RE: A Calorie Is Still A Calorie

[Guest guest]

Seshadri P.

A calorie by any name is still a calorie.

Arch Intern Med. 2004 Aug 9;164(15):1702-3. No abstract available.

PMID: 15302648 [PubMed - in process]

With the increased popularity of low-carbohydrate diets, Hays et al1 give an

interesting perspective on the role of carbohydrate in weight loss. Although

alluded to in the " Methods " section, it is impossible to believe that during the

study, mean caloric intake increased by 1000 kcal/d in control subjects without

these subjects gaining weight.2 The control groups' poststudy caloric intake

most likely represents what both the control and high-carbohydrate diet groups

usually ate prior to the study. Using this assumption, there is a mean

nonsignificant deficit of more than 500 kcal/d between high-carbohydrate and

control group individuals. Weekly, this becomes a 3500-kcal deficit, which is

approximately the deficit needed to

metabolize a pound of fat.2 Tied into this is the assumption that ad libitum is

limited to 150% of estimated intake when usual intake for these subjects might

be 200% of estimated intake.

Contrary to data from this study, new data from the National Health and

Nutrition Examination Survey show an increase in the percentage of carbohydrates

eaten, although the US population is continuing to become obese.3 The emphasis

should be on intake of complex carbohydrates and not all carbohydrates. Studies

have shown that replacement of simple carbohydrates with complex carbohydrates

and artificial sweeteners can cause weight loss.4 However, no matter what

macronutrient the calories come from, limitation of calories using low- or

high-carbohydrate diets will induce weight loss.5 The success of extreme

carbohydrate intake diets demonstrates that fat and carbohydrate calories are

tightly tied to each other in our US diet. For example, the average restaurant

serving of 2 cups of spaghetti and meat sauce has 650 kcal.6 Eighty-eight grams

of carbohydrate are estimated from the spaghetti, which equals 352 kcal, and

leaves the rest, almost half and mostly all fat kilocalories, attributed to the

meat sauce.6 In this instance, choosing a high- carbohydrate (spaghetti only) or

low-carbohydrate diet (meat sauce only) would cut caloric intake in half. The

lack of choices and the poor

palatability of these extreme diets may be a large contributor to decreases in

total caloric intake.

REFERENCES

1. Hays NP, Starling RD, Liu X, et al. Effects of an ad libitum low-fat,

high-carbohydrate diet on body weight, body composition, and fat distribution in

older men and women: a randomized controlled trial.

Arch Intern Med. 2004;164:210-217.

2. Position of the American Dietetic Association, Dietitians of Canada, and the

American College of Sports Medicine: nutrition and athletic performance. J Am

Diet Assoc. 2000;100:1543-1556.

3. Centers for Disease Control and Prevention (CDC). Trends in intake of energy

and

macronutrients-United States, 1971-2000. MMWR Morb Mortal Wkly Rep.

2004;53:80-82.

4. Vermunt SHF, Pasman WJ, Schaafsma G, Kardinaal FM. Effects of sugar intake on

body weight: a review. Obes Rev. 2003;4:91-99.

5. Bray GA. Low-carbohydrate diets and realities of weight loss.

JAMA. 2003;289:1853-1855.

6. Boroushek A. The Doctor's Pocket: Calorie Fat and Carbohydrate

Counter. Costa Mesa, Calif: Family Health Publications; 2000:156.