Physician Phollies IV: Dr. Cate Asks How Many Calories in Mayo?

I really thought this was a joke, and a silent hat tip goes out to the person who brought this to my attention so's that I don't get them on anyone's bad list for contributing to such a post here at the Asylum.  But OMG.

... now that Mark Sisson is whipping up wonderful mayo, I can get to work on the backlog of tuna salad, pea salad, and deviled eggs I’ve been denying myself. ... I thought I’d enjoy some tuna salad with two heaping spoonfuls of Mark’s zippy mayo—call it research for  lower calorie  meal plans for my new business, the FatBurn Factory.  With the addition of a few capers, instant lunch! But I need to know for, for the sake of my patients, ... 
Yeah I know what you're thinking.  What the heck is pea salad, and is there anyone else on the planet denying themselves of this dish?  


I'm willing to bet that more college students these days would be able to tell you roughly how many calories there are in mayonnaise than would be able to pick our current Vice President out of a line-up.  I'm not quite what that says about civics and politics in our society -- grin -- but I've known since I was around 16-17 years old that a tablespoon of fat is roughly 100 calories.  Oils, being slightly more dense coming in at around 120 cal, butter & mayo right smack around 100, and whipping cream around 50.   These are all essentially 100% fat, so the difference is in the density and water content.

Before getting into Shanahan's ridiculous discussion on calories, we have this lovely:
Of note, Primal Blueprint deserves props not just for being the only source of actual-food mayonnaise available throughout the US, but also for truth in advertising. They give a real, honest appraisal of the calorie count: 100 per Tbsp. The tub brand says a Tbsp of their product weighs 13 grams and therefore contains only 90 calories. Lies. My measurement came in at the weight you’d expect for a tablespoon of oil: 15 grams. See photos.
Alrighty then, this woman has a scale, knows how to calculate the weights of her food using the manual method of weighing the instruments first, then instruments + items and subtracting out instrument weight.  Or I imagine that fancy scale of hers has a TARE button!   But before this Shanahan admits to having made her own mayo, and she seems aware of oil, tell me again how it is that a 45-ish year old woman (she graduated medical school in 1994 according to medical license) had NO idea how many calories were in mayo??!!??  But Hellmann's is hardly telling lies about their mayo.  It's called water and air, Cate.  Their mayo has a distinctly whipped texture and water is the second ingredient on the label.  Yes, 13 g total weight, 10 g fat, and 90 calories is about right.   Meanwhile to truth in advertising and math ... 12 grams of fat would be 108 calories ... but who's counting, right?

Still, NOT SO FAST!! Actual-food mayonnaise as opposed to what? You can buy similar mayos at various places, I'm betting even my local supermarket. But did the oil just jump out of the avocados into Mark's paleo/primal blender? Do organic egg yolks separate from the whites voluntarily? Vinegar and salt in some primal plasma cave-al explosion? Give me a freaking break. Don't look now, but the O6:O3 ratio of this overpriced schlop is 13:1 and at 12.5% O6 fatty acids. Yikes! No wonder this stuff is marketed as so addictive (it's just like smoking pot for the munchies according to paleo psychiatrists). 

ASIDE: Seriously, if you need to buy mayo from Thrive Sell Me A Membership Market made by Mark Sisson, you really shouldn't bother.  I mean a "discounted" $7.45 for 12 oz?  Here's a not-so-large female hand holding 15 oz (that's 25% more for those into percentages -- double grin) of the "tub mayo" as Dr. Scamalamadingdong  calls it.  Damn Hellmann's, they used to make their canola version full fat.  The neat thing about not eating mayo by the spoonful, is that when you do eat it, it really doesn't matter a whole lot if you eat the tastier real stuff.  It lasts in the fridge, and if you happen to throw away some just to be on the safe side, you won't go broke.   But for crying out loud, get a stick blender (with some attachments even ... may I suggest this one from Hamilton Beach -- love mine -- or this Cuisinart?) and make your own.  It's really easy.   

Shanahan has been in the weight loss business for some time now.  She was also an athlete and attended Rutgers Univesity (what is it about that place that churns out calorie denialists) on a Track scholarship, so please don't try to tell me this woman is this clueless about the calories in mayo.  Or perhaps she is.

In New Hampshire Shanahan "spearheaded a weight loss program called TRIM, Treatment for the Reversal of Inflammatory Metabolism", and as she'll tell you every chance she gets, she somehow came to be a nutritional consultant for the LA Lakers -- an arrangement that has seen the health and performance of the LA Lakers reach unprecedented levels (just don't ask what is unprecedented about them ... of course it's not the diet!).  Eat at Chipotle!!  Who knew there were so many calories in their burritos??!!  There's no tactful way to say this.  This woman is not too bright.  How did I do?

The really bizarre thing here is that after moving to California she's now moved to Denver (attention Jeffry Gerber, get your LDL particle rising HEAL clinic up and going fast!) and founded a Fat Burn Factory?

Who decides to make a low calorie lunch with mayo, let alone, 3T!!  Don't know where she sources her tuna, but the drained weight of tuna in regular cans these days is only -- gasp! -- 4 ounces.    Add in 3 T of mayo and you've transformed around 175 (depends) calories of albacore into almost 500 calories. 

Who in their right mind would go to Fat Burn Factory after reading this delusional post?   They're even going to be getting insurance to cover it?  

Insurance will cover the service of a properly educated and licensed RD for weight loss advice, and don't give me the nonsense about how it doesn't work to eat less and move more.    Your cells do not lose their ability to burn fat.  That is just wrong.

Scientific Denial

Dr. Cate seemingly had an epiphany as to why it is so hard to maintain weight loss.  It turns out calories count after all, and there were two explanations given at a recent conference she attended:

Do calories really count?
A recent event piqued my interest in calorie counts. At a medical meeting here in Denver in April, one of the presenting doctors claimed that in order to maintain their weight loss, a person needs to continue to follow a more calorie-restricted diet than a person who was never overweight because the act of losing weight slows their metabolism permanently. This phenomenon has been described for decades and called a variety of names over the years, most recently the “starvation-mode effect.”
Later that same day at the conference, a doctor from the NIH suggested that all that was nonsense. He asserted we do not need to invoke any such ideas as a so-called “starvation mode” to explain why successful weight maintenance appears to depend on continued calorie restriction. ...
I'll get to the under-reporting point, which has merit but is somewhat misplaced, in a bit.  But Shanahan continues, and I'll quote a rather large chunk for educational purposes here:
So who is right?
I am siding with the lone-wolf from NIH. I don’t believe there can be such thing as “starvation mode” that persists beyond any actual starvation periods.
Hold up!  Why the false dichotomy?  Metabolic adaptation and caloric under-reporting are not mutually exclusive reasons.   They're vitually unrelated at that.  But I digress ... 
Why not?
For one thing, the idea that if you’ve lost weight you have to eat less than you would have if you never had been overweight is not a physiologically sound concept. It’s an emotional, punitive notion that reflects society’s general disrespect for overweight people. When I first heard the idea it sounded like “Your body is mad at you for having once been overweight and wants to make you pay.”
Obviously, when she first heard the idea, she didn't bother to look into one iota of the scientific evidence in support of it.    There is no denying the evidence, and since she claims to have been in the weight loss business -- presumably with some success and some difficult patients -- I'm sure she has a few anecdotes of her own of people regaining -- or more likely, not losing -- on "normal calories".  That said, I do remain skeptical as to (1) the magnitude of this adaptation, particularly as relates to the "after" state of the body (e.g. still overweight in many cases), but more importantly (2) the persistence of this adaptation.  I've yet to see anything much more than a few months out of weight loss, and I don't recall there being any study measuring TDEE & RMR before weight loss, at goal, and then periodically for a year or more afterwards once consuming weight-maintaining calories.  There really is so much better use for NuSI's money ... SIGH.   There is a feasible explanation (likely more than one) for the observation that doesn't involve metabolic adaptation, but Shanahan is not making one, because she's not buying any of the evidence.  (Also, in the course of last minute research in the book revamp, I've found some interesting things about the rebound metabolisms of anorexics -- got something quick to share on that soon.)

But to deny it?  This is reminiscent of Chris Kresser referencing peer review on the diet of Okinawans at the AHS12 Safe Starches "Debate", and Shanahan responding with "I don't believe that" ... cuz Okinawans in Hawaii and all that

Not physiologically sound?  Hello, this woman doesn't know basic physiology from cosmology it seems.  More on that in a bit.
Additionally, I’m not sure how it would be possible for one group of people who used to be overweight with the same diet and activity level (age, race and so on) as another group that was never overweight to have different caloric requirements. It could be possible if people who were once overweight but have since lost weight have reduced body temperatures or other measurable metabolic parameters indicative of reduced energy requirements, such as lower resting heart rate or blood pressure. Or, in the alternative, something that alters their relative food absorption ability, like an underactive digestive system.
Ummm ...  Yeah ... that's kinda exactly what they mean!!
In the absence of any explanation other than the body “remembers” its previous weight and “wants” to get back to it, I remain unconvinced that your body must forever pay penance for the unforgivable sin of having been overweight.
Well, she's unconvinced, but this should make anyone think twice about going to her for fat loss treatment!! 


So this "lone NIH scientist" suggests that no "starvation mode mumbo jumbo" (my words) need be invoked, it's under-reporting.  

But under-reporting, or lack of realization of how much one eats, is likely to contribute to excess weight to begin with, and/or an inability to LOSE weight despite thinking one is consuming foods in a caloric deficit.


It would be an unlikely explanation for regaining weight (again, unless you've ignored anything related to calories such as portion sizes all along), however.  What, the person all of a sudden loses their eyesight and measuring spoons?    I can definitely buy into the idea that when a successful dieter relaxes a bit, and perhaps leaves the spoons in the drawer because they've gotten a little cocky in their guestimating abilities, some regain from calorie creep kicks in.  But this really isn't what they're talking about.

So anyway, I guess this was Shanahan's demostration of not having a clue what a tablespoon of mayo looks like or how many calories are in it.   This is an unbelievable admission for anyone who claims to have knowledge of nutrition and consults with the LA Lakers (nevermind the -- now defunct? -- partnership with Sisson for metabolic counseling?).

I'm going to skip over the absurdity of not knowing about calories in mayo if consider yourself at all knowledgeable of nutrition.  Food even.  This is basic stuff.  But the second part of her admission is a teaching moment, because most people have an especially hard time visualizing what certain amounts look like on a plate.  This is particularly difficult for stuff that is often "free poured", squirted or even "spooned out" with a normal eating utensil.   Clearly Shanahan didn't have a clue that two dollops from her teaspoon amounted to 3 tablespoons.    

Here's where dining out or getting take out for a week may help alter your perceptions.  Order all condiments on the side and take note of those cups they come in, or from packets -- make sure to squeeze the everliving everything out of them ;-) and use your finger or rubber spatula to get everything out of the cups.  The usual size cup for sauces, dressings and such is shown with ketchup and fries here.   That's 2 oz, also known as 1/4 cup which I learned at a very early age when baking with Mom.  Want to know the "fill line", use a standard measuring cup to test.  Those Shrek thimbles?  You can pack 200 calories of $i$$on'$ mayo in one of those!  

A "small one" is 1 oz.
2 oz cup = 4 Tablespoons 
(12 teaspoons!)  link

Yeah, yeah, it's irresponsible of me not to point out that there may be a gram or two of sugar in that blue cheese or ranch dressing because we all know how much ketchup everyone puts on all the fried chicken wings everyone's eating.   Hi Blaine ;-)

The reality is that most people don't measure cooking oils, sauces and salad dressings, and at ~100 calories a pop, those tablespoons really add up.   For this reason alone, and because NHANES shows a shocking degree of underreporting in the overweight and obese, it is highly likely that NHANES data showing flatlined fat consumption are quite a ways off.  Lots of waste in this stuff, but so too sugar and sugary condiments.  But no doubt we consume too much.  Don't fool yourself into thinking that swapping soybean for avocado oil gets you a bye either.  

Deep Nutrition Defended

But wait, in your book Deep Nutrition, you say calories don’t count…
In Deep Nutrition, we condemned a calorie-centric view toward food because it de-emphasizes things like nutrient density, source, cooking technique and so on—things that can have a profound effect on your metabolism, your health, and yes, your weight. This isn’t to say that a significant chronic over intake of calories will have no impact on your weight.
While food is far more than calories, i if we eat more food than we need, no matter how high quality it may be, our bodies will store the excess as fat . Calorie counts help us to determine if we are eating more than we need. They do not tell us anything about the adequacy of nutrition. A fundamental understanding of traditional diets is essential to understanding whether or not your diet is meeting your nutritional needs.
Yes, and conversely Dr. Cate, if we eat less food than we need, no matter how low quality it may be, our bodies will still dip into our fat stores and our cells will burn that fat to meet energy needs.  Fact. 

Remember when Shanahan said the concept of starvation mode wasn't physiologically sound?  Below is just some of the nonsense contained in Deep Nutrition as regards body fat and calories.

There really ought to be a mechanism through which someone can have their medical degree revoked for writing things like this.  At the very least, medical boards should not grant license to operate a weight loss clinic.

My advice for doctor shopping:

  1. If they've written a book, read it and if you don't have the expertise to judge, ask someone who does if it is medically sound.  If it is not ... RUN AWAY.
  2. If they advise that you read anything by Food Babe, Mark Hyman, Gary Taubes, Nina Teicholz, William Davis, David Perlmutter, Eric Westman, Stephen Phinney, Jeff Volek, Robert Atkins, Loren Cordain, Cate Shanahan, Mark Sisson, Dallas Hartwig or Melissa Hartwig (no longer the Hartwigs apparently) ... I'm sure I left a few out ... RUN AWAY.
  3. If they begin any sentence with "they didn't teach me this in medical school" ... RUN AWAY.
If you don't trust your doctor for nutritional advice, and perhaps where most doctors are concerned you shouldn't, get a referral to an RD.  That's what THEY went to school for.   Even Amy Kubal, the Paleo RD will tell you that.  Here she is in September 2011, before her health decline helped along by following and promoting the paleo diet, talking with Jimmy Moore about what she learned in real college.  Not Food Pyramid, and not nonsense, but biochemistry, metabolism and ... what's this? ... nutritional therapy for various conditions based on treating people appropriately so they don't end up sitting in a hot fatty mess ... not with paleo woo woo.   

"A lot of what you'll learn 
is the science behind it"

This is why you should skip the nutritionists trained in any other way if you have a serious illness that you believe has a nutritional component underlying it or necessary to treat or manage.