18 ms·
Petro Dobromylskyj is one of the foremost experts of fat metabolism. He has a blog called Hyperlipid where he's been blogging about fat metabolism and interpret
by smooth_remmy 4y ago
Petro Dobromylskyj is one of the foremost experts of fat metabolism. He has a blog called Hyperlipid where he's been blogging about fat metabolism and interpreting research for close to 10 years.
He thinks the GLP-1 inhibitor drugs will be a disaster in the long term because they 1) cause weight loss but also 2) cause the body to create lots of new adipocyte (fat cells). Increasing the number of adipocytes is very unusual after puberty. As long as you are taking the GLP-1 inhibitor drugs you will lose or maintain weight, but as soon as you stop you will gain a lot of weight back.
Here is the blog post: https://high-fat-nutrition.blogspot.com/2023/01/glp-1-agonists.html https://high-fat-nutrition.blogspot.com/2023/01/glp-1-agonis...
- post_break 4y agoSo drug companies should be seeing alarm bells going off. You can profit off this drug, and it's an endless supply of revenue.
- JamesBarney 4y agoWith every weight loss intervention when you stop you gain back the weight. GLP-1 agonists don't seem to be any different than another other intervention.
- smooth_remmy 4y agoThe point is that you could gain back the original weight plus more. Most adults who become obese have not increased their number of fat cells - their fat cells just become larger. The GLP-1 drugs literally increase the number of fat cells.
- Scoundreller 4y agoHow does liposuction fare in long term fat loss?
- Scalene2 4y ago> Weight gain was reported in 43 percent of the responders, with 56 percent of them gaining between 5 and 10 pounds 6 months after their surgery. Fat return was reported in 65 percent of the responders. https://pubmed.ncbi.nlm.nih.gov/16651945/ https://pubmed.ncbi.nlm.nih.gov/16651945/
- kuhewa 4y agoLiposuction isn't a solution for fat loss beyond some localised cosmetic reduction. You can't use it to put a morbidly obese person in normal BMI range.
- Scoundreller 4y agoMy point is that you end up with fewer fat cells, but unsure whether this has any impact on weight regain. (Which is worth assessing if there are concerns about these drugs increasing the number of fat cells (otherwise unusual in adulthood) and creating a risk of fat volume rebound beyond initial levels after discontinuation).
- kuhewa 4y agoWeight is back to baseline within a few months after lipectomy and sometimes greater than baseline. In animal models there is regeneration of fat cell number following lipectomy along with increase in cell size, and which mechanism predominates depends on how large the fat cells were before (manipulated by reducing food). This is the critical fat cell size hypothesis, and in humans there is similarly evidence that fat cell number increases (hyperplasia) in advanced stages of obesity after the cells reach critical size (hypertrophy) but I'm not aware of that being studied in situ in lipectomy recovery. I'd make a confident guess that it depends on how obese the patient is and perhaps their baseline number of fat cells. But there are a lot of different mechanisms and feedbacks at play and I'm not sure how much insight can be gained from comparing localised lipectomy to systemic adipocyte proliferation resulting from a drug.
- nsxwolf 4y ago
- thomascgalvin 4y ago> The point is that you could gain back the original weight plus more. This is also common in all weight loss interventions, though the reason is generally from metabolic slowdown, not the creation of new adipose tissues.
- ansible 4y agoI suppose the concern goes something like this. Under certain metabolic conditions, each fat cell (in a region) decides it needs to be size X, and grows / shrinks accordingly. And under other conditions, each fat cell (in the same region) decides it needs to be size X*3. If there are more fat cells, then and they all decide to increase in size, then that could be a substantial weight gain, beyond what would be expected otherwise.
- JamesBarney 4y agoThey've studied this, they put people om semaglutide then took them off of it for a year. Looks like every other weight loss intervention. https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725 https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
- paulpauper 4y agogastric bypass does not have this problem as bad
- JamesBarney 4y agoKinda, drugs/diet/exercise you can stop. But most people don't undo the gastric bypass surgery. (I don't even know if it's possible)
- toomuchtodo 4y agoA family member has had gastric bypass. You can have everything “replumbed” if complications require failing back to something similar to previous state. https://pubmed.ncbi.nlm.nih.gov/27387697/ https://pubmed.ncbi.nlm.nih.gov/27387697/ With that said, I would be interested if new weight loss drugs negate the need for gastric bypass in the first place. Comes across as medieval and barbaric if the hormones/drugs are superior.
- ceejayoz 4y ago> With every weight loss intervention when you stop you gain back the weight. GLP-1 agonists don't seem to be any different than another other intervention. Except for one thing: it's fairly easy to not stop a drug. You just... keep taking it. Long-term use of these drugs for maintenance purposes looks entirely feasible. Not quite as easy to maintain as a gastric bypass, but close enough to be a big deal. The same isn't true for exercise and diet; it's very easy to fall off those wagons.
- milleramp 4y agoI wonder how breaking old habits and establishing new habits over a year or so would stop a serious rebound?
- linsomniac 4y agoIt is, in my personal experience, all to easy to fall back into the old habits.
- j33zusjuice 4y agoNo doubt. The old habits are easier. It’s way easier to order in food and lay in bed than to cook and workout. Of course, it’s overly reductionist to assume weight loss is as easy as “stop laying around, eat healthy, and exercise.” It kind of is that simple, but there are so many factors that help prevent us from good habits. I think my biggest issue is that food is one of the few things in my life that’s ever evoked a positive response for me. I’ve gone years without being fat, but it comes back because of some issue I encounter, and I lack the tools to deal with it in a better way. So I get depressed and eat, and eventually hate myself for falling apart again, and so we go, forever and always.
- paulpauper 4y agoThe low success rates of diets suggest very hard to establish new habits
- s1artibartfast 4y agoMany things are hard, but that does not mean they should not be done.
- pessimizer 4y agoIf there are easy alternatives with the same outcomes, hard things absolutely should not be done (unless you're practicing for an emergency situation where the easy thing is not available.)
- 1024core 4y agoGiven that injections cost ~ $1000/month, you're saying basically that it'll be a great recurring revenue stream for the companies. A CFO's wet dream.
- deleted 4y ago[deleted]
- paulpauper 4y agoconsider that treating obesity-related consequences also costs money and enriches companies as well. I think its worth it
- newsclues 4y agoConsidering the benefits of good diets and exercise, I think it's worth it not trying to hack or shortcut our way to a healthy life with weird drugs or whatever.
- nerdawson 4y agoI did a little bit of research and for people in the UK it appears to be substantially less. I found a few health companies offering it for <$250/mo. I’ll probably wait until it’s readily available on the NHS but it is tempting.
- onionisafruit 4y agoMy US doctor recommended it to me last week and said there was a way for it to cost about $200/mo if I want to do that. I thought it was strange that he said it that way instead of just saying the price, but I didn't follow up because we were 45 minutes into the appointment and I was ready to get out of there. I'm supposed to book a follow up appointment after I've read about it, so I guess I'll find out what he means then.
- ceejayoz 4y agoPretty much every expensive medication has a copay assistance program in the US. For trirzepatide: https://www.mounjaro.com/hcp/savings-resources https://www.mounjaro.com/hcp/savings-resources They typically are income blind and make your out-of-pocket price negligible. I'm on a med (Skyrizi) that's $18k per shot, one every three months; their assistance program ensures I don't pay more than $5. They chip in on the deductible/coinsurance/copay, you don't skip the medication due to cost, and they still get significant money out of your insurer. Everybody wins, until everyone's premiums go up next year.
- wins32767 4y agoThe only thing I see from him on google scholar is about mechanical ventilation for small animals. What's his background?
- m_a_g 4y agoHere is an introduction I found from his blog: >I am Petro Dobromylskyj, always known as Peter. I'm a vet, trained at the RVC, London University. I was fortunate enough to intercalate a BSc degree in physiology in to my veterinary degree. I was even more fortunate to study under Patrick Wall at UCH, who set me on course to become a veterinary anaesthetist, mostly working on acute pain control. That led to the Certificate then Diploma in Veterinary Anaesthesia and enough publications to allow me to enter the European College of Veterinary Anaesthesia and Analgesia as a de facto founding member. Anaesthesia teaches you a lot. Basic science is combined with the occasional need to act rapidly. Wrong decisions can reward you with catastrophe in seconds. Thinking is mandatory. I stumbled on to nutrition completely by accident. Once you have been taught to think, it's hard to stop. I think about lots of things. These are some of them.
- rootusrootus 4y agoOh man, the first result for him on Google is a link to a YouTube video. That makes my BS meter instantly peg.
- Scalene2 4y agoWhat kind of crap do you watch on YouTube that manages to taint the entire platform?
- eganist 4y agoyoutube consistently steers everyone who touches it to more and more extreme content with the passage of time. It's not unique, and often times that content tends to be anti-science. I'm not the OP but youtube is tainted for anything other than entertainment and a few select channels like the ones by PBS e.g Space Time.
- wolverine876 4y ago> one of the foremost experts of fat metabolism Is it correct that the source is a veterinary anaesthesiolgist? https://news.ycombinator.com/item?id=34252195 https://news.ycombinator.com/item?id=34252195
- jononomo 4y agoYes, he is the world's leading expert on this subject because credentials aren't everything
- wetpaws 4y agoCount me as a world leading expert as well then.
- jononomo 4y agoYou actually have to know what your'e talking about to be an expert, though.
- wolverine876 4y agoI don't see evidence that this person knows what they are talking about. I see they talk a lot about it, but we know very well that talking, including in the specific manner they do (at length, citing lots of stuff), are also traits of people who are completely deceived or deceiving, conspiracy theorists and fabulists, etc.
- ramraj07 4y agoCredentials aren’t everything but at the least I want someone to be in the field doing things in practice (research or patients) everyone else including me should shut up otherwise.
- wolverine876 4y agoYou go with it then, but personally I wouldn't even let this person anaesthesize me.
- aussiesnack 4y ago> one of the foremost experts of fat metabolism. What makes you say that? In my experience, there are no 'experts' in empirical fields who are no themselves deeply and practically engaged with actual research. Being well-read does not make you an expert. Writing blog posts and appearing on YT doesn't make you an expert. Critics are not experts. To be an expert in anything you have to get your hands dirty. Nothing I can see from this guys publications or bio make it seems like he's an expert in human fat metabolism at all, let alone a 'foremost' one. I base this on a fairly cursory survey, so I'm happy to be corrected. But convincing corrections would absolutely require details regarding what he has contributed to the field.
- JamesBarney 4y agoI don't know if I'd call a veterinary anaesthetist a foremost expert on fat metabolism. His thoughts on insulin signaling are not consistent with the consensus among obesity researchers. He thinks glp-1 works through uncoupling or fat browning which is just not true. The consensus among most obesity researchers is the cause of obesity is primarily neurological, not metabolic. Basically the brain can't properly regulate weight in the current obesogenic environment. When you look at GWAS most of the genes related to obesity are active in the brain, (as opposed to genes for diabetes which are more closely related to fat/metabolism etc...). I'd describe Petro Dobromylskyj as a smart hobbyist with an outsiders views of obesity, not a foremost expert on fat metabolism.
- givemeethekeys 4y agoIs human metabolism really so different from other mammalian metabolism?
- deleted 4y ago[deleted]
- jessriedel 4y ago1. If the expert consensus is that the cause is neurological rather than metabolic, it seems more important to not that human neurology really is so different than other mammalian neurology. 2. Clinical anesthesiology is pretty far from this topic.
- computing 4y agoyes. yes it is.
- sarchertech 4y agoThe only published paper I can find by him is on small animal ventilation, so I don’t think he’s a “foremost expert” on fat metabolism in animals either.
- jononomo 4y agoHe is basically the world's leading expert, but you can only see credentials, lol.
- csours 4y agoN of 1, but I've gone off it for months and maintained my weight.
- aantix 4y agoHow much did you lose, how long did you take it, and how long have you been off of it?
- csours 4y ago380->340 over 6 months. I was off for 6 months and maintained 340 with diet changes and exercise. You cannot go back to the old diet and expect to maintain. I'm back on now to lose some more. Some other things I've learned: Take the first shot on an empty stomach. Expect the first 3 days to be rough. Hunger is more than one sensation, and when you have severe calorie deficit, your body will feel very bad (at least at first). It is critical to control your food environment - don't bring junk food home, don't go to restaurants too often. I learned to slow down and enjoy the food reward, instead of trying to chase it. No words will tell you how to do this for yourself. There is a feeling that I call "future hunger", where I don't feel bad, but I feel like I will in a while. In the past, my body and mind would get frantic when I felt this way. Now I have a very small snack and ask myself "do you feel bad right now, or do you feel like you're going to feel bad". Again, these words may not translate. More than one serving of salty and sugary snacks should NEVER be within arms reach, and preferably not in the same room. Your mind will remember these snacks and oftentimes eat them without conscious effort.
- koboll 4y ago>As long as you are taking the GLP-1 inhibitor drugs you will lose or maintain weight, but as soon as you stop you will gain a lot of weight back. Sounds like the opposite of a disaster for pharmaceutical companies. Well, on the upside, the demand for this is so great that cheap generics shouldn't be too far away, right? And it seems like an insurance no-brainer to cover it for life, right?
- hollerith 4y agoThe cheap generics never appear till the last of the patents have expired regardless of demand.