HEALTHCARE IS ALL ABOUT WHO PAYS FOR WHAT

[jaeger19]

99% isn't "a very good portion." That's nearly universal, and you're condemning 99% as effectively being fat, lazy, undisciplined slobs who don't give a shit they are killing themselves, and they know it. I do not think that is fair.

That kind of advice doesn't work. If it was as easy as that, everyone would succeed, and we wouldn't have an obesity epidemic. Do you really think 99% of the obese are unwilling to cut out one soda?

The studies show that exercise is great for lots of reasons, just not for weight loss.

Now you just STOP RIGHT THERE. pointing out that compliance is a major issue is not..In any way..saying that obese people are lazy fat slobs.
That's YOU MAKING THAT JUDGEMENT FOR THE REASON FOR NON COMPLIANCE..NOT ME.
For example your low carb high fat diet.
Did it occur to you that maybe the reason my obese lady doesn't comply with a low carb high fat diet is because her husband and kids aren't obese? And they don't want to be on such a diet and so she either has to make them a be on her diet..or she has to go to the extra time and expense to prepare to meals..one for herself and another for the rest of the famimy???
You cannot address the barriers to compliance..if you cannot even acknowledge that people are not complying.
Yes..a lot of obese are unwilling to cut one soda. For lots of reasons. It's their source of caffeine.. and they get headaches if they cut back. It's part of their ritual.
Soda is cheaper than other healthier drinks..
They have enablers at home that buy the soda for them..
Lots of reasons.
Yes exercise is great for lots of reasons..
Now find time in a busy working moms schedule for 20 minutes of exercise including cardio and resistance training.
Especially when she has knee pain..back pain..and is exhausted from work and kids.

 

[bave]

What you are talking about is "success of the individual", what I am talking about is success of the individuals. Plural!

We are thus on two different planets. Yours purely selfish, mine more open and encompassing of humanity.

Which are two alternately different "ways of living" - yours is highly self-centered malarkey and thus puerile ...

The median household income in France is nearly half of that of the US, I wouldn't talk about the screaming success of the average frenchmen.

As to your school analysis, just let me know when you see some world class students come out of France. It doesn't happen. 3 universities out of the top 150, the first being ~50th. Compared to the 102/150 for the US.

99% isn't "a very good portion." That's nearly universal, and you're condemning 99% as effectively being fat, lazy, undisciplined slobs who don't give a shit they are killing themselves, and they know it. I do not think that is fair.

That kind of advice doesn't work. If it was as easy as that, everyone would succeed, and we wouldn't have an obesity epidemic. Do you really think 99% of the obese are unwilling to cut out one soda?

The studies show that exercise is great for lots of reasons, just not for weight loss.

Yes, that is exactly what I think. Everyone knows that soda, beer, and fast food is bad for you. It is however cheap, readily available, and good tasting. They still do it even though they know they are dying. There are *reams* of medical data on this topic. None of it gets better.

 

[JasperL]

Now you just STOP RIGHT THERE. pointing out that compliance is a major issue is not..In any way..saying that obese people are lazy fat slobs.
That's YOU MAKING THAT JUDGEMENT FOR THE REASON FOR NON COMPLIANCE..NOT ME.

You say 99% fail your advice, then blame them. Well, why do they fail something so simple as cutting 250 calories a day plus a walk? They can't really care about their health if they're unwilling to try that. And this isn't some of them failing, but virtually every obese person in this country failing something as painless as cutting out one soda plus a walk. It's insulting to them. They KNOW the advice is crap, but you blame them for failing it.

For example your low carb high fat diet.
Did it occur to you that maybe the reason my obese lady doesn't comply with a low carb high fat diet is because her husband and kids aren't obese? And they don't want to be on such a diet and so she either has to make them a be on her diet..or she has to go to the extra time and expense to prepare to meals..one for herself and another for the rest of the famimy???

If you're advising cutting out one of two 22 ounce sodas per day, I know you are not seriously recommending LCHF. They are contradictory in theory and in every meaningful way in practice. The only sensible diet for someone with metabolic disease is ZERO sugar. And then you have to explain why. It's as lacking in common sense in theory as a doctor telling a patient smoking a pack a day to keep smoking, just not as much. Cut out 4 cigarettes and you'll be fine. No, you'd tell them - quit smoking! Sure, most fail the first, second, third, maybe 4th tries, but the advice is the same - keep trying. And even then 99% don't fail.

CGMs show them the impact - and then show them that reversing the disease they know damn well is killing them is not only possible, but can be done in days or weeks. They can eat a certain way and see their blood sugar rock solid for days, no drugs.

And, again, you said in an earlier post that once they get diagnosed it's too late for the T2 diabetic. That's just false. It's not too late. Doctors are 'reversing' it or putting T2 in remission, off all drugs, all over the country, and the numbers are growing. And they do it by cutting out carbs, which is actually a great way to control blood sugar, indefinitely.

Yes, absolutely, it's hard to be on one diet when the family doesn't buy in. The answer is not to then throw up your hands, but find a way to get the family on board, and there is nothing unhealthy about a LCHF diet. It's essentially - eat raw foods, but omit starchy veggies like potatoes. Everything else is fine. I don't believe 99% of families would refuse to support mom's decision, which is quite literally her life or death from a terrible disease that causes her to feel worse and worse every year, limbs hacked off, etc. then die early.

You cannot address the barriers to compliance..if you cannot even acknowledge that people are not complying.
Yes..a lot of obese are unwilling to cut one soda. For lots of reasons. It's their source of caffeine.. and they get headaches if they cut back. It's part of their ritual.
Soda is cheaper than other healthier drinks..
They have enablers at home that buy the soda for them..
Lots of reasons.
Yes exercise is great for lots of reasons..
Now find time in a busy working moms schedule for 20 minutes of exercise including cardio and resistance training.
Especially when she has knee pain..back pain..and is exhausted from work and kids.

Again, "a lot" is not 99%.

I'd really suggest you look more seriously into LCHF diets. There's a ton our there, including podcast by The Diet Doctor that interview a series of physicians and top-level researchers that I know you'll find compelling if you have an open mind. Jason Fung has a bunch of lectures online that go over the basics.

 

[JasperL]

Yes, that is exactly what I think. Everyone knows that soda, beer, and fast food is bad for you. It is however cheap, readily available, and good tasting. They still do it even though they know they are dying. There are *reams* of medical data on this topic. None of it gets better.

Show me the "medical data" if you want, such as that dieting for the obese is as simple as not eating soda, beer and fast food. You'll fail, but it's worth a try for you if you think it's this simple.

 

[danielpalos]

A lack of coverage sufficient for herd immunity is a health and safety concern for our Union; especially when only indulged by our representatives to Government through unequal protection of the laws.

We need a war on communicable diseases!

Vote blue not red!

 

[bave]

Show me the "medical data" if you want, such as that dieting for the obese is as simple as not eating soda, beer and fast food. You'll fail, but it's worth a try for you if you think it's this simple.

We have done experiments where we have given people unlimited, 100% healthcare, with large sample sizes and specifically focused on chronic issues like diabetes and obesity and saw zero improvement. That's with full bore therapy, nutrionists, specialists, everything from top down.

What do you think it is? 90%+ of the obesity is quite literally people eating too much and burning too few calories. That's it.

 

[jaeger19]

You say 99% fail your advice, then blame them. Well, why do they fail something so simple as cutting 250 calories a day plus a walk? They can't really care about their health if they're unwilling to try that. And this isn't some of them failing, but virtually every obese person in this country failing something as painless as cutting out one soda plus a walk. It's insulting to them. They KNOW the advice is crap, but you blame them for failing it.



Yes, absolutely, it's hard to be on one diet when the family doesn't buy in. The answer is not to then throw up your hands, but find a way to get the family on board, and there is nothing unhealthy about a LCHF diet. It's essentially - eat raw foods, but omit starchy veggies like potatoes. Everything else is fine. I don't believe 99% of families would refuse to support mom's decision, which is quite literally her life or death from a terrible disease that causes her to feel worse and worse every year, limbs hacked off, etc. then die early.

Again, "a lot" is not 99%.

I'd really suggest you look more seriously into LCHF diets. There's a ton our there, including podcast by The Diet Doctor that interview a series of physicians and top-level researchers that I know you'll find compelling if you have an open mind. Jason Fung has a bunch of lectures online that go over the basics.

1. Now stop lying. You claim I label them lazy slobs..now you say I blame them ..when clearly I recognize that just me giving them advice doesn't work because of barriers outside my and many ways their control.
YOU are the one making the judgment on why they can't follow my advice.
When they try to cut soda they suffer withdrawal for example and have headaches that make them less able to function.
They get home after work and don't have time to walk then after picking up the kids from various practices.. and then getting dinner ready.. cleaning the house.. helping with home work.. and by then it's dark outside..and unsafe to walk. Now if they are rich enough to afford a treadmill..
Look you need to stop. Just tell people to eliminate sugar? That works just as well as saying stop smoking.
You know what works...weaning them off cigarettes.. encouraging them when they make small changes instead of demanding a life altering withdrawal filled abstinence.
Which most will fail and then give up.
Sure some people can do it..particularly if highly motivated..like having a severe disease..and if they have a good support system.
Most don't have that.
Seriously do you think people WANT to be obese and feel unhealthy.? You think they NEED A DOCTOR to tell them to eat better and exercise? Or about low carb diets?
There are barriers to compliance.
Yes.99% of families would not support moms decision..because the ramifications are so far out in the future for most. Heck...you are assuming every obese person has diabetes. They don't.
Good Golly Miss Molly. We can't get a good portion of Americans to listen to us about vaccination for covid..
And you think obesity is easy?
Honestly..you are part of the issue.. you don't want to understand why there is noncompliance.
I get it..you are jazzed up about your success thus far with a high fat low carb diet.. but your experience and situation is not everyone's.
And don't be so sure that low carb high fat diets are all that safe either.

Low carbohydrate diets are unsafe and should be avoided

Your access to the latest cardiovascular news, science, tools and resources.

www.escardio.org

I have seen these fads come and go. And the research is usually confounded by multiple variables such as amounts..types of fats.. the benefits of weight loss other risk factors.
I have had people start low carb high fat diets and have seen their liver enzymes go haywire.

Ketogenic Diet-induced Elevated Cholesterol, Elevated Liver Enzymes and Potential Non-alcoholic Fatty Liver Disease

A 57-year-old woman with class I obesity (BMI = 31.42 kg/m[2] ) and a medical history significant for binge-eating disorder with emotionally-triggered eating, post-traumatic stress disorder, and untreated depression and anxiety, presented for follow-up ...

www.ncbi.nlm.nih.gov

 

[JasperL]

We have done experiments where we have given people unlimited, 100% healthcare, with large sample sizes and specifically focused on chronic issues like diabetes and obesity and saw zero improvement. That's with full bore therapy, nutrionists, specialists, everything from top down.

You've moved the goal posts, but I agree. It's because the 'standard' advice fails. That's my point. When advice fails 99% of patients, a normal person might look at why the advice is failing, and not blame the patients.

We know it's blood sugar (glucose) that's killing T2 diabetics. That's from eating carbs, and we need 0g of carbs per day. Fat doesn't move blood sugar at all - zero effect. Protein has a small impact. So ask your doctor buddies why the standard approach is for patients to eat about half their calories from carbs, that convert to blood sugar, that's slowly killing T2 diabetics, and requires daily shots of insulin. And the ADA tells the same T2 patients to sharply limit fat consumption, that has NO effect on blood sugar, and in fact does a fantastic job fueling our bodies. That's on their main page, but they have recently (2019) finally conceded that LCHF diets are OK for some. Nice. It's hard to find that recommendation, but it's there.

Keto diets can reverse T2 diabetes in a few days, weeks at most. Get people off drugs. Ask them why that's not a first line recommendation for T2 diabetics. LCHF diets also get us fat adapted, and the body doesn't care whether it's fat we eat or our stored body fat. There's lots of people like me who find we can lose weight nearly effortlessly on high fat diets. Skip a meal, or two, and the body doesn't much care because there's 100,000 calories in fat storage. I lost 50 pounds with very little hunger or discomfort and never counted a calorie. Skipped breakfast, sometimes lunch, then for dinner ate all I wanted, made sure I was reasonably full, satisfied.

What do you think it is? 90%+ of the obesity is quite literally people eating too much and burning too few calories. That's it.

Yeah, but saying that is to say nothing useful. For starters, it's been known for a century at least that calories in impacts calories out, so reducing calories in a typical diet slows BMR, which means more calories have to be cut to keep losing weight, which lowers BMR, then plateau, then cut more calories, etc..... And how much we eat is impacted by hunger, or our hormones, and for 10s of thousands of years, we humans maintained something like normal body weight with no concept of calories. We just ate food when hungry. Then didn't eat for a while. Then when hungry we ate again. And our weight stayed normal. Then about 50 years ago, that changed. Why did that change, here where there are a bunch of lazy fat slobs who don't care about themselves, but all over the globe? The ME has some of the highest diabetes levels on the planet. China is booming with T2 diabetics. If we don't know WHY we can't solve it. Anywhere the 'western' diet is introduced, obesity, then metabolic disease follows. Why is that? Can't be just CICO....

 

[bave]

You've moved the goal posts, but I agree. It's because the 'standard' advice fails. That's my point. When advice fails 99% of patients, a normal person might look at why the advice is failing, and not blame the patients.

We know it's blood sugar (glucose) that's killing T2 diabetics.

Keto diets can reverse T2 diabetes in a few days, weeks at most.

I am not trying to be a dick here, I swear, but do you know any physicians? They all tell their patients these things. This isn't rocket science. The problem is the patients DGAF. They don't care they are killing themselves. They don't even monitor their blood sugars half the time. They continue to guzzle high sugar drinks and snarf down the snacks as their vision fades and their lower legs turn purple. A hundred years ago this problem solved itself, society let the stupid and apathetic die, now we carry them for decades to their grave while we throw finite resources into one lost cause after another.

Is it hard to change your diet and exercise? Yea it is. Is it complicated? No. Is it somehow elusive knowledge? No. People don't have the discipline and willpower to make the right decisions, not just in this, but in a huge range of things in society. You want single payer healthcare? I am willing to have that conversation, but before that conversation moves forward there has to be an agreement on the cutting off of healthcare for the non-compliant. One of the largest reasons US healthcare is the disaster we see now is because we allow people to make horrific decisions with no consequences from the system. Other models around the world would "ration" these people right out of care and into the ground.

Yeah, but saying that is to say nothing useful. For starters, it's been known for a century at least that calories in impacts calories out, so reducing calories in a typical diet slows BMR, which means more calories have to be cut to keep losing weight, which lowers BMR, then plateau, then cut more calories, etc..... And how much we eat is impacted by hunger, or our hormones, and for 10s of thousands of years, we humans maintained something like normal body weight with no concept of calories. We just ate food when hungry. Then didn't eat for a while. Then when hungry we ate again. And our weight stayed normal. Then about 50 years ago, that changed. Why did that change, here where there are a bunch of lazy fat slobs who don't care about themselves, but all over the globe? The ME has some of the highest diabetes levels on the planet. China is booming with T2 diabetics. If we don't know WHY we can't solve it. Anywhere the 'western' diet is introduced, obesity, then metabolic disease follows. Why is that? Can't be just CICO....

What changed 50 years ago? Oh yea, American daily activity. 50 years ago men worked in labor intensive jobs and women in the home had to work a hell of a lot harder physically as well. Now we have appliances and machines to do everything while everyone works from a recliner. The body wants to get fat, the differnce is in the US we have the luxury and the ability to afford the sedentary life style and the calories to allow it to happen. In other countries you have either more expensive calories or a lifestyle that burns them far faster. Just go look at someone who works in a manual labor intensive field. You see a lot of fat lumberjacks? Fat stonemasons? Hell no.

Look, I am in my mid 40's. I would love to eat more, and more garbage, but I don't. Because I want to stay fit. So I swim/row/lift every damned day for over an hour. I hate it. I hate watching what I eat. But I do it because that is the responsible adult thing to do.

We need to start holding adults responsible again, that's it in a nutshell. Want to kill yourself with Heroin? Obesity? Alcohol? I don't care, I really don't. I am a libertarian at heart. I do however care when you want society to pay for your choices.

 

[JasperL]

1. Now stop lying. You claim I label them lazy slobs..now you say I blame them ..when clearly I recognize that just me giving them advice doesn't work because of barriers outside my and many ways their control.

The point is very simple. If advice fails 99% of patients, the advice is crap. You can do the math on the projected weight loss of cutting one soda per day, and that projection will be wrong, even if they follow it perfectly. Multiple studies show this very clearly. The "projected" weight loss from calorie restriction doesn't come close to actual. And it's because when you cut CI, then the body reduces CO.

It's also very likely that the obese person is a metabolic wreck. CDC estimates that about 34 million are diabetic, and another 88 million are pre-diabetic. So 122 million, or roughly one half of the adult population in this country has chronic high blood sugar, is swimming in insulin nearly all day, and that inhibits burning fat. Cutting a little sugar doesn't move the needle on those problems, and what's frustrating is the answer seems pretty simple. If your problem is blood sugar is too high, cut the carbs. If the problem was lead poisoning that you're getting daily from food, who would recommend eating a little bit less lead in your food, and hoping the liver gets rid of it? For a T2, high glucose, uncontrolled glucose, daily spikes of glucose is poison, so don't eat carbs that convert to glucose. Why is that not first line treatment? Go to the ADA website and see if you can find that as a recommended diet.

YOU are the one making the judgment on why they can't follow my advice.
When they try to cut soda they suffer withdrawal for example and have headaches that make them less able to function.

Sure, because they're addicted to sugar, carbs, they don't ever burn body fat, and so need a dose of carbs every couple of hours. The way through that isn't to eat a few less carbs. It's to learn to burn fat, and that takes days or a couple weeks. You can't get there if you never start.

Look you need to stop. Just tell people to eliminate sugar? That works just as well as saying stop smoking.

OK, but what's the advice to smokers? Quit smoking. It's not "smoke 12 cigarettes per day." You can't get to zero sugar unless that's the goal, and it should be the goal.

You know what works...weaning them off cigarettes.. encouraging them when they make small changes instead of demanding a life altering withdrawal filled abstinence.
Which most will fail and then give up.

I'd like to see a study on that. Fact is the 'small changes' approach, CICO, only fails about 99%. That's what the data show. How is that considered "working?" And obesity gets worse every year.... Seems that approach is working fabulously!!

Sure some people can do it..particularly if highly motivated..like having a severe disease..and if they have a good support system.
Most don't have that.
Seriously do you think people WANT to be obese and feel unhealthy.? You think they NEED A DOCTOR to tell them to eat better and exercise? Or about low carb diets?
There are barriers to compliance.

Eat better isn't advice. Exercise is great, but not for weight loss. And LCHF and/or IF is fringe advice. Since I've been doing it, I've talked with dozens of people about it. Not even 1 in 10 have any idea what it's about or why anyone would do it.

Yes.99% of families would not support moms decision..because the ramifications are so far out in the future for most.

I just don't believe 99% of families wouldn't support a family member. It's insulting to the integrity of the families that they'd disregard the health needs of a loved one. I'm sure you'd do it, without question, so why do you think 99% of the rest of the world doesn't have the same concern as you?

Heck...you are assuming every obese person has diabetes. They don't.

I'd think the Venn diagram of obese and metabolically wrecked (T2 or pre-T2) is not quite a perfect circle, but it's very close. See above...

Good Golly Miss Molly. We can't get a good portion of Americans to listen to us about vaccination for covid..
And you think obesity is easy?

No, I know it's hard, which is why it angers me that the standard advice is so terrible, and that makes it far harder than it should be.

 

[JasperL]

Honestly..you are part of the issue.. you don't want to understand why there is noncompliance.

Don't tell me what I don't understand. For starters, I "understand" that when something has failed as badly as standard nutrition advice for 5 decades, it's time for a new paradigm, not blaming the obese, or their family, because they failed to succeed following crap advice.

I get it..you are jazzed up about your success thus far with a high fat low carb diet.. but your experience and situation is not everyone's.

Of course it's not, and I don't presume that my n=1 is evidence. But what I do know is the approach works as promised for me. My first goal was 30lbs and it was so easy I moved it to 40, then 50, and got there with ease.

There's tons of data, studies, and now hundreds or thousands of doctors getting great results in the real world, with real people, with supposedly 99% unsupportive families, abandoning the CICO model for a LCHF regimen. I've heard at least dozens of docs lecture on their journey, and the barriers to success, and how they get patients through them. They have support groups, weekly meetings, use CGMs that feed data 24/7 to physicians or nurses who monitor it and follow up right THEN when things look out of whack, have long sessions at the start that warn them of the effect of stress, lack of sleep, on appetite and weight loss and provide tools to deal with them, how to get back on track WHEN they fail, and much more.

And don't be so sure that low carb high fat diets are all that safe either.

Low carbohydrate diets are unsafe and should be avoided

Your access to the latest cardiovascular news, science, tools and resources.

www.escardio.org

That's a crap study with crap conclusions based on crap epidemiological data - a single questionnaire about food intake one day, then they follow the person for a few years. If you read it you know "low carb" is about 40% of calories from carbs, which is no one's definition of "low carb." So it's a study of people following a traditional 'western diet' but who ate the fewest carbs on that unhealthy diet. The 'low carb' population is mostly male, poorer, and heavily hispanic, so we can guess the 'carbs' they do eat aren't whole foods, and someone eating a hamburger with white bread bun (that would be be a "low carb" meal in this study) is treated the same as someone whose carbs are from broccoli, salads and sweet potato. That's a world apart from an actual LCHF/Keto diet recommended by any competent physician or nutritionist.

It's that kind of garbage research and conclusions that got us here, where fat is demonized and there's no distinction in carbs between table sugar/white bread and whole foods.

I have seen these fads come and go. And the research is usually confounded by multiple variables such as amounts..types of fats.. the benefits of weight loss other risk factors.

Calling LCHF a "fad" diet isn't an argument against anything. It makes me think you've never actually investigated the diet, or the theories behind it. And the study you cited above is just horrible evidence. There are plenty of RCTs you can cite if you're familiar at all with the literature.

I have had people start low carb high fat diets and have seen their liver enzymes go haywire.

Ketogenic Diet-induced Elevated Cholesterol, Elevated Liver Enzymes and Potential Non-alcoholic Fatty Liver Disease

A 57-year-old woman with class I obesity (BMI = 31.42 kg/m[2] ) and a medical history significant for binge-eating disorder with emotionally-triggered eating, post-traumatic stress disorder, and untreated depression and anxiety, presented for follow-up ...

www.ncbi.nlm.nih.gov

Yeah, that's shocking that a keto diet doesn't work for 100% of patients 100% of the time. It's also shocking that a person on a handful of different drugs for various problems needs regular doctor supervision...

This person developed NAFLD from keto diet, apparently, but you know what's a bigger risk factor for NAFLD, with FLD traditionally a disease of alcoholics, now now seen as early as children? High carb diets, especially diets high in fructose from sugar or fruit drinks. So, yeah, you have a case study of n=1. Nice job.

Frankly it was interesting reading. The study acknowledges the many benefits of keto diets for a large number of people and why they work. The takeaway is patients need monitoring, which of course every doctor advising that diet does on a routine basis. And hyper-responders - those who see LDL go way up instead of down which is typical - on keto diets is also a known issue. No one knows if the high LDL with healthy HDL and low TG is a good or bad thing. There are studies ongoing to try to find out.

 

[JasperL]

I am not trying to be a dick here, I swear, but do you know any physicians? They all tell their patients these things. This isn't rocket science. The problem is the patients DGAF.

Do you know any obese people? None of them GAF? I guess it's easier to blame patients than doctors giving crap advice.

They don't care they are killing themselves....

You're using "they" as if this apathy represents 100% of the obese and that's just not true.

Is it hard to change your diet and exercise? Yea it is. Is it complicated? No. Is it somehow elusive knowledge? No.

Why did our bodies suddenly become unable to control appetite, food intake, then metabolism to keep us at a normal weight for roughly all of human history, and only in the past 50 years suddenly that fails, worldwide? Half the country has metabolic disease. How is it not plausible that metabolic disease, especially insulin resistance, doesn't in fact promote fat storage, and inhibit fat burning, hence, obesity? Give a patient insulin, what's the predictable result? Weight gain. Etc. What do you know about this? More to the point, what does the average patient know about this, the role of insulin, hormones that signal satiety, how what we eat affects those hormones, how chronically high insulin levels, which is the standard state of affairs for the T2D and the pre-diabetic, prevent fat burning, and promote fat storage?

What changed 50 years ago? Oh yea, American daily activity. 50 years ago men worked in labor intensive jobs and women in the home had to work a hell of a lot harder physically as well. Now we have appliances and machines to do everything while everyone works from a recliner.

Sounds plausible, but that's actually not supported by the data. The studies are pretty clear exercise has only a very small impact on weight. Those guys working hard labor ate a bunch more than the lawyers, and yet the lawyers in 1950 were overwhelmingly still thin....

The body wants to get fat

That's just wrong. The body doesn't want to get fat. 100 years ago large shares of the U.S. had all the food they wanted. And obesity was all but unknown. Goodness, when I was in HS in the 1970s, every one of us had all the food we wanted, at any time we wanted, and we had ONE fat kid in our class. One. Not one of us tried to be skinny, we just were, without effort. Now we have obese children, children with NAFLD....

, the differnce is in the US we have the luxury and the ability to afford the sedentary life style and the calories to allow it to happen. In other countries you have either more expensive calories or a lifestyle that burns them far faster. Just go look at someone who works in a manual labor intensive field. You see a lot of fat lumberjacks? Fat stonemasons? Hell no.

There's an obesity and diabetes epidemic, which are tied at the hip, worldwide.

And the fact is obesity is if anything a disease of the poor, and it's because bad calories - refined grains, sugar, corn, corn by products - are really, really cheap. Some of the earliest 'victims' were native Americans we uprooted from their traditional homelands and agriculture and hunting grounds, then fed with cheap and easily stored refined grains and sugar. Suddenly, overnight, entire populations who had been lean and healthy for many thousands of years suddenly became obese, and diabetic. That's not CICO - that's physiology.

Look, I am in my mid 40's. I would love to eat more, and more garbage, but I don't. Because I want to stay fit. So I swim/row/lift every damned day for over an hour. I hate it. I hate watching what I eat. But I do it because that is the responsible adult thing to do.

Good for you, and I do that as well, but I also found as I got older that exercise every day didn't work to keep weight from creeping up. And the implication is that because you can do it, then everyone who doesn't keep their weight in check is 'irresponsible', and that is true here and all over the globe. I just don't think that's a fair conclusion.

 

[jaeger19]

The point is very simple. If advice fails 99% of patients, the advice is crap.

No its not. thats like saying that if I tell my patients to get vaccinated and they choose not to.. then it was my advice that was crap and not their decisions.

You can do the math on the projected weight loss of cutting one soda per day, and that projection will be wrong, even if they follow it perfectly. Multiple studies show this very clearly. The "projected" weight loss from calorie restriction doesn't come close to actual. And it's because when you cut CI, then the body reduce.

Sure. So? A journey of a thousand miles starts with one step. So they cut out that one 20 ounce soda... No headaches.. and they lose a pound in 14 days. YEAH.. success. And then you suggest adding walking.. and hey.. lets cut out the donuts you like to have at work because the office staff bring in donuts. and then in a month they have lost 3 pounds. And then you suggest hey.. why don;t you add lifting some weights, or using bands for resistance.
OR we could throw down your keto diet and say.. "okay.. remove all sugar from your diet and completely change your lifestyle. "
And the patient doesn;t do a dang thing because the change is so overwhelming and costly.

It's also very likely that the obese person is a metabolic wreck. CDC estimates that about 34 million are diabetic, and another 88 million are pre-diabetic

Sure... it seems simple. But that 88 million that are prediabetic. have already tried losing weight. They have tried making such large drastic changes in their life and invariably failed.. and said screw it.
OR you can incrementally get them to improve their situation until they arrive at a point where they have some success and don;t see that they have to make such a major change...

Go to the ADA website and see if you can find that as a recommended diet.

Sure.
Here you go:
"Research shows that both the amount and the type of carbohydrate in food affect blood glucose levels. Studies also show that the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response than the Glycemic Index (GI). Based on the research, for most people with diabetes, the first tool for managing blood glucose is some type of carbohydrate counting.

Because the type of carbohydrate can affect blood glucose, using the Glycemic Index may be helpful in “fine-tuning” blood glucose management. In other words, combined with carbohydrate counting, it may provide an additional benefit for achieving blood glucose goals for individuals who can and want to put extra effort into monitoring their food choices."
ttps://healthjade.net/what-is-the-american-diabetes-association-ada-diet/

 

[jaeger19]

OK, but what's the advice to smokers? Quit smoking. It's not "smoke 12 cigarettes per day."

If you want success? You tell them "you should quite smoking".. Lets start with reducing the number of cigarettes you smoke a day. We can also use things like nicotine gum, patches.. maybe even medications to help you quit. When they tell you that they have tried to quit smoking cold turkey and failed twice.. you say "yep, but we are going to try to wean you off so you can quit without so many symptoms".

Listen... you complain that the advice isn;t working? So it must be the advice? Guess.. what.. its often advice.. JUST LIKE YOURS.
DOING EXACTLY WHAT YOU ARE SAYING. "You need to eliminate suger.. you need to go to this diet"..

You can't get to zero sugar unless that's the goal, and it should be the goal.

I'd like to see a study on that. Fact is the 'small changes' approach, CICO, only fails about 99%. That's what the data show. How is that considered "working?" And obesity gets worse every year.... Seems that approach is working fabulously!!

UM no "doc".. the small changes approach is what works. Its worked way way way more than YOUR approach which is "you need to make a radical change in your life and get rid of suger today!!!". Some can do it... if they have strong support systems and the time and money to do it. Most FAIL with your approach. What approach do you think 99% of doctors take with obesity? You think they do a small change approach like me.. where they spend time outside clinic hours to go over their food diary and make changes? Where you have them stop in biweekly to advance their program or give them support.
Or do you think they see the patient for 15 minutes.. go over their meds and then say "okay,, you need to lose weight, you need to stop eating sugar"..and then hand them a pamplet or booklet on a low carb high fat diet? Or some other "diet du jour".
I can dang well tell you its not the approach that takes more time and investment and frankly not being reimbursed.
Its being done your way. And its not working.

Eat better isn't advice. Exercise is great, but not for weight loss.

Yes its necessary for weight loss otherwise your metabolism will adjust to a lower rate of calories. Not to mention for a lot of obese people, the reason they eat is for depression, or boredom and exercise influences and improves their hormone levels and reduces hunger, depression and eating.
"In conclusion, this exercise regimen had a positive effect on reducing appetite which is related to reduced acylated ghrelin responses over time. This finding lends support for a role of exercise in weight management."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761859/

"Exercise reduces patient-per- ceived symptoms of depression when used as monotherapy (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials [RCTs] with signifi cant heterogeneity). It relieves symptoms as eff ectively as cognitive behavioral therapy (CBT) or pharmacologic antidepressant therapy"
https://mospace.umsystem.edu/xmlui/...oesExerciseAlleviateDepression.pdf?sequence=1

"People who suffer from depression, anxiety, and other mental health disorders are more likely to gain weight over time and become obese than people who don’t, a new study shows" https://www.webmd.com/depression/news/20091006/depression_anxiety_linked_weight_gain

 

[jaeger19]

And LCHF and/or IF is fringe advice. Since I've been doing it, I've talked with dozens of people about it. Not even 1 in 10 have any idea what it's about or why anyone would do it.

I just don't believe 99% of families wouldn't support a family member.

Well.. you are wrong.

It's insulting to the integrity of the families that they'd disregard the health needs of a loved one.

They don;t see it as a disregard of the health needs of a loved one. Mom isn;t even taking insulin. Mom is just overweight and has been most of her whole life. She is known as the cook. Where everyone comes to meet to get tamales and menudo.. and Ceviche. Home made tortillas and arroz con pollo. They see her eating and cooking as love.

I'm sure you'd do it, without question, so why do you think 99% of the rest of the world doesn't have the same concern as you?

Actually NO. No.. it didn;t happen without question in my family. My grandmother was diabetic. She wasn;t managing her diabetes even when I was a teenager. When I was in medical school.. she was worse. And yet my uncle was still getting her coffee cakes for her... because she was 90 and wanted them. And I would watch her eat a "sliver"... except that she ate a sliver of that coffee cake every 10 minutes. And I called my uncle on it and he said "look.. she is 90 and she wants it and its cruel to deny it to her".
My own children began to get obese. They began to struggle with their weight.. and my wife and my wifes family were extreme enablers. I would say "look.. no more soda for these kids.. why get them hooked on sugar.". And they would in front of me offer my kids a soda!. And both of my inlaws were diabetic!!!
My wife would have cake, cookies and sweets on the counters for the boys. Because thats how she "loved them". I struggled all the time to get them to eat right, but my wife saw it as her role to treat them...
"oh they will just "grow out of it".. they said. (her family)

Luckily.. when the boys were old enough to say no themselves.. I bribed them with a biggest loser contest where the three of us ate better and worked out together and the person that lost the most weight every week. I paid 20 dollars, and the next one got 10 and the last person.. as long as they lost weight, got 5 dollars. Finally I was able to get them down to a healthy weight. BUT... they will likely always struggle with weight because of the obesity they had as children.
And thats minor.
I have patients families that will take mom out for breakfast at the local place that is famous for these giant cinnamon buns.. about the size of a plate.. and order it for her.. right after her appointment and we have discussed weight loss.

So don;t try telling me 99% of families are supportive. In fact.. is likely the family dynamics that is one of the reasons for obesity. Why do you think childhood obesity is so rampant? You think the kids are choosing to be obese?

 

[bave]

Do you know any obese people? None of them GAF? I guess it's easier to blame patients than doctors giving crap advice.

Some of them care, just not enough to change. It's that simple. It is no different than smoking. They are addicted to eating, they generally enjoy it, and changing that is difficult and they are too mentally weak to manage it.

You're using "they" as if this apathy represents 100% of the obese and that's just not true.

Ok, 80%? 90%? 98%? It is the overwhelming majority who have it in their power to get it under control but just don't.

Why did our bodies suddenly become unable to control appetite, food intake, then metabolism to keep us at a normal weight for roughly all of human history, and only in the past 50 years suddenly that fails, worldwide? Half the country has metabolic disease. How is it not plausible that metabolic disease, especially insulin resistance, doesn't in fact promote fat storage, and inhibit fat burning, hence, obesity? Give a patient insulin, what's the predictable result? Weight gain. Etc. What do you know about this? More to the point, what does the average patient know about this, the role of insulin, hormones that signal satiety, how what we eat affects those hormones, how chronically high insulin levels, which is the standard state of affairs for the T2D and the pre-diabetic, prevent fat burning, and promote fat storage?

Again, go look at the diet of someone doing manual labor. Every seen a fat landscaper? Lumberjack? Anything that involes walking a lot? No. Why? They burn calories. If you sit on your fat ass and eat crap all day you will gain weight. You can rip up and down the nutritional pyramid all you want, it is still calories in > calories out.

Sounds plausible, but that's actually not supported by the data. The studies are pretty clear exercise has only a very small impact on weight. Those guys working hard labor ate a bunch more than the lawyers, and yet the lawyers in 1950 were overwhelmingly still thin....

Really? Again, find me a fat guy who runs a weedwacker all day.

Good for you, and I do that as well, but I also found as I got older that exercise every day didn't work to keep weight from creeping up. And the implication is that because you can do it, then everyone who doesn't keep their weight in check is 'irresponsible', and that is true here and all over the globe. I just don't think that's a fair conclusion.

Fair or not, it is the person's responsibility to manage their weight through diet and exercise. Look at your position on this entire topic. America needs to reduce healthcare costs, you then go on to defend the patients who are driving the vast majority of healthcare spending. Do you know how much of our healthcare system is built around taking care of people not taking care of themselves? Screw that. If you want to be fat, knock yourself out. Buy two plane tickets. Pay for your own healthcare. Bring your own damned scooter to cart the fat asses around while they pick up more snacks and crap.

Think about that for a moment. It is now verbotten to fat shame and we put scooters all over the place to shuttle the grotesquely obese about. America no longer has the fortitude to tell the truth, tell people hard truths, and make hard decisions.

 

[jaeger19]

Don't tell me what I don't understand. For starters, I "understand" that when something has failed as badly as standard nutrition advice for 5 decades, it's time for a new paradigm, not blaming the obese, or their family, because they failed to succeed following crap advice.

Yeah.. you don;t understand that its not "standard nutrition advice." Its largely your "don;t eat suger".. and "here is a pamplet of the " diet du jour".. thats the new fad.

There's tons of data, studies, and now hundreds or thousands of doctors getting great results in the real world, with real people, with supposedly 99% unsupportive families, abandoning the CICO model for a LCHF regimen.

Sure. And as you said there are millions of patients who are obese and pre diabetic or diabetic.. that have not responded. Despite getting the SAME ADVICE of those that did respond.

I've heard at least dozens of docs lecture on their journey, and the barriers to success, and how they get patients through them. They have support groups, weekly meetings, use CGMs that feed data 24/7 to physicians or nurses who monitor it and follow up right THEN when things look out of whack, have long sessions at the start that warn them of the effect of stress, lack of sleep, on appetite and weight loss and provide tools to deal with them, how to get back on track WHEN they fail, and much more.

Thats great. Now work with a medicaid population where NONE of that is paid for. Nor is there time for. I am a rarity in the states I practice in because I can take the time.. sometimes an hour.. to work with people one on one. and I can give free care that insurance won;t pay for.. because I own my facilities.. and I can decide to take the time. The vast number of medical providers don;t have that option.

That's a crap study with crap conclusions based on crap epidemiological data - a

No its not. Its a real world study of 24k plus participants which they followed for over 10 years. It shows that those with the lowest carb intake, had higher risks of death in particular from stroke, and cva and cancer. Now.. are you going to tell me that everyone one who starts a LCHF/keto diet follows it exactly for over 10 years and has regular follow ups with their nutritionist?
Do you have a study that shows what happens when someone has been on a strict Keto diet for 10 years for obesity.
Most studies on a keto diet that long are on children and for epilepsy.
In other words. This is a cautionary tale. And you my friend ignore it at potential peril.

Calling LCHF a "fad" diet isn't an argument against anything. It makes me think you've never actually investigated the diet, or the theories behind it. And the study you cited above is just horrible evidence. There are plenty of RCTs you can cite if you're familiar at all with the literature.

Yeah.. there are small studies with limited exposure. The long term study of a LCHF diet I have found was 24 weeks.
The study I cited wasn;t horrible evidence. It had a large N.. it was over 10 years and it controlled for other factors. You don;t like the results so you choose to call it a crap study.

Yeah, that's shocking that a keto diet doesn't work for 100% of patients 100% of the time. It's also shocking that a person on a handful of different drugs for various problems needs regular doctor supervision...

Yeah.. its also a cautionary tale that maybe your love of the keto diet is misplaced. I have seen such fads come and go... Perhaps it will be viable for people to use for years. However, I am not going to be pushing a diet for long term that may not be healthy long term.

This person developed NAFLD from keto diet, apparently, but you know what's a bigger risk factor for NAFLD, with FLD traditionally a disease of alcoholics, now now seen as early as children? High carb diets, especially diets high in fructose from sugar or fruit drinks. So, yeah, you have a case study of n=1. Nice job

Well.. actually I also have a study with 24k plus patients but hey.. you don;t like that one either.

. Frankly it was interesting reading.

Exactly. There is no reason to start going crazy for the keto/lchf diet yet. They may work in the short run, but not in the long run. They may be good for only certain people with certain criteria. However, there is not enough evidence to demand that every physician start singing the praises of keto diets to their patients.

 

[jaeger19]

Some of them care, just not enough to change. It's that simple. It is no different than smoking. They are addicted to eating, they generally enjoy it, and changing that is difficult and they are too mentally weak to manage it.

Thats not true

Ok, 80%? 90%? 98%? It is the overwhelming majority who have it in their power to get it under control but just don't.

Nope

Again, go look at the diet of someone doing manual labor. Every seen a fat landscaper? Lumberjack? Anything that involes walking a lot? No. Why? They burn calories. If you sit on your fat ass and eat crap all day you will gain weight. You can rip up and down the nutritional pyramid all you want, it is still calories in > calories out.

Actually I have lots of patients who work manual labor and are clinically obese. Yep..and I have several fat landscapers.

Really? Again, find me a fat guy who runs a weedwacker all day.

All the time. An internet search:
https://www.facebook.com/FAT-BOYS-Landscaping-213847848634053/
Its CALLED fat boys landscaping and I can see the guys in one of the pictures and they appear clinically obese.

Fair or not, it is the person's responsibility to manage their weight through diet and exercise. Look at your position on this entire topic. America needs to reduce healthcare costs, you then go on to defend the patients who are driving the vast majority of healthcare spending. Do you know how much of our healthcare system is built around taking care of people not taking care of themselves? Screw that. If you want to be fat, knock yourself out. Buy two plane tickets. Pay for your own healthcare. Bring your own damned scooter to cart the fat asses around while they pick up more snacks and crap.

Think about that for a moment. It is now verbotten to fat shame and we put scooters all over the place to shuttle the grotesquely obese about. America no longer has the fortitude to tell the truth, tell people hard truths, and make hard decisions.

Ironically, I would not be surprised if you are clinically obese.

 

[JasperL]

No its not. thats like saying that if I tell my patients to get vaccinated and they choose not to.. then it was my advice that was crap and not their decisions.

If 99% ignore your advice, you're the problem.

Sure. So? A journey of a thousand miles starts with one step. So they cut out that one 20 ounce soda... No headaches.. and they lose a pound in 14 days. YEAH.. success. And then you suggest adding walking.. and hey.. lets cut out the donuts you like to have at work because the office staff bring in donuts. and then in a month they have lost 3 pounds. And then you suggest hey.. why don;t you add lifting some weights, or using bands for resistance.
OR we could throw down your keto diet and say.. "okay.. remove all sugar from your diet and completely change your lifestyle. "
And the patient doesn;t do a dang thing because the change is so overwhelming and costly.

The difference is keto will reverse the metabolic disease, which is actually the core problem, because it's that metabolic dysfunction, insulin resistance, that leads to T2D, and all the horrible consequences that follow. Cutting out a little sugar doesn't do that.

Sure... it seems simple. But that 88 million that are prediabetic. have already tried losing weight. They have tried making such large drastic changes in their life and invariably failed.. and said screw it.

They've almost invariably tried CICO and that has failed, 99% of the time that fails, we know this, every doctor, every study, they all show nearly complete failure with this approach. Very, very few have tried LCHF diets, because very, very few people recommend that. The reason all those docs you can hear on Diet Doctor podcasts or Low Carb MD podcasts are so passionate about LCHF and fasting is they finally, for the first time in their careers are seeing lots of people get better. Seriously, listen to some of them. Find one with Jason Fung and hear his case. If you're not convinced, that's fine, but you'll understand my point of view.

Sure.
Here you go:
"Research shows that both the amount and the type of carbohydrate in food affect blood glucose levels. Studies also show that the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response than the Glycemic Index (GI). Based on the research, for most people with diabetes, the first tool for managing blood glucose is some type of carbohydrate counting.

Because the type of carbohydrate can affect blood glucose, using the Glycemic Index may be helpful in “fine-tuning” blood glucose management. In other words, combined with carbohydrate counting, it may provide an additional benefit for achieving blood glucose goals for individuals who can and want to put extra effort into monitoring their food choices."
ttps://healthjade.net/what-is-the-american-diabetes-association-ada-diet/

Counting carbs is not restricting them. I can count to 300g of carbs per day, then jab enough insulin the app says will control that. But it requires insulin, often long and short acting. And the problem is they are full of sugar, the insulin can no longer jam it into cells, so they need more insulin to jam the sugar somewhere. The way to solve that isn't more sugar, then more insulin. It's to dramatically reduce carb intake.

Keto is entirely different in every possible way. I'm really not sure you have looked into the theory at all. It's pretty interesting. You should listen to just one lecture by Jason Fung, or many others, explaining the basics. It might change your mind.

 

[JasperL]

UM no "doc".. the small changes approach is what works. Its worked way way way more than YOUR approach which is "you need to make a radical change in your life and get rid of suger today!!!". Some can do it... if they have strong support systems and the time and money to do it. Most FAIL with your approach. What approach do you think 99% of doctors take with obesity? You think they do a small change approach like me.. where they spend time outside clinic hours to go over their food diary and make changes? Where you have them stop in biweekly to advance their program or give them support.

How can I know what you do? If it works, god bless and I mean that sincerely.

Or do you think they see the patient for 15 minutes.. go over their meds and then say "okay,, you need to lose weight, you need to stop eating sugar"..and then hand them a pamplet or booklet on a low carb high fat diet? Or some other "diet du jour".

I'm going to quit here because if you're calling it a "diet du jour" then you either don't know the theory behind it or you reject it, and you've not said you have examined it and rejected it. There are lots of very sharp, scientific minds, affiliated with outstanding institutions who embrace LCHF and it's because the results make sense with what they know about hormones, how they work, how insulin works, what is insulin resistance, etc. Here's a primer if you are interested.

The Carbohydrate-Insulin Model of Obesity: Beyond ‘Calories In, Calories Out’

Despite intensive research, the causes of the obesity epidemic remain incompletely understood and conventional calorie-restricted diets continue to lack long-term efficacy. According to the Carbohydrate-Insulin Model (CIM) of obesity, recent increases ...

www.ncbi.nlm.nih.gov

Yes its necessary for weight loss otherwise your metabolism will adjust to a lower rate of calories. Not to mention for a lot of obese people, the reason they eat is for depression, or boredom and exercise influences and improves their hormone levels and reduces hunger, depression and eating.
"In conclusion, this exercise regimen had a positive effect on reducing appetite which is related to reduced acylated ghrelin responses over time. This finding lends support for a role of exercise in weight management."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761859/

"Exercise reduces patient-per- ceived symptoms of depression when used as monotherapy (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials [RCTs] with signifi cant heterogeneity). It relieves symptoms as eff ectively as cognitive behavioral therapy (CBT) or pharmacologic antidepressant therapy"
https://mospace.umsystem.edu/xmlui/...oesExerciseAlleviateDepression.pdf?sequence=1

"People who suffer from depression, anxiety, and other mental health disorders are more likely to gain weight over time and become obese than people who don’t, a new study shows" https://www.webmd.com/depression/news/20091006/depression_anxiety_linked_weight_gain

Right, exercise is great in 100 different ways, but weight loss isn't one of them, not really. You can run 5 miles a day and gain weight. You can eat a good diet, sit and watch TV, and lose weight. Diet is the 95% solution, roughly. Exercise for health, not for weight loss. That's what the evidence shows.

Heck, I gained my weight over about 10 years and exercised 4 mornings/week, every week, 5:45-6:45am in a 'bootcamp' style class, hike on weekends, bike in the afternoons/evenings, I walk our dogs at least 2 miles per day, often 3, every single day. Our vacations for years have been biking/hiking trips to various U.S. and foreign destinations - that's the purpose, planned, guided. We don't do the beach, sit and drink, or cruise thing. Was 150lbs or so, then tried to keep it around 160 for a few years, then under 170, finally topping off at about 190.5 during COVID, BMI 29.4, or borderline obese. Exercised consistently that whole time, every week. I'm glad I did it and still do but diet drove the weight gain and diet took it off, current BMI 22.2.

 

[jaeger19]

If 99% ignore your advice, you're the problem.

The difference is keto will reverse the metabolic disease, which is actually the core problem, because it's that metabolic dysfunction, insulin resistance, that leads to T2D, and all the horrible consequences that follow. Cutting out a little sugar doesn't do that.

They've almost invariably tried CICO and that has failed, 99% of the time that fails, we know this, every doctor, every study, they all show nearly complete failure with this approach. Very, very few have tried LCHF diets, because very, very few people recommend that. The reason all those docs you can hear on Diet Doctor podcasts or Low Carb MD podcasts are so passionate about LCHF and fasting is they finally, for the first time in their careers are seeing lots of people get better. Seriously, listen to some of them. Find one with Jason Fung and hear his case. If you're not convinced, that's fine, but you'll understand my point of view.

Counting carbs is not restricting them. I can count to 300g of carbs per day, then jab enough insulin the app says will control that. But it requires insulin, often long and short acting. And the problem is they are full of sugar, the insulin can no longer jam it into cells, so they need more insulin to jam the sugar somewhere. The way to solve that isn't more sugar, then more insulin. It's to dramatically reduce carb intake.

Keto is entirely different in every possible way. I'm really not sure you have looked into the theory at all. It's pretty interesting. You should listen to just one lecture by Jason Fung, or many others, explaining the basics. It might change your mind.

1. So the problem with people not vaccinating or wearing masks is due to medical providers..
Got it.
2. Look dude.. you don't get it.
Doctors recommend low carb high fat diets. They recommend keto diets.
And 99% refuse to follow that advice as well
The refusal to follow it isn't because of the type of diet.. its because they aren't at a point they can immediately make such a drastic change in life. Because of all sorts of barriers.
They get told to try getting rid of sugar and handed a pamphlet or booklet.

It's just too daunting. Cripes most patients don't even know what carbohydrates are actually.
A food diary isn't just counting calories .. its a start in people realizing what they are eating. Ask a person what they had in a day..they often can't tell you everything much less the amounts of each.
I doubt half could tell you what foods had carbohydrates.

 

[JasperL]

Yeah.. you don;t understand that its not "standard nutrition advice." Its largely your "don;t eat suger".. and "here is a pamplet of the " diet du jour".. thats the new fad.

It's not a fad....

Thats great. Now work with a medicaid population where NONE of that is paid for. Nor is there time for.

I agree - as I said very early on, our system is broken, and all the incentives are to ignore the obesity, let the obese stay that way, then make money treating all the chronic illnesses.

No its not. Its a real world study of 24k plus participants which they followed for over 10 years.

Epidemiological evidence is very, very weak. If you spend 5 minutes you'll find studies of the same data set that find no association between carbs and risk of disease/death, and that if one controls for diet quality - i.e. treats those who eat whole foods as a different diet than those whose carbs came from cokes and white bread and cake - that low carb diets reduce risk, and that high carb diets can also reduce risk, if the carbs are quality/whole foods. So what kind of carbs matters - broccoli =/= cake with frosting =/= sweet potato/carrots/squash =/= waffle with maple syrup. That's ****ing obvious, but your study ignored that entirely.

So you can find what you want in the data, which makes them virtually useless for nutrition. We found "associations" between fat and heart disease 60 years ago and that myth still won't die. They forgot to account for smoking.... So we got low fat foods, laced with sugar, recommendations to BASE our diets on highly refined carbs, breads, pastas, which is garbage food for the keto crowd and vegans, something everyone can agree on today. We still live with that mistake - look at your 'yogurt' aisle. Lots of fat free yogurt, with 25g of added sugar. HEALTHY!!! That's from epidemiological studies and 'associations.'

It shows that those with the lowest carb intake, had higher risks of death in particular from stroke, and cva and cancer.

But 220g of carbs per day, 40% of caloric intake per day - what the study called "low carb" - is NO ONE'S DEFINITION OF LOW CARB. You can't have any grasp of the theory behind LCHF or keto and expect any of the benefits of an LCHF diet consuming 220g of carbs per day, and the authors knew it. The upper limit is something like 100g per day, and that's for people in reasonably good metabolic health, which would exclude the 122 million in this country with T2 or pre-T2, and that's who the diet is aimed at.

Exactly. There is no reason to start going crazy for the keto/lchf diet yet. They may work in the short run, but not in the long run. They may be good for only certain people with certain criteria. However, there is not enough evidence to demand that every physician start singing the praises of keto diets to their patients.

The reason they should be tried is they work, they actually reverse diabetes, get people off drugs, off insulin, no longer subject to wild swings in blood sugar. People feel better, they lose weight, mental health often improves, the diet reverses NALFD, lowers blood pressure.

We also know what doesn't work in the long run - the alternatives. Using the standard treatment, diabetes is chronic and progressive, more insulin, more weight gain, more insulin, more weight gain, hacked off limbs, blindness, and a dozen or so chronic conditions tied directly to obesity and T2, including a greater risk of cancer, heart attack, stroke.

No, the diets aren't for everyone, but they ought to be a standard, recommended option, because they work better than anything else. And you can't have long term data until people in enough numbers are on the diet long term, and have support from their doctors, nutritionists, counselors, etc. along the way.

 

[Dans La Lune]

So work harder, get paid more, foreign concept to some.

That's a laughable concept since capitalism doesn't work that way. Did you think anyone wouldn't notice that?

Third, only an idiot would send their kid to be a physician in the US at this point. It's a terrible job that is in decline. In the 80's it was a good gig. 90's it was fine. In the 21st century it hit the fan. Longer hours, more stress, less pay. You are seeing huge declines in the quality of students in the US medical education system. The best and the brightest are now heading to finance and tech and have been for some time.

Where the easy money is. So much for 'work harder, get paid more'. You just debunked yourself.

Fourth, there is also a reason why France's economy is such an abysmal failure. State controls and regulations are a great place to start. It is also worth noting that the median household income in France is about half that of the US.

Subtract healthcare costs from income in the US. Not to mention student debt, which follows you until you're dead.

 

[jaeger19]

How can I know what you do? If it works, god bless and I mean that sincerely.

I'm going to quit here because if you're calling it a "diet du jour" then you either don't know the theory behind it or you reject it, and you've not said you have examined it and rejected it. There are lots of very sharp, scientific minds, affiliated with outstanding institutions who embrace LCHF and it's because the results make sense with what they know about hormones, how they work, how insulin works, what is insulin resistance, etc. Here's a primer if you are interested.

The Carbohydrate-Insulin Model of Obesity: Beyond ‘Calories In, Calories Out’

Despite intensive research, the causes of the obesity epidemic remain incompletely understood and conventional calorie-restricted diets continue to lack long-term efficacy. According to the Carbohydrate-Insulin Model (CIM) of obesity, recent increases ...

www.ncbi.nlm.nih.gov

Right, exercise is great in 100 different ways, but weight loss isn't one of them, not really. You can run 5 miles a day and gain weight. You can eat a good diet, sit and watch TV, and lose weight. Diet is the 95% solution, roughly. Exercise for health, not for weight loss. That's what the evidence shows.

Heck, I gained my weight over about 10 years and exercised 4 mornings/week, every week, 5:45-6:45am in a 'bootcamp' style class, hike on weekends, bike in the afternoons/evenings, I walk our dogs at least 2 miles per day, often 3, every single day. Our vacations for years have been biking/hiking trips to various U.S. and foreign destinations - that's the purpose, planned, guided. We don't do the beach, sit and drink, or cruise thing. Was 150lbs or so, then tried to keep it around 160 for a few years, then under 170, finally topping off at about 190.5 during COVID, BMI 29.4, or borderline obese. Exercised consistently that whole time, every week. I'm glad I did it and still do but diet drove the weight gain and diet took it off, current BMI 22.2.

It's diet du jour because there have been tons of diets over the years. All with " tons of articles and doctors supporting them"
That then fell out of favor for the next diet.
I get that you think you have found the holy grail for weight loss. Color me more skeptical until actual good long term research is available.
You have to exercise for long term weight loss.
Sure. Eat a good diet and sit on the couch and you will lose some weight.. and then it will stop. Because your body will strive for homeostasis and will lower its metabolism.
And then if you return to eating just as you did before..you gain the weight back and more.
Exercise is a key to weight loss. It increases the metabolism..reduces the depression and anxiety that trigger eating and can reduce hunger.
Of course it must be accompanied by diet control.

 

[JasperL]

1. So the problem with people not vaccinating or wearing masks is due to medical providers..
Got it.

Around me, about 80% of the over 50 are vaccinated. That's different than less than 1%.

2. Look dude.. you don't get it.
Doctors recommend low carb high fat diets. They recommend keto diets.

I asked you to show me where the ADA does, and you cannot. You can try the AHA, or any other mainline group. You'll fail. You can't find those recommendations in FDA recommendations or CDC recommendations. Here's the CDC page on diet for diabetes. 3/4 of that plate is carbs - non-starchy is half, starch like high carb potatoes, carrots, etc. is 1/4. 1/4 is lean meats/proteins. There's no fat recommendation - lean meat. That's a high carb, low fat diet plan.

And I don't want to make this combative, but when you refer to keto as a fad, you really cannot be recommending it to your patients, because you don't believe in it, either don't want to recognize or reject the entire theory behind the diets.

It's just too daunting. Cripes most patients don't even know what carbohydrates are actually.
A food diary isn't just counting calories .. its a start in people realizing what they are eating. Ask a person what they had in a day..they often can't tell you everything much less the amounts of each.
I doubt half could tell you what foods had carbohydrates.

Again, if you're interested listen to some podcasts by people, doctors like you, doing this every day. One tool that many find near miraculous in teaching patients are CGMs. People can see, in real time, all day, every day, how what they eat affects their glucose levels. If they try keto, they can see nearly straight lines for DAYS. Or they can see 'heart healthy' oatmeal, with bananas and some OJ shoots glucose over 200. Then try bacon and eggs - nothing, not a blip. Is bacon and eggs for breakfast, giving up your latte with skim milk, or cream and sugar in coffee, but all the heavy cream you want, worth rock solid glucose levels, no insulin? It will be for some people, although it's very hard at times. I miss pizza, ice cream, bread, cookies, cake, crackers....



Then when they KNOW, maybe they make the commitment. They can choose - shooting insulin every day, OR a pretty drastic lifestyle change that makes them healthy, feel better, etc.