Good Calories vs. Bad Calories | JRE Obesity Debate

The point that we keep getting away from that I haven't had an opportunity to, and Stefan knows this as well as I do, if you're gaining say four pounds a year of fat, or let's say between 20 and 40 you've put on 40 extra pounds, so now you're obese, you're a nice lean healthy young guy in 20 like many of us were, and by the time you're 40 you've got 40 pounds of excess fat, that's the equivalent of putting in about 10 calories, storing about 10 calories a day into your fat tissue that you don't burn or metabolize, so you eat say 2700 calories a day, half carbs, you know, 35% fat, 15% protein, and 10 calories a day get trapped in your fat tissue. Less than a bite's worth of food, less than a sip's worth of beer. So the question we're actually trying to ask is, or answer, and this is again just my approach as a curious journalist with a science background is how do we explain those 10 calories, because when we talk about those obese women with starving children, all those obese women we're doing was storing 10 or 20 calories a day, depending on how quickly they became obese, and those populations that tends to happen quickly in their 20s. So we're asking this question, how do we, you've got a situation where we have to end up with 10 calories stuck in the fat cells every day, that's a 20, 30, 40 billion fat cells, so it's divided up very small, and is the brain somehow regulating that? Or again, is there a dysregulation in the body involving pick your hormones, pick your enzymes when, that somehow traps fat in the fat cells, or prevents the fat from being used for fuel when it's released from the fat cells? And so if you think about it that way, like you let yourself go to seed, today Joe Rogan decides I'm done, I'm going to do nothing but drink beer, and you might start drinking five beers a day, and over the course of 10 years you get 20 pounds, and it's all here. That 20 pounds over the course of 10 years is only about 20 calories, you might have added 800 calories of beer to your diet, and stored 20 calories as fat. How does that happen, and why does it go here, and not elsewhere? And as Stefan said, this is insulin dependent fat tissue. So those are that's when we're talking about this, like this question, can somebody get fat during a famine, or can they stay fat during a famine? All they have to do is hold on to 10 calories a day extra. If they're only eating 1200, 10 gets stuck in their fat cells, 1190 is excreted or expended. It's not that hard to imagine, and there's nothing in the laws of physics that says it, so what could be dysregulated about their fat cells, even during a relative famine, not a complete famine, but a relative famine that might be, and again, animal experiments of which there are probably hundreds by now, different animal models, you can disassociate obesity from eating too much in the animals. Can I pause you for a second? So essentially you're saying that even if someone is taking in a good amount of calories, a smart amount of calories, 2000 calories a day, if you're taking in these calories in the form of sugar, your body is going to take a certain percentage of them, even if you're getting enough food and stored as fat, whereas if you were taking in just protein and vegetables and things along those lines, your body would not do that. Well, so this is a, gets to the mechanism question and the evidence question. But you're saying that, right? So you're saying that if two people were on the same diet, one of them is on 2000 calories of chicken and fish and vegetables, and the other one is on 2000 calories of milkshakes and sugary drinks and pasta and bullshit, that that person is going to gain a certain amount of calories and just put them to fat regardless. Right. That's, yeah, that's the hypothesis. Same activity. And that hypothesis, this being a science, that hypothesis can be tested. And as Stefan thinks, it's been tested 80 times. So Stefan, you're- I think it's, they've done a bad job of testing it and we will both tend to reject the studies that we don't like when we define don't like by whether or not they got the answer we think is correct. Your perspective is that this is not the case. Your perspective is that like, as you were saying in the study where they closely monitored these people's diets and they added additional fat and additional carbohydrates, that they both gain the same additional amount of weight. Yeah, that's right. I mean, if curious hypothesis is correct. You have to see different levels of fat gain. I mean, Gary- Was it a short term study that they did? Yeah, it was short term. How short term was it? Two in three weeks. Well, that's very short term. Yeah, it is very short term, but still. Well, Gary says that insulin is the thing that gets fat in fat cells and that, I mean, you would see some kind of difference. If insulin made any difference, you should have seen some kind of effect, right? Some kind of difference in fat gain. Well, actually, I don't want to start taking out charts, but this gets into insulin dynamics that was worked out. So over a ... I promised I wasn't going to say oi, oi on the show, but it's my, thanks to my Brooklyn-born mother, it's my program then. And the same is true. A lot of these overfeeding experiments do the same thing. So when they talk about overfeeding, they literally overfeed. So they kind of do a reasonable way of figuring out what you're eating. Stefan said they measured, they calculated how much energy they needed to stay in energy and balance. And again, right there, that's a problem because one of the hypotheses says that the energy balance is dependent on the macronutrient content of the food. So you're going to get a different level depending on what the macronutrient content is. And then ... Different level of ... Of what's necessary for energy balance. So the classic example is a study that's my not-for-profit funded that's been very controversial, where they got their subjects. This is David Ludwig and Kara Ebeling and their colleagues at Harvard and Boston Children's Hospital. And they did this study in Framingham and they basically got subjects to lose 10 or 12% of their body weight. And then they randomized them to three different diets of three different macronutrient compositions. And they basically calculated their energy expenditure on the three different diets, which is kind of exactly what we're talking about. Because if you want to be in energy balance, you know you feed people exactly what they're expending. And in that study, which was published a year ago, and they saw different levels of energy expenditure depending on the carbohydrate content of the diet. So the higher level of carbohydrates, this is trying to keep them in energy balance. The higher the carbohydrate, the lower the energy expenditure. The lower the carbohydrate, the higher the energy expenditure. So again, it's just whether or not they did the study right. Who knows? Science is a compilation of a lot of studies and we're trying to address exactly this point. But merely building that into the experiment, we know what their energy expenditure should be. And then the point is when you increase and again, part of the trick of doing science is to say, look, we have competing hypotheses, multiple hypotheses. And it's vitally important that you always keep the multiple hypotheses in mind when you're interpreting the study. So one hypothesis says it's how much they eat and another hypothesis says it's what they eat and that what they eat is moderated primarily through insulin. And when you do these experiments, like the experiment that Stephen is talking about, Stephen, I'm completely confused. If you overfeed them, you start out with a 50% carb diet, now you overfeed them. If there's a threshold effect on insulin, which it turns out there is, then you're just moving them. And when you look at insulin dynamics, when insulin is below a very low point, the fat cells will mobilize fat and the lean tissue will burn it for fuel. And above that point, you get pretty much flat. So if you start people who are eating 1500 calories from carbs and you add them, bump them up to 2500 calories from carbs, you're still in the plateau side of the insulin. You wouldn't necessarily expect to see any difference. The only way you expect to see a difference, and this is why it helps to really interrogate both hypotheses so that you know when you're doing the experiment whether or not you're actually testing something you want to set up the experiments that a hypothesis predicts. The two hypotheses predict something entirely different. This experiment, arguably the two hypotheses predict the same thing. You'll get fat gain because insulin is elevated regardless. And when insulin is elevated, you're going to get fat gain. The question comes back to this again, always vital to keep this in mind. What could possibly cause a 10 or 20 calorie excess that causes fat storage? I have a friend that was 400 pounds when he was 18. He was a tall kid, about 6'5". He was say 200 pounds overweight. 200 pounds overweight is roughly 100 excess calories over 18 years stored in your fat cells. Even if you assume that you have to consume 300 calories to have 100 excess stored in your fat cells, that's two Coca Colas a day that he was drinking or one half a quarter pounder a day that he was eating that his lean friends weren't. The question would be why can't he just stop doing that? Again, Stefan would say because his brain won't let him. I would say because his insulin is elevated, it doesn't matter whether he stops it or not. He's got an interesting underlying mechanism. Okay. All right. So now, again, it's easy to tell stories. It's not easy to tell stories that are supported by scientific evidence. Now I want to bring people's attention to reference number 11 on my site. There have been 29 studies now that have measured differences in energy expenditure, metabolic rate. Is this the Kevin Hall study? I think it's meta-analysis, correct? There have been 29 studies to date that have measured calorie expenditure, metabolic rate on diets differing in carbohydrate and fat content. When you put all those studies together, or at least the first 28 together, and you look at what the overall literature says, it makes almost no difference to metabolic rate, whether people are eating carbohydrate or fat. In fact, this very small difference that it does make actually favors high carbohydrate rates. So you get a slightly higher metabolic rate when the diet is predominantly carbohydrate. Now this study that Gary cited is the one study out of these 29 that has reported a larger effect than any others of carbohydrate restriction on energy expenditure. So this study reported an effect bigger than any of these other 28. And the difference we would say is Gary, I'm not done. Gary, please. Thank you. And interestingly, if you actually look at the data, and these data have been reanalyzed by a researcher named Kevin Hall, and if you look at the data, you find that some of the participants, some of the data that represent some of these participants are literally physically impossible. They break the first law of thermodynamics. This is a conservation of energy. Gary knows about this. He has a physics background. And they literally don't add up. And when you start subtracting the clearly erroneous data from the pool of subjects, this big effect size starts to shrink and shrink and shrink and shrink until after you've gotten rid of all of it, this study does no longer reports a higher energy expenditure on a very low carbohydrate diet. And it's consistent with the previous 28 studies that were done. So that's my perspective on that. But I want to go back to this. And if you know, Gary, you've started for a long time, and I'm going to talk for as long as I want now. I want to talk about human energy metabolism and this idea of the 10 extra calories a day. Gary, I really continue to get the feeling that you do not understand human energetics, because that's not how it works. Well, now I'm just saying 10 calories stored in a fat tissue. That's just problematic. 10 calories. I didn't say anything about how much you have to eat. I'm not done. Okay, no, but you're insulting me. You got to stop doing that, dude. Gary, keep acting like you think I'm an idiot. All right, are you done now? Are you done? Can we be clear that we're talking about? Are you done now? Can I just finish this? No, you can't. Until I'm done without Gary, you have time to respond. You can respond, write down notes on what you want to respond to. And after he's done, you can do it. But we're going to get a long discourse on something that's not the point. Well, it is the point. Thank you. Now, what you see, there's basically two things you need to pay attention to here in terms of energetics. One is the imbalance between intake and expenditure. And that is very small. So it only takes a little bit of extra calories to cause somebody to start gaining fat. However, as they gain fat, their bodies get bigger, they're gaining fat and lean mass. People with obesity have more fat, more lean mass, and their calorie needs go up and up and up the larger their bodies get. And so even though the imbalance between energy and taking expenditure is small, their calorie needs end up being quite a bit higher. Can I pause for a second? Yeah. So you're saying that someone just gaining calories, eating additional calories, their body gains lean mass as well as fat? Yeah, that's correct. How does the brain regulate that? I didn't say it regulated that. Well, hold on, Gary, Gary, Gary, hold on. That's fascinating. How does the brain do that? Is muscle muscle? They're gaining muscle tissue? Some of it's muscle, some of it's liver and organs. Is this because they're carrying around this extra weight? And so the extra calories and then on top of that carrying around the extra weight forces their body to grow larger? Presumably, I'm actually not sure what the mechanism is. But it doesn't have anything to do with the brain. It's just a coincidence. I don't know what it causes. That's what I'm saying, Gary. So, but the point is by the time the person has obesity, they are consuming 20% to 35% more calories than they were when they were lean. So that's not just one or two cokes a day that is allowing them to remain obese. They are consuming 20% to 35% more calories. That is what the most accurate studies are saying. And so it's not just 10 extra calories or maybe just one or two cokes. We're talking about a substantial amount of extra calories. But isn't this a generalization because we don't know, I mean, what's the ratio of how much fat people are, how much weight people are gaining? Everybody gains a different amount of weight. Like when you're saying they're eating 20% to 30% more calories, like who is? Like how much are they gaining? People get fat, they get 20 pounds overweight. People get fat, they get 100 pounds overweight. They mean it varies widely. Yeah, and that's why I give a range because what you see is that people who are overweight, so they're in the overweight range, you just have some extra fat, they eat about 10% extra calories. People who have a little bit of obesity eat about 20% extra calories. People who have very, very great obesity eat more like 35%. So it tracks with the amount. I'm sorry, is it possible what he was saying that if you do consume 10 extra calories over long periods of time, that will accumulate? No, it's not 10 extra calories, you're accumulating 10 extra calories. So it's like a dime is going into the bank, so how much do you have to deposit to get the dime? It is correct that if every day you eat 10 calories more than what you need, then yes. Or your body stores. Yeah, we'll say that. If your body is storing 10% extra calories over top of what you need, but the thing is that as you get bigger, what you need goes up and up and up. Because you're carrying around more. Correct. And so it's 10% and 10 extra calories, sorry, not percent, it's 10 extra calories on top of the elevated amount that you're already eating. So you end up with these big differences in calories take. So that's how that's how it really works.