DoctorTro Profile picture
Sep 29, 2021 15 tweets 4 min read Read on X
🚨THREAD

Why calories NEVER mattered...

1/n
We have known as far back as 1982 that tracking calories, food logging is inaccurate & doesn’t predict weight loss

10.1093/ajcn/35.4.727.

2/n
Meta-analysis in 2008 by Harnack and French, then follow-up in 2014 from Eblel, Kiszko reviews and assesses the evidence on the effectiveness of calorie labeling at the point of purchase

"Concerns on the effectiveness of calorie labeling policies"

10.1007/s10900-014-9876-0

3/n
Less than 0.1% of people getting fast food actually care about calories...

10.2105/AJPH.2008.136457

4/n
Men actually INCREASE intake with calorie information

10.1186/1479-5868-5-63

5/n
nutritional labeling in a college setting caused some people to eat more....

10.1016/0271-5317(95)02001-C

6/n
dietitians miscalculate calories by 10-20%, lay people around 20-30% and some patients with obesity up to 50%

10.1016/s0002-8223(02)90316-0

7/n
Head to head, calorie counting performs worse than EVEN the low fat diet (the diet that failed the last half century)

10.1136/bmj.314.7073.29

8/n
There are millions of people with access to calorie information with no END in sight to the obesity pandemic

9/n
Many patients actually DONT like tracking or counting calories

10.1016/j.invent.2016.12.003

10/n
There's more

11/n
SUMMARY:

Calorie estimation for both intake & expenditure are inaccurate, even for orthorexic dietitians/trainers

Several real-world examples from NYC, college cafeterias, menus etc have shown that calorie information has no clear positive impact on food intake

11/n
Educating patients on calories has been an overall disastrous experiment with no signs of real world improvement

Calorie counting and point tracking diets HAVE never been shown to be superior to ANY approach

Consider stopping the bullshit & actually helping people instead

/end
If you want to hear me lecture on this join me this Saturday for a Grand Rounds for @TheSMHP @DougieReynolds

We will discuss why calories NEVER mattered and the history & importance of glycemic variability...
@DrBubbs this one is for you!

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More from @DoctorTro

Sep 2
🚨THREAD🚨

STRESS AND WEIGHT REGAIN
While very few physicians have embraced it yet, our practice has been thriving on the use of remotely monitoring patient biometric data. In our clinic, almost all of our patients have smart equipment in their homes which wirelessly sync with our practice.
We monitor body weight, fat mass, water weight, muscle mass, blood pressure, heart rate/heart rate regularity, and blood sugar⁠—all remotely. The patient can remain in the comfort of their own home and data is securely submitted wirelessly to our practice in real-time. This data is analyzed by me and my staff, which we then use to help encourage our patients who are doing well in their journeys. It has also helped us to identify patterns that predict weight regain and has given our practice the unique ability to reach out to our patients in real-time to intervene, increase contact, and lend a helping hand when times are tough. In our practice, gone are the days when you would see your physician six months later, after regaining 30 pounds. @gotowardhealth
Read 22 tweets
Aug 21
I have a serious problem with the term “pre-diabetes.”

The prefix “pre” is used to describe what comes before something.

In reality, “pre”-diabetes is actually AFTER or “post” 15 years of the high insulin levels & inflammation associated with the modern lifestyle.
Prediabetes is usually diagnosed by checking an a1c level, which is the percentage of hemoglobin that binds to sugar as a percentage of normal hemoglobin.

If you a1c is between 5.7 and 6.4, you are considered to have “pre-diabetes”
To achieve this level of pre-diabetes, you must sustain enough carbohydrate/glycemic excursions & weight gain where your average glucose rises sufficiently above normal levels.

The a1c describes your speed, your are past your speed limit.
Read 13 tweets
Aug 21
Obesity doesn’t just “happen” to individuals… it spreads like an infectious disease.

🧵 Let me explain…
A landmark NEJM study tracked 12,000+ people for 32 years. The shocking finding? If your friend became obese, your risk of becoming obese rose by 57%
This effect wasn’t limited to family. It held true for spouses, siblings, and friends… proving that social networks spread obesity.
Read 8 tweets
Aug 20
Defund the American Academy of Pediatrics.
It’s not a neutral medical body… it’s a corporate mouthpiece. Here’s the proof 🧵
💊 Big Pharma
AAP takes money from pharma giants.
Their guidelines? Push GLP-1 injections and bariatric surgery for kids… but demonize reducing carbs and sugar. Profit over prevention.
🥤 Junk Food Industry
AAP is bankrolled by Coca-Cola, Nestlé, PepsiCo, and formula makers.
The result? Silence on ultra-processed foods… but endless focus on drugs and surgery.
Read 8 tweets
Aug 19
After helping thousands of patients lose weight, here’s my advice for those looking for lifelong, sustainable life changes. These are the “5 MUSTS” anyone trying to lose weight lifelong NEEDS to do.

🧵/Thread
Before you understand my “5 musts”, simply ask yourself -what are the side effects of your prior weight loss attempts- NOT your reasons, NOT what you want to happen, what went wrong, what made you stop?
The 5 Musts: #1 HUNGER
Most people quit diets because they feel low energy, tired & hungry. Your weight loss attempt will need to manage HUNGER. Are food choices making you full, or are they leaving you craving more a couple of hours later? Stick to:: 🐠🥩🍳🍗🍖🍤🫑🥑🥬🥦
Read 10 tweets
Aug 14
There are 5 types of hunger that ideally should be taught to all patients with obesity

Without cultivating an awareness of appetite, hunger and cravings, a patient with obesity will not know what they are fighting against

So Let’s start!
We are going to start with some easy ones…

The Cephalic phase response aka food cues - this is hunger stimulated when in presence of food.

These signals are deeply ingrained and can be conditioned

Think of Pavlov & commercials - these aren’t going away quickly or ever
Second up is appetite triggered by Social cues to eat

our social lives, whether they are business meetings, family dinners or birthdays

Unless you are going monk mode - this cue to eat is also not going away & requires attention to manage
Read 21 tweets

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