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Getting close to a year ago, I talked about GOLO, a weight loss program that I heard about from an ad in a podcast I was listening to. I found it oddly satisfying, because they were trying to launder the standard science on CICO through explicit anti-CICO messaging; truly a beauty of capitalism. Their biggest tag line for what they think is going wrong with a lot of people was insulin resistance. Whelp, while I was at the gym this morning, what popped up in my podcast list? A two hour long Peter Attia podcast specifically on insulin resistance with MD/PhD Gerald Shulman, an academic researcher on the topic.
They talked about the prevalence of insulin resistance in the population. No, it is not obscure. Obesity basically causes it directly, and yeah, the population obesity numbers are high. They also talked about diabetes, both Type I and Type II, as well as some studies on healthy, lean young adults who had two parents with Type II diabetes and who displayed insulin resistance (i.e., at high risk of developing Type II diabetes). But yeah, lots of people do have insulin resistance, so things like GOLO are at least capturing a slice of reality, even though it's clear that they're not really specially targeting insulin resistant individuals. They're not testing people for insulin resistance and then tailoring their program accordingly; they're again just laundering the standard advice and giving it to all comers, whether they're actually insulin resistant or not.
They talked a lot about molecular mechanisms, evolutionary explanations, etc., in great gory detail, far more than I could do justice trying to reproduce here. I'll hopefully suffice by describing one concept; they distinguish between insulin resistance in muscle versus what happens in the liver down the chain (which can cause fatty liver disease, which is now working its way up to being one of the leading causes of death or other conditions that cause death). Apparently, many folks develop muscle insulin resistance, so glucose is not able to be deposited in muscle as glycogen, so it ends up in the liver, and all sorts of problems follow.
What can we do about this? "Exercise reverses this muscle insulin resistance ... exercise in muscle actually will prevent fatty liver and liver insulin resistance". [EDIT:
They talked about a couple different studies, butUpon further review in the comments below; I think this part was just one study. They did talk about other studies generally, but I had interpreted this section as referring to two different studies, but now I think it refers to just one] remember that population of otherwise healthy, lean, young adults with parents who have Type II diabetes? They had them do a singleboutsession of exercise (45min3 sets of 15min at 65% VO2Max), and that was sufficient to open up the necessary translocation pathway, resulting in "more glucose deposition as muscle glycogen and significant reductions in [something too technical for me to try to explain in this comment] and significant reductions in liver triglyceride."What about beyond that population, thinking about just other obese people? "What can we do about this? If we can get our patients to lose weight; this of course is the best. Diet and exercise of course is the best thing, and that's the first thing I tell my patients. We really drill into them how we can really fix everything that's wrong with them through this process. [Emphasis added; italics felt true to the audio; bold is my own focus]"
We know a lot about how this works. We know how to fix it. Exercise still is the single most effective medical intervention we know of. If exercise were a pill being prescribed, it would be hands down the most effective thing for all-cause mortality. Paired with diet, it's basically a superpower against a vast swath of modern maladies. Doctors know this, they know how it works and why, they've known this for a long time now, and they'll say it in public. Some, like this guy, will even say it so bluntly to patients. But many doctors know that patients don't want to hear it. They don't want to hear the science; they don't want to "follow the science" (i.e., actually do the thing). He also mentions that even though they try to drill this into patients, many of them still just don't do it. Patients get annoyed with doctors telling them the truth, and this results in a lot of doctors giving up and not even telling them anymore. Just avoid the topic. I had one obese friend tell me that she practically begged her doctor for advice with her weight, and he said, "You know, you're just getting older..."
You don't have to believe the GOLOs of the world. You don't have to believe the sign on the gym swearing that they'll help you lose 20lbs in 30 days. They're grifting, and they're helping to confuse many many people about how their bodies work. But the evidence is pretty solid that basically whatever the excuse is, in this case insulin resistance, the most well-documented and scientifically-supported solution is still diet and exercise.
I want to hear the science. I want desperately to do the science. But opportunities keep disappearing. I’ve become quite bitter, actually.
In early 2000, I had a job where I could eat as much salad as I wanted, for free. I got a Torso Track from late night TV and dropped from 210 to 190 in a single summer. I was in the best shape of my life. Then I moved on from the dishwashing job with free salad to custodial at a gym. I wasn’t allowed to use the equipment, and ironically, I got bursitis of the knee while kneeling to wipe the floor mats under the machines and impingement of the shoulder from all the mopping. I could not use my Torso Track anymore. I went over 210, because I now had muscle weight and a bigger frame to hang fat on.
I had a nightmarish two decades of codependency and sedentary jobs, piling on the weight of another small dog, never making 25% more than minimum wage for Albuquerque despite the dollar amount of my wages rising; trapped in the inflation trap.
I joined a gym with a pool in January 2020, free to me because of the ACA’s gym benefit, planning on swimming my way down from my now larger weight. Then COVID LOCKED THE GYM DOORS.
When I got a new job after the lockdowns lifted, my new schedule included time on Tuesdays and Thursdays after work to go to the YMCA, and I started doing so. Then my schedule shifted again, and I couldn’t anymore. My membership has languished.
Then I saw the 2022 film The Whale in theaters, directed by Darren Aronofsky and adapted for screen by Samuel D. Hunter, the original playwright. The film stars Brendan Fraser, an actor I admire, whose struggles I’d read about. It was like a punch in the gut. I joined an anti-obesity twelve step program and started learning why I had spent twenty years making excuses and drowning my sorrows in calories. I was actually doing things differently with my food consumption, and moving away from seeing overeating as an inevitability.
I had developed an eating plan and started to use it. Then I got a medical issue because I was trying to help someone move a cabinet, and I could no longer use that eating plan, nor is it safe for me to exercise much.
Oh, and I could have afforded GLP-1 after I finish paying off my car this autumn, but my living situation is going to change and the cost will rise by the amount I’ve been paying for my car.
I can’t hear the science over the racket of all my spoons being constantly taken.
I sympathize. I'd love to help, but I can't quite tell from your comment the reason why you can't use that eating plan, so I can't really do much to help point you in the right direction to create a new one that will work for your new situation. I'm not asking you to disclose your medical issue, and I really don't need to know in any way. But you'll likely need to find someone who you can be close enough to to talk about it with and work out a game plan for the future that fits your individual scenario.
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