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Always Hungry? “Forget Calories!” Says New Diet Book


If you’re like many people, you see a New Year as a new opportunity to find a better way to eat to achieve or maintain a healthier body weight or avoid winter weight gain. Perhaps you’ll try a new fitness class or two, or start yoga or meditation to manage stress. As a registered dietitian nutritionist, #moveitorloseit guru and motivator, I fully support any effort one takes to eat and live better or enhance their physical or fitness level. The problem is, there’s no one book or solution that will be the answer for everyone.

While there are countless new plans, products and programs, many of which make promises that sound too good to be true (and are, in fact, too good to be true for most), the onus is on the individual to find a program that is sensible, sustainable, and science-based. (They can also consult a registered dietitian nutritionist for guidance on finding a suitable eating plan by contacting the Academy of Nutrition and Dietetics.)

Although no one diet that has been proven to be the be-all-end-all answer for weight loss and disease prevention, a new diet book called Always Hungry? may be helpful in your pursuit. It is written by David Ludwig, MD, PhD, a practicing endocrinologist and researcher at Boston Children’s Hospital, professor of pediatrics at Harvard Medical School, and professor of nutrition at Harvard School of Public Health. (Dr. Ludwig is also a fellow Advisor for Parents Magazine.)

Endorsed by noted experts including Andrew Weil, MD, Harvard Professor Walter Willett, and Dr. Barry Sears, Always Hungry? says to “forget calories, to forget cravings, and to forget dieting.” But should we, if permanent and sustainable weight loss and improved health is our goal?

While I won’t at this time answer that question, I will say that I was more than happy to take a look at Always Hungry? per Dr. Ludwig’s request, especially since my sense is dieters will flock to it. At first glance, the three things I most appreciate about the book are that 1) It makes no outrageous weight loss promises; 2) It’s holistic, and encourages physical activity, sleep, and stress management as key components of the program; and 3) The book has a heavy science base.

Below you’ll find Dr. Ludwig’s responses to my many questions as well as a few of his tips to help you eat well in the New Year:

EZ: In Always Hungry?, you encourage readers to forget calories. Why is that, and do you completely disagree that calories in and calories out play a role in weight loss and long-term weight management?

DL: The calorie in, calorie out concept is based on a principle in physics, called the First Law of Thermodynamics. This concept works very well for toaster ovens, but humans aren’t machines. When we start a typical weight loss diet, the body fights back, with rapidly rising hunger and slowing metabolism. The more severely we cut calories, the more intensely the body fights back–a battle between mind and metabolism we’re destined to lose.

And even if we were one of the supremely disciplined people–fewer than 1 in 10 of us can keep weight off with a lower calorie diet–we’re not necessarily doing our body a favor. If weight loss occurs from proportionately more muscle and less fat, overall health may not improve.

In truth, no one, not even professional nutrition researchers, can accurately estimate their energy balance to within 350 calories a day. An error of that magnitude on a daily basis would mean the difference between remaining thin or becoming massively obese in 5 years. For that matter, if our conscious control of calories were key to weight control, how did humans ever management to avoid becoming obese, before the very concept of calories was invented?

EZ: In your book, you say that for sustainable weight loss you need to feed your fat cells well. Please explain what that means.

DL: We tend to think of obesity as a condition of excess, but it’s really an issue of starvation to the body. The fundamental problem in obesity isn’t too many calories in fat cells, it’s too few in the blood stream and available to fuel our metabolism.

The low fat diet we’ve been told to eat for 40 years, in combination with unhealthful lifestyle factors, has triggered our fat cells to take in and store too many calories, leaving too few for the rest of the body. The brain senses that lack of available calories as a threat to survival, so we get hungry, and metabolism slows down. Restricting calories only make that situation worse. Think of it as a distribution problem.

It’s like the medical condition edema, in which fluid leaks out of the blood stream into the legs or other locations. Despite having an excess of total body water, people with edema may have unquenchable thirst, because the water doesn’t stay where it’s needed, in the blood stream.

With weight gain, the obvious culprit is all the highly processed carbohydrates that we started eating during the low fat craze–not just sugar but also refined starches like bread, white rice, pasta, potato products and low fat snacks. These raise insulin levels, driving fat cells into a feeding frenzy. I like to call insulin the Miracle Grow for fat cells because of its dominant effects on calorie storage.

The solution is to increase intake of healthy fats, get the right balance of carbohydrate and protein, and also follow some simply lifestyle prescriptions focused on quality sleep, stress relief and enjoyable physical activities. These measures lower insulin levels and help calm chronic inflammation (insulin’s twin troublemaker). When that happens, fat cells release their excess calories back into the body, hunger decreases and metabolism speeds up, resulting in weight loss without the struggle.

Because this approach works with, not against, your body, you get to eat until satisfied, snack when hungry, and never count calories again. It’s Diet Without Deprivation.

EZ: Like many weight loss diets, your plan has several phases. Why do you think it’s necessary for people to start with a restrictive phase one for two weeks in which they give up starches and added sugars?

DL: The majority of the US population (approaching 70%!) has a body mass index in the overweight or obese range. In addition to high body weight, a lifetime of eating highly processed foods, excessive stress, sleep deprivation, and perhaps even adverse early life influence have created insulin resistance and chronic inflammation throughout the population. Phase 1 was designed to reverse these metabolic abnormalities as quickly as possible, to jump start weight loss. (Though it is the most restrictive part of the program, Phase 1 is considerably less severe than a traditional very low carbohydrate diet, as you still get to have fruits, beans and some other carbohydrate sources.)

As insulin levels fall, people may experience for the first time in years an optimal flow of calories to the brain, which transitions the body out of starvation mode. Many of the participants in our national pilot test reported that their cravings vanished within a few days, even before the first pound was shed, and that they didn’t miss the processed carbohydrates, with all the rich satisfying high fat foods.

However, we quickly transition into Phase 2, adding back whole kernel grains, potatoes (except white potato) and a touch of added sugar. Then in Phase 3, we mindfully incorporate some of the more processed carbohydrate, according to individual tolerance. We include symptom trackers and other tools to help create an individualized prescription that’s right for each person.

EZ: Can’t starches and added sugars be part of a healthy, balanced and nutritious eating plan that promotes weight loss and long-term weight management even at the start of a weight loss plan and new way of eating for life?

DL: Some people may be able to do well with more starches and sugars right from the start, but they would tend to represent the rather small proportion of the population who responded well to the conventional low fat diets of the last few decades (and they probably don’t need to look any further). But most people will do best eliminating fast digesting carbohydrates for at least a short while. In fact, research from my group published in the November issue of the journal Obesity showed that just 1 month on a low carbohydrate diet seemed to reset metabolism, allowing people to add back carbohydrates without the adverse effects.

EZ: What are your thoughts about current Dietary Guidelines for Americans and your hopes for the soon to be released updated guidelines?

DL: For the last 35 years, the USDA Dietary Guidelines have been focused on reducing saturated and total fat intake, to the neglect of carbohydrate quality. This emphasis has inadvertently imbued highly processed carbohydrates, like fat free SnackWells, with a health halo, causing more harm than good. This year, the Dietary Guidelines Advisory Committee has switched gears, recommending against any upper limit on dietary fat, and specifically cautioning against use of low fat foods for weight loss. In a recent New York Times op-ed, my colleague Dariush Mozaffarian of Tufts and I advocated for full adoption of these recommendations.

While there is growing consensus against the value of low fat diets, the question of saturated fat remains more controversial. Recent research suggests that replacing saturated fat with sugar or starch is not a good trade-off.  And to make matters more complicated, different types of saturated fats can have different effects. In my view, saturated fats aren’t the public health enemy #1 there were made out to be. And some foods high in saturated fats (for example, real dark chocolate) can make a tasty contribution to a healthy diet. Nevertheless, much data suggest that an emphasis on unsaturated fats (olive oil, nuts, avocado) is best for heart health.

Hopefully, the new USDA recommendations will begin to reverse 40 years of misinformation about dietary fat in general, and help us refocus our efforts on aspects of diet that will really make a difference for body weight and risks for diabetes and heart disease.

EZ: Based on your book, what are three things people who are overweight can do today to enhance their health and lose weight slowly and steadily and keep it off in the New Year?

DL: Many diets promise sensation weight loss. Of course, most don’t live up to the promise. But even if they did, what’s the point in losing 30 pounds in 30 days, if you’re starving, tired, and struggling to keep the weight off?

The program in Always Hungry? targets the underlying cause of weight gain–fat cells stuck in calorie storage overdrive. This way, you lose weight with your body’s cooperation. The rate of weight loss may be slower than with severe calorie restriction, but without hunger, the results are progressive and sustainable. The three key steps are

1) Turning off the starvation response (eat when hungry until satisfied, stop eating before becoming overfull, and snack when hungry);

2) Reprograming fat cells to release excess calorie stores with a diet that lowers insulin levels (the best way to start this is by replacing highly processed carbohydrates with healthy fats); and

3) Support your diet with key lifestyle practices focused on quality sleep, stress reduction, and enjoyable (moderate) physical activities.

To learn more about Dr. Ludwig and Always Hungry?, visit his website here.

You can also follow Dr. Ludwig on Facebook and on Twitter at @davidludwigmd.

Full disclosure: I was sent a complimentary copy of Always Hungry? from the publisher. All opinions are my own.

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About The Author

Elisa Zied is a nationally recognized registered dietitian nutritionist, author, speaker, and spokesperson. A trusted source of food, nutrition, and health information, Elisa has garnered millions of media impressions, lending her expertise and real-world perspective to dozens of TV shows, web sites, news organizations and magazines. She’s the author of four nutrition books and is currently working on her first novel. You can find her previous Food, Fitness & Fiction posts here and connect with her on Twitter, Instagram, Tumblr and Facebook.

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