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Comment by johnr2 | Hacker News Reader

> cutting out sugar

I'll assume you mean refined sugar here. I'd expect the benefits of eating fresh fruit and sugar-containing vegetables to outweigh most of the harm done by their sugar content.

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By eating the whole fruit, you're consuming the fiber, which changes how your body metabolizes the sugar (more slowly), as opposed to say, drinking a glass of apple juice.

The sugar itself between fruits and refined sugars contained in processed foods isn't all that different. Apples contain fructose, glucose, and sucrose, but in different ratios compared to table sugar. The more important factor is the quantity of sugar you're consuming.

But we don't even need to eat sweet fruits. If you look at your plate size as a constraint, then fruit carries an opportunity cost. You're adding sweet fruit in place of something else which could add more nutritional value in that same space. If you do eat fruit, then eat something which isn't sweet (tomato for example.)

Very few vegetables (starchy tubers are the main exception) contain much sugars (and specifically fructose, which is uniquely bad for your liver), so I think it's worth separating out fruit vs vegetables, but yes, there's also a very different metabolic response to acellular sugars (the best review I've seen on the subject is actually a talk given by Gabor Erdosi: https://www.youtube.com/watch?v=8rcfvRGZsDs), but I'd also say that the harm is contextual. If you're metabolically flexible, or if you're actively replenishing muscle or liver glycogen, your body comp is where you want it, and your insulin sensitivity/glucose disposal is good, then yeah, sure, have some fruit if you want. If you're like the majority of American adults though, then it's probably not doing you any favors.

* 2013–2014 NHANES Data shows 70.2% of US adults are overweight or obese. [1] 37.7% being obese. Note, that this percentage is reported at 39.8% in 2015-2016 (using the same NHANES data). [2]

* The NIH estimates that "Between 30 and 40 percent of adults in the United States have NAFLD." [3]

* The CDC says: "An estimated 33.9% of U.S. adults ... had prediabetes in 2015" and "Nearly half (48.3%) of adults aged 65 years or older had prediabetes." (only 1/3 are "aware" of this). Another 9.4% of the population is estimated to be diabetic. [4] That means well over half of American adults are pre-diabetic or diabetic, and that number is only going up.

It's important to recognize that diabetes is only the endpoint and it is usually preceded with Metabolic Syndrome markers. Here's a recent analysis of 2009-2016 NHANES data: https://www.liebertpub.com/doi/10.1089/met.2018.0105

* 80.1% of Americans had at least one marker of MetS by ATP III criteria

* Using more restrictive (calculated in the study) cutoffs gave a result of 12.2% of American adults in "optimal metabolic health"

Sadly, what's notably missing from all of this is measurement of fasting insulin - almost no one gets this measured (and I've both had personal experience and tons of stories from friends where Doctor's will actively fight back when requesting to have your FI tested) - it's been know for decades that hyperinsulemia and insulin resistance (best calculated by HOMA or HOMA2, indices which require FG and FI to calculate) will precede hyperglycemia by years or decades (subclinical diabetes). The insulin assay costs $8 direct-to-consumer pricing in the US when added onto standard FG/A1c testing. (FI is also required to calculate your NAFLD LFS, the best index for diagnosing NAFLD.)

To me, what was sort of shocking/amazing to me after doing my own research is how negligently ignorant GPs/clinicians are about literally the most common disease that's killing their patients.

Based on what I've learned this year, I have some (pretty well-founded IMO) opinions now, but I'm actually not all that interested in these Nutrition Wars arguments (the quality of the research is very poor and population-level dietary policy has honestly been such a disaster, but almost impossible to turn around due to institutional momentum/regulatory capture) but so much of metabolic health is contextual and bio-individual. I'd rather people pick some good surrogate markers they can track sequentially and then make controlled lifestyle modifications and see what actually helps them. Everyone should just do more of what works for them, and do less of what doesn't and worry less about what "experts" say on the matter.

[1] https://www.niddk.nih.gov/health-information/health-statisti...

[2] https://www.cdc.gov/nchs/data/databriefs/db288.pdf

[3] https://www.niddk.nih.gov/health-information/liver-disease/n...

[4] https://www.cdc.gov/diabetes/data/statistics-report/prevalen...

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