Calories In Versus Calories Out: Not the Whole Story

Five Reasons Not to Blame Yourself for Weight

You have probably heard that weight is a matter of “calories in versus calories out” (CICO). If you eat more calories than you burn through exercise, you gain weight, right?

Wrong. Weight is not just about calories in versus calories out, and blaming yourself for failing to lose weight is neither helpful nor based on facts. Research has revealed at least five little-known factors that may play a part in controlling your weight.

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As you may have experienced, people with diabetes are usually told to lose weight. This advice can be frustrating and counterproductive. Yes, exercise and good eating will help your health and glucose control, but weight may keep bouncing back.

We need to know this because studies clearly show that for people with diabetes, self-blame leads to higher glucose levels and poorer self-management. Self-compassion, on the other hand, facilitates healing.

What are some of these factors influencing weight, and what, if anything, can we do about them?

1. Intestinal bacteria

The germs in our guts influence how our bodies process food. Scientific American reports that “Gut bacteria alter the way we store fat, how we balance levels of glucose in the blood, and how we respond to hormones that make us feel hungry or full. The wrong mix of microbes, it seems, can help set the stage for obesity and diabetes from the moment of birth.”

Thin people tend to have a greater variety of bacteria in their guts than overweight people do. Especially important seem to be Bacteroidetes, a phylum of bacteria that break down plant starches and fibers. If you have a large variety of Bacteroidetes, you can eat more fiber and break it down for energy and other functions.

Without these good bacteria, your body won’t like fiber and will crave refined carbs like sugar. Studies show that mice raised in a sterile environment with no bacteria preferred more sweets than normal mice. People who crave chocolate have different gut bacteria than people who can leave chocolate alone.

Along with appetite, bacteria regulate how much of the calories we eat are actually absorbed. (What does that do to the “calories in” part of the calories in versus calories out equation?) Bacteria also control our fat storage.

In one study, mice were raised in a sterile environment and then fed bacteria. The donors were four sets of twin human sisters, one thin and one overweight in each pair. “The mice ate the same diet in equal amounts,” Scientific American reported, “yet the animals that received bacteria from an obese twin grew heavier and had more body fat than mice with microbes from a thin twin.”

Changing our intestinal bacteria

We inherit our original gut bacteria from our mothers and caregivers. According to a study by the University of Missouri, people who grow up in the same household tend to have similar gut bacteria long after they move away from one another.

However, there are ways to change our germs. What you eat influences which bacteria will grow in your gut. According to science journalist Knvul Sheikh writing in Scientific American, “Choosing between a BLT sandwich or a yogurt parfait for lunch can increase the populations of some types of bacteria and diminish others.”

Eating more fiber often attracts a better mix of gut bacteria. Fiber foods are often called “prebiotics” and include vegetables, whole grains, beans and legumes, garlic, onion, and fibrous fruits such as berries. You can also take fiber supplements. Remember to drink a lot of water to keep the fiber soft.

We can consume healthy bacteria directly with “probiotic” foods. These include yogurt, sauerkraut and kimchi, pickles, dark chocolate, tempeh, miso, natto, and sourdough bread, among others. You can take probiotic supplements as well.

2. Metabolic rate

We usually think of “calories out” in terms of exercise. In reality, moving around accounts for only about one-third of our energy use. Between 60 and 75 percent of our energy output is called “basal metabolism.” It’s the energy we need, even at rest, to keep warm, pump blood, breathe, fight infections, grow new cells, think, and carry out a thousand other inner functions we never think about.

The basal metabolic rate, or BMR, varies widely between people. Several factors influencing BMR include height, weight, and muscle mass, which increase BMR, and aging and muscle thinning, which reduce it.

Hormones such as thyroid and growth hormone and catecholamines such as adrenalin raise BMR. The stress hormones cortisol and the metabolic hormone insulin lower BMR. Metabolic rate is largely controlled by our genes.

The slower your BMR, the less food you need to keep you going. This is why people with low thyroid levels gain weight so easily. How can you adjust your BMR?

Changing metabolic rate

It’s hard to raise metabolic rate, but you can easily lower it by cutting the calories you take in. The National Institute on Aging has found in several studies that restricting calories slows your BMR.

Reducing calories in automatically reduces calories out. Our bodies do this to survive in times when there is no food, a major reason why dieting usually fails to provide lasting weight loss.

Raising BMR takes more effort. Exercise helps. The fitness website Shaping Concepts says that hard, short strength training or vigorous cardio workouts increase levels of growth hormone and adrenaline, raising BMR.

Diet makes a difference. We can reduce insulin levels, causing increased BMR, by eating fewer carbohydrates, especially sugars and starches. Increasing protein intake helps develop muscles and prevent muscle loss, leading to higher BMR.

Get plenty of sleep to raise levels of growth hormone and reduce levels of cortisol.

Various substances raise metabolic rate. Studies show caffeine found in coffee or tea raises BMR for three hours after ingestion. Caffeine also stimulates fat cells to break down.

Nicotine, found in cigarettes, raises metabolic rate while decreasing appetite and interfering with food absorption. So, nicotine is a great weight-loss drug, if you ignore the side effects such as cancer, heart disease and death.

A healthier substance to raise BMR is ginseng. In one Korean study of mice, those who consumed ginseng burned much more fat than those who didn’t.

According to a study in the online journal PLOS One, capsaicin, found in hot peppers, increases metabolism and may prevent the slowdown that comes with diets. You can buy supplements if the peppers are too hot for you.

3. Insulin function

Insulin resistance makes it highly probable that you’ll store more fat than you need. Insulin resistance and high insulin levels are major causes of Type 2 diabetes as well as weight gain.

High levels of insulin, commonly seen with insulin resistance, increase the storage of fat. Insulin prevents fat cells from releasing fat for energy.

Several factors can cause insulin resistance. Most of them are genetic, but there are other causes. Inflammation anywhere in the body can lead to insulin resistance. Physical inactivity makes it harder for insulin to work. Stress releases hormones such as cortisol that raise insulin resistance.

According to the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), abdominal fat may cause insulin resistance, even though it’s also a symptom of it. Fat cells may release inflammatory chemicals that raise insulin resistance. Fat in the liver may directly interfere with insulin function there.

Other causes cited by the NIDDK include certain medications, older age, sleep problems, especially sleep apnea, and cigarette smoking. Mark Marino, MD, wrote in Diabetes Self-Management that medications including steroids, two classes of blood pressure drugs, antipsychotic medications, and the B vitamin niacin can worsen insulin resistance.

Highly processed foods such as white bread, pasta, white rice, and soda digest very quickly and spike blood sugar levels. These spikes cause high insulin levels, leading to insulin resistance.

Reducing insulin resistance

Exercise reduces insulin resistance. A more active lifestyle — for example, walking more, driving less, not sitting in one place too long — improves insulin function.

Poor sleep, even for just one night, has been shown in some studies to cause insulin resistance. Make getting more sleep a priority, and get checked for sleep apnea if you think that might be a problem for you.

The diabetes medications thiazolidinediones (TZDs, which include Actos and Avandia) are called insulin sensitizers, meaning they reduce insulin resistance. Metformin combats insulin resistance in the liver.

Foods that may reduce insulin resistance include avocados, nuts, lemon, garlic, many vegetables, whole grains, cocoa, and green tea.

Supplements include turmeric, cinnamon, ginger, berberine, chromium, vitamin D, lipoic acid, and resveratrol (found in red wine and grapes).

4. Environmental chemicals

These have a huge influence on weight because they can stimulate fat cell growth, change digestion, create insulin resistance, and increase appetite. These chemicals include persistent organic pollutants (POPs), which are found in agricultural chemicals, air pollution, and plastics (phthalates).

A 2006 study in Diabetes Care found that obesity did not increase the risk of Type 2 diabetes in obese people with very low levels of POPs in their bodies. An editorial comment on this study in The Lancet stated, “This finding would imply that virtually all the risk of diabetes conferred by obesity is attributable to persistent organic pollutants, and that obesity is only a vehicle for such chemicals.”

One point indicating that pollution causes weight gain is that animals — whether on farms, in zoos, pets, in laboratories, or in the wild — have been getting fatter over the past 30 years or so. Their exercise and eating patterns have presumably not changed, so chemicals may well be the cause.

The research group Diabetes and the Environment has created pages on all these chemicals and more, including estrogen-like compounds, antibiotics and fungicides. It’s quite eye-opening and frightening. You can see it at diabetesandenvironment.org.

Dealing with toxic pollution

How can you protect yourself from chemical pollution? We were exposed to these chemicals even before we were born, and we are exposed anew each day. It makes sense to eat organic food whenever you can afford it. Another way is to limit your exposure to plastics, for example, by avoiding drinks in plastic bottles.

5. Stress

Physical and emotional stress cause insulin resistance, stimulate fat growth, raise blood sugar and blood pressure levels, and interfere with sleep. Stress evolved as our bodies’ “fight or flight” response to a threat. Now we have stress responses to financial worries, family conflicts, job problems, and concerns about our safety, popularity, and many other things. Our bodies aren’t used to such constant stress.

Stress is a response to threats beyond your power to control, so the less power you have, the more stress you will have. Poorer Americans tend to be heavier, largely because of relative poverty, which brings more stress, less sleep, and less availability of healthy food. Stress stimulates people to eat comfort foods — sugary, salty or fatty things that make us feel better for a few minutes and leave us worse off and heavier than we were before.

Dealing with stress

We can cope with stress through breathing practices, meditation, hugs, prayer, spending time in nature, relaxation tapes, gentle exercise, having a pet or a beloved hobby, or giving service to others. Trauma specialist Maggie Phillips, PhD, has found that vigorous exercise after a stressful event keeps stress from building up in the body.

Reducing stress is also possible. Getting help with problems and changing stressful situations are good starts.

Setting more realistic expectations is another skill, which brings us back to self-compassion. Be merciful to yourself, and be realistic about weight. Much of it is out of your control, and it’s quite possible to be healthy at a weight your doctor might consider too heavy.
None of this means you shouldn’t exercise more or try to eat better. Those things will help you enjoy life and feel better. It just means the effects of these behaviors on your weight are uncertain. Don’t let people shame you with calories in versus calories out. Show them this article.

Want to learn more about weight management? Read “Tried and True Weight-Loss Techniques” and “Strategies for Weight Management.”

Learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on Diabetes Self-Management.
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