Low Carb and Paleo Dieting as Religious Zealotry
Some believe Dr. Atkins was the greatest thing since sliced bacon. I am not one such idolizer.
Perhaps Gary Taubes will issue a fatwa, proclaiming me an infidel and demanding I be publicly pulverized with frozen steaks for daring to question the validity of the Lord Atkins bestowed prophecy.
Or maybe I’ll just get some hate mail.
Some low carbers love to defend their faith, and there are many interesting parallels between low carb and paleo dieting and religious zealotry, but first I wish to provide a brief explanation about my opinions on religion.
I am friends with and related to some devout religious people. In my experience, people of faith are often the kindest, most giving and decent folk I’ve met. I think much of the negative stereotypes seen in the media – the kind that get viewers and clicks – shows the warped minority that in no way represent the majority of believers of a variety of world religions. You know, good folk I’d be happy to hang out with.
Sure, there are the, “You’re going to burn in hell,” kind of religious people, but I’m convinced they’re far less common than the, “Here, take half my sandwich,” type. Likewise, I suspect that the majority of people who follow low carbohydrate diets are polite and decent. Unfortunately, like with religion, it’s the loud mouth asshole minority we hear the most from. I’m not trying to create a straw man argument here. This article is about comparing a vocal minority to a vocal minority.
For any decent religious folk I offend with this post, I’ll happily make you a yummy sandwich in atonement. And yes, it will contain bread.
Humans are Hardwired to Believe
Before getting into paleo dieting, let’s first look at Stone Age behaviors from a different perspective: trying to make sense of the world.
Troglodytes were too ill informed to understand what stars, the moon or lightning is, so they made stuff up in order to cope with the unknown. We evolved to seek some kind of otherworldly protection from strange and fearful things.1 It has also been suggested that there are important collective benefits to shared spirituality, and so it has been naturally selected for over the millennia.2
We seek answer to that which we do not understand, and many people don’t understand why they can’t lose weight so they constantly grasp at straws from the variety of bullshittery available in the weight loss field. They are programmed to believe.
In 2011 the FTC launched yet another survey of consumer fraud in the U.S. and once again weight loss scams were found to be the number one form of fraud people fall victim to. It’s not all “bank inspectors” and pyramid schemes; fraudsters scammed millions of Americans wanting to lose weight by selling pills, powders, machines, wraps, creams and even “weight-loss earrings.”3
Are people who believe such things stupid? Not necessarily.
In his 1997 book Why People Believe Weird Things, Skeptics Society founder Michael Shermer asserted “smart people” could be more susceptible to outrageous claims than others, “because they are skilled at defending beliefs they arrived at for non-smart reasons.” These non-smart reasons can include peer pressure, sibling and parental influences, life experiences, cultural pressure and even genetic predispositions. Shermer further explained: “More than any other, the reason people believe weird things is because they want to. It feels good. It is comforting. It is consoling.”4
I had a chat with Shermer to get specific details.
“Weight loss is so susceptible for fraud because it’s so hard to do and the signs of progress are so slow,” Shermer told me. “The reward is not enough for most people. Anything that appeals to shortening the process is going to sell.”
The publishing industry sure knows this. I had a weight loss book published by Random House last year. While shopping it around, my agent received the following rejection letter from a major publishing house:
There’s so much I really like here, David. James has a brash and audacious voice, and a sensible and straightforward message. His column in the LA Times is great, and I like the way he approaches the material … But my main concern, I hate to admit, is the sensible, measured nature of his program. Despite his flashy prose, he actually writes like the informed journalist that he is … sane, levelheaded, with proven advice. And while that’s great journalism, I worry that it’s not as salable of a diet plan.
And people wonder why they can’t lose weight. Scams are what sell.
Now I’m not saying low carb dieting is anywhere near the level of fraud as selling a flat belly in earring or cream form, but am simply providing some perspective on how gullible people can be when it comes to falling for weight loss fraud. And there is often a scammy component to low carb, at least when proponents proclaim that weight loss is something other than creating a consistent caloric deficit.
See, there are many low carb proselytizers who would deny …
The Law of Weight Loss
It’s quite simple. If you have a caloric deficit, you lose weight. If caloric balance is positive, you gain weight. Energy balance is a direct representation of the first law of thermodynamics, the one that says energy can neither be created nor destroyed. We’re not talking about a hypothesis here, or even a theory, but a physical LAW OF THE UNIVERSE. Ever hear of the law of gravity? A law is something scientists are so damn sure of there is no disputing it. You can’t deny the first law of thermodynamics any more than you can deny the fact that if you jump out of a high-flying airplane without a parachute, gravity will not be your friend. (Note to fans of The Secret: the “Law of Attraction” is not a real scientific law.)
And yes, I do know there are bestselling low-carb authors who question this law. They present themselves as “controversial.” They assert that years of accepted science is wrong. Let me ask you a question: The next time you get into an airplane, would you rather it was designed, built and tested in a scientifically proven manner, or a controversial one?
I thought so.
Excess fat can’t be blamed on insulin, carbohydrates or the Loch Ness Monster. Gaining body fat comes from taking in more calories than you burn. Anyone who can prove otherwise will surely win a Nobel Prize in physics for disproving the first law of thermodynamics. I am unaware of that particular Nobel having been awarded.
Back on planet Earth, the link between weight loss and calories has been proven myriad times.
Rudolph Leibel et al. conducted a carefully controlled study in 1992, which was published in the American Journal of Clinical Nutrition and asserted: “Variations in fat intake from 0% to 70% of total energy under conditions of equal energy intake produced no significant changes in body weight over periods of observation averaging 33 d [days].” In language that we can all understand: Leibel’s study put participants on balanced energy diets: they controlled to ensure that the participants took in the same number of calories that they burned over a 33-day period. The participants got a varied range of overall fat content, from 0 percent to 70 percent, but everyone’s weight stayed the same, once again proving the first law of thermodynamics.5
Why did the participants’ weight stay the same? Because they were on maintenance-level calories. It does not matter what percentage of protein, carbohydrates or fat you consume in the grander scheme of weight loss and gain. It is all the simple formula of calories in minus calories out. Golay and Bobbioni, in their 1997 article “The Role of Dietary Fat in Obesity,” agree: “… fat is almost exclusively used or stored in response to day-to-day fluctuations in energy balance.”6
In 2004 Buchholz and Schoeller looked at the published data to answer the question “Is a calorie a calorie?” The results were published in the American Journal of Clinical Nutrition. They conducted a thorough metabolic analysis of the effects of diets that varied in fat, protein and carbohydrates and came to assert, “We conclude that a calorie is a calorie. From a purely thermodynamic point of view, this is clear because the human body or, indeed, any living organism cannot create or destroy energy but can only convert energy from one form to another.”7
Beyond this, there is so much research that proves the whole calories in vs. calories out rule8 that any arguments claiming that weight loss is something other than an energy balance issue are as real as professional wrestling. What’s more, in my job as a syndicated fitness columnist I’ve interviewed a number of the world’s top obesity researchers, and for every one it’s a “Well, duh!” that weight loss is calories in versus calories out, regardless of the type of calories.
If you eat 2,000 calories of chicken wings and butter-fried pork rinds a day, yet burn 2,500 calories a day, you will lose weight. You will also be one unhealthy bugger.
If you eat 3,000 calories of spinach, kale and egg whites a day, yet burn 2,500 calories a day, you will gain weight. Harsh, but true.
Is this sinking in? Although it didn’t qualify as an official study, Mark Haub’s experiment bears consideration. Haub is a nutrition professor at Kansas State University, although you may know him better as “Twinkie Guy.” In 2010, Twinkie Guy proved he could lose weight living mostly on Twinkies, Doritos, Oreos and other treats just by consuming fewer calories than he burned. He lost 27 pounds in two months, though I imagine that due to the low satiety factor and high reward value of the food, he must have felt he was starving the entire time. He didn’t do the experiment to endorse a junk food weight loss program but to prove a point: calories are all that matter to weight loss.
So how do people have the audacity to still question the first law of thermodynamics? The same reason people seek to dismiss evolution as “just a theory” and promote an alternative “scientific” explanation. Which brings us to …
Low Carb Dogma as Intelligent Design
Okay, you’ve got your weight loss claims like those frequently made by the likes of Jorge Cruise who asserts you can lose up to 14 pounds in 14 days with his “belly fat cure,” and Jillian Michaels saying you can lose up to 5 pounds a week doing yoga.
Almost a pound a day of weight loss from yoga? Right.
Such proclamations are in the realm of creationism, being about as likely as the earth having appeared six-thousand years ago, when Adam and Eve were kicked out of the Garden of Eden because God got sick of cleaning up all the mess left behind from their pet tyrannosaurus. The reality is that the only people who can lose a pound a day weigh almost as much as a Smart Car. For someone who is say, 40 or 50 pounds overweight, in order to lose a pound of fat a day they’d need to drastically restrict calories and run an entire marathon every day. That’s neither realistic nor advisable.
But what about the guys like Gary Taubes, who make seemingly plausible claims and science up their declarations with cherry-picked research?
Intelligent design proponents assert there is an “evidence-based scientific theory about life’s origins.”9 They do indeed assert that intelligent design meets the qualifications to be called a theory.10 The Union of Concerned Scientists has a problem with that, asserting that ID doesn’t meet a number of criteria to qualify as a theory, including that it “cannot be tested by observation and experimentation in the natural world, and the existence of an ‘intelligent’ agent in the origin of life can not be tested nor is it falsifiable.”11
At least low-carbers got one thing right by referring to their alternative to the first law of thermodynamics as the “insulin hypothesis” and not a theory. Championed by Taubes, it proclaims that carbohydrate ingestion causes a spike in insulin, which in turn causes fat storage to be increased in fat cells, and this is why people are obese, not because of excess calorie consumption.
And the amount of cherry picking and misrepresentation of science is rife in both camps. The theory of evolution has been supported with repeated testing and is accepted as a valid explanation in scientific circles. Intelligent design has not and is not. The first law of thermodynamics, represented as calories in vs. calories out in terms of weight loss, as already mentioned, is indisputable. The insulin hypothesis is not only disputable, it is just plain wrong.
And yet, the faithful are unswerving in their belief.
The Apocalypse is Nigh
Some people believed the world was going to end on December 21st, 2012. One of my sister’s friends (and said friend’s boyfriend, who I happen to know is a first-rate tool, but that’s not relevant) spent a small fortune traveling around prior to the Mayan apocalypse date to “say goodbye” to all their friends because they were certain there would be no December 22, 2012. In related news, these two people are fans of the quacktacular website NaturalNews.com.
And there are plenty of other fringe religious groups talking about the upcoming rapture, like, it’s gonna happen this weekend. I mentioned one such rapture in an LA Times column because I was nearing the end of some hard race training, and the proposed end of the world was right before my race. I would have been pissed if all that training was for naught.
Sure, we can scoff at such silliness, but people are far more likely to believe apocalyptic proclamations about what you eat. Wheat Belly was a bestseller, and I have no doubt the recently published Grain Brain will hit the New York Times list of bestsellers as well because the author spouts inflammatory nonsense to garner attention, like “Gluten is this generation’s tobacco.” Really, Dr. Perlmutter? How many deaths can you prove are caused by gluten each year? Only 1% of the population is celiac, and yet, according to the World Health Organization, tobacco kills 50% of regular users.12 And don’t forget how Dr. Lustig has made a career out of demonizing sugar – the stuff is toxic, don’t ya know?
Demonizing food groups is a major tenet of low carb. Eating bread is sin.
Blogger Melissa McEwan recently wrote an excellent piece of satire to prove how easily people could be duped into believing outlandish nutritional claims using cherry-picked research. Entitled, “Just Kale Me: How your Kale habit is slowly destroying your health and the world,” the author had many people buying into her hypothesis before she felt guilty and posted an update telling everyone that it was all a joke made to prove a point.
And what was that point? That the statement erroneously attributed to P.T. Barnum was nonetheless correct: “There’s a sucker born every minute.”
Selling Tickets to Heaven
Gary Taubes is well known for stating that exercise is useless as a tool for weight loss, erroneously claiming that exercise works up an appetite and stalls weight loss. On the other side of the issue, I’ve made my career out of extolling exercise as an absolutely critical component for sustainable weight loss because of it’s power to transform you into a better eater, not to mention all the other health and physique improving benefits it imparts.
Read those two articles and decide whom you believe.
Unfortunately, people would rather have just a diet prescription to lose weight than a diet and exercise prescription. That’s why the majority of weight loss books are just about diet, with most either only paying lip service to physical activity, or ignoring its role in healthy weight loss completely. For proof, visit your local bookstore.
It’s a sad truth that the majority of people hate to exercise. Only 23% of Americans engage in minimal exercise,13 and when people hear there is some kind of metabolic miracle by ingesting a mythical macronutrient ratio, it’s like a ticket to weight-loss-while-being-a-couch-potato heaven akin to atoning for your sins via a confession, a conversion, a donation, or some Hail Mary’s.
Faith Healing as Proof it Works
When people go on low carbohydrate diets they remove things such as doughnuts, muffins, highly processed cereals, sugary treats and other processed crap that is high in calories, low in satiety, and super tasty so as to promote over-consumption.
And so, often, they lose weight. It’s a miracle!
This isn’t some type of metabolic advantage from low-carbohydrate dieting, nor is it proof of the insulin hypothesis. The carbohydrate restriction creates a de facto restriction of many problematic junk foods (while often also removing good, unrefined carbohydrates), and so, calories are reduced and weight is lost.
This isn’t that different from those who believe their medical condition was cured via prayer. They prayed, they got better, and therefore it must have been the prayer that did the job. Just like some low-carbers think it was cutting carbs that lead to weight loss instead of simple caloric restriction, some faithful think it was prayer that healed them instead of a physician using science-based medicine.
The one thing I wonder is, if prayer does heal people all the time, why won’t it re-grow limbs on amputees?
But just like Jehovah Witnesses have died by refusing blood transfusions while being told to prayer harder, there are those who are being made sick by paleo who are told to “Grok harder.”
It’s a clear case of inflexibility of dogma. You dare not question that which is known. Instead, spread the glorious word, and create a support group for your beliefs. Speaking of which …
Evangelizing, the Blog as Church, and Defending the Faith
Low-carbers love winning over converts. It means more page views for their blogs, more books sold, higher sales of package foods with the Atkins symbol on them, and high prices on gluten-free cardboard food.
There is something called the International Paleo Movement Group, and Jimmy Moore does regular love-ins with his favorite low carb heroes on his blog. I can find tons of low carb groups of Facebook, but for some reason can’t find a single “high carb” one. There is much love to go around in the low-carb community, as long as you are one of the chosen people. It’s a great support structure for those seeking the nutritionally like-minded.
And like religion, there is also infighting amongst various denominations and sects, where “My god is better than your god” becomes “My Grok is better than your Grok.” There are apostates as well, who are shunned for leaving the fold.
And the missionaries go out into the world to spread the word. I remember one person who went by the handle “jhklat” who, every time I mentioned the word “calories” in an LA Times article, went on a rant about how it wasn’t calories, but carbs, and that we should all read the New Dietary Testament known as Good Calories, Bad Calories by Gary Taubes.
Low carb fanatic Fred Hahn seems pretty determined to evangelize as well, generating much fun on Dr. Spencer Nadolsky’s Facebook page, and the butt-hurted holy warriors came out in force to crusade against respected nutrition expert Alan Aragon in the comments of his interview criticizing paleo diets, like he was an invading heathen who had taken Jerusalem.
Ketogenic Diets = Snake Handling
Potentially dangerous, and I just don’t see the point.
The Perils of Dating Outside Your Dietary Religion
Many try to find a mate with their own religious beliefs, hence the existence of sites like JDate and Christian Mingle. Apparently, paleo eaters have their own dietary preferences for whom they will become romantically involved with, and there are rules to follow on how to date a paleo. Even though that article says you shouldn’t feel pressured to convert, they’d probably still like you to convert.
And that’s not the only article about advice on how to date a low-carber. There’s also this one on Match.com. And many people express their love of low carb on their dating profiles, so it’s a field you can select for.
Because in relationships, you only have to deal with the issue of what happens on holy days about once a week, but meals happen with much higher frequency. If you’re not in alignment, it can be a source of conflict.
Can you imagine the discussion between a paleo and a vegan on how they will raise their children?
Follow the Money
If aliens showed up with indisputable scientific evidence that there is no god, would churches suddenly close their doors and say, “Whoa. Guess we all need to find new jobs now.”
No, they’d dig deeper not just because of their faith, but because money and jobs are at stake. A few years ago a post at 180 Degree Health explained why Jimmy Moore continued to dig deeper into low carb even though it appeared to be harming his health and not allowing him to sustain his weight loss, saying, “His (Jimmy’s) websites, business, and life are all dedicated to eating a low-carb diet. How does he escape? What else can he do but perpetually eat fewer and fewer carbohydrates …”
In both religion and low carb, there is a lot of money at stake. Atkins Nutritionals, the rapid growth of gluten-free products, paleo products … changing dietary dogma means a massive loss of income, and people like to keep the money rolling in. They depend on it. And so, they are resistant to the idea that their dietary choices might be wrong.
My Beef with Too Much Beef
Don’t get me wrong, I love cow. And pig. And lamb. And chicken. And a host of other tasty critters that walk the earth, fly the sky, or swim the seas.
But I limit meat in favor of lots of unrefined carbohydrates. I do this because I exercise. I don’t just exercise, I quest for enhanced physical performance. Low carb sucks for that.
I know low carb works for some people, primarily the obese who are either sedentary or minimally active.
“There is not a lot of extra room for carbs when training volume is low,” Alan Aragon told me. “When you’re cutting calories for weight loss, carbs are going to have to bear the brunt of the restriction because you can’t cut too far into protein or fat or you’ll lose muscle and inhibit certain hormone functions.” But note that he said, “When training volume is low.” Aragon states that low carb is not a good choice for a physically active person.
I don’t think anyone’s training volume should be low.
I’m an evangelizer too. I preach the gospel of an active lifestyle, and for that, you need carbs. There is a pile of evidence which shows higher carbohydrate intake being preferable for those who embrace the exercise lifestyle.14 Anecdotally, I’ve interviewed numerous Olympic champions and professional athletes, and without exception they extolled the virtues of high carbohydrate intake to fuel their athletic endeavors.
The National Weight Control Registry in the United States tracks several thousand people who have successfully maintained weight loss. The average amount lost is 66 pounds, and these people have kept it off for an average of 5.5 years. Eighty-nine percent of these successful losers use a combination of diet and exercise.15
And there is much additional evidence to show that people who exercise regularly in conjunction with dietary changes have more success with sustaining fat loss than those who use diet alone, not to mention that exercise ensures it’s fat being lost and not fat-free mass.16 So it just makes sense to fuel appropriately.
Yes, I am an evangelizer; I encourage you to move your ass. At what, I don’t care, although I discourage exercises that have a high risk of injury. Find your fitness Zen and endeavor to get good at it.
Choose whose advice you want to follow. While not scientific proof of a lack of efficacy, many of the leaders in the low-carb camp don’t exactly have impressive physiques. Dr. Michael Eades admitted to needing to wear a girdle before he could appear on TV. And excuse me for being silly, but I’ll stack my midsection up against that of Dr. Wheat Belly any day.
Low-carb can work okay for people on low or no exercise, but you can aspire to better than that. You can aspire to not just losing weight but to being physically fit. Low-carb diets don’t fuel exercise performance, so it’s a half-assed way to lose weight.
My way is better, so choose my way. Choose full-assed.
This is the conclusion, and some of you have likely concluded that I am an atheist. I am not. I am open-minded on the subject, and if God chooses to speak to me, I shall listen. If you must fix a label to my spiritual beliefs, put me down as “Undecided,” although Pastafarian does seem to fit nicely with my choice of diet.
Some atheists are vocal assholes. I could name names. Some people who are anti low-carb are equal in their assholery, and just as fundamentalist in their beliefs. I could name some of those names as well. But certainly not any vegans. Vegans never proselytize or guilt-trip anyone over the evils of animal holocaust. They’re too busy studying China, or something.
Dietary fundamentalism is not limited to low-carb, but the LC crowd seems to be the most vocal and dogmatic. Part of this I believe stems from the fact that LC is not all it’s cracked up to be. It gets mediocre results, there is difficulty in sustaining it, and it’s not a wise choice for the physically active. And so, they need to create powerful, vocal support groups to convince themselves that they’re doing the right thing.
And here is where low-carb fundamentalists are significantly different from most religious organizations. The LCers are motivated for selfish reasons. Many religions follow the tenets of helping those less fortunate, providing food, shelter, clothing, and other tangible support to those in need. They are the aforementioned “Here, take half my sandwich” kind of people, and I respect that.
And that’s where the analogy ends. Low carb preaching serves to perpetuate low carb eating, and that’s about it. Most of what they’re “giving back” to the community is a bunch of factually inaccurate information. I am fine with their right to exist, but excuse me for being tired of all the noise.
This piece was first published on my old website on September 27, 2013.
James S. Fell, CSCS, is an internationally syndicated fitness columnist for the Chicago Tribune, Los Angeles Times and AskMen.com. He is the author of Lose it Right: A Brutally Honest 3-Stage Program to Help You Get Fit and Lose Weight Without Losing Your Mind, published by Random House Canada.
- Keith Anderson, Consumer Fraud in the United States, 2011: The Third FTC Survey, March, 2013, p. 20. (http://www.ftc.gov/os/2013/04/130419fraudsurvey.pdf Accessed August 31, 2013.)
- Michael Shermer, Why People Believe Weird Things: Pseudoscience, Superstition, and Other Confusions of Our Time (New York: St. Martin’s Griffin, 2002), pp. 275, 283–4.
- Rudolph Leibel et al., “Energy Intake Required to Maintain Body Weight is not Affected by Wide Variation in Diet Composition,” American Journal of Clinical Nutrition, 55, 1992: 350-5.
- Golay and E. Bobbioni, “The Role of Dietary Fat in Obesity,” International Journal of Obesity Related and Related Metabolic Disorders, Suppl 3, June, 1997: S2-11.
- Bucholz and D. Schoeller, “Is a Calorie a Calorie?” American Journal of Clinical Nutrition, (79)5, 2004: 899S-906S.
- Schoeller and A. Bucholz, “Energetics of obesity and weight control: does diet composition matter?” Journal of the American Dietetic Association, 105(5 Suppl 1), 2005: S24-8; KR Westerterp, “Physical activity, food intake and body weight regulation: insights from doubly-labeled water studies,” Nutrition Reviews, 68(3), 2010: 148-54; T. Brown et al., “Systematic review of long-term lifestyle interventions to prevent weight gain and morbidity in adults,” Obesity Reviews 10(6), 2009: 627-38; James Hill, “Understanding and addressing the epidemic of obesity: an energy balance perspective,” Endocrine Reviews, 27(7), 2006: 750-61; L Tappy, “Metabolic consequences of overfeeding in humans,” Current Opinion and Medical Nutrition and Metabolic Care, 7(6), 2004: 623-8; Annsi Manninen, “Is a calorie really a calorie? Metabolic advantage of low-carbohydrate diets,” Journal of the International Society of Sports Nutrition, 1(2), 2004: 21-26; Manny Noakes et al., “Comparison of an isocaloric very low carbohydrate / high saturated fat and high carbohydrate / low saturated fat diets on body composition and cardiovascular risk,” Nutrition and Metabolism, 3(7), 2006: epub.
- Stephen C. Meyer, “Not by chance: From bacterial propulsion systems to human DNA, evidence of intelligent design is everywhere,” The Discovery Institute. http://www.discovery.org/a/3059. Accessed September 25, 2013.
- Discovery Institute, “What is Intelligent Design?” http://www.intelligentdesign.org/whatisid.php. Accessed September 25, 2013.
- Union of Concerned Scientists, “Evolution and Intelligent Design,” http://www.ucsusa.org/scientific_integrity/what_you_can_do/evolution-and-id-footnotes.html Accessed September 25, 2013.
- World Health Organization, “Facts and Figures about Tobacco,” February, 2006: http://www.who.int/tobacco/fctc/tobacco%20factsheet%20for%20COP4.pdf – Accessed September 14, 2013.
- Curt Lox et al., The Psychology of Exercise: Integrating Theory and Practice (Scottsdale: Holcomb Hathaway, 2006), p. 27.
- Haff et al., “Carbohydrate supplementation and resistance training,” Journal of Strength and Conditioning Research, 17(1), 2003: 187-86; P. Mcdermid and S. Stannard, “A whey-supplemented, high-protein diet versus a high-carbohydrate diet: effects on endurance cycling performance,” International Journal of Sport Nutrition and Exercise Metabolism, 16(1), 2006: 65-77; D. Christensen et al., “Food and macronutrient intake of male adolescent Kalenjin runners in Kenya,” British Journal of Nutrition, 88(6), 2002: 711-717; L. Burke et al., “Carbohydrates for training and competition,” Journal of Sports Science, 29 Supple, 2011: epub; R. Keith et al., “Alterations in dietary carbohydrate, protein, and fat intake and mood state in trained female cyclists,” Medicine and Science in Sports and Exercise, 23(2), 1991: 2121-6; T. Vandenbogaerde and W. Hopkins, “Effects of acute carbohydrate supplementation on endurance performance: a meta-analysis,” Sports Medicine, 41(9), 2011: epub; J. Helge, “Adaptation to a fat-rich diet: effects on endurance performance in humans,” Sports Medicine, 30(5), 2000: 347-57; A. Lima-Silva et al., “Effects of a low- or a high-carbohydrate diet on performance, energy system contribution, and metabolic responses during supramaximal exercise,” Applied Physiology, Nutrition and Metabolism, 38(9), 2013: epub; N. Cermak and L. van Loon, “The Use of Carbohydrates During Exercise as an Ergogenic Aid,” Sports Medicine, July, 2013: epub; J. Langfort et al., “The effect of a low-carbohydrate diet on performance, hormonal and metabolic responses to a 30-s bout of supramaximal exercise,” European Journal of Applied Physiology and Occupational Physiology, 76(2), 1997: 128-33.
- National Weight Control Registry, http://www.nwcr.ws/Research/default.htm. Accessed November 10, 2012.
- Foster-Schubert et al., “Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese postmenopausal women,” Obesity, 20(8), 2012: 1628-38; T. Wu et al,. “Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-analysis,” Obesity Reviews, 10(3), 2009: 313-23; D. Villareal et al., “Weight loss, exercise, or both and physical function in obese older adults,” New England Journal of Medicine, 364(13), 2011: 1218-29; I. Imayama et al., “Dietary weight loss and exercise interventions effects on quality of life in overweight/obese postmenopausal women: a randomized controlled trial,” International Journal of Behavioral Nutrition and Physical Activity, Oct, 2011: epub; C. Abbenhardt et al., “Effects of individual and combined dietary weight loss and exercise interventions in postmenopausal women on adiponectin and leptin levels,” Journal of Internal Medicine, 274(2), 2013: 163-75; T. Frimel et al., “Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults,” Medicine and Science in Sports and Exercise, 40(7), 2008: 1213-9; C. Curioni and P. Louenco, “Long-term weight loss after diet and exercise: a systematic review,” International Journal of Obesity, 29(10), 2005: 1168-74; W. Miller et al., “A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention,” International Journal of Obesity and Related Metabolic Disorders, 21(10), 1997: 941-7; M. Jakicic et al., “Relationship of physical activity to eating behaviors and weight loss in women,” Medicine and Science in Sports and Exercise, 24(10), 2002: 1653-9; L. Grubbs, “The critical role of exercise in weight control,” Nurse Practitioner, 18(4), 1993: 20-2, 25-6, 29; A. King et al., “Diet vs exercise in weight maintenance. The effects of minimal intervention strategies on long-term outcomes in men,” Archives of Internal Medicine, 149(12), 1989: 2741-6.