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by dcolkitt 2217 days ago
> fasting, intermittent fasting, keto, carnivore etc diets.

To preface, I'm a long-time intermittent fasting, and tend to eat fairly carnivorous (though supplement with a lot of vegetables and legumes). But none of what you've listed is a silver bullet.

The research is pretty conclusive that the proximate cause of all metabolic disease is caloric intoxication.[1] Regardless of the timing and consumption of calories, if a person continuously has an excess energy balance they're at risk of metabolic disease. In particular, the more dogmatic proponents of keto are refuted by the fact that some hunter-gatherers, like the Hazda, consume up to 50% of their calories from simple sugars. And like all hunter-gathers, they have virtually zero incidence of metabolic diseases.

That isn't to say that diet isn't important. Excess calories are the proximate cause, but the type of food being consumed ultimately influences satiety and therefore overall consumption. In particular, the highly processed, hyper-palatable, easily digestible, highly convenient, hyper-varied, calorically dense food found in the industrialized West makes it extremely easy to overeat. In some sense, we're literally getting fatter because our food is becoming more delicious. Quoting the famous Matt Crowley tweet: "We take it for granted today, but a single Dorito has more extreme nacho flavor than a peasant in the 1400s would get in his whole lifetime."

Low-carb, low-fat, intermittent fasting, six small meals a day, no eating after 6, cleanse detox, vegetarian, carnivore, keto, high-fiber, high-protein, gluten-free, etc. They all seem to work to a certain extent, even when they directly contradict one another. And that's largely because any arbitrary restriction on food consumption decreases variety (fewer options), reduces convenience (arbitrary rules makes it harder to eat take out), and lowers palatability (many recipes require substitutions or removals that ruin the taste).

The upshot is that the older and more popular a fad diet becomes the less effective it will be. When enough of the market's on a diet the food industry will figure out how to make hyper-palatable that still conform to the rules.

[1] https://www.stephanguyenet.com/why-the-carbohydrate-insulin-...

2 comments

Bingo! This post is what I wish every person was taught about health. It always goes back to calories in/calories out...
How do you explain slim people in the west getting type 2 diabetes? While it is associated with obesity it happens to slimmer folk too. They are not consuming too many calories which would imply its related to the kinds of food they are eating.
Is there a statistically significant number of slim/fit/healthy people "in the west" getting T2D?

Because, like most things, genetics and environmental factors do play a part, even if it's a small part.

There was an article recently on the front page of a founder of an AI company finding out that he has cancer throughout his body and a massive blood clot next to his heart.

He was super fit and had a very low resting BP, and no previous signs of any of this. Complete surprise to him.

However, this is not the norm, and neither is otherwise healthy people suddenly waking up to find they have T2D. There is conclusive evidence that key factors (like weight gain, visceral fat etc) play in severely increasing the risk of T2D.

I understand and I'm opposed to things like fat shaming, especially in light of people actually having hormonal issues that they struggle to control. It makes no sense to point out these people as problem actors because they didn't bring it upon themselves.

But I know for a fact, witnessing myself how people gorge on junk food and massively sugary starbucks drinks around me, that no, a good portion of those fat people have no hormonal problems - they're fat because of terrible lifestyle choices, and put themselves at risk not just of T2D, but of every other problem from head to toe.

Half the country doesn't get declared "obese" because of some mysterious disease that is genetically passed on from their parents or grandparents. They get declared obese because mega corps en large advertise and sell them shit to eat from a very young age, and parents find it hard to eat healthy themselves.

> I understand and I'm opposed to things like fat shaming

and then we jump right into it

> witnessing myself how people gorge on junk food and massively sugary starbucks drinks around me, that no, a good portion of those fat people have no hormonal problems

Interesting you brought up genetics earlier in your comment but then ignored it when discussing the "lifestyle choices" of fat people.

It is now established that genetic variations can be responsible for a 1.67 fold higher rate of obesity [1] Just having the wrong genes means more of the calories you consume end up as stored fat, with a subsequent reduction in mitochondrial thermogenesis by a factor of 5 in those cells.

Lets stop blaming "lifestyle choices" and fat people's lack of willpower for this public health crisis and find ways to control it through meaningful interventions that address the real issues underlying the phenomenon.

1. https://en.wikipedia.org/wiki/FTO_gene#Obesity