July 16, 2009

Magic Weight Loss Pill, take III

It's been awhile since we've had a post about a Magic Weight Loss Pill. (See here and here for earlier posts.) The Magic Weight Loss Pills crowd was feeling neglected.

Weight loss is simple arithmetic. Everyone says so.
Calories In = Calories Out.
Make sure your Calories Out are more than your Calories In and you'll lose weight.

What's so difficult? It's not le science rockette. Or... is it?

[Warning: post contains the words "Calculus" and "Weight Loss" and "Metabolism." Tomatoes might also be involved at some point.]

The tricky part about arithmetic like Calories In = Calories Out is that it doesn't always add up when you're talking about the human body.

[A horde of angry nay sayers rise up, pitch forks in hand, torches blazing, ready to dispute the previous sentence. Merry types faster to get her point in before the riot begins and people start throwing tomatoes.]

Rather than arithmetic, it's more like calculus.

Note: My definition of calculus does not really have much to do with asymptotes or any other kind of totes. Rather, it's shorthand for "any kind of math that I do not want to deal with, thankyouverymuch and please make all this math go away now."

Fail credit:http://www.flickr.com/photos/themadlolscientist/ / CC BY 2.0

The Calories In = Calories Out equation can fall down when it comes to the Calories Out part.

[Some of the crowd stops, fruit/vegetable in hand, to consider this. Then from somewhere in the back of the crowd sails one tomato splat]

In other words, while number crunchers can weigh every infinitesimal spec of protein, fat, or carbohydrate that crosses your lips, physiologists are still trying to measure all the variables that explain why some humans burn off calories faster (or slower) than others.

Different people burn calories at different rates. You cannot simply look up "calories burned" on a chart and assume that that number applies to you.

[Another splat]

Some other possible reasons you might not have lost weight even if you've been limiting your calories and working out regularly:

- You've built muscle instead
- If a female between puberty and menopause, TOM
- You might have worked the muscles so hard that inflammation has set in, which would result in water retention
- Your thyroid might be out of whack

[Another splat]

Why yes, I do have a link at this point:

Researchers at the University of Pittsburgh showed that overweight people who do not lose weight when they follow an exercise program are likely to suffer from low thyroid function, and therefore should be able to lose weight if they take thyroid hormones (Medicine & Science in Sports & Exercise, February 2009).

Dr. Mirkin explains the science behind the study thusly:

"When you eat, blood sugar levels rise. Your pancreas responds by releasing insulin into your bloodstream which drives sugar into cells where it can be used for energy. As you gain weight, fat cells fill with fat. This blocks insulin receptors so your cells cannot respond adequately to insulin and blood sugar rises to higher levels. This causes your pancreas to release even more insulin....

"...muscles become extraordinarily responsive to insulin when you exercise so you need far less insulin to drive sugar from your bloodstream into cells. Insulin levels go way down with exercise, but the effect gradually tapers off in about 18 hours. So you have to exercise every day to maintain the benefit of lowered insulin levels, and overweight people who exercise every day usually lose weight.

"However, some overweight people cannot lose weight no matter how much they exercise. This study shows that many of these people have low thyroid function which prevents the cells from responding to insulin and drives both insulin and blood sugar to very high levels."

[The ellipses (...) are where I cut part of the article out. These tomatoes are getting pretty hard to dodge, and I want to finish this post and go clean up. Want to read the part that I snipped out? The link above has it in all its tomato-free glory. Duck! splat]

This is not to say that taking a magic hypothyroid pill will magically make the weight drop off. What the study suggests is that a thyroid pill can level the playing field (to mix a metaphor) and make your personal Calories Out closer to the average.

Is this a cheat, an excuse, or a possible solution?

Your thoughts?


  1. I don't know if this was covered in the original journal article or not as the article you linked to also doesn't say but nowhere is there any mention of diet.
    What were these overweight people who were exercising every day but not losing weight eating? Were they eating a calorie appropriate diet or were they eating anything they felt like?

    Diet has a huge impact on weight loss, about 80%, whereas exercise only accounts for 20%. If your diet is bad and contains way too many calories you will not lose weight regardless of how much exercise you do. This is not a problem caused by low thyroid levels. It is the old calories in is greater than calories out theory in action.

  2. Good point, Riayn.

    I remember one weekend where I entered every single friggin' calorie in Sparkpeople. I averaged 1500 calories a day.

    In the same weekend, I did two bicycle rides, totaling over 55 miles in two days.

    Based on Sparkepeople's estimate of calories burned for my height/weight, I had a calorie deficit of 4,000 calories for that weekend. According to the scale, I gained two pounds. (No, I did not lose any inches.)

    Calories In does not immediately equal Calories Out.

  3. You'll get no tomatoes from me here... The human body is not a machine and everything that happens in there is due to chemical processes, which are affected by our hormones, enzymes, etc. Our biochemistry can be thrown out by food additives, incorrect vitamin and mineral levels, hydration, toxins, sleep deprivation, lack of sunlight, digestive issues, allergies, hormonal fluctuations, temperature, acidity, body weight, fat percentage, amount of muscle, time of the day, etc.

    If it was really a straight question of calories in / calories out, we would see people making the necessary calculations, eating the right amount of calories and burning the required calories and then losing exactly the same amount of weight (as per the calculations) week in and week out. It simply does not happen.

    Thyroid problems are on the increase and many people are actually falling through the diagnostic cracks. I am displaying some of the symptoms of an under-active thyroid and will most definitely not treat it with synthetic hormones. That's just not part of my healing protocol, so I am looking for dietary ways to get my hormonal system working properly again.

    Great subject!

  4. Even if one is willing to take synthetic hormones, finding a physician willing to prescribe them if you don't fall squarely into the category of hypothyroid is just about impossible.

    I have many thyroid symptoms, but my blood levels are in the low-normal range. I eat moderate servings of healthful foods, walk a minimum of five miles/day and am maintaining a 40-pound surplus.

    It's discouraging, especially when my extra weight means my health insurance premium is higher than it needs to be. I'm not ill, don't take medication, have perfect BP/cholesterol/blood sugar numbers, etc., but Aetna thinks my weight is reason enough to charge me more.

  5. This was really interesting because you do hear that phrase over and over. Our bodies are amazingly complex, and it's good to have information that can help us in our desire to get healthy.

    On a funny note, when I was struggling to lose weight, I was convinced I had a thyroid issue. I was almost glad when my thyroid was found to be enlarged, but my magic pill weight loss hopes were dashed when the doctor said it was functioning fine (after testing.) I did eventually lose all my weight!

  6. Interesting!

    I too suspect there's got to be SOME reason why it's more complicated than calories in, calories out; since it seems clear that not everyone gets the same deal when it comes to metabolism.

    If someone has thyroid issues that are making weight loss difficult, I don't see how taking a pill to normalize functioning would be "cheating." Seems like a medical problem, and if a pill can fix it, I'd take the pill!

  7. Exactly! I eat an average of 1200-1400 calories a day, I run 3-4 miles 4 days a week. I have trained for and ridden in 5 century rides. After 2 weekend rides of 40 to 60 miles each, and controlled calorie intake, I still don't lose weight. My doctors, bless their hearts, usually start with, you'd be surprised how many calories there are in a soda. The only time I drink soda, boys, is when you've put me in the hospital for surgery. I eat clean nearly all of the time, with home made meals of mostly veggies and lean meats. No bread, no pasta, no soda, no candy, no cakes, no...you get the idea? My thyroid? My doctor laughed and said every woman hopes it's her thyroid....Not saying that's it, but it isn't as simple as simple math. So thanks for this, because at least it's nice to know I have company!

  8. I have a few friends who have thyroid issues and do take the pills - one thing I hear from them is that it's hard to regulate and they are constantly having to go back to the doctor to readjust their dosage. So sadly, even with taking a thyroid pill, I don't think it would be easy. (darn it!)

    1. I take synthroid and i dont lose any weight - tests every few months for the last 10 years and changes to the dosage up and down and no weight loss at all. The only time I lose weight is when i diet and go to the gym. There is no secret pill. Sorry guys. A thyroid pill may help IF you diet and exercise too but alone it does nothing for your weight.

  9. Kar you have company. I do take thyroid medicine and it still is not the hoped for "magic pill". It did not bring a change in the weight loss. After trying many things (and the diet and exercise has always been part in various forms since this started in my thirties) working out in some form morning and night to keep the metab. up and running (along with low cal, clean) seems to be what works to get it moving at least sometimes.

  10. If it were as simple as calories in = calories out = healthy.... we wouldn't even be discussing this, or have diet blogs or anything else. People who try to simplify something as complex as this should just say that the brain is a computer with no variations, or that since there's no proof of God, then God doesn't exist.

    Liked the article.

    Vee at www.veegettinghealthy.blogspot.com

  11. I just saw an article on a drug that enabled rats to lose 50% of their fat in ONE WEEK! They are working on a version for people, so they say.

    Are these the same folks who have the Brooklyn Bridge up for sale?

  12. It's never really calories in/out. Otherwise the topic at MizFit's place yesterdaqy wouldn't have been relevent (about how sometimes you're not eating enough to lose weight!). Starvation mode, types of calories (so I'm told), etc. I swear, people that can understand all of it should get paid more!

  13. When you eat, your blood sugar only spikes if you eat tons of carbohydrates with all of your meals. This is what drives insulin production and takes all the sugar and stores it for later. This is what prevents weight loss. If you exercise regularly but not 24/7, your body does not need that instant energy boost from excess carbs. Cut out the grains, dairy, and sugar and watch your weight plummet due to insulin not playing a large factor in "saving" all of that sugar. If you start focusing your diet around healthy meats / fats / vegetables / fruits, your body will become accustomed to burning fat for fuel. A.K.A. the fat on your butt. You also don't have to eat every "3 or 4 hours" because fats and protein take way longer to metabolize and chances are you'll eat way less and stay full way longer.
    I've been reading Mark Sisson's Primal Blueprint and have become a Primal convert. I'm sorry for preaching. This theory does seem to work, though!

  14. Ah, weight. It's such a fickle thing. I know folks who have had thyroid issues, gotten on the magic pill and it's worked wonders with no change to diet/exercise. I know others who've had thyroid problems and the pill hasn't helped their weight one lick despite diet/exercise. *shrug*

    It's an enigma wrapped in a mystery this whole metabolism and weight calculus.

    (I have a masters in engineering - none of my advanced math classes went near this formula! But thanks for the flash back to what we lovingly termed "diffy-screw".)

  15. Actually I am hypo-thyroid and I do take medication to regulate.

    Back when I wasn't on medication my energy levels were crazy looooooow. Now that everything is stablizing I feel like a normal human being who doesn't need 3 hour naps in the middle of the afternoon to function. (Yay for college! Where any human being can sleep 11-13 hours a day..not so much in the working world these days)

    In terms of weight loss? Not so much, calories still matter. I have actually noticed I am more sensitive to carbs these days and have to be diligent about bread/pasta/rice etc. The bread, oh how it loves my hips! For me, the medication is not a miracle weight loss drug.

    Regardless, my dosage is small, I can't speak for those who are constantly having to adjust dosages, or on extremely high dosage to regulate. I just know that it throws my energy levels all kinds of out of whack when I forget to take it.

  16. Don't know if I agree with the thyroid magic pill concept or not, but what you reprinted is certainly food for thought. If anything, this theory would encourage people to see their doctor about weight loss plans and begin a dialogue about their health, reinforcing and formalizing a commitment to lose weight. Thus, I likey.

  17. I found that the best way to loose weight and stay healthy is discipline. It is crucial to get the right information but the key ingredient is to stay focused and consistent with the actions. Go and do exercise there is no magical pill that will substitute workout, eat healthy, eat the right food and rip the benefits. You will become skinny. Playing sports is great way of shaping some parts of your body just be consistent. Do not starve yourself but eat healthy instead 5 times a day.

  18. I tell people that yes, calories in/calories out is PART of the equation but not all of it. For me, at least, I have learned along the way as I changed my food choices that certain foods work better for me than others & that even changes thru the years. I also have found that my protein/carb/fat ration also makes a difference. I do think there are some people that do better with more carbs & others not so much.

    For me, I have always had to do much more than "the other person" to stay fit, to keep my weight off etc.

    Like Merry & Kar, it does not always come down to the exact science for me. Our bodies are all different & work different so I think it is not all this calories in/out. My experience has proved this.

  19. This subject is close to my heart and you put it really well. Great post! I was futzing around for a month, gaining strength and muscle I don't doubt, but not losing any actual weight to speak of. I finally broke my plateau not by eating less (fingers in a cross of warding) but by avoiding carbs at night and increasing general activity. Let's see how long that formula works before I have to tweak it again.

  20. I just thought I'd crash the party and play devil's advocate by mentioning the Set Point Theory:


    I'm not saying I believe the theory, just that it is a theory.

    Also, although I'm not a nutritionist or dietitian, it seems like some of the people who have commented here are not getting nearly enough calories for the amount of activity they're engaging in. In which case, the body can go into starvation mode and hoard all the calories it can get.

  21. Kathy spake thusly:
    some of the people who have commented here are not getting nearly enough calories for the amount of activity they're engaging in

    But isn't that the whole point of using Calories In = Calories Out as the basis of a weight loss theory?

  22. I share your definition for calculus.

  23. Hmm, Merry, that was a little too deep for me at the moment. And is there really such a tense as spake? (Damn, and in my real life I'm an editor!) So, I think what you're saying is that what I just said would support the idea that the theory of calories in = calories out is bogus, no? But if your body is working at a level that requires, say, 2,000 to 3,000 calories to operate efficiently, but you're only giving it 1,200, then the body will not use those 1,200 calories like it would 2,000 to 3,000 calories. Oh, never mind, I don't know what I'm saying. And now it's time for me to go to work and argue with people about whether it's speak/spoke/spake.

  24. I had my neck zapped by radiation for treatment for Hodgkin's lymphoma, and about a year later my thyroid decided it was, oof, verrrrry sleepy. So they put me on meds for it and it did indeed take a while to get the dosage right. I ended up going down a notch on the dosage because at the higher dose, my hair started falling out and my resting heart rate was about 95 -- not fun. But in terms of weight and energy, I didn't really notice how the pill affected it. What I DO notice is that when I'm eating healthily and working out, I feel much better.

    So thyroid problems are important to treat, but the pill won't haul your ass to the gym for you (alas). And I really wish there was some "natural" way to treat this stuff (I don't fancy being on a pill for the rest of my life), but I haven't found a good alternative. Stupid radiation! Although I suppose I should be grateful to it for, um, killing off the Hodgkin's. Then again, I'm into cranky fitness, so I have to be cranky about SOMETHING!

  25. Oh, if they ever invent a pill that will haul your ass to the gym, I am going to buy a stockpile!

    Kathy, I think we're in agreement that CI=CO doesn't always work. Or I'm confused too. But starvation mode means your body slows down the metabolic rate trying to conserve energy, i.e. the Calories Out part is lower than before. Which is one reason why I tend to gnash my teeth when people say this stuff is simple.

    Sorry about the archaic verb form. :)

  26. This post is very timely for me. I've hit a weight loss plateau that's persisted through calorie cutting and upping my workout schedule. Nothing I do seems to help. Perhaps it's time to schedule a doctors appointment...

  27. Hey - where's the CU16, or whatever that one was where if you're actually sticking to your workout plan you can increase your oxygen capacity, and if you're in a couch potato phase you can still fool your doctor with an increased VO2 max?

    Merry and Cranky, I remember you all did cover that, and I will sit and wait patiently for that one.

    *sits, waits*

  28. Merry and Crabby. I am so sorry. It is Thursday, and I am sleep-depped, as usual.

  29. Magic weight loss pill... i dont ever think such a thing will exist, unfortunately :(
    -Jack @ Energy Pill

  30. We are an experiment of one, so in many things you may find similarity, analogy and helpful info, but always, your mileage may vary.

    I believe the studies and stats that suggest that hypothyroidism is increasing and under-diagnosed/treated. (which just stinks, as hypo really has a negative effect on physical and mental health)

    Not all hypothyroid patients have weight problems and even for those who do, adjusting thyroid may only partially address weight (if at all). And not all weight problems are caused (only) by thyroid problems. The Venn diagrams have an intersection, but may or may not have a huge overlap. However, some compassion seems to be in order. For some rare and lucky people (so I hear) feeling well again, weight issues aside, is as simple as take the little pill and all will be well, like the docs seem to think. For many (maybe most?) it's just not that easy. If your thyroid is screwed up, your metabolism is too (which affects the amount of calories you burn, etc). It can take a lot longer to get things back in line than the blood tests make it appear, and other systems may have been affected by the thyroid imbalance. It's a fairly invisible struggle for some folks, and a tough one. Thanks for posting the article as for thought and discussion.

  31. When I was diagnosed as hypothyroid, I was fourteen and continued to grow for another six years, so weight loss was not involved. Energy gain, now! I could sit up for more than fifteen minutes without propping my head up on my hand. So the supplement may not haul you to the gym, but it will make it more likely that you will do something when you get there.

    Mary Anne in Kentucky

  32. ugggggh science.

    yeah um, as a personal trainer, I can tell you that weight loss is not so simple. and when you have to tell someone that is doing so well with their diet and exercise that gained weight- its probably the worst part of the job

  33. I like this post, thank you. I agree that there is more than just calories and out in this equation, I have seen it in myself and others.

  34. It is inetresting to know upon...to understand what foes on inside the body as I eat and stuff in more of the wrong things.

  35. As a physiologist I can say that calories in must equal calories out. Its part of the laws of energy conservation. The part that frustrates us all is that we don't yet understand what factors influence individual variability in the calories out portion. Energy (calories) can not disappear, only chnage form.

  36. Interesting post. I have been tested for hypothyroidism, and was within "normal" although it was high.

    The Cals IN VS. Cals Out equation does not always equal weight loss. And, I think plateaus are definitely a testament to the set-weight theory. For example, my body loves weighing 160-165. I can easily lose down to that weight--and if I drop below, I quickly gain back up unless I'm going psycho on exercise and diet.

    Many of my girlfriends are the same way--they have a "magic" numbers their bodies easily gravitate towards (can drop down to it easily, gain back up to it easily).

    To me, this speaks to it all being so much more than simple subtraction. Hormones, set-weight theory, metabolism differences, etc. all play a factor unique to everyone.

  37. The point you make in the post that everyone is different, and that people burn calories at different rates is spot on.

    However, keep in perspective that only about 5% of people who are overweight are so because of metabolic reasons. The rest of us are just going to have to do the hard work of losing weight through exercise and diet.

  38. I agree that people whose thyroids are whacked out are in the minority, but now you've sparked a new thought: what about people with metabolic syndrome? There was a comment a couple posts back by a woman who overcame that condition, but she had to put a lot more time into exercising than the average person.

    The only thing I am sure of is that there are a lot of variables. Argh.

  39. Like many, my thyroid is out of whack, too ... but it's OVER-active. When my doc told me, I cried, "Doesn't that mean I should be losing weight instead of gaining?!" And he said, "Yeah, but your appetite is up, so even though your metabolism is faster than usual, it doesn't necessarily result in weight loss."

    I can't tell you how long I was swearing after that visit ...

  40. Hello there. :) I absolutely loved this post. It's so true. I myself have a slow thyroid -- the autoimmune version of hypothyroidism called Hashimoto's. And the thing many people and even DRs don't acknowledge and validate is that slow thyroids are not our fault and also, therefore, the inability of us to either keep weight off or to actively lose weight is not our fault. It can be frustrating. How is your thyroid doing? Have you found any treatments to be helpful? For me, I've learned that calories in = calories out doesn't work for many thyroid patients. I actually write a thyroid-specific nutrition column for www.dearthyroid.com, called "How To Kick Your Thyroid's Ass". I'd LOVE to hear your comments on it.

    This disease can be really challenging for alot of us. It changes our lives dramatically. We have a great support community over there, so please stop by!

    Thanks again for being so honest about your health and struggles with weight. I think transparency like that is so important!

    Liz :)


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