Lots of the numbers here are confusing in relation to other numbers…
“The researchers found that just under 3% of people in the UK, France and Germany, and 4% of those in the US have MASH, but diagnosis rates were below 18%. That means about 20 million people in the US, UK, Germany and France are living with MASH but only 2.5 million people have a diagnosis, leaving more than three-quarters – about 16.7 million people – unaware they have the condition.”
2.5/20 is 12.5%, which is under 18% but a very weird and specifc way to put it; 16.7 is more than 3/4 of 20 indeed (by a lot), but adding 2.5 to 16.7 is about 19 not about 20. This just all seems randomly off in various ways that make little sense to me. Anyone has any good theory how such sentences escape editorial edits, or can find a simple typo or two that make this paragraph coherent again?
For those who are curious, there's some anecdata online that extended fasting (days or weeks) can reverse this disease.
I can't find much published research on it to be fair, but I think the science in this field is lagging behind people's personal experiences.
If there's evidence to the contrary let me know, I'm not trying to spread misinformation. It's just one of the things I consistently recall reading over the years.
https://prolonlife.com/ sells a prepackaged fasting-mimicking diet. plenty of reviews online about the subjective effects on energy levels and soforth during the fast.
I didn’t like it. day 2.5-3 will put me back into the headspace of food scarcity and even knowing that the next meal was sitting in the box and that this is temporary … it was a mental challenge for
me. if you’ve never experienced food scarcity, it can be all-consuming and seriously warp your cognition and emotional baseline.
Personally it is a strange thing. Diffcult to do over 24 hours but easy over a few days. Once you get over the head space of "im hungry must eat!" It turns into "im hungry, oh well".
But this is a sample size of 1 and results definetly vary wildly between folks.
That's not an eating disorder. Just because you're cold doesn't mean you need to put on a sweater. Learning not to let minor discomforts bother you builds discipline and character.
Fasting is great because you live off of your muscles. Keep at it and you will loose so much muscle, you will develop an eating disorder. The stomach and intestines are muscles too.
My understanding is that if you are healthy and you fast, it's great.
If you are actually ill and fast it's still great but it only hides your illness and you are on a very bad path (eating disorder)
Anorectic are very dosciplined and proud of their ability to not eat. Hunger not being "well so what" is normal healthy biology. It is not just discomfort. It is biologcal mechanism to prevent very real harm.
Yhe issue with anorexia is that it works as cycle - if ypu have genetic predisposition, starwing affects metabolism, your discomfort about food gets worst and you are in it.
Even cutting back a couple hundred calories a day can leave you absolutely exhausted, in my experience. Even just increasing exercise by a couple hundred calories a day without eating more is also incredibly exhausting, after a few weeks it becomes thought dominating second-by-second.
If you're going to fast, especially extended fasting, it would serve a person well to drop carbs and sugar and get into ketosis, at least for a while, so your body can start burning fat more effectively. If you've never done this before, it can be an uncomfortable process, with a lot of headaches, mood swings, etc. Making sure you take in enough electrolytes (sodium, magnesium, and potassium) will help a lot during all this, and during longer fasts.
I cleaned up my diet about a month ago, and have accidentally done some 24 hour fasts when I was busy and it's been fine. By the time I do eat, I'm really not even hungry, though my stomach may be growling a bit. The first time I ever did this, I had horrible headaches and felt miserable for a while, but subsequent times have been easier.
Good sleep maters too. Bad sleep will throw your hormones out of whack. I'm extremely hungry when this happens, and crave all the wrong things. Knowing what's going on helps a little.... just a little.
I find all this much easier than just trying to cut back by 200 calories with what I normally eat. It's all about hormones.
Exhaustion is in people's heads to an extent, but I think you're lying about your energy intake and/or activity level. If you do three 36 hr fasts per week then you're effectively only eating 2.5 days per week. Consuming 1500 kcal/day on non-fasting days equates to only 3750 kcal/wk total. Running burns at least 90 kcal/mi even for a small person so if you're doing 35 mi/week that means >3000 kcal/wk just from exercise, plus at least 7000 kcal/wk for basal metabolism. At that rate you would therefore be losing about 2 lb/wk of fat, which is an unsustainable for more than a few weeks at a time.
As a point of comparison I'm a large man and fairly active with endurance sports so I have to consume about 3100 kcal/day (with no fasting) to maintain body weight.
Every time the New York Times publishes a health-related article, the comment section is filled with comments just like this: just self-congratulations without any useful takeaways for anyone else, and zero self-awareness that would enable them to realize, hey, not everyone is like me.
Whenever one feels tempted to utter “it’s all in your head”, my advice is to take a step back and reflect on how little I know about the circumstances of others, and then, you know, maybe just keep it to myself.
Behavioural patterns are heavily influenced by hormonal balance and as such, success-rates of different self-help strategies (diets, fasting, resistance and/or endurance training) are highly individual. This also extends to addictive behaviours.
"Hormon-typical" individuals have an easier time shaping their behavior because they don't face imbalances that complicate adherence. For them, sticking to a program is trivial. Combine that with lack of reflection, and many of these individuals delude themselves into thinking their success of following simple programs (which are simple in design, and only difficult in adherence) is somehow an accomplishment worthy of note. Low-empathy individuals, in particular, often interpret this as evidence of their own superiority, while dismissing others as mediocre.
So you see such comments a lot, because many people are "hormon-typical" and also low empathy. See any discussion about diet, fitness, Ozempic, etc.
Sounds like anorexia behavior. Those people do sport a lot, eat a little, right up the the moment the cumulative body damage is just too much. Pro-ana forums are full of people who live on very little calories and are at complete denial about health harm they cause to themselves.
That feels like the incorrect framing, the burden of proof is on the initial claim. That'd be like saying "I've heard online that leprechauns live on the moon. I haven't found published research on it, but I think science in this field is lagging behind personal telescopic experience. If there's evidence to the contrary let me know, but I've read it online a lot." and treating that like it's proof of moon leprechauns.
It's not exactly the same, as there are studies, there just haven't been a lot yet, since a lot of the study around it is new, although fasting has been practiced for thousands of years. There is no money in fasting, so the number of organizations willing to fund the studies goes way down.
> In conclusion, current evidence suggests that intermittent fasting in patients with NAFLD is a feasible, safe, and effective means for weight loss, with significant trends towards improvements in dyslipidemia and NAFLD as illustrated through non‐invasive testing (NIT).
If someone has NAFLD, they can either sit around and eat cake for 20 years waiting for the science, or they can try doing some fasting, which is very low risk (assuming they don't have other issues going on), and find out very quickly if it works for them. Sure, it's an n of 1 in that case, but who cares, if they are the test subject it only matters if it works on them.
I'd add to this that the carbs should be kept low and the diet having quality foods outside of the fasts. Eating aforementioned cake during a feeding window every day is going to leave a person miserable, burning muscle, and still leave the hormones all screwed up. Insulin needs to be controlled and lowered. Fasting does that quickly, but don't abuse it during your meals on a regular basis.
From what I've read elsewhere, fasting can help in the early stages to reverse it, but once real damage occurs that sticks around.
There may be some medical benefits to periodic fasting, especially for people with excess adipose tissue. But in terms of "no harm" the Memel et al paper you linked doesn't seem to mention anything about loss of lean muscle tissue. This can cause serious harm for some patients — especially older patients with the "skinny fat" body type — by leading to sarcopenia (higher musculoskeletal injury risk) and endocrine dysfunction (muscle is a glucose sink). Loss of muscle can be limited to an extent by doing resistance training and maintaining high protein intake during non-fasting periods. But overall there are still a lot of unknowns in this field.
A lot of that would be covered under the “other issues” I mentioned. Obviously, consult with your doctor first.
In terms of muscle loss, from what I’ve read, muscle loss is more of an issue for low calorie carbohydrate based programs. When fasting there might be some muscle loss when at the very start, but then it tends to preserve muscle, and like you said, adequate protein intake and resistance training can mitigate that.
Those, like Peter Attia, who saw muscle loss from long term keto and fasting over several years, weren’t using fasting as a medical intervention. He was already metabolically healthy, but maintained a pretty extreme fasting protocol in an effort to gain longevity benefits, effectively experimenting on himself based on some results of early studies around the benefits of fasting for longevity.
The general theory now seems to be making the fasts much less frequent once healthy. Maybe only a couple times per year.
I’m sure this area of study will continue to evolve slowly.
From your chosen quote, it doesn't seem to indicate that fasting specifically changed things, but fasting being an "effective means for weight loss" was the bit that really mattered. I don't see anything to divorce the two - general weight loss and improvement to the FLI.
> Available evidence suggests that any form of caloric restriction may be beneficial and specific forms of IF should be tailored to the individual.
Also important to notice that once the liver is damaged it's not recommended to fast:
> Additionally, it is important we investigate the possible risks of fasting in patients with cirrhosis, which is currently not recommended.
I wonder, given the instances of common diseases that were discovered/strongly suspected recently to have a microbial component (eg. ulcers + heliobacter pylori, Guillain–Barré + cytomegalovirus, Alzheimer + HSV, Several cancers in men and women + HPV), what are the odds we'll eventually discover fatty liver disease is a symptom or is triggered by "hepatitis X" or something like that?
This frankly scares me somewhat. I had a liver ultrasound where the radiologist warned me I had some signs of fat on the liver though not extensive yet.
I weigh 72kg at 178cm height. At peak, when I got tested I weighed around 86kg. I was barely overweight and definitely not obese and yet...
Knowing the weight alone is not enough though: you can be 72kg and fat or 86kg and very lean but also very muscular.
E.g. I'm 178cm as well but when I was 71kg I was visibly "fat", or at least skinny fat to be charitable. I'm currently 67kg but very lean and somewhat muscular.
At 86kg I had a bit of dad bod going on. Not a huge gut but somewhat pudgy here and there. Not hugely so and not overly visible as most of it was visceral fat. I haven't had an ultrasound since losing the weight. I hope the liver looks better now. I've been eating fewer calories, healthier calories and swimming. Hopefully that's enough to at least halt the damage done by my old lifestyle.
I had moderate NFLD and managed to get rid of it completely by just eliminating fried food, most dairy, and sugary snacks for about 6 months, I also almost never eat red meat. It's not so much about being overweight, but what you're eating.
Yep, the dietary recommendations have been consistent for decades at this point. Dairy, meat, sugars and excessive oils are not great for us. A little in moderation is fine, that is a lot lower than what most people think.
But it isnt pushed hard because it is difficult to steer the ship of humanity. Like how doctors will say "lose some weight" but they arent really expecting miracles on it as they know the battle that is.
Dietary recommendations have fluctuated widely for decades, and still differ substantially between sources. So far there is zero direct evidence that meat consumption causes fatty liver disease; I mean it's possible but we just don't know one way or the other. The only real data we have comes from low-quality observational studies (basically junk science).
If someone wants to try limiting meat consumption as an "n=1" experiment to see how it affects their body composition and other biomarkers then go ahead. Just don't expect a major impact from that one factor.
Generally speaking, I actually don't think I recall much of a link between meat and fatty liver, it always seemed to be closer linked to highly refined sugars and possibly high levels of dairy but less of a link there.
I eat enormous amounts of dairy and red meat and recently I had abdominal surgery and the doctor afterwards confirmed I was in very good shape and had no signs at all of fatty liver and very little visceral fat generally.
I eat around a pound of beef a day, a gallon of yogurt a week, and almost everything (eg oatmeal) is made with copious amounts of butter.
I think unless you know something specific about your genetics, just eat plain natural foods people have been eating for millennia and you will be perfectly fine. Basically, buy plain meat, vegetables, grains, and dairy and prepare them yourself. Don’t eat preservatives, corn syrups, or novel vegetable oils like canola. Maybe they’re fine but there’s no reason to risk it. Also do your best to make sure what you eat followed the same rule; eg my beef was grass fed and finished and was not fed skittles in a feedlot. Diet affects animal meat as well, just as it does us.
This is good advise to get behind. I do feel like a lot of the optimal dietary advice is far to hard lined and that a better path really is just whole foods in moderation.
Bmi is one metric but you need to combine it with a measurement of your belly circumference. I had similar numbers but the weight was al in the belly and got diagnoses as type 2 diabetic with high cholesterol etc.
HFCS isn't any meaningfully different from sugar. It's basically chemically the same as honey. And no, they don't put it in everything. It's in soda and certain sweets (obviously) and sweet sauces, but it's not like it's creeping into unexpected places in some huge way. Yes, there may be foods with a hint of sweetness that have a hint of HFCS, but then it's a negligible amount anyways. HFCS isn't some kind of bogeyman. It's essentially just sugar. Treat it accordingly.
HFCS is typically 42:58 or 55:45 fructose:glucose. Table sugar is 50:50. HFCS is only "high fructose" relative to unprocessed corn syrup, not relative to table sugar and other common sweeteners.
A small difference at small levels but one which obviously matters when it's shoved into countless foods without most people event realizing. It's not just in soda and candy; it's in bread, pasta, almost any processed food (crackers, ketchups and other sauces, canned fruit, applesauce, lunch meat, peanut butter, the list goes on) and many foods one might not considered processed.
It makes sense to try to eliminate it even though it's "only" a small difference. Might as well remove the difference at all and look out for things with no HFCS shoved in it for no reason.
>HFCS 42 is mainly used for processed foods and breakfast cereals, whereas HFCS 55 is used mostly for production of soft drinks.
In other words, the type of HFCS that's "shoved into countless foods" has less fructose than table sugar, not more. If fructose is the villain here, that actually constitutes an improvement over table sugar.
Plain pasta almost never contains any HFCS. Maybe you can find some that does but that's not what most people are buying in their local grocery store. (The sauce is often a different story.)
Fair - I went back and re-edited enough times my original message got jumbled, and I had been thinking of pasta dishes you could buy, which almost invariably have HFCS, but absolutely correct plain pasta pretty much never does.
The point is, it doesn't matter if your ketchup is made with sugar or HFCS. If it weren't HFCS, it would be sugar, because ketchup is supposed to be sweet, and they have the same nutritional effect.
Similarly, it's not suprising when pasta sauce has some sweetness added -- grandma also likely added a bit of sugar if she found tomatoes too acidic, which many do.
The only thing that matters is that it's sugar. HFCS isn't somehow worse. If you're trying to eliminate sugar overall then sure, of course avoid HFCS. But if you're fine with a certain moderate amount of sugar per day, then the relatively small amounts of HFCS in things like pasta sauce and peanut butter are fine. The same way the sugar or honey in teriyaki sauces is. They count towards your daily allotment of sugar. For people trying to eat relatively healthily, avoid the soda but there's no reason to worry about the HFCS in ketchup or normal amounts of tomato sauce, for goodness' sake. The only reason to avoid HFCS entirely is if you're truly cutting sugar out of your diet entirely. Otherwise they're just substitutes for practical nutritional purposes.
That's another fair point that specifically tomato-based products often have sugar, but also kind of missing the forest for the trees. For various reasons, we have a slew of foods that one might not expect to have added sugar (like lunch meat, ham notwithstanding, or applesauce which is already sweet without extra sugar, to pick from my short list above), that do because of reasons. In any case it does pay to still look, because if you're not careful you could pick one random tomato sauce that has double the amount of sugar compared to the jar right next to it on the shelf (Bertolli Tomato & Basil, 11g per serving; Newton's Own Marinara, 6g per serving).
These choices add up, which is the point I was trying to make originally (though I agree I did not do a good job of it); I understand I was being pedantic so I understand the nature of the responses to me. The point is that small differences, isolated, don't matter, but in aggregate they absolutely do. We make arguments like this all the time in software when trying to write correct, performative code -- the milliseconds add up, and so do the grams of sugar.
The anti-HFCS movement, despite having its targets aimed for wrong reasons, is still aiming at the right thing: being more mindful of what's in the things we put in our bodies.
This is wrong. As another commentator pointed out,the body processes fructose differently from sucrose.
As for honey (and fruit, for that matter) - they are full of beneficial compounds that help your body regulate blood sugar.
To illustrate this, someone I know of with type I diabetes who ate natural honey didn't need to inject as much insulin as when eating commercially processed/heated honey - those beneficial compounds are destroyed during the process. Same for fruit vs fruit juice...
I cannot find the study at the moment (Google you used to be great at this!) but there was one seeing how diabetics blood sugar was impacted from just fruit consumption. Got to the point where even at 20 serves per day (4 times the recommended) in most people it didnt cause an issue. Bundling that sugar with fiber was a big part of regulating sugars.
Corn syrup might or not be different, Im no expert in that field, but simply having highly refined sugars without the filler is monocropping your diet in weird ways. In the same way soil is being killed by mono cropped agricuture, we are doing the same with our gut biome. The flow on impacts are still being discovered.
Any answer that begins with "if everyone just-" is tantamount to doing nothing and those are the other options available, nothing except for weight loss drugs has managed to put a dent in widespread obesity.
It has nothing to do with spirituality or morals. Skinny-country person moves to the US, they get fatter (statistically speaking). They weren't skinny at home because they were better spiritual warriors or whatever, but because they didn't live in the US.
The options are to fix what are probably a whole bunch of problems across multiple domains at a cost of $(enormous sum) with a project spanning many decades (and which may easily be derailed and set back years and years at any time), so that living in the US doesn't make people gain weight, or... drugs, that work today. From a policy perspective, those are the only options. There's no good reason to think that reversing "moral decline" or whatever will help, since that doesn't seem to be why some other countries are skinnier.
Just to enumerate a few of the sides of this problem:
- economics. Junk food is more available because processed foods last longer and can be stored at mini marts and gas stations. It is true that beans and rice are cheaper than junk food, but junk food is a very cheap way for a dopamine hit.
- time: people have less time to cook due to working and commuting
- urban planning: walkable neighborhoods are few in the US. Lots of daily exercise is foregone for this simple reason.
- culture: the US has a very pleasure-seeking culture. Given the choice of having healthy food vs gratifying food, we tend to the latter.
All of these factors conspire to get us where we are.
> It’s more a spiritual / moral decline of culture in the west.
It's not a question of decline. There's no reason to think that humans today have less self control than in the past. We're dealing with obesity now because tasty, cheap food didn't exist until the second half of the 20th century.
I think there is a long list of reasons to think it is lower.
Self control is a skill which requires practice. A huge amount of our time and practice is devoted to chasing immediate gratification. Doom scrolling, tv, ect. This is all practicing the opposite.
The thing we seem to be learning especially now with GLP-1 drugs is that a lot of skinny people are not skinny because they have iron self control, but because they don't need it, because their bodies aren't constantly sending them screaming chemical signals to eat. These drugs turn those signals down and suddenly people stop wanting to eat so much.
So another hypothesis that seems totally in keeping with the data is that either 1) some group of people have always had this problem in history, they just haven't had access to food like we do now, and/or 2) something about modernity is pushing those chemical triggers up to overdrive in more people.
Self-control really sucks as a solution to anything. When was the last societal problem solved by a national campaign of personal self-control?
Im not saying there isnt a biological component. I think a large portion of the USA has a trashed metabolic and hormonal system. A lot of this damage is irreversible from overconsumption.
unless we start dosing children with GLP-1s preventatively for weight and medicate them for attention we should probably think about how we relate to our environmental conditions long term and prevent patterns from repeating.
There are lots of people out there not living their best lives
It’s not actually that tasty though. Maybe it was 40 or 50 years ago. But now most of it is flavorless. It just commonly available. And it’s not even cheap anymore. For the most part.
If you don't find it tasty, you probably don't have a problem with overeating it. But many people can finish half a bag of Doritos in one binge. I'm one of those people. They're delicious and don't satiate me fast enough to moderate consumption. That's why I don't buy Doritos in the first place. If they're around, I'll eat them.
I just swear that soda pop and junk food tasted better in the 80s. Doritos are actually still pretty solid. But it seems like everything that’s using high fructose corn syrup simply does not taste like the stuff did when they were using cane sugar for everything. I also think they got the food scientists going far deeper than that, and there were changes to the recipes that just continually drove pennies out of the product. But it’s no longer the product that it was back in 1970 or 1980. One example that always comes to mind for me is Sun Drop. He used to be able to see the bits of fruit floating around in one of those bottles. I don’t think Mountain Dew taste good anymore either it has changed.
Sure, our obesity epidemic is because everybody just suddenly decided to start eating more a few decades ago. Much more likely there is some environmental factor causing it. I guess calling it moral decay feels more self-righteous though.
> It’s more a spiritual / moral decline of culture in the west
It's not just the West.
"Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country's population" [1]. (It's about 7% in America [2].) Meanwhile in China, "the incidence of overweight and obesity among school-age children...was 15.5% in 2010, rising to 24.2% in 2019 and soaring to 29.4% in 2022" [2]. Same story in Vietnam: "The prevalence of overweight among children aged under 5 years increased from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, prevalence rose from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively" [3].
OP is right. "If everyone just..." is shorthand for wishing upon a star that the world were different. It's not a serious solution for reality as it is. (To the degree there is a social trust variable at play, it's in folks doing mental gymnastics to reject the clinical data.)
"yet those same people are unable to put less food in their mouths"
And you think that addiction is a moral/spiritual problem? Nope, it is an endocrinological problem. And precisely drugs like Ozempic have made it very clear, because it doesn't just treat obesity, but many other addictive behaviors like compulsive shopping or gambling. By "merely" altering hormonal balance in the target organism.
People once thought that smallpox was divine punishment for sins. It is 2025, we are on Hacker News, and yet the very same pattern of thinking emerges here, against all the scientific knowledge.
This is an example of equivocation: Insofar as there is a definition of "drug" for which "Thankfully, dealing drugs is forbidden" is (well, minus the subjective judgement "thankfully") categorically true, it is not one for which either "Addiction needs a drug" or "Drug needs dealers" is also categorically true.
Given the "successes" of various prohibitions and wars on drugs all around the world, I don't think this is going to work, at least not with major unintended consequences (hello sugar-smuggling gangs with machetes!). People are really good at trafficking banned substances.
Treating addiction as a disease would probably be less violent and less likely to produce major human rights violations.
There is a middle road of simply taxing highly processed foodstuff more without banning it outright, but that also creates perverse incentives for governments which now have a source of income that they don't want to jeopardize.
Regulating food works relatively well in Europe, despite all its flaws. Like making sure that what we are sold as "food" is actually, you know, food and not something that tastes and smells like food.
I am an European too, and while I agree that overall quality of food in Europe is fairly good, we have been hit by the obesity pandemics pretty hard - which indicates that whatever we do is not a solution.
We do know that some punishments were the result of sin. We have scriptural evidence. It’s also possible that smallpox was. The mechanism in which that things occur could very well be naturalistic, of course. These areas of examination are mutually exclusive.
Are you ready to throw stones in glass houses? We can list a thousand sins of people with actual political power that dwarf the sin of “accommodating” so-called lifestyle choices. Then we can talk about how those same people abuse trust at every opportunity.
I love how this is framed as if it's obviously a sinister thing, like some shadowy force made up MASH in order to sell drugs, rather than it being kind of a medical miracle that effective treatment regimes are becoming available.
In the article is this paragraph: Dr Paul Brennan, a co-author of the Lancet paper and a hepatologist at NHS Tayside, said: “GLP-1s (including Wegovy and Mounjaro) offer the potential to resynchronise our metabolism, by introducing feelings of satiety – fullness – and delaying the time the stomach takes to empty. These effects often result in reduced calorie intake, and improvements in how the liver handles nutrients as a result of weight loss, thus reducing scar tissue formation in the liver.”
I haven't been able to cure the fatty liver by self-control, so I'm intending to ask the doctor about a medical solution on my next visit.
This particular article came after that decision!
I know what you mean, and perhaps this is also a signal to "short" stock in sugar companies.
That is, i wonder if the article possibly mentioned the eyeball-attracting names of the weight-loss drugs as more enticing than just saying "cut out added sugars and these livers may well fix themselves".
> and then get them on the drugs for life, knowing full too well that they won't make the lifestyle adjustments needed to get them off the drugs.
What are you basing this on? Everyone I know who went on and off Ozempic kept off clinically-meaningful amounts of weight.
There is religious intensity to this popular unsaid (and blatantly incorrect) assumption that the human body left alone is perfectly made, and that any intervention in its mechanism is prima facie evil.
The human body left alone in original East African savannah sorta worked, hunters and gatherers don't suffer from metabolic disease much. (Though obviously they still succumb to injuries, infections and random disease such as appendicitis.)
The human body left alone in a modern supermarket world is way off its original evolutionary envelope. I am a descendant of 300 generations of agricultural people and I still struggle with processing of milk. Most of our commercially sold foods aren't 300, but 1-2 generations old. We just cannot be adapted to that.
> human body left alone in original East African savannah sorta worked, hunters and gatherers don't suffer from metabolic disease
One, we don't know that. But two, it's fair to assume they didn't because their constraint was starvation.
Look, metabolic disease makes sense from a preservation angle. It's a safe assumption, in the wild, that one will not suddenly come across permanent sources of excess calories. So if one assumes starvation is the enemy, and the body finds itself amidst excess calories, it must assume this is a finite resource to be competed for. Herego, stuff your face. Build fat cells. And under no circumstance shoud you give up a fat cell. No, reduce voluntary motion and--if necessary--cut basal metabolism to ensure we can get these calories into our bodies before someone else exhausts them.
For what it's worth, I'm on the other end of the spectrum. My body happily burns away fat stores. This is frankly great in the modern world! But if I get seriously sick (or thrust into a starvation environment), my odds of dying are high--it's why folks with a mid-twenties BMI have a longer life expectancy than those of us closer to twenty. Not techhnically underweight, and with plenty of muscle. But also with less of a buffer.
> human body left alone in a modern supermarket world is way off its original evolutionary envelope
It's arguable that the evolutionary envelope was leapt off around the development of agriculture and animal breeding. (We're still on patch Tuesday from c.a. 10,000 BCE on lactase.)
We have studied hunters and gatherers which survived into recent times and they indeed seem to be very metabolically healthy. "Starvation" is a strong word, but they certainly don't live in a world of plenty and tend to be lean.
What you are describing is so-called "thrifty gene hypothesis", it makes a lot of sense, but it hasn't been corroborated by actual genomic observations yet.
> What you are describing is so-called "thrifty gene hypothesis", it makes a lot of sense, but it hasn't been corroborated by actual genomic observations yet
The problem with thrifty genotype is hunter-gatherers seem to have had less caloric volatility (if we control for habitat quality) [1]. So to the degree such genes might have emerged, it would have had to have been selected for during migrations. That, in turn, requires it be a relatively human-specific adaptation, which frankly makes me sceptical.
The article isn't just poor journalism, it crossed the line into soft propaganda for the weight loss drugs.
There is a lot of money riding on these drugs, and there is a story as to how we have got here. The drug companies that are marketing these weight loss drugs switched up their game after their previous cash cow, insulin, ran out of patent protection. Sure, they have got a new fix, but they care about their shareholders, not anyone's waistline. This does not make them evil, it is just business.
Standard practice for all drugs is to get them through the regulatory hoops for one thing, in this case diabetes (2) and then go off label, to get them prescribed for weight loss and now, fatty liver disease.
All of these conditions are one an the same, metabolic syndrome. So it does make sense to have these 'off label' uses, but you have got to respect the hustle.
If the article was properly researched then it would have outlined how that lifestyle interventions are preferable to prescription drugs, and that plenty of research papers have shown that Mediterranean and whole food, plant based diets (devoid of processed foods and animal products) have had some success at reversing fatty liver disease and enabling patients to obtain a healthy BMI.
I know some people throw a temper tantrum if a banana or a chickpea is placed on their plate, but the heart of the problem is lifestyle choices. Nobody is selected by a cruel roll of the dice to get metabolic syndrome, it is a lifestyle of car dependency, processed foods and saturated fats from animal products, probably washed down with fizzy drinks and alcohol.
Your mates that took Ozempic is anecdotal. Also anecdotal, everyone I know that follows Michael Pollan's advice to eat (mostly) plants has a healthy BMI.
> drug companies that are marketing these weight loss drugs switched up their game after their previous cash cow, insulin, ran out of patent protection
Are you disputing GLP-1's efficacy?
> If the article was properly researched then it would have outlined how that lifestyle interventions are preferable to prescription drugs
This would have struck me as CYA filler. We know diet and exercise work. Nobody reading Lancet is confused about that. And if they're reading The Guardian and are confused about that, they're not going to have the ephiphany halfway through a medical opinion.
> plenty of research papers have shown that Mediterranean and whole food, plant based diets (devoid of processed foods and animal products) have had some success at reversing fatty liver disease and enabling patients to obtain a healthy BMI
Compared to GLP-1?
I have a sore throat right now. I'm eating lots of ginger and garlic and foods rich in vitamin C and zinc. (Taken with hot teas.) If it were to progress into serious tonsillitis, I'd be pretty pissed off at the surgeon throwing a honey-lemon tea reference into their briefing.
> the heart of the problem is lifestyle choices. Nobody is selected by a cruel roll of the dice to get metabolic syndrome
Sure. Yes. If people made better decisions in the past we'd have fewer problems today.
In reality we have a lot of people who didn't make good decision in the past. Their bodies are failing. If GLP-1 works, it works. Getting conspiratorial about Big Pharma or butthurt that nobody mentioned feta cheese and hummus isn't useful for the targets of such an article, people thinking about the health of their loved ones as well as the arc of public policy.
You don't need to wonder. It's in the Acknowledgements section of the paper.
> JVL, HEM, and CJK acknowledge institutional support to ISGlobal from grant CEX2023-0001290-S, funded by MCIN/AEI/10.13039/501100011033, and the Generalitat de Catalunya, through the CERCA Programme. CDB is supported in part by the Southampton National Institute for Health and Care Research Biomedical Research Centre (NIHR 203319).
Funding statement: This work was supported by Novo Nordisk and Echosens via a grant to ISGlobal. The funding sources had no role in the study design, writing of this manuscript, or decision to submit the paper for publication, but did carry out the data modelling.
> JVL, HEM, and CJK acknowledge institutional support to ISGlobal from grant CEX2023-0001290-S, funded by MCIN/AEI/10.13039/ 501100011033, and the Generalitat de Catalunya, through the CERCA Programme. CDB is supported in part by the Southampton National Institute for Health and Care Research Biomedical Research Centre (NIHR 203319).
> Funding statement: This work was supported by Novo Nordisk and Echosens via a grant to ISGlobal. The funding sources had no role in the study design, writing of this manuscript, or decision to submit the paper for publication, but did carry out the data modelling.
Fun to see my local government funding something that appeared on HN :)
Lots of the numbers here are confusing in relation to other numbers…
“The researchers found that just under 3% of people in the UK, France and Germany, and 4% of those in the US have MASH, but diagnosis rates were below 18%. That means about 20 million people in the US, UK, Germany and France are living with MASH but only 2.5 million people have a diagnosis, leaving more than three-quarters – about 16.7 million people – unaware they have the condition.”
2.5/20 is 12.5%, which is under 18% but a very weird and specifc way to put it; 16.7 is more than 3/4 of 20 indeed (by a lot), but adding 2.5 to 16.7 is about 19 not about 20. This just all seems randomly off in various ways that make little sense to me. Anyone has any good theory how such sentences escape editorial edits, or can find a simple typo or two that make this paragraph coherent again?
For those who are curious, there's some anecdata online that extended fasting (days or weeks) can reverse this disease.
I can't find much published research on it to be fair, but I think the science in this field is lagging behind people's personal experiences.
If there's evidence to the contrary let me know, I'm not trying to spread misinformation. It's just one of the things I consistently recall reading over the years.
Edit since I'm being downvoted:
https://pmc.ncbi.nlm.nih.gov/articles/PMC6893587/ (prolonged fasting, ~8 days)
> The improvement of FLI correlated with the number of fasting days (r = −0.20, p < 0.0001)
https://eglj.springeropen.com/articles/10.1186/s43066-021-00... (ADF rat model)
> MSRDF rats showed cure of grade-1 NAFLD and significantly decreased LW than other groups and normalized HOMA-IR, HbA1C TC, LDL-C, ALT, and CRP.
https://www.cell.com/cell-metabolism/fulltext/S1550-4131(22)... (exercise + ADF, humans)
https://www.nature.com/articles/s41467-024-45260-9
this is the main thing I could find.
https://prolonlife.com/ sells a prepackaged fasting-mimicking diet. plenty of reviews online about the subjective effects on energy levels and soforth during the fast.
I didn’t like it. day 2.5-3 will put me back into the headspace of food scarcity and even knowing that the next meal was sitting in the box and that this is temporary … it was a mental challenge for me. if you’ve never experienced food scarcity, it can be all-consuming and seriously warp your cognition and emotional baseline.
Personally it is a strange thing. Diffcult to do over 24 hours but easy over a few days. Once you get over the head space of "im hungry must eat!" It turns into "im hungry, oh well".
But this is a sample size of 1 and results definetly vary wildly between folks.
I can concur - that shift in mindset to "i'm hungry, oh well" is crucial for your body I feel.
this is easier to do when you aren’t on the programmed diet that has you tantalizing your equanimity constantly.
> "im hungry, oh well"
The real danger is if you dont swap back and just created yourself an eating disorder.
That's not an eating disorder. Just because you're cold doesn't mean you need to put on a sweater. Learning not to let minor discomforts bother you builds discipline and character.
Fasting is great because you live off of your muscles. Keep at it and you will loose so much muscle, you will develop an eating disorder. The stomach and intestines are muscles too.
My understanding is that if you are healthy and you fast, it's great. If you are actually ill and fast it's still great but it only hides your illness and you are on a very bad path (eating disorder)
Anorectic are very dosciplined and proud of their ability to not eat. Hunger not being "well so what" is normal healthy biology. It is not just discomfort. It is biologcal mechanism to prevent very real harm.
Yhe issue with anorexia is that it works as cycle - if ypu have genetic predisposition, starwing affects metabolism, your discomfort about food gets worst and you are in it.
Even cutting back a couple hundred calories a day can leave you absolutely exhausted, in my experience. Even just increasing exercise by a couple hundred calories a day without eating more is also incredibly exhausting, after a few weeks it becomes thought dominating second-by-second.
Hunger is truly a powerful driver.
If you're going to fast, especially extended fasting, it would serve a person well to drop carbs and sugar and get into ketosis, at least for a while, so your body can start burning fat more effectively. If you've never done this before, it can be an uncomfortable process, with a lot of headaches, mood swings, etc. Making sure you take in enough electrolytes (sodium, magnesium, and potassium) will help a lot during all this, and during longer fasts.
I cleaned up my diet about a month ago, and have accidentally done some 24 hour fasts when I was busy and it's been fine. By the time I do eat, I'm really not even hungry, though my stomach may be growling a bit. The first time I ever did this, I had horrible headaches and felt miserable for a while, but subsequent times have been easier.
Good sleep maters too. Bad sleep will throw your hormones out of whack. I'm extremely hungry when this happens, and crave all the wrong things. Knowing what's going on helps a little.... just a little.
I find all this much easier than just trying to cut back by 200 calories with what I normally eat. It's all about hormones.
This sounds like a diet problem. You eat till your stomach is full. That because your food is not actually feeding you.
Long story short: meat and vegs + fruits. It takes a while.
and that’s when you’re doing it willingly :)
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Exhaustion is in people's heads to an extent, but I think you're lying about your energy intake and/or activity level. If you do three 36 hr fasts per week then you're effectively only eating 2.5 days per week. Consuming 1500 kcal/day on non-fasting days equates to only 3750 kcal/wk total. Running burns at least 90 kcal/mi even for a small person so if you're doing 35 mi/week that means >3000 kcal/wk just from exercise, plus at least 7000 kcal/wk for basal metabolism. At that rate you would therefore be losing about 2 lb/wk of fat, which is an unsustainable for more than a few weeks at a time.
As a point of comparison I'm a large man and fairly active with endurance sports so I have to consume about 3100 kcal/day (with no fasting) to maintain body weight.
Your math is off, here's my schedule:
Sunday 10pm - Tuesday 10am - No food.
Tuesday 10am - Tuesday 10pm = 1500
Tuesday 10pm - Thursday 10am = No food.
Thursday 10am - Thursday 10pm = 1500
Thursday 10pm - Saturday 10am = No food.
Saturday 10am - Sunday 10pm = 3000 (Sat 1500cal, Sun 1500cal)
6000cal.
Though I agree there probably is some fuzziness in those 1500 days that I'm not properly accounting for.
You are losing weight, right?
Every time the New York Times publishes a health-related article, the comment section is filled with comments just like this: just self-congratulations without any useful takeaways for anyone else, and zero self-awareness that would enable them to realize, hey, not everyone is like me.
Whenever one feels tempted to utter “it’s all in your head”, my advice is to take a step back and reflect on how little I know about the circumstances of others, and then, you know, maybe just keep it to myself.
Looking at the numbers posted I suppose it was just undeclared sarcasm :)
I'm willing to believe that, but Poe's law is almost as much a certainty as gravity. :-)
Behavioural patterns are heavily influenced by hormonal balance and as such, success-rates of different self-help strategies (diets, fasting, resistance and/or endurance training) are highly individual. This also extends to addictive behaviours.
"Hormon-typical" individuals have an easier time shaping their behavior because they don't face imbalances that complicate adherence. For them, sticking to a program is trivial. Combine that with lack of reflection, and many of these individuals delude themselves into thinking their success of following simple programs (which are simple in design, and only difficult in adherence) is somehow an accomplishment worthy of note. Low-empathy individuals, in particular, often interpret this as evidence of their own superiority, while dismissing others as mediocre.
So you see such comments a lot, because many people are "hormon-typical" and also low empathy. See any discussion about diet, fitness, Ozempic, etc.
Yes of course it's in your head.
But I've always been a skinny person. Maybe it is less exhausting if you have lots of fat to run off of.
Sounds like anorexia behavior. Those people do sport a lot, eat a little, right up the the moment the cumulative body damage is just too much. Pro-ana forums are full of people who live on very little calories and are at complete denial about health harm they cause to themselves.
That feels like the incorrect framing, the burden of proof is on the initial claim. That'd be like saying "I've heard online that leprechauns live on the moon. I haven't found published research on it, but I think science in this field is lagging behind personal telescopic experience. If there's evidence to the contrary let me know, but I've read it online a lot." and treating that like it's proof of moon leprechauns.
It's not exactly the same, as there are studies, there just haven't been a lot yet, since a lot of the study around it is new, although fasting has been practiced for thousands of years. There is no money in fasting, so the number of organizations willing to fund the studies goes way down.
To put some numbers to it:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10564080/
> Only five out of the 1304 studies on NAFLD involved IF.
Here is one that mentions there may be some efficacy to the idea and no harm.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8958240/
> In conclusion, current evidence suggests that intermittent fasting in patients with NAFLD is a feasible, safe, and effective means for weight loss, with significant trends towards improvements in dyslipidemia and NAFLD as illustrated through non‐invasive testing (NIT).
If someone has NAFLD, they can either sit around and eat cake for 20 years waiting for the science, or they can try doing some fasting, which is very low risk (assuming they don't have other issues going on), and find out very quickly if it works for them. Sure, it's an n of 1 in that case, but who cares, if they are the test subject it only matters if it works on them.
I'd add to this that the carbs should be kept low and the diet having quality foods outside of the fasts. Eating aforementioned cake during a feeding window every day is going to leave a person miserable, burning muscle, and still leave the hormones all screwed up. Insulin needs to be controlled and lowered. Fasting does that quickly, but don't abuse it during your meals on a regular basis.
From what I've read elsewhere, fasting can help in the early stages to reverse it, but once real damage occurs that sticks around.
There may be some medical benefits to periodic fasting, especially for people with excess adipose tissue. But in terms of "no harm" the Memel et al paper you linked doesn't seem to mention anything about loss of lean muscle tissue. This can cause serious harm for some patients — especially older patients with the "skinny fat" body type — by leading to sarcopenia (higher musculoskeletal injury risk) and endocrine dysfunction (muscle is a glucose sink). Loss of muscle can be limited to an extent by doing resistance training and maintaining high protein intake during non-fasting periods. But overall there are still a lot of unknowns in this field.
A lot of that would be covered under the “other issues” I mentioned. Obviously, consult with your doctor first.
In terms of muscle loss, from what I’ve read, muscle loss is more of an issue for low calorie carbohydrate based programs. When fasting there might be some muscle loss when at the very start, but then it tends to preserve muscle, and like you said, adequate protein intake and resistance training can mitigate that.
Those, like Peter Attia, who saw muscle loss from long term keto and fasting over several years, weren’t using fasting as a medical intervention. He was already metabolically healthy, but maintained a pretty extreme fasting protocol in an effort to gain longevity benefits, effectively experimenting on himself based on some results of early studies around the benefits of fasting for longevity.
The general theory now seems to be making the fasts much less frequent once healthy. Maybe only a couple times per year.
I’m sure this area of study will continue to evolve slowly.
Add also refeeding syndrome to the list of risks. It can also serve as trigger for eating disorder.
Long calories deficit can lead to permanent brain damage too. And heart damage.
From your chosen quote, it doesn't seem to indicate that fasting specifically changed things, but fasting being an "effective means for weight loss" was the bit that really mattered. I don't see anything to divorce the two - general weight loss and improvement to the FLI.
> Available evidence suggests that any form of caloric restriction may be beneficial and specific forms of IF should be tailored to the individual.
Also important to notice that once the liver is damaged it's not recommended to fast:
> Additionally, it is important we investigate the possible risks of fasting in patients with cirrhosis, which is currently not recommended.
so live a life of gluttony and "reverse" it in few days of fasting. seems like a good deal.
I wonder, given the instances of common diseases that were discovered/strongly suspected recently to have a microbial component (eg. ulcers + heliobacter pylori, Guillain–Barré + cytomegalovirus, Alzheimer + HSV, Several cancers in men and women + HPV), what are the odds we'll eventually discover fatty liver disease is a symptom or is triggered by "hepatitis X" or something like that?
That won't be the case for a disease that is almost 100% correlated to asedentary lifestyle, bad diet and alcoholism
This frankly scares me somewhat. I had a liver ultrasound where the radiologist warned me I had some signs of fat on the liver though not extensive yet.
I weigh 72kg at 178cm height. At peak, when I got tested I weighed around 86kg. I was barely overweight and definitely not obese and yet...
Knowing the weight alone is not enough though: you can be 72kg and fat or 86kg and very lean but also very muscular.
E.g. I'm 178cm as well but when I was 71kg I was visibly "fat", or at least skinny fat to be charitable. I'm currently 67kg but very lean and somewhat muscular.
At 86kg I had a bit of dad bod going on. Not a huge gut but somewhat pudgy here and there. Not hugely so and not overly visible as most of it was visceral fat. I haven't had an ultrasound since losing the weight. I hope the liver looks better now. I've been eating fewer calories, healthier calories and swimming. Hopefully that's enough to at least halt the damage done by my old lifestyle.
I had moderate NFLD and managed to get rid of it completely by just eliminating fried food, most dairy, and sugary snacks for about 6 months, I also almost never eat red meat. It's not so much about being overweight, but what you're eating.
You totally changed your diet and didn't lose weight?
I did lose weight, but it wasn't crazy dramatic.
Yep, the dietary recommendations have been consistent for decades at this point. Dairy, meat, sugars and excessive oils are not great for us. A little in moderation is fine, that is a lot lower than what most people think.
But it isnt pushed hard because it is difficult to steer the ship of humanity. Like how doctors will say "lose some weight" but they arent really expecting miracles on it as they know the battle that is.
Dietary recommendations have fluctuated widely for decades, and still differ substantially between sources. So far there is zero direct evidence that meat consumption causes fatty liver disease; I mean it's possible but we just don't know one way or the other. The only real data we have comes from low-quality observational studies (basically junk science).
If someone wants to try limiting meat consumption as an "n=1" experiment to see how it affects their body composition and other biomarkers then go ahead. Just don't expect a major impact from that one factor.
Generally speaking, I actually don't think I recall much of a link between meat and fatty liver, it always seemed to be closer linked to highly refined sugars and possibly high levels of dairy but less of a link there.
Not to mention, there's a good chance that your doctor is fatter than you are.
I eat enormous amounts of dairy and red meat and recently I had abdominal surgery and the doctor afterwards confirmed I was in very good shape and had no signs at all of fatty liver and very little visceral fat generally.
I eat around a pound of beef a day, a gallon of yogurt a week, and almost everything (eg oatmeal) is made with copious amounts of butter.
I think unless you know something specific about your genetics, just eat plain natural foods people have been eating for millennia and you will be perfectly fine. Basically, buy plain meat, vegetables, grains, and dairy and prepare them yourself. Don’t eat preservatives, corn syrups, or novel vegetable oils like canola. Maybe they’re fine but there’s no reason to risk it. Also do your best to make sure what you eat followed the same rule; eg my beef was grass fed and finished and was not fed skittles in a feedlot. Diet affects animal meat as well, just as it does us.
This is good advise to get behind. I do feel like a lot of the optimal dietary advice is far to hard lined and that a better path really is just whole foods in moderation.
Bmi is one metric but you need to combine it with a measurement of your belly circumference. I had similar numbers but the weight was al in the belly and got diagnoses as type 2 diabetic with high cholesterol etc.
The two big ones are high fructose corn syrup and alcohol.
I feel the hfcs is the bigger issue here because it is put in everything in the US, but moderating both of these will help.
Look at labels and put back anything with hfcs.
https://www.nih.gov/news-events/nih-research-matters/how-hig...
https://pmc.ncbi.nlm.nih.gov/articles/PMC6549781/
HFCS isn't any meaningfully different from sugar. It's basically chemically the same as honey. And no, they don't put it in everything. It's in soda and certain sweets (obviously) and sweet sauces, but it's not like it's creeping into unexpected places in some huge way. Yes, there may be foods with a hint of sweetness that have a hint of HFCS, but then it's a negligible amount anyways. HFCS isn't some kind of bogeyman. It's essentially just sugar. Treat it accordingly.
Fructose is processed by the body quite differently than sucrose, in a way quite relevant here.
And actually one of humanity's major evolutionary advances.
HFCS is typically 42:58 or 55:45 fructose:glucose. Table sugar is 50:50. HFCS is only "high fructose" relative to unprocessed corn syrup, not relative to table sugar and other common sweeteners.
A small difference at small levels but one which obviously matters when it's shoved into countless foods without most people event realizing. It's not just in soda and candy; it's in bread, pasta, almost any processed food (crackers, ketchups and other sauces, canned fruit, applesauce, lunch meat, peanut butter, the list goes on) and many foods one might not considered processed.
It makes sense to try to eliminate it even though it's "only" a small difference. Might as well remove the difference at all and look out for things with no HFCS shoved in it for no reason.
Wikipedia:
>HFCS 42 is mainly used for processed foods and breakfast cereals, whereas HFCS 55 is used mostly for production of soft drinks.
In other words, the type of HFCS that's "shoved into countless foods" has less fructose than table sugar, not more. If fructose is the villain here, that actually constitutes an improvement over table sugar.
Plain pasta almost never contains any HFCS. Maybe you can find some that does but that's not what most people are buying in their local grocery store. (The sauce is often a different story.)
Fair - I went back and re-edited enough times my original message got jumbled, and I had been thinking of pasta dishes you could buy, which almost invariably have HFCS, but absolutely correct plain pasta pretty much never does.
The point is, it doesn't matter if your ketchup is made with sugar or HFCS. If it weren't HFCS, it would be sugar, because ketchup is supposed to be sweet, and they have the same nutritional effect.
Similarly, it's not suprising when pasta sauce has some sweetness added -- grandma also likely added a bit of sugar if she found tomatoes too acidic, which many do.
The only thing that matters is that it's sugar. HFCS isn't somehow worse. If you're trying to eliminate sugar overall then sure, of course avoid HFCS. But if you're fine with a certain moderate amount of sugar per day, then the relatively small amounts of HFCS in things like pasta sauce and peanut butter are fine. The same way the sugar or honey in teriyaki sauces is. They count towards your daily allotment of sugar. For people trying to eat relatively healthily, avoid the soda but there's no reason to worry about the HFCS in ketchup or normal amounts of tomato sauce, for goodness' sake. The only reason to avoid HFCS entirely is if you're truly cutting sugar out of your diet entirely. Otherwise they're just substitutes for practical nutritional purposes.
That's another fair point that specifically tomato-based products often have sugar, but also kind of missing the forest for the trees. For various reasons, we have a slew of foods that one might not expect to have added sugar (like lunch meat, ham notwithstanding, or applesauce which is already sweet without extra sugar, to pick from my short list above), that do because of reasons. In any case it does pay to still look, because if you're not careful you could pick one random tomato sauce that has double the amount of sugar compared to the jar right next to it on the shelf (Bertolli Tomato & Basil, 11g per serving; Newton's Own Marinara, 6g per serving).
These choices add up, which is the point I was trying to make originally (though I agree I did not do a good job of it); I understand I was being pedantic so I understand the nature of the responses to me. The point is that small differences, isolated, don't matter, but in aggregate they absolutely do. We make arguments like this all the time in software when trying to write correct, performative code -- the milliseconds add up, and so do the grams of sugar.
The anti-HFCS movement, despite having its targets aimed for wrong reasons, is still aiming at the right thing: being more mindful of what's in the things we put in our bodies.
This is wrong. As another commentator pointed out,the body processes fructose differently from sucrose.
As for honey (and fruit, for that matter) - they are full of beneficial compounds that help your body regulate blood sugar.
To illustrate this, someone I know of with type I diabetes who ate natural honey didn't need to inject as much insulin as when eating commercially processed/heated honey - those beneficial compounds are destroyed during the process. Same for fruit vs fruit juice...
I cannot find the study at the moment (Google you used to be great at this!) but there was one seeing how diabetics blood sugar was impacted from just fruit consumption. Got to the point where even at 20 serves per day (4 times the recommended) in most people it didnt cause an issue. Bundling that sugar with fiber was a big part of regulating sugars.
Corn syrup might or not be different, Im no expert in that field, but simply having highly refined sugars without the filler is monocropping your diet in weird ways. In the same way soil is being killed by mono cropped agricuture, we are doing the same with our gut biome. The flow on impacts are still being discovered.
Sucrose is glucose-fructose, and is easily split. My understanding is that it is all split by digestion.
The glucose and fructose than act the same as glucose and fructose from HFCS.
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Any answer that begins with "if everyone just-" is tantamount to doing nothing and those are the other options available, nothing except for weight loss drugs has managed to put a dent in widespread obesity.
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It has nothing to do with spirituality or morals. Skinny-country person moves to the US, they get fatter (statistically speaking). They weren't skinny at home because they were better spiritual warriors or whatever, but because they didn't live in the US.
The options are to fix what are probably a whole bunch of problems across multiple domains at a cost of $(enormous sum) with a project spanning many decades (and which may easily be derailed and set back years and years at any time), so that living in the US doesn't make people gain weight, or... drugs, that work today. From a policy perspective, those are the only options. There's no good reason to think that reversing "moral decline" or whatever will help, since that doesn't seem to be why some other countries are skinnier.
Just to enumerate a few of the sides of this problem:
- economics. Junk food is more available because processed foods last longer and can be stored at mini marts and gas stations. It is true that beans and rice are cheaper than junk food, but junk food is a very cheap way for a dopamine hit.
- time: people have less time to cook due to working and commuting
- urban planning: walkable neighborhoods are few in the US. Lots of daily exercise is foregone for this simple reason.
- culture: the US has a very pleasure-seeking culture. Given the choice of having healthy food vs gratifying food, we tend to the latter.
All of these factors conspire to get us where we are.
> It’s more a spiritual / moral decline of culture in the west.
It's not a question of decline. There's no reason to think that humans today have less self control than in the past. We're dealing with obesity now because tasty, cheap food didn't exist until the second half of the 20th century.
I think there is a long list of reasons to think it is lower.
Self control is a skill which requires practice. A huge amount of our time and practice is devoted to chasing immediate gratification. Doom scrolling, tv, ect. This is all practicing the opposite.
The thing we seem to be learning especially now with GLP-1 drugs is that a lot of skinny people are not skinny because they have iron self control, but because they don't need it, because their bodies aren't constantly sending them screaming chemical signals to eat. These drugs turn those signals down and suddenly people stop wanting to eat so much.
So another hypothesis that seems totally in keeping with the data is that either 1) some group of people have always had this problem in history, they just haven't had access to food like we do now, and/or 2) something about modernity is pushing those chemical triggers up to overdrive in more people.
Self-control really sucks as a solution to anything. When was the last societal problem solved by a national campaign of personal self-control?
Im not saying there isnt a biological component. I think a large portion of the USA has a trashed metabolic and hormonal system. A lot of this damage is irreversible from overconsumption.
unless we start dosing children with GLP-1s preventatively for weight and medicate them for attention we should probably think about how we relate to our environmental conditions long term and prevent patterns from repeating.
There are lots of people out there not living their best lives
Other countries with access to phones and TVs but not mass produced foods stay leaner.
lots of other differences I imagine
It’s not actually that tasty though. Maybe it was 40 or 50 years ago. But now most of it is flavorless. It just commonly available. And it’s not even cheap anymore. For the most part.
If you don't find it tasty, you probably don't have a problem with overeating it. But many people can finish half a bag of Doritos in one binge. I'm one of those people. They're delicious and don't satiate me fast enough to moderate consumption. That's why I don't buy Doritos in the first place. If they're around, I'll eat them.
I just swear that soda pop and junk food tasted better in the 80s. Doritos are actually still pretty solid. But it seems like everything that’s using high fructose corn syrup simply does not taste like the stuff did when they were using cane sugar for everything. I also think they got the food scientists going far deeper than that, and there were changes to the recipes that just continually drove pennies out of the product. But it’s no longer the product that it was back in 1970 or 1980. One example that always comes to mind for me is Sun Drop. He used to be able to see the bits of fruit floating around in one of those bottles. I don’t think Mountain Dew taste good anymore either it has changed.
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Sure, our obesity epidemic is because everybody just suddenly decided to start eating more a few decades ago. Much more likely there is some environmental factor causing it. I guess calling it moral decay feels more self-righteous though.
> It’s more a spiritual / moral decline of culture in the west
It's not just the West.
"Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country's population" [1]. (It's about 7% in America [2].) Meanwhile in China, "the incidence of overweight and obesity among school-age children...was 15.5% in 2010, rising to 24.2% in 2019 and soaring to 29.4% in 2022" [2]. Same story in Vietnam: "The prevalence of overweight among children aged under 5 years increased from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, prevalence rose from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively" [3].
OP is right. "If everyone just..." is shorthand for wishing upon a star that the world were different. It's not a serious solution for reality as it is. (To the degree there is a social trust variable at play, it's in folks doing mental gymnastics to reject the clinical data.)
[1] https://en.wikipedia.org/wiki/Obesity_in_India
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC10357130/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC9947684/
"yet those same people are unable to put less food in their mouths"
And you think that addiction is a moral/spiritual problem? Nope, it is an endocrinological problem. And precisely drugs like Ozempic have made it very clear, because it doesn't just treat obesity, but many other addictive behaviors like compulsive shopping or gambling. By "merely" altering hormonal balance in the target organism.
People once thought that smallpox was divine punishment for sins. It is 2025, we are on Hacker News, and yet the very same pattern of thinking emerges here, against all the scientific knowledge.
> And you think that addiction is a moral/spiritual problem? Nope, it is an endocrinological problem.
Interesting point. Addiction needs a drug. Drug needs dealers.
Thankfully, dealing drugs is forbidden.
Selling unhealthy and bordeline addictive "food" is défini legal though. Should we regulate this more?
> Addiction needs a drug. Drug needs dealers.
> Thankfully, dealing drugs is forbidden.
This is an example of equivocation: Insofar as there is a definition of "drug" for which "Thankfully, dealing drugs is forbidden" is (well, minus the subjective judgement "thankfully") categorically true, it is not one for which either "Addiction needs a drug" or "Drug needs dealers" is also categorically true.
Given the "successes" of various prohibitions and wars on drugs all around the world, I don't think this is going to work, at least not with major unintended consequences (hello sugar-smuggling gangs with machetes!). People are really good at trafficking banned substances.
Treating addiction as a disease would probably be less violent and less likely to produce major human rights violations.
There is a middle road of simply taxing highly processed foodstuff more without banning it outright, but that also creates perverse incentives for governments which now have a source of income that they don't want to jeopardize.
Regulating food works relatively well in Europe, despite all its flaws. Like making sure that what we are sold as "food" is actually, you know, food and not something that tastes and smells like food.
I am an European too, and while I agree that overall quality of food in Europe is fairly good, we have been hit by the obesity pandemics pretty hard - which indicates that whatever we do is not a solution.
We do know that some punishments were the result of sin. We have scriptural evidence. It’s also possible that smallpox was. The mechanism in which that things occur could very well be naturalistic, of course. These areas of examination are mutually exclusive.
Are you ready to throw stones in glass houses? We can list a thousand sins of people with actual political power that dwarf the sin of “accommodating” so-called lifestyle choices. Then we can talk about how those same people abuse trust at every opportunity.
Your buzzwords are useless.
I love how this is framed as if it's obviously a sinister thing, like some shadowy force made up MASH in order to sell drugs, rather than it being kind of a medical miracle that effective treatment regimes are becoming available.
In the article is this paragraph: Dr Paul Brennan, a co-author of the Lancet paper and a hepatologist at NHS Tayside, said: “GLP-1s (including Wegovy and Mounjaro) offer the potential to resynchronise our metabolism, by introducing feelings of satiety – fullness – and delaying the time the stomach takes to empty. These effects often result in reduced calorie intake, and improvements in how the liver handles nutrients as a result of weight loss, thus reducing scar tissue formation in the liver.”
I'm excited by the prospects of GLP-1 for reduction in inflammation. I have to wonder if that plays a role in helping people lose weight as well.
I haven't been able to cure the fatty liver by self-control, so I'm intending to ask the doctor about a medical solution on my next visit. This particular article came after that decision!
> Call me cynical, but every article in a newspaper is published for a reason, and I think I know where this is going.
I wouldn’t call you cynical; I’d go so far as to call you conspiratorial.
I know what you mean, and perhaps this is also a signal to "short" stock in sugar companies.
That is, i wonder if the article possibly mentioned the eyeball-attracting names of the weight-loss drugs as more enticing than just saying "cut out added sugars and these livers may well fix themselves".
> and then get them on the drugs for life, knowing full too well that they won't make the lifestyle adjustments needed to get them off the drugs.
What are you basing this on? Everyone I know who went on and off Ozempic kept off clinically-meaningful amounts of weight.
There is religious intensity to this popular unsaid (and blatantly incorrect) assumption that the human body left alone is perfectly made, and that any intervention in its mechanism is prima facie evil.
The human body left alone in original East African savannah sorta worked, hunters and gatherers don't suffer from metabolic disease much. (Though obviously they still succumb to injuries, infections and random disease such as appendicitis.)
The human body left alone in a modern supermarket world is way off its original evolutionary envelope. I am a descendant of 300 generations of agricultural people and I still struggle with processing of milk. Most of our commercially sold foods aren't 300, but 1-2 generations old. We just cannot be adapted to that.
> human body left alone in original East African savannah sorta worked, hunters and gatherers don't suffer from metabolic disease
One, we don't know that. But two, it's fair to assume they didn't because their constraint was starvation.
Look, metabolic disease makes sense from a preservation angle. It's a safe assumption, in the wild, that one will not suddenly come across permanent sources of excess calories. So if one assumes starvation is the enemy, and the body finds itself amidst excess calories, it must assume this is a finite resource to be competed for. Herego, stuff your face. Build fat cells. And under no circumstance shoud you give up a fat cell. No, reduce voluntary motion and--if necessary--cut basal metabolism to ensure we can get these calories into our bodies before someone else exhausts them.
For what it's worth, I'm on the other end of the spectrum. My body happily burns away fat stores. This is frankly great in the modern world! But if I get seriously sick (or thrust into a starvation environment), my odds of dying are high--it's why folks with a mid-twenties BMI have a longer life expectancy than those of us closer to twenty. Not techhnically underweight, and with plenty of muscle. But also with less of a buffer.
> human body left alone in a modern supermarket world is way off its original evolutionary envelope
It's arguable that the evolutionary envelope was leapt off around the development of agriculture and animal breeding. (We're still on patch Tuesday from c.a. 10,000 BCE on lactase.)
We have studied hunters and gatherers which survived into recent times and they indeed seem to be very metabolically healthy. "Starvation" is a strong word, but they certainly don't live in a world of plenty and tend to be lean.
What you are describing is so-called "thrifty gene hypothesis", it makes a lot of sense, but it hasn't been corroborated by actual genomic observations yet.
> What you are describing is so-called "thrifty gene hypothesis", it makes a lot of sense, but it hasn't been corroborated by actual genomic observations yet
The problem with thrifty genotype is hunter-gatherers seem to have had less caloric volatility (if we control for habitat quality) [1]. So to the degree such genes might have emerged, it would have had to have been selected for during migrations. That, in turn, requires it be a relatively human-specific adaptation, which frankly makes me sceptical.
[1] https://pubmed.ncbi.nlm.nih.gov/24402714/
The article isn't just poor journalism, it crossed the line into soft propaganda for the weight loss drugs.
There is a lot of money riding on these drugs, and there is a story as to how we have got here. The drug companies that are marketing these weight loss drugs switched up their game after their previous cash cow, insulin, ran out of patent protection. Sure, they have got a new fix, but they care about their shareholders, not anyone's waistline. This does not make them evil, it is just business.
Standard practice for all drugs is to get them through the regulatory hoops for one thing, in this case diabetes (2) and then go off label, to get them prescribed for weight loss and now, fatty liver disease.
All of these conditions are one an the same, metabolic syndrome. So it does make sense to have these 'off label' uses, but you have got to respect the hustle.
If the article was properly researched then it would have outlined how that lifestyle interventions are preferable to prescription drugs, and that plenty of research papers have shown that Mediterranean and whole food, plant based diets (devoid of processed foods and animal products) have had some success at reversing fatty liver disease and enabling patients to obtain a healthy BMI.
I know some people throw a temper tantrum if a banana or a chickpea is placed on their plate, but the heart of the problem is lifestyle choices. Nobody is selected by a cruel roll of the dice to get metabolic syndrome, it is a lifestyle of car dependency, processed foods and saturated fats from animal products, probably washed down with fizzy drinks and alcohol.
Your mates that took Ozempic is anecdotal. Also anecdotal, everyone I know that follows Michael Pollan's advice to eat (mostly) plants has a healthy BMI.
> drug companies that are marketing these weight loss drugs switched up their game after their previous cash cow, insulin, ran out of patent protection
Are you disputing GLP-1's efficacy?
> If the article was properly researched then it would have outlined how that lifestyle interventions are preferable to prescription drugs
This would have struck me as CYA filler. We know diet and exercise work. Nobody reading Lancet is confused about that. And if they're reading The Guardian and are confused about that, they're not going to have the ephiphany halfway through a medical opinion.
> plenty of research papers have shown that Mediterranean and whole food, plant based diets (devoid of processed foods and animal products) have had some success at reversing fatty liver disease and enabling patients to obtain a healthy BMI
Compared to GLP-1?
I have a sore throat right now. I'm eating lots of ginger and garlic and foods rich in vitamin C and zinc. (Taken with hot teas.) If it were to progress into serious tonsillitis, I'd be pretty pissed off at the surgeon throwing a honey-lemon tea reference into their briefing.
> the heart of the problem is lifestyle choices. Nobody is selected by a cruel roll of the dice to get metabolic syndrome
Sure. Yes. If people made better decisions in the past we'd have fewer problems today.
In reality we have a lot of people who didn't make good decision in the past. Their bodies are failing. If GLP-1 works, it works. Getting conspiratorial about Big Pharma or butthurt that nobody mentioned feta cheese and hummus isn't useful for the targets of such an article, people thinking about the health of their loved ones as well as the arc of public policy.
I wonder who funded the study....
You don't need to wonder. It's in the Acknowledgements section of the paper.
> JVL, HEM, and CJK acknowledge institutional support to ISGlobal from grant CEX2023-0001290-S, funded by MCIN/AEI/10.13039/501100011033, and the Generalitat de Catalunya, through the CERCA Programme. CDB is supported in part by the Southampton National Institute for Health and Care Research Biomedical Research Centre (NIHR 203319). Funding statement: This work was supported by Novo Nordisk and Echosens via a grant to ISGlobal. The funding sources had no role in the study design, writing of this manuscript, or decision to submit the paper for publication, but did carry out the data modelling.
https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...
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I was wondering why it didn't recommend reducing carbs and increasing vegetables; instead recommended drugs.
Vegetables have carbs in them?
Not many outside potatoes etc, hence the word "reducing."
According to the paper (https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...):
> JVL, HEM, and CJK acknowledge institutional support to ISGlobal from grant CEX2023-0001290-S, funded by MCIN/AEI/10.13039/ 501100011033, and the Generalitat de Catalunya, through the CERCA Programme. CDB is supported in part by the Southampton National Institute for Health and Care Research Biomedical Research Centre (NIHR 203319).
> Funding statement: This work was supported by Novo Nordisk and Echosens via a grant to ISGlobal. The funding sources had no role in the study design, writing of this manuscript, or decision to submit the paper for publication, but did carry out the data modelling.
Fun to see my local government funding something that appeared on HN :)