Who Cares if 3,500 Calories Don't Make a Real Life Pound?
                      by Dr. Yoni Fredhoff, M.D. 12/12/13 @weightymatters

If there's a more painful discussion in nutrition and obesity these days beyond the one that circles the question, "Do 3,500 calories really make up a pound?", I don't know what it is.

So here are some truths.

• People are not walking math formulas whereby if they have 3,500 more or less calories than they burn they'll gain or lose a pound.
  
• 3,500 calories of one food or type of food will likely have a different impact on health, hunger, thermic effect, and weight than 3,500 calories of another food or type of food.
  
• Different people have different caloric efficiencies whereby they are seemingly able to extract more calories from food or reserves than others and lose weight with more difficulty (and gain with greater ease).
  
• And yet here's the only truth that matters.

From a weight management perspective, the currency of weight is calories. While exchange rates undoubtedly do vary between foods and between individuals, you'll always need your own personal deficit to lose, and surplus to gain.

All other discussion, while certainly academically interesting, given that there are No Other Alternate Measures Available to track, or tests to determine individual responses to different calorie sources, serves to foment confusion.

If weight's your concern, more important than anything else is finding a life that you enjoy that contains fewer calories than before. Getting stuck in the minutia of what type of calories may lead to an every so slightly faster or greater loss, rather than truly crafting a life that's enjoyable (and hence sustainable), might help in the short run, but will almost certainly defeat you in the long.

I agree with the following illustration used by Dr. Sharma, M.D. a medical specialist who deals with obesity issues.

Weight Management is like a rubber band.

Weight Loss is pulling on the rubber band.

Weight Maintenance is KEEP pulling on the rubber band.

The individual question regarding our own Weight Management is: 

“HOW MUCH CAN WE PULL ... AND KEEP PULLING?"

This is analogy describes my own lifetime experience. That Truth is especially applicable to my past 7 years of maintenance within the “normal” BMI range, after years of yo-yo dieting up to a high of 271 lbs at 5’0” tall”, with a subsequent total weight loss of 156 lbs. To better visualize this amount, this number was 58% of my TOTAL body weight, which is a similar total amount lost by many of the winners of the “Biggest Loser” television show.

Rubber bands come in different sizes and strength. So do the bodies of people. It naturally follows that the more weight a person loses, the more the "tension of the rubber band".  This is why it usually takes far less effort for someone who loses 10 lbs to maintain that weight-loss, than someone who loses 100 lbs. 

Bodies appear to have a Set Point, which is like a rubber band in it's natural state .. unstretched.  However, it is clear that weight-gain will drive the body's natural Set Point higher. Although most people hope and pray that weight-loss will re-set that altered Set Point back to a lower number, all available evidence indicates that this is a one-way--upward-only--survival path.  Click link for more information about Set Point.

   I’ve been reading a great many things written by Dr. Sharma. At this point, I have a lot of respect for his expertise and point of view.

I like the fact that Dr. Sharma believes that people need to stop beating themselves up for a lack of motivation, and understand that there are very good reasons why they struggle with their weight. He says:

”Everyone talks about eating right and exercising, which is so simplistic. I talk about things like time management and the links between mental health, depression and overeating. And I tell everyone to never trust a diet book that has recipes.”

His advice to other physicians is:

“Telling obese people to ‘eat less and move more’ is like telling someone with depression to cheer up. It’s not that easy. And telling someone that it is demonstrates your lack of understanding.”

Below is a recent video clip of Dr. Sharma.

Today I watched a technical, but interesting, video of a University lecture given on March 26, 2013 by Stephen C. Woods about Peptides, Food Intake and Body Weight: Problems of Interpretation.

Peptides are organic substances of which the molecules are structurally like those of proteins, but smaller. Peptide Hormones include insulin, leptin, ghrelin, glucagon, growth hormone, obestatin as well as many, many others.

For many years Dr. Woods has been involved in obesity scientific research, primarily re insulin.

He said that a key question is whether the Responses that counter drug/food effects are actually Unconditional, invariant and whether or not traditional concepts of Homeostatsis are viable.

In considering this question, note the following:

Homeostaisis --- Unconditioned stimulas equals Unconditioned Response.

There are ...

Homeostatic Controls - Hypothalamus (part of the brain primarily involved with involuntary stimulas and response of Peptides)

and....

Non-Homeostatic Controls – Amugdala, Accumbens, etc ( parts of the brain involving Anxiety, social situations, learning, hedonics, etc.)

The process of Homostaisis can be disturbed by Non-Homeostatic Controls.

Food intake involves BOTH types of Controls at the same time. Food intake is a Behavior which involves BOTH (unconditioned) physiological and (conditioned) psychological factors: An Example of a Conditioned stimulas and Conditioned response is Pavlov’s dog.

Based on his many years of involvement with scientific research re Peptides, Dr. Woods states the following Conclusions:

Conclusion 1:
Different labs get different results when administering Peptides and assessing food inake.

Conclusion 2: 
Peptides alter food intake in some situations and not others.

Conclusion 3:
The ability of a Peptide to alter food intake varies within the same lab.

Conclusion 4:
Subtle, or not so subtle, environmental factors can determine whether a Peptide influences food intake, and can even reverse the direction of the response.

To watch the lecture click the following link: Peptides, Food Intake and Body Weight: Problems of Interpretation.

For the past eight-and-a-half years I’ve entered all of my daily food into a computer program that tells me the micronutrients in that food, including calories. The computer program that I choose to use is called DietPower.

I’ve written quite a lot about calories, including the impossibility of achieving a totally accurate calorie count. Below are links to two of those articles:

Do Calories Matter?

Calorie Detective – Lying Food Labels

A calorie is simply a measurement of energy, the amount of heat that something gives off through chemical processes. This is an “inexact” scientific concept which has been simplified for general use. Although there is nothing “perfectly accurate” about a calorie measurement, at this time there doesn’t appear to be an alternative way for Science to better measure the potential energy which is contained inside foods.

For me, “counting calories” is personally helpful as a “general” measuring tool,
while understanding that:

• All bodies are not the same.
  
  
• It is important not to put too much Faith into the exact calorie numbers that “Experts” SAY one’s body burns.
  
  
• It is important not to put too much Faith into the exact calorie numbers allegedly contained in any food item.

Even though it is true that our bodies process different macronutrients differently, … at the end of the day… it still remains that if a body consumes more energy than a body expends, it will accumulate fat.

The article below states the Paleo / Low-Carb position against using calories as a food measurement tool, which is basically: “The concept of the “calorie”, as applied to nutrition, is an oversimplification so extreme as to be untrue in practice.”

There Is No Such Thing As A “Calorie” (To Your Body)
           by J. Stanton, online Paleo blogger, 
                author of The Gnoll Credo (2010)  (science fiction fantasy about primitive man)

A friend of mine once said “The problem with explaining complicated systems to the layman is this: it’s easy to simplify a concept to the point that that it’s no longer true.”

To that end, I submit the following hypothesis:

The concept of the “calorie”, as applied to nutrition, is an oversimplification so extreme as to be untrue in practice.

What Is A “Calorie”, Anyway?

The dietary calorie is defined as “the amount of energy required to increase the temperature of 1 kilogram of water by 1 degree Kelvin.”

The dietary calorie is actually a “kilocalorie” = 1000 calories, which is why you’ll occasionally see it abbreviated as “kcal”.

It’s an obsolete unit: the “joule” is the modern unit of energy. There are 4.184 joules in a calorie, and 4184 in a dietary calorie (kilocalorie).

Problem: Our Bodies Don’t Use “Calories”

You may already see the problem here: a “calorie” is a unit of energy transfer. We determine the number of “calories” in a food by, quite literally, burning it and measuring how much heat it generates.

This is a bomb calorimeter. Note: not equivalent to the human digestive and metabolic system.

Unfortunately, our bodies are not steam engines! They do not burn the food we eat in a fire and convert the heat into mechanical work. Thus:

There is no biochemical system in our bodies whose input is a “calorie”.

Every metabolic pathway in our body starts with a specific molecule (or family of molecules), and converts it into another molecule—usually consuming energy in the process, not producing it.

This is why we must eat food in order to stay alive. The chemical reactions that build and repair each one of the trillions of cells in our bodies, from brain to toe, from eye to pancreas, require both energy and raw materials. The chemical reactions that allow our cells to perform their necessary functions, from transporting oxygen to parsing visual input to generating muscular force to manufacturing mucus and bile and stomach acid and insulin and leptin and T3, require both energy and raw materials. And the chemical reactions that allow our cells to communicate, via hormones and neurotransmitters, require both energy and raw materials.

In summary, the food we eat has many possible fates. Here are the major ones:

• Food can be used to build and repair our tissues, both cellular (e.g. muscles, skin, nerves) and acellular (e.g. hair, collagen, bone mineral).
  
  
• It can be used to build enzymes, cofactors, hormones, and other molecules necessary for cellular function and communication.
  
  
• It can be used to build bile, stomach acid, mucus, and other necessary secretions, both internal and external.
  
  
• It can be used by gut bacteria to keep themselves alive, and the waste products of its metabolism can meet any of the other fates listed here.
  
  
• It can fail to be digested or absorbed, and be excreted partially or completely unused.
  
  
• It can be converted to a form in which it can be stored for future use, such as glycogen or fat.
  
  
• It can be transported to an individual cell that takes it in, and converts it to energy, in order to perform the above tasks.

Note that only the last of these fates—immediate conversion to energy—even approximates the definition of a dietary “calorie”.

Why “Calories In, Calories Out” Is A Radical Oversimplification

By now, the problem with “calories in, calories out” should be obvious:

The fate of a “calorie” of food depends completely on its specific molecular composition, the composition of the foods accompanying it, and how those molecules interact with our current metabolic and nutritional state.

Note that “our current metabolic and nutritional state” is the definition of satiety, as I explain in my ongoing article series “Why Are We Hungry?”, and in my 2012 AHS presentation.

Did you just have an epiphany? I hope so.

So What Matters, If Not “Calories”?

Of the possible fates I listed above, only one is wholly undesirable…storage as fat.

I speak from the modern, First World point of view, in which obesity and the metabolic syndrome are more common health problems than starvation.

And while space does not permit a full exploration of all the possible fates of an ingested “calorie” (it’s called a “biochemistry textbook”), I will give a few examples.

A Few Possible Fates Of A “Calorie”: Protein

Imagine a molecule of “protein”.

Proteins are made up of chains of amino acids. (Learn more about proteins and their structure here.) Some proteins, such as meat, are readily digested and absorbed. Some are poorly digestible, such as the prolamins found in grains like wheat and corn, and part of them will either feed gut bacteria or be excreted. Then, once protein is absorbed, its composition of amino acids determines how much of the protein we can use to build and repair (the first three fates in the list above), and how much must be burned for energy or excreted.

The amino acid composition of grains is different than what our bodies need, since the metabolic needs of a grass seed are very different than the metabolic needs of a human being. That’s why grains score so low on measures of protein quality, such as the PDCAAS, compared to meat and eggs. (Grains score 0.25-0.4, versus approximately 1.0 for all animal-source proteins.)

But even if the protein is perfectly digested, absorbed, and of high quality, that is no guarantee of its fate! If we’ve already absorbed enough complete protein for our body’s needs, additional protein will still be converted to glucose, burned for energy, or excreted, no matter how high its quality. (Our bodies have no dedicated storage reservoir for protein…the process of muscle-building is very slow, and only occurs when stimulated by the right kinds of exercise.)

So, right away we can see that a “calorie” of meat protein that is digested, absorbed, and used to build or repair our bodies is not equal to a “calorie” of meat protein surplus to our needs. Nor is it equal to a “calorie” of wheat protein that is only partially digested, poorly absorbed, and disruptive to the digestive tract itself! (e.g. Fasano 2011)

A Few Possible Fates Of A “Calorie”: Fructose

(Again, space does not permit a full exploration of all possible fates of all possible types of “calories”, so these explanations will be somewhat simplified.)

Imagine a molecule of fructose.

Under ideal conditions, fructose is shunted immediately to the liver, where it is converted into glycogen and stored for future use. However, fructose has many other possible fates, all bad. It can fail to be absorbed, whereupon it will feed gut bacteria—a process that can cause SIBO, and consequent acid reflux, when continued to excess. If our liver is already full of glycogen, fructose is converted to fat—a process strongly implicated in NAFLD and visceral obesity. And when our liver is overloaded with fructose (or alcohol, which uses part of the same metabolic pathway), it can remain in circulation, where it can react with proteins or fats to form AGEs (advanced glycation endproducts), useless and/or toxic pro-inflammatory molecules which must be filtered out by the liver.

A typical Big Gulp contains over 100 grams of HFCS. Even the typical “healthy” fruit smoothie contains over 90 grams of high-fructose fruit sugar!

An adult liver can only store, at most, 100-120g of glycogen…and our bodies never let it become deeply depleted.

The problem here should be obvious.

Now ask yourself: which of the above fates has any meaning relative to the definition of a “calorie”?

A Few Possible Fates Of A “Calorie”: Starch

I can’t possibly explore all the fates of starch, but here are some common ones.

Starch is made of glucose molecules chained together. Upon digestion, it’s broken down into these individual glucose molecules, and absorbed—usually reasonably well, unlike fructose (though certain forms, called “resistant starch”, are indigestible and end up being used for energy by our gut bacteria).

Once glucose enters our bloodstream, its fate depends on a host of metabolic and nutritional factors. Ideally, because high blood glucose is toxic, our muscles and liver are not already full of glycogen, and insulin will quickly force it into one of them, whereupon it will be stored as glycogen and used as needed. Our brain and red blood cells also need glucose, since they can’t run on fat, and if they’re low on energy they can burn it too.

Unfortunately, as we’ve seen, our liver has a very small storage capacity, and the capacity of our muscles isn’t very large either—1-2% of muscle mass.

A 155 pound (70 kilo) adult at 14% bodyfat will contain about 66 pounds (30 kg) of muscle, leaving him with 300-600 grams of glycogen storage, depending on his level of training. (Source.)

Note that only reasonably intense exercise (> 50% VO2max) significantly depletes muscle glycogen, and only from the muscles used to perform the effort. Also note that the mainstream recommendation of 50-60% of daily “calories” from carbohydrate equals 300g-360g for a 2400 “calorie” diet.

Again, the problem here should be obvious.

Then, our cells will try to switch over to burning the surplus of available glucose, instead of burning fat for energy.

People with impaired metabolic flexibility have a problem switching between glucose and fat metabolism, for reasons that are still being investigated.

This is yet another example of how our nutritional and metabolic state affects the fate of a “calorie”; why a “calorie” of fat and a “calorie” of sugar are not equivalent in any sane sense of the word; and why different people respond differently to the same number and composition of “calories”.

Next, our body will try to “rev up” our basal metabolic rate in order to burn off the excess glucose…if sufficient cofactors such as T3 are available, and if our metabolic flexibility isn’t impaired. And a continued surplus will be (slowly) converted to fat in either the liver or in fat cells…but if it remains in circulation, it can react with proteins or fats to form AGEs (though more slowly than fructose).

Note that these proteins and fats can be part of living tissues: neuropathy, blindness, and all the complications of diabetes are consequences of excessively high blood sugar over the long term.

Are you starting to understand why the concept of a “calorie” is so oversimplified as to be effectively meaningless?

A Few Possible Fates Of A “Calorie”: Fat

Explaining all possible fates of all possible fats, even cursorily, would require an even longer section than the above two! However, I trust my point is clear: the fate of dietary linoleic acid differs from the the fate of DHA, the fate of palmitic acid, or the fate of butyrate, and their effects on our nutritional and metabolic state will also differ.

But Wait, There’s More

I also don’t have time or space to explore the following important factors:

• Energy loss when food is converted to different forms of storage (e.g. gluconeogenesis, glycogenesis, lipogenesis) or retrieved from storage
  
  
• How different types and quantities of dietary protein, fat, and carbohydrate affect our hormonal and metabolic environment
  
  
• How the fate of a “calorie” depends on the composition of the other foods it’s eaten with
  
  
• How different types and quantities of food, as well as our nutritional and metabolic state (our satiety), affect our perception of hunger
  
  
• The host of known, measurable differences between individuals, such as MTHFR genes, the respiratory quotient, and the bewildering variety of hormones on the HPTA axis.

Conclusion: The Concept Of A “Calorie” Is So Oversimplified As To Be Meaningless

Let’s recap some of the possible fates of a “calorie”:

• Food can be used to build and repair our tissues, both cellular (e.g. muscles, skin, nerves) and acellular (e.g. hair, collagen, bone mineral).
  
  
• It can be used to build enzymes, cofactors, hormones, and other molecules necessary for cellular function and communication.
  
  
• It can be used to build bile, stomach acid, mucus, and other necessary secretions, both internal and external.
  
  
• It can be used by gut bacteria to keep themselves alive, and the waste products of its metabolism can meet any of the other fates listed here.
  
  
• It can fail to be digested or absorbed, and be excreted partially or completely unused.
  
  
• It can be converted to a form in which it can be stored for future use, such as glycogen or fat.
  
  
• It can be transported to an individual cell that takes it in, and converts it to energy, in order to perform the above tasks.

Note that only the last of these fates—immediate conversion to energy—even approximates the definition of a dietary “calorie”.

I hope it is now clear that the fate of a “calorie” depends on a bewildering host of factors, including our current nutritional and metabolic state (our satiety), the composition of the other foods it’s eaten with; our biochemical individuality, both genetic and environmental; and much more.

Takeaways

• There is no biochemical system in our bodies whose input is a “calorie”.
  
  

• The food we eat has many possible fates, only one of which approximates the definition of a dietary “calorie”.
  

• The fate of a “calorie” of food depends completely on its specific molecular composition, the composition of the foods accompanying it, and how those molecules interact with our current metabolic and nutritional state—our satiety.
  

• Therefore, the concept of the “calorie”, as applied to nutrition, is an oversimplification so extreme as to be untrue in practice.
  

• Therefore, the concept of “calories in, calories out”, or CICO, is also unhelpful in practice.
  

• The health-supporting fates of food involve being used as raw materials to build and repair tissues; to build enzymes, cofactors, and hormones; to build bile, mucus, and other necessary secretions; to support “good” gut bacteria, while discouraging “bad” bacteria; and, once all those needs are taken care of, providing energy sufficient to perform those tasks (but no more).
  

• Therefore, we should eat foods which are made of the raw materials we need to perform and support the above functions.

• Biochemical individuality means that the optimum diet for different people will differ—as will their tolerance for suboptimal diets.

• However, eating like a predator—a diet based on meat, fish, shellfish, vegetables and fruit in season, and just enough starch to support your level of physical activity—is an excellent starting point.

The author of this article is J. Stanton, who is an online Paleo blogger, and the author of The Gnoll Credo (2010) which is a science fiction fantasy about primitive man.

I've been unable to discover information about J. Stanton’s education or any indication that he has any professional credentials. At present, no bio exists on his blog, and his biography as posted on Amazon is quoted below:

"J. Stanton has written and published home and arcade video games, rock, electronic, and tribal music, automobile reviews, US and foreign patents, business plans, political campaign websites, and advertising copy. He spends much of his time ascending and descending mountains on skis, on bicycles, and on foot."

 I’ve enjoyed reading past nutritional articles in J. Stanton’s blog at www gnolls.org, and a year or so ago I got his book, The Gnoll Credo (2010) from Amazon. Although I do read a great many books, enjoy reading, and have read lots of science fiction, this book did not hold my interest. I’ve not yet been able to force myself to read beyond the first few pages. Perhaps I’m too civilized or perhaps the plot is too much of a “boy” thing for me. However, I do own the book, and someday, I might choose to finish reading it.

We live in a world of Unrealistic Expectations.

Like I keep saying:

Being Fat is Hard
Losing Weight is Hard
Maintaining Weight is Hard
Choose your Hard.

Fat Is Officially Incurable (According to Science)
              By: David Wong

Let's get this straight: The number of people who go from fat to thin, and stay there, statistically rounds down to zero.

Every study says so. No study says otherwise. None.

Oh, you can lose a ton of weight. You'll gain it back.
Here's one study running the numbers.
Here's a much larger analysis of every long-term weight loss study they could find. 
They all find the exact same thing: You can lose and keep off some minor amount, 10 or 15 pounds, for the rest of your life -- it's hard, but it can be done. Rarer cases may keep off a little more. But no one goes from actually fat to actually thin and stays thin permanently.

And when I say "no one," I mean those cases are so obscenely rare that they don't even appear on the chart. They can't even find enough such people to include in the studies. It's like trying to study people who have survived falling out of planes. Being fat is effectively incurable, every study shows it, and no one will admit it.

So the guy or girl you see in the "Before" and "After" photos in weight loss commercials, who completely changed body type with diet and exercise? You know, like Jared from Subway, who lost 230 pounds? Either they're about to be fat again in a couple of years, or they're a medical freak occurrence, like the sick guy who was told he had six months to live but miraculously survives 20 years. That guy exists, we all know famous examples. But it's a rare, freak situation, living in defiance of all of the physical processes at work.

How rare? Well, this person did the math and as far as they could tell, two out of 1,000 Weight Watchers customers actually maintain large weight losses permanently. Two out of a thousand. That means if you are fat, you are 25 times more likely to survive getting shot in the head than to stop being fat.  

Meanwhile, here's an article where scientists marvel at the amazing success of Weight Watchers, because a study of their most successful customers showed they permanently lost 5 percent of their weight. Wow! You come in at 300 pounds, you stay at 285!   Next stop, thong store!
 
So please remember this the next time the subject comes up at the office or on some message board and you get bombarded by thin 20-year-olds insisting the obese need to just "cut out the junk food" or "take care of themselves" or "do some exercise." The body physically won't allow that for a formerly fat person.

"Well, just stop eating so much!" Sure, kid. To feel what it's like, try this:

Go, say, just 72 hours without eating anything. See how long it is until the starvation mechanism kicks in and the brain starts hammering you with food urges with such machine gun frequency that it is basically impossible to resist. That's what life is like for a formerly fat person all the time. Their starvation switch is permanently on. And they're not going 72 hours, they're trying to go the rest of their lives. It's like being an addict where the withdrawal symptoms last for decades. Here’s a breakdown of the science in plain English.

As that article explains, the person who is at 175 pounds after a huge weight loss now has a completely different physical makeup from the person who is naturally 175 -- exercise benefits them less, calories are more readily stored as fat, the impulse to eat occurs far, far more often. The formerly fat person can exercise ten times the willpower of the never-fat guy, and still wind up fat again. The impulses are simply more frequent, and stronger, and the physical consequences of giving in are more severe. The people who successfully do it are the ones who become psychologically obsessive about it, like that weird guy who built an Eiffel Tower out of toothpicks.

Statistically, the only option with any success rate is a horrible, horrible surgical procedure. I can find no data whatsoever that says otherwise. Keep all of this in mind the next time you see a Jenny Craig or Bowflex commercial.

            David Wong of www. cracked.com