The Nutrition Science thread

[J. Barron DeJong]

It’s an interesting study, but one also must consider individual differences in opioid receptors/reward systems when consuming what would be considered hedonistic foods (salt, fat, sugar). I don’t think money has anything to do with obesity, as we do often see those with the lowest financial means and the greatest preponderance of obesity.

There is no simple answer. Sedentary lives, easy food access of poor nutritional quality, etc. Modern life doesn’t exactly lend itself to inherent or mandatory movement like it did in centuries or even decades past.

I’m not an expert on receptors by any stretch. Can’t even pretend to play one. But that’s why they injected nutrients directly into the stomach, right? To bypass all the sensory receptors that would trigger a response from actually eating food?

[Dantheman]

What was the difference in the two studies (one you quoted and the one OG quoted) that resulted in a 400kcal difference? THAT is a large difference between studies that appear to be studying the same/similar things? and i do agree that 500kcals is a significant amount.

In OG's study participants were fed isocaloric diets and they examined the difference in calories absorbed. The Cell study I linked to gave participants ad libitum access to two different diets (unprocessed vs. highly processed) and tracked how much food ended up in their mouths.

I’m not an expert on receptors by any stretch. Can’t even pretend to play one. But that’s why they injected nutrients directly into the stomach, right? To bypass all the sensory receptors that would trigger a response from actually eating food?

Correct.

[Trackhead]

I’m not an expert on receptors by any stretch. Can’t even pretend to play one. But that’s why they injected nutrients directly into the stomach, right? To bypass all the sensory receptors that would trigger a response from actually eating food?

I think in part, yes. Regardless, interesting study and certainly another piece of the puzzle. Obesity impairs so many physiologic functions including leptin, insulin sensitivity, testosterone production, aromatase, etc it’s no surprise it may have long term sequela on dopamine signaling and food reward. I mean, a heroin junky NEVER stays at the same usage level, nor does an alcoholic. Always need more to achieve the same reward.

The media push that obesity is not unhealthy is misguided, at best. No need to fat shame, but there’s little argument that obesity is anything but pathologic.

[californiagrown]

The media push that obesity is not unhealthy is misguided, at best. No need to fat shame, but there’s little argument that obesity is anything but pathologic.

The push to de-stigmatize unhealthy and objectively negative characteristics and behavior has gone overboard. Issues should be de-stigmatized to the point where people arent afraid to admit and address those issues. They should not be de-stigmatized to the point where they are deemed acceptable or celebrated (addiction, obesity, being a trump supporter, etc).

[Trackhead]

Agreed 100%. The Trump slide in is also hilarious

[ötzi]

But, they're still better off with metformin and Wegovy and no lifestyle changes than nothing at all...

I'm way behind on this thread sorry and maybe this was discussed but it looks increasingly like pretty much everyone should be on metformin. First article google found just now (but there's a bunch): https://pubmed.ncbi.nlm.nih.gov/3354...2C%201.07%5D).

[Trackhead]

For diabetics it is the first line drug. It’s cheap, well tolerated, and effective. The only people who should be taking metformin are folks with DM2, not the general population.

[ötzi]

What part of "all-cause mortality" do I misunderstand? https://pubmed.ncbi.nlm.nih.gov/28802803/

[old goat]

It’s an interesting study, but one also must consider individual differences in opioid receptors/reward systems when consuming what would be considered hedonistic foods (salt, fat, sugar). I don’t think money has anything to do with obesity, as we do often see those with the lowest financial means and the greatest preponderance of obesity.

There is no simple answer. Sedentary lives, easy food access of poor nutritional quality, etc. Modern life doesn’t exactly lend itself to inherent or mandatory movement like it did in centuries or even decades past.

Money has a lot to do with obesity, and the study suggests why. Poor people, especially those living in food deserts, tend to have diets high in processed calories and poor access to unprocessed complex calories, as well as poor education in nutrition.

The gut flora calorie thing is of course only part of the picture.

[mcski]

For diabetics it is the first line drug. It’s cheap, well tolerated, and effective. The only people who should be taking metformin are folks with DM2, not the general population.

Why? I mean it sure ain’t as bad as horse dewormers. I haven’t seen any studies yet on it and warnings it’s gonna kill ya. Seems pretty innocuous for the most part. Am I missing something?

[Trackhead]

When I was working a bit in the villages/roadless communities in Alaska, where all they have is fish, caribou, moose, you should have seen the daily flights of food that came in. Guess what it all was.......

You could eat fresh salmon, caribou, and soda/chips/candy. No middle ground.

[Dantheman]

The only people who should be taking metformin are folks with DM2, not the general population.

The fact that diabetics who take metformin are healthier and live longer than non-diabetics who don't take it suggests otherwise. It's probably a stretch to say that everyone should take it, but everyone who is insulin-resistant probably should, and that's as much as 75% of the population.

Just getting enough exercise is better, but let's be real here.

[ötzi]

It's too bad there's no data on non-diabetics who take it vs. those who do but it's not unreasonable to suspect that the benefits might extend to everyone. But getting a study to test for that is problematic as it's a prescription medication and they can't just give it to people randomly.

[Dantheman]

It's too bad there's no data on non-diabetics who take it vs. those who do but it's not unreasonable to suspect that the benefits might extend to everyone.

I seem to recall that a study like that may be in the works. But, it's hard to replicate the unintentional experiment we've been running where diabetics have been taking metformin for years to decades.

...it's a prescription medication...

Berberine is the exact same thing in non-rx supplement form.

[Trackhead]

The fact that diabetics who take metformin are healthier and live longer than non-diabetics who don't take it suggests otherwise. It's probably a stretch to say that everyone should take it, but everyone who is insulin-resistant probably should, and that's as much as 75% of the population.

Just getting enough exercise is better, but let's be real here.

Insulin resistance (HgA1c) is routinely measured/monitored when establishing care in any overweight or obese patient, and in many others. If you meet laboratory criteria for insulin resistance, then you are prescribed metformin (unless contraindication exists) as a standard of care. So yes, that's already happening, and has been happening for decades.

Anecdote Warning: I have yet to see any observational evidence in my clinical world of diabetics having healthier lives than non-diabetics. I manage type 2 diabetics every day. Very few are managed on metformin monotherapy alone, as most progress and need various combinations of other medications.

Even the often cited here, Peter Attia is skeptical. His summary, as I'm sure you have read, is an excellent overview of limited current/conflicting evidence.

[ötzi]

Berberine is the exact same thing in non-rx supplement form.

Was not aware of that. Interesting, thanks.

TH I hear you loud and clear and defer to your first-hand knowledge. And a quick reading of the abstracts from a couple of studies doesn't make me an expert but they do seem to say that statistically speaking your observations may be misleading when it comes to longevity at least.

[Dantheman]

Insulin resistance (HgA1c) is routinely measured/monitored when establishing care in any overweight or obese patient, and in many others. If you meet laboratory criteria for insulin resistance, then you are prescribed metformin (unless contraindication exists) as a standard of care. So yes, that's already happening, and has been happening for decades.

Anecdote Warning: I have yet to see any observational evidence in my clinical world of diabetics having healthier lives than non-diabetics. I manage type 2 diabetics every day. Very few are managed on metformin monotherapy alone, as most progress and need various combinations of other medications.

Even the often cited here, Peter Attia is skeptical. His summary, as I'm sure you have read, is an excellent overview of limited current/conflicting evidence.

A1c is a measure of hyperglycemia, not insulin resistance (though obviously you can't have the former without the latter). People can be insulin-resistant for many, many years before or without progressing to hyperglycemia. Google says 20ish million people take metformin every day but at least 50% of the population has insulin resistance, so most people with IR are not taking metformin.

To be clear, I don't think metformin is any kind of panacea and far inferior to just exercising. But, a typical person who barely exercises, has moderate insulin resistance that is trending towards pre-diabetes, and is already taking a statin and an ACE inhibitor would probably be better off if they were also taking metformin.

[Trackhead]

A1c is a measure of hyperglycemia, not insulin resistance (though obviously you can't have the former without the latter). People can be insulin-resistant for many, many years before or without progressing to hyperglycemia. Google says 20ish million people take metformin every day but at least 50% of the population has insulin resistance, so most people with IR are not taking metformin.

To be clear, I don't think metformin is any kind of panacea and far inferior to just exercising. But, a typical person who barely exercises, has moderate insulin resistance that is trending towards pre-diabetes, and is already taking a statin and an ACE inhibitor would probably be better off if they were also taking metformin.

Agree, believe me I’m aware of the physiology of DM2 and insulin resistance, it is after all, my day job to understand it. It’s a test that is cheap, offers great clinical value, and offers far more than some esoteric expensive unavailable test for “insulin resistance” that only a university lab would perform. Remember in the real world we have 10-15 minutes per patient, 15-20 per day. HgA1c is a real world lab with real world utility for managing DN2 glycemic control.

And you’re right, most people when finally diagnosed with DM2 have already likely incurred damage to nephrons, cardiac, and retinas, which is why they all get screened for those issues upon diagnosis.

So yes, so many Americans are probably prediabetic that a bulk of the obese population probably would benefit from Metformin. Most people don’t do annual physicals, the ones that do, figure out immediately if they need Metformin or whatever else. But we don’t prescribe without a diagnosis, just like we don’t give statins to people assuming their lipid profile sucks. Gotta follow current consensus evidence or you look like a dumbass to your peers and everyone else. Don’t wanna be a quack prescriber.

[bennymac]

a “fasting insulin” test is not so out there and unavailable (sure it’s not gonna be processed in every little lab and it’s not as useful for DM2 monitoring)

[bennymac]

Berberine is the exact same thing in non-rx supplement form.

Berberine is not the exact same thing as Metformin

[Dantheman]

Agree, believe me I’m aware of the physiology of DM2 and insulin resistance, it is after all, my day job to understand it. It’s a test that is cheap, offers great clinical value, and offers far more than some esoteric expensive unavailable test for “insulin resistance” that only a university lab would perform. Remember in the real world we have 10-15 minutes per patient, 15-20 per day. HgA1c is a real world lab with real world utility for managing DN2 glycemic control.

And you’re right, most people when finally diagnosed with DM2 have already likely incurred damage to nephrons, cardiac, and retinas, which is why they all get screened for those issues upon diagnosis.

So yes, so many Americans are probably prediabetic that a bulk of the obese population probably would benefit from Metformin. Most people don’t do annual physicals, the ones that do, figure out immediately if they need Metformin or whatever else. But we don’t prescribe without a diagnosis, just like we don’t give statins to people assuming their lipid profile sucks. Gotta follow current consensus evidence or you look like a dumbass to your peers and everyone else. Don’t wanna be a quack prescriber.

I'm definitely not suggesting that every patient, or any patient, should be tested for IR using expensive clamp techniques and/or insulin infusion tests. Anyone who is more than ~15 lbs overweight and gets less than an hour of vigorous exercise per week (a solid majority of genpop) almost certainly has IR, no lab test needed.

Berberine is not the exact same thing as Metformin

You're right, that's an incorrect statement. They're different compounds with very similar physiological effects. Detailed breakdown for anyone interested: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839379/

[oldnew_guy]

This last page is insane.

Our population is so fucked up from our culture and diet that they should all be taking a prescription drug to counteract the effects of our culture and diet. JFC.

[Supermoon]

This last page is insane.

Our population is so fucked up from our culture and diet that they should all be taking a prescription drug to counteract the effects of our culture and diet. JFC.

Well as an individual you can’t fix your genetics, systemic racism, or capitalism, so you do what you can.

[californiagrown]

Well as an individual you can’t fix your genetics, systemic racism, or capitalism, so you do what you can.

The genetics of the vast majority of people dont need fixing. Their culture does. Our society is addicted to instant gratification, and IMO that is the cause of 95% of problems.

[Trackhead]

I'm definitely not suggesting that every patient, or any patient, should be tested for IR using expensive clamp techniques and/or insulin infusion tests. Anyone who is more than ~15 lbs overweight and gets less than an hour of vigorous exercise per week (a solid majority of genpop) almost certainly has IR, no lab test needed.

Honestly, you'd be surprised sometimes, a fair amount of folks you'd think would be slam dunk DM2 patients don't even have an A1c meeting prediabetes criteria. Then other ethnic groups aren't that overweight and surprise you the other way, shit renal function, shit A1c.