The previous post discussed some reasons you might be in a calorie deficit but not losing weight. You can read it here. Much of this discussion centred on how we don’t burn calories inside our bodies. Instead, we convert the chemical energy in food into ATP and other forms of energy. The vast majority of these processes occur inside our mitochondria. And the health of our mitochondria is the linchpin in not just a healthy metabolism but also a healthy mind and body.
Not sure what mitochondria are? I’ve written this post to explain what mitochondria are and what they do. But also the dreadful consequences of harming them.
“Once upon a time” is how all the best fairytales and one of my favourite Bon Jovi songs start. But sometimes, it’s how experiments begin as well. This story is about a group of determined young men from Minnesota who wanted to do something for their country in the middle of a global catastrophe. But it will also help you to understand how you can be in a calorie deficit but not lose weight.
To set the scene, the second world war had broken out in Europe five years earlier, and it was only sixteen years after the Great War had ended. Both wars were prolonged and resulted in massive personal and economic expense. The horsemen of the apocalypse were riding roughshod all over Europe and Asia. Millions died. Famine was rife.
Against this backdrop, some researchers became committed to discovering the best methods to help people recover from famine. Although their study was published too late to help the survivors of World War 2, they knew it was only a matter of time before another famine would occur.
So today, I’d like to delve deeper into one pivotal study from the mid-1940s on using a calorie-deficit diet plan to induce extreme weight loss and starvation.
This study, beginning in 1944, was led by Ancel Keys to examine the effects of semi-starvation. Yes, that Ancel Keys. The one who convinced most of the world that saturated fat caused heart disease. Ironically, his work on starvation revealed a slew of fascinating facts on the adverse physiological effects of malnutrition, while his legacy was to create malnutrition worldwide by steering dietary advice down the path of high carbohydrate, low fat and saturated fat diets.
But back to the starvation study. In addition, the group wanted to determine the optimal approach to refeeding people who were starving. And this experiment provides some of the best evidence against caloric restriction diets. It’s usually called the Minnesota Starvation Experiment but was published in two tomes of The Biology of Human Starvation.
In the name of nutrition science, 36 previously healthy young male ‘conscientious objectors’ were put through the wringer. They volunteered to participate in a study to get them to lose about a quarter of their body weight over 6 months.
Four volunteers didn’t manage to complete the study. But the remaining 32 were calorically restricted to between 1331 and 1658 kCal per day for 6 months. This was followed by a period of rehabilitation. The diet they were forced to consume was a low-fat (30g a day), whole food, plant-based diet with token amounts of meats and dairy products per week. Their diet was also low in protein (only 50g a day), mostly from plants.
Their calorie intake needed to be adjusted up and down weekly to ensure they met their weight loss goals because their bodies responded unpredictably to creating a calorie deficit. They did this by increasing and decreasing their intake of bread and potatoes. So their carbohydrate intake was a bare minimum of 215g per day throughout the experiment and usually a lot more than this. Sometimes, their carbohydrate intake during semi-starvation was practically 300g per day!
I don’t have access to a breakdown of the micronutrients in their diet, but without meat, organ meats, fish, and dairy, I can predict substantial deficiencies in multiple nutrients with such a low protein intake. These would include shortfalls in at least:
Given the increased strain that this malnutrition would place on mitochondrial health in the setting of a carbohydrate-based diet, I would also expect there to be inadequate intakes of thiamine, niacin, and pyridoxine.
And in states of poor health due to illness, stress, surgery, and malnutrition, several other amino acids become conditionally essential to get from the diet. These are cysteine, arginine, glutamine, tyrosine, glycine, ornithine, proline, and serine. Taurine is also likely to become essential on a diet low in methionine and cysteine since these amino acids are the building blocks for taurine synthesis.
If you’ve calculated you’re in a calorie deficit but not losing weight, it could be because your metabolism is slowed by nutritional deficiencies like those above. Insufficient nutrient intakes are rife on a calorie-restricted diet. The worst thing you could do is restrict your calories further.
By the end of the semi-starvation period, these poor men were shells of their former selves, suffering from fatigue, oedema, depression, and weakness, with altered personalities and behavioural changes. They could no longer function at their work and studies and even developed addictions to chewing gum and smoking to cope with starvation. Of course, they were also painfully emaciated and had lost a lot of lean muscle mass, not just fat.
About halfway through the starvation period, Keys and Co gave them a single relief dinner where they could choose whatever they wanted to eat. So instead of two meals, they had just one. But what a meal it was. The total calorie count for that meal was about 2 300 kCal. The menu was chicken and dressing with potatoes, gravy, and many other things. The dessert was strawberry shortcake.
That night, everyone had to get up to urinate. It turned out that the animal proteins, with their extra amino acids, B vitamins and minerals from the chicken and dairy, induced a diuresis. As a result, their weight the following morning was several pounds lighter, having lost the water retention. It only took a few days to regain the excess water weight.
This helps to illustrate:
From the perspective of caloric intake, the most fascinating observations occurred after the semi-starvation period ended. The next few months of rehabilitation in the trial were devoted to investigating how to help them regain their lost muscle and weight and get them back to their former vitality levels. The 32 men were divided into 4 groups with different calorie intakes to compare their weight gain.
Initially, the lowest calorie intake group had almost an additional 400 kCal of the same plant-based foods added. While the highest-calorie group received an extra 1400 kCal per day. Some of the men received a protein supplement. This was in the form of casein and purified soybean protein which were baked into the bread and effectively disguised.
A few were given a very low vitamin supplement which sometimes failed to cover their daily recommended intakes. This hexavitamin supplement contained:
Considering what we’ve learned about nutrition in the last 80 years, you wouldn’t expect this supplement to supply enough nutrients to make much of a difference in these extreme diet conditions.
If instead, they’d been given a single 80g slice of veal liver, their daily nutrients would have been boosted by:
A slice of liver even two or three times a week would have helped them replenish some of their nutrient stores. Of course, the researchers were most interested in how people respond to refeeding following famine. And you wouldn’t expect there to be good availability of organ meats in that context. But we’re faced with a different situation these days with rampant malnutrition resulting from poor dietary advice and choices.
According to the calories in, calories out theory, a difference of 500 kCal per day compared with your regular diet should result in a weight change of 1 pound per week.
So if it held true, the men eating the extra 400 kCal per day should have gained almost 350g per week or about 50g of weight per day. Instead, they lost weight in the first few weeks as they urinated out the oedema fluid. And they only gained 1.2g per day or 50g over six weeks. As a result, they became even more demoralised than they were during the semi-starvation period.
Likewise, according to a calorie deficit weight loss calculator, the men receiving an extra 1400 kCal per day should have gained 2.8 pounds per week (1270g) or 6.4 ounces (180g) per day. But they didn’t get anywhere near that. Instead, they gained under 2.5 ounces (70.5g) per day or 6.5 pounds (2.96kg) over the entire 6 weeks.
Moreover, none of them increased their activity levels while failing to gain weight. In fact, during their semi-starvation period, they walked 22 miles a week outdoors and spent half an hour on a treadmill at a 10% incline at 3.5 miles per hour once a week. However, that fell by the wayside when they entered the rehabilitation phase.
After 6 weeks of disappointing weight gain and poor morale, the men in each group were allowed an extra 800 kCal per day from weeks 7-10. And for the last 2 weeks of rehabilitation, their calories increased again by about 260 kCal per day. The protein intake throughout recovery ranged from 61-152g per day, depending on the group and the stage.
After 12 weeks of controlled refeeding, their average BMIs at 18.4 were still well below what they were pre-starvation. 12 participants volunteered to remain at the lab for a further 8 weeks of unrestricted eating. During this phase, they could go out to eat, eat as many meals per day as they wanted, and eat whatever they could get their hands on. Their diets were utterly unconstrained. All they had to do was report back exactly what they ate.
And they gorged themselves all day, snacking between meals and going back for seconds and thirds. Finally, after watching them eat until they got sick, Keys decided to limit their unrestricted eating to weekends only. And on weekends, some men managed to put away as much as 7 000 to 11 000 kCal per day. Although they eventually levelled off to a more reasonable 3 200-4 500 kCal/day. This was still at least double the amount they consumed during the starvation experiment.
The men returned to their pre-starvation weight by week 16 of rehabilitation, but their weight gain didn’t stop there. It continued to climb until 33 weeks after the end of starvation before stabilising and beginning to fall again. And their body weight overshot by an average of about 9.2% above their baseline. Six of these men had their body fat measured. And they discovered that although they’d gained an average of 3.6kg in weight from before starvation, they’d put on 4.3kg of fat.
Although none became obese, 5 men became overweight with a BMI of 25-30. Before the semi-starvation experiment, the highest BMI of any man was 25.4, and the average was 21.9. The mean by week 33 had increased to 23.6. But while the average weight gain by week 33 was about 10% more than their pre-starvation weight, they’d lost lean muscle mass and gained an extra 40% fat. As a result, the average weight gain was 6.44kg (14 pounds and 3 ounces) above the weight they’d entered the experiment. Some never returned to their pre-experiment weights, while it took the rest anywhere from 6 months to 5 years to get back in shape.
These men had built up a nutritional debt due to their mild caloric restriction but severe malnutrition. Their appetites reflected their need to replenish lost nutrients, not to replace calories. Driven to eat by primal urges, they couldn’t be satisfied until their metabolic machinery had improved. And that took varying amounts of time for each individual. Some never wholly recovered their metabolism after only 6 months of very abnormal dieting with a caloric deficit which by our standards today is mild.
It’s as if their bodies, having been subjected to starvation, were reset to cling to extra energy for months or years afterwards. And this would make sense from an evolutionary perspective. Because, in nature, you may be subject to consecutive periods of limited food availability. Packing away a bit extra, like a camel’s hump, should allow you to survive a little bit longer, provided you can nourish yourself well in between when food availability improves.
So explain that using the calories in, calories out model. You can’t, can you?
As discussed in the previous post, a healthy metabolism relies on healthy cells. And cells use mitochondria to produce most of their ATP energy.
When you’re starving, you do mobilise energy from storage. Initially, you liberate glucose (sugar) from glycogen stored in your liver and muscles. And you start to release fat from stored adipose tissue. A lot of the fats get converted into ketone bodies by your liver. These ketones can be used as fuel instead of glucose, fat, and amino acids. In fact, once your brain has become keto-adapted again (all healthy babies and young children are keto-adapted by default), ketones are your brain’s preferred source of fuel. You also begin to break down proteins (mostly in muscle) to convert their amino acids into glucose.
So that takes care of your energy needs.
But you still have many repair and cellular function requirements to manage. Those neurotransmitters don’t make themselves, you know.
All matter in the universe constantly tries to revert to chaos and disorder as energy attempts to escape from areas of high energy to lower energy areas. A bit like my house and garden. This describes the second law of thermodynamics, which states that, in a closed system, entropy only increases.
Although they aren’t closed systems, organisms, cells and mitochondria are organised. They have structures and functions. And while mitochondria focus on making concentrated energy in the form of ATP so that it can be transported around cells to precisely wherever energy is needed, entropy is trying to do the opposite. Entropy is like a playful puppy that turns your house upside down and pees all over your carpet. Just like a puppy will carry off your socks and shoes, entropy tries to dissipate all that energy equally throughout the cell and beyond.
So it’s like there’s a tug of war between entropy and most of the processes in your cells that are trying to organise everything and keep things running. Entropy tries to make everything in your cells disintegrate by sharing the cellular energy equally. So your cells have to work hard to replace everything as it falls apart.
This work uses up energy. But it also needs machinery. That machinery is supplied by proteins, amino acids, vitamins, minerals, fats, and even structural carbohydrates. And while your cells do an extraordinary job of recycling things, nothing inside your body can indefinitely withstand damage from free radicals. Most of these are made in your mitochondria. And the worse your mitochondrial dysfunction, the more free radicals escape.
After all, this is why we need to eat food; to supply the nutrients we need to keep our cells running.
When our food supply stops or is inadequate, we still need vitamins and minerals, amino acids, and other compounds to:
Luckily, we’re made out of meat, one of the most nutrient-dense foods you can find. That’s right; we start to break down our muscles, bones, teeth, skin, and organs to supply the nutrients we need to keep ourselves alive. And the more physiologically stressed we are, the more nutrients we need so that we can repair our tissues, fight off infection, and make sure everything keeps functioning.
This is why critically ill patients and people recovering from trauma and surgery have such accelerated weight loss and muscle wasting. Unfortunately, rather than supply additional nutrients to help with increased demands, ICU and hospital patients are given intravenous sugar and saline and left to fend for essential nutrients themselves. Sometimes, they are prescribed total parenteral nutrition (TPN). But it’s not designed with people in a catabolic state in mind. Instead, TPN emulates nutritional requirements based on daily recommended intakes of healthy people made up decades ago by shaking a magic 8 ball.
The more muscle and tissue you break down to supply the nutrients to keep yourself alive, the less there is left to use. It’s like running out of savings in the bank when you’re out of work. So you’ll slow your metabolic rate to cover essential functions only to conserve energy and resources.
Of course, when you have been in a state of semi-starvation, getting your health back will be a real uphill struggle. You’ll need far more nutrients than someone who has been eating well because you’re so depleted. It’s not just that you’ll need the nutrients to make muscle proteins. On top of those, you’ll need the nutrients to make the enzymes and activate the genes required to make those muscle proteins. And, of course, muscle is only one of the tissues you need to repair. These situations can make you vulnerable to semi-starvation:
So the Minnesota Starvation Experiment helps to demonstrate why you can be in a calorie deficit without losing weight:
During the semi-starvation period, Ancel keys noted that all the participants experienced “intense preoccupation with thoughts of food, social introversion, loss of sexual interest, decrease in self initiated activity, and emotional changes tending toward irritability and depression.”
This is how Harold Blickenstaff remembered his obsession with food during the experiment:
“I don’t know many other things in my life that I looked forward to being over with any more than this experiment. And it wasn’t so much . . . because of the physical discomfort, but because it made food the most important thing in one’s life- . . . food became the one central and only thing really in one’s life. And life is pretty dull if that’s the only thing. I mean, if you went to a movie, you weren’t particularly interested in the love scenes, but you noticed every time they ate and what they ate.”
When I read this, I recalled that some of my clients with a history of repeated calorie restriction over many years using Weight Watchers and similar reduced-calorie diet plans had described comparable relationships with food: food became the one thing they looked forward to with relish every day. They had no other interests outside the daily grind of work and looking after their family. So much so that they feared changing their diets because, the way they saw it, life would cease to have any joy. Now I realise that was the malnutrition talking.
During rehabilitation in the Minnesota Starvation Experiment, the depression scores fell as calorie intakes (and, by extension, nutrients) and weights increased. Those who received the least calories during the 12-week rehabilitation period took the longest to recover from depression, while those who received the most food recovered the fastest. Depression scores improved rapidly when the men were allowed to gorge themselves as much as they liked.
Keys and Co. assessed the participants’ mental health using the Minnesota Multiphasic Personality inventory (MMPI) at baseline, after 24 weeks of starvation, and after 12 and 33 weeks of rehabilitation. When starved, they found significantly increased scores in hysteria, depression, and hypochondriasis. These were known as the “neurotic triad,” although I suspect they would be better called the “gaslighting triad.” If starving yourself to death isn’t an adequate reason to become anxious, agitated and believe there’s something wrong with your health, I’m not sure what is. Now that we know that depression is the way we manifest sickness behaviour, it should be evident that hysteria, depression, and a concern about your health are appropriate adaptive responses to situations where your life is in danger.
One participant, with a previous history of pushing himself to the point of burnout, experienced “severe depression and psychological decompensation at the end of the starvation period.” This led to two attempts at “unconscious” self-mutilation. In what appears to not be an accident, he severed three fingers of his left hand while chopping wood. Being the trooper and overachiever he was, he completed the experiment following a brief hospitalisation.
There were an additional 4 men who were dropped from the experiment because they couldn’t stick with the diet and failed to lose sufficient amounts of weight. When I first read this, I assumed they struggled with hunger and perhaps lacked the other participants’ determination and willpower. But the truth was much more complicated.
The psychological responses of these 4 non-compliant men were fascinating. Like the 32 men who completed the entire experiment, these four men developed the typical “semi-starvation neurosis” with increased hysteria, depression and hypochondriasis during starvation. But unlike the completers, three of the four non-compliant men also saw increases in traits related to the “psychopathic deviate” scale. This scale measures increased:
I’m not sure why being energetic, extroverted, unconventional, creative, or even immature would be considered psychopathic. Unless you have a vested interest in pathologising perfectly normal personality traits… Most of the time, those traits are helpful and not even annoying.
Incidentally, introversion was classed as a depressive trait, while chronic pain and “lacks insight concerning causes of symptoms” are in the hysteria heap, so you can’t win. I bet I know what you’re thinking: ‘if “lack of insight concerning causes of symptoms” is a sign of hysteria, then most of my doctors are hysterical.’
“There were also marked elevations of the “psychotic” side of the MMPI profile, although not reaching abnormal values.”
If you’re interested in knowing what they are, these traits include (if these sorts of lists bore you, skip past them):
Paranoia – Paranoid style, guarded, extremely sensitive to opinions of others; may feel mistreated; blames others; suspicious, resentful, withdrawn; hostile and argumentative, overly sensitive; guarded, distrustful, angry, resentful, psychotic symptoms, including delusions of persecution and ideas of reference
Psychasthenia – Extreme psychological turmoil (e. g., fear, anxiety, tension, depression); intruding thoughts, unable to concentrate; obsessive-compulsive symptoms, moderate anxiety, depression, fatigue; insomnia, bad dreams; guilt, perfectionism, feeling unaccepted, anxious, tense, uncomfortable; insecure, lacks self-confidence; meticulous, indecisive; shy, introverted.
Schizophrenia – Confused, disorganised thinking; hallucinations and/or delusions; impaired contact with reality; rule out medical conditions, substance abuse, schizoid lifestyle; unusual beliefs; eccentric behaviours; confused, fearful, sad; somatic complaints; uninvolved; excessive fantasy and daydreaming, limited interest in other people; impractical; feelings of inadequacy and insecurity
Hypomania – Manic symptoms, including excessive, purposeless activity; hallucinations, delusions of grandeur; confusion, flight of ideas, excessive energy, lacks direction, conceptual disorganisation, unrealistic self-appraisal; impulsive, low frustration tolerance, active, energetic, extroverted, creative, rebellious, enterprising, impulsive.
Reading through those lists, I can’t help but wonder what was going through the heads of the people who developed them and what they had against ordinary people. Why do they feel that “normal” = being a happy puppet?
Reading this, you might conclude that the non-compliant men became more recalcitrant and difficult. But, on the contrary, their stories are so frightening and bizarre that you’d need a heart carved out of marble not to sympathise with them. Their personalities changed so much that they could barely recognise themselves. Half of them needed to be admitted to psychiatric hospitals when they suffered distressing psychiatric symptoms.
“During the first few weeks of semi-starvation, one of the men began to have strange dreams of “eating senile and insane people.” His MMPI profile suggests similarity to patients with a schizoaffective psychosis.
“He then began impulsively to break the controlled diet, concealed his dietary violations and began minor shoplifting sprees stealing candy and trinkets that had no value for him. He wrote voluminously and showed a distinct flight of ideas. He then developed a violent emotional outburst threatening suicide and violence; he was admitted to a psychiatric ward. The clinical picture suggested hypomania: he was overly talkative, elated and emotionally labile. He quickly returned to normal after being allowed to eat ad libitum. We learned that this man died sometime after the original experiment.”
This does sound like a significant swing in personality and cognitive function secondary to malnutrition.
“The other man began to use enormous amounts of chewing gum (40-60 packs per day) and later stole some food items. He began to compulsively root in garbage cans and actually ate garbage. Since he failed to lose weight despite drastic cuts in his diet, he was dropped from the experiment at the end of the starvation period. Subsequently he ate huge amounts of food, became sick and vomited. He sought psychological help and voluntarily sought admission to the psychiatric ward twice in a short period of time. “His symptoms subsided over a period of weeks and he eventually made a satisfactory adjustment” We interviewed this participant at follow-up. He told us he gained about 30 pounds above his control weight after the starvation period by overeating and was bothered by looking fat. It took him about a year to return to normal eating and normal weight. He denied any further psychiatric problems and eventually earned a PhD.”
Almost 10% of the participants developed the most severe behavioural and personality issues caused by calorie-restriction. That’s a staggering number. Their brains were even more vulnerable to the ravishes of malnutrition than the others. In my book, we should try even harder to protect vulnerable groups from harm. At least these men got their personalities back again when they nourished themselves.
Think about how many people are walking around today with similar problems who are drugged up with “antipsychotics” instead of being fed properly. And what effect will semi-starvation have on the developing brains of children? How many people have committed crimes because their brains are so impoverished in nutrients that they can’t make rational decisions?
The moral of the story is, don’t restrict calories. It could have devastating, painful, frightening (and decidedly embarrassing) effects on your mental and physical health.
Returning to the 32 men who successfully completed the entire experiment, while psychological recovery tracked well with increased food intake, physical healing took longer. Unfortunately, two men took longer than 8 months after the end of the semi-starvation period to fully recover energy and health. One of them took up to two years to regain his former stamina and strength.
The men reported becoming obsessed with food and cooking. During the rehabilitation period, many felt they couldn’t control their eating. Some developed binge eating behaviours during rehabilitation, and a couple of them even ate until they vomited. One man needed to be admitted to hospital because his stomach became so swollen after overeating. And in the ad libitum rehabilitation phase, where they were allowed to eat as much as they wished of whatever they wanted, there were days when some of the men consumed 7 000-11 000 kCal per day! Over half of them couldn’t feel satiated after they ate regular meals and continued eating even though they felt full.
After 12 weeks of controlled refeeding, their average BMIs at 18.4 were still well below what they were pre-starvation. And it wasn’t until 33 weeks into rehabilitation that their weight gain stabilised and started to go back down.
Although none became obese, 5 men became overweight with a BMI of 25-30. Before the semi-starvation experiment, the highest BMI of any man was 25.4, and the average was 21.9. The mean by week 33 had increased to 23.6. But while the average weight gain by week 33 was about 10% more than their pre-starvation weight, they’d lost lean muscle mass and gained an extra 40% fat. As a result, the average weight gain was 6.44kg above the weight they’d entered the experiment (they had data on 21 men rather than 32). Some never returned to their pre-experiment weights, while it took the rest anywhere from 6 months to 5 years to get back in shape.
These men had built up a nutritional debt due to their mild caloric restriction with severe malnutrition. Their appetites reflected their need to replenish lost nutrients, not to replace calories. Driven to eat by primal urges, they couldn’t be satisfied until their metabolic machinery had improved. And that took varying amounts of time for each individual. Some never wholly recovered their metabolism after only 6 months of very abnormal dieting.
Comparing these experiences with people with eating patterns involving binge eating, bulimia, anorexia nervosa, and yo-yo dieting is not hard.
The dangers of altering your diet to exclude or restrict the most nutrient-dense foods should be more apparent now. If you’re not sure which foods are the most nutrient-dense, I’ve written about them in this:
Less than 6 months of a low-calorie diet in a group of perfectly fit and healthy young men produced cellular damage that altered cognitive function and damaged metabolism, sometimes irreparably. Yet this is the approach many people suggest adults of all ages and even children use to manage their weight.
Is it any wonder we’re witnessing epidemics of yo-yo dieting, disordered eating, weight gain, obesity and metabolic syndrome? Not to mention depression, irritability, brain fog, apathy, and fatigue? Malnutrition even contributes to burnout.
And we know that nutrient deficiencies are rampant throughout the UK and the rest of the world. Our government has been documenting increasing malnutrition for years. I’ve written about how our dietary guidelines have contributed to this here.
I hope you understand that losing weight using a malnourishing diet comes at a terrible cost. If you follow a low-fat, high-carbohydrate, plant-based, calorie deficit diet plan, you can develop depression, lethargy, fatigue and torturous mental health problems. Physical ill-health will also occur if you persist in eating this way for long periods. And the reduced metabolic rate it causes can leave you regaining more weight after coming off the diet.
Once you hop aboard the low-calorie diet hamster wheel, there’s no escaping it unless you thoroughly review your dietary philosophy and start eating differently. And with every turn of the wheel, your weight will increase by a few more pounds.
The Minnesota Starvation Experiment demonstrates how dangerous it is for your mental health to use a calorie deficit to try to lose weight. But other studies back it up and provide more evidence of the damaging effects counting calories has on your physical health. I’ll cover some of those in the next post. You can discover 10 more scary reasons not to eat less and exercise more here.
If you’re interested in improving your health while optimising your weight but aren’t sure how to do this without calculating a calorie deficit, you should schedule a free clarity call to discuss it with me.
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