Great write up by Dr. Jason Fung

obesity
fung
(Richard Hanson) #21

At the heart of Dr. Fung’s argument is the fact that calories from different sources have different metabolic consequences. The classic, long standing assertion that it is simple CICO, that a calorie is a calorie is clearly false. CICO is a gross oversimplification of the issue of obesity and weight loss.

Eating 100 kcal of glucose has a profoundly different impact on the body then eating 100 kcal of oleic acid.

However, to assert that calories don’t count is to ignore the reality that eating 10000 kcal of sugar also has a profoundly different impact on the body then eating 100 kcal of sugar. Calories do count and different levels of caloric intake of the same foods do make a difference.

If not … then everyone would be in ketosis without regard to the number of grams/calories of carbs we eat, but we all know this is not true.

Dr Fung’s assertion that calories don’t count doesn’t even come close to passing a basic, rational, scratch and sniff test. Calories do count, energy is part of the story but calories are not the entire story.

Anyone who is a bit confused by this, I would invite them to do a simple n=1 experiment. Get out the kitchen scale, measure out 1 g of sugar, about 4 kcal, and consume it. Then test your blood glucose level over the next two hours every thirty minutes and record the results. After that, measure out 250 g of sugar, about 1000 kcal, and choke that down. Test and record your blood glucose levels as above.

If calories don’t matter, then the results of both trials will be identical.

If that is not convincing, do the same thing eight times a day for a year and come back and tell us that you did not put on any fat.

I know that this is a reduction ad absurdum, but then the assertion that calories don’t count is absurd.

Keto for Life!
Richard

#22

If calories don’t count at all, then why concern ourselves at all with BMR. Calories definitely count, but they are not the whole picture.

(Richard Hanson) #23

+1

Calories are likely not even the most important part of the whole picture, but that does not imply that calories are meaningless or that calories are not a significant variable in this somewhat complex multi-variable problem.

Keto for Life!
Richard

(Marie Dantoni) #24

Entertaining oversimplification… Dr Fung is really smart (and funny, and makes a lot of sense) but I’m fairly certain he took the CICO discussion to an illogical extreme.

#25

Are you seriously questioning whether over consumption can cause greater weight loss than fasting?

(Ross) #26

I am questioning if the science has been done. AFAIK it has not.

We have multiple N of 1 tests now where people have lost significant body fat while eating a high calorie ketogenic diet in what appears to be in major caloric surplus. That this appears to be repeatable should give everyone pause and screams the need for some larger study.

We are so quick to assume that we need to “burn fat” in order to remove it from out body fat stores. Maybe that’s not how this works, or not completely, when a state of keto adaptation. I’m raising the possibility that we’re all stuck in a cultural mindset that assumes it must be burned, or that caloric restriction will always produce better weight loss results than the alternatives.

One thing that sticks with me from Fung’s book was his observation that the human body want’s to return to a “set weight” once in a state of keto adaptation. That the body seems to return to that set weight (remove fat from the body) even while in caloric surplus is…ODD!!!

(Doug) #27

I agree, Ross. Many of us commenting on this thread approach things from slightly different angles, but it definitely is not only the “burning calories” that is at work; the “calories out” part is more complex and mysterious than that.

For 30 years I only gained 5 lbs. per year, and there were innumerable weeks when I should have gained that much, based solely on caloric surplus. There were times when I felt hot, sweated during sleep, etc. - almost surely because there were plenty of extra calories floating around and my body knew it - but this doesn’t come close to explaining where all the calories went.

I think there’s rather a flip side to this, as with the examples of people who are strictly keto, no cheating, right on their macros, and still find it extremely hard to lose weight.

I haven’t had a gall bladder now for two years, and I figure some fat calories literally go right through me without being absorbed/digested. We can calculate “calories in” and then figure how many are burned, stored and excreted, and I think there is still some “magic” that often goes on where the numbers don’t add up well.

(Ross) #28

In other words, all other things being equal, we have two groups (IF keto & high cal keto).

The main known variable between the two groups appears to be caloric intake.

Both groups report similar results (both lose about the same amount of weight at similar rate)

Would you conclude that caloric intake is a significant factor for weight loss?

(Doug) #29

Yes - I’m far from giving up on that. Lower the caloric intake enough, and weight loss happens, period. I contrast that with anecdotal accounts - and I admit there are enough to warrant investigation - of weight loss with apparent caloric surplus.

I don’t think we can generalize about both groups reporting similar results. For example, there are some people who don’t report much weight loss with IF keto. My opinion - we see a higher percentage of people who don’t report much weight loss with high calorie keto.

(Ross) #30

Hey Doug,

You’re not the first person here I have heard mention the fat flows thru them undigested. Even with a GB, I suppose why would the body expend valuable resources on digesting food it didn’t need? I wonder if there is a feed-back mechanism?

(Ross) #31

Very much agree with you from the above. I agree we’re looking at very preliminary yet intriguing results. Even so…and this is colored from my own experiences where I lost 20 to 30 pounds while clearly being in what should have been surplus…I am a bit skeptical.

(Doug) #32

Ross, I think that evolutionarily, we’re set up to store the fat, the body considering it more valuable than the metabolic cost of its digestion. It’s a fascinating topic - perhaps the feedback mechanism you mention is related to the weight set point theory (and who knows what else?).

@richard made the good point a while back that there are very few “binary switches” in our bodies. If we accept that there is a “set point” that our bodies try to maintain, I’d think there is a sliding scale of response, i.e. the farther we are away from that point (at least on the low side), the more the body will alter processes to try and achieve it. If the body thinks “Starvation!” then it really clamps down on metabolism. Don’t think there is an analogous thing if we are above it - seems to me we then get a rising set point.

I hope this whole deal really gets investigated, even just from a sense of curiosity - where in the heck do the “extra” calories all go, for being in substantial surplus, if not into weight gain? I have never tried the “high calorie keto” for enough time to test it myself, but I want to check that shit out! :grin:

(VLC.MD) #33

Hormonal Obesity by Dr. Fung

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Some notes from the article.

Food can be burned or stored as fat.
BMR is useless.

the confusion arises because of an assumption that basal metabolic rate stays stable under all conditions, which is known to be false for the last, oh, hundred years. Metabolic rate may increase or decrease by up to 40%.

Calories are not an accepted currency in our body.
There are no calorie sensors.

Our body gains or loses fat according to detailed hormonal instructions from our brain. The rise and fall of insulin is the main stimulus to weight gain.

You can estimate a foods insulin effect based on net carbs (carbs- fibre) + 0.54 protein. Even then, this formula only accounts for about 50% of the known insulin effect, so there is still much more we need to learn. The least insulinogenic diet is low carb, high fibre, moderate protein, high in natural fats. In other words, a real food, LCHF diet.

So remember, the common currency of the body is not calories. But neither is it dietary fat, protein or carbohydrates. It’s not fibre. It’s not ketones. The only currency the body really cares about is insulin. If you want to lose weight, reduce insulin. If you want to gain weight, increase insulin. That’s the common currency. Since our body only cares about insulin, we better learn the insulin effect of foods.

However, in this case, the oral glucose was far, far better at stimulating insulin than the intravenous. Furthermore, this mechanism had nothing to do with the blood sugar. Insulin response is not the same as the blood sugar response. This had not been seen before. Eventually, it was discovered that the stomach produces hormones – now called incretin hormones that increase the insulin secretion. Since the intravenous glucose bypasses the stomach, there is no incretin effect. This may account for 50-70% of the insulin secretion after oral glucose intake.

So far, two incretin hormones have been described in humans. These are Glucagon Like Peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Both hormones are deactivated by the hormone dipeptidyl peptidase-4 (DPP4). Inhibition of DPP4 by drugs like saxagliptin causes an increase in the levels of the incretin hormones. This raises insulin levels and helps to lower blood sugars.
(source: https://idmprogram.com/incretin-effect/ )

I modified his Hormonal obesity to better fit my eye.

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—===—
Dr. Fung’s point here is that the type of food you eat and it’s impact on your insulin is the important part of food. 100 calories of sugar has a different impact on insulin than 100 calories of fat. In fact the impact of 100 calories of sugar is so different than 100 calories of fat … it makes calorie discussion irrelevant. The question isn’t should I eat 100 calories of food ? It should be what type of food should I put in my body ?

Maybe phrased another way, people get fat based on the type of food they eat more than the number of calories they eat. As well, you don’t heal your metabolism by eating fewer calories (same foods), you fix yourself by eating the right types of food (almost independent of calories).

Phrased another way …

(VLC.MD) #34

If your job was to determine if a given intake of food would be fattening or not … but you were only allowed to ask one question … what would you ask ?
Options:
A) How many calories is the intake ? (calories)
B) What type of food is it ? (macros)
C) What is the impact of the intake on Insulin ? (insulin)

Fung says C.
It’s not that they aren’t interrelated. It’s just the conversation about what to do with obesity is focused on A and it should be C.
Note: B is a better predictor than A. (as all us keto’ers know). KetogenicForums.com uses B as a proxy to estimate C.
FWIW, The sugar industry says A.
—===—

EDIT: Another idea is that calories determine the size of the fat gain/loss vector but not the direction of the vector ! C determines the direction of the vector in a binary way (fat loss, fat gain).

(Doug) #35

Nice post, VLC. Totally agree about hormonal obesity - high enough insulin and we’re storing fat while the cells in our tissues are being starved, a truly vicious circle.

This is the rub, for me. Up to a 40% increase/decrease in metabolism doesn’t come close to explaining the “things are not adding up” factor, mainly on the high side - we can indeed burn more fuel by running a higher temperature; that’s the main effect of the body revving up the metabolism. Yet it’s the same as us consciously exercising - it’s depressing how efficient we are at making heat and doing physical work. “If I eat that hamburger, I’ll have to run five miles to burn it off…”

(Ross) #36

image

Bickman just had a presentation relating to this subject.
There’s a lot going on there, but nutshell he thinks in a keto adapted state we tend to store less energy (fat), use more (crank up heat generation) and also simply waste more (piss and breath our ketones just to get rid of them at a very high rate). Might also waste them by not bothering to digest everything we eat if we don’t need it too I suppose.

Those waste and heat factors could make all the difference in the world depending on how they were up or down regulated in keto caloric surplus VS IF.

(Doug) #37

DUDE right on - would explain some things. :sunglasses:

(Richard Hanson) #38

Another question:

If you ask Dr. Fung, which would be the least fattening for an obese person to consume at a meal

a) 20 g of table sugar.
b) 200 g of table sugar
c) 2000 g of table sugar

What would be his most likely response?

I think this is also a very easy question to answer.

Calories matter as do a lot of other factors, many of which are likely to be more important then calories. It is fortuitous that in the real world we can ask more then one question.

Keto for LIfe!

Best Regards,
Richard

(VLC.MD) #39

c) 2000 g of table sugar

(Ross) #40

Fung’s response would be “Don’t eat table sugar”.

I don’t see how a discussion about hypothetical eating of table sugar has anything to do with the impact of a change in caloric intake with respect to eating a ketogenic diet.

We all know the rules governing a carb adapted diet VS a keto adapted diet are very different.