11 The rocky relationship of saturated fat and

prostate cancer.
By Alan Aragon

13 Intermittent fasting: After over a decade of

research, where are we today?
By Alan Aragon

Copyright © December 1st, 2015 by Alan Aragon

Home: www.alanaragon.com/researchreview
Correspondence: [email protected]

2 Cardio: Who needs it, and who doesn’t.

By Alan Aragon

6 The effects of whey protein with or without

carbohydrates on resistance training adaptations.
Hulmi JJ, Laakso M, Mero AA, Häkkinen K, Ahtiainen JP,
Peltonen H. J Int Soc Sports Nutr. 2015 Dec 16;12:48.
[PubMed]

7 Altering fatty acid availability does not impair

prolonged, continuous running to fatigue:
Evidence for carbohydrate dependence.
Leckey JJ, Burke LM, Morton JP, Hawley JA. J Appl
Physiol (1985). 2015 Nov 19:jap.00855.2015. [PubMed]

8 Comparison of the effect of daily consumption of

probiotic compared with low-fat conventional
yogurt on weight loss in healthy obese women
following an energy-restricted diet: a randomized
controlled trial.
Madjd A, et al. Am J Clin Nutr. First published December
23, 2015, doi: 10.3945/ajcn.115.120170 [PubMed]

9 How does thinking in black and white terms relate

to eating behavior and weight regain?
Palascha A, van Kleef E, van Trijp HC. J Health Psychol.
2015 May;20(5):638-48. [PubMed]

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 1

 Are weights alone enough for good cardiovascular health?
There is some crossover benefit of each type from the standpoint
Cardio: Who needs it, and who doesn’t.
of athletic performance. However, this occurs in the direction of
By Alan Aragon resistance training benefitting endurance performance,1-4 and not
____________________________________________________ the other way around.5,6 The morphological adaptations to
resistance training and endurance training are obviously different
A hasty answer (think muscle gain & muscle retention). Fat loss comparisons
between strength versus endurance-type training have not
“Do I have to do cardio?” That’s a question I hear a lot. “Yes, if
consistently shown either to be superior to the other,7-9 even
you care about protecting your cardiovascular health.” That’s the
when energy expenditure was equated between conditions.10,11
answer I hear a lot. The problem is that the question is asked by
Unsurprisingly, under hypocaloric conditions, strength training
folks hoping for an answer along the lines of cardio being more
is superior for preserving lean mass.
of an option than a necessity. So, is that the correct answer? No,
it’s not. This is because no considerations were made for the With that out of the way, let’s address the question of whether or
individual’s goals, preferences, and tolerances – not to mention not resistance training alone is enough to attain good
their pre-existent training program and physical activity aside cardiovascular health. But first, we need to define good
from training. The correct answer can only be found by digging cardiovascular health. The American Heart Association (AHA)
through more questions. defines “Ideal Cardiovascular Health” for adults (>20 yrs old) by
specifying the following parameters:12
Individual goals & circumstances matter
The initial answer to most exercise questions is a question right  Current Smoking: never or quit >12 months ago
back: What’s the goal? The goal is a critical determinant of the  Body Mass Index (BMI): <25 kg/m2
direction you take. Goals for doing cardio vary widely, and thus  Physical Activity: ≥150 min/wk moderate intensity or ≥75 min/wk
the type and amount of cardio corresponding to the goal vary vigorous intensity or combination
widely as well. For example, if someone wanted to improve their  Healthy Diet Score: 4-5 of the guidelines listed here13
triathlon time, of course cardio must be done (and lots of it),  Total cholesterol: <200 mg/dL
since the training must reflect the goal. In an opposite example,  Blood pressure: <120/<80 mm Hg
if a full-time construction worker’s goal was to gain muscle,  Fasting Plasma Glucose: <100 mg/dL
then adding formal cardio would antagonize the goal.
So, if you look at that list and see that you have all of the
Now let’s go in the middle of those two extremes – an office parameters nailed, then according to the AHA, you’ve achieved
executive who weight-trains 4 days a week for about an hour. “Ideal Cardiovascular Health.” Now, is it possible to attain the
Does he need to do cardio? You might have an answer ready to above values on resistance training alone, minus any formal
blurt out, but let me remind you once again that we first have to cardio? That question was rhetorical – of course it is. I’ve
ask what’s the goal. The goal is the strongest determinant of the personally witnessed it in numerous case studies in my own
foundational framework of the protocol. Personal preference and practice as well as those of others in the field. I’ve seen many
physical tolerance determine the finer details. Let’s imagine that individuals with no formal exercise program whatsoever
his goal was to lose 40 lbs of fat. Well damn, throw him on the maintain all of the clinical parameters on that list. I would also
treadmill, right? Here are some more details: he has already lost point out that those standards are not free of controversy; they
20 pounds and is currently losing a consistent 1-2 lbs per week, are ultimately the opinion of the AHA, which like all health
has good blood work, is happy with his progress, has finally organizations, does not have everything right all the time (i.e.,
found a training program that he enjoys, and he hates the mere their controversially conservative stances on sodium,
idea of doing any sort of formal cardio on top of that. Does he cholesterol, and saturated fat intake).
need to do cardio to protect his cardiovascular health? No – not
at this stage in the game. However, people’s life circumstances Recommendations by the major health organizations – how
change, and goals can change as well. much of which type of physical activity?
Speaking of change, let’s take the previous example and change The important detail missing from the AHA’s recommendations
a little detail: he LOVES running, and he has no prohibitive in the peer reviewed literature is a recommended breakdown of
orthopedic or cardiac issues. Is formal cardio warranted in this the resistance- vs. endurance-type training. In a 2015 press
case? Of course it is. Now, here’s a trick question: would this release,14 the AHA recommends the following for “Overall
cardio-loving individual achieve better health in this scenario Cardiovascular Health:”
than the previous one? Yes, you say? I’ll throw in a twist. Let’s
imagine that the guy who hates the idea of formal cardio loves to  At least 30 minutes of moderate-intensity aerobic
flex his green thumb, and he’s got a huge yard that he tends to activity at least 5 days per week for a total of 150
for several hours a week. Let’s also imagine that he’s got kids minutes, OR At least 25 minutes of vigorous aerobic
that he plays with in that big yard almost every day. Would activity at least 3 days per week for a total of 75
adding formal cardio to this routine still be necessary to protect minutes; or a combination of moderate- and vigorous-
his heart health? Think about it. intensity aerobic activity.

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 2

  Moderate- to high-intensity muscle-strengthening Important, yet overlooked NEAT considerations
activity at least 2 days per week for additional health
benefits. The universal claim that everyone needs to force some amount
of formal cardio to protect heart health ignores the fact that
Recommendations for adults by the US Department of Health & individuals vary widely in not only their volume of exercise, but
Human Services (HHS) are similar, even in their de-prioritizing also in their amount of NEAT. NEAT has been defined as,
of “muscle strengthening” activity:15 “...the energy expended for everything that is not sleeping,
eating, or sports-like exercise. It includes the energy expended
 For substantial health benefits, adults should do at least walking to work, typing, performing yard work, undertaking
150 min/week of moderate-intensity, or 75 min/week of agricultural tasks, and fidgeting.”14 A shining example of a high-
vigorous-intensity aerobic physical activity, or an NEAT person is my wife, who has dedicated minimal time to the
equivalent combination of moderate- and vigorous gym, but has been lean for all of her adult life. Among the many
intensity aerobic activity. things I find fascinating about her is that she gets up in the
 For additional and more extensive health benefits, morning and never sits down until it’s time to go to bed. Not
adults should increase their aerobic physical activity to only does she never sit down, she never stops moving. Her blood
300 minutes (5 hours) a week of moderate intensity, or work is awesome, as are all of her other health markers. Does
150 minutes a week of vigorous intensity aerobic she need to add formal cardio?
physical activity, or an equivalent combination of
moderate- and vigorous-intensity activity. Additional Another personal example was my struggle to gain muscle while
health benefits are gained by engaging in physical I was a full-time college student. Walking across campus all day
with a full backpack of books was a fine source of interference
activity beyond this amount.
in the quest to get more meat on my frame. I was also a drummer
 Adults should also do muscle-strengthening activities
in a rock band, and practice both with and without the rest of the
that are moderate or high intensity and involve all
band was another source of energy expenditure that antagonized
major muscle groups on 2 or more days a week, as
my gainz. Any drummer reading this knows that we are
these activities provide additional health benefits.
champion fidgeters. Even when we’re not on a kit, we’re
hand/finger-tapping and foot-bouncing away, all day. Stacking
The American College of Sports Medicine (ACSM)’s guidelines
these elements of NEAT on top of bicycling as a means of
are also similar, with the addition of a joint flexibility/mobility
transportation was a good recipe for compromising rates of
component:16 muscle gain. But hey – I’m sure my endurance was great (too
 The ACSM recommends that most adults engage in bad endurance was not my goal).
moderate-intensity cardiorespiratory exercise training
NEAT has a solid body of literature supporting its potency.
for ≥30 min/day on ≥5 days/week for a total of ≥150 Below is a graph by Levine,17 illustrating the components of
min/week, vigorous-intensity cardiorespiratory exercise energy expenditure in sedentary adults:
training for ≥20 min/day on ≥3 days/week (≥75
min/week), or a combination of moderate- and
vigorous-intensity exercise to achieve a total energy
expenditure of ≥500-1000 MET minutes per week.
 On 2-3 days/week, adults should also perform
resistance exercises for each of the major muscle
groups, and neuromotor exercise involving balance,
agility, and coordination.
 Crucial to maintaining joint range of movement,
completing a series of flexibility exercises for each the
major muscle-tendon groups (a total of 60 s per
exercise) on ≥2 days/week is recommended.

As you can see, all of those organizations converge on a

variation of the same theme, which involves a total of 150
min/week completed over the course of at least 5 days per week
(although the HHS omitted specifying frequency). All of them
are also in agreement that resistance training should be done at
least 2 days per week. Any way you slice it, the emphasis
appears to be on aerobic work, with strength training taking
second priority in terms of volume/frequency. Now, is this a
good prescription for the general, sedentary population? Yes. What follows is a schematic by Trexler et al,18 illustrating the
However, designing programs for individuals involves the more components of energy expenditure. This one is similar to
delicate process of examining the full range of variables. One of Levine’s but it also includes exercise activity thermogenesis
the most important variables is non-exercise activity (EAT) in addition to the thermic effect of food (TEF), NEAT,
thermogenesis (NEAT), which I’ll discuss next. and basal metabolic rate (BMR):

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 3

 If the goal is to build endurance capacity – especially for sports
competition – formal cardio (predominantly in the form of the
sport in question) is obviously necessary to achieve the desired
adaptations. However, for the goal of achieving or maintaining
good cardiovascular health, individual lifestyle differences can
significantly alter the recommendations. Note the 2000 kcal
difference between the lowest and highest NEAT levels in the
previous set of occupation types. Depending on duration and
intensity, 2000 kcal is the equivalent of roughly 3-5 training
sessions. Occupational NEAT must be factored into
programming. Non-occupational NEAT must also be considered
when evaluating the relative necessity of programming formal
cardio sessions into a routine. Therefore, the following scenarios
necessitate the programming of formal cardio sessions in
addition to resistance training:
Notice how NEAT is substantially greater than EAT. My point is
that you cannot make hasty judgments about the need to add  Goals specifically geared toward building endurance
cardio without a diligent assessment of the individual’s profile of capacity
energy expenditure, which includes both exercise and non-  Low-NEAT occupation combined with a low-NEAT
exercise components. And once that’s done, you still have to lifestyle outside of work (little to no walking, little to
factor in personal preference and tolerance, which ultimately no physical play, little to no housework or physical
impact adherence to the program. hobbies)
 Low volume of resistance training (less than 3 hours
Weights impart cardiovascular (& other) benefits per week), particularly if the training protocol involves
little to no training to failure, the reps are low, and the
The Editor’s Cut of the November 2010 issue of AARR went
rest intervals are long
into depth about the favorable cardiometabolic effects of
resistance training, so I’ll refer you to that article for the full
In contrast, it is not necessary to program formal cardio into the
scoop rather than regurgitate it here. In a nutshell, resistance following scenarios (I’ll reiterate that you’re free to add cardio
training is an effective for preventing and alleviating the ‘Big 3’
sessions if you enjoy it):
components of the metabolic syndrome: dyslipidemia,
hypertension, and impaired glucose control. The trusty weights  High-NEAT occupation (full-time)
have additional benefits that include the preservation of muscle
 High-NEAT lifestyle outside of work (regular walks or
mass, bone mass, and immunity. Another under-appreciated and
hikes, physical play, housework, yard work, physical
under-recognized benefit of resistance training is its ability to
hobbies, etc)
impart gains in cardiovascular fitness. A relatively recent review
by Steele et al20 concluded that adaptations to resistance training  High volume of resistance training (6 hours per week or
to failure (up-regulation of mitochondrial enzymes, more)
mitochondrial proliferation, conversion towards a type IIa  Moderate to high volume of aerobically-oriented
phenotype, and capillarization) are similar to those of traditional resistance training – high reps, short rest periods,
aerobic endurance exercise. Thus, it’s possible that similar substantial endurance component (4 hours a week or
cardiovascular health benefits can be reaped – in addition to more)
musculoskeletal benefits.  Moderate to high volume of resistance training where
work sets are taken to failure (4 hours a week or more)
Conclusions & practical considerations
Back to the original question of whether or not doing ‘formal’ Keep in mind that the above scenarios are a snippet of many
cardio is necessary for good cardiovascular health, the answer possibilities. There are plenty of scenarios that fall under the
depends on several factors. To reiterate, the recommendations by gray area of “may or may not benefit from adding formal cardio
the major health organizations are appropriate for the general, sessions to achieve good cardiovascular health.” For those cases
sedentary population. However, things can change considerably of uncertainty, your job as the skilled practitioner is to make that
when individual scenarios are examined. Have a look at the judgment, and assist in the progression towards the appropriate
escalating NEAT levels in the following range of occupation direction – if any program adjustment is warranted at all.
types, as outlined by Levine:19
References
 Chair-bound: 300 kcal/day 1. Vincent KR, Braith RW, Feldman RA, Kallas HE,
 Seated work, no option of moving: 700 kcal/day Lowenthal DT. Improved cardiorespiratory endurance
 Seated work, discretion & requirement to move: 1000 kcal/day following 6 months of resistance exercise in elderly men
 Standing work; e.g., shop assistant, home maker: 1400 kcal/day and women. Arch Intern Med. 2002 Mar 25;162(6):673-8.
 Strenuous work; e.g., agriculture: 2300 kcal/day [PubMed]

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2. Jung AP. The impact of resistance training on distance Van Horn L, Winston M, Wylie-Rosett J. Diet and lifestyle
running performance. Sports Med. 2003;33(7):539-52. recommendations revision 2006: a scientific statement from
[PubMed] the American Heart Association Nutrition Committee.
3. Chtara M, Chamari K, Chaouachi M, Chaouachi A, Koubaa Circulation. 2006 Jul 4;114(1):82-96. [PubMed]
D, Feki Y, Millet GP, Amri M. Effects of intra-session 14. AHA. American Heart Association Recommendations for
concurrent endurance and strength training sequence on Physical Activity in Adults. Last reviewed Feb, 2014.
aerobic performance and capacity. Br J Sports Med. 2005 [AHA]
Aug;39(8):555-60. [PubMed] 15. HHS. 2008 Physical Activity Guidelines for Americans
4. Mikkola JS, Rusko HK, Nummela AT, Paavolainen LM, Summary. [no review date specified] [HHS]
Häkkinen K. Concurrent endurance and explosive type 16. Garber CE, Blissmer B, Deschenes MR, Franklin BA,
strength training increases activation and fast force Lamonte MJ, Lee IM, Nieman DC, Swain DP; American
production of leg extensor muscles in endurance athletes. J College of Sports Medicine. American College of Sports
Strength Cond Res. 2007 May;21(2):613-20. [PubMed] Medicine position stand. Quantity and quality of exercise
5. Wilson JM, Marin PJ, Rhea MR, Wilson SM, Loenneke JP, for developing and maintaining cardiorespiratory,
Anderson JC. Concurrent training: a meta-analysis musculoskeletal, and neuromotor fitness in apparently
examining interference of aerobic and resistance exercises. J healthy adults: guidance for prescribing exercise. Med Sci
Strength Cond Res. 2012 Aug;26(8):2293-307. [PubMed] Sports Exerc. 2011 Jul;43(7):1334-59. [PubMed]
6. Kikuchi N, Yoshida S, Nakazato K. The effect of high- 17. Levine JA. Nonexercise activity thermogenesis (NEAT):
intensity interval cycling sprints subsequent to arm-curl environment and biology. Am J Physiol Endocrinol Metab.
exercise on upper-body muscle strength and hypertrophy: A 2004 May;286(5):E675-85. [PubMed]
pilot study. J Strength Cond Res. 2015 Dec 18. [Epub ahead 18. Trexler ET, Smith-Ryan AE, Norton LE. Metabolic
of print] [PubMed] adaptation to weight loss: implications for the athlete.J Int
7. Weinstock RS, Dai H, Wadden TA. Diet and exercise in the Soc Sports Nutr. 2014 Feb 27;11(1):7. [PubMed]
treatment of obesity: effects of 3 interventions on insulin 19. Levine JA. Nonexercise activity thermogenesis--liberating
resistance. Arch Intern Med. 1998;158(22):2477–2483. the life-force. J Intern Med. 2007 Sep;262(3):273-87.
[PubMed] [PubMed]
8. Wadden TA, Vogt RA, Andersen RE, et al. Exercise in the 20. Steele J, Fisher F, McGuff D, Bruce-Low S, Smith D.
treatment of obesity: effects of four interventions on body Resistance training to momentary muscular failure improves
composition, resting energy expenditure, appetite, and cardiovascular fitness in humans: a review of acute
mood. J Consult Clin Psychol. 1997;65(2):269–277. physiological responses and chronic physiological
[PubMed] adaptations. J Exerc Physiol. 2012 Jun;15(3):53-80. [JEP]
9. Wadden TA, Vogt RA, Foster GD, et al. Exercise and the
maintenance of weight loss: 1-year follow-up of a controlled
clinical trial. J Consult Clin Psychol. 1998;66(2):429–433.
[PubMed]
10. Geliebter A, Maher MM, Gerace L, et al. Effects of strength
or aerobic training on body composition, resting metabolic
rate, and peak oxygen consumption in obese dieting
subjects. Am J Clin Nutr. 1997;66(3):557–563. [PubMed]
11. Geliebter A, Ochner CN, Dambkowski CL, Hashim SA.
Obesity-related hormones and metabolic risk factors: a
randomized trial of diet plus either strength or aerobic
training versus diet alone in overweight participants. J
Diabetes Obes. 2014 Jul 29;1(1):1-7. [PubMed]
12. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D,
Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G,
Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS,
Masoudi FA, Robertson RM, Roger V, Schwamm LH,
Sorlie P, Yancy CW, Rosamond WD; American Heart
Association Strategic Planning Task Force and Statistics
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[PubMed]
13. American Heart Association Nutrition Committee,
Lichtenstein AH, Appel LJ, Brands M, Carnethon M,
Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris
WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F,

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 5

 assessed via DXA, muscle thickness (cross-sectional area; CSA)
was assessed via ultrasound.
The effects of whey protein with or without
carbohydrates on resistance training adaptations. Study limitations

Hulmi JJ, Laakso M, Mero AA, Häkkinen K, Ahtiainen JP, The authors acknowledged the limitation of having only a single
Peltonen H. J Int Soc Sports Nutr. 2015 Dec 16;12:48. [PubMed] time point of dietary journal assessment (once during the second
4-week block of the 12-week resistance training period). This is
BACKGROUND: Nutrition intake in the context of a resistance a potentially profound limitation since there’s no way to
training (RT) bout may affect body composition and muscle compare habitual dietary habits with the dietary conditions
strength. However, the individual and combined effects of whey imposed during the trial. The potential for an unaccounted
protein and carbohydrates on long-term resistance training margin of significant difference compromises the strength of the
adaptations are poorly understood. METHODS: A four-week results – especially since the study was assessing the effect of
preparatory RT period was conducted in previously untrained nutritional factors as well as training factors. A final limitation is
males to standardize the training background of the subjects. that the results might not apply to trained/athletic populations.
Thereafter, the subjects were randomized into three groups: 30 g
of whey proteins (n = 22), isocaloric carbohydrates Comment/application
(maltodextrin, n = 21), or protein + carbohydrates (n = 25).
Within these groups, the subjects were further randomized into
two whole-body 12-week RT regimens aiming either for muscle
hypertrophy and maximal strength or muscle strength,
hypertrophy and power. The post-exercise drink was always
ingested immediately after the exercise bout, 2-3 times per week
depending on the training period. Body composition (by DXA),
quadriceps femoris muscle cross-sectional area (by panoramic
ultrasound), maximal strength (by dynamic and isometric leg
press) and serum lipids as basic markers of cardiovascular
health, were analysed before and after the intervention.
RESULTS: Twelve-week RT led to increased fat-free mass,
muscle size and strength independent of post-exercise nutrient
intake (P < 0.05). However, the whey protein group reduced Regarding body composition (as seen above, click the images to
more total and abdominal area fat when compared to the see larger versions) significant & similar increases in lean mass
carbohydrate group independent of the type of RT (P < 0.05). and CSA were seen in all groups. Importantly, the extra
Thus, a larger relative increase (per kg bodyweight) in fat-free carbohydrate (34.5 g maltodextrin in the protein-carb condition
mass was observed in the protein vs. carbohydrate group did not lead to greater gains in lean mass than the protein-only
(P < 0.05) without significant differences to the combined group. condition (37.5 g whey protein concentrate, containing 30 g
No systematic effects of the interventions were found for serum protein). This is essentially a longer-term corroboration of the
lipids. The RT type did not have an effect on the adaptations in null results seen in acute studies testing the addition of
response to different supplementation paradigms. carbohydrate to sufficient protein doses (≥ 20 g) on protein
CONCLUSIONS: Post-exercise supplementation with whey synthetic response. Regional differences in fat mass change were
proteins when compared to carbohydrates or combination of detected in favor of the protein-containing conditions.
proteins and carbohydrates did not have a major effect on Significant & similar decreases in leg fat mass were only seen in
muscle size or strength when ingested two to three times a week. the protein and protein-carb groups – not in the carb-only group.
However, whey proteins may increase abdominal fat loss and Furthermore, decreases in trunk and android fat mass were also
relative fat-free mass adaptations in response to resistance greater in the protein-containing groups. What’s interesting
training when compared to fast-acting carbohydrates. about this result is that the greater caloric load of the protein-
SPONSORSHIP: This work was supported by Tekes-National carb condition did not prevent it from outperforming the carb-
Technology Agency of Finland with University of Jyväskylä. only condition in the fat loss department. Increases in leg CSA
were not significantly different across all groups.
Study strengths
Increases in maximal & isometric strength were not differently
While several acute (short-term) studies have examined the affected by any of the interventions. This lack of difference
effects of protein with- versus without the coingestion between the hypertrophy- versus strength-focused regimes might
carbohydrate,1-4 this is the first study to carry such a comparison be due to the untrained/newbie status of the subjects, whose
out in a longitudinal design capable of assessing effects on both neural gains may predominate initial adaptations. Blood lipids
muscle hypertrophy and performance. This study had a relatively were similarly unaltered across all conditions. Ultimately, the
large number of subjects, which raises the statistical power and results of this study reinforce the fat loss advantage of protein’s
allows more confidence in the results. A 4-week preparatory satiating & thermic effects,5 more so than a special temporal
phase enabled the standardization of subjects’ training status. advantage of protein ingestion in the postexercise “anabolic
Training protocols were periodized. Body composition was window.”6,7

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 6

Altering fatty acid availability does not impair (21.1 km) in attempt to bolster external validity and reflect real-
prolonged, continuous running to fatigue: Evidence world race conditions. 24 hours before testing, carbohydrate
for carbohydrate dependence. intake was standardized at 8 g/kg. This insured that each subject
enetered each trial with similarly stocked glycogen levels.
Leckey JJ, Burke LM, Morton JP, Hawley JA. J Appl Physiol
(1985). 2015 Nov 19:jap.00855.2015. [PubMed]
Study limitations
PURPOSE: We determined the effect of suppressing lipolysis
The sample size was small (12 subjects), but each subject
via administration of nicotinic acid (NA) on fuel substrate underwent all 4 conditions. The results seen might be limited to
selection and half-marathon running capacity. DESIGN: In a the exercise testing protocol (running for ~84 min @ 78.8%
single-blinded Latin square design, 12 competitive runners VO2max). Carbohydrate dosing during exercise in the fed
completed four trials involving treadmill running until volitional conditions was 44 g/hr. It can be argued that this dose was
fatigue at a pace based on 95% of personal best half-marathon suboptimal. Recent work by Smith et al8 compared wide range
time. Trials were completed in a fed or overnight fasted state: 1) of hourly CHO doses (0-120 g in 10 g increments) consumed
Carbohydrate (CHO) ingestion before (2 g CHO·kg·BM-1), and during 2-hours of cycling at 70.8% of VO2max followed by a
during (44 g·h-1) [CFED]; 2) CFED plus NA ingestion [CFED- time trial. The greatest performance occurred at 78 g/hr, after
NA]; 3) fasted with placebo ingestion during [FAST] 4) FAST which point performance decreased. “Multiple transportable”
plus NA ingestion [FAST-NA]. RESULTS: There was no carbohydrates (a mix of glucose, maltodextrin, and fructose) was
difference in running distance (CFED 21.53 ± 1.07, CFED-NA used in the latter study, . The present study did not report the
21.29 ± 1.69, FAST 20.60 ± 2.09, FAST-NA 20.11 ± 1.71 km) carbohydrate source. A final limitation that is that the subjects
or time to fatigue between the four trials. Plasma free fatty acids were not keto-adapted (via having been on a ketogenic diet for a
(FFA) and glycerol concentrations were suppressed following number of weeks prior to testing), which has been touted to
NA ingestion irrespective of pre-exercise nutritional intake but increase endurance capacity. However, performance benefits of
were higher throughout exercise in FAST compared to all other keto-adaptation have been elusive.9,10
trials (P<0.05). Rates of whole body CHO oxidation were
unaffected by NA ingestion for CFED and FAST, but were Comment/application
lower in FAST
compared to CFED-
NA (P<0.05). CHO
was the primary
substrate for exercise
in all conditions,
contributing 83-91%
to total energy
expenditure with
only a small contri-
contribution from at-based fuels. CONCLUSIONS: Blunting This study yielded two major findings. First of all, nicotinic
the exercise-induced increase in FFA via NA ingestion did not acid-mediated suppression of circulating fatty acid availability
impair intense running capacity lasting ~85 min nor alter had no impact on endurance capacity. This lack of difference
patterns of substrate oxidation in competitive athletes. While was seen despite the two fed conditions involving a large
there was a small, but obligatory use of fat-, the oxidation of amount of carbohydrate (2 g/kg) ingested 2 hours before
CHO-based fuels predominates during half-marathon running. exercise and 44 g/hr during. The other major finding was that all
SPONSORSHIP: This study was funded by research grants from 4 conditions showed a predominance of carbohydrate use (83-
the Department of Sports Nutrition at the Australian Institute of 91% of total energy expenditure) to fuel muscular work, as
Sport (AIS) and SiS (Science in Sport) Limited, UK. shown in the table above. Importantly, this was seen despite 2 of
the conditions being in a fasted state (no carbohydrate ingested
Study strengths pre- or during exercise), with one of the fasted conditions being
free of the administration of nicotinic acid & thus primed to
This study is innovative since it’s the first to objectively and maximally allow lipolysis.
systematically address the question of whether or not the
suppression of endogenous fatty acid use is a limiting factor in The implications of these findings are important in answering
endurance capacity during higher-intensity running. This the questions and claims about altering fuel substrate utilization
investigation was inspired by the relatively recent push of the to increase the oxidation of fatty acids. In plain language, this
idea that strategies to increase the utilization of fats (as opposed study was not a victory for those who believe in the benefit of
to the dominant fuel, carbohydrate) can be beneficial due to the being better able to ‘tap into’ stored fat to fuel endurance
vastly greater abundance of body fat for fuel than stored performance. If mobilizing and using more stored fat
carbohydrate. Subjects were competitive runners, not untrained (intramuscular as well as adipose-derived) was ergogenic, we
individuals. A good design move was setting the treadmill speed would have seen more endurance capacity in the conditions with
at 95% of their personal-best performance of a half-marathon lowered carbohydrate availability. That simply was not the case.

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 7

 parameters) have become a topic of great interest in recent years.
This study is the first to ever compare a probiotic-enriched, low-
Comparison of the effect of daily consumption of fat yogurt with a standard low-fat yogurt. The sample size was
probiotic compared with low-fat conventional yogurt uncommonly large for a diet-related study (89 subjects were
on weight loss in healthy obese women following an randomly assigned to 2 groups). Compliance was enforced via
energy-restricted diet: a randomized controlled trial. twice-weekly phone interviews and a 3-dau food questionnaire
that was completed at 3 points during the trial. Subjects who did
Madjd A, et al. Am J Clin Nutr. First published December 23, not provide sufficient detail in their dietary records were
2015, doi: 10.3945/ajcn.115.120170 [PubMed] excluded from the study. The yogurt products compared were
BACKGROUND: Despite evidence for the beneficial effects of macronutritionally identical.
probiotics and low-fat dairy products, to our knowledge, no
study has compared the beneficial effect on weight loss of Study limitations
consuming a probiotic yogurt (PY) compared with a standard
The authors acknowledged some limitations (occasionally,
low-fat yogurt (LF) during a hypoenergetic program.
OBJECTIVE: We compared the effect of the PY with LF authors lazily or egotistically neglect to mention the limitations
yogurt consumption on body weight and cardiometabolic risk of their work). Only women were included in the study, so
factors in women during a weight-loss program. DESIGN: questions remain open about how the results might have differed
Overweight and obese women [body mass index (in kg/m2): 27- in men. The study’s duration (12 weeks) leaves uncertainty
40; age: 18-50 y) who usually consumed standard LFs were about longer-term effects of the treatments. A final limitation
asked to consume either PY or LF every day with their main they conceded to was that they were at the mercy of self-
meals for 12 wk while following a weight-loss program. reported food intake, which is subject to a certain degree of
RESULTS: A total of 89 participants were randomly assigned inaccuracy and/or dishonesty. I would add to these limitations
to one of the 2 intervention groups. Baseline variables were not that although exercised was encouraged (the goal was to work
significantly different between groups. A statistically significant up to 60 minutes of exercise 5 days a week), it was not a formal
reduction in anthropometric measurements and significant or enforced assignment. Thus, there was the potential for
improvements in cardiometabolic risk characteristics were confounding variability in physical activity across the subjects.
observed over the 12 wk in both groups. However, no significant
differences in weight loss and anthropometric measurements Comment/application
were seen between groups after the
intervention. Compared with the LF
group, the PY group had a greater (mean
± SD) decrease in total cholesterol (PY = -
0.36 ± 0.10 mmol/L, LF = -0.31 ± 0.10
mmol/L; P = 0.024), low-density
lipoprotein cholesterol (PY = -0.35 ± 0.10
mmol/L, LF = -0.31 ± 0.11 mmol/L; P =
0.018), homeostasis model assessment of
insulin resistance (PY = -0.55 ± 0.32, LF
= -0.42 ± 0.20; P = 0.002), 2-h
postprandial glucose (PY = -0.61 ± 0.24
mmol/L, LF = -0.44 ± 0.19 mmol/L; P <
0.001), and fasting insulin concentration
(PY = -1.76 ± 1.01 mU/mL, LF = -1.32 ±
0.62 mU/mL; P = 0.002), as secondary endpoints after the study. As seen above, the main finding is that no significant differences
No significant differences were found for fasting plasma in weight loss (or waist circumference) were seen between
glucose, high-density lipoprotein cholesterol, or triglycerides groups (note that P values in the far-right column are for the PY
within both groups after the 12 wk. CONCLUSION: group relative to the LF group). However, significant between-
Consumption of PY compared with LF with main meals showed group differences were seen in total cholesterol (by virtue of the
no significant effects on weight loss. However, it may have probiotic yogurt group’s larger drop in LDL-C), and insulin
positive effects on lipid profiles and insulin sensitivity during a sensitivity, which improved more the probiotic group. The
weight-loss program. This trial was registered at authors conceded that these apparent advantages of the probiotic
http://www.irct.ir/ as IRCT201402177754N8. SPONSORSHIP: treatment could potentially be due to differences in other aspects
Supported by the School of Life Sciences, University of of the diets. They made this disclaimer because previous
Nottingham and the Digestive Disease Research Institute, research has not supported the finding that probiotic-enriched
affiliated with Tehran University of Medical Sciences. yogurt improves lipid profile.11-13 As for the improvement in
insulin sensitivity, a recent meta-analysis by Ruan et al supports
Study strengths
it, reporting that probiotic consumption may have a modestly
Effects of probiotic supplementation on the gut microbiota and beneficial effect on glycemic control.14 This could have
its implications for bodyweight/fat control (among other clinical therapeutic implications for pre-diabetics and diabetics.

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 8

 and “weight regainers.” Control variables included body mass
index (BMI), age, sex, and education level.
How does thinking in black and white terms relate to
eating behavior and weight regain? Results
Palascha A, van Kleef E, van Trijp HC. J Health Psychol. 2015
The participants had the following characteristics: Aged 15-74
May;20(5):638-48. [PubMed] years; 64.7, 28.2, & 7.1 % of them were classified as highly,
ABSTRACT: This study explores the role of dichotomous thinking middle, and low-educated, respectively. 34% were on a diet, and
on eating behavior and its association with restraint eating and 22.8% regained weight after weight loss within the past 5 years.
weight regain in a wide range of people. In a web-based survey with Restraint eating was positively correlated with weight regain,
241 adults, dichotomous thinking and behavioral outcomes related dieting, and dichotomous thinking. Weight regain positively
to eating (restraint eating, weight regain, body mass index, dieting) correlated with dieting. Eating-specific dichotomous thinking
were assessed. Results showed that eating-specific dichotomous positively correlated with all of the variables examined.
thinking (dichotomous beliefs about food and eating) mediates the Dichotomous thinking persistently showed significant
association between restraint eating and weight regain. We conclude correlations regardless of the presence of the control variables.
that holding dichotomous beliefs about food and eating may be Higher levels of dietary restraint were seen alongside increasing
linked to a rigid dietary restraint, which in turn impedes people's levels of dichotomous thinking. Importantly, eating-specific
ability to maintain a healthy weight. dichotomous thinking (but not general dichotomous thinking)
was positively correlated with weight regain. Here are the
Background & purpose authors’ hypotheses along with confirmation or lack of:
This study is conceptually strong, since it tackles the question of 1) Dichotomous thinking (general and eating-specific) is
the role dichotomous thinking plays in helping or hindering positively associated with restraint eating: CONFIRMED.
bodyweight management. Within the context of dietary restraint, 2) Dichotomous thinking (general and eating-specific) is
dichotomous thinking falls under the “rigid” (as opposed to the positively associated with weight regain: NOT
“flexible”) approach. Dichotomous thinking, as the term implies, CONFIRMED.
involves an all-or-nothing, rule-based mode of operation. Unlike 3) Eating-specific dichotomous thinking mediates the
previous research focused on narrow subpopulations (i.e., obese association between general dichotomous thinking and
subjects with eating disorders), this study’s aim was to generate restraint: CONFIRMED.
findings that represent the general population. 4) Eating-specific dichotomous thinking mediates the
association between general dichotomous thinking and
Design weight regain: NOT CONFIRMED.
5) Eating-specific dichotomous thinking mediates the
association between restraint eating and weight regain:
CONFIRMED.

Limitations & conclusions

The authors acknowledged that the use of convenience sampling
resulted in an unbalanced proportion of males and females (with
almost 4 times as many females). Also, this study’s cross-
sectional design is classified as observational. It’s not a
controlled intervention complete with randomly assigned
subjects to experimental & control groups, and thus, it cannot
demonstrate causation or direction of causality – it can only
draw associations. Furthermore, self-reported data is subject to
inaccuracy & bias. An important limitation is that no distinction
was made between voluntary and involuntary weight loss. The
The above schematic depicts framework of the study and the following excerpt from the conclusion eloquently sums up the
elements under investigation. 241 subjects (49 M, 192 F) implications of the findings:
completed the online survey of this cross-sectional study.
Participants were blinded about the purpose of the study, only “This implies that an increase in restraint eating may relate to
told that it was for the fulfillment of the requirements of an MSc more weight regain due to the tendency of restraint eaters to
thesis on eating behavior. A validated, 11-question survey think about food and dieting in dichotomous terms. This “all
(Dichotomous Thinking in Eating Disorders Scale – DTEDS) or nothing” thinking style may be the reason why people fail
was used. Two subscales were used to examine eating-specific to adhere to their diets and regain weight in the long-term.
dichotomous thinking (DTEDS-Eating, such as perceiving foods [...] We showed that it was the dichotomous beliefs about
as good or bad), and general dichotomous thinking (DTEDS- food and dieting that predicted weight regain, rather than
General). The Dichotomous Thinking Inventory (DTI), a 15- the restraint eating behavior per se. This shows that a rigid
question survey, was used to determine the general tendency of form of dietary restraint that encompasses a cognitive
the subjects toward dichotomous thinking. Measures of eating dysfunctionality (in this case, dichotomous thinking) may
behavior involved the use of the Dutch Eating Behavior impede people’s ability to control their intake and lead to
Questionnaire (DEBQ), which identified “weight maintainers” weight regain.”

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 9

 14. Ruan Y, Sun J, He J, Chen F, Chen R, Chen H. Effect of
Probiotics on Glycemic Control: A Systematic Review and
1. Koopman R, Beelen M, Stellingwerff T, Pennings B, Saris Meta-Analysis of Randomized, Controlled Trials. PLoS
WH, Kies AK, Kuipers H, van Loon LJ. Coingestion of One. 2015 Jul 10;10(7):e0132121. [PubMed]
carbohydrate with protein does not further augment
postexercise muscle protein synthesis. Am J Physiol
Endocrinol Metab. 2007 Sep;293(3):E833-42. [PubMed]
2. Staples AW, Burd NA, West DW, Currie KD, Atherton PJ,
Moore DR, Rennie MJ, Macdonald MJ, Baker SK, Phillips
SM. Carbohydrate does not augment exercise-induced
protein accretion versus protein alone. Med Sci Sports
Exerc. 2011 Jul;43(7):1154-61. [PubMed]
3. Hamer HM, Wall BT, Kiskini A, de Lange A, Groen BB,
Bakker JA, Gijsen AP, Verdijk LB, van Loon LJ.
Carbohydrate co-ingestion with protein does not further
augment post-prandial muscle protein accretion in older
men. Nutr Metab (Lond). 2013 Jan 25;10(1):15. [PubMed]
4. Gorissen SH, Burd NA, Hamer HM, Gijsen AP, Groen BB,
van Loon LJ. Carbohydrate coingestion delays dietary
protein digestion and absorption but does not modulate
postprandial muscle protein accretion. J Clin Endocrinol
Metab. 2014 Jun;99(6):2250-8. [PubMed]
5. Leidy H, Clifton P, Astrup A, Wycherley T, Westerterp-
Plantenga M, Luscombe-Marsh N, et al. The role of protein
in weight loss and maintenance. Am J Clin Nutr. 2015; pii:
ajcn084038. [Epub ahead of print]. [PubMed]
6. Aragon AA, Schoenfeld BJ. Nutrient timing revisited: is
there a post-exercise anabolic window? J Int Soc Sports
Nutr. 2013 Jan 29;10(1):5. [PubMed]
7. Schoenfeld BJ, Aragon AA, Krieger JW. The effect of
protein timing on muscle strength and hypertrophy: a meta-
analysis. J Int Soc Sports Nutr. 2013 Dec 3;10(1):53.
[PubMed]
8. Smith JW, Pascoe DD, Passe DH, Ruby BC, Stewart LK,
Baker LB, Zachwieja JJ. Curvilinear dose-response
relationship of carbohydrate (0-120 g•h(-1)) and
performance. Med Sci Sports Exerc. 2013 Feb;45(2):336-
41. [PubMed]
9. Burke LM, Kiens B. "Fat adaptation" for athletic
performance: the nail in the coffin? J Appl Physiol (1985).
2006 Jan;100(1):7-8. [PubMed]
10. Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk
M, Zydek G. The effects of a ketogenic diet on exercise
metabolism and physical performance in off-road cyclists.
Nutrients. 2014 Jun 27;6(7):2493-508. [PubMed]
11. Sadrzadeh-Yeganeh H, Elmadfa I, Djazayery A, Jalali M,
Heshmat R, Chamary M. The effects of probiotic and
conventional yoghurt on lipid profile in women. Br J Nutr.
2010 Jun;103(12):1778-83. [PubMed]
12. Ivey KL, Hodgson JM, Kerr DA, Thompson PL, Stojceski
B, Prince RL. The effect of yoghurt and its probiotics on
blood pressure and serum lipid profile; a randomised
controlled trial. Nutr Metab Cardiovasc Dis. 2015
Jan;25(1):46-51. [PubMed]
13. Fabian E, Elmadfa I. Influence of daily consumption of
probiotic and conventional yoghurt on the plasma lipid
profile in young healthy women. Ann Nutr Metab.
2006;50(4):387-93. [PubMed]

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 10

 saturated fat and prostate cancer.3 However, a common
methodological flaw is the lack of adjusting for total energy
The rocky relationship of saturated fat and prostate intake. This opens the possibility that an excessive total caloric
cancer. intake (rather than total fat or saturated fat per se) may be at
play. A minority of studies did in fact adjust for total energy, but
By Alan Aragon
their results are conflicting. A prospective cohort study by
____________________________________________________
Giovannucci, et al5 examined the relationship between advanced
prostate cancer and dietary fat over a 4-year period. Total dietary
Introduction & background
fat, including saturated fat primarily from red meat, was found to
Prostate cancer has rightly earned its perpetual place in both the have a positive correlation. Interestingly, dairy fat (with the
academic and lay press. Among American men, prostate cancer exception of butter) had no association. A subsequent cohort
is the second-highest cause of cancer death, with lung cancer at study by Veierød, et al6 with a longer follow-up period (10
the lead.1 Although prostate cancer rarely occurs before the age years) found no association between energy-adjusted intake of
of 40, an estimated 1 in 7 men will be diagnosed with prostate total fat, saturated fat, mono-unsaturated fat or poly-unsaturated
cancer during his lifetime. Interestingly, the vast majority of fat and prostate cancer. An odd finding in this study was that
prostate cancer cases are not fatal. Of the estimated 220,800 new prostate cancer risk was higher with skim milk than whole milk.
cases of prostate cancer in the US this year, 27,540 deaths will
occur. Once diagnosed, the 15-year survival rate is estimated to More recently, a large, multicenter, 8.7-year prospective cohort
be 94%. study by Crowe, et al7 involving 142,250 subjects and adjusting
for energy intake (also height, weight, smoking, education, and
The highest rates of prostate cancer occur in industrialized marital status) failed to find a significant correlation between
countries, and among them are western countries, including the total fat or fatty acid type (including saturated fat and the ratio of
US. The Western diet (characterized by a high intake of total & polyunsaturated to saturated fat) and prostate cancer risk. In
saturated fat, refined carbohydrate foods, and processed meats) addition, no significant associations were found between
has been associated with prostate cancer.2 However, because of a prostate cancer risk and the consumption of fat from dairy
multitude of concurrent variables, it has been difficult to products, fish, and even red meat.
elucidate the specific role saturated fat might play in the
pathogenesis of the disease. It’s noteworthy, but perhaps Meta-analytical data challenge the dietary fat-prostate
unsurprising that the association between unsaturated fats and cancer hypothesis
prostate cancer is weak to nonexistent.3 A small wrinkle of irony
here is that a few studies have reported an increased risk of The underlying utility of meta-analyses is their ability to provide
prostate cancer with higher intakes of alpha-linolenic acid,4 a quantitative, aerial view of the body of evidence. A properly
which is plant-derived omega-3 polyunsaturated fatty acid. Note done meta-analysis is the opposite of a cherry-picked set of
that this finding has not remained consistent in subsequent studies or data to support one’s pre-existent beliefs. It is
research. comprehensive and objective, rather than subject to confirmation
bias. Perhaps the most significant challenge to the saturated fat-
Proposed mechanisms underlying the saturated-fat/prostate prostate cancer hypothesis is a recent systematic review & meta-
cancer hypothesis include an increase in serum sex hormone analysis by Xu, et al,8 which found no significant associations
levels which could predispose individuals to prostate cancer or between total fat, saturated fat, and unsaturated fat and prostate
hasten its progression. High-heat cooking-mediated increases in cancer risk.
prostatic carcinogens (e.g., polycyclic aromatic hydrocarbons
and heterocyclic amines) is another proposed mechanism, but A noteworthy strength of this study was its investigation of a
this is less directly related to saturated fat than to the method of dose-response relationship between each type of fat and prostate
food preparation. The following discussion will review the cancer (which it did not detect). Furthermore, a sensitivity
human evidence and attempt to draw some tentative conclusions analysis was done to find unduly robust study results that could
about this complex and important topic. have skewed the overall findings (which was not the case). The
authors acknowledged the limitations of their analysis, which
Equivocal evidence, questionable threat included the confounding potential of variation in physical
activity levels, as well as the limitation of the studies only
Before diving in, it is important to keep in mind that the majority involving Americans and Europeans. Different results in other
of cancer research in humans is observational (non- populations cannot be ruled out. The null findings of Xu et al’s
experimental). It is logistically unfeasible to perform cancer- meta-analysis echo the results of another recent meta-analysis by
related experiments in humans. The time, expense, and ethical Chua, et al,9 which found no significant risk of prostate cancer
constraints are prohibitive. As such, we are limited to drawing associated with the consumption of omega-3 or omega-6 fatty
correlations/associations between variables, rather than polyunsaturated acids.
demonstrating causation, which is only possible in randomized
controlled trials (RCTs). Concluding perspectives
Several earlier observational studies have reported a frustratingly Collectively, the data do not support a consistent or meaningful
equivocal mix of positive and null correlations between correlation between not only saturated fat and prostate cancer,

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 11

but unsaturated fat and total fat as well. However, keep in mind
that the research has its share of caveats and limitations. In
addition the limitations I listed previously, epidemiological
research relies on survey methods whose accuracy depends on
the recall ability of the subjects, which is questionable. Survey
data are commonly collected at widely separated and arbitrary
time points, which can magnify the recall errors.

As the cliché goes, more research is needed to fill in the gaps of

our understanding of this topic. The practical steps towards
prostate cancer prevention would be to rotate a variety of whole
food sources of fat rather than consistently consuming a
monolithic concentration of a single type. Also, increase the
intake of whole and minimally refined plant foods, which can
provide compounds with the potential to antagonize cancer
development. Proactively avoid the consumption of charred
parts of meat, and limit your consumption of processed meat to a
minority of your intake. Other lifestyle factors such as smoking,
excessive drinking, and physical inactivity should be minimized,
and where possible, avoided. Maintain favorable body
composition and regular exercise, manage psychological stress
levels, get adequate sleep, and don’t forget to call your mom at
least once a week to say hello.

References
1. American Cancer Society. What are the key statistics about
prostate cancer? 2015. Available from:
http://www.cancer.org/cancer/prostatecancer/detailedguide/
prostate-cancer-key-statistics.
2. Mishina T, Watanabe H, Araki H, Nakao M.
Epidemiological study of prostatic cancer by matched-pair
analysis. Prostate. 1985;6(4):423-36. [PubMed]
3. Kolonel L, Nomura A, Cooney R. Dietary fat and prostate
cancer: current status. J Natl Cancer Inst. 1999;91(5):414-
28. [PubMed]
4. Pelser C, Mondul A, Hollenbeck A, Park Y. Dietary fat,
fatty acids, and risk of prostate cancer in the NIH-AARP
diet and health study. Cancer Epidemiol Biomarkers Prev.
2013;22(4):697-707. [PubMed]
5. Giovannucci E, Rimm E, Colditz G, Stampfer M, Ascherio
A, Chute C, et al. A prospective study of dietary fat and risk
of prostate cancer. J Natl Cancer Inst. 1993;85(19):1571-9.
[PubMed]
6. Veierød M, Laake P, Thelle D. Dietary fat intake and risk of
prostate cancer: a prospective study of 25,708 Norwegian
men. Int J Cancer. 1997;73(5):634-8. [PubMed]
7. Crowe F, Key T, Appleby P, Travis R, Overvad K,
Jakobsen M, et al. Dietary fat intake and risk of prostate
cancer in the European Prospective Investigation into
Cancer and Nutrition. Am J Clin Nutr. 2008;87(5):1405-13.
[PubMed]
8. Xu C, Han F, Zeng X, Liu T, Li S, Gao Z. Fat intake is not
linked to prostate cancer: a systematic review and dose-
response meta-analysis. PLoS One. 2015;10(7):e0131747.
[PubMed]
9. Chua M, Sio M, Sorongon M, Dy J. Relationship of dietary
intake of omega-3 and omega-6 Fatty acids with risk of
prostate cancer development: a meta-analysis of prospective
studies and review of literature. Prostate Cancer.
2012;2012:826254. [Prostate Cancer]

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 12

 deficit. Of note, not all WDF studies involve zero energy intake
in the ‘fasting’ days. Although WDF has been consistently
Intermittent fasting and body composition: After over effective for weight loss, Harvie et al saw no difference in
a decade of research, where are we today? bodyweight or body fat reduction between the WDF (2 ‘fasting’
days of ~647 kcal) group and controls when the weekly energy
By Alan Aragon
deficit was equated over a 6-month period.9 A subsequent study
____________________________________________________
by Harvie et al10 compared two WDF diets (one with 2
Speaking of decades... structured energy-restricted ‘fasting’ days and one whose 2
‘fasting’ days consisted of ad libitum protein and unsaturated
The last time I wrote an article about intermittent fasting (IF) fat) with daily energy restriction (DER). Both WDF diets caused
was almost a decade ago. A rich body of research on the topic greater 3-month fat loss than daily energy restriction. An
has been published since then. The ongoing interest in IF is not important detail here is that at 3 months, the 70% of the fasting
surprising, given its mystique that’s wrapped in ancient spiritual days were completed in the WDF groups while the DER group
origins, all the way to its modern applications to clinical and achieved their targeted caloric deficit only 39% of the trial.
aesthetic goals. The aim of this article is to bring the reader up-
to-date on the scientific findings, with a particular focus on Time-restricted feeding
comparing IF regimes with conventional/linear dieting. After all,
the question is not whether IF works – it obviously does, as does TRF typically involves a fasting period of 16-20 hours and a
any mode of caloric restriction. The question is whether it works feeding period of 4-8 hours daily. The most studied form of TRF
better than conventional dieting for improving body is Ramadan fasting, which involves approximately 1 month of
composition, and if so, to which contexts can we apply it. complete fasting (both food and fluid) from sunrise to sunset.
Unsurprisingly, significant weight loss occurs, and this includes
Variations on a theme a reduction in lean mass as well as fat mass.11,12 Aside from
Ramadan fasting studies, there’s a scarcity of human TRF
Let’s get some labeling/classification aspects out of the way. In research in the peer-reviewed literature. Stote et al13 compared 1
the literature, the broad categories that I call linear and non- versus 3 meals per day in eucaloric (weight–maintenance)
linear dieting have been called daily caloric restriction and conditions for 8 weeks and surprisingly found 1 meal resulted in
intermittent caloric restriction, respectively. They have also been fat loss and lean mass gain, while no significant improvements
called continuous energy restriction and intermittent energy were detected in the 3-meal group. Unfortunately, the use of
restriction. The intermittent category (what we call IF) can be bioelectrical impedance (BIA) keeps these results questionable.
further divided into three subclasses:1 alternate-day fasting Perhaps the only other longitudinal TRF study was done back in
(ADF), whole-day fasting (WDF), and time-restricted feeding 1971 by Young et al,14 who found no significant differences in
(TRF). weight loss and body composition change between 1, 3, or 6
meals per day.
Alternate-day fasting
As for TRF programs in the lay press, Hofmekler’s Warrior
The most extensively studied IF variant is ADF, which typically Diet,15 published in 2002, was perhaps the first popular diet book
involves a 24-hour fasting period alternated with a 24-hour to expose the general audience to TRF for weight loss. It
feeding period. Complete compensatory intake on the feeding involves a 4-6 hour feeding period at night, and an 18-hour
days (to offset the fasting days’ deficit) does not occur, and thus “under-feeding” period during the day. The diet draws
total weight loss and fat loss occurs on ADF. Lean mass- inspiration and justification from the purported habits of our
retention has been an intriguing effect of ADF reported by Stone Age ancestors, as well as other leaps of faith involving the
Varady et al.2-4 Lean mass loss in ADF conditions has also been sympathetic and autonomic nervous system. Berkhan’s
observed by other investigators.5-7 However, the latter effect Leangains system of TRF has a 16-hour ‘fasting’ period and an 8
might be attributable to more severe energy deficits. The more hour feeding period.16 What separates this protocol from others
lean mass-friendly Varady model is actually an energy-restricted is its attention to macronutrition, and its administration of
period (~25% of maintenance requirements, typically in the form branched chain amino acids (BCAAs) during the fasting period.
of a single meal at lunchtime) alternated with a 24-hour ad As a matter of trivia that you might enjoy, Hofmekler and
libitum (as desired) feeding period. Berkhan were recently referenced in the peer-reviewed
On the note of alternating fasting and feeding periods of the literature.17
same length, alternate-week energy restriction (one week on
~1300 kcal/day, one week on the usual diet) has only a single The most comprehensive systematic review on IF to-date
study to-date, but is worth mentioning since it was as effective
Seimon et al18 recently published the largest systematic review
as continuous energy restriction for reducing body weight and
of IF research to-date. Importantly, they compared the effects of
waist girth at 8 weeks and 1 year.8
intermittent energy restriction (IER) to continuous energy
restriction (CER) on bodyweight, body composition, and other
Whole-day fasting
clinical parameters. Their review included 40 studies in total, 12
WDF involves one to two 24-hour fasting periods through the of which directly compared an IER with a CER condition. They
week of otherwise maintenance intake in order to achieve the found that overall, the two diet types resulted in “apparently

Alan Aragon’s Research Review – December 2015 [Back to Contents] Page 13

equivalent outcomes” in terms of bodyweight reduction and resistance training (RT) 3 days a week for 8 weeks – versus an
body composition change. In addition, neither IER or CER was RT group presumably on their usual diet. No between-group
superior to the other at improving glucose control/insulin differences were seen in body composition, but interestingly,
sensitivity. No different effects on thyroid, cortisol, and sex TRT+RT outperformed the RT in leg press maximal strength
hormones were seen between IER and CER, though the authors and in bench press endurance. The full text of this will be
concede that there’s insufficient research comparing interesting to dig into if/when this study makes it into
neuroendocrine effects of the two diet types to draw definitive publication.
conclusions in this area. Interestingly, IER was superior at
suppressing hunger. The authors speculated that this might be The Editor’s Cut of the May 2012 issue of AARR pondered the
attributable to ketone production in the fasting phases. However, question of what might be the lower threshold of meal frequency
this effect was somewhat immaterial since it failed to translate for optimizing muscle gain. I concluded that this threshold,
into superior improvements in body composition or greater based on what we knew at the time, was probably 3 protein-rich
weight loss. meals. I contended that a lower daily meal frequency than that
would compromise maximal rates of muscle gain. Since that
Limitations of the review included the standard ones – relatively time, a replication of well-controlled studies has shown the
small sample sizes, relatively short trial durations, and superiority of 4 doses of 20 g whey eliciting a stronger anabolic
heterogeneous study designs making comparisons outside of the response during a 12-hour period than 2 doses of 40 g or 8 doses
same study difficult. An acknowledged limitation worth of 10 g.24,25 These findings made me re-think my position of a 3-
highlighting was that 14 of the 40 studies were by the same meal minimum. It’s plausible that folks with the goal of
research group (Varady et al, University of Illinois at Chicago). maximizing rates of muscle gain should look to a minimum of 4
Ideally, a more diversified and less concentrated set of labs is daily doses of protein at of at least 20-40 g (older subjects
less likely to repeat the same errors or preserve the same biases. require 35-40 g to maximize the anabolic response26-28).
Speaking of the potential for bias, Varady has published a lay-
directed book titled, The Every-Other-Day Diet.19 I’m not Of course, the big limitation is that acute studies can measure
claiming that Varady is destined to make sure her ADF study protein synthesis but they can’t measure changes in body
results will always square up with her book, but it’s one of the composition. Recent work by MacKenzie-Shalders et al29 found
potential caveats nevertheless. I would add to these limitations no significant difference in lean mass increase between a high
that there’s a severe lack of IER (and IER vs CER) studies that protein intake (2.6-2.7 g/kg) spread across 4 vs 6 meals in elite
include a structured training component. rugby players. This findings are interesting, but once again, 3
meals per day remains a gray area in the question of a minimum
This limitation also plagues the body of research comparing for maximizing muscle growth. Perhaps future studies will
various within-day meal frequencies. Readers familiar with my compare 3 meals versus 5 or 6 for this purpose – while imposing
work know that Brad Schoenfeld, James Krieger, and I did a an energy surplus and a progressive resistance training program.
meta-analysis on the effect of meal frequency on body Seems like just a matter of time before someone in the current or
composition, and found that higher meal frequencies were newer generation of researchers attacks this gap in the literature.
associated with greater losses of fat mass and greater retention of
lean mass.20 However, sensitivity analysis revealed that the Concluding perspectives & applications
removal of a single study21 completely eliminated the significant
effect of meal frequency on changes in body composition. It’s IF has proven itself to be an effective approach to dieting, and
worth noting that the studies in our analysis (and in this entire has outperformed conventional dieting in some cases. In the
body of literature) lacked sufficient protein. An exception was interest of cohesion to the topic, this article didn’t delve into IF’s
Arciero et al,22 who found that 6 meals per day at 35% of total effect on athletic performance. However, it’s important to keep
kcal as protein was superior to 3 meals per day for reducing total in mind that IF protocols can compromise performance goals if
body fat and abdominal fat. Furthermore, 6 meals per day careful modifications are not made. In general, IF is best applied
increased lean mass despite hypocaloric conditions. to goals oriented toward altering body composition and clinical
markers that occur alongside body fat reduction This is not to
What about muscle gain? say that muscle gain cannot occur with IF – it’s just that the rates
of gain will not likely be maximized. As for which IF variant to
The retention of lean mass in IF studies has been seen chose (ADF, WDF, TRF, etc) if one decides to try IF, the good
repeatedly. However, the question of muscle gain via IF remains news is that they all have demonstrated effectiveness in the
unanswered since the investigative focus of IF research has been literature, and therefore can be chosen on the basis of personal
on weight/fat loss and accompanying clinical effects. No IF preference. Just remember that there is no special metabolic
studies in the current literature have focused on the goal of gains magic in IF, just like there’s no stoking the metabolic furnace
in muscle size and/or strength. As such, No IF studies to-date (at with 6 meals a day.
least none that have passed peer review) have included a
structured, progressive resistance training program. This is un-
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“If you’re going through hell, keep going.” – Winston Churchill

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