Millions in west don't know they have aggressive fatty liver disease, study says

I can concur - that shift in mindset to "i'm hungry, oh well" is crucial for your body I feel.

> "im hungry, oh well"

The real danger is if you dont swap back and just created yourself an eating disorder.

If you're going to fast, especially extended fasting, it would serve a person well to drop carbs and sugar and get into ketosis, at least for a while, so your body can start burning fat more effectively. If you've never done this before, it can be an uncomfortable process, with a lot of headaches, mood swings, etc. Making sure you take in enough electrolytes (sodium, magnesium, and potassium) will help a lot during all this, and during longer fasts.

I cleaned up my diet about a month ago, and have accidentally done some 24 hour fasts when I was busy and it's been fine. By the time I do eat, I'm really not even hungry, though my stomach may be growling a bit. The first time I ever did this, I had horrible headaches and felt miserable for a while, but subsequent times have been easier.

Good sleep maters too. Bad sleep will throw your hormones out of whack. I'm extremely hungry when this happens, and crave all the wrong things. Knowing what's going on helps a little.... just a little.

I find all this much easier than just trying to cut back by 200 calories with what I normally eat. It's all about hormones.

This sounds like a diet problem. You eat till your stomach is full. That because your food is not actually feeding you.

Long story short: meat and vegs + fruits. It takes a while.

and that’s when you’re doing it willingly :)

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There may be some medical benefits to periodic fasting, especially for people with excess adipose tissue. But in terms of "no harm" the Memel et al paper you linked doesn't seem to mention anything about loss of lean muscle tissue. This can cause serious harm for some patients — especially older patients with the "skinny fat" body type — by leading to sarcopenia (higher musculoskeletal injury risk) and endocrine dysfunction (muscle is a glucose sink). Loss of muscle can be limited to an extent by doing resistance training and maintaining high protein intake during non-fasting periods. But overall there are still a lot of unknowns in this field.

From your chosen quote, it doesn't seem to indicate that fasting specifically changed things, but fasting being an "effective means for weight loss" was the bit that really mattered. I don't see anything to divorce the two - general weight loss and improvement to the FLI.

> Available evidence suggests that any form of caloric restriction may be beneficial and specific forms of IF should be tailored to the individual.

Also important to notice that once the liver is damaged it's not recommended to fast:

> Additionally, it is important we investigate the possible risks of fasting in patients with cirrhosis, which is currently not recommended.

I did lose weight, but it wasn't crazy dramatic.

Dietary recommendations have fluctuated widely for decades, and still differ substantially between sources. So far there is zero direct evidence that meat consumption causes fatty liver disease; I mean it's possible but we just don't know one way or the other. The only real data we have comes from low-quality observational studies (basically junk science).

If someone wants to try limiting meat consumption as an "n=1" experiment to see how it affects their body composition and other biomarkers then go ahead. Just don't expect a major impact from that one factor.

Not to mention, there's a good chance that your doctor is fatter than you are.

I eat enormous amounts of dairy and red meat and recently I had abdominal surgery and the doctor afterwards confirmed I was in very good shape and had no signs at all of fatty liver and very little visceral fat generally.

I eat around a pound of beef a day, a gallon of yogurt a week, and almost everything (eg oatmeal) is made with copious amounts of butter.

I think unless you know something specific about your genetics, just eat plain natural foods people have been eating for millennia and you will be perfectly fine. Basically, buy plain meat, vegetables, grains, and dairy and prepare them yourself. Don’t eat preservatives, corn syrups, or novel vegetable oils like canola. Maybe they’re fine but there’s no reason to risk it. Also do your best to make sure what you eat followed the same rule; eg my beef was grass fed and finished and was not fed skittles in a feedlot. Diet affects animal meat as well, just as it does us.

Fructose is processed by the body quite differently than sucrose, in a way quite relevant here.

And actually one of humanity's major evolutionary advances.

This is wrong. As another commentator pointed out,the body processes fructose differently from sucrose.

As for honey (and fruit, for that matter) - they are full of beneficial compounds that help your body regulate blood sugar.

To illustrate this, someone I know of with type I diabetes who ate natural honey didn't need to inject as much insulin as when eating commercially processed/heated honey - those beneficial compounds are destroyed during the process. Same for fruit vs fruit juice...

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It has nothing to do with spirituality or morals. Skinny-country person moves to the US, they get fatter (statistically speaking). They weren't skinny at home because they were better spiritual warriors or whatever, but because they didn't live in the US.

The options are to fix what are probably a whole bunch of problems across multiple domains at a cost of $(enormous sum) with a project spanning many decades (and which may easily be derailed and set back years and years at any time), so that living in the US doesn't make people gain weight, or... drugs, that work today. From a policy perspective, those are the only options. There's no good reason to think that reversing "moral decline" or whatever will help, since that doesn't seem to be why some other countries are skinnier.

> It’s more a spiritual / moral decline of culture in the west.

It's not a question of decline. There's no reason to think that humans today have less self control than in the past. We're dealing with obesity now because tasty, cheap food didn't exist until the second half of the 20th century.

Sure, our obesity epidemic is because everybody just suddenly decided to start eating more a few decades ago. Much more likely there is some environmental factor causing it. I guess calling it moral decay feels more self-righteous though.

> It’s more a spiritual / moral decline of culture in the west

It's not just the West.

"Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country's population" [1]. (It's about 7% in America [2].) Meanwhile in China, "the incidence of overweight and obesity among school-age children...was 15.5% in 2010, rising to 24.2% in 2019 and soaring to 29.4% in 2022" [2]. Same story in Vietnam: "The prevalence of overweight among children aged under 5 years increased from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, prevalence rose from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively" [3].

OP is right. "If everyone just..." is shorthand for wishing upon a star that the world were different. It's not a serious solution for reality as it is. (To the degree there is a social trust variable at play, it's in folks doing mental gymnastics to reject the clinical data.)

[1] https://en.wikipedia.org/wiki/Obesity_in_India

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC10357130/

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC9947684/

"yet those same people are unable to put less food in their mouths"

And you think that addiction is a moral/spiritual problem? Nope, it is an endocrinological problem. And precisely drugs like Ozempic have made it very clear, because it doesn't just treat obesity, but many other addictive behaviors like compulsive shopping or gambling. By "merely" altering hormonal balance in the target organism.

People once thought that smallpox was divine punishment for sins. It is 2025, we are on Hacker News, and yet the very same pattern of thinking emerges here, against all the scientific knowledge.

Are you ready to throw stones in glass houses? We can list a thousand sins of people with actual political power that dwarf the sin of “accommodating” so-called lifestyle choices. Then we can talk about how those same people abuse trust at every opportunity.

Your buzzwords are useless.

> human body left alone in original East African savannah sorta worked, hunters and gatherers don't suffer from metabolic disease

One, we don't know that. But two, it's fair to assume they didn't because their constraint was starvation.

Look, metabolic disease makes sense from a preservation angle. It's a safe assumption, in the wild, that one will not suddenly come across permanent sources of excess calories. So if one assumes starvation is the enemy, and the body finds itself amidst excess calories, it must assume this is a finite resource to be competed for. Herego, stuff your face. Build fat cells. And under no circumstance shoud you give up a fat cell. No, reduce voluntary motion and--if necessary--cut basal metabolism to ensure we can get these calories into our bodies before someone else exhausts them.

For what it's worth, I'm on the other end of the spectrum. My body happily burns away fat stores. This is frankly great in the modern world! But if I get seriously sick (or thrust into a starvation environment), my odds of dying are high--it's why folks with a mid-twenties BMI have a longer life expectancy than those of us closer to twenty. Not techhnically underweight, and with plenty of muscle. But also with less of a buffer.

> human body left alone in a modern supermarket world is way off its original evolutionary envelope

It's arguable that the evolutionary envelope was leapt off around the development of agriculture and animal breeding. (We're still on patch Tuesday from c.a. 10,000 BCE on lactase.)

> drug companies that are marketing these weight loss drugs switched up their game after their previous cash cow, insulin, ran out of patent protection

Are you disputing GLP-1's efficacy?

> If the article was properly researched then it would have outlined how that lifestyle interventions are preferable to prescription drugs

This would have struck me as CYA filler. We know diet and exercise work. Nobody reading Lancet is confused about that. And if they're reading The Guardian and are confused about that, they're not going to have the ephiphany halfway through a medical opinion.

> plenty of research papers have shown that Mediterranean and whole food, plant based diets (devoid of processed foods and animal products) have had some success at reversing fatty liver disease and enabling patients to obtain a healthy BMI

Compared to GLP-1?

I have a sore throat right now. I'm eating lots of ginger and garlic and foods rich in vitamin C and zinc. (Taken with hot teas.) If it were to progress into serious tonsillitis, I'd be pretty pissed off at the surgeon throwing a honey-lemon tea reference into their briefing.

> the heart of the problem is lifestyle choices. Nobody is selected by a cruel roll of the dice to get metabolic syndrome

Sure. Yes. If people made better decisions in the past we'd have fewer problems today.

In reality we have a lot of people who didn't make good decision in the past. Their bodies are failing. If GLP-1 works, it works. Getting conspiratorial about Big Pharma or butthurt that nobody mentioned feta cheese and hummus isn't useful for the targets of such an article, people thinking about the health of their loved ones as well as the arc of public policy.

I was wondering why it didn't recommend reducing carbs and increasing vegetables; instead recommended drugs.