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.
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.
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.
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.
The implication here is that somewhere along the way in the last 50-ish years people just lost the ability to have discipline. All at once. Across the entire globe.
Does that sound reasonable to you? Keep in mind 50 years ago almost everyone smoked.
Personal responsibility has not changed. I don't understand how people can say this when the problem is to such a widespread degree.
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
Our bodies and responses were "designed" for such a system where obesity is impossible. The mechanisms that power obesity are vital for the survival of the human race.
The agriculture revolution only happened 10,000 years ago. This is all very new to us.
The real agriculture revolution only started in 1913 with the invention of the Haber-Bosch process for manufacturing fertilizer from fossil fuels. That's what really enabled excessive carbohydrate consumption for common people. Before that, humans were barely scraping by and it was still common for poor people to starve to death, even in relatively advanced countries.
Responding to efforts to cure a social ill by calling it a personal responsibility problem is, in context, implying that we should not be exerting those efforts, that this is not our problem, this is their problem, that humans should just be better, why can't you just be better you piece of shit?
It is a disinvitation to solutions, and the rest follows naturally from that. I think a lot of people are using this as a thought-terminating cliche without actually considering how hostile the stance is.
Every problem is personal for the person facing it. When one looks at attempts to cure AIDs, and offers a contextual response of "This is a personal problem" or "This is a matter of personal responsibility", the only meaning of that which is legible is that we shouldn't collectively be trying to cure AIDs, that this isn't our business, and low-key, that sufferers deserve it for their behavior.
That was practically the consensus social position forty years ago.
We didn't have an obesity crisis. Now we have an obesity crisis. Did the human race just become less responsible? Or are they enduring a new, situational, societal-level problem that affects many people collectively based on the socioeconomic & cultural conditions they were born into? Conditions that didn't exist 20,000 or 1,000 or even 60 years ago.
This is a longstanding conservative trope that excuses us from dealing with any and all social problems because we don't owe anything to each other. It is a declaration of social atomization.
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.
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.
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.
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:
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.
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.
> 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".
> That's clearly double unhealthy behavior and will bring unintended consequences
Consider: GPL-1 inhibitors are actually root-cause solutions, and diet/exercise are not root cause solutions.
That's because the cause of obesity is not eating. The cause of obesity is a propensity to overeat. The cause begins in your brain and automatic responses, not on the table or the gym.
That's why you and I can eat, be satisfied, and not be obese.
Diet/exercise doesn't address the root cause. It fixes the symptom - obesity. But those people are still addicts, and if they fall off then they're off and will become obese again, much like an alcoholic. This diet "rubber banding" is extremely common.
Ozempic and others address the root cause, by lowering the desire or propensity to eat, perhaps closer to that of someone with a normal brain and normal regulation.
> That's why you and I can eat, be satisfied, and not be obese.
Who said so?! I have been obese (clinically, BMI) multiple times. And all the time I got back to overweight then normal weight by exercising and eating less (than what I wanted! Because eating until I feel like exploding is so good).
> Consider: GPL-1 inhibitors are actually root-cause solutions, and diet/exercise are not root cause solutions.
False. Overeating is caused by lack of movement and bad diet. There is no point in discuss the rest starting from a completely wrong point.
> Overeating is caused by lack of movement and bad diet
Is this some kind of joke? A bad diet doesn't cause overeating - overeating IS the bad diet. Also not moving doesn't cause overeating, because how could it? What, I sit down and suddenly a burrito appears in my hands?
The cause of overeating is a propensity to overconsume, i.e. you have an addiction. Diet and exercise address the SYMPTOMS, but not the ROOT CAUSE. You STILL have an addiction. In the exact same way someone who is sober is STILL an alcoholic.
Because drinking alcohol is not actually the root cause of alcoholism. The root cause is an addiction to alcohol. You can't get rid of the addiction, but you can treat the symptoms - by never drinking, by being sober. But you did not address the root cause.
By my logical analysis, I conclude GLP-1 inhibitors better address the root cause than diet and exercise. To further strengthen my point, you've more or less admitted this by pointed out you've been obese "multiple times". If you had addressed the root cause this would be impossible! But you did not address the root cause but merely the symptoms via diet and exercise. You still had the addiction, so when you slipped you became obese again. This cannot happen while taking a GLP-1 inhibitor because you no longer have the extreme desire to eat. Even when you lost weight, you still had the extreme desire to eat.
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.”
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?/
>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.
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.
I don't think it is fair to say 100% manageable - I'm not aware any study has ever shown that. There are many sub-types. And there are extenuating circumstances for some people.
Just want to call this out, as it is very demoralizing to hear this sort of message when it does not apply to you.
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.
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.
Or, rephrased, the doctor would rather prevent you from dying by giving you insulin as opposed to saying "just stop being fat lol" and then you lose both of your legs.
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.