Another Annoying False Dichotomy: Calorie Quality vs. Calorie Quantity

Warning: this post is all over the map. I tried to keep rambling to a minimum, but I didn’t succeed. Didn’t do much editing either, so let me know about any ridiculous typos :).

In the everlasting debate between the “calories don’t matter” mantra and the bastardized touting of the relevance of caloric intake in weight loss and weight gain to promote an agenda such as Coca-Cola’s recent ad campaigns, one side of the argument is lost in translation. Much like the Paleo vs. SAD false dichotomy, it seems that there is a blatant exclusion of the middle ground going on here. Knowing that calorie quantity matters is not mutually exclusive from placing emphasis on food quality. You can believe both are crucial at the same time.

I’ve been growing weary of arguing with folks on the internet, but when someone posts an article like this one, I feel the need to chime in.

The article is titled “Obesity expert explains why counting calories isn’t best for weight loss” (ironically, the article is posted on a site called Caloriecountdiet.com). I know I know, you’re probably thinking: not this again. Trust me, I feel your pain. I figured I would be tired of this topic after addressing a popular dietitian’s tirade about her hate for calories, but I guess I’m a sucker for writing about things that piss me off.

And the ‘calories don’t count’ message seems to do just that. Honestly, it’s amusing to me that this discussion even needs to take place. It is so painfully obvious that calories are the main arbiters of weight loss that it’s  silly. I’ll quote an individual I was conversing with on Twitter, NickM, who worded the issue quite interestingly: “Trumpeting “calories count” re diet is as fatuously unhelpful as “moles of O2 count” re breaths.” (I hope I’m not misinterpreting his quote here, and if I am, call me out on it!)

My question is: then why are people still proclaiming that calories don’t count? Why are people still touting the idea that only carbohydrates count, or only insulin matters, or eat whole foods and you won’t get fat, regardless of how many calories you consume? Why are people falling into this trap if the relevance of calories, in the context of weight management, is such an elementary concept? NickM argues that saying “calories count” is unhelpful, and in a sense I agree because it is a rather reductionist viewpoint that doesn’t say anything about the multi-factorial nature of body fat loss. But, for those who believe that calorie intake plays no role, it can be a message that is absolutely essential. There are endless examples of those who adopted a “whole food” diet, an Atkins diet, etc., and failed to lose weight.

Confusion ensues because they aren’t eating carbohydrates, they’re only eating whole foods, yet they’re not losing weight. What’s going on? The answer is right in front of their faces (excess calories), yet they’ve been misled to believe that calorie intake is irrelevant. It’s a shame, really.

To avoid rambling on, I’ll get to addressing some of the main points in the article I linked above, hopefully providing some clarity for those who are struggling with this murky issue.

Article Evaluation

The article begins with quite the strawman, stating:

“But obesity experts say focusing exclusively on counting calories without examining the quality of the calories you consume won’t result in long-term weight loss or optimal health.”

Quality certainly matters, no disagreement there. I do disagree, however, with the association between those who recognize the role that calories play in weight gain/loss and those who believe that quality does not matter in the slightest. This is a false dichotomy, as I mentioned above, and one that is worsened by recent Coca Cola advertisements. For those of you who are unaware, Coca-Cola recently launched a campaign that puts the calorie total of their products at the forefront. Now, whether this is good or bad depends on your perspective. Coca-Cola is a company looking to sell products, so the message that their product is low in calories, therefore it’s okay to drink is not exactly transparent.

However, saying that calories count is not incorrect, and I don’t think Coca-Cola is saying that food quality isn’t significant. Their beverage isn’t exactly the  pinnacle  of health (understatement of the year), but people should know this by now. It’s not healthy to guzzle a dozen cokes per day, regardless of how low in calories they are. I’m rambling a bit here, but I can see how some would be misled by the Coca-Cola advertisement. But let’s get real: people know by now that downing soft drinks is not healthy, just as they know smoking is not healthy, yet they choose to do it anyways. We know food quality is of great importance, it’s just a matter of whether or not we choose to act on this knowledge.

The point is: you don’t have to be on one side or the other. You can acknowledge the validity of the energy balance equation while understanding that food quality can have an impact on energy balance and overall health.

The article goes on to quote Bill Lagakos, in an excerpt from Jimmy Moore’s podcast. Mr. Lagakos states:

“The ‘calories in, calories-out’ paradigm is grossly simplistic,” Dr. Bill Lagakos said Oct. 17 on a podcast with weight-loss blogger Jimmy Moore. “It’s been repeated so often people accept it as true. [But] a calorie is not a calorie.”

I agree that ‘calories in, calories out’ is overly simplistic, in the way some say it. However, to address this issue, I will defer to Lyle McDonald’s post covering the energy balance equation. I listened to a bit of Jimmy Moore’s interview with Dr. Lagakos, and I found that he (Dr. Lagakos) misrepresented Lyle’s description of the entirety of the energy balance equation (I’m not going to hold this against him as he was somewhat “put on the spot”).

Here’s Lyle’s depiction of the energy balance equation:

Energy In (corrected for digestion) = (BMR/RMR + TEF + TEA + SPA/NEAT) + Change in Body Stores

As you can see, there’s a bit more to the equation than calories consumed vs. energy expended through formal exercise. There are many factors that play into the energy balance equation, so I will agree with Dr. Lagakos that simply saying “calories in, calories out” can be misleading and reductionist.

Also, a calorie is a calorie like an inch is an inch. It is a unit of measurement. But, I agree that not all calories are metabolized by the body in the same fashion, which I believe is what Dr. Lagakos meant in the context of his interview.

So far, nothing seriously wrong with the article, just a few minor points of contention.

However, things start to get a bit funky when the author of the article chimes in with their “pearls of wisdom” (for the record, I have no idea who the author of this article is, as there is no name associated with the site).

“For example, 400 calories of a rib-eye steak is not the same qualitatively as 400 calories in a Pop-Tart. The reason is because the low-carb steak and the high-carb Pop-Tart will affect the body’s blood sugar, insulin and other hormones in radically different ways.”

I probably shouldn’t even address this because it’s so ridiculously stupid, but I enjoy wasting my time. The first thought that comes to your mind after reading the above passage should be “duh”. Well, this sort of analogy seems to be commonplace among those who argue that quality of calories is the only factor that plays a role in weight gain/loss. First of all, 400 calories of rib-eye steak would obviously have exponentially more protein, causing greater satiety than a Pop-Tart, which has little volume and is mostly made up of fat and carbohydrates.  So, if you’re going to create an analogy honing in on food quality, at least compare foods with similar macronutrient compositions. And, as a side note, it’s always amusing when someone touts the radical difference in hormonal responses between two foods, yet they fail to specify what hormones they’re actually referring to. They typically only mention insulin, as if it is the only hormone in existence.

Moving on, the author posts another gem, almost rivaling the silliness of the analogy above:

Monitoring carb intake — over calories — is a better approach to weight loss, says Lagakos, because a low-carb diet has a smaller impact on insulin, the master hormone when it comes to weight loss.

Me thinks the author of this post has never delved into research on the topic of varying macronutrient compositions and their impact on weight loss. When calories and protein are controlled, there is no significant fat loss difference between high and low carbohydrate diets. Insulin, schminsulin. (Note: I’m not sure if Dr. Lagakos actually said the above, and because there are not quotations, I will assume that the author of the article is responsible for the blatantly flawed logic).

Claiming that insulin is the “master hormone” regarding weight loss is silly, as insulin is just one of the many hormones that play a role in body mass regulation (namely leptin, ghrelin, glucagon, the catecholamines, cortisol, etc.). If insulin was such a significant determining factor, how would high carbohydrate diets be comparable  to lower carbohydrate diets in terms of weight loss (1, 2, 3, 4, 5, 6)? Surely the higher insulin levels as a result of higher carbohydrate intake would be enough to stifle fat loss aspirations? But, they’re not. Macronutrient composition of the diet should be based upon individual preferences, not some unsubstantiated fear of carbohydrates or insulin. Adherence, regardless of diet type, is key (8). Monitoring carbohydrate intake when attempting to lose body fat would only be effective because of its impact on energy balance.

The author goes on to state:

“This is because high-quality dietary fat makes you feel fuller, longer, so you won’t get hungry as quickly. In contrast, the low-fat, high-carb diet formula long espoused by SAD (the Standard American Diet) is sure to produce increased hunger and body-fat storage.”

Let’s be clear: I’m not a proponent of any diet. Whatever gets the job done, whatever you enjoy, and whatever fits your personal preferences is what you should stick to. That out of the way, let’s address the above passage.

Based on reading that passage alone, it is quite clear that the author is an advocate of a low carb diet, which is fine. However, to say the SAD is a low fat diet is a bit misleading. Sure, the diet recommended by the USDA is low fat, but to assume that people actually follow the recommended diet is a gigantic leap of faith. I would contend that the SAD is more of a high carb, high fat, low protein diet. And as a result, it’s just freakin’ high in calories in general.

The author seems to be implying that higher fat, lower carb diets are more satiating than lower fat, higher carb diets. This may be true, but I think a big piece of the puzzle is missing here: protein. It seems that when someone switches to a high fat, low carb diet, they tend to spontaneously increase protein intake. So, in terms of hunger control, protein seems to be the determining factor over high fat content and low carb content (7). Whether either diet promotes body fat storage is going to be dependent upon…you guessed it, caloric intake.

Wrapping Up

I apologize for this post being a bit scattered. The main point I wanted to get across was that you don’t have to choose between disregarding calories and only focusing on food quality and only focusing on food quantity. Both matter. The quality of the food you consume can have a large impact on the quantity due to greater satiety and overall micronutrient content. However, attention must be paid to quantity as well, especially if the goal is fat loss. Do you have to diligently count calories? No, but you should be cognizant and have a general idea of the amount of food you’re taking in on a consistent basis.

This will give you the ability to make adjustments on the fly and moderate your food intake according to your individual goals and preferences.

So, both quality and quantity matter! It’s not either or, so don’t exclude the middle ground.

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