# Unjustified premises lead to fraudulent conclusions (II)

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How are the unjustified premises included in the CICO hypothesis?

The energy balance formula (EB), which is frequently used to explain how we should proceed in the case of wanting to lose, gain or maintain weight, is as simple as I quote below:

EB = caloric intake (CI) – caloric expenditure (CO).

The above equation is based on the Law of Thermodynamics

Alberto Hernández

I hope that at the end of this article we all will see in the previous quote the same deception that I see.

## The conservation of energy principle

Well then, here we go. The conservation of energy principle: the energy present in the chemical links of the products that we eat (IC), either ends up being used by the body to generate movement/heat (CO), or ends up stored in a tissue/organ of the body (Adipose Tissue, GLycogen, Muscle Tissue, TUMor, etc.):

As an important note at this time, assuming a given energy intake, hypothetically the energy stored in the adipose tissue can change in response to the physiological/hormonal signals it receives, and that change, logically, would result in that either the energy expenditure would be affected or the energy stored in the rest of organs tissues would be affected. Nothing in the energy balance equation tells us this is impossible. Why do I say that it is important to highlight this possibility? Because one of the ideas that I want to explain with this article is how in the CICO hypothesis this possibility is “magically” eliminated. I will try to clarify in this article how this “magic” happens.

## We make a definition

We define energy balance (EB) as calories IN (CI) minus calories OUT (CO):

And, once we have that definition we have two coupled expressions for EB, that is, two expressions that are dependent on each other:

The above equalities for EB are only correct when used together. Together they are the energy conservation equation. It is not possible to consider one of the equalities in isolation, because the other equality also contributes to establishing the correct values ​​of equality we select. With rigor, they can never be used separately.

What happens if we use only one of the two previous equalities? Please note that this is exactly what the quote at the beginning of this article does:

EB = caloric intake (CI) – caloric expenditure (CO).

If the first equality was used alone, we would arrive to a wrong conclusion, which is that EB is determined by the difference between CI and CO. Is it not what the equality says? No, it isn’t!!, because in that case the second equality is ignored! EB is not a “dead” term in this first equality, determined just by CI and CO: if we think about it for a moment, the reality is that the term EB could change because of changes in the second equality and CO could just reflect those changes. By ignoring the second equality and interpreting EB = CI-CO as the formula for calculating EB, we have arrived at the deceptive conclusion that CI and CO are the important terms for EB, the terms that “determine” it and, therefore, the only terms we have to look at. By using the first equality alone, a false causality has been created. And the important thing here is that we don’t see that we make a mistake!

The balance between calories IN and calories OUT determines our weight. Óscar Picazo

In summary: we erroneously interpret that EB is determined by CI and CO. Assuming that the intake is controllable, this points to the energy expenditure (CO) as the parameter responsible for establishing a value for the energy balance (EB).

Although we already know that we are making a mistake, I will go on with this reasoning in order to expose the conclusions it leads to. With a EB that has been (fraudulently) determined by CI and CO, now we use the second equality.

Once we have a EB term that has already been established by equality 1), another deception is created, which is to assume that the only energy in our body that can change is the one stored in the adipose tissue (AT). This is absolutely unwarranted and is deceptive (as proved if we just apply the same mistake to any other term of the second equality):

From this (false) second equality, it follows that the energy balance (EB) value established by CI and CO will command the adipose tissue to store or release energy. As I already anticipared that it would happen, by using the 2 equalities one after the other, instead of always using them together, an unjustified premise has been included in the argument: the possibility that the AT term changes by itself and the rest of terms adapt to that change has been removed. The chain of mistakes that have been made has turned the adipose tissue into a passive tissue: now it obeys what is commanded by the difference between the Calories IN and Calories OUT. This conclusion has not been reached because it is what physiology says, nor because it is what is inferred from the laws of thermodynamics, but as a result of the reasoning mistakes that have been made. Note that without deceptions and paralogisms that conclusion cannot be reached.

If we look again at the quote I presented at the beginning of the article, what do we see now?

How are the unjustified premises included in the CICO hypothesis?

The energy balance formula (EB), which is frequently used to explain how we should proceed in the case of wanting to lose, gain or maintain weight, is as simple as I quote below:

EB = caloric intake (CI) – caloric expenditure (CO).

The above equation is based on the Law of Thermodynamics

Alberto Hernández

If CI and CO determine EB, only one of the two equalities is used: the first one. And, as a result of that mistake, the adipose tissue is no longer a “living” tissue, capable of changing by itself while other terms adapt to its changes. Adipose tissue is not considered, because the adipose tissue is not explicitly included in the second equality. CI and CO determine EB, period. What terms are relevant in the computation of EB? If we only use one of the two equalities, only the terms included in that equality will matter. The whole approach to the treatment of obesity from this very moment is focused on CI and CO exclusively. And if it doesn’t work, then it is concluded that CI and CO are more complex than was previously thought. But, as we have seen, that one is not the error in the foundations of CICO.

It is very easy to understand what I am saying, if we start from the second equality (instead of using first one, which is what CICO does). If in the second equality we assume that AT changes by itself, that would lead us to the conclusion that AT determines the changes in EB:

And then from the first equality we would conclude that CI and CO are irrelevant. Can the second equality be used in isolation to calculate EB? It is not a rhetorical question. What is our answer?

The deception that I explain in this article is used in the arguments that defend the CICO hypothesis as the way in which our body behaves: in the speech a value for the energy expenditure is assumed and, therefore, for the energy balance, and then the second equality is used, to wrongly conclude that the adipose tissue is forced to adapt to an energy balance that has been established (by using fallacious arguments) without taking into account the adipose tissue. We clearly can see this in two quotes from Stephan Guyenet, PhD:

Any energy that’s left over after the body has used what it needs is stored as body fat. Stephan Guyenet, PhD

When calorie expenditure decreases and calorie intake increases, the energy balance equation leaves only one possible outcome: fat gain. We gained fat as we ate more calories than we needed to remain lean, given our physical activity level. In other words, we overate. Stephan Guyenet, PhD

I emphasize again how, in the behavior described in the two quotes above, it is not possible for the adipose tissue to change by itself and affect the energy balance (defined as CI-CO). As we have seen, this is possible in the correct equation, i.e. the energy conservation equation, but it is not possible in the CICO hypothesis.

## Conclusion

The reasoning mistakes that I have explained in this article lead to the conclusion that the energy balance is established by the calorie intake (CI) minus the energy expenditure (CO). Once the energy balance term is established without taking into account the adipose tissue, this tissue is supposed to just obey the (false) energy conservation equation.

In short, with this long explanation what I try to make clear is that in the CICO hypothesis the adipose tissue is mistakenly turned into a passive tissue: from being a living tissue it is turned into a dead term, unable to change by itself. How is this fraudulent premise, which is a fundamental part of this hypothesis, introduced in CICO?That is what I have tried to explain in this article, although just to realize that it happens is a step forward in understanding the deception.

NOTE: if the 2 equalities are considered separately, to take into account many factors that affect the terms of the equalities doesn’t fix the reasoning mistakes that create CICO.

NOTE: EB=CI-CO is at the same time correct as an arbitrary definition and —for the reasons that I have explained in this article— wrong as the formula that allows the computation of EB. As we have seen, if that definition is used as an isolated formula, the principle of conservation of energy is being ignored.

# 80 years of energy balance pseudoscience

The prejudice and stupidity cycle:

# “Pseudo-sciences do not talk about physiology”

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## How to detect a pseudo-medicine? It’s very easy: pseudo-sciences do not talk about physiology

Writing about pseudo-medicine is relatively easy. Most pseudo-medicines are simple and self-contained. Being fundamentally fictional, outside of real complications, you do not have to fret overmuch about physiology and anatomy and plausibility and all the other aspects of medicine that make being a doctor a lot like Barbie in a math class. It’s tough. (source)

How do they say we can detect a pseudo-science? It is quite simple: pseudo-sciences are unable to give explanations based on physiology or anatomy that can be verified in scientific experiments. We have a textbook example: the energy balance pseudoscience. Are there any physiologic mechanisms that support this theory? None: it is based on “energies that enter” and “energies that leave”, and physiology is replaced by a mathematical operation that lacks a plausible link with the actual function of our organs and tissues. Clear as day: we have found a pseudo-science.

## In obesity you have to talk about energy, not physiology

But, apparently, with obesity it is the opposite: pseudoscience is talking about physiologic mechanisms, because that distracts our attention away from the actual cause, which is “genetic, environmental and behavioral.” No physiology, please! Without mundane and dirty physiologic mechanisms, because we know a lot about physics laws and this is an energy problem. We are damn good at physics.

We need to understand why some people gain weight easily and others don’t. Taubes doesn’t have an answer for that: his “cause” of obesity is more of a “mechanism” that doesn’t really get at the underlying genetic, environmental, and behavioral causes. While we are waiting to understand that, we still have the practical problem that overweight people need to lose weight now. It is undeniable that if you can find a way to reduce total calorie intake sufficiently, you will lose weight. (source)

Just a physiologic mechanism that is irrelevant in order to treat obesity. In obesity it does not matter if we treat causes or symptoms (see).

The two quotes above come from the same website: Science Based Medicine. They can easily see that they are the ones who defend pathetic pseudo-science: they simply have to apply their own detection criteria for pseudo-sciences. To put heroes face to face with their true identity is not cruelty: it is to move forward so that obesity stops being treated with a theory that is pure charlatanism (see).

## What are the physiologic mechanisms that support the energy balance theory?

What are the physiologic mechanisms that link our energy intake with all the energy stored in our body, in all its formats? What are the physiologic mechanisms by which “eat less (calories)” works?

What are the physiologic mechanisms that detect a decrease in the energy intake, and how is that information translated into the physiologic signals that reduce the fat that is stored in the adipocytes? What explanation does the energy balance theory give on those physiologic mechanisms?

Why do these people ignore the actual reaction of our body, as can be found in scientific journals, to food restriction and replace it with fantasies falsely based on a general law of physics that has nothing to do with our physiology?

NOTE: I wonder why they use Barbie as an example of someone who has problems with a math class … Are they saying that Ken would not have those problems? I think it’s obviously clear what they’re saying.

# CICO denial

— Last summer I gained 5 kg of muscle mass
— How did you do that?
— I consistently ate more than I expended
— That’s not a way to gain muscle, bro
— What are you, a CICO denier? Increasing your muscle mass is an energy balance problem: when people gain muscle mass, it’s always because more calories were consumed than were expended. This is a hard fact, man
— You are right. No one can break the Laws of Thermodynamics

The simple, unavoidable fact of human physiology is that you can’t increase your muscle mass without creating a calorie surplus. Whether you do this by eating more, moving less or a combination of the two, is a matter of preference.

# Making up a physiologic behaviour from a physics constraint

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When you eat more calories than you burn, the excess calories are primarily shunted into your adipose tissue. Your adiposity, or body fatness, increases. It really is as simple as that (Stephan Guyenet, PhD)

No, it is not as simple as that. As a matter of fact, that idea is a perfect example of the energy balance pseudoscience. The laws of physics do not tell you how things work, but rather the constraints under which they work. Whatever happens in a system, its behaviour cannot violate nature laws: matter cannot be created from nothing, an object will not accelerate unless a net force is applied or energy can not be created nor destroyed. Nevertheless, those limitations are often irrelevant in practice. For example, according to the Law of Conservation of Matter, you cannot accumulate matter in your body unless more matter enters the body than exits. But that fact is irrelevant for understanding growths in a living being.

What I want to explain in this blog entry is that the fraud in the energy balance theory does not lie in the maths —since this theory is indeed compatible with the physics constraint imposed by The First Law of Thermodynamics—, but in the physiologic behaviour that this theory makes up by using language tricks.

I am going to use a water tank as an analogy. Water is poured regularly into the tank and part of its contents is lost through a drain. We know that water cannot accumulate in the tank unless more water comes in than is lost through the drain. That is a true as useless, because it is just saying accumulation with different words. But, do you think that when more water comes in than goes out, the excess water is accumulated in the tank?

I am going to present two simple models based on a water tank. Both of them are compatible with the physics laws, since water is not created nor destroyed in any of them, but they behave differently. I insist: my point is that the energy balance theory is a fraud not because of its maths but because it makes up a physiologic behaviour.

## Model #1

Let us assume, for example, the following behaviour of the drain: the rate at which water flows from the tank is constant. In this case, if the rate of water flowing into the tank is bigger than the drain rate, water will accumulate in the tank. We could say “excess water” accumulates in the tank.

But let us assume that the drain rate is adaptative and equal to the rate of water poured into the tank. Would you say that, in this case, “when more water comes in than goes out, excess water accumulates in the tank“? No it does not and, in this case, there is no such thing as excess water. Not always it is correct to say that “when more water comes in than goes out, the excess water is accumulated in the tank“.

It is our physiology knowledge what would lead, where appropriate, to talk about “caloric excess”. From the First Law of Thermodynamics we cannot deduce a physiologic behavior, which is what the fraudulent energy balance theory does.

For example, the storage of carbohydrates as glycogen cannot be caused by an intake that exceeds their oxidation, because that would mean that by increasing our carbohydrate intake we could gain as much weight as we wanted. But physiology says it is not like that.

a chronic imbalance between carbohydrate intake and oxidation cannot be the basis of weight gain because storage capacity is limited and controlled, conversion to fat is an option which only occurs under extreme conditions in humans, and oxidation is increased to match intake (Broskey et al.)

Physiology determines if it is correct to speak of a specific “excess” as a cause of a specific accumulation.

## Model #2

In this model part of the contents of the tank is lost through the drain, but part is lost because it overflows the walls of the tank.

Please note that our body has physiologic mechanism that can dissipate unnecessary nutrients as heat. One of these mechanisms are the uncoupling proteins, which can be found in several organs and tissues in our body.

Moreover, in this model the walls of the tank are not fixed, but they can dynamically expand or contract, changing the total volume of the tank. In this model the position of the walls is regulated by the concentration of specific substances in the water.

Let us assume that a specific substance is present in the water and it makes the tank expand. As a consequence of that expansion, the total volume of water stored in the tank increases. Would you say that, in this case, “when more water comes in than goes out, excess water accumulates in the tank“? No, this not correct. The use of the term “excess water” is unwarranted.

Water is not accumulated because more water comes in than goes out, although more water will come in than go out when water accumulates.

This model does not violate universal laws of physics —water is not magically created nor destroyed— and the existence of another model that is also compatible with the physics laws, but with a behaviour different from that of the energy balance theory, clearly shows that this theory goes beyond the physics constraint that the First Law of Thermodynamics establishes: it introduces an unwarranted physiologic behaviour. As I said before, the fraud of the energy balance pseudoscience does not lie in the maths but in the unwarranted physiologic behaviour that it makes up.

Fundamentally, obesity is a problem of energy imbalance, which only develops when energy (food) intake exceeds total energy expenditure (Schrimpton et al.).

Obesity is not a problem of energy imbalance: it is a problem of excessive triglyceride accumulation in the adipose tissue. There is no physiologic basis for talking about “energy” or “energy excess” in regard to weight changes in the human body.

# Energy Balance Pseudoscience and Causality Hoax (2/2)

The messages I want to convey with this second part of the blog post are as follows:

• To complete the explanations from the first part, which can be summarized as that the energy balance theory does not rightfully derive from the laws of thermodynamics. Energy intake and energy expenditure are not necessarily neither the cause nor the solution to the obesity problem
• To clarify the causality fraud and its consequences in practice by means of a simple mathematical model of body weight dynamics, but also to explain the limitations of mathematical models.

I will use a very simple model of body weight dynamics, taken from an article (see) from Kevin Hall, a well-known promoter of the energy balance pseudoscience. In the past I have criticized the pretensions of this gentleman to interpret the forecasts of his mathematical model as scientific evidence, something always reprehensible but it is especially so in his case because he uses his results to blame the victims, the obese, for not being able to lose weight (see, see).

Please, do not bother criticizing the modifications I’m going to introduce in the mathematical model: I do not intend to propose an alternative model nor to improve the model. The ideas I want to convey are others and the model I use seems quackery to me, because instead of modelling the phenomenon of interest, which is the accumulation of triglycerides in the adipose tissue, what the model does is model the terms of the energy balance. Any model that is based on the energy balance theory is, in my opinion, insurmountable quackery (see first part of this entry).

## Model #1: A model that lacks a physiological adaptation

I assume hereafter that the daily energy intake is as the picture below shows (it is the relatice change with respect to the baseline, which is supposed to be a point of intake&weight equilibrium):

The model is very easy to understand. The energy intake is the input (on the left side) and the body weight is the output (on the right side). Each day we calculate (yellow block) the difference between caloric intake and energy expenditure and, in this model, that value determines the daily weight gain. The body weight is calculated as the cumulative sum (orange block) of all these daily changes.

This model does not include a physiological adaptation mechanism.

In the graph below, on the left I show the body weight evolution with time and on the right the energy expenditure evolution. By design of this model, when the energy expenditure is reduced around 200 kcal/d the body weight will stabilize. It can be shown that when the energy intake is a constant the model stabilizes its output at weight=intake/epsilon, which in this case is -200/25.8 =-7.75 kg. There is no need to run the model to know that result because, as I said above, it is part of the design of the model.

We are not seeing a rebound effect (i.e. a physiological adaptation) because in the Model #1 we do not include a physiological adaptation mechanism.

Do we deduce from this simulation that the physiological adaptation does not exist in real life and that what happens is that obese people simply eat more than they tell us? (see).

## Model #2: A model that does include a physiological adaptation

Let us suppose that, triggered by the food restriction, our physiology has changed. In Model #@ we maintain that there is a certain tendency to lose body fat, driven by the fact that we are eating too little, but now our adipose tissue has become especially prone to accumulate body fat (see the lightgray block and a new yellow block that adds these two effects in the figure below):

In this new version of the model, the body weight evolves as shown in the pictures below (blue curve on the left side). The energy expenditure is reduced as shown by the blue curve on the right side. The graph on the right shows that the simulated energy expenditure has been gradually reduced by around 50 kcal/d additional to what we expected (which would be the red curve):

In this model, the body weight is not regained by “eating more than it is expended”, but rather by the opposite, because the physiological adaptation that has been modeled is caused by the food restriction, i.e., for “eating an insufficient amount of food” in a sustained way. Does this model violate any laws of physics? Please consider that for our body functioning with the substrates that have not been stored is like we’ve just consumed a few grams less of food each day. It is not that hard to understand that Model #2 does not violate any law of physics or suppose an impossible situation for our body.

I believe there is no point in explaining how I implemented the physiological adaptation mechanism in Model #2. What I want to explain is that when I believe that there is a physiological adaptation and, therefore, I include an adaptation mechanism in the model, the model shows a physiological adaptation. And Model #2 is not doing anything clearly impossible: we are talking about an additional reduction of the energy expenditure of 50 kcal/d after two years. Note that the Hall calculations were that the CALERIE2 participants were consuming around 37 kcal/d more than they actually consumed (difference between black and white bars in the graph), which is a difference of the same order of magnitude of those 50 kcal/d that I have simulated. What the Hall model attributes to an increased energy intake when compared with actual data is probably caused by the physiological adaptation whose effects Hall despises.

In short, the message here is that when Hall argues that there is no physiological adaptation in reality because his model does not show a physiological adaptation, his argument is fallacious: if he included the appropriate mechanism in his model, his model would show a reduction of the energy expenditure that goes beyond his present prediction. Just as I have done. In short, his argument can be summarized as follows: “the physiological adaptation does not exist in real life because I did not want to include it in my mathematical model”.

This simulation illustrates the very long equilibration time for weight loss in obese subjects and demonstrates that the weight loss plateau observed after 6 mo cannot be a result of physiological adaptation (source)

## Model #3: An “energy” model that does include a physiological adaptation

Model #3 is, mathematically speaking, identical to Model #2. It also includes a physiological adaptation mechanism, but the magnitude of that reaction now changes directly the total energy expenditure and the energy balance equation is applied to compute the magnitude of the daily body fat accumulation.

Note that the evolution in time of intake, energy expenditure and body weight are identical to those of Model #2, because mathematically models #2 and #3 are identical (it has only changed at which point of the feedback loop the physiological adaptation is applied). What is different between these two models is the assumed causality.

In Model #2 the adipocytes have changed their behavior and they seek to recover the lost body fat, and the rest of the body can not spend what has already been stored in the adipose tissue. Therefore, as a consequence of gaining weight, the energy expenditure is reduced exactly like in Model #3. A reduction in the total energy expenditure would only be a consequence of the underlying physiological process that is actually causing the changes in the accumulated body fat.

For the sake of clarity, these are the  weight (blue curve on the left) and energy expenditure (blue curve on the right) for Model #3:

The energy balance pseudoscience assumes that if you are regaining weight this is caused by an energy imbalance. What I am showing here is that other causalities are compatible too with the first law of thermodynamics: it is possible that the cause of gaining weight is a physiological adaptation regardless of the calorie intake or the energy expenditure. The adaptation can be driven by starvation, by losing weight, by a change in the mean size of the adipocytes or by another physiological cause. In this case, the energy expenditure would be an irrelevant possible symptom of the underlying physiological process that is indeed being caused by food scarcity. Model #2 does not violate any law of physics but it does highlight the causality fraud of the pseudoscientific energy balance paradigm.

it can be calculated that a weight loss of 20-kg body weight in an obese patient will result in an obligatory average reduction of 400 kcal in daily EE. Besides this obligatory or passive energy economy, further reductions in daily EE can also be expected as it has repeatedly been demonstrated that the fall in EE is greater than predicted by the loss of body mass, thereby underscoring the operation of mechanisms that actively promote energy conservation through adaptive suppression of thermogenesis. (source)

May be it doesn’t happen “through” suppression of thermogenesis: they are assuming that an effect is the cause.

## How to avoid the physiological adaptation

From the point of view of the energy balance theory, if there is a physiological reaction equivalent to 50 kcal/d, if you eat 50 kcal less you will compensate for the physiological effect. But understanding the process requieres understanding causality: if the cause of the physiological adaptation were an excessive intake, reducing the energy intake would make the reaction disappear and the weight would remain stable. But the cause of that reaction is not necessarily that you eat “too much”, but rather the opposite. The adaptation may be caused by losing weight “eating of less”, i.e. by scarcity of food. If we confuse energy expenditure, a symptom, with the cause of weight regain, we will not prevent that weight regain.

What does the model predict if we even consume 50 kcal/d less? That the physiological reaction will continue to exist, because its cause is not an excessive energy intake. Reducing the energy intake is treating a symptom, the “energy balance”, not fixing the actual cause of that reaction.

I do not intend to draw any conclusions as if in real life there is or not a physiological adaptation similar to the one that I have included in the model. My message is exactly the opposite! What I try to explain is that no useful conclusion can be drawn from a simulation, about the existence or inexistence of such adaptation, because a mathematical model simply does what we command it to do.

And the other conclusion has to do with causality: if a factor makes us fatter, it has to make us fatter, not necessarily have a direct effect on our energy intake or on our energy expenditure. We save money for reasons that can not be deduced by examining the factors that affect our incomes or expenses.