Medical Nutrition Therapy
An accredited and experienced dietitian will assess your food/beverage choices, eating patterns to determine IF you are consuming the required vitamins, minerals and macros that your body requires at THIS stage of your life. This is a constantly shifting process and so the nutritional advice provided to you is based on YOUR health profile and other life circumstances you may be experiencing at the time.
In the mean time, you may find the following of interest:
https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/
Which Medical Nutrition Therapy is “the best?”
A couple of years ago, a group of researchers looked at all the published scientific information available at the time on this very question *Kim JY. Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance.
J Obes Metab Syndr. 2021 Mar 30;30(1):20-31. doi: 10.7570/jomes20065. PMID: 33107442; PMCID: PMC8017325..
The results: Significant weight loss was observed with any low-carbohydrate or low-fat diet. Weight loss differences between individual named diets were small. This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.
There is also the consideration that some particular "diets" have been shown to be more effective for certain metabolic health complications eg DASH diet for those with high blood pressure; low-GI choices for those with pre-diabetes/insulin resistance, PCOS & T2Diabetes etc.
Take home message: dietary modification needs to be tailored to YOUR health profile, and SUSTAINABLE. Therefore, before embarking on any "diet" speak to Dr Rigas, your regular GP or an accredited dietitian to ensure (i)it is appropriate (ii)be advised on how to follow it properly and (iii)for a metabolic health and medication review, as the latter may need to be adjusted accordingly over time.
Which is better: intermittent vs daily calorie restriction?
An American study ^^Ruth Schübel et al; Effects of intermittent and continuous calorie restriction on body weight and metabolism over 50 wk:a randomized controlled trial, The American Journal of Clinical Nutrition, Vol 108, Issue 5, 2018, Pages 933-945. published a few years ago looked at this very question.
The results, intermittent calorie restriction(CR) and daily calorie restriction diets appear to be equally as effective in decreasing body weight, fat mass, and potentially, visceral fat mass (fat around the organs which is harmful to one’s health
). However, intermittent restriction regimens may be superior to daily restriction regimens in that they help conserve lean mass at the expense of fat mass.
Take home message: intermittent calorie restriction is effective and appears to be better than daily calorie restriction when it comes to sparing lean mass (ie preserving your muscles and bones) at the expense of fat cells.
As effective in reducing adiposity and potentially visceral adipose cells (the ones near the vital organs that are harmful to one's health) and hence decreasing body weight. However, intermittent restriction regimens may be superior.
Is losing weight slowly is better than losing weight quickly?
A couple of years ago a landmark Australian study Purcell K et al, The effect of rate of weight loss on long-term weight management: a randomised controlled trial; The Lancet Diabetes & Endocrinology(2014): Vol2(12) p954-962 designed a great study to answer this timeless and yet very important dilemma.
The results: The rate of weight loss does not affect the proportion of weight regained within 2.5 years (approx. 144 weeks). These findings are NOT Purcell K et al, The effect of rate of weight loss on long-term weight management: a randomised controlled trial; The Lancet Diabetes & Endocrinology(2014): Vol2(12) p954-962 consistent with present dietary guidelines.
Take home message: different adjunct anti-obesity/metabolic ill-health therapies result in different rates of reduced adiposity and hence weight loss. Purcell K et al, The effect of rate of weight loss on long-term weight management: a randomised controlled trial; The Lancet Diabetes & Endocrinology(2014): Vol2(12) p954-962 The bottom line: losing weight more quickly results (i)greater weight loss as a result of a greater reduction in adiposity however (ii) makes NO difference to how many patients will experience a relapse of their obesity/metabolic ill-health in the long run. This is because of metabolic adaptation.
Conclusion
In summary, intermittent calorie restriction [ICR] and daily calorie restriction [DCR] diets appear to be equally as effective in decreasing adiposity (potentially visceral adiposity) and weight. However, ICR regimens may be superior to DCR regimens, in that they help CONSERVE lean mass at the expense of adipose/"fat cell" mass. These findings add to the growing body of evidence showing that ICR may be implemented as another viable option for the management of obesity/metabolic ill-health.
Why is this important?
As one ages, the risk of developing fragile bones increases; this risk is even higher in:
- females,
- those with a family history of osteoporosis,
- after gastric bypass or SADI/duodenal switch (bariatric metabolic surgery) and/ or
- if a person is regularly taking certain medications.
Therefore, the goal is to try and preserve and ideally strengthen one's muscles/bones not lose them. In addition to the correct nutrient intake +/- supplements if clinically indicated, resistance and weight-bearing exercise can help.
Do meal replacements really work and are they safe?
Numerous studies have been published however, in 2020 a group of medical doctors ## Efficacy and safety of very low-calorie ketogenic diet (VLCKD) in patients with overweight and obesity:
A systematic review and meta-analysis.
Castellana, M., et al.
Rev Endocr Metab Disord 21, 5–16 (2020).
undertook a review of the existing published scientific literature on this very topic. At that time point, there appeared to be safety and efficacy data out to 4 years.
The results: Modern-day very low-energy meal replacements can result in a measurable reduction in adiposity, including visceral (which is around the vital organs and harmful to one's health) and clinically meaningful improvements in metabolic health including but not limited to:
- pre-diabetes and/or T2 Diabetes,
- metabolic dysfunction-associated steatotic liver disease (MASLD) previously known as non-alcoholic fatty liver today
- PCOS and other
Take home message: very low-energy meal replacements are a safe and effective therapeutic option to manage obesity and metabolic ill-health, and have also been shown to effectively used intermittently to prevent/ manage early relapses.
However, before embarking on a very low-energy meal replacement program, speak to Dr Rigas, your GP or an accredited dietitian, because your obesity-related health complications will require reviewing and your medication dosing may need to be adjusted accordingly over time.
