8 ms·

> This approach is generally referred to the calorie-in/calorie-out (CICO) model. While true to an extent, this perspective is too simplistic, given one key fac

> This approach is generally referred to the calorie-in/calorie-out (CICO) model. While true to an extent, this perspective is too simplistic, given one key fact: leptin is primarily produced in adipose tissue [1]. This fact means body fat is actually an endocrine system organ. This part I think needs more explanation. The reason calories-in/calories-out model is too simplistic (I would call it almost useless if not completely wrong) is because of mitochondrial uncoupling proteins [1] that control how much energy in the protein gradient gets converted to ATP and how much is lost to waste heat. These uncoupling proteins are upregulated by leptin so when your leptin levels fall, your body literally changes how efficient its metabolism is to do more work with fewer calories. Body fat isn't just an endocrine organ, it might be the primary metabolic controller with a nasty catch 22 feedback loop - which would help explain why a certain minimum percentage of body fat is required or else a person enter organ failure. That's why there are some people who don't seem to gain much weight despite eating a lot of food: their bodies are naturally less efficient and lose a lot more energy to thermogenesis. Without taking that metabolic adaptation into account, CICO is nothing but harmful dogma that needs to die. Otherwise people are fighting what might be one of the most important biological adaptations humans have. [1] https://en.wikipedia.org/wiki/Uncoupling_protein https://en.wikipedia.org/wiki/Uncoupling_protein

ninkendo 3y ago
CICO doesn’t work across individuals for reason you outline (just because I lose weight with a certain level of calories, doesn’t mean you will, etc.) But for a single individual, working to establish your base metabolic rate by counting every calorie and weighing yourself regularly, you can always find a way to be successful with the CICO model. If you establish a baseline that your metabolic rate is (say) 2000 calories a day, then eating 1600 calories a day will cause you to lose roughly a half-pound to a pound per week. It does not mean that every individual’s baseline metabolic rate is the same. As you also outline, your base metabolic rate also changes as your weight does, so re-baselining by continually measuring caloric intake and your weight to recalibrate is always going to be necessary. Given the above CICO almost seems tautological: Measure the weight loss you actually observe at a given calorie level, and that tells you… how much weight you will lose at that given calorie level. So it is almost useless as you describe. BUT, the main reason I’m still a proponent of CICO is that it simplifies dieting away from thinking about what you eat, and instead focuses on how much you eat. If I establish that I need to eat 1800 calories a day, I can still have a Big Mac meal and drink some beers. But I may not be able to eat much else that day. That alone makes it useful for me. What isn’t useful to me, are diets that essentially limit the type of food you eat and tell you to just go nuts and eat however much you want: I will often find myself hating the foods I’m restricted to, and the quantity I eat may end up being such that I gain weight anyway. To me, CICO is simply a technique that says “actually measure how much you’re eating”, no more and no less. That is what makes it a useful tool.
- waterheater 3y ago
  Knowledge of leptin changes this because what you eat does actually matter. The goal should be intermittent fasting, where you eat little-to-no carbs about five consecutive days/week and then plenty of carbs two consecutive days/week. This approach ensures leptin levels in the obese body remain high enough to prevent onset of starvation mode while minimizing glucose levels to promote catabolic action on body fat [1]. The bottom line is: you're welcome to eat your Big Mac and beers, just only two days out of the week. Also, stress has an important role to play on weight loss. Stress causes your adrenal glands to release cortisol. Cortisol increases glucose levels through gluconeogenesis by making glucose from non-carbohydrate sources, such as proteins from muscles. [1] https://en.wikipedia.org/wiki/Catabolism https://en.wikipedia.org/wiki/Catabolism
  - ninkendo 3y ago
    It sounds like any other of these diets that tell you when and how to eat but not how much. I’m pretty sure I could gain weight when doing everything you describe, if I eat really terribly during the days I eat “plenty of carbs”. The key to CICO is that you’re actually measuring not just the calories you eat, but the weight you gain/lose, and are continually calibrating. If my diet jacks up my leptin levels such that I don’t lose weight, that will show up on the scale, and I have to adjust my calories down to compensate. With this system I am guaranteed to lose weight so long as I don’t cheat. This is trivially true: the calibration could technically push you all the way to zero calories per day (which will never happen in practice, obviously.) Case in point, I lost 50 lbs with this approach, eating McDonald’s nearly every single day. I kept it off for roughly 8 years. (I since became a dad and have let myself go tremendously, gaining ~30lbs back, but I will cross that bridge soon.)
    - waterheater 3y ago
      >If my diet jacks up my leptin levels such that I don’t lose weight, that will show up on the scale, and I have to adjust my calories down to compensate. >With this system I am guaranteed to lose weight so long as I don’t cheat. Unfortunately, that's just not true. Here's some great quotes from the book "The Obesity Code" (which I've just recently found and find an excellent book): >The abrupt increase in obesity began exactly with the officially sanctioned move toward a low-fat, high-carbohydrate diet. >A 30 percent reduction in caloric intake results in a 30 percent decrease in caloric expenditure. >Total energy expenditure is the sum of basal metabolic rate, thermogenic effect of food, nonexercise activity thermogenesis, excess post-exercise oxygen consumption and exercise. >Since hormones control both Calories In and Calories Out, obesity is a hormonal, not a caloric, disorder. >If hormones regulate fat growth, then obesity is a hormonal, not a caloric disorder. >Sugar will increase the blood glucose level and provoke an insulin response from the pancreas. Olive oil will not...[cause] significant increase in blood glucose or insulin. The two different foods evoke vastly different metabolic and hormonal responses." All of this is to say that it's not enough to simply adjust calories. Yes, calories matter to a point, and everyone knows that starvation (e.g., 0 calories for an extended period of time) is effective in the long-term, but starvation will also harm your body, and no reasonably-minded person can suggest it as a viable approach to weight loss. The best available scientific evidence shows that continuing to decrease caloric intake can make weight loss more difficult for an obese person.
nradov 3y ago
I am skeptical about reports of people who don't seem to gain much weight despite reading a lot of food. Most of those reports are merely anecdotes, or at best observational studies, and we know that most people are terrible at accurately tracking their caloric intake. More rigorous studies that involved putting subjects into locked environments and carefully measuring their intake have consistently found that the CICO model is accurate. However, as a practical matter for people who want to lose adipose tissue there are likely more effective approaches than CICO.
- notfed 3y ago
  Anecdote: throughout my life, on many occasions, I've gone on multi-month binges of over-consuming massive quantities (1500+ cals) of desserts on a daily basis, while retaining a sedentary lifestyle. I always seem to weigh the same weight (skinny). I realized I've been doing this over the past month. I weighed myself yesterday. Same weight. Clearly something is different about my body, at least when it comes to sugar calories. It just doesn't seem to readily convert it to fat. Is it really that hard to believe that some people's bodies actually behave a little more rationally than most?
  - nradov 3y ago
    It really is that hard to believe. Have you ever had a resting metabolic rate test? Have you ever gone several weeks carefully tracking everything you consume using an accurate food scale? I am skeptical that even during binge periods you were really taking in as many calories as you claim. That said, there are limits to what the human digestive system can absorb from a single meal. Binge eaters do sometimes exceed that limit and just poop out the excess without storing it as fat.
    - psd1 3y ago
      Lol. We exist. I got the taste for raspberry ripple ice cream in my mid-20s, and ate 10 litres a week - that's 2000+ kcal a day just in dessert. That's not binging. I put that on top of 500g dry weight of pasta with cheese and sauce, and kept it up for months. Plus breakfast, lunch, and several beers. And packets of chocolate biscuits. I was covering 10km a week or less, no marathons. No tapeworms, either. You may be right that I was shitting a lot of it out; the horrible shits are what turned me off the ice cream habit. Nonetheless, I ate well over 4000 kcal every day, for years, and never put on weight. 6000 was typical. And most of that was potatoes and wheat, which are very bio-available carbs. I've always been a black hole for food. I suspect I radiate it as heat. Exes have told me I'm hot - in a caloric sense. I feel the cold more, now that I eat less. To the overweight, if it helps at all, know that I have other struggles.
screye 3y ago
CICO works quite well at the extremes. It's effectiveness varies, but it is directionally correct. If someone is sitting at a 35+ BMI, then their caloric intake is so out of whack, that CICO helps ground them. Similarly, an anorexic who starves gets a clear directive for increasing weight by increasing calories. CICO also promotes calorie general calorie comparison. It helps you understand that a milkshake has the same weight impact as an average Mediterranean lunch bowl. Now the absolute impact on both foods will vary from person to person. But comparatively, it helps ground the unhealthiness of foods like sugar rich shakes and icecream.
- waterheater 3y ago
  The key insight from leptin is that the carbohydrates in the milkshake actually causes weight gain, not the calories. Yes, you do need to know how many calories your specific body needs to properly operate. For example, taller people require more calories than shorter people. However, obesity is a hormonal issue stemming from leptin resistance, not a caloric intake issue.

ninkendo 3y ago

CICO doesn’t work across individuals for reason you outline (just because I lose weight with a certain level of calories, doesn’t mean you will, etc.) But for a single individual, working to establish your base metabolic rate by counting every calorie and weighing yourself regularly, you can always find a way to be successful with the CICO model. If you establish a baseline that your metabolic rate is (say) 2000 calories a day, then eating 1600 calories a day will cause you to lose roughly a half-pound to a pound per week. It does not mean that every individual’s baseline metabolic rate is the same. As you also outline, your base metabolic rate also changes as your weight does, so re-baselining by continually measuring caloric intake and your weight to recalibrate is always going to be necessary. Given the above CICO almost seems tautological: Measure the weight loss you actually observe at a given calorie level, and that tells you… how much weight you will lose at that given calorie level. So it is almost useless as you describe. BUT, the main reason I’m still a proponent of CICO is that it simplifies dieting away from thinking about what you eat, and instead focuses on how much you eat. If I establish that I need to eat 1800 calories a day, I can still have a Big Mac meal and drink some beers. But I may not be able to eat much else that day. That alone makes it useful for me. What isn’t useful to me, are diets that essentially limit the type of food you eat and tell you to just go nuts and eat however much you want: I will often find myself hating the foods I’m restricted to, and the quantity I eat may end up being such that I gain weight anyway. To me, CICO is simply a technique that says “actually measure how much you’re eating”, no more and no less. That is what makes it a useful tool.

waterheater 3y ago
Knowledge of leptin changes this because what you eat does actually matter. The goal should be intermittent fasting, where you eat little-to-no carbs about five consecutive days/week and then plenty of carbs two consecutive days/week. This approach ensures leptin levels in the obese body remain high enough to prevent onset of starvation mode while minimizing glucose levels to promote catabolic action on body fat [1]. The bottom line is: you're welcome to eat your Big Mac and beers, just only two days out of the week. Also, stress has an important role to play on weight loss. Stress causes your adrenal glands to release cortisol. Cortisol increases glucose levels through gluconeogenesis by making glucose from non-carbohydrate sources, such as proteins from muscles. [1] https://en.wikipedia.org/wiki/Catabolism https://en.wikipedia.org/wiki/Catabolism
- ninkendo 3y ago
  It sounds like any other of these diets that tell you when and how to eat but not how much. I’m pretty sure I could gain weight when doing everything you describe, if I eat really terribly during the days I eat “plenty of carbs”. The key to CICO is that you’re actually measuring not just the calories you eat, but the weight you gain/lose, and are continually calibrating. If my diet jacks up my leptin levels such that I don’t lose weight, that will show up on the scale, and I have to adjust my calories down to compensate. With this system I am guaranteed to lose weight so long as I don’t cheat. This is trivially true: the calibration could technically push you all the way to zero calories per day (which will never happen in practice, obviously.) Case in point, I lost 50 lbs with this approach, eating McDonald’s nearly every single day. I kept it off for roughly 8 years. (I since became a dad and have let myself go tremendously, gaining ~30lbs back, but I will cross that bridge soon.)
  - waterheater 3y ago
    >If my diet jacks up my leptin levels such that I don’t lose weight, that will show up on the scale, and I have to adjust my calories down to compensate. >With this system I am guaranteed to lose weight so long as I don’t cheat. Unfortunately, that's just not true. Here's some great quotes from the book "The Obesity Code" (which I've just recently found and find an excellent book): >The abrupt increase in obesity began exactly with the officially sanctioned move toward a low-fat, high-carbohydrate diet. >A 30 percent reduction in caloric intake results in a 30 percent decrease in caloric expenditure. >Total energy expenditure is the sum of basal metabolic rate, thermogenic effect of food, nonexercise activity thermogenesis, excess post-exercise oxygen consumption and exercise. >Since hormones control both Calories In and Calories Out, obesity is a hormonal, not a caloric, disorder. >If hormones regulate fat growth, then obesity is a hormonal, not a caloric disorder. >Sugar will increase the blood glucose level and provoke an insulin response from the pancreas. Olive oil will not...[cause] significant increase in blood glucose or insulin. The two different foods evoke vastly different metabolic and hormonal responses." All of this is to say that it's not enough to simply adjust calories. Yes, calories matter to a point, and everyone knows that starvation (e.g., 0 calories for an extended period of time) is effective in the long-term, but starvation will also harm your body, and no reasonably-minded person can suggest it as a viable approach to weight loss. The best available scientific evidence shows that continuing to decrease caloric intake can make weight loss more difficult for an obese person.

nradov 3y ago

I am skeptical about reports of people who don't seem to gain much weight despite reading a lot of food. Most of those reports are merely anecdotes, or at best observational studies, and we know that most people are terrible at accurately tracking their caloric intake. More rigorous studies that involved putting subjects into locked environments and carefully measuring their intake have consistently found that the CICO model is accurate. However, as a practical matter for people who want to lose adipose tissue there are likely more effective approaches than CICO.

notfed 3y ago
Anecdote: throughout my life, on many occasions, I've gone on multi-month binges of over-consuming massive quantities (1500+ cals) of desserts on a daily basis, while retaining a sedentary lifestyle. I always seem to weigh the same weight (skinny). I realized I've been doing this over the past month. I weighed myself yesterday. Same weight. Clearly something is different about my body, at least when it comes to sugar calories. It just doesn't seem to readily convert it to fat. Is it really that hard to believe that some people's bodies actually behave a little more rationally than most?
- nradov 3y ago
  It really is that hard to believe. Have you ever had a resting metabolic rate test? Have you ever gone several weeks carefully tracking everything you consume using an accurate food scale? I am skeptical that even during binge periods you were really taking in as many calories as you claim. That said, there are limits to what the human digestive system can absorb from a single meal. Binge eaters do sometimes exceed that limit and just poop out the excess without storing it as fat.
  - psd1 3y ago
    Lol. We exist. I got the taste for raspberry ripple ice cream in my mid-20s, and ate 10 litres a week - that's 2000+ kcal a day just in dessert. That's not binging. I put that on top of 500g dry weight of pasta with cheese and sauce, and kept it up for months. Plus breakfast, lunch, and several beers. And packets of chocolate biscuits. I was covering 10km a week or less, no marathons. No tapeworms, either. You may be right that I was shitting a lot of it out; the horrible shits are what turned me off the ice cream habit. Nonetheless, I ate well over 4000 kcal every day, for years, and never put on weight. 6000 was typical. And most of that was potatoes and wheat, which are very bio-available carbs. I've always been a black hole for food. I suspect I radiate it as heat. Exes have told me I'm hot - in a caloric sense. I feel the cold more, now that I eat less. To the overweight, if it helps at all, know that I have other struggles.

screye 3y ago

CICO works quite well at the extremes. It's effectiveness varies, but it is directionally correct. If someone is sitting at a 35+ BMI, then their caloric intake is so out of whack, that CICO helps ground them. Similarly, an anorexic who starves gets a clear directive for increasing weight by increasing calories. CICO also promotes calorie general calorie comparison. It helps you understand that a milkshake has the same weight impact as an average Mediterranean lunch bowl. Now the absolute impact on both foods will vary from person to person. But comparatively, it helps ground the unhealthiness of foods like sugar rich shakes and icecream.

waterheater 3y ago
The key insight from leptin is that the carbohydrates in the milkshake actually causes weight gain, not the calories. Yes, you do need to know how many calories your specific body needs to properly operate. For example, taller people require more calories than shorter people. However, obesity is a hormonal issue stemming from leptin resistance, not a caloric intake issue.