I’m curious about this as I have loved ones with T2D.
What makes this work groundbreaking? It seems like one doctor talked about how at his practice he started telling people to go low carb and noticed they were improving.
But his data doesn’t compare the 27% of his patients who opted in to the low carb diet to those who chose another option.
The low carb diet has been around for a while? Has there not been a RCT looking at how it works for treating diabetes?
He makes an argument on why RCTs aren’t so good that is unconvincing to me.
> However, when it comes to actual clinical implementation, RCTs have a problem. So many variables have been removed that the studies no longer represent real people leading ordinary lives outside of a tightly controlled trial. For example, in our National Health Service (NHS) clinic, very few patients with hypertension do not have a weight problem. Many of them are also on drugs for joint pain, reflux or depression. This is why the results seen in RCTs often do not roll out into real-world, clinical practice. For this to occur we need interventions that have a high degree of ‘external validity’—approaches for that better represent the ‘ordinary’ people who populate our clinics. Away from the carefully controlled conditions of clinical trials, results can be very different in the messy, complex world of everyday general practice.
I noticed that he mentioned a RCT on the low carb diet showing good results and read it, but it seems to be p-hacked. They don’t even mention the mean change in weight between the two groups, but only the percent that achieved a 5 or 10% reduction in weight at some point during the study. The also said that 55% of patients lost weight and 45% gained weight.
Consuming fewer calories, especially fewer carbohydrates, will help lower your blood insulin, which is the necessary condition that allows adipose tissue to finally release its excess stored energy.
Even though calorie restriction works great in lab rats as the researcher can control what the rat eats and the rat can't do anything about it regardless of how hungry it becomes, it's not that simple with humans, particularly after a year or two, once the initial willpower is lost.
So, rather than fixating on lowering calories without further considerations, a more effective approach is maximizing the satiety obtained per calorie consumed. It's harder than it sounds! One might be tempted to simply consume large quantities of leafy vegetables, but that will only lead to them learning how hunger is a multidimensional experience. What do I mean by that? You can feel your stomach stretched out and full, and still feel hungry, because satiety isn't only triggered by how far your stomach has stretched, nor by the precise number of calories you have consumed.
In practice, in order to maximize satiety one must strike a balance between the volume of the food consumed, its protein content, and the amount of insulin-raising carbohydrates it contains. That's the reason so many people find success in low-carbohydrate diets, which emphasize these three satiety factors rather than the excessively simplistic calorie count approach.
I'm a master of hunger, I'm always hungry. With the low calories diet, it's like you said: alk veggies won't make you feel full, it comes from multiple sides.
The core problem is when you are on very low calories, sometimes it's hard to find that food you are needing. Sometimes it's a glass of milk, sometimes an apple, sometimes something with fat
From what i understand the amount you eat might not be all that relevant. The differnce between thin people who eat huge amounts and fat people who eat almost nothing is that the former eat lots of fat and protine in a kind of frenzy with long breaks between meals, the later eat primarly carbs and sugar very regularly.
Calorie restriction under the Newcastle Protocol is only required for between 8-12 weeks, typically once you've lost around 15kg on average. Afterwards, it's a matter of maintaining the weight loss through (improved) diet and exercise.
> Afterwards, it's a matter of maintaining the weight loss through (improved) diet and exercise.
I just don't see how a person who is unable to lose weight at present is going to be able to maintain weight loss 8-12 weeks in the future.
Calorie restriction lowers insulin at the expense of constant hunger, and once the person is no longer in that initial mindset of being willing to endure constant hunger and reverts to eating ad libitum, their hyperinsulinemia will return and they will gain weight.
If they are unable to follow a highly satiating diet today, what makes us think that they will be able to do so after a period of 8-12 weeks of intense constant hunger? To me it reads like another one of those interventions that sounds great to doctors because it should work on paper, and that will be used to blame patients once they regain weight. The doctor will point at a study that shows that some patients are able to do it and that's it.
And don't get me started on how calorie restriction leads to substantial loss of skeletal muscle mass, reducing the amount of glycogen storage that can rapidly absorb spikes of blood glucose, or how hard it is to restore that lean tissue, especially on older patients.
My diabetic wife has long been horrified at the dietary recommendations coming from the ADA, they are worse than useless. I don't blame the whistleblower for settling but it's a shame those people won't take consequences for actively harming people in exchange for corporate contributions. Their nonprofit status doesn't keep them from paying the top officers fat salaries out of those donations.
> In case you’re curious, the ADA and Splenda appear to be still at it. As I write this, the ADA’s Diabetes Food Hub web page still features no fewer than 203 recipes – some marked “sponsored”, some not – that include Splenda, whose parent company’s $1m contribution has brought to light the utter insanity of our diabetes epidemic.
If you call yourself the "American Diabetes Association", (why) aren't there regulations against such stuff? For eg in some countries you cannot use the name of the city/state/country unless you're a government entity.
I agree, it seems extremely misleading, especially for medical organizations. The US government doesn't make consumer clothes, so I don't think anyone's too confused with American Eagle Outfitters not being government-ran, but the US does have several government-ran Health and Human Services divisions and U.S. Public Health Service agencies (e.g. the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), etc.)
I wonder what percent of Americans think that the American Diabetes Association is a government-ran organization. My guess is that it's quite high. You'd have to design a poll correctly (e.g. "From the following list, select which ones are government-ran organizations") to not give the answer away, but I imagine it's a high percentage.
Why does "Bank of America" get to call itself that? Growing up there was a "USA Federal" credit union [1] too, with a stylized American flag logo.
Similarly there's a historic "New Yorker" hotel in New York City, and the totally separate "New Yorker" magazine, neither of which have any official affiliation with the city.
The short answer is that no, there don't seem to be regulations against it. Why any business seems to be able to take the name of a country or state or city, and therefore gain an aura of authenticity or approval, and then prevent any other from doing the same (since the name got taken, you can't have two Bank of Americas) -- I've never understood why the government allows these things.
America is a pair of continents, not the name of a country. The US federal government doesn't hold a trademark. The notion that companies shouldn't be allowed to name themselves after geographic features or political regions is absurd.
In the US, if you ask 100 people what "America" is, they'll tell you it's the name of the country they live in. And since language is defined by use, yes -- America is the name of a country. The shortened version, of course, just like "Mexico" is the shortened version of the "United Mexican States". Surely you're not going to claim that Mexico isn't the name of a country either?
And no, "America" is not a pair of continents in standard usage -- that's "the Americas" you're probably thinking of (plural and with the definite article). Which is a rare term to come across, essentially unused in regular conversation, reserved for some highly specific contexts.
And I'm saying that companies being able to name themselves after political regions is absurd. How is that fair? I don't get to name my company "Google Bank" (and make it seem falsely associated with Google), so why should I get to name my company "New York Bank" (and make it seem falsely associated with New York)?
Asking people in the US seems like a sort of skewed sample; surely everyone in the Americas at least should get a vote on whether or not they want to distinguish more clearly between the continents and this one large country some of us happen to live in.
I do agree though that it is not so ambiguous really in the case of America, the Americas, North America, and South America—because there isn’t a singular “America” continent to refer to (unless we want to dip into the nightmare that is counting and naming the continents; Europe is a subcontinent, I’ll happily die on that hill). But “American” seems a little ambiguous, what else should we call somebody from the Americas, if we want to refer to them in that context? Nobody would say “An Americasian.”
This is one of those places where in some languages - Spanish, of course, and I would assume Portuguese - "americano" (or equivalent) basically means "Western Hemisphere". But in others, like English, "America" means the United States of America, just like "Mexico" means the United Mexican States. If you're using English, "North American", "Central American", and "South American" cover most of the situations you're talking about. "American" without further qualification in English means the USA. And it is justifiable: there is exactly one country on the planet with "America" in its name.
From my outsider perspective it's by being by far the most important country on the continent in terms of size, influence, economy and so on. Also, it's (afaik? cannot think of a counter-example) the only country which has America in its name and usually people talk about countries, not continents.
It helps that a demonym for “person who lives in any part of the Americas” is something we almost never want to use. If “American” only meant that, we’d practically never use it.
So in American English, at least, using it the way we do causes no real trouble.
Travel to some other american countries and ask
them what they think of the appropriation of the word. Not everyone is a fan.
I don't really get how you think a company using the name of the country is wrong but somehow a country appropriating the name of the continent is just fine?
Do some traveling and broaden your horizons. It isn't a particularly novel or even rare opinion.
"American" is one of the idiocies of the English language, and you'll notice it is the only language that presumes that that word refers only to US citizens.
If we are talking about how people use this work in other languages, then yea of course I don't know what or how they use that language. I assumed we were talking about English spoken in the West.
In common parlance, in both the US and abroad, it's commonly used as an agnomen for the USA, and that's okay. When people need to be more specific, they can say North America, South America, or "the Americas". It's fine, it works and isn't confusing.
The Federal Reserve is not privately owned. Parts of the Federal Reserve System are privately owned. The most important part, the Federal Reserve Board, is an independent federal agency like the FAA and SEC. The board members are appointed by President and confirmed by Congress.
The Federal Open Market Committee controls monetary policy. It is composed of seven Board members and five regional bank presidents.
The regional Federal Reserve Banks implemented monetary policy. They are privately owned by member banks, but legally considered both government and private.
The important thing is that the Board is at the top and controls the lower levels.
Sort of. It's actually worse. It gets to claim privately owned when being government is inconvenient; it gets to claim delegated authority from government when that's convenient.
Why can they call it the "American Diabetes Association" is a pretty easy question. The First Amendment.
Part of the First is that the government cannot ban you from using a word unless there is a very good reason do so. "American" is a word that is not associated exclusively with the government, nor was it ever used that way historically. In fact, the word "American" predates the US Government.
Since the word does not now, nor has it ever, implied governmental affiliation, it would be illegal for the US Government to attempt to obtain a monopoly on the word by banning others from using it.
I would be surprised if there is a lack of regulation. To give you an example from my country, the government has trademarks that identify government agencies. That includes the Canada workmark (with the flag over the final "a") and the flag to the left of the words "Government of Canada / Government du Canada". As trademarks, their use is protected. Yet words like Canada or Canadian don't convey any association with the government or even the country.
Nobody has your interest in my mind, except in so far as aids their interests. Doesn’t matter how many regulations or labels or non profit signals there are.
Worth noting that the only requirements to be recognized as an Association by the IRS is that there must be a dated, written document showing its creation, signed by at least two people. [1]
From the linked study, "These findings of positive associations between artificial sweetener intakes and increased T2D risk strengthen the evidence that these additives may not be safe sugar alternatives."
This is news to me. I was under the impression that: 1) artificial sweeteners were a safe substitute for sugar for people with diabetes and 2) diabetes came from excess sugar consumption which wasn't a problem with artificial sweeteners.
Yes it is new. The WHO only changed their guidance about a year ago [1]. Still, as far as I know the evidence is only associational. From the paper the article links to: "Potential for reverse causality cannot be eliminated".
So it sounds like artificial sugars can actually cause diabetes? That's unfortunate. Occasionally I drink Coke Zero as an alternative to Coke, but perhaps I should start replacing that with unsweetened seltzer water like La Croix.
No, the "Potential for reverse causality cannot be eliminated" means that instead of artificial sweeteners causing diabetes, causality can be reversed: Diabetes causes the intake of artificial sweeteners.
All these studies just show an association, but can not prove the direction of causality. For whatever reason, the idea that diabetic and overweight people deliberately seek out zero sugar sweeteners so that they can enjoy sweetness without making their situation worse just doesn't seem like a plausible explanation to them.
Personally, if you can't definitively prove something is bad for you after 45+ years of research, I just don't care anymore. People can occasionally drink Coke regular without issue, I wouldn't be worried. Most of the time, diabetes is not caused by merely occasional consumption of sugars.
Sugar does more than one thing. It's mere presence triggers hormone related actions in the body and its energy content is what the reaction is supposed to deal with.
If a sweetener behaves like sugar as far as taste is concerned, that is it fools one part of your body into reacting as though it is sugar, it seems plausible that it might also fool other parts of the system.
Zero calorie sweeteners by definition cannot cause insulin responses.
I can easily verify this by using my families blood glucose monitors before and after I’ve had a diet soda. I’ve done this several times and I have zero increase in blood glucose levels from a Diet Coke. It actually goes down since time passes between me starting the drink and finishing it.
The obsession from even purportedly good doctors with trying to find reasons to vilify anything that might taste good while not spiking glycemic loads is horrifying to witness.
I’m extremely upset, especially as someone with two diabetic parents and a history of diabetes. Both parents are diabetic because they’re fat as hell.
That is what you expect if you raise your insulin, insulin reduce blood glucose, so if the sweetener increased insulin without adding sugar then it reduces blood glucose.
> goes down since time passes between me starting the drink and finishing it.
Blood sugar levels are stable unless you eat sugar, they don't go down over time, unless you do something to add insulin to make it go down or add sugar to make it go up. Here it sounds like you adding insulin when drinking that and thus making it go down.
You are making the strong statements here, not me, I'm just saying your evidence there wasn't enough to support your strong statements. If you have more evidence such as the insulin index being zero, you should have brought that up.
If the insulin index is 0 then per definition it doesn't increase insulin, yes, but the glycemic index being 0 doesn't say it about insulin, as your post suggest, so your post was definitely wrong. I was not wrong pointing out that your post was wrong.
Your impressions 1 and 2 can both be correct, and there still be an association between artificial sweeteners and type 2 diabetes.
It has been shown for decades that this association exists, it's establishing cause, and causal direction that's hard. Does consuming artificial sweeteners cause diabetes? Or does having diabetes cause the consuming of artificial sweeteners?
Exccess calorie consumption and resulting obesity can cause diabetes. Consuming too much sugar is one way to consume too many calories, but so is too much starch, or too much fats, or (perhaps most commonly) too much food in general.
There is type of diabetes that is simply hereditary and that is all there is to it. It is not rare. Then there is also pregnancy diabetes that comes and goes with pregnancy (they make routine test for it).
> There is type of diabetes that is simply hereditary and that is all there is to it.
This is a common misconception. Type 1 diabetes cases are more often acquired with no family history, there are some genetic associations but it is actually less strong than Type 2 (insulin resistance/diet related diabetes) where family history is a substantial risk factor. Pregnancy (gestational) diabetes isn’t just pregnancy related either as it is more likely in those with metabolic syndrome/obesity and is associated with type 2 as well, so it is also partially diet related.
> Not all diabetes is from sugar.
I would go further and just say no diabetes is “from sugar”, it’s just a completely uselessly simplistic way of looking at it (I know this was in response to GP comment). It’s not like low carb diets even prevent some people from getting type 2.
Type 2 diabetes is a disease of acquired insulin resistance for which excessive consumption of high glycemic index food (eg processed food with high sugar content) is a major risk factor, but not the only one.
Do we know if type 2 diabetes itself is actually hereditary, or is it possible that the genetic component makes individuals eat more sugar which causes type 2 diabetes?
It’s an interesting bit of ancient word and medicine trivia but it isn’t terribly elucidating about the mechanism or course of diabetes in modern times.
Your body always has some glucose metabolism going, even if you’re in ketosis, etc there’s always “sugar metabolism” - your blood glucose doesn’t drop to 0 unless you’re dead. It’s simply not a useful abstraction to link sugar consumption to diabetes as implied by the GP.
And ultimately diabetes is defined as a condition of dysregulation of sugar in the blood.
In fact, these days most well cared for people with controlled diabetes don’t have sugar in the pee unless they’re taking a medication specifically to put it there.
Also if you want your mind blown and why you can’t diagnose based on etymology alone (at least not without a sense of humor) - lookup “diabetes insipidus”. Literally means “sweet pee that isn’t sweet”.
The historic reason is that excessive urination is common to both.
Yes, but from an education perspective it’s probably hurting more people than it helps to use this terminology. It’s better to label the true source of the problem, rather than reduce the blame to “sugar”
Is the association correlation or causation? Because that is very important. People with higher BMI (thus higher risk of diabetes) tend to be self conscious about their diet, they might consume more artificial sweeteners than healthy individuals. They can be already diabetic to begin with before artificial sweetener was consumed frequently.
My hard and fast rule in america is that everything aside from unions do not work in the interest of the people. The sooner this is taught to our kids, the better off they'll be from being indoctrinated from the trash on instagram/tiktok.
The more complete and histocally evidenced rule is that all institutions eventually just work to continue and/or expand their existence in itself.
They can get founded in the genuine interests of some cause (and often are), but each transition in leadership tends to find itself more professionalized in some way and more divorced from the founding cause, with process (and/or corruption) becoming their effective mandate instead.
Unions, sadly, have shown no exception, which is what allowed public opinion to eventually swing against the post-war batch of them. We could use some fresh unions in many industries for sure, but there's no truth in putting them on a pedestal. They're prone to devolve and corrupt just like everything else, and there are people who still carry the experience of having seen them do so.
"First, there will be those who are devoted to the goals of the organization. Examples are dedicated classroom teachers in an educational bureaucracy, many of the engineers and launch technicians and scientists at NASA, even some agricultural scientists and advisors in the former Soviet Union collective farming administration.
Secondly, there will be those dedicated to the organization itself. Examples are many of the administrators in the education system, many professors of education, many teachers union officials, much of the NASA headquarters staff, etc.
The Iron Law states that in every case the second group will gain and keep control of the organization. It will write the rules, and control promotions within the organization.
"
I found this revelatory at one point in my career, but this shouldn't have been a surprise as the administrators literally control all promotions and will thus turn the organization into one that serves the managerial class over actual technical ability and knowledge.
As a technical worker, your best option is to try to become extremely valuable and make it known that your continued employment is predicated upon promotions when they should be due. For example, if senior engineer is available at 5 years and you're working your butt off, you need to make it known that you're expecting it or they may just push it out to 6 years if they think they won't lose you. If you're really good at your job and it would be difficult to replace you and put your manager behind schedule, they'll be incentivized to take care of you. It's all a game.
On the flip side... don't try this if they're trying to get rid of you. Be prepared to walk away if you can if they're not taking care of you.
Another thing I learned is that if you want to join management, you have to pretty much stop acting technical. They usually don't like adding technical staff to management as 1.) it may make them look incompetent, 2.) you provide more value to the company doing technical work at a lower salary, and 3.) it shows you might actually not be a good fit for that kind of work, although this isn't necessarily true.
Not all unions are perfect and there are certainly issues. That being said, the American solution of getting rid of them entirely is throwing the baby out with the bathwater. Individual employees just do not have the negotiating heft of a corporation, particularly in the US with employer provided healthcare and whatnot.
> The more complete and histocally evidenced rule is that all institutions eventually just work to continue and/or expand their existence in itself.
This isn’t more complete and historically evidenced. This is a Law Named After Person/Dilbert Quip, which is the pit of cliches that a lot of HN comments fall into on sociology.
What, other than just cynicism,[1] have these Stated Truisms contributed to? These rules are so rigid (so they can be pithy, snappy) that they sound immutable. Is the point only to, say, feel smug about how the manager directly above you has been promoted to his level of incompetence?
[1] Cynicism is fine and good. But just-cynicism has no way of moving beyond itself to a better state. The difference between critique and throwing your arms up.
> They can get founded in the genuine interests of some cause (and often are), but each transition in leadership tends to find itself more professionalized in some way and more divorced from the founding cause, with process (and/or corruption) becoming their effective mandate instead.
Nothing in history is ever just a downward spiral of corruption and rigidity. Outside things happen, revolts happen, things are replaced, systems are overturned.
That quip is a cynic joke, not a statement of historical fact. There are many organizations that simply kill themselves and die out via people leaving as the original purpose don't matter anymore.
It's an extensively treated paradigm in sociology. With sociology being a "soft" science and not having access to a methodology as rigorous as physics, it's certainly contestable and there are of course many sociologists who have made arguments against it or that simply don't consider it convincing, but it's not just some casual insight and certainly not someone's "joke".
The reason I mentioned it, in any case, was to relate it to previous commentor's supposition that unions were excluded from their "rule" (which was a casual insight). You needn't take either this perspective nor theirs as true yourself, but there's not much case to exempt unions if you're going to start looking through the world from that lens in the first place.
Maybe in some pop sociology books, but actual real sociology as a science does not treat it as an established truth at all. The sociology being "soft" does not mean you can cherry pick what suits you and pretend there is consensus about your cherry pick.
In that sense, not even physics is like physics.
Also, the actual sociology, if anything, tend to be very nuanced where majority of the claims are packed into conditionals and probabilities. As a science, it super rarely makes simplistic claims like this.
this has lots of "real" in it but details matter. At a formative time, American politics specifically substituted "safe" leadership in union upper management.. either connected to party politics or just directly from old-Right Europe who had lots of experience dealing with workers and systems. Yes, there were real Mafia families in the Teamsters, in other words. The fiery and violent revolutions across the world did have their impacts on America.
Since the 1980s, evolution via bureaucracy and golf clubs, court cases and election results seem to have been more the driving force.. people can only get so fat before their eyes start to glaze over and trivial concerns take the airtime.
Unions also don't always work in the interest of everyone they represent. For instance, they tend to be protective of older and longer working members in exchange for limiting upward mobility of younger members. Or building policies that encourage the growth of the union as an organization, despite potential costs.
It’s true. My first job was as a cashier at Kroger. I remember looking at the pay tables and being shocked. You could make impressive money as a cashier at Kroger… if you worked there for 30 years. Virtually no one I worked with had even worked there for more than a few years either. Meanwhile, I earned just above the federal minimum wage and multiple hours of my weekly earnings went to little more than protecting my “right” to “no-call, no-show” for six straight days in a row before being fired. I never did this. It seemed unfair. Others did and I had to work that much harder on those days.
One day a union rep stopped by. He was very well-dressed, and he had this beaming smile. He gave me a t-shirt. That pretty much summed up the benefits I experienced.
I remain pro-union, but every time the subject comes up I think there’s a lot more nuance there than people would like to admit. My Dad, for example, has worked at a union job for over 30 years. Ironically, he’s a Republican. He makes decent money now, but the job is very labor intensive, and the healthcare sucks. He’s repeatedly turned down a promotion into management because he’d be out of the union and earning a salary that is not that much higher than what he currently earns per hour. He’s also told me repeatedly that kids just don’t want to work anymore because the turnover rate is high. Many starting out, especially those with dependents, complain that it’s not worth it for what they earn. He holds that although it’s not great it’s enough. Recently, in an attempt to persuade him to take a promotion, he learned that the healthcare plans offered to management are 2-3x cheaper for better benefits than what the union has negotiated. It’s been pretty crazy to watch his opinion slowly begin to shift.
He is staying in for protection. The extra money doesn't make up for having your experience count as added protection (they can't fire him, they can reduce those jobs and employees with more service time will keep the job first).
If a company can fire quickly and replace with cheaper options no one is going to last more than a few years. Many software shops do this (meta, Amazon, generic local company, etc.
I share your experiences working in a union environment when younger and having family have live long jobs. In one case I felt the union was against me or my class of worker (student employee) because we took away from regular union jobs. Still had to pay dues. The other union job just took a few dollars from my paycheck but gave me a wage I couldn't earn elsewhere.
When you become an older worker, and experience firsthand the vulnerability of seniority, you realize why your union was always so protective of older workers. I would think many tech workers over ~35 can relate.
The fundamental idea of most unions seems to be, that once labor recognizes that it is working for a monopoly, instead of working to break up that monopoly, they decide to form one of their own in order to gain some power of negotiation with their employer. Typically to the detriment of the consumer market and the labor market.
For new entrants into the labor market, as you've flagged, now they have to successfully negotiate between two overly large entities with predictably unfortunate results. Labor is best served as a competitive market and unions should only be used in the few limited circumstances where they are otherwise unavoidable.
Unions aren't acting in the interest of the people generically, often not even the members of the union. Otherwise they wouldn't go to court to force people who don't even want to be in the union to pay dues, even when the dues go to political campaigns unrelated to the purpose of the union, as in Janus v. AFSCME (where the support for political causes by the union meant it violated public sector workers freedom of speech if they are compelling fees from non-members, a relatively narrow ruling not impacting most unions).
> Otherwise they wouldn't go to court to force people who don't even want to be in the union...
Even worse, they might request your dismissal if you don't join. Here is a direct quote from the Union agreement of a major university, where I teach part-time: "The Union may request that a Part-time Faculty Member who fails to join the Union, maintain Union membership, pay an agency fee, or make a charitable contribution in lieu of an agency fee shall be dismissed. If the Union makes such a request, the Employer shall comply... If the Part-time Faculty Member fails to pay within that time period, and the Union so verifies, the Part-time Faculty Member’s employment will be terminated at the Union’s request".
If anything, unions are only acting in their own interest.
Arguably, a union has to hold the position of requiring membership, and against those who don’t want to join. Collective bargaining only works when your position represents the group to the point where it can’t be dismissed.
But yeah, It’s challenging for a union to remain exclusively dedicated to serving its membership. I think it’s increasingly complicated with national unions which exist for the sake of unions as a concept, but not necessarily any union members.
Unions doesn't work that way in Europe, it is not something unions must do.
Collective bargaining works as long as you are a collective that bargains together, you don't need to have every single person be a art of that collective.
The point of that decision by a right-wing court was to make it harder for public sector workers to stand together in unions. Unions are democratic institutions, with dues and leadership decided by the membership, and the idea that some people pay and some don't even though the entire unit is represented doesn't make a ton of sense. Just like it wouldn't make sense if 2 people in a unit of 1000 wanted to be in a particular union to just say those 2 can bargain collectively.
The weird "speech" argument was basically that their worksite issues are inherently political. I disagree. Unions have separate political funds from the worksite stuff that are optional.
A group for whom even FDR, the great co-opter of unions, had to pretend to be opposed to unionization.
Seriously, civil service protections are there for you and don't apply to private-sector employees. But you claim the right to strike against your fellow citizens and deprive them of government services? This isn't Andrew Carnegie; it's your fellow citizens.
1. I’m not a public sector worker, weird assumption.
2. I advocate for private sector to unionize as well. I’m not the one who brought up Janus/private sector.
3. You’re telling me people with important jobs (private or public) shouldn’t be able to strike to improve the very services we all depend on? Hospital workers striking for better patient ratios? Teachers for their students?
Taking away those freedoms is wrong and dangerous.
"You" being used impersonally here; I don't mean you specifically.
Private sector unions are crap under US law, but they're a good concept in general.
No, public sector employees should not be allowed to strike. They get special protections (civil service) that do not apply to private-sector workers. Public sector workers work for the rest of us; we're not all fat-cat capitalists taking their potential wages to make ourselves rich. We're their fellow citizens, and when government employees strike, what's the average citizen to do? Your mother died while abroad, your passport is expired, but hey, the State Department clerks are on strike, so guess what? You're not going.
You want things to change, vote someone in who agrees with you like any other citizen. The only strike-breaking measure that's easily available to the government (due to civil-service laws) is conscripting everyone in the job or replacing them with military/National Guard, which is swatting a fly with a Buick.
I think our fundamental disagreement is that I view public sector employment as more similar to private sector in the day-to-day than you do.
Secondarily, I think you fail to think through what happens when PRIVATE sector workers like hospital workers, or nursing home workers, or other important jobs go on strike. It can't just be the case that if the general public is hurt by it, they lose worker protections. Especially when often the goals of those strikes are to improve the services. There's not really a reason to separate out private from public sector here. Private sector jobs are also important to the general public.
There’s a movie clip I’ve seen with Brad Pitt of all people, explaining how America isn’t a nation, it’s a business. A business you don’t own and can’t escape. And you’re on your own. Something to that effect anyway. I’d love to know the movie or show! Its such a perfect example of a truth we all know but that never gets spoken aloud.
The Founding Fathers would be deeply ashamed of us, I think.
I think the founding fathers would be confounded by us more than anything else.
Probably by federalism, the focus on the presidency, Senate elections by the general populace, the role and power of the Supreme court, and a pile of other things.
> the founding fathers who held other humans in bondage for all sorts of free labor
Actually, slavery was a bitter dividing line among the founders of the USA. It is intellectually lazy to ascribe slavery to all of the founders of the USA. It also insults those who were vocally and politically against slavery, from the very earliest days. You can find many examples with any effort at all.
Is there anything at all to be said about the fact that slavery ended up being permissible anyway? Or is that just lazy?
Like, doesn't the sheer magnitude of the inhumanity that actually existed in these times kind of overshadow whatever armchair-enlightment some guys voiced?
How could you be aware of what they did in those times even the slightest bit, and yet still be concerned that one might "insult" guys who have been dead 200 years? How can that even make sense?
Slavery wasn't invented in America. It was common during the Roman Empire and thousands of years before that. Blaming 18th century folks for not righting every wrong up to their time is lazy, as it would be to attribute full-responsibility to you today for something improved and looked down upon in the future.
(None of us are fully independent but gain and suffer inertia from history and society at large.)
Still, we can learn from Ancient Greece, American Founders, as well as folks today.
I apologize, this is such a strange way to be positioned to all this. The point of bringing up something like the practice of slavery in early America is not about "blaming" people about anything. They are already dead! Many generations over. This conceit that the bare acknowledgement of history itself should merely serve to assign blame or culpability to certain people or another feels just so wrong.
The point is that it happened. It was determined and sustained by countless totally mechanical and impersonal conditions and tendencies. Just as the operative ideologies in play in the minds of all our fave founding fathers can only be viewed from our purview as some composite of factors, not as some collection of good guys and bad guys. To point out that maybe they should not be a moral compass to us today is not scapegoating them in some grand moral court of human existence! Its just making a point, and urging historical context as a tool to maybe be a little more rational about our world today. There is nothing at stake but that.
This whole thread is a bit weird now rereading it. My post was pushing back on the narrower idea that past folks' ideas in subject area A should be disregarded because they may have participated in now unacceptable subject area B. Also that Americans tend lack context around the subject.
Yes it was so divisive in the late 18th century in what became the U.S. that the founding father punted the issue so that the 13 states would ratify the new constitution. The issue was swept under the rug until that rabble rouser Abe Lincoln got elected, and all the slave states seceded between the time he got elected and inaugurated, sone 80 years after the signing of the declaration of independence.
Feel free to downvote because I’m not gonna accept your revisionist history.
Almost all of the founding fathers either owned slaves or weren't willing to stick their necks out to stop it. We absolutely should question their judgement.
Politics is the art of the possible. Given what post-slavery America looked like for the former slaves (not much different), the question becomes: do you care so much about slavery, which is an ancient institution, that you give up the idea of forming a united front?
Was it good? No, it was a bad idea. But that's something we say comfortably from our homes in a large, powerful country. In 1787... this was a remote and weak place. If you wanted the slave-dependent colonies to join, you had to either buy their slaves from them or allow it to continue. And there wasn't enough money to buy them.
I'm not sure why you're complaining about instagram/tiktok, because "everything aside from unions do not work in the interest of the people" is the kind of facile, black-and-white statement that is perfectly suited for the modern ragebait industry.
The standard rhetorical sleight of hand that is standard any time "the people" are cited. To be fair unions are slightly better than most users in that department as they have actual votes.
That’s… honestly not a bad take. If we’re not paying for it then we’re the product, not the customer. Need to clarify that unions aren’t for ALL PEOPLE, just the people who pay for them
I was shocked by the ADA's nutritional training (required by my insurance company) but I figured that the actuaries had decided they'd delay amputation better by encouraging people to eat a small slice of cake rather than no cake at all.
The entire American medical system manages to act against the interests of both patients and doctors, the two essential classes of participants. It’s a rather remarkable achievement.
Since when do publically traded corporations care about sustainability of business models? They'll cheerfully destroy a business for short term gain and then leverage the funding elsewhere.
Endless capture of our intuitions by entrenched incumbents.
I'm pretty convinced that unless you're an athlete, everyone should be on a low carb diet (<100g a day for moderately active). Our bodies aren't equipped to deal with the speed-ball you get each meal with the standard american diet. Aside from diabetes and obesity, the is growing data on keto-diets improving psychiatric, neurological, or even cancer outcomes.
Like most associations and trade groups, they are beholden to whatever gives them money. It's like when the Academy of nutrition and dietetics was sponsored by Pepsi and Mars.
That group has rubbed me the wrong way for a long time, ever since I saw one of their publications (ca. mid-2000s, I think?) and found it full of glossy food stylist photos, magazine-like layouts, and stock vacuous advice like eating "smaller portions" and a "varied diet". For all of its shortcomings and the undeniable political swamp it has to ford through editing and publication, I bet you'd very much get more specific, actionable, and evidence-based dietary advice from the Dietary Guidelines for Americans than from whatever that rag was.
There's a chance that I'm misremembering this or confabulating details from multiple publications from different organizations, but skimming the current website ("eatright.org", lol) has done nothing to make me doubt the general vibe.
It's an awful organization. They push dietetics licensure preventing people from getting nutrition information from a provider of their choice, because the organization depends on dietitians paying yearly for the Registered Dietitian credential. You can't get a license without being an RD. It is the most useless form of government regulation, but thankfully they have lost a lot of states. Now you only need a license in about 14 states.
If you want to see something really hilarious, look up Pepin Tuma, their former government affairs guy. Total jerk. There are countless videos of him threatening and berating government committees over their skepticism of the license. He was finally fired a couple of years ago.
The ADA has for a very long time told diabetics to keep eating carbs. Their tune is finally changing, but no, they don't give a shit about anyone other than themselves.
One drug advertisement I’ve seen on Pinterest lately says “diet and exercise can’t treat diabetes” which may be true of type 1 diabetes, but last time I checked 90% of the diabetes in the US is type 2 and diet improvements should absolutely be the first line intervention.
Diet and exercise are extremely effective in treating type 1 diabetes. But some exogenous insulin (and other medications) are usually still required.
For type 2 diabetes, research had shown that many patients can put the condition into remission through lifestyle changes alone. Nutritional ketosis is very effective in reversing insulin resistance.
You’re talking out of your ass about type 1 diabetes. Type 1 diabetics stop producing insulin entirely and are 100% dependent on exogenous insulin. My 12 year old son is a type 1 diabetic. He plays ice hockey, and his blood sugar will have a tendency to spike during games without having eaten anything for hours prior simply due to emotions/Adrenalin, whereas at practice he’s more likely to experience low blood sugars.
Edit: Since I can't reply to another one of your posts below, I'm going to respond here. There's a "honeymoon period" after the initial symptoms of type 1 appear that yes you will still produce some insulin, for most patients it's about a year, but after that, no insulin is produced.
Zero-carb isn't a realistic long term solution. My son was diagnosed at 18 months of age. Feeding him nothing but bacon, steak and chicken is not particularly good idea for a toddler or growing child.
> Diet and exercise are extremely effective in treating type 1 diabetes. But some exogenous insulin (and other medications) are usually still required.
I think you are misinformed about Type 1 diabetes. Maybe you are thinking of some other condition?
In Type 1 diabetes, the pancreas stops producing any insulin. Insulin must be administered regularly (always, not usually) or the person will die. "Other medications" aren't required.
One's diet and exercise are relevant to Type 1 diabetes treatment, but are not a treatment method.
I'm sorry for your daughter's condition, but I think you are misinformed about type 1 diabetes. Most patients still product some endogenous insulin, it's just usually not enough. Like any chronic condition, it's a spectrum and there are outliers at both ends. I've learned to be very cautious about using words like "always" or "never" because of the odd cases that occasionally come up.
Diet and exercise are very effective at treating type 1 diabetes, just usually not sufficient. With a minimal or zero carb diet plus the right exercise regime, some patients find that they can go much longer between insulin doses while still maintaining good blood glucose control. In particular, I think a lot of people don't appreciate the necessity of doing resistance training to build enough skeletal muscle mass as a glucose sink.
It would probably be more accurate to say that diet and exercise alone are not enough for most people with Type 2 diabetes in the US. They are still an important part of intervention. But as a practical matter, telling people who've developed Type 2 to just suddenly gain the willpower to do both of those things really isn't going to be enough to stop progress of the disease.
There is nothing about carbs themselves that is bad for diabetics.
Carbs are necessary macronutrient for everybody.
If you mean certain foods that also have a high percentage of carbs then sure but carbs are not the problem.
Take this line from the article itself, for example.
> It can be challenging for many people with diabetes to forgo the breads, sweets, pastas and starches that form the basis of many diets.
What’s common about these foods isn’t that they’re high in carbs. It’s that they’re nutritionally deficient foods that have been stripped of all their fibers and basically reduced to sugars.
Further, the diets promoted as low carb popularly are not good diets either for diabetics or for non diabetics.
This is a wild claim to make and doesn't seem to hold true scientifically. Humans require fat, protein, and various vitamins usually received from vegetables. There is no requirement that comes from carbohydrates as they effectively are just empty calories.
Carbohydrates are not necessary for survival, but there are circumstances when they are necessary, for instance when a very intense effort is required to be sustained for a long time it is impossible to achieve a maximum performance without eating carbohydrates, because they can be absorbed and used for energy production faster than the alternatives.
Moreover, there is not enough data to decide whether a diet lacking almost completely carbohydrates results in optimal health in the long term, even if it may have favorable effects when replacing a worse previous diet.
Carbohydrates are also the cheapest kind of food. While eating them in excess is bad, obtaining less than 50% of the energy intake from carbohydrates still results in a much lower cost of the food than replacing all of them with expensive fats and proteins.
For diabetes prevention, it is likely that it is more important to avoid sugar than it is to avoid starch, because in many traditional societies where starch was a big fraction of their food, diabetes was nevertheless uncommon.
What is know for fact that this "carbs are evil" messaging absolutely sux for anyone having to deal with eating disorder - both sic people and their close ones. And if I had to choose between diabetes and eating disorder, I would go for diabetes.
> Carbohydrates are not necessary for survival, but there are circumstances when they are necessary, for instance when a very intense effort is required to be sustained for a long time it is impossible to achieve a maximum performance without eating carbohydrates, because they can be absorbed and used for energy production faster than the alternatives.
And some people require an intake of 8000+ kcal a day. Not relevant to anything.
Nothing gives me quick, accessible energy like carbs though. Energy to think and love my body. Yes I’ve seen documentaries on low carb high fat ultra athletes, but they still have their fats with a bowl of pasta. God only knows their saturated fat intake too. A carbless diet does not seem well rounded, and is thus unhealthy. So carbs are essential.
It does not follow from you personally deriving psychological benefits or quick energy from eating carbs that a diet which excludes them is not well rounded or is unhealthy.
So you go from "does not seem well rounded" to "therefore is essential"?
Here's some facts.
There are nine essential amino acids that our body needs to function properly and cannot produce by itself from something else.
Meat provides those amino acids and carbs do not.
Carbs are a source of energy but so is fat, proteins, ketones and alcohol.
In addition to reversing diabetes, people on low carb / high fat diets, including carnivore, often report increase in overall energy levels and lifting of a mental fog that they experienced on standard carb and sugar heavy diet.
That energy spike that carbs and sugar give you is a glucose spike in blood and the downside of it is that often it goes in the other direction (i.e. lethargy) when you come off of it.
That's the "nap after heavy meal" effect.
This is not an anti-carb just anti what you do, elevating carbs into some unquestionably good, unique energy source necessary for you to think or love your body.
Consuming carbs in moderation is fine.
The problem is that our modern diet and what is available in grocery stores or restaurants make it almost impossible to consume carbs in moderation.
And apparently plenty people like you don't even understand that carbs are, in fact, bad for most people.
U.S. stats on this are shocking: 73.6% americans over 20 are overweight and 42.4% obese (all obese people are overweight but not all overweight people are obese)
> A carbless diet does not seem well rounded, and is thus unhealthy.
Why “thus”. Just saying that lacking something is not well rounded thus unhealthy just looks some sort of middle of the road fallacy.
Diets that are not about calorie restrictions are all about excluding certain things. And they all claim to be better than the potentially more versatile middle of the road diet.
> There is nothing about carbs themselves that is bad for diabetics.
That is untrue. A Type 1 diabetic requires insulin proportional to the amount of carbohydrates they eat. The larger the insulin dose, the higher the potential error in the dose compared to the carbs (it’s inexact). If the error is on the “too much” side it can drive blood sugar fatally low. This happens, unfortunately often.
Nowadays the artifical pancreas software can quite nicely counteract the carb spikes. It's not very hard, just take all your basals for the next two hours and then have no insulin delivery for that time. Especially if you eat fast carbs, this is the right strategy.
More complex is to dose for fat, protein and carb mixture. You basically need almost no insulin first, but in the next four hours you need 1.3-1.4x your basal to cope with the raising sugar.
> Meat is considered a complete protein source, meaning it contains all nine essential amino acids that your body cannot produce on its own
Do carbs?
> Carbohydrates primarily provide energy for your body and are not a significant source of amino acids. Essential amino acids, which your body cannot produce on its own, are primarily found in protein-rich foods such as meat, dairy, eggs, and some plant-based sources like quinoa and soy
So you're 100% wrong: carbs do not provide essential amino acids and meat does.
The mechanism behind type 2 diabetes is well known and it's all about eating too much carbs.
Sugars and carbs are converted to glucose in your blood.
You can't have too much (or too little) glucose in blood.
Some of it is burned as fuel but the rest has to be removed somehow so body starts producing insulin to push glucose into cells where it's get converted into fat.
If you can't produce insulin, you have type 1 diabetes and need insulin injections.
If you overeat carbs you store more and more fat. You become over-weight and insulin gets worse at moving glucose from your bloodstream.
The diagnostic test for diabetes is literally: do you have too much glucose in your blood (compared to what is healthy range) or related test a1c which tests for elevated levels of insulin in your blood.
If you know the above, then how in the world can you claim that carbs are not the problem? It is literally the thing that causes diabetes.
The simple solution to reversing type 2 diabetes is therefore to stop eating carbs. That's low carb diets like keto or carnivore.
You make very wrong assertions (carbs are not the problem; carbs have all macronutrients; low carb diets are bad) without a single supporting argument or reference.
"We now know that type 2 diabetes is caused by excess fat inside liver and pancreas.
...
The Twin Cycle Hypothesis described how it might be possible to explain the cause of type 2 diabetes in a very simple way.
...
It was clear from that time onwards that type 2 diabetes is caused by too much fat building up within the liver, then overspilling to the rest of the body - including the pancreas. This starts up a second vicious cycle inside the pancreas, with the fat actually switching off normal insulin production...One of the most important discoveries is that of the Personal Fat Threshold. Type 2 diabetes is not caused by ‘obesity’. Different people have different levels of tolerance of fat within liver and pancreas. But if you have type 2 diabetes, you have crossed your ‘personal fat threshold’.
The explanation for T2D from the PDF paper from your own link explicitly singles out carbs and explains why they are critical to causing the disease process you describe.
> During any one period of time, if more calories are ingested than metabolized then any fat excess is stored either subcutaneously, viscerally or in the liver. But any excess carbohydrate cannot be stored once the glycogen depots are full. If more glucose is ingested than can be oxidized for energy or stored as glycogen, it has to be turned into fat by the process of de novo lipogenesis. This process only happens in the liver in humans, and triglyceride synthesized in situ is particularly likely to be stored in hepatocytes rather than exported for safe storage in subcutaneous adipose tissue.
> The newly synthesized fat has three possible fates: it can be oxidized for energy; exported as VLDL in the plasma to be delivered to other tissues or it can be stored in a rather full liver. As de novo lipogenesis is stimulated by insulin, those people who are relatively insulin resistant in muscle—and who therefore have a raised plasma insulin level—are especially likely to accumulate fat in the liver. This could explain the reason why muscle insulin resistance is the first detectable signal of risk for Type 2 diabetes.
I feel like diabetes will be difficult to cure because it's like tobacco: you need to buy expensive consumables at regular intervals (needles, cgms, insulin, etc).
Stem cell therapy to restore beta cell functionality (for T1) would threaten and disrupt that sweet regular cash flow. So I imagine companies will fight hard to keep diabetics purchasing their regular consumables until the end if time if possible
Doing this would be worth so much money that if you can do it, you should. You’ll make a mint. Currently, islet cell transplants are possible, but barely available.
The insurance companies that pay for a lot of the supplies you talk about would prefer a one stop solution if it costs less. The big expense due to diabetics for insurance companies is not those consumables, it’s the consequences of dialysis and amputations.
I am surprised that 1 million allegedly buys that level of corruption and influence.
It seems strange it would only cost 1 million to make the association a corporate shrill for Stevia when diabetes as an issue costs billions to the US.
If you're going to forgo your princibles and be corrupt then at least get higher price for doing so!
The best guidance on avoiding diabetes or living with it is found on YouTube and not the ADA. The ADA guidance and standards of care are often incorrect or outdated or very conservative. For example standard care says you can’t reverse insulin resistance, which is just plain wrong.
From the article, it looks like the ADA didn't give dangerous advice, and the doctor accusing them has views about diabetes opposed to the current medical consensus. For example, the Dr. claims the ADA is surpressing that a low carb diet can reverse type 2 diabetes. However, it isn't a low carb diet specifically which can "reverse" type 2 diabetes, it's a low calorie diet in general and the resulting weight loss.
> This content is brought to you by Splenda, a proud supporter of the American
> Diabetes Association
> A Message from Splenda
> Splenda® is committed to helping people achieve their health goals by making it
> easier for people to reduce the amount of added sugar in their diet. You likely know
> Splenda Original Sweetener (“the yellow packet”), but did you know we also make
> Splenda Stevia? Splenda Stevia is a plant-based sweetener made from the
> sweetest part of the leaves of the stevia plant. And just like Splenda Original,
> Splenda Stevia contains zero calories and zero sugar. The people you see can use
> Splenda Stevia to make a variety of delicious recipes from appetizers and drinks to
> entrées and desserts.
> Check out the ADA's Diabetes Food Hub® for recipes that use Splenda Stevia, like
> these Slow-Cooker Sweet & Spicy Turkey Meatballs, which are perfect for a football
> party, and these Gluten-Free Mini Eggnog Cupcakes which add cheer to any holiday
> gathering!
WHY??!!! I get upset enough with tech YouTubers making misleading claims about VPN sponsors, but the American Diabetes Association allowing sponsors that sell products that several studies link with causing and worsening diabetes to write parts of their newsletters is an entirely different degree of unethical behavior. No, the link between artificial sweeteners and diabetes has not been firmly established and more research is needed, but it's a likely enough connection that the CDC and WHO[1] have expressed concern and have noted the potential links.
I get it, organizations have to get funding somehow. But if the American Lung Association started allowing vape companies to write part of their newsletters, I think people would rightfully be outraged. Sure, vaping is less bad for you than cigarettes, and may even be a helpful way of quitting for some, but allowing them to be a sponsor is a major conflict of interest and causes you to lose credibility.
I thought Splenda has almost nonexistent calorie and I am not sure what makes it different from aspartame functionally. Any reputable research on the direct damages caused by Splenda?
The study above references 4 different studies that indicate that artificial sweeteners can affect glucose tolerance through changes in the microbiota composition:
The article also references 4 studies that indicate that artificial sweeteners have side effects in terms of obesity, cardiovascular disease, and mortality.
What about dosage? I couldn't find a succinct summary. Can you point out the part indicating how much they experimented with? How many grams of Splendar per day would indicate danger?
> My view is that diabetes is an urgent national scandal. Over 100 million Americans have diabetes or prediabetes, and 100,000 die from the condition annually. In addition, every year hundreds of thousands of people with diabetes have limbs amputated or suffer blindness or kidney disease. Diabetes costs our country $400bn annually to treat.
So about 4x as many deaths per year as homicide, twice as many as suicide, twice as many as car crashes, twice as many as accidental falls, and a multiple of plenty of other preventable causes of death. Obviously some of these other types of deaths take far more years off people's lives than diabetes, but I think the author is right to call it an urgent national scandal.
> Her meticulous account depicts the world’s most important diabetes patient advocacy organization as a cynical fund-raising machine, anxious to please its corporate overlords at the expense of the millions of people with diabetes it is supposed to be trying to help. “The defendant’s conduct shows that they were party to a scheme to defraud the American people by approving and endorsing recipes submitted by Splenda to be lauded by the ADA as a healthy choice for people with diabetes, when the ADA knew that those recipes were contrary to the ADA’s guidelines and well-established and emerging scientific principles,” the complaint reads. In case you’re curious, the ADA and Splenda appear to be still at it. As I write this, the ADA’s Diabetes Food Hub web page still features no fewer than 203 recipes – some marked “sponsored”, some not – that include Splenda, whose parent company’s $1m contribution has brought to light the utter insanity of our diabetes epidemic.
I really wish this could have gone to the discovery phase. Hopefully there will be investigations.
> And although type-2 diabetes is often reversible through a low-carbohydrate diet, the ADA and the pharmaceutical industry don’t seem very interested in acknowledging that. Instead, they promote a laundry list of corporate deals and pharmaceutical treatments that have failed to stem the disease’s lethal and expensive impact on American life.
I'm not naïve enough to think that all (or even most) of the tens of thousands of people dying from type 2 diabetes each year would be saved if the ADA didn't give poor advice, but I also think it's wrong to think that it'd have had no impact: insulin has been infamously expensive for many years in the US, and insulin pumps are thousands of dollars. I certainly think some of the millions of people who ended up dying from type 2 diabetes would have made lifestyle changes had it been made clear that it's often reversible with diet changes, if for no other reason than to save money. If you don't have a pump, having to take insulin shots throughout the day is a pain the ass, so again, I think some people would have made lifestyle changes to avoid that had it been made clear that it was an option.
Health insurers, who buy quite a lot of diabetes treatment, would much rather buy a cure. And they really don't want to pay for untreated diabetes. I've heard from an insurance CEO who wishes their plan could pay the electric bill for diabetes patients to ensure they don't lose power and refrigeration, which would make their insulin get too warm
The "trust the authorities" perspective currently en vogue is certainly not that "doing your own research works." It's that one needs an MD or PhD in a medical field in order to evaluate research, and hence should defer judgment on personal decisions to such qualified individuals (or more often, in practice, to institutions which purport to speak for them like the AMA, AAP, or American Diabetes Association).
Does anybody say that? I see a lot of "some guy making a convincing-seeming argument on youtube is not doing your own research unless you fact check it by legitimately looking for omitted or incorrect statements, because there's a million crazy echo chambers out there".
"Do your own research" can be a red flag, but only because so many people are bad at research, not because research is bad. It's important to look for comprehensive information and not just search for what you already think is correct.
other comment> The "trust the authorities" perspective currently en vogue is certainly not that "doing your own research works." It's that one needs an MD or PhD in a medical field in order to evaluate research, and hence should defer judgment on personal decisions to such qualified individuals (or more often, in practice, to institutions which purport to speak for them like the AMA, AAP, or American Diabetes Association).
It's not that you need it, it's that you'd better put serious effort in to make up for it, and you need to take scientific consensus very seriously (Which is not the same as listening to the most prominent voices. But if almost every expert top to bottom is saying the same thing, they're almost certainly right.)
And for 95% of things, you're not going to put in enough research to understand from base principles. So if you're outsourcing, outsource to someone competent.
I'm not quite ready to publish my hypothesis that prediabetes is a scam. I need to research it a little more. But a statistician friend of mine responded:
A handful of years ago, I looked into the National Health and Nutrition Evaluation Survey, NHANES. To first order, the 1AC level defining pre-diabetes, 6.5, is rather close to the median level. So that's scam-adjacent. Every once in a while, my doctor thanks me for giving him this NHANES table.
As soon as you say this, someone will respond "My father has diabetes and he had his foot amputated!" This is not minimizing diabetes; it's questioning whether prediabetes is a thing.
How is it different from saying "Men over 60 have pre-prostate cancer?" Or, "we all have pre-death?"
You should have a regular blood test and your doctor should be monitoring a lot of things, including blood sugar. If the level is close to diabetes, he or she should warn you. But that's different from saying, "you have a disease."
I have no credentials here, but I'm often working in this space and your take is the polar opposite of what I normally hear from the endos and diabetes researchers that I've worked with. More accurate terms might be diabetes and morbid diabetes.
That the cutoff for prediabetes is close to the median level is a statement that much of the population is actually unhealthy in this regard.
This comes closer to a cogent answer, which is what I was after.
> future health issues
like?
As I said, I'm not ready to publish this, but I wanted to hear some arguments that made sense. So thanks.
To me, "probability of progression from pre-diabetes to diabetes" is the only reason to say it's a real condition rather than just a risk factor.
Furthermore, it would be the derivative of the level, rather than the level itself.
And finally, it would have to be separated from other unhealthy conditions. Meaning, if they drink too much AND have pre-diabetic A1C, ERROR! Otherwise, how do you know it's not the alcohol?
With all due respect, if you're "working on a paper" on this, but the hazard ratios for differing HbA1c values is a novel discussion point to you, I am wary of what else you "don't know".
According to what I understand from researches in this area is that even a slight increase in A1C is highly correlated with later progression. You may not like the term, but it effectively communicates the situation.
If you're going to try an appeal to authority, then at least come up with a plausible authority instead of some random statistician who likely doesn't know the basics of physiology. The first thing you need to understand is that normal ≠ healthy. For example, a resting heart rate of up to 100 bpm is considered "normal" in the sense that it doesn't require urgent medical intervention. But of course anything over 60 bpm for an adult usually indicates some underlying pathology with a risk of premature morbidity and mortality.
The essence of type 2 diabetes is insulin resistance. Like many medical conditions it exists on a spectrum. The specific HbA1c thresholds of 5.7% for pre-diabetes and 6.5% for diabetes are inherently arbitrary and serve mainly to make communication easier. But there is a clear correlation between elevated HbA1c levels and higher all-cause mortality.
Also note that HbA1c tests aren't perfect for diagnosing type 2 diabetes and can have false positives or false negatives. If there is reason to suspect diabetes then it would be wise to conduct additional tests to get a better understanding of the patient's metabolic condition.
However, some PCPs / endo will order up A1c as well as glucose challenge, depending on certain factors (eg, family history, BMI, symptoms). If I were you, order up the following:
- A1C
- 12 hour Fasting blood glucose levels
- Two-hour glucose tolerance test: this test will measure blood glucose levels before and after ingestion of 75 g of glucose solution (if the results show blood levels that fall between 140 mg/dL to 199 mg/dL, it is diagnostic of prediabetes.
- A random plasma glucose test
Personally, if you have a family history of diabetes/obesity, you should get checked often. Some providers have been writing rx's of GLP-1's to aid in weight loss, which reduces the risk of developing T2DM.
> some random statistician who likely doesn't know the basics of physiology.
since you know nothing about him, that's hardly called for. I could doxx him but he didn't consent to that. And he said his doctor thanked him for it.
And you have fuzzed the difference between "a disease" and "something to watch for." If ~50% of the US population needs to be watched, the doctor learns nothing by having a label put on their HbA1c level. The word added nothing to their understanding.
> If there is reason to suspect diabetes then it would be wise to conduct additional tests to get a better understanding of the patient's metabolic condition.
And finally, you just confirmed what I said. It's not "a disease" -- it's a risk factor. Like smoking, drinking, obesity, or sedentariness.
The more everyone objects without any logical argument, the more it's confirmed:
"if that biomarker, all by itself, predicts type 2 diabetes better than random chance, in the absence of any other risk factor, we're entitled to call it a disease."
Labeling insulin resistance as a "risk factor" is correct only in a narrow, technical sense. That's not helpful for patients and clinicians who need to make treatment decisions in the real world. The terminology is irrelevant. Instead of getting hung up on semantics you need to spend some time learning the basics of human metabolism and the endocrine system.
Insulin resistance is a risk factor in the same way that a growing malignant tumor is a risk factor: unless you expect to die soon from something else you should take urgent measures to fix it. While a HbA1c test isn't perfect, it's pretty good as a cheap and easy initial screening for insulin resistance. If you want to believe that it's some kind of "scam" then I don't know how to help you.
The average US person today has at least some level of metabolic problems. Playing games with statistics won't change that reality or the negative long-term outcomes.
> pre-diabetes [...] is rather close to the median level
but according to the NIH, 30.7% of Americans are overweight, and 42.4% are obese. as the median American is overweight, it doesn't seem a stretch to claim that the median American is also pre-diabetic? I don't know whether it's true or not, but your evidence seems a bit thin.
You've literally provided zero evidence beyond hearsay from an alleged statistician friend.
The prediabetes level is drawn from where you see a huge uptick in the risks for developing diabetes mellitus.
You want data? There is plenty of it out there. If you're gonna try to dispute the established understanding, you need to bring evidence or you are just wasting people's time.
I switched health providers and got a physical recently. One of my labs came back with "pre-diabetic" check marked. I asked my doctor about this and I was .1% into the metric. It could have been either side of the line. I'm very fit because I enjoy hiking and exploring.
I already avoid sugar and bread. I work out nearly every day. I'm very active and my BMI is on point. My blood sugar was fine. It was another metric that I can't recall at the moment - but it seemed weird. Regardless, a very obese nurse sat me down and gave me tips for changing my diet.
This was likely your A1C, or a metric of the last three months or so of your sugar levels.
Just because you feel healthy doesn’t necessarily mean you are healthy. You may have, for example, a pancreas condition. Or it may be nothing at all, and just something to track, which is why you never base any medical decisions off a single test.
Your last sentence is nonsense. People can provide exceptional (and correct) advice without necessarily following it themselves, and for all you know this nurse has spent the last year actively trying to improve their health.
It's strictly a question of his likelihood P for developing diabetes. If his P is the same as that of other people with lower A1C, then "prediabetes" is nonsense.
Recommanded readings
https://nutrition.bmj.com/content/early/2020/11/02/bmjnph-20...
https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-20...
https://nutrition.bmj.com/content/early/2023/12/14/bmjnph-20...
Those papers are the most read papers of BMJ nutrition whole history, and this is the top journal of the field