Nutritional Pearl: Eat Less—Better in Body and Mind

Terry is a 37-year-old man who has been struggling to lose weight for many years. Upon your recommendation, he is preparing to begin following a caloric restriction diet but expresses concern that the preoccupation with managing what he eats will be detrimental to his mood.

How do you advise your patient?
(Answer and discussion on next page)

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Answer on next page

Answer: A caloric restriction diet could not only aid in weight loss efforts, but also significantly improve overall mood and decrease tension.

Caloric restriction (CR) describes a diet that deliberately minimizes caloric intake (usually 1200 to 2000 calories per day) while still consuming 100% or more of the recommended daily allowance of all essential nutrients. Those following CR will avoid processed foods, trans-fats, refined carbohydrates, desserts, snacks, and soft drinks while consuming about 26% of their calories from protein, 46% from complex carbohydrates, and 28% from fat.

Research has found that compared with following a more usual American diet (which averages between 2000 and 3500 calories per day), those following a CR diet have lower cholesterol levels, better heart function and cholesterol scores, lower markers of inflammation, and markedly less plaque in the coronary arteries.
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By now you're probably thinking, "That's all very nice, but wouldn't a CR diet suck all the joy out of life? Sure, I might live longer, but how happy am I really going to be?"

The Research

It's true that much of the research surrounding CR has focused on its physical effects. However, a recent study looked at overall quality of life, including mood, sleep quality, and even sexual function. A multicenter team of researchers recruited 188 men and women who were healthy and not clinically obese (having a body mass index under 28 mg/kg²) to participate in a 2-year study of CR. The participants were all a minimum of 20 years of age with a cutoff of 47 (for women) and 50 (for men) at the start of the study.

Two-thirds of the participants followed a CR diet for 2 years, with their goal being to consume 25% fewer calories than they had previously been accustomed to. The other third of the participants followed their usual diets. At the start of the study, after 1 year, and at the end of the study, both groups responded to a battery of tests measuring mood, stress levels, overall quality of life, amount and quality of sleep, and sexual function.

The Results

Much of the existing research on CR has focused on its effects on those who are overweight or obese, so the authors were somewhat surprised to see that the results in these normal-weight and somewhat-overweight persons were similar to other studies of those who were overweight or obese. In short, compared with those who continued with their usual diet, those who followed a CR diet lost more weight (of course) but also significantly improved their overall mood while decreasing their level of tension. Those on their usual diet actually experienced increased depression and slept for less time than those on CR, whose levels of depression or amount of sleep did not change significantly.

What’s the “Take-Home”?

We know that for those who are clinically obese, losing weight can improve overall quality of life, decrease depression, and improve sleep quality; it's great to know that these positive effects are available to those who are already of clinically normal weight. A higher overall quality of life allows you to enjoy what you have: friends, family, your work or avocation, and yes, even a good meal. While CR has well-documented positive effects, that doesn't mean that CR is the only diet that can have these effects for you.

As I like to say to my patients, "Perfect is the enemy of better." Work on the quality of the calories you consume by choosing the best fats, lean protein, and complex carbohydrates in reasonable amounts. You'll feel the effects in both body and mind.

Reference:

Martin CK, Bhapkar M, Pittas AG, et al; Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) Phase 2 Study Group. Effect of calorie restriction on mood, quality of life, sleep, and sexual function in healthy nonobese adults. JAMA Intern Med. 2016;176(6):743-752.