Why Plant-Based Might be the Healthiest Diet for Weight Control

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The Healthiest Diet for Weight Control

We know that vegetarians tend to be slimmer, but there’s a perception that veg diets may somehow be deficient in nutrients. So how’s this for a simple study, profiled in my video Nutrient-Dense Approach to Weight Management: an analysis of the diets of 13,000 people, comparing the nutrient intake of those eating meat to those eating meat-free.

They found that those eating vegetarian were getting higher intakes of nearly every nutrient: more fiber, more vitamin A, more vitamin C, more vitamin E, more of the B vitamins (thiamin, riboflavin, & folate), more calcium, more magnesium, more iron, and more potassium. At the same time, they were also eating less of the harmful stuff like saturated fat and cholesterol. And yes, they got enough protein.

And some of those nutrients are the ones Americans really struggle to get enough of—like fiber, vitamins A, C, and E, calcium, magnesium, potassium—and those eating vegetarian got more of all of them. Even so, just because they did better than the standard American diet isn’t saying much—they still didn’t get as much as they should have. Those eating vegetarian ate significantly more dark green leafy vegetables, but that comes out to just two more teaspoons of greens than meat eaters on average every day.

In terms of weight management, the vegetarians were consuming, on average, 363 fewer calories every day. That’s what people do when they go on a diet and restrict their food intake—but it seemed like that is how vegetarians just ate normally.

How sustainable are more plant-based diets long term? They are among the only type of diet that has been shown to be sustainable long-term, perhaps because not only do people lose weight but they often feel so much better.

And there’s no calorie counting or portion control. In fact, vegetarians may burn more calories in their sleep. Those eating more plant-based diets appear to have an 11% higher resting metabolic rate. Both vegetarians and vegans seem to have a naturally revved up metabolism compared to those eating meat.

Having said that, the vegetarians in the first study mentioned were also eating eggs and dairy, so while they were significantly slimmer than those eating meat, they were still, on average, overweight. As profiled in my video, Thousands of Vegans Studied, the only dietary pattern associated on average with an ideal body weight was a strictly plant-based one. But at least the study helps to dispel the myth that meat-free diets are somehow nutrient-deficient. In fact, the editor-in-chief of the Journal of the American Dietetic Association asked, “What could be more nutrient dense than a vegetarian diet?”

Anyone can lose weight in the short term on nearly any diet, but diets don’t seem to work in the long-term. That’s because we don’t need a “diet”; we need a new way of eating that we can comfortably stick with throughout our lives. If that’s the case, then we better choose to eat in a way that will most healthfully sustain us. That’s why a plant-based diet may offer the best of both worlds. It’s the only diet, for example, shown to reverse heart disease–our number one killer–in the majority of patients, as described in my video: One in a Thousand: Ending the Heart Disease Epidemic.

There are a number of theories offered as to why those eating plant-based are, on average, so much slimmer. Check out these videos for more information:

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my videos for free by clicking here and watch my full 2012 – 2015 presentations Uprooting the Leading Causes of Death, More than an Apple a Day, From Table to Able, and Food as Medicine.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

58 responses to “The Healthiest Diet for Weight Control

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  1. Sorry, I don’t understand this statement: “Those eating vegetarian ate significantly more dark green leafy vegetables, but that comes out to just two more teaspoons of greens than meat eaters on average every day.” It seems to contradict itself. Is it “significantly more”? Or just two teaspoons? Thanks!

    1. “Significant” is just a scientific way to say that the difference between the meat-eaters and vegetarians was likely not due to random chance. Though two teaspoons is not a lot, it was still a “significant” difference between the two groups.

  2. I just turned 65, had a lumpectomy, IORT and reconstruction surgery June 4 of this year and I have been eating mostly vegan for a little over three months now and was feeling great at first, but in the last month or so I started having major anxiety and some depression – feels like what I hear about menopause (which I went through with flying colors years ago) – sweats, fatigue, stressed, forgetfulness, making crazy mistakes, emotional and my temperature is a little low just around 98. I am taking B12 and flax seed meal. I am trying to eat all the necessary vegan food groups. What could I be missing? Don’t know what it could be besides my diet. I am trying to add back some animal protein to balance me back to be able to start vegan again after doing more research. Help!!!

    1. You might try taking a quality B complex rather than just B12 since the B vitamins work in symbiosis. I take one made by Jarrow that I like a lot.

    2. First, I want to offer my support. You have been through a lot and taken control of your destiny. What does your doctor say about the anxiety and other symptoms?

      One thing that comes to my mind…I have found that getting myself in motion makes all the difference. Just some gardening or whatever you enjoy doing just might kick those blues in the keister. Ruth Heidrich has some good stuff on her site: http://www.ruthheidrich.com

      You’ve come to the right place…there are others here with solid nutrition background to help.

      Best wishes Jeannejo. You will beat this.

      1. Actually this is no longer true if you listen to Dr. Gregor’s thyroid info. Soy and cruciferous veggies are not the culprits but processed soy is. Just an update.

    3. Cut out all grains (pasta, bagles and breads), and vegetable oils (with the exception of Extra Virgin Olive Oil), and add in healthy fats, in particular from grass-fed butter (10-20g per day), grass-fed full-fat yogurt and cheese, and pastured eggs.

      And I would also add in Omega3 supplement with direct DHA and EPA from Algae sources, like the Ovega3 based oil (Flax seeds and Flax seeds oils are a waste of time and money), search on Amazon for suitable supplements (pills and oils).

      Omega3 DHA and EPA fats and the cholesterol (in the eggs) are of paramount importance for the health of your brain.

      B12 supplementation is fine, but the most effective is the Methylcobalamin, in sub-lingual films. Get the 1000 mcg pills and take one pill every day for a month, then two pills a week for the rest of your life.

      Iron. It does not matter how much iron you have in your veggies if you cannot absorb it. non-heme iron found in veggies is poorly absorbed, especially if your stomach acidity is low and you are well into your adulthood. Consider Heme-iron supplements, like Proferrin, at 10 mcg per pill, once a day, they really restore iron stores in less than three month. And you do not need to care about whether you have food or liquids with tannins, or the acidity of your stomach (and not an orange juice is not going to cut it). And no GI distress, unlike other non-heme iron junk supplements.

      You can do all this while sticking to a vegetarian diet (fucking hell, good old vegetarian like we meant it decades ago, not vegan), with the exception of Proferrin, that is derived from the bovine or porcine blood. But for that matter you can start with common non-heme iron and see how you fare (get an iron blood panel, check ferritin levels in particular).

      1. Butterfat and full fat dairy are “healthy fats?” Sorry, you seem to be on the wrong web page. The Paleo/Wheat Belly/Grain Brain aficionado web pages are elsewhere.

      2. very confusing statements! did not dr Gereger suggested that grounded flax seed oil is the best source of not only omega but a host of other stuff?

        1. Ground Flax Seeds, or flax oil, contains ALA, a kind of Omega3 fat that our body needs to convert to other kinds of Omega3 fats, DHA and EPA. The conversion ratio is very poor in most people and worsens with aging or excessive Omega6 intake (because there is an enzymatic competition on the pathways for conversion of those FATs is forms that usable by our body) .
          You might take a skeptic stance on this assertion, as I did for a number of years, but they I had my blood levels of DHA and EPA checked and they were not at all good, notwithstanding I had plenty of ALA in my blood, because I was consuming lots of flax ground seeds and oil (first class products by the way, organic and properly produced). Well it turns out that my body does a very poor job at converting ALA to EPA and DHA. My wife as well, while my kids performed a little better. This is in line with research studies indicating a worsening conversion power as we age.
          Nevertheless I did no want to impair the brain and nervous system development of my three kids, as well as risk a dementia myself in my old age, so I turned to a supplement oil with native DHA and EPA, derived from Algae, so it is also vegan, even though we are not Vegan in our family. Those Algae are the same stuff that fish eat to get their Omega3 fats, so we cut out the fish in the middle and everyone is happy ;)

          do yourself a favor, check your blood levels, everyone of us is different, and most of us need to get reliable EPA and DHA source. The same goes for the B12.

    4. Thank you all below who have responded to me – I am not sure how to reply to each of you all at once, so hope this is clear.

      I will look into taking a B complex like MV Coffman recommends. :)

      I haven’t been back to my GP yet due to just getting Medicare ins and not having picked a supplemental ins yet. And I really try to keep in motion like Coacervate recommends cuz not moving feels worse, but I am so emotionally drained, I feel like I need a long vacation – lol.

      I will mention getting my thyroid checked once I get my ins straightened out. Yes, I do eat lots of raw cruciferous veggies cuz I thought it was a good thing based on some of Dr. Greger’s videos. Thanks Julie and for next para:

      I have not been eating lots of soy tho based on the fact that I had hormone responsive breast cancer, I know Dr. Greger recommends it, but others do not and I am not sure who is right – sorry Dr. G if you read this – I really think you are da best, but I haven’t done MY homework enough to be sure about soy yet (altho, I really enjoy soy, esp. tofu – I used to eat it all the time a few years back. – did this contribute to having breast cancer like some suggest?)

      —> COULD USE FEEDBACK: I also don’t want to take the hormone blocker drugs like Femara, Tamoxifen and the others my Dr’s are recommending – I was hoping to avoid them and just medicate via vegan nutrition. :) Just the thought of taking these drugs give me anxiety. :) I feel stuck between a rock and a hard place – ouch!

      1. Hi Jeanne,
        I was going to mention the blocking drugs but I read in the last paragraph you weren’t taking them. Couldn’t it be just your hormones adjusting?

        I have never seen any research on thyroid and cruciferous vegetables. And just to make sure I did a Pubmed search just now. None-notta-zilch. Let me know if you find anything. I am hypothyroid and have never been affected by them.

        I am not sure why Nicola is recommending dairy and cheese? I can’t say that makes sense to me. And eggs? Go above and look under health topics and Dr Greger has a bunch of videos that you might find helpful. His year in review are great if you haven’t already watched them.

        Also before taking iron have it tested. I am sure your doctors are testing these things but either way take a test first.

        Good luck Jeanne.

        1. Hi Veganrunner – hormones adjusting to what – to my surgery or to a vegan diet??? I didn’t know about PubMed, I will go there and look around. Well, I have actually taken it on myself to add some eggs back to my diet cuz I was feeling so bad and thought I might need a little animal protein. Not sure what’s right at the moment, I just want to feel better. I will go get tested soon as I get my insurance straightened out. Thank you for your comments.

          1. Hi Jeanne,

            Have you tracked your micronutrient intake? Cronometer.com is useful for this. There is nothing in animal protein that you can not get from plant protein. The proportions of individual amino acids are different, though it is the animal based amino acid profile that shows deleterious results in inducing cancer promoting growth factors. It may be helpful to find out if you are actually deficient in any specific nutrients before adding in foods known to contain numerous harmful substances without knowing if they contain anything you actually need. If you track your micronutrient intake and you don’t see any deficiencies, then you can at least rule that out. Then perhaps a blood panel with tests for vitamin levels to make sure you’re in fact absorbing what you consume, along with various hormone levels may help shed some light on the problem.

            Particularly before adding in eggs, you may want to look at the videos regarding arachidonic acid and mood. In addition to cancer promoting methionine content and amino acid profiles, eggs contain inflammatory trans, saturated, and omega 6 fats. Eggs that boast high omega 3 content generally come from hens that have been fed flax, so nothing is gained by going through the middle-hen, other than inflammation, cancer and heart disease promotion, and microbial pathogens.

            All the best. Hope your insurance issue doesn’t cause too much of a headache, and that you can get some answers and feel better soon.

    5. Many studies have found that extremely low fat diets are associated with depression. Eating some olive oil, avocado, walnut oil, or canola oil in your food may help if you are eating an extremely low fat diet.
      John S
      PDX OR

        1. The type of fat also matters, as I said, DHA and EPA are the ones your brain needs the most and those are not in the above foods. Only in oily fish, grass-fed fatty cuts of meats, or grass-fed full-fat diaries, but above all and foremost supplements. And you can find also vegan supplements with DHA and EPA, derived directly from Algae, which is what the fish take it from. So you cut out the man, er, the fish in the middle and go straight to the source, also avoiding possible pollutants (like PCBs and mercury) as well as rancid oils.

          the only catch is that Algae based supplement tend to cost three times as much. If you are serious about the reasons for being veg*an, then this should not be an obstacle.

          Here is one such supplement you can get in the US


        2. I mentioned above to eat some nuts, but we should not be eating lots of nuts. They can be hard on the digestive system. If you will eat a wide variety of fruits, veggies, nuts, seeds and grains and make sure you are getting enough calories you should be alright. You did say above that you were eating a lot of raw in the cabbage family. I personally from my experience and from what i read it should not affect your thyroid. But if you eat a lot of raw foods you may need more calories. You cannot get enough calories on a lot of raw food without eating a lot of fat and a lot of fat is not good either. Hard on the liver. If yo uare not getting sufficient calories then you will not be getting sufficient nutrients.

    6. Are you eating enough? Drinking a couple of litres of water a day? Most people who claim to fail at a plant based diet don’t eat enough. Maybe go get a blood test to see how your B12 levels etc. are. You could also be low in vitamin D.

    7. Hi, have you tried using cronometer.com to see which nutrients might potentially be missing from your diet? Also, I would suggest you eat enough carbohydrates, from whole food sources of course, they are definitely a brain food. They also give you a natural high, which makes you far less dependent on stimulants (coffee, tea, etc.) for a boost. Bananas, dates, potatoes, rice, etc. get enough in, and if you keep your fat intake low, you can really fill up on them without gaining weight. I haven’t read John McDougall’s book, the starch solution, yet, but I imagine it to say something similar, he’s done a lot of research and he’s a physician, whereas I’m not :-) Wish you the best.

  3. Dr. Greger, you mentioned that the vegetarians were naturally consuming fewer calories. I would love if you could comment on the success of high-carb low-fat diets such as “Raw Till 4”.

    As we saw with numerous other high-antioxidant and low-fat foods shown in your videos (i.e. grape juice), an increase of calories doesn’t always equal an increase of bodily fat. I’ve been having great success eating over 3,000 calories a day, mostly coming from fruit, and consuming less than 10% total calories from fat. If there’s any clinical data on this I would love to hear about it.

  4. My experience as a vegetarian was that we tended to eat a wider variety of foods because I was forced to think outside the “meat, veggie, potato, salad” box.

    Still, I was vegetarian for 10 years and never lost a pound, unless I cut calories as well.

    1. From Jeff Novick:

      If you allow people to eat “ad libitum” or all they want till the are comfortably full, from low calorie dense foods, they will lose weight, not be hungry and do not have to count calories.

      Of course, calories still count, but it becomes almost impossible to over consume calories from the foods you choose if you follow these recommendations.

      These are averages

      Fresh Veggies are around 100 cal/lb

      Fresh Fruits around 250-300 cal/lb

      Starchy Veggies/Intact Whole Grains around 450-500 cal/lb

      Legumes around 550-600 cal/lb

      Processed Grains (even if their Whole grain) around 1200-1500 cal/lb

      Nuts/Seeds around 2800 cal/lb

      Oils around 4000 cal/lb

      What they found is if the calorie density of the food is below 400 calories per pound, not matter how much they eat, they all lost weight.

      Between 400-800 calories per pound, with some moderate exercise, they all lost weight.

      Between 800-1200 calories per pound, people gained weight, except for those with very high activity levels

      Over 1200 calories per pound, everyone gained weight.

      Remember, the physical sensation of “fullness” is influenced in a large part by the filling of the stomach and the triggering of the stretch receptors. This would happen regardless of the calorie density of the food, as long as enough food was consumed.

      However, between 400-800 calories per pound is the range where people either maintained, gained or lost a little. It was the area that I call the “cut-off” zone and the results depending on the person and their activity level.

      These numbers are also inline with other recommendations.

      The recent WCF/AICR report on cancer recommends that the average calorie density of our diets be around 550-600 calories per pound, to avoid obesity and weight problems.

      A starch based diet, made up of starchy vegetables and intact whole grains along with some fruit and veggies, will have a calorie density under 500 calories per pound and maybe even 400 calorie per pound. It would be near impossible to overeat.

      You can also see the problem with many of the “low fat” diets that focused on processed whole grains, like whole wheat bread, crackers, dry cereals. At 1200-1500 calories per pound, if they become a large part of the diet, they can raise the overall calorie density and make it much easier to overeat on calories and easy to gain weight and/or not lose weight, even with a higher activity level. Hence the principles of the MWL program is to avoid those foods, or really limit them.

      In regard to how many calories to eat, that is another number, that….

      1)has no simple answer unless you plan to maintain the exact same physical activity, exercise, stress, temperature, etc etc every day. The concept that everyone needs a certain calorie level that can be determined is wrong.

      2) i do not think people need to know this number nor do I think there are any great ways to calculate it. All the forumlas have great margins of error in them. So does all estimates of how many calories there are in food. Any calorie estimate you see on any food package can be up to 20% off. Formulas can be over 40% off. Professionals trying to track their calorie intake can be 30% off. Why attempt to measure something that we have such poor ways of measuring.

      3) calorie density is a much better approach then counting calories as it uses general guidelines and principles to help make healthier choices.

      We should focus our diets on a variety of healthy foods within the healthy food groups, get enough activity and physical exercise, and not worry about micromanaging our intake.

      If we need to lose weight, then we can shift our overall calorie density down by focusing on and including more foods lower in calorie density and limiting the higher calorie dense foods. If we need to gain some weight, then we can do the opposite and include more higher calorie dense healthy foods. Of course, we can also adjust activity levels to coincide with our food intake and our goals.

      To Summarize for simplicity for those interested in weight maintenance

      Eat Freely:

      (Foods Low In Calorie Density)

      Fruits and veggies

      Eat Relatively Large Portions Without Concern:

      (Foods Moderate In Calorie Density)

      Starchy Veggies, Intact Whole Grains and Legumes

      Limit These Foods

      (Foods High In Calorie Density)

      Breads, Bagels, Dry Cereals, Crackers, Tortilla’s, Dried Fruit

      Extremely Limit These Foods:

      (Foods Very High In Calorie Density)

      Nuts, Seeds, OIls, Solid Fats, Junk Foods

      The beauty of calorie density is that it frees us from all these numbers and having to count, portion weigh and/or measure anything. So, don’t get caught up in the numbers and for those who do not like numbers, just understand the principle.

      – Hunger & Satiety

      Whenever hungry, eat until you are comfortably full. Don’t starve and don’t stuff yourself.

      – Sequence Your Meals.

      Start all meals with a salad, soup and/or fruit

      – Don’t Drink Your Calories

      Avoid liquid calories. Eat/chew your calories, don’t drink or liquify them. Liquids have little if any satiety so they do not fill you up as much as solid foods of equal calories.

      – Dilution is the Solution: Dilute Out High Calorie Dense Foods/Meals

      Dilute the calorie density of your meals by filling 1/2 your plate (by visual volume) with intact whole grains, starchy vegetables and/or legumes and the other half with vegetables and/or fruit.

      – Be Aware of the Impact of Vegetables vs Fat/Oil

      Vegetables are the lowest in calorie density while fat and oil are the highest. Therefore, adding vegetables to any dish will always lower the overall calorie density of a meal while adding fat and oil will always raise the overall calorie density of a meal

      – Limit High Calorie Dense Foods

      Limit (or avoid) foods that are higher in calorie density (dried fruit, high fat plant foods, processed whole grains, etc). If you use them, incorporate them into meals that are made up of low calorie dense foods and think of them as a condiment to the meal. For example, add a few slices of avocado added to a large salad, or a few walnuts or raisins added in a bowl of oatmeal and fruit.

      1. Hi Toxin!
        Dr Greger did not recommand to limit nuts, as you can see in his video ” Nuts and Obesity: The Weight of Evidence” 2 years ago. Has this changed?
        BTW, thank you very much to all of you, Dr Greger and Team, for that so useful Work! Now, we better know what to eat or not.

        1. Thanks for your post.

          I personally do not think consuming nuts as a significant portion of calories is the most healthful approach. Heart disease reversal has only been demonstrated on a low fat plant based diet, not one high in nuts. I think the studies Dr. Greger shares in the video are valuable, but I question the applicability they have with a slim “vegan” who does not consume much fat. When you take anyone eating the standard American diet and give them something healthy, positive benefits will almost always be present.

          1. Thanks Toxins.
            OK for a low fat, and good fat, intake. But too many is not healthy. So, how much is enough? I’d like to Know what the latest recommandations are.

            1. Adding an ounce or 2 of nuts is fine. I prefer walnuts and flax, as they are the healthiest. If you are generally consuming a starch based diet with lots of veggies, you shouldn’t have any problems.

    2. Some vegans use a lot of oil, and way too much of the fatty plants (nuts, nut butters, avocado) and they WILL have trouble losing weight. Eating whole foods, plant based, no added oil, and keeping nuts and avocado in their proper place as special occasional treats, will result in weight loss for sure. Granted there may be fewer calories, but this way of eating requires no portion control or actual calorie counting and hunger is non-existent. Dr. John McDougall outlines a terrific plan for success for both health and weight loss in The Starch Solution.

  5. nutrition dense if we look at 100 gr beef it has more vitamins/minerals then 100 gr of blueberries or green veggies like Kale. so you get more nutrition out of beef then veggies or fruit. how can you say then that veggie are more nutrition dense. if beef has more.

    1. I think you need to look up the most commonly used definition of nutrient density. Grams of a food are not relevant when calculating nutrient density defined as the total nutrient content to total energy content. You should be comparing 100kcal of beef with 100kcal of blueberries or green veggies. I think you will find fruits and vegetables far more nutrient dense.

  6. I have seen studies that claim that biologically we are meant to be vegans, due to the structure of our teeth, the length of our intestine, as well as the fact that most people are unable to digest diary. Is being vegan significantly better for you biologically?

  7. I have been vegan for a few months and I can defiantly agree with the statement that you feel better mentally and physically when you go meat(and diary)-free.

  8. I am vegan and I obtain the same, if not more calories than meat-eaters. It is just harder to ensure that I get enough protein but that is why I think vegans are healthier, they pay more attention to what they put into their bodies.

    1. If looking for additional protein sources let me know! I’ve found many folks who try a vegan diet can get plenty. Dr. Greger mentions protein recommendations in this video, if interested. Thanks, joe!

  9. Hi everyone,

    Just wondering if high-carb low fat is optimal for healthy individuals doing strength training as I feel my hormones low (testosterone 2.59 ug/l, often tired but fine otherwise) maybe because missing some fat ? Total cholesterol 1.02, eating 10g flaxseeds and a little less than an ounce on other nuts/seeds daily with total caloric intake above 3000kcal. I have read insulin sensitivity better with low fat which is why I am doing eat considering the tons of beans, grains & fruits I am eating but is this smart or not when already healthy?

    So how much fat would be recommended ?

    1. Hey Dr. Antoine, testosterone levels are measured in ng/l, and a normal range is 300 to 1050. Doing your conversion gets you a level of 2590…way above normal. You might want to recheck your numbers. Anyway, a diet that is high carb is ideal for strength training, because you need a lot of glycogen (muscle sugar) which comes from eating carbs. Insulin sensitivity should remain fine as long as you remain active and eat unsaturated fats from plant sources. I hope this helps!

      1. Hello,

        Ihave rechecked my numbers and they were accurate : 2.59 ug/l or 8.99 nmol/l

        Average numbers are between 2.40 and 8.59 ug/l or 8.33 to 30.02nmol/l so I am on the lower range despite I eat all foods that typically increase T except saturated fats.

        I don’t feel terrible at all, just wondering if adding some fats would help out hormones without messing with insulin

        Do you think I can go to 50g fat a day without any issues (onlywhole plant foods, no oil no sugar no salt for me)

  10. While low-carb diet advocates are correct about avoiding simple carbohydrates like table sugar, low-fat diet advocates are correct about avoiding saturated fat and cholesterol as well. Saturated fat, cholesterol, and simple carbs are bad for our health, for various reasons.

    Instead of going for an “extreme” diet, whether it be low-carb or low-fat, why not eat a diet that is based on the right kinds of fats and the right kinds of carbs? What matters more to our overall health is the sources of fats and carbs we are eating, not avoiding carbs and fats entirely.

    At the end of the day, a calorie is a calorie:

    “We conclude that a calorie is a calorie. From a purely thermodynamic point of view, this is clear because the human body or, indeed, any living organism cannot create or destroy energy but can only convert energy from one form to another. In comparing energy balance between dietary treatments, however, it must be remembered that the units of dietary energy are metabolizable energy and not gross energy. This is perhaps unfortunate because metabolizable energy is much more difficult to determine than is gross energy, because the Atwater factors used in calculating metabolizable energy are not exact. As such, our food tables are not perfect, and small errors are associated with their use.

    In addition, we concede that the substitution of one macronutrient for another has been shown in some studies to have a statistically significant effect on the expenditure half of the energy balance equation. This has been observed most often for high-protein diets. Evidence indicates, however, that the difference in energy expenditure is small and can potentially account for less than one-third of the differences in weight loss that have been reported between high-protein or low-carbohydrate diets and high-carbohydrate or low-fat diets. As such, a calorie is a calorie.”

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