Is Weight Management as Simple As Calories In, Calories Out? With Dr. Timothy Noakes

For a long time, weight loss and weight management strategies have focused on counting calories. The question we ask in today’s episode is: Does that work? That is, if you count accurately, will it predict your weight loss or gain?

To answer these questions, we pit two theories against each other. On one side, there is the argument that you can’t break the laws of thermodynamics, and therefore a calorie is a calorie is a calorie, and you just need to know what goes in your body and how it gets used to understand which direction your weight will go.

On the other side, there is the carbohydrate-insulin model, based on the fact that insulin promotes energy storage and, as a result, the belief is that low energy availability then promotes intake.

We’ll discuss the evidence for and against the viability of each of these theories, then turn our attention to what is arguably a more important question: Do we over-equate weight loss with improved health? And what are the most healthy ways to lose weight?

We’re excited to be joined today by a leading voice in the world of exercise physiology, Dr. Timothy Noakes, whose work has had a significant impact on nutrition as well as many other aspects of sport science.

Let’s make you fast!

Nutrient Density Table

References

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Photo from Unsplash by: Toa Heftiba

Episode Transcript

Chris Case 00:00

Hey everyone, welcome to Fast Talk your source for the science of endurance performance. I’m your host Chris Case.

Does Counting Calories Work?

Chris Case 00:18

For a long time, weight loss and weight management strategies have focused on counting calories. The question we ask in today’s episode is, does that work? That is if you count accurately will it predict your weight loss or gain? To answer these questions, we put two theories against each other. On one side, there is the argument that you can’t break the laws of thermodynamics, and therefore, a calorie, is a calorie, is a calorie, and you just need to know what goes in your body and how it gets used to understand which direction your weight will go up or down. On the other side, there is the carbohydrate-insulin model based on the fact that insulin promotes energy storage and as a result, the belief is that low energy availability then promotes further intake. We’ll discuss the evidence for and against the viability of each of these theories, then turn our attention to what is arguably a more important question, do we over equate weight loss with improved health? What are the healthiest ways to lose weight? We’re excited to be joined today by a leading voice in the world of exercise physiology, Dr. Timothy Noakes, whose work has had a significant impact on nutrition as well as many other aspects of sports science. Let’s make you fast.

Ryan Kohler 01:40

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Chris Case 02:13

Well, it’s been many years Dr. Noakes since we’ve had you on Fast Talk, welcome back.

Dr. Timothy Noakes 02:18

Lovely to be with you. Thank you so much for inviting me back.

Chris Case 02:21

Trevor, we have a complicated, I guess you could even call it controversial subject to talk about today. I don’t know if it’s worth revealing the fact that we reached out to a lot of people to be on this show about this subject and some of them turned us down, and I would assume that’s because of this complicated and controversial nature.

Trevor Connor 02:42

It is a controversial one, and so Dr. Noakes, thanks for joining us and be willing to take this one on because as Chris said, we reached out to some other people who are considered experts in the subject to get their opinion on this, and we got the “No comment.” They just didn’t want to say anything about this. We are talking about, does weight loss comes down to calories in calories out? I just want to qualify this by saying I don’t recommend calorie counting to my athletes, it’s something that I rarely say that’s a good idea. I think there’s a lot of issues with it, I think it can lead to a lot of negative psychology in how you view diet. So, we’re going to talk about calories, we’re going to bring up this issue, go into the laws of thermodynamics, I just want to say upfront, that we’re not necessarily here saying we’re proponents of count every calorie that you eat, and Dr. Noakes, I know you’re going to look forward to this part, what we’re going to hopefully end with is a conversation of what are the healthy ways to lose weight.

Chris Case 03:47

Right.

Dr. Timothy Noakes 03:48

Sure, I look forward to that. I think I’ll be able to explain to you why the others didn’t want to take it on.

Chris Case 03:57

Great.

Trevor Connor 03:58

Good.

Chris Case 03:59

So, let’s start with the basics, Dr. Noakes, because there is this notion that a lot of people have about calories in and calories out is all it comes down to.

Calories In, Calories Out

Dr. Timothy Noakes 04:08

Yeah, well the calorie is the amount of heat that you need to add to water to raise its temperature one degree. So, the question is, how does that relate to the story of nutrition? I’m going to tell you that the calorie in, calorie out story is a very, very simplistic, obviously right explanation. I mean, it’s the energy in must determine your weight gain if you don’t expend the same amount of energy or the same with weight loss. The trouble is, it’s been hijacked by the industry as an explanation that all foods are the same, so that all calories that you eat affect the body equally. So, it doesn’t matter if you have 1000 calories of meat or 1000 calories of sugar, the effect on the body are identical, and that’s where the problem arises because it’s not, and so that’s point one. Point two is, we cannot measure your calorie consumption or your calorie use to within accuracy, I would say 5 to 10%. Anyone who tells you that you can measure the daily energy expenditure accurately, and knows exactly how many calories are in food, in the sense of how much energy comes out of the food that you eat, is absorbed into the body and stored as energy or used as energy is lying, we can’t. So, to start counting calories, and then trying to calculate how many calories you expended, because you ran a certain distance or did an amount of exercise is nonsensical. The reality is that the accuracy of the calculations if you want to remain in normal body weight, are beyond anything that a human scientist could do, we do not have the technology, could if we put you in a laboratory and said, this is how much you must eat, because this is how much energy you’re expending, we couldn’t get it right. The only thing that can get it right is what we call the appestat in the brain, which makes the calculations perfectly. If you’re in proper body weight, it matches identically the calories, the energy that you’re eating, and the energy expended.

Trevor Connor 06:31

So, I actually want to jump in there and just take a step back for anybody who’s kind of new to this concept. So, as you said, a calorie is a unit of energy. That’s literally what you’re measuring, you gave the simple explanation that it’s what it takes to raise a liter of water one degree Celsius. There are laws of thermodynamics here, the first law is energy cannot be created or destroyed. So, you know, I think it’s really important that everybody understands this, that at that very simplistic level, it really does come to calories in calories out because anything that says otherwise is basically breaking the laws of thermodynamics.

Dr. Timothy Noakes 07:12

That’s correct. To lose weight, you have to have a higher energy expenditure then you have an intake, no one debates, it’s the advice that comes from that that is totally wrong.

Trevor Connor 07:24

Right.

Dr. Timothy Noakes 07:24

The human is not a black box, into which you put energy and it gets burned, so you put food and it gets burnt as energy. Unfortunately, we have a brain, and if you want brainless biology, then you could talk about calories in and calories out. But unfortunately, the nature of the calories that you take in determines exactly how many calories you’re going to eat, and that’s the key. Similarly, it’s probable that as you start to store calories, your desire to exercise goes down. So, the calories in and calories out is not independent of the nature of the food that you’re eating, and it’s not independent of your desire to be physically active. Those are both tightly tied up with what you’re eating, and that’s where the problem arises.

Trevor Connor 08:20

While our answer is a lot more complicated, we started this episode by asking if weight loss is a simple matter of calories in, calories out. PEARL iZUMi Advanced Development Project Manager, Rob Pickels, gives us a simple answer but then explains why it isn’t so simple.

Rob Pickels: Is Weight Loss a Simple Matter of Calories In, Calories Out?

Rob Pickels 08:35

In regard to weight loss, yeah, I think that at the very simplest breakdown, calories in versus calories out. It’s a very easy concept to understand, and frankly, I think that gets you 95% of the way there. For most people, that’s everything that you need, right? If you can get 95% of the way there with a very simple explanation, then life is grand. I don’t believe it’s 100%, I think that there is a bit more going on here. I think that we would have to understand the nuance of substrate utilization within people, I think that we would have to understand the nuance of inflammatory factors with different foods that you have, and how does that affect your metabolism? Let’s say, I don’t know if you’re allergic to wheat, and you’re eating a lot of wheat as part of your calories, is that inflammation that then comes from that celiac disease or whatever you have, is that affecting your metabolism such that the math just doesn’t quite work out as simply as calories in, calories out? At the same time, I don’t know that we have a lot of study in that, I don’t know that we can truly understand that. I don’t know that I wouldn’t necessarily recommend that to people on a day-to-day basis without that deep knowledge. So, yeah, I would probably say calories in equals calories out if I was giving general advice.

Dr. Timothy Noakes 10:04

The problem arises very simply because of the sugar industry, and the sugar industry when it was trying to promote the idea in the 50s and the 60s, that sugar is healthy for you and gives you energy, but everyone knew that sugar makes you fat and carbohydrates make you fat. That was the standard belief in the 50s and the 60s when I was growing up, everyone knew that carbohydrates make you fat, and sugar particularly makes you fat. You only must go back into the literature to the 1800s and the 1900s, everyone knew that sugar was the problem. So, what the sugar industry had to do was to now make sugar healthy, and so what they did was they argued that there’s no difference from where your energy comes, if it comes from sugar, or if it comes from fat, there is no difference. Therefore, how do you lose weight? Oh, well, you don’t have to cut sugar, you must cut fat, you cut fat a little bit few calories off, and you’ll be fine. That honestly is the reason that the calories in, calories out model works. Coca-Cola particularly drove this argument, they funded many millions of dollars, an organization called the Global Energy Network Balance, GENB, and that was funded through a front organization called The International Life Sciences Institute. A friend of mine ran the show until he was exposed, the irony was he was exposed because of an article that I wrote with Dr. Aseem Malhotra and Jeff Ehrlich. We never targeted anyone, we just said that you can’t outrun a bad diet, and it became an interesting article, people loved it from the title. It’s time to make the point that you can’t outrun a bad diet, and then we refer to the influence of Coca-Cola on science. Then, O’Connor, who is a journalist from the New York Times took it up and then investigated and discovered that Coca Cola company was funding this Global Energy Balance Network, specifically to argue that it’s the calories in, calories out model and that if you cut your calories, you can lose weight. There is absolutely no evidence in the literature that dieting makes any difference in the long-term, so this was a false claim, and it was being driven directly by Coca-Cola. So, that’s where the story arises, and that’s why those people you spoke to didn’t want to speak about it.

Chris Case 12:54

Dr. Noakes, maybe you could go into a little bit more detail about why it’s so hard to accurately count calories?

The Difficulty of Accurately Counting Calories

Dr. Timothy Noakes 13:01

The reason is that we don’t know what’s happening to those calories that you ingest. So, when you ingest it’s got to go through a digestion process, it’s then going to be tackled by some of the bacteria in the gut, and we don’t know what they’re going to do to the food that you’re eating, and that is going to remove some of the calories from it. In addition, your body heats up when you eat, and that will influence calorie loss, and that may be different for different foods. So, these are processes that are minuscule and very difficult to measure, and again, I make the point that to balance your daily calories, calories in, calories out, so you do not gain weight, you have to be accurate to within a few calories in a quarter teaspoon of sugar, that’s it if you’re out by that amount, or let’s say one flight of stairs walking, if you’re out by that amount every day, you will put on kilograms during the year. So, the accuracy, it must be much greater than we can measure in the laboratories, that’s the first point. The second point is that I mean as having written widely on running, we know that the energy cost of running differs by 10 to 15% between different runners. So, if you think that you’ve gone and run 1000 calories, you could have spent 1100 calories or you could have just spent 900 calories. So, that difference of 100 calories again is going to destroy your balance, if you keep doing that every day and thinking that you’re spending 100 calories more than you really are, your balance will be completely out. So, what I’m trying to say is that we do not have the techniques in the laboratory to be accurate enough to keep your weight stable. If you are weight stable all it tells us, is you are matching your calories in and your calories out exactly for your personal biology. That’s all we can say. If the weight is going up, you’re eating more calories then you’re expanding. That really doesn’t help us in weight loss, because the body is not simply a box that just burns calories and stores it or burns it, it’s much more complex than that. The key, as I’ll indicate is, the calories you eat determine the calories that you will eat, what you eat determines what you will eat. Simply taking the same diet that you’ve been eating that made you fat and thinking that I can eat exactly the same composition, but just a few calories less, I will lose weight is completely fallacious.

Trevor Connor 15:49

So, one thing I just want to bring up, I remember going to a presentation by Dr. Joseph Donley, he is considered one of the top researchers on weight loss, and we actually asked him that very specific question about calories in, calories out. He gave the example of the caloric chamber. So, we actually have these chambers, you can put people in them, you can measure exactly how many calories they are consuming, and this chamber is actually able to measure exactly how many calories they burn. When you do that, yeah, it really matches up, you basically see weight loss, weight gain matches up with how much you consume, how much you burn. His point that he made to us is all these factors, there are so many factors that affect what you burn, that is actually really hard to measure. He said, you know if you use one of that software that counts your calories, he goes, “You can be 200 calories off, there’s a big range of error.” He pointed out, when you look at an obese child next to a skinny child, often the difference in what they’re eating is only 150-100 calories. So, the margin of error in the software is the difference between what you’re trying to achieve and where you might be.

Chris Case 17:05

Right. It adds up over time for sure.

Dr. Timothy Noakes 17:08

Yep, precisely. Although you indicate that it can be measured, we had one of those rooms where you could measure metabolic rate, and I can tell you there were about six in the world that actually worked. They are incredibly complex to build.

Trevor Connor 17:24

Yes.

Dr. Timothy Noakes 17:26

To be accurate, it’s astonishingly difficult. So, 99.999% of people will never get to a laboratory where you can actually measure accurately your calories, your expended, and even then, you’re not going to be able to calculate accurately the calories in, because everybody is going to be individual, as you’ve indicated, we process food differently, and that’s going to make another factor, that’s going to be influenced as well, that’s going to influence the calculations.

Trevor Connor 17:57

And just to show how complicated this is, when you’re talking about well, how much do you expand? You’re talking about your resting energy expenditure, which is affected by the foods you eat that can increase it or decrease it. There’s what’s called the thermic effect of food, so there’s calories that are expended in the actual processing of food, and different nutrients are gonna have different thermic effects. Here’s what’s called adaptive thermogenics, which is some diets are gonna actually cause you’re basically slowing down your metabolism, metabolism is just basically a measure of your total energy expenditure or the balance of energy in your body. Fiber consumption with food can affect how much you excrete, and you can just keep going. So, I think this is part of what you’re getting to, which is the actual diet you eat can have a big effect on both the calories in and calories out making this next to impossible to accurately measure.

Dr. Timothy Noakes 18:54

Yeah, then if I could add another bit of work done by one of my former students, she looked at the daily energy expenditure of people who have going from sedentary people, to moderately active, to highly active, and the idea that if you become a marathon runner, you’re going to suddenly expand far more energy than anyone else isn’t true, because she found there was a ceiling and above that ceiling, people did not, even though they ran more each day, they didn’t expend more calories, why was that? Because they went to sleep more, they rested more, they didn’t walk as much, and they didn’t do other activities, all of us who ran a lot know that, absolutely. I remember one Olympic gold medalist in the marathon saying that the worst thing for him was go shopping with his wife, because the extra energy expenditure that he couldn’t cope with. He could run 20 miles a day, but he couldn’t go to the supermarket to buy food because that was extra energy expenditure, and he didn’t have any extra calories for that. So, that’s the other point, that’s how it’s inaccurate. The other point is in all these calculations they forget, so for let’s say, you go out and you’ve run, and you think you’ve expanded 1000 calories, what you forget is that, if you just stayed at home, you expanded 200 calories. So, the difference is only 800 calories, it’s not 1000 calories, but that is never putting into these equations. They always forget that the time that you are exercising, you’ve got to subtract the energy expenditure, if you had spent that time at rest, there is an added energy expenditure of exercise, but you have to subtract what would have happened if you hadn’t been exercising? You would have been burning some calories. So, the calculations go wrong there again, all the calculations never include the resting metabolic rate whilst you were exercising, they never exclude that amount. So, it’s a disaster guy going down this route. So, and trying to be over-scientific, because we cannot match the brilliance of the brain, in matching how much energy you need, and making sure that you get the right type of food in the right number of calories.

Trevor Connor 21:19

As Dr. Noakes pointed out, even athletes doing huge volumes of work often burn fewer calories than they think. Petr Vakoc, a pro on Team Alpecin–Fenix, who just finished racing at the Tour de France talked with us about this challenge.

Petr Vakoc: Athletes Doing Huge Volumes of Work Often Burn Fewer Calories Than They Think

Petr Vakoc 21:34

Yeah, for me, it’s really important to start early enough and to not be afraid to be in another race weight or close to the race weight quite early, because I realized that once the races are coming closer, it’s very, very difficult to lose any weight without it having a detrimental effect on your recovery. So, for me it works best in the preseason camps or later in the season if you are on altitude again. So, I always lose weight on the trainings, never in the races, and then yeah, the struggle for me, the biggest struggle is always to keep the weight when the racing starts, and especially when you have a lot of one-day races quite a long time apart, because then your overall training and racing load is not that high, but you always on, I always feel hungry and getting the balance right between having enough and not eating too much, that was something that has been the biggest challenge for me in the weight management area.

Chris Case 23:01

Do you count calories?

Counting Calories

Petr Vakoc 23:04

I don’t do it very often, but every now and then I really make sure to see how am I doing? Generally, I have a really good idea about how many calories or how much I eat. It doesn’t change that much, and it’s helpful, especially I would say, during the races or between the races, and then just maybe for a couple of easy days after the race then I really make sure to count how much I eat, because then always it feels like I don’t need that much, but if you only ride maybe an hour, or I have a complete day off, it’s not that much good that you actually have to eat in the day.

Chris Case 23:55

For a lot of pro cyclists that struggle with their diets, even eating disorders, do you see that?

Eating Disorders

Petr Vakoc 24:10

Yeah, I’ve seen a few riders having trouble with eating not enough. But I mean, it’s quite, quite rare. I can only think of maybe two riders that I saw, and I thought like okay, this is not healthy, this is not right. I mean, generally, a lot of cyclists or most of the cyclists are very skinny, but I don’t they’re that many pro cyclists with eating disorders, not at least in the themes that have been.

Chris Case 24:58

One of the other things that come to mind here for professionals who are traveling all over the place, you know, you’re in Belgium one day, you’re in Portugal the next day, they don’t have necessarily the same foods in these places. Do you struggle to get what you need as you travel around? Or do you kind of have the go-to foods that you know you can eat, you know, generally that they work with your stomach and your digestive system that you kind of know what calorie they have? Or is that a struggle?

Petr Vakoc 25:37

Oh, I think the hardest is the travel itself, and that’s something that I implemented only in the last couple of years is to always make sure to take my own food with me for the travel, especially for the longer travel days. It’s still difficult to get good food on the go, and I think that’s where, in the past the biggest mistakes, but once I’m in a place, it’s usually quite simple to get the right food anywhere in the world. My go-to meal is rice, chicken, then some vegetables, and that’s something you can get really everywhere, you can just ask for it, even if it’s not available. So, that’s not an issue, but the travel itself always leads to eating bad food if you are not ready for that.

Chris Case 26:39

Yeah, it is nice that pretty much every culture in every place, rice, chicken, vegetables, that’s nice that can be a go-to, because that is accessible nearly everywhere.

Petr Vakoc 26:55

It’s like balanced meals also. It’s really, really simple to solve.

Trevor Connor 27:04

Another thing, I have a bias towards evolutionary biology, and an important side of evolutionary biology is this concept that we evolved in a time of caloric scarcity. It was never an issue of over-consuming, it was always an issue of getting enough calories to survive. So, our bodies are designed to try to be very efficient with calories. So, you have these issues, and you’re bringing this up, when you start reducing the calories you consume, you naturally start to want to rest more, our bodies are designed to say, I’m not getting enough calories, this is going to put me in a starvation state, so I’m going to do everything to start expanding fewer calories because this is actually a survival mechanism. It’s no longer appropriate in modern society where there’s a caloric excess, it’s not a problem getting enough calories, but this is how our bodies are designed.

Dr. Timothy Noakes 27:53

Yeah, absolutely.

Chris Case 27:56

So, Dr. Noakes, I want to get back to something you’ve mentioned already, which is how the, you know, all calories not created equal, so to speak, there’s a debate between high carbohydrate and low carbohydrate, but it also seems like what you’re saying is, the type of calories that you’re putting into your body influences what you want to ingest next. Do I have that correct?

Type of Calories and How They Influence What You Eat Next

Dr. Timothy Noakes 28:23

Yes, I would say so. So, I think one of the beauties of understanding nutrition and what good nutrition is, you have to be fat once upon a time. If you were once fat, and you reverse your fatness, then you have a much better insight into what’s going on, and Gary Taubes makes this point all the time. The scientists who kind of ignore the effects of what you’re eating and say, well, it doesn’t really matter, you can eat carbohydrates or you can eat fats, you can be thin by just controlling your calories, they are generally thin and they’ve never had an issue with weight, so they don’t understand what it is to have an abnormal metabolism that drives you to eat the wrong foods, which then make you fat. That’s a critical distinction, so I was fortunate that I lost 20-40 pounds by changing my diet, and I was heading towards type two diabetes, I shouldn’t be alive today. My dad had the diagnosis for 10 years and died from type two diabetes, and I’ve been 10-11 years with the diagnosis and I’m doing pretty well, probably not perfect, but doing well enough. So, I ascribe my success and the fact that I’m not dead, I finally understood the problem, and as I see it, the problem is particularly in ultra-processed foods that we are forcing our bodies to eat. Humans went through three different dietary patterns. The first was, we were mainly carnivorous 3-4 million years ago, then we went through the agricultural revolution 12,000 years ago, and then in the last 100 years, we’ve gone through this ultra-processed food, highly industrialized diet, which is completely different to what we’d ever eaten before. The problems arise when you start eating highly addictive foods, highly addictive foods include refined carbohydrates and sugar. That’s what swung the balance away from our ability to control our weight. So, to get back to the point, the reason why the low carbohydrate diet works very well for some people, not for everyone, but for some people, and by and large, most people is that they’re insulin resistant, and they hyper-secrete this hormone insulin. I suspect there are many other hormonal abnormalities, and it’s this abnormal hormonal milieu that causes them to be perpetually hungry, and so they over-consume calories. Regardless of how motivated they are, they just can’t stop eating. I once interviewed a guy who had lost 400 pounds of weight, and I said, “Tell me, what was your condition when you weighed 620 pounds,” and he said, “I was perpetually hungry, I could eat a full meal, and within half an hour, I’d want to eat another meal.” That’s the reality. So, in my opinion, weight control is about making sure that you get rid of your food cravings, and a lot of those food cravings are sugar addictions or addictions to other ultra-processed foods. So, there’s a whole body of evidence rising now that its ultra-processed foods, high sugar, high refined carbohydrates that have upset the brain, and now the brain can’t calculate accurately the calories in, calories out the balance. So, consequently, you tend to put on weight. Now, for those people who have a sugar addiction, perhaps a bit of carbohydrate addiction, it’s very clear that the best diet for them is one that restricts the foods to which they are addicted, and those generally are carbohydrates, and sugar, and ultra-processed foods. Once they take ultra-processed foods out of their diet, they find that they’re not hungry all the time, and they can eat less frequently, and it’s much easier for them to fast for 16 or 18 hours, and their weight loss becomes much easier. So, my interpretation of that is that this is a brain-driven phenomenon and that to lose weight, and to maintain a healthy weight, you have to find the foods to which you’re not addicted, which do not drive your calorie consumption. So, that’s where I differ.

Dr. Timothy Noakes 33:05

In the majority of people that I’ve described, it is definitely in the carbohydrate side of things, but in others, fat can drive too much energy consumption, and they will benefit by taking more protein. So, I think, if I read the literature carefully over the last six months or so, there’s a great belief that in fact, protein deficiency is something else that drives our overconsumption of calories, and we don’t have the definitive evidence, but there’s clearly a lot of people who are increasing their protein intake and finding that that saturates them and they can lose weight. If you look historically, at the thinnest athletes, the ones who had the least body fat, they were the bodybuilders that always promoted a high protein diet, but they could have had carbohydrates, they could have had quite a lot of carbohydrates in the diet, but they restricted the fat and supplemented with protein. So, to summarize where we’ve got, we take our calories from fats, carbohydrates, and protein, and what each individual has to discover is the exact contribution of all of those three macronutrients which they will find the most satiating at the lowest calorie consumption. That’s the key. So, is always calories in and calories out, as we’ve argued, but the key is the nature of the food that you eat, and the nature of your brain determines whether you’ll be satiated by lots of protein, by lots of fat, and whether you’ll be overstimulated by carbohydrates. To me that’s the ultimate decision on what you should be eating, you have to find out for yourself. So, although I may benefit from a low carbohydrate diet, I know the diet that we propose, 10% of people put on weight on the diet. So, that’s not the right diet for them, and for them that by and large it was to increase the protein content. So, this is very complex and unfortunately, the complexity hasn’t been tweaked out, and now we’ve got the two camps. We’ve got the low carb and the high carb camps, and what we need to do is take a step back and say it’s pretty complex, the brains really important, and we need to explain what happens anecdotally. For example, so if you do a clinical trial, and you do a study with people losing weight, that is not the same as people free-living and changing their diets, and that’s a big error we’ve made. We try to interpret the laboratory studies as definitive evidence for the advice we should give to free-living humans, and it doesn’t work because free-living humans can lose 100 kilograms or 200 pounds on one or other diet, and that never happens in the clinical trials, for reasons that I don’t understand. So, the clinical trials do not reflect what we see in real life.

Trevor Connor 36:11

Part of the issue of clinical trials is A, it’s difficult to actually get people to adhere to the diets, a lot of the clinical trials are very short-term. So, I’ve seen this a lot in the research where people go, well, there are these studies of low carbohydrate, high carbohydrate diets, but at the end of the day, there was such low adherence, you can’t really take anything from the study. So, we’ve tried the studies, they’ve often kind of failed, where I think when you have people in real life who have these weight issues and say I need to do something, they’re motivated, and you see these people that actually do adhere to their diet and produce results.

Dr. Timothy Noakes 36:50

Precisely, and I couldn’t agree with you more. The problem is that the scientists who are doing the diet studies believe only what they see in front of them in their clinical trials, and they don’t have experience of treating real patients in real life. I’m an exercise physiologist, and I know that the problem was, you always want to be able to explain everything on the test that you do in the laboratory. So, if you measure oxygen consumption, or you do a muscle biopsy, and you measure the fiber composition, or the muscle glycogen content, what you do is you say, well, this explains all of the exercise physiology, which of course it doesn’t. That’s the problem, the people who are speaking to the media and the press, they’re credible because they work at a famous laboratory in a famous University, and they spend their lives doing clinical trials, which have some relevance to the real world, but they’re not the answer. The answer as I’ve observed, the answers to the problems of weight control, they’re out there in the general public, the general public is discovering what works and they are telling us, and they’re asking us for an explanation, and we still don’t have a full explanation.

Importance of Insulin

Trevor Connor 38:06

So, I do want to go back, I really want to emphasize a point that you brought up is the importance of insulin and all this. So, it has been demonstrated time and time again in the research that insulin sparks hunger. So, there’s an interesting effect that if you consume a high simple carbohydrate diet, that’s going to spike your insulin and that’s not going to satiate you, that’s actually going to make you hungrier. That’s not controversial, that’s been proven. Now, carbohydrates and protein, both spike insulin, but the only thing that gets insulin to really high levels are those simple sugars, and you brought this up about protein, two really important things about protein is, A protein is highly satiating, it’s hard to eat a ton before you say I’m full, I don’t want to eat much more. We also talked about the thermic effect of food, protein actually has a very high thermic effect, something like 30% of the calories you consume from protein are needed to process the protein, where when you look at carbohydrates and fats, very low thermic effect. So, I have seen research that says when you are on that high fat, low carbohydrate diet, and I have seen some studies where they go, yeah, we see benefits of this, and they try to address it. The direction I’ve seen that research go is saying, it’s actually the higher protein content of the diet that saturates that has that higher thermic effect, so it’s raising the amount of calories that you’re burning, and it’s keeping insulin down. That’s one of the big ones, I really want to point that out again, as an evolutionary biologist, when you look at eating natural foods, vegetables, fruits, lean meats, eggs, fish, no processed foods, it’s very hard to really elevate your insulin. It takes processed foods that you see in the Western diet to see those sort of insulin levels that we now start thinking of as being normal, which they aren’t. Dr. Noakes, how do you feel about that?

Dr. Timothy Noakes 40:05

Yeah, I absolutely agree with you. I just don’t like to get pigeonholed into the argument of you know, the calories in, calories out, or the carbohydrate-insulin model. I kind of tried to direct it towards the hunger model or obesity. So, the other part of the hunger model is protein tends to come with lots of nutrients. Ted Naman who is very active on social media, and wrote the book PE Diet, has really stimulated a lot of good thinking that nutrient density may also be a factor and that you need a nutrient-dense diet, part of the hunger is because we’re not getting the nutrients. I think that’s a fascinating idea, I don’t know how you prove it or disprove it, but it’s certainly important. Let’s make the point, if you have type one diabetes, you die of starvation, you die of thinness, you have to have insulin to put on weight, to put on fat, so insulin has to be central to the model, in the sense that it’s acting on fat tissue, if you have high insulin, you can’t burn the fat, so you store the fat and you can’t burn it. So, no question that carbohydrates in those people who hyper-secreting insulin are, that it’s a key factor. I deal with a lot of patients and myself included, I study myself, obviously, and I had to get my grams of carbohydrates way down to 25 grams or less every day, to get the real benefits, and I think that’s the problem that you can be so sensitive to carbohydrate that just going to 30 or 40 grams of carbohydrate is not going to help you. In the clinical studies, the clinical studies go right down to those very low carbohydrate intakes. So, I absolutely agree that insulin is a crucial factor and that carbohydrates have a bigger effect on insulin than the other macronutrients. So, I absolutely agree with you, and I just want to make the point that insulin has huge effects on the body, but it also as you’ve indicated has effects on the brain. In my case, when cutting the carbohydrates, the effect was almost instantaneous, and it was like it’s a hormonal effect. So, I suspect that we will eventually get the whole story. I think part of the problem is that the people promoting the different models the carbohydrate-insulin theory or the calories in, calories out energy surplus model of obesity, the models are very complex, and they tend to ignore the brain. The brain is so critical to this whole discussion that it can’t be excluded, and unfortunately, we don’t yet know fully how the brain works in people who are obese, and those who are thin, we don’t necessarily know the difference. I would argue that food addiction is is a key factor that we’ve ignored.

Trevor Connor 43:17

Ex-World Tour rider and now gravel racing expert, Ted King, talked with us about what it’s like watching his weight as a pro, and the dangers of eating disorders at that level. Let’s hear what he has to say.

Ted King: Weight Watching as a Pro

Ted King 43:28

Yeah, I would say at some point in the vast majority of professional cyclist careers, they’re going to have some semblance of an eating disorder. I think it will run the gamut from very mild to severe. I don’t think I had anything terribly severe, but at some point, in my career, I would be on the verge of starvation. A lot of that actually, to be honest, was you spent enough time in a very traditional program and we would go to training camps and be riding five hours a day and fuel that on boiled spinach, boiled broccoli, and cauliflower just like the most ridiculous meal you’ve ever seen, and pasta, so they’re not actually starving you, but when you have a team doctor literally standing over the entire team as we eat, it’s understood that everybody early season is overweight, that’s just sort of the general assumption. No matter how lean you are, you’re going to be overweight. I know things are changing, I’ve been out of World Tour racing for six years now five years. So, there is a much better understanding but especially in a traditional program like that, that sort of thinking does exist. I know that I’m not celiac, but that would be one way that I would very easily control weight would be turned on and turn off eating gluten, and I don’t have any adverse reactions to gluten, it’s just a very simple thing to do, in the afternoon eat a carrot instead of eating a cracker, instead of eating bread, instead of eating a cookie, instead of going to a bakery and having any sort of baked goods, because you know that there is gluten in it, that was a simple way for me to control calorie consumption. I am something of a believer in the thermodynamics side of things, like you said, I do believe in calories in, calories out, calories in versus calories expended. So, I guess I tend both in my career, and now I look at it in a macrocycle. So, this time of year, we’re going to be riding less it is cool outside, you’re doing sort of more based miles, and inevitably, your weight might be a little bit higher, because you’re just riding less than the volume and intensity that you’re going to get in season, and so you might want to curb your caloric consumption in this time of year. That said, I don’t know when this podcast is going to come out, but it’s the holidays, and the holidays are a time for delicious gluttony. So, you know, it’s a bit of a tough toss-up. I also don’t get on a scale these days, I get on a scale, maybe once a month for mere curiosity, and whereas in my world tour racing career, you could obsess, you can get on a scale twice a day, three times a day, five times a day, I mean, those are those are obviously signs of obsession about weight. Those are things that I happily don’t do now because I don’t need to. Yes, I’m competitive in gravel racing, but having gone through the rigmarole and the obsession of weight and calories, and that whole world, I just, I don’t need to, I don’t want to, I ride a bike because I like riding a bike. I like looking at that macro picture of okay, I’m eating more, so maybe I should ride a little bit more.

Chris Case 46:47

It seems like the answer would be pretty obvious, but could you spell out what are the pitfalls of that counting calories mentality, that obsession?

Pitfalls of Counting Calories

Ted King 46:58

I think that calorie counting can be done safely, and it can be done healthfully. Just counting calories alone is on the precipice of an obsession, I celebrate food, I love food, I love getting together with family and friends and what it means to break bread so to speak, it’s a little bit of a bummer when you can’t celebrate that because you’re so obsessed about calories. The risk is the potential subsequent steps, that alone isn’t a problem, it’s what calorie counting can very quickly lead to.

Trevor Connor 47:45

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Chris Case 48:28

Well, that’s what I was hoping we could just briefly address next. I know it’s a big subject, and we don’t have all the answers, but you mentioned sugar, highly processed foods have these addictive qualities, why do they have these addictive qualities?

Why Are Sugar and Highly Processed Foods Addictive?

Dr. Timothy Noakes 48:45

I was gonna say because sugar must have had some evolutionary role that made it very attractive for us. So, that may be one possibility. So, all we know is that they stimulate the same parts of the brain that other addictive activities do and that people will argue that sugar is as or more addictive than cocaine, and it acts through the same pathways in the brain. So, the argument that sugar isn’t addictive, I think is very weak, and certainly, humans act as if it is addictive, and if you deal with children, you will notice that once they can’t get their sugar, the behavior changes and conversely, it changes when they’re given sugar. As a sugar addict myself, I appreciate that it has all the characteristics of addiction, and the only treatment is complete avoidance of sugar but if you’re going to eat processed foods, they are so laden with sugar, something like 80% of ultra-processed foods have sugar in them and a lot of sugar. The problem for society is that children are getting exposed to sugar from six months or earlier, as soon as they are taken off the brace, they are given other milk and that is full of sugar. The weaning foods that most children are weaned onto are full of sugar. So, the addiction begins at a very early stage, and it is so advanced that the question is whether we can ever get rid of that in society?

Trevor Connor 50:22

So, I’ll throw in the evolutionary biology perspective of this and our explanation for why sugar is addictive. First, you have to remember the brain survives on glucose. So, now I know and you’re a big proponent of the keto diet, and the brain can survive on ketones, but even in a purely ketogenic state, your body ramps up gluconeogenesis, the brain still needs to get about 30% of its energy from glucose. If it doesn’t get any glucose, your brain will starve. So, your brain, because it’s controlling the hunger signals is saying, when you encounter sugar, give it to me, when you encounter carbohydrates, give it to me. Now, you might not agree with this, but this is my evolutionary biology perspective, which is, our bodies don’t ever want to overconsume something. So, you hear people all the time say, “Why are all the things that I like the most so bad for me?” My explanation is these things that we really crave, in evolutionary times, were actually quite rare. It was actually very hard to get simple sugars, occasionally, you would encounter honey or maple syrup, and I’m sure the hunter-gatherers absolutely loved it and consumed it, but then it would be weeks before they would encounter it again. So, because it was rare, your brains basically said, when you encounter this, eat it.

Chris Case 51:42

As much as you can, get it in.

Trevor Connor 51:44

So, your brain had a craving, but it was controlled by the fact that it was rare. So, you just didn’t ever consume that much. We have the issue now that you have this craving, and it’s everywhere. So, now we can dramatically over consume it.

Dr. Timothy Noakes 51:59

Absolutely, and to get honey was pretty dangerous.

Chris Case 52:04

To put a further point on the debate, I guess you could call it over sugar, a few years ago, there were some legitimate studies in very respectable journals that kind of uncovered what was going on here. It wasn’t so much a conspiracy theory, there were actual devious, intense and manipulation happening within the industry to promote sugar over other things. Trevor, do you want to chime in here and give us a sense of how deep it went?

Manipulation Within the Sugar Industry

Trevor Connor 52:42

Yeah, let me just give the quick two minutes and then Dr. Noakes, please take this. This is really important because I abhor conspiracy theories. But when people come to me and go, oh, there’s this in the industry, this industry is trying to do this or that, I just shut off. But this is one where this isn’t just conspiracy theory, a few years ago, there were these two reviews published and we’ll put the references on the website for these, where these were published in a high impact journal where they went back and reviewed 20 years’ worth of internal communications within the sugar industry. This goes exactly what you were saying Dr. Noakes, at the time, research was starting to come out showing that sugar was contributing to heart disease, and the sugar industry didn’t want that, so they funded research to point the finger at fat. It was biased research, and what’s really interesting is the person who led this research funded by the sugar industry was then hired by the USDA to come up with the food pyramid.

Dr. Timothy Noakes 53:45

Yeah, absolutely. That’s all correct. I spent the last year or so writing columns for the CrossFit magazine, and they asked me to look into how the diet-heart hypothesis evolved. It goes back to the guy called Ancel Keys, and we won’t discuss him today, but what I will say was that in the 1960s, the clear evidence was that carbohydrates were driving heart disease because they raised blood triglyceride concentrations. So, in the late 1950s, the evidence published in the major journals was that people with heart disease had high blood triglyceride concentrations, and the reason why diabetic patients were getting heart disease was that they had high triglyceride concentrations, and the blood cholesterol concentrations were not grossly elevated. So, the hypothesis was very strong, that it’s carbohydrates, not fats. So, that was the one stream. Against that, we had the American Heart Association, which was driving the fat story. The defining moment was in June 1965, when four articles appeared in the Annals of Internal Medicine, I think it was the June issue. Those four articles all focus specifically on carbohydrates, and sugars as driving hypertriglyceridemia, high triglyceride levels, and then the risk that they pose to the heart. This caused such a problem for the sugar industry that they sent off their Vice President, and he was sent to Harvard, and he met with the professors of nutrition at Harvard, and he said to them, “Guys, we have a problem, we have these four articles, which are suggesting that sugar is toxic for humans.” We would like you to write a review showing the opposite, that fat is what is killing humans and not sugar. It took them a year and a half to write the article, but in November 1967, in the New England Journal of Medicine in two parts, the Harvard people wrote the article that said, sugar is not the problem, it is fat that is the problem. That basically killed the debate, the debate ended in November 1967, the end of the debate, it’s all fat. Then, of course, the American Heart Association, and then all the global organizations, and the National Institute of Health started funding these major trials of a low-fat diet in chronic disease, and particularly heart disease. And you know, what was so important? Not one of the studies ever looked at sugar.

Trevor Connor 56:33

Yep.

Dr. Timothy Noakes 56:33

So, the National Institute of Health never did a study in which they reduced the sugar intake of a population. They spent all their money, and it went to billions of dollars, they spent all their money, reducing the saturated fat or replacing fat with polyunsaturated fats, and they did all those clinical trials. Essentially, they all came to naught, there was not one study, which convincingly showed that if you removed saturated fat from the diet, or you reduced your fat intake by replacing with polyunsaturated fats, that you improve your health. In fact, they tended to show the opposite that these were harmful. If you took saturated fat out of the diet, harm developed. The key point is that the influence of the sugar industry was so powerful, that sugar was never tested in a long-term clinical trial.

Trevor Connor 57:29

So, I found one of these reviews. So, this is the 2016 September issue, and it was published in JAMA Internal Medicine, which I can’t emphasize enough, that is a highly respected journal. The title of this review is, Sugar Industry and Coronary Heart Disease Research a Historical Analysis of Internal Industry Documents. Let me just read two sentences out of the abstract. So, it starts with, “early warning signals of coronary heart disease, CHD, risk of sugar sucrose emerged in the 1950s. We examine the Sugar Research Foundation, internal documents, historical reports, and statements relevant to early debates about the dietary cause of CHD and assemble findings chronologically into a narrative case study. Then it continues, the SRF, so that’s the sugar industry, “set the reviews objectives, contributed articles for inclusion, and received drafts.” The SRF funding and role was not disclosed. “Together with other recent analyses of sugar industry documents, our findings suggest the industry-sponsored a research program in the 1960s and 1970s that successfully cast doubt about the hazards of sucrose while promoting fat as the dietary culprit.”

Chris Case 58:40

There you go.

Trevor Connor 58:41

Can’t be more clear than that.

Chris Case 58:43

Yeah.

Dr. Timothy Noakes 58:45

So, I eventually wrote a book about my trial with Marcus Boras, called Real Food on Trial. It’s well-reviewed on Amazon. We included some of that, but the story that you’ve just mentioned is described in the most recent book we wrote called The Eat Right revolution. We wrote this because we wanted to describe what happened to the science, the poor nutrition science, and how it had been controlled by the industry over the last 50 years. So, we go through all the evidence of how the industry has influenced the dietary guidelines in this period. I focus specifically also on that story that you’ve just described, and we call it two catastrophic events that began the current dietary disaster. This is the one chapter I wrote, and the first one, the first Apocalypse, the great Harvard sugar bribe of 1965, as you’ve indicated, this is no conspiracy theory. If you read The Eat Right Revolution, you’ll see exactly what happened. It’s no conspiracy, it was just industry defending its target, its markets, and making sure that we never question that ultra-processed, highly processed foods are not good for us.

Trevor Connor 1:00:10

I think this review was a factor, but you are now seeing more and more research being done on the impact of simple sugar on heart disease. This research started in the 50s and 60s, and sure enough, it is showing there is a direct link.

Chris Case 1:00:24

So, do we want to turn our attention? We have touched upon this a few times now, but do we want to get into the more practical ways in which people can control weight? Can do it healthily? Set aside whatever marketing ploys are out there in the world, it sounds like you both have very strong opinions here, and are well-grounded in science. So, why don’t we turn our attention there?

Practical Ways To Control Weight

Trevor Connor 1:00:55

Dr. Noakes, something on this basis, I was really glad to hear you say this, and I’d like to hear more of your opinion on this because I will tell you this is my big bias is the importance of nutrient density. So, I’ll give you my statement, which is, I think we forget about the quality of the foods when we start talking about just macronutrient ratios or calories. I will make the statement; I can have somebody lose weight eating at McDonald’s. Now, the fact of the matter is, you’re going to have to lock him in a room because they’re going to try to break the door because of the sugar addiction, it’s going to be absolutely miserable, but you can lose weight eating at McDonald’s, but that doesn’t answer the question, is that a healthy way? Is that a healthy way to eat? I want to hear what you have to say, but I feel that when you are eating a nutrient-dense diet, you are eating healthier. I do think it’s going to make it easier because it helps reduce those hunger signals. It is going to make it easier to control weight, but how do you feel?

Dr. Timothy Noakes 1:01:59

Well, I mean, that’s my only experience and dealing with people and I’ve interacted with tens of thousands of people, you know, I introduced the Banting diet to South Africa. There’s a Banting Facebook page in my town, which has 2 million people, 2 million followers, it’s more than any other political parties in South Africa. That tells you that the move to eat real foods has really satisfied a lot of people and help them sort out the problems. So, I have no question that if we were to assess the people who successfully lost weight and control their hunger, you would find that the main change was from ultra-processed foods to the type of foods you’re talking about the real foods. I know Dr. Cordain, maybe doesn’t have such a strong opinion about animal-based foods, but in my experience for most people, animal-based foods are very helpful, because they are nutrient-dense, as you’ve indicated, they take away that hunger. The issue is, as we’ve discussed, you have to decide, is it more protein or is it more fat? For some people, the fat is satiating for other people, the protein is satiating, and whether that’s related to the nutrient density, I don’t know. I would think that in the next five years or so we’re going to see more and more the theory that its nutrient density that is driving satiety, rather than the low carbohydrate or the high fat, high protein components of the diet. So, I’m looking forward to discovering more about that and having more research done, I think that we’ve got hoodwinked into this, it’s all the carbohydrates, or it’s not all the carbohydrates, we need to broaden the debate beyond that.

Eating Nutrient-Dense Foods

Trevor Connor 1:03:54

I actually wrote a paper with Dr. Cordain, all about nutrient density, anybody can do this, we just use the standard nutrition software that does an analysis of the various foods. We did an analysis of the nutrient density of the different food classes and then rank them. Here’s the order it goes, top highest nutrient density, seafood, then vegetables, then fruits, then lean meats, then eggs, and now we’re getting into the low nutrient density, then it goes legumes, starchy roots, that’s your potatoes, things like that, and rounding at the bottom of the list is whole milk, whole grains, nuts, and seeds.

Dr. Timothy Noakes 1:04:37

Yeah, there you go. If you were eating the foods from the top of that list, you would be very quickly losing weight and you’d be able to regulate your weight much better. So, there are some carbohydrates in those top ones, but there are much more of the carbohydrates in the lower nutrient-dense foods as I see it. So, I would agree with you, and people like Ted Naman, who are talking about nutrient density, that’s exactly the diet he would be prescribing. For me, because I have type two diabetes, I have to be wary about the carbohydrate content of the diet, because I can’t assimilate carbohydrates, I can’t cope with it, and my glucose goes out of control, so for other health reasons, I restrict the vegetables and the carbohydrate-containing vegetables particularly. The problem is that not everyone who is obese is insulin resistant, but the majority are, and the more you’ve moved towards diabetes, the more difficult it is for you to cope with adding carbohydrates. I think that’s the refinement, if everyone was healthy, what you have described is perfect, that’s the way we should be eating, and that would allow some people to eat more carbohydrates than others, and that we wouldn’t have to restrict the carbohydrate intake as much as I promote. I’m talking to the people who have serious insulin resistance, pre-diabetes, diabetes, and they benefit most by reducing the carbohydrates way down to almost absent. That’s where the problem arises, the argument becomes, Noakes he restricts carbohydrates too much, but in the nutrient-dense foods, you can have some carbohydrates, because they’re good foods, and they’ll be healthy. But unfortunately, the carbohydrate content, in my opinion, makes them not acceptable for people with insulin resistance. The longer you had your insulin resistance, and the more diabetic or pre-diabetic you are, the more, unfortunately, you have to restrict the carbohydrates in the diet. A lot of the research is not done on these people who are in that range, who are as insulin resistant or pre-diabetic as myself and others.

Trevor Connor 1:07:07

I’m really glad you brought up that difference with people who are diabetic, people who are insulin resistant, and then people who are not, obviously, you need to take a different approach. Obviously, we’re a podcast that’s focusing on cyclists, so I think most of the people we’re talking to are not insulin resistant, but something I really want to point out that you alluded to, is I get asked this question all the time when people hear I don’t eat grains, like how do you get your carbohydrates? People think carbohydrates and grain products are the same, vegetables and fruits if you’re classifying food but what is their primary macronutrients are carbohydrates, the difference between vegetables and fruits have a low glycemic load, which means when you eat them, they aren’t going to spike your insulin the way processed food or simple grains, especially processed grains are going to spike your insulin, and as those big spikes in insulin that are going to lead to those unhealthy effects.

Trevor Connor 1:08:04

So, this is a personal experience that really clued me in on the importance of nutrient density. This goes back a lot of years, I was doing one of my five-day training camps, I was up in Victoria. So, we were doing this at the center. I was struggling this whole camp, and what was really strange, so back then I was all about the eat as many carbohydrates as you can, so when we’d stopped to grab food, I would just be wolfing down the candy and every bit of simple sugar I could. In this particular camp, we would stop at gas stations, and for some reason, I didn’t want sugar. I kept wanting turkey jerky.

Chris Case 1:08:44

Okay.

Listening to Your Body

Trevor Connor 1:08:45

I don’t know why, but we would go into the gas station, and I would buy my turkey jerky and eat it, and I just couldn’t get enough and had no idea why this was, until soon after the camp, I started getting cracks at the corner of my lips. So, I talked to one of my nutrition instructors about this and we looked it up and discovered cracks at the corners of your lips are one of the symptoms of riboflavin deficiency and looked it up, turkey jerky is very high and riboflavin. So, this kind of clued me in that, I think we think hunger signals are an on-off signal, it’s just you’re hungry and you eat food or you’re not hungry. I do believe our bodies have an actual pretty good sense of saying, I’m not only hungry, but I’m hungry for something. I think we’re often hungry for nutrients, and we have gotten bad at listening to exactly what the hunger signal is. So, I do think part of this satiation issue is we eat these low nutrient density foods, our bodies go, I’m hungry, and is hungry for something, so you go and wolf down a Big Mac and your body goes, well thank you, I’m going to store those calories because that was a whole A lot of calories, but he still didn’t give me what I need, so I’m not shutting off that hunger signal. I have worked with a lot of people who say I’m hungry all the time, and I tell them to eat nutrient density, and I do believe that you are then satisfying the hunger signals better, your body goes, okay, now you’ve given me what I need, great, I’m going to turn the hunger off. I do think that is one of the issues with these ultra-processed foods is their low nutrient density, your body’s not getting what it needs, so it’s going to keep telling you I need something. That’s my theory, Dr. Noakes, how do you feel about that?

Dr. Timothy Noakes 1:10:36

I think that’s a fabulous story because it resonates with me because I always think that personal anecdotal experience is so important, and we underestimate it. I think that I’ve tried to make this point that when I got into a low carbohydrate diet, and it cured my diabetes, and then I thought, well, it’s cutting the carbohydrates, but of course, I changed the diet completely, and I cut out all those ultra-processed foods. So, I think what’s happened is that we are saying it’s a low carbohydrate, and for people with diabetes, clearly low carbohydrate is very important. For the person who is carbohydrate tolerant, it’s not the cutting the carbohydrate that’s important, it’s cutting the ultra-processed foods and eating real foods, and energy-dense foods you described, and that’s what we’re going to come with, I think, in the end, we’re going to realize that the carbohydrates are toxic for a proportion of the population, but the bigger problem is the lack of nutrient density in the ultra-processed food, and, of course, the addictive nature of those foods. So, I think in the end, we will come to an agreement that what we thought was the problem with eating too much carbohydrate, it’s not, it’s eating foods that are not nutrient-dense, and ultra-processed. The focus really needs to shift away from focusing, it’s just the carbohydrates to saying no, it’s ultra-processed foods that you’ve got to get rid of, and you’ve got to replace them with energy, nutrient-dense foods, nutrient-dense foods. I like the table that you had there, Trevor, or the description because I think that’s important, we need to rank our foods on their nutrient density, not on the grams of carbohydrate, the grams of fat, and the grams of protein. I want to draw attention to Chris Froome, who I don’t know if you know, but he trained in South Africa before he went overseas and became a world-class cyclist, and in South Africa, he was quite chubby. There are pictures of him, weighing about eight kilograms more than he does now, and the story is that Chris went to do the Spanish race, the tour of Spain, and he came second, so he came from being the 30th-day cyclist in the world to suddenly coming second. He came home to Cape Town to see his girlfriend who happened to know something about nutrition, and she looked at him she said, “Chris, you look terrible. What happened?” So, he said, “I lost eight kilograms, and became second in the Tour of Spain.” She said, “Well, that’s great. What did you do?” He said, “No, I went on a high protein diet.” I think what he meant was he was on a low carbohydrate high protein diet, and he then went on and won the Tour de France and became the very special cyclist that he is. His problem in my interpretation, he’s insulin resistant, and he can’t tolerate many carbohydrates. He definitely continues to eat carbohydrates when he’s doing a hard effort, and he does take in carbohydrates during the race, so it’s not a zero-carbohydrate man. I would guess that during the offseason, he restricts his carbohydrates, because if he doesn’t, he’s eight kilograms heavier, and he’s not competitive, he’s not world-class anymore. I think a lot of people and it’s not cycling because you’re talking to very good cyclists, but as a runner, and I was always interested in how you could have obese runners, and some of them pretty good, and if you go to marathon today, you’ll see that the guys finishing over three and a half hours is a high proportion of people who are carrying excess weight, and that’s because we and myself, I’m one of the causes, we’ve over promoted carbohydrates for exercise performance. If you’re running a three-hour marathon or three and a half hour marathon or four-hour marathon, you can do that perfectly well on a very low carbohydrate diet. So, I’m not arguing that people like Chris Froome do need some more carbohydrates when they’re training hard and they’re competing at a world-class level, but Chris Froome is a different animal than the rest of us, and we really need to understand that a high carbohydrate diet may help some athletes at the very top of their games, but for the rest of us, it’s probably much easier to regulate our weight by being a little bit more cautious on how many carbohydrates we eat.

Eating a Low Carbohydrate Diet

Trevor Connor 1:15:16

I’ll point out, I still consider myself a relatively competitive cyclist. I also feel that I do eat healthily, and I will tell you, my diet is about 30 to 40% carbohydrate, so I’m not a low carbohydrate person, but it’s the source of my carbohydrates. As I said, I get them mostly from what I consider healthier sources, which I eat a lot of fruits and vegetables.

Dr. Timothy Noakes 1:15:38

Yeah, absolutely. You are still eating a relatively low carbohydrate diet compared to North Americans who are probably eating 50 to 60% carbohydrate, and as you have indicated, you’re eating healthy carbohydrates, you’re not getting the insulin spikes all the time. So, you’re absolutely correct that, but you are still eating a relatively low carb diet, in fact, the only publication that was used in my trial by the opposition said a low carbohydrate diet is anything below 45% carbohydrate. Of course, I don’t believe that I think a low carb diet is 5% carbohydrate, but it shows that the average nutritionist in the world has been taught that you must not go below 45% carbohydrate, so you are eating a relatively carbohydrate-restricted diet compared to the rest of North America.

Trevor Connor 1:16:31

My issue with that 60-65% recommendation I’ve done this, I’ve tried to put together menus to get to that percentage on what I consider healthy foods. I personally do not believe you can eat over 60% of your calories from carbohydrates without starting to eat a whole lot of low nutrient density, highly processed, high simple sugar foods.

Dr. Timothy Noakes 1:16:55

Precisely. One of our top triathletes in South Africa, who then went and set the Iron Man record in South Africa, as a South African I should say, and the junk he was eating on the diet to get him all those carbohydrate calories was amazing, you can’t eat that diet because it’s nutrient-poor and a disastrous diet and he immediately improved and was it because he was eating less carbohydrate? Maybe, but maybe it’s because he now had a more nutrient-dense diet, and he was just healthier in all ways. So, I absolutely agree with you, if you’re eating more than 60% carbohydrates, that’s going to be a dreadful diet in terms of nutrient density and the quality of the diet.

Trevor Connor 1:17:41

So, I remember hearing an interview with Floyd Landis, so I’m sure most of our listeners remember him he, unfortunately, won the Tour de France but then got busted for doping. In this interview, he talked about the diets he ate, and his comment was, “Oh, no, we all ate like crap, we had to it was the only way to survive.” You can hear interviews with guys from that era who talked about going out for six-hour rides, and then they come home and take a sleeping pill, because they’d be ferociously hungry, and just knock themselves out and not eat. So, that goes back to you can lose weight on a horrible diet, it’s just miserable, and that’s kind of what they’re doing. I’m a big believer that I think part of the reason that era was so reliant on doping was because they were eating such a bad diet, they needed to compensate for what that diet was doing to them.

Dr. Timothy Noakes 1:18:32

That’s a fascinating comment, which I’ve not heard before. That’s certainly something to think about. I must tell you that Dave Scott, the great triathlete, one of the world’s greatest triathletes in Ironman, really built the discipline of ultra-marathons, you know, I’m from South Africa, and we have the comrade’s marathon which has been going since 100 years, this year exactly. That’s a 90-kilometer race, and already in the 70s, we had thousands of runners, and now it’s up to 20,000 or so. It was the only ultra-marathon where you had more than let’s say 100 athletes, and along came the Ironman, and all of a sudden you had thousands of people competing in an event that lasted 8 to 15 hours. Dave Scott, obviously, dominated originally, and I spoke to him quite recently because he read my book on the high-fat diet, and he adapted his diet six years ago. He was a vegetarian when he was competing in Ironman, and then he slowly reintroduced particularly fish and other healthy animal-based foods. He said, “When I read your book, then I went more completely, and I cut out the grains and benefited from it.” He said that he would never prescribe the high carbohydrate diet to any athlete because he says, “You can’t survive on that diet.” That comes back to what you’ve said that he said that you, you can survive a few years at a world-class level, but then you just burn out. Again, I would argue that it’s a nutrient-poor diet that’s causing the problems.

Trevor Connor 1:20:18

As we just talked about, nutrition is about a lot more than calories. Hannah Finchamp, a coach and a mountain and gravel pro on the Orange Seal Off-Road Team, talked to us about the importance of nutrient density and giving our bodies what they need.

Hannah Finchamp: The Importance of Nutrient Density and Giving Our Bodies What They Need

Hannah Finchamp 1:20:32

Oh, man, it’s a tough question, and t’s such a hot topic. It’s a delicate subject, too, I think that it really does need to be addressed, because I think by so many people avoiding it, it becomes even more sensitive, but you know, I think of food as fuel. As a professional athlete, I have all of these things measured and dialed in, as I’m sure all the pros do, you go get adnexa, you get whatever sort of body composition tests done so that you can really truly know like, hey, what is my race weight? What is safe? Where am I functioning with optimal performance and health? Putting both those things. So, for me, what’s really important is having those really specific measurements where I can know based on the science where I’m at. For people who don’t have access to that, I think the important thing is to focus on the food being fuel first, you know, I think that we can maintain better race weight when we’re focusing on fueling during the right times. So, when you wait, I feel like I’m going to get in trouble, right? Because there are so many fad diets, like intermittent fasting and stuff like that, but I think that, you know, at least for me, and my philosophy is fueling in the right moments, so waking up and immediately eating, getting your metabolism going, you know, early in the morning, it’s eating when you’re on the ride, so that you’re fueling your performance well, you’re not hurting your performance, and then also coming back and raiding your cabinets, because you’re so starving, and you don’t have time to cook anything, and now you’re just eating whatever you have laying around. So, it’s eating during that, it’s having your recovery drink right after when your metabolism is still high, and you can really utilize those things and maybe having protein before bed, it’s really hitting all those nutritional checkpoints. I think that when we hit those nutritional checkpoints, and we work with our metabolism, and with those nutrients that our body needs, our body really can figure it out on its own. So, it’s just giving our bodies what it needs in order for it to find its optimal weight, as you might say, or you know, performance, health level.

Chris Case 1:23:18

Dr. Noakes, anything else that you wanted to make sure we addressed today?

Dr. Timothy Noakes 1:23:23

No, I think you got all my biases in.

Chris Case 1:23:28

Great.

Dr. Timothy Noakes 1:23:29

I didn’t want to fall on either side of the calories in, calories out. I think it’s more nuanced than that. I think that actually is more, what I’m observing is that people are beginning to realize that carbohydrates can be a problem and that restricting carbohydrates to 30% to 40% may be beneficial for a number of people. Once you’ve got diabetes, or pre-diabetes marked insulin resistance, that’s the indication that you’ve got to be more careful on the carbohydrates. I think that nuance is coming through. So, even Kevin Hall, I think I see him shifting his position slightly, and that in time, we will all come back to the same realization that it’s how the foods influence your hunger that that’s critical, and that will be good if we can get there, and that’s what we need to make the argument. You must eat so that you aren’t hungry and get the most nutrient-dense foods for the least calories, that’s the way you remain healthy.

Chris Case 1:24:40

On the subject of nutrient density, Trevor, I know you have a story you’d like to share. We like to close out an episode with the take-home message from each of the people in the room. Dr. Noakes, I’ll start with you, we have started to come to some very conclusive statements here, but maybe you could restate it again, to give listeners out there a sense of the most important message from this episode, from this discussion.

Dr. Timothy Noakes Takeaway Message

Dr. Timothy Noakes 1:25:08

Yeah, thanks, Chris. So, my most important message is that if you want to control your weight, you must get rid of food cravings, you have to find the foods that satiate you, and those are the foods that give you the most nutrient density at the lowest number of calories. For many foods, there are animal or fish-based foods, and they certainly are not ultra-processed food. So, the first step in controlling your hunger, and ultimately controlling your weight, and controlling how many calories you need is to make sure you’re eating nutrient-dense foods that satiate you.

Chris Case 1:25:50

Very good, Trevor, what would you add?

Trevor Connor Takeaway Message

Trevor Connor 1:25:53

I think the best summary was just given, and I’m trying to think of other things, there are so many things to touch on, a little overwhelmed here. I’m going to start with the original question, which is, does it come down to calories in, calories out? The incredibly simplistic answer is, can’t break the law of thermodynamics? Yes, the issue is, you can’t measure that. I think the more important question is what Dr. Noakes, you were getting at, which is what is the health of that diet? I agree with you 100%, that you really do need to focus on that nutrient density, that’s going to push you towards a healthier diet, which also is going to have that side effect, I think of satiating you, and making it really easy, or much easier to keep your weight down. Chris, your thoughts?

Chris Case Takeaway Message

Chris Case 1:26:47

Yeah, you know, it’s really a fascinating subject, nutrition, weight loss. People make it really complex, for lots of different reasons, but if you just went back to the chart, we just referenced, and you look at the top five foods that have the most nutrient density, and you told people don’t look at anything else besides basically this chart, this chart is your guide, ignore the food pyramid, it’s ridiculous, look at this chart. It becomes extremely simple in some ways, eat these foods, you’ll not only lose weight, you’ll be a healthier person, which means not only healthy and physically, but very likely mentally as well. However, this is where nutrition, diet, and food get so complicated is you’ve got industry, you’ve got money, you’ve got marketing, all sending you different messages, wrong messages, some people have a hard time wading through all of that noise to get to what they need to get to. I would argue that once it is clear, it’s pretty simple.

Trevor Connor 1:28:02

Well, Dr. Noakes, thanks so much for coming on the show.

Dr. Timothy Noakes 1:28:05

Pleasure.

Chris Case 1:28:06

Yes, it’s been a pleasure to have you on the show again. Thanks very much for your time.

Dr. Timothy Noakes 1:28:10

Fantastic. Thank you both so much, it’s been a very invigorating discussion, and I hope that your audience will learn from it.

Chris Case 1:28:19

That was another episode of Fast Talk. Subscribe to Fast Talk wherever you prefer to find your favorite podcast and be sure to leave us a rating and review. The thoughts and opinions expressed on Fast Talk are those of the individual. As always, we’d love your feedback, join the conversation at forums.fasttalklabs.com to discuss each episode. Become a member of Fast Talk Laboratories at fasttalklabs.com/join and become a part of our education and coaching community. For Dr. Tim Noakes, Trevor Connor, Rob Pickels, and Ted King. I’m Chris Case. Thanks for listening.