Not only that but high intakes of added sugars and fast-acting, high-glycemic carbohydrates are linked to an increased risk of cognitive decline and dementia. Excess simple sugars, particularly fructose and sucrose, promote insulin resistance, chronic inflammation, and vascular damage that impair brain function and accelerate neurodegeneration. So with other words, you diet is a major contributing factor here. The medical establishment and big pharma simple ignores the fact that the biggest health risk for a human being is the "modern" high sugar diet that Kellogs introduced in the US and spread to the western world (even to Asia at some extent).
I'm not sure how the medical establishment ignores this, from my understanding (and please correct me if I'm wrong as I'm not fact checking myself in this moment) - the association between the two is largely linked to vascular dementia (obesity, hypertension, yadda yadda).
I think it's hard to argue "The medical establishment" ignores diet as an important factor.
I think the reality a lot of the time is doctors prescribe something to help. They can't force a diet change on a patient, and they're not mutually exclusive interventions.
It's easy to say "just diet ez" and it's hard to "just diet".
If you can administer a treatment as a simple one and done thing, that's alright. If it's a pill you got to take every day, that's pretty bad. More than once a day? Horrible. Why? Because a lot of patients just don't have it in them to take a pill 3 times a day consistently.
If it's purely an "exercise willpower" thing or a "change your lifestyle" thing? You might as well give up.
The medical establishment wants to do things that work. Telling people "go diet" doesn't work. Semaglutide, evidently, does.
You underestimate what people Will do to lose weight without putting in any effort or changing their lifestyle
bro the problem is not eating burgers every time you see them. if eating a pill once a day will prevent somebody from having these urges people will easily make this a routine. fat people don't like being fat (body positive is the world biggest cope). if you give them something they gotta take once a day, takes 10 seconds, they will throw their money at you.
You say force a diet change on a patient. OP certainly meant forcing a diet change in the input of American factories. Sugar can be found in fruits. That's the right place. If you need some, use fruits, maybe alcohol. Everything else can be slashed. No sugar in prepared meals anymore. No sugar in pasta anymore. And most of all, no sugar in water. Sugar input makes more damage than cocaine today.
We can call it the Prohibition II. There will be underground bars with sick people binging on sugar. We can change the shape of sugar to prevent restaurants from adding it to food. We can make it bitter. Absolutely need sugar? Eat that lemon-tasting block. We can call it The War On Sugar.
people are so addicted to sugar that you are getting downvoted and maybe even flagged.
I like "The War on Sugar" idea (even tho I went out 1 hour ago to buy lots of chocolates and candies, as I'm an addict).
I think it’s more because it’s kind of a strange rambling rant? He didn’t make any good points, he just made an analogy between it and alcohol prohibition like 7 times. He didn’t even bother to bring the idea home in the end, he just left it free-floating there. It’s just not a great comment.
Closed the gyms during COVID not the McDonald's
The medical establishment that I have familiarity with (in the US) pretty much only ever treats symptoms, not causes.
Don't believe me? Next time you go to see your primary care physician, ask them what you should be doing to lower your risk of whatever malady tends to run in your family. (Diabetes, cancer, dementia, etc.) They're going to stare at you in blank confusion for a few seconds before making some vague suggestion about a better diet and more exercise. Guaranteed.
The reasons are many, and detailed enough to write MANY books about, but the low hanging fruit is: we don't have a culture of monitoring and improving our own individual health, physicians are trained almost exclusively to solve problems not prevent them, modern nutrition science is a joke, omnipresent health insurance distorts incentives for everyone, doctors are too overworked to get to know their patients, private equity has captured a large chunk of health care, drugs are positioned as the first line of treatment for almost everything, etc.
In my experience that’s wildly inaccurate. Dietary choices, weight loss, exercise, etc are often given as an effective means of avoiding and or controlling a wide range of conditions.
People are instead blowing off such advice because they don’t want to hear it.
I never knew Kaiser Permanente was so "anti-establishment" but I get pages of recommendations for healthy eating and exercise every time I go and also randomly as part of my "Personal Action Plan".
Everyone pretty much knows how to be healthy- good diet (leafy greens, abstain frand exercise. Diets, fads, etc are all just ways people sidestep being slightly uncomfortable rather than limit what they eat and do. Lots of societal things male it harder, eg hyper-palatable foods/ads/overworked/food availability, but that’s the long and short of the root cause.
Diabetes is well known to be a massive risk factor for dementia - so no, people are not ignoring this!?
More broadly, diet is a frustrating modifiable risk factor - there are lots of studies suggesting the (somewhat nebulous) "Mediterranean" diet is protective, and beyond that, omega 3s.
But human diet is uncontrolled, highly varied, and reporting is difficult to obtain and unreliable (people don't want to admit what they ate), so a lot of these data are seen as interesting, promising but unconfirmed.
> The medical establishment and big pharma simple ignores the fact that the biggest health risk for a human being is the "modern" high sugar diet
The medical establishment isn’t ignoring this at all. They’ve been pushing for healthier diets forever. Primary doctors have always been pushing for healthy eating.
That doesn’t mean patients welcome the advice or follow it. Everyone knows that eating high sugar diets and being overweight is unhealthy.
There was some short-live resistance to the idea that being overweight was unhealthy, but that wasn’t coming from the medical establishment. That was an anti-science, anti-medicine movement that went mainstream under a misplaced desire to not make anyone feel bad in any way. That movement has lost steam quickly as an easier option has appeared for reducing appetite and inducing weight loss.
I don’t understand how you’re trying to twist this into a claim that big pharma is ignoring the impact of unhealthy eating. GLP-1 drugs work by reducing unhealthy overeating and cravings for unhealthy foods.
There was a fringe that said being overweight was not unhealthy, but the more salient points were the following:
1. BMI was basically just pulled out of a hat, and it turns out that for many health concerns, the overweight class does better than the normal weight class, with the actual “clearly worse” outcomes really coming up as you trend into obesity.
2. Environmental and genetic factors are huge contributors to people being overweight. To some degree moralizing about weight loss is a bit like telling kids with asthma they should live in places with less pollution. Or telling someone with breast cancer to not have the BRCA gene.
3. Doctors would regularly miss health problems because they’d blame them on people being overweight / not exercising enough. Especially for difficult to diagnose issues, it’s easy to just point at the number you have that “looks bad”.
4. We still have no firm reason why people are gaining weight. The popular answer is sugar and processed foods but those very much already existed at scale in the 50s.
The tragedy is that it turned into a morality play where fat people were blamed for it, despite in many ways being as genetic as getting breast cancer.
The reality is people who actually study obesity know that basically GLP-1s are the only health intervention other than bariatric surgery that consistently works. At a population level no intervention has reversed fattening anywhere in the world.
To your point 4, we have lots of good reasons why people are gaining weight: they eat more. It's not exactly rocket science.
Obvious reasons include:
a) food is very cheap, especially processed food
b) portion sizes are comically large in the US
c) ubiquity of snacking and eating on the go, which is mostly high calorie
d) few people smoke now, and cigarettes are potent appetite suppressants
e) less social disapproval of being fat. To fair degree, being overweight is contagious
I agree completely with your last paragraph, at a society level. At an individual level, though, it's all on us to exercise self control for ourselves. Just most people don't want to.
Re point a, cheap calories have been around in abundance for 5 decades. The trend has actually been toward more fresh food being available, not more junk (most candies, sodas, and white bread brands are ancient).
lol at point e.
This is so not true. For a while there was a tiny blip where a corner of the internet was fat friendly.
I know a black lesbian from the south who was obese and managed to lose fat by weightlifting. She said by far being obese was worse socially than either of the other things. As part of getting in shape she started jogging and people mocked her for being fat while exercising.
> despite in many ways being as genetic as getting breast cancer.
This claim is utterly silly on its face. Look at pictures of folks in the US 60 years ago compared to today. The population did not randomly mutate a genetic condition towards the propensity of obesity. Folks who come from societies that are not all that overweight did not magically develop a genetic condition upon immigrating to the US. This claim is entirely non-credulous and most folks claiming such are doing so in bad faith.
Environmental is by far and away the largest factor. Meaning most everyone lives surrounded by highly palatable horrible-for-you food and lives extremely sedentary lifestyles entirely optimized for convenience.
It's really not something that needs ANY more examination than that. Fixing it is the hard bit. Everything else on top of this is a rounding error and not something that needs to even be discussed until the first order factor is fixed. Then we can start discussing nuance, outliers, and details. It's a waste of time otherwise.
GLP-1s are the only thing that has turned the tide even a little bit. Because people eat less. Any other benefit from that is again - secondary and perhaps interesting, but not the primary mode of action. GLP-1s proved it is the American diet that is the problem.
> Everyone knows that eating high sugar diets and being overweight is unhealthy.
There is a lack of evidence that the public understands what healthy and healthy effectively mean to their day to day lives,
aside from “looking better”.
They controlled for BMI at least, so they knew that was going to be a common question. BMI is a pretty good proxy for that, and they still said that the majority of the effect came from the compound and not BMI.
Guess what category of drug reduces the intake of large amounts of sugar?
Is it the one that also reduces the intake of large amounts of protein?
Fructose is blood sugar invisible, and plays no part in this conversation. Fructose can cause fatty liver and has been attributed with lots of voodoo, but the weird fructose focus of some is not evidence based. It's nonsense.
"The medical establishment and big pharma simple ignores the fact "
Do you really think the "medical establishment" hasn't been *screaming* about poor diets for decades? The fact that people ignored them doesn't give you an opening to suddenly spout horseshit. And big pharma has had an enormous focus on blood sugar for decades, and you're here yipping like they just want to sell you boner pills. What bizarre world is this?
> the "modern" high sugar diet that Kellogs introduced in the US and spread to the western world (even to Asia at some extent).
Kellogg? Did you know that white rice has a glycemic index significantly higher than table sugar (because, as previously mentioned, fructose is not a blood sugar)?
Yeah, a lot of people have bad diets, but infinitely more pressing is sedentary lifestyles. The reason Asia gets away with a rice-heavy diet (which is almost pure glucose, in a very simple form), though this is turning the wrong way, was busy, active lifestyles. The biological reality is that eating a big bowl of frosted flakes is perfectly fine if you follow it up with high amounts of activity.
Glucose is quite literally fuel for your body. And it's fine if you're actually using that fuel, but becomes a problem when often the overweight (and insulin resistant) and sedentary flood their blood with glucose, with nowhere for it to go.
> Fructose can cause fatty liver
It is also a large contributor to rising triglycerides levels and uric acid due to the way it is metabolized. Which in turn contributes to high blood pressure. It also makes Acetyl-CoA, which stimulates lipogenesis.
It is not even true that it is 'blood sugar invisible'. 30-50% of the fructose is converted in glucose and that's visible. The rest won't be available until you start burning fat.
> Yeah, a lot of people have bad diets, but infinitely more pressing is sedentary lifestyles.
No, that's only part of it. And a small part at that. The world didn't suddenly decide to get less active all of a sudden. You can blame some of the sedentary behaviors on societal changes (like suburbs and car dependency in the US), but other countries are getting just as unhealthy, metabolically speaking, and fat.
> The biological reality is that eating a big bowl of frosted flakes is perfectly fine if you follow it up with high amounts of activity.
It has to be really high. We are talking about hours to burn up that bowl of frosted flakes. Spend an hour at a treadmill, calculate the calories you spent. Now check the nearest cereal bar nutritional information. You'll be in for a surprise. You cannot outrun a bad diet.
Diet is most of what needs to be controlled for metabolic health. Resistance training will build muscles, and they are a good buffer since they will eat simple carbs even when you are inactive. Add cardio for cardiovascular health. But, unless you are an athlete or you are active the whole day, you should go easy on the frosted flakes.
>The world didn't suddenly decide to get less active all of a sudden
In many ways, yes it did. There is a shocking decline in active calories in every developed country, and it has been exported to the developing world as well. People are astonishingly lazy, on the average.
Like, Christ, it's so bad that the recommendation to take a brief, slow walk after meals is revolutionary now. Because the average person just waddles to their chair and then "digests". It is astonishing how lazy the average person is in many countries.
>It has to be really high. We are talking about hours to burn up that bowl of frosted flakes.
I love that you declare that I'll be "in for a surprise", as if you're educating me. Hilarious stuff.
In any case, really high is...a bit of an exaggeration. I cycled 30km this morning, at the crack of dawn. A fairly casual, 20km/h or so ride down to the lake and back. That's an estimated 900 calories, or about three bowls of frosted flakes with milk. And the fun thing is that I didn't even eat this morning and did it purely on glucose reserves. This wasn't some athletic thing and was very much a casual "catch the end of summer" thing. Actual athletes absolutely destroy those numbers. People engaged in basic recreational sports destroy those numbers.
And that bike ride is something people would do just getting to and from places in the not to distant past. Where people were constantly moving and doing. Now most of the readers of this comment will have done nothing today beyond moving from seat to seat in various transporters and digestion chambers.
We've all been around someone who is spectacularly lazy who'll tell you about their "metabolism", and who'll jealously jeer when a peer eats without concern and somehow stays healthy. In the vast majority of cases, the latter person is active in their life, and the former person is one of those seat-to-seat people. Being active impacts every facet of your life, and endless choices throughout the day, and it yields an enormous impact on your health.
edit: meant to address the fructose. The fructose converted to glucose does so slowly enough that there is a marginal impact on blood sugar. And the average person consumes multiples more glucose than fructose. Should people consume less fructose (ergo sugar, even if the current admin is trying to healthwash sucrose)? Absolutely. But glucose and simple carbs are the biggest vehicle towards blood sugar and overwhelming glucose reserves.
But there's the exercise paradox, which is that it doesn't work.
https://en.wikipedia.org/wiki/Exercise_paradox
Possibly it works in the extremes, but if so, it's modern and unnatural.
Wear a blood glucose monitor for a month or two. Don't make any changes whatsoever to diet or activity levels for the first 2 weeks.
Then change it up so you are taking a mile or two walk after every meal. Don't change your diet.
Note the difference in blood sugar levels. It won't happen for everyone but the difference just an extremely moderate level of activity makes - especially directly after meals - was actually one of my larger surprises doing exactly the above.
If I am diligent about my 10k steps/day, I find it difficult to put on weight unless I'm eating like total crap. Combine an effort to try to never eat simple carbs with the above walking regimine and most folks are going to drop weight faster than they would ever expect. Quadruple (or more!) true if you also add a GLP-1 to the mix.
Exercise and basic activity absolutely, unequivocally "works" for removing glucose from blood, which was the foundation of this argument. I'm not giving people diet advice. Indeed, we were talking about frosted flakes, and there are cyclists that have glucose energy drinks -- massive dumps of glucose -- that they consume while riding, and the impact on their blood sugar is utterly negligible. Because activity is an incredible modulator, given that your muscles literally run on glucose, and of course your leg muscles are your largest consumers.
Further, the Hadza study in no universe declared that it requires activity "in the extremes"[1] to alter energy consumption. Not only was their activity not particularly large, they were 112lb men consuming 2,650 calories a day (which is huge for that small of a man. The caloric recommendation for a 112lb active man is 2,000 calories...). The human body is not a magic energy machine that harvest energy from the air, and while it can modulate some things such as "fidgeting" and some other basic processes, the idea that the activity you do doesn't reflect your energy consumption has zero scientific backing.
The exercise paradox is that someone consuming enormous amounts of food but then adding a little exercise routine probably isn't going to achieve much. Which...of course. Control the calories going in is infinitely more effective. But anyone trying to assuage themselves by declaring the exercise paradox for why they're sedentary is cosmically misinformed. The fact that active Hadza men stayed lean on what would normally be considered a massive caloric excess is not the evidence for this belief.
[1] - Paradoxically the study actually entirely contradicts the way you are using it, and I think you might have heard a poor summary of it. The study wasn't that activity doesn't use more calories -- of course it does as the human body isn't a perpetual motion machine -- but rather that going from a lot of activity to an extreme amount of activity starts to plateau and doesn't just linearly move up forever, as the body will start conserving elsewhere. So no, it doesn't require "extreme" exercise, and that is not at all what the study says. And if a 112lb American sedentary man was consuming 2,650 calories a day, they quickly would be significantly more than 112lbs.
You say they did little exercise ("their activity not particularly large", "little exercise routine") and yet they stayed lean, QED. But also you say they didn't achieve much. I don't know what you're saying. I suppose this flailing around is a kind of exercise, and you like exercise.
I know the study said nothing about "extreme exercise", I put that part in to appease you by providing a way in which you might be right.
OK, reading again, you mention "basic activity" at the start, which is reasonable, in contrast with your massively strenuous starvation bike rides. If the thesis is "move around a little in order to accomplish the basic energy expenditure which is as good as it gets," then fair enough.
>You say they did little exercise
LOL, no, I didn't. You seem to have read my comment like your understanding of that study.
Moderately active hunter/gatherers consuming a massive number of calories a day for their size saw plateauing energy consumption, where increasing the activity saw a reduced climb. Again, humans are not perpetual motion machines, and anyone seriously arguing that doing more activity is magically free suffers from self-delusion.
I referred to "little exercise" relative to gluttonous people with a gross calorie excess who then add a little exercise routine and thinks they'll lose weight. They'd be massively more successful cutting calories.
This really isn't difficult to understand.
I edited a conclusion in, maybe we can agree on it.
Incidentally, because I'm puzzled by the "perpetual motion" aspect too, another lever the body can pull is to reduce or increase energy that goes to the immune system and the brain. (But in searching for the Hadza I found https://news.ycombinator.com/item?id=47042766 "Thinking hard burns almost no calories but destroys your next workout", so it's debatable.)
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