What Science Got Wrong About Weight Gain

Coming up on this mini episode of the Doctor's Pharmacy.

Such a pervasive myth that weight gain is all about calories in, calories out. Why did we get it so wrong? And how do we not sort of stay stuck in this idea that all calories are the same?

Hi, I'm Kasia Perowicz, one of the producers of the Doctor's Pharmacy podcast. Although many scientists and nutrition experts would have us believe that eating and gaining weight is as simple as calories in and calories out, we know this isn't true. Dr. Hyman spoke to investigative science and health journalist Gary Taubes about how this myth originated and why it's the quality of the calories you eat that matters most.

So you were on an interview video with a panel with a trainer from the Biggest Loser who was saying that weight gain is all about calories in and calories out. It's such a pervasive myth and it isn't just a math problem. It's energy balance, calories in, calories out. And you're proposing a different idea which suggests that it's not about the calories, it's about what calories you eat.

So can you take us down into how that works? Macronutrients influence insulin differently. So carbohydrates stimulate insulin secretion, protein stimulates in a little bit, fat does not. So you basically, you think of your fat stores as like the wallet that you go to the ATM, you take money out of the ATM, that's the food you're eating and you got to do something with it. So you put it in your wallet, but you got to be able to get it out of your wallet freely when you need it. And insulin doesn't let you get it out of your wallet.

So as long as you're eating a high starch sugar diet, you can't get the money, namely the fat, out of your wallet or namely your fat cells.

Yeah, it's, you know, what happened is, and there was a lot of discussion back then, that carbohydrates are turned into fat when you eat excess carbs and they're not really turned into fat. That's a difficult process for your body to do when it's energy expensive and it doesn't do it that much. But what your body does is make sure you burn the carbs and when insulin's elevated, that's what you're burning. So it's not only telling your fat tissue to store fat, it's telling your lean tissue your muscles and your organs to burn carbohydrates and not to burn fat. Yeah.

Can you take us down into how that works?

It comes out of the history of modern nutrition from the 1860s onward. The entire science of nutrition was measuring the calories in food and the calories expended by humans. That's one thing they could measure because it had this device called a calorimeter. It was invented in the 1860s. And then you could study vitamin and mineral nutritional deficiencies, you could study protein deficiencies, fiber deficiencies, things like that. This is what nutrition science was. So by the early 19th century, early 20th century, when it comes around to developing a hypothesis of obesity, it was hard to see how vitamins and minerals and protein could be involved. So, but you had these calories thing and you had physicists talking about the laws of thermodynamics. So you come out with this Energy balance hypothesis, because all you can measure is energy. And then the science of nutrition doesn't kick up the science of endocrinology. So you know how foods, how much energy is carried into the body. You don't know how foods influence hormonal states because you can't measure hormones. It's not until 1922 that insulin's discovered. The whole science of endocrinology is a sort of inchoate thing that most physicians and researchers know nothing about.

I mean, the problem with the law.

Of thermodynamics is not that it's false. It's just doesn't tell you tell you anything about why we get fat.

It's true, it's physics, it's not biology. So when you mix physics and biology, it gets confusing.

When endocrinology starts to emerge as a viable science in the 1920s, the endocrinologists really aren't thinking in terms of obesity. It's not something they study. Then World War II comes along and everyone's starving. It's not an issue. And by the time that 1959-60, when Technologies invented that allows you to measure hormones and the bloodstream accuracy. It's a revolution in the science of endocrinology because now you could actually measure hormones. Hormones. And you could figure out their effect on, you know, end points, tissues, organs in the body. The field of obesity is basically dominated by psychologists and psychiatrists who are trying.

To figure out why fat people eat.

So much and how to stop it. It's a moral failing. It's a more, well, they might not think about it that way, but they're, they're gonna try and It's because you have your willpower. They treat it as much, yeah. You don't have willpower and so how can we get fat people to eat less? That's what they're doing, that's what they care about. And they're not endocrinologists, they don't care about hormones, they believe that a hormonal explanation of obesity is like an excuse for fat people to get to do whatever they want. This stuff happens in science all the time, people get the wrong answer, they push wrong hypotheses for decades, but in this case there are huge implications. for us and for obesity and the prevention and treatment.

So then when you sort of started thinking about this, you sort of realized it was this whole body of literature that was pointing in the wrong direction from where we're going. But it was sort of ignored. And so you've been really bringing that information research to light.

But that's, yeah.

And explaining how we get fat has nothing to do with energy balance, which is yet what all nutritionists, doctors, scientists, Governments and food industry are all telling us there's no good and bad calories. You have big gulp, which has 46 teaspoons of sugar and 750 calories. It's exactly the same as 21 cups of broccoli, which has a half a teaspoon of sugar and 35 grams of fiber, and they're exactly the same.

Again, the idea that obesity is just a hormonal regulatory disorder. And this was another German idea. It was gaining traction. It actually sort of won over the German research community and by the late 1930s, The Germans and Austrians were doing the best medical research in the world. And then the war comes and it just evaporates. But the idea is it's got to be a hormonal regulatory disorder and there are all kinds of ways that that's clear. You just look at how people fatten differently. Men and women fatten differently. So men get fat above the waist, women below the waist. It tells you that sex hormones are playing a role. You could have sort of isolated areas of fat accumulation. So the question is in effect what regulates fat storage? in different fat depots in the human body and clearly hormones are playing a role and everyone always knew insulin played some role because type 1 diabetics who lack insulin can't store body fat. Yeah, I mean, they can't metabolize the fat, they can't burn the fat that they eat, they can't store it. That's right.

So they can't store it. Like as a doctor treating type 1 diabetic, when they come in, they're producing zero insulin. Yeah. They're eating 10,000 calories a day. They're starving. They're hungry and they're losing weight even though they're eating 10,000 calories a day. So how could that be?

Yeah, and that also tells you that there's a disassociation between caloric intake and fat accumulation, and that insulin is in that pathway. And so the 1960s, I said you get this science of endocrinology suddenly, and by 1965 or so, it's been pretty well worked out how insulin regulates fat accumulation. It does it through a the whole, you know, sort of sea of enzymes and receptors. It sort of locks it in the fat cells and you can't get it out.

Exactly.

So, and this is textbook medicine. Yeah, it's so startling, Gary, to me.

That the science is so clear and yet the practice of medicine is so far from the science.

Well, because the practice of medicine has always been about energy balance. So the same textbooks that will say fat cells get fat because of elevated insulin. we'll tell you that obesity is caused by taking in more calories than we expend. There's this disconnect. Yeah, so anyway, that's the gist of the science is you elevate insulin, you store fat. You want to get rid of the fat, you have to drop insulin.

So how do you do that?

That's the good calories, the bad calories.

What are the bad calories?

So the good calories by this paradigm, and it's very much a paradigm, are fat, healthy fats, and we could discuss what those are and what aren't. And the bad calories are going to be carbohydrates, the more refined and fructose-rich, the bad calories, the more they're going to work to elevate insulin and keep fat locked away.

The take-home message is this: food is information, quality matters more than quantity. Telling someone who's overweight that all he or she has to do is eat less and exercise more is like telling someone who's poor that all he or she has to do is make more and spend less. These kinds of simple equations ignore many factors. What makes us thin, fat, or somewhere in between does indeed have something to do with how much we eat and exercise, but the oversimplification stops there. When calories are burned in a laboratory, they are all created equal and release the same amount of energy. There is no difference between a thousand calories of broccoli and a thousand calories from gummy bears until they are metabolized. Your body is not a laboratory. The calories you eat are absorbed at different rates, have different amounts of fiber, carbohydrates, protein, fat, and nutrients, all of which translate into different complex metabolic signals that control your health and your weight. Remember, the quality of the food we put into our bodies drives our gene function, metabolism, and overall health. I hope you enjoyed this mini episode of the Doctors Pharmacy Podcast. Thanks for tuning in. Hi everyone, I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. it's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

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