What if everything you ever learned about weight loss was wrong? What if losing weight has nothing to do with calories -- counting them or cutting them out by sheer willpower? What if, in fact, most health professionals (including doctors and dietitians), our own government and especially the food industry are giving us weight loss advice guaranteed to make us fat?
Here's their mantra: "Eat less and exercise more. The secret to weight loss is energy balance. There are no good or bad calories. It's all about moderation."
If you doubt that this advice could be wrong, just look around. We have tripled our obesity rates since 1960, and in the last decade, cases of Type 2 diabetes in children have increased by over 30 percent. In 1980, there were no children with Type 2 diabetes (formerly known as adult onset diabetes), and now, there are over 50,000. Seven out of 10 Americans are overweight. The advice is not working. Could it be the wrong advice?
Nobody wakes up in the morning saying, "Hey, I want to gain weight today. I am going to overeat. I want to be fat."
Rather, we have a $60 billion weight loss industry. It specializes in helping people count calories, eat less and exercise more. When are we going to realize that that our approach -- as a scientific community and as policy makers -- is failing miserably at stemming the tsunami of obesity and related health, social and economic costs?
Could it be we have it all wrong? Could it be the world is round, not flat, even though it looks flat, just as it seems that if you eat fewer calories than you burn, you will lose weight?
The answer is yes. Our focus on calories has missed the mark entirely. Even if you held the Guinness world record for calorie counting, you could easily be off by 100 calories a day. Do that for 30 years, and you will be 20 to 30 pounds overweight.
The End of Counting Calories
David Ludwig and Mark Friedman published the most important scientific paper in the Journal of the American Medical Association since the Watson and Cricks paper on DNA in 1953, which changed our whole way of thinking about genes. They also explained their findings in the New York Times piece, "Always Hungry? Here's Why."
It's not that Isaac Newton and his first law of thermodynamics was wrong. It's right -- energy is conserved in a system. This is the whole foundation of our calories in/calories out, energy balance concept of weight loss. Just eat less and exercise more, and all the pounds will melt off.
But there is one fatal flaw in that thinking. The law states that energy is conserved in a "system." It is true that, in a vacuum, all calories are the same. A thousand calories of Coke and a thousand calories of broccoli burned in a laboratory will release the same amount of energy.
But all bets are off when you eat the Coke or the broccoli. These foods have to be processed by your metabolism (not a closed system). Coke and broccoli trigger very different biochemical responses in the body -- different hormones, neurotransmitters and immune messengers.
The Coke will spike blood sugar and insulin and disrupt neurotransmitters, leading to increased hunger and fat storage, while the thousand calories of broccoli will balance blood sugar and make you feel full, cut your appetite and increase fat burning.
Same calories -- profoundly different effects on your body.
Is Your Fat Hungry?
Dr. Ludwig, for the first time, explains why. It's not overeating that makes you fat. It's being fat that makes you overeat. Once you start to consume refined carbs, such as bread, rice, potatoes, pasta and any form of sugar, you start making a certain kind of fat cells called VAT or visceral adipose tissue.
This is no ordinary fat. It is super fat. Hungry fat. Dangerous fat. This fat starts an inexorable cascade that leads to obesity. It's like falling down an icy slope where it's almost impossible to stop yourself. You need a big ice axe and crampons. We ordinary mortals are no match for this hungry fat.
Here's what happens.
Those hungry fat cells suck up all the available fuel in your blood stream (glucose, fats, ketones). Your body then thinks, "Oh, my god, I am starving. I better eat more and slow my metabolism, so I don't die." The problem is, anything you eat gets sucked up into those fat cells around your belly, leading to a vicious cycle of hunger, overeating, fat storage and a slowing down of your metabolism. No wonder we gain weight and can't lose it.
The key trigger for all this is a simple common hormone that we all need (but not too much of).
If we make too much insulin, it drives the fuel in our blood into our fat cells. Too much insulin also does a lot of other bad things like cause heart attacks, high cholesterol, Type 2 diabetes, cancer and dementia.
When it comes to causing spikes of insulin that start this miserable chain reaction, not all calories are created equally. Sugar and refined carb calories are the culprits. Americans eat, on average, about 152 pounds of sugar and 146 pounds of flour a year (almost a pound of sugar and flour per person per day!). These are actually pharmacologic doses of sugar and flour!
Eat More Calories, Weigh Less?
There are many studies showing just how different sugar and fat calories are. Most scientists still hold on to the dogma that fat makes you fat, that fat causes high cholesterol and that low fat is the way to go to live a long healthy life. Plenty of evidence proves otherwise. What if the fact that this conventional wisdom is completely wrong is what has actually caused our obesity epidemic?
Dr. Ludwig points to studies in which all calories are held to be equal, but those participants kept on a low sugar and refined carb diet burned 325 more calories a day than those eating a low fat diet. Bottom line: Eating a high carb, low fat diet slows down your metabolism.
Most striking was an animal study (and yes, we are not animals but the results are still very impressive). The study found that animals eating a low fat diet put on 70 percent more body fat even while eating fewer calories than animals eating a low carb diet.
Let me say this again. Animals eating a low fat diet and fewer calories got fatter than those eating more calories and a low sugar and carb diet -- 70 percent fatter.
If you restrict your calories, you will end up triggering very ancient biological adaptions that protect us from starvation. You will slow your metabolism and get a lot hungrier.
You can't voluntarily control your weight over the long term. Willpower is no match for these ancient programmed hormones that make sure you don't starve to death.
The Key to Automatic Weight Loss
Dr. Ludwig proposes a novel, radical but scientifically true way to solve the obesity epidemic once and for all.
Don't worry about how much you eat, because you will never be able to control that. Rather, focus on what you eat, the quality of the food you eat, the composition of the food you eat (high in fiber, good quality protein and fat, low in starch and sugar). Then, you won't be hungry and will shift from fat storage to fat burning. And you will prevent most chronic disease including heart disease, Type 2 diabetes, cancer and dementia.
10 Take Home Lessons: Forget the Calories, Focus on the Quality of Your DietHere are the take-home lessons from Dr. Ludwig's paper:
- Overeating doesn't make you fat. Your fat cells make you overeat.
- You make hungry fats cells by eating sugar and refined carbs.
- Restricting your calories will slow your metabolism, make you hungry and guarantee that your weight loss attempts will fail.
- Eating a higher fat, higher protein, lower sugar and refined carb diet will speed up your metabolism and cut your hunger.
- Controlling what you eat is much easier than controlling how much you eat.
- Forget calorie counting. It's not about the calories but about diet quality and dietary composition. Just try eating 1,000 calories of broccoli.
- End our scientifically-outdated position that all calories are equal and weight loss is simply a matter of eating fewer calories than you burn.
- Lower insulin by a sugar detox, and watch your body lose weight effortlessly without hunger or cravings.
- To learn more, watch the movie Fed Up or read The Blood Sugar Solution 10-Day Detox Diet (my medically-designed program to cut insulin and detox from sugar and refined carbs).
- Stop blaming yourself for lack of willpower, and start empowering yourself by eating real, whole, fresh food that's low in sugar and starch.
Wishing you health and happiness,
Mark Hyman, MD
Correction: An earlier version of this post said David Ludwig and Mark Epstein published a piece in JAMA. The piece was by David Ludwig and Mark Friedman.