The real story here, for me, isn't that Turkish doctors are getting lackadaisical. It's that British citizens are being forced to use medical tourism for the procedure in the first place when the benefits are huge, not just for the patient but for relieving the burden on the healthcare system in the long-term. If we can change the culture of how we approach food to lead to a much healthier country, our medical system can dedicate more energy to other ailments.
this post was submitted on 20 Jun 2025
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If we can change the culture of how we approach food to lead to a much healthier country, our medical system can dedicate more energy to other ailments.
I agree with this 100%. the epidemic of NCD (non-communicable chronic diseases) are mostly rooted in diet, and chemical exposures (on food). The US spends $1 billion per day on T2D diabetes, and there are almost 1 billion humans on earth right now with diagnosed T2D.
Societies relationship with food isn't working, and it needs to improve. (we can happily debate about what optimal would look like, but whatever that is, we as a society are not doing it)
procedure in the first place when the benefits are huge, not just for the patient but for relieving the burden on the healthcare system in the long-term.
I'm on the fence with this statement, I think there are circumstances where bariatric surgery makes sense (hell, I even considered it) - but I think it should way down the treatment option list rather then the first option (or second with the slgt2 and glp1 being first). Metabolic health needs to change in the western world, giving people more lifestyle support in breaking their addictions to unhealthy food and encouraging them to stay on track.
The current model of 15m of medical oversight every year isn't working.
Quite frankly I think many medical providers have fucking given up on diet and lifestyle interventions because 'they dont work', and 'people wont do them'. The blaming the patient mindset is a trap where the more drastic interventions thrive.
we can happily debate about what optimal would look like, but whatever that is, we as a society are not doing it
One of the things is actually tackling it. So foods we know lead to health issues or that even aren't proven to be healthy should cost more than organic foods and healthy foods. Also seeds that destroy soil or don't grow back naturally should cost more. We need self-sustainable diets for the land and population.
but I think it should way down the treatment option list rather then the first option
Yes, it should be down the list, but the people that are going to Turkey aren't going as the first option. Personally, I think semaglutide is better than the surgery and should be the go-to, but getting patients there is the problem. Patients shouldn't feel they have no other choice.
Quite frankly I think many medical providers have fucking given up on diet and lifestyle interventions because 'they dont work', and 'people wont do them'. The blaming the patient mindset is a trap where the more drastic interventions thrive.
Most medical professionals don't care. Most patients need care and supervision and doctors don't have the time or interest to provide that.
We need self-sustainable diets for the land and population.
I have ideas here, rejiggering the governmental food advice is a start. The food pyramid is so unhelpful as to be actively harmful. I think the first pass should be to raise awareness of the harms of sugar and processed grains. Remove them from government subsidies and food services.
I think semaglutide is better than the surgery and should be the go-to
Better then surgery, yes. But I don't think it should be the starting to go. A lifestyle program with health couching, food monitoring, and metric oversite (like the virta health service) should be the first go to in any metabolic practice. It's not just about getting the weight down, but teaching people on how to be healthy in a ongoing basis. Takes a village and all that.
Most patients need care and supervision and doctors don’t have the time or interest to provide that.
Agreed, that is where the west is failing, and that is where we need to start reversing it. NCDs are not going away, they are just going to get bigger and more expensive. I imagine we will see some of the less wealthy countries start with the more holistic metabolic interventions (they have less money to throw at the expensive interventions).
I have ideas here, rejiggering the governmental food advice is a start. The food pyramid is so unhelpful as to be actively harmful. I think the first pass should be to raise awareness of the harms of sugar and processed grains. Remove them from government subsidies and food services.
You sound like Evil Food Supply, and that's a good thing. They offer some great advice.
Better then surgery, yes. But I don't think it should be the starting to go. A lifestyle program with health couching, food monitoring, and metric oversite (like the virta health service) should be the first go to in any metabolic practice. It's not just about getting the weight down, but teaching people on how to be healthy in a ongoing basis. Takes a village and all that.
Telling people is one thing but just the way our brains are set up makes it hard without seeing results. That's why semaglutide is so good, because it suppresses hunger which then makes the stomach shrink which teaches people to eat less and drink less and then encourages them to make positive dietary choices.
Takes a village and all that.
This is incredibly relevant. I have family that are forever offering me the wrong type of food and drink and that's because society just doesn't understand.
I imagine we will see some of the less wealthy countries start with the more holistic metabolic interventions
You generally see better more balanced diets in what's caused emerging countries.
Evil Food Supply, and that’s a good thing.
Looks like a cool channel, subscribed, thanks!
That’s why semaglutide is so good
I've seen some worrisome data. Semaglutide doesn't teach people a better eating pattern, it doesn't push people toward more satiating nutritious food. It appears to reduce hunger (nausea) but unless people eat better food they are going through a very slow from of malnutrition while they are on the drug. Eventually people need to come off the drug, and at that point they have lost a considerable amount of muscle mass (something like 40% of the weight loss on the drug is muscle mass) but haven't necessarily improved their eating patterns.
I think these type of drugs are a great tool for people who can't do a health intervention, but it should be seen as a bridge to helping someone build better behaviors not as a replacement for better eating.
This is incredibly relevant. I have family that are forever offering me the wrong type of food and drink and that’s because society just doesn’t understand.
Be strong! This is where online communities are important to help people develop and maintain better habits.
Semaglutide doesn't teach people a better eating pattern, it doesn't push people toward more satiating nutritious food.
I can't speak for other people but my experience with it was that it forced me to eat at regular times. Forced me into strict portion control, whereby too much and I felt nauseous and too little and I had acid reflux. This in turn meant that I had to quickly figure out what I could and couldn't eat and made sure I was eating nutritious enough meals to get me through my days as I had to make the most of what little I could eat. Even in terms of drink, I had to cut juice and alcohol as my body just couldn't handle anything. I'm probably the exception rather than the rule, but it changed my life and allowed me to put into action things I had always theorised about but couldn't reconcile.
Eventually people need to come off the drug, and at that point they have lost a considerable amount of muscle mass (something like 40% of the weight loss on the drug is muscle mass)
Ugh, don't get me started on how much weaker I am, but it's something to work on.
I think these type of drugs are a great tool for people who can't do a health intervention, but it should be seen as a bridge to helping someone build better behaviors not as a replacement for better eating.
Sometimes people just need help and it's not one size fits all. This is why we need doctors that are hands on so they can understand the optimal treatment for each patient.
it changed my life and allowed me to put into action things I had always theorised about but couldn’t reconcile.
Wow, that is really great! Thank you for sharing your experience.
This is why we need doctors that are hands on so they can understand the optimal treatment for each patient
100%
weaker I am, but it’s something to work on.
Have you transitioned off the drugs and are on a maintenance nutrition program? I've done a huge amount of reading in the ketogenic / zero carb space and I'm happy to share any literature on muscle improvement and sustainment that could be helpful to you
Have you transitioned off the drugs and are on a maintenance nutrition program? I've done a huge amount of reading in the ketogenic / zero carb space and I'm happy to share any literature on muscle improvement and sustainment that could be helpful to you
I'm still on the drugs, though as I approach my one year anniversary, I suspect I'll start having those conversations with my doctor. But please do share your findings and insights on diet. Right now, although I'm eating a balanced diet, I feel like the calorie deficit is doing the heavy lifting.
But please do share your findings and insights on diet.
Full disclosure I run the !ketogenic@dubvee.org and !carnivore@dubvee.org communities, so I have quite the bias.
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People following a low-carb nutritional protocol have reported better results then slgt2/glp1 inhibitors alone, especially when considering muscle wasting (a ketogenic intervention usually gains muscle)
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The muscle loss is thought to be due to nutritional deficits rather then the drugs themselves. Since you said your eating a balanced diet - does that mean your getting 2g per kg of ideal body weight complete (ASF or high DIAAS) protein per day?
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CICO is technically true, but not clinically relevant - the carbohydrate model of obesity has more clinical impact. I can send over the paper if you want the details but if the bodies hormones are allowed to operate normally (without elevated insulin) the normal hunger and satisfaction signals are sufficient to get healthy.
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Are you measuring your muscle over time? With a inbody scale, or dexa scan? That can be helpful
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As far as I'm aware a low carbohydrate diet can be combined with the drugs
Update
- Sauna use has been associated with muscle retention in people who don't exercise, this is wild speculation on my part, but the slgt2/glp1 drug muscle loss may be attenuated by frequent sauna use - if you have it available
People following a low-carb nutritional protocol have reported better results then slgt2/glp1 inhibitors alone, especially when considering muscle wasting (a ketogenic intervention usually gains muscle)
I agree that carbs aren't great, but they do have their place and can be vital to overcoming diabetes in some patients.
The muscle loss is thought to be due to nutritional deficits rather then the drugs themselves. Since you said your eating a balanced diet - does that mean your getting 2g per kg of ideal body weight complete (ASF or high DIAAS) protein per day?
Probably not to be honest. I'm struggling to get enough protein.
the carbohydrate model of obesity has more clinical impact.
What is this?
I can send over the paper if you want the details
Please do
Are you measuring your muscle over time? With a inbody scale, or dexa scan? That can be helpful
I haven't. I've never even heard of a dexa scale.
As far as I'm aware a low carbohydrate diet can be combined with the drugs
I think, especially in a cooler climate such as the UK, low carbs makes sense as your body doesn't have the sun to burn through the carbs (and starch) as efficiently.
Sauna use has been associated with muscle retention in people who don't exercise, this is wild speculation on my part, but the slgt2/glp1 drug muscle loss may be attenuated by frequent sauna use - if you have it available
I've actually been thinking about visiting a sauna, so this is timely advice, thank you.
I agree that carbs aren’t great, but they do have their place and can be vital to overcoming diabetes in some patients.
I'm aware of the Randel cycle (not a cycle) and how the potato/mcdougal/rice diets can help some people reduce their insulin resistance. However, I don't think there is any necessity for a carbohydrate in human nutrition, at least not published in literature. In so far as some low glycemic carbohydrates can help a patient displace more glycemic carbohydrates I would agree it is a valid tool. If we look at type 2 diabetes as a state of carbohydrate intolerance (which it really is because of blood glucose being driven directly by carbohydrate consumption) then it is not advisable for any type 2 diabetic to incorporate carbohydrates in their protocol.
This is a interesting paper (and my notes) on the absolute requirements of carbohydrates in human nutrition: Paper - Confronting myths: relative and absolute requirements of dietary carbohydrates and glucose as metabolic fuels. - 2024
I’m struggling to get enough protein.
Fight fight!
the carbohydrate model of obesity has more clinical impact.
What is this?
I can send over the paper if you want the details
Please do
Paper - The Carbohydrate-Insulin Model of Obesity - Beyond “Calories In, Calories Out” - 2018
I really need to move my notes off of lemm.ee this weekend. TLDR on the paper insulin is the driver of obesity, reducing insulin is the solution to obesity (allowing the body to enact its amazing homeostasis capabilites)
I haven’t. I’ve never even heard of a dexa scale.
You can use any capacitive scale that estimates muscle mass to give you a broad indicator of progression or retention. Inbody scanners are fairly common at gyms, some places have dexa body composition scanners which are even more complete, but any measurement from any system is good enough here to milestone progression. It could even be weekly hand grip strength measurements.
I think, especially in a cooler climate such as the UK, low carbs makes sense as your body doesn’t have the sun to burn through the carbs (and starch) as efficiently.
I'm not familiar with any mechanism between sunlight and carbohydrate mobilization. Perhaps just warmer climates make being outside nicer so people are more active?
I’ve actually been thinking about visiting a sauna, so this is timely advice, thank you.
Start slow! and enjoy it (make sure not to take your glasses into the sauna, I melted mine).
Happy to talk at length and get into the details about any of the above.
This is interesting, thanks for sharing. Sadly a keto diet is beyond me as I suffer from KPD.
Always happy to share! I'm genuinely happy you read what i wrote!
KPD https://en.wikipedia.org/wiki/Ketosis-prone_diabetes ?
You might find this interesting Ketosis, ketoacidosis and very-low-calorie diets: putting the record straight - 2011
TLDR: DKA and Ketosis are distinct biological states, and eating carbohydrates does not provide a benefit in avoiding DKA. i.e. DKA is resolved with insulin and not injecting/consuming glucose.
Update - Above you said your on a SLGT2 inhibitor, which does decrease insulin levels, so there is a DKA risk with that medication by itself, with your KPD condition I agree its probably not great to combine SLGT2i medication and a strict ketogenic diet
3.5.2.2.2 Medications that increase ketoacidosis risk - SGLT2 inhibitors: These medications carry a risk of euglycaemic ketoacidosis. TCR alone cannot cause ketoacidosis, but it may enhance the risk posed by SGLT2i by lowering insulin concentrations because insulin inhibits ketone formation. SGLT2i-induced ketoacidosis may occur with normal BG concentrations, and this heightens the risk of ketoacidosis going unrecognised. It is worth noting that a VLCD (typically less than 50 g of carbohydrate a day) can produce a physiologically normal state of ketosis, that should not be confused with the pathological state of diabetic ketoacidosis. Despite recent literature supporting slight cardiovascular risk reduction and renal protection of SGLT2i, it is recommended that SGLT2i are used with caution in those adhering to a low carbohydrate eating plan. It is appropriate to stop SGLT2i in many cases, particularly in those adhering to a VLCD (30–50 g/day). A GLP-1 agonist is a safer choice as a second-line agent after metformin. See Murray et al. [299] for an excellent review of the physiology of an LCD mimicking many effects of SGLT2i - From Ketogenic : The Science of Therapeutic Carbohydrate Restriction in Human Health
Surgeries have real risks, I think that can be lost on people who are only looking at the positive outcome.
Weight loss surgeries are pernicious especially because the patient needs to adapt to a healthy maintenance diet after the surgery so they get enough nutrition (The nature of the surgery diminishes the amount of nutrition they can get from food)... Which is exactly what they needed in the first place to avoid surgery.