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Sugar's role in diabetes seems likely to be true, but to say that CICO is false and a mutually exclusive explanation compared to the way in which insulin affect

by sn9 9y ago

Sugar's role in diabetes seems likely to be true, but to say that CICO is false and a mutually exclusive explanation compared to the way in which insulin affects one's metabolism is empirically false [0]. Taubes would be hard pressed to explain how you could lose weight on a diet of Twinkies or how those subsisting on high carb, low fat, low protein diets that fail to meet their caloric needs in famine-afflicted regions remain thin. The way insulin works and the way the body requires a caloric surplus to gain weight are not remotely mutually exclusive ideas and to suggest otherwise requires cherry-picking the literature in a way that's scientifically irresponsible. [0] https://examine.com/nutrition/what-should-i-eat-for-weight-loss/ https://examine.com/nutrition/what-should-i-eat-for-weight-l...

jmull 9y ago
The issue with CICO isn’t that it’s wrong. It’s that it isn’t helping us solve the epidemic of metabolic disorders. While true (it’s simply a restatement of a law of thermodynamics after all) It’s an unhelpful, apparently mostly irrelevant model.
- sn9 9y ago
  How is it unhelpful? For the obese, it presents the simplest and most actionable advice that has the highest relevance to their most pressing health problem.
  - grzm 9y ago
    The CICO message has been part of diet advice for decades. If hearing this message in and of itself were helpful, one would expect that we wouldn't be observing the current levels of obesity in the US. The biology and human behavior are more complex than that.
    - sn9 9y ago
      There are simpler explanations. People have no idea how much they consume and frequently underestimate how much they eat. Inaccurate measurement and non-existent tracking systems sabbotage people's attempts at modifying their weight. This is frequently solved by getting people to buy a food scale and weigh everything they eat for a few weeks and calculating the actual caloric content of their food. Food scales are frequently all people need to make real and persistent changes to their weight. The biology isn't complex enough that ignoring CICO or telling people that it's wrong is useful or helpful and not harmful.
      - grzm 9y ago
        > People have no idea how much they consume and frequently underestimate how much they eat. Inaccurate measurement and non-existent tracking systems sabbotage people's attempts at modifying their weight. I agree, and believe this is part of it. People aren't paying attention to what they eat. This is specifically why understanding human behavior is important and that only repeating CICO is not useful. If people are interested in understanding how metabolism regulation works and finds that it's useful in modifying their diet to help them be healthier, that should be encouraged, shouldn't it? If understanding how different foods affect hunger, insulin levels, diabetes, muscle gain, fat loss, I think that should be a good thing. If someone focuses purely on calories, they can easily deprive themselves of nutrients and hungry, making it hard to keep themselves on the diet and failing to get or keep themselves healthy.
        sn9 9y ago
        You can't claim that understanding how metabolism works is useful and suggest that understanding how CICO works isn't useful in the same breadth. Understanding CICO is sufficient to derive all useful, actionable advice for healthy weight management (e.g., maybe you're measuring wrong, stop eating calorically dense foods, eat foods that are more satiating, etc.). Understanding the difference in how fructose is metabolised compared to glucose is majoring in the minors and is far less likely to help someone achieve their goals. CICO is the most important factor and the simplest to understand. Suggesting people teach themselves biochemistry and physiology without understanding the basics is silly and far less realistic. Ignoring CICO is setting people up for failure which will discourage compliance and further improvements.
        grzm 9y ago
        > You can't claim that understanding how metabolism works is useful and suggest that understanding how CICO works isn't useful in the same breadth. I believe you're misreading what I'm saying: I'm saying that only repeating CICO is not helpful. That itself does not give people the tools they need to be able to maintain health. You yourself point this out in saying it's "sufficient to derive all useful, actionable advice for healthy weight management": Not everyone is able to derive things from first principles. Perhaps we're talking past each other. I'm more satisfied understanding human behavior and metabolism regulation than only repeating CICO and expecting people to derive everything else from there.
  - jmull 9y ago
    > How is it unhelpful? Because it’s been tried and hasn’t helped. CICO-based treatment has been popular for decades yet the problem has continued to get worse (much worse). I know it works for some but it has not worked for many more. We can stick our heads in the sand about this or admit that we need to be looking for a better answer.
    - sn9 9y ago
      When it doesn't work for someone, that means they were doing it wrong rather than that they were defying the laws of thermodynamics. The useful thing to do at that point is to diagnose what they were doing wrong and how to correct for that instead of claiming they were defying the laws of physics.
      - grzm 9y ago
        Just an aside that struck me. The phrase "laws of thermodynamics" when applied to diet has always felt a bit off and I think I put my finger on why. The laws of thermodynamics is used in physics while diet is in the realm of biology or biochemistry. While of course chemistry and biology aren't in opposition to the physics, there's a reason it's useful to treat them separately. Anyway, none of this is meant as criticism or argument. Perhaps not much more than a personal insight into phrasing.
jm2721 9y ago
CICO is not 'false', per se, but it's fundamentally misleading and tautological. Yes, people will lose weight on a calorie restricted diet of just twinkies. However, their bodies metabolic rate will decrease gradually to the point where continuing to maintain a caloric deficit will be unsustainable (i.e. a 500 calorie deficit if your basal metabolic rate is only 750 or 1000), at which point they'll stop losing weight, but still be 'skinny fat'. They'll also cause potentially irreparable harm to their liver and pancreas, and if they do manage to sustain it for longer periods, be on the express track for diabetes and heart disease. The difference between eating equivalent calories of twinkies or a salad is that one is a toxic substance and the other isn't. In the same vein, as another poster mentioned above, you can say that a milligram is a milligram, but a milligram of cyanide will kill you while a milligram of water is harmless. That's why more and more people are challenging CICO; it gives you the false sense that replacing meat and vegetables with coke and doritos is harmless as long as they're equivalent calories. Nobody is suggesting that CICO and the insulin theory are mutually exclusive; what the author is saying is that CICO is a profoundly unhelpful statement for people looking to lose weight, improve their health, or reverse diabetes/heart disease. > Taubes would be hard pressed to explain how those subsisting on high carb, low fat, low protein diets that fail to meet their caloric needs in famine-afflicted regions remain thin. Thin doesn't mean healthy. We're talking about disease, not necessarily weight, and you can have metabolic syndrome even if you're considered 'thin'. Most people who are thin with a poor diet have visceral fat (fat around the organs) which is far worse than subcutaneous fat (as a risk factor).
- sn9 9y ago
  If your BMR is 750-1000, you're likely a female shorter than 5' and/or weighing less than 100 lbs. At that point, you are likely severely underweight and probably shouldn't be trying to lose weight. I'm not denying that there are other reasons to eat a diet with greater nutritional density, but trying to convince people that CICO is wrong is far more harmful than trying to convey that it is literally the most important factor in trying to modify your weight. If you want to make changes in your life, you need to know the right things to measure, and your caloric intake relative to how your weight changes is the single most important factor for people trying to lose weight. If you're not even doing that, it's unlikely you'll succeed, as millions of people who struggle with their weight will understand. Once you've convinced people of the value of that, it then becomes more productive to go into the value of high protein intake and strength training to further improve body composition, the importance of eating a diet centered around fruits and vegetables, etc. For people that are severely overweight, getting their weight down will have the highest impact on their health. >Nobody is suggesting that CICO and the insulin theory are mutually exclusive; Taubes literally argued this in the paragraph where he quoted the biochemistry text.

by sn9 9y ago

jmull 9y ago

The issue with CICO isn’t that it’s wrong. It’s that it isn’t helping us solve the epidemic of metabolic disorders. While true (it’s simply a restatement of a law of thermodynamics after all) It’s an unhelpful, apparently mostly irrelevant model.

sn9 9y ago
How is it unhelpful? For the obese, it presents the simplest and most actionable advice that has the highest relevance to their most pressing health problem.
- grzm 9y ago
  The CICO message has been part of diet advice for decades. If hearing this message in and of itself were helpful, one would expect that we wouldn't be observing the current levels of obesity in the US. The biology and human behavior are more complex than that.
  - sn9 9y ago
    There are simpler explanations. People have no idea how much they consume and frequently underestimate how much they eat. Inaccurate measurement and non-existent tracking systems sabbotage people's attempts at modifying their weight. This is frequently solved by getting people to buy a food scale and weigh everything they eat for a few weeks and calculating the actual caloric content of their food. Food scales are frequently all people need to make real and persistent changes to their weight. The biology isn't complex enough that ignoring CICO or telling people that it's wrong is useful or helpful and not harmful.
    - grzm 9y ago
      > People have no idea how much they consume and frequently underestimate how much they eat. Inaccurate measurement and non-existent tracking systems sabbotage people's attempts at modifying their weight. I agree, and believe this is part of it. People aren't paying attention to what they eat. This is specifically why understanding human behavior is important and that only repeating CICO is not useful. If people are interested in understanding how metabolism regulation works and finds that it's useful in modifying their diet to help them be healthier, that should be encouraged, shouldn't it? If understanding how different foods affect hunger, insulin levels, diabetes, muscle gain, fat loss, I think that should be a good thing. If someone focuses purely on calories, they can easily deprive themselves of nutrients and hungry, making it hard to keep themselves on the diet and failing to get or keep themselves healthy.
      - sn9 9y ago
        You can't claim that understanding how metabolism works is useful and suggest that understanding how CICO works isn't useful in the same breadth. Understanding CICO is sufficient to derive all useful, actionable advice for healthy weight management (e.g., maybe you're measuring wrong, stop eating calorically dense foods, eat foods that are more satiating, etc.). Understanding the difference in how fructose is metabolised compared to glucose is majoring in the minors and is far less likely to help someone achieve their goals. CICO is the most important factor and the simplest to understand. Suggesting people teach themselves biochemistry and physiology without understanding the basics is silly and far less realistic. Ignoring CICO is setting people up for failure which will discourage compliance and further improvements.
        grzm 9y ago
        > You can't claim that understanding how metabolism works is useful and suggest that understanding how CICO works isn't useful in the same breadth. I believe you're misreading what I'm saying: I'm saying that only repeating CICO is not helpful. That itself does not give people the tools they need to be able to maintain health. You yourself point this out in saying it's "sufficient to derive all useful, actionable advice for healthy weight management": Not everyone is able to derive things from first principles. Perhaps we're talking past each other. I'm more satisfied understanding human behavior and metabolism regulation than only repeating CICO and expecting people to derive everything else from there.
- jmull 9y ago
  > How is it unhelpful? Because it’s been tried and hasn’t helped. CICO-based treatment has been popular for decades yet the problem has continued to get worse (much worse). I know it works for some but it has not worked for many more. We can stick our heads in the sand about this or admit that we need to be looking for a better answer.
  - sn9 9y ago
    When it doesn't work for someone, that means they were doing it wrong rather than that they were defying the laws of thermodynamics. The useful thing to do at that point is to diagnose what they were doing wrong and how to correct for that instead of claiming they were defying the laws of physics.
    - grzm 9y ago
      Just an aside that struck me. The phrase "laws of thermodynamics" when applied to diet has always felt a bit off and I think I put my finger on why. The laws of thermodynamics is used in physics while diet is in the realm of biology or biochemistry. While of course chemistry and biology aren't in opposition to the physics, there's a reason it's useful to treat them separately. Anyway, none of this is meant as criticism or argument. Perhaps not much more than a personal insight into phrasing.

jm2721 9y ago

CICO is not 'false', per se, but it's fundamentally misleading and tautological. Yes, people will lose weight on a calorie restricted diet of just twinkies. However, their bodies metabolic rate will decrease gradually to the point where continuing to maintain a caloric deficit will be unsustainable (i.e. a 500 calorie deficit if your basal metabolic rate is only 750 or 1000), at which point they'll stop losing weight, but still be 'skinny fat'. They'll also cause potentially irreparable harm to their liver and pancreas, and if they do manage to sustain it for longer periods, be on the express track for diabetes and heart disease. The difference between eating equivalent calories of twinkies or a salad is that one is a toxic substance and the other isn't. In the same vein, as another poster mentioned above, you can say that a milligram is a milligram, but a milligram of cyanide will kill you while a milligram of water is harmless. That's why more and more people are challenging CICO; it gives you the false sense that replacing meat and vegetables with coke and doritos is harmless as long as they're equivalent calories. Nobody is suggesting that CICO and the insulin theory are mutually exclusive; what the author is saying is that CICO is a profoundly unhelpful statement for people looking to lose weight, improve their health, or reverse diabetes/heart disease. > Taubes would be hard pressed to explain how those subsisting on high carb, low fat, low protein diets that fail to meet their caloric needs in famine-afflicted regions remain thin. Thin doesn't mean healthy. We're talking about disease, not necessarily weight, and you can have metabolic syndrome even if you're considered 'thin'. Most people who are thin with a poor diet have visceral fat (fat around the organs) which is far worse than subcutaneous fat (as a risk factor).

sn9 9y ago
If your BMR is 750-1000, you're likely a female shorter than 5' and/or weighing less than 100 lbs. At that point, you are likely severely underweight and probably shouldn't be trying to lose weight. I'm not denying that there are other reasons to eat a diet with greater nutritional density, but trying to convince people that CICO is wrong is far more harmful than trying to convey that it is literally the most important factor in trying to modify your weight. If you want to make changes in your life, you need to know the right things to measure, and your caloric intake relative to how your weight changes is the single most important factor for people trying to lose weight. If you're not even doing that, it's unlikely you'll succeed, as millions of people who struggle with their weight will understand. Once you've convinced people of the value of that, it then becomes more productive to go into the value of high protein intake and strength training to further improve body composition, the importance of eating a diet centered around fruits and vegetables, etc. For people that are severely overweight, getting their weight down will have the highest impact on their health. >Nobody is suggesting that CICO and the insulin theory are mutually exclusive; Taubes literally argued this in the paragraph where he quoted the biochemistry text.