We've all heard it and it makes so much sense it is obvious to anyone that it drives everything about obesity.
Calories in vs Calories out.
If you eat more than you need you'll get fat.
If you use more than you eat you'll burn fat.
But is it really that simple? I listened to a couple podcasts with science writer and author Gary Taubes who has a different idea on the question - why do we get fat?
The main one I'll focus on where you can find much of the following is The Drive Podcast episode #167 with Peter Attia M.D.
Gary first looked into nutrition in the late 90's to do a quick article about a diet study. He quickly found, just like his past work in reporting physics research, that nutrition is filled with “pathological science” or research tainted by bias.
Now, this is an incredibly long podcast, if you're interested in hearing about all the pitfalls and biases that can be present in many scientific fields, I think it's well worth listening from about 30 mins in. To get straight into nutrition, epidemiology and public health you'll need to jump ahead to 1 hr 24 mins..
Through his work in nutrition he began to question the science around both dietary fat and then obesity.
When doing an article about fat in the diet he talked to an administrator from NIH (National Institutes of Health in the USA) who said this:
"When we told people to go on low fat diets in 1984... we thought if nothing else they'd be avoiding the densest source of calories in the diet so if they avoided fat they'd lose weight... and low and behold now we have an obesity epidemic. Apparently people stopped eating fat, started eating carbs and that got them fatter"
Taubes decided to write an article about the obesity epidemic and came across 5 trials in which the Atkins diet (high in fat with no restriction on calories) was compared to a low fat, calorie restricted diet.
All 5 found people lost more weight on the Atkins diet.
Despite this he still wrote in the article that being “overweight ofcourse is caused by taking in more calories than you expend" which he says he now thinks is "both wrong and meaningless".
So why do we get fat?
Doing his research he came upon pre WWII research from Europe saying obesity is not an energy balance issue but a hormonal regulatory disorder. This is the hypothesis he argues for.
That work implicated insulin as the hormone determining fuel availability.
Now we get to the real crux of the issue and it is very important that we make this important distinction.
From the standard way of thinking, when people consume more energy than they burn it gets stored as body fat and if that continues over time they get obese.
The hormone hypothesis flips this thinking on its head.
It suggests that if fat cell metabolism is dysregulated this leads to preferentially storing calories as fat (rather than burning them, storing in muscle etc.) which then leads to hunger as the body feels as though there isn't enough energy and causes overeating.
I'll try to simplify and repeat that for clarity...
Either we get fat because we eat too much or we eat too much because our bodies don't allow calories to be released from fat.
One more time just in case. Eating too much could be the cause of obesity or it could be a symptom of the underlying fat cell/hormonal dysfunction.
"If your liver thinks there's enough fuel available then you’re not going to be hungry, if it thinks fuel is scarce it will release inhibitions on food seeking behaviour."
From the 1930's to the 60's studies into fat cell metabolism were showing that even starving people are still storing and burning calories in/from fat tissue. Gary asserts that all of this research is left out of the science of obesity and the sole focus is on energy imbalance
Of course, conventional obesity scientists refute that a) they've ignored fat metabolism, and b) that obesity is caused by hormonal dysregulation.
For me, in my personal experience I see a lot of truth in the hormonal hypothesis and I think the fact that what we as a western culture are currently doing isn't working suggests other causes are worth considering.
So what could be driving this dysregulation if indeed this is the cause?
As previously stated, insulin is a large player and so we would need to control insulin from being too high for too long (a good idea anyway).
Naturally eating a high carbohydrate diet can cause insulin spikes but refined carbs, junk food and sweetened drinks would be much more likely to cause the dysregulation proposed in the hypothesis.
Also poor sleep patterns, high stress levels, and a lack of exercise (particularly strength training) all lead to elevated insulin and insulin resistance.
Other factors to consider would be environmental endocrine (hormone) disruptors such as plastics, certain ingredients in beauty products and pesticides although paying attention to the big rocks referred to above, i.e. diet, sleep, stress and exercise, will likely be more than enough.
And so we're left with these recommendations if you want to lose body fat:
Get quality sleep,
Manage your stress,
Exercise consistently including resistance training and,
Eat a healthy diet (maybe with a low carb focus).
Basically, live a healthy lifestyle!
It always seems to come back to that...
I'd love to get your response.
Do you agree that hormonal dysregulation is a plausible cause of obesity or do you think it's all about the calories? How will you use this info in your life if you found it interesting?
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