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Are carbs really the waist-expanding enemy we’ve been led to believe they are? A dietician weighs in on this touchy topic…
The post Do You Really Need To Give Up Carbs To Lose Weight? appeared first on Women’s Health.
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It seems every “keto for women” forum abounds with stories about menstrual cycles gone wild in the first few months of keto. Irregular cycles, breakthrough bleeding, and periods lasting much longer than normal are common complaints. Sometimes these stories are cited as evidence that keto isn’t good for women, at least not premenopausal women, and that we need carbs for healthy hormones. Yet, many women don’t notice any changes in their menstrual cycles at all, while others report improvement in PMS symptoms and cycle regularity from the get-go.
What gives? Why do some women’s cycles apparently become wacky when they start keto, while others feel like keto is the key to period bliss? Can keto “mess up” the menstrual cycle?
We know that diet—what and how much we eat—can profoundly affect our hormones. This is true for both women and men. One of the reasons people are so excited about ketogenic diets is specifically because keto shows promise for helping to regulate hormones and improve cellular sensitivity to hormones such as insulin and leptin.
At the same time, women’s hormones are especially sensitive not only to dietary changes but also to downstream effects such as body fat loss. Furthermore, one of the ways women’s bodies respond to stressors is by turning down the dial on our reproductive systems. It’s reasonable to hypothesize, then, that women might have a tougher time adapting to or sustaining a ketogenic diet. Keto can be stressful depending on one’s approach, and that might negatively impact women’s reproductive health. But do the data actually bear that out, or is so-called “keto period” more misplaced hype than genuine fact?
Note that throughout this post, I’m going to use the term “reproductive health” to refer to all aspects of women’s menstrual cycle, reproductive hormones, and fertility. Even if you aren’t interested in reproducing right now, your body’s willingness to reproduce is an important indicator of overall health. When your reproductive health goes awry—irregular or absent periods (amenorrhea) or hormone imbalances—that’s a big red flag. Of course, post-menopausal women can also experience hormone imbalances that affect their health and quality of life (and low-carb and keto diets can be a great option for them).
Menstrual Cycle 101
Let’s briefly review what constitutes a normal, healthy menstrual cycle, understanding that everybody’s “normal” will be a little different. A typical cycle lasts from 21 to 24 days on the short end to 31 to 35 days on the long end, with 28 days being the median. Day 1 is the first day of your period and begins the follicular phase, which lasts until ovulation. Just before ovulation, levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (a form of estrogen) spike. Next comes the luteal phase covering the approximately 14 days from ovulation to menses. LH, FSH, and estradiol drop, while progesterone rises. Estradiol bumps up again in the middle of the luteal phase. If a fertilized egg is not implanted, menstruation commences, and the whole cycles starts over again. All this is regulated by a complex communication network under the hypothalamic–pituitary–gonadal (HPG) axis, which is closely tied to the actions of the adrenal (the A in HPA axis) and thyroid glands.
Across the cycle, fluctuations in body weight are common as fluid is retained and then released along with shifts in estrogen and progesterone. Changes in blood glucose are also normal, and insulin-dependent diabetics often find that they need to adjust their dose at different times of their cycles to keep their blood sugar in check. The most common pattern is higher blood glucose readings in the pre-menstrual period (the second half of the luteal phase), and lower readings after starting your period and before ovulation. This is generally attributed to the fact that progesterone, which is highest during the luteal phase, is known to reduce insulin sensitivity. However, different women experience different patterns, which can also be affected by other factors such as oral contraceptive use.
Normal fluctuations in insulin resistance and blood glucose can mean that women get lower ketone readings at certain times of the month than others. When these occur premenstrually—and so they tend to coincide with a period of (transient) weight gain and food/carbohydrate cravings—women often feel as though they are doing something wrong. Rest assured that these variations reflect normal physiology.
The many factors that affect your cycle and the levels of your sex hormones include: other hormones, gut health and microbiome, metabolic health (e.g., insulin sensitivity), environmental toxins, stress, sleep, immune health, nutrient deficiencies, activity level and energy expenditure, and age. Each affects the others, and all (except age of course) can be affected by diet. It’s no surprise, then, that it can be extremely difficult to pin down a root cause of menstrual changes or reproductive issues.
What the Research Tells Us About Keto and Menstruation
As I said at the outset, there are lots of anecdotes, both positive and negative. In my experience, most women whose cycles seem to go crazy when they start keto find that things get back to normal—and often a better version of normal—after a few months.
First, it’s tricky to determine the effects of keto per se, since many people combine a ketogenic diet with calorie restriction (intentionally to lose weight or unintentionally due to the appetite suppressing effects of keto) and with fasting (intermittent and/or extended). Each of these can independently impact the factors listed above, lead to weight loss, and affect the menstrual cycle and reproductive health.
So, is there any evidence that keto itself causes changes to menstruation?
The scientific evidence is scant….
The one statistic you’ll see floating around the interwebs is “45% of (adolescent) females experience irregular menstrual cycles on keto.” This statistic comes from one small study of adolescent girls using a therapeutic ketogenic diet to treat epilepsy. Six of the twenty girls reported amenorrhea (loss of period) and three were diagnosed with delayed puberty. However, the ketogenic diet used for epilepsy is different and usually much stricter than an “everyday” keto diet needs to be, and epilepsy is frequently associated with menstrual dysfunction regardless of diet.
To extrapolate the findings of this study and argue that nearly half of teenage girls (or women generally) are likely to experience menstrual problems from going keto is a huge leap.
The fact is, I’m unable to find any studies done in healthy human females (or mice for that matter) demonstrating that otherwise normal menstrual cycles are disturbed by going keto.
5 Ways Keto-Related Factors *Might* Affect Your Menstrual Cycle
With the limited amount of research looking directly at keto and menstruation, let’s look first at whether there are direct effects of carbohydrate restriction or elevated ketone production on the menstrual cycle. Those are the defining characteristics of keto and what differentiates keto from other ways of eating. Then we can examine indirect effects that occur due to factors such as weight loss. These are not unique to keto, though they might be more likely on a ketogenic diet compared to other ways of eating.
There is no real body of evidence that looks at ketogenic levels of carb restriction and menstruation, but there are some clues. In this small study, functional hypothalamic amenorrhea (FHA) was associated with dietary fat restriction; women with FHA actually ate non-significantly more carbs than matched controls and nearly identical total calories. Likewise, in this small study, FHA was associated with lower fat intake but no significant difference in carb intake.
This meta-analysis looked at the effect of low-carb (not keto) diets on markers of reproductive health among overweight women. The researchers found four studies that examined effects on menstruation; all showed improved menstrual regularity and/or ovulation rates. Of six studies that looked at levels of reproductive hormones, five reported significant improvements.
Carb restriction also results in decreased insulin production. Hyperinsulinemia and insulin resistance are frequently associated with polycystic ovarian syndrome (PCOS), one of the leading causes of female infertility and a frequent cause of menstrual irregularity. There is currently a lot of interest in using keto to treat PCOS, but only one small study has so far directly tested the effectiveness of a ketogenic diet to treat PCOS, with positive results.
No studies have looked at the direct effects of ketones on menstruation.
Of course weight loss is not unique to keto, but keto can be very effective for weight loss. Some women experience rapid weight loss when first starting a keto diet. Weight loss in and of itself can impact menstruation through a variety of pathways. A key way is by reducing the hormone leptin. Leptin’s main job is to communicate energy availability to the hypothalamus—high levels of leptin tell the hypothalamus that we have enough energy on board, which also means we can reproduce. Low leptin can disrupt the menstrual cycle and is linked to hypothalamic amenorrhea.
Body fat loss can also affect estrogen levels since estrogen is both stored and produced in adipocytes (fat cells). While fat loss in the long term will decrease estrogen production, it is possible that rapid fat loss might temporarily raise estrogen levels and can also affect estrogen-progesterone balance. These transient changes in estrogen levels might underlie some of the menstrual irregularities women report.
Stress can impact the menstrual cycle in myriad ways. Cortisol acts on the hypothalamus and pituitary glands, affecting hormone levels, sleep, immune function, and gut health, to name a few. Diets can be a source of stress, both at the physiological and psychological levels. Keto has a reputation for being especially stressful because it is more restrictive than other low-carb diets, but this can be mitigated by following the Keto Reset tips for women.
Thyroid dysregulation is another common cause of menstrual irregularities, and there remains a pervasive belief that keto is bad for thyroid health. Indeed, the thyroid is sensitive to nutrient deficiencies and caloric restriction, and thyroid hormones, especially T3, do frequently decline on keto. However, as Mark has discussed in a previous post, changes in T3 levels might not be a problem, especially in the absence of other problematic symptoms. Moreover, many practitioners now use keto as a cornerstone in their treatment of thyroid disorders.
What Should I Take From These Findings?
The first takeaway: there just isn’t much direct evidence about how keto might affect your menstrual cycle, positively or negatively. We have some studies suggesting that low-carb diets improve some aspects of menstruation and reproductive health, but keto is more than just another low-carb diet. Ketones themselves have important physiological properties, such as being directly anti-inflammatory, which might positively impact women’s reproductive health.
Second, the ways that keto is likely to (negatively) affect menstruation aren’t unique to keto, they’re common to any diet: hormone shifts mediated by energy balance, stress, and weight loss.
Furthermore, since keto is so often combined with caloric restriction, time-restricted eating, and fasting, even the anecdotal evidence might not be able to tell us all that much. If a woman is eating ketogenically, in a big caloric deficit, and doing OMAD (one meal a day), and her leptin plummets, how are we to know what really caused it? We don’t have good evidence that otherwise healthy women start a well-executed ketogenic diet and end up messing up their menstrual cycles.
That said, women do need to be cognizant of the sum total of the signals they are sending their bodies when it comes to energy availability and stress. A lot of women come to the keto diet with a history of adrenal, thyroid, metabolic, and reproductive issues. It’s important that they’re extra careful about how they approach keto. Done correctly, it might be just what the doctor ordered. I encourage any woman who’s dealing with other hormonal issues to work with a medical practitioner to tailor a keto diet to her unique needs.
But I’m Telling You, Keto Made My Period Go Haywire!
Ok, I believe you, really! But changes do not necessarily equal dysfunction. It is normal to experience hormone fluctuations when you make a massive—or even a relatively small but important—shift in your nutrition. Sometimes those fluctuations are unpleasant or unwanted, such as a period that lasts 14 days or one that arrives a week before you planned while you’re on vacation. However, that doesn’t make them bad from a health perspective. We need to respect that our bodies are dynamic systems. Changing the input will invariably change the output, and the system might need a few months to adapt to a new normal.
If your cycle goes wonky but you’re otherwise feeling good, give it a few months to sort itself out. If after a few months it’s still all over the place (or definitely if you’re having other disruptive symptoms), enlist help. In the meantime, check to make sure you’re not short-changing yourself nutritionally or calorically. Scale back on fasting efforts, and consider shifting more toward a traditional Primal way of eating.
At the end of the day, if you go keto and experience negative effects, stop. Keto is super hyped right now, but if your body is sending you clear signals that keto is not a good approach for you at this time, don’t do it. You can always try again later. It might be that your first attempt at keto didn’t work, but with a few adjustments and some experimentation over time you can find a version of keto that works for you.
Thanks for reading, everyone. Do you have comments, questions, or feedback? Let me know below.
Comninos AN, Jayasena CN, Dhillo WS. The relationship between gut and adipose hormones, and reproduction. Human Reproduction Update 2014; 20(2): 153–174.
Fontana R, Della Torre S. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients. 2016;8(2):87.
Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obesity Reviews 2007;8(1):21-34.
Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014;37(11):1049–1056.
Tena-Sempere M. Roles of Ghrelin and Leptin in the Control of Reproductive Function. Neuroendocrinology 2007;86:229-241.
The post Keto and the Menstrual Cycle: Is There Reason To Worry? appeared first on Mark’s Daily Apple.
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While some keto or low-carb proponents claim fiber is useless at best and actively harmful at worst, I come down on the side that says fiber is probably helpful for most people. Some folks have persistently better responses to low- or no-fiber keto diets, and I won’t argue with that—I’ve seen it happen and I’ve read the studies where de-emphasizing fiber can actually improve constipation, for example.
I’ll just say that I have an opposite reaction, and, most importantly, I love eating a variety of plant foods that also happen to contain a ton of great nutrients in addition to fiber.
Do I buy into the idea that fiber is important because it is every human being’s responsibility to produce as much colonic bulk as humanly possible? No.
Do I think we should be consistently pushing the limits of our digestive tracts, performing feats of bathroom heroism so momentous they border on Herculean, and making sure the toilet bowl buckles beneath us? No.
The real value of fiber lies not in its coarseness, its tendency to form colonic bulk, to keep us topped off. The true value lies in its fermentability. A fermentable fiber is a prebiotic fiber—fiber that feeds our gut bacteria.
I will, however, explain why we need to be feeding our gut bacteria. Our gut bacteria form a physical barrier against incursions and colonization by pathogenic bacteria; they take up room along the gut lining so pathogens can’t. If we don’t feed our gut bacteria with prebiotics, it won’t be around to protect us. After antibiotic treatment where both good and bad gut flora are indiscriminately targeted and wiped out, pathogenic obesity-promoting bacteria take advantage of the open space. That’s a worst-case scenario, but it shows what can happen when the harmony of the gut is disturbed by antibiotics or, to a less extent, a lack of fermentable prebiotic fibers.
Gut bacteria also convert antinutrients like phytic acid into nutrients like inositol. The almond meal-obsessed keto eater would do well to have a powerful gut biome set up to convert all that phytic acid to inositol.
Now, some writers will come up with specific blends of fibers, powders and gums to create the “optimal” prebiotic diet for your gut bacteria, but that’s pretty silly. The gut is a complicated place. We’ve barely begun to even identify all its inhabitants. To think we know the precise blend of isolated fiber that will make them flourish, and then act on that, is a mistake.
1) Almonds and Pistachios
Nuts are usually favored in health-conscious circles for a few reasons. They like the monounsaturated fat. They like the mineral profile, or the complete protein, or their ability to dissemble into nut meals and form baked goods. But what gets short shrift is the fiber content. Now, I can’t speak for other nuts, but almonds and pistachios in particular contain fiber with potent prebiotic effects. People who eat almonds and to an even greater extent pistachios end up with improved gut bacteria profiles.
2) Green Bananas
Ripe bananas are difficult to squeeze into a ketogenic diet. The green banana—an unripe one—is mostly resistant starch, a type of starch that cannot be digested and travels untouched until colonic bacteria metabolize it. It’s one of the best stimulators we know of butyric acid production. And sure, you could do a spoonful of raw potato starch to get your resistant starch, but the beauty of the green banana is that it also provides potassium, another nutrient that some find difficult to obtain and stay keto.
3) Wild Blueberries
Blackberries, boysenberries, raspberries, and strawberries are all loaded with fiber, and you should eat them. They’re lower carb than you think, they’re loaded with polyphenols, and topped with some real whipped cream they make a fantastic dessert. But wild blueberries are special. They’re smaller than other berries, which increases the amount of skin per ounce you get, and skin is where all the polyphenols and fiber lie. Heck, even the blueberry’s polyphenols have prebiotic effects on the gut biome.
A few years ago, I wrote a whole post on mushrooms. Suffice it to say, they’re quite wonderful, bordering on magical. I did not discuss the fiber they contain. It turns out that all the various mushroom polysaccharides/fibers, including beta-glucans, mannans, chitin, xylans, and galactans also act as potent prebiotics that improve the health of the host.
Your standard avocado has about 12-15 grams of fiber, if you eat the whole thing. I
Great with chili powder, salt, and lime juice, jicama is about 11 grams of carbs per cup, but half of those are inulin, a potent prebiotic fiber with a tendency to really ramp up butyrate production.
Onions are another fantastic source of inulin. They go into almost every dish of every cuisine, so there’s no excuse not to be eating onions.
I’ve been known to treat garlic like a vegetable, roasting an entire cast iron pan full until brown and sweet and chewy. They’re another great source of prebiotic fiber.
Broccolini is a major part of my favorite meal of the day—my Big-Ass Keto Salad. Broccoli (and cruciferous vegetables in general) has been shown to have modulatory effects on the gut biome.
12) Dark Chocolate
13) Animal Fiber
Obligate carnivores like cheetahs who don’t eat any plants (willingly) still have gut bacteria. These gut bacteria thrive on “animal fiber,” the gristle and cartilage and other bits of connective tissue that comprise a good 20-30% of the walking weight of a prey animal. Humans are not obligate carnivores, but eating the entire animal has been a mainstay of advanced hominid existence for millions of years. I find it very likely that something, someone, somewhere inside our guts is breaking down the animal fiber we eat—so you’d better be eating some!
Not so tough, is it? It’s not like I’m suggesting you load up on bran muffins, psyllium smoothies. I don’t want you dumping flax meal into everything or munching on those awful fiber gummies. Just eat some basic, healthy, low-carb plant matter—foods that don’t really scream “fiber”—and the rest will take care of itself.
What’s your favorite low-carb source of fiber? Let me know down below.
Thanks for reading, everyone.
Hernández E, Bargiela R, Diez MS, et al. Functional consequences of microbial shifts in the human gastrointestinal tract linked to antibiotic treatment and obesity. Gut Microbes. 2013;4(4):306-15.
Ukhanova M, Wang X, Baer DJ, Novotny JA, Fredborg M, Mai V. Effects of almond and pistachio consumption on gut microbiota composition in a randomised cross-over human feeding study. Br J Nutr. 2014;111(12):2146-52.
Jiao X, Wang Y, Lin Y, et al. Blueberry polyphenols extract as a potential prebiotic with anti-obesity effects on C57BL/6 J mice by modulating the gut microbiota. J Nutr Biochem. 2019;64:88-100.
Jayachandran M, Xiao J, Xu B. A Critical Review on Health Promoting Benefits of Edible Mushrooms through Gut Microbiota. Int J Mol Sci. 2017;18(9)
Nielsen ES, Garnås E, Jensen KJ, et al. Lacto-fermented sauerkraut improves symptoms in IBS patients independent of product pasteurisation – a pilot study. Food Funct. 2018;9(10):5323-5335.
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For this week’s edition of Dear Mark, I’m answering three questions from readers. First, is the reduced protein efficiency in older adults due to inactivity, or is it something inherent to the aging process, or both? Second, how does a person know if they’ve actually “earned” any carbs? Does everyone on a keto diet earn carbs by virtue of exercising, or is there more to it? And finally, how can a hardgainer with a packed schedule all week long and limited gym time maintain what little muscle mass he’s managed to gain?
Let’s find out:
Interesting observation on protein needs and training in Sunday with Sisson – general consensus is that older folks need more protein as they age but maybe that’s because they are less active and not simply a result of aging.
That’s probably part of it, but it’s not all of it.
In studies where they compare resistance training seniors who eat extra protein with resistance training seniors who don’t, only the seniors eating extra protein gain muscle mass.
Now, it may be that a lifetime of inactivity degrades your ability to utilize protein, and if these older adults had always lifted weights they would have retained their protein efficiency. But maybe not. As it stands, all else being equal, an older adult needs more protein to get the same effect, even if he or she is lifting weights.
Enjoyable read. As someone who lives a ketogenic lifestyle, and who is athletically active, I am not sure exactly how to go about consuming the carbs I’ve “earned.” I rarely run into problems with athletic energy, at least not below anaerobic threshold. Not sure that eating more carbs will improve my performance. And, if they would improve my performance, how does one go about calculating earned carb replacement without losing the fat burning benefits of ketosis?
It sounds like you’re in a good place.
When I say “eat the carbs you earn,” I’m talking to the people who do run into problems with athletic energy, poor performance, insomnia, and other symptoms of exercise-induced stress. Typically, the people who “earn their carbs” are doing stuff like CrossFit, high volume moderate-to-high intensity endurance work, martial arts training, and team sports.
I doubt extra carbs will improve your performance if most of your training takes place in the aerobic zone. But if you wanted to experiment, you could try a small sweet potato immediately after a workout where you passed the anaerobic threshold.
That’s the best way to determine if you’ve earned carbs. Eat 20-30 grams after a workout and see if you enjoy performance gains without gaining body fat. There’s no consumer-friendly way to directly calculate carb debt; self-experimentation is it.
I recently took a job that has me out of bed at 4am and not home until 6pm Monday Through Friday. Is there an efficient way I can maintain muscle mass only lifting weights Saturday and Sunday? I’m a hardgainer at 5’10” and only 140lbs. I’m afraid giving up my 5 day split will ruin what muscle I’ve been able to gain.
Any hardgainer has to eat, and eat, and eat. Increase your food intake. Just eat. Stick to healthy Primal fare, but pack in the food. Meat, milk, veggies, potatoes, rice, eggs, avocados, fruit. Throw some liver in, too (old bodybuilder staple). It doesn’t sound like fat gain is an issue for you, so I’d take advantage of that and just consume calories.
As for training, get some exercise snacks in during the week.
As soon as you wake up, do a quick superset of pushups. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. Wait 30 seconds. Do as many pushups as you can. There you go. That shouldn’t take more than 5 minutes in the morning. Can you squeeze that in?
Repeat this every morning with a different exercise. Pullups, bodyweight rows, kettlebell swings, handstand pushups, dips, bodyweight squats, goblet squats, reverse lunges, reverse weighted lunges. Just choose one thing to do every morning, cram as many reps as you can using the same format (max reps, 30 s rest, max reps, 30 s rest, max reps). Buy any equipment you can if you choose to use weights.
When you get home at night, do the same thing with a different exercise. Morning pushups, evening KB swings, etc. That way, you get about 10 minutes per weekday of intense strength training without impacting your sleep or schedule in any real meaningful way.
Make sure your sleep hygiene is rock solid. Dim those lights at night, turn on f.lux or night mode, wear the blue blocking goggles, get to bed (ideally) by 8:30, 9 to give you 7 to 7.5 hours of sleep. Sleep is essential for gaining lean mass (and staying healthy in general).
On the weekend, hit the weights hard on both days, hitting the entire body. Go high volume/reps. If size is your goal, dropping the weight a bit and focusing on range of motion and a high rep count (10-15 per set) is very effective.
Food, sleep, reps. Good luck!
Thanks for stopping in today, everybody. Additional thoughts for these folks—or questions of your own? Share them below.
Tieland M, Dirks ML, Van der zwaluw N, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713-9.
The post Dear Mark: Protein Efficiency in Seniors, Earned Carbs, Hardgainer with Limited Time appeared first on Mark’s Daily Apple.
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As you and millions of other people embark on new dietary journeys, you’re going to hear a ton about calories.
“Calorie counting is everything.”
“If you aren’t counting calories, you won’t lose weight.”
“Just eat less calories than you expend.” For one, it’s “fewer.” Two, that’s not the whole picture.
These statements aren’t wrong exactly, but they offer an overly simplistic picture of the relationship between weight loss and calories. They ignore context. And context is everything, especially when you’re talking about calories and weight loss.
Most people (even many scientists) believe that the body composition challenge is a relatively simple equation: to lose weight you must reduce calories (either eat less or burn more), to gain weight you must add calories (eat more or burn less), and to maintain weight you keep calories constant (eat and burn identical amounts). Calories in over calories out.
Right away, it sounds preposterous. Are people really maintaining perfect caloric balance by dutifully tracking and comparing their intake to their burn? Are they walking six fewer steps lest they lose an extra ounce off their midsection?
Are All Calories the Same?
The truth is, it’s more like a complex equation where you have to factor in many other very important variables:
- Am I getting calories from fat, protein, or carbs?
- Am I getting my calories through whole foods or refined processed foods?
- Are my glycogen stores full or empty?
- When’s the last time I exercised?
- Am I insulin-sensitive or insulin-resistant?
- Am I trying to lose “weight” or lose fat?
- How’s my stress level?
- Am I sleeping enough?
The answers to all those questions (and more) affect the fate of the calories we consume. They change the context of calories.
Ideally, all that complexity is handled under the hood. That’s how it works in wild animals. They don’t calorie count. They don’t think about what to eat or how to exercise. They just eat, move, sleep, and somehow it all works. I mean, they die, often violently, but you don’t see obese, metabolically-deranged wildlife—unless the obesity and metabolic derangement is physiological, as in bears preparing to hibernate. Somehow they figure it out. They’ve delegated the complex stuff to their subconscious.
This is generally true in “wild humans,” too. Hunter-gatherer groups by and large did not and do not show any evidence of metabolic derangement, obesity, or the other degenerative trappings of modern humans living in civilization. They are fully human in terms of physiology, so it’s not that they have special genetic adaptations that resist obesity. They’re living lifestyles and eating diets more in line with our evolutionary heritage. They’re moving around all the time, not going through drive throughs. They’re eating whole unprocessed foods that they have to procure, catch or kill.
What they don’t have is the ridiculous concept of calories and macronutrients floating around in their heads, informing their dietary choices. They don’t even think about food in terms of calories, or movement in terms of calories expended. Metabolically speaking, they consume their calories in the proper context.
But you? You might have to think about context. You might have to answer those questions and create the proper context.
Most people do not think about context. They home in on the number of calories the food database claims the food they’re eating contains, plot it against the numbers of calories the exercise database claims the exercise they’re doing expends, and then wonder why nothing’s working. That’s why “dieting doesn’t work”—because, as practiced in accordance with the expert advice from up high, it doesn’t. Almost invariably, the people who see great results from strict calorie counting, weighing and balancing, those types who frequent online weight lifting forums and have the freedom to spend hours perfecting their program, have the other relevant variables under control without realizing it.
They’re younger, with fewer responsibilities—and less stress and fewer disruptions to their sleep.
They’re lifting weights and training religiously, creating huge glycogen sinks and maintaining optimal insulin sensitivity.
They’re eating a lot of protein, the macronutrient that curbs hunger and increases energy expenditure the most.
They’re eating mostly whole foods.
They’ve had less time on this earth to accumulate metabolic damage.
Not everyone is so lucky.
Fat burning, glucose burning, ketone burning, glycogen storage, fat storage, gluconeogenesis, and protein turnover—what we do with the calories we consume—do not occur at constant rates. They ebb and flow, wax and wane in response to your micronutrient intake, macronutrient intake, energy intake, exercise and activity habits, sleep schedule, stress levels, and a dozen other factors. All of these energy-related processes are going on simultaneously in each of us at all times. But the rate at which each of these processes happens is different in each of us and they can increase or decrease depending on the context of our present circumstances and our long term goals. All of these processes utilize the same gene-based principles of energy metabolism—the biochemical machinery that we all share—but because they all involve different starting points and different inputs as well as different goals or possible outcomes, they often require different action plans. We can alter the rate at which each of these metabolic processes happens simply by changing what and when we eat and addressing the non-dietary variables. We can change the context.
But don’t controlled trials demonstrate that a “calorie is a calorie”?
People hear things like “in controlled isocaloric trials, low-carb diets have never been shown to confer a metabolic advantage or result in more weight loss than low-fat diets.” While often true, they miss the point.
People aren’t living in metabolic wards with white lab coats providing and precisely measuring all their food. They’re living in the real world, fixing their own food. Free living is entirely uncontrolled with dozens of variables bleeding in from all angles. In the lab situation, you eat what they give you, and that’s that. The situations are not analogous—real world vs. controlled lab environment.
In real world situations…
Why a Calorie Isn’t Just a Calorie
The macronutrient composition of the calories we eat alters their metabolic effects.
The metabolism of protein famously increases energy expenditure over and above the metabolism of fat or carbohydrate. For a given caloric load, protein will make you burn more energy than other macronutrients.
Protein is also more satiating than other macronutrients. Eat more protein, curb hunger, inadvertently eat less without even trying (or needing a lab coat to limit your intake).
Protein and fat together (AKA “meat”) appear to be even more satiating than either alone, almost as if we’re meant to consume fat and protein in the same meal.
The isocaloric studies tend to focus on “weight loss” and discount “fat loss.” We don’t want to lose weight. We want to lose fat and gain or retain lean muscle mass. A standard low calorie diet might cause the same amount of weight loss as a low-carb, high-fat diet (if you force the subjects to maintain isocaloric parity), but the low-carb approach has been shown to increase fat loss and enhance muscle gain. Most people who lose weight with a standard approach end up losing a significant amount of muscle along with it. Most who lose weight with a low-carb, higher-protein-and-fat approach lose mostly fat and gain or retain most of their muscle.
Take the 2004 study that placed overweight men and women on one of two diets: a very low-carb ketogenic diet or a low-fat diet. The low-carb group ate more calories but lost more weight and more body fat, especially dangerous abdominal fat.
Or the study from 1989 that placed healthy adult men on high-carb or high-fat diets. Even though the high-carb group lost slightly more body weight, the high-fat group lost slightly more body fat and retained more lean mass.
Both describe “weight lost,” but which is healthier?
Whether the calories come in the form of processed or whole food determines their effect.
We even have a study that directly examines this. For two weeks, participants either supplemented their diets with isocaloric amounts of candy (mostly sugar) or roasted peanuts (mostly fat and protein). This was added to their regular diet. After two weeks, researchers found that body weight, waist circumference, LDL, and ApoB (a rough measure of LDL particle number) were highest in the candy group, indicating increased fat mass and worsening metabolic health. In the peanut group, basal metabolic rate shot up and neither body weight nor waist size saw any significant increases.
Your current metabolic state determines the effect of calories.
In one study, a person’s metabolic reaction to high-carb or low-carb diets was determined by their degree of insulin resistance. The more insulin resistant a subject, the better they did and the more weight they lost on low-carb. The more insulin sensitive a subject, the better they did and the more weight they lost on low-fat. Calories were the same across the board.
In another study, insulin-sensitive obese patients (a rarity in the general population) were able to lose weight on either low-carb or low-fat, but insulin-resistant obese patients (very common) only lost weight on low-carb.
Whether you exercise determines the effect of calories.
If you’ve just finished a heavy lifting workout followed by a sprint session, your response to a given number of calories will differ from the person who hasn’t trained in a year.
Training: Your muscle glycogen stores will be empty, so the carbs you eat will go toward glycogen storage or directly burned, rather than inhibit fat burning. Your insulin sensitivity will be elevated, so you can move protein and carbs around without spiking insulin and inhibiting fat release. You’ll be in hypertrophy mode, so some of the protein you eat will go toward building muscle, not burned for energy.
Not Training: Your muscle glycogen stores will be full, so any carbs you eat will inhibit fat burning and be more likely to promote fat storage. Your insulin sensitivity will be low, so you’ll have to release more insulin to handle the carbs, thereby inhibiting fat burning the process. You won’t have sent any hypertrophy signals to your muscles, so the protein you eat will be wasted or burned for energy.
How you slept last night determines the effects of calories.
A single night of bad sleep is enough to:
- Give you the insulin resistance levels of a diabetic. Try eating carbs in an insulin-resistant state and tell me a “calorie is a calorie.”
- Make the reward system of your brain light up in response to junk food and dampen in response to healthy whole food. The more rewarding you find junk food, the more your brain will compel you to eat more of it.
- Reduce energy expenditure. Your “calories out” drops if you sleep poorly.
And those are just a few important variables that determine the context of calories. There are many more, but this post has gone on long enough…
The Take-Home Message
If calorie-counting works for you, great! You’re one of the lucky ones. Own that and keep doing what you’re doing. You’ve clearly got a good handle on the context of calories.
If calorie-counting and weighing and measuring failed you in the past, you’re not alone and there’s a way forward. Address the variables mentioned in this post that need addressing. Do you need better sleep? Do you need to manage stress better? Could you eat more protein or fat, eat more whole food and less processed food, or get more exercise, or lift more weights, or take more walks?
Handle those variables, fix those deficiencies, and I bet that your caloric context will start making more sense. The trick isn’t to increase the number of variables you plug into your calories in/calories out formula. It’s to make sure all your lifestyle and dietary ducks are in a row so that the caloric balance works itself out.
By understanding how these metabolic processes work, and knowing that we can control the rates at which each one happens through our diet (and exercise and other lifestyle factors) we needn’t agonize over the day-to-day calorie counting. As long as we are generally eating a PB-style plan and providing the right context, our bodies will ease into a healthy, fit, long-lived comfort zone rather effortlessly.
So, what’s your caloric context looking like? Thanks for reading today, everyone.
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Claesson AL, Holm G, Ernersson A, Lindström T, Nystrom FH. Two weeks of overfeeding with candy, but not peanuts, increases insulin levels and body weight. Scand J Clin Lab Invest. 2009;69(5):598-605.
Volek J, Sharman M, Gómez A, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutr Metab (Lond). 2004;1(1):13.
Mccargar LJ, Clandinin MT, Belcastro AN, Walker K. Dietary carbohydrate-to-fat ratio: influence on whole-body nitrogen retention, substrate utilization, and hormone response in healthy male subjects. Am J Clin Nutr. 1989;49(6):1169-78.
Cornier MA, Donahoo WT, Pereira R, et al. Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Obes Res. 2005;13(4):703-9.
Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. JAMA. 2007;297(19):2092-102.
Benedict C, Hallschmid M, Lassen A, et al. Acute sleep deprivation reduces energy expenditure in healthy men. Am J Clin Nutr. 2011;93(6):1229-36.
***This article was substantially revised from the original version, which you can read here.
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Carbs are usually one of the first things to get the boot when you’re trying to shape up your diet. But cutting too many won’t help you lose weight.
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