How to Lose Weight When Chronic Illness Prohibits Exercise
Many with chronic pain or ME/CFS put on weight due to the condition’s ability to limit physical activity. The traditional weight loss method of exercise is usually off the table since exercise is contraindicated, especially in ME/CFS.
Yet, weight loss is a critical factor to reduce generalized inflammation.
Since chronic pain and chronic fatigue are both associated with inflammation, returning to a healthy weight is essential for symptom improvement. In overweight individuals, the reduction of body fat improves mitochondrial function of fat cells and decreases the production of cytokines, towards a less inflammatory response.
But if I can’t exercise, how can I lose weight?
Since the exercise boon of the 1970’s, the general consensus has been eat less, move more. However, nutrition research has not always supported this notion. For starters, moving more makes one eat more. And in some instances, overweight people actually consume fewer calories than their normal weight peers. Moving more and eating less is clearly a gross oversimplification.
More focus on Macros, less on Calories
Believe it or not, dietary fat is not a major determinant of body fatness. Weight maintenance is simply more complex. In randomized trials lasting more than 1 year, fat consumption ranging from 18% - 40% of total energy has little if any effect on body fatness. Many of the low fat, and thus low calorie, recommendations that make headlines are based on short-term studies only.
Instead of focusing on this low fat, low calorie model of weight loss, understand that our metabolism is governed by a complex interplay of satiety hormones. These hormones interact with specific neurons in the brain that regulate hunger, body temperature, and digestive processes. These factors are more strongly related to weight gain than simply over consuming calories. Given the complexity of metabolism and appetite regulation in the brain, counting calories is truly a futile task.
The single most important aspect to weight loss is choosing a dietary strategy that one can adhere to and sustain. The energy and willpower required to count calories and militantly control portion sizes is a recipe for disaster, and can quickly take the joy out of eating. If you have a chronic illness on top, the easiest, least labor intensive approach to weight loss is the only way to ensure adherence and results.
Percentages and ratios of carbs, fat, and protein are diet macros to use when trying to lose weight. These are the only numbers one should consider when planning a diet for weight loss. No calorie counting. No weighing food portions. Keep it simple. Many choose to use mobile apps, like MyFitnessPal, to monitor precise daily macros.
While no single diet plan works universally for everyone, there are some universal truths worth noting. These are tips that no nutritionist should ever disagree with. They’re no-brainers when it comes to a goal of weight loss:
Processed foods are empty of nutrition and are fattening
Sugary drinks are the biggest source of excessive, nutrient-poor calories
Eating after 9pm will promote weight gain
More fruits and vegetables are always a good idea
Eat more protein, especially seafood
Drink more water
With these things in mind, let’s consider what the research says about the most effective diets for weight loss. All of these are effective, evidenced-based approaches that can achieve weight loss without the need to exercise.
Low Carb Diet
Did you know that the amount of carbohydrate intake required for optimal health in humans is unknown? Yet the standard American diet is heavy on carbohydrate, at more than 45% of total dietary intake. A low carbohydrate diet is usually defined as a diet that gets ≤40% of calories from carbohydrate. There is a lot of room for variation in a diet that contains ≤40% of carbohydrate, making it flexible and easy to adhere to. There is no good evidence that a high carbohydrate diet is essential for health, much less will ensure weight maintenance. In most trials, high carbohydrate diets over 40% of calories promote weight gain in the long term, especially when the carbohydrate comes from processed foods.
The best evidence of the efficacy of a low carb diet comes in numerous trials in diabetic patients. Reduction of overall carbohydrate intake has demonstrated the most evidence for improving blood sugar and body weight. This diet is now recommended by consensus by the American Diabetes Association—a truly amazing milestone!
But is it safe? Low carb diets are now the recommended therapy for diabetics. It is also highly effective at lowering inflammatory markers like C-reactive protein (CRP) and triglycerides. A total of 41 studies published between 1963 and 2018 were included in a 2019 meta-analysis. Of them, 40 were classified as safe and effective for inclusion in the analysis. The 41st did not meet the criteria for analysis.
What about whole grains?
The carbs in a low carb diet should generally come from vegetable sources. However, grains can be included in moderation. However, the truth of the matter is that many whole grains branded as health foods are actually processed food with a high glycemic load, meaning more likely to promote weight gain. In a meta-analysis, whole grain consumption caused no weight loss, and caused weight gain in those with obesity or diabetes. Be wise to grains, they are not to be completely demonized. Unprocessed grains, especially whole kernel grains seem to be better choices for weight reduction or maintenance. Choose oats, rye, teff but in limited quantities to maintan a low carb lifestyle.
A very low carbohydrate diet (VLCD) is ketogenic and it allows for an even lower amount of dietary carbohydrates – usually less than 50 g of carbohydrate per day. However this can also be variable as discussed in other posts. In the absence of adequate dietary carbohydrate, this diet promotes weight loss by relying on the production of energy by burning stored fat. This process generates ketone bodies which can be used as a fuel source for the brain.
During a ketogenic diet, there is never total absence of dietary carbohydrate nor is there total absence of glucose in the blood. Either of these would be catastrophic events for the body. Instead, the liver generates glucose independently and continues to store that glucose as glycogen. After a few weeks, a metabolic adaptation occurs, known as keto-adaptation. Read more about this in a prior post.
Another way in which ketogenic diets promote weight loss is that that may raise calorie expenditure. This means that the body generates more heat (calorie burning) simply by eating a keto diet. How’s that for weight loss without exercise?!
A meta-analysis of randomized, controlled trials showed that ketogenic diets achieve greater weight loss than low fat diets in the long term. A year long, controlled trial of 349 individuals with type II diabetes produced weight loss, improved blood sugar regulation, and allowed for medication reduction following a keto diet.
But is it safe? The strongest evidence of safety for a keto diet comes from the recent clinical trial in diabetics referenced above. To date, few diet trials extended this long. Also noteworthy, there was good adherence to the diet during this trial showing it’s safe and sustainable.
Fewer long-term quality studies of fasting have been performed compared to low carb and keto diets. For starters, there are too many fasting methods to have continuity in the literature. However, of the studies available, most have demonstrated that intermittent fasting, either in consecutive days of restriction or by fasting 16 hours per day or more, may result in weight loss. For those will chronic conditions like ME/CFS and fibromyalgia, the intermittent 16-22 hour fast is recommended. Read how this works here.
Is it safe? The safety of intermittent fasting in people with special health situations, including pregnancy and disordered eating, has not been studied. However, some fasting protocols (such as the last meal consumed at 3pm) can be reasonably assumed to be safe. In general with fasting protocol safety, a little common sense goes a long way.
Still need help with weight loss? I can help. Consider a diet consultation.
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Evert AB, et al. (2019) Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 42(5):731-754.
Willett WC & Leibel RL. (2002) Dietary fat is not a major determinant of body fat. Am J Med. 2002 Dec 30;113 Suppl 9B:47S-59S.
Sadeghi, O. et al. (2019) Whole-Grain Consumption Does Not Affect Obesity Measures: An Updated Systematic Review and Meta-analysis of Randomized Clinical Trials. Advances in Nutrition.
Bolla AM et al. (2019) Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes. Nutrients, 11(5), 962.
Beuno, NB et al. (2013) Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition. 110, 1178–1187.