Counting Calories Just Doesn’t Add Up

For decades, the advice for losing weight has been rather simple “Eat less, move more,” or even “Eat fewer calories than you burn!” However, despite the seeming simplicity of it and the willingness of millions to follow it, it seems that we just can’t get rid of those extra pounds. It could be, as many have put it, that the patients simply have no willpower or discipline to follow said rules -- or could it be that the advice itself is wrong? The fact that this weight-loss prescription has an estimated 99.4% failure rate (99.9% for the morbidly obese) seems to suggest that it is time to reconsider the efficacy of such a paradigm and come up with alternative models.

The traditional equation suggests that the fat in our bodies is a result of (calories in) minus (calories out): a simple explanation, but fatally flawed. The first mistake it makes is that it does not distinguish between types of calories, it simply assumes that the only important variable is the number of calories consumed. But do olive oil and sugar have the same metabolic responses from the body? No! While the former is absorbed through the small intestine and transported to the liver, causing neither a rise in insulin nor in blood glucose levels, the latter (sugar) does raise both, provoking a response from the pancreas. It is quite clear that not all calories are created equal.

This model also assumes that fat storage is unregulated by hormones. Actually, every vital function and system of the human body is autonomically regulated by hormones: blood glucose by insulin and glucagon, height by human growth hormone (HGH), sexual maturity by estrogen and testosterone, body temperature by thyroxine, and countless others. The gastrointestinal, respiratory, circulatory, hepatic and renal systems (just to provide a few examples) are all tightly regulated by hormones and are certainly not controlled consciously. On the other hand we are led to believe that the growth of fat cells is essentially unregulated, so that the simple act of eating will result in fat growth.

This is far from the truth, as nowadays they are still discovering new hormonal pathways in the regulation of fat growth; the most famous of all is leptin, although others play a role in it too, like adiponectin, hormone-sensitive lipase, lipoprotein lipase and adipose triglyceride lipase. This also makes us realize that, given that hormones regulate fat growth, then obesity is a hormonal disorder, not a caloric one.  

This also connects to the myth that the decision to eat or not, or even to feel hungry is mostly if not entirely conscious. The truth is that we consciously decide to eat in response to hunger signals that are hormonally mediated, in that same fashion we stop eating when the body sends signals of satiety, also hormonally mediated. This explains why we may respond to the same smell of delicious food in a different fashion before and after having a large meal; of course the smell is the same, but the body’s response is not. This is indeed also under automatic control, just as you cannot decide consciously when you need to breathe or pump blood.

Perhaps the most important mistaken assumption of the calorie-counting model is that it assumes that the caloric intake and expenditure (calories in and calories out respectively) are two completely independent variables, and not linked together. This is said in part because although energy intake is very easy to measure (by the food you eat), energy expenditure is more complicated, being the sum of basal metabolic rate, thermogenic effect of food, non-exercise activity thermogenesis, excess post-exercise energy consumption and exercise. In reality, the problem of fat-storing is one of energy distribution, with too much energy being divested to producing fat instead of heat, muscle or bone production (just to mention some), so many obsess about calorie input when output is far more important; and, worst of all, the truth is we cannot decide the ways in which the body spends that energy

Many experts however ignore this and choose to focus solely on exercise as the only way energy is spent. They assume the fact that the rest of energy expenditure remains constant and that caloric expenditure is not linked in any way to caloric intake, so their theory is that if you eat less and are spending the same amount of energy (or even more, with the exercise) you have to lose weight. This is false, these two processes (intake and expenditure) are linked, and total energy/caloric expenditure is not constant. In fact it can go up or down by as much as 50% depending upon the caloric intake (among other factors) to maintain energy balance. So, for example, a 40% reduction in calorie intake is counterbalanced by a 40% reduction in calorie expenditure. In simpler terms: Calories Out does respond to Calories In, and in ways that are out of our conscious control, so if you consume less calories, your body is going to adjust to spend less energy, with the net result being no weight-loss at all.

This was demonstrated by one of the most ambitious nutrition studies ever done: the Women’s Health Initiative. This randomized trial evaluated the calorie-reduction, low fat approach for weight-loss in almost 50,000 women. One group of these women was encouraged through intensive counseling to reduce their daily caloric intake by 342 calories and to increase their level of exercise by 10%, the expected result was that they would lose an average of 32 pounds every single year. However, when the final results 7 years after came, to the surprise and disappointment of the health experts, virtually no weight loss had occurred despite good compliance of the subjects, not even a single pound.

It is no surprise then that this great rebuke of the caloric-reduction approach was simply ignored, with no effort to adjust that model or to look for better explanations on the part of its defenders; the studies and statistics that have proved time and time again that this effort leads to failure on the vast majority of cases were forgotten and discarded, recurring to the same old strategy of blaming the patients for said failure: “It is them who are not complying, it is them who do not have the willpower to live healthy”. Having said that, this story does not end here, as we have not yet answered the most important question of all regarding this issue, because…if calories do not cause obesity, then what does? This, dear readers, we will examine in detail in another article very soon, to give it the attention it deserves.

[This article was written based on information found in The Obesity Code and The Diabetes Code, both by Jason Fung].

In the world of nutrition and health, it is very common for a new diet, a new method or a new “miraculous cure” to appear almost every day. Apart from being rationally skeptical of any kind of definitive cure for anything, I think we should be able to overcome the ever-present ad novitatem fallacy (the idea of something being better or superior just because it is new) and look to the past –as well as to the present- for answers.

A good example of past traditions being useful in the way we conceive health is the revival of fasting, a practice that goes back in a medical context to the father of modern medicine himself, Hippocrates. Even though it has been present as part of our lives as humans in almost every culture and religion for millennia, fasting (more specifically intermittent fasting) has made a comeback since 2012 with the help of doctors such as Michael Mosley, Jason Fung, and journalist Kate Harrison, among others.

But what is intermittent fasting? In a nutshell it consists of the voluntary abstinence of food for certain periods, be it hours or even days. The main objective of the fast is to deprive the body of glucose, so that it turns to other sources of energy such as glycogen (excess glucose stored in the liver) and fat, the last functioning as the long term food energy storage. This not only helps the body to burn said fat and lower insulin levels, but also produces other many benefits, depending on the fasting regime you are following.

One is the production of ketone bodies, which is one of the products of said breakdown of fat stores (called triglycerides); ketones can then be used to supply approximately 75% of the brain’s energy needs, as they are capable of crossing the blood brain barrier (a thing that not all forms of fat can do). Another positive is that not only do the insulin levels go down -and blood glucose too, in a span as short as 24 hours- but regular fasting, by routinely lowering insulin levels, can improve insulin sensitivity; this is very important because the main factor driving type-2 diabetes is insulin resistance, and regular fasting can help significantly with this.

Another byproduct of this is that fasting rids the body of excess salt and water, as insulin causes salt and water retention in the kidney; this in turn helps to reduce blood pressure slightly, while decreasing LDL-cholesterol and triglyceride levels. It is also beneficial for losing weight, first by producing results that are almost twice as better as those of bariatric surgery patients. But even in studies comparing fasting approaches to caloric restricted diets, the fasting groups not only lost more weight generally, but lost twice as much of the dangerous visceral fat.

Talking about cancer, fasting provides many benefits. It lowers the activity of IGF-1, a hormone associated with cell proliferation in many cancers; it also lowers pro-inflammatory cytokines like IL-1β and IL-6, both known cancer promoters. On the other hand it promotes mechanisms in our body that can help fight cancer, like limiting cell growth and proliferation, or promoting autophagy, a process where damaged or inefficient cells are sacrificed for economizing purposes, including the dysfunctional mitochondria in cancer cells.

Finally, it can improve your cognitive readiness. When you eat, blood goes to your digestive system to deal with the great influx of food, leaving less blood for brain function, this helps to explain why you may feel sleepy and not very alert after eating large meals; fasting does precisely the opposite, allocating more blood to your brain.

Now we know that fasting has been around for many millennia for a reason, not only as a significant part of religious rituals, but because it has many benefits for our health, of which the ones shown before are just only one part of the picture of what this practice can do for us. Of course, as always, if you have found this could be an option that seems suitable for you, we encourage you to start with the assistance and guidance of a nutritional expert or a physician. In the following articles we will expand on this subject, tackling common myths surrounding this practice and the best ways to start.