Dr Jason Fung mauled by impeccable logic of Calorie Restriction fans...

[Mr_Pot]

If we take in energy from food we can do two things with it, store it or get rid of it. Storage is almost entirely by weight gain. The calculation "Calories in - Calories out = weight gain" is correct but doesn't work in practice, because although we can measure reasonably accurately the energy from food, we cannot measure the energy out, so we can't calculate how much will be stored. A second problem which can defeat those on a calorie reduced diet is that as they begin to lose weight their energy use reduces and over time it becomes impossible to continue to lose weight without ever increasing calorie reduction.

 

[Member496333]

Also, extracting energy from food carries an energy penalty in itself, and this penalty is different between the three macronutrients, so straight away a calorie is not a calorie.

 

[Jaded Judi]

I am confused!!! What happens to patients that have exocrine pancreatic insufficiency then, plus diverticular disease? They can't eat much fat and have to take enzymes to help digest food. Would a low calorie diet help?! The Newcastle diet has been suggested to me to bring my blood sugars down -although I am not fat just a little well rounded and in my 60s, I have lost weight since being diagnosed in 2014, and have trouble with my tum anyway. On metformin SR at the moment which doesn't agree with me.
Answers on a postcard please!!!

 

[ATZ]

Also, extracting energy from food carries an energy penalty in itself, and this penalty is different between the three macronutrients, so straight away a calorie is not a calorie.

A calorie is always a calorie, it's simply a unit of measurement like a centimetre. The fact that different nutrients (protein, carbs and fats) have different energetic costs to digest and utilise does not invalidate a calorie being a calorie.

 

[ATZ]

I'm amazed at some of the cognitive dissonance going on in this thread.

Type 1 diabetics lose weight because they're not producing insulin and therefore not able to make best use of blood glucose. That is, if ever, a perfect illustration of calories in vs calories out at play. The body cannot absorb energy (from food) so it loses weight from energy stores (primarily fat but some muscle too) in order to fuel itself.

I mean if weight gain or obesity was primarily hormonally driven how do you guys square the fact that if you kept insulin elevated (even artificially) but ate nothing, you'd still lose weight/fat?

Or how do you explain the guy who ate only potatoes for a year but lost 117lb? Aren't potatoes high GI and "bad" for blood glucose levels?

Or how do you explain the science teacher who lost 56lb eating only Mcdonalds for only 6 months straight?

Or the university professor who ate mostly twinkies yet still lost 27lb in weight?

Or the man who ate 80% of his calories from ice cream for 100 days straight yet lost weight and improved his health parameters?

And these are just anecdotal evidence, these are backed up by reams and reams of clinical evidence demonstrating that weight gain is almost exclusively a problem of energy availability and overconsumption that any one particular hormone.

 

[Member496333]

A calorie is always a calorie, it's simply a unit of measurement like a centimetre. The fact that different nutrients (protein, carbs and fats) have different energetic costs to digest and utilise does not invalidate a calorie being a calorie.

I meant with regard to the CICO model. A thousand calories of fat will not have the same outcome as a thousand calories of carbohydrate. Since the human body is not a calorimeter, whether or not a calorie is a calorie before it is consumed is somewhat irrelevant.

 

[ATZ]

I meant with regard to the CICO model. A thousand calories of fat will not have the same outcome as a thousand calories of carbohydrate. Since the human body is not a calorimeter, whether or not a calorie is a calorie before it is consumed is somewhat irrelevant.

This still doesn't invalidate CICO.

Losses during digestion just account for the calories out side of the equation.

And you'd absorb less energy from 1000kcal of carbohydrate than you would fat. A fact many low carb evangelists forget.

 

[Member496333]

I'm amazed at some of the cognitive dissonance going on in this thread.

Type 1 diabetics lose weight because they're not producing insulin and therefore not able to make best use of blood glucose. That is, if ever, a perfect illustration of calories in vs calories out at play. The body cannot absorb energy (from food) so it loses weight from energy stores (primarily fat but some muscle too) in order to fuel itself.

I mean if weight gain or obesity was primarily hormonally driven how do you guys square the fact that if you kept insulin elevated (even artificially) but ate nothing, you'd still lose weight/fat?

Or how do you explain the guy who ate only potatoes for a year but lost 117lb? Aren't potatoes high GI and "bad" for blood glucose levels?

Or how do you explain the science teacher who lost 56lb eating only Mcdonalds for only 6 months straight?

Or the university professor who ate mostly twinkies yet still lost 27lb in weight?

Or the man who ate 80% of his calories from ice cream for 100 days straight yet lost weight and improved his health parameters?

And these are just anecdotal evidence, these are backed up by reams and reams of clinical evidence demonstrating that weight gain is almost exclusively a problem of energy availability and overconsumption that any one particular hormone.

I’m a little confused by this, and I’m hoping you can clarify. You open with a clear example of a hormonal imbalance affecting energy distribution, but you then close by implying that energy distribution is not affected by hormonal imbalance. Or rather, almost not.

In any case welcome to the forums.

 

[lucylocket61]

I'm amazed at some of the cognitive dissonance going on in this thread.

Type 1 diabetics lose weight because they're not producing insulin and therefore not able to make best use of blood glucose. That is, if ever, a perfect illustration of calories in vs calories out at play. The body cannot absorb energy (from food) so it loses weight from energy stores (primarily fat but some muscle too) in order to fuel itself.

I mean if weight gain or obesity was primarily hormonally driven how do you guys square the fact that if you kept insulin elevated (even artificially) but ate nothing, you'd still lose weight/fat?

Or how do you explain the guy who ate only potatoes for a year but lost 117lb? Aren't potatoes high GI and "bad" for blood glucose levels?

Or how do you explain the science teacher who lost 56lb eating only Mcdonalds for only 6 months straight?

Or the university professor who ate mostly twinkies yet still lost 27lb in weight?

Or the man who ate 80% of his calories from ice cream for 100 days straight yet lost weight and improved his health parameters?

And these are just anecdotal evidence, these are backed up by reams and reams of clinical evidence demonstrating that weight gain is almost exclusively a problem of energy availability and overconsumption that any one particular hormone.

The difference is that the people in those anecdotes did not have their insulin response compromised, as happens with diabetes. Dr Fung is talking in the context of diabetes..

 

[Member496333]

And you'd absorb less energy from 1000kcal of carbohydrate than you would fat. A fact many low carb evangelists forget.

That may be so, but a thousand calories of carbohydrate will illicit a large insulin response, whereas the fat will not. So completely different metabolic responses to the same given amount of energy input. Anyway I suspect we shall have to agree to disagree.

 

[bulkbiker]

I'm amazed at some of the cognitive dissonance going on in this thread.

I'm more amazed that you can so easily dismiss decades of experience from people who have tried, and in almost all cases, failed to lose weight and more importantly maintain weight loss by following the CICO mantra. Exercising more and restricting what you eat rarely leads to sustainable weight loss (Biggest Loser Study) . Until hormonal responses to food are fixed and brought into play maintained weight loss is extremely hard to achieve.
Have no idea where you are coming from on the diabetes spectrum so maybe you'd like to make that clear?
However at your relatively young age (36) according to your profile it may well be that CICO is proving successful for you in the short term however losing weight s "easy" maintaining that loss over years is far more difficult.

 

[ATZ]

That may be so, but a thousand calories of carbohydrate will illicit a large insulin response, whereas the fat will not. So completely different metabolic responses to the same given amount of energy input. Anyway I suspect we shall have to agree to disagree.

And?

1000kcal of fat will elicit a large response of acylation stimulating protein. Fat can be stored in the absence of insulin at almost 100% efficiency

 

[copilost]

Believing that what happens inside the body is more complex than simply CICO is not inconsistent with CICO. If your model is: put fewer calories in for ever, measure weight at various points until death by starvation, CICO holds. Similarly if the model is: put more calories in, measure weight at various time points until death by obesity complications, CICO holds. I'd be surprised if anyone would argue on that.

Although I'd argue if we are talking about 1 calorie a day I doubt you'd be able to see any discernible effect in a lifetime. Plus Type 1 diabetics don't conform with this because of what happens between putting calories in and how the body deals with food.

There isn't a cognitive dissonance between CICO and accepting the nuances of how the body responds, adapts, adjusts and processes food. The differences you are rejecting are not about energy absolutes but about how we measure and understand a complex organism that has feedback loops and adaptation capacity within a given time frame. Long term, with no adaptive counter balance, CICO will be predictive of outcome, short term with adjustments, balance, finesse, perhaps not so much.

 

[ATZ]

I'm more amazed that you can so easily dismiss decades of experience from people who have tried, and in almost all cases, failed to lose weight and more importantly maintain weight loss by following the CICO mantra. Exercising more and restricting what you eat rarely leads to sustainable weight loss (Biggest Loser Study) . Until hormonal responses to food are fixed and brought into play maintained weight loss is extremely hard to achieve.
Have no idea where you are coming from on the diabetes spectrum so maybe you'd like to make that clear?
However at your relatively young age (36) according to your profile it may well be that CICO is proving successful for you in the short term however losing weight s "easy" maintaining that loss over years is far more difficult.

People fail to lose weight because dieting is HARD.

We live in an age of unprecedented energy availability coupled with low levels of daily activity. People suck at estimating their energy intake, especially when faced with a constant barrage of high palatable and calorie-dense foods. Also, exercise while great for health and strength is a poor weight loss intervention.

The biggest loser study is hardly a demonstration of the inefficiency of CICO either, it perfectly proves it. Restrict someone's intake aggressively, forcefully exercise them and they all lost weight, the issue was weight maintenance post-trial, the intervention didn't address their (largely) psychological issues around food. It's a modern day example of the Minnesota semi-starvation study.

And CICO is not a mantra, it's the law of thermodynamics. Whether you eat low fat, low carb, keto, fast or any other dietary philosophy ultimately they all work by creating an imbalance between energy being consumed and energy being expended. Hormones like insulin are important sure, but it's not the only hormone (I realise this is a diabetes forum) involved in weight loss or gain, or responsible for the issues we have today.

Where I'm coming from? Being diabetic doesn't mean you cannot lose weight or in fact need any special approach to be able to. In fact, one of the very first diets for the treatment of overweight diabetics was Kempner's "Rice Diet" that had patients eat high amounts of rice, fruits and vegetables.

So no, it isn't about balancing hormones to lose weight.

 

[copilost]

I'd add for clarity, we need to know what the calories in, calories available equation is, because that might not be a direct equivalent (see type 1 diabetes).

 

[copilost]

People fail to lose weight because dieting is HARD.

We live in an age of unprecedented energy availability coupled with low levels of daily activity. People suck at estimating their energy intake, especially when faced with a constant barrage of high palatable and calorie-dense foods. Also, exercise while great for health and strength is a poor weight loss intervention.

The biggest loser study is hardly a demonstration of the inefficiency of CICO either, it perfectly proves it. Restrict someone's intake aggressively, forcefully exercise them and they all lost weight, the issue was weight maintenance post-trial, the intervention didn't address their (largely) psychological issues around food. It's a modern day example of the Minnesota semi-starvation study.

And CICO is not a mantra, it's the law of thermodynamics. Whether you eat low fat, low carb, keto, fast or any other dietary philosophy ultimately they all work by creating an imbalance between energy being consumed and energy being expended. Hormones like insulin are important sure, but it's not the only hormone (I realise this is a diabetes forum) involved in weight loss or gain, or responsible for the issues we have today.

Where I'm coming from? Being diabetic doesn't mean you cannot lose weight or in fact need any special approach to be able to. In fact, one of the very first diets for the treatment of overweight diabetics was Kempner's "Rice Diet" that had patients eat high amounts of rice, fruits and vegetables.

So no, it isn't about balancing hormones to lose weight.

I disagree. In the purist sense CICO works. But it isn't sensitive to mechanisms in the body. It's entirely plausible that a "special" approach will be more effective. These ideas aren't mutually incompatible.

 

[Richard'63]

I'm sort of amazed at how people are try to prove that humans are immune to the first law of thermodynamics.

 

[lucylocket61]

I'm sort of amazed at how people are try to prove that humans are immune to the first law of thermodynamics.

I am amazed that people dont realise that, for some of us, reducing calories doesn't lead to weight loss.

 

[Richard'63]

You have to be in calorie deficit! You have to be consuming less than your lifestyle requires.

 

[copilost]

I'm sort of amazed at how people are try to prove that humans are immune to the first law of thermodynamics.

oh pfft, they aren't (immune or trying to prove it). The science lies in the measurement and interpretation. Subtlety of understanding.