Why do diets work in the short term?
Producer Potts 0:07
When we start a diet like low carb or carnivore that eliminates large groups of foods, we tend to feel better right away, and we see success in those goals that we are looking to achieve. Why do we see this short term success with these very restrictive diets?
Dr. Sarah 0:27
I think there’s a few different things going on here, and it’s worthwhile noting that this is not really a question that scientists have tested in clinical trials. You know? Why? Why does somebody feel better right away? How much of that is placebo effect? So when you, when you feel like the placebo effect is definitely part of this. Can we say how? How big of a part? We don’t know, but when you make a change expecting to feel better, that’s what the placebo effect is, right? When you your brain is expecting to feel better, and it makes it feel better, like you see biological changes as a result of thinking that you are being treated with something good. So definitely, the placebo effect is part of it. And like, the placebo effect is real, like the benefits are real benefits. It’s not that it’s all, all that feeling better is in your head. That’s not what placebo means. Placebo means a real, legit benefit that is not explained by the treatment, that is explained by the expectation of treatment, some kind of manifestation of those expectations that our body does, which is actually pretty, pretty cool. So the placebo effect, I think, is part of this. We’re sold the promise of these diets, so we expect that treatment effect, and there is one because of placebo. So definitely, I think that’s part of what’s going on here. I think that nutrition is another part that’s going on. So depending on where you started from, you still might be getting a more nutrient dense diet, or you might be filling nutrient shortfalls that existed in your previous diet. You might be trading it for other nutrient shortfalls that are going to magnify over time and eventually be one of the many reasons why we tend to hit a wall with these diets. We tend to hit a point where they’re no longer beneficial, or we start to backslide. But that’s another thing that happens, right is whether, like, let’s say you’re, you know, going from a diet to low carb, you might be eliminating a lot of ultra processed foods for that low carb diet. You might be eating more vegetables. You might be eating a more nutritious diet. You might be getting more certain vitamins or minerals that you haven’t been getting enough of. Then, over time, the things that you’re not getting enough of, there are a bunch of nutrients that are harder to get on a low carb diet. Doesn’t mean you’re automatically not getting them on the low carb diet. They’re just more common, and it’s just that that structure makes it harder to get them and you have to be more proactive. And I think that it’s not, well, like, that’s not part of the communication around low carb diets, like, Oh, and by the way, you have to make sure you’re getting enough of all of these different nutrients because it’s harder to get on these diets. I think the only diet where that’s kind of like part of the conversation is, is veganism. So on a vegan diet, like vegans know they need to get their B 12 from somewhere, they probably need to supplement. With B 12. So I think that’s not part of other diets, even though the list of nutrients that are harder to get on those diets are just as long, not the same, but different nutrients. So I think part of it is you’re getting more of, maybe some nutrients that you haven’t had enough of, and that can make a big difference in terms of how you feel than these other nutrients that you had been getting enough of, but now you’re not in this new dietary structure. It takes a while for the amorphous symptoms of nutrient insufficiency, so just nutrient shortfalls, like not getting enough of the nutrient that we actually need to thrive, but not getting so low that it causes a disease of deficiency. Symptoms of nutrient insufficiency tend to be very vague, very, very hard to pinpoint. They’re things like headaches, low energy, joint and muscle pain, right? Like they tend to be like brain fog, right? They tend to be things that are really hard to attribute to anything. You can easily brush it off as a sign of stress or not getting enough sleep, and so it’s really hard to recognize their link to diet, and especially diet shortfalls, right? A thing that’s lacking, we tend to always breach the blame of like, the thing I’m eating that has a toxin. In it, then I should restrict. And we tend not to think of, oh, I restricted all these things, and now I’ve got this whole group of nutrients that are really, really hard to get, that my body still needs. So I think what happens when we first adopt a diet like this? We’ve got part placebo, part, you know, an increase of some nutrients that maybe we weren’t getting enough of that can definitely, like, improve how we feel initially. I think that a part of this can be gut microbiome shifts. So especially if we’re talking about a diet like carnivore where you’re eliminating all sorts of fiber, like you’re starving your good bacteria, but you’re also starving the bad ones, and if you started that with some kind of gut dysbiosis, yes, you’re going to make that gut dysbiosis worse over time, but you still might have a reduction in GI symptoms when you first adopt a carnivore diet, because you’re not feeding the bad bacteria. You’re not feeding the good bacteria. Again, that’s going to become a problem, but initially you’re benefiting from the bad bacteria being starved before you start to have things creep up due to lack of those good bacteria. So I think, you know, especially when we’re doing these, like big shifts, there’s all there’s often, I’m not gonna say always, there’s often a trade that we made. We’re getting more of this, but we traded for less of this, and it’s the more of this first thing that is responsible for that initial good feeling, plus a little bit of placebo.
Producer Potts 6:30
I have a follow up. So in one of your videos, you talked about how, you know, there’s this whole idea that, like, there’s all these foods that are inflammatory. But then you said in your video something that was really interesting to me, that was like, it’s actually the overabundance of energy or food in our diets that are inflammatory. So another thing with these diets is a lot of times you’re going from probably eating more food to liking less if you’re cutting out big food groups, so in like you so you would have some decreased inflammation. I would guess, if you were kind of decreasing, if you were coming into an energy level that’s probably lower than what you should be. But was, you know, you were eating much higher before, and that’s that whole thing you were talking about, depending on what diet you were starting with, and these changes, right? Yes.
Dr. Sarah 7:24
So definitely like, Thanks for identifying that. So that’s definitely another possibility, going from hyper caloric, too many calories, to either hypo kyloric, right, calorie deficit, or EU caloric like, the same amount of calories consumed as we burn. So a hypocaloric diet, right? More calories than we need. Whether that is I’m just eating more food than I actually need, or I’m, like, intentionally bulking like that. That is something that is something that some people choose to do. It’s important to understand that more calories than we’re expending is an inflammatory eating pattern, whereas the same amount of calories I’m expending or fewer, as long as we’re not so low in calories that we’re starting to activate stress responses and stuff like that, that can help to reduce inflammation. It’s not the only contributor. Obviously, the immune system is fantastically complex, but yes, that could absolutely be part of feeling better. I think the other thing I was going to say was sort of related, which is, you know, when you say the goals, right? The diets work initially, most of the time what we’re talking about is weight loss, right? Most of the time when we say, I was talking about weight loss personally, but yeah, exactly. And the diet worked for me at first, and then it stopped working. Most of the time we’re talking about weight loss. So studies that look at how different diets work for weight loss. Basically showed they all work. You can lose weight on any diet. It’s how sustainable that is over the long term, and the risk of weight regain on the other side, right, that is different for different diets. So most of these dietary structures are like low carb paleo ketogenic diets. The reason why people successfully lose weight is the structure tends to focus on more satiating foods, so foods that fill you up for fewer calories, and people tend to spontaneously end up with a caloric deficit. So as you know, eating fewer calories than they need to maintain their weight without necessarily counting calories or or trying over time. That does not mean that that weight loss is any easier to maintain on the other side. And in fact, you. With low carb diets, we lose more lean mass, so more muscle mass than a macronutrient like balanced diet that has the same caloric deficit. So it is better to have that caloric deficit without the low carb aspect. So there’s again, right? There’s always this, like, this trade off that’s happening, especially when we approach diet purely from the point of view of wanting to lose weight. And so what happens is, over time, right? That caloric deficit decreases because our calorie intake, like I adopted this low carb diet, it reduced my calories by 400 calories per day, or whatever, and that added up to that would probably translate to three pounds a month, or somewhere in that ballpark. It’s not exactly 3500 calories per pound. There’s a little bit more to it than that, but roughly, we can use that as a rough estimate. But over time, my basal metabolic rate drops. It just takes less energy to move a smaller body. Some of that can be maladaptation to too large of an energy deficit. So a larger energy deficit can lower our thyroid hormones a little bit. It’s not causing hypothyroidism, but it lowers our thyroid hormones a little bit, which lowers our basal metabolic rate. Part of that can be maladaptive, because we’re reducing not our basal metabolic rate, but our non exercise activity, thermogenesis, or neat it’s got a neat acronym that is the calories that we burn doing things that are not exercise, like fidgeting, walking across the house, the type of movement that we do that’s not, I’m going for a walk, I’m going to the gym, right? It’s not exercise. All of that other movement that we do throughout the day adds up to a fair bit of our calorie burn throughout the day, and when we are under a calorie deficit without trying, without thinking about it, we tend to reduce our activity, like fidgeting. We tend to fidget less, and we tend to conserve energy, so we’re burning fewer calories that way. So what happens over time? This does not matter how you’re achieving your calorie deficit over time, that deficit decreases, because we’re burning less calories, either by reducing our basal metabolic rate, which is dependent on what diet we’re following, if you exercise that can help to preserve lean mass and basal metabolic rate, if you’re eating more protein, that can help right? So depending on exactly what we’re doing, a smaller calorie deficit will also help slow and steady super wins this race. But then also, we might be reducing our non exercise activity, thermogenesis, and if we’re getting too aggressive, we might also reduce our exercise thermogenesis, right? We might also not have the same energy for the same workout at the gym. So all of those things decrease the calories outside of the calories in versus calories outside of the equation. But weight loss is not just calories in, calories out. Hormones are also important here. It’s both. It’s, I can’t stand this debate of like, colors versus just thermodynamics. We’re not a closed system. The laws of thermodynamics don’t apply, but it is thermodynamics sort of, but it’s actually biology, but it’s also hormone adaptation. So that’s the biophysicist in me. People say it’s just thermodynamics. I’m like, tell me what advanced thermodynamics class you’ve taken, because I have Dr cowleski, he was awesome. All right. So shout out, Bob. If you’re watching, I hope you’re doing well. So, so, uh, so here’s where hormones kick in. So we have other adaptations. We kind of already touched on a hormonal adaptation with the thyroid hormones production being lower. So other hormonal adaptations that we can have over time when we have a caloric deficit, one is our ghrelin starts to go up. So our ghrelin is we’ve got two main hunger hormones, leptin and ghrelin, and they work opposite of each other. Ghrelin is the one for making us feel hungry, and leptin is the one for making us feel full. So ghrelin is highest when we have an empty stomach, right, when it’s been a long time since we’ve eaten, and then we eat and it goes back down. But what happens under a prolonged caloric deficit is our ghrelin starts to inch up. So the baseline ghrelin will be higher and higher and higher, and how much it comes down when we eat won’t be as much, so you have to eat more to feel as full. So what happens during weight loss is we get hungrier and hungrier and hungrier over time, at the same time as that energy deficit that we were maintaining is getting lower and lower and lower and again, this is why slow and. Study wins the race. This is why things like working on volume eating, which means filling up on a lot of usually non starchy vegetables, is kind of the food. So foods that have a lot of water and fiber but not a ton of calories, also, those are great nutrient dense foods too. So those can also be a really helpful strategy here. But that’s like, that’s what’s driving weight regain cycles, right? The yo yo is you hit a point where whatever the dietary structure was, from counting calories to low carb, low fat, carnivore, paleo, keto, like whatever it is, whatever the strategy is for achieving the energy deficit causes some adaptations to our metabolism that means that that energy deficit, like how short we are on calories each day, is getting less and less and less. Even if we’re eating the same amount of calories, we’re also expending fewer calories during the day, then our hunger also increases. And for a lot of people, we hit that moment where, especially when we’ve adopted a restrictive mindset, so we followed one of these diets where we are also cutting out our favorite foods. We really feel like we’re missing that cake, that pizza, that, whatever it is, we hit this moment of disinhibition where I gave in. I was at a birthday party my you know, co workers got together of, you know, for drinks on a Friday night, alcohol increases disinhibition, so we’re more likely to like, Okay, go ahead and eat that pizza if we’ve had a drink or two, but also not getting enough sleep. Is that right? Just prolonged living with restrictions? Do we hit that moment where we’re like, we just gotta give in. We gotta, we gotta we gotta do the thing. We gotta cheat. I hate that word,
Dr. Sarah 16:44
so when that happens, then we tend to, like, fall off the wagon, and we’re at the situation where we now are burning fewer calories than we were when we started this whole project, and I’m hungrier than I was at the beginning of this whole project, which is why often people will hit that moment where I’ve given in. Now it’s really, really hard to get back on this restrictive diet bandwagon, and now I’m going to like now I’m eating to match my hunger, because I’m disinhibited, this inhibited that is such a hard word to say. I’m now matching what I’m eating to match my increased hunger, and I’m gaining back the weight that I lost on the diet. So that is the wall that people tend to hit no matter what diet they’re following. If you layer on top of that, nutrient deficiencies, which can, uh, increase cravings, but also just increase fatigue, right? Can increase all of those amorphous symptoms we already talked about, if you layer on top of that gut dysbiosis, and now you’re not following that plan anymore, because we hit, we hit that inflection point where we bounce, bounce the yo yo, back up again. That’s like, that’s where people are doing that, like, on again, off again, and it worked until it didn’t go right, and then I had to do the next more restrictive thing, which worked until it didn’t. And so I think there’s a question like this that is driving weight regain cycles, which is the technical term for dieting, the psychological and physiological factors are fairly well understood. And how to, you know, that’s why, like things like cognitive behavioral therapy as part of exercise programs as well as that’s why, like intuitive eating can be, like, a really helpful strategy in here, right? Like, there’s a lot of different pieces to that. This is where the Health at Every Size program, which I’m not an expert in, but you know, really looks at increasing nutrition, but also working on lifestyle factors. There’s a lot of things that we can do on this side of the equation, get some exercise, lower stress, get enough sleep, that can help to improve the likelihood of that bounce back of the yo yo that aren’t part of what these diets are teaching us, right? That isn’t because these diets restrict all these things, it will reduce your caloric intake and your nutrient intake, and maybe potentially cause some health issues as a result, over time. And it’s not part of what actually is sustainable, lifelong healthy habits that can help someone achieve a healthy weight for them. And I want to specify that we really can be healthy at any and every size. That what is determining health is not necessarily our size, but our eating patterns, our health related behaviors, like whether or not we smoke or drink, our lifestyle and all the things we don’t have control over, like genetics and epigenetics and social determinants of health and access to medical care, those are all really important key contributors. Resources to how healthy we are independent of our size. So the things that are affecting feeling good initially, you might feel really happy that you’re losing weight, if you are like most of us, and you have been taught by society that you have higher value if you’re in a smaller body, right? Most of us believe that to our core, and I think that fighting back against that message is one of the biggest services that the body positivity movement is doing for us right now. And there’s, there’s a lot of work left to do, right to to really reverse that societal value that is placed on thin bodies, but that might be part of why you feel better. The mental health boost of my scale is going in the right direction. I mean, right? Yeah, better because your inflammation is lower, because you’re eating in a caloric deficit instead of a caloric excess. You might feel better because you’re getting more certain nutrients that you weren’t getting before, you might feel better because there’s a switch off in terms of, uh, you know, substrate for your gut bacteria that’s starving some bad bacteria also happens to be starving some good bacteria, but there’s an initial symptom resolution because of that. So, you know there, there’s so many different possibilities to explain feeling better at first, and so many different trade offs that bite us in the Yeah, in the end, right?
Producer Potts 21:33
It’s, it sounds like the thing is, that our body naturally fights against us, losing weight and diet culture isn’t helping, because these things are short term. Or, you know, we try to do the quick fix, or, let me, you know, whatever. And I think, like, that’s this. The reason I brought this question is, you know, I see this on your social media, people are like, Well, why do I feel better with this? And it’s like, we feel better, but it is short term, and that’s the thing that I, for myself, have been discovering with Nutri more by focusing on nutrient density, yeah, and focusing on health as the goal is just, it’s, you know, I’m getting to a place where things do feel better, and it is healthier, it’s slower, yeah, but it’s going in the right direction. I have, there’s no backslide, you know, and I think that’s really important. So
Dr. Sarah 22:44
you made me think of one other potential contributor here to feeling better at first, and that is, uh, unintentionally, among all the foods that you restricted on this new diet, you may have cut out something that you were allergic to or intolerant to, because that’s another possibility here. Like, I didn’t know that I was gluten intolerant until I went paleo 12 years ago, 13 right? 13 years ago, and that was not something I knew. But like, I felt so much better, but I felt so much better because I was cutting out something that was causing a lot of my or contributing to a lot of my health challenges, obviously, not all of them. And so, um, so that’s a like, another possibility of what’s going on. But I think, you know, I think what’s so important about this conversation is we’ve touched on a couple of different aspects of it that are psychological, right? That is, um, I feel better because I feel like I’m making progress towards these goals that society has told me are really important, right? And I feel better because I expect to feel better, and there’s some placebo effect, yeah? And I think, you know, I think this is why I don’t like, like, yes, nutribures a diet, but not a diet, right? That’s why I call it a dietary philosophy. It’s just the goal of getting all of the nutrients our bodies need from the foods we eat. But it’s why I try to frame all of the educational resources that we create in terms of adopting healthy eating patterns, right? Not a diet we go on because then we tend to go off, right? Not something that makes us feel deprived, not something where we’re restricting anything. We’re focusing on more nutrient dense foods, but we’re making room for all foods so that we’re getting enough joy from our diets that we can stick to it, that we never hit that moment of disinhibition, and you can, you can still achieve a caloric deficit with Nutri bore, if that’s something that’s important to you. But instead of doing that trade right, I’m trading all of these foods with nutrients in order to have the structure that causes a caloric deficit. You’re you’re not treating health. For for weight loss, you’re supporting health and healthy weight loss. That’s more maintainable, but we’re still gonna have, like, if, if the clerk deficits too big, we’re still gonna have those maladaptations that make it really hard, which, again, is why I say slow and steady wins the race. And I think it’s really important to understand that the words thin and the words healthy do not mean the same thing, right, right? Exist, but when they don’t, if I have to choose between one, I’m going to choose healthy over thin. Like, yeah, every time. And granted, that might not be everyone’s priorities, especially because society keeps telling us just how important it is that we’re all thin, which is, you know, again, part of, part of the toxic that’s another video. That’s another soapbox for another day. But, yeah, I think there’s, there’s a lot of possibilities going into feeling better at first. And if it’s, I’ve cut out a food that I’m allergic to, that could be a long term improvement, right? That could be right, I feel better now for as long as I’m continuing this diet because I don’t like I might not know what it is, but I cut out this thing that I was allergic to. So there are also explanations for why that diet might still feel better over the long term. You might have traded in a lot of ultra processed foods for a lot more whole foods. And even though that diet’s not the best diet you could be on, it’s still a step in a better direction than what you were on. So, right? You know, I think that, I think that it’s complicated, which is probably why no scientists have actually done studies to measure this, because it is so complicated. There are so many different factors, and I, I don’t want to take away somebody’s feeling good on a diet either, right? I don’t want to say, Oh, you feel good for now, even though that’s kind of what this whole video has been, even though that’s kind of what we’ve just been talking about. But
Producer Potts 26:54
I will just point out this is where nutrivore can come in, because you said before, nutribore is something you can layer on top of a dietary structure that you have found that works for you, to make sure that you are then looking at that diet, not in the terms of restriction, but looking at that diet into the terms of making sure that you’re getting all the nutrients that our bodies need to do, all the things our bodies need to do, right you’re
Dr. Sarah 27:20
doing your, I mean, depending on what you’re layering out on top of, you’re reducing, or maybe getting rid of altogether, those different trade offs where the trade is eventually gonna build up to be a problem, right? So the fewer of those like trades we can make where we’re just improving diet quality and hopefully still getting lower inflammation, and, let’s say healthier body composition. Let’s maybe say that as the goal, as opposed to like, because, again, we’re looking for health, not right, not weight loss. I mean, maybe also weight loss, but health as the top priority. So like, maybe, you know, ideally, we’d be able to have all of the above right, and we would be able to create a modest, sustainable caloric deficit that’s not going to create so many maladaptations, while also increasing our nutrient intake and increasing the intake of those foods that support long term health, while also addressing lifestyle factors and other health related behaviors, while also setting realistic goals and not restricting foods and so not creating deprivation, so that we have that moment of disinhibition where we hop on The diet roller coaster one more time, and that’s why. So just to, just to pull out my book, so the focus of nutrit is health, not weight loss. But there are a few places where I do with a caveat, so that if you really don’t want to read anything about weight loss, you’ve got the trigger warning. You can, you can skip over a couple of paragraphs. There are a couple of places where I talk about the benefits of higher protein intake, for example, for preserving lean muscle mass through weight loss, and in the appendix. So again, if this is if you need a purely like Nutrivore, weight inclusive, weight weight loss is not a focus of this book at all, but there is that information there, if weight loss is a goal for you, and it’s in the appendices, where, if it’s not a goal for you, you don’t have to see it, but if it is, it is there. So you know, the goal of Nutrivore is health first, but it is compatible with weight loss goals if that’s something that’s really important to you. And again, this is, this is your choice to decide it’s not. It’s not up to me to tell you whether or not that is a poor society or society, or anyone else to tell you whether or not that is a good goal for yourself. I hope that that goal is not driven by society telling you you have more value in a thin body. I hope that goal is something that comes from uh, internal, internally, but as somebody who has, uh, had my weight. Fluctuated by a lot over my lifetime. In many times I’ve gone through that yo yo myself, I don’t know how to fully separate out what I want for myself versus what society tells me what I want for myself. So also, like recognizing it’s really hard to know how much of that is internal versus so much programming? Not, not, very little subliminal, actually, a lot of that’s over perfect. So, so if weight loss is a goal for you, nutrivore does give tools on how to do it slowly and steadily and safely with a higher chance of maintaining at the end, because it’s working on healthy habits, not a thing that you do for a short period of time to achieve those goals that you then stop doing. But also, if you’re looking for a weight inclusive approach that’s focused on health and not weight, this book is, is that so, you know we, we want to honor your goals, no matter what they are, and give you the tools that we can for you to achieve them, whatever, whatever your your health goals are.
