CICO and rant

“Wait… what?  nutrient partitioning?”

Calories In, Calories Out should not be interpreted as “eat less, move more,” but rather kept in its more meaningless form of: “if you eat less than you expend, you’ll lose weight.”  At least then, it’s correct… meaningless, but correct.  Eating less and moving more is no guarantee of fat loss, in part, because total energy expenditure isn’t constant and there’s that whole thing with nutrient partitioning.

For obese insulin resistant folks, this is Low Carb’s strong suit: it causes “eat less, move more”spontaneously.

For some obese insulin sensitive patients, for whatever reason, their adherence and success is greater with Low Fat.  You might say, “yeah, but those suckers had to count calories.”  To that, I’d counter with: “it doesn’t matter, THEY WERE MORE SUCCESSFUL COUNTING CALORIES ON LOW FAT THAN NOT COUNTING ON LOW CARB.”  The spontaneous reduction in appetite obviously didn’t cut it.  Do not be in denial of these cases.

There are different obesity phenotypes – insulin resistant and insulin sensitive being two examples – and they respond better to different treatments.  Three other distinct obesity phenotypes: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); and combined IFG/IGT.  They exist.  Might they respond differently to different levels of carb intake?  Dietary protein or fat?  Exercise?  Sleep?  My money’s on “yes.”

The new Taubes video is great; he is undoubtedly aware of Chris Gardner’s epic work but fails to address this critical point.



CICO isn’t really wrong unless “CI” assumes we can actually accurately count calories and “CO” is interpreted as exercise.  No one is arguing that Low Carb breaks the Laws of Thermodynamics; when people lose weight on a low carb diet, it’s because fewer calories were consumed than were expended.  The point is, for obese IR on LC this happens spontaneously and requires no knowledge of CI or CO.  Does it work for everybody? …well, sort of, but some do better on Low Fat <- FACT.




How to make low fat work for you? (I’m not kidding) (well, maybe a little)

1)      Be young and fit (markers of insulin sensitivity).

2)      Carbs must be Paleo-friendly.  This is not a negotiation.

3)      You’re gonna have to count calories (every LF study confirms this). Find out your baseline, and shoot for a few hundred less.  This is harder because Paleo foods are less likely to come with a nutrition facts label, so just know this: if you’re not losing weight, then you’re not in an energy deficit &/or counting wrong.  Calories in must go lower.  Nobody said this was going to be easy.  If you start to lose muscle, try upping the protein and decreasing the energy deficit.

4)      You don’t really need to watch fat intake & shouldn’t opt for “fat-reduced foods” since: 1) they’re usually crappy; and 2) “calories in” are going to be closely monitored.  In other words, don’t expect a big difference between high carb and very high carb diets… the impact of insulin on adipose tissue saturates at very low levels of insulin.  Wait… what?  nutrient partitioning?


calories proper

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  • keithlovesfood

    Hey Bill,

    Great post as usual. Quick question: You briefly mention high carb vs very high carb at the very end. Care to expound on this a little more? How high are we talking?

    • Bill Lagakos

      Thanks, Keith.

      In my opinion, can’t give an exact number for this, eg, grams, g/kg, %kcal, etc.
      At the very low end, need to measure ketones: very low carb = ketogenic. This can be a wide range of absolute intakes depending on body comp, body weight, activity, fitness, etc., etc. Just plain old “low carb” is probably around 2-3x higher.
      At the high end, average is ~50%, so a bit more than that I suppose.

  • Young Chipotle

    Hey Bill, great article. Calorie counting has become way easier than before, specially with apps like myfitnesspal for smartphones! They’re database is mostly USDA nutrition info ( and all you really have to do is give your food a quick weighing and you’ll be as accurate as is possible these days.

    One question. When you say Paleo-carbs; you mean fruits, veg, nuts? Or do I have to give up nightshades?

    • Bill Lagakos


      I use the phrase “Paleo carbs” broadly: it can include nightshades, assuming they’re not in the form of processed junk food. …I’m really just referring to processed junk food.

  • Cheesy

    Hi Bill, thanks for this post. I would actually like to ask you about the other article of yours that you link to around the end of this one (“impact of insulin …”): after reading it I find that something is missing, and that is glucagon. The insulin injection experiments could have checked what would happen if you injected glucagon as well. And to simulate amino acid effect on hormonal status, I’d guess the glucagon injection (if these experiments had done that) should happen a little BEFORE insulin injection (because from my naive POV, I would think that you would rather anticipate an insulin surge and its blood glucose lowering effect when digesting amino acids, so you prepare yourself by secreting glucaon to avoid hypoglycemia when digesting those AAs).

    I am no expert at all, I am just trying to understand whether these insulin injection experiments make sense when in a real situation, glucagon would be present.

    • Bill Lagakos

      Glucagon injections would do little to hinder the effects of physiological (postprandial) insulin on adipose tissue. The effects of insulin on adipose tissue are very robust!

  • carbsane

    Point 3. “Every LF Study Confirms this” is incorrect. 50% carb, 30% protein, 20% fat — reduced ~450 cal/day spontaneously.

    There are studies on the MaPi diet and traditional Hawaiian diet, both ad libitum but quite low fat.

    The reason LF “requires” calorie counting in many is because it isn’t low fat, it’s not all that different from what folks are generally consuming so automatic reductions can be difficult.

    Meanwhile, many low carbers must count calories to lose weight further and/or keep from regaining. You see it in all of the forums and blogs.

    For most, a CICO solution has to involve eating less and/or moving more. Some will sit in ice baths (CO). Some may see nominal changes in NEAT (again, CO). There is no evidence of any verifiable long term change in REE for various macros etc. across a wide range of variables on both sides of CICO. If anything, long term carb restriction favors lower CO due to adaptation.

    • This Old Housewife

      Oh lord…a high-carb troll. Carbsane tried to take down Jimmy Moore and failed. Now I see he/she has moved on.

    • 2lbs of Starch

      Many people lose weight on an ad libitum high-carb diet (no calorie counting). Almost everyone 100 years ago kept thin on an high-carb diet without counting calories.

      I’ve lost 60 lbs eating mostly bread, noodles, and tortillas. I eat low fat, because it’s preferentially stored when eating high carb. Exercise did the rest.

      • Kindke

        low-fat is a disaster for me, makes me store huge amounts of subcutaneous fat especially in belly area.

        • 2lbs of Starch

          I’m happy if you reached your goals on a low-carb diet.

          • Kindke

            I did NOT reach my goals on low-carb,

            The statistics overwhelmingly indicate that for 90% of people obesity is not reversible through diet alone.

            Having said that, I would certainly be much fatter with carbs in my diet.

          • 2lbs of Starch

            Ok, I’m happy that you’re right then.

          • mikemarkham

            If find that difficult to believe. Where are these statistics that I missed?

          • Bill Lagakos

            it’s probably not too far off… most diet studies that extend >6 months show at least partial weight regain.

          • mikemarkham

            Factor in weight regain: These are patients potentially in a clinical setting/in an experiment. It is temporary and when they slack off, they will gain weight.

            This is akin to stating if someone is sober and they drink again, they’ll get buzzed or drunk – a no-brainer.

    • thermo

      Carbsane….straight bitch

  • rs711

    Hi Bill,

    You’re somewhat of a pink unicorn, you know? [i.e., pointing significant instances where CHO reductions isn’t the primary determinant of weight loss all the while recognizing the general direction of the literature pointing to CHO restriction as being the primary/a major determine of weight loss] You’re no-nonsense old school scientific approach earns you my vote of confidence (for what it’s worth!).

    I thoroughly enjoyed Taubes’ last video too. Your comment “[he] fails to address this critical point [regarding weight loss in IR or IS people]” got me thinking about another point Taubes brought up: differences in where/how much fat accumulates throughout the body.

    Say an obese person is diagnosed as IR on the basis of an OGTT concomitant to plasma insulin measures and you observe some of their fat cells to be larger/more numerous & others not (e.g. butt fat & forearm fat, respectively). This tells us (1) and reminds us of (2 & 3):

    (1) Here we have a “cross-over control” of sorts (different body parts) loosely speaking.
    (2) Cancer cells have tons more insulin receptors than non-cancerous cells & are characterized by an astonishing ‘energy independence’ – like little evil black holes.
    (3) Feedback between the brain & insulin is different than between insulin & adipose cells, as it should be, considering what insulin is supposed to do for adipose cells and what it needs to relay back to the brain. A similar phenomenon could occur in different adipose cell locations.

    My speculative mind brings me to consider: if their insulin sensitivity ‘default settings’ are less of the problem (duh?) then their downstream epigenetic response apparatus might be more of the problem (less duh?).

    That ‘epigenetic response apparatus’ may be configured such that insulin mediated signaling (CHO—>insulin) is less effective than caloric restriction (calorie counting on LF diets) for reconfiguring the interplay between various pathways leading to cell cycle check-points (e.g. controlling adipose expansion/proliferation).

    You could also easily substitute ‘caloric restriction’ with ‘sleep’ & assume that variable to be more important than diet macros or conscious caloric intake in aiding weight normalization (depending on that individuals’ context).

    So although ‘insulin settings’ may not always be the best area of focus (as you’ve convincingly shown), I’m not sure that it entails an absence of fat as the deterministic variable (even considering Occam’s Razor). Neither am I sure that conscious calorie counting actually does what it says on the tin, since over (20yrs of something?) it’d require 0.8% accuracy long-term [].

    Nevertheless, and most importantly, what I think you’ve shown is that their is A LOT to be learned about where/how real-life LCHF situations fail or under perform in weight loss scenarios. That is where progress will be made (I’d bet).

    Thanks (hopefully my comments weren’t TOO tortuous to follow)

    • Bill Lagakos

      “You’re somewhat of a pink unicorn, you know?”

      I accept that :-)

  • DiabetesReviewer

    Hi Bill, bought your book. Digesting it now…

    • Bill Lagakos

      Thanks! Please let me know what you think :-)

  • Galina L.

    Keeping a weight loss is harder than loosing it. The good hunger management is the important feature of a LC diet , and counting carbs could be done while counting calories.

    • Kindke

      both losing and maintaining are hard, the point is that they both require constant intervention , everyday you have to tell yourself what you can and cant eat

      Theres only so much you can fighting with yourself most you can endure.

      Ive likened it to diabetes many times, a diabetic has to think about their blood sugar everytime they eat. I dont spend a single second anytime of anyday thinking about my blood sugar because I know my body perfectly regulates it

      On the other hand, I have to constantly monitor what I eat to control my weight. Something most thin people *probably* dont spend much time thinking about because their bodies perfectly regulate thier weight

      • Bill Lagakos

        great insights, Kindke.

    • mikemarkham

      That’s likely one of the biggest advantages of LCHF. For most, there is no hunger pangs and most if not all cravings go away. If that isn’t sustainable, I don’t know what is.

      • Galina L.

        Too many people can’t loose a satisfactory for them amount of weight by just counting carbohydrates, and the question is, what to do next?
        In my case LC allowed me to practice fasting when my weight loss stalled . I used to be too hungry before to tolerate skipping meals.

        • mikemarkham

          Personally I haven’t heard of a TON of people having issues with it and I’m not here to say they weren’t doing it correctly (i.e. I’ve heard people doing low-carb who still drink juice and eat bread).

          Intermittent fasting is a great method for weight loss…and for health even if you’re not trying to lose weight.

          • Galina L.

            Such individuals are often middle-aged females, and their issue is not doing something wrong, but their body resisting weight-loss too well.

          • mikemarkham

            Yes, this age group and sex have the most difficult time. It is a ‘wonder’ that 10, 20, 30, 40 or 50+ years of eating poorly takes a lot to reverse a metabolic wasteland!

          • Galina L.

            There are many factors that predispose a person to weight problems. I have been eating in a generally healthy way all my life and exercising, but had to get on crash diets from time to time to eliminate an accumulating weight gain. After 46 I have to be on a permanent LC diet. Many people I know can eat poorly most of their life and develop weight problems only at middle-age.

          • Carla Flaim

            Thank you! that is me… Can’t seem to lose even though carbs <40 most days. Had better results back in the day of calorie counting and low fat. I have gained 20 pounds trying to lose fat by LCHF and paleo. Frustrating doesn't begin to describe it.

          • Galina L.

            It is possible to over-eat a LC food, especially high fat dairy, nuts, deli items. I found out that limiting the amount of meals to 2 , sometimes 3 a day allowed me to stay not hungry and not over-eat at the same time. If you are comfortable counting calories, why not to do it ? Eating a LF diet is not the prerequisite for counting calories. Low fat diet kept me abnormally hungry, also, my health significantly improved on a LC diet. I didn’t became model-thin, BTW.

          • Carla Flaim


  • Galina L.

    It looks like there are two types of dieting, when people could forget about calories – the initial stages of LC dieting, when at least 20 lbs are lost absolutely effortlessly, and a very low fat diet when fat is below 5%, weight is being lost, but people feel a lot of hunger , according to the data about the rice diet brought up recently by Denise Minger during her last AHS presentation. There is something particularly fattening about the fat/carbohydrates combination, and out of two options LCarbing looks like a more reasonable diet option long-term because it provides more satiety and allows more nutritional foods.

    • Someone

      Hey Galina, I completely disagree with you.
      I am rather high’ish carbs (maybe around 45% of my cals, high protein and low’ish fat (max 30% of my cals), sometimes I eat even more carbs. My satiety “system” is just fine. And every Monday, I fast during the whole day without problems (from Sunday evening to Tuesday morning). I just happen to eat whole foods, no processed junks, and of high quality with an emphasis on prebiotic foods (tubers, veggies, leafy stuff, legumes and pseudo-grains like quinoa and buckwheat). I eat a fair amount of animal foods but that must make about 1/4 of my foods. That would be anything (ruminant meat and organs, fish, eggs, fermented dairy and their natural fat content, bone marrow, broth, etc). I eat 2 meals / day, no snacking. I eat slowly and with gusto and most of all, I prepare my meals at home (for me and my family, and I am a dude 😉 ). I am lean, feel good, and my health markers are all fine. I am 40 y.o. and was feeling like shit during my 20’s and early 30’s. All I had to do was:
      – clean the diet with real foods only
      – sleep correctly
      – avoid stressing about shit
      – move my ass for the fun of it
      – don’t sit all day and night in front of a screen
      – enjoy nature as often as possible
      These factors (other than diet) are as important. I lost something like 20kg 3 years ago and have not gained anything back. I don’t count calories, I eat until I feel I had enough (and some meals will even be without animal stuff). I think low carbing is a mistake in many ways but I have neither the desire nor the time to develop. Anyway, good luck.

      • Galina L.

        Yes, our anecdotal evidences are all over the place. My best friend could also fast on the food high in carbohydrates, but she is naturally thin and started to accumulate middle-age spread before her fasting routine. Now she is using a hormone-replacement therapy with the same result.
        All my life I had a very strong sense of hunger, which made fasting impossible. I thought other people had better will than me, but I found out they felt hunger less. LCarbing changed that. I also have been eating self-cooked traditional food all my life, making my own fermented vegetables like my mom. My life-style is healthy.
        May be the abnormal appetite is the mark of a particular metabolic state which indicates the necessity in LCarbing, and the indicator of a healthy diet for you is the degree of a hunger which allows you to fast.

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  • Ted Naiman

    Awesome post as usual.

    I have ordered countless insulin levels in countless patients over the past 15 years….fasting, postprandial, random….low carb diets, ketogenic diets, low fat diets, standard American diet….thin, obese, skinny-fat, you name it.

    I think that a lot of the dietary debate is fueled by some people’s lack of appreciation for insulin.

    I find myself wishing that everyone’s insulin level showed up at all times as a number, oh let’s say right on their forehead, changing in realtime. Maybe even throw a color in there (green for low single digits and red at higher levels). I think we would see some MAJOR changes in mainstream dietary advice (and it wouldn’t involve “eat less and more more”).

    Bottom line: if you are insulin resistant and you aren’t happy with your body composition and if you want to avoid chronic diseases then you really might want to restrict your carbohydrates. Just sayin’. And I freely admit, as do you, that there are many insulin sensitive persons out there that do not need to restrict carbohydrates. And until that number shows up your forehead, make sure you know where you are at, and make sure that your diet matches your genetics.

    Keep up the good work!!! ?(???)?

    • Bill Lagakos

      interesting — like, what if people could *feel* hyperglycemia

  • redheadlg

    Glad you brought this up. I get very frustrated when I see “gurus” on all sides ignore what doesn’t fit into their paradigm. There are clearly a number of people who eat very high carb/low fat to satiety in the form of fruits and starches (including whole grains) and lose a ton of weight and remain lean, even middle-aged non-athletic females. And the McDougall’s of the world – repeating the same “the fat you eat is the fat you wear” mantra – won’t address the many people on extremely high fat diets who go from obese to lean. As far as I can see you’re one of the few people out there (I would add Denise Minger to this) really acknowledging all of these factors and exploring them without inherent dogma. Until we really figure out why all of these factors can co-exist and apply them to real-world individual cases, there’s just going to be more frustrated fat people and a lot of continued sneering by so-called “experts.”