> The CIM provides a conceptual framework with testable hypotheses for how various modifiable factors influence energy balance and fat storage. Rigorous research is needed to compare the validity of these 2 models

https://academic.oup.com/ajcn/advance-article/doi/10.1093/aj...

Compare this to the article

> A landmark paper proves that obesity is not just energy in and out; the type of food matters.

The paper does not say what the article claims. The paper is about proposing a credible alternative model of weight gain and is a call for further research. This article, like most science journalism, is fake news and we need to stop sharing “stories” like this

I wish you'd posted this as a top-level comment, so that you could become the highest-ranked comment!

Didn’t think anybody would see it since there were so many pre-existing comments

> It's like if a patient came to their doctor complaining of water retention, and the doctor said "well clearly you're drinking more than you're excreting" and sent the patient home with instructions to drink less and pee more.

I agree that if that were the only thing the doctor said, they would be a pretty terrible doctor. What would happen in the real world is that the doctor would try to diagnose why the person is drinking more than they're excreting, and help stop that from happening, whether it's a psychological reason, an illness, or some other reason.

What the doctor for sure needs to have, though, is a base understanding that if someone is complaining of water retention, the underlying thing that is happening really is that they're drinking more than they're excreting. That's the basis of the diagnosis process. "You drink, then you excrete liquids, and if there's a misbalance there you have a problem" - if the doctor denies that, it's impossible to diagnose anything.

> but the EBM to me just seems hilariously inadequate to explain the obesity crisis.

I'd just like to point out that people usually talk about diet/nutrition in two contexts. One is the context of "how should I personally eat to lose weight" (or gain weight, but losing is more common). The other context is "how do we explain the society-wide obesity epidemic.

Those are very different questions. They both need to start by taking the EBM seriously, since it's completely proven science (both on a theoretical and on a practical level).

But I completely agree with you that the model by itself doesn't explain the obesity epidemic. It doesn't even try to, really - it just says that we know for sure people are eating more calories now, and therefore they are becoming obese. Why they are eating more calories is a separate mystery (though, in my mind, it's not very mysterious - far larger access to far more calorically-dense but nutritionally-poor foods).

> though, in my mind, it's not very mysterious - far larger access to far more calorically-dense but nutritionally-poor foods

This doesn’t seem so obvious to me… it seems reasonable to me that any abundance of calorically-dense food would lead to obesity. I don’t think it is obvious without study that the food being nutritionally poor is a requirement for widespread obesity.

Body needs more nutrients, so it eats more of food. But to give you enough nutrients, you must now consume too much calories. Hence, obesity crisis.

> I don’t think it is obvious without study that the food being nutritionally poor is a requirement for widespread obesity.

I think calorically dense is "sufficient". Maybe nutritionally poor is a poor choice of words - I was trying to say calorically-dense, but not very satiating.

Nah. EBM does explain the obesity crisis. We're just eating more.

The average American consumes more than 3,600 calories daily – a 24% increase from 1961, when the average was just 2,880 calories.

And that's just the average.

EBM is just begging the question. You gain weight when you have a positive energy balance, and you have a positive energy if you eat more than burn. It's trivially true, otherwise you are violating laws of conservation of energy. Therefore, it has no real explanatory power.

Biology is all about homeostasis, cybernetics, and feedback loops. People aren't universally overweight in industrialized countries, therefore it suggests something is messing with those feedback loops.

These feedback loops are myriad and complex, ranging from the simple control loop that tries to keep blood sugar in range, to the choices you make based on concepts such as self image.

One of the shocking things I figured out when researching this that no one ever talks about is just how efficient fat is.

If you burn 2000 calories a day and eat 2000 calories a day, you are in a steady state. Won't gain or lose any weight. But if you burn 2000 calories a day and eat 2100 calories a day, you have a 100 calorie gain. This should all be obvious. So you do that a month and a few days, and after a month or so you are up 3500 calories, which is one pound.

Now that you are one pound of fat heavier, you now burn an additional couple calories per day. If you continue to eat 2100 calories, you will gain 10 pounds before you reach your equilibrium weight from consuming 2100 calories.

Every 10 daily calories is worth 1 pound. Every daily apple is worth 10 pounds long-term. The 720 calorie average above is worth 72 pounds of fat. And that's even before we consider if now that you burn more calories, you will start eating more calories to keep the same offset?

> EBM is just begging the question. You gain weight when you have a positive energy balance, and you have a positive energy if you eat more than burn. It's trivially true, otherwise you are violating laws of conservation of energy. Therefore, it has no real explanatory power.

That's not true. You can see it's not true by the fact that so many people do in fact dispute consequences of this claim, despite it both being trivially true and proven multiple times in studies with actual humans.

If you eat at a calaoric defict, no matter what you are eating, you will lose weight. That is both undeniable and widely denied, and has lots of explanatory power, because at the end of the day, a correct question to ask about the world is "why are people eating more calories?".

There are certainly other factors which matter, depending on why you are asking the question: if it's for personal weight loss reasons, a good question to ask is "what kind of diet will allow me to eat less calories in the easiest way". If it's to explain the obesity epidemic, the answers are "why are people in general consuming more calories now than they were in the past".

But if you discard the base mechanism by which people are gaining weight, you don't even know what questions to ask.

EBM makes it seem that the only thing affecting the weight of human is calorie balance and there will not be any scenario where calorie deficit might not always lead to weight loss.

If water is free of calorie, has weight, affects body in some way, shouldn't that be taken into account?

Weeks of 1000kCal deficit without weight loss might not necessarily mean EBM is wrong. But EBM doesn't explain the phenomenon.

Usually what's looked at is average weight, since you're absolutely right - weight can fluctuate for many other reasons, including amount of water in your body. You can drink a liter of water before weighing yourself and weigh 1 liter more, though obviously that isn't anything we care about.

But if you're running a 1000kCal deficit for weeks, you are going to lose weight. Just think of the limit case - if you normally eat 3000kCal to be at maintenance, then running a 3000kCal deficit will cause you to lose weight quickly, then eventually die for lack of food. Eating at 3000kCal will cause your weight to stay the same. Deficits in between will cause you to lose weight more slowly.

> "what kind of diet will allow me to eat less calories in the easiest way"

I think this is still kind of missing the point about why people think that the EBM is unhelpful.

Intentionally eating fewer calories to lose weight is a little bit like lowering the mains voltage going to your house because the thermostat is stuck at too high of a setting and your house is too hot. In the extreme case it will work (how could it not?) but it's going to cause all sorts of other problems in the meantime.

In the case of diet those other problems take the form of constant intrusive thoughts of eating, irritability, inability to think clearly, feeling cold all the time, and disinterest in any kind of movement/exercise.

And it also (in the mind of the CIM adherents and friends) focuses attention away from the real problem (maybe my thermostat is broken) and toward something that doesn't really have anything to do with the real problem (maybe the voltage that seems to work for everyone else is too high for my heating system).

> I think this is still kind of missing the point about why people think that the EBM is unhelpful.

I don't think it's missing the point so much as disagreeing with the point :)

> Intentionally eating fewer calories to lose weight is a little bit like lowering the mains voltage going to your house because the thermostat is stuck at too high of a setting and your house is too hot. In the extreme case it will work (how could it not?) but it's going to cause all sorts of other problems in the meantime.

So this is why I have a problem with people arguing against the EBM and arguing against carbs (assuming I'm right of course!). It's teaching people a wrong underlying mechanism, that CICO "doesn't work", and that what foods you eat is more important than how much you eat.

What we should be teaching people is that any diet will produce weight loss, assuming it causes them to consume fewer calories. They need to find a diet that works for them and fits their lifestyle, and doesn't cause the above side-effects.

For one person that might be going keto and getting rid of carbs, because that seems to be a fairly "automatic" way of doing things, that causes people not to have hunger, and also not count calories. Great! They should do that.

For other people, getting rid of carbs is simply not something they can do for a sustained time. For them, other options might be better. Finding ways to make less calorically-dense foods, finding more fulfilling or lower-calorie versions of foods they like, etc.

For me personally, when I started my (relatively small) weight-loss journey a year ago, I just did pure calorie counting, which seemed to fit my life the best. I could still eat whatever I wanted, I just had to be smarter about amounts. I also had to learn to sometimes eat more fulfilling foods, otherwise I'd be hungry. It was a great way to learn about how nutrition and hunger work, and it's what I think will help most people.

So many people I ran into were surprised that this worked for me. After all, the only way to lose weight is to stop eating carbs, or so think a huge chunk of the population (including me a year and a half ago!).

> In the case of diet those other problems take the form of constant intrusive thoughts of eating, irritability, inability to think clearly, feeling cold all the time, and disinterest in any kind of movement/exercise.

Yes, just saying "eat less, move more" is definitely not the end of the conversation, because it's hard. You need to learn about foods and nutrition. You need to learn to substitute lower calorie alternatives or have more satiating meals. But you need to understand the underlying mechanism to even get there - if you think it's just about carbs, you're severely limiting your options and understanding.

There are an awful lot of people who work eight hours, come home, and plop in front of a screen until they go to bed. They do this for decades until they die. People didn't do this as much when there were only three stations on TV and you'd find other things to do. It isn't that much of a mystery.

Really?

Both lab rats and wild animals have been consistently gaining weight for the last 50 years. Is your hypothesis that they have just gotten lazy?

more tasty food available for less money and less effort over time. harder to resist because it tastes better and is easier to obtain and prepare in terms of time and money.

Yes, but why are we eating more? It's not like people in 1961 had more willpower than those in 2021.

I think there's some truth to the CIH and palatability. It's pretty hard to argue that food engineering hasn't made super tasty snacks designed to get you hooked. Those same snacks just so happen to mostly be high-carb as well.

> It's pretty hard to argue that food engineering hasn't made super tasty snacks designed to get you hooked. Those same snacks just so happen to mostly be high-carb as well.

I mean, this pretty much answers the question. Also, I suspect, more hidden fat and sugar. It would be interesting to track the calories of processed food that you generally wouldn't associate with snacks, such as bread or salad dressings. I could imagine those got a higher sugar amount over the decades.

The other side of the equation might also be to blame - less energy output: Today, more areas are optimised for cars, not for walking. We also spend more time in front of a screen - both at work and for leisure.

> I mean, this pretty much answers the question.

It really doesn't though.

Wild animals and lab rats have been gaining weight.

Note: This ignores the factors in the article to keep it simple, those affect many things which contribute to or decrease hunger, satiety, etc.

I think it's as simple as the availability and quantity of food in front of us at all times.

We're eating just as often as in the past, but portions (of everything) are so much larger and our bodies will eat more if it's available.

Satiety is always a lagging indicator to stop eating, so by default we'll over eat if we can. Combine this with food always being available and it doesn't take a genius to figure out where the trend is going to go.

This feels even more accurate to me as I've started doing alternative day fasting (because I'm about 50 lbs overweight), but I've been tracking my food intake on days I eat and I'm almost always eating 2500-3500 calories.

Stuff adds up quickly.

* 500 calories for a bowl of cereal with milk

* 1,000 calories for a sandwich from a sandwich shop

* 1,000 calories for dinner

* 500+ calories from drinks

And eating all of that doesn't make me feel stuffed. It's what makes me feel full. Which I know is a good bit more than "just enough" which I've done when I was working out a lot and watching every calorie I ate.

Jesus, all of those quantities are shocking to me.

A cup of cereal is under a hundred calories, and a cup of milk less than 200, so a bowl of cereal with milk should run about 2-300 calories. 500 calories is a Big Mac. Are you spooning sugar into it? Cream?

What the heck kind of sandwich has 1000 calories? Okay, a fully loaded footlong from Subway maybe, but you seriously have that for lunch? A normal sandwich, such as you might make at home, has 300-500 calories. No 6 inch sub has more than 600 calories. Why is your lunch the same size as your dinner?

1000 calories for dinner is more reasonable, but still - that's a huge dinner. That's like a generously large platter of spaghetti bolognese. I don't know how you could be hungry for that after downing an equivalent meal at lunchtime.

500 calories from drinks is truly horrifying because unless you're chugging milkshakes that's probably all high fructose corn syrup. A quarter of your recommended daily caloric intake, in the form of pure refined sugar! That's an express ticket to diabetes-ville right there. 4+ cans of coke daily is not a healthy intake.

I'm not trying to lay into you here. I'm glad you're experimenting with fasting. But, reality check - I would physically struggle to eat that quantity of food without being sick. I wonder if all that soda is messing with your appetite?

As someone that eats (maybe I should turn that into "used to eat") a lot of cereal, knowing that they're pretty unhealthy for me, I did an experiment just now: I poured a large but not exceptional (for me) amount of cereal into my cereal mug, half an inch from the rim, and then poured it into a measuring cup. It came out to 1 3/4 cups.

Then I looked at the labels in my pantry: Store brand muesli - 330 kcal per cup / Kashi GOLEAN - 176 kcal per cup

I also looked up cereals I ate as a kid (I find them too sugary now): Frosted Mini-Wheats - 210 kcal per cup-ish / Cap'n Crunch - 150 kcal per cup / Froot Loops - 113 kcal per cup

These numbers are surprising to me but they probably shouldn't be. Despite Froot Loops being subjectively the most sugary cereal I've eaten and the muesli having a proportionally low amount of sugar, the density of the muesli (82g per cup!) compared to the Froot Loops (29g per cup) means that it's crazy calorie-dense per volume (which is how most people eyeball their cereal, I think).

Having eaten 600-700 kcal worth of cereal with milk just before I typed this, and not thinking that amount particularly remarkable (but the calorie count was surprising!), I'm starting to wonder how my weight has remained stable and well below average my entire adult life. I pretty much only drink water (and the cereal milk), so at least I have that going for me.

I’ll bite, here are a few relevant observations.

I like honey bunches of oats cereal. It’s delicious. The variety I like is also ~200 calories _per cup_. That’s before adding milk of any kind. Add a little bit of milk and tip the box a bit more than usual (I imagine a lot of folks are not very precise when measuring breakfast cereal) and we’re easily sailing over 500 calories. I eat a modest 1700 calorie diet most days and I could easily crush 1,000 calories of this cereal without even feeling full.

Likewise for sandwiches. The best rated local sandwich shops near me offer a selection of (very likely) 1,000+ calorie sandwiches. They also do not list calories so my estimates are based on casually deconstructing them and plugging in constituent ingredients into MyFitnessPal ensembles with surprising results. It’s surprising because I’ve proven I can eat more than one without feeling full.

It doesn’t take a mad genius in an evil food lab somewhere underground to make food that’s guaranteed to derail a diet. The ingredients are cheap, easy, and abundant everywhere.

That’s the problem.

It's not usually the main portions of food that's a problem. It's all the little things that are added to enhance the flavor.

The worst example I can think of is, one of my favorite sandwiches, Jersey Mike's Club sub. The "mini" is the size with a reasonable portion. It has Provolone cheese, mayo, bacon, and olive oil on it (if you get it "Mike's way") that takes it from 280 Cal to 640 Cal without changing size (visibly). But I don't always get the mini. Sometimes I get the regular which brings it up to a whopping 1,120 Cal.

And yes, there are plenty of times I'm not really hungry for dinner, but I'm so accustomed/habituated to eating dinner with my wife that I'll eat out of habit. I wasn't hungry, so I chose a small serving, but that still ends up being 500-600 Calories that I didn't need.

So that's 1,200 - 1,800 calories in two main dishes. It is way more food than I need? Do I feel stuffed after eating it? Not usually.

Most people don't realize how many calories are in oil. Check out the label of your olive oil next time you put into a pan to cook.

In a sense you are right, but it is VERY easy to get yourself accustomed to larger portions. I would have absolutely no problem eating a 1000 calorie dinner, even a 1500 calorie dinner. Carbs and dairy are very easy to eat a lot of without noticing.

Your body is incredible at adapting, and it's happy as pie to adapt to a high calorie diet. A few months ago I started calorie counting rigorously and was shocked at how many calories I was casually consuming in what I felt was a normal diet.

The easiest switch I made (and I acknowledge it's not for everyone) is having precisely the same breakfast and lunch every weekday which is a 300 calorie breakfast and 500 calorie lunch. Only one milky coffee per day (in Australia coffee is often made with all milk, no water).

If you come home from work having eaten 800 calories then it's no great hardship to keep within 1000 calories in the evening. But if you've had 1500 calories before 5pm you're stuffed.

Breakfast (560 - 640 Cal)

* Two servings of frosted mini-wheats (120g - 400 Cal)

* 1 or 1 1/2 cups (240/360 ml - 160/240 Cal) of whole milk

To fill out a day when I was eating super carefully my lunches (1/2 each) would be 1 cups of steamed broccoli and 1/2 a Turkey sandwich.

Lunchs Total (566 Cal) - 1/2 per lunch

* Broccoli (200g - 72 Cal)

* 2 Slices Oroweat whole wheat bread (200 Cal)

* 4 oz deli Black Pepper Turkey (164 Cal)

* 2 Tsp whole grain mustard (30 Cal)

* 1 Tbsp Miracle Whip (25 Cal) / 1 Tbsp Mayonnaise (100 Cal)

Pair that with a dinner of Marie Callender's Chicken Pot Pie (600 - 930 Cal)

* 10 Oz Chicken Pot Pie (600 Cal) / 15 Oz (930 Cal)

So without any snacks or beverages that puts me at 1,726 Cal - 2,136 Calories.

If I had a glass of milk with lunch and dinner and some Almonds for a snack (1 oz 175 Cal) that would add another (495 - 655 Calories).

Total of 2,221 Cal - 2,791 Cal.

And this is me watching what I eat, but just getting a little sloppy around snacks and beverages. I could easily blow past that by having a Red Bull or soda. Maybe some dessert at some point in the day. It could be easy to add another 1,000 Cal.

I don’t mean to sound rude, but frosted cereal, miracle whip and pot pie are not indicators of a good diet.

Once you start eating whole foods (mostly meat, vegetables, nuts and eggs), you’ll realize how easy it is to lose weight (particularly once you start exercising). I think the trouble is that most people have conditioned their tastebuds to respond to highly processed food, so they think they can’t eat “normally”.

Bullshit. It was honestly one of the hardest things I've ever done. I would spend a few hours a week planning meals and shopping. And then cooking for another 2 hours each day. (Yes, I realize this is pretty standard, but I'm not interested.) I don't enjoy cooking for myself (I don't mind doing it for friends and whatnot though). I did it for three years consistently to lose my last 30 lbs (and got under 10% BF @ 160 lbs.), but I hated having to think about food all the time.

Finding, shopping, choosing and cooking whole foods was the biggest pain in the ass I had when I was single. I don't mind eating healthy, but I hate the work that goes into it. And given the choice I'm going to throw butter, honey, mayo, avocado, etc onto whatever I'm eating to make it tastier.

Is my diet unhealthy? Yup and I know exactly how unhealthy it is. But I love sweet things. That's just something I've come to accept.

Did my tastebuds adjust when I ate healthier? Also, yup, but and I was fine with it at the time. When I met my wife my eating habits slowly got worse until I didn't think about my food choices at all and just when with whatever sounded good at the moment and that was also fine.

But I've learned over the last 10 years that thinking about food constantly (in order to consistently eat healthy) multiply that by two with because my wife's food preferences are vastly different than my own and it's a burden I don't want.

All that is what lead me to alternate day fasting. This is a much easier choice than watching what I eat (I'm being a bit hyperbolic for effect, I'm adjusting my diet too, but not drastically like in the past). I eat enough every other day to sustain myself at a nice 170 lbs, so that's just what I'm going to do. I actually don't find it a burden at all to not eat for a day.

[Edit: Also, food choices were pretty random off the top of my head, but still you picked on the miracle whip, but not the mayo?]

I'm not saying you can't keep your weight in check on that diet if you do ADF. I'm saying that your diet is far from normal or healthy - which you yourself admit. Sugar-frosted cereal in particular is just downright terrible. No-one should think of that as "normal".

Drinking 500+ calories a day is almost 1.5lbs a week, cutting that alone would contribute a lot to weight loss. Try drinking a gallon of water a day instead.

Yup. Totally. I don't actually do that any more.

But it wouldn't be unusual for me to have three cans of soda a day if I'm not paying attention. Two during the work day and one with dinner, so that's still 500 Calories.

In the last year I've figure out one of the causes for this. I'm, apparently, very sensitive to the flavor of water.

I picked up a home reverse osmosis filter and my water consumption has gone back through the roof and soda consumption down to 1 every few days just because I like the flavor.

Calories from drinks are a good example of stuff with a very different balance between calories and satiety, the carbs in drinks don't really create a feeling satiety even if consumed in huge amounts but do provide loads of energy.

Eating 500 calories worth of non-starchy vegetables, on the other hand, would be much harder, because you would feel stuffed.

Yea - cramming everything full of sugar to encourage over-consumption might be habit forming even for the individuals that try to minimize consuming those sugar laden goods in their adult life.

Maybe a big chunk of folks can naturally avoid this but, honestly, modern life is basically about being bombarded continuously with advertising to over-consume while blaming everyone who falls victim to it - whether it be racking up credit card debt or overeating.

We can afford more enticing food.

Why are we eating more though? Normally you would expect what, maybe people get pudgy when they live in a realm of excess availability and little exertion, but the percentage of 300+ lb people rising so dramatically in the last 30 years isn't so simply explained.

I would suspect multiple things at play, some combination of processed food, food scientists tweaking flavors so that we don't burn out on eating foods, increased carbohydrate and calorie density, PFAs and endocrine disruptors in the food and water, plastic gloves leaking human analogue hormones into fast food fry grease or some currently unidentified hidden factor is a play here.

Somehow these things the combination has to be shorting out the satiation signal so that people don't stop eating when they have enough. Trying to listen to your body when your body is being lied to.

It's not as simple as people eat too much. Something is creating the hole that they are trying to fill.

N == 1, but when I eat in certain way (lots of veg + fruit, reduce white bread and pastry, no caloric drinks), my body stays the same weight, as measured by clothing size, without any further conscious effort.

I suspect that this is the way how our ancestors in the 1950s-1970s stayed slim (at least compared to us) without calorie counting or even knowing what calories were, even though they held white collar jobs too. Body tries to find an in/out equilibrium, and ultra processed foods disrupt this process.

Take any photo of an engineering or academic team from that period and compare it to a photo of people doing similar jobs today. A massive difference in size, though the job's physical demands aren't that different.

I'd say it's a necessary explanation, but not sufficient.

>My hunch with the CIM is that a human in good health can pretty effortlessly maintain a non-obese weight without much regard for things like macronutrient balance, but that some fairly widespread factor has disrupted that regulation mechanism in a large fraction of the population.

In the USA, Percent of adults aged 20 and over with overweight, including obesity: 73.6% (2017-2018)

>That in a sense a keto/low-carb diet is a workaround for a mechanism that's broken in a lot of people, rather than some platonic ideal of how everyone should be eating.

This was studied several times now and they haven't discovered it. Some people assert GI microbiome is broken and there has been success there. Others are asserting that it's glysophate somehow interrupting, that keto avoids the larger concentrations of glysophates in our food.

The one that seems simplest is that 100 years ago we didnt eat carbs unless you were poor. For thousands of years we ate game meats. About 75 years ago the governments of the world were fooled by political activists and they started an experiment on us. I have 73.6 reasons that experiment failed.

     a keto/low-carb diet is a workaround for a mechanism that's broken in a lot of people

I think you're onto something from my own experience. I don't think you are entirely correct though. It's not a workaround as much as cure.

This might just be anecdotal evidence but my body was definitely broken. My gut was b0rked and I was in a cycle of eating more and more carb-y food to not feel hungry/cravy/fatigued all the time.

What getting on the right probiotics and doing keto did for me was what I think is to restore the natural state human bodies should be in again. I finally am able to feel "full" again and eat when I'm actually hungry vs. just eating three meals a day (plus 'cravings').

Now I don't subscribe to any religion but I do think that any religion that includes a "fast" does right is to basically do something akin to keto. I don't believe in any of the religious aspects of fasting but I do recognize that the easiest way to get a large populace to stay healthy is to subscribe them to a religion and then let the religion dictate things that keep them healthy and happy.

E.g. I don't eat breakfast any longer. I just don't need it. I don't feel hungry in the morning any longer. I oftentimes don't even feel hungry at lunch any longer and only do so around maybe 2pm. Not being bound to traditional meals and customs around eating helped me with this. I just go scour the fridge at 2pm to find some cheese and eat some almonds. Maybe some peanut M&Ms (at the office - at home it'd be say raspberries with cream). I can totally recommend peanut M&Ms with cheese actually! Awesome combination!

As you can see in my comment history some people have asked before after comments like this one from me. What I did was try a lot of different probiotics but what I think helped in the end is Garden Of Life - Primal Defense. You don't have to use that brand but what I think did it is the Bacillus Subtilis included in it, which wasn't part of any of the other probiotics I tried. I'm sure there are others that have that one. I started off with 1 a day, then 2 a day, then 3 a day and I felt like crap for a few weeks. Then it all went away and I felt awesome. I'm still on those to make sure I maintain a healthy gut flora but I'm down to one in the morning and one in the evening and I also made Sauerkraut from it (i.e. empty a capsule into your Cabbage and let it ferment).

I’ve recently learned how important a health gut flora is. I took a course of antibiotics and had a month of severe depression, anxiety, constipation and general sense of hopelessness. It was fucking awful. I’ve completely cut out sugar and processed foods and refined carbs. I’m starting to feel genuinely good. That month was the scariest period of my life.

The experience has also shown me how ignorant we still are in terms of nutrition and medicine. My surgeon basically gaslit me, and handed me 5 different prescriptions. Hopefully we get to a place where nutrition is taking seriously, and we get proper tools to evaluate our body’s health

Amen! Thanks for sharing!

I would like to add that _all_ of my blood markers improved to completely normal levels when doing keto. Except for cholesterol, which improved too (HDL and LDL) but not to "normal" levels. I've been on statins before (up to max dose over ~15 years) and it did nothing except to cause muscle pain as the dose went up, which caused me to stop them, because the heart is a muscle and a serious (if seldom) side effect of statins is to cause muscles (including the heart) to do things they shouldn't. In an arm muscle it's painful. In a heart muscle it's deadly.

Same experience with gaslighting from most doctors. Not helpful at all. I figured this all out through experimentation and internet research. What triggered it for me was getting migraines worse than drinking 10 bottles of sweet wine from a 333ml bottle of alcohol free beer. A long research period that also explained a lot of previously just weird experiences. And none of the doctors helped at all.

My current GP is awesome though in that regard. She doesn't know much about this stuff either but she's curious. She googled with me, prescribed the blood tests needed etc. Just awesome!