有很多人，高学历，相信自己聪明，说所有的饮食降低卡路里。所以，任何可以自动工作的饮食都会降低卡路里。这似乎是许多学者和研究人员以及其他不愿意生活在现实世界中的人们的倒退。他们说，“这种饮食（古代，低碳，整体食物等）的作品，因为它造成了”卡路里的赤字。” 也就是说，减少你吃的卡路里会造成卡路里的赤字。他们经常援引旧卡路里卡路里规则或“能量平衡”范式。
体脂变化=卡路里摄入 - 卡路里输出。是。这是真的。
当然，这与拥挤的酒吧相似。
酒吧人群变化=人们在外。但是呢？谁在乎？它没有告诉我们为什么酒吧拥挤或如何处理。在这个模糊的范例之下，学者们会大声宣布，当真正的问题是超级碗在城里的时候，做一个较小的入口门将解决问题。
热力学第一定律总是如此，但与人类健康完全无关。是的，如果卡路里在超过卡路里，那么你会增加脂肪。但是如果你吃更多的卡路里，你会燃烧更多的卡路里。如果你摄入更少的热量，你会少燃烧。所以身体肥胖没有全面的改变。就像酒吧 - 如果有更多的人进来，但有更多的人离开，那么没有改变。
从能量平衡范例来看，人们现在完全无理地假设热量输出保持稳定，从而减少卡路里摄入量（食物）会自动导致体内脂肪的损失。正如我已经写了
很多最次，这是完全错误的。基础代谢可能增加或减少高达40％。
但是这个错误的信念导致了我称之为主要的热量减少（CRaP）的策略。所以很多人认为，简单地减少卡路里摄入量是一个合理的减肥策略。他们认为间歇性禁食或古生酮或生酮饮食引起的荷尔蒙变化（主要是胰岛素和胰岛素抵抗）是无关紧要的。对他们来说，这全是关于卡路里的摄入量。但是，我们相信循证医学。那么，减少卡路里摄入量作为主要策略的证据在哪里会导致长期有意义的减肥呢？
人们认为，减少“卡路里”会导致长期的身体脂肪流失是一个科学证明的事实。实验上，这很简单。带一些人。随机化他们。给他们一些卡路里限制。看着他们减肥，从此过上幸福快乐的生活。其他谁继续他们的平常饮食不减肥。简单。
有人可以向我指出这些研究吗？我们已经推荐了近半个世纪的“少吃多吃”策略。这些研究在哪里？啊对。他们都确凿地表明，CRaP不会产生长期的体重减轻。我们来看看这些研究。特别是随机控制的。
The TODAY study was a study of diabetics using medication (metformin) with or without lifestyle changes. This was primarily the calorie-deficit approach so beloved by academic physicians. The main study showed that this CRaP method produced no clinical benefits in diabetes management. What about weight loss?
Let’s see. At the beginning of the study, the average Body Mass Index of the lifestyle group was 34. After 5 years of dietary counselling to reduce calories, the average BMI was…….. 34. Nice job, guys. Glad you spent the last 5 years of your life counting calories?
The Diabetes Prevention Program was another randomized lifestyle study that aimed to prevent diabetes, which was, in fact successful. But the question here is about weight loss.
With intensive counselling to reduce intake of calories weight loss was terrific (7kg). At first. In the long term, not so much. In a pattern familiar to every person who has ever dieted, the weight starts to regain despite continued compliance to the diet. Within a few years, there is only a small difference in weight (2 kg or less than 5 pounds) and by the end of the study, there is virtually no difference.
Body weight decreases nicely within the first 6–12 months, but thereafter shows steady weight regain.
What about non-diabetics? Let’s look at the Women’s Health Initiative. Almost 50,000 women were randomized into the trial and given instructions to reduce their fat intake. This is the largest and most important nutrition study ever done of the low fat caloric restriction diet intervention.
Over 7 years, women reduced their daily calorie intake by 361 calories per day. They reduced their percentage of calories from fat and increased their carbs. They also increased their daily exercise by 10%.
Sounds like they followed the ‘Eat Less, Move More’ advice to a tee. So they must have lost lots of weight and thanked their academic doctors profusely as they slipped into their skin-tight yoga pants. According to standard Calories In/ Calories Out thinking, participants should have lost 30 pounds of fat per year.
Yeah, not really. Here’s what happened to weight loss. Against the comparison group that followed their usual diet, there was an initial weight loss, followed by the now familiar weight plateau and then eventual regain. There were no improvements in waist circumference either. After 7 years, instead of 30 pounds per year, they lost about 1/4 pound — in 7 years! That’s about the weight of a really good bowel movement. Yeah, I said it.
There are many who complain that this was not specifically a weight loss study. It’s always easy to nitpick study design after the fact. But the fact remains that two groups were randomized. One received dietary counselling to reduce calories, specifically from fat. As a result, calories were reduced. Isn’t it all about calories?
Let’s also use a little common sense here. Is this WHI result so unbelievable? Hundreds of millions of people have followed a calorie reduced diet. I certainly have tried it. What’s our personal experience? Pretty much exactly like the WHI study proved.
Also, it is important to note that women did, in fact, stick to their calorie reduced diet. Yet the weight regain still happened. BUT it wasn’t because of non compliance. This is often ignored, because physicians giving the dietary advice want desperately to believe that people fail on their diets because they didn’t follow it. They simply cannot face the super-obvious but highly inconvenient truth staring them in the face. If these women followed the diet, but still failed to lose weight — the problem is the DIET, and not the PATIENT. Doctors cannot play their favourite game of ‘Blame the Victim’.
So, every single diet works by reducing calorie intake, right? But every single study of reducing calorie intake shows no benefit in weight loss. How does that work? Where is this magical fairyland where reducing caloric intake automatically causes long term weight loss? How can all diets be successful only to the extent that they reduce caloric intake, when reducing caloric intake is proven to NOT cause weight loss?
We profess to live in an age of evidence based medicine. But this only seems to apply to everything that is not the accepted conventional wisdom. The status quo always gets a free pass. Where is the evidence that cutting calories causes weight loss? Bueller? Bueller?
