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<\/p>\n<\/p>\n
Do you think calorie controlled diets work?<\/p>\n
Do you think all calories are the same?<\/p>\n
Do you think people are overweight because they eat too much?<\/p>\n
Then think again. Here are the notes from this month’s talk.<\/p>\n
<\/p>\n
CALORIES- and why you should not count them<\/strong><\/p>\n Everybody has heard of calories. An intake of calories which exceeds the calories expended is the commonly accepted reason for putting on weight, and to a certain extent that is true as energy not used is stored as fat. On this basis, apart from being more active, if you want to lose weight the message is to cut calories e.g.<\/p>\n But it\u2019s not as simple as that.<\/p>\n What is a calorie?<\/strong><\/p>\n A calorie is a unit of energy. Two categories:<\/p>\n The term \u201ccalories\u201d in this talk refers to large calories and I\u2019ll use a capital \u201cC\u201d, typos apart.<\/p>\n So, for example, a large banana contains about 100 kcals or 100 Calories.<\/p>\n How do we measure food Calories?<\/p>\n 1 g fat = 9 Calories<\/p>\n 1g protein = 4 Calories<\/p>\n 1g carbohydrate = 4 Calories<\/p>\n Calories in\/Calories out (the energy balance equation) <\/strong><\/p>\n <\/strong>Calories in (food) minus Calories out (energy expenditure) = weight gained\/(lost)<\/p>\n This equation is based on the First Law of Thermodynamics, which says that energy is conserved within a system and cannot be lost. In this case, the system is us.<\/p>\n If the energy balance equation is positive, we gain weight.<\/p>\n If the energy balance equation is negative, we lose weight.<\/p>\n If you eat food of any type from any source, if you don\u2019t burn it off by generating heat or exercising or any other form of energy expenditure, you will gain weight. This is true.<\/p>\n So, according to the energy balance equation, failure to maintain a normal weight implies one of two things;<\/p>\n Obesity is due to eating more than the body needs.<\/p>\n Eating less and moving more is the answer to staying lean.<\/p>\n That is the energy balance equation. It is generally accepted as true and incontrovertible.<\/p>\n Simple.<\/p>\n This is bad news for the 66% of the population who are either overweight or obese, because the energy balance equation also implies that:<\/p>\n Obesity is a behavioural disorder<\/p>\n The blame is on the individual.<\/p>\n Food companies are complicit in this blame \u2013 \u201cCalories from sugary food\/drink are fine as part of a Calorie controlled diet\u201d<\/p>\n Governments blame obesity on lifestyle \u2013 Michelle Obama\u2019s \u201cEat less, move more\u201d campaign, the NHS weight loss plan based on Calorie restriction etc.<\/p>\n The acceptance of the Calories in\/Calories out hypothesis of weight control puts the blame squarely on the individual for poor food and lifestyle choices. Is this so? What does the evidence about the energy balance equation tell us?<\/p>\n Evidence against Calories in\/Calories out <\/strong><\/p>\n <\/strong>1.Observations <\/strong><\/p>\n 1900s \u2013 Pima Indians \u2013 lean, sinewy, fit hunter-gatherer population until white man took over their territories and fed them meagre government rations of white flour\/sugar\/canned goods. They got fat, 40% obesity rate, despite being very poor, on the verge of famine and labouring hard<\/p>\n 1930s – Hilde Bruch, a German paediatrician who moved to New York in the 1930s, was shocked by the fat American children, two decades before fast food. These children ate excessively, despite medical advice and parental control. She commented: \u201cMany made strenuous efforts to lose weight, practically giving up on living to achieve it.\u201d But maintaining a lower weight involved \u201cliving on a continuous semi-starvation diet\u201d and they couldn\u2019t do it. Bruch said of obesity:<\/p>\n \u201cMore than in any other illness, the physician is called upon to do a special trick, to make the patient do something \u2013 stop eating \u2013 after it has already been proved that he cannot do it\u201d<\/p>\n 1951 \u2013 Italy and Greece \u2013 less food per capita than any other European country, 2400 Cals\/d compared to 3800 Cals\/d in USA. Yet the working classes, especially the women, were fat.<\/p>\n 1961 \u2013 Trinidad \u2013 1\/3rd<\/sup> of women over 25 were obese with an average Calorie intake below 2000\/day.<\/p>\n 1974 \u2013 Chilean slum dwellers, very poor, mostly heavy labourers, of those over 45, 40% of men and 50% of women were obese<\/p>\n 2005 – Sao Paulo, Brazil, slum dwellers, women were obese with thin, underweight, stunted children. Did these women really over eat whilst their children were half starved? They were too poor to overeat and too active in hard jobs to exercise more! Surely the \u201ceat less, move more\u201d mantra did not explain the cause of these women\u2019s obesity?<\/p>\n 2.Research <\/strong><\/p>\n Women\u2019s Health Initiative<\/p>\n A study by the American National Institute of Health in the 1990s.<\/p>\n 20,000 women, of which half were obese, were put on a low fat diet, eating 360 Calories\/day less than their normal diet. After 8 years, their abdominal fat and waist circumference had increased and they lost on average 2lbs each. If Calories in had reduced by 360\/day and 1lb fat = 3500 Calories, they should have lost 36lbs in the first year alone.<\/p>\n New York hospital study<\/p>\n 100 obese people were put on a diet of between 800 and 1500 Calories\/day for 2 years.<\/p>\n Initially, only twelve lost 20lbs and one lost 40lbs. Only two of the 100 maintained any weight loss at all after 2 years.<\/p>\n Tuft\u2019s Review \u2013 an analysis of all diet trials since 1980<\/p>\n Weight loss of 9-10lbs in the first 6 months was followed by all weight being regained.<\/p>\n Pennington biomedical research centre study, USA, the largest obesity institute in the states<\/p>\n 800 overweight\/obese by an average of 50lbs each at the start, randomly assigned to 4 diets, all under eating by 750 calories\/day. They lost 9lbs on average initially but were on average heavier than at the start of the trial by 1 year.<\/p>\n 1970s \u2013 Stanford University \u2013did a study on 13000 runners. Those with the highest mileage were leaner. But ALL got fatter every year, even those running >40m\/week.<\/p>\n Using the energy balance equation, men in their 20s running 20m\/week needed to increase their mileage to 60m\/week in their 40s to stay lean, while women running 15m\/week in their 20s needed to up their mileage to 75m\/week by their 40s!<\/p>\n So exercise did not prevent weight gain in these runners.<\/p>\n \u201cExercise \u2013 the miracle cure\u201d report from the Academy of Medical Royal Colleges Feb 2015<\/p>\n 30 minutes of moderate exercise, 5 times a week is described as a \u201cmiracle cure\u201d, more powerful than drugs for chronic disease, reducing the risk of CV disease, type 2 diabetes, dementia and some cancers by at least 30%. BUT exercise does not promote weight loss.<\/p>\n \u201cIt is time to bust the myth of inactivity and obesity – you cannot outrun a bad diet\u201d by Malhotra, Noakes and Finney in the British Journal of Sports Medicine 2015.<\/p>\n This study comments:<\/p>\n <\/strong>Calories in\/ Calories out -Conclusion<\/strong><\/p>\n Increasing calories out by exercise alone does not control weight gain<\/p>\n Restricting calories in fails to achieve long term weight loss.<\/p>\n To quote Hilde Bruch:<\/p>\n \u201cUnder eating is not a cure for obesity, just a temporary reduction of a symptom. So if under eating is not a cure, over eating is not the cause\u201d.<\/p>\n The 20 calories\/day calculation<\/strong><\/p>\n Let\u2019s use the energy balance equation to calculate how much we are over eating to gain the 2lbs\/year which, on average, we put on (50lbs between ages 25 and 50).<\/p>\n 1lb fat = 3500 Calories<\/p>\n So 2lbs fat\/year = 7000 Calories<\/p>\n Over 365 days, that\u2019s 7000\/365 = 20 Calories\/day, roughly<\/p>\n 20 Calories\/day is equivalent to one bite of a croissant, 3 bites of an apple or 2oz beer i.e. not much!<\/p>\n If we really only over ate by this much, surely cutting down by two bites of a croissant a day when we started to see ourselves getting fat and lose a bit of weight would be easy? So why do we all get fatter with age?<\/p>\n It\u2019s ridiculous to assume that our homeostatic mechanisms cannot cope with a variation in our Calorie intake of less than 1\/100th<\/sup> of the daily total OR that when we start to put on weight, a tiny adjustment to our intake isn\u2019t enough to reverse it.<\/p>\n The energy balance equation is true in retrospect \u2013 if you eat more then you expend you will gain weight. But this is not an explanation. It\u2019s equivalent to explaining why someone is an alcoholic by saying it\u2019s because they drink too much. So the evidence from observation and research studies shows that restricting Calories in and\/or increasing Calories out both fail to prevent weight gain.<\/p>\n Why?<\/p>\n Why does calories in\/calories out fail to explain our weight gain\/loss?<\/strong><\/p>\n <\/strong>The energy balance equation makes assumptions that we need to question:<\/p>\n The energy balance equation presumes that Calories in and Calories out are independent variables i.e if you alter one, the other is unaffected.<\/p>\n But they are not independent, they depend upon each other. Reduce Calories in and your body will save energy so Calories out falls, and vice versa.<\/p>\n Your main daily energy expenditure is your Basal Metabolic Rate (BMR).<\/p>\n Decreased Caloric intake can reduce BMR by 40%.<\/p>\n Increased Caloric intake can increase BMR by 50%.<\/p>\n Thus weight loss is quick at first on a Calorie controlled diet, then it slows as Calories out fall in response to perceived semi-starvation and the body expends less energy to compensate.<\/p>\n Your body temperature falls, you feel cold, your skin, nail and hair cells multiply more slowly so your skin and hair look dull and lifeless, you are lethargic as your muscle cells are short of energy, your concentration is poor as your brain is short of fuel and you are miserable. Calories out fall because Calories in has fallen. They are dependent variables \u2013 alter one and you alter the other. Weight loss slows or stops. Then as you lose the willpower to stay hungry\/tired\/miserable and go back to eating normally, the weight piles back on faster than ever because your energy expenditure is still spuriously low. This is also known as \u201cyo-yo\u201d dieting.<\/p>\n Calories out is altered by Calories in.<\/p>\n Here\u2019s a quote from the British cycling website article on weight loss this week<\/p>\n \u201cWeight loss is as simple as Calories in versus Calories out\u2026It doesn\u2019t matter what form, fat, carbs or protein, those Calories take, if the balance is negative<\/strong>, you will lose weight.\u201d<\/p>\n This is true.<\/p>\n So it follows that it doesn\u2019t matter whether the Calories in are from fat, carbohydrates or protein, all Calories are the same aren\u2019t they? Wrong.<\/p>\n Here\u2019s a quote from the US Secretary of State for Agriculture on the release of the 2011 US dietary guidelines:<\/p>\n \u201cIf folks want to maintain a healthy weight, they have to be sensitive to the Calories in and the Calories out \u2013 not every Calorie is the same<\/strong>\u201d<\/p>\n In other words, whether you take those Calories in as fat, carbohydrate or protein matters a lot \u2013 their metabolism is quite different.<\/p>\n Carbohydrates <\/strong>(flour\/sugar\/sweets\/soft drinks\/beer etc) all raise blood glucose rapidly, thus stimulating the release of insulin, which drives fat into the fat cells for storage and reduces the uptake of glucose and fat by the muscles and other cells. Energy expenditure falls. Energy balance is positive. We get fat.<\/p>\n \u201cCarbohydrates drive insulin drives fat storage\u201d (Professor George Cahill from Harvard Medical School).<\/p>\n Fat and protein<\/strong> have a much lesser effect on blood glucose and hence on insulin production. Our muscle and other organ cells have more energy available to them because the fat cells take less in a lower insulin environment. Our energy expenditure rises. Energy balance is negative. We lose weight.<\/p>\n So the type of macronutrients (fat\/carbohydrate\/protein) we eat as \u201cCalories in\u201d alters our metabolism by altering insulin production and fat storage. Calories in alters Calories out.<\/p>\n Fat and protein take more energy to metabolise than carbohydrates. Protein requires 12% more energy to digest than carbohydrates, which is equivalent to 220 Calories\/day. Calories out is higher for the same Calories in from carbohydrates so the energy balance equation is more likely to be negative.Calories in alters Calories out.<\/p>\n If the weather is cold, energy expenditure rises as you use more energy to stay warm. You are hungrier and eat more. Calories out alters Calories in.<\/p>\n By far the greatest component of calories out is your BMR. Exercise increases your energy expenditure but compared to BMR the % increase is small. Exercise suppresses appetite during and immediately after but then it increases (due to homeostasis) and you will eat more.<\/p>\n Again – you cannot outrun a bad diet. Diet is far more important than exercise for weight loss (although of course exercise has vast benefits in other ways). Calories out alters Calories in.<\/p>\n Fat and protein both reduce appetite and induce a feeling of satiety (having had enough to eat) compared to carbohydrates, which increase appetite. So Calories in are naturally lower on a low carbohydrate, moderate fat and protein diet compared to the low fat, high carbohydrate diet advised by the NHS and the USDA. Calorie controlled diets are by definition low fat\/high carbohydrate (because fat is high Calorie) and they make you hungry!<\/p>\n Calories in alters Calories in.<\/p>\n If our diet is carbohydrate based, glucose levels and hence insulin levels are constantly high. Insulin receptors downgrade their sensitivity. More insulin is released to remove glucose from the bloodstream. Fat cells take up more energy and store it as fat, driven by high insulin. Muscle and other cells are deprived of energy and are \u201chungry\u201d. We are hungry. We eat more (carbohydrate). Glucose and insulin levels rise. Fat cells get fatter. We get fatter and hungrier.<\/p>\n Think of it as a \u201cweight thermostat\u201d. High carbohydrates drive a high insulin level, which resets our weight thermostat to a higher weight \u2013 the higher the insulin level the fatter we get.<\/p>\n In contrast, in non insulin resistant people, if they overeat their BMR rises (from 1800 Calories\/day to 2700 Calories\/day in one study of overfeeding prisoners) to burn off the extra energy as heat and keep their weight at their set weight level.<\/p>\n Due to insulin resistance, our fat cells take up too much energy and our other cells are deprived so we are hungry. We don\u2019t get fat because we overeat, we overeat because we are fat.<\/p>\n Calories in alters both Calories in and Calories out.<\/p>\n People with insulin resistance can have a reduced REE i.e. they are more efficient at not expending energy, reducing their daily energy requirement by around 200 Calories\/day, as their fat-free mass uses fewer Calories. Calories in alters Calories out.<\/p>\n SUMMARY<\/strong><\/p>\n Calories in\/ Calories out and the energy balance equation is flawed<\/p>\n Weight gain\/loss is not as simple as changing either Calories in or Calories out in isolation.<\/p>\n Counting Calories will not help with weight control and is actually detrimental.<\/p>\n All Calories are NOT the same.<\/p>\n Obesity is not a behavioural failure.<\/p>\n Obesity is a hormonal disorder of fat regulation.<\/p>\n Fat is not an inert energy store, it\u2019s an active body system which is constantly taking in and releasing fat all day long.<\/p>\n Control of fat regulation is hormonal.<\/p>\n Many hormones cause fat release but only insulin causes fat storage.<\/p>\n Obesity is a hormonal imbalance of insulin:<\/p>\n High insulin = fat accumulation<\/p>\n Low insulin = fat release<\/p>\n Dietary carbohydrates and sugars drive insulin drives fat accumulation<\/p>\n Overeating is a symptom not a cause of obesity<\/p>\n Eating less as a cure for obesity fails<\/p>\n Exercise alone is not enough to prevent fat accumulation<\/p>\n Lowering insulin levels is the key to staying lean<\/p>\n So how do we lower insulin levels? <\/strong><\/p>\n Avoid carb-rich foods, starchy foods, sugary foods, soft drinks, beer, sweets etc.<\/p>\n Avoid \u201clow fat\u201d foods which contain sugar to make them palatable eg low fat yoghurts<\/p>\n High quality protein (eg egg, quality meat) raises insulin less than processed meats<\/p>\n Increase your consumption of natural fats and fibre<\/p>\n Eat real food \u2013 grass fed meat\/fish\/seafood\/eggs\/fruit\/vegetables\/nuts\/seeds<\/p>\n Carbohydrates drive insulin drive weight gain. Avoid them.<\/p>\n Eat at regular intervals if you are hungry. Don\u2019t bother with breakfast if you\u2019re not hungry. Skip a few meals if you\u2019re not hungry. Do not snack in between meals as this keeps insulin levels higher for longer \u2013 better to let insulin levels drop before the next meal. Don\u2019t eat a lot before bedtime.<\/p>\n Cortisol is the \u201cfight or flight\u201d hormone released in times of stress to enable us to survive a threat. In the short term it raises blood glucose and usually works in opposition to insulin (which lowers it). However, in chronic, long term stress (work\/commuting\/family issues\/illness) cortisol levels are chronically elevated so glucose levels are constantly high \u2013 and this leads to constantly elevated insulin levels. Insulin resistance and weight gain follow. High cortisol causes weight gain via high insulin levels (Cushing\u2019s disease). Low cortisol causes weight loss (Addison\u2019s disease).<\/p>\n So stress causes weight gain. Chill.<\/p>\n Sleep deprivation is a major cause of stress because it increases cortisol levels. In 1910, people slept on average 9 hours\/day. Now more than 30% of us get less than 6 hours\/day and shift workers even less. Sleeping 5-6 hours\/day or less is associated with a 50% risk of weight gain. The point at which weight gain starts is less than 7 hours\/day. Sleep 7 hours\/day or more.<\/p>\n Exercise is a short term stressor and the adrenalin and cortisol released in response to physical activity opposes insulin so that the muscles can take up glucose from the blood. Also exercise reduces stress long term, reducing cortisol levels and hence insulin in between exercise sessions and aiding sleep.<\/p>\n Exercise increase builds muscle, increases muscle cell insulin sensitivity and reduces visceral fat. Exercise reduces insulin resistance.<\/p>\n The positive effects of exercise are due to the positive effects on our metabolism, NOT the Calories expended in exercising.<\/p>\n Part of our evolutionary past – of course we didn\u2019t eat 3 meals a day at regular times when we were hunter-gatherers \u2013 we ate when food was available. Many meals were missed, often for days. Intermittent fasts of 12-48 hours are very effective at lowering insulin levels and increasing insulin sensitivity. GP advice should be sought before fasting as care is needed if you are diabetic, have other health issues or are training heavily.<\/p>\n Whilst the cause of obesity (and many other metabolic diseases) is indeed poor food and lifestyle choices, the current advice on reducing Calories in by eating less and increasing Calories out by exercising more fails to control weight gain or achieve long term weight loss.<\/p>\n Instead the advice should focus on healthy food choices NOT calories and lifestyle changes which reduce insulin levels.<\/p>\n And finally: Susan Sontag, an American intellectual, said of obesity in 1978:<\/p>\n \u201cTheories that diseases are caused by mental states and can be cured by willpower are always an index of how much is not understood about the physical terrain of a disease\u201d.<\/strong><\/p>\n <\/strong>Additional studies etc:<\/p>\n In 2007, Stanford University conducted an \u201cA TO Z Weight Loss Study\u201d. Subjects were instructed to eat as much fat and protein as they wanted but avoid carbohydrates i.e a high fat, high saturated fat diet. They were compared with those on a low fat, low saturated fat restricted calorie diet. Those who ate mostly fat and protein not only lost more weight, <\/strong>but also other health parameters improved, namely:<\/p>\n Another Stanford University study compared a high protein diet with a high carbohydrate diet.<\/p>\n Diet 1: 45% protein\/35% carbs\/ 20% fat \u2013 insulin metabolism improved<\/p>\n Diet 2: 60% carbs\/20% protein\/ 20% fat \u2013 insulin metabolism worsened<\/p>\n Evidence for hormonal control of weight includes George Wade\u2019s study of ovariectomised rats in 1970.<\/p>\n Gp1: ovaries removed, free access to food, rapidly obese, activity levels unchanged<\/p>\n Gp 2: ovaries removed, controlled diet, rapidly obese but sedentary<\/p>\n Gp 3: Ovaries removed, given oestrogen, normal weight and activity levels<\/p>\n Conclusion: ovariectomised rats have low oestrogen levels, higher insulin, their fat gets fatter and they overeat to compensate. If calories are restricted as in gp 2, they become sedentary. Oestrogen supplementation keeps the ovariectomised rats a normal weight with normal activity levels. Obesity, appetite and activity levels are hormonally controlled.<\/p>\n Zucker rats: Bred to be clinically obese. These rats stay obese even in the face of starvation, using up their muscles instead for energy. No matter how little these rats are fed, they remain obese to death.<\/p>\n Reading List:<\/strong><\/p>\n NB:The above aims to inform so that individuals can make their own dietary choices \u2013 it does not constitute dietary advice<\/strong><\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Do you think calorie controlled diets work? Do you think all calories are the same? Do you think people are overweight because they eat too much? Then think again. Here are the notes from this month’s talk. CALORIES- and why you should not count them Everybody has heard of calories. An intake of calories … Continue reading Calories – and why you shouldn’t count them 5\/3\/18<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"_links":{"self":[{"href":"http:\/\/physicality.info\/index.php?rest_route=\/wp\/v2\/posts\/825"}],"collection":[{"href":"http:\/\/physicality.info\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/physicality.info\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/physicality.info\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/physicality.info\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=825"}],"version-history":[{"count":5,"href":"http:\/\/physicality.info\/index.php?rest_route=\/wp\/v2\/posts\/825\/revisions"}],"predecessor-version":[{"id":1010,"href":"http:\/\/physicality.info\/index.php?rest_route=\/wp\/v2\/posts\/825\/revisions\/1010"}],"wp:attachment":[{"href":"http:\/\/physicality.info\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=825"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/physicality.info\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=825"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/physicality.info\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=825"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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