More studies continue to surface showing that cancer patients have a lower risk of their disease coming back if they remain metabolically healthy – i.e. keep off the excess fat, keep blood sugar levels normal, and keep muscles adequately stimulated.1 As a result, it is important for clinicians to continue to counsel, motivate, and support patients to make healthy decisions. Is part of this motivation giving the typical “eat less, exercise more” advice?
One area that has seemed to plague both patients and physicians is the “eat less, exercise more” advice that has been freely doled out for several decades. For most people, diet and exercise are not mutually exclusive, and if they start eating less, it becomes harder to exercise. This has been shown by Dr. Phinney decades ago, when he studied individuals who underwent severe calorie restriction followed by exercise.2 Both lowered their metabolic rates significantly, and the combination led to a severe decrease, which is often why people quit their diet and exercise regimens when they start feeling terrible.
Metabolism falls by almost 30% when we eat much less and exercise more.
Not only is this advice incredibly ineffective,3 but newer studies reveal it may be counterproductive. A study that recently caught my eye looked at how patient stigma affects their exercise habits. Individuals that internalize their weight issues and those that experience “anti-fat attitudes” respond by exercising less the more they are stigmatized.4
Does this mean that the more someone is told to eat less, exercise more – advice that more often than not makes people feel shame about their failure – the more it will directly cause people to exercise less? According to this study it may. I have personally seen the eat less, exercise more advice stigmatize people both within and outside of the hospital, by making them feel undisciplined and like a failure.
Eat Less, Exercise More?
If we genuinely want people to eat less and exercise more, let’s give them advice that actually provides them the tools to be both effective and healthier. Multiple randomized studies have shown that a higher fat, lower carbohydrate diet results in the unprompted lowering of calories by participants.5 Multiple randomized studies have shown that a low-carbohydrate, high-fat diet helps individuals lose weight and is superior to a low-fat diet.6,7
And to top it off, in similar individuals, other randomized studies show that energy levels drop less with weight loss when on a lower carbohydrate diet.8 If we genuinely want people to eat better, eat less, and exercise more, we need to stop with the calorie-restriction talk and stick with tangible advice and promote the foods that can lead to weight loss, healthy exercise habits, and sustainable health to help reduce cancer risk.
Eat Less, Exercise More References:
- Champ, C. E., Volek, J. S., Siglin, J., Jin, L. & Simone, N. L. Weight Gain, Metabolic Syndrome, and Breast Cancer Recurrence: Are Dietary Recommendations Supported by the Data? Int. J. Breast Cancer 2012, 9 (2012).
- Phinney, S. D., LaGrange, B. M., O’Connell, M. & Danforth Jr, E. Effects of aerobic exercise on energy expenditure and nitrogen balance during very low calorie dieting. Metabolism 37, 758–765 (1988).
- Burke, L. E. & Dunbar-Jacob, J. Adherence to medication, diet, and activity recommendations: from assessment to maintenance. J. Cardiovasc. Nurs. 9, 62–79 (1995).
- Vartanian, L. R. & Novak, S. A. Internalized Societal Attitudes Moderate the Impact of Weight Stigma on Avoidance of Exercise. Obesity 19, 757–762 (2011).
- Hite, A. H., Berkowitz, V. G. & Berkowitz, K. Low-carbohydrate diet review: shifting the paradigm. Nutr. Clin. Pract. 26, 300–308 (2011).
- Hashimoto, Y. et al. Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies. Obes. Rev. 17, 499–509 (2016).
- Mansoor, N., Vinknes, K. J., Veierød, M. B. & Retterstøl, K. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. Br. J. Nutr. 115, 466–479 (2016).
- Ebbeling Cb, S. J. F. F. H. A., et al. & al., E. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA J. Am. Med. Assoc. 307, 2627–2634 (2012).
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Thanks for another inspiring post, Dr, Champ. I’m looking forward to being cancer free very soon. What kinds of exercise do you recommend cancer patients take on. I’ve heard different things from different people. Patricia Daly, mentioned “gentle exercise, maybe walking” in her talk at Tampa. But, she’s starting back with the triathlon training. I used to do marathons. I quit doing that a long time ago. Seems like those long slow distance types of activities aren’t a great idea. How about yoga or Pilates or Olympic lifting? Crossfit?
Lots of low intensity (walking, etc.) intermixed with some high intensity (weights, sprints) seems to be the optimal combination. I agree with avoiding the grinding grueling activities like marathons, which wear the body down…
The standard advice on health & fitness, irrespective of cancer, is invariably limited to ‘calories in’ versus ‘calories out’….hence carb load versus activity level. However there is not sufficient focus on “nutritional value” or “nutritional status” of their diet & a there needs to be a re-consideration of the need for restoration of a range of minerals & salts, structural & functional proteins, antioxidants & other protective components that may be depleted during & after vigorous exercise or during a very demanding cancer treatment regimen that includes onslaught on the body from radiation, toxic chemotherapeutic drugs, & surgery. I’ve always wondered if vigorous exercise programs that regular people embark on without changing their diets other than carbo-loading is healthy for the body in the long run. Also, can cancer patients really be expected to resume as demanding exercise habits as they might have been pursuing prior to treatment when their bodies need to re-direct those precious resources to fighting to restore itself to normalcy again. There ought to be an emphasis on “being active” versus “exercising” and education about nutritional replenishment, shouldn’t there?