Why are people so hell bent on defending CICO

[PaulL]

Like the old adage about medicines: you know it’s good for you, because it tastes terrible!

[OldDoug]

The mistake was thinking that a simple measure can explain the workings of a complex system. The energy in/out is only the description the overall state and ignores all the more important reactions/processes that are initiated/completed within. As I like to phrase it, what really matters for human metabolism is what happens between the ‘in’ and the ‘out’.

The overall system isn’t really complicated, though, from the standpoint of physics. There’s intake, and then storage, metabolism and excretion. Everything that occurs after the “In” is reflected in storage and "Out.

There are calorimeters now that people can live in, and everything is measured, respiration and all. There’s no “magic” at work, and calories in, calories out is there all along.

The mistake was thinking that a simple measure can explain the workings of a complex system.

That’s not the argument, though. Calories in, calories out - the ‘out’ is the result of whatever ‘complexity’ is there; no reason to complain about it.

There are some illogical leaps at work, as well as generalizations from the particular - this is what has bugged me all along.

For most of the world, there’s no issue to begin with, and whether they say “eat less, move more” or not, it’s working for them.

As with the tweet from the original post, that does not mean that it is as simple as that, for everybody, as a practical matter.

Why, in practice, is it not as simple as “eat less, exercise more”? Because, while that’s obviously true as stated, not all people who want to lose weight can keep to that. So that tweet generalizes from the particular, and is not recognizant of what is true for all.

‘CICO’ doesn’t draw distinctions between the macronutrients, but it also does not rule them out. Whatever one eats, it applies. If eating fat versus carbs, for example, affects the ‘out’ (which does appear to be demonstrably true for some people), it’s nothing against CICO. “CICO” in no way says that the quantities are fixed. It only says, in effect, “Here is what you have…”

[PaulL]

For most of the world, there’s no issue to begin with, and whether they say “eat less, move more” or not, it’s working for them.

Except that it never worked for me. Eating a well-formulated ketogenic diet to satiety and not moving was how I lost my fat.

All stinting on calories or trying to exercise more did for me was to increase my hunger, and I was already eating to the bursting point without satiety.

[OldDoug]

Except that it never worked for me.

Well sure, Paul. “Most of the world,” there, did not include you. I’m in the same boat as you, and even with all the other hundreds of millions of people (maybe even a billion?) like us, we’re still a minority. But that doesn’t change anything in this discussion. The tweet from the first post here was not correct about it being “as simple as” that, without qualification. But that does not mean that the ‘formula’ for weight loss, i.e. ‘eat less, move more,’ is incorrect. Obviously, it’s true as stated. The fact that it’s not as simple as that reflects that not everybody can stay with that program.

Eating a well-formulated ketogenic diet to satiety and not moving was how I lost my fat.

Okay, great. But that’s no argument against CICO.

All stinting on calories or trying to exercise more did for me was to increase my hunger, and I was already eating to the bursting point without satiety.

So in the end you found a way to make the “In” less than the “Out.”

[PaulL]

Okay, great. But that’s no argument against CICO.

It is for me. Eating less and moving more never caused me to lose so much as a pound of fat. If it had, I wouldn’t be here. Remember the distinction I made above, between CICO as an ideology, and the facts of physics, and bear in mind Taubes’s point about the Second Law saying nothing about direction of causality.

The fact that Bill Gates got rich because he took in more money than he spent tells us all we need to know, right?

[Hallie]

Bugger the physics! The experience of low carb doctors in Australia is going from a depressing workplace where patients get sicker and nothing seems to help, to 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 now their patients are getting better and reducing their 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.

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 )

Anyway, I’m off to give directions to a friend to reach our farm out on the highway. I’ll tell her to fill up the car in central canberry then drive on the highway to Cooma until exactly 5.678 litres of petrol is used. You’ll see the farm gate on your left at exactly that point. Larger model of car use 6.49 litres. No problems with that is there? If you stop for a toilet break, or to dodge a kangaroo or get stuck behind a slow tractor it will still work because physics works. Just take it into account.

If you miss the farm it’s because you didn’t try hard enough or you made one of The Top 10 Weight Loss Mistakes that every trad dietician craps on about ugh!!
I mean, top 10 car fuel calculation mistakes!

[OldDoug]

the distinction I made above, between CICO as an ideology, and the facts of physics, and bear in mind Taubes’s point about the Second Law saying nothing about direction of causality.

The 2nd Law doesn’t argue against CICO. 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. It doesn’t say anything about that. It just says, “Hey - here’s what you have.” If it’s an ideology, then as above - it’s a true statement that everybody will lose weight if they keep the “In” less than the “Out.” There’s no logical blame to be laid at the feet of CICO here. Taubes - maybe he has a point, but it also doesn’t matter for CICO - whatever the direction of causality, the end result of CICO is still going to be there.

[amwassil]

CICO the dietary regimen (as I term it) and/or the ideology (as Paul terms it) is not the straight application of the laws of thermodynamics. Doug, neither I nor anyone else argues that the first law does not apply to human metabolism as much as anywhere else. 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. What I have seen is ‘a calorie is a calorie is a calorie’. Just as the article by Feinman I linked above.

What I have seen is people ruining their metabolisms precisely because ‘a calorie is not a calorie is not a calorie’. Many folks on this forum did this to themselves and spent years undoing the damage. CICO the regimen/ideology tells folks simply to eat less and move more. It tells them to eat less fat and less calories overall. But it doesn’t tell them that glucose derived from carbs drives insulin to store fat, as they are starving themselves trying to burn it. It doesn’t tell them about all the hormonal interactions that occur to help or hinder utilizing onboard fat stores. It simply over simplifies everything into reducing ‘in’ and increasing ‘out’. Ignoring what happens in the process. And for a lot of folks, maybe most if not all, what happens in the process can be devastating.

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. This is what I have an argument with - not the laws of thermodynamics.

[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.