Cutting calories, counting calories

Despite abundant evidence that reducing calorie intake is 1) ineffective over the long-term, 2) harmful, and 3) miserable, the majority of people continue to believe that cutting calories is an effective method to lose weight. It’s expressed by doctors, for instance, when they echo the silly phrase “move more, eat less.” Or dietitians who offer useless advice like “push the plate away” or “use smaller plates to make your meal look bigger.” Or, worst of all, “eat many small meals every two hours”—disastrous advice. Imagine I told you that, to quit smoking, drink a bottle of vodka to subdue the impulse—absurd advice that does not work. Advising you to reduce calories is equally ridiculous.

The same principle applies to pharmaceuticals and bariatric procedures like lap-band and gastric bypass: they exert their effects largely by leading to reduced calorie intake and are thereby accompanied by all the same adverse effects (as well as side-effects unique to the drug or procedure, such as the inevitable small intestinal bacterial overgrowth, or SIBO, that develops with gastric bypass, a major impediment to long-term health and weight management).

Among the problems that emerge when you reduce calorie intake by these methods:

  • Loss of subcutaneous fat more than visceral fat. It surprises many people that the problem is not obesity per se. It’s how much fat is in the abdomen surrounding organs like the intestines and liver. Abdominal fat is inflamed, exports inflammatory mediators to other parts of the body, and drains via the portal venous system directly to the liver, exposing the liver to inflammation. Subcutaneous fat is not inflamed, does not emit inflammatory mediators, and does not drain to the liver. Cutting calories tends to favor loss of subcutaneous (buttocks, thighs, arms, face, neck, etc.) more than abdominal visceral fat, thereby not yielding the full benefit of weight loss (likely one of the reasons behind the so-called “Ozempic face” phenomenon).
  • Loss of muscle—Typically, one-third of weight lost by reducing calories is muscle. If you lose 50 pounds via calorie reduction, around 17 pounds lost is muscle. This carries serious implications for future health. Loss of muscle means that basal metabolic rate drops and you regain weight even when you maintain a low calorie intake. Formal study of the Biggest Loser TV show participants showed that, despite the spectacular weight lost accomplished during show due to a reduced calorie diet and extreme exercise, all the weight was regained even though participants maintained a reduced calorie intake and moderate exercise program after the conclusion of the show. Did you catch that? Let me repeat for emphasis: They regained all the weight despite maintaining a low-calorie diet and exercise program. In other words, losing weight by reducing calories virtually guarantees return of the weight. And, of course, the bulk of weight regained is fat, not muscle, making the situation worse with each cycle of weight loss-weight regain. Loss of muscle has also been associated long-term with increased potential for falls, fractures, frailty, and even an increase in mortality. Yes: cutting calories can be deadly.
  • Development of gallstones—Cutting calories or, worst of all, cutting calories and cutting fat, has been demonstrated to provoke formation of gallstones in a shocking proportion of people. Simple studies in which people underwent gallbladder ultrasound at the start and participated if no gallstones were present, then went on a low-calorie or low-calorie-and-low-fat diet, ultrasound repeated at 4,8, and 12 weeks. While results varied depending on the age and sex of participants, an incredible number developed gallstones starting as early as 4 weeks. In one study over 50% of participants developed gallstones over the course of the study, many necessitating surgery. Gallstones likely develop from the relative inactivity of the gallbladder, i.e., bile stored in the gallbladder that is not expressed and instead stagnates and allows formation of crystals that lead to stone formation. Cutting calories therefore leads to gallstone formation in a surprising proportion of people.

Is there a way to preferentially lose abdominal visceral fat and thereby achieve greater metabolic benefits such as reduced blood sugar and blood pressure, reverse fatty liver and high triglycerides, normalize hormones such as testosterone and estrogen? Is there a way to lose weight while preserving muscle and thereby basal metabolic rate? Is there a way to lose weight while keeping your gallbladder active and squeezing out bile so that stones don’t form? Yes, of course there is. You accomplish this by engaging in a lifestyle that reverses insulin resistance, inflammation, and endotoxemia, while not limiting fat intake. If you are engaged in any of my programs, whether called “Wheat Belly,” “Wheat Belly Detox,” “Undoctored,” “Super Gut,” or the strategies advocated in my, you are engaged in a program that does not reduce metabolic rate, does not cause loss of muscle, and does not lead to gallstone formation. It just leads to health, just as it did for the humans who followed this lifestyle for the first 3.5 million years that Homo sapiens followed such a lifestyle before doctors, dietitians, food manufacturers, and dietary guidelines got in the way.