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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.
Things like this are why I sort of support things like Keto or Paleo. It seems that the main trick is to get people to eat fewer calories (and less processed foods at the same time) while not making it feel like eating less food. Keto and Paleo do this by making people eat rather filling foods that take a while to digest which, while it would lower insulin because you aren’t spiking sugar ten seconds after you eat, also keeps your stomach full longer so you don’t want more food too quickly.
I think the reason that people used to be thinner is at least in part that up until the advent of TV, computers, gaming and the internet, social activities were far more active— recreational sports leagues, roller skating, swimming, dancing, going for walks. People were not overtly exercising the way we think about it, but they were so naturally active that they likely got the equivalent of a workout every day just from the extra walking, the active social activities, and fun sports leagues that kept people busy before we decided that we could socialize over the internet from the couch, and before play devolved into mashing buttons on an Xbox while trash talking over a headset.
I don’t think modern entertainment is bad per se, but I think one rather long term solution to the exercise thing is to stop making it a separate thing to do outside of normal life and more of a side effect of normal living. The biggest problem I see in the exercise thing is just how not fun it is. Playing basketball on a court with your buddies is fun. Going to a gym to do sets is work. Taking your SO on a date and going dancing is fun. Aerobics is work. If we had those kinds of things cheap and available and not segregated by skill level, I think there’s a good chance of people losing more weight. As it sits, I’m watching youth league sports and it’s so competitive so quickly with so much of a time energy and money commitment at very young ages that it’s forcing kids to stop playing sports at very young ages and they just never get to enjoy being physically active. My nephew started with select sports at age 8. And for all the kids that aren’t good enough to do that, they end up not being active in sports because of the lack of church leagues or rec leagues. It’s insane. Our biggest issue is people not being active and we force kids to stop being active by 8-10 unless they’re rich enough for traveling teams and good enough to make those teams.
Same, but for me it's fasting, intermittent or otherwise. The easiest way I've found to cut caloric intake without much effort or unhappiness is to just skip 1-3 meals. I've found that once you've done it a couple times, it becomes pretty easy to avoid getting "hangry", which is the main objection friends have given me when I recommend it. "I could never do that, I get so horrible to be around when I skip a meal."
There's a ton of science about fasting being good for you (e.g. it's great for insulin resistance), and I think it makes sense from an "is it lindy" perspective. Certainly our hunter gatherer ancestors didn't eat three meals a day everyday, so it makes sense to me that our bodies would be optimized for skipping meals.
I've fasted for as long as four days. Longer fasts like that are definitely much more difficult, not because of hunger (you more or less stop being immediately hungry after about 24 hours) and more because you have to deal with some physical weakness, imbalanced electrolytes, things like that. Definitely well worth doing, I strongly recommend it, but definitely much more difficult than just fasting for a day or less.
This does not fit my experience at all. I also did a 4-day water fast once and my hunger slowly grew from a 6/10 on day 1 to a 10/10 on day 4. That is to say, from self-torture, to completely unbearable.
Very interesting, that wasn't my experience at all. After the first 24 hours it was mostly a vague "yeah I could definitely eat" rather than the acute "damn I'm hungry". That made it easy for me to gently titrate up my first meals, what did you do for your first meals after, how did that go?
On the night of the 4th day, at 3am, I couldn't get to sleep no matter what I tried. So i went into the kitchen and binged so brutally that I nearly fell into a coma. I can't tell you exactly what I ate but I would summarize as "whatever the hell was inside the fridge and contained carbs".
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