CICO is useless because it is a short term weight loss method that does not address blood glucose dysregulation. Overweight/obesity
requires a long term fat loss method that consistently addresses blood
glucose dysregulation. That's really all you need to know about CICO and why it fails as a treatment for obesity.
Overweight/obese people misuse both the calories that come in and the ones that go out, irrespective of their amounts. So, if you want to actually reverse overweight/obesity you need a protocol that you can follow for the long term and that the body will not adapt to and then compensate. Because if it adapts, the benefits will stop and if it compensates, the benefits will go in the reverse.
1. The body cannot adapt to caloric intake. This is a myth.
Denying that the body adapts to caloric intake is like denying that the earth is round. This adaptation has been very well documented, not only in starvation studies, but in the exhaustive research done on overweight/obesity in humans. All you have to do is “do your Googles” to find it for yourself.
The body simply becomes efficient to whatever condition it is exposed to. It adapts to it. It doesn’t do this with everything. For example, walking does not result in adaptation. You can walk, at the same speed and for the same distance daily, and continue burning the same amount of fat, regardless of whether you follow the same walking routine for a week or for decades. Calories are different. The body adapts to caloric intake. It has to or it wouldn’t be able to survive changes in nutrient availability. It would just simply starve every time food wasn’t readily available.
When you run on a chronic caloric deficit the body simply adapts and adjusts to lower calories. This allows it to become efficient at surviving with the calories available. The body does this by under expressing leptin so it burns less fat, ramping up the stress response to produce more glucose and slowing down metabolic rate to conserve energy. Those three things are the description of overweight/obesity. This is why we refer to overweight/obesity, on this blog, as a starvation adaptation and not simply as “you eat too much”. This adaptation results in a metabolism that is honed for thrift - the preservation and growth of body fat. This protects it from starvation. If the body did not adapt to the calories available, it would simply continue losing weight, until it died.
The more calories you reduce, in order to acquire the same results, the more the body adapts, until you reach a critical level that you simply cannot sustain, unless you are put in an unusual situation like a famine or you are being held at the Gulag. Even then, you would lose even more lean muscle mass, barely tap into your fat mass and die of malnutrition before bikini season. For this reason, calories can affect body weight in the short term, but not body composition in the long term. In order to lose enough body fat to reverse overweight/obesity, you need a long-term protocol that will not result in adaptation, which does nothing but spare body fat - the very thing you are trying to get rid of.
At this point, many people will ask themselves that if the body adapts to nutrient availability, then why does it go into “starvation mode” with the overweight/obese? Why would higher nutrient availability result in a starvation response? It doesn’t make any sense! Dear friends, this is because the body is not responding to the higher nutrient availability solely through caloric information. The body uses multiple sources of information to determine nutrient availability of which calories are only a small and insignificant part but blood glucose is a large and extremely significant part. The body puts much more importance on blood glucose information regarding its nutrient status, than anything else.
If the body solely relied on caloric information, then it would simply gain weight and then lose it when calories were lowered. That is normal weight gain and loss and it is completely driven by available calories. That is how metabolically healthy people lose and gain weight. The “starvation mode” of the metabolically dysfunctional and overweight/obese is being driven by abnormal postprandial fluctuations in blood glucose, which effect insulin release and expression. This in turn under expresses leptin.
When you eat a pizza and your blood glucose rises to 170 mg/dl afterwards, insulin levels abnormally raise to help clear this massive amount of glucose. This rise in insulin persists for many hours causing blood glucose to then dip to 75 mg/dl, while you sleep. Abnormal insulin function also interferes with the release of body fat for energy, as it has an effect on leptin function. Tissues and organs will begin to become "insulin resistant" in order to spare glucose to be stored as fat instead. The fat mass, on the other hand, will become very insulin sensitive in order store as much of this glucose as possible. This only increases fat mass, further deteriorating blood glucose regulation as the more body fat you have, the greater the insulin demand you will need.
This erratic and large disparity between blood glucose highs and lows eventually causes for metabolism to go into “starvation mode”. It will now do whatever it takes to keep blood glucose high, to match insulin release and expression, so it never takes a dip. These large disparities in blood glucose, from hyperinsulinemia and abnormal insulin expression, signals starvation to the body and counter regulatory systems are activated, which do nothing but increase and preserve body fat. This is why studies have shown that carbohydrates, primarily in the form of sugar, are particularly obesogenic, irrespective of calories, because of the changes they cause in metabolic function. This is also why diabetes tracks linearly with body fat percentage. This is not surprising as the storing and sparing of body fat is the usually the first indication, for many people, that their metabolism has shifted in a pathological way.
Eventually, with time, the body will aim for the highest blood glucose possible, as it increases its blood glucose set point higher and higher to match hyperinsulinemia and insulin expression. That is called diabetes. Diabetes is the end stage of poor blood glucose regulation. This adaption also maintains the body’s insulin and body fat set points to very high as well. That is called obesity.
That’s why this blog does not focus on number of calories, but on type of calories, as that has a more profound effect on the metabolism of the overweight/obese. Some calories affect blood glucose negatively and others don't.
2. No one gets fat off plain potatoes because it's not the carbs in the potatoes that cause weight gain, it's the calories. Plain potatoes do not have added calories.
The statement itself is correct, but so are these:
- No one gets fat off plain broccoli.
- No one gets fat off air.
That’s because no one gets fat off anything they don’t eat. No one eats plain potatoes. No one eats plain broccoli. No one eats air. People eat other foods and that’s where the problem comes in.
Potatoes are always added to other foods.
Adding doesn’t make you slim. So, it is irrelevant whether plain potatoes do not make you fat. If you want to live off potatoes alone, then that’s another story. We have already made it clear that carbs are just fine in the context of starvation. People are not starving in Western civilization, nor are they forced to. We don’t live like hunter/gatherers or agrarian peasants because we don’t have to. For this reason, we don’t need potatoes.
We don’t need added carbohydrates, just like we don’t need added fats. Potatoes can take a back seat to more nutritious, which are readily available to us.
Plain potatoes are not particularly high in calories, but they are particularly high in blood glucose disruption. A calorie is not a calorie, as calories are not partitioned in the same way, so they affect body composition differently depending on their effect on blood glucose. Not all calories are equal because some calories are mainly burned (fat), others are mainly stored (carbs) and others are used to build cells (protein). Potatoes will be stored and that’s why, though they aren’t particularly high in calories, they are still very obesogenic.
Why is this “body composition” so important if weight is weight? Because body composition, not weight, is what ultimately determines overweight/obesity and/or metabolic dysfunction. You can have the same weight as a bodybuilder, but if it’s all fat, you are obese.
This is why calorie tracking hasn’t put a single dent in diabesity. Calories only affect weight, not body composition. The battle is not between you and the scale. The battle is between you and your blood glucose regulation.
3. If you eat at a caloric surplus, you will you “get fat”.
You will gain weight, not “get fat”. Body builders eat at caloric surpluses, all of the time, but they don’t “get fat”. Certain athletes also eat at caloric surpluses when they need to build muscle for a particular event. Both of these people need to be continuously mindful that the weight they are putting on, from excess caloric intake, is muscle growth, not fat growth.
Calories affect weight in the short term. They don’t affect it in the long term, as deficits cannot be sustained in the long term without the body adapting and compensating, sparing and building its fat mass at the expense of its lean muscle mass. This occurs when leptin is under expressed (sparing of fat mass) and the adrenal stress response becomes over expressed (break down of lean body mass). This is sarcopenic obesity. This is the hallmark of what occurs when there is a chronic caloric deficit.
As I stated above, about body composition, you have to make sure that the calories you intake, are the ones that will be partitioned correctly in your body. The way you know that is by how your blood glucose is affected.
4. Calories are just a “con”.
Absolutely not. They are useless as a primary treatment for obesity.
Calories work well when you are generally healthy and only have a bit of weight to lose, 20 or less pounds, or when you want to lose weight for a specific reason, like an athletic competition or bikini season. This is because you have to be metabolically sound for caloric deficits to produce true benefits and not an adverse reaction instead.
Calories can work alongside your carb restricted diet, if you have issues with satiety or have an "eating disorder", which causes you to binge and not recognize normal eating behaviors. This is especially true for the person who can drink a carton of heavy cream and swear up and down that’s completely normal. If they were still eating carbs, it’s not unusual for them to eat an entire loaf of bread, for instance, or a whole box of cereal. This type of behavior is very common amongst some lifelong obesity sufferers. They have no satiety signaling whatsoever, so their portions and choice of foods becomes skewed.
This type of behavior is near impossible to reverse. Once the person gets to that stage, they are basically delusional and living in denial. Getting them to adhere consistently to any dietary protocol is marked by failure. For this reason, many of these people require calorie tracking alongside carbohydrate restriction. Because their satiety, visual and reasoning systems are simply not allowing them to see how unusual their eating habits are, they must instead rely on numbers.
5. You can ignore calories on "keto".
It depends on what you're using a ketogenic protocol for.
If you are using it for the treatment of a degenerative condition, such as a neurological disease or cancer, then you will have to track calories, as those ketogenic protocols require an astronomical amount of dietary fat in order to keep ketone levels consistently up. Calorie control is the standard approach for any energy centered diet.
The goal of these protocols is not metabolic health or weight loss. It is simply to run certain cells of the body on fat only, starving them of glucose. These people also restrict protein, to a certain degree, in order to restrict the body's production of its own glucose, starving these cells further. It is a very intense and uncomfortable dietary protocol, which requires medical supervision, as you don’t only have to track calories closely, but you also have to track nutrient status, especially protein deficiency.
Of course, these patients don’t particularly care about metabolism or lean muscle mass loss, as they are only concerned with keeping themselves alive longer or preventing the requirement of invasive medical treatments such as brain surgery to halt epileptic seizure activity.
Ketogenic diets for the treatment of obesity and metabolic disorders, generally do not require calorie tracking because the dietary fat content is not raised by much. These types of diets are diets of elimination, not addition. The ketosis in these diets is acquired solely through the restriction of carbohydrate. Protein is not restricted because people with metabolic problems require more protein, since they are catabolizing their lean muscle mass at an exaggerated rate. Protein is also the macronutrient that will help them normalize their gluconeogenesis, which does not function properly when there is metabolic syndrome.
Therefore, the ketones these people produce should be coming from the burning of their own body fat, not from the burning of dietary fat. These ketogenic diets cause a cyclical type of ketosis, which is the normal state for human metabolism to be in. These diets are also composed of palatable foods, so they are not uncomfortable or unsustainable. You generally do not need a doctor's supervision to follow these protocols either.
6. Weight loss works through caloric deficits.
Yes. Calories effect all short term weight loss and gain. That’s how all animals fluctuate their weight depending on the seasons and their reproductive cycles.
Obesity is not short term. For this reason, calories do not affect it long enough or profoundly enough to reverse it. This is because you cannot sustain a caloric deficit long enough to have this effect and calories do not affect blood glucose regulation consistently and profoundly enough to make a difference. That's two things working against you.
Even if you were to take the obese person, lock them in a cell and keep them under a forced caloric deficit, until they were skin and bones, once they are released and you visit them again, in about a year or two, they will be right back to obesity, but much worse than before. This is because you cannot reverse the metabolic adaptation that causes obesity by forcefully causing a caloric deficit with what’s on the plate. Just like you cannot cure diabetes by forcefully causing low blood glucose with what’s on the plate. Your body has to regulate its own blood glucose properly and it also has to regulate its own calories properly.
Calorie tracking is like chasing symptoms. It makes you believe that the loss of 10 -20 - 30 pounds means you are headed in the right direction, all while gaining more body fat in the interim. Eating bacon and then seeing your blood glucose not go up to 300 mg/dL makes you think you are headed in the right direction as well, all while having Dawn Phenomenon and a low blood glucose of 55 mg/dL during the overnight fast. Do not be gaslighted.
gas·light /ˈɡaslīt/ verb: manipulate (someone) by psychological means into questioning their own sanity. Example: Treating obesity through caloric deficits and/or treating diabetes by eating butter.
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