Refuting CICO platitudes

[PaulL]

While it’s true that “oxidative burning” is not the end-all of human metabolism, so what? That’s not the argument. That’s all that happens in the bomb calorimeter, but the exact same thing goes on in the human body. That’s what cellular respiration is - oxidative burning of fatty acids, amino acids or sugars.

Not to belabour the point, but the relative energy yields of the three macros in terms of ATP are different from their relative combustion values. That is literally all I was saying. I’m not denying the laws of thermodynamics, just saying that we should really be looking at ATP yield instead of caloric value, if we want to know what the foods we eat are doing for us. We’ve learned quite a bit about biochemistry in the past century and a half; shouldn’t we be applying that knowledge to human nutrition?

[islandlight]

Thank you all so much for your input. In the other forum, I didn’t want to mention keto, because I knew it would be attacked. In fact, it was mentioned, and dismissed as mumbo jumbo.

However, I and a couple of other people tried to point out that merely eating smaller portions and less fat didn’t always work, for us or for people in general. We were accused of feeling sorry for ourselves, being unwilling to care for our health, etc.

I wrote a couple of short responses, saying that I’m healthier than most people my age, etc. And that attacking other people’s food choices is not helpful.

I’m not going to say any more about it though. A lot of closed minds in that forum.

[PaulL]

However, I and a couple of other people tried to point out that merely eating smaller portions and less fat didn’t always work, for us or for people in general. We were accused of feeling sorry for ourselves, being unwilling to care for our health, etc.

There are documented cases of people on restricted calories who still put on weight. A researcher who studied obese mice (genetically modified) remarked that they didn’t put on fat if they ate too much, they put on fat if they ate at all. So some people really do have a genetic propensity toward obesity, and such people are particularly vulnerable to a high-carbohydrate diet.

It’s not always that the patient is non-compliant. Gary Taubes points out that diet books tend to be written by doctors who discovered that following their own advice didn’t work for them. In the case of their patients, they could always suspect the patient of not following the diet, but in their own case they knew they were following the advice properly. So that was the point where they began to suspect that the advice (eat less, move more) was flawed.

Taubes believes that the standard advice is promulgated by thin doctors who don’t themselves have a weight problem, and who figure that if the advice works for them, it should work for everybody. Unfortunately, the situation is more complicated than that.

[islandlight]

Thank you, Paul. One of the “dissenters” did point to a similar study.

[PaulL]

There are documented cases of people on restricted calories who still put on weight.

There are also documented cases of people on an unrestricted ketogenic diet, who still lost weight while eating a thousand calories or so more than the other participants in the study. And there is the case of Sam Feltham, who ate a 5000-calorie ketogenic diet for 28 days. He found that his weight went up slightly, but the DEXA scan showed that he had lost some fat, even while putting on some muscle.

[OldDoug]

Not to belabour the point, but the relative energy yields of the three macros in terms of ATP are different from their relative combustion values.

Significantly different? And even if so, would it really matter? In the end, aren’t we still ending up with water, carbon dioxide and energy? If we convert from ‘caloric yield’ to ‘ATP yield’ or the reverse, the basic physical relationships or equations, i.e. ‘CICO,’ etc., are unchanged. Maybe I’m missing your point. There are also different energy yields from different fats like palmitic acid, stearic acid, etc. (for one example), and I just can’t see any meaningful change in the discussion anywhere.

That is literally all I was saying. I’m not denying the laws of thermodynamics, just saying that we should really be looking at ATP yield instead of caloric value, if we want to know what the foods we eat are doing for us. We’ve learned quite a bit about biochemistry in the past century and a half; shouldn’t we be applying that knowledge to human nutrition?

Paul, indeed, and I don’t mean to argue to hard against you here. We’ve probably done this same discussion before, and I just don’t remember it. Maybe things come down to matters of degree or even “splitting hairs,” I don’t know.

What the foods we eat are doing for us - that’s considerably bigger than CICO, and I think it’s where the discussion really lies, where the true arguments are to be had, or at least clarified.

The foods we eat - it is fact (I think it should be uncontested) that, for example, “a calorie (or any other energy unit) of one macronutrient won’t necessarily affect us the same way as a calorie of another, and that for many people they definitely don’t affect them the same way.”

I think and hope that we all accept that - the basic premise of keto diets, insulin resistance, the frequent metabolic changes from diets, etc. But that doesn’t invalidate CICO. CICO is just a statement of quantities, a relationship, part of an equation. With the different macronutrients the “out” is frequently changed by the “in.” Thus my frequent and long-standing arguments about it.

It’s certainly not true to say that the ‘calories in’ is all that matters, and that it cannot matter what kind of calories they are. It’s also just as false to say that this means CICO doesn’t work. If we are insulin-resistant and eat a lot of carbs and starve our sells and slow out metabolism, then we’ve changed the ‘out.’

[OldDoug]

I’m not going to say any more about it though. A lot of closed minds in that forum.

Laurie, in the very first post here, you said you hate debates. If somebody won’t really consider things and/or is entrenched with the mindset that “all calories are the same,” then they’re not going to change, and it cannot be worth your while to try and enlighten them.

Their way may work for them. It works for most of the world’s people, really - they’re not fat and they’re not problematically insulin-resistant, though both those things are changing for the worse, in general. Years hence, some of those individuals will find out that you’re right.

[islandlight]

Thank you, @OldDoug . Certainly, if something works for them, or if they believe something they read, fine. What bugs me is that they want to dictate or legislate what other people should eat, etc. Oh well.

[Alecmcq]

Here’s my answer: the number of calories you consume and burn does matter… the problem is that this thinking is just not practically useful because the calories in and calories out are not independent of each other. You can’t just restrict your calorie intake and assume you will lose weight forever, your body will adjust by burning fewer calories. You also can’t do more exercise and assume you will lose weight, as the body will compensate again by spending fewer calories on other things. Not to mention the psychological impact of a forced calorie deficit. Been there, got the t-shirt.

So you have to find something that is useful to encourage your body to burn the thing you want to actually reduce: bodyfat (well, most of us do, anyway). What is the best way to allow our bodies to burn bodyfat? Have a low insulin level. How do we do that? Eat low carb. Simples. What prevents the body from burning its bodyfat? High insulin.

The balance of the total calories in and total calories out is the score, but we do not have control over calories out, so simply having a CICO strategy of “eating less and moving more” does not work in most people: proven again and again.

[OldDoug]

the calories in and calories out are not independent of each other.

Indeed, Alec. They are two separate statements.

Yet - especially in the case of insulin resistance - don’t we have some control over calories out? If by lowering our insulin level we have the body store less fat and burn more of it (a thing which demonstrably happens for many people who eat ketogenically), then by conscious choice haven’t we altered the calories out part?

[Alecmcq]

don’t we have some control over calories out?

I prefer to say that we can influence calories out rather than control it. End of the day, the body decides what calories it wants to spend. We can influence it in a direction, and I agree that if you are low carb you stand a chance of influencing it in the right direction.

I experience this regularly in being really hot during the night, I have to kick the duvet off. Body spending calories just because it wants to.

[OldDoug]

End of the day, the body decides what calories it wants to spend.

So true! I’ve had it after 3 or 4 days of fasting, getting profoundly ‘hot’ - a very pleasurable sensation, actually - and you’d think the body would be more in conservation mode. Sadly, it’s a rare thing in my experience and cannot be counted upon.

[ajbennett]

Conservation of mass is a scientific law, so in some sense CI/CO always applies. CI > CO is a state of adding non-water weight and CI < CO is a state of reducing non-water weight. The complexity of human metabolism can’t break the rules of mass balance - every carbon, oxygen, nitrogen, and hydrogen atom has to go somewhere.

That said, it’s a classic mistake to treat “CI” and “CO” as something that (1) you can easily measure and (2) stays constant.

In human trials, naive estimates of weight gain and weight loss based on simple subtraction tend to fail very badly. e.g. “I’m eating 500 kcal less than my body uses every day. Therefore, I will burn off 1 pound of fat every week.”

Overfeeding tends to upregulate energy consumption (increasing CI leads to increasing CO), and starvation tends to downregulate energy consumption (decreasing CI leads to decreasing CO).

There are several assumptions there:

• You know exactly how much energy-per-day your body uses
• That energy-per-day consumption stays exactly the same when you radically alter the amount and/or the composition of the food energy you take in.
• You’re removing the proper foods and not creating deficiencies in macronutrients or micronutrients in your 500 kcal/d reduction.

Low carb and keto diets succeed because CI < CO. That doesn’t mean they succeed because of explicit calorie counting and bookkeeping. Possible mechanisms could be:

• Cutting out low-satiety foods based on flour, sugar, and seed oils gets rid of excess energy without getting rid of any desirable nutrients (reduce CI).
• Adding high-satiety foods like meat and eggs (high protein), and non-starchy vegetables (high fiber) helps people feel full on fewer calories (reduce CI while maintaining satiety).
• There may be a true metabolic advantage of sustained or periodic ketosis/fat-burning mode as compared to sugar-burning mode. For example, David Ludwig and collaborators article in JAMA 2012[1] found ~300 kcal advantage and their article in BMJ 2018[2] found something similar (increase CO, or at least maintain it).

Ebbeling et al, JAMA

Among overweight and obese young adults compared with pre-weight-loss energy expenditure, isocaloric feeding following 10% to 15% weight loss resulted in decreases in REE and TEE that were greatest with the low-fat diet, intermediate with the low-glycemic index diet, and least with the very low-carbohydrate diet.

[1] https://jamanetwork.com/journals/jama/fullarticle/1199154
[2] https://www.bmj.com/content/363/bmj.k4583

[PaulL]

Low carb and keto diets succeed because CI < CO.

And here Gary Taubes would point out that the assumed direction of causality is usually wrong. The imbalance between CI and CO is not the cause of the weight (fat) loss, but rather it is the fact that low insulin has put the body into fat (weight) loss mode that has caused the imbalance. Those laws of thermodynamics aren’t as obvious as people assume, lol!

I tend to think Taubes has nailed this one, because we all know people who added lean mass while shedding fat mass on a ketogenic diet, so CICO can’t possibly be the complete explanation of what’s going on.

[OldDoug]

The complexity of human metabolism can’t break the rules of mass balance - every carbon, oxygen, nitrogen, and hydrogen atom has to go somewhere .

Good post, Jack. Exactly right.

That said, it’s a classic mistake to treat “CI” and “CO” as something that (1) you can easily measure and (2) stays constant.

Agreed. It should be obvious to all that of course it’s not necessarily going to stay constant. Measuring, though - nobody needs to measure, in the first place. It’s fine if people like data for its own sake, etc., but I sure don’t ‘count’ anything in practice, and neither do many others. We don’t need to know exactly what the In and Out are, for CICO to apply. Let’s make it work for us, whether we care about counting or not.

Low carb and keto diets succeed because CI < CO. That doesn’t mean they succeed because of explicit calorie counting and bookkeeping.

Definitely. And same for the case where high-carb diets work, or where they fail - as in the oft-quoted “eat less and move more” dictum that may result in a reduction in energy expended. CICO is just the messenger, CICO is telling us what is going on, regardless of whether our desires are being fulfilled or not.

CI > CO
CI = CO
CI < CO

Take your pick.

[PaulL]

This reminds me: why is it that we never bring the law of conservation of mass into play when discussing body weight?

[OldDoug]

And here Gary Taubes would point out that the assumed direction of causality is usually wrong. The imbalance between CI and CO is not the cause of the weight (fat) loss, but rather it is the fact that low insulin has put the body into fat (weight) loss mode that has caused the imbalance. Those laws of thermodynamics aren’t as obvious as people assume, lol!

Paul, quite reasonable. I also think it’s not necessary to know or deem a “first cause” if you will, because CICO means a condition will be in effect. Even if CICO is itself an effect - and certainly, as with an otherwise isocaloric diet with insulin resistance resulting in fat gain and a reduction in the “Out” - CICO is affected, it still operates and applies. Nothing is changed as far as the laws of thermodynamics.

I tend to think Taubes has nailed this one, because we all know people who added lean mass while shedding fat mass on a ketogenic diet, so CICO can’t possibly be the complete explanation of what’s going on.

Well, nobody said it was a complete explanation. CICO isn’t telling us what the macronutrients are, to begin with, nor body composition, nor the phase of the moon.

why is it that we never bring the law of conservation of mass into play when discussing body weight?

Because it should be obvious? If anything, I think this goes to the “Let’s not pretend there is magic going on,” i.e. as Jack said, it all

has to go somewhere .

[PaulL]

Unfortunately, CICO is all-too-often used, usually by the makers of processed edible food-like substances, to assert that it doesn’t matter what we eat, as long as we don’t eat too much (Robert Lustig derides this as the “calories are fungible” argument). Fortunately, we all have learned that it’s what we eat that makes the major difference, not how much.

[Alecmcq]

I think we’ve got to the nub of it here… the important thing is how we achieve a calorie imbalance to lose weight. It is not just “eat less move more”. This is a failed philosophy.

We need to create and sustain the right hormonal conditions within the body to generate the calorie imbalance to lose weight in the long term.

[ajbennett]

Unfortunately, CICO is all-too-often used, usually by the makers of processed edible food-like substances, to assert that it doesn’t matter what we eat, as long as we don’t eat too much (Robert Lustig derides this as the “calories are fungible” argument). Fortunately, we all have learned that it’s what we eat that makes the major difference, not how much.

Yeah, that seems to me to be the biggest weakness of the “calories are equal” argument. It may come from a processed food company selling their “100 calorie packs” containing two tiny cookies, or from a dietician promoting calorie counting.

In terms of biochemistry and metabolism, I believe that 100 calories of cookies generates the same amount of ATP in the body as 100 calories of steamed broccoli. But that assumes that you stop at 100 calories! Nobody eats a cup of broccoli and triggers a broccoli binge of ten more cups. You can’t say the same thing about cookies.

In terms of behavior, habit, craving, addiction, and other important human factors, these foods are worlds apart.

(This is a long-winded way of saying “I agree” )