Paywalled, but I recently listened to one of the vegan doctors (I think it was McDougall) talking about these. It’s pretty crazy stuff.
Also, as an aside, it’s amazing to me the lengths to which people will go simply to avoid changing their habits.
My endocrinologist has plant-based diet material all over her office. She tells her patients that she’d be out of a job if everyone would eat a healthy (McDougall, Gregor, etc) plant-based diet. Almost none of her patients follow her dietary advice.
Eggs are my 1 exception (although I usually throw away the egg yolk - that's where all of the cholesterol is, and the primary reason for eating vegan for me is to reduce cholesterol consumption). My typical breakfast is 3-4 eggs, with the yolk from only 1. A single egg yolk contains ~70% your daily cholesterol needs. Before going vegan I'd eat a 4 egg omlet with cheese, which would be 250%+ daily cholesterol consumption at breakfast, not including whatever meat I had for lunch/dinner.
Fish, too. I have a few vegan friends, and fish is the 1st food they reintroduce when cycling off the vegan diet.
Remember no one says you can't make exceptions while dieting. For example, the rules I set for myself are pretty simple "when at the grocery store, only buy vegan foods" but "when eating at a restaurant, no limits!" - I find this is the perfect balance for me, and makes going out to eat very much a treat compared to eating at home!
Maybe the difference is I'm not vegan or vegetarian for philosophical reasons, purely health reasons.
I don't really care what the label is to be honest, it's just how I eat.
Vegetarian is probably closer to being more accurate. But then again I will happily order a steak at a restaurant. So maybe I don't deserve any of these labels at all :)
A better way to put it is I prefer eating vegan rather than I am vegan
Yes, I understand there is a label for a diet that includes fish and not other animal protein.
But my point is that people more or less ignore that there are specific labels with clear meanings and go for labels that have a vibe that they like, regardless of their accuracy.
Like 'vegan' has a philosophical overtone, it isn't just a label for a plant based approach to eating, it's a strict approach rooted in a rejection of (at least perceived) animal exploitation. So someone that eats plants most of the time and grabs the occasional steak as a treat isn't really anywhere close to vegan.
You're missing out if you're not having whole eggs. They're a rich source of choline and other vitamins and minerals. I wouldn't say 4 a day, but 1 or 2 a day isn't bad. Egg yolks are much better for you than cheese, which isn't very nutritious.
It's sadly ironic you're being downvoted for suggesting prevention. It could be effective but there is no way to patent it. There's simply not enough profit in prevention.
To your point, a high percentage of physical health, as well as some memtal health, could be prevented with changes to dirt and lifestyle. Americans have been (falsely) led to believe their diseases are common everywhere. That's simply not true.
We increase demand and yet expect healthcare costs to fall. Not doubt, the healthcare system could use a makeover, but it's not the HC system's fault the American diet and lifestyle are so pro-ill health.
We never had a drug to treat obesity so y’all were “there’s no medicine so it’s not a disease, you just have to eat less and exercise and stop being lazy!”
Now there’s a drug and “diet was not a marketable thing anyway!”
I suspect it's because they've shoehorned a vegan slant to it, which is unnecessary for and to some extent counterproductive to improving diet overall.
I don’t think they’re being downvoted for suggesting prevention; people overwhelmingly agree that eating healthy is the first step in weight control.
Instead, they’re being downvoted for performing a dimension reduction from “unhealthy weight” to “overeating junk food.” This isn’t the reality for many people, and that assumption (including by doctor) does more harm than good.
> people overwhelmingly agree that eating healthy is the first step in weight control.
It is an interesting thing. I know it is anecdotal but if you ask my mum how to loose weight her mental model is that you have to do more sports. That is her first reaction. And when asked what kind of sports she overwhelmingly defaults to ab crunches. (because your tummy is where you want to lose the weight, obviously that is what you need to exercise)
Now of course we know that you are not going to ab crunch your way to a healthy weight if you are eating too much. And if you try, you are most likely won't do enough exercise consistently enough to make a dent. And if you somehow do, most likely you will unconsciously adjust your caloric intake to maintain your current weight. And lo and behold my mum struggled to maintain a healthy weight all her life.
What I'm saying is that while it is indeed the consensus that eating healthy is the first step in weight control, maybe not everyone has internalised it quite yet? Of course one anecdote is not enough to say anything, but I would not be surprised if my mom is not alone in having unhelpful mental patterns about weight loss.
In fact, just the fact that you said "eating healthy" is tricky in itself. Because my mom would have said she is eating healthy! She read in an article that white sugar is bad, so she replaced it with brown. She heard that red meats are bad, so she only cooked with poultry. She heard that fats are bad, so she only used oil.
Now of course we know that in this context "eating healthy" is mostly about portion sizes. Doesn't matter what kind of sugar your pie is made with if you are eating too much of it.
What I'm saying with this is that even if "people overwhelmingly agree that eating healthy is the first step in weight control" they might have very different notions in their head what it means to "eating healthy". For example my mum would have professed that she is indeed eating healthy, after all there is plenty of vegies under all that cream sauce. (Doing this while serving you a manifestly unhealthy portion, and not even flinching.)
So we just have to be careful what it means when "people overwhelmingly agree" on this or that.
No; the downvoting comes because of the suggestion - which runs counter to much of the evidence at this point - that obesity is caused by "bad habits" rather than have real biological causes that can be treated medically.
Of course there a biological cause...intake more calories than you use and your biology will store that excess as fat. That's it. It's been that way since the beginning.
What you're parrotting is the normalizing of the idea that an individual is not responsible for their own choices for diet, lifestyle and exercise. Outsourcing such basic and foundational aspects of being human is a *very* dangerous direction.
Be careful of the false gods you're buying; be mindful of who is selling that (and how they profit from that sell).
I put on weight in the US no matter what I eat if I eat until I'm full. I naturally drift up by about a pound a year, and faster if I recently dieted. The only way to lose weight is to be constantly hungry. I will sometimes do that for a few months to get my weight under control. It then wanders back up. I've tried all sorts of diets, including plant-based, and it doesn't help. I need to be hungry all the time.
I find it easy to lose weight in less developed countries, even eating what would be considered much less healthy food in the US (fried fatty food, lots of meat, etc.). The food also tastes more, for lack of a better word, real.
I'm not sure we have any clear sense of what, in out hyper-efficient industrial food economy does this. Come to think of it, we don't even know it's the food -- could be something else environmental.
>I'm not sure we have any clear sense of what, in out hyper-efficient industrial food economy does this. Come to think of it, we don't even know it's the food -- could be something else environmental.
Food or environmental, but in a larger sense, it's likely to be some additives, is my uneducated gut-feel (pun unintended) guess. Here by additives, I don't mean only ones in food, but also fertilizers, pesticides, other synthetic chemicals, and agricultural and industrial effluents.
Applying Occam's Razor I think the main contributor for most people is probably American portion sizes. The average American eats around 3,600 calories per day, more than any other country, and way more than they need (2000-2500 unless you're regularly doing strenuous physical activity). Anecdotally a meal in America is just way bigger than in most other countries I've visited or lived in. Once you get accustomed to the larger portion size it's hard to dial it back down.
We don't need a complicated explanation, the simple factual explanation for Americans being the fattest people in the world is, they eat more calories than anyone else.
You can easily tell that’s there’s something wrong with that 3,600 calorie per day number.
3,600 calories per day is the maintenance weight for 350lbs man who exercises 1-3 days per week.
Depending on distributions there’s some wiggle room, but if the average calorie consumption were anywhere near that high you’d expect to be average weight to be about 150 lbs more than it is.
The body will metabolize the extra calories _for some time_, but eventually it will run out of coping mechanisms and it will give up, resulting in going up to 350lbs
That's why kids who grow up eating unhealthy can look healthy for a while, but eventually they look like their parents. And once the body is out of buffer, any extra calory goes straight into storage
If you eat more than your maintenance weight, you’ll gain weight. There’s not a long term coping period.
Basal metabolic rate does go down with age, but basal metabolic rate and total energy expenditure are mostly stable between 20-60. The basal metabolic rate of a 60 year old is about 120 calories less than that of a 20 year old. And actual maintenance calories are 200-300 lower for people with low to moderate exercise.
What happened is that the kid is either eating more, or is exercising less.
A normal 20 year old who isn’t an exercising a significant amount can’t regularly eat 3600 calories and maintain a healthy weight. That is to say, the average 20 year old with a healthy BMI who exercises 1-3 times per week will gain somewhere around 2 lbs per week eating 3600 calorie per day. They’ll gain less over time if they don’t start eating more as they get closer to 350lbs because their maintenance weight will go up.
also, metabolism and genes play a role, the latter which determines the former. people with good genes can increase metabolism to keep weight the same despite eating a lot more than needed, without becoming obese.
Biology is certainly a factor. BMR varies between individuals (even of the same weight and body composition). However it’s probably a smaller factor than the genetic influence on hunger and satiety.
And despite individual variation in BMR, I haven’t heard any evidence that some people have the ability to significantly ramp up their metabolism in response to consuming more calories.
This is my observation as well. I lived for a few years with one of the lowest obesity rates in the world - Vietnam. The diet isn't necessarily that much more healthy - it's super carb heavy.
But portion sizes are very small. Workers doing heavy construction work will have a large bowl of pho for lunch. That's like 400-500 calories. They are super lean and muscular.
Vietnamese ppl can carry a lot of abdominal fat--visceral fat especially. bmi can be misleading for these people. and a lot of big stomachs there too. the thin limbs and short statures can create the false illusion of thinness
> Applying Occam's Razor I think the main contributor for most people is probably American portion sizes.
That's not an answer, though. Or at least not a root cause.
Why are American portion sizes bigger?
Why do I need to eat more American food to be satiated?
In China, I'm regularly taken out to banquets, where people stuff themselves until they can't eat anymore. I do too. I still lose weight. Other places, we feast too. I'm then full for a long time.
In the US, I'm back to hunger pangs a lot more quickly.
Not sure about your individual situation, but I bet American businesses are better at engineering satiety than Chinese ones, because they've had more time to apply more expertise to it.
What does it mean to engineer satiety? An example is Doritos, they are a food which has been very effectively engineered to compel more consumption without making you full. More consumption and less satiety equals more revenue. Lots of American junk food is engineered with this principle in mind.
A roast duck with some rice and vegetables or something at a banquet will have much better satiety per calorie than Doritos and Hot Pockets, or most typical fast food meals, probably even fast casual meals etc.
In theory, I knew all of that... but I never quite put two and two together.
That's very insightful.
What I don't quite understand, though, is the lack of satiety even from American food not engineered like this. There's a big difference between basic foods like meats and vegetables between the industrial crops of the US and ones from local farms in less industrialized countries.
My hypothesis -- with zero evidence -- is that industrial foods are lower on some nutrient my body needs, and my body wants to eat to get enough.
Protein is notably declining across staples. Protein is not substitutable like carbohydrates. Meaning that your body will trigger you to eat until you get enough protein. Conversely, if you have an abundance of protein and the various micronutrients or vitamins your body can happily convert protein to carbohydrates via ketogenesis. One can subsist on a nearly complete protein diet so long as nutrient deficiencies causing diseases like scurvy are addressed. The same is not true of fat or carbs.
obesity is common elsewhere too. not just an American problem; it is even common in Nigeria now. also even people with normal BMI can still have a lot of abdominal fat, as sometimes seen in south and east Asia.
IDK if it is universal but once I hit 20s I gained weight rapidly despite eating same. Most of my friends gained weight too. Obviously puberty ends and metabolism drops but I feel like for me it's on the drastic end. For me to stay lean and not skinny fat means either eating not the tastiest food like lots of vegetables or being in the state of slight hunger for the rest of my life.
It feels like there is a pick 2 situation between lean body, being full of energy and being satisfied by food
yeah look at almost any celebrity. Despite $ for personal trainers ,chefs, and nutritionists, many still put on fat with age. seems inevitable. same here started gaining weight after being stable for so long. i know my activity level did not change much.
For me it is more like a pound a week when I visit my relatives. I am the bread has sugar in it. Initially everything tastes way too sweet but if I stay for 3 weeks or so I find the opposite when I get back home to Austria
> I put on weight in the US no matter what I eat if I eat until I'm full.
I’d put money on this not being the case with McDougall, if you follow it strictly. I’ve known several dozens of people personally who have switched, and he has a few published papers on many hundreds of patients. You eat as much as you want. It’s quite hard to keep the pounds on until you hit some natural base weight. (I had to add some fats back into the diet after a while because I otherwise look too thin.)
It should be noted, if you’re on insulin, you need to see a doctor when starting the diet, because you’re likely to need to reduce or eliminate your insulin pretty quickly. Same is true for blood thinners, blood pressure meds, and a number of other drugs. If you’re on a lot of meds, it’s probably worth going through his 12 day program.
I’m unaffiliated— just have personally seen the reversal of supposedly genetic disease and am a fan.
> Also, as an aside, it’s amazing to me the lengths to which people will go simply to avoid changing their habits.
I couldn’t agree more on this point.
I lost ~110 lbs in a year, exciting obesity by eating only meat and dairy with vigorous exercise.
I’ve been able to maintain the weight loss for 2 years, even after entering carbs back into my diet. I gained back 10-15 lbs depending on the week but I’m still at a healthy weight.
It was easy. No side effects. It was cheap — I largely stopped eating out. I feel way better overall everyday.
For interventions that work across populations we need to find things that work for millions of people.
It’s good that you are able to do this. I think that’s a great accomplishment and you should feel proud. The challenge is figuring out how 100 million people can. It’s obviously not easy based on how many people struggle and fail.
The hard part is the switch in attitudes and behavior that is very difficult to initiate and maintain.
Saying “I did it through willpower is easy since I did it” is about as accurate and useful as saying “World peace is easy because the Dalai Lama did it through willpower.”
We can take 1,000 people and test out your method vs. semaglutide and see which one has the bigger impact. I’m willing to bet that the semaglutide group will have a greater change.
> it’s amazing to me the lengths to which people will go simply to avoid changing their habits.
You think people are just choosing to not change habits?
Do you also dislike people taking PrEP [0] because they could just change their habits?
If anything this drug has shown is that habits and biology are so intertwined.
“Following dietary advice” is very hard, as evidenced by the 2/3 of the US who are obese or overweight (and the 50% of Western Europe).
It’s also hard to follow economic advice, as evidenced by not everyone making $250k/year.
Similarly, if there was a new drug that cost $10k/year that made people make 30% more annual income, people would definitely take that instead of just studying harder or whatever advice they could follow to increase income.
That "not changing habits" thing has nothing to do with Ozempic. Based on my experience with the drug (taken six months for type 2 diabetes), you won't lose any weight at all on it UNLESS you change your habits. What the drug does is make it easier for you to change your habits!
> What the drug does is make it easier for you to change your habits!
This is the entire point. The medication exists to change behavior. That’s why this medication exists and the habit changes are possible because of the meds.
It’s like saying that depressed people just need to change their habits. And their anti-depressant meds just make it easier to change habits. But that the meds have nothing to do with habits.
Huh. Judging from the replies here, maybe the diet angle isn’t as common knowledge as I thought. If you think the science is unclear on this, I recommend listening to / reading Dr Caldwell Esselstyn, Dr McDougall, and Dr. Michael Greger (nutritionfacts.org). The latter has a non profit that reads 60k research papers annually and produces videos and materials explaining the findings.
I know but it seems overstated? I don't see a ton of articles saying "latest increase in oil prices is affecting Denmark's economy" despite it having a lot larger effect?
Reminds me a bit of the Covid-Vaccine from Biontech. The small (220K inhabitants) City of Mainz was able to pay all it's debts within one year just due to the Taxes paid by them. And it shifted the state of Rheinland-Pfalz from receiver to giver ob subsidies to other states.
We see the problem of coincidence of wants here with regard to currency transfers, and the real effects of attempting to alleviate it. National currencies just don't make sense in a globalized economy.
We have this notion that currency is managed in a super-political way. However, there is everything political with currencies and currency management. It is literally the difference on depression and labor shortage.
For me, it is weird that this responsibility is deferred from political processes and the democracy.
If a sovereign country wants to own its own politics, it also need to own its own currency.
Yes, but at the same time nobody exists in a vacuum, especially not small countries like Denmark in highly globalised economies. Collaboration on something like the Euro makes small countries more powerful and effective, and thus more sovereign, compared to adhering to some technical definition of sovereign and being all the more easy to ignore or manipulate by global and/or much larger economies.
For the small ones, cooperation bring power, it does not take it away.
> Collaboration on something like the Euro makes small countries more powerful and effective, and thus more sovereign ...
Effective, yes – just like a single party system is more effective than having multiple parties and democratic processes.
more sovereign – how? I really can't see how Spain is more sovereign managing their unemployment issues when they can not control supply of their own currency, and thus investment?
No, nothing like a single party system. Or are you saying a nation only fighting for itself is like a single party system?
Control = power x influence. The argument was that more control can be had through having a local currency. I think, for smaller countries, more control and thus more sovereignty is had through teaming up, because the cooperation is (at least in the case of the EU) democratic, and is a tool more powerful than any national tool ever could be, and therefore control is larger.
Ideally, currency should just exist and people should pick it based on how well it suits their needs.
National currencies are fine in an environment where most economies are mostly domestic, because the effect of import and export on currency availability and foreign currency exchange is miniscule. This was the environment when these national currency schemes were devised. In a globalized economy, every country has trade imbalances which means they all need to have foreign currency reserves, adjust their reserves when economics change on the ground and adjust interest rates, this is a massive overhead for every country in the world that doesn't need to exist.
> National currencies just don't make sense in a globalized economy.
If that were true, then you would happily trade your American dollars for rubles. Because it just doesn't make sense that they should be valued differently, right?
That’s certainly not something I would want to do now, but let’s assume there already was only one currency. Would Russia or whatever one country, be able to single-handedly tank the worth of the global currency? I am not an economist, so this is a genuine question.
I'm not an economist either, but my armchair take is that the value of a particular currency depends very much upon the perception that the entity who prints the currency will maintain the status quo (i.e. they won't unexpectedly go bankrupt tomorrow).
I believe what would happen with a single world currency is that it would generally be very unstable due to things like war, economic policy that proves disastrous for one or more of the members of that currency club, and as a result it would become untrusted.
For instance, recall the US housing crisis of 2008-2009. This caused massive economic damage, and resulted in the United States printing money at unprecedented levels. Imagine now that the world utilized a single currency and one single nation faces a similar crisis. Would the world be expected to accept that the entire currency should be devalued due to excessive money printing simply because a small member country couldn't keep their shit in order?
To frame this idea in a simpler fashion, imagine a single person named Scott who creates their own currency. That person hands out the currency when purchasing goods and services, and later on people can come back and spend that currency in order to purchase Scott's belongings. This works pretty well because Scott never hands out currency that he isn't able to back up with his belongings.
Now imagine that there is a group of ten people who print their own currency, and you can use that currency to purchase the belongings of any of those ten people, regardless of who gave you that currency. Let's imagine that Scott is by far the richest person in that group, and Carlos is the poorest. When Scott hands out massive amounts of money for legitimate goods and services, that money can now be spent amongst any of the ten members. Let's imagine that someone decides to spend that money to purchase the belongings of Carlos. It turns out that Carlos does not have enough belongings to sell compared to the amount of money possessed by this spender. Nonetheless, all of Carlos's goods are purchased in one fell swoop (before inflation even has a chance to show itself), and Carlos now has zero belongings.
Now imagine that instead of being a person, Carlos is a country. No one living in that country would be able to purchase goods anymore, because they were bought out. This would result in ridiculous inflation (meaning that the purchaser of those goods received a massive discount compared to the real value of the goods purchased in that place), and the country's economy would essentially be broken with no fix on the horizon as long as they continued to use that same currency.
I think it's important to remember that currency isn't just printed paper, but a promise that you can redeem that paper for goods and services. When an entity is no longer able to provide goods or services then the currency that entity uses loses value because it cannot be trusted to be redeemable in some places. If that currency happens to be the common currency used by the rest of the world... well, sucks to be the rest of the world I guess.
Keep in mind that when a country which uses their own local currency experiences economic problems, they can still purchase more reliable currency using their unreliable currency, and then purchase goods from that place reliably (even though that other country won't be able to do the same). Because the other country cannot reliably purchase goods from the economically compromised country, they will impose a very high exchange rate based on the risk that the exchanged currency will not be redeemable. This is the essential quality that local currencies possess, an exchange rate. Exchange rates are what keep global currencies sane, and based in reality.
TLDR: The value of a currency depends upon the ability for holders of that currency to redeem it for goods and services. The reason the dollar is strong is because goods and services from the United States can be reliably purchased using the dollar. If t...
I disagree with the OP big time. A single currency has benefits (ease of transactions across the globe, elimination of currency risk, etc) but it also has significant downsides, as we saw during the 2007+ financial crisis where countries like Greece couldn’t use monetary policy to help reduce the burden their economies were facing.
But saying that we should switch to a global currency does not mean one thinks different national currencies are the same. In fact, it very much implies the opposite, because then you already essentially have a global currency in all but name.
That's nothing like what I said. If you don't understand what I mean just ask. I haven't argued that all national currencies are equivalent in value and interchangeable, nothing I said can reasonably be construed to imply that.
This is, btw, exactly the reason why the interest rates are pushed down as a consequence of Novo having success.
If the Danish central bank did not need to maintain this peg, they'd probably just let the value of the DKK increase relative to the USD – instead this manifests as more expensive housing in Denmark as the interest rates are kept artificially low.
> If the Danish central bank did not need to maintain this peg, they'd probably just let the value of the DKK increase relative to the USD – instead this manifests as more expensive housing in Denmark as the interest rates are kept artificially low.
Assuming the majority of purchasers of Danish housing are made by those who are paid in DKK, so this is in fact keeping the prices low.
Because if the value of 1 DKK relative to a euro declines, they will need to spend more on imported goods, travel, etc., and therefore less income for a potential mortgage.
I don't think you entirely understand the situation.
The DKK is pegged to the EUR at 750 +- some percent. This means that the Danish central bank has large foreign currency reserves to adjust the value of the DKK when trade create imbalances.
As I wrote:
> It is soft pegged and has leeway.
> This is, btw, exactly the reason why the interest rates are pushed down as a consequence of Novo having success.
Currently the Danish central bank runs with an interest rate that is lower than the EUR-zone to protect this peg. Ie. it is cheaper to borrow money in Denmark and the DKK/EUR rate is constant.
The reason that it is actually not more expensive to buy housing in Denmark is because of the rather unique martgage system we have (we trade mortgage bonds directly in the market) and laws regarding vacant housing (it can not stay vacant).
Ok but look at what they have to do to maintain the peg. It requires active management by teams of experts and government employees and massive amounts of capital reserves, just because the country contains a business that sells products to America. This is a symptom of the coincidence of wants problem, except between economies under national currencies rather than individuals, a problem you would not have if either globalization were not a fact or national currencies did not exist.
We don’t have a global economy. Compare the ratio of foreign vs domestic trade globally and countries largely cycle money internally. It does vary with very small countries having more foreign trade, but they also don’t necessarily have an independent currency.
Yes, most commerce in any particular national currency is domestic. But the amount of capital reserve a treasury or central bank needs in foreign currencies scales with the percentage of their commerce that is import and export. If less than 1% of trade is with external economies, that's not too big of a deal. If 10% is, that's a huge amount of capital that has to be taken out of productive use and put towards purchasing foreign currency to stick in a vault. It doesn't have to he the majority, it just has to be a not insignificant amount to see the problem. And then any significant changes create crises like this, where a government has to scramble to purchase foreign currencies or change interest rates to adjust their currency supply, these all have impacts on the domestic economy such as inflation, deflation, unemployment etc.
Those currency reserves are offset by other countries buying up your currency to use as reserves.
So quite a bit ends up canceling out with central banks creating currency from thin air to exchange for currency foreign central banks created from thin air.
Nothing more american than self-medication using drugs that should be for diabetics, leading to both diabetics ending up in life threatening conditions because of a lack of said medicine, as well as a high likelihood of suicidal thoughts and self harm coming from the use of said medicine (https://www.ema.europa.eu/en/news/ema-statement-ongoing-revi...)
Watch as how, miraculously, every famous actor, singer, public personality that was overweight suddenly got thin because they decided to just "start exercising" a year ago, exactly as the time where Semaglutide's effects were starting to be known.
Your link makes no claim about a “high likelihood.” In fact, it more or less says the opposite:
> Liraglutide and semaglutide medicines are widely used, with an exposure of over 20 million patient-years to date. It is not yet clear whether the reported cases are linked to the medicines themselves or to the patients’ underlying conditions or other factors.
(This is besides the fact that all medicine is iatrogenic in nature: medicine is prescribed not because it’s perfect, but because the side effects it produces are considered preferable against the symptoms it treats.)
> The review was triggered by the Icelandic medicines agency following reports of suicidal thoughts and self-injury in people using liraglutide and semaglutide medicines. So far authorities have retrieved and are analysing about 150 reports of possible cases of self-injury and suicidal thoughts.
> Liraglutide and semaglutide medicines are widely used, with an exposure of over 20 million patient-years to date. It is not yet clear whether the reported cases are linked to the medicines themselves or to the patients’ underlying conditions or other factors.
I think 150 case reports (3 reports from Iceland) across 20 million patient-years, with no evidence of a causality, seems to be very far from a "high likelihood" at the moment.
Hardly my fault if the FDA is one of the most notoriously incompetent safety administrations I've seen in my life. Additionally, approved or not, self-medication is an absurdly stupid thing to do, and most users of it did not go through a doctor for it.
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[ 4.2 ms ] story [ 195 ms ] threadAlso, as an aside, it’s amazing to me the lengths to which people will go simply to avoid changing their habits.
My endocrinologist has plant-based diet material all over her office. She tells her patients that she’d be out of a job if everyone would eat a healthy (McDougall, Gregor, etc) plant-based diet. Almost none of her patients follow her dietary advice.
Eggs are my 1 exception (although I usually throw away the egg yolk - that's where all of the cholesterol is, and the primary reason for eating vegan for me is to reduce cholesterol consumption). My typical breakfast is 3-4 eggs, with the yolk from only 1. A single egg yolk contains ~70% your daily cholesterol needs. Before going vegan I'd eat a 4 egg omlet with cheese, which would be 250%+ daily cholesterol consumption at breakfast, not including whatever meat I had for lunch/dinner.
Fish, too. I have a few vegan friends, and fish is the 1st food they reintroduce when cycling off the vegan diet.
Remember no one says you can't make exceptions while dieting. For example, the rules I set for myself are pretty simple "when at the grocery store, only buy vegan foods" but "when eating at a restaurant, no limits!" - I find this is the perfect balance for me, and makes going out to eat very much a treat compared to eating at home!
It kinda sounds to me as if someone said “I’m vegetarian but steaks are my only exception”.
I don't really care what the label is to be honest, it's just how I eat.
Vegetarian is probably closer to being more accurate. But then again I will happily order a steak at a restaurant. So maybe I don't deserve any of these labels at all :)
A better way to put it is I prefer eating vegan rather than I am vegan
But you can be a vegetarian and eat fish apparently.
But my point is that people more or less ignore that there are specific labels with clear meanings and go for labels that have a vibe that they like, regardless of their accuracy.
Like 'vegan' has a philosophical overtone, it isn't just a label for a plant based approach to eating, it's a strict approach rooted in a rejection of (at least perceived) animal exploitation. So someone that eats plants most of the time and grabs the occasional steak as a treat isn't really anywhere close to vegan.
But it never says eggs and fish are unhealthy — just that a plant-based diet is healthy (which is true).
To your point, a high percentage of physical health, as well as some memtal health, could be prevented with changes to dirt and lifestyle. Americans have been (falsely) led to believe their diseases are common everywhere. That's simply not true.
We increase demand and yet expect healthcare costs to fall. Not doubt, the healthcare system could use a makeover, but it's not the HC system's fault the American diet and lifestyle are so pro-ill health.
Now there’s a drug and “diet was not a marketable thing anyway!”
Instead, they’re being downvoted for performing a dimension reduction from “unhealthy weight” to “overeating junk food.” This isn’t the reality for many people, and that assumption (including by doctor) does more harm than good.
It is an interesting thing. I know it is anecdotal but if you ask my mum how to loose weight her mental model is that you have to do more sports. That is her first reaction. And when asked what kind of sports she overwhelmingly defaults to ab crunches. (because your tummy is where you want to lose the weight, obviously that is what you need to exercise)
Now of course we know that you are not going to ab crunch your way to a healthy weight if you are eating too much. And if you try, you are most likely won't do enough exercise consistently enough to make a dent. And if you somehow do, most likely you will unconsciously adjust your caloric intake to maintain your current weight. And lo and behold my mum struggled to maintain a healthy weight all her life.
What I'm saying is that while it is indeed the consensus that eating healthy is the first step in weight control, maybe not everyone has internalised it quite yet? Of course one anecdote is not enough to say anything, but I would not be surprised if my mom is not alone in having unhelpful mental patterns about weight loss.
In fact, just the fact that you said "eating healthy" is tricky in itself. Because my mom would have said she is eating healthy! She read in an article that white sugar is bad, so she replaced it with brown. She heard that red meats are bad, so she only cooked with poultry. She heard that fats are bad, so she only used oil.
Now of course we know that in this context "eating healthy" is mostly about portion sizes. Doesn't matter what kind of sugar your pie is made with if you are eating too much of it.
What I'm saying with this is that even if "people overwhelmingly agree that eating healthy is the first step in weight control" they might have very different notions in their head what it means to "eating healthy". For example my mum would have professed that she is indeed eating healthy, after all there is plenty of vegies under all that cream sauce. (Doing this while serving you a manifestly unhealthy portion, and not even flinching.)
So we just have to be careful what it means when "people overwhelmingly agree" on this or that.
A small percentage of people do, and you see that just walking the streets. The rest are eating and lifestyle'ing themselves to an early grave.
What you're parrotting is the normalizing of the idea that an individual is not responsible for their own choices for diet, lifestyle and exercise. Outsourcing such basic and foundational aspects of being human is a *very* dangerous direction.
Be careful of the false gods you're buying; be mindful of who is selling that (and how they profit from that sell).
I put on weight in the US no matter what I eat if I eat until I'm full. I naturally drift up by about a pound a year, and faster if I recently dieted. The only way to lose weight is to be constantly hungry. I will sometimes do that for a few months to get my weight under control. It then wanders back up. I've tried all sorts of diets, including plant-based, and it doesn't help. I need to be hungry all the time.
I find it easy to lose weight in less developed countries, even eating what would be considered much less healthy food in the US (fried fatty food, lots of meat, etc.). The food also tastes more, for lack of a better word, real.
I'm not sure we have any clear sense of what, in out hyper-efficient industrial food economy does this. Come to think of it, we don't even know it's the food -- could be something else environmental.
But that's how my own body behaves.
Food or environmental, but in a larger sense, it's likely to be some additives, is my uneducated gut-feel (pun unintended) guess. Here by additives, I don't mean only ones in food, but also fertilizers, pesticides, other synthetic chemicals, and agricultural and industrial effluents.
We don't need a complicated explanation, the simple factual explanation for Americans being the fattest people in the world is, they eat more calories than anyone else.
3,600 calories per day is the maintenance weight for 350lbs man who exercises 1-3 days per week.
Depending on distributions there’s some wiggle room, but if the average calorie consumption were anywhere near that high you’d expect to be average weight to be about 150 lbs more than it is.
That's why kids who grow up eating unhealthy can look healthy for a while, but eventually they look like their parents. And once the body is out of buffer, any extra calory goes straight into storage
Basal metabolic rate does go down with age, but basal metabolic rate and total energy expenditure are mostly stable between 20-60. The basal metabolic rate of a 60 year old is about 120 calories less than that of a 20 year old. And actual maintenance calories are 200-300 lower for people with low to moderate exercise.
What happened is that the kid is either eating more, or is exercising less.
A normal 20 year old who isn’t an exercising a significant amount can’t regularly eat 3600 calories and maintain a healthy weight. That is to say, the average 20 year old with a healthy BMI who exercises 1-3 times per week will gain somewhere around 2 lbs per week eating 3600 calorie per day. They’ll gain less over time if they don’t start eating more as they get closer to 350lbs because their maintenance weight will go up.
And despite individual variation in BMR, I haven’t heard any evidence that some people have the ability to significantly ramp up their metabolism in response to consuming more calories.
But portion sizes are very small. Workers doing heavy construction work will have a large bowl of pho for lunch. That's like 400-500 calories. They are super lean and muscular.
That's not an answer, though. Or at least not a root cause.
Why are American portion sizes bigger?
Why do I need to eat more American food to be satiated?
In China, I'm regularly taken out to banquets, where people stuff themselves until they can't eat anymore. I do too. I still lose weight. Other places, we feast too. I'm then full for a long time.
In the US, I'm back to hunger pangs a lot more quickly.
What does it mean to engineer satiety? An example is Doritos, they are a food which has been very effectively engineered to compel more consumption without making you full. More consumption and less satiety equals more revenue. Lots of American junk food is engineered with this principle in mind.
A roast duck with some rice and vegetables or something at a banquet will have much better satiety per calorie than Doritos and Hot Pockets, or most typical fast food meals, probably even fast casual meals etc.
That's very insightful.
What I don't quite understand, though, is the lack of satiety even from American food not engineered like this. There's a big difference between basic foods like meats and vegetables between the industrial crops of the US and ones from local farms in less industrialized countries.
My hypothesis -- with zero evidence -- is that industrial foods are lower on some nutrient my body needs, and my body wants to eat to get enough.
Protein is notably declining across staples. Protein is not substitutable like carbohydrates. Meaning that your body will trigger you to eat until you get enough protein. Conversely, if you have an abundance of protein and the various micronutrients or vitamins your body can happily convert protein to carbohydrates via ketogenesis. One can subsist on a nearly complete protein diet so long as nutrient deficiencies causing diseases like scurvy are addressed. The same is not true of fat or carbs.
It feels like there is a pick 2 situation between lean body, being full of energy and being satisfied by food
I’d put money on this not being the case with McDougall, if you follow it strictly. I’ve known several dozens of people personally who have switched, and he has a few published papers on many hundreds of patients. You eat as much as you want. It’s quite hard to keep the pounds on until you hit some natural base weight. (I had to add some fats back into the diet after a while because I otherwise look too thin.)
It should be noted, if you’re on insulin, you need to see a doctor when starting the diet, because you’re likely to need to reduce or eliminate your insulin pretty quickly. Same is true for blood thinners, blood pressure meds, and a number of other drugs. If you’re on a lot of meds, it’s probably worth going through his 12 day program.
I’m unaffiliated— just have personally seen the reversal of supposedly genetic disease and am a fan.
I couldn’t agree more on this point.
I lost ~110 lbs in a year, exciting obesity by eating only meat and dairy with vigorous exercise.
I’ve been able to maintain the weight loss for 2 years, even after entering carbs back into my diet. I gained back 10-15 lbs depending on the week but I’m still at a healthy weight.
It was easy. No side effects. It was cheap — I largely stopped eating out. I feel way better overall everyday.
It’s good that you are able to do this. I think that’s a great accomplishment and you should feel proud. The challenge is figuring out how 100 million people can. It’s obviously not easy based on how many people struggle and fail.
The hard part is the switch in attitudes and behavior that is very difficult to initiate and maintain.
Saying “I did it through willpower is easy since I did it” is about as accurate and useful as saying “World peace is easy because the Dalai Lama did it through willpower.”
We can take 1,000 people and test out your method vs. semaglutide and see which one has the bigger impact. I’m willing to bet that the semaglutide group will have a greater change.
You think people are just choosing to not change habits?
Do you also dislike people taking PrEP [0] because they could just change their habits?
If anything this drug has shown is that habits and biology are so intertwined.
“Following dietary advice” is very hard, as evidenced by the 2/3 of the US who are obese or overweight (and the 50% of Western Europe).
It’s also hard to follow economic advice, as evidenced by not everyone making $250k/year.
Similarly, if there was a new drug that cost $10k/year that made people make 30% more annual income, people would definitely take that instead of just studying harder or whatever advice they could follow to increase income.
[0] https://www.cdc.gov/hiv/risk/prep/index.html
This is the entire point. The medication exists to change behavior. That’s why this medication exists and the habit changes are possible because of the meds.
It’s like saying that depressed people just need to change their habits. And their anti-depressant meds just make it easier to change habits. But that the meds have nothing to do with habits.
That's such a wrong take. Try something more like: isn't it amazing that we're discovering the underlying biological causes of obesity?
I would assume that things like energy costs would have a far bigger impact.
We have this notion that currency is managed in a super-political way. However, there is everything political with currencies and currency management. It is literally the difference on depression and labor shortage.
For me, it is weird that this responsibility is deferred from political processes and the democracy.
If a sovereign country wants to own its own politics, it also need to own its own currency.
For the small ones, cooperation bring power, it does not take it away.
Effective, yes – just like a single party system is more effective than having multiple parties and democratic processes.
more sovereign – how? I really can't see how Spain is more sovereign managing their unemployment issues when they can not control supply of their own currency, and thus investment?
Control = power x influence. The argument was that more control can be had through having a local currency. I think, for smaller countries, more control and thus more sovereignty is had through teaming up, because the cooperation is (at least in the case of the EU) democratic, and is a tool more powerful than any national tool ever could be, and therefore control is larger.
National currencies are fine in an environment where most economies are mostly domestic, because the effect of import and export on currency availability and foreign currency exchange is miniscule. This was the environment when these national currency schemes were devised. In a globalized economy, every country has trade imbalances which means they all need to have foreign currency reserves, adjust their reserves when economics change on the ground and adjust interest rates, this is a massive overhead for every country in the world that doesn't need to exist.
If that were true, then you would happily trade your American dollars for rubles. Because it just doesn't make sense that they should be valued differently, right?
I believe what would happen with a single world currency is that it would generally be very unstable due to things like war, economic policy that proves disastrous for one or more of the members of that currency club, and as a result it would become untrusted.
For instance, recall the US housing crisis of 2008-2009. This caused massive economic damage, and resulted in the United States printing money at unprecedented levels. Imagine now that the world utilized a single currency and one single nation faces a similar crisis. Would the world be expected to accept that the entire currency should be devalued due to excessive money printing simply because a small member country couldn't keep their shit in order?
To frame this idea in a simpler fashion, imagine a single person named Scott who creates their own currency. That person hands out the currency when purchasing goods and services, and later on people can come back and spend that currency in order to purchase Scott's belongings. This works pretty well because Scott never hands out currency that he isn't able to back up with his belongings.
Now imagine that there is a group of ten people who print their own currency, and you can use that currency to purchase the belongings of any of those ten people, regardless of who gave you that currency. Let's imagine that Scott is by far the richest person in that group, and Carlos is the poorest. When Scott hands out massive amounts of money for legitimate goods and services, that money can now be spent amongst any of the ten members. Let's imagine that someone decides to spend that money to purchase the belongings of Carlos. It turns out that Carlos does not have enough belongings to sell compared to the amount of money possessed by this spender. Nonetheless, all of Carlos's goods are purchased in one fell swoop (before inflation even has a chance to show itself), and Carlos now has zero belongings.
Now imagine that instead of being a person, Carlos is a country. No one living in that country would be able to purchase goods anymore, because they were bought out. This would result in ridiculous inflation (meaning that the purchaser of those goods received a massive discount compared to the real value of the goods purchased in that place), and the country's economy would essentially be broken with no fix on the horizon as long as they continued to use that same currency.
I think it's important to remember that currency isn't just printed paper, but a promise that you can redeem that paper for goods and services. When an entity is no longer able to provide goods or services then the currency that entity uses loses value because it cannot be trusted to be redeemable in some places. If that currency happens to be the common currency used by the rest of the world... well, sucks to be the rest of the world I guess.
Keep in mind that when a country which uses their own local currency experiences economic problems, they can still purchase more reliable currency using their unreliable currency, and then purchase goods from that place reliably (even though that other country won't be able to do the same). Because the other country cannot reliably purchase goods from the economically compromised country, they will impose a very high exchange rate based on the risk that the exchanged currency will not be redeemable. This is the essential quality that local currencies possess, an exchange rate. Exchange rates are what keep global currencies sane, and based in reality.
TLDR: The value of a currency depends upon the ability for holders of that currency to redeem it for goods and services. The reason the dollar is strong is because goods and services from the United States can be reliably purchased using the dollar. If t...
But saying that we should switch to a global currency does not mean one thinks different national currencies are the same. In fact, it very much implies the opposite, because then you already essentially have a global currency in all but name.
Likewise, if you disagree with my critique, just respond.
This is, btw, exactly the reason why the interest rates are pushed down as a consequence of Novo having success.
If the Danish central bank did not need to maintain this peg, they'd probably just let the value of the DKK increase relative to the USD – instead this manifests as more expensive housing in Denmark as the interest rates are kept artificially low.
Assuming the majority of purchasers of Danish housing are made by those who are paid in DKK, so this is in fact keeping the prices low.
When the cost of servicing a mortgage goes down, the price will go up.
How do you support that prices should go down?
The DKK is pegged to the EUR at 750 +- some percent. This means that the Danish central bank has large foreign currency reserves to adjust the value of the DKK when trade create imbalances.
As I wrote:
> It is soft pegged and has leeway. > This is, btw, exactly the reason why the interest rates are pushed down as a consequence of Novo having success.
Currently the Danish central bank runs with an interest rate that is lower than the EUR-zone to protect this peg. Ie. it is cheaper to borrow money in Denmark and the DKK/EUR rate is constant.
The reason that it is actually not more expensive to buy housing in Denmark is because of the rather unique martgage system we have (we trade mortgage bonds directly in the market) and laws regarding vacant housing (it can not stay vacant).
So quite a bit ends up canceling out with central banks creating currency from thin air to exchange for currency foreign central banks created from thin air.
https://www.newyorker.com/magazine/2023/03/27/will-the-ozemp...
Watch as how, miraculously, every famous actor, singer, public personality that was overweight suddenly got thin because they decided to just "start exercising" a year ago, exactly as the time where Semaglutide's effects were starting to be known.
> Liraglutide and semaglutide medicines are widely used, with an exposure of over 20 million patient-years to date. It is not yet clear whether the reported cases are linked to the medicines themselves or to the patients’ underlying conditions or other factors.
(This is besides the fact that all medicine is iatrogenic in nature: medicine is prescribed not because it’s perfect, but because the side effects it produces are considered preferable against the symptoms it treats.)
> Liraglutide and semaglutide medicines are widely used, with an exposure of over 20 million patient-years to date. It is not yet clear whether the reported cases are linked to the medicines themselves or to the patients’ underlying conditions or other factors.
I think 150 case reports (3 reports from Iceland) across 20 million patient-years, with no evidence of a causality, seems to be very far from a "high likelihood" at the moment.
correlation != causation
Except it’s literally approved to treat obesity by the FDA
But it is your fault for saying wrong information.
It’s also not self-medicating as, in the US at least, it must be prescribed by a doctor.