Many experts still believe that “one calorie is one calorie.” If we apply this idea to weight control, we have to only be concerned with the number of calories in our diet, regardless of what different foods we eat or how we eat them. Of course, the human body is not that simple, and many researchers have warned against this kind of thinking.

In explaining this, I thought I should make a distinction between reactions that occur "inside" the body (after absorption) and those that occur “outside" the body (before absorption) (*1).
In this article, I would like to consider the Atwater coefficient, which is the basis for calorie labels on food products, as an issue that occurs outside the body. 

By feeding volunteers various foods and calculating the difference in the heat of combustion between the food and the excreta, he approximated the calories absorbed by his volunteers. It is said that Atwater also took into account the dietary fiber which we can’t digest (*2), and proteins, some of which are excreted in the urine as urea after being absorbed. 

More than one-hundred-twenty years after this experiment, these "Atwater coefficient" are still the basis for caloric calculations for all foods[1].

( *2: It is now known that dietary fiber produces some energy through fermentation and breakdown by  the bacteria in the large intestine[2].)

We ingest food and then break down complex food molecules into simple structures such as glucose and amino acids by various digestive enzymes. After that, we get an energy source by absorbing them. Naturally, this is a completely different process compared to burning food in the laboratory. 

   
According to Professor Rob Dunn (North Carolina State University), every calorie count on food labels is based on estimates or approximations, and are not an accurate reflection.

Recent research has revealed that how many calories we get from a given food depends on a variety of factors, including which species we eat, how we cook food, which bacteria are in our gut, and how much energy we use to digest different foods (diet-induced heat production).[4]
   

A study by Janet A. Novotny at the U.S. Department of Agriculture (2012) found that when people eat almonds, they take in just 129 kcal per serving, not the 170 kcal listed on the label. It is beginning to be proven that nuts such as peanuts, almonds, and walnuts have a more robust cellular structure than other foods with similar levels of energy sources, and that their cell walls limit digestion. It is possible that the Atwater coefficient overestimates the digestibility of nuts.[5]
    

Furthermore, some have pointed out that industrial food processing not only exposes food to high temperatures and pressures, but also softens food by adding air, to make it even easier to get more calories.

Corn, for instance, which is considered indigestible, is made into potage, and raw peanuts are roasted and processed into peanut butter. These processes must have dramatically increased the amount of energy available to the body. In other words, not all pork dishes are the same. The energy used for digestion and the absorption rate differ when roasting a chunk of pork versus making it into pâté.
   

Some research has shown that the energy required for digestion is not the same. This is called “diet-induced thermogenesis,” and it requires a great deal of energy to convert proteins into amino acids, fats into fatty acids, and carbohydrates into glucose. It is said that when proteins are broken down into amino acids, they require much more energy to digest than fats, because enzymes must unravel their tightly wound bonds[6].

It also differs between whole grains and refined wheat. A 2010 study found that people who ate 600-or 800-kcal portions of whole-wheat bread with sunflower seeds, kernels of grain, and cheddar cheese, expended twice as much energy to digest that food as those who ate the same amount of white bread and "processed cheese products.” Consequently, those who ate whole-wheat bread substantially obtained ten percent fewer calories, they said[7].

Most babies have lactase, an enzyme necessary to break down lactose sugar in milk, but it is said that most adults don’t produce this enzyme.

It has also been found that when starches such as rice and spaghetti are left to cool after being cooked, some of these starches crystallize into structures that digestive enzymes cannot easily break down.

What’s more, some microbes are present only in specific ethnic groups. Some Japanese, for example, have a microbe in their intestines which is suitable for breaking down seaweed. It has been found that these intestinal bacterium stole the seaweed-digesting genes from a marine bacterium that lingered in raw seaweed [4].
    

The general Atwater coefficients were calculated based on the average daily diet of Americans at the time. Digestibility for carbohydrates, fats, and proteins were assumed to be 97, 95, and 92 percent respectively, and after adjusting a little for this, protein and carbohydrates were set at 4kcal/g, fats at 9kcal/g, and alcohol at 7kcal/g[8]. Although metabolizable energy values vary slightly for proteins, depending on whether they are vegetable or animal protein, and for carbohydrates, depending on whether they are sugar or starch, the coefficients were derived by a system of an average.

On the other hand, specific Atwater coefficients are also allowed, which divides food into several groups and applies a representative coefficient of that group to the entire group.

It is said that the U.S. Food and Drug Administration (FDA) allows a total of five variations on the theme including these, and some point out that depending on the method chosen by the food company, there may be variation on the calorie labels[9]. When such uncertainties add up, the daily caloric intake could vary widely.
    

Prof. Dunn mentions as follow:

(1) It is possible to modify the Atwater system for every food group, as in the almond example. However, this would require a challenge to reexamine the amount of nutrients retained in the excreta for every food. 

(2) However, even if we completely revised calorie counts, they would never be accurate because how many calories we extract from food depends on a complex interaction between food, the human body, and its many microbes. In particular, the process of digestion is so complex that it is probably impossible to derive an accurate formula for calorie calculation that will suit everyone.

(3) Instead, we should think more carefully about the energy we get from food in the context of human biology. Processed foods are easily digested in the stomach and intestines, and thus provide a lot of energy for very little work. On the other hand, vegetables, nuts, and whole grains require more sweat to digest, offer far more vitamins and nutrients than processed foods, and keep our gut bacteria happy[4].
    

I believe that researchers and nutritionists at that time, including Atwater, were committed to ensuring that people could have an adequate amount of nutrition, and the calorie counting system they created had great merit. But I suspect it has been misperceived by some and is now causing problems with those who are overweight.
The reason why the issue of being overweight remains unresolved indefinitely is because many people are too fixated on the caloric value of foods.

Let's say you eat, as in the example in the section 2-[III], 400kcal of a meal: whole-wheat bread, nuts, and grilled chicken. Assuming that, after taking into account the energy required for digestion, you obtained ten percent fewer calories (360kcal), the argument that "wouldn't it be the same if you ate 360 kcal worth of white bread and chicken terrine?" is complete nonsense.

I I have been explaining throughout this blog that the fundamental difference between obese people and lean people can be explained by the difference in set-point weight, and that having a higher set-point weight is related to an increase in absorption efficiency, which is induced by intestinal starvation.  In addition, since one of the key factors causing intestinal starvation is how fast you digest food, both digestion and absorption ability are extremely important in my theory.

      
Nevertheless, if we believe that only numbers based on averages of subjects are all we have, we ignore them. As Prof. Dunn mentions, I don’t believe that the complexity of digestion and absorption for a diverse population can be described by a system using an average.

(Please read the following article for other issues in "calorie counting.")

There is No Meaning in Simply Calculating Calories You Consume

Those foods contain far more vitamins and minerals than processed foods, and their fiber content keeps our gut bacteria in good condition, gives us moderate satiety, prevents rapid absorption of glucose, and provides many other health benefits. Depending on how you eat them, it should be possible to lose weight without worrying about caloric intake.
    

The Atkins diet is a type of low-carbohydrate diet proposed by cardiologist Robert Atkins that restricts the amount of carbohydrates for energy and instead uses "fat" as an energy source. It is characterized by limiting carbohydrates to twenty to twenty-five grams per day for the first two weeks and then gradually increasing.

According to Dr. Fung, the author of “The Obesity Code,” Dr. Atkins weighed nearly one-hundred kilograms in 1963, and when he began working as a cardiologist in New York City, he needed to lose weight. 

However, he couldn’t lose weight successfully on a conventional calorie-restricted diet, so he tried the low-carb diet based on the medical literature, which worked well as advertised, and he recommended it to his patients. 

New studies started appearing around 2005, comparing the Atkins diet to other diets that were once considered the standard, and what were the results[1]?

Let's take a look. I would like to express my thoughts on this at the end of this article. 

"In 2007, the Journal of the American Medical Association published a more detailed study: Four different popular weight plans were compared in a head-to-head trial.

One clear winner emerged-the Atkins diet. The other three diets (Ornish, which has very low fat; the Zone, which balances protein, carbohydrates and fat in a 30:40:20 ratio; and a standard low-fat diet) were fairly similar with regard to weight loss. 

"Longer-term studies of the Atkins diet failed to confirm the much hoped-for benefits.
Dr. Gary Foster from Temple University published two-year results showing that both the low-fat and the Atkins groups had lost but then regained weight at virtually the same rate. (*snip*) 

A systematic review of all the dietary trials showed that much of the benefits of a low-carbohydrate approach evaporated after one year.

Experts who advocate low-carbohydrate diets seem to think that carbohydrates cause weight gain because they eventually stimulate insulin secretion.

However, Dr. Fung mentioned that the carbohydrate-insulin hypothesis is incomplete. Various problems are cited, but he raised the "paradox of the Asian rice eater" and the "diet of Kitava Island, in Papua New Guinea" as notable examples.  

Most Asians have been eating a diet based on refined rice as their staple food for at least the last five decades; a study conducted in the late 1990’s found that carbohydrate intake in China and Japan was similar to or rather, higher than in the U.K. and the U.S. 

Since Dr. Fung just mentioned the paradox of the Asian rice eater, I would like to mention this.

I am Japanese and was born in 1970, and I think that I should know how our diet has changed in the last five decades, and as a result, how obesity has increased in our society. 
(This is explained in more detail in the following blog.)

[Related article]  Why Does the Body Perceive That It Is More Starved than in the Past?

In short, I believe that carbohydrates are a contributing cause, but not the quantity itself.
Japan was basically an agrarian society, and rice cultivation has always been important. Until at least 40-50 years ago, I believe most Japanese people had eaten a lot of rice as it is called the staple food, but at the same time, they also ate a lot of fibrous vegetable dishes using roots or stems of plants, fermented soybean product called “natto,” and fish and meat dishes. Rice cakes called “mochi” and Japanese sweets as well.

At least in my family, my father was strict about family members eating meals three times a day at a regular time, every day.
  

I believe that the "three factors plus one" of my intestinal starvation theory can explain how the various factors intertwine, and how weight gain occurs. It's not just the amount of carbs eaten that matter.

The "Do calories make people fat, or carbs?" concept is said to be a debate that has been going on since the 1800’s[3], and I think both are true in some ways, but neither is perfect.

If you reduce the amount of any energy source beyond what your body needs, it’s obvious that you will lose weight in the short term. However, if you go back to your original diet, in the long run, you will also regain the weight you had lost, as various studies have confirmed, and as most people who have been on a diet have probably realized.

The reason for this is that the human body inherently has a homeostatic mechanism that drives it to return to its set point weight. So, the point is that in order to avoid rebounding, you must lower your set-point weight itself. 
(For more details, please refer to the article below.)

[Related article]  There Are Two Steps to Lose Weight the Right Way

In terms of this rebound in the Atkins diet in section three, I don't think it necessarily means that low-carb diets, including Atkins, are ineffective. I’m positive that it’s the one of the correct ways to lose weight.

However, if we focus too much on blood sugar and insulin levels, we lose sight of another important point.

              
What I mean is that  the key to a low-carb diet, I believe, is not just reducing carbohydrate intake but also increasing foods that are less digestible and take longer to digest, such as fiber-rich foods, meat, fats, and dairy products.

When plenty of undigested food remains in the gastrointestinal tract, it helps to sustain a feeling of fullness and reduces hunger. In the long run, I think this approach can lower absorption rates. In particular, I believe fats and oils in the diet should not be reduced, but rather should be consumed regularly at every meal and even when having snacks. 

Considering all of the above, I think that dieticians do not need to ban sweets such as chocolate, candy, ice cream, etc. so strictly. What’s most important is to make the diet sustainable without overburdening yourself, even allowing occasional indulgences in sweets.

(1) In the early 2000’s, the Atkins diet became a huge trend in the U.S., inspired by the low-carb diet that was rekindled in the 1990’s. In the short term, the Atkins method not only helped people lose weight, but it also significantly improved blood pressure, cholesterol, and blood glucose levels.

(2) However, in long-term studies, the subjects rebounded, as seen with low-fat diets. After one year from the end of the study, all the benefits of Atkins diets were gone.
Dr. Fung considered the "carbohydrate-insulin hypothesis" an incomplete theory. Carbohydrate intake itself was not the problem.

(3) My thoughts. If there is no change in your set-point for body weight, rebound can occur if you eat as you used to. In order to lose weight correctly, your set-point weight itself needs to be lowered.

             
(4) The key to a low-carb diet is not just controlling the amount of insulin released. It’s also important to reduce refined carbohydrates while increasing the intake of fiber-rich foods and those that take longer to digest.
When plenty of undigested food remains in the gastrointestinal tract, it helps sustain a feeling of fullness and alleviates hunger. Over time, I believe this approach can lead to a decrease in absorption rates.

<Reference>
[1] Jason Fung. The Obesity Code. Greystone Books, 2016, Pages 96-99.
[2] Jason Fung. The Obesity Code. Pages 103-105.
[3] Gary Taubes. Why We Get Fat.  New York: Anchor Books, 2011, Pages 148-162.

In Japan, the image of sumo wrestlers in particular may lead to the image that "eating more makes you fat," but I would like to explain that this is the same mechanism as "those who end up rebounding after dieting and gain more weight than before" or "those who gradually gain weight by skipping breakfast or having a late dinner.”

First of all, I'm going to illustrate how both of them gain weight in the figure below. 
  

When you see big eaters in a food eating competition, some may ask, "Why don't they get fat even though they eat so much?” But, from my theory, it is not at all surprising.

It’s not that they have a special "non-fattening constitution," but that anyone who eats like that from morning to night is less likely to gain weight (although I wonder why they can eat so much food at once).

Please understand that the way of eating of a sumo wrestler is a far cry from that of an eating competitor.
   

(1)A wrestler must weigh at least sixty-seven kilograms to be admitted. People who are overweight or muscular from the beginning tend to have stronger stomachs, and are thought to have a relatively high digestive rate. Such people are more likely to induce gut starvation than thin people.

(4)They traditionally eat two meals a day: the first meal is around eleven a.m. after morning practice, and dinner is around six p.m.
Since they practice from the early morning without breakfast, if dinner is finished at seven p.m., it means that they do not eat for about fifteen to sixteen hours until the next meal. It make sense to do intense morning training on an empty stomach to gain weight.

Of course, there are some wrestlers who try to eat snacks or supplements late at night in order to take in more calories, but my idea is that it makes easier to gain weight when they don't eat.

(1)Sumo wrestlers are famous for being big and fat, but they do not gain weight because their daily caloric intake exceeds their daily caloric expenditure.
Their traditional diet and exercise makes sense in terms of weight gain in that it facilitates the creation of intestinal starvation.

(2)Intestinal starvation is more likely to be induced when a person who has a big body from the start eats relatively easily digestible foods with lots of carbohydrates (rice) and two meals a day.

(3)The mechanism by which wrestlers gain weight is the same as that of "people who diet and gain more weight than before due to the rebound effect.”
In the case of sumo wrestlers, since they eat a lot every day, this happens almost simultaneously, and they appear to eat a lot and gain weight.
    

According to a survey, more than fifty percent of Japanese people put on some weight during the period of staying at home by government order to prevent the spread of the coronavirus.

I think two classic examples of "eating a lot or stopping exercising makes you fat" fit here.
Normally, these people were under the strain of their jobs, moving all day long, eating in moderation, and paying attention to caloric intake. If that tension is gone and they simply exercise less and eat more, they will naturally gain weight.

Sometimes I hear people say, "I ate too much at the all-you-can-eat buffet yesterday and gained three kilograms in one night.” They may have simply gained body fat or the weight of the food in their gut may also be a factor.

But It is a big mistake to say, "Okay, let's skip today's lunch." 

With the recent gourmet food boom, many delicious foods are introduced on television and social media, while many people are worried about gaining weight and are trying to eat less.

If you skip meals or eat light meals (e.g. hamburgers and coffee) to reduce calorie and carbohydrate intake, you will deal with hunger for a longer period of time.

Even if you lose a little weight temporarily, the lack of fats/oils, dairy products, and fibrous vegetables can lead to intestinal starvation and an increase in your set-point weight over the long haul.

Unknowingly, your set-point weight may go up, and one day, when you eat like you used to, you may find that you have reached your highest weight ever. And it will be harder to lose weight than before.

The first step in becoming leaner is to eat three well-balanced meals religiously every day. 
Even if you want to reduce total caloric and carbohydrate intake, be sure to consume a variety of foods from a diverse group of foods.
   　　　

(1) Some people claim to have gained a few kilos during the Covid self-quarantine period, but I believe most cases can be explained by a return to one’s set-point weight as well as a rebound effect after dieting.

(2) The idea of adjusting for yesterday's excess calories by eating fewer calories today is a mistake when it comes to maintaining a stable weight in the long run.

(3) People who usually eat less and hold back on the foods they want to eat for dieting, and occasionally splurge on treats, are more likely to gain weight over the long haul.
Irregular eating, where a person eats on and off, can cause intestinal starvation when dealing with hunger over many hours, unknowingly increasing their set-point weight.

(4) Since the gastrointestinal tract basically begins with breakfast and the food we eat reaches the rectum in around twenty hours or so (it differs from person to person), it is important to eat three well-balanced meals every day if you do not want to gain weight.
           

"Obese children often have obese siblings. Obese children become obese adults. Obese adults go on to have obese children. Childhood obesity is associated with a 200 percent to 400 percent increased risk of adult obesity. This is an undeniable fact. (*snip*)

Families share genetic characteristics that may lead to obesity. However, obesity has become rampant only since the 1970s. Our genes could not have changed within such a short time. Genetics can explain much of the inter-individual risk of obesity, but not why entire populations become obese.

Nonetheless, families live in the same environment, eat similar foods at similar times and have similar attitudes. Families often share cars, live in the same physical space and will be exposed to the same chemicals that may cause obesity–so-called chemical obesogens. For these reasons, many consider the current environment the major cause of obesity.

"The classic method for determining the relative impact of genetic versus environmental factors is to study adoptive families, thereby removing genetics from the equation.(*snip*)

Dr. Albert J. Stunkard performed some of the classic genetic studies of obesity. Data about biological parents is often incomplete, confidential and not easily accessible by researchers. Fortunately, Denmark has maintained a relatively complete registry of adoptions, with information on both sets of parents.

"Studying identical twins raised apart is another classic strategy to distinguish environmental and genetic factors. Identical twins share identical genetic material, and fraternal twins share 25 percent of their genes. 

In 1991, Dr. Stunkard examined sets of fraternal and identical twins in both conditions of being reared apart and reared together. Comparison of their weights would determine the effect of the different environments.

The results sent a shockwave through the obesity-research community. Approximately 70 percent of the variance in obesity is familial.(*snip*)

I think this is a very interesting study because it compared data from biological parents and adoptive parents.

However, can we assert from the results of this one alone that the influence of genetics was much greater and environmental factors were much less significant?

I believe, as Doctor Fung mentions, the rapid increase in obesity in recent years (since about 1970) has much to do with changes in our living environment (what we eat, irregular lifestyle,etc.),not the genes.

The study considers a child living with adoptive parents or twins raised separately to be a "change in living environment," but I think there is a problem with this study.

If a family can afford to take in a child as adoptive parents, don't they have some money to spare and feed their adoptee a somewhat balanced diet three times a day?
Although what they eat and caloric intake may differ from family to family,  those changes are not necessarily "environmental changes" that cause changes in weight. Just because the adoptive parents are thin does not mean that adoptees will become thin even if they eat the same diet.

In Japan over the past few decades, our traditional eating habits have been declining.  Instead, Westernized eating and diverse work styles have become more prevalent.
Amid these changes, intestinal starvation is more likely to be induced when unbalanced diets (high in easily digestible carbohydrates and ultra-processed foods, and with a lack of vegetables, etc.) combines with irregular lifestyle habits (skipping breakfast, eating late at night, etc.).

This is what I would like to call the "environmental factors and human behaviors" for the recent obesity epidemic, and while genetic factors are, of course, undeniable, I believe that environmental factors are quite significant.
           

From my theory, that means that their set-point weight has not changed, and in this study, if there are no environmental factors that cause changes in their set-point for body weight, then wouldn't the body shape from childhood basically continue?

But, I’m simply wondering what the childhood body shape is due to? Whether it is genetic factors or the way food is prepared during childhood－including weaning－is a question that remains unanswered.

(1) In a study regarding adoptive families and examining how genetic and environmental factors influence being overweight, no correlation was found between the weight of adoptive parents and that of their adoptees. On the other hand, when the adoptees were compared to their biological parents, there was a consistent correlation between the weight of both.

A study of twins raised separately also concluded that "genetic influences are far more significant.”

(2) Many researchers had previously blamed "environmental factors and individual behavior” for the recent obesity epidemic, but this study concluded that genetics had far more impact than environmental factors.

However, I find this study problematic. The fact of children living with adoptive parents or twins raised separately is not necessarily an environmental factor that causes changes in weight.

(3) Of course, I do not think we can ignore the genetic factor, but I believe that the recent obesity epidemic is caused by a combination of what we eat－westernized diets, refined carbohydrates, processed foods, etc.－plus lifestyle changes. 

A major change in weight and body shape occurs when one’s set-point weight goes up, which is induced by intestinal starvation.

(4) If there is no significant change in one's set-point weight, I think the body shape from childhood is expected to continue. However, I 'm uncertain what determines childhood body shape, whether it is heredity or the way food is prepared during childhood, including weaning.