
Challenges and opportunities for better nutrition science - barney54
https://www.bmj.com/content/369/bmj.m2470
======
nkurz
The title does not mean that they think calories have no impact on nutrition.
They state their stance more clearly midway through the paper:

"We need urgently to overturn calorie counting as the mainstay of nutritional
advice and prevention of obesity. There is growing consensus that it lacks
value as a practical tool in weight management. It is impossible to measure
intake accurately, and too many variables influence calorie expenditure to
make calorie counting useful. New research in humans suggests our bodies and
metabolic rates can behave differently when given identical calories in
different contexts."

This seems accurate to me. What we're doing isn't working great, and it seems
unlikely that if we had less emphasis on calorie counting that the obesity
epidemic would be much worse. So let's try something else, and see if it works
better!

~~~
bad_user
Having calories on food packages helps though, even if it is reductionist,
because it's a good surrogate for foods high in energy, low in nutrients, the
kind of food that's designed to be overeaten.

For whole food, I agree that calories don't matter because we can trust our
satiety signals. For junk food designed to be overeaten, I find that
information quite useful.

Note that I do track my calories periodically.

In spite of popular claims it isn't that hard, technically speaking and it
doesn't have to be super accurate.

The problem with calorie counting is one of mentality. Because you end up
thinking about how many calories you have left, it ends up draining you
emotionally and you can suffer binging episodes due to it. The brain is
unpredictable and we can't necessarily control ourselves which is why we can
get fat in the first place.

I think everyone should try to measure their calories for educational
purposes. If you do, the best app is Cronometer, by far.

But to lose weight you need first of all long term compliance, so you need a
strategy that can work long term. Counting calories doesn't work long term if
you're too emotional and you can't help to treat those numbers as anything
else than just data. Counting calories definitely doesn't work for me.

~~~
ctur
Seconding Cronometer as a good tool; it’s the best I’ve found, supports data
export, and isn’t full of “social” features that obscure the key feature: easy
and accurate calorie tracking. In particular it’s database is more accurate
than the crowd sourced ones like MyFitnessPal.

~~~
bad_user
It's accurate indeed, it has useful info on vitamins and minerals. Some people
use it for that and not for calorie counting.

It also makes estimating home cooked meals doable because everything comes
measured in grams. You just insert your recipe. Estimating home cooked meals
in other apps like Myfitnesspal is super frustrating.

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hirundo
"The top 10 companies control over 70% of what we eat and drink and have
annual sales larger than the gross domestic product of many countries ...
systemic change is needed first and this is likely to require governmental
action.”

But when the government acts, it acts according to the influence of the
companies that its regulatory agencies have been captured by, particular those
same top 10 companies that control most of what we eat and drink. This is not
a new development. When U.S. nutritional recommendations emerged in the early
1970s they were already being written by these same companies and their
predecessors. From my perspective they were already dead wrong, and those
recommendations have wrought enormous damage in chronic disease and lives cut
short. There is no realistic prospect that this is about to change.

I've been watching as one of my favorite nutrition authors, Nina Teicholz, has
been tilting at these windmills via the Nutrition Coalition. They have
struggled mightily to present the dissenting science to the people who control
these recommendations, and have met with roughly the same success as Don
Quixote. Watching them lose their innocence is like watching a slow motion
train crash and not being able to do a thing about it.

My preference is to get the government out of the nutrition science business,
but that's about as unlikely. Barring that the best approach is to either
ignore them or count them as just one more opinion, and to do the research and
N=1 experimentation for yourself.

~~~
nsl73
> My preference is to get the government out of the nutrition science
> business, but that's about as unlikely.

It’s critically important that the government is in the nutrition science
business and it does nutrition science correctly. Think about all of the ways
the government is implicitly taking a stance on nutrition. The farm bill,
school lunches, checkoff programs, government cheese, prison meals, snap, and
many more.

The problem is one of incentive alignment. For example, the FDA is responsible
for both the agricultural industry and the health of the population, which
currently are at odds as the agricultural industry producing a lot of junk
food.

Democratic systems can work by increasing the transparency of the government
and by increasing the education of the voting population.

~~~
rdudekul
"Democratic systems can work by increasing the transparency of the government
and by increasing the education of the voting population." Most of the big
problems facing the humanity can be addressed using transparency of government
combined with better education for all. To that list I would add, decreasing
the role corporate money plays into influencing government and universities.
For this to happen we need to rethink Economics
([https://www.ted.com/talks/kate_raworth_a_healthy_economy_sho...](https://www.ted.com/talks/kate_raworth_a_healthy_economy_should_be_designed_to_thrive_not_grow)).

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war1025
Sort of a tangent, but I legitimately thought at the start of lockdown that
people would lose weight on average because they couldn't go out to eat
anymore. It turns out I just completely underestimated how much people eat
out, and how quickly they would all switch to just getting take out.

I have friends that would always talk about how we spend way more than them at
the grocery store each week. Obviously, they'd tell me, it's because we didn't
shop at Aldi. Nope. Turns out it's because we cook and eat at home.

I don't remember where I heard it (maybe Michael Pollen?), but the advice I
try to follow is: Eat whatever you want, just make it yourself.

~~~
hnarn
> the advice I try to follow is: Eat whatever you want, just make it yourself.

This is categorically bad advice. Anyone that has an obese friend that’s into
baking knows why. It’s very easy to make incredibly unhealthy and calorie-
dense food at home.

I understand the sentiment but there is nothing about the process of making
your own food that makes you a more healthy person. It all depends on the
ingredients and the amount.

It’s obviously better to eat healthy takeout every day than it is to cook home
made french fries for dinner.

~~~
jeffdavis
I think it comes from the idea that you'll have more knowledge about what you
are eating.

There's some truth to that, but cooking for yourself still hides a lot. And it
might end up just being a false sense of health.

It's also what stage you are at. Most people can't make soda at home, so
eliminating that alone might be a big help for some.

~~~
hnarn
> Most people can't make soda at home

Sure, but most people also already know that soda is unhealthy for you, so
they can stop buying it and drink water with their food instead. It doesn't
require a framework of "home cook everything" to make these small, incremental
changes: in fact I'd argue that these changes are easier than what's
essentially just a diet by another name.

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jasonv
I couldn’t disagree more, having used it for myself, and having coached
hundreds doing it as a personal trainer.

An individual who employs reasonable practices well can thrive using this
modality.

EDIT: IIFYM is “act, measure, adjust” using calorie counting and body weight /
size measurements. I understand that there are triggers for some individuals
in that statement. Doesn’t really change what needs to be done if body weight
/ size goals need to be addressed. And yes, there may be other manners of
going about this, but those will mostly work around directly engaging in the
anchors of IIFYM.

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maps7
> New research in humans suggests our bodies and metabolic rates can behave
> differently when given identical calories in different contexts.

I wonder what the "a calorie is a calorie" zealots would say about this?

~~~
chrisseaton
> I wonder what the "a calorie is a calorie" zealots would say about this?

I don't think any serious person ever meant this literally. You're
misrepresenting them by saying this.

There are a lot of calories in coal but I can't digest it so they aren't the
same as the calories in sugar. That's obvious, nobody serious is disputing
that.

What everyone I know means when they say this is that if you're eating a
massive cheese burger or a huge bag of nuts or a kilo of jerky then don't try
to kid yourself that for some elaborate reason (I've worked hard today,
they're healthy, I deserve a treat, I walked 100m today, I took the stairs
instead of the elevator) that the calories in it don't matter. The calories in
it are still calories. That's what they mean.

In practice, for me, in my experience, limiting my calorie intake is the only
way to control weight to where I want to be. And that means not kidding
yourself that a cheese burger doesn't matter for whatever crazy reason.

~~~
luckylion
> I don't think any serious person ever meant this literally. You're
> misrepresenting them by saying this.

I believe sibling comments do pretty much say that.

> In practice, for me, in my experience, limiting my calorie intake is the
> only way to control weight to where I want to be.

Aren't you doing that by choosing what you eat and not eat, mostly? E.g. "I'm
not going eat some carrots instead of that bag of chips while watching TV"
instead of "I'm going to only eat 80% of that bag of chips"?

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snowwrestler
Calorie counting functions properly for controlling weight. The physics and
chemistry of it is sound. And the empirical proof is the many thousands of
professionals who use it successfully: models who need to be a certain shape;
football players who need to be heavy so they don't get lifted off their feet
by their competitors; or dancers who need to be light so that they can get
lifted off their feet by their partners.

I say that up-front because there are a bunch of people out there who think
that the basic science of calorie counting is wrong; that there are other
hidden factors that keep some people thin and make other people fat.

BUT, what is true--and which this article highlights--is that calorie counting
is super hard to do. As a system, it's hard "operate". You can't make
mistakes, like forget to enter a meal or a snack, or forget to properly record
activity. And it's kind of miserable to live that way. That's probably one
reason it's mostly professionals who really do it well.

In software terms, calorie counting has terrible UX. And our food system has
bad defaults. The cheapest, most heavily-advertised food is often high in
calories per volume.

And of course calorie-counting does nothing for your nutrient intake, which is
arguably more important to think about now because foods across the board
(i.e. even organic kale) seem to have falling nutrient content.

~~~
majkinetor
You are simply wrong.

Calorie counting is impossible to do right and meaningful. All that experience
you mention is simply a chance and has a tone of confouding variables.

Your internals are not fixed like a machine, parts of the system can be shut
down (such as reproductive system) and parts of it can demand more energy at
specific times (like immune system) and parts of it can appear (like cancer).
There are also other factors like hyperinsulinemia which is more like
logistics problem (some parts of body get bunch of energy while others are
starving). With this kind of dynamic, relying on calorie counting is simply
usless as all people are on various states on this system.

Sure, when you bring calories down to 0 you will certainly di of wasting but
that has 0 practical value.

~~~
conistonwater
Calorie counting is well supported by the studies in which people stay in
metabolic wards and are fed a controlled calorie-counted diet. This is close
enough to regular life experience to be meaningful, and would disprove your
assertion that it's simply chance. You, on the other hand, bring up a lot of
fairly extreme situations (immune system fighting an infection, cancer,
shutting down the reproductive system), which simply do not happen nearly
often enough to be relevant here. So the comment you're replying to is not
"simply wrong".

~~~
watwut
It is not close enough to real life. The controlled calorie counted diet given
to you by doctor is also designed to contain all iron you need, all vitamins
of all kinds you need, fiber and so on. It is not random person food minus
whatever that person finds easy or reasonable to kick out.

The people in metabolic wards are also not expected to be performing in work
simultaneously, they are not expected to perform family duties or handle
stressful situations reasonably. That also makes it massive difference against
normal life where needs like this contribute to peoples failure to keep
perfect diet.

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Dumblydorr
There is physics supporting calorie in, calorie out. However, there is also
pharmacokinetics to consider...if your calories are a sugary solution like
juice, Coke, beer, etc, they will be absorbed into the bloodstream much more
quickly, spiking blood sugar and leading to rapid storage in fat cells.

Contrast that with the same calories from a lean chicken breast, it's going to
be hours until that's fully digested and absorbed, meanwhile it's much more
filling and prevents more calories from being eaten. Also because its protein
and not sugar, your body metabolizes it differently and it is not going to be
stored as efficiently.

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barney54
There is a lot of interesting points in this article--not just about demoting
the calorie as nutritional advice--such as the lack of funding for basic
nutritional studies and the role of large food companies.

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hackandtrip
I skimmed the contents, but I don't get any alternative to the standard
calories counting.

It's the only way to quantify the intake without revolutionising the food
industry packaging, or am I missing something?

~~~
nsl73
Weight watchers will allow you to scan a barcode of some food and it will tell
you how many “points” it is, and someone in weight watchers has a limited
number of “points” they can consume in a day.

This is an example of an existing solution to quantifying intake without
adjusting packaging.

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katzgrau
If you're just calorie counting, you can certainly have success, but it's not
a bad idea to maintain some idea of where you stand in terms of your
consumption of fat, carbs, and protein.

If you calorie count and generally try to stay around 33/33/33 in terms of
percentage of macronutrient consumption by the end of the day, it's hard to go
of course.

It's a course set of rules, but sometimes keeping it simple as opposed to
precise (since the pursuit of precision involves complicated and likely to be
overturned theories) makes it easier to embark on that journey to begin with.
I can't tell you how many people I know who say that want to lose a few pounds
but reject calorie counting because they heard that's not the right way to do
it. They rarely find an alternative so they never get started.

Im saying that as someone who has gained and lost significant weight to
achieve goals (lifting, running, maintenance) at various times.

PS: If you do decide to diet, regardless of what you do - cut out alcohol
consumption if that's currently a thing for you, and you'll be amazed at how
effortlessly weight comes off, even if you don't really make many changes to
other parts of your diet.

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johnchristopher
I believe it's more urgent to get rid of "serving" as measurement.I recently
tried to build up a dash diet shopping list and was sent on a wild hunt for
what is a serving exactly (turns out a serving is different depending on the
food and measured in different cups and other imperial units).

Most dash diet books (or others) I read spend 200 pages out of 250 explaining
basic useless nutrition factoids then get on a "sample week menus" that aren't
practical at all if all you want to know is "how much pounds of this and that
should I eat per day or per week ?".

I should open a blog about how to get that (easy recipes, easy shopping list),
would be a nice journey.

~~~
nsl73
It’s a little annoying, but you can do the math with a spreadsheet and a
scale. Also many online resources has nutritional information for an item per
100g, and adjusting measurements of weight to other measurements of weight is
much easier than adjusting measurements of volume to measurements of weight.

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jeffdavis
I guess the holy grail is to get to the point where you can take some lab
tests (genetic?) and a doctor can tell you: "eat this kind of diet, avoid
these kinds of foods, and you'll be healthy".

Obviously it would take a lot to get there, but having a few high quality
studies that can give a lot of people at least some advice (without tons of
qualifiers and weasel words) would be a huge help.

This might cost ~50B, but that seems worth it.

~~~
conistonwater
This is kind of funny, but we're already there! Take 0 tests, eat a balanced
diet with plenty of vegetables, don't eat too much, avoid processed meats and
junk food and the rest of it, exercise, and you'll be healthy, you've heard it
yourself already too. How many people do you know who'd actually do it if a
doctor said something like that to them? You kinda manage to both under- and
over-estimate the current abilities of food science at the same time, and if
people don't already do the things that we pretty well know for sure, an extra
$50B won't really change any of that, that's a people problem.

~~~
firethief
If people took a high-tech test and were told that that advice was
personalized, imagine how much better compliance would be though.

~~~
conistonwater
So like a very expensive placebo?

~~~
jeffdavis
Not quite.

Right now there's a lot of confusion. Is gluten a problem for me, or dairy, or
fat, or sugar, or alcohol, or caffiene? It's easy to get overwhelmed.

If you eliminate everything that _might_ be bad for you, there's not a lot
left. There's a lot of value in specificity because it's actionable.

~~~
conistonwater
I suppose I just fundamentally don't agree with you about the confusion
existing in the first place. Here's my understanding. All of those things are
fine, in moderation, unless you have a specific medical condition against
something. Except for alcohol: that's just bad for you in proportion to the
amount you drink. And that's already with existing research, as far as I know,
I might not like it but I don't get overwhelmed.

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troughway
I thought we already knew that caloric contents are context dependent? Or are
we living in some strange dietary multiverse?

Weight gain, weight loss, muscle gain, muscle loss, are operations almost
independent from each other. There’s a lot of huckstering out there that
burning fat and gaining muscle are somehow interlinked or “oppose” eachother
such that while you do one, you automatically undo the other. But this is just
as ridiculous as the constant lack of good information on nutrition.

A few days ago we had that article on how Vegan diet tends to have people
eating garbage. This is again because eating healthy and avoiding eating X
have nothing to do with one another, but in the marketing of things we equate
veganism with uber healthy eating.

At any rate, we need a comprehensive explanation of how the body works at all
stages, and how does nutrition and exercise impact the body _at each of these
stages_. Once you enter ketosis for example, rules change. Something to
consider.

Food for thought.

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Exmoor
Maybe I'm misunderstanding this, but I honestly couldn't disagree more with
the overall premise with regards to losing weight. Yes, nutrition is certainly
vastly more complicated than the single data point calories provide, but the
vast majority of people (myself included) will never, ever be able to
ascertain that knowledge much less be able to interpret them in a way useful
for their own health benefit.

For me, calorie counting was a revelation. I'd tried eating less and
exercising more without much success, and then I read a simple explanation of
calorie counting and realized the whole thing could be simplified into a
simple math problem. If I just kept track of my inputs (food) and roughly knew
my outputs I could control my weight. Once I focused on that I lost ~45lbs in
a year.

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fortran77
The obese and overweight will see these headlines and keep eating 6,000
kcal/day thinking "See! It doesn't matter."

~~~
sk0g
Anecdotal, but a few overweight people I've known have been terrible at
estimating how much they eat.

Usually they'd skip over/forget very hefty 'snacks', or think a portion is a
portion, while scooping up a small family's serving onto their plate.

The really sad thing is when they don't have a coping mechanism for sadness
except for eating, which leads to them being sad over body image issues. It's
a terribly vicious cycle.

~~~
nmfisher
> Anecdotal, but a few overweight people I've known have been terrible at
> estimating how much they eat.

That's pretty much the thrust of the article. Calorie counting works in
theory, but evidently the average person finds it too hard to follow (either
miscalculating, overestimating, forgetting to track or just giving up).

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paultopia
Less p-hacking would be a start.

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whatsmyusername
I’ve lost weight multiple times using calorie counting. It’s literally the
only thing that works for me.

~~~
alecbenzer
A theory I've heard is that _any_ kind of diet is useful for losing weight,
because it forces you to think more carefully about what you're eating.

But ditto, I've lost 50lbs twice in my life and both times were basically just
via calorie counting.

~~~
shoes_for_thee
Likewise, in my adventures in power lifting and body building, I gained ~25-40
lbs on several occasions. The only way to do this reliably for me was to count
calories.

Once you establish your basic metabolic rate, it simply works. Yes, it is a
pain in the ass. Yes, it's a lot of effort and discipline.. but the results
are predictable and reliable.

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nattefury
as

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tekproxy
I eat 5000 calories worth of sawdust a day and can't gain weight.

~~~
ceejayoz
Insoluble fiber is not included in calorie counts on nutritional labels.

~~~
makomk
As I understand it, what's actually subtracted from the calorie counts on
nutritional labels is a very rough estimate of the number of calories that
aren't actually available because they're stuff like insoluble fiber, based
mostly on the type of food. So it's not necessarily that accurate.

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texasbigdata
This seems so condescending. Maybe it wasn't their intent.

"But obtaining a mere $2m-$4m (£1.6m-£3m; €1.8m-€3.6m) for a nutrition study
is a lifetime aspiration for most nutrition scientists".

~~~
tenuousemphasis
Why does that seem condescending?

~~~
texasbigdata
CDCs entire "preventing global disease" division is $450M in funding.... For
example.

