Doing your own research (1 Viewer)

[Joe Schmo]

But my point overall is less about plunges or saunas...but that is there nothing besides eating veggies, sleeping good, and exercising that would be recommended as "healthy habits". That stuff is like 2,000 years old knowledge lol.

What percentage of people are doing all these things? I bet it’s 10%, or less. And they probably wouldn’t agree on the specific diet, nor exercise regimen for optimal health.

So the high yield intervention is working to improve the fundamentals first, rather than entertaining every health hack du jour.

Seeing both perspectives I can see where the cracks are forming. I'm a data guy so solving a problem with the highest probability of success makes the most sense almost all of the time. The example of weight loss is a great one. If a PC has 100 overweight patients and tells all of them to eat better, exercise more and he'll check back with them in 6 months. Maybe 10% (no idea the real number) come back with results. If he prescribes that same 100 weight loss medication and 25% come back with results, it drives the theory to prescribe medicine as option A. I can understand why a PC doc would lean the way they do and spending extra time per patient to facilitate a lower success rate isn't a good use of their time.

That said, there is still the 10% who don't require the extra level of medical intervention that would now be subject to any side effects or complications that come from pharmaceutical treatments. These are most likely the people willing to explore holistic treatment options. I'm a believer that these holistic options do work for a lot of people, but not everyone. This group probably feels alienated by PCs who don't take the time to individualize treatment plans.

Compounding the issue is how poorly the overall US healthcare system is performing. We're not doing well and this "do your own research" really took off once this country tried to implement a once size fits all healthcare formula.

This sort of gets back to the notion that some dr's are good with their patients and perhaps some not so good because for me and me alone, my doc has been very proactive in guiding me toward living a healthier life and while I drive him nuts with my lack of follow through(I'm an American fatty with high bp and high cholesterol) he is more than willing to talk to me and to listen to me about treatments. I believe he may prescribe me ozempic in the future as I still have not managed to curtail my lifestyle enough to effectuate the desired results in my health. I am good with his process and am pleased I have such a good doctor. I can't imagine having a doctor that viewed me as an accounting statistic or who wouldn't care enough to talk and listen to me. That's gotta suck.

 

[jm192]

But my point overall is less about plunges or saunas...but that is there nothing besides eating veggies, sleeping good, and exercising that would be recommended as "healthy habits". That stuff is like 2,000 years old knowledge lol.

What percentage of people are doing all these things? I bet it’s 10%, or less. And they probably wouldn’t agree on the specific diet, nor exercise regimen for optimal health.

So the high yield intervention is working to improve the fundamentals first, rather than entertaining every health hack du jour.

Seeing both perspectives I can see where the cracks are forming. I'm a data guy so solving a problem with the highest probability of success makes the most sense almost all of the time. The example of weight loss is a great one. If a PC has 100 overweight patients and tells all of them to eat better, exercise more and he'll check back with them in 6 months. Maybe 10% (no idea the real number) come back with results. If he prescribes that same 100 weight loss medication and 25% come back with results, it drives the theory to prescribe medicine as option A. I can understand why a PC doc would lean the way they do and spending extra time per patient to facilitate a lower success rate isn't a good use of their time.

That said, there is still the 10% who don't require the extra level of medical intervention that would now be subject to any side effects or complications that come from pharmaceutical treatments. These are most likely the people willing to explore holistic treatment options. I'm a believer that these holistic options do work for a lot of people, but not everyone. This group probably feels alienated by PCs who don't take the time to individualize treatment plans.

Compounding the issue is how poorly the overall US healthcare system is performing. We're not doing well and this "do your own research" really took off once this country tried to implement a once size fits all healthcare formula.

I think there's a lot of individualization that goes into it that we just don't talk about.

When I see patient X and they have a problem. I have to consider their other problems. I have to consider their other medications. I have to consider their kidney and liver function. I have to consider their allergies. I would argue every treatment is individualized for those reasons.

I don't always sit there and say "Oh, I'm doing this instead of that because of your renal function." Now if a patient asks for a particular drug and there's a reason that drug won't work, I certainly explain it. And again, I consider that "individualizing it."

I gave this example earlier in this thread or the other one but to respond to the weight loss example"

A 40 something year old guy wants Wegovy. One of the contraindications is a personal or family history of medullary thyroid cancer. His grandfather had it. I explained for that reason, that's a bad medicine for him. That would put him at increased risk for something that would kill him. Again, I think that's...individualizing. I certainly didn't throw the Wegovy at him to get better results.

I used to work exclusively in the hospital. Everyone with community acquired pneumonia gets Antibiotic regimen #1. Unless, you have an allergy to one of those antibiotics. Or if you previously grew a specific bacteria on a sputum culture. Or you were just felt to be really high risk for Pseudomonas or MRSA. Or you had a prolonged QTC interview that eliminates the Azithromycin. Or maybe you have a second infection I have to consider, and a different antibiotic regimen takes care of both problems. That's individualized. And if you DO get antibiotic regimen #1--I still considered all of that same stuff on your behalf. Realizing you didn't check any of those boxes--this is the right antibiotic regimen for you.

I certainly don't always say "I would have gone with antibiotic regimen #1, but because of reason X specific to you, I'm using a different one." But I certainly think I've individualized it.

 

[Scoresman]

So much talk of LP(a) recently which is fantastic (not only here). Mine is at about 130-140, when normal range is below 29. So yeah, I've got those genes. My dad and grandfather both passed of heart attacks in their 40s. When I moved to Oregon, my new doctor really took an interest in my condition and motivated me to lose 50 pounds, and put me on 80mg of a statin so my cholesterol at least is really low. Diet is good with the occasional exception here and there. I've even inquired about getting in on a trial for new LP(a) reducing medicine but they seem to only want people who have already had a heart attack for those. So now patiently waiting for these to come out.

 

[Pip's Invitation]

So much talk of LP(a) recently which is fantastic (not only here). Mine is at about 130-140, when normal range is below 29. So yeah, I've got those genes. My dad and grandfather both passed of heart attacks in their 40s. When I moved to Oregon, my new doctor really took an interest in my condition and motivated me to lose 50 pounds, and put me on 80mg of a statin so my cholesterol at least is really low. Diet is good with the occasional exception here and there. I've even inquired about getting in on a trial for new LP(a) reducing medicine but they seem to only want people who have already had a heart attack for those. So now patiently waiting for these to come out.

Hopefully in the next year or two. There are five in development -- four injectables and one oral -- and it will be interesting to see who gets to market first.

 

[Scoresman]

So much talk of LP(a) recently which is fantastic (not only here). Mine is at about 130-140, when normal range is below 29. So yeah, I've got those genes. My dad and grandfather both passed of heart attacks in their 40s. When I moved to Oregon, my new doctor really took an interest in my condition and motivated me to lose 50 pounds, and put me on 80mg of a statin so my cholesterol at least is really low. Diet is good with the occasional exception here and there. I've even inquired about getting in on a trial for new LP(a) reducing medicine but they seem to only want people who have already had a heart attack for those. So now patiently waiting for these to come out.

Hopefully in the next year or two. There are five in development -- four injectables and one oral -- and it will be interesting to see who gets to market first.

Thanks! Good to hear it's that soon! In "doing my own research", it looks like taking estrogen may lower LP(a), and I already have manboobs, dont need them to get any bigger!

 

[Joe Schmo]

So much talk of LP(a) recently which is fantastic (not only here). Mine is at about 130-140, when normal range is below 29. So yeah, I've got those genes. My dad and grandfather both passed of heart attacks in their 40s. When I moved to Oregon, my new doctor really took an interest in my condition and motivated me to lose 50 pounds, and put me on 80mg of a statin so my cholesterol at least is really low. Diet is good with the occasional exception here and there. I've even inquired about getting in on a trial for new LP(a) reducing medicine but they seem to only want people who have already had a heart attack for those. So now patiently waiting for these to come out.

Hopefully in the next year or two. There are five in development -- four injectables and one oral -- and it will be interesting to see who gets to market first.

Thanks! Good to hear it's that soon! In "doing my own research", it looks like taking estrogen may lower LP(a), and I already have manboobs, dont need them to get any bigger!

I'm up to a b-cup myself

 

[Joe Schmo]

Speaking of research, scientists may have made lemonade out of lemons: https://www.newsweek.com/cancer-advanced-melanoma-treatment-hepes-virus-rp1-2095374

 

[Terminalxylem]

the vast majority regain the weight they lost within a few years.

I know 3 people that had bariatric surgery and all regained the weight and then some. One was a close friend from high-school who really wasn't all that overweight and suffered pretty bad complications that required hospitalization. A second developed breast cancer (not related) and was unable to take low dose aspirin as a means of lowering recurrence (i don't know how accepted this is, but she was regretful over it).

I hadn't heard much about this surgery lately, especially with the glp-1 drugs readily available. I had assumed they were kind of phased out.

Bariatric surgery isn’t perfect, but it’s much better than behavioral modification for sustained weight loss. The drugs are a better option though, imo.

The doctors I’ve spoken to about this all say that, pretty much universally, their patients would rather go on a drug regimen than have surgery.

Weight-loss surgery still exists, but it’s mainly now reserved for people who were unable to lose weight with one of the new drugs or who are contraindicated for them (pancreatitis, for example).

Given that choice, it’s a no-brainer imo. The question is, how long should you trial diet and exercise before considering meds?

The cardiologists are recommending starting early, which makes sense, particularly if you have obesity-associated comorbidities. I guess an argument can also be made to use the meds to “kick start” weight loss, as the improved functionality may make maintaining behavioral modification easier.

 

[Pip's Invitation]

the vast majority regain the weight they lost within a few years.

I know 3 people that had bariatric surgery and all regained the weight and then some. One was a close friend from high-school who really wasn't all that overweight and suffered pretty bad complications that required hospitalization. A second developed breast cancer (not related) and was unable to take low dose aspirin as a means of lowering recurrence (i don't know how accepted this is, but she was regretful over it).

I hadn't heard much about this surgery lately, especially with the glp-1 drugs readily available. I had assumed they were kind of phased out.

Bariatric surgery isn’t perfect, but it’s much better than behavioral modification for sustained weight loss. The drugs are a better option though, imo.

The doctors I’ve spoken to about this all say that, pretty much universally, their patients would rather go on a drug regimen than have surgery.

Weight-loss surgery still exists, but it’s mainly now reserved for people who were unable to lose weight with one of the new drugs or who are contraindicated for them (pancreatitis, for example).

Given that choice, it’s a no-brainer imo. The question is, how long should you trial diet and exercise before considering meds?

The cardiologists are recommending starting early, which makes sense, particularly if you have obesity-associated comorbidities. I guess an argument can also be made to use the meds to “kick start” weight loss, as the improved functionality may make maintaining behavioral modification easier.

We also are learning that these drugs have an effect on brain chemistry and appear to suppress cravings for food, drugs and alcohol. That is a form of behavioral modification in itself.

 

[Terminalxylem]

But my point overall is less about plunges or saunas...but that is there nothing besides eating veggies, sleeping good, and exercising that would be recommended as "healthy habits". That stuff is like 2,000 years old knowledge lol.

What percentage of people are doing all these things? I bet it’s 10%, or less. And they probably wouldn’t agree on the specific diet, nor exercise regimen for optimal health.

So the high yield intervention is working to improve the fundamentals first, rather than entertaining every health hack du jour.

Seeing both perspectives I can see where the cracks are forming. I'm a data guy so solving a problem with the highest probability of success makes the most sense almost all of the time. The example of weight loss is a great one. If a PC has 100 overweight patients and tells all of them to eat better, exercise more and he'll check back with them in 6 months. Maybe 10% (no idea the real number) come back with results. If he prescribes that same 100 weight loss medication and 25% come back with results, it drives the theory to prescribe medicine as option A. I can understand why a PC doc would lean the way they do and spending extra time per patient to facilitate a lower success rate isn't a good use of their time.

That said, there is still the 10% who don't require the extra level of medical intervention that would now be subject to any side effects or complications that come from pharmaceutical treatments. These are most likely the people willing to explore holistic treatment options. I'm a believer that these holistic options do work for a lot of people, but not everyone. This group probably feels alienated by PCs who don't take the time to individualize treatment plans.

Compounding the issue is how poorly the overall US healthcare system is performing. We're not doing well and this "do your own research" really took off once this country tried to implement a once size fits all healthcare formula.

With behavioral modification alone, somewhere between 10-20% maintain 5-10% weight loss, up to 5 years. That’s about half as much weight as the best medications facilitate losing.

Though serious AEs are rare, many patients stop Ozempic eventually, probably due to cost and minor, mostly gastrointestinal side effects. So the drugs aren’t a guaranteed long term solution, either.

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity. Moreover, they may not be fully aware of the benefits the medications offer beyond weight control.

As more data accumulates, I find myself agreeing more with the idea of a multimodal approach: diet, exercise, and early pharmacologic intervention. I think this is the best balance for harm reduction, at the minimum.

At the same time, we need major overhaul of healthcare and our nutrition priorities, as it’s best not to become obese in the first place.

 

[Joe Bryant]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

 

[Peggy]

Also, I fundamentally object to the idea of “health hacks”. Healthy habits aren’t meme-worthy shortcuts.

Your patients see you for minutes a year. The other 364+ days they are being bombarded on social media, podcasts, YouTube, and in real life. Wanting to feel better and trying things they have seen or heard when they are not in the doctor's office office is not new. It has been happening long before the internet. The difference now is the scale and speed. Instead of dismissing it, maybe start by acknowledging wh

Also, I fundamentally object to the idea of “health hacks”. Healthy habits aren’t meme-worthy shortcuts.

Your patients see you for minutes a year. The other 364+ days they are being bombarded on social media, podcasts, YouTube, and in real life. Wanting to feel better and trying things they have seen or heard when they are not in the doctor's office office is not new. It has been happening long before the internet. The difference now is the scale and speed. Instead of dismissing it, maybe start by acknowledging why people turn to these things in the first place?

I don’t think I’m communicating effectively. My point was, good health isn’t a secret, or quick fix.

I’ve acknowledged the shortcomings of conventional western medicine, so it’s easy to understand why some people seek out something different. But the scale and speed of mis/disinformation is exactly why this strategy has become a problem, for both patients and healthcare providers.

So no more bias against the patients who do their own research? Hate the game not the player?

The difference is, I realize my bias exists, and work to mitigate it.

But your post is a great example how people with good intentions can perform faulty “research”, and when called on it, they become defensive.

y people turn to these things in the first place?

I don’t think I’m communicating effectively. My point was, good health isn’t a secret, or quick fix.

I’ve acknowledged the shortcomings of conventional western medicine, so it’s easy to understand why some people seek out something different. But the scale and speed of mis/disinformation is exactly why this strategy has become a problem, for both patients and healthcare providers.

So no more bias against the patients who do their own research? Hate the game not the player?

The difference is, I realize my bias exists, and work to mitigate it.

But your post is a great example how people with good intentions can perform faulty “research”, and when called on it, they become defensive.

imho you’re less about self-awareness and more about self-importance. It’s all right there in post 1 (and everything since). Take care.

I’m sorry you feel that way. AFAIK, we’ve never had bad interactions before this, but I agree, my wording in the OP poisoned the we

There are many doctors on the forum but you're the only one I know about.

That’s funny, because I’ve never disclosed my profession.

I thought you were a GP in Hawaii who bitched about his patients.

You got the Hawaii part right.

To quote @Joe Bryant : "Interesting."

He's a nurse.

 

[Terminalxylem]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

Maybe.

But it seems like people worried about long term harm from the meds are more outspoken. On top of that, there are many who look at the failure of behavioral modification as a lack of willpower.

ETA Why the quotes around “laypeople”? Do you think many medical professionals share concerns for unrecognized harm from weight loss meds, or object to the term for some reason?

 

[Joe Bryant]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

Maybe.

But it seems like people worried about long term harm from the meds are more outspoken. On top of that, there are many who look at the failure of behavioral modification as a lack of willpower.

Maybe. I see lots of people concerned about long-term harm from obesity. Again, I think that's part of why the drugs are so incredibly popular.

I do see some asking questions about possible long-term side effects of the drugs. And that seems proper to me.

I don't know the questions will really have much effect though. It seems like it's on pace to do around 130 billion in sales by 2029. https://www.ubs.com/global/en/investment-bank/insights-and-data/2024/glp-1-a-medication.html

I don't see anything slowing down this train.

 

[Terminalxylem]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

Maybe.

But it seems like people worried about long term harm from the meds are more outspoken. On top of that, there are many who look at the failure of behavioral modification as a lack of willpower.

Maybe. I see lots of people concerned about long-term harm from obesity. Again, I think that's part of why the drugs are so incredibly popular.

I do see some asking questions about possible long-term side effects of the drugs. And that seems proper to me.

I don't know the questions will really have much effect though. It seems like it's on pace to do around 130 billion in sales by 2029. https://www.ubs.com/global/en/investment-bank/insights-and-data/2024/glp-1-a-medication.html

I don't see anything slowing down this train.

is that a bad thing, in your opinion?

 

[Max Power]

But my point overall is less about plunges or saunas...but that is there nothing besides eating veggies, sleeping good, and exercising that would be recommended as "healthy habits". That stuff is like 2,000 years old knowledge lol.

What percentage of people are doing all these things? I bet it’s 10%, or less. And they probably wouldn’t agree on the specific diet, nor exercise regimen for optimal health.

So the high yield intervention is working to improve the fundamentals first, rather than entertaining every health hack du jour.

Seeing both perspectives I can see where the cracks are forming. I'm a data guy so solving a problem with the highest probability of success makes the most sense almost all of the time. The example of weight loss is a great one. If a PC has 100 overweight patients and tells all of them to eat better, exercise more and he'll check back with them in 6 months. Maybe 10% (no idea the real number) come back with results. If he prescribes that same 100 weight loss medication and 25% come back with results, it drives the theory to prescribe medicine as option A. I can understand why a PC doc would lean the way they do and spending extra time per patient to facilitate a lower success rate isn't a good use of their time.

That said, there is still the 10% who don't require the extra level of medical intervention that would now be subject to any side effects or complications that come from pharmaceutical treatments. These are most likely the people willing to explore holistic treatment options. I'm a believer that these holistic options do work for a lot of people, but not everyone. This group probably feels alienated by PCs who don't take the time to individualize treatment plans.

Compounding the issue is how poorly the overall US healthcare system is performing. We're not doing well and this "do your own research" really took off once this country tried to implement a once size fits all healthcare formula.

With behavioral modification alone, somewhere between 10-20% maintain 5-10% weight loss, up to 5 years. That’s about half as much weight as the best medications facilitate losing.

Though serious AEs are rare, many patients stop Ozempic eventually, probably due to cost and minor, mostly gastrointestinal side effects. So the drugs aren’t a guaranteed long term solution, either.

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity. Moreover, they may not be fully aware of the benefits the medications offer beyond weight control.

As more data accumulates, I find myself agreeing more with the idea of a multimodal approach: diet, exercise, and early pharmacologic intervention. I think this is the best balance for harm reduction, at the minimum.

At the same time, we need major overhaul of healthcare and our nutrition priorities, as it’s best not to become obese in the first place.

How good are people maintaining the weight loss after coming off the medication?

My wife was recently prescribed wegovy, but we passed because insurance only covered half. Doc gave her 90 days of phentermine instead. It's helped with her motivation to workout and eat better. She likes it, but is already worried about how things will be once she stops using it.

And I get that serious side effects are rare, but there are very real quality of life side effects with these things. Right now we're dealing with increased irritability and difficulty remaining asleep. It got to a point last week where we had to have a discussion if the meds were worth it. Even with our daughter telling her she doesn't like being around her right now, we're pressing on with the meds for now.

 

[Nipsey]

Also, I fundamentally object to the idea of “health hacks”. Healthy habits aren’t meme-worthy shortcuts.

Your patients see you for minutes a year. The other 364+ days they are being bombarded on social media, podcasts, YouTube, and in real life. Wanting to feel better and trying things they have seen or heard when they are not in the doctor's office office is not new. It has been happening long before the internet. The difference now is the scale and speed. Instead of dismissing it, maybe start by acknowledging wh

Also, I fundamentally object to the idea of “health hacks”. Healthy habits aren’t meme-worthy shortcuts.

Your patients see you for minutes a year. The other 364+ days they are being bombarded on social media, podcasts, YouTube, and in real life. Wanting to feel better and trying things they have seen or heard when they are not in the doctor's office office is not new. It has been happening long before the internet. The difference now is the scale and speed. Instead of dismissing it, maybe start by acknowledging why people turn to these things in the first place?

I don’t think I’m communicating effectively. My point was, good health isn’t a secret, or quick fix.

I’ve acknowledged the shortcomings of conventional western medicine, so it’s easy to understand why some people seek out something different. But the scale and speed of mis/disinformation is exactly why this strategy has become a problem, for both patients and healthcare providers.

So no more bias against the patients who do their own research? Hate the game not the player?

The difference is, I realize my bias exists, and work to mitigate it.

But your post is a great example how people with good intentions can perform faulty “research”, and when called on it, they become defensive.

y people turn to these things in the first place?

I don’t think I’m communicating effectively. My point was, good health isn’t a secret, or quick fix.

I’ve acknowledged the shortcomings of conventional western medicine, so it’s easy to understand why some people seek out something different. But the scale and speed of mis/disinformation is exactly why this strategy has become a problem, for both patients and healthcare providers.

So no more bias against the patients who do their own research? Hate the game not the player?

The difference is, I realize my bias exists, and work to mitigate it.

But your post is a great example how people with good intentions can perform faulty “research”, and when called on it, they become defensive.

imho you’re less about self-awareness and more about self-importance. It’s all right there in post 1 (and everything since). Take care.

I’m sorry you feel that way. AFAIK, we’ve never had bad interactions before this, but I agree, my wording in the OP poisoned the we

There are many doctors on the forum but you're the only one I know about.

That’s funny, because I’ve never disclosed my profession.

I thought you were a GP in Hawaii who bitched about his patients.

You got the Hawaii part right.

To quote @Joe Bryant : "Interesting."

He's a nurse.

Really?

 

[Terminalxylem]

But my point overall is less about plunges or saunas...but that is there nothing besides eating veggies, sleeping good, and exercising that would be recommended as "healthy habits". That stuff is like 2,000 years old knowledge lol.

What percentage of people are doing all these things? I bet it’s 10%, or less. And they probably wouldn’t agree on the specific diet, nor exercise regimen for optimal health.

So the high yield intervention is working to improve the fundamentals first, rather than entertaining every health hack du jour.

Seeing both perspectives I can see where the cracks are forming. I'm a data guy so solving a problem with the highest probability of success makes the most sense almost all of the time. The example of weight loss is a great one. If a PC has 100 overweight patients and tells all of them to eat better, exercise more and he'll check back with them in 6 months. Maybe 10% (no idea the real number) come back with results. If he prescribes that same 100 weight loss medication and 25% come back with results, it drives the theory to prescribe medicine as option A. I can understand why a PC doc would lean the way they do and spending extra time per patient to facilitate a lower success rate isn't a good use of their time.

That said, there is still the 10% who don't require the extra level of medical intervention that would now be subject to any side effects or complications that come from pharmaceutical treatments. These are most likely the people willing to explore holistic treatment options. I'm a believer that these holistic options do work for a lot of people, but not everyone. This group probably feels alienated by PCs who don't take the time to individualize treatment plans.

Compounding the issue is how poorly the overall US healthcare system is performing. We're not doing well and this "do your own research" really took off once this country tried to implement a once size fits all healthcare formula.

With behavioral modification alone, somewhere between 10-20% maintain 5-10% weight loss, up to 5 years. That’s about half as much weight as the best medications facilitate losing.

Though serious AEs are rare, many patients stop Ozempic eventually, probably due to cost and minor, mostly gastrointestinal side effects. So the drugs aren’t a guaranteed long term solution, either.

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity. Moreover, they may not be fully aware of the benefits the medications offer beyond weight control.

As more data accumulates, I find myself agreeing more with the idea of a multimodal approach: diet, exercise, and early pharmacologic intervention. I think this is the best balance for harm reduction, at the minimum.

At the same time, we need major overhaul of healthcare and our nutrition priorities, as it’s best not to become obese in the first place.

How good are people maintaining the weight loss after coming off the medication?

My wife was recently prescribed wegovy, but we passed because insurance only covered half. Doc gave her 90 days of phentermine instead. It's helped with her motivation to workout and eat better. She likes it, but is already worried about how things will be once she stops using it.

And I get that serious side effects are rare, but there are very real quality of life side effects with these things. Right now we're dealing with increased irritability and difficulty remaining asleep. It got to a point last week where we had to have a discussion if the meds were worth it. Even with our daughter telling her she doesn't like being around her right now, we're pressing on with the meds for now.

Rebound weight gain is a real problem coming off meds.

Phentermine isn’t nearly as effective as Wegovy, and has it’s own set of side effects. If she tolerated it, I’d pony up the extra $ for Wegovy. See if you qualify for financial assistance, as the price will likely come down, eventually.

 

[Peggy]

Also, I fundamentally object to the idea of “health hacks”. Healthy habits aren’t meme-worthy shortcuts.

Your patients see you for minutes a year. The other 364+ days they are being bombarded on social media, podcasts, YouTube, and in real life. Wanting to feel better and trying things they have seen or heard when they are not in the doctor's office office is not new. It has been happening long before the internet. The difference now is the scale and speed. Instead of dismissing it, maybe start by acknowledging wh

Also, I fundamentally object to the idea of “health hacks”. Healthy habits aren’t meme-worthy shortcuts.

Your patients see you for minutes a year. The other 364+ days they are being bombarded on social media, podcasts, YouTube, and in real life. Wanting to feel better and trying things they have seen or heard when they are not in the doctor's office office is not new. It has been happening long before the internet. The difference now is the scale and speed. Instead of dismissing it, maybe start by acknowledging why people turn to these things in the first place?

I don’t think I’m communicating effectively. My point was, good health isn’t a secret, or quick fix.

I’ve acknowledged the shortcomings of conventional western medicine, so it’s easy to understand why some people seek out something different. But the scale and speed of mis/disinformation is exactly why this strategy has become a problem, for both patients and healthcare providers.

So no more bias against the patients who do their own research? Hate the game not the player?

The difference is, I realize my bias exists, and work to mitigate it.

But your post is a great example how people with good intentions can perform faulty “research”, and when called on it, they become defensive.

y people turn to these things in the first place?

I don’t think I’m communicating effectively. My point was, good health isn’t a secret, or quick fix.

I’ve acknowledged the shortcomings of conventional western medicine, so it’s easy to understand why some people seek out something different. But the scale and speed of mis/disinformation is exactly why this strategy has become a problem, for both patients and healthcare providers.

So no more bias against the patients who do their own research? Hate the game not the player?

The difference is, I realize my bias exists, and work to mitigate it.

But your post is a great example how people with good intentions can perform faulty “research”, and when called on it, they become defensive.

imho you’re less about self-awareness and more about self-importance. It’s all right there in post 1 (and everything since). Take care.

I’m sorry you feel that way. AFAIK, we’ve never had bad interactions before this, but I agree, my wording in the OP poisoned the we

There are many doctors on the forum but you're the only one I know about.

That’s funny, because I’ve never disclosed my profession.

I thought you were a GP in Hawaii who bitched about his patients.

You got the Hawaii part right.

To quote @Joe Bryant : "Interesting."

He's a nurse.

Really?

I may have got him mixed up with someone else. But by his own words he works in heathcare, said a monkey could do his job 90%+ of the time, doesn't really like his job, had decreased job satisfaction during covid and works one 70+ hour week per month.

He also said "I've sold out to corporate, assembly-line medicine." Which is funny considering this thread.

 

[Mister CIA]

Maturity level seems to have dipped in this thread.

 

[DA RAIDERS]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

If they acknowledge it why don’t they do anything about it other than seek out the magic pill. The laziness of the average American is dumbfounding

 

[Joe Bryant]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

If they acknowledge it why don’t they do anything about it other than seek out the magic pill. The laziness of the average American is dumbfounding

No argument there.

 

[gianmarco]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

If they acknowledge it why don’t they do anything about it other than seek out the magic pill. The laziness of the average American is dumbfounding

It's not a "laziness" issue for many. Same way we don't say the same thing about alcoholism or drug use or other similar addiction issues.

 

[Terminalxylem]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

If they acknowledge it why don’t they do anything about it other than seek out the magic pill. The laziness of the average American is dumbfounding

No argument there.

I’ll argue.

While some failure at weight management may be due to lack of willpower, your body adapts to increased weight, making losing it exceedingly difficult.

It’s much easier to avoid obesity than reverse it, especially if you’re closed-minded to utilizing all the tools we have to combat it.

 

[Max Power]

But my point overall is less about plunges or saunas...but that is there nothing besides eating veggies, sleeping good, and exercising that would be recommended as "healthy habits". That stuff is like 2,000 years old knowledge lol.

What percentage of people are doing all these things? I bet it’s 10%, or less. And they probably wouldn’t agree on the specific diet, nor exercise regimen for optimal health.

So the high yield intervention is working to improve the fundamentals first, rather than entertaining every health hack du jour.

Seeing both perspectives I can see where the cracks are forming. I'm a data guy so solving a problem with the highest probability of success makes the most sense almost all of the time. The example of weight loss is a great one. If a PC has 100 overweight patients and tells all of them to eat better, exercise more and he'll check back with them in 6 months. Maybe 10% (no idea the real number) come back with results. If he prescribes that same 100 weight loss medication and 25% come back with results, it drives the theory to prescribe medicine as option A. I can understand why a PC doc would lean the way they do and spending extra time per patient to facilitate a lower success rate isn't a good use of their time.

That said, there is still the 10% who don't require the extra level of medical intervention that would now be subject to any side effects or complications that come from pharmaceutical treatments. These are most likely the people willing to explore holistic treatment options. I'm a believer that these holistic options do work for a lot of people, but not everyone. This group probably feels alienated by PCs who don't take the time to individualize treatment plans.

Compounding the issue is how poorly the overall US healthcare system is performing. We're not doing well and this "do your own research" really took off once this country tried to implement a once size fits all healthcare formula.

With behavioral modification alone, somewhere between 10-20% maintain 5-10% weight loss, up to 5 years. That’s about half as much weight as the best medications facilitate losing.

Though serious AEs are rare, many patients stop Ozempic eventually, probably due to cost and minor, mostly gastrointestinal side effects. So the drugs aren’t a guaranteed long term solution, either.

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity. Moreover, they may not be fully aware of the benefits the medications offer beyond weight control.

As more data accumulates, I find myself agreeing more with the idea of a multimodal approach: diet, exercise, and early pharmacologic intervention. I think this is the best balance for harm reduction, at the minimum.

At the same time, we need major overhaul of healthcare and our nutrition priorities, as it’s best not to become obese in the first place.

How good are people maintaining the weight loss after coming off the medication?

My wife was recently prescribed wegovy, but we passed because insurance only covered half. Doc gave her 90 days of phentermine instead. It's helped with her motivation to workout and eat better. She likes it, but is already worried about how things will be once she stops using it.

And I get that serious side effects are rare, but there are very real quality of life side effects with these things. Right now we're dealing with increased irritability and difficulty remaining asleep. It got to a point last week where we had to have a discussion if the meds were worth it. Even with our daughter telling her she doesn't like being around her right now, we're pressing on with the meds for now.

Rebound weight gain is a real problem coming off meds.

Phentermine isn’t nearly as effective as Wegovy, and has it’s own set of side effects. If she tolerated it, I’d pony up the extra $ for Wegovy. See if you qualify for financial assistance, as the price will likely come down, eventually.

Thanks. I clicked around and don't appear to qualify. The out of pocket for Wegovy is about $700 monthly before some smaller discounts apply. Her BMI isn't really high to justify that right now.

 

[Terminalxylem]

But my point overall is less about plunges or saunas...but that is there nothing besides eating veggies, sleeping good, and exercising that would be recommended as "healthy habits". That stuff is like 2,000 years old knowledge lol.

What percentage of people are doing all these things? I bet it’s 10%, or less. And they probably wouldn’t agree on the specific diet, nor exercise regimen for optimal health.

So the high yield intervention is working to improve the fundamentals first, rather than entertaining every health hack du jour.

Seeing both perspectives I can see where the cracks are forming. I'm a data guy so solving a problem with the highest probability of success makes the most sense almost all of the time. The example of weight loss is a great one. If a PC has 100 overweight patients and tells all of them to eat better, exercise more and he'll check back with them in 6 months. Maybe 10% (no idea the real number) come back with results. If he prescribes that same 100 weight loss medication and 25% come back with results, it drives the theory to prescribe medicine as option A. I can understand why a PC doc would lean the way they do and spending extra time per patient to facilitate a lower success rate isn't a good use of their time.

That said, there is still the 10% who don't require the extra level of medical intervention that would now be subject to any side effects or complications that come from pharmaceutical treatments. These are most likely the people willing to explore holistic treatment options. I'm a believer that these holistic options do work for a lot of people, but not everyone. This group probably feels alienated by PCs who don't take the time to individualize treatment plans.

Compounding the issue is how poorly the overall US healthcare system is performing. We're not doing well and this "do your own research" really took off once this country tried to implement a once size fits all healthcare formula.

With behavioral modification alone, somewhere between 10-20% maintain 5-10% weight loss, up to 5 years. That’s about half as much weight as the best medications facilitate losing.

Though serious AEs are rare, many patients stop Ozempic eventually, probably due to cost and minor, mostly gastrointestinal side effects. So the drugs aren’t a guaranteed long term solution, either.

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity. Moreover, they may not be fully aware of the benefits the medications offer beyond weight control.

As more data accumulates, I find myself agreeing more with the idea of a multimodal approach: diet, exercise, and early pharmacologic intervention. I think this is the best balance for harm reduction, at the minimum.

At the same time, we need major overhaul of healthcare and our nutrition priorities, as it’s best not to become obese in the first place.

How good are people maintaining the weight loss after coming off the medication?

My wife was recently prescribed wegovy, but we passed because insurance only covered half. Doc gave her 90 days of phentermine instead. It's helped with her motivation to workout and eat better. She likes it, but is already worried about how things will be once she stops using it.

And I get that serious side effects are rare, but there are very real quality of life side effects with these things. Right now we're dealing with increased irritability and difficulty remaining asleep. It got to a point last week where we had to have a discussion if the meds were worth it. Even with our daughter telling her she doesn't like being around her right now, we're pressing on with the meds for now.

Rebound weight gain is a real problem coming off meds.

Phentermine isn’t nearly as effective as Wegovy, and has it’s own set of side effects. If she tolerated it, I’d pony up the extra $ for Wegovy. See if you qualify for financial assistance, as the price will likely come down, eventually.

Thanks. I clicked around and don't appear to qualify. The out of pocket for Wegovy is about $700 monthly before some smaller discounts apply. Her BMI isn't really high to justify that right now.

Yikes. That’s pricey. Hopefully you can figure out a compromise that works.

 

[Joe Bryant]

I’ll argue.

 

[Terminalxylem]

So much talk of LP(a) recently which is fantastic (not only here). Mine is at about 130-140, when normal range is below 29. So yeah, I've got those genes. My dad and grandfather both passed of heart attacks in their 40s. When I moved to Oregon, my new doctor really took an interest in my condition and motivated me to lose 50 pounds, and put me on 80mg of a statin so my cholesterol at least is really low. Diet is good with the occasional exception here and there. I've even inquired about getting in on a trial for new LP(a) reducing medicine but they seem to only want people who have already had a heart attack for those. So now patiently waiting for these to come out.

Hopefully in the next year or two. There are five in development -- four injectables and one oral -- and it will be interesting to see who gets to market first.

Which is closest to approval? How effective is it?

 

[fatness]

And I get that serious side effects are rare, but there are very real quality of life side effects with these things. Right now we're dealing with increased irritability and difficulty remaining asleep. It got to a point last week where we had to have a discussion if the meds were worth it. Even with our daughter telling her she doesn't like being around her right now, we're pressing on with the meds for now.

This doesn't sound easy to navigate as a family, and I hope you all get through it and things become easier for all of you.

 

[Pip's Invitation]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

Maybe.

But it seems like people worried about long term harm from the meds are more outspoken. On top of that, there are many who look at the failure of behavioral modification as a lack of willpower.

Maybe. I see lots of people concerned about long-term harm from obesity. Again, I think that's part of why the drugs are so incredibly popular.

I do see some asking questions about possible long-term side effects of the drugs. And that seems proper to me.

I don't know the questions will really have much effect though. It seems like it's on pace to do around 130 billion in sales by 2029. https://www.ubs.com/global/en/investment-bank/insights-and-data/2024/glp-1-a-medication.html

I don't see anything slowing down this train.

You’re right about the train. According to a presentation at the American Diabetes Association Scientific Sessions last month, there are more than 200 GLP-1 products in development.

 

[Pip's Invitation]

So much talk of LP(a) recently which is fantastic (not only here). Mine is at about 130-140, when normal range is below 29. So yeah, I've got those genes. My dad and grandfather both passed of heart attacks in their 40s. When I moved to Oregon, my new doctor really took an interest in my condition and motivated me to lose 50 pounds, and put me on 80mg of a statin so my cholesterol at least is really low. Diet is good with the occasional exception here and there. I've even inquired about getting in on a trial for new LP(a) reducing medicine but they seem to only want people who have already had a heart attack for those. So now patiently waiting for these to come out.

Hopefully in the next year or two. There are five in development -- four injectables and one oral -- and it will be interesting to see who gets to market first.

Which is closest to approval? How effective is it?

Three of the injectables are all pretty close and should see phase 3 results reported by the end of next year. All 5 of them have lowered Lp(a) by 75% or more in phase 1 and 2.

The phase 3 cardiovascular outcome trials will ultimately tell the story.

 

[Terminalxylem]

Looking around a little at some other information on Means.

I like Dr. Andrew Huberman and think he usually does thoughtful interviews with people.

He interviews Dr. Means and said he loves her work and her book and talks to her here if people are looking to understand more.

- YouTube

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

youtu.be

In this episode, my guest is Dr. Casey Means, MD, a physician trained at Stanford University School of Medicine, an expert on metabolic health and the author of the book, "Good Energy." We discuss how to leverage nutrition, exercise and environmental factors to enhance your metabolic health by improving mitochondrial function, hormone and blood sugar regulation.

We also explore how fasting, deliberate cold exposure and spending time in nature can impact metabolic health, how to control food cravings and how to assess your metabolic health using blood testing, continuous glucose monitors and other tools.

Metabolic dysfunction is a leading cause of chronic disease, obesity and reduced lifespan around the world. Conversely, improving your mitochondrial and metabolic health can positively affect your health span and longevity.

Listeners of this episode will learn low- and zero-cost tools to improve their metabolic health, physical and mental well-being, body composition and target the root cause of various common diseases.

Read the full show notes, including referenced articles and additional resources: https://go.hubermanlab.com/nFNXu30

Regarding the bolded, it’s a stretch to say Means is an expert on metabolic health.

She’s got an undergrad degree in biology, almost completed ENT residency, and has no relevant scientific publications. But she did write a best selling book on “good energy”, so there’s that.

This is what we’ve come to accept as experts - intelligent people, usually with an unrelated degree from an elite school (Stanford seems over represented, for whatever reason), who empower their audience to improve health outside conventional medicine. They do this by making grandiose, unsubstantiated claims, sprinkling in some “sciencey”, but meaningless jargon, then direct their freshly minted acolytes to buy stuff. Conveniently enough, they often sell it on their websites.

Again, I know our system is broken, particularly preventative care, but I’m not sure this brand of expertise will fix it.

I just started the Huberman podcast linked above.

In the first 6 1/2 minutes, he confidently makes a couple of unsubstantiated claims without batting an eye, interspersed with advertising Means' book and three "healthy" products. Then the interview begins, but that intro definitely does not make me optimistic the next 2 hours and 50 minutes will be reliably grounded in science.

For those of you who like his podcast, what about it appeals to you?

 

[Terminalxylem]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

Maybe.

But it seems like people worried about long term harm from the meds are more outspoken. On top of that, there are many who look at the failure of behavioral modification as a lack of willpower.

Maybe. I see lots of people concerned about long-term harm from obesity. Again, I think that's part of why the drugs are so incredibly popular.

I do see some asking questions about possible long-term side effects of the drugs. And that seems proper to me.

I don't know the questions will really have much effect though. It seems like it's on pace to do around 130 billion in sales by 2029. https://www.ubs.com/global/en/investment-bank/insights-and-data/2024/glp-1-a-medication.html

I don't see anything slowing down this train.

You’re right about the train. According to a presentation at the American Diabetes Association Scientific Sessions last month, there are more than 200 GLP-1 products in development.

This is one of the reasons I dislike big Pharma, as they'll try to eke out as much money as possible via a zillion "me too" drugs.

 

[Pip's Invitation]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

Maybe.

But it seems like people worried about long term harm from the meds are more outspoken. On top of that, there are many who look at the failure of behavioral modification as a lack of willpower.

Maybe. I see lots of people concerned about long-term harm from obesity. Again, I think that's part of why the drugs are so incredibly popular.

I do see some asking questions about possible long-term side effects of the drugs. And that seems proper to me.

I don't know the questions will really have much effect though. It seems like it's on pace to do around 130 billion in sales by 2029. https://www.ubs.com/global/en/investment-bank/insights-and-data/2024/glp-1-a-medication.html

I don't see anything slowing down this train.

You’re right about the train. According to a presentation at the American Diabetes Association Scientific Sessions last month, there are more than 200 GLP-1 products in development.

This is one of the reasons I dislike big Pharma, as they'll try to eke out as much money as possible via a zillion "me too" drugs.

I expect only a handful of them will make it to market and most won't even make it to testing in humans. But it's an awful lot of money and work-hours for what amounts to a lottery ticket.

 

[DA RAIDERS]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

If they acknowledge it why don’t they do anything about it other than seek out the magic pill. The laziness of the average American is dumbfounding

No argument there.

I’ll argue.

While some failure at weight management may be due to lack of willpower, your body adapts to increased weight, making losing it exceedingly difficult.

It’s much easier to avoid obesity than reverse it, especially if you’re closed-minded to utilizing all the tools we have to combat it.

We’ve discussed this before and my old habits/opinions are hard to kick. But you opened my eyes to if it works and there’s a plethora of health benefits on top of the weight loss, why wouldn’t you.

 

[Terminalxylem]

While laypeople seem to focus on potential, unrecognized med toxicity, they often fail to acknowledge the long term harm caused by obesity.

I'm not sure about all "laypeople", but most everyone I know acknowledges the long term harm from obesity.

I think that's part of why the drugs are so incredibly popular.

If they acknowledge it why don’t they do anything about it other than seek out the magic pill. The laziness of the average American is dumbfounding

No argument there.

I’ll argue.

While some failure at weight management may be due to lack of willpower, your body adapts to increased weight, making losing it exceedingly difficult.

It’s much easier to avoid obesity than reverse it, especially if you’re closed-minded to utilizing all the tools we have to combat it.

We’ve discussed this before and my old habits/opinions are hard to kick. But you opened my eyes to if it works and there’s a plethora of health benefits on top of the weight loss, why wouldn’t you.

I felt the same way, and have really changed my opinion over time.

I’m also open to other solution(s), but this seems better than the trajectory we've been on.

 

[Joe Bryant]

For those of you who like his podcast, what about it appeals to you?

For myself, what I said was, “I like Dr. Andrew Huberman and think he usually does thoughtful interviews with people.” I could say that about a lot of podcasts.

To answer your question, I think this article from TIME covers some of what other people find appealing.

How Andrew Huberman Got America to Care About Science

His long-form science podcast consistently sits near the top of the charts

time.com

I’ve no doubt people will still have objections to the TIME article or problems with him or the show. No worries. I was only answering the question.

I’ll leave it at that for me today here as it looks like the Footballguys site is down again this morning and needs help.

 

[FarFromHome]

Fitness is about how people prioritize time each day. Everyone wants to be fit. Everyone technically can be at least kind of fit. Not everyone wants to put the time in each day to be fit. Is that lazy? For decades I thought it was. I just don't think that any longer. It's just a difference in how we value time each day. I'm wired to put time into my body each day. Everyday. It's a mental marathon. It's engrained into my muscle memory. Im weird like that. I've also got two family members in my household on Ozempic. They take the shot once a week and that's the only real time they put in for fitness. Thats the journey they choose and I cheer them on. Everyone's journey is different.

 

[Max Power]

Fitness is about how people prioritize time each day. Everyone wants to be fit. Everyone technically can be at least kind of fit. Not everyone wants to put the time in each day to be fit. Is that lazy? For decades I thought it was. I just don't think that any longer. It's just a difference in how we value time each day. I'm wired to put time into my body each day. Everyday. It's a mental marathon. It's engrained into my muscle memory. Im weird like that. I've also got two family members in my household on Ozempic. They take the shot once a week and that's the only real time they put in for fitness. Thats the journey they choose and I cheer them on. Everyone's journey is different.

Setting a fitness regiment was key to my mental health. I make time for it every day because it's what I enjoy doing. Even when I'm not at the gym, I'll be looking into new things to try the next time I go and that is fun and exciting for me. My wife finally came around on the gym aspect and has now fallen in love with it. I have a large detached garage that is about 2/3 gym equipment which she finally took the plunge to figure out how to use everything out there. Before that the gym was intimidating to her. She didn't want to go to a commercial gym, feel judged, look stupid, not know what she was doing and I get all those concerns. I totally understand why others would never want to set foot in a commercial gym.

I don't judge people who want to use Ozempic either. I understand the desire and even the need for it. It's not my cup of tea in part because I'll always be skeptical that pharmaceuticals aren't always as safe as companies claim.

 

[Terminalxylem]

Looking around a little at some other information on Means.

I like Dr. Andrew Huberman and think he usually does thoughtful interviews with people.

He interviews Dr. Means and said he loves her work and her book and talks to her here if people are looking to understand more.

- YouTube

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

youtu.be

In this episode, my guest is Dr. Casey Means, MD, a physician trained at Stanford University School of Medicine, an expert on metabolic health and the author of the book, "Good Energy." We discuss how to leverage nutrition, exercise and environmental factors to enhance your metabolic health by improving mitochondrial function, hormone and blood sugar regulation.

We also explore how fasting, deliberate cold exposure and spending time in nature can impact metabolic health, how to control food cravings and how to assess your metabolic health using blood testing, continuous glucose monitors and other tools.

Metabolic dysfunction is a leading cause of chronic disease, obesity and reduced lifespan around the world. Conversely, improving your mitochondrial and metabolic health can positively affect your health span and longevity.

Listeners of this episode will learn low- and zero-cost tools to improve their metabolic health, physical and mental well-being, body composition and target the root cause of various common diseases.

Read the full show notes, including referenced articles and additional resources: https://go.hubermanlab.com/nFNXu30

Regarding the bolded, it’s a stretch to say Means is an expert on metabolic health.

She’s got an undergrad degree in biology, almost completed ENT residency, and has no relevant scientific publications. But she did write a best selling book on “good energy”, so there’s that.

This is what we’ve come to accept as experts - intelligent people, usually with an unrelated degree from an elite school (Stanford seems over represented, for whatever reason), who empower their audience to improve health outside conventional medicine. They do this by making grandiose, unsubstantiated claims, sprinkling in some “sciencey”, but meaningless jargon, then direct their freshly minted acolytes to buy stuff. Conveniently enough, they often sell it on their websites.

Again, I know our system is broken, particularly preventative care, but I’m not sure this brand of expertise will fix it.

I just started the Huberman podcast linked above.

In the first 6 1/2 minutes, he confidently makes a couple of unsubstantiated claims without batting an eye, interspersed with advertising Means' book and three "healthy" products. Then the interview begins, but that intro definitely does not make me optimistic the next 2 hours and 50 minutes will be reliably grounded in science.

For those of you who like his podcast, what about it appeals to you?

Watched the whole thing. My takeaways:

1. It was long, too long for my attention span. Both host and guest were well spoken.
2. The basic advice was sound, but not earth shattering: move regularly, avoid ultra processed stuff in favor of whole foods, get adequate sleep, consider time restricted feeding and cold plunges.
3. A lot of buzzwords, like metabolic health, mitochondria, oxidative stress, and antioxidants. These are general concepts that are probably important, but hard to measure, and even harder to correlate with clinical outcomes. Both Means and Huberman were connecting dots where hard data doesn’t exist.
4. They alluded to supplements, and were mostly forthright in disclosures about limited evidence.
5. She recommended frequent testing that definitely is not evidence based.

Overall, it was OK. There were valid criticisms of conventional medical care, as well as some unfair characterizations. Although it wasn’t flagrant, she was advertising a bit, particularly the battery of unnecessary (imo) blood tests. And I really dislike the product promos Huberman makes throughout the podcast.

I also see how this format appeals to those interested in “functional” medicine, making people feel in control of their health, even if based more on emotion than demonstrable clinical outcomes.

 

[Mitchie]

Fitness is about how people prioritize time each day. Everyone wants to be fit. Everyone technically can be at least kind of fit. Not everyone wants to put the time in each day to be fit. Is that lazy? For decades I thought it was. I just don't think that any longer. It's just a difference in how we value time each day. I'm wired to put time into my body each day. Everyday. It's a mental marathon. It's engrained into my muscle memory. Im weird like that. I've also got two family members in my household on Ozempic. They take the shot once a week and that's the only real time they put in for fitness. Thats the journey they choose and I cheer them on. Everyone's journey is different.

I'll argue it is lazy, I get people are wired differently but even putting forth minimal effort would yield dividends. A 15 minute walk after dinner, taking the stairs up 2 or 3 flights instead of the escalator or elevator, parking your car at the edge of a parking lot instead of driving around for 20 minutes to get 500 feet closer, a short workout while watching TV, and not even going to talk about diet where a lot of people don't make much effort. that is probably more will power than lazy but somewhat similar.

 

[Terminalxylem]

It's not my cup of tea in part because I'll always be skeptical that pharmaceuticals aren't always as safe as companies claim.

Are there any medications you feel safe taking? Aspirin after a heart attack? Chemotherapy for cancer? Blood pressure medications? Over the counter meds?

I’m guessing you take, or would take some of those, so where do you draw the line?

 

[Mitchie]

It's not my cup of tea in part because I'll always be skeptical that pharmaceuticals aren't always as safe as companies claim.

Are there any medications you feel safe taking? Aspirin after a heart attack? Chemotherapy for cancer? Blood pressure medications? Over the counter meds?

I’m guessing you take, or would take some of those, so where do you draw the line?

not directed to me but sorta a weird question, diet and exercise can fix being overweight for most people, but drugs are the only option in certain situations.

 

[Max Power]

It's not my cup of tea in part because I'll always be skeptical that pharmaceuticals aren't always as safe as companies claim.

Are there any medications you feel safe taking? Aspirin after a heart attack? Chemotherapy for cancer? Blood pressure medications? Over the counter meds?

I’m guessing you take, or would take some of those, so where do you draw the line?

I feel good about over the counter stuff and prescription drugs that have a solid track record or history. Drugs that are newer scare me more because its those first several years on the market where we figure out there might be complications.

It's also going to depend on what the prescription is for. Major issue and I'm probably taking it because the benefit outweighs any potential risk. Something lower on the concern scale I'm probably passing on it or researching alternatives. When I was being treated for PTSD, I was given about six different prescriptions to try over a couple years. I didn't like it. Looking back it was helpful to get me out of a funk, but I've found more natural ways to address my issues going forward. I definitely feel much better about things now than I did when I was on multiple prescriptions.

 

[Terminalxylem]

It's not my cup of tea in part because I'll always be skeptical that pharmaceuticals aren't always as safe as companies claim.

Are there any medications you feel safe taking? Aspirin after a heart attack? Chemotherapy for cancer? Blood pressure medications? Over the counter meds?

I’m guessing you take, or would take some of those, so where do you draw the line?

not directed to me but sorta a weird question, diet and exercise can fix being overweight for most people, but drugs are the only option in certain situations.

Theoretically, diet and exercise should work. But in practice, they’re seldom enough to lose a lot of weight, or maintain it, for most people. At what point would you consider those failures aren’t solely due to lack of willpower?

As far as other meds, there’s always the option of refusing treatment, or turning to stuff outside of conventional medicine.

 

[Mitchie]

It's not my cup of tea in part because I'll always be skeptical that pharmaceuticals aren't always as safe as companies claim.

Are there any medications you feel safe taking? Aspirin after a heart attack? Chemotherapy for cancer? Blood pressure medications? Over the counter meds?

I’m guessing you take, or would take some of those, so where do you draw the line?

not directed to me but sorta a weird question, diet and exercise can fix being overweight for most people, but drugs are the only option in certain situations.

Theoretically, diet and exercise should work. But in practice, they’re seldom enough to lose a lot of weight, or maintain it, for most people. At what point would you consider those failures aren’t solely due to lack of willpower?

As far as other meds, there’s always the option of refusing treatment, or turning to stuff outside of conventional medicine.

Just not quite seeing that these are analogous for the majority of people. Yes there are people who are severely obese and I think the drugs along with hopefully some lifestyle changes are likely the best option. Many people who are not severely obese have lost weight and kept it off so while harder for some than others it is a reasonable goal. As far as other treatment for cancer and heart attacks, forgoing standard medical treatments does not seem like it's worked out for most people, I'm sure there are exceptions. Of course each drug has a different set of risks that has to be weighed in making the decision.

 

[Terminalxylem]

It's not my cup of tea in part because I'll always be skeptical that pharmaceuticals aren't always as safe as companies claim.

Are there any medications you feel safe taking? Aspirin after a heart attack? Chemotherapy for cancer? Blood pressure medications? Over the counter meds?

I’m guessing you take, or would take some of those, so where do you draw the line?

not directed to me but sorta a weird question, diet and exercise can fix being overweight for most people, but drugs are the only option in certain situations.

Theoretically, diet and exercise should work. But in practice, they’re seldom enough to lose a lot of weight, or maintain it, for most people. At what point would you consider those failures aren’t solely due to lack of willpower?

As far as other meds, there’s always the option of refusing treatment, or turning to stuff outside of conventional medicine.

Just not quite seeing that these are analogous for the majority of people. Yes there are people who are severely obese and I think the drugs along with hopefully some lifestyle changes are likely the best option. Many people who are not severely obese have lost weight and kept it off so while harder for some than others it is a reasonable goal. As far as other treatment for cancer and heart attacks, forgoing standard medical treatments does not seem like it's worked out for most people, I'm sure there are exceptions. Of course each drug has a different set of risks that has to be weighed in making the decision.

I didn’t necessarily say it was a perfect comparison.

I was really just interested in Max’s threshold for drug safety, as I know he was very reluctant to consider SARS-CoV-2 vaccination.

 

[MTskibum]

Fitness is about how people prioritize time each day. Everyone wants to be fit. Everyone technically can be at least kind of fit. Not everyone wants to put the time in each day to be fit. Is that lazy? For decades I thought it was. I just don't think that any longer. It's just a difference in how we value time each day. I'm wired to put time into my body each day. Everyday. It's a mental marathon. It's engrained into my muscle memory. Im weird like that. I've also got two family members in my household on Ozempic. They take the shot once a week and that's the only real time they put in for fitness. Thats the journey they choose and I cheer them on. Everyone's journey is different.

My brother runs marathons, does half ironmans, etc. He works out WAY more than me.

I am 6'1" 170 pounds, he is 6'2" 240 pounds.

It is not just about fitness.

 

[FarFromHome]

Fitness is about how people prioritize time each day. Everyone wants to be fit. Everyone technically can be at least kind of fit. Not everyone wants to put the time in each day to be fit. Is that lazy? For decades I thought it was. I just don't think that any longer. It's just a difference in how we value time each day. I'm wired to put time into my body each day. Everyday. It's a mental marathon. It's engrained into my muscle memory. Im weird like that. I've also got two family members in my household on Ozempic. They take the shot once a week and that's the only real time they put in for fitness. Thats the journey they choose and I cheer them on. Everyone's journey is different.

My brother runs marathons, does half ironmans, etc. He works out WAY more than me.

I am 6'1" 170 pounds, he is 6'2" 240 pounds.

It is not just about fitness.

I agree. Some people are just fortunate with body types that can be fit with minimal effort, while others have to work twice as hard to simply break even. Height and weight isnt always the simple tell all barameter. For example I'm also 6 ft 1 like you. I wouldnt be happy at all at 170 lbs. I hit 190 and I don't feel as strong. My sweet spot is 205. I guess everyone's level of fitness is kinda defined differently. Good discussion.

 

[parasaurolophus]

Just want everybody to know, if you are allergic to ozempic you should not take ozempic. Also if you experience hot dog fingers and golden retriever head syndrome then you should consult your doctor.