The Obesity Code. Jason Fung

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СКАЧАТЬ an insulin response from the pancreas. Olive oil will not. When olive oil is absorbed by the small intestine and transported to the liver, there is no significant increase in blood glucose or insulin. The two different foods evoke vastly different metabolic and hormonal responses.

      These five assumptions—the key assumptions in the caloric reduction theory of weight loss—have all been proved false. All calories are not equally likely to cause weight gain. The entire caloric obsession was a fifty-year dead end.

      So we must begin again. What causes weight gain?

       HOW DO WE PROCESS FOOD?

      WHAT IS A calorie? A calorie is simply a unit of energy. Different foods are burned in a laboratory, and the amount of heat released is measured to determine a caloric value for that food.

      All the foods we eat contain calories. Food first enters the stomach, where it is mixed with stomach acid and slowly released into the small intestine. Nutrients are extracted throughout the journey through the small and large intestines. What remains is excreted as stool.

      Proteins are broken down into their building blocks, amino acids. These are used to build and repair the body’s tissues, and the excess is stored. Fats are directly absorbed into the body. Carbohydrates are broken down into their building blocks, sugars. Proteins, fats and carbohydrates all provide caloric energy for the body, but differ greatly in their metabolic processing. This results in different hormonal stimuli.

       CALORIC REDUCTION IS NOT THE PRIMARY FACTOR IN WEIGHT LOSS

      WHY DO WE gain weight? The most common answer is that excess caloric intake causes obesity. But although the increase in obesity rates in the United States from 1971 to 2000 was associated with an increase in daily calorie consumption of roughly 200 to 300 calories,¹ it’s important to remember that correlation is not causation.

      Furthermore, the correlation between weight gain and the increase in calorie consumption has recently broken down.² Data from the National Health and Nutrition Examination Survey (NHANES) in the United States from 1990 to 2010 finds no association between increased calorie consumption and weight gain. While obesity increased at a rate of 0.37 percent per year, caloric intake remained virtually stable. Women slightly increased their average daily intake from 1761 calories to 1781, but men slightly decreased theirs from 2616 calories to 2511.

      The British obesity epidemic largely ran parallel to North America’s. But once again, the association of weight gain with increased calorie consumption does not hold true.³ In the British experience, neither increased caloric intake nor dietary fat correlated to obesity—which argues against a causal relationship. In fact, the number of calories ingested slightly decreased, even as obesity rates increased. Other factors, including the nature of those calories, had changed.

      We may imagine ourselves to be a calorie-weighing scale and may think that imbalance of calories over time leads to the accumulation of fat.

      Calories In – Calories Out = Body Fat

      If Calories Out remains stable over time, then reducing Calories In should produce weight loss. The First Law of Thermodynamics states that energy can neither be created nor destroyed in an isolated system. This law is often invoked to support the Calories In/Calories Out model. Prominent obesity researcher Dr. Jules Hirsch, quoted in a 2012 New York Times article,⁴ explains:

      There is an inflexible law of physics—energy taken in must exactly equal the number of calories leaving the system when fat storage is unchanged. Calories leave the system when food is used to fuel the body. To lower fat content—reduce obesity—one must reduce calories taken in, or increase the output by increasing activity, or both. This is true whether calories come from pumpkins or peanuts or pâté de foie gras.

      But thermodynamics, a law of physics, has minimal relevance to human biology for the simple reason that the human body is not an isolated system. Energy is constantly entering and leaving. In fact, the very act we are most concerned about—eating—puts energy into the system. Food energy is also excreted from the system in the form of stool. Having studied a full year of thermodynamics in university, I can assure you that neither calories nor weight gain were mentioned even a single time.

      If we eat an extra 200 calories today, nothing prevents the body from burning that excess for heat. Or perhaps that extra 200 calories is excreted as stool. Or perhaps the liver uses the extra 200. We obsess about caloric input into the system, but output is far more important.

      What determines the energy output of the system? Suppose we consume 2000 calories of chemical energy (food) in one day. What is the metabolic fate of those 2000 calories? Possibilities for their use include

      •heat production,

      •new protein production,

      •new bone production,

      •new muscle production,

      •cognition (brain),

      •increased heart rate,

      •increased stroke volume (heart),

      •exercise/physical exertion,

      •detoxification (liver),

      •detoxification (kidney),

      •digestion (pancreas and bowels),

      •breathing (lungs),

      •excretion (intestines and colon) and

      •fat production.

      We certainly don’t mind if energy is burned as heat or used to build new protein, but we do mind if it is deposited as fat. There are an almost infinite number of ways that the body can dissipate excess energy instead of storing it as body fat.

      With the model of the calorie-balancing scale, we assume that fat gain or loss is essentially unregulated, and that weight gain and loss is under conscious control. But no system in the body is unregulated like that. Hormones tightly regulate every single system in the body. The thyroid, parathyroid, sympathetic, parasympathetic, respiratory, circulatory, hepatic, renal, gastrointestinal and adrenal systems are all under hormonal control. So is body fat. The body actually has multiple systems to control body weight.

      The problem of fat accumulation is really a problem of distribution of energy. Too much energy is diverted to fat production as opposed to, say, increasing, body-heat production. The vast majority of this energy expenditure is controlled automatically, with exercise being the only factor that is under our conscious control. For example, we cannot decide how much energy to expend on fat accumulation versus new bone formation. Since these metabolic processes are virtually impossible to measure, they are assumed to remain relatively stable. In particular, Calories Out is assumed not to change in response to Calories In. We presume that the two are independent variables.

      Let’s take an analogy. Consider the money that you earn in a year (Money In) and the money that you spend (Money Out). Suppose you normally earn and also spend $100,000 per year. If Money In is now reduced to $25,000 per year, what would happen to Money Out? Would you continue to spend $100,000 per year? Probably you’re not so stupid, as you’d quickly become bankrupt. Instead, you would reduce your Money Out to $25,000 per year to balance the budget. Money In and Money Out are dependent variables, since reduction of one will directly cause a reduction of the other.

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