Metabolic health or calories in calories out (CICO)?

Which has the greatest effect on health and weight? The calories - calorie content of food and the amount consumed? Or the hormonal effect of food and the physiological effects?

The Best Strategy

1. Prioritize metabolic health by focusing on food quality and hormonal regulation first:

• Reduce refined carbs and sugar.

• Eat more protein, healthy fats, and whole foods.

• Use low-carb or keto strategies if applicable.

• Incorporate physical activity, especially walking and resistance training.

2. Allow a calorie deficit to follow naturally once hunger and cravings are under control and metabolic function improves.

By addressing metabolic health first, overweight individuals set themselves up for easier, more sustainable weight loss and long-term health improvements. This is why approaches like low-carb, high-protein diets with an emphasis on nutrient-dense foods are so effective for those who are overweight and metabolically unhealthy.

The question of calories versus hormonal and physiological effects of food on health and weight is nuanced. Both play a role, but the relative importance depends on individual circumstances, goals, and metabolism. Here’s a breakdown:

1. Calories and Energy Balance

• Core Concept: Weight gain or loss is influenced by energy balance (calories consumed vs. calories expended).

• If you consume more calories than your body uses (a surplus), you gain weight.

• If you consume fewer calories than your body uses (a deficit), you lose weight.

This principle works under basic thermodynamics and is an important factor in weight management.

However, it’s not just about calories because the body doesn’t process all foods the same way.

2. Hormonal and Physiological Effects of Food

Different foods and macronutrients trigger different hormonal and metabolic responses, which affect:

• Hunger and satiety (regulated by hormones like ghrelin, leptin, and insulin)

• Fat storage and breakdown (influenced by insulin, glucagon, cortisol, etc.)

• Blood sugar regulation (important for health and energy)

• Metabolic rate (e.g., protein has a higher thermic effect than carbs or fats)

• Cravings and food addiction (processed, high-sugar foods can trigger reward pathways in the brain)

For instance:

• High-carbohydrate foods (especially refined carbs) elevate insulin, which promotes fat storage and limits fat breakdown.

• High-fat, low-carb diets (like keto) lower insulin, improve satiety, and encourage fat burning.

• Protein-rich foods promote satiety and muscle preservation while also requiring more energy to digest.

This means that while a “calorie is a calorie” technically, the hormonal impact of 100 calories of candy is very different from 100 calories of steak.

3. Impact on Health

• Quality of calories (nutrient density, whole vs. processed foods) has a major impact on overall health.

• Highly processed foods, sugars, and trans fats may disrupt hormones, increase inflammation, and lead to metabolic issues like insulin resistance.

• A diet emphasizing whole, nutrient-dense foods (proteins, healthy fats, fiber, vitamins) can optimize hormones, satiety, and metabolic function.

Summary

1. For Weight Loss: Calories matter, but hormonal responses (especially insulin regulation) influence how easy it is to sustain a calorie deficit.

2. For Health: The hormonal and physiological effects of food have a greater impact. Food quality and how it influences metabolism, inflammation, and hormones determine long-term health.

A combined approach focusing on:

• Nutrient-dense foods (quality over quantity)

• Hormonal balance (low insulin spikes, satiety, and stable energy)

• Calorie awareness (without obsessive tracking)

is ideal for most individuals. For someone on a low-carb or ketogenic diet (as you are), focusing on the hormonal impact of food (e.g., keeping insulin low) is particularly effective for both weight and health goals.

Metabolic health and weight are deeply interconnected. Most individuals who are overweight are indeed metabolically unhealthy—this includes conditions like insulin resistance, elevated blood sugar, inflammation, and poor lipid profiles. These issues often make weight loss harder because the body’s hormones and metabolism are dysregulated.

Here’s the best strategy to approach this:

1. Address Metabolic Health First

Focusing on metabolic health by improving hormonal responses to food should take priority. Why?

• When insulin resistance and other metabolic dysfunctions are present, the body tends to:

• Store more fat instead of burning it.

• Experience increased hunger and cravings.

• Exhibit poor energy regulation and fatigue, making calorie restriction unsustainable.

By improving metabolic health, the body naturally becomes better at:

• Burning fat for energy.

• Regulating hunger and satiety hormones (like leptin and ghrelin).

• Managing energy and cravings, which makes it easier to achieve a sustainable calorie deficit.

How to Improve Metabolic Health:

• Reduce refined carbs and sugar: Lower insulin levels and improve insulin sensitivity.

• Focus on high-quality protein and healthy fats: Improve satiety and stabilize blood sugar.

• Prioritize nutrient-dense, whole foods: These improve energy and provide essential nutrients for metabolic repair.

• Incorporate low-intensity movement and resistance training: These improve insulin sensitivity and fat-burning capacity.

A low-carb or ketogenic diet is particularly effective here because it directly addresses insulin resistance and promotes fat burning. It also helps regulate appetite, making calorie reduction easier without constant hunger.

2. Calorie Deficit Comes Naturally Second

Once metabolic health improves, achieving a calorie deficit becomes easier because:

• Hunger and cravings decrease.

• Energy levels improve, so movement increases naturally.

• Fat burning becomes more efficient (lower insulin = greater access to fat stores).

At this point, you may still need to monitor calories to ensure you’re in a deficit, but the process becomes far more manageable and sustainable.

Why Not Focus on Calories First?

Starting with a strict “calories in, calories out” (CICO) approach when someone is metabolically unhealthy often backfires because:

1. Hunger and cravings are harder to control due to dysregulated insulin and leptin.

2. Severe calorie restriction slows metabolism over time, making weight loss less effective.

3. It doesn’t address the root cause of metabolic dysfunction, meaning long-term success is unlikely.