Brynda, your links make for some interesting reading. A couple notes.
First, I did not “ignore” your personal anecdote. Your story does not mean that most doctors don’t understand weight loss, just that that particular doctor didn’t (or didn’t understand yours, or was an ass).
Another thing, insulin resistance != weight problems. There are many different reasons why someone might have problems losing weight. Someone upthread mentioned that they battle depression. S/he would have to get the depression treated before even thinking about going on a diet (although a better diet might improve their mood and brain chemistry, but IANAD, so I’ll stop right there).
Bottom line is that if you want to lose weight, you need to burn more calories than you take in. That is undisputed. There may be another reason why one might be compelled to eat more calories than they can burn, which is not as easy. So while Crafter_Man is taking a simplistic approach, generally speaking he’s correct.
Isn’t this sort of a circular argument? So there are a bunch of people with high insulin levels, but high insulin levels are a response to high blood sugar which is a result of an unhealthy diet. So which happened first, the high insulin or the overweight condition? This is part of the reason why losing weight reverses Type II diabetes. But, whether or not this woman has high insulin levels, or low thyroid hormone levels, or polycystic ovaries, or whatever, she still was overweight and her doctor still only told her the truth.
Insulin or not, anyone restricting their calories enough to have appreciable weight loss is going to feel ‘miserable hunger’ when they stick to their diet until they get used to the reduced food volumes. I know I did, and didn’t claim is was because my metabolism was all messed up, I just ate too damn much for a decade or so and my body adapted to that. Once I got used to smaller meals and fewer snacks, I am no longer miserably hungry unless I forgot my lunch.
Lord knows I have cravings. I absolutely love French fries, sausage, bacon, and ice cream. I crave the stuff. But I haven’t touched any of them in over 10 years.
The bottom line is that a lot of people are fat. They’re fat because they eat too much. The eat too much because they crave food. This craving may or may not be exacerbated by a physical medical condition. (My money is that it’s usually not due to a physical medical condition.)
I doesn’t matter if you have an insulin problem, cysts, or a painful hangnail. If you’re fat, it’s your fault.
No, my personal anecdote was that of the many doctors I have seen since I was diagnosed, only a very few (and those were specialists in this area) have even heard of a condition that is estimated to affect 70 to 80 million people. I wouldn’t call that impressive education about a very significant condition related to weight loss, myself. Not a particular doctor, many doctors. So you didn’t ignore it, but you did misread it.
I know that IR is not the only cause of having difficulty losing weight. That is why my cites in the post to you are about doctors’ education about nutrition, not insulin resistance. Doctors are not well-educated about weight loss, both in terms of nutrition education and in terms of knowing about insulin resistance.
But he is taking the simplistic approach that might work for cells and applying it to human behavior. I never said losing weight wasn’t about limiting intake and increasing activity. All I said, and I have the cites to back it up, is that insulin resistance makes it harder for humans to lose weight. As my endocrinologist put it, getting my insulin levels in a more normal range leveled the playing field so that I could lose weight.
When you strip away all the B.S., losing weight ultimately comes down to discipline and dedication.
Every time we have these discussions the Fat Brigade[sup]TM[/sup] shows up to “educate” us how their condition is not their fault. They claim they have a “medical anomaly” that makes them fat, and that the “calories in vs. calories burned” equation doesn’t apply to them. You’ve heard it a thousand times: “Diet and exercise don’t work for me.” Uh huh. And the Pope is a member of Al Qaeda.
It’s all bullshit, of course, as any respectable doctor will tell you.
I used to be fat. For most of my life. But instead of blaming it on a medical condition, I assumed responsibility and began eating less. And eating better. And exercising. That was 10 years ago. It’s been a tremendous struggle, as I am always craving greasy & calorie-laden food. But I’ve somehow manages to stick to my diet & fitness plan over the years. And I’ve kept the weight off.
If you’re running a blood sugar of 50 due to high insulin levels, you don’t have a “craving”, you have your body essentially informing you “if you don’t eat, you will die. You MUST take action right now.” It’s not quite as strong as the “craving” for air when you’re on the bottom of a lake, but it’s 10,000 times more imperative than a “craving” for some chips or iced cream.
My bad for not answering you, although it should have been clear from the quoting and all that I was talking to Crafter Man, not you.
Ok, on to you:
I don’t know which came first, high insulin or being overweight. As I read my cites (and I hope you did, too), the doctors don’t know, either. I do know my experience, which is that lowering my insulin to normal through medication allowed me to diet. Before then, all the willpower in the world didn’t allow me to tolerate the crazy hunger I experienced. After the meds, my hunger was tolerable. For me, the medication made a difference. Since only I experienced my hunger before and after the meds, I can’t convince you it was different than yours. Heck, I don’t even know that. All I know is that my hunger with high insulin was less tolerable to me than my hunger with normal insulin. Period. I am not “claiming” my metabolism was messed up, it was. Blood tests and all. Insulin 5 times normal. Doctors willing to prescribe medication.
Here’s the point I think everyone has missed, because you want so badly to argue–I said I lost weight through diet and exercise. Every single time, I said that. All I am saying is that the insulin resistance made it harder, and when it was fixed, it was easier. Why is it so unbearable for some of you to believe that losing weight is harder for some than others? Not on a cellular level, perhaps (although I know that insulin affects fat storage in some way, but don’t know much beyond that), but certainly on the level of human behavior.
Um, Brynda, all you’re saying is that a medical condition might make you want to crave food. Big deal. It doesn’t mean a person must give in to their cravings.
Heck, we all have cravings, in all aspects of our lives. But does that mean we should act on each and every one of them? No. Conventional wisdom says we must practice discipline & restraint.
So as I said, if you had an insulin problem, and you became fat, it was squarely your fault.
Oh, and nice personal insults BTW. They’re entertaining. Keep it up.
That’s exactly it. I felt like I would die if I didn’t eat something. I would know that I shouldn’t eat, and that I had carrots at home, but I felt like if I didn’t eat right away, I couldn’t stand it.
Crafter Man didn’t make my cry, but now I am. Thank you so much for backing me up on this.
Unfortunately, it doesn’t seem to resolve completely, just become less severe. Metformin is helpful in this regard, as are some other medications.
But even with optimum treatment, the effect is often to just decrease the frequency of excess insulin episodes, not eliminate them completely. So some people are “dying to eat something” 3 or 4 times a week instead of 3 or 4 times a day. It can still wreak havoc on efforts to lose weight.
Even removing the polycystic ovaries doesn’t guarantee that the disease goes into remission.
Oh, and QtM, can I amend my statement above to say that not all doctors don’t know about this? Obviously you do. I just wish more of your colleagues did.
Oh, and to address the point of the OP, if I don’t piss off some patients from time to time, I’m not practicing good medicine. There are many instances where I’m ethically obliged to tell people things they don’t want to hear.
My duty as a doc is to not present it in a hostile or demeaning way, but to present it as something they need to know, then offer meaningful options. I’ve seen other practitioners frequently present information in ways that do the patient no good, and that can frankly do harm. I’ve been guilty of the same thing too. But I believe I’m learning to be better at doing this.
Some folks get pissed off regardless of how I present it. Oh well.
THIS is the critical point - it is NOT a level playing field. On a level playing field, I wouldn’t even BE overweight, much less struggling this hard to lose weight.
As for the simplistic crowd, I give you the analogy of the car engine. Simplistically, you put gas in, the engine burns it, the car goes. We all know there is a helluva lot more going on under the hood than that. In my case, I have a couple of knocks under the hood.
