Yoni Freedhoff, MD, founder and medical director of Ottawa’s Bariatric Medical Institute has written an article entitled “Counting Calories Is Flawed but Here’s Why I Still Do It”. His article takes the complex math of unique burn rates of foods and people and assumes these differences are irrelevant to calorie counting validity. And hence why counting calories continues to be Yoni’s go-to obesity management tool. Yoni says because it’s simple, it’s scientific and there’s nothing better yet, even if it’s technically not correct that a calorie is a calorie or that the human system complicates the math. Yoni feels he can still keep it simple by counting calories, just whole foods are less, some people can eat all they want and some can’t.
Yoni describes the differences in people:
Some of us are walking around driving Humvees while others drive hybrids. The Humvee drivers are the folks who get virtually no fuel economy for their energy stores and consumption. Humvee drivers are like that study subject who barely gained weight despite eight weeks of over feeding, eating whatever they want without having to worry about their waists. The hybrid drivers are the folks who can look at an indulgence and gain weight.
I see a lot of scientists reducing these concept to linear assumptions: that you can count them more or less in straight lines. It certainly makes them easier to conceptualize and work with. Yoni reduces this down to burning rates with his car analogy; how many calories one burns. However this is a over-simplified version that leaves out the why. I assume Yoni thinks we can leave out the why. Whereas I think the ‘why’ matters. It matters because those nuances give us necessary information about interaction and causes. So when I include the why, I see things a bit more complicated and on a deeper level. It’s about more than just calorie burning and counting, but calorie management. What we are doing with that energy, not just how efficiently we get rid of it, but the inbetween, what it really does for us and what we are trying to do, save or use it. So, while Yoni’s answer to why we are different is burning rates, my answer is how we manage and react to stress.
For example, obesity associated genes like, FTO, Ucn3 and Mrap2 are all associated with highly sensitive areas of the brain for stress signalling, like the melanocortin, HPA axis and hypothalamus and hormones like gherlin and leptin. These regulate what and how we respond to and cope with stress. (Stress is information from the environment about what we need to pay attention to, process, react and sets off unique coping styles to this information. Stress is also a call for resources or change). Eating or not eating, storing or not storing are part of stress coping and information communicating mechanisms. Stress and adaptation are complicated concepts, but they also follow very distinct rules and fit into a framework of advanced physics and systems modeling. The details are not the subject of this post, but the eventual delineation using these rules and facts of physiology should give us greater predictability for disease outcomes and suspected culprits interfering with our ability to properly handle and mismanaging stess and adaptations (like crappy foods and obesity). Yoni’s example, that different car models burn calories at different rates sounds reasonable, but really those different rates of burning, on a deeper level, most likely about how one manages stress and energy.
Eating whole foods because they have fewer calories available
Yoni cites some terrific evidence about thermal effect of food, but then limits its description to calorie counting:
Consider some incredibly cool data from an experiment published in the journal Food and Nutrition Research a few years back . Researchers compared the “thermic effect of food” (TEF, or the energy your body uses to actually process and absorb what you’re eating) following the consumption of a whole food grilled cheese sandwich (multigrain bread with whole grain and intact sunflower seeds along with cheddar cheese) versus a processed food grilled cheese sandwich (white bread and Kraft singles).
Junk food can be really terrible. I describe junk food as rocket fuel, too extreme and creating too much pollution for us to clean up, an onslaught of calories without buffers. It damages or alters the system putting it into hyperprotective modes or as we know it; inflammation and excessive oxidative stress.
Yoni’s qualifier of healthy whole foods is they are healthy if they have fewer calories. Which is not a great qualifier in my opinion. It’d lead us to the wrong logic that healthy is lower calorie choices, when healthy is rather about getting proper amounts of calories in the right context. Much like the analogy of calories being the men that show up to build a house. We want as many men as possible but only in context to the tools, materials and work that needs to be done. This is why some higher calorie foods can be great for you…in the proper context.
Counting Calories is only valid when we’re looking at a flattened world.
Calorie science is fairly straightforward and a well understood math. And flat world science works. It’s the math we use, for example, to build level instead of curved foundations for houses. We use a simplified and well-understood assumption that the world is flat, because on that practical level, it is flat. But when we build buildings and ignore the larger round world and climate that house exists in, we are liable to build buildings that under incliment circumstances will topple. We won’t be able to see those issues as clearly, and eventually struggle with “mysterious” building failures.
So when Yoni speaks of his science, I see exactly what he’s saying, and he is completely valid and logical in his worldview of calories. The problem is, is that worldview is a flat worldview. It is merely one layer, one flattened side of a circle. It works and it’s true in its isolated reasoning, but once you have to put the layers together you have to expand to a different form of science.
When Yoni and others start admitting, allowing for, even ever so slowly, that it is what the system does with the calories, instead of the calories themselves, you are entering, dabbling, and ultimately suggesting evidence that there is a larger worldview involved. The problem is, Yoni and many others like him, will admit it’s true that the system matters, but they are saying they don’t yet have to move to a systems model, because they think their linear model will still work just fine.
My question to those researchers is first do they know they are speaking in a limited context? And if they are, are they creating a proper argument, and supported with evidence, that that limited context is the valid one to take under the circumstances?
You see there are many dieting points of view out there. And many of them have a glimmer of the larger picture. They are the flat sides in this round world. Flat science gives us diametric points of view that may all have equal validity, when looked at them in their respective linear terms. However, when you have to put all of those linear points of views together, you have to switch to nonlinear dynamic rules and concepts. And much like straightlines turning into curved lines, it changes what you see and how you view those once diametric views.
What Yoni would have to do to support his argument is prove that the growing influence of stress mechanisms that are impacted by microbiota, endocrine disruptors and macronutrient ratios aren’t pertinent in causing or needed in reversing obesity and metabolic disturbances. Because it would certainly seem from the evidence that one could that argue successfully that these stress mechanisms are becoming more and more relevant to those detrimental outcomes. Moreso than straight weight gain from calories, is the stress activation and over-activation from excessive calories and stress tipping points being lowered and overwhelmed. Yoni’s attempt to lock the influence into calorie dynamics is true to a point. Energy regulation is always a part of it, even a central part, but that doesn’t make it central in the way that we should think about it. Indirect influences can matter just as much and present better ways to address the issues rather than, or in conjunction with, head-on methods.
I’m not here to debate carbs, proteins, or fats, but in my opinion, they matter. They matter in terms of that thermic effect of food I was talking about before, but they also matter in terms of satiety or fullness.
For Yoni whole foods create satiety because they are harder to break down. Hes’ not wrong, but the nuances he misses is that it is also because they signal the brain/body that they have resources. Resources for building their house properly and they don’t need any more (or don’t need others). These whole foods influence our immune-stress-neural signals for fullness as well as their physical bulk. These signals, under stress, can become discombobulated and misleading. In a linear world, an outside force acts on a system and the outside force creates the outcome. But in a systems view, it’s the outside force interacting with the system and it’s the system creating the outcome. In many ways a calorie perspective, the outside force, doesn’t give us the knowledge to get us to the right answers. We’d eat protein and fiber because it’s “filling” from a calorie perspective, instead of eating foods to help in building our systems from a stress/adaptation perspective. Being full is a signal or communication for greater purpose… not just from bulk.
From Thinking In Systems: A Primer:
“So, what is a system? A system is a set of things—people, cells, molecules, or whatever—interconnected in such a way that they produce their own pattern of behavior over time. The system maybe buffeted, constricted, triggered, or driven by outside forces. But the system’s response to these forces is characteristic of itself, and that response is seldom simple in the real world….The system, to a large extent, causes its own behavior! An outside event may unleash that behavior, but the same outside event applied to a different system is likely to produce a different result. (p.34)…You’ll be thinking not in terms of a static world, but a dynamic one. You’ll stop looking for who’s to blame; instead you’ll start asking “What’s the system?”” ~ Donella Meadows
Calorie counting is Euclidian math you can use to lose weight, but to address obesity and metabolic disorders we need non-Euclidean math and a Stress Perspective. Why? While calories are part of stress, stress mechanisms from a systems perspective better explains some of the evidence. It makes more sense to look at stress than to blame calories. Such as:
Why breakfast can be good or bad (depends on stress)
Why sleep has such a strong influence (because of stress)
Why skipping meals can be good or bad (depends on stress)
Why one diet can be right for one person and not another (depends on stress)
Why macronutrient manipulation or fasting can be good or bad (depends on stress)
How being overweight can or can not be associated with obesity (depends on stress)
Why are probiotics, microbiota, endocrine disruptors, etc involved (because they impact stress)
So while stress mechanisms (balancing a system and getting it the resources it needs) seems more complicated, it’s actually much more simple and logical. We need to eat whole foods because they balance stress and give us the tools, materials and proper information to build a better house.
Whole foods are healthier because of what they communicated not because they have fewer calories.
For simple advice for simple public directives, Yoni may be giving great advice for people to make a diary, eat whole foods and count their calories. But from a science perspective trying to figure out disease processes, this may be inadequate to truly understand how it came about and what it will take to reverse it.
So no I don’t agree that if something is flawed we should follow it any way. I think we should take a step back and look at the larger world, the rounder world and switch to the proper method of science and mathematics to start making better decisions about foods that go beyond the sole use of the calorie perspective.
References and More reading on Satiety:
- Psychobehavioural Factors Are More Strongly Associated with Successful Weight Management Than Predetermined Satiety Effect or Other Characteristics of Diet. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3389694/
- Perinatal programming of neuroendocrine mechanisms connecting feeding behavior and stress. http://www.ncbi.nlm.nih.gov/pubmed/23785312
- Management of metabolic syndrome through probiotic and prebiotic interventions. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263193/
- Changes in satiety hormone concentrations and feed intake in rats in response to lactic acid bacteria. http://www.ncbi.nlm.nih.gov/pubmed/23850967
- Periprandial changes of the sympathetic–parasympathetic balance related to perceived satiety in humans. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225999/
- Effects of baked products enriched with n-3 fatty acids, folates, β-glucans, and tocopherol in patients with mild mixed hyperlipidemia. http://www.ncbi.nlm.nih.gov/pubmed/23529988
- Effects of dietary fatty acid composition from a high fat meal on satiety. http://www.ncbi.nlm.nih.gov/pubmed/23688821
- Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. http://www.ncbi.nlm.nih.gov/pubmed/16015276
- Ghrelin, Appetite Regulation, and Food Reward: Interaction with Chronic Stress. http://www.hindawi.com/journals/ijpep/2011/898450/
- Cellular Bioenergetics as a Target for Obesity Therapy. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880836/
- βAR Signaling Required for Diet-Induced Thermogenesis and Obesity Resistance http://www.sciencemag.org/content/297/5582/843.abstract
- Inhibition of the hypothalamic-pituitary-adrenal axis in food-deprived rats by a CCK-A receptor antagonist. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1571903/
- MTOR signaling and ubiquitin-proteosome gene expression in the preservation of fat free mass following high protein, calorie restricted weight loss. http://www.nutritionandmetabolism.com/content/9/1/83
- Thermogenic responsiveness to beta-adrenergic stimulation is augmented in exercising versus sedentary adults: role of oxidative stress. http://www.ncbi.nlm.nih.gov/pubmed/16308351
- The association between beta-adrenergic receptor gene polymorphisms and personality traits. http://www.ncbi.nlm.nih.gov/pubmed/23012891
- Comparison of metabolic rate and oxidative stress between two different strains of mice with varying response to caloric restriction. http://www.ncbi.nlm.nih.gov/pubmed/18541398 ( It is hypothesized that the genotype-specific extension of life span by caloric restriction may involve modulation of oxidative stress produced as a result of an interplay between metabolic rate and energy balance during aging.)
- Personality, metabolic rate and aerobic capacity. http://www.ncbi.nlm.nih.gov/pubmed/23372763
- Human Skeletal Muscle Mitochondrial Uncoupling Is Associated with Cold Induced Adaptive Thermogenesis. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0001777
- Adaptive thermogenesis can make a difference in the ability of obese individuals to lose body weight. http://www.ncbi.nlm.nih.gov/pubmed/22846776
- Construction of cholecystokinin transgenic mouse and its effects on food intake. http://www.ncbi.nlm.nih.gov/pubmed/19781389
- Effect of glycomacropeptide fractions on cholecystokinin and food intake. http://www.ncbi.nlm.nih.gov/pubmed/20205966
- Glycomacropeptide (GMP) is not critical to whey-induced satiety, but may have a unique role in energy intake regulation through cholecystokinin (CCK). http://www.ncbi.nlm.nih.gov/pubmed/17964616
- Glycomacropeptide and α-lactalbumin supplementation of infant formula affects growth and nutritional status in infant rhesus monkeys. http://ajcn.nutrition.org/content/77/5/1261.long
- Gut microbiota and sirtuins in obesity-related inflammation and bowel dysfunction. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235071/
- Dietary strategies to increase satiety http://www.ncbi.nlm.nih.gov/pubmed/12499328
- Meals with similar energy densities but rich in protein, fat, carbohydrate, or alcohol have different effects on energy expenditure and substrate metabolism but not on appetite and energy intake.
- Comparison of metabolic rate and oxidative stress between two different strains of mice with varying response to caloric restriction. http://www.ncbi.nlm.nih.gov/pubmed/18541398