Lower Obesity Rate During Residence at High Altitude Among a Military Population | Hacker News Reader

Lower Obesity Rate During Residence at High Altitude Among a Military Population

journals.plos.org

38 pointsatticora51 comments

Everyone ought to read "A Chemical Hunger"(1) which posits that the relationship between altitude and obesity is real(2), and is mediated by lithium in the drinking water.

(1)https://slimemoldtimemold.com/2021/08/02/a-chemical-hunger-p...

(2)

  -Higher altitudes are associated with lower obesity rates in the US and other countries, including Spain and Tibet.
  -Colorado, the highest-altitude US state, has the lowest obesity incidence.
  -County-level obesity data in the US reveals clear patterns in the Rockies, Sierra Mountains, and Appalachians.
  -"Altitude anorexia" causes sudden weight loss in individuals relocating to high-altitude areas.
  -Similar weight loss effect is observed in lab rats moved to higher-altitude labs.
  -Evidence suggests a relationship between altitude and lower diabetes rates, independent of variables like age and BMI.
  -Oxygen and carbon dioxide variations with elevation alone do not explain the altitude-weight relationship.
  -Submarines with elevated CO2 levels do not consistently lead to weight gain, refuting atmospheric explanations.

> Submarines with elevated CO2 levels do not consistently lead to weight gain, refuting atmospheric explanations

How are the reduced partial pressure of oxygen and low temperature rejected as causes? The two largest metabolic taxes I experience at altitude are the fatigue during acclimation, which I understand to be the production and maintenance of red blood cells (as well as dehydration), and lower temperatures.

Submarines also have reduced partial pressure of oxygen, (18-19%). https://www.sciencedirect.com/science/article/pii/0378427489...

> Submarines also have reduced partial pressure of oxygen, (18-19%)

The article defines high altitude at 1.96km, or 6,430 feet. That’s a less-than 16.5% effective oxygen atmosphere [1].

[1] https://www.higherpeak.com/altitudechart.html

actually according to the CDC Washington D.C. has a lower obesity rate than Colorado, but they do overlap with error bars. And D.C. is basically at sea level.

https://www.cdc.gov/obesity/data/prevalence-maps.html

Washington D.C. is not a state, it's a federal district.

https://en.wikipedia.org/wiki/Washington,_D.C.

When compared to states, DC is almost always the highest or lowest regardless of what the metric is. There is no state with remotely close to the level of urbanization DC has so it's almost always an outlier.

Washington D.C., being a small, densely populated region that is covered by a coherent public transit system, is very different from Colorado (which has large areas that are rural and heavily car-dependent) in ways that might well bias obesity rates independently of the (relatively small) effect from altitude.

A comparison between Colorado and an actual state (which will involve non-urban regions) might be better.

> -Submarines with elevated CO2 levels do not consistently lead to weight gain, refuting atmospheric explanations.

From my circle of friends in the Navy, submarine food is not super appealing, which may be a large factor in weight difference observed after a tour.

I had always thought that Submarine chow was better so as to act as a morale booster. Apparently that's not the case.

I think the problem is they have to go a long time between supplies, so there's not much that's fresh. And I don't think there's that much variety.

That said, some sailors consistently come back bigger, and some consistently come back smaller, so it's mixed. :)

Having cruised on a carrier and known folks who deployed on land overseas, this is not unusual. Everything is contextual, and when you put some folks in the context of deployment, they decide the remedy for boredom is to work out a lot. Or their job requires it (infantry, hauling heavy things, etc). Other people don't have either of those, and just eat, do their jobs, and sit around.

I have noticed overall that the tendency seems to be for most folks to get trimmer, just because in general you're walking/moving around more and there's generally no alcohol available. Going up and down ladderwells to get everywhere burns calories even if you're not a gym rat.

Is it possible the non standard atmosphere affects appetite or taste sensation?

This lithium thing is laughable. They lean on a fake study that claims 100% efficacy in improving mood. I'm here to tell you it doesn't work that way.

My psychiatrist (trained in Forensics) insists that I have bipolar disorder and nothing else. She exclusively pushes bipolar medication, because I can't possibly suffer from anything else that can be treated any other way. She knows full well that lithium intake (as well as other drugs I've taken, such as Risperidone) nearly always leads to weight gain and obesity. I can draw clear and unambiguous lines from my hospitalizations to my weight gains--even after losing 180 pounds, I porked up again to all-time highs. These gains are chiefly due to my loss of self-esteem and confidence, but also to drugs. Gynecomastia, partly because of Risperidone, perhaps also due to obesity itself. (Don't let them pretend that gynecomastia is limited to adolescent boys; I'm 51.)

She also became quite anxious when I reported high levels of caffeine intake, but her concern for my anxiety was a mere façade: caffeine disrupts the activity of serum lithium and accelerates its elimination from the body, therefore invalidating any therapeutic levels that we might achieve by pill intake! So go ahead, guzzle that 2L Pepsi Cola, it will relieve the nasty adverse effects!

Long ago, upon my mid-90s "bipolar" "diagnosis", my father recounted a 100% B.S. anecdote of a small Italian village where they discovered everyone's mood was so mellow, and it was because of natural lithium deposits in their groundwater. I knew it was B.S. and I was appalled that my scientist father could believe such fairy tales, after teaching me everything about chemistry, biology, and geology, far beyond any college education I later obtained.

The physicians prescribing drugs also tag-team each other to see who can induce "side effect synergy". This is a syndrome that has no clinical term, because it's a dirty secret. Once you are on 3-4 different drugs, collate all the possible side effects, identify the ones you're suffering and the ones that may pre-exist, and you'll find that there's almost a deliberate escalation of adverse effects as they add more medications to your arsenal.

There is good news, folks; I am drug-free for 60 days as of this writing, and I feel better than ever. I have identified a regimen of supplements which I take faithfully, and supplements make me feel good, not ashamed and not oppressed. Supplements are food!

That's perhaps disingenuous: I do indeed take drugs - Traditional Medicinals teas are unambiguously natural drugs, to regulate my blood pressure, treat anxiety and agitation, and relieve pain and assist digestion. I have no trouble taking natural drugs; it's the pharmaceuticals that are toxic and overall, cause harm.

Since going drug-free, my diarrhea was relieved and I've lost nearly 20 pounds. My goal is 60 more pounds away and I'm confident, with divine help, that I can succeed with this. Of course, weight loss is a permanent lifestyle commitment and not a fad diet or a month in the gym. But it's the single most healthful thing we can do for ourselves; the benefits are limitless.

Congratulations. What are some of your favorite / most impactful supplements you're taking right now?

I’d also like to know. If you’re curious or looking for answers in the meantime, there are a bunch of forums where such supplements are discussed, Reddit’s r/nootropics being what I’m most familiar with. BUT - While these supplements can massively help some people, you can also hurt yourself in a not so good way if you mess things up. Use common sense and read up ten times more than you need to. (I’m assuming that this warning is good enough for the average HN reader, seriously, please be responsible.)

I am very happy with magnesium glycinate, which my Catholic PCP recommends to combat leg cramps. This supplement also aids sleep and relaxation in general, which is very important to me.

Selenium is a great thing: I am somewhat forced to consume foods which promote inflammation, such as homogenized milk and processed, frozen dinners. However, selenium is known to neutralize inflammation to a certain extent. It also binds to heavy metals that may enter the bloodstream, such as when I was undergoing a cleanse. Finally, selenium supports the mood overall, and so one capsule a day seems like a bargain!

I don't get into a lot of exotic substances; many supplements are 100% physician-approved, such as D3, B-complex, and C; I also make liberal use of high-quality organic coconut oil, ACV, and chlorophyll.

Re: sibling comment: indeed, intemperate use of supplements is quite dangerous. What's dangerous for me is that I still don't have a licensed physician's oversight. It's all reading authoritative books and guesswork. Unfortunately, it is extremely rare to find physicians who can perform tests and establish baselines that will aid in judicious use of any supplements! Furthermore, the arts and sciences of healing and nutrition are inextricably bound up with spirituality and religion, and being a Christian, I do not wish to become a disciple of woo from yet another crackpot guru.

When does a substance cross from natural to unnatural? Lithium is naturally occurring, ibuprofen is made from tree bark. These are not unique examples.

Aspirin is the one from tree bark (willow trees), not ibuprofen.

Aspirin is chemically synthesized in labs in high-volume industrial manufacturing. They could not rationally harvest it from willow bark and call it a real drug.

I do indeed drink a tea containing meadowsweet, which is the original salicylate compound which inspired aspirin. The TM blend also includes turmeric and ginger and is chiefly aimed at supporting digestion. I am unsure of its efficacy versus consuming whole ginger and such, but it sure tastes good!

> The physicians prescribing drugs also tag-team each other to see who can induce "side effect synergy". This is a syndrome that has no clinical term, because it's a dirty secret.

My sides are hurting, physicians caring so much about a patient that they bother talking to each other on their own accord is already hard to believe, but not only that, they’re actually conspiring to induce more side effects

This paper did a pretty poor job of controlling for cultural factors IMO. I would think there are significant differences in local base culture between locations. E.g. maybe if you are assigned to Colorado Springs there is more of a local focus on outdoor activities that leads to improved fitness, vs if you were closer to sea level in the Mojave desert where its simply too hot to be so active outdoors outside of forced marching.

Exactly my thought. High elevation could mean proximity to cool hikes, skiing, mountain biking, etc, while low elevation could equal corn fields and drinking beer while fishing on a lake.

... and please don't respond with counterpoint examples. Yes, I'm aware high elevation can be flat/boring and low elevation can be exciting and full of outdoor adventure.

There is a condition called “altitude anorexia”(1) where individuals who move to a high-altitude location sometimes lose a lot of weight all at once - see also (2), (3), and weight loss results(4). This effect also seems to apply to lab rats who are moved to labs at higher altitudes.(5)

(1)https://pubmed.ncbi.nlm.nih.gov/18284032/ (2)https://www.wired.com/2010/02/high-altitude-weight-loss/ (3)https://www.liebertpub.com/doi/abs/10.1089/15270290432296375... (4)https://academic.oup.com/icb/article/46/1/25/661337?login=fa... (5)https://jn.nutrition.org/

I live in Colorado. A large chunk of the state intentionally moved here specifically due to outdoor recreation opportunities and had kids who also do these (skiing, hiking, climbing, biking, etc). We also have ample public land and parks/green space/trails in which to recreate - which states like Texas lack.

The military may not have the same choice on where to move, but when they get here there's opportunities and communities to be active.

This subject about CO being fit came up recently when Robert Lustig was on the Huberman podcast:

https://www.youtube.com/watch?v=n28W4AmvMDE&t=7000s

This was my experience when I moved to CO. On the east coast I had to drive to running trails and cycling routes by my house had no shoulders and a lot of traffic. In CO I had access to 120 miles of trails from my backyard and the roads had either dedicated bike lanes or wide shoulders.

Add in a walkable grocery store and I was a lot more active in CO than I was on the east coast.

That sounds awesome! Where in CO was this?

Or if you prefer, is that the case for anywhere outside Boulder?

This was outside of Boulder, in Westminster, just west of 25 on 136th.

They also seem not to have controlled for terrain. High altitude locations are, generally, more mountainous. That means, even without any increase in perceived exercise, you are doing more vertical as you go about your day.

I grew up in the mountains. When I went to basic training I was all set for serious hiking. But basic training wasn't in the mountains. I was shocked at house easy long marches were when there were no real hills.

They also seem to have overlooked D3 levels. Colorado in particular, has much higher UV levels and people tend to have higher D3 levels.

A surprising number of calories are spent repairing skin damage. Increased uv exposure at altitude probably makes a difference, but probably doesn't help skin cancer rates.

A chart showing BMI vs altitude could help cut through individual bases differences. If there is a trend downward it would show a dose-response effect. I didn't find such a chart in the paper. Instead they have a chart showing how many data points were available by altitude.

From extensively researching the hpa-axis space my educated guess of what is going on:

At higher altitude you have higher levels of vitamin D, that in turn downregulates 21-Hydroxylase which means higher CRH is needed for the same levels of cortisol. The higher CRH means higher levels of Leptin, NPY, and Gastrin meaning less hunger and lower obesity rates.

This is presumably the same reasons why you gain weight all fall for winter/spring babies and lose it in the spring/summer. Just so happens at high altitudes you get more sun, more vitamin D.

Does this mean that supplemental vitamin D could control body weight to some extent?

Yup, here is the first paper from a google search on that topic https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071442/ There are a number of ways to hack the hpa-axis, vitamin D being an cheap and easy one.

Worth noting that there are plenty of reasons why the hpa-axis might shift one way or another, lack of vitamin D is simply one of many. Chronic pain would be another (which low dose naltrexone often works well for).

To my knowledge most rigorously performed studies say no. For example, here's from my first pubmed result:

> Most MAs as well as the individual RCTs reported null-findings on risk of cardiovascular diseases, type 2 diabetes, weight-loss, and malignant diseases.

Rejnmark L, Bislev LS, Cashman KD, et al. Non-skeletal health effects of vitamin D supplementation: A systematic review on findings from meta-analyses summarizing trial data. PLoS One. 2017;12(7):e0180512. Accessed January 5, 2024. https://www.qxmd.com/r/28686645

EDIT(S):

> Although additional studies in unsupplemented individuals are needed to confirm these findings, our results support the view that the association between obesity and lower serum 25-hydroxyvitamin D may be due to reversed causation with increased adiposity leading to suboptimal concentrations of circulating vitamin D.

    Mallard SR, Howe AS, Houghton LA. Vitamin D status and weight loss: a systematic review and meta-analysis of randomized and nonrandomized controlled weight-loss trials. Am J Clin Nutr. 2016;104(4):1151-1159. Accessed January 5, 2024. https://www.qxmd.com/r/27604772

> Vitamin D3 supplementation during weight loss did not increase weight loss or associated factors compared with placebo

    Mason C, Xiao L, Imayama I, et al. Vitamin D3 supplementation during weight loss: a double-blind randomized controlled trial. Am J Clin Nutr. 2014;99(5):1015-25. Accessed January 5, 2024. https://www.qxmd.com/r/24622804

> Body weight in both groups decreased significantly (-7.5% in the vitamin D group and -10% in the placebo group; P < 0.05 for both), with no between-group differences.

    Cefalo CM, Conte C, Sorice GP, et al. Effect of Vitamin D Supplementation on Obesity-Induced Insulin Resistance: A Double-Blind, Randomized, Placebo-Controlled Trial. Obesity (Silver Spring) 2018;26(4):651-657. Accessed January 5, 2024. https://www.qxmd.com/r/29504254

> There was no effect of vitamin D on weight loss.

    Bassatne A, Chakhtoura M, Saad R, Fuleihan GE. Vitamin D supplementation in obesity and during weight loss: A review of randomized controlled trials. Metabolism. 2019;92:193-205. Accessed January 5, 2024. https://www.qxmd.com/r/30615949

I thought it was very well known that higher elevation results in reduced appetite.

I certainly have not been interested in eating whenever I've been above 5000m

I can't say no to aeroplane food.

I assumed, naively, this may have something to do with gas/air. Anyone whose lived at elevation and at sea level has probably noticed how bags of chips are flat at sea level, and bursting at the seems at 5k feet. Could that effect make us feel more full?

No part of you has gas and is sealed like a bag of chips, and any stomach gas would quickly reset to a new altitude. Otherwise scuba diving would probably not work at all. Equalizing your inner ear to pressure changes, and possibly farting, is all it takes to reset your internal gas pressure to altitude changes.

higher altitude means less oxygen, means you need to inhale/exhale more to get the proper amount of oxygen, and also faster heart rate. Is it possible the metabolism of people at higher altitudes burn more calories just trying to get the same amount of oxygen?

Isn't there also higher suicide rates among people living at high altitude? If so, do they have similar causes?

Lithium

This tracks with my anecdotal experience being from Colorado

https://www.axios.com/local/denver/2021/09/20/colorados-obes...

Thermodynamics is a prime suspect. Higher equals colder. The increased cost of temperature regulation would account for some extra fuel burning. The data should be available to separate the effects.

You would expect cold climates not at altitude to show similar effects. I am not sure that is the case.

Wouldn't colder cause the body to want to pack on the pounds as insulation?

I wonder if the availability of different food types differs between high and low altitude locations?

There was a paper about 10-15 years ago where they mentioned that they noticed decreased appetite and increased metabolism at higher altitudes. [1] kind of goes over this. I used to live in a high altitude town (~ 7000 ft) and definitely noticed that my appetite was much lower and whenever I traveled had much more stamina.

[1] - https://journals.physiology.org/doi/full/10.1152/japplphysio...

I wonder if swimming has a similar effect.

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