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196 points amichail | 22 comments | | HN request time: 0.413s | source | bottom
1. jasonpeacock ◴[] No.41874143[source]
How long does this cure last until the unhealthy diet & lifestyle that originally caused the insulin resistance bring it back again?

It's frustrating, as Type 2 diabetes is 100% manageable through diet. You don't even have to exercise, just eat healthy. Today, with the use of continuous glucose monitors, you have all the data you need to make informed diet decisions - you know exactly what "eat healthy" means for your body.

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2. sctb ◴[] No.41874297[source]
Not sarcasm: I'm sure it would be frustrating to see so much scientific and commercial effort going into treating TIID pharmacologically when you believe the solution is trivial. But you could also consider all of these developments as evidence that the prescription of "just eat healthy" isn't broadly useful.
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3. jasonpeacock ◴[] No.41874379[source]
100% agree, it's a modern cultural problem. We look for drug and technology solutions because "doing the right thing" is hard.
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4. meiraleal ◴[] No.41874422[source]
> But you could also consider all of these developments as evidence that the prescription of "just eat healthy" isn't broadly useful.

As programmers, we usually prefer to remove code to fix a bug than adding patches on top of buggy code. Let's not pretend that the same logic does not apply here.

That's clearly double unhealthy behavior and will bring unintended consequences. Which might be better than the current predicament but still let's not pretend this is not a "monkeypatch".

5. nessguy ◴[] No.41874436[source]
Considering the article mentions ReCET and semaglutide, presumably most people in the study weren't resuming the unhealthy diet.

Semaglutide is ozempic. By itself it can be enough to help people get their A1C down through healthier diets.

For me to find the study especially interesting, I'd have to see a comparison between ReCET + semaglutide vs just semaglutide. And upon re-reading I see that's their plan.

> “We are currently conducting the EMINENT-2 trial with the same inclusion and exclusion criteria and administration of semaglutide, but with either a sham procedure or ReCET. This study will also include mechanistic assessments to evaluate the underlying mechanism of ReCET.”

6. baq ◴[] No.41874478{3}[source]
GLP-1 drugs don’t make you burn fat, they make you eat healthy (or healthier, at least). That’s why they’re so amazingly effective and the reason why is even more amazing - they hack your reward subsystem.
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7. mapt ◴[] No.41874524{3}[source]
When you say "it's a modern cultural problem", do you mean, as most people appear to mean, "This is not a social problem worth solving, these people deserve it for their moral failings, and their death is a useful example for the rest of us"?

Most people don't actually say it out loud, but this is all directly implied by the "personal responsibility" retort that is wildly popular among people who don't actually suffer from a given malady, in response to attempts to address it collectively.

replies(1): >>41875161 #
8. waldrews ◴[] No.41874534[source]
s/Broken ankles are 100% manageable by not walking where you could slip and fall. If only today's society made informed decisions about their walking habits, we wouldn't need all these artificial casts and surgeries. How long does a cured ankle last till the lifestyle of walking around breaks it again?/
9. stavros ◴[] No.41874622[source]
Well, shit. I can't believe it never occurred to these obese people to just eat right!

You, sir, are a modern messiah. Well done.

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10. nradov ◴[] No.41874681{4}[source]
GLP-1 drugs seem to increase resting heart rate. I suspect that also increases total daily energy expenditure, although I don't know that we have reliable data on that yet.
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11. rootusrootus ◴[] No.41874769{5}[source]
That can happen, but is not universal. My resting heart rate has been dropping (probably in lock step with my weight), it has not risen one bit since I started taking tirzepatide. And my heart rate variability has been trending up, not down.

Why do you suspect it changes energy expenditure?

12. soganess ◴[] No.41874945{3}[source]
Friendly fwiw: Your parent clearly does not think it is a "modern cultural problem":

  > "when _you_ believe the solution is trivial" (emphasis mine)
They were trying to start a polite dialogue with you by displaying that they could see things from your purview. Probably with the hope of building common-ground that would, in turn, invite you to maybe see the other side:

  > "But you could also consider..."
Perhaps reconsider their olive branch?
13. s1artibartfast ◴[] No.41875161{4}[source]
not OP, but I agree it is modern cultural problem and a personal responsibility problem.

However, I dont agree with your supposition following from that.

I think that obesity is a symptom of a cultural problem worth solving, not an individual moral failing, and there are better ways to learn than death.

There are lots of things in our culture that result in physical and mental sickness. It is good to treat the symptoms, but we should also pay attention to the cause.

Culture operates both at the individual and collective level. One can not exist without the other. One can not change without changing the other. Personal beliefs and actions shape collective culture, and culture shapes personal beliefs.

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14. s1artibartfast ◴[] No.41875220[source]
>How long does this cure last until the unhealthy diet & lifestyle that originally caused the insulin resistance bring it back again?

Not Sarcasm:

1) We simply don't know. Effects seem durable while people take the drug, but we have limited long term data. We dont have large populations that have taken it for 10 or 20 years

2) When people go off GLP-1 drugs, about 50% of them bounce back to their original weight or gain more. about 50% of people hold steady or go on to lose more weight.

This demonstrates that individual behavior and actions play a critical role, even for people who have taken the drug.

15. Spooky23 ◴[] No.41875363{3}[source]
We have government policy that reshaped American agriculture 70 years ago to lower the cost curve for food. That was accomplished by industrialization of food production. That drives Americans to eat the way they do.

Travel to Italy or France and the difference is shocking — both in terms of the look of the people and the quality of the food.

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16. kjksf ◴[] No.41875484[source]
A big part of the problem is that if you go to a doctor with diabetes, 90%+ he will tell you to use insulin. He won't tell you to loose weight and go on keto diet.

Still popular opinion is that eating meat and fat is bad for you (heart attack) but no many understand that eating sugar and carbs is a highway to diabetes).

In fact many people who go on keto and reverse diabetes report that doctors instead of congratulating them and telling other patients to do the same, tell them that keto diet (i.e. eating lots of meat) will give them heart attacks.

Most people don't know how bad sugar and carbs are because no one tells them.

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17. s1artibartfast ◴[] No.41875538{4}[source]
There are also very relevant cultural differences between the French and Americans. It is not just the food on the shelves, or price, but healthy attitudes and behavior around eating and life in general.

The average American is 50% richer than the average French, and have access to everything they need to eat like one if they choose.

In fact, much of the difference is the French choosing not to eat - both in terms of frequency and quantity.

Healthy food attitudes can absolutely be learned and taught. If you see a 200lb 10 year old, the difference between them and their classmates isn't the contents of the supermarket. Its what is going on at home, the actions of their parents, and what they are learning.

I say this not to blame or pass judgement, but to demonstrate that induvial behavior and actions matter.

18. rootusrootus ◴[] No.41875626{5}[source]
Biologically, obesity could be seen as a win.

It is the natural consequence of the human body's strategy for finding enough sustenance to drive that big brain over an evolutionary timeline that was mostly dominated by scarcity.

We like to call it a disease because we want to live longer. But all of the consequences happen after most humans have procreated, so there is no evolutionary pressure[0] to change it.

[0] Yes, I understand evolution isn't quite that simple

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19. nradov ◴[] No.41875928{6}[source]
Obesity reduces fertility for both sexes. This is one of the factors behind declining birth rates.
20. buu700 ◴[] No.41876030{3}[source]
Just to expand on this and clarify one point, as someone who's been keto for over 12 years, the meat part isn't even necessary. Nowadays I pretty much get all my protein from mycelium (Meati cutlets and Quorn grounds), eggs, and whey protein isolate, with plenty of healthy* saturated fats from butter, coconut milk, and heavy cream. Not that I'm a strict vegetarian, but I generally don't buy meat to cook at home anymore and no longer consider it important for a well-formulated keto diet.

I point this out because I've gotten the impression that many seem to view keto and veganism as opposite sides of a "culture war", and use that to justify reacting to one or the other with hostility. In reality, they're entirely orthogonal. One is a range of macros while the other is an ethical philosophy, and they aren't in any way mutually exclusive.

*: To preempt the usual comments on this, my current LDL is 54 and HDL is 57. At its lowest point a few years ago, my total cholesterol was exactly 100. I don't buy that saturated fat is necessarily unhealthy at all.

21. dazc ◴[] No.41876467[source]
In the UK, a continuous monitor costs around £100 a month and isn't available on prescription for type 2 patients. This can be a major problem for many people who may already be suffering a drop in income due to ill health.

I agree they can be a game changer for managing the condition though and, for me, it's money well spent.

22. dazc ◴[] No.41876482{3}[source]
No doctor is going to lose their job as a result of following established guidelines.