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I wish keto worked too. The hard science says it doesn’t.

Calories in, Calories out.

a.k.a. CICO.

a.k.a the Energy Balance Model of Obesity or EBM.

If you eat the same number of calories you burn through movement, living, breathing and digestion, then your weight will not change.  If calories in are greater than calories out, your weight will go up.  And vice-versa.  This is definitely true but not actually this simple.

The keto craze has led to the rise of the idea that as long as you’re not eating carbs, total calories don’t really matter so much because insulin is the real problem. This is known as the Carbohydrate-Insulin Model or CIM. This was made popular by my Canadian colleague, Dr. Jason Fung, in his book The Obesity Code.

For anyone who has read it, I bet you thought it was pretty plausible. 

I also drank the Kool aid. It sounded so perfect.  Just find food joy in the fatty things.  Eventually, you won’t even want carbs and you’ll lose weight.

I read his books.

I told my patients to buy his books.

I directed my patients to the recipes on his website. 

I attended a full day seminar for patients at his clinic in Toronto.

I enrolled in his program.  As a patient.

Notably, I did not lose weight. I did gain some though.

Admittedly, my own personal case study is not influential to the larger body of evidence but it did prompt me to keep asking questions and to eventually become certified in obesity medicine. 

It’s actually still about calories in and calories out.  But also some other things too.

The EBM is the most accurate and valid version available at the moment to explain why we weigh what we weigh. And Calories in, Calories out is part of it but not the whole story.

The EBM has a few important pieces:

  • The brain decides what you eat and what you weigh, mostly.
  • Our noticing mind (the frontal cortex) isn’t aware of most of our appetite signaling. 
  • Weight regulation is like a very complex symphony of signaling between the endocrine, nervous and metabolic systems. You probably can’t just out think it.
  • The environment (which refers to a lot of stuff, not just climate) influences the symphony.

Plus, about 75% of the body mass index is heritable.  Both the CIM and the EBM agree on this part. And so the take home here is that we must learn to accept a much broader array of body sizes as healthy, because we can’t know that they aren’t without a personalized look into their health.  Can’t get that on Instagram.

When it comes to calories, the brain regulates them over time.  We food and weight track over days but the lag on brain-based regulation is much longer than that. Probably in the order of weeks to months.

In the EBM, the kinds of calories matter too but not because of a reliance on insulin as a storage hormone.  Highly rewarding foods influence how the brain lays down reward tracks between cells and changes how hunger is experienced.  This can lead to more eating and more calories in for some people with the right underlying DNA.  But not for others.  It’s that personal.

In Responsive Eating™, we don’t spend much time thinking about fats, carbs or proteins for this reason.  We understand food as highly rewarding or satisfying, or both.  This is because these categories speak to how our brain experiences the food which is ultimately what matters. 

I don’t have a magical list of these foods because they’re highly personalized.

You can forgive yourself for being into carbs.

There is likely not a ton you can do about how profoundly rewarding certain foods are but you can learn to respond to the cues differently, and use evidence-based medicine to support a personal understanding of your body. 

At 37 years old, I had to build my own mental framework to learn to change how I experience certain food cues.  It’s a matter of practice and medicine. And it has changed my life.

It’s very much a “control what you can, let go of what you can’t” kind of approach without feeling like you’re bound to just swallow the whole world in the process.  Trust me.  You won’t. Your brain has your back. And so does science.

You can take the free version of my course Responsive Eating™ by signing up here: and learn the system for yourself.

I think you’ll agree that most of the keto disciples have been restored to their original weight.

This is because the brain will gently push them there over time though some will develop lifelong patterns to support ongoing low carb diets.  These aren’t necessarily bad and some people may respond very well in terms of overall health to fewer carbs but high fat, low carb life is not a magic bullet. 

I know we all wish it was.

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