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Monday, Aug 29 2011 12:00 PM

Weighing the benefits of super low-calorie diets

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    By Casey Christie / The Californian

    Janice Medford maintains her weight by working out at Bakersfield Fit Boot Camp with kick-boxing and many other forms of exercise.

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BY KELLIE SCHMITT, Californian staff writer kschmitt@bakersfield.com

Nine hundred calories doesn't go that far.

That's about what is in one double Whopper, a Baja steak burrito, or a scone and blended coffee drink.

But for Bakersfield resident Shelly Fairbanks, who is eager to lose weight, that's her caloric intake for an entire day.

"If you make up your mind, it's doable," said Fairbanks, who has lost about 25 pounds since May. "But you need to be dedicated and determined. It's not fly by night."

Some low-calorie diets call for just 800 to 1,000 calories a day, a dangerously small figure if you're trying to maintain proper nutrition. That's why people like Fairbanks are working with weight-loss doctors who help ensure all the right nutrients are packed into those measly meals.

Even as overweight patients turn to the diets like this to shed unwanted pounds, some Americans are adopting the restricted calorie approach as a permanent lifestyle. The University of California, San Francisco is examining the benefits of slashing those calories, which advocates say can lead to longer lives. At the same time, critics argue it can be unhealthy to focus too narrowly on caloric intake.

"You need to make sure you're not only cutting calories but also boosting nutrient intake," said Elisa Zied, a New York-based registered dietitian and author. "You have to weigh the pros and cons. You want to have a long life, and a healthy life, but you also want to be able to eat in the real world."

MEDICAL WEIGHT LOSS

People often try a lot of diets before coming to see Dr. Jan Trobisch, who specializes in weight-loss medicine.

When patients walk into his Bakersfield office, they usually have no idea how many calories they're consuming --though he estimates 2,000 to 5,000 a day. Not knowing is part of the problem.

"Just by doing this, you create awareness," he said. "They start realizing this caramel frappuccino is 350 calories and think 'I'm going to skip it.'"

Most patients don't feel hungry on the plan, he said. Many people use food to fill emotional urges, eating when they're stressed, sad, happy or bored. By removing that dependence, Trobisch says they're more clearly able to discern actual hunger.

"Does your stomach rumble?" he said. "If it's anything other than that, it's emotional. Food is there to keep you alive, not entertain you."

Cutting so many calories shrinks the stomach, creating "the natural lap band." When patients ease back into a less strict regime, they naturally want to keep eating less, he said.

The rapid weight loss linked to these low-calorie regimes helps motivate patients to keep going forward, Trobisch said. In just six weeks, most people lose 15 to 30 pounds. At that point, the "brainwashing" phase is over, and patients can increase their calories to 1,000 or 1,200 while still losing weight.

A key concern about such approaches is whether it's healthy to drastically trim intake. The concern is that losing too much muscle too fast can be dangerous, especially since the heart is a muscle. Trobisch says that's why it needs to be done under medical supervision, where he can monitor vital signs, water and muscle composition.

He also provides patients with nutrient-dense shakes and bars, which pack all of the components the body needs into the limited calories, he said.

Once they're off the products and on to real world foods, he coaches them on calorie-reducing strategies such as: Never go hungry to a mall; drink lots of water; or take a few bites of that cookie, then toss it. He prods them to think about mindless consumption including sampling when preparing a dish or eating a few leftover meatballs.

'TIRED OF BEING FAT'

Bakersfield resident Fairbanks, 47, got on the low-calorie diet when the extra 50 pounds she was carrying did too much damage to her health and self-image. She'd tried other approaches, like the low-carb diet, but they all failed.

"When I looked in the mirror, I was tired of being fat," she said.

Now, when co-workers eat lunch out, she drinks her low-calorie, nutrient-packed fruit shake.

"The act of not eating is hard," she said. "But I don't feel lethargic and I'm not hungry."

Monitoring calorie intake has done wonders for her awareness, she said. She realizes that an extra handful of chips or beers by the pool do make a difference.

Occasionally, Fairbanks admits, she cheats. When she was making tacos for her family, she gave in. And, she's a sucker for Alice Springs chicken and a baked potato from Outback Steakhouse.

"I cheat so I don't go crazy, so I don't feel deprived and go off the deep end," she said. "But, now I eat less and feel full faster."

Bakersfield resident Janice Medford is a low-calorie success story. Like Fairbanks, she did the regimen through a doctor specializing in weight-loss medicine. Three years after she dramatically reduced her calories, Medford is a fit 127 pounds, down from 169 pounds and 41 percent body fat.

"I didn't feel well, and I was sluggish," she said. "When I got on the scale one day, I said 'enough is enough.'"

Medford dropped her more than 3,000 calories a day to about 1,000, a figure she achieved thanks to the doctor's meal-replacement shakes.

"And I worked out like a mad woman," she said, adding that it was important to keep muscles and ward off sagging skin.

Even though she was consuming just 1,000 calories, she kick-boxed in the morning, did an additional hour of cardio and walked for 45 minutes at night.

At one point, the combination of all that exercise and low calories brought her weight too low. She adjusted it higher, and now consumes about 1,500 calories a day. Medford still likes cupcakes, but she now knows their calorie content and how long she'll have to work out to burn it off.

"You have to be really dedicated," she said. "A lot of people like to eat. I love to eat. But I was sick and tired of feeling this way. I refused to buy bigger pants."

The low-calorie approach doesn't work for everyone. Medford said several friends tried the medical approach after seeing her success, but didn't have similar results. One friend lost more than 100 pounds, but regained almost all of them.

"If you're going to eat pizza, drink beer or drive through Taco Bell, don't waste his time," she said, speaking of her doctor, Payam Kerendian.

Kerendian, who limits his own calorie intake, acknowledged it's difficult to adjust to changing habits, especially for people who aren't used to eating healthy. But for people who succeed, it's worth it, he said.

"They are starting another adventure, a journey that's leading them to a healthier life," he said. "The diet might be boring but the outcomes are exciting."

FEWER CALORIES FOR LIFE

One of the most important aspects for calorie reduction is ensuring the limited calories one consumes are packed with the right nutrients, said Zied, the dietician. While some studies suggest benefits in areas such as cardiovascular health, those study participants are eating high-quality diets. She also points to the risks in losing weight too quickly such as gallstones, bone density loss and drops in muscle mass.

There's also the social element of eating, and the psychological satisfaction that comes from savoring foods like chocolate, she added.

The approach is "fascinating and if you're committed to it, great, but I think most people would benefit from eating a little less and moving a little more," she said.

Bakersfield nutritionist Kathlyn Lujan agrees that eating healthy should be the emphasis, not limiting calories. Lujan advises people to focus on which foods fill their plate. The majority should be fruits and vegetables, and portion sizes should be a fist or the palm of your hand.

"It can't be just about the numbers," she said. "You can't live that way."

But others say you can and should adopt calorie restriction as a lifestyle -- even if you're not overweight. Members of the Calorie Restriction Society International say limiting calories while maintaining proper nutrition can improve health and extend lifespan.

They point to studies that document how limiting calories has led to longer lifespan in species ranging from worms to monkeys. But the scientific community hasn't reached consensus on whether humans respond the same way.

That's what the ongoing UCSF study is hoping to determine. The Calorie Restriction with Optimal Nutrition and Aging Study is analyzing humans whose calorie intake is extremely low. They'll be examining the health repercussions, whether restriction slows down aging and the psychological profiles of people who are able to chronically resist.

Even though animal studies have linked low calories to longer lifespan, it's hard to gauge those effects on humans, said Janet Tomiyama, a Rutgers University associate professor who is working on the study.

"What is the human equivalent of giving a worm less glucose?" she said. "If you're in a lab, and just not giving a worm as much glucose to eat, I don't think that worm feels deprived."

But human beings can feel that deprivation, and that can lead to stress, she pointed out. Tomiyama has worked on a separate study that shows how dieting increases stress hormones, and she wonders what role stress can play in wiping out the longevity effect.

The researchers are crunching data for the UCSF study, and "the jury is out," Tomiyama said. For now, there's one consensus in the medical community: exercise and healthy food is a good thing, she added.

"The more I study dieting, the more I'm starting to think that maybe weight loss isn't what we should be aiming for," she said. "When you focus so much on weight, it distracts you from your true purpose: You want to be healthier."

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