The Calorie Debacle – T2D 19

posted in: Calories, Health and Nutrition | 65

The Calorie Debacle

Eat Less. Cut your calories. Watch your portion size. Those form the foundation of conventional weight loss advice over the last 50 years. And it’s been an utter disaster, perhaps only topped by the nuclear meltdown of Chernobyl. This advice is all based on a false understanding of what causes weight gain.

Why don’t we ever consider the critical question of “What causes obesity?” We believe that we already know the full answer. It seems so obvious, doesn’t it? We think that excessive intake of calories causes obesity. We think that this is a caloric imbalance. Too many ‘calories in’ compared to too few ‘calories out’ leads to weight gain. This Calorie Balance model of obesity has been drilled into us since childhood.

Fat Gained = Calories in – Calories Out

The underlying, unspoken premise is that these are independent variables fully under conscious control. This completely ignores the multiple overlapping hormonal systems that signal hunger and satiety. This further assumes that basal metabolism remains stable and unchanging.

But these assumptions are known to be incorrect. Basal metabolic rate can adjust up or down by forty percent. Restriction of calories invariably leads to a reduction in metabolism, ultimately defeating weight loss efforts.

For the last 50 years, we have unquestioningly followed this ‘Caloric Reduction as Primary’ program. Dietary fat, being high in calories were restricted. We made food guides, food pyramids, and food plates to indoctrinate children into this brand new low-calorie religion. ‘Cut your calories’ was hymn of the day. “Eat Less, Move More!” we chanted.

Nutrition labels were mandated to include calorie counts. Programs and apps were created to more precisely count calories. We invented small appliances like Fitbits to measure exactly how many calories we were burning. Using all of the ingenuity that makes us human, focused like a laser beam, and dogged as a turtle crossing a road, we cut calories. What was the result? Did the problem of obesity simply fade away like the morning mist on a hot summer day?

The results could hardly have been worse if we had tried. The storm of obesity and type 2 diabetes started in the late 1970’s and today, some forty years later, it has become a global Category 5 hurricane, threatening to engulf the entire world.

What went wrong?

Only two possibilities can explain how obesity could spread so rapidly in the face of this shiny new advice to reduce fat and calories. Perhaps the ‘Caloric Reduction as Primary’ advice is simply wrong. The second possibility is that this advice was good, but people simply were not following it. The spirit was willing but the flesh was weak.

This is the game called, “Blame the Victim”. This shifts the blame from the advice giver (the advice is bad) to the advice taker (the advice is good, but you are not following it). Was the entire obesity epidemic simply a sudden, simultaneous, coordinated, worldwide lack of willpower? The world can barely agree upon which side of the road we should drive, but yet, without discussion we all decided to eat more and move less?

By declaring that their scientifically unproven caloric reduction advice was flawless, doctors and nutritionists could conveniently shift the blame from themselves to you. It wasn’t their fault. It was yours. No wonder they loved this game so much! To admit that all their precious theories of obesity were simply incorrect was too psychologically difficult. Yet evidence continued to accumulate that this new caloric restriction strategy was about as useful as comb to a bald man.WHS-3

The Women’s Health Initiative was the most ambitious, important weight loss study ever done. This enormous randomized trial involving almost 50,000 women evaluated this low-fat, low calorie approach to weight loss. Through intensive counseling, women were persuaded to reduce daily caloric intake by 342 calories and increase exercise by 10%. Calorie counters expected a weight loss of 32 pounds over a single year. This trial was expected to validate conventional nutritional advice.

But when the final results were tallied in 1997, there was only crushing disappointment. Despite good compliance, over 7 years of calorie counting led to virtually no weight loss. Not even a single pound. This study was a stunning and severe rebuke to the Caloric theory of obesity. Reducing calories did not lead to weight loss.

So, there were now two choices. First, we could respect the expensive, hard-won scientific evidence to devise a most robust, more correct theory of obesity. Or, we could simply keep all our convenient, preconceived notions and ignore the science. The second choice involved far less work and far less imagination. So, this groundbreaking study has largely been ignored and relegated to the dustbins of nutritional history. We have been paying the pied piper every since, as the twin epidemics of obesity and type 2 diabetes explode.

Real world studies only served to confirm this stunning fiasco. Conventional dietary treatment of obesity carries an estimated 99.4% failure rate. For morbid obesity, the failure rate is 99.9%. These statistics would not surprise anybody in the diet industry, or even, for that matter, anybody who has ever tried to lose weight.

The Calories In, Calories Out theory had gained widespread acceptance based on its seemingly intuitive truth. However, like a rotting melon, digging past the outer shell reveals the putrid interior. This simplistic formula is riddled with erroneous assumptions.

The most important source of error is that reducing ‘Calories In’ leads to a reduction in metabolic rate, or ‘Calories Out’. A 30% reduction in calorie intake is quickly met with a decrease in basal metabolic rate of 30%. The net result is that no weight is lost.

The other major false assumption is that weight is consciously regulated. But no system in our body is wholly unregulated like that. The thyroid, parathyroid, sympathetic, parasympathetic, respiratory, circulatory, hepatic, renal, gastrointestinal and adrenal systems are all closely controlled by hormones. Body weight and body fat are also strictly regulated. In fact, our bodies contain multiple overlapping systems of body weight control. Body fat, one of the most important determinants of survival in the wild, is not simply left to the vagaries of what we decide to put in our mouths.Hunger and Desire To Eat

Hormones control hunger, telling our body when to eat and when to stop. Ghrelin is a powerful hormone that causes hunger, and cholecystikinin and peptide YY are hormonal satiety signals, which tell us that we are full and should stop eating. Think about the last time you were at the all-you-can-eat buffet. Imagine that you’ve already eaten many heaping platefuls of food, and you are completely, 110% full. Now, could you eat a few more pork chops? Merely the thought might make you nauseous. Satiety hormones are exerting a powerful effect to stop you from eating. Contrary to many popular beliefs, we do not simply continue eating simply because food is available. Calorie consumption is under tight hormonal control.

Studies show that weight loss leads to persistent elevations in ghrelin which leads to increased hunger even 1 year after weight loss. It was simply the loss of willpower, these patients were actually, physically, measurable hungrier.

Hormones also regulate our basal metabolic rate, the baseline level of energy needed to keep our bodies running normally. This is the energy used to generate body heat, to power our heart muscles, our lungs, our liver, our kidneys, etc. Low caloric intake reduces basal metabolic rates as much as 40% in an effort to conserve energy. Deliberate over-feeding increases basal metabolic rates as the body tries to ‘burn’ off the excess energy.

Fat accumulation is really not a problem of energy excess. It’s a problem of energy distribution. Too much energy is diverted to fat production as opposed to, say, increasing, body-heat production. This energy expenditure is controlled hormonally. For example, we cannot decide how much energy to expend on fat accumulation versus new bone formation. Therefore, what is important is how to control the hormonal signals we receive from food, not the total number of calories we eat..

As long as we believed, wrongly, that excessive caloric intake led to obesity, we were doomed to failure. Under this paradigm, 500 calories of brownies is just as fattening as 500 calories of kale salad, a notion that is clearly ridiculous. Blaming the victim turned obesity from a hormonal disorder into a moral failure and excused medical professionals from their botched attempts to treat the obesity epidemic.

We could not ‘decide’ to be less hungry. We could not ‘decide’ to increase basal metabolic rate. If ate less calories, our body simply compensated by decreasing metabolic rate. Different foods evoke different hormonal responses. Some foods were more fattening than others. Calories were not the underlying cause of weight gain. Therefore, reducing calories could not reliably reduce weight.

Obesity is a hormonal, not a caloric imbalance. The hormonal problem was mainly insulin.

65 Responses

  1. We made food guides, food pyramids, and food plates to indoctrinate children into this brand new low-calorie religion.

    I’m currently picturing a black pyramid with a ring of children dancing around it, offering plates of the “preferred foods” (the ones pictured on the pyramid) and chanting as they go around and around it–this may be a good opening to some sort of nutritional horror movie. If only Hitchcock were still alive!!

  2. So how come some people can just count calories and eat at a deficient and lose weight while others can’t?
    Though some people will weigh and count every little thing and that’s just plain ridiculous. We didn’t’ evolve with calorie tracking apps and weight scales.

    • Maybe some people are just fat because of traditional reasons. They then lose weight and start blabbering if I can do it anyone can. People with real hormonal issues aren’t going to be part of the successful 1%.
      Note almost every story of big weight losses starts with out of control gluttony even exceeding CICO predictions.

      • David Sandy, I deeply resent your insulting remark stating that out of control gluttony is the cause of big weight gains.
        I have been dieting all of my life and after losing weight, I always gained it back and then some. I have T2D and have followed Diabetes Association and my dietiticians advice for 15 years. The result? In
        January of this year I weighed 300 lbs. THIS WAS NOT DUE TO GLUTTONY!!!!!
        Since I found Dr Fung’s website and have read his books, I have lost over 50 lbs. I follow an LCHF protocol with 15 grams on net carbs, 40 grams of protein and 80% fat daily. I also intermittent fast daily and once a month I fast for 5 continuous days. Do I sound like an undisciplined glutton to you???

        There are many people in my situation of have developed Insulin Resistance and have gained weight doing exactly what they have always been told to do. Dr Fung’s explanation of the science and his guidance have helped thousands of people.

        People like you who fat shame others should be ashamed of yourself for making us feel guilty and inadequate.

        I don’t know what you are trying to prove on this blog, but accusing people like me of gluttony is the height of fat discrimination, and I for one am sick of people who do that from people I meet to the vast majority of the medical profession who have constantly advised me that I should let them mutilate my body with bariatric surgery! I know a lot of people who have had the surgery and now have continuing and irreversible damage that they have to live with for the rest of their lives.
        The notion of bariatric surgery is the result of the views of people like you who believe that people like me are just gluttons!!!!!!

        • I said some not everyone. 3 years ago I weighed 440+ now I weigh 250 and am going lower like it was nothing after I found Dr Fung.

          However, problems don’t have to be binary.
          There can be people fat because they are glutton.
          Then there could be people fat because they need specific advice.

          There can be a combination of above.

          Those people are the current success stories and they talk about it with the it worked for me and I was an out of control glutton everyone must be. This provides anecdotal evidence that standard advice givers latch onto due to confirmation bias. This has led to the situation that you and I faced where the correct information for us was suppressed or just not looked into.

          If we continue to promote the narrative that everyone necessarily is 100% hormonal then any example of someone who loses weight through standard means will serve to disprove the hormonal narrative.

          • David Sandy,

            Thanks for your reply. Had I read your other posts, I might not have posted my reply. I congratulate you on your progress.

            I guess I am overly sensitized by the condescending and disgusted attitude that many people (both lay and professional) have shown towards me over the decades.

            Feelings of guilt and worthlessness due to a condition that is denied by the medical establishment in Canada are very hard to bear.

            I have seen no scientific evidence that proves that extreme obesity is caused simply by “gluttony” Dr, Fung and many other
            respected researchers have laid out clear and convincing evidence of research showing that the cause of obesity is hormonal and not related CICIO. I defer to their professional expertise.

          • Deb Griffith

            Maybe not so much “out of control gluttony”, here in the USA, but victims of fast food, convenience stores, and successful marketing and production of all that swett, good-tasting soda and junk food that swarm our shelves, and that are so cheap that the indigent and less fortunate among us can only afford to feed their families foods that are rife with carbs and sugar. I tried to get my local family clinic on board with a program based on Dr. Fung’s program, and they said, these people are poor, and all they can afford to eat is food that is not really good for them. How do we overcome that? I had no answer.

          • Charlene

            Reply to Deb Griffith–
            These folks within the community you spoke may be poor– but remember Dr Fung debunks the excuses and says everyone can fast. No money? You can still fast. Can’t cook? You can still fast. I doubt Dr Fung would mind if I add; No healthy food available? You can still fast.

          • Richard S Stone

            I find this thread of comments somewhat amusing, aside from the hurt feelings, of course.

            I lost about fifteen lbs. with IF alone. And my point in posting is that continuing on this program as far as I am concerned is the liberation, to some extent, from having to eat ONLY “healthy” foods (Although I generally do…). Thus, if I want a fast-food burger, I eat one. Or maybe two, along with large fries and a real sugar-sweetened cola. Or beer. Yes I like the paleo foods as well, but really a big fat burger on occasion is just perfect.

            And when someone is having a birthday party, I eat as much cake as is socially acceptable.

            The reality is that I am probably going to fast for 18-24 hours after that delicious indulgence and during that IF time my insulin production is going to be very low, to the point of vanishing. Why not eat EXACTLY what I want if I’m in the mood? I can lose more weight on a more continual 22-24 hour fasting IF program, but I don’t want to do that. I can stabilize my weight and eat exactly what I want on an 18-6 or even 16-8 IF schedule, and do some (2-4?) 22 hour fasts during the week.

            None of this calls for great expense or will-power or self denial. In fact, it lets you eat the foods you like to eat. Of course, you may find that the foods you like to eat change somewhat, but that’s a different issue.

      • Eleanorina

        Patrick,

        Studies have found that for people without insulin resistance, many types of diets are effective. For those with insulin resistance, it’s the low carb-high fat approaches which are effective.

    • One factor among several is that reducing calories will also tend to reduce some of what is hormonally problematic, at least for the short term. For example, if a dieter opts to switch from soda to water as a calorie reduction method, they are also causing a sugar reduction.

    • I’m one of those who can just count calories, eat at a deficit and lose weight. Must have done it a dozen times, losing the same 20-30 pounds–the number I needed to lose creeping up year after year. A bit over a decade ago, I switched to a low carb diet–and lost 20 easily. The other ten–I still yo-yo a bit, but I’ll trade a 10 pound yo-yo for a 30 pound one any day. Calories in calories out does work, in the extreme–because you can push things past your body’s ability to compensate. But is it worth it? Maintenance is everything.

  3. I passed 250 this morning. My high was 440+. I’ve tried for 20 years since college to lose weight. I’ve lost 100 pounds off fasting starting Jan 2016

    These CICO fanatics are so dogmatic that now a metabolic slowdown has been proven; they are just saying that means they were right all along! You just need to eat even less.

    This is clear goal post shifting. No one ever started mentioning a metabolic slowdown as a real factor. They just go strictly off their formulas.

    They ignored countless reports that the slowdown makes you feel cold sick and miserable. I experienced this.

    With fasting I feel incredible. It’s almost easy.

    • Hi David. What fasting protocol are you following?

    • Awesome. 100 pounds in 10 months. What type of fasting?

      • I don’t follow a protocol. Strictly determination and willpower and use of intuitive judgment. I don’t calorie count. I do mainly 5-10 fasts as they fit into my schedule. Longest was 20. If you click on my name I’m starting a blog where I talk about it. Not much yet, but I have an instagram feed where I post all the yummy food I eat when not fasting. I should have the first articles about my experience up within 2 weeks the drafts are done.

        It wasn’t willpower or gluttony. It was just knowledge that you need to fast.
        FASTING
        It’s the secret.

        • I will be interested in following your blog

        • Thanks David. I read your blog and found it really inspiring. I agree that it can be very socially awkward to do longer fasts, and there is even a lot of pressure from my family to not do them. My personal record is 96 hours, but I hope to do even longer fasts to reap more of the rewards.

          Out of curiosity, do you have any restrictions on the type of foods you eat when not fasting?

        • Stevo,

          My only hard rule is no sodas or juice. I’ll go into that in depth in a later post. I periodically restricted various things throughout my life and I think it’s led to good habits so I can effectively self manage as long as I fast. (Example I eat small amounts of bread)

          The other rule I follow is I eat things that might be bad but I run in through a badness yumminess tradeoff filter. So no cadbury bars only godiva.

    • >No one ever started mentioning a metabolic slowdown as a real factor

      Not only that, they said that a relatively small caloric deficit (like 500 kcal/day) would *prevent* metabolic slowdown. What are they saying now, or are they just denying?

      • Currently CICO proponents seem to have three major narratives they are split between

        Pseudoskeptical denial based on “flaws” in the study.
        Just not hearing it.

        And the major one is now

        CICO still works. You just have to eat even less and it’s your own fault you got fat in the first place so you need to suffer and accept the consequences of your past bad behavior. We knew this all along. Why should we spend money trying to fix this problem.

    • Do you have the links to the studies with metabolism and fasting? Fung has so many blog posts it’s hard to find the right one.

    • Thats fantastic David, congrats! However, I think people still tend to oversimplify this issue, on both sides. In my case, I lost 125 in 16 months. I retired Feb of 2015, long before hearing about Jason Fung. Between Feb 1st and mid June (4 1/2 months) I lost 20lbs for no apparent reason other than, I believe, I retired from a 2+ hr/day commute. A franticly BS job for the prior 5 yrs. It was then I was declared T2D with an A1C of 8.5. Again, pre-Dr Fung, pre Dr Taylor, pre- Dr Kraft, pre- Dr Mosley. I did have MyFitnessPal and now in a position to control and log what I put in my mouth I told MFP I wanted to lose 2lbs / wk. Oh yeah, let’s not forget being told by the dietitian I now had a progressive chronic disease. So between July 1st and mid June 2016, I dropped 100lbs more. For those unaware, Dr Taylor did outstanding research proving T2D was, in most cases, completely curable/reversible. In 3 months my A1C when from 8.5 to 5.8. By the end of May 2016 I had completely plateaued out for the second time which is when I found the Fung YouTube vids and preordered Obesity Code. Doing IF got me to the 185 mark but since then I’ve gone up 5-10lbs. I suspect the 185 was artificially low as I had been fasting and likely had an empty GI track. I am currently doing the 18-20 hr fast every day. Some days, just to shake it up I do have breakfast (RaisinBran) and lunch (turkey sandwich). For the most part I stay completely away from simple carbs (sugar and refined flour products). From conversing w/Sten (a regular here) I have done two 5 day fasts..sought of a reverse 5-2 Mosley regime. I think that initial 20lbs was attributable to cortisol as well as some amount of poundage since then. Which means I, honestly, can not condemn CRaP diets as that’s what I used for the bulk of that 125 lbs, right up until it stopped working, as Dr Fung predicts it will. It is now a year later and my A1C has been consistently below 6.0 and my expectation is, at the end of Nov it will be low 5’s or high 4’s.

      But, to your success, let me add the following. Nothing beats success like success. It doesn’t matter how one gets there, so long as they get there.

  4. doing HIIT decreases my appetite. seems counterintuitive. what’s the mechanism here?

    • The decrease is due to the body’s fight or flight reponse shutting down digestion in order to cope with the extreme exertion.

    • Karen .. men and women behave differently to HIIT .. as a general rule ..

      You fall into the general rule. Women obtain a hunger supression effect .. generally.

      Men just the opposite .. again as a general rule.

      Because I am carrying around 10% body fat .. I don’t follow the general rule. When I am very lean .. I do follow the general rule. In fact to avoid that I strictly follow the “lean gains” 16 hour fatsing and 8 hour feeding protocol.

    • Dr. Larry Siders

      Karen,
      I experience the same decrease in hunger after doing HIIT. My theory is that the HIIT depletes glycogen stores and switches hormones into “fat burning” mode. And after finally reaching “fat burning mode”, hunger fades (hormones that control hunger are adjusting). This theory is supported (at least for me) by the fact that HIIT has less effect on hunger the first day of a fast when glycogen stores are still high enough that the ~250 to 350 calorie HIIT workout doesn’t use up the last of the glycogen stores.

      AND according to my caliper readings. Fat utilization (and therefore fat loss) is highest when HIIT workouts are done after the first day of fasting (I can only do HIIT on alternate days.)

      Of course any fasting interval will hasten fat burning…but there is no doubt that fat utilization is higher after glycogen reserves are lowest…and fat stores have to be used…and almost all long term “casters” report reduced hunger after the first day or two.

      Also…fat losses (via caliper readings) are accelerated when doing HIIT only AFTER uthe first day of fasting.

  5. Another brilliant article Dr Fung, I always learn so much from your posts. I can see how hard it must be for doctor’s and dieticians to admit they were wrong and go back to basic training from the likes of your good self but they have a moral obligation to their patients to admit they got it all WRONG as did we all, from being brainwashed by our respective governments. I am in my early 60’s and can scarcely remember a chubby adult or child in post war Britain never mind the obesity which is so common place these days. Something is obviously very wrong with our health guidelines and you have made me change my whole way of thinking. It’s not about the calories, it *is* about the hormones.

    As an example I probably am severely insulin resistant plus most probably pre-diabetic. When I found the Diet Doctor website I started eating one LCHF meal a day. And yet the scales only went up and down by 7 lbs for 2 months. Now if this was truly about calories and obviously I was eating much less than before then why didn’t my weight seriously drop if I was eating so few calories? Well then I read your TOC book and realised that the sugar free sweets and mints I’d been eating (0 calories) were spiking my insulin all day long. It wasn’t until I started extended fasting that I’ve started seeing some serious change. Now some might say well that’s because you’ve gone from eating 7 meals a week to 3 or 4 meals, but really I don’t think that is it at all.

    I now believe it is all hormonal and yes we do all eat too much these days but giving our bodies a break can only be a good thing, especially when autophagy kicks in. 🙂

  6. In previous post Dr. Fung points out that basal metabolic rate is not decreased when a person fasts INTERMITTENTLY. The 40% drop in BMR occurs only over long periods of caloric restriction, as the graph demonstrates, representing the body’s attempt to maintain its original set point.

    • Actually,

      in extended fasting the calorie restriction doesn’t seem to occur. See Dr. Fung talking about the mad scottsman. The bmr reduction occurs with calorie restriction. Fasting is different.

      This also accord with my experience.

  7. Kathy Meyer

    Even though I never truly believed CICO, I still blamed myself. One day I decided to start tracking my calories and daily exercise in a tracker. I discovered what I already knew: I was technically running at a deficit every day of my life. I almost always ate below 1500 calories, and did light activity, and still weighed over 250 pounds. So if the CICO theory worked, I shouldn’t even exist! So many of us knew this and did assume we had very slow metabolisms, but just thought if we worked harder or ate less fat and calories, we’d eventually lose weight. We thought we just weren’t doing enough.

    Amazing now that I’ve lost 65# on LCHF + IF that I can see how clearly wrong it all was. Even on Atkins I would lose weight and then it would all come to a grinding half. I never knew what insulin resistance was, and Dr. Fung’s work has been a revelation. I regularly incorporate fasting with a ketogenic diet, and feel I will lose all the weight I had gained and lost, gained and lost, in the last 40 years.

    The sad thing is that if you walked into your doctor’s office, or talked to a nutritionist, or registered dietician’s office, they’ll just keep repeating the words — judging you for your lack of will power and gluttonous ways. When will this end?

    • I think it will only end when there is huge money to be made in the fields of those professionals/big pharm who continuously look for more money and find there is plenty to be made in the LCHF arena. I see coaches, IF specialists, specialty diabetic reversing doctors, LCHF restaurant chains, an explosion of new processed foods (that carry unknown threats), carb “blocking” medications (face it people want a “skinny” pill), Keto Flu–pharm products, private support groups and scores of “how to books”. I also see Keto spas becoming more popular than strip mall tanning salons. Then of course there are college/university degrees and certifications to be purchased. Naturally, government and insurance companies will want in too–because all those who work there will want to increase their job security.
      Once the world smells money– it will end.
      There are already numerous food blogs that earn big bucks sharing their recipes–and I love these blogs because they are re-inventing the wheel for me.
      If you are an entrepreneur this just might make you a ga-billionaire.

  8. “the hormonal problem was mainly insulin” So what about the recent studies demonstrating the herb Berberine is as effective as Metformin without the side effects? And when synergized with d-limonene provides, in addition to blood sugar reduction, other health benefits.

    https://www.ncbi.nlm.nih.gov/pubmed/?term=berberine+and+d-limonene

    • For all you know this herb affects insulin or the satiety hormones.

    • I have read berberine is hard on microbiome and a break from it is required along with taking a probiotic, regularly. I have taken in for limited time and have read it is a substitute for metformin, but why take anything if intermediate fasting and LCHF diet can retrain body to not be insulin resistant?

  9. Liliana Diaz

    This makes a lot of sense. I used to be overweight and after loosing the weight my body is extremely sensitive to gain again. I have been on a LCHF regimen for a while but not very successful in loosing the last 15 pounds of extra visceral fat. I know is due to a hormonal imbalance and a decrease basal metabolic rate. I recently incorporated fasting into my routine with the purpose of helping my system to balance the hormones. What do I need to do to increase my basal metabolic rate?

    • Eat monounsaturated and saturated fasts, and consider heavy weight training and HIIT.

      • Richard S Stone

        I think what Dr. Fung is suggesting is that you cannot directly control your Basal Metabolic Rate. Instead you can manage it indirectly by fasting. Dr. Fung is not a supporter of the exercise aspect of weight loss, as I see it. The thing to avoid is caloric restriction and continual eating during the day and night. And based on what he has posted I do not think exercise is critical to weight loss or insulin resistance.

        Still, as I see this, exercise is part of the concept of being fully healthy, and exercise has some effects on mood.

        You have choices in fasting too: I did not find it necessary to go to a full-on fast of many or even several days. I lost weight with 22-24 hour fasting periods. Dr. Fung has posted that fasting appears to work better when combined with a LCHF diet. I am sure that is correct. While fasting you may find that you have more time (after all, you should have an extra hour or two…): why not do some exercise in that time? Nothing extreme. Just take a walk or do something physical.

        • Richard, have you read Dr Fung’s new book on Fasting? One question I’ve had for some time is the blurring of LC and VLC. In the Complete Guide to Fasting, it feels like he uses them interchangeably. Perhaps part of the problem is I did Atkins several times in the past and Atkins tends to equate carbs < 10gr/day to be the way to maintain ketogenesis. I've been trying to keep mine, < 30% of calories. I find it ever so confusing. Any thoughts?

          • Stephen T

            Walt, that seems to be mixing up the amount of calories with the type of calories. Low calories and very low calorie diets can’t work long term. A low carbohydrate way of eat can and does work, but anywhere near 30% carbohydrates wouldn’t be thought by most people to be low carb, although it’s certainly a lot better than the standard diet. I’d say I’m more in the 5% – 10% carb range and it means I’m rarely hungry and sometimes go into ketosis, but it’s not something I concern myself about.

          • Steven, LC and VLC are for low carb and very low carb. So if the current recommendation by, at least MyFitnessPal is for 55% carbs 30 is, by comparison low by about 1/2.

            Probably an operative question is when talking diets is, is it a Diet or a diet. Strictly speaking a diet is what one eats, period. I believe Diet is a short time adjustment to what one eats but not intended to be a life long thing. To that extent I don’t esp have an issue with Atkins or the 10g or less of carbs short term but I question how long term successful that can possibly be. Even Atkin’s maintenance mode is much higher but the 10g is a ‘quick’ noticable result.

  10. I also am a testament to CICO doesn’t work. I have always worked out and watched what I ate. The more I track what I eat the more obsessed I become… That and NOTHING works to keep the weight off long term. There are certain people who are ADAMANT about CICO and say that fasting is only helping with that, but I disagree. Then why fast? Just don’t eat that much, track your meals… Dr. Fung speaks to my problem. If it were CICO then I should be size 0. Seriously, I am always the one NOT eating dessert NOT eating carbs NOT eating summer fruits and sugar and and and… so WTheck!

    Thanks so much for this…

    If anyone has ANY suggestions on what worked for them… do you count calories, macros during your ‘eating hours’? What hours do you fast? Do you eat any fat during your fast? Thanks.

    • Carolyn, I try to eat and fast in a relaxed and non-obsessive way. A routine you can keep up for the long term is much better than a few weeks of one approach and then searching for another. I know that I’m not going to eat junk or anything with added sugar, so I don’t think about that. I don’t have any food in the house that doesn’t fit in with my low-carb approach because, although I’m fairly disciplined, it means I won’t be tempted. I live alone so that’s much easier for me than it would be if living with someone who wanted different, probably unhealthy, things in the house.

      I don’t count calories because it’s not helpful for me and I see it as a pain. I eat low carb because it helps to keep my insulin down and a higher fat diet means I’m not hungry. People who want to lose weight need to remember that the body doesn’t use fat until all the carbs have been used and the insulin level has dropped. Not eating many carbs before a fast makes sense to me because there’s less to use up.

      I drink coconut oil twice a day with some salt. It’s filling and I need the salt because low insulin means fluid loss and that takes salt with it. My fasting is rarely beyond 16 – 18 three or four times a week, but I always have at least a 12 hour fast before I eat breakfast, which is often more like lunch. I have the same fast days each week, so it’s part of my routine. I tend to have my last food at about 6.30 p.m. and then eat again the following day at 11.00 a.m. or maybe a little later. The surprising thing for me was that hunger in the morning isn’t really a problem. I know that’s not a long fast by some people’s standards but it’s enough to be worthwhile.

      Best wishes.

  11. Dr. Fung, is it possible to increase one’s basal metabolic rate after decades of yo yo dieting?

    Would a combination of LCHF and Fasting be sufficient or are there other methodologies that need to be applied (such as excercise) to increase BMR?

    • From the recent research (because I wondered the question to myself) .. (short answer) no.

    • Hi Birgit,

      I will offer you some hope. There was a study that came out a few months ago studying the Biggest Loser contestants in the US. The study showed that their metabolic rates were significantly lower after several years following the show. On the surface, this seems like a pretty bleak message. However, if you look at their baseline figures, those metabolic rates look pretty good. You cannot tell me that their time on the show was the first diet they had ever tried. Those contestants more than likely were yoyo dieting for years and years prior. During the show and following it, they were brainwashed into thinking that frequent meals containing minimal fat and calories was the right way to go, while performing an excessive amount of exercise.

      What if simply eating more fat raises your metabolism? We know that eating more calories raises your metabolism. We also know that fat has minimal impact on insulin, and you cannot store fat without higher insulin levels. Eating more fat (without more protein or carbs) should in theory raise your metabolism without adding to your waistline.

      The message – eat healthy fats until you are truly full when not fasting. Since January, I’ve dropped about 45 pounds simply doing this and fasting without significant exercise. I am now also eating more calories than I have been in years.

      • Perhaps a controversial “Biggest Loser” show is on order. Why not have a CICO vs. LCHF season. Controversy sells. The sheer scandal of the contestant “breaking all the rules” would draw in millions of viewers. I would love to see Dr Fung coaching someone through to not only lose weight–but possibly lose/reduce some medications.
        I am envisioning the CICO contestants with crazy non-stop exercise and the LCHF taking wonderfully, relaxing moderate hikes in the woods.
        I girl can dream.

        • I totally agree. It would be fun to watch one group do an extended fast with minimal exercise versus the traditional subway sandwiches and torturous exercise. One group would be up at 5AM to hit the gym, while the other would sleep in, walk downstairs in their robe, and enjoy a cup of black coffee while leisurely watching the morning news on television. 🙂

        • I agree. That would be cool to see Dr. Fung on Biggest Loser. 🙂

      • Thanks, Stevo,
        that sounds very encouraging

  12. Roger Bird

    Despite the fact that I think that the “Blame the Victim” game players are wrong, I understand why they are confused. We separate the objective (insulin, glucose, sugar, obesity, etc.) from the subjective (hunger, anger, fear, etc) so stridently and so strongly that we often fail to understand that they intersect in the human body just as the physical intersects with the spiritual in the human body. In plain English for our purpose, they don’t realize that the hunger generated by high insulin and eating sugar per se is a hunger that is simply irresistible. Part of the power of dealing with insulin (and cortisol) levels rather than calories is that focusing on the hormones helps to manage the hunger to manageable levels. The very people who play the “Blame the Victim” game would also be unable to resist such extreme levels of hunger generated by out-of-control hormones and sugar.

  13. Hello all–
    I am new to this community and after stalking ya’ll for some time, I interjected a few of my thoughts today. I have a question for anyone who knows the answer or who can direct me to a resource for the answer.
    Sadly, I am a victim of CICO–but I am trying to make the success with that work for me. I am currently on the down side of the scale. CICO got me to lose 120+- pounds and I am currently below goal. The problem is I was seeing inevitable incremental gains that comes along with CICO. A dear friend recommended TOC and I am on Day 49 of LCHF with IF of 17-24 hours daily. I have lost 11+ pounds in 7 weeks! I am in awe and will do LCHF forever!
    My question is do I continue doing my IF schedule (totally doable for me) and keep my LCHF at under 30 carbs, fat at 75+% and protein under 30g forever? I guess my question is will I naturally stop losing weight or do I have to intercede by changing my routine?

    • Richard S Stone

      My experience is that you may have to do IF forever, and LCHF too, BUT how much of a burden does that have to be? If I do a 18-6 kind of schedule I stay with LCHF, but if I go with a large meal of burgers and fries, and I stay with the 18-6 schedule, nothing bad happens.

      But what does that IF schedule amount to? Skipping breakfast? And then eating lunch at 1pm? Is that in any way extreme? And if on one day you eat breakfast, perhaps meeting friends, etc, is the world going to end? Probably not, so long as you go back to IF. If your bodily systems are working properly IF will take you to minimal insulin/fat storage, on a “normal” basis, and you can eat what you want. But again, knowing what you know, why would you (for example) eat cake for every meal?

      If you read Dr. Fungs’s personal description, what he seems to do is something like a 16-8 schedule and 2 to 4 days of 22-24 hour fasts during the week.

      My other experience is that if you lose weight with the 22-24 hour schedule, and then you go (back) to 16-8 or 18-6 schedule, you will “re-gain” some weight, but not much. Maybe 2 lbs? No reason to panic, particularly if you know it’s going to happen.

    • Charlene, I think we all have a natural weight that we’d be at if we weren’t stimulating our appetite with the modern diet. No creature on the planet gets fat except humans and the animals we feed. I think that says a lot.

      So, I think you’ll stop losing weight when you hit your natural weight. That’s what happened to me. I adopted the LCHF way of eating and without any effort lost 10 pounds. I’m roughly back at the weight I was thirty years ago, but then I stopped losing weight and that’s good. I adopted fasting because I thought it was a natural approach and healthy. I know some do it to kick start weight loss that has stalled for some reason. Perhaps because years of the modern diet have messed things up a little and fasting resets things.

      I’m with Richard. Being a little bit relaxed about it all is a good thing. I’ll never stop eating low carb, but it might vary. I now regard 14 – 18 hour fasts as normal, but I have no need to push it. My fasting is like my exercising – moderate and often.

    • @Charlene

      Quote : “Everyone has a set point and, just as you have no control over your height, eye color or hair color, you also have no control over what your set point will be. Your body is biologically and genetically determined to weigh within a certain weight range.”

      Set Point Theory

      http://www.mirror-mirror.org/set.htm

    • Thank you Richard, Stephen and Andy for your input– I guess I’ll have to wait and see what my body does. IF paired with LCHF really fits my lifestyle–I think I’ll keep things as is until/unless I develop health issues.

      Thanks again–I am very new to all of this–but it feels like the permanent answer I am looking for.

  14. […] Read More on this subject by Jason Fung in his blog post titled The Calorie Debacle. […]

  15. It’ s amazing the differing comments and opinions in this comment thread, considering we must all follow Jason Fung or be searching for similar stuff.

    I think if I showed this article to a cross section of my work colleagues, they would just be like “what is this crap” and wouldn’t even ponder it or do there own reseach into it. Sad really.

    I have been keto for 10 months and loving it.

  16. Katy Meier

    I really love Dr.Fungs articles and learn every time new things. But I have one question going on in my mind for long time… If I eat only food that don´t cause Insulin (like fat), and I eat about 5.000 calories per day (I´m a women 46 years old, so no way to use them all for energy). What happens with the more calories (or food)? Do I store them as fat anyway, even if it don´t causes Insulin? Or what happened to this surlpus of energy? (Of course I don´t eat only fat, it´s only a hypothesis)

    • Katy, interesting thought. When you’re off the sugar and carb rollercoaster – eating followed by high and then low blood sugar, and eat again – and instead eat a higher fat diet, your body will know when it’s had enough. We have an off switch, which is why we didn’t used to get fat (and no other creature does so). Fat satiates the appetite and refined, or two many, carbs fuells appetite. You can eat almost endlessly on sugar and carbs and I’m sure we’ve all seen it. So, I don’t think you could eat those 5,000 calories of fat. I believe I read in Nina Teicholz’s book that they tried to get people to overeat meat and they couldn’t do it.

  17. […] Hormones control weight gain and obesity, NOT calories in, calories out. […]

  18. Rajesh Pankaj

    Hi Dr. Fung, This is Rajesh from India, a big fan of your work. I have T2D since 2013, getting treated with Metformin 500 mg XR twice after each meal. I also tried SU-JOK therapy for almost a year with no significant improvement. But with all the restrictions, this September I became depressed thinking that I never getting out, I never be the same as earlier. Then I came across Prof Roy Taylor diabetes research online which opens my eyes. I immediately started my dies limiting it to more or less 800 Cal, mostly comprises of green vegetables(boiled n raw). At that point I was 71 Kg (waist: 37 Hgt: 5′ 7″) and avg RBS was 225-250(On Metformin). Following it for almost 8 weeks, weight drops to 62, RBS: 140-180(I stopped taking Metformin when started the diet), waist (on Naval): 34, Hip: 35. Hunger is never away nor ever my BS came to normal on my Glucometer. And then I it the Weight-Loss Plateau. I started researching again and found Diet Doctor and your blog. I must say its like blessing from a higher power. Not only it educated me in whole new way and open my eye to the reality, it relieves me that I can fill my tummy now without thinking about FAT. I am following a mix of yours dietary advice since last week and started 24 HRS fast twice a week starting this week. The only real problem I am stuck to is what to eat. If I opt out wheat Rice Legumes, there is almost nothing left to eat except green vegetables. You might know that regular Veg Indian diet main consist of Chapati(wheat Flour), Daal(Legumes) and Chaval(Cooked Rice). Could please suggest me “how, what and how much” should I eat? Thank you once again for the great work you are doing.

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