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The article refers to the usage in nutrition science: CICO - "calories in equal calories out". We are learning that this is not the whole truth.

kleiba 5y ago
The notion "a calorie is a calorie", however, refers only to the "CI" part.
na85 5y ago
The problem is it's very poorly understood, even by medical professionals. I had this very argument with an MD who was trying to tell me that if you operate at a sustained caloric deficit you'll eventually stop losing weight. On some level, CICO must be true. Famine is a thing. If you consume a very small but still nonzero amount of calories you will eventually die. So it's not correct to say that "CICO is BS" or anything similar. Whether CICO is an effective way of sustainable weight loss is another conversation.
- whatshisface 5y ago
  >I had this very argument with an MD who was trying to tell me that if you operate at a sustained caloric deficit you'll eventually stop losing weight. Depending on the definition of "sustained" (I assume the MD meant sustained absolute calories per day, not sustained calories below metabolism) it could be true, because as your body shrinks it reduces its metabolism partly because there is simply less of it.
  - na85 5y ago
    Well then you'd reach a caloric equilibrium and you'd no longer be at a sustained deficit.
- amelius 5y ago
  It's like in medieval times when someone had a toothache, the tooth was pulled. Because a tooth that is not there can't cause pain. It's physically sound! But then someone said: yeah sure, except perhaps we can be smarter about it.
- paulmd 5y ago
  it's certainly true though that as your weight decreases the amount of energy it burns also decreases, and there can be additional backlash in terms of the body severely reducing the metabolism (and the resulting lethargy/etc can complicate efforts to exercise/etc). Furthermore metabolism varies in general by age, gender, and genetics in general. and on the flip side, the amount of energy you absorb varies by the type of molecule the body is metabolizing, and also the leading indicators are that the gut microbiome plays a huge amount in determining how much energy the body absorbs. Two people can absorb several hundred calories' difference from eating the same diet and the same quantity, and over a scale of a week+ that turns into pounds gained or lost. "CICO" is a massive oversimplification of an incredibly complex set of chemical processes. Like yes obviously your body cannot violate the laws of thermodynamics but we've just agreed that two different people will neither take in nor burn out the same amount of calories from doing the exact same things! Again, two people could eat the exact same things in the same amounts and exercise the same amount, and potentially gain a pound every week while another person holds weight. And the problem is that this oversimplified advice gets translated into oversimplified medical recommendations/etc, and an incredible amount of moral opprobium. Fat people are an easily visible target and are systematically discriminated against - they are paid less, they have worse interpersonal outcomes, and they receive worse medical care. The first answer of a doctor to a fat person is always "lose weight" - I have a relative whose complaints were ignored until she finally had a volleyball sized ovarian tumor removed in a hysterectomy - and that goes doubly for women in general, whose medical complaints are downplayed/ignored in general. And - not that it matters - but fat people have lower lifetime health spending. They're not "costing you" anything, not that that is ever a good reason to abuse a group of people, but our healthcare spending is hugely back-loaded towards end-of-life care, the third knee replacement and the two weeks in the hospital with congestive lung failure, all tend to be avoided by fat people. They die early and don't incur those expenses. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/ On a personal level, "what can I do to improve my own health", yes, the answer is correct that for your own personal metabolism the only thing you can do is to reduce your caloric intake. But everything past that, we're gradually realizing it's been horribly oversimplified by this idea that humans are the same as a blast calorimeter. It certainly doesn't apply on population-wide scales, there have pretty obviously been dietary shifts (massive increases in consumption of HFCS and other processed sugars) and potentially microbiome or hormonal shifts due to chemical exposure that have compounded these issues and exacerbated the decrease in activity. And that is certainly obscured (and attempts to study and remediate it stymied) by the "just eat less than you burn bro!" that is so popular.
- darkarmani 5y ago
  > I had this very argument with an MD who was trying to tell me that if you operate at a sustained caloric deficit you'll eventually stop losing weight. It can be true. Your body tries to maintain homeostasis and can adjust your base metabolic rate. Just like if you hyperventilate, your blood pH will be maintained by buffering until you exceed the buffering capacity (co2). If you drop your calories low enough, of course, you will continue to lose weight. > So it's not correct to say that "CICO is BS" or anything similar. It is BS if you are able to show different amounts of calorie utilization under different diets. I didn't realize the difference was close to 300 Calories though.
EamonnMR 5y ago
So a correct formulation would be ci * e = co where e is efficiency. This article is arguing that there are many possible values for e and you can influence e with your calorie sources. My point is that most of why CICO matters is that e is never greater than 1.
- wrycoder 5y ago
  Bodyfat is a storage medium. There are time delays, which complicate energy balance and weight loss in practice. Also, some calorie-deficient diets result in a higher average degree of hunger than others with equal caloric input. Some high carb diets produce insulin spikes and subsequent hypoglycemia and hunger pangs. And some calorie-deficient diets result in different muscle/fat loss ratios than others. Finally, not all exercise activities have the same effect on body composition. Long slow distance promotes a lean body, but it's not for everyone.
- jkhdigital 5y ago
  The value of e is a sideshow, and the entire CICO equation is a sideshow: an equation is a grossly oversimplified model. Humans are not static heat engines. The macronutrient composition of the food we eat changes the metabolic environment. This is the first axiom to accept, before you can even begin to talk about optimizing an equation.
  - edanm 5y ago
    You're not wrong, per se, but to a very reasonable approximation, that doesn't matter. CICO is much closer to being "true" than not. If someone wants to lose weight, a simple (though not necessarily easy to execute) plan is to calculate their rough current TDEE, then eat those amount of calories minus 300 or so, and if they're not losing weight, do 200 calories less than that. Rinse and repeat. If someone follows the above protocol, and we take as a given they stick to it, do you agree that they'd lose weight? In practice, other diets can be easier to adhere to, for various reasons: 1. Eating at a caloric deficit makes you hungry, which makes it harder to not overeat. 2. People are bad at counting calories, so might get wrong numbers. 3. It's not fun to count calories, so people might not do it. In many ways, something like keto that works for a lot of people without the annoyance of counting calories, can be much better for many people. But in terms of the underlying mechanics, it's still a calorie deficit that is producing those results, which might give more flexibility to people who do want to count calories. (E.g. for me, counting calories was way better than any other "diet" I tried - I could keep eating what I wanted, so was able to be very flexible with my "diet" while still losing weight).

kleiba 5y ago

The notion "a calorie is a calorie", however, refers only to the "CI" part.

na85 5y ago

The problem is it's very poorly understood, even by medical professionals. I had this very argument with an MD who was trying to tell me that if you operate at a sustained caloric deficit you'll eventually stop losing weight. On some level, CICO must be true. Famine is a thing. If you consume a very small but still nonzero amount of calories you will eventually die. So it's not correct to say that "CICO is BS" or anything similar. Whether CICO is an effective way of sustainable weight loss is another conversation.

whatshisface 5y ago
>I had this very argument with an MD who was trying to tell me that if you operate at a sustained caloric deficit you'll eventually stop losing weight. Depending on the definition of "sustained" (I assume the MD meant sustained absolute calories per day, not sustained calories below metabolism) it could be true, because as your body shrinks it reduces its metabolism partly because there is simply less of it.
- na85 5y ago
  Well then you'd reach a caloric equilibrium and you'd no longer be at a sustained deficit.
amelius 5y ago
It's like in medieval times when someone had a toothache, the tooth was pulled. Because a tooth that is not there can't cause pain. It's physically sound! But then someone said: yeah sure, except perhaps we can be smarter about it.
paulmd 5y ago
it's certainly true though that as your weight decreases the amount of energy it burns also decreases, and there can be additional backlash in terms of the body severely reducing the metabolism (and the resulting lethargy/etc can complicate efforts to exercise/etc). Furthermore metabolism varies in general by age, gender, and genetics in general. and on the flip side, the amount of energy you absorb varies by the type of molecule the body is metabolizing, and also the leading indicators are that the gut microbiome plays a huge amount in determining how much energy the body absorbs. Two people can absorb several hundred calories' difference from eating the same diet and the same quantity, and over a scale of a week+ that turns into pounds gained or lost. "CICO" is a massive oversimplification of an incredibly complex set of chemical processes. Like yes obviously your body cannot violate the laws of thermodynamics but we've just agreed that two different people will neither take in nor burn out the same amount of calories from doing the exact same things! Again, two people could eat the exact same things in the same amounts and exercise the same amount, and potentially gain a pound every week while another person holds weight. And the problem is that this oversimplified advice gets translated into oversimplified medical recommendations/etc, and an incredible amount of moral opprobium. Fat people are an easily visible target and are systematically discriminated against - they are paid less, they have worse interpersonal outcomes, and they receive worse medical care. The first answer of a doctor to a fat person is always "lose weight" - I have a relative whose complaints were ignored until she finally had a volleyball sized ovarian tumor removed in a hysterectomy - and that goes doubly for women in general, whose medical complaints are downplayed/ignored in general. And - not that it matters - but fat people have lower lifetime health spending. They're not "costing you" anything, not that that is ever a good reason to abuse a group of people, but our healthcare spending is hugely back-loaded towards end-of-life care, the third knee replacement and the two weeks in the hospital with congestive lung failure, all tend to be avoided by fat people. They die early and don't incur those expenses. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/ On a personal level, "what can I do to improve my own health", yes, the answer is correct that for your own personal metabolism the only thing you can do is to reduce your caloric intake. But everything past that, we're gradually realizing it's been horribly oversimplified by this idea that humans are the same as a blast calorimeter. It certainly doesn't apply on population-wide scales, there have pretty obviously been dietary shifts (massive increases in consumption of HFCS and other processed sugars) and potentially microbiome or hormonal shifts due to chemical exposure that have compounded these issues and exacerbated the decrease in activity. And that is certainly obscured (and attempts to study and remediate it stymied) by the "just eat less than you burn bro!" that is so popular.
darkarmani 5y ago
> I had this very argument with an MD who was trying to tell me that if you operate at a sustained caloric deficit you'll eventually stop losing weight. It can be true. Your body tries to maintain homeostasis and can adjust your base metabolic rate. Just like if you hyperventilate, your blood pH will be maintained by buffering until you exceed the buffering capacity (co2). If you drop your calories low enough, of course, you will continue to lose weight. > So it's not correct to say that "CICO is BS" or anything similar. It is BS if you are able to show different amounts of calorie utilization under different diets. I didn't realize the difference was close to 300 Calories though.

EamonnMR 5y ago

So a correct formulation would be ci * e = co where e is efficiency. This article is arguing that there are many possible values for e and you can influence e with your calorie sources. My point is that most of why CICO matters is that e is never greater than 1.

wrycoder 5y ago
Bodyfat is a storage medium. There are time delays, which complicate energy balance and weight loss in practice. Also, some calorie-deficient diets result in a higher average degree of hunger than others with equal caloric input. Some high carb diets produce insulin spikes and subsequent hypoglycemia and hunger pangs. And some calorie-deficient diets result in different muscle/fat loss ratios than others. Finally, not all exercise activities have the same effect on body composition. Long slow distance promotes a lean body, but it's not for everyone.
jkhdigital 5y ago
The value of e is a sideshow, and the entire CICO equation is a sideshow: an equation is a grossly oversimplified model. Humans are not static heat engines. The macronutrient composition of the food we eat changes the metabolic environment. This is the first axiom to accept, before you can even begin to talk about optimizing an equation.
- edanm 5y ago
  You're not wrong, per se, but to a very reasonable approximation, that doesn't matter. CICO is much closer to being "true" than not. If someone wants to lose weight, a simple (though not necessarily easy to execute) plan is to calculate their rough current TDEE, then eat those amount of calories minus 300 or so, and if they're not losing weight, do 200 calories less than that. Rinse and repeat. If someone follows the above protocol, and we take as a given they stick to it, do you agree that they'd lose weight? In practice, other diets can be easier to adhere to, for various reasons: 1. Eating at a caloric deficit makes you hungry, which makes it harder to not overeat. 2. People are bad at counting calories, so might get wrong numbers. 3. It's not fun to count calories, so people might not do it. In many ways, something like keto that works for a lot of people without the annoyance of counting calories, can be much better for many people. But in terms of the underlying mechanics, it's still a calorie deficit that is producing those results, which might give more flexibility to people who do want to count calories. (E.g. for me, counting calories was way better than any other "diet" I tried - I could keep eating what I wanted, so was able to be very flexible with my "diet" while still losing weight).