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Protein Matters: Yet More Peer-Reviewed Evidence That There Is No Such Thing As A “Calorie” To Your Body (Part IV)

(This is a multi-part series. Go back to Part I, Part II, or Part III.)

Empirical Evidence: Greater Weight Loss And Fat Loss On Isocaloric High Protein Diets

Dozens of studies have demonstrated that high-protein diets result in greater loss of bodyweight and fat mass than isocaloric lower-protein diets. (Isocaloric = containing the same number of “calories”.)

Instead of bombarding you with citations, I’ll point you to references 11 through 44 (and 2) of this excellent paper:

Nutr Metab (Lond). 2012 Sep 12;9(1):81. doi: 10.1186/1743-7075-9-81.
Dietary protein in weight management: a review proposing protein spread and change theories.
Bosse JD, Dixon BM.
(Fulltext available here.)

While some will critique that the satiating effect of higher dietary protein sometimes results in voluntary hypophagia [11], leading to an energy intake discrepancy between groups, there is evidence that increased dietary protein leads to improved body composition and anthropometrics under iso-, hypo-, and hyper-caloric conditions [2, 11-44]. Thus, the traditional dogma of “energy in versus energy out” explaining weight and body compositional change is not entirely accurate.

Now, it’s quite possible to pick a fight by cherry-Googling a few studies that show no advantage to high-protein diets. CITATION WAR!!11!!!1 Who’s right?

Rule Of Thumb: When there is a wide spread of outcomes, it’s likely that other factors, besides the one being studied, are influencing the results.

For instance, there are studies showing that calcium supplementation increases weight loss, and studies showing it does not. Instead of arguing that the studies opposing one’s hypothesis must all be flawed or fabricated, it’s more productive to look for other factors…

…and indeed, we find that calcium supplementation only increases weight loss if one is calcium-deficient to begin with.

Br J Nutr. 2009 Mar;101(5):659-63.
Calcium plus vitamin D supplementation and fat mass loss in female very low-calcium consumers: potential link with a calcium-specific appetite control.
Major GC, Alarie FP, Doré J, Tremblay A.

The application to such controversies as “Is there a metabolic advantage to low-carb diets?” should be obvious.

First, we know that a host of factors besides protein intake influence weight and fat mass (some of which I discussed in Part II and Part III). Furthermore, the dozens of studies in question prescribed a wide range of diets—anything from nutrient shakes to nuts to protein supplements to prepared meals to “we give you dietary advice; you keep dietary records and we’ll analyze them for compliance”—so we would rightly expect some of these changes to influence study outcomes. Unfortunately, it’s difficult to discern patterns across such a wide range of variables.

However, Bosse and Dixon have found two factors that can easily be compared between studies: protein spread and protein change.

Protein spread is the difference in protein content between low- and high-protein diets; protein change is the difference in protein content between a test subject’s habitual diet and the high-protein diet.

“In studies where a higher protein intervention was deemed successful there was, on average, a 58.4% g/kg/day between group protein intake spread versus a 38.8% g/kg/day spread in studies where a higher protein diet was no more effective than control. The average change in habitual protein intake in studies showing higher protein to be more effective than control was +28.6% compared to +4.9% when additional protein was no more effective than control. Providing a sufficient deviation from habitual intake ["protein change" -JS] appears to be an important factor in determining the success of additional protein in weight management interventions.” (Ibid.)

Even more striking, when the authors excluded studies in which the protein content of the low-protein diet was insufficient to meet the RDA, the mean difference in spread increased from 19.6% to 21.7%, and the mean difference in change increased from 23.7% to 37%!

Figure 2, Protein spread

Figure 3, Protein change


For those skeptical about the ranges in the above graphs: “…There appeared to be plausible explanations for nearly all outliers.” (Ibid.) Read the Discussion section if you’re interested in the details.

For instance: “A flaw in previous trials was that at times higher protein groups consumed more protein than control, yet less than their habitual intake, and saw no difference in anthropometrics [33, 52, 57, 61]. Thus, the “intervention” diet was really not an intervention to their metabolism. [...] In some cases, increasing the % of kcals from protein during energy restriction can actually result in less protein being consumed during intervention than habitual intake as a simple function of energy deficit.” (Ibid.)

For example, if you design a 1000-”calorie” diet for someone whose habitual intake is 1900 “calories” with 15% protein, you’ll have to include 28.5% protein just to give them the same amount of protein they were getting before.

“What is the protein spread on this study?” and “What is the protein change in this study?” are common-sense questions to ask. If protein spread is too small, the diets will be too similar to cause significantly different outcomes. If protein change is too small, the “high-protein” diet won’t be different enough from a subject’s habitual diet to cause a significantly different outcome. So while other factors are very likely to influence the outcome, it’s clear that protein change (and, to a lesser extent, protein spread) account for most of the difference between outcomes in high-protein dietary interventions.

Conclusion: A calorie is not a calorie when you consume it as protein instead of fat or carbohydrate.

Our Story So Far

  • A calorie is not a calorie when you eat it at a different time of day.
  • A calorie is not a calorie when you eat it in a differently processed form.
  • A calorie is not a calorie when you eat it as a wholly different food.
  • A calorie is not a calorie when you eat it as protein, instead of carbohydrate or fat.
  • Controlled weight-loss studies do not produce results consistent with “calorie math”.
  • And, therefore:

  • Calorie math doesn’t work for weight gain or weight loss.

What happens if we decide to “count calories” anyway? Continue to Part V, “Can You Really Count Calories?”.

(This is a multi-part series. Go back to Part I, Part II, or Part III.)

Live in freedom, live in beauty.

JS


“A wonderful, inspired, original, inspiring story…A cry of joy and terrifying beauty, an extraordinary commentary on the human condition, something that can change the way you see the world and your place in it…

…This book reflects some of the deepest teachings from Tibetan Buddhism; the fearless radical insight of Dorje Drollo, speaker of the Three Terrible Oaths…

…Evokes a direct and total engagement with life, and explains why hyenas laugh. READ IT!!!”

Yes, this is a review of The Gnoll Credo.

If you haven’t yet read it, ask yourself: what value might I place on such an experience? I suspect it exceeds $10.95 US…so click here and buy one.

Thank you.

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30 comments

Permalink: Protein Matters: Yet More Peer-Reviewed Evidence That There Is No Such Thing As A “Calorie” To Your Body (Part IV)
  • [...] / Posted on: July 09, 2013GNOLLS.ORG – (This is a multi-part series. Go back to Part I, Part II, or Part III.) Empirical Evidence: [...]

  • Bill Lagakos

    “Thus, the “intervention” diet was really not an intervention to their metabolism.”

    I like this quote, especially regarding high protein diets: we know urea cycle enzymes are regulated in part by dietary protein quantity, so changes from baseline are going to be just as important (if not more so) than differences between groups.

  • eddie watts

    i was actually so excited to see an update that i could not focus enough to read the damn thing!

    this is not really surprising and i imagine anyone who exercises and eats appropriately will be all “well duh!”

    that being said i am glad why it cleared up the reason why some “high protein” diets fail.
    because they’re not actually high protein at all!

    reminds me of the many “low carb diets” that failed when compared with high carb low fat…but the low carb diet was in fact 40% carbs…

    (now i will reread the whole thing and check out all the links!!)

  • Bill Lagakos

    The [notorious] Bray 1000 kcal overfeeding study:
    Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial.
    PMID: 22215165
    The High Protein group increased protein intake by 135 grams whereas the Low Protein group decreased it by 39. Everybody experienced the same increase in body fat, but the HP group gained lean mass whereas the LP actually lost it (despite being in a major calorie surplus).
    This is a big argument against caloric equality imo…
    “body composition”

  • ItsTheWooo

    Bill, I experience this more often than not; scale might stay the same or increase but my body shape changes with fat loss when I eat a basis of protein/meat.

    Minimizing protein I find actually can minimize hunger sometimes, but I tend to think this is secondary to catabolism of own protein tissues/protein and drop in growth hormones. Evidence of this is that in spite of the lower appetite I find I do not lose much body fat but definitely lose lean mass.

    Another benefit to higher protein intake is maximum albumin synthesis and high blood levels of protein, which exert osmotic pressure to reduce edema/fluid retention in the tissues. This lack of fluid retention in subcutaneous tissues promotes a leaner more defined look as well. Of course, this vanity benefit is independent of the numerous health benefit of high blood protein like fast wound healing and strong immune system.

    I believe carbsane described this phenomenon as “dehydrating”, lol. OTOH, constantly bolusing your blood stream with sucrose and spiking insulin promoting renal salt/fluid retention & hypertension is very hydrating and good for you ;) !

  • Bill:

    That's actually a rarely documented confounding variable in many diet studies: what were the subjects eating before the intervention? 

    Investigators will take pains to sort by age, weight, BMI, medical status, and so on — but they rarely account for the variation in human diets.

     

    eddie:

    Thank you!  Yes, “What were the subjects eating before?” seems like a very common-sense question to ask…and you're reminding me of Chris Masterjohn's classic article New Study Shows that Lying About Your Hamburger Intake Prevents Disease and Death When You Eat a Low-Carb Diet High in Carbohydrates.

     

    Bill:

    Nutrient partitioning is a whole new subject…and yes, protein strongly affects it.  Even the studies that show no absolute weight advantage for high-protein diets show improved body composition.

     

    ItsTheWooo:

    It's surprising how much lean mass is lost on typical hypocaloric diets.  Here's an interesting study showing that, for normal weight women, losing ~0.5kg/week preserves lean mass, whereas losing 1kg/week is catabolic and tanks hormone levels.

    J Int Soc Sports Nutr. 2010 Jan 25;7(1):4. doi: 10.1186/1550-2783-7-4.
    Moderate energy restriction with high protein diet results in healthier outcome in women.
    Mero AA, Huovinen H, Matintupa O, Hulmi JJ, Puurtinen R, Hohtari H, Karila TA.

    Given that, just imagine the results from your average “cleanse” (read: zero-protein crash diet).  Repeat this cycle a few times and you, too, can be skinny-fat!

     

    JS

  • eddie watts

    JS that last study showed that the women lost bench press but gained squat endurance strength and counter movement jump improved too…

    i can see jump distance going up but maybe this is more because women struggle more than men to improve bench press due to lower upper body musculature and therefore lose that strength faster?

    would be interesting to see the same thing with men though

  • eddie:

    Actually, counter movement jump distance increased more in the 0.5kg/wk group (see Table 1), though not significantly…I have no idea why the text of the study claims otherwise.  I suspect the increase in endurance is because starvation diets (~1000 kcal) are a high-fat diet of one's own adipose tissue, and consequently require high levels of fat oxidation, which Type 1 muscle fibers are much better at than Type II fibers.  But this is speculation.

    Another interesting part is in the “General Mood” section:

    “In 0.5 KG, 57% of the subjects (n = 4/7 = 4 subjects from 7 subjects) reported that they had more alertness in work/studying and training during the weight loss regimen. Similarly in 1.0 KG, 44% of the subjects (n = 3/8) reported that they had more alertness in school and only 25% reported that they had more alertness during training. Furthermore in 1.0 KG, 50% of the subjects (n = 4/8) reported that they had felt less alertness during training when no one in 0.5 KG gave such an answer (n = 0/7). The subjects in 0.5 KG also reported better general mood and no one from this group reported any kind of anxiety when 37.5% (n = 3/8) in 1.0 KG reported that they were more anxious and felt more tired than usual.”

    Also, I need to amend my statement: the 1.0kg/wk group did not lose more lean mass in the first four weeks (although there is no indication that the authors measured it…: what the authors say is that their hormonal environment is more catabolic, so that they'd expect to lose more lean mass as the diets continue.

    Also, I noticed that cortisol was up 15% in the 1.0kg/wk group, though the authors called that “no difference”.

    Also, I noticed that the authors claim “Metabolic acidosis has been linked to muscle wasting in obese subjects who were acidotic due to weight reduction diets [19,20]. The correction of the acidosis has been shown to reverse the muscle wasting in that condition [21,22].”  However, neither reference 21 or 22 supports that contention: they show only that bicarbonate supplementation reduces urinary nitrogen excretion in either patients with renal failure in the short term (1 week), or in patients on a 3-week PSMF (this study also confuses ketoacidosis with ketosis), which is a long way from proving muscle wasting.

    This sort of sloppy science is why I don't bombard people with 15+ citations per article: there's a lot of shecky work out there, and if someone gives me that many cites for a blog post, I'm calling BS on them actually having read them, let alone verified that they support the hypothesis!

  • CarbSanity

    Fair demands: denounce Nikoley, issue a formal apology to the women of Paleo – and THEN we’ll talk.

  • Paul N

    So this is right in line with Paul Jaminet’s approach of set your baseline protein intake – in grams/day, not % of calories.
    Given that protein is a building block, not just calories, it should come as no surprise that that low protein diets lead to catabolism.

    I know of many women (only ever women) who do those “cleanses”. they feel good for the first day or two, and then start to feel anaemic.

    I suspect they have some good autophagy going for the first day or two, then the catabolism sets in.

    I once had a neighbour who was a woman in her 20′s who was a competitive basketballer, who, at a (vegan) friends urging, did one of these cleanses, and a two week “rabbit food” diet. Her game performance was terrible!

    It is interesting to see the bodies of women (differences seems more observable than in men) who do “jump” sports, like basketball, volleyball, tennis, downhill skiing, figure skating (*lots* of jumps) etc, compared to those that cycle or (especially) run. The jump sports women clearly have more muscle mass and appear to have better skin. The runners approach the anaemic look of runway models, but perhaps that is their goal?

    I guess you could classify those sports as those resembling predator activities – pouncing – and those resembling prey activities – running. I suspect the eating patterns are similar too!

  • Berneck

    J.

    This was an excellent article! It lead me to your other article, Dietary Protein 101. In that article you mentioned that you would follow-up with “measures of protein.” I can’t seem to find that follow-up article. Was there a follow-up?

  • Paul N:

    Yes, protein is a daily essential…and like all essential macro- and micro-nutrients, just because you're eating less food doesn't mean your body's requirement magically decreases!  So yes, it's best to measure your target protein intake in grams, rather than as a percentage of “calories”.

    And yes, I encourage both men and women to play like predators, not “exercise” like prey.  Your body quickly adapts to the low-level steady-state demand of “cardio”, often leaving you fat — whereas adaptation to occasional intense effort will cause your body to divert more resources towards building strength (“nutrient partitioning”). 

    Remember that muscle mass is counterproductive to long-distance running: note the relentlessly tall and skinny build of the Kalenjin, who win most marathons these days.  And as I point out in this article, male ultra-endurance running champions carry an average of 17% bodyfat — nowhere near the coveted “six-pack”.  And there is plenty of evidence, scientific and anecdotal, that long-distance running is not healthy!

     

    Berneck:

    No, I haven't yet finished that particular series…if I've written a followup, I generally place the link to the next part at the end of the article.

    JS

  • Dave

    You know, J, running can be thought of as playing the game “persistence hunter.” Human running wasn’t just about escaping as prey. Excellent article, btw.

  • Dave:

    The data we have (as opposed to speculation or second-hand stories) shows that persistence hunting only works with a very specific animal — old male kudu — and that the speed of a successful persistence hunt is 6.2-6.6 km/h (3.9-4.1 MPH). (Source.)

    That's a fast walk, not a “run”…

    …and the fact that no one has ever been witnessed to successfully ran down any other animal (despite years of trying, e.g. “Running After Antelope”) should prove to us that neither long-distance running nor persistence hunting is the driving feature of human evolution it's been claimed to be. 

    I need to write an article about this misconception sometime!

    JS

  • tatertot

    Can I suggest a future topic? “A calorie is not a calorie when you eat it as fiber or resistant starch”

    You know where I’m headed with this…4 calories of fermentable fiber hits the large intestine and is converted to butyrate and finally absorbed as 2 calories of fat. I’d love to see you break this down. Nobody has really tackled it yet except bro-sciency sounding sound-bites.

    Lovin’ this series!

  • tatertot:

    You're correct: fiber and “resistant starch” (which, strangely, doesn't seem to be counted as fiber in nutrition labels) are counted at 4 kcal/gram, which overestimates available energy by at least a factor of 2.

    One must also account for the energy of digestion, which tends to be high in the case of unprocessed foods high in RS and fiber.  Paul Jaminet contends that, as a result, green vegetables actually have negative “calories”…and I believe the evidence supports him.

    JS

  • Tonto

    Ref: Running/Persistence hunting; As a kid growing up on prairie/farmland, we used to run down and kick to death (then bring home and eat) ground-hogs (woodchucks), prairie dogs, and jack rabbits that strayed too far from their den. Great fun, great exercise, you’d be exhausted to the point of puking after a 2-3 minute chase. This ‘game’ was taught to us by our elders, and has been done since time immemorial here on the rez.

    Larger game was also chased in this manner using a series of stone fences and relay runners strategically positioned. Sometimes ending at a cliff the exhausted animals would dive over and die at the bottom.

    Sorry if this doesn’t fit the discussion…

  • Dave

    J, I look forward to that article on persistence hunting. Personally, I am more in love with the idea of running than the actual activity itself. I’ve never been able to sustain a running habit. Since I don’t own motorized transport, I walk and ride my bicycle. Of course, in my younger days I attempted running with the wrong diet(s) and the wrong techniques, so it doesn’t really surprise me that I suffered various health issues and injuries as a result of running. Or, should I say, I was unhealthy to begin with and running was just another stress on my body that it wasn’t in a position to deal with.

    With respects to the article, I have noticed a difference in body composition compared to the time I attempted veganism and my current HFLC Way of Eating. I did get thin eating vegan (mostly vegan, to be honest) since I didn’t consume much high quality protein. I avoided dairy and eggs, and I used lots of wheat flour, potatoes, legumes, and vegan meat substitutes. (I ate fruits and vegetables, too, but they didn’t supply much in the way of energy.) It did me no favors in the strength department. These days, though, I am both thin and strong on a diet that conventional wisdom says will make me fat and sick.

  • neal matheson

    I wrote some stuff on persistence running a while back, I’m not really a fan of the idea from an evolutionary point of view. However I recently found some interesting anecdotal evidence of persistence “hunting” in Scotland.
    http://ceathairne.blogspot.co.uk/2013/07/long-distance-running-among-highlanders.html

    Older but possibly relevant; http://spearthroweruk.blogspot.co.uk/2012/03/how-they-actually-exercise.html

  • Tonto:

    Thank you for sharing that…and yes, it absolutely fits into the discussion! 

    “Larger game was also chased in this manner using a series of stone fences and relay runners strategically positioned”…that confirms what I've read from other sources, which is that Native Americans didn't practice straight all-day persistence hunting: they herded wild animals into natural terrain features, usually (as you said) with teams of runners, and constructed very long and elaborate fences and corrals where the terrain didn't provide them.

    I review two books on the subject in this article (“Survival by Hunting” and “Imagining Head-Smashed-In”), and I'm very interested in your opinion if you choose to read them.

    That's interesting that you were able to catch small animals with a few minutes of sprinting and the smarts to keep them away from their burrows!  Having grown up in suburbs, I never had those types of opportunities…though unlike the city kids, I at least got to climb trees, scramble down ravines, etc.

    I do note, however, that none of these activities qualifies as “persistence hunting”, let alone long-distance steady-state cardio.

     

    Dave:

    It's possible to get thin by losing muscle mass…and from the studies I've read, most diets that aren't “high protein” result in significant loss of muscle mass as well as fat mass.  As mentioned above, our protein requirements don't decrease just because we're eating less food, so staying at 15% protein when dieting is likely to leave us protein-deficient and losing lean mass.

    Additionally, endurance exercise is catabolic, and requires a higher protein intake to preserve muscle mass than even strength training!

    Result: vegan diet + jogging = skinny-fat.

     

    neal:

    Thank you for the links!  The exercise article seems to agree with Mark Sisson's approach: lots of walking around and occasional sprints or heavy lifting, as opposed to “cardio”.  And I agree that examples from agriculturalists aren't relevant to our evolutionary context, either.

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  • sylvie

    If you’re a vegetarian who eats dairy, fish, and eggs, and are on a strict budget, how should you spend the money to maximize nutrition and minimize the negative effects of hormones, chemicals, mercury, and antibiotics found in these sources? For instance, if you’re buying factory eggs, should you limit your egg consumption? There needs to be a paleo pecking order for people who can’t afford and/or don’t have access to free-range, antibiotic-free, pastured products.

  • Dave

    Sylvie, what is ‘paleo’?

    I just got finished with a fascinating book, Unlearn, Rewild, by Miles Olson. This man and his ‘tribe’ of modern primitives lives pretty close to a ‘paleolithic’ lifestyle. Our paleolithic ancestors did not rely on domesticated animals and plants for food. Miles describes a lifestyle that is intimately associated with the land one lives on. Not once did he mention the need for pastured eggs, raw milk, or grass fed beef. He does recommend eating insects and wild game. He also mentions learning about local plants that can be useful, too.

    So, what is ‘paleo’? Is it just another marketing term to get consumers to buy more expensive and presumeably healthier food? Perhaps, instead of striving for some ideal presented by the gurus of the moment, one can simply start from the basics. Weston A Price concluded that refined sugars and white flour (and all the products made from them) caused malnutrition and physical degeneration. So, while one may not be able to afford expensive eggs or dairy, one can eliminate the worst offenders of “the displacing foods of modern commerce” from one’s diet. Start with the basics and go from there. If that means one has to eat CAFO eggs and dairy for the time being, just accept that it is a stage in a process of gradual improvement.

    Best of luck to you in your journey!

  • sylvie:

    Follow the link Fmgd gave.  

    And remember: it is axiomatic that you have to eat something.  If you stop eating meat or eggs because you're worried about antibiotics or hormones, you'll have to eat something else instead — something made of nutritionally empty, pesticide-drenched GMO corn, soy, or wheat.  

    Eggs, for example, are so packed with nutrition that even the worst factory eggs are better than not eating eggs at all!  Same with most paleo foods: CAFO beef is better than not eating meat, conventional cabbage is better than not eating vegetables, etc.

    That being said, if you're pescetarian, you really do have to watch out for methylmercury content — and eating wild ocean fish doesn't help.  Also, even the cheapest China-farmed fish, like tilapia, is more expensive than beef, pork, or chicken…

    However, if you're adamant about remaining pescetarian, canned mackerel, sardines, etc. will help stretch your budget, as well as provide you lots of healthy omega-3 fat.  If you have the money to spare, pastured eggs are the first thing I'd upgrade from standard industrial supermarket food.

    Dave:

    Exactly.  CAFO eggs are better than not eating eggs.

    JS

  • Meatnomnom

    Mr Staton, 

    What do you think about the research suggesting that fish with more selenium than mercury is safe? (As is the case with non-predatory ocean fish)

    Paper here: http://www.soest.hawaii.edu/oceanography/courses_html/OCN331/Mercury3.pdf

  • Meatnomnom:

    I've seen that study, and the Chris Kresser article based on it.

    Note that the study is:

    1. A rat study

    2. It only checked the rats for gross developmental deformity (excessively low weight, hind-limb crossing)

    The doses required to cause neural and cognitive damage in humans are (AFAIK) orders of magnitude smaller than the doses required to cause gross developmental deformity in humans: note that nowhere in the annals of “Minamata disease” (methylmercury poisoning) is growth impairment noted as an effect.

    So I'm suspicious that selenium is or can be totally protective of methylmercury poisoning…especially in children and fetuses.

    JS

  • Dana

    Woo: Eating more protein reduces edema??? I had thought I was losing water weight just from the reduction in carbs –> reduction in insulin –> kidneys were doing their job. But if the eating the protein reduces edema in other ways, that is really good news for me. I have had problems with edema since I was 18. I don’t know what’s up, have never found out and am not sure it’d be worth wrestling with doctors for a diagnosis. BUT, I *do* have issues with not getting a lot of protein even as a low-carber. I just… don’t eat a lot. It’s crazy. So, that’s something I need to watch out for in future. Maybe I can finally put this stupid mystery condition to bed.

    Stanton: Fish vs. methylmercury… fish contains selenium, which helps adult human bodies detox from mercury. (We are better at this than kids are, which is one reason mercury is so dangerous for them.) If it were me and I were pescetarian, I would still skip the major predator fish like swordfish and shark, but something like salmon ought to be safe enough.

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