The Proof is in the Pudding – More Turds in the PunchBowl

Have you ever heard the phrase “The proof is in the pudding”? It is also sometimes “The proof of the pudding is in the eating.” What does this mean? No matter what you think, you need to look at the results to really judge something.

Suppose you think that adding chalk to a pudding recipe will make it better. You might come up with all kinds of great reasons why – it will make the colour lighter, it will improve the texture, it will improve the flavour. But none of this really matters in the end. The only question you need to ask is this – “How does it taste?”  If the taste is horrible, then it doesn’t matter about what you think, or why you might believe the chalk is good. The proof lies in the results – the taste of the finished pudding. The proof is in the pudding.

So let’s apply this to obesity. The dominant nutritional theory of the last half century has been Calories In, Calories Out. We had erroneously believed that excessive calories is what leads to obesity. (You can review the Calories series to learn more about why this is wrong). Within this paradigm, reducing ‘calories in’ would lead to reduced weight. Furthermore, increasing exercise would increase ‘calories out’ and therefore, also cause weight loss. Fat, being very calorically dense (9 calories/gram as opposed to about 4 for carbs and protein), should be the main thing to reduce in your diet for weight loss.prevalence-of-obesity

So here we have the low fat, low calorie diet combined with increased exercise. This is very neatly summarized by the Eat Less, Move More approach. And this has been the standard dietary prescription for the last half century. We can invent all kinds of mechanisms (Calories In, Calories Out) as to why it should work, but does it? What are the results? Everything depends on the results. The proof is in the pudding.

Well, here’s the results. A huge, rampant global obesity epidemic. The Center for Disease Control (CDC) in Atlanta recently updated its obesity map for the United States and the results are, well, horrifying. No state had an obesity rate below 20%. As late as 1995, no state had an obesity rate higher than 20%.ObesityEpidemic2014

So let’s juxtapose these two incontrovertible facts together:

Fact #1 – Conventional weight loss advice is to Eat Less, Move More, or Caloric Reduction as Primary (CRaP).

 

Fact #2 – Obesity is just friggin’ exploding all over the damn place.

Considering these two facts together, there are only 2 possible conclusions. One possibility is that the advice is good, but people are simply not able to follow it. This would be a real stretch of the imagination. Nobody really wants to be fat. When doctors advised people to stop smoking, they stopped smoking. When doctors advised to watch their blood pressure and cholesterol, they watched their BP and cholesterol. When doctors advised to increase exercise, they increased exercise. Yet somehow, they didn’t follow a low-fat, calorie reduced diet? Doubtful.

This belief is the recourse of cowards everywhere and also known as ‘Blame the Victim’. It is far easier to suppose the advice that we give is good and the victim has somehow brought this on him or herself. This shifts the psychological blame from the advice giver to the advice taker. Just as ignorant people may have once believed “Those blacks brought the violence upon themselves by sitting in the white-only section”, ignorant people now believe that “Those fat people brought this on themselves”.
Americans Have followed advice

Further, the data does not support the supposition that people did not follow this advice. People did in fact, reduce their intake of fat significantly, just as the doctors advised.  This was replaced by carbohydrates, just as the 1977 Dietary Guidelines suggested. What scares me most of all, by the way, is the +91% on vegetable oils (shudder).

So, it was not simply that people did not follow the advice. They did. So we cannot really suggest that the reason that dietary advice failed is that people were not listening. They were.

Are Americans eating more calories? Not really. The correlation between obesity and the increase in calorie consumption has recently broken down. Data from the National Health and Nutrition Examination Survey (NHANES) in the United States from 1990 to 2010, finds no association between increased calorie consumption and weight gain. While obesity increased at a rate of 0.37 percent per year, caloric intake remained virtually stable. Women slightly increased their average daily caloric intake from 1,761 calories to 1,781, but men slightly decreased theirs from 2,616 calories to 2,511.

So, what’s the only remaining possibility? That the advice to Eat Less and Move More is simply wrong. This is logically the most correct response. In fact, given the severity of the obesity epidemic, it is likely that most or all of our conventional Eat Less, Move More advice is wrong.

Let’s see what the success rate of the CRaP methodology. Here’s an interesting paper detailing the damage we’ve done. Researchers in the UK looked at close to 175,000 obese men and women excluding those that received bariatric surgery. Most, we can assume got the CRaP advice to cut calories. During 9 years of follow up, how many were able to achieve a normal weight?

Success rates averaged 1 in 210 for men and 1 in 124 for women. For both, say 1 in 167 or 0.006. That, is a 0.6% chance of success and a 99.4% chance of failure. But for those who were most obese (BMI>40), the odds drop down to 1 in 1290 for men and 1 in 677 in women. For both, say 1 in 983.5 or 0.001. That is a 0.1% chance of success or a 99.898% chance of failure.

But I don’t really need a study to convince you of the truth. This reeks of truth. You knew it already. Eat Less, Move More never, ever works. After all, who hasn’t tried the CRaP method? Face it, we have all tried it. And we have all failed. 99.898% failure rate? Yeah, sounds about right to me.

The dietary advice was simply wrong. Yet nutritional authorities like the National Institutes of Health’s Kevin Hall continue to preach, and preach. Let’s get out of the ivory tower and into the real world, because that is where we all live, not your metabolic lab.

But here’s the most important thing to understand.

Whether it is the first (good advice that people do not follow) or second possibility (bad advice that people follow), IT DOESN”T MATTER. The advice is still bad. If you give advice that nobody is able to follow, it is still bad advice.

So, again, following logically, the Caloric Reduction as Primary (CRaP) advice is bad because we have a raging obesity and diabetes epidemic. The proof is in the pudding. What is to be done? Again the only logical conclusion is to CHANGE THAT ADVICE.Opposites

We should follow George Costanza’s (from Seinfeld) advice. When he realized that all his decisions were bad, he deliberately did the opposite of his instincts, and the results were great. This was only a sitcom, but maybe there is something here.

If we did everything opposite to what we were told (the Costanza diet), we could hardly be worse off than we are today.

What is absolutely crucial to understand is this. We need to stop lying to ourselves. We lie to ourselves that we are providing good advice. We lie to ourselves that people would be just fine if they followed the Eat Less, Move More model. It is simply not true. It is a lie that we tell ourselves so that we do not have to face the hard truth that we are failing.

It is very difficult to face the cold steel of logic that says that all of our medical training, resources and money have been completely for waste. We have not helped anybody. Instead, if anything, we have made it worse. After 50 years, we are making the problem worse. So instead, we lie to ourselves that this is a difficult problem, and we are doing the best we can. We need to stop pretending that we are doing a good job. We are not. We are bad doctors. We are bad dieticians. We are doing an absolutely, horrible job of managing obesity. The proof, as they say, is in the pudding.

But it is so hard to speak the truth. You become as popular as a turd in a punchbowl. For example, Nina Teicholz recently wrote a brilliant and courageous article trying to bring some real change in the USDA dietary guidelines. For this she is relentlessly attacked by certain individuals like Dr. David Katz. Let’s follow the logic here. We’ve given a low-fat, calorie reduced diet advice (fact). We’ve developed a critical obesity and diabetes epidemic (fact). So, logically, changing course may be a good thing.

Of course, that’s not the way people like Dr. David Katz sees it. He argues over and over again to continue with our current advice. Why is he so stupid? The proof is in the pudding. Our current advice got us into this mess. We won’t get out of it by following the same failed advice. It matters not even a little bit, WHY you think the current advice is good. It failed. Face it. But I don’t really think he is that stupid. Rather it is a case of cognitive dissonance.

The truth is that influential people like the pompous Katz have staked their reputation on this advice, and it is better for them that millions of people be condemned to obesity, diabetes, blindness, amputation, dialysis etc rather than their reputation be smirched. He would rather lie to himself, than acknowledge the truth which is plainly before his very eyes. No, it is far easier for him to blame the millions of victims here. For example, he write “The DGAC (Dietary Guidelines Advisory Committee) is excellent”. Excellent except for the raging diabesity epidemic. He writes in another article “I have neither eggs, nor eggplants to sell you” praising the guidelines. No, only your books full of idiotic advice.

Only by acknowledging the truth, can we start the catharsis. We can start the healing, but only by facing the cold, hard, difficult truth. We are FAILING. For obesity, as for type 2 diabetes, we get an ‘F’ for ‘Fat’. Time to change our advice. The sooner, the better.

65 Responses

  1. I think you are absolutely correct. I now eat exactly opposite of what the recommendations are: I try to eat 75%+ of my daily calories in fat, and particularly animal fat; I avoid all “whole grains” or processed grains; I try not to eat any oil and instead use pork fat, beef fat, bacon fat, etc.; I eat plenty of “red meat”; I no longer eat 5-6 times per day; etc. About the only thing I follow is I eat some fish product from a few times per week to daily.

    I believe when there are huge studies like the Women’s Health Initiative that are complete failures and basically prove the low fat diet does not work, one should reconsider that diet.

  2. Dr. Katz might truly believe what he preaches because he is probably one of the minority who can tolerate carbohydrates. People like him say things like “you just need a little moderation and self control…” In our family we have a category for these people. We say they were born on third base and think they hit a triple. They are completely self-delusionl. Nothing can be done with them. We will have to move the revolution forward in spite of these people. Keep up the good work Dr. F!

    • I’ve never heard this before and LOVE it: ” We say they were born on third base and think they hit a triple. ” I will be using this phrase…

      Another thing is that some people look like they are on third base (slim, no blood sugar problems) but have an invisible metabolic disease such as heart disease.

    • Ha ha 🙂
      The one I had heard before was “He was born on the finish line and he thinks he won the race.”

    • haha.. i know many people like this… who eat stick thin even though they eat only carbs and think they are like that because of their superior eating habits!

  3. Well spoken. Often indeed you hear that the issue is not the dietary advice but the lack of adherence to it that causes obesity etc. Clearly proven wrong hereby.

  4. Dr.Garry Lee

    Totally right Jason. I’m 40lb down without hunger on lchf for 17m. It’s changed my shape and I think my health. I could only lose weight before by terrible hunger. Bad genes. All my father’s family were fat. Grandmother and uncle died of DM2. I’m sure I was heading that way. Katz is an pernicious pompous poorly-read puerile prolix self-exalted nobody, and they are just his good points. Nina wounds him because he has no answer for her other than to abuse her. He is a bully as well.

  5. Thank you Dr Fung.

  6. Don Ewart

    Try to find full fat yogurt in the supermarket. Those markets are not trying to improve our health, they are just stocking what sells. That’s all the proof I need that their customers are simply blindly following the failed government guidelines. And it’s causing health care costs to go through the ceiling.

    • Grocery stores will change their products if customers ask. Go to the service desk and request full-fat no sugar added yogurt.

  7. Greetings Dr. Fung: many thanks for another factual and helpful post. On the negative side it truly seems that many have too much (including big money) riding on failed guidelines. That said, one good thing about the Internet is that the truth can get out there if we seek it. If the student is ready the teacher will appear! Again, thanks for your honest dedication to the real values of your profession. Hippocrates would be proud!

  8. NHANES data is notoriously unreliable. Self-reports, based on memory. Bad bad bad. Plus, knowing that obese people underreport their intake more than lean people, and that obesity rates have been increasing over time, we can even assume that NHANES data has gotten worse during the past few decades.

    The food availability data form the Economic Research Service is probably not perfect, but it is a whole lot more credible (as they don’t rely on self-reports). Here is what they say:

    “In 1970, Americans consumed an estimated 2,039 calories per person per day; whereas in 2010, they consumed an estimated 2,544 calories (after adjusting for plate waste, spoilage, and other food losses).”

    http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/summary-findings.aspx

    Americans have not been eating less. Not even close. The increase in average caloric intake more than explains the increase in obesity. (In fact, I wonder why it hasn’t been worse. My guess is that there are quite a few obesity-resistant folks who are just burning a whole lot of extra energy instead of storing it.)

    I, for one, think it matters to know whether the advice is *wrong* or *unsustainable*. First, knowledge is good. Science and all that stuff. Then, if the advice is right and calorie restriction works, then we can focus on finding ways to make it more tolerable (for instance, some people are simply less hungry when the go low-carb, which makes calorie restriction more feasible [but that doesn’t work for everyone, so we need more approaches to make calorie restriction sustainable]).

    • Your comment shows how complex metabolism research is. I also think that you wish the same thing that Dr. Fung wishes: to be a true scientist and ask more questions.

      Dr. Fung concentrated his post on the Eat Less, Move More advice and did not fully explain the other currently popular advice that eating a low fat diet is better than a low carb diet. As every physiology book explains, carbs drive the production of insulin and insulin increases fat storage. Part of the reason insulin increases fat storage is because it greatly reduces the ability of a body to access its fat stores. In other words, one’s fatty acids cannot get out of the fat cells with too much insulin hanging around. Now, depending on your genes and age, one’s insulin resistance will go up over time causing even more insulin to be in the body after eating a carb. The increased insulin will reduce access to one’s fat stores. This can/will cause the body to be temporarily starved for energy as the carbs run low and one is being good and moving more. But the body can magically turn muscle into blood sugar and thus curtail the starvation. So, the dual advice to eat low fat and to eat less while moving more can make you ‘fatter’ even though one does not show any weight gain on the scale. This can turn into a vicious cycle until some equilibrium is reached.

      So, the metabolic impact of a low carb diet has not been researched as much or as long as it should have been to date. The reason for that lack of research is the pompous leaders of the DGAC, NIH, AHA, ADA, university research centers, etc and their cognitive dissonance. They should be doing the research for two reasons. First, as Dr. Fung has explained here their current advice is not working for whatever reason. Second, they should be scientist, who by definition must asks questions, and thus start looking for the answer to your question. Is the current advice wrong and/or unsustainable?

      Finally, I think that the current nutritional advice givers should, at least, immediately drop or erase their current advice or, at best, allow for the possibility that a low carb diet is healthy. I’ve been successfully controlling my diabetes and my overall health with a low carb diet for 11 years. I’m not alone. There are thousands and thousands of people like me. We may not represent randomized, controlled trials, but we are real facts and could be called soft research. By ignoring our soft research, the current nutritional leaders can be said to be pompous, stupid, lost in cognitive dissonance, etc. But I would go further and say that they are criminally damaging my health for fame (reputation) and fortune.

      • Claire Lee

        The insulin-fat-loss link still isn’t that clear just yet, as more studies will be needed.

        A recent study by Dr. Kevin Hall found that while his low-carb subjects had a 22% reduction in overall insulin secretion compared to his low-fat subjects didn’t, his low-fat subjects actually lost more fat.

        Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity. Cell Metabolism, 2015; DOI: 10.1016/j.cmet.2015.07.021

        • Claire: That study started with an adaptation to a base diet high in carbs. Then made the subjects to perform exercise at will on either diet. I think the results where favorable to a high carb diet because as high carb adapted you will not feel like exercising when subjected, without adaptation, to a lower carb intake. And even because they where measuring “balance” (of fat ) not where low insulin promoted more fat burning or not.

    • Great points Valerie. I first want to say that I respect Dr. Fung’s work tremendously..truly a brilliant man. There are a few points that I think would have made this argument stronger. First, I was thinking the same think about NHANES Valerie. This is certainly not the data that I would use to support nutritional reporting. In fact, I wouldn’t use self reporting for any reliable data, especially when we know both dietitians under-report their calories by a few hundred and the average consumer under-reports on average 400 calories when measured via doubly labeled water (http://www.ncbi.nlm.nih.gov/pubmed/12396160). Second, I think support needs to be supplied about patient adherence to decades old lifestyle prescription. Are people moving more? I’m seeing that people are very sedentary, even during leisure time (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177254/)–self reported (I know I know, but exercise isn’t nearly as complicated as calorie counting). Third, are people really doing more for heart health? Well, let’s just say for a moment we do use NHANES (http://www.ers.usda.gov/media/977765/summaryeib105.pdf). What you’ll find is that people are eating less fat since 1970 (<10g), but you'll find that people are eating away from home more and the quality of fat within their diet is less healthy. This is all assuming the recommendation for the last 30 years for heart health has been a low fat diet–which it has been. Fourth, are people quitting smoking because their doctors said so? Cessation rates are really pretty low and especially for older adults which is probably whom we are talking about relate to these population statistics (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376894/). Young smokers are having more success quitting, but probably not because of medical prescription but because of changing social norms and alternative options. So, I'm not so sure people are sticking to lifestyle prescriptions. Heck, even when the prescription is easy (pharmaceuticals), the adherence rate can be problematic (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/). This isn't so much about blame the victim as a cultural shift in our physical and dietary habits. We commute more, sit more at work, eat out more, and expend less calories. With all this being said, there are more variables than just calories in and calories out which I fully acknowledge. But for healthy individuals, study after study which directly measure caloric intake whether it be doubly labeled water or metablic ward, show that caloric restriction generally works. I think an entire piece could written on lifestyle prescription adherence.

    • Claire Lee

      One other factor I wonder is if our current generation of gut microbes affects how we process calories.

      For example, a study by Jan-Hendrik Hehemann and Mirjam Czjzek found that native Japanese people had a gut microbe that allows them to process and digest seaweed, while non-native-Japanese could not.

      Who knows what modern farming and food practices have done to us?

      Transfer of carbohydrate-active enzymes from marine bacteria to Japanese gut microbiota. Nature 464, 908-912 (8 April 2010) | doi:10.1038/nature08937; Received 9 November 2009; Accepted 19 February 2010

      • You should check the whole study.
        It lasted for just SIX DAYS, which is not even remotely enough to start fueling exclusively on fat.
        Furthermore, the subjects were not following a LCHF diet strictly speaking, I believe around 30% (!!!) came from carbohydrates.
        This study is a boon for the old way of thinking about dietary advice, and it totally ignores that one of the biggest merits of LCHF is the ability to comply without feeling hunger.

        • Claire Lee

          The psychological aspect of different diets is definitely one area of importance in fat loss.

          However, the scientific and biological aspects need to be examined as well.

          You might have issues with the study, and say that more are needed. But this is a very rigorous study. Until there are more studies, this is the information we have.

          In addition, the fact that there was a major reduction in insulin secretion and yet it did not result in greater fat loss is also an area of interest.

          • There are more rigorous studies. This is just what you like and therefore stick to.

  9. Bravo! This is a brilliant piece of work!

  10. Dr. Fung, I read recently a clip from Dr. Mike Gregor that increased fat intake increases insulin levels, especially hepatic insulin. what is your view? How does a person already being “fat” burn his stored fat while at the same time consuming a diet high in fat ?

    • Bhanu: it has worked for me; 6 years ago I was at 199 lb. Switched to strict LCHF diet; burned 50# of body fat, lowered blood sugar and blood pressure, now I weigh 25% less (or perhaps even less…I don’t weigh anymore but my size 6 jeans get looser and looser). I’m never hungry, practice intermittent fasting (one meal per day), and am healthier than I’ve ever been (i.e. I feel great at 71!). Can’t argue with success. All my blood tests are perfectly normal now.

  11. Dr. Fung, I recently read a clip from Dr. Mike Gregor who states that a diet high in fats raises insulin levels, especially hepatic insulin. What’s your view? Also, how does an overweight person burn his/her own stored fat, while at the same time consuming a diet high in fat?

  12. Bhanumathy K Scioscia

    Dr. Fung, I recently read a clip by Dr. Mike Gregor saying that a diet high in fats leads to increased insulin levels, especially hepatic insulin. What’s your view on this? Also, when a person is overweight, how does he/she use the already stored fat as fuel, while at the same time consuming a diet high in fats?

  13. Devialini De Souza

    They say that repeating the same thing and expecting a different result is the definition of insanity. So, we can safely conclude that our authorities are insane!!

    I have now been on LCHF for about a month and have lost a total of 14 kg. 5 kg of these were lost on a calorie restricted diet with lots of exercise – about 2 hours a day and it took me 2 months to lose that weight. During that time, I also got really ill with a nasty bacterial infection so 2 kg of the 5 kg was lost that way.

    Comparing the 2 results, that is:

    5 kg took 2 months on the eat less, move more approach type of the diet
    9 kg on the low carb, high fat diet with moderate exercise – about an hour 3-5 times a week took 4 weeks (1 month)

    I’d say the LCHF diet is the definite winner for me.

    I feel great. Have no hunger. In fact some days, I need to eat only once a day as I am simply not hungry. I also fast twice a week as recommended by Dr. Fung. I recently went for a consultation with my physician and he has now reduced my medication by half!!! This is definitely the greatest news for me as I am a diabetic and my medication had been steadily increasing. At some point, the doctor recommended that I go on insulin as well. I refused as I know insulin makes you put on weight. I was already having issues with my weight and I did not want to put on more weight. Then I came across your videos and blog and the rest, as they say, is history

    I have read all of your articles and like you say “the proof is in the pudding” and I am living proof.

    Thank you Dr. Fung for saving my life.

    • Yes, you are the proof, but you are no longer the pudding. You show that the proof is in the man.

  14. Wenchypoo

    Fact #2 – Obesity is just friggin’ exploding all over the damn place.

    Fact #3–Now we’re exporting it–with each new market Big Food enters worldwide, obesity soon follows.

  15. Wenchypoo

    Katz, the Fuhrman bros., Alice Lichtenstein, most doctors, and every single “health lobby” (ADA, AMA, AHA, etc.) have their money parked in the Old Science, so that’s what they’re going to shout from the rooftops–they’re trying to protect their investments. They want to stay with the investment strategy “what brung ’em” into media fame and fortune

  16. THANK YOU, THANK YOU, THANK YOU!!!

  17. For Dr. Fung, one important, obvious suggestion: Everyone believes that if one burns more calories than one consumes that weight will be lost. So instead of arguing that this is false, simply point out that there is one more step in the process to losing weight and keeping it off, that of going into the metabolic fat-burning mode and staying one it–a very low carbs diet with fasting.
    The eat less exercise advice is not wrong, just incomplete. The common advice of “eat less and exercise more”; this should also include “stay in the fat-burning mode with a very low carb diet”, and “this will work quicker with the addition of fasting”. This addition piece leads into the explanation of the role of insulin resistance and how this diet cures it. Insulin resistance is caused by the Western diet which is low in fats and thus high in carbs including the sugar fructose which starts the path to insulin resistance.
    On my health website (http://healthfully.org/rh/id8.html) I have a recommendation very similar to yours, only I suggest a short-term fast as many days and hours as the dieter feels comfortable with (for higher compliance). In your video Richard’s Story, his did this and lost 40 lbs. Your comment on the short-term fast would be appreciated. Dr. Michael Mosley of the BBC also recommends a short-term fast.
    One last bit of interest, the US Dietary Guidelines issued in 2015 continue with “more turds in the punch bowl (from your blog’s title) and this has resulted in an article in the BMJ (British Medical Journal Sept 23, 2015) on the stench coming from those guidelines. This leads to one more comment, follow the bucks. Bad advice is a result of corporate political influence. To blame a person (David Katz) instead of the corporation behind the curtain is a partial truth. You have an article up on food industry funding dietary conferences. A current article in In These Times lists the donations made by Coca Cola.

    Dr. Jason Fung: Both short term fasts and longer ones have their place. We use both extensively.

    • It doesn’t matter if the eat less and burn calories advice is true or not. Why? Because you have no clue about what happens with the calories put into your mouth and stored around your body. Consumed and expended calories are not independent variables and there are many more important factors along the way, such as food interaction with the gut flora, absorption (in)completeness, thermal effect, hormonal influence, etc. By simply estimating calories of food intake and expenditure the inaccuracy is already too high to rely on the method. How do you know the rate your REE drops at a certain calorie reduction? No way.
      So while the energy balance theory might work in principal, it is completely useless in practice. Therefore we should simply forget about it.
      Fasting is suitable not only for fixing metabolic problems, but also for preventing them if started at a healthy stage. For most people this seems to be the only way of eating carbs and natural (animal) fats together on the long term. When a certain metabolic derailment is reached however, a more drastic dietary intervention is needed on top of intermittent fasting.

  18. for the articles with 4 imbedded links go to http://healthfully.org/radf/id7.html at the bottom of thepage

  19. Margaret Cihocki

    I would argue that the opposite of “count your calories” is “Don’t count your calories” not “calories don’t count.” Because calories do count, we just don’t need to count them, no? Just saying… Otherwise awesome post, as usual.

    • Hi Margaret. I think you might like to read 2 things: Bill Lagakos’ book Calories Proper & any basic medical biochemistry textbook focusing on metabolism that you can find in your local science library. The body is not a bomb calorimeter. It doesn’t count calories, nor can it. It knows absolutely nothing about calories, just as my dog is ignorant of quasars, or my bicycle of comic books. 😀 The body has no “calorie receptor” nor does it have any mechanism for tracking them. How the body actually tallies energy is far more complicated & much more interesting. I’m sure you’ll be interested in learning about it.

  20. The tragedy is that “eat less – move more” CAN work, for a while, for some people. I lost weight that way – several times! It slowed the “inevitable progression” of my diabetes but glucose levels fluctuated wildly after meals. However I could never sustain the reduced calorie intake and the lost weight always went back on.

    Two years ago I began yet another strictly reduced calorie diet. It was a lot of work, weighing everything I ate and calculating calories, carbohydrate, fat, salt and protein, but I averaged 1,500 calories a day for several months. I lost 45 pounds in six months and was discharged from the diabetes clinic because my blood glucose levels had become non-diabetic.

    My diet wavered a few months later, when I listened to my doctors’ pleas not to lose any more weight and I let my calorie intake increase over 2,000 a day, (Well I was HUNGRY all the time!). My weight increased and the glucose levels became less stable so I reduced the calories again. It was harder to keep up the constant weighing and calculating whilst suffering hunger pangs and cravings, but it brought my weight and glucose back under control so what else could I do?

    A year ago I decided to risk a lower (NOT ZERO) carbohydrate diet. I was still consuming quite a lot of carbohydrate compared to a LCHF diet but it was much less than I had been used to. It seemed to work, but I was still weighing and calculating.

    Then I found Dr Fung’s and Megan Christie’s web postings and they all made sense in the light of my own experience. I soon had the confidence to stop weighing food and I began intermittent fasting. This is much easier to sustain than the calorie-restriction approach (although my calorie intake is probably lower now – I just don’t need to calculate it) and I feel much stronger and healthier.

  21. Haha “turds in the punchbowl”. Dr Fung I love your style of writing. I know there was a comment from a medic in your previous post about language and professionalism which I disagree with. No-one can argue your youtube presentations are extremely informative and professional, however your humourous writing style here will appeal to all the people who are frustrated, annoyed and fed up with current dietary advice. You only have to see the overwhelming response by the people to the ADA facebook diet post to see that it will only be people power that will thrust the dinosaur establishment from it’s perch. My poor late mother followed their guidelines, I wish she had known what you are now sharing because I would probably still have her today and she may have been spared an agonizing miserable last few years of life. You are the new fresh generation of modern brave doctors. Thank you for your tenacity and courage to change many lives for the better.

  22. “Are Americans eating more calories? Not really. The correlation between obesity and the increase in calorie consumption has recently broken down. Data from the National Health and Nutrition Examination Survey (NHANES) in the United States from 1990 to 2010, finds no association between increased calorie consumption and weight gain.”

    And of course the CICO-path counter-argument to this is that “we’re a lot more sedentary now than we were back in the 1990’s. ‘Calories out’ has been significantly reduced”

    Well, that’s BS. I was alive in the 90’s. People weren’t exactly athletes back then. In fact, we were very sedentary, for the most part. I’ll concede that we *are* more sedentary than we were back in the 1990’s, mostly due to the internet, but this slight downtick in physcial activity cannot explain the massive obesity epidemic. CICO also can’t explain why some of the leanest people I know are both lazy couch potatoes AND food junkies. They have appetites of potheads They will eat anything you place in front of them yet they’re lean and healthy. They don’t count calories. They don’t even know what calories are, yet their weight is perfectly regulated. On paper, they should be morbidly obese. Reality tells a different story.

    The CICO model of fat loss/fat gain is a joke.

  23. Wenchypoo

    The graph mid-article (dietary guideline adherence 1997-2005) can be interpreted another way: by turning it upside-down. Then the view is a little different: it now shows the foods most heavily subsidized vs. the foods that don’t get much subsidies (and we bare the costs of). It’s NO WONDER the consumption of fruits & veggies get shouted from every rooftop–by doing so, it gets Uncle Sam off the hook for paying the farmers!

  24. […] Dr. Jason Fung: The Proof is in the Pudding […]

  25. Dr Fung wants to claim that somehow people were following a calorie restricted diet while total calories have gone up every year. That’s an amazingly unbiased thought process right there =D Of course he is surprised that people are getting fatter year by year while eating some 1000 calories extra per day.

    This year’s winner in world championship in Misleading Graphs. You forgot to put cheese in there and the ever growing meat consumption (until like 2-3 years ago), well that’s an honest mistake I guess. Very few people follow the dietary guide lines. But hey, maybe you count sodas, pizzas and burgers as according to guide lines.

    • Not following you here… I see both meat (-17%) and cheese would be in “animal fats” (-16%), or in “whole milk” maybe (-73%).

      Furthermore as the article mentions calory intake was stable, while obesity increased, what is your basis for claiming the opposite?

      • Nah, cheese consumption has gone way up. http://www.pcrm.org/sites/default/files/images/media/blog/cheese_consumption.jpg
        Meat has been going up until 2007. http://3.bp.blogspot.com/-h0WeNy_hkH4/U52XWGKsoYI/AAAAAAAACqg/ijnZczl4Xxc/s1600/meat.png
        Calories up between 1971-2006: http://ajcn.nutrition.org/content/93/4/836.long

        Yes, calories and meat consumption has been trending downwards in the last coupe of years. But with such a huge over consumption (http://www.nationalgeographic.com/what-the-world-eats/) what is it that is surprising that people continue to increase in weight? Sure, each level of over consumption has a level of weight equilibrium somewhere, but what is that says we have reached it already?

        Animal fats would be lard and things like that.

        I don’t doubt fasting can play a role in improving health, how ever trying to pin the obesity epidemic is just absurd. There is no guide lines telling people to drink sodas and eating pizzas and supersized burgers.

        • What caused and causes the huge over consumption is carbs. For most people, carbs send blood sugar and insulin through the roof which then cause hunger…and the eating of more carbs. When I was on low fat and eating oats for breakfast, pasta for lunch, and brown rice and beans for dinner, I was immediately hungry after eating and hungry literally all the time. That’s what a high carb diet does to you.

          You can prove this to yourself. Get some lard (not hydrogenated), butter, coconut oil, and tallow (not hydrogenated). Eat as much of this as you possibly can for the next week. Count all your calories. Take your weight during this process.

          The next week, eat something high carb, like pasta, pretzels, etc. Eat as much of this as you want (not CAN, but WANT). Count your calories. Take your weight during this process.

          I guarantee you that you will eat many more calories of carbs than of fat.

          To blame the obesity epidemic on fat intake (or meat intake or vegetable intake) simply ignores reality.

          • I don’t doubt the claim from low carbers that they feel more satiety on fat. That’s not exactly in opposition to the calorie theory tho, right?

            I feel full and happy whether I eat carbs or fat, so I guess there’s a genetic component in our satiety response. But then again, I don’t eat pretzels and pasta. Refined carbs are less satiating than whole foods. No responsible dietitian is recommending refined carbs.

            I don’t blame obesity specifically on fat intake or meat intake. However I do blame it on higher total calories and junk food as refined carbs, added sugar, added fat (deep fried empty calories and what not), lack of fibers.

    • I love these guys and their obsession with calories. Most have no idea what a calorie even is or how it’s measured. They just love to spout the prevailing dogma thinking it makes them sound smart. ‘Dr. Fung, I’ll come to your site and spam your comments, and show you, and anyone else that will listen, just how much smarter than you I am’. I made the mistake of listening to these types for far too long and all I got for it in the end was a fatty liver and a 40 inch waist, while constantly starving myself and destroying my joints in a futile attempt to ‘burn’ calories. What a waste!!!

      Once I started listening to Dr. Fung my life changed in such a profound way I can’t even begin to quantify it. I’m down 40 lbs in three months, and I now have a 30 inch waist. My blood pressure went from high 150s/90s to consistent low 100s/60s. And my fasting blood glucose went from a consistent 115 prediabetic to low 70s. Yesterday I had half a pound of bacon and 8 eggs scrabbled in a whole stick of butter. 2 large avocados. A 12 piece sashimi tray. Nuts by the handful. A 1lbs ribye steak pan seared in olive oil and finished with butter. And to cap things off an entire pint of chocolate Häagen-Dazs ice cream. Oh my God!!! The calories!!!! How am I still alive?!?

      Dr. Fung, thank you. Don’t pay any attention to the haters. Keep up the good work.

      Dr. Jason Fung: Thanks Tony. I don’t really mind these calorie guys. I mostly just pity them. They can’t get their minds around anything other than Calories In, Calories Out and wonder why they can’t lose weight. As if the entire obesity and diabetes epidemic is simply a matter of people not ‘wanting’ to get rid of it badly enough. Just Eat Less and Move More. Sigh.

      • Claire Lee

        Hi Dr. Fung,

        I don’t think that’s fair. While I agree there might definitely be trolls, I think most of us are just looking for the truth.

        The problem is there are conflicting studies out there. Sure, some might be biased due to who is funding them, but there are others that are quite legitimate and it would be great if we could discuss them to find out the real answer.

        For example, the recent study by Grant M Tinsley et al, “Intermittent fasting combined with resistance training: effects on body composition, muscular performance, and dietary intake” concludes that,

        “In the absence of any other dietary guidance, restricting caloric consumption to a 4-hour window on 4 days per week was not sufficient to elicit body composition improvements in 8 weeks, although lean mass was maintained in both groups. This form of IF was sufficient to reduce caloric intake on fasting days, but this did not translate to body fat reductions in many subjects. Untrained young men experience similar strength adaptations whether they eat normally or perform this form of IF. Protein intake may be of particular concern for individuals implementing IF and young men beginning a resistance training program.”

        It just makes things more confusing. I’ll also add that I finally lost weight and kept it off by becoming a vegetarian. I didn’t count calories, but I also didn’t limit my carb intake.

        • I think the main problem lies in Calorie Trolls looking for ‘truth’ in all the wrong places. It’s inappropriate to preach Christianity in a synagogue, Islam in a Christian church, Satanism in a Hindu temple. However, certain individuals with transparent agendas, post in these comments gleefully, or so it seems, trying to pick apart anything Dr. Fung says, some thinking they make a point by filling their comments with links to ridiculous half-baked articles that contradict clear observable reality.
          The internet is replete with forums where one can freely engage in intellectual discourse. Why come here? No amount of links to questionable articles will change the fact that Dr. Fung has profoundly changed, mine, my family’s, and my friends lives forever. His approach works. Fantastically well. In the real world, that’s all that matters. Maybe 10 years from now we’ll find out he got some of the details wrong (I doubt it). But does it really matter? Does it change my fixed fatty liver, my improved lipid profile, my normal blood pressure, my perfect fasting blood glucose, my low Homocysteine levels?
          Those that claim “but I lost weight eating nothing but rabbit food, see Fung you’re wrong” just manage to betray their ignorance. Dr. Fung has never claimed that other diets don’t work. They obviously all do. It’s their long-term efficacy that comes into question. At the very least, when trying to ‘disprove’ what Dr. Fung has to say, I suggest the Calorie Trolls have the decency of reading all of his work, not just try to pick apart one post out of context and in isolation. He has spent at least two years, as far as I can tell, very methodically explaining his position in this blog.
          I’m here for the real world knowledge and practical advice Dr. Fung offers free of charge. Period. Those of you who don’t agree with his views, instead of constantly trying to beat the guy up, go ‘prove’ your points somewhere else. Please.
          I was going to keep going, but I think I’ve made my point, and besides, my bucket of deep fried chicken wings with extra blue cheese is getting cold. (Oh My God!!! Not those crazy calories again!!!)

          • Claire Lee

            If this was just about the psychological effectiveness of different diets then I would totally agree that it’s inappropriate to come to a forum for one diet and argue about another diet.

            But if we’re discussing the science of diets, the real biological and chemical facts, then those interested in real science would embrace more information.

            In fact, contradicting scientific results should be exciting for everyone because while it means there is still a lot to learn, it also means we’re getting closer to finding the truth by eliminating suppositions with facts.

            That’s the beauty of science.

  26. charles grashow

    http://wholehealthsource.blogspot.com/2014/04/calorie-intake-and-us-obesity-epidemic.html
    After appropriate adjustments*, ERS data show that on average, US adults consumed 363 more calories per day in 2009 than we did in 1960.
    * Gross values reduced by 28.8% to account for waste between production and consumption (adjustment determined by the ERS). Also adjusted for an artifact in 2000 that results from a change in the liquid oils assessment method and artificially inflates fat intake.

    http://health.heraldtribune.com/2014/07/15/americans-calorie-intake-increased-years/
    Americans on average eat nearly 2,600 calories a day, almost 500 more than they did 30 years ago, according to the U.S. Department of Agriculture.

    But what’s most troubling isn’t the increase in our caloric intake, so much as its make-up. More than 92 percent of the uptick in caloric intake since 1970 is attributable to oils, fats, and grains. Thirty years ago, the combination was responsible for roughly 37 percent of our daily calories; today, it makes up closer to 47 percent.

    Between 1977 and 1978, fast food accounted for just more than 3 percent of calories in the U.S. diet; between 2005 and 2008, that share skyrocketed to over 13 percent.

    http://www.usda.gov/factbook/chapter2.pdf

    • If CICO were the whole story and the average American consumes 500 more calories a day than they used to, the average American would be 200 pounds heavier within about 4 years, unless they’re exercising off 500 more calories than they were 30 years ago. I don’t believe that is happening.

      A report that lumps the increase in oil, fats and grains all into one category is useless for learning if changes relating to HFLC or LCHF had any effect.

  27. Speaking of calorie guys Calorie Counting Charles has landed aboard the Fung lifeboat.

    • For anyone who may not know Mr Grashaw is a CICO low fat high carb promoter. He will duly insist he is not but this seems to be at odds with his constant criticism of LCHF on many blogs. His cruel constant mocking and obsession with Jimmy Moore borders on creepy. That “stupid schmuck” that you call him Mr Grashaw has helped me more than your cut and pastes ever will, and yes I will follow the “sycophants” doing Jimmy’s 30 day fast in January with as much interest as you although in a good way, I ask kindly please that you keep your poison away from Dr Fung who is only doing good things for people.

  28. I am over 74 years – and have eaten artegen LCHF costly since more than five years – with the result that I do not have pain somewhere and eat no medication.

  29. Jason Fung,
    I can feel your frustration. You try so hard to prove your stance and it does not always work. But, you do catch many to your way of thinking, and those people do reap the benefits of your understanding.
    Me included. I am off insulin and blood pressure pills, have tons of energy and no brain fog. You have changed my life and have given me a full measure of hope.
    Do NOT be discouraged. Keep up the good fight without frustration.

  30. Dr Fung, you seem to be getting more passionate with each blog post, about the nutritional lies being foisted on us by those who should and (in many case do) know better. I commend you for not pulling your punches. Millions of people are getting more and more unhealthy, many of them in desperation and through tears trying one thing after another after another to lose weight, and meeting nothing but failure.

    On these people , there descends a group of outright charlatans, masters at preying on their desperation with carefully crafted e-mails and other advertisements, weaving a convincing case that theirs is the one product that is finally going to work for them. I get very angry when I see those e-mails and ads.

    But the group you’re addressing, I think, is more subtle—although just as harmful. It’s entirely unacceptable—when there is a body of literature and scientific studies, dating back centuries in some cases, which demonstrates the falsity of the mainstream pronouncements of the so-called nutrition experts and the condescending lectures from our government—it is unacceptable in light of such contrary evidence for these things to go unchallenged.

    I do think there is a significant movement in the right direction, thanks to the work of people like you, Gary Taubes, and many more. People like me who finally understand the truth about the cause and cure of unwanted weight gain are greatly in your debt.

    You made a statement, I believe, in an earlier blog post that you had given treatments to your patients in the past that you now understand were based on faulty science. Since you have been there, you likely have great insight into how the mainstream professional deniers can be reached. Perhaps this would be a good subject for a future blog post. What is the best way to approach a medical professional who is captive to the mainstream lies?

    I have friends and family who are doctors or other medical professionals, and they can be the hardest people to get through to on this subject. While there are undoubtedly unscrupulous people who see the truth and pretend not to, I suspect that the doctors in “the trenches” are for the most part not deliberately dishonest. So why do they not see the truth you and others so clearly explain.

    That’s not a rhetorical question. Something is constraining them from embarking on a journey such as yours. I, for one, don’t fully understand the nature of the pressures and constraints that such a person would need to overcome in order to swim against the current in the river of nutritional lies and myths in which they operate. Perhaps you can serve a role also of promoting the education of the educators.

    Dr. Jason Fung: I also know many doctors and suspect that the main problem is a general lack of interest in nutrition. It is not taught in medical school, it will not help them advance in academic medicine, it won’t make them any money and so there is a sense of ‘not my problem’. So most doctors will not make the effort it takes to look critically at the issues.

    • Mark, consider peer pressure and the power of AMA disapproval.

      Doctors who’ve tried to move in different directions in the past have been thoroughly ravaged in the same way that most powerful opponents of change do these things and I believe it’s still happening.

  31. Thanks for a really great, common sense article, Dr. Fung.

  32. […] Intensive Dietary Management – The Proof is in the Pudding – More Turds in the PunchBowl […]

  33. Heather Twist

    I’d like to comment on just one part of the consumption graph. Eggs! The government scared us off eggs, and we eat far fewer of them these days. But more, there are fewer eggs in foods … cookies for instance, used to contain eggs usually. So did ice cream, mayo, pudding, sauces. Breakfast usually included an egg or two also.
    So why is that an issue? Because when eggs are added to a person’s diet … the person loses weight! Eggs are an incredible appetite suppressant, and for some reason tend to cause weight loss for other reasons too. The thinnest people I know are the egg-lovers.

  34. You are going to save my life, Dr Fung! Thank you!

  35. Many years ago the “Calories in, Calories out” theory did not make any sense to me because I figured that people would just keep on growing larger and larger and larger, since they were supposedly eating too many calories all of the time. But they didn’t. They just got really large, and then they sort of stopped getting large.

  36. Arthur C Clarke said “Science progresses one funeral at a time.” Given the amount of blood on the hands of these cowards, I think that this is what is going to happen.

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