Thursday, October 06, 2022

Diabetes 2

Mostly out of personal interest, I pay some attention to the latest thinking about diet/exercise/weight and health. I am just an asshole with an opinion on these matters, of course, but my general takeaway is that for most things, the impact of diet at least within some range of "not obviously extremely unhealthy,"* is probably swamped by other factors (genetic) generally, in that there isn't all that much you can do. 

This is for general health, some specific individuals and conditions might have different answers. An example is high salt intake doesn't seem to cause high blood pressure, but if you have high blood pressure reducing your salt intake is probably wise. 

Weight in and of itself is much less important than is emphasized, certainly within a range of being "moderately overweight," with a lot of aesthetic and "moral" issues associated with being overweight being spun as health concerns. Doctors love to blame all health problems on weight, especially but not just for women.

My understanding is: best not to gain the weight, but once you do the benefits of losing it aren't clear, especially, but not just, given the difficulties of dieting in practice.  And weight gain certainly doesn't cause shooting deaths.

As for exercise, the big thing is don't be sedentary. The "10,000 steps" thing is not magic, of course, but it's a reasonable goal to aim for and prevents this.

The standout really is Type 2 diabetes, where diet really does matter a lot. Sugar, obviously. If you have it or pre-diabetes, losing weight probably is a very good idea, even if you aren't all that overweight, however viewed. And not being sedentary, particulary moving after eating, is very important.

It isn't true that every other comparable country is a walker's paradise where cars are unnecessary, but it is true that no place I have visited has ever been so absolutely hostile to walking in the course of your normal daily life as much of the US is. Physically and culturally.

That's the difference between making an effort to get those "10,000 steps," and just getting most of them through normal daily activity.
It calls for reframing the epidemic as a social, economic and environmental problem, and offers a series of detailed fixes, ranging from improving access to healthy food and clean water to rethinking the designs of communities, housing and transportation networks.

“It’s about massive federal subsidies that support producing ingredients that go into low-cost, energy-dense, ultra-processed and sugar-loaded foods, the unfettered marketing of junk food to children, suburban sprawl that demands driving over walking or biking — all the forces in the environment that some of us have the resources to buffer ourselves against, but people with low incomes don’t,” Dr. Schillinger said.
*This not to say that there aren't benefits to healthier diets, though views on what is "healthy" change over time,** complicating things, just that a lot of people who have high cholesterol, for example, really can't do much about it no matter how "healthy" they eat. Just their bodies doing it to them.

**Arguably the Type 2 Diabetes epidemic was kickstarted by the "low fat" craze. Whatever the merits of reducing fat consumption, or restricting anything in particular, it's important to ask what people are likely to replace it with. It was sugar.