placebo group, without side effects. Reference: Public Library of Science Hub for Clinical Trials. 2007 Oct;2(10):991.
CLA burns fat while you sleepOverweight adults who took conjugated linoleic acid (CLA) burned more calories from body fat while sleeping, in a new study. Researchers from the University of Wisconsin at Madison, recruited 23 otherwise healthy but overweight men and women with a body mass index (BMI) of 25 to 30, aged 18 to 44, to take 3.2 grams of CLA per day at breakfast or a placebo for six months. To accurately measure how much and what types of energy participants burned, doctors placed each man and woman inside a special sealed monitoring room called a metabolic chamber for 24 hours at the start and end of the study. After six months, those who had taken CLA burned an average of 4 grams more body fat while asleep than they had at the start of the study, while those in the placebo group burned 7 grams less. Those in the CLA group also burned 3.3% less energy from protein while asleep compared to the start of the study, while the placebo group burned 0.3% more. Compared to the start of the study, the placebo group burned an average of 43 fewer calories while asleep, while there was no change in the CLA group. Doctors noted that those who took CLA also burned more body fat while awake, but that this result was not statistically significant. This is one of the first studies to measure over a 24-hour period how CLA burns fat. Earlier studies measured shorter periods of time, did not use a metabolic chamber and did not monitor sleeping hours. Doctors said the study confirmed that CLA burns body fat rather than fat from the diet. Reference: American Journal of Clinical Nutrition: 2007, Vol. 86, No. 3, 797-804
The essential amino acid leucine continues to be the focus of research, especially in regards to examining the effects of adding supplemental leucine to meals and protein drinks. Whey protein is naturally high in leucine making up about 10% of the amino acids. Thus, a 20 gram serving of whey protein delivers about 2 grams of leucine. While this is an effective dose of leucine, current findings suggest it may not be optimal.
 
In one study, adults at least 60 years of age consumed 20 grams of whey protein with a small amount of added leucine (3 grams total) or a control milk product matched for calories. 1 They performed a bout of resistance exercise on one leg 15 minutes before ingesting the drinks so they could measure rates of muscle protein synthesis just due to the drink (by examining the rested leg) and in response to exercise (by examining the exercised leg). They found that consuming the leucine-enriched whey drink resulted in a 47% increase in muscle protein synthesis, whereas the milk drink had a much smaller impact (10%). The increase in muscle protein synthesis in the exercised leg was also higher in the leucine-enriched whey drink (28%) versus the milk drink (3%). These results support the use of whey protein with added leucine as superior to a traditional milk product for stimulating muscle protein synthesis in healthy older subjects.

In a different study, researchers examined whether adding leucine to a drink low in total protein was beneficial. 4 Active men were randomly assigned to ingest one of five whey protein isolate supplements after resistance exercise:
• 25g whey (3g leucine),
• 6.25g whey (0.75g leucine),
• 6.25g whey + extra leucine (3g leucine total),
• 6.25g whey + extra leucine (5g leucine total),
• 6.25g whey + extra BCAAs (5g leucine total).
 
They all drank a 241 calorie beverage with 5.6g of fat from coconut oil and 23g of carbohydrate (sucrose) for the whey only group, and 35g of carbohydrate for the other groups to match energy levels across all groups. During the first 1.5 hours after ingestion, all groups experienced similar, significant increases in muscle protein synthesis. From 1.5 to 4.5 hours after ingestion, the group who received 25g of whey experienced the highest rate of muscle protein synthesis (~267%). Interestingly, the group who received 6.25g of whey protein + extra leucine (5g leucine) also experienced a high level of muscle protein synthesis (~220%) despite containing about half the amount of total amino acids. The other groups came in a close second.
 
The results provide evidence that adding extra leucine to low (suboptimal) protein meals can significantly improve the anabolic effect on muscle. Practically, this means if you want to consume one-fourth the amount of whey and add a teaspoon of extra leucine powder you can get the same benefit as consuming a full 25 grams of protein from whey. 
References
1. Luiking YC, Deutz NE, Memelink RG, Verlaan S, Wolfe RR. Postprandial muscle protein synthesis is higher after a high whey protein, leucine-enriched supplement than after a dairy-like product in healthy older people: a randomized controlled trial. Nutr J. 2014 Jan 22;13(1):9.
2. Churchward-Venne TA, Breen L, Di Donato DM, Hector AJ, Mitchell CJ, Moore DR, Stellingwerff T, Breuille D, Offord EA, Baker SK, Phillips SM. Leucine supplementation of a low-protein mixed macronutrient beverage enhances myofibrillar protein synthesis in young men: a double-blind, randomized trial. Am J Clin Nutr. 2013 Nov 27. [Epub ahead of print]
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