Why are people so hell bent on defending CICO

[OldDoug]

Bugger the physics!

That makes no sense. And neither does pretending about CICO or the reality of weight loss. Obviously, lots of people can’t or don’t want to maintain what is essentially just ‘calorie restriction’ - but in the case of ketogenic eating, with improved access to stored fat via lowered insulin, and often greater satiety, the frequent resulting weight loss is because of the physics - because the body’s energy balance is such that it’s drawing on those fat stores. CICO doesn’t care what the exact deal is - it’s just reflecting it.

ditching the language and instructions of CICO, giving patients food types guidance with no counting and Viola! Happy doctors no longer about to quit because their patients are getting better, reducing medications!!! and feeling good! It’s a revelation based on deliberately throwing away the calorie balance idea. “You can’t unsee it” is what these doctors say.

Again, “calories in, calories out” does not pronounce good/bad about what’s going on, or what’s desired; it only notes what is.

“The language” - well, again, it’s true for everybody that if the In is lower than the Out, weight loss will result. So it’s not CICO that is on trial - and I hear you about Australia and the medical community there - it’s pretending that one approach will necessarily fit all that is the problem.

Of course in a metabolic chamber you could tally everything up to prove that physics works, but this DOES NOT HELP WITH THE ADVICE to help patients, and I can’t stress this enough (although I tried )

For lots of us, me included, the type of calories does matter. Let’s say that cutting out almost all carbs results in the body drawing on fat stores, and in weight loss. So the 'Out" is greater than the “In” and we’re all happy, right? CICO is just as well satisfied there as it would be if a carb-heavy diet and food restriction or increased exercise resultes in metabolic slowdown and weight gain.

If you miss the farm it’s because you didn’t try hard enough

Maybe, maybe not. But if the ‘In’ is less than the 'Out," with CICO, then weight loss will result.

That does not say that everybody can stay with that (especially depending on diet), nor that it’s only ‘bad people’ who aren’t able to, etc.

We know that in practice “eat less, move more,” does not work for everybody, if weight loss is desired. But in no way is that the fault of CICO. CICO will be reflecting what is going on, nothing more.

Pretending that the saying/theory will work for everybody is faulty.

To make it a completely true prescription, then it ought to be “eat less - enough less, and move more - enough more.” This is because if there’s an energy surplus, and the body is storing it as fat, then whatever surplus there is has to be dealt with until things ‘go negative’ and weigh loss results, and merely eating a given amount less and/or moving (some) more may not achieve it.

[Hallie]

Calorie balance as a primary focus doesn’t work as advice for physicians helping people to get healthy and lose weight. I’m interested in changing the advice to save lives. Of course I understand that you can’t break physics.

At 2 years the vast majority of reduce-calories- and-increase-exercise dieters are fatter than before they started, and it’s well over 90%. I don’t mind if you’re in the 5% of people for whom CICO as the primary framework works fine for, it’s the others that I’m concerned about. I’m out to improve advice and health, not to prove I’m a clever critical scientific thinker on the internet…

Well not today anyway

[OldDoug]

But you claim ‘CICO’ takes into account the second law and recognizes that the various caloric sources have different effects. Please cite some reference from CICO the ideology or dietary regimen to back up that claim. I have not seen any such.

Well good grief, Michael, think about it.

We are in agreement that, for example, a carb heavy diet and calorie restriction may result in metabolic slowdown. The ‘Out’ there, as in ‘calories out,’ changes. CICO will be reflecting the differing effects of metabolic slowdown (or no slowdown). The different effects you mention will be part and parcel of CICO. There’s no logical “blame” of CICO here.

“Calories in, calories out” - it doesn’t care what type of calories they are. It can be any type or source of calories.

What I have seen is people ruining their metabolisms precisely because ‘a calorie is not a calorie is not a calorie’.

CICO doesn’t say what the calories are, nor what they have to be or cannot be. It just says, “here’s what we’ve got…”

CICO the regimen/ideology tells folks simply to eat less and move more.

That’s a pretense. “Calories in, calories out.” It’s not telling folks anything except what’s going on with the energy balance. Beyond that - if we leave CICO behind, and look at “eat less, move more,” then obviously if one does that enough, one will indeed lose weight.

It’s obviously also pretending to state that every person - complicated, emotional beings that we are - will have weight loss success, there. But it’s not because the dictum or notion is faulty, it’s just that people can’t stay with it.

Most fail because the regimen/ideology is not sustainable - eventually you have to start eating again or die of starvation. Because the process ruined the metabolism, back comes to metabolic dysfunction.

Actually, comparatively few people who want to lose weight are dying of starvation. And for most people on earth, the energy balance isn’t such that they’re getting fatter, especially to any really harmful degree.

But of course we can say that "lots of people are." Well, this is because the ‘In’ is bigger than the ‘Out.’ If ketogenic eating is the solution, then great, and CICO will reflect that.

[OldDoug]

Calorie balance as a primary focus doesn’t work as advice for physicians helping people to get healthy and lose weight. I’m interested in changing the advice to save lives. Of course I understand that you can’t break physics.

I wouldn’t say that people need to count calories at all, but it looks like the group of people you are talking about - those with insulin resistance, metabolic syndrome, etc. - often benefit from configuring things such that they get increased access to their own fat stores, maintain higher metabolisms (and of course lower insulin and blood sugar), etc. And CICO certainly has no problem with that.

At 2 years the vast majority of reduce-calories- and-increase-exercise dieters are fatter than before they started, and it’s well over 90%. I don’t mind if you’re in the 5% of people for whom CICO as the primary framework works fine for, it’s the others that I’m concerned about. I’m out to improve advice and health, not to prove I’m a clever critical scientific thinker on the internet…

No argument on the results of the ‘standard’ weight-loss programs found so many places. In the U.S., ‘Jenny Craig’ - from its own figures - found that 99.5% of their customers did not keep the weight loss during the following 2 years. Ouch.

However, CICO works for 100% of people. Either you’re going to be gaining weight, or staying the same, or losing, and CICO has the three relationships that show what will happen. Among the diet-program customers with such a horrible record of long-term failure, the ‘Out’ became larger than the ‘In,’ and here we are.

[amwassil]

Doug, I’m not arguing about thermodynamics nor how it applies to human metabolism. I’m arguing that thermodynamics in the human metabolism does lots of other stuff in the process of putting energy in and taking energy out than the simple obvious in/out totals represent. I’m arguing that a dietary regimen and ideology called ‘CICO’ ignores much of thermodynamics in order to simplify it to a kindergarten level understanding. Eat less move more - according to CICO dogma doesn’t matter what you eat less of nor how exactly the more comes about. But it matters a lot. You know it does because you are knowledgeable about CIM theory. I’m saying CICO ignores it all. The ‘in/out’ that is everything in CICO, is just a small part of the overall process. That’s what I’m claiming.

[Hallie]

The Tweet:
“Anyone who tells you weight loss isn’t as simple as"eat less, exercise more" is full of ■■■■■ It is that simple. You do that consistently and you will totally transform yourself.”
This is the twitter post that inspired this whole thread.

Embedded in this simple tweet is the assumption that taking every bit of food into account in a calorie counting app, and tallying that up against a total daily energy expenditure with adjustment for physical activity, will automatically lead to weight loss for everyone. Anyone who thinks that every human (with varying levels of brown fat, of mitochondrial health and density, of metabolic rate, of the partitioning of lean mass, of sitting still versus constant movement, of insulin baseline and size of excursions, of ghrelin and leptin, cortisol and sleep quality, of which mitochondrial complexes are most active and the respiratory quotient … and % of absorption of different foods in the gut dependant on gut health… ok I’m out for now) can do the daily maths and get results does not yet understand enough physiology and biochemistry.

It’s advice that has doctors and their struggling patients filled with frustration.

The carbohydrate insulin model, on the other hand is profoundly useful. Fix your insulin first, and a calorie deficit will be the result. It really does seem like magic doesn’t it! CICO is there as the result, not as the primary driver of advice.

Or as Ben Bikman would say:

The Endocrine model incorporates the Calorie model, except for a sliver because there are always some exceptions

[OldDoug]

I’m arguing that thermodynamics in the human metabolism does lots of other stuff in the process of putting energy in and taking energy out than the simple obvious in/out totals represent.

That’s two different things. Agreed that human life/metabolism/cellular processes, etc., is incredibly complex. But the process is different from the result. And the result is the 'Out," and that’s really pretty simple. How we get there isn’t what CICO describes.

I’m arguing that a dietary regimen and ideology called ‘CICO’ ignores much of thermodynamics in order to simplify it to a kindergarten level understanding.

I have to disagree again, Michael. Whatever happens along the way, the In & Out are there. In a given case, it’s because of thermodynamics and all the body’s cellular processes that the CICO quantities are what they are.

Eat less move more - according to CICO dogma doesn’t matter what you eat less of nor how exactly the more comes about.

Here too - think about it. If done enough, that will result in weight loss, period. “Eat less, move more,” is different than CICO, though - the former is a prescription for supposed weight loss. CICO will be going along with whatever happens, loss or not.

But it matters a lot. You know it does because you are knowledgeable about CIM theory. I’m saying CICO ignores it all. The ‘in/out’ that is everything in CICO, is just a small part of the overall process. That’s what I’m claiming.

That’s still mixing up different things. Yeah, I’m with you on carbs and insulin. But in no way does CICO “ignore” that. CICO will reflect that. And when it comes to weight loss, yes, the In has to be less than the Out. CICO does not depend on any certain mix of macronutrients. CICO is not saying that “all calories are the same.” It doesn’t have to say anything of the sort. Regardless of what one eats, as long as the In is less than the Out, then down goes the weight. And the same for vice-versa weight gain.

The different things I see: CICO - is just what it says,

“All calories are the same.” Of course that is not true, and CICO doesn’t pronounce on things, there.

“Eat less, move more.” If done enough, then foolproof, but that’s not practical or tolerable for all people. The aim of it, however - weight loss - does go right back to CICO and the undeniable physical truth there.

[amwassil]

I’m focused on what I consider the important thing - what is lost or gained.

The CICO equation is: Tot = CI - CO

If ‘Tot’ is negative you lose weight, if positive you gain weight. That’s all CICO says. That’s the energy balance. As you have reiterated several times, as far as it goes that’s correct. We’re agreed.

I’m arguing that’s only part and not the most important part of what actually happens in the real world. I think it more significant whether the ‘weight loss or gain’ is fat mass or lean mass. The CICO equation and simple energy balance say nothing about that. Energy Balance™; doesn’t care whether you’re dead or alive, healthy or not.

Folks who want to lose, want to lose fat - not muscle mass or bone density. Folks who want to gain, want to gain muscle mass and bone density not fat. As @Hallie points out above CICO is only part of the answer. (It would be nice, Hallie, to post a link! Thanks.) Sure, you have to maintain an energy deficit to burn it and a surplus to store it. However, whether you lose/gain fat mass instead of muscle and/or bone density - the CICO equation tells you nothing. It all depends on exactly what the energy input is and how it is processed to output. You know that, Doug, and claim that CICO says so. I don’t think CICO the diet/ideology says so. If you can cite something, prove me wrong.

[Fangs]

I did wonderful on CICO

I lost 70 lbs fast and I actually did ‘force some exercise’ to ‘help me’ on my CICO plan.

Not sustainable long term tho. Key to it all, sustainability long term! CICO can’t do that for many at all cause if damn near the regain failure rate is like 90 something % then, it shows it isn’t a long term sustainable plan.

Hunger and being non-nourished are forces a physical body can’t handle long at all…and then throw in the mind games of ‘dieting’ and you can’t win at all…ugh…

[Janie]

Thank-you, Fangs. Me exactly.

People keep arguing the science of CICO while completely ignoring that standard dietician advice of CICO does not work for losing weight AND keeping it off. And that’s the point, not proving the theory.

[PaulL]

So we’re agreed on the physics of what’s going on, but how about ‘CICO’ itself? It does not say that all calories are the same.

Actually, it does. That’s the notion behind “calories in, calories out,” “eat less, move more,” and “a calorie is a calorie”: that all calories are the same. You may not agree with that notion, but the vast majority of companies and nutrition experts who use those terms are using them for the express purpose of asserting that all calories are in fact the same.

For example, Coca-Cola uses CICO to say that the calories from their product are the same as the calories from other foods (stipulating for the sake of argument that Coca-Cola can even be considered a food), and all that matters is not to consume too many calories, regardless of their source, and we’ll be fine.

Researchers in the pay of the sugar industry—which, by the way, donated the money that established the Department of Nutrition at the Harvard School of Public Health—have argued that sugar is a perfectly fine food, even if it contains no nutritional benefit but calories—we just have to avoid eating too many calories. So “calories in, calories out” actually does mean that all that counts is the amount of calories you are eating and expending.

So you may very well not use “CICO,” “eat less, move more,” and “a calorie is a calorie” to mean that all calories are the same, but many, if not most, people do, and that is the idea that people on these forums are arguing against when they say CICO is bogus. The fact that you use “CICO” in a more nuanced fashion is irrelevant, because we are not arguing against that nuanced view.

In fact, we all—you, I, David Ludwig, Robert Lustig, and Richard Feinman—happen to agree on that nuanced view. We are all dedicated to demolishing the notion that all calories are the same. Even you agree with the rest of us that they are not.

So let’s agree that we are all actually acknowledging the same reality and just arguing over definitions. When I argue against CICO, I’m arguing from the same point of view that you are arguing from and objecting to a particular way that term is used by many, many people, a use of the term that I recognise you yourself do not use. I am arguing against other people who use the term in a way you do not; I am not arguing against you.

I hope that all this makes things a bit clearer.

[amwassil]

A calorie is a calorie is a calorie

Despite protestations to the contrary, I don’t think there’s any doubt that CICO the diet/ideology proclaims that calories in/out is all that really matters and anything else merely roadside events.

Exhibit A:

“Calories in, calories out” and macronutrient intake: the hope, hype, and...

Conclusion

The CHO-insulin hypothesis predicted that lowering dietary CHO significantly should cause insulin levels to fall, leading to release of fat from adipocytes that would 1 ) increase fat loss and 2 ) increase EE to claimed amounts in the range of ≥350 cal/day (range 400–600). Neither of these effects was observed in two current and highly rigorous metabolic ward studies, one of which was the actual NuSI study being discussed.

Weight gain or loss is not primarily determined by varying proportions of CHO and fat in the diet, but instead by the number of calories ingested.

That says it about as succinctly as it can be said.

So we’re agreed on the physics of what’s going on, but how about ‘CICO’ itself? It does not say that all calories are the same.

Actually, it does. That’s the notion behind “calories in, calories out,” “eat less, move more,” and “a calorie is a calorie”: that all calories are the same. You may not agree with that notion, but the vast majority of companies and nutrition experts who use those terms are using them for the express purpose of asserting that all calories are in fact the same.

[GME]

A bunch of soda producers got together and started a campaign to place these stickers where they sell sugar-laden drinks. They want to keep CICO alive because it let’s them off the hook. People are just taking in too much, it isn’t the toxic nature of their product.

[OldDoug]

I’m focused on what I consider the important thing - what is lost or gained.

Okay, Michael, but we’re really talking about losing fat here, right?

The CICO equation is: Tot = CI - CO

If ‘Tot’ is negative you lose weight, if positive you gain weight. That’s all CICO says. That’s the energy balance. As you have reiterated several times, as far as it goes that’s correct. We’re agreed.

Yeah, and that makes such intuitive sense that I truly wonder at all the debate about it.

I’m arguing that’s only part and not the most important part of what actually happens in the real world. I think it more significant whether the ‘weight loss or gain’ is fat mass or lean mass. The CICO equation and simple energy balance say nothing about that. Energy Balance™ ; doesn’t care whether you’re dead or alive, healthy or not.

Agreed - if we’re speaking as the Energy Balance or CICO, then we’re just saying what reality is, without further specification. In practice, fat loss is (almost) always what’s desired, and there is the separate matter of how much lean tissue one loses and its composition, i.e. skin, muscle, etc. There’s still no indictment of CICO there.

Folks who want to lose, want to lose fat - not muscle mass or bone density. Folks who want to gain, want to gain muscle mass and bone density not fat. As @Hallie points out above CICO is only part of the answer. (It would be nice, Hallie, to post a link! Thanks.) Sure, you have to maintain an energy deficit to burn it and a surplus to store it. However, whether you lose/gain fat mass instead of muscle and/or bone density - the CICO equation tells you nothing. It all depends on exactly what the energy input is and how it is processed to output. You know that, Doug, and claim that CICO says so. I don’t think CICO the diet/ideology says so. If you can cite something, prove me wrong.

In the real world, yeah - fat loss is what’s wanted, to generalize. No debate that CICO is only part of the answer; but in no way does that impugn it. For some of us, there are other things to think about, no question - and that’s not the debate.

Nobody is claiming that CICO forecasts the ratios of bone loss, muscle loss, fat loss, etc. Of course it doesn’t - there is not nearly enough information to address that. I have never claimed that CICO tells us more than it does. What I see are people pretending that it does, however.

[OldDoug]

I did wonderful on CICO

I lost 70 lbs fast and I actually did ‘force some exercise’ to ‘help me’ on my CICO plan.

Not sustainable long term tho. Key to it all, sustainability long term! CICO can’t do that for many at all cause if damn near the regain failure rate is like 90 something % then, it shows it isn’t a long term sustainable plan.

Fangs, you found a way to make CICO work for you, longer-term. I take it for granted that keto eating often enables people with problems in accessing their stored fat to improve the situation.

[MarkGossage]

No-one with a brain denies that a calorie is exactly what is produced when you burn stuff in a bomb calorimeter.

Problem for the CICO guys is that we eat food not calories.

Food has multiple influences on our body (which isn’t a sealed system either) which is why CICO is a load of bull.

[OldDoug]

People keep arguing the science of CICO while completely ignoring that standard dietician advice of CICO does not work for losing weight AND keeping it off. And that’s the point, not proving the theory

That’s not due to any fault of CICO, but rather people not keeping the ‘In’ less than the ‘Out.’ No argument that that is what happens a huge amount of time, for people with insulin resistance who are still eating a carb-heavy diet, i.e. keto will often help matters, there.

[OldDoug]

Problem for the CICO guys is that we eat food not calories.

No, CICO has no problem at all there, Mark. CICO doesn’t presume to pronounce on the “multiple influences” you mention.

[OldDoug]

So we’re agreed on the physics of what’s going on, but how about ‘CICO’ itself? It does not say that all calories are the same.

Actually, it does. That’s the notion behind “calories in, calories out,” “eat less, move more,” and “a calorie is a calorie”: that all calories are the same. You may not agree with that notion, but the vast majority of companies and nutrition experts who use those terms are using them for the express purpose of asserting that all calories are in fact the same.

Paul, at the best, that is generalizing from the particular. Most people in the world aren’t ‘fat’ and the makeup of their calories really doesn’t change their weight. Now of course for some of us, the carbs versus fat/protein does make a difference. But if we are generalizing, then even the illogical extention of CICO to “a calorie is a calorie” will be more true than false.

For example, Coca-Cola uses CICO to say that the calories from their product are the same as the calories from other foods (stipulating for the sake of argument that Coca-Cola can even be considered a food), and all that matters is not to consume too many calories, regardless of their source, and we’ll be fine.

What a marketer says doesn’t change reality. However, a person would still lose weight, even on a “nothing but Coke diet,” as long as they kept with the CICO dictum.

Researchers in the pay of the sugar industry—which, by the way, donated the money that established the Department of Nutrition at the Harvard School of Public Health—have argued that sugar is a perfectly fine food, even if it contains no nutritional benefit but calories—we just have to avoid eating too many calories. So “calories in, calories out” actually does mean that all that counts is the amount of calories you are eating and expending.

And as stated, regardless of other concerns which are not addressed there, that is true. CI < CO = weight loss, if we’re generalizing.

So you may very well not use “CICO,” “eat less, move more,” and “a calorie is a calorie” to mean that all calories are the same, but many, if not most, people do, and that is the idea that people on these forums are arguing against when they say CICO is bogus. The fact that you use “CICO” in a more nuanced fashion is irrelevant, because we are not arguing against that nuanced view.

Hold on a second - again, “eat less, move more” will work, if done enough. And for most of the world, the bumper-sticker take of “a calorie is a calorie” holds true.

I certainly agree that for some people, what the “calories in” are makes a very meaningful difference. But in no way does that make generalized pronouncements like “CICO is bollocks” true. CICO, per se, is always true. And even the physically false extention of it to “all calories are the same” doesn’t alter the reality that weight loss will come from the ‘In’ being less than the ‘Out.’

So let’s agree that we are all actually acknowledging the same reality and just arguing over definitions. When I argue against CICO, I’m arguing from the same point of view that you are arguing from and objecting to a particular way that term is used by many, many people, a use of the term that I recognise you yourself do not use. I am arguing against other people who use the term in a way you do not; I am not arguing against you.

For a relatively small slice of the pie, I do think we’re acknowledging the same reality, i.e. that for some people what the calories ‘In’ are is massively important. But that doesn’t mean that unqualified statements about CICO being wrong are valid.

I don’t think we’re really arguing over definitions. I think we’re just considering things in different ways. It’s quite a leap from ‘CICO’ to “all calories are the same.” And granted - this is a keto forum - but even if we just talk about people for whom the type of calories really, really does matter, then the as-stated things like “eat less, move more” will work, if done enough. Eating less would not necessarily be required for weight loss, if the ‘Out’ increases. So for some people just “moving more” is enough. Likewise, for some people just eating ketogenically is enough.

So I see a twisty-turny course that makes some leaps, and that neglects some truisms, and the endpoint is that “CICO is wrong?” And even beyond that - as a practical matter, why keto often works for weight loss, where other procedures did not, is because the person’s CICO state is then configured correctly.

[amwassil]

Let’s start here with an overview:



Then the discussions.

A Calorie by Any Name Is Still a Calorie

The Carbohydrate-Insulin Model of Obesity

PS: CICO includes a diet that consists entirely of Diet Coke. Since calories in of Diet Coke are zero and caloreis out will be whatever your REE happens to be, I think we can guarantee you will be in a caloric deficit and lose weight. So @OldDoug is right. CICO is physics and works.