It’s not simply about calories – our bodies are far more complex than that

The first law of thermodynamics states that ‘energy cannot be created or destroyed, but can be changed from one form to another’. This is often seized upon by proponents of the ‘calories in-calories out’ theory as proof that calorie counting is the way to go, and that it therefore doesn’t what proportion of micronutrients one eats.

But the body is shockingly complex. Thousands of simultaneous metabolic pathways are running every moment of every day in every one of the 100 billion cells that make up the human body. Energy is not only used to synthesise required molecules, repair, digest and absorb but is also lost as heat. Furthermore some reactions are more ‘exothermic’ – or heat releasing – than others. The ingestion of protein, for example, is associated with a more heat-releasing reaction than fat or carbohydrates as the body requires more energy to digest it. The measurement of energy contained in food is an inexact science and to pretend otherwise is foolish.

Those who feel that carbohydrates are being seriously maligned at the moment and are firm believers in the old, discredited ‘fat is the enemy’ fallacy will consistently point to calories as both medium and message, treating carbs as identical to fat and protein provided the calorie content is the same. This is facetious in the extreme, and ignores all the evidence that it is refined carbohydrates, processed trans and polyunsaturated fats that are the true enemy of human health.

The body does not react to calories; it reacts to macronutrients present in food.  A low-calorie diet works in the short term, but as research has shown, most people will regain weight. Why is this? Simple physiology. Evolutionary development has predisposed our metabolisms to decrease whenever food is scarce as a method of preservation. Resume ‘normal’ eating patterns and you gain weight, even if this gain is initially kept off by high-activity levels.

A narrow-minded focus on calories is, essentially, pointless. 500 calories of sugar is simply not the same as 500 calories of fat. Why? Sugar stimulates the production of insulin, a hormone with a half-life of 4-6 minutes. Once insulin is present in elevated levels in response to a high carbohydrate load, the body is primed for ‘anabolism’: to build up its muscle, protein and fat stores. Blood sugar then decreases as carbohydrates are taken up by cells, and the craving for more sugar starts soon after. When this happens multiple times a day, as is the case when processed, sugary food is eaten, the path to being ‘curvy’ is initiated.

At this point if excess fat is eaten, it will be stored as body fat. But were one to simply eat 500 calories of fat rather than sugar, the majority of the ingested fat would simply be burned for fuel in the absence of an insulin spike as without it, the body cannot store fat. This of course is a gross oversimplification. But the reality is that we eat a mixed diet, and this hormonal response is reduced. So if hormonal activity is complex, how can calories be the ‘simple’ answer? Whether or not a person gains or loses weight on a particular diet is determined by the hormonal response to that food, its micronutrients, their genetics and epigenetics, physical activity and resting metabolic rate. Calories are far from the most important consideration.

Proper nutrition is about manipulating hormones via careful selection of healthy food, resulting in the body utilising its own fat stores as well as ingested carbohydrates, protein and fat without resulting systemic inflammation or deposition of excess fat. What constitutes ‘proper’ nutrition varies from person to person and differs based on insulin resistance, level of activity, response to certain foods and a myriad of other factors. Some individuals lose a tremendous amount of weight on a high-fat diet, others require higher levels of carbohydrates to see any effects. This is widely acknowledged by personal trainers, bodybuilders and athletes. The body is too complex for the simplistic calorie hypothesis to be definitive. Numerous researchers in the field attest to this and for those wanting a primer on the latest calorie research, I would suggest the work of Dr. Jonathan Baylor.

I sincerely hope that my gross oversimplification of human biochemistry has illustrated my fundamental point: that you cannot ignore the complexity of the reality in favour of an over-simplistic concept to explain complex phenomena.

Those bleating about ‘calories in, calories out’ as the solution to obesity really need to start reading, and understanding the literature that has been available for the last 20 years rather than simply repeating what others have told them.  As a Professor of Orthopaedic surgery so elegantly observed during my medical school days: ‘You have to learn to tell the difference between chicken salad and chicken s*&t.’


  • JB

    This seems like an advert for low carb/high fat/ketogenic diets and there is a single “reference” for all the claims it makes. Suggesting Dr. Jonathan Baylor (sic) who peddles diet programs and “detox” supplements as a valid source of information is ridiculous. As a Dr yourself, I am suprised you even suggest such biased sources with obvious conflicts of interest.

    You state that a low calorie diet does not work long term to which you cite a small study, which is not freely available, that without the details, is irrelevent to your point.

    “Resume ‘normal’ eating patterns and you gain weight…”, I might be misunderstanding this but you are suggesting that if someone who was on a hypoenergetic diet loses weight and then goes back to eating “normally” i.e. clearly a hyperenergetic diet, they gain the weight back as if this is proof that low calorie diets don’t work.

    Can you cite an overfeeding study in which participants didn’t gain weight and fat mass? How about a calorific deficit study where subjects did not lose weight and fat mass? If not, how can you really state that calories are irrelevant and that people who are “bleating about calories in, calories out” are wrong because after all, that is the consensus.

    • Tarek

      I always welcome some honest criticism so thank you very much. To address your pertinent points:

      1. Please see the work of Dr. Mat Lalonde, Harvard researcher. Bailor wrote an excellent book summarising the research on calories but it was my proofreading of the draft that was at fault as the reference was supposed to be Lalonde.

      As for references, I trust the following will satisfy you:

      Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity.New England Journal of Medicine, 2003.

      Samaha FF, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, 2003. ( Calorie unrestriction in high-fat arm)

      3. Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. The Journal of Pediatrics, 2003.

      4. Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. The Journal of Clinical Endocrinology & Metabolism, 2003. ( low fat group calorie restricted)

      5. Aude YW, et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat.Archives of Internal Medicine, 2004

      6. Yancy WS Jr, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Annals of Internal Medicine, 2004

      7. JS Volek, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism (London), 2004.

      8. Meckling KA, et al. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. The Journal of Clinical Endocrinology & Metabolism, 2004. ( calories matched)

      9. Nickols-Richardson SM, et al. Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet. Journal of the American Dietetic Association, 2005

      10. Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes. Diabetic Medicine, 2006

      12. Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study. The Journal of The American Medical Association, 2007.

      16. Shai I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. New England Journal of Medicine, 2008

      In case you have any issues accessing them the following website has an excellent summary of each one:
      http://authoritynutrition.com/23-studies-on-low-carb-and-low-fat-diets/

      2. Everyone has “obvious conflicts of interest” but unfortunately people are very selective in acknowledging them e.g. the cholesterol AHA guidelines had 6 experts on the board with direct ties to industry, as did the NICE guidelines ( not 6 though) on cholesterol.

      3. The details of quoted studies are either open source or only open to subscribers. This does not invalidate their use as a reference and you would need to address any concerns to the publishers that make million of dollars hiding original research, often funded by the public, behind paywalls.

      4. Please re-read the blog; I’m not suggesting that calories do not play a role in weight loss; to do so would be to wilfully ignore the accumulated years of experience of elite athletes, bodybuilders, personal trainers and the like who are experts at body composition changes and who didn’t need to wait for “evidence” to validate what they knew worked. I may be a medic but I don’t ignore experience just because there isnt a piece of paper to validate it, simply because one often needs to wait for evidence before dismissing it out of hand. What however I am suggesting is that it is ALOT more complex than a simple calorie reduction. The physiology of the body is more complex than the calorie brigade will acknowledge, arrogance that is both breathtaking and tragic. If it was simply about calories we wouldn’t have the obesity problem. Furthermore obesity is not only seen in affluent settings; various tribes including North American Indian tribes who suffered shocking degrees of poverty in the past also had an issue of obesity.

      5. I don’t always respect ” consensus”. Once upon a time it was also consensus that leeches were essential to medical care, the earth was flat and that electric was generated by phantoms. We live in a world where thankfully knowledge is available and accessible if one knows where to look. Consensus is often coloured by political considerations and other behind the scenes machinations that result in evidence/results either being dismissed, distorted, briefed against or simply buried. We are now able to access information other than what is being quoted to justify a particular view point and with the explosion of knowledge in all branches of the sciences we can appreciate the greater perspective than perhaps we might once have. We can also find evidence that the mainstream orthodoxy is either in denial over, or simply unaware of; thankfully the days of scientist /doctor knows all and knows best are behind us

      6. I used anecdotal examples of high-fat diets to state clearly that these showed that the issue was more complex; I did not suggest they constituted the silver bullet that demolished the calorie idea. For references re: “overfeeding” please see the studies quoted above

      Please bear in mind blogs like these have a limit on words, hence I can’t always put explicit links to studies in or expand on particular points.

      • JB

        Thank you for the response, I appreciate there are limitations in this format. I hope that my style of writing makes sense and does not cause offence in any form as this is not intentional.

        1. Sorry I don’t think I was clear there, I should have perhaps made those 2 separate sentences. That was one of the impressions I got from the article however I meant that there weren’t any references to the suggestions made throughout. I am also unsure of why you are citing a website that suggest postive aspects of a low carb over a low fat diet when I didn’t question if LCHF diets were better than LF diets nor do you specifically mention them or make that comparision in your article.

        I was initially impressed by the list of references until I saw you had copied it from some random “nutrition” website, another unreliable and biased source. Did you look at the studies yourself or critically analyse them? Is there a single study where a low carb diet didn’t have a calorific deficit and lost weight? What do opposing studies show? Have you seen the other sorts of things on this website concerning fructose, grains and sweeteners?

        2. Everyone has conflicts of interest but you were referring to someone who makes a living out of promoting certain types of diets and supplements i.e. direct ties to the diet and supplement industry. It doesn’t make sense to me that you can ignore that yet accuse current guidelines being wrong because of alleged industry ties. Experts in the field usually become experts in the relevant industry but that’s not the reason to dismiss them as it’s essentially a shill gambit. What exactly did the experts get wrong? To limit saturated fat intake? You also state PUFAs are linked to being unhealthy, does this include the Omegas and CLA?

        3. I meant the study linked is limited, it’s small, there’s no control etc. Details of how they lost weight, there’s no mention of calories just behavioural therapy, and why they regained weight isn’t clear. You therefore cannot make the suggestions that low calorie diets don’t work long term based on that study. You then appear to suggest carbs are a problem and that eating fat would be a much better alternative, hence my opinion that this article is almost a low carb/keto diet advert.

        4. No, I appreciate that you do not mean calories don’t play a role in weight loss, I take issue with all the other claims that go above calories role in weight loss. You also state that people lose weight on a high carb diet and a high fat diet but what’s the common theme? A calorific deficit perhaps? As an assistant professor, it worries me that you defer to the anecdotes of personal trainers and bodybuilders. Why wouldn’t we have the obesity problem if it’s simply about calories? Does thermodynamics not apply? It seems there may be several factors such as people either eating more food in a time of plenty and/or there is a decrease in the levels of physical activity such as more public and personal transport. Is there evidence that shows that people become obese from eating a caloric deficit? People might eat a flawless diet but if they eat too much or don’t excercise enough, they will gain weight. Is there a citation for the American Indian’s obesity problem in the past claim?

        5. An assistant professor using a fallacious argument like this is very concerning. I am aware science has been wrong before but you should know consensus changes with the evidence available because that is science. It does not mean that consensus isn’t important as it’s a reflection of the evidence and the relevant experts of their fields. You also appear to be making allegations that are touching conspiracy theory. We can access lots of information yes that’s great, but it’s what we do with and how we interpret the information that matters. The days of scientists/doctors knowing best are behind us? Are you not one of those? Who knows best instead then? If I need an operation, I don’t go and research how to do it myself, I go to a surgeon.

        6. Yes but I thought the article was about how it’s not about simply calories. If people lose weight on a high fat diet or a low fat diet or a twinkie diet that’s great, but I guarantee they had a calorific deficit which is why I question your suggestions that calories are not that important. There are no studies with any type of controlled diet, whether high fat or low carb etc, that showed weight loss that did not have a calorific deficit. Yes I do understand you’re saying they are and they aren’t, I just get the impression you’re pushing too much to the “they aren’t” side with limited evidence and justification for doing so.

        I mentioned the twinkie diet which was actually an experiment carried out by a professor of nutrition that suggests calories really are the most important thing. It’s not concrete evidence nor of course advisable (unfortunately!) but it’s different.

        Thank you for taking the time to read this. Unfortunately I anticipate this to be a case of agreeing to disagree as we may start to go in circles.

        • Tarek

          Not at all. Health and robust discussion is the only way to assure progress or even to correct one’s self.

          1. When you mentioned that part of the article appeared to be an advert for low-carb/ketogenic diets and only had 1 reference throughout I assumed you wanted references for them.

          I copied the references from a nutrition website run by a colleague who is a medical student and a personal trainer, thus au fait with the science on the one hand and the practicalities of it in his capacity as a personal trainer. I’m not in any way endorsing his site neither am I giving it the medical seal of approval, but it is a very handy resource in that it lists papers published in peer-reviewed journals with a summary of the pertinent findings. I have of course read the papers in their entirety and if you go through the list I gave you you will find several have addressed the issue of calories in the both arms.

          To answer your question specifically, the studies below did not restrict calories in the low-carb arms.

          Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity.New England Journal of Medicine, 2003.

          Samaha FF, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, 2003. ( Calorie unrestriction in high-fat arm)

          3. Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. The Journal of Pediatrics, 2003.

          4. Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. The Journal of Clinical Endocrinology & Metabolism, 2003. ( low fat group calorie restricted)

          You will always find opposing studies on pubmed. As for the other things you mention on the website I haven’t actually gone through them yet so I can’t really comment.

          2. My point was that we shouldn’t listen to the “experts” without being aware of their conflicts of interest simply as their views will be informed by them, regardless of the extent. It is an open secret what happens with drug-company sponsored trials between the trial and publication of the results. Someone else with a conflict of interest e.g. having a vitamin to sell will be transparent in that any claims they make can easily be looked up on pubmed, with charlatans making outrageous claims quickly identified.

          Where did the experts get it wrong? The wrong kind of diet for optimal health for a start relying on hope rather than evidence: http://openheart.bmj.com/content/2/1/e000196.abstract?sid=fbbffa67-1071-4690-899c-5d802e0fba39

          Saturated fat intake has no bearing on cardiovascular mortality so that was another thing that they got wrong Am J Public Health. 2013 Sep;103(9):e31-42. doi: 10.2105/AJPH.2013.301492. Epub 2013 Jul 18

          The relationship between cholesterol and saturated fat intake and cholesterol in isolation with cardiovascular disease was another fallacy. The studies are all available to illustrate this.

          My comment on PUFA’s were a little broad; of course Omega 3 / CLA are extremely healthy fats; I was referring to cooking oils marketed as polyunsaturated.

          3. For low-calorie diets not working long-term:

          Am Psychol. 2007 Apr;62(3):220-33.

          Medicare’s search for effective obesity treatments: diets are not the answer.

          Mann T1, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J.

          Author information

          Abstract

          The prevalence of obesity and its associated health problems have increased sharply in the past 2 decades. New revisions to Medicare policy will allow funding for obesity treatments of proven efficacy. The authors review studies of the long-term outcomes of calorie-restricting diets to assess whether dieting is an effective treatment for obesity. These studies show that one third to two thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance. In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.

          JAMA. 2006 Jan 4;295(1):39-49.

          Low-fat dietary pattern and weight change over 7 years: the Women’s Health Initiative Dietary Modification Trial.

          Howard BV1, Manson JE, Stefanick ML, Beresford SA, Frank G, Jones B, Rodabough RJ, Snetselaar L, Thomson C, Tinker L, Vitolins M, Prentice R.

          Author information

          Abstract

          CONTEXT:

          Obesity in the United States has increased dramatically during the past several decades. There is debate about optimum calorie balance for prevention of weight gain, and proponents of some low-carbohydrate diet regimens have suggested that the increasing obesity may be attributed, in part, to low-fat, high-carbohydrate diets.

          OBJECTIVES:

          To report data on body weight in a long-term, low-fat diet trial for which the primary end points were breast and colorectal cancer and to examine the relationships between weight changes and changes in dietary components.

          DESIGN, SETTING, AND PARTICIPANTS:

          Randomized intervention trial of 48,835 postmenopausal women in the United States who were of diverse backgrounds and ethnicities and participated in the Women’s Health Initiative Dietary Modification Trial; 40% (19,541) were randomized to the intervention and 60% (29,294) to a control group. Study enrollment was between 1993 and 1998, and this analysis includes a mean follow-up of 7.5 years (through August 31, 2004).

          INTERVENTIONS:

          The intervention included group and individual sessions to promote a decrease in fat intake and increases in vegetable, fruit, and grain consumption and did not include weight loss or caloric restriction goals. The control group received diet-related education materials.

          MAIN OUTCOME MEASURE:

          Change in body weight from baseline to follow-up.

          RESULTS:

          Women in the intervention group lost weight in the first year (mean of 2.2 kg, P<.001) and maintained lower weight than control women during an average 7.5 years of follow-up (difference, 1.9 kg, P<.001 at 1 year and 0.4 kg, P = .01 at 7.5 years). No tendency toward weight gain was observed in intervention group women overall or when stratified by age, ethnicity, or body mass index. Weight loss was greatest among women in either group who decreased their percentage of energy from fat. A similar but lesser trend was observed with increases in vegetable and fruit servings, and a nonsignificant trend toward weight loss occurred with increasing intake of fiber.

          4. The common theme is that everyone is different, and we don't need publications to tell us that before we accept it. The world of bodybuilding has provided, for anyone bothered to investigate it, an open air laboratory where one could directly observe the results of a diet at variance with conventional wisdom, and the synergistic effect of exercise in all its varieties. They are the experts at manipulating of food macronutrients and dare I say it, calories. It is among this world that many studies, albeit smaller studies and perhaps not as methodologically rigorous, showed potential benefit ( I can't claim "benefit" as sample sizes were small" ) that required larger studies to be done, something that never happened as none wants to fund a trial they can't directly benefit from. Of course I refer to "natural" i.e. drug-free bodybuilding as steroids / insulin/HGH all of course act as major confounders to any postulated hypothesis.

          I believe in not being so blind that I only form opinions that are "blessed" by a published paper. I respect the experience of others; in this case provided that experience does not violate the laws of biochemistry and submits a reasonable explanation that I can then double check with reference to the literature.

          Absence of proof is not simply proof of absence, and in many cases exists because the trial was not or has yet to be, carried out. Advances in medicine / changes in paradigm / new hypotheses don't depend on a trial for their initial genesis; the trials come later and serve to prove or disprove a new hypothesis.

          5. Of course thermodynamics applies. The body follows the laws of physics, but calories are inexactly measured and furthermore, it is easier to demonstrate the first law in a closed mechanical system than it is in a living organism. The obesity problem is a complex one, with roots in the kind of food we eat now as opposed to 40 years ago, changes in lifestyle to a more sedentary one and the fact that food for many is now an addiction thanks to the efforts of food scientists. Calories are undoubtedly part of this to some extent, but to say that the problem can be simplified to being one of excess calorie consumption? Ludicrous. If only it were that easy.

          6. It is because I hold an academic rank that I see consensus for what it is. Human beings like certainty; the medical, political and scientific worlds love uniformity as it is easier to police and to establish a consensus that excludes "troublemakers" with all the attendant benefits of said consensus.

          "Consensus" gave us nonsense food guidelines that caused an epidemic of obesity and its complications that we have enjoyed for the last 20 years. They were based on zero evidence: http://openheart.bmj.com/content/2/1/e000196.abstract?sid=fbbffa67-1071-4690-899c-5d802e0fba39

          In the case of the saturated fat fallacy it all came down to Ancel Keys versus John Yudkin ( low-fat versus low carb proponent). Keys misrepresented the data he had, and was simply better at getting his message across even though what Yudkin warned about came to pass. It was " consensus" that came down on Keys' side, and his own student at Harvard who pushed his ideas, based more on dogma than science. So much for "evidence".

          There was no conspiracy of silence or of suppression; it was simply one dogma against another with "evidence" utilised as expedient.

          My words were : "the days of scientist /doctor knows all AND knows best are behind us", meaning that the days of a knowledge monopoly are gone. When it comes to health and nutrition for example most doctors know nothing except the scraps they were taught at medical school and I have met single parents without a university education who, by self-education and voracious reading knew more about the subject than all my contemporaries. Medicine has become more of a partnership now than it was, and whilst I will always hold the opinion that the informed opinion of a doctor by virtue of their training and experience is more valid than that of a non-medically qualified patient who googled their disease for a few minutes, I will personally gladly listen to what any patient has to say who has done their own "research" simply because knowledge comes from all sources, however unlikely. The chance of a patient having a morsel of information that I may have forgotten / never came across is always there, something that could not have been said for times gone by.

          I'm relieved to hear you'd go to a surgeon if you needed one !

          7. Calories play a role, undoubtedly; the history of bodybuilding specifically pre-contest preparation blows a hole wide in the theory that calories are irrelevant. In the short-term, calorie counting works, but the fact that 2/3 of patients who follow calorie controlled diets regain the weight ( see refs above) once they stop calorie counting says that there is much more to the issue than mere calories.Having said that I would happily volunteer for a "Kitkat" diet study regardless of the agenda of the investigator.

          I incorporate attention to healthy eating and exercise in my own practise, and have lost count of the number of patients I've seen who were told to count calories / eat low-fat and whose weight rebounded subsequently, leaving them frustrated, disillusioned and in several cases almost depressed, resigned to being unhealthy or "fat" unless they stapled their mouths shut or had a gastric bypass. This is the reason why I push hard against the oversimplification of the metabolic processes of the most complex system on this planet, the human body.

  • Dr Charlie, a biochemist

    Anyone interested in biology must realise that the body does not recognise a calorie instead it possesses very
    sophisticated mechanisms for recognising chemicals and then organising metabolic routes in order to either utilise the chemicals or store them.

    One of the prime tasks is to maintain an energy store and the best material for this job – is fat since it
    possesses over twice the amount of energy per unit of weight than carbohydrate. So the average man
    contains around 10 kg of fat as against around ½ kg of carbohydrate. During evolution, when we did not have
    supermarkets, our reserves may have to see us through days or even weeks until our next meal walked by. Anthropologists established in the 18/19th centuries that the food preferences of the remaining hunter/gather populations (ie those populations who had not taken up our agrarian life style) were: firstly large animals, then small animals, then fish and lastly vegetation.

    It was vital then that our fat stores were replenished – and not utilised – in times of plenty – and our
    biochemical responses to food still reflect this. After all we only went over to farming wheat
    and consuming carbohydrates in a big way some 10,000 years ago – after evolving as hunter/gathers for several million years.

    So how do the mechanisms work (please check in a first year biochemistry text book, for example, Harper’s
    Biochemistry), well the interesting thing is that fat itself does not stimulate a hormone that leads to its deposition in the adipose tissue – rather it relies on the presence of another food stuff to cause the release of the storage
    hormone, insulin. So insulin, directs the uptake of fat into the adipose tissue and restricts it liberation from this
    tissue by acting upon the two different lipases that are responsible for carrying out these functions – and by stimulating the liver to create fat that is then exported to the adipose tissue and deposited – again under the
    direction of insulin.

    The food stuff that causes the release of insulin is, of course, carbohydrate. The rapid rise in blood glucose concentration following the consumption of sugars and starch leads to insulin release.

    So by way of an example, if you awoke and ate say some butter, the fat would simply be metabolised to produce
    energy – just in the same manner as the fat that has been released from your fat stores over night in order to keep your body ticking over. However, if you get up and eat a starchy cereal breakfast, immediately the pancreas will release insulin, our storage hormone, in response to the glucose released from the starch. The insulin will immediately prevent further release of fat from our adipose tissue and in fact now instructs this tissue to
    take up any fat present in the blood stream. In addition, insulin also instructs the liver to convert the excess
    blood glucose into fat that is then packed into lipoprotein particles, vLDLs. These particles are released into
    the blood stream and again under the influence of insulin their fat content is deposited into the adipose tissue and LDL is formed.

    In other words, insulin converts the liver into a fat factory and then directs the adipose tissue to store it and limit its release. Is it any wonder then that people put on weight when we are told to consume carbohydrate with every meal and snack.

    If you doubt this – think about how pate de fois gras is produced – geese are feed a high carbohydrate diet and the carbohydrate is converted to fat – result fatty liver; and to produce the fatty marbling of
    meat, cattle are fed grains for a few weeks before slaughter. In humans, children carry out the same
    process when fed a high carbohydrate gruel on weaning. This occurs in parts of Africa and the
    children develop a large tummy (kwashiorkor) due to the formation of a fatty liver. The reason that the fat is not
    released from the liver in two of the above cases is that the diet is so short of protein that the liver cannot produce the specialised protein coat for the vLDL particles and so the fat cannot be exported from the liver and simply accumulates within the organ.

    Also consider the fact that the lipid profile of people who have a high carb diet shows much larger amounts of triglyceride (fat) than those who have a high fat/low carb diet. Usually, 3 times as much. This seems
    counter-intuitive, until you remember that the low carb eaters will be burning their fat, whilst the carb eaters will be churning out lots of fat from their livers. It is ironic that we have been told for the last 30 years to limit our consumption of saturated fat to protect our heart – yet the very consumption of the “healthy grains” has ensured that our blood vessels are flooded with the stuff.

    The answer to obesity is very simple – do as medics used to direct patients to do – if you want to slim cut down on starchy foods (bread, pasta, potatoes, pastries, cakes etc) – on the other hand if you are under
    weight and wish to gain pounds then eat these starchy material.

    In the 1970s, the dietary recommendations were changed in the USA with the formation of the food pyramid and the substitution of “healthy” grains for fat. Immediately, the levels of obesity, diabetes, autoimmune diseases (bowel etc) and cancer started to rise. A few years later the revised policy was adopted in Britain and again the level of disease rocketed. A few years later the recommendation were adopted in Sweden and disease rocketed. It does not take a brain the size of a planet to link the rise in disease in every country to the date when the change in dietary policy was introduced.

    It must be noted that no research was carried out prior to the change in the recommendations and it was against the advice of our own nutritional expert, Professor Yudkin and Professor Phillip Handler, a biochemist
    and at that time the President of the American Academy of Sciences even testified before the Senate and in effect said that if the recommendations were adopted then this would constitute the largest experiment ever conducted on the American population. It was and it has been a disaster.

    By the way, America now seems set to reverse its dietary guidelines and remove its embargo on cholesterol, fat and salt and warn against the over consumption of carbohydrate – if it can perform the U-turn without
    anyone noticing.

    Finally, just a few words concerning the relationship between blood glucose and cancer. This relationship was established nearly 100 years ago when Otto Warburg demonstrated that cancer cells can no longer utilise fat and therefore must gain their energy from glucose. In order to do so they organise their biochemical pathways so that they can utilise glucose at a greater rate to compensate. He received a Nobel Prize for his work in the 1930s and we now know why this occurs at the cellular/molecular level. Unfortunately the methods of treatment have still not changed to reflect the fact that cancer is principally a metabolic disease – not a genetic one.

    Obviously, cancer cells possess an Achilles heel in that they must have a rich supply of glucose to further their aggressive character – healthy cells do not. You would think that there would be cries of “Eureka” – but there is silence.

    Why are we not making use of this knowledge?

    When Warburg was a boy, about 1 person in 10 got the disease – now only around 100 years later, the rate is nearly 1 in 2 with people succumbing at an ever younger age. Yet we have known from the work of medics/anthropologists who studied the hunter/gather populations how free they were of this disease at all ages –
    until they adopted the Western diet.

    • Tarek

      Agreed.

    • Exactly …”why are we not making use of this knowledge?” From a cynical perspective, I would conclude that there are far too many “commercial interests” involved regarding the the “dietary requirements” of the western world.
      Sadly, it would seem that our “best interests” regarding nutrition are being undermined by commercial, and hence, socio/political considerations which only pay truly cynical and dishonest lip service to the current obesity epidemic.
      And it is that …an epidemic …something that could eventually be treated, through the process of Education.

    • Fiona1933

      so do you advocate avoiding all grains?

      • Dr Charlie, a biochemist

        Fiona 1933 – an interesting question.

        I suppose we should differentiate between grains by separating them into those that contain the glutens, as well as starch, and those that do not contain gluten – only starch.

        If we deal with the latter first – then the rapid production of glucose from the starch has been linked to – insulin release and obesity and diabetes by the mechanisms outlined above; promotion of the growth of the vast majority of cancer cells (again mentioned above); epilepsy; and dementia.

        Since I have not mentioned the last two before, I’ll give a brief word. Firstly, it has been found
        that the sooner a baby is taken off breast milk – the more likely it is to suffer from epilepsy. Secondly, we now know that a baby fed breast milk is in mild ketosis – ie it is using fats and
        ketone bodies for energy and to sustain the rapid growth of the brain. It does not seem surprising to me that if the diet of the baby is changed too quickly to a carb regime that trouble could
        occur and it seems to offer an explanation of why the adoption of a very controlled, very high fat diet (as adopted in the John Hopkins University Hospital in the 1930s) brings relieve to the infants suffering from this disease.

        Dementia may have several causes, but again it seems to becoming clearer that one may be due to the resistance to glucose uptake in the brain and this would explain why a high fat, ketone producing diet may help control the disease by offering an alternative energy supply.

        Going onto gluten, we know that this material interferes with the controlled production of the hormone zonulin in the cells of the gut, causing their tight junctions to part and allowing various partially digested proteins produced from the food/gut bacteria to enter the body. This stimulates the immune system into action to counter the threat. Unfortunately in some people the response causes the destruction of the gut but in others the auto-destruction can occur in other tissues.
        So as well as the inflammatory bowel diseases, depending upon the tissue affected, we can have the following autoimmune diseases – arthritis, type 1 diabetes, ankylosing spondylitis, psoriasis, lupus and many more. Again the number of cases of bowel disease has risen sharply since the change to our dietary recommendations.

        So I try to stay away from all grains, especially those containing gluten, like wheat. Although
        carbohydrate is not a human dietary requirement, some people say that they do feel better with a small amount of carb in their diet, say 50 to 100 g per day obtained from potatoes, sweet potatoes, carrots etc.