I Ate a Stick of Butter, and It Didn't Work

Jan 26, 2020

or to say it another way:  you must really be an idiot

(originally published here on Medium 1/23/2020)

Humans like explanations. 

The more simple, the more palatable they are.  If any idea can be compacted into a tight clean linear equation – we can sit more comfortably with it. 

How many people have you met that enjoy calculus more than algebra?  My point exactly.  It’s easier, it’s linear.  We like tweets, headlines, bullet journals, armless chairs, we freaking love Marie Kondo – and it’s real love. 

Simple is comfortable.

Simple is joy. 

Better yet, if we can program algorithms into a gadget so that it becomes unobtrusive, simple, informative, parceled down into teensy informatic bits of data - we love that even more. Bonus points if it makes a graph too! Sleep tracking. Food tracking. Heart rate tracking.  Exercise tracking.

We track our kids, our bike rides, our investments, our macros, our screen time, our mileage, our fertility, our grades, our steps, our Amazon orders...  It is exhausting to even consider all of it, but we have partitioned the experience of being a human into fragments of inconsequential measurements.

I cannot, however, write another single word about nutrition without debunking the myth of calories in and calories out (CICO). 

Oh yes, I’m going to go there.  It is the eleven thousand pound fluorescent yellow polka-dotted elephant sitting in our living room. 

#1 Nutritional Myth on Earth: Calories In = Calories Out

It is a complete and total disaster that we can no longer afford to ignore.

The hangover diet culture from the 1980s is suffocating the ever loving oxygen right out of our brain so much so that we have become a society who believes we might attain better health by eating sticks of butter.

I’ll just stop there and let you listen to the echo of how completely unbelievably ridiculous that sounds.

We can no longer work around this and ignore it. 

I bought into CICO for decades, and I am a doctor!  I would even go so far as to say I’m a reasonably intelligent doctor, but I can’t even count the number of times I stayed on the treadmill before sunrise until the calorie counter offset the amount of calories in the breakfast bar I was going to eat on my way to work. 

(Photo by Kwasi Kyei on Unsplash)

I’m not laughing at you, I’m laughing with you because I know at least half of you did this exact thing today!  How much more successful can you feel than to make it to lunchtime and be at a caloric net zero. It is comfortable, linear, measureable, so simple it is beautiful. 

But it is wrong.

In a more tangible analogy – answer the question for me: How far can a car go on a tank of gas?  What kind of fuel, what kind of engine, how big, how small, city driving, highway driving, snow, are you towing a camper, are you running the air conditioner, is there a head wind, a tail wind, are the tires inflated, is the oil filter clean? 

See how ignorant that sounds to assume that the human body is more simplistic than a car engine? Thankfully, God has a better track record than Pontiac or we would all be doomed.

CICO comes from First Law of Thermodynamics – conservation of energy. Neither created or destroyed.  And that is true if you are accounting for the energy balance of the entire universe

But if you believe calories in and calories out theory at the level of one human body– you are discounting the hormonal influence of nutrition, the trillions of reactions happening at the cellular level. 

Insulin, cell receptors, heat capacity, formation of chemical bonds, mitochondrial health… and listen to me - if you are micromanaging your organelles, you are taking counting macros to a whole new level.  Have fun with that, and I hope I don’t hurt your feelings, but you’re really not my kind of people. I think the world is going to be a very difficult place for you. 

Energy balance in the human body fortunately subscribes to an incomprehensibly elegant design despite us because the most brilliant PhD dissertation can never account for everything we know and all the things we haven’t discovered yet.

All that to say, calories in your mouth plus calories out on your smartwatch app cannot be presumed to marry in the first law of thermodynamics. 

The human body is way too tightly regulated physiologic environment.  And if you are an evidence-based kind of person (now we’re speaking the same language) - we have lots of proof that this isn’t true.

(Photo by Roman Mager on Unsplash)

Mostly obviously is that the various models of caloric restriction and "eat less, move more" we have used over last 50 years — do not work. We can continue to believe that we just aren’t trying hard enough…

...or we can finally learn from our mistakes and acknowledge that the CICO hypothesis is not actually correct!

However, despite the wrongness of CICO on the day to day basis - suddenly subscribing to the idea that “calories don’t have anything to do with energy balance” is an equally ignorant camp.  Calories do represent energy (obviously) since that is the literal definition of a calorie.  But the practical misunderstanding is that they don’t matter in the normal range of energy commerce where human physiology exists – which is where you and I live, thankfully.

If you take in an overwhelming amount of calories – even from hormonally quiet foods…. you will gain weight. 

If you eat 15,000 calories a day, every day, of anything, you will gain weight - not that weight matters at all in regards to health, but it seems to be what everyone is talking about. 

But doctor, what if I eat 15,000 calories of cauliflower? 

Are you serious?  Is that an actual question?

Good luck.  I would invite you to try that and get back with me.  Anyhow, if you eat a bazillion calories of anything you will gain weight because in the BIG PICTURE - calories are energy.

Conversely, if you take in an underwhelming, nearly negligible, number of calories on a regular basis, you will lose weight, although it rarely equates to improved health.

See anorexia nervosa or sub-Saharan Africa. Or the more proximal image of the starving middle-aged moms in 1983 jacked up on dexatrim and Tab. Point taken.

In summary:

  • Eating astronomically large amounts of calories will likely make you gain weight
  • Eating nearly zero calories will likely make you lose weight
  • Eating within a very wide range of normal physiologic calories for a human has very little to do with whether you lose or gain weight

AND most importantly... whether you lose or gain weight has just about zero relevance to your overall state of health!

So back to the stick of butter. 

In full disclosure, I have used more butter this week in my kitchen than I did during the entire Clinton administration.  I’m not picking on butter. Butter is a healthful, useful condiment that is not causing people to drop dead of strokes despite what your doctor says (that’s a whole other article). 

But for the love of all that is good and holy, if you are whacking off a stick of butter and eating it at 9pm to “get your macros”. You have lost your damn mind in this toxic diet culture narrative. 

Please do not wipe off your greasy fingers just to write me an email that says how you’re not feeling better because you just ate a stick of butter. 

I’m kidding, but I’m not really kidding. 

Our food psychology has made us certifiably nuts.  We want to make the intricate workings of human physiology so straightforward that in the year 2020 we are actually considering eating sticks of butter. 

Lord help us all.

(Photo by Jon Tyson on Unsplash)

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