In July 2017, the CrossFit Foundation convened its first academic nutrition conference: “Beyond Calories—Diet and Cardiometabolic Health.”

The importance of diet to health was clear when scientists unraveled the relationship of Vitamin C to scurvy, Vitamin B1 to beriberi, and Vitamin D to rickets. However, how important is this relationship today, when these and other essential dietary components are available as supplements, and the leading cause of death worldwide is cardiovascular disease? It is commonly understood that diet is important with regard to how much we eat: excess caloric intake causes accumulation of excess body fat, and excess body fat is associated with increased risk for cardiometabolic disease. However, as long as we are consuming all the dietary essentials, either in food or by supplementation, does it matter what we eat? Is it only the quantity of calories that matters, or are there specific pathways/mechanisms by which commonly-consumed dietary components may contribute to obesity, diabetes, and cardiometabolic diseases independently of their energy content?

Such questions take on additional relevance in light of the oft-cited “energy balance” or “calories in, calories out” theory of nutrition—the notion that the harm derived from indulging in a sugar-sweetened or otherwise unhealthy product is solely based on the excess calories consumed, calories which can be neutralized or “balanced” through an equivalent caloric spend via physical activity. The food and beverage industries point to the energy balance theory when rationalizing or marketing their products, claiming that each product can fit into a healthy lifestyle if balanced by physical activity, i.e. energy expenditure.

But do our dietary choices have other effects on our cardiometabolic health, regardless of how well we balance our caloric consumption and output?

With this in mind, the CrossFit Foundation hosted the 2017 “Beyond Calories” conference. Twenty-two leading international nutrition scientists and researchers met for a day of public presentations and private discussion to review the current landscape of nutrition science and the effects of specific dietary components or patterns on obesity, cardiovascular disease, and type-2 diabetes.

The conference summary and position paper, “Pathways and Mechanisms Linking Dietary Components to Cardiometabolic Disease: Thinking Beyond Calories,” published in Obesity Reviews in May 2018, provides an overview of the challenges involved in conducting and interpreting nutrition science, and helps to articulate why the opinions and conclusions drawn by nutrition experts regarding the effects of food components such as fat, sugar, and carbohydrate on health have been so conflicting in the past and are still conflicting today.

Importantly, lead author Dr. Kimber Stanhope (University of California, Davis) wrote, “there is one dietary component for which the research evidence transcends the difficulties associated with conducting nutritional research studies. The authors agree that consumption of sugar-sweetened beverages increase cardiometabolic risk factors/risk compared with calorically-equal amounts of starch.” While the paper’s conclusions may impact many potential public health debates and policies, ranging from product and marketing regulation to research funding, this particular conclusion has significant implications for the individual seeking to make healthy consumption choices beyond the energy balance paradigm.

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The schedule of presentations can be viewed below, and full conference video accessed here.

Schedule

Introduction: Public Health, Public Policy

Laura Schmidt, University of California, San Francisco

"It’s not just the calories”—Implications for science, public policy, and public health

Emerging Concepts in Nutritional Effects on Adiposity

Eric Stice, Oregon Research Institute

Elevated brain reward region response to high-calorie, highly palatable foods: Does it lead to weight gain and can it be prevented?

Peter Turnbaugh, University of California, San Francisco

Microbes and diet-induced obesity: Fast, cheap, and out of control

Allison Sylvetsky, The George Washington University

Non-nutritive sweeteners: Helpful or harmful for weight management and chronic disease prevention?

Anja Bosy-Westphal, University of Hohenheim, and Arne Astrup, University of Copenhagen

Debate: Does high carbohydrate diet promote obesity?

Nutritional Effects on Cardiometabolic Health

Kimber Stanhope, University of California, Davis

Fructose and glucose and starch: Carbohydrates on different paths

Jean-Marc Schwarz, Touro University – California College of Osteopathic Medicine; University of California, San Francisco

Weight-independent effects of fructose on hepatic de novo lipogenesis, liver fat, lipid profile and insulin resistance

Michael Goran, University of Southern California

Secondhand sugars: Role of dietary sugars in the early development of obesity and metabolic risk

Ronald Krauss, Children's Hospital Oakland Research Institute

Saturated fats vs. unsaturated fats vs. carbohydrates for cardiovascular disease prevention and treatment

Conclusion

Janet King, Children's Hospital Oakland Research Institute

Diet and health: Thoughts and applications beyond calories in the real world

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