In the new paper soon-to-be published by Public Health Nutrition, a Cambridge University Press journal, doctors Sean Lucan and James DiNicolantonio question prevailing ideas on obesity and weight gain, with respect to calorie counting, while arguing for a more qualitative, rather than quantitative, approach to nutrition.1 Dr. Lucan is a practicing family physician and researcher whose work focuses on urban food environments and how they influence dietary behavior. Dr. DiNicolantonio is a cardiovascular research scientist at St. Luke’s Mid America Heart Institute. We caught up with Dr. DiNicolantonio to discuss his new paper and ask his views on calories, food quality, the Paleo Diet, and more.
In their paper, the doctors observed that most public health initiatives addressing obesity approach the problem arithmetically. In other words, make a balance sheet, add calories in, deduct calories out, and whenever there’s a deficit, weight loss should occur. This approach can also be summarized as “eat less, move more.” Research shows, however, that caloric intake and caloric expenditure are coupled, and thus consuming fewer calories “will necessarily result in a compensatory drive to reduce calories expended.”2 People who cut calories often fail to lose weight because they get tired and hungry, and this hunger drives them toward higher-calorie foods. Maintaining caloric deficit, the doctors argue, “is practically and biologically implausible.”
So what makes us gain weight? Is a calorie a calorie? In other words, do 100 calories of salmon have the same physiological impact as 100 calories of sugar or 100 calories of bread? In fact, different foods have substantially different effects on key hormones related to satiety, food consumption, weight maintenance, and body composition, particularly ghrelin (an appetite-stimulating hormone) and leptin (an appetite-suppressing hormone). Long-term overconsumption of refined and rapidly absorbable carbohydrates, the doctors explain, may promote leptin resistance, a condition they characterize as “a neurohormonal drive to ‘eat more’ and ‘move less.’”
We asked if sugar, in all its guises, is driving the obesity epidemic. “Refined/rapidly absorbable carbohydrates as well as added sugars (sucrose, also known as table sugar, and high fructose corn syrup) as well as free sugars, honey, 100% fruit juice, and syrups (agave syrup for example) are the primary drivers of obesity,” said DiNicolantonio.
Many people are surprised to learn that fruit juice is so metabolically destructive. Dr. DiNicolantonio refers to fruit juice as “soda without the buzz,” echoing Dr. Loren Cordain’s claims that fruit juice is “liquid candy” following the report fruit smoothies were equally as unhealthy as soda beverages. “Fruit juice actually has a higher fructose to glucose ratio than most sodas,” said DiNicolantino. “The rapidly absorbable sugar that is provided outweighs any small benefit provided from vitamins and minerals supplied in fruit juice.”
We also asked Dr. DiNicolantonio for his thoughts on the Paleo Diet. He observed that there are “good” and “bad” interpretations of Paleo. The bad interpretations, or more accurately, misinterpretations, would be those including highly processed animal foods or otherwise inferior quality animal products. “Then there is good/healthy Paleo,” he explained, “which is someone who is consuming animal products from animals set to pasture and never grain finished.”
In his paper, DiNicolantonio argues that with respect to calories, quality is far more important than quantity. He feels the same way about Paleo—quality predominates. “In essence, you can eat animal foods and be healthy, or you can eat them and be unhealthy. It depends on how the animal is bred and fed, as well as how the person is cooking the animal products.”
So if you’re trying to lose weight, quantitative strategies like caloric restriction probably won’t help. The Paleo Diet, on the other hand, is a scientifically vetted, evolutionary approach to health and wellness, including reduced body weight. The Paleo Diet works because it’s fundamentally a qualitative strategy, focusing on nutrient and ingredient quality rather than quantity consumed.
Christopher James Clark, B.B.A.
Christopher James Clark, B.B.A. is an award-winning writer, consultant, and chef with specialized knowledge in nutritional science and healing cuisine. He has a Business Administration degree from the University of Michigan and formerly worked as a revenue management analyst for a Fortune 100 company. For the past decade-plus, he has been designing menus, recipes, and food concepts for restaurants and spas, coaching private clients, teaching cooking workshops worldwide, and managing the kitchen for a renowned Greek yoga resort. Clark is the author of the critically acclaimed, award-winning book, Nutritional Grail.
 Lucan, S and DiNicolantonio, J. (Embargo: November 24, 2014). How calorie-focused thinking about obesity and related diseases may mislead and harm public health. Public Health Nutrition. doi:10.1017/S1368980014002559