"Dealing with racism in our daily lives is a major factor in our health and well-being. The experience of racism makes Black people sick, whether it's mental and emotional health or even physical health." - Jamila Taylor, reproductive rights advocate
Many of the Black women interviewed spoke of how the cumulative stress of racism, on top of the trauma of pregnancy loss, felt like a double burden. Some hesitated to become pregnant at all, afraid they wouldn't survive the experience in a medical system stacked against them. Their losses were also more likely to be dismissed or met with stereotypes about their ability to handle hardship. As one woman put it: "The checklist doesn't exist...you can't be safe if you are a Black birthing person."
Section: 2, Chapter: 8
In the 1840s, Dr. Marion Sims, the "father of gynecology," performed experimental fistula surgeries on enslaved women without anesthesia. One 17-year-old girl, Anarcha, endured 30 surgeries over 4 years. Sims subscribed to the racist belief that Black people didn't feel pain like white people. He later experimented on poor Irish immigrants. The field of gynecology was built on the bodies of society's most vulnerable women, a legacy that continues to impact care disparities today.
Section: 1, Chapter: 2
Even if you manage to lose weight, you likely did it in the same environment (family, job, commute, city) that made you obese. This environment will constantly tug you back:
- Junk food is still ubiquitous, cheap, heavily marketed - you swim in it
- You likely still face the stress, emotions, lifestyle that led you to overeat
- Your family/social habits around food may not have changed
- You now face intense biological backlash from your own body
Some determined individuals can white-knuckle their way through this, but it's not a realistic solution for populations. To reduce obesity, we can't just say "have more willpower" - we have to actually change the environment we all live in.
Section: 1, Chapter: 6
For many, compulsive overeating serves a crucial emotional purpose. It soothes anxiety, numbs trauma, fills voids of loneliness and boredom. It's a way to "feed" unmet needs. So when a drug like Ozempic suddenly removes the overeating outlet, it can trigger a kind of psychological earthquake. Difficult emotions come flooding back. Stressful situations feel overwhelming without food to soften the edges.
For some, it may even trigger a switch to other compulsions like alcoholism. Before starting weight loss drugs, it's crucial to understand "what job overeating was doing for you" and to line up alternative coping tools. Ozempic may block destructive eating behaviors, but it doesn't automatically resolve their emotional drivers.
Section: 1, Chapter: 8
Fat acceptance advocates like Shelley Bovey grapple with a core tension. On one side is the urgent need to dismantle anti-fat stigma and oppression. On the other is the reality that obesity can take a serious toll on health and quality of life. Some key perspectives:
- Denying obesity's harms can mean denying lived experiences of immobility, pain
- Glorifying thinness as a panacea ignores its own mental/physical risks
- Framing desire for weight loss as "brainwashing" invalidates legitimate health concerns
- There's a difference between self-love and denying agency in changing health behaviors
A new paradigm may be needed - one that treats weight loss as healthcare, not a referendum on worth. Untangling health from social judgment is crucial.
Section: 1, Chapter: 11
"The body's tendency to hold on to what we have [is] a brilliant survival strategy...Evolution could never have anticipated that we would have an abundance of energy [dense food] all the time. The system was designed for one environment that took millions of years to create, and now it's trying to cope with a radically different environment... Of course, that's really bad news for individuals with obesity, because they're fighting their biology, and their biology is, in effect, 24/7."
- Michael Lowe, hunger and obesity researcher, on how weight loss triggers biological backlash that relentlessly drives weight regain
Section: 1, Chapter: 6
Ozempic and similar drugs were initially thought to work solely in the gut to increase satiety. But new research suggests they also act powerfully on the brain, potentially boosting self-control across the board. Key findings include:
- GLP-1 receptors are found extensively in the brain's appetite and reward centers
- Stimulating these receptors in rats reduced cravings for junk food but not healthy chow
- The drugs also reduced cravings for cocaine, alcohol, nicotine in rats - by up to 50%
- In human anecdotes, the drugs reduce addictive urges around alcohol, drugs, gambling
This raises fascinating questions - could obesity drugs help treat addiction and impulsive behavior more broadly? Are we on the cusp of a self-control revolution?
Section: 1, Chapter: 7
Inflammation is a key way obesity wreaks havoc on health. As fat cells expand, the body perceives the stretching as "damage" and floods fat tissue with inflammatory chemicals. This chronic inflammation impairs immune function and the body's ability to heal itself. It also directly promotes the development of diabetes, heart disease, and cancer. Reducing obesity-induced inflammation is one key way weight loss could boost health.
Section: 1, Chapter: 4
The author's friend Lara confronts him about his real motives for taking Ozempic. She argues that despite his focus on health benefits, vanity and the desire to conform to societal ideals are also driving him. "If this drug gave you all the same benefits to your health, but it also gave you boils on your face, would you take it?" she challenges. The author has to admit he likely wouldn't. This tension between health and looks dogs many Ozempic users. There's an inherent risk and hypocrisy, Lara argues, in harming your health to look healthier. Those considering the drugs must interrogate their own motives ruthlessly and make peace with that tension.
Section: 1, Chapter: 9
Starting in the late 1970s, something unprecedented happened - obesity rates skyrocketed across the world, more than doubling in the US between 1979-2000. This had never happened before in human history and could not be explained by genetics. The food environment had transformed, flooding us with addictive processed foods.
Scientist Paul Kenny ran an experiment where rats were exposed to the modern American diet - cheesecake, bacon, sugary foods. The rats quickly became addicted, ballooned in weight, and kept overeating even when it meant enduring painful electric shocks. When the junk food was taken away, they starved rather than going back to healthy chow. This mirrors how the human food environment has overridden our natural appetite regulation.
Section: 1, Chapter: 2
The author outlines 12 potential risks associated with Ozempic and similar drugs:
- "Ozempic face" and "Ozempic butt" - rapid weight loss can leave facial skin and buttocks saggy
- Thyroid cancer - some evidence GLP-1 drugs may boost risk by 50-75%
- Pancreatitis - GLP-1 drugs linked to 9x higher risk of sometimes fatal pancreas inflammation
- Stomach paralysis - 3.7x higher risk of digestive tract "freezing"
- Loss of muscle mass, increasing frailty/fall risk in elderly
- Malnutrition from appetite suppression
- Risk of shortages for diabetes patients as weight loss use soars
- Off-brand, possibly contaminated versions proliferating as demand outstrips supply
- Depression/anhedonia if drugs "numb" pleasure from food and life
- Unknown long-term risks that may only emerge years later
- Suicidal thoughts - flagged as a potential risk by European regulators
- Potential developmental harms if used by pregnant women
Section: 1, Chapter: 5
Individuals considering Ozempic have to weigh two sets of serious risks - the well-established dangers of obesity (diabetes, heart disease, cancer, etc) vs the more uncertain risks of powerful new drugs. While these drugs seem to reduce obesity risks, they may carry risks of their own. There are no easy answers, but an honest consideration of this tradeoff is essential.
The author's friend Judy makes the case for taking Ozempic despite its risks and limitations. She compares it to her taking chemotherapy for cancer - an imperfect treatment made necessary by dire circumstances. While in an ideal world we'd solve obesity by fixing the food environment, Judy argues we have to act to save lives now with the tools available, even if they are artificial and risky. The house is already on fire - we can't wait for better building codes before putting it out.
Section: 1, Chapter: 3
In 1984, Daniel Drucker, a young Canadian scientist, accidentally discovered GLP-1 while studying the inner workings of glucagon genes in a run-down lab in Massachusetts. He found that GLP-1 could stimulate the creation of insulin, a crucial discovery that would later lead to the development of new diabetes and weight loss drugs.
Scientists discovered that the venom of the Gila monster lizard contained a copy of GLP-1 that lasted much longer in the human body than natural GLP-1. This led to the development of drugs that could elevate GLP-1 levels for a whole week, bringing blood sugar under control for diabetics. Researchers then found these drugs also caused significant weight loss in obese people.
Section: 1, Chapter: 1
Bariatric surgery, which reduces weight comparably to the new weight loss drugs, shows the power of substantial weight loss to improve health. In studies of severely obese people, in the 5 years after bariatric surgery:
- Diabetes disappeared in 75% of patients
- Hypertension resolved in 60%
- Risk of dying from diabetes fell 92%
- Risk of cancer death fell 60%
- Risk of heart disease death fell 56%
- Overall mortality risk fell 40%
This suggests if Ozempic can reverse obesity, it may dramatically cut the risk of obesity-related disease and death as well.
Section: 1, Chapter: 4
Obesity dramatically increases the risk for a staggering range of serious diseases, including:
- Diabetes: Obese men are 6x more likely and obese women 12x more likely to develop diabetes, which can lead to blindness, amputations, kidney failure and early death.
- Physical pain: Extra weight strains joints, leading to chronic pain. Obese people are 3x more likely to need knee/hip replacements.
- Heart disease: Obesity contributes to high blood pressure, atherosclerosis, and heart failure. Each 5-point BMI increase boosts heart failure risk 41%.
- Cancer: Obesity is linked to 9 types of cancer and is the 2nd biggest cause of cancer in the US/UK.
- Dementia: Obesity and its related conditions increase dementia risk.
Section: 1, Chapter: 4
Visiting Japan, the author is stunned to discover a wealthy modern nation that has seemingly avoided the obesity crisis plaguing the West. Some eye-popping facts:
- Japan's obesity rate is just 3.6%, vs 25% UK and 42% US
- Japanese obesity is falling by nearly 1% a year even as national wealth grows
- The average Japanese person weighs 23 lbs less today than the average American
- This astonishing leanness translates to the highest healthy life expectancy on earth
So what's Japan's secret? The author finds a food culture laser-focused on quality, not quantity - small portions, simple preparations, celebrating natural flavors. But it's not a culture of deprivation - the Japanese simply don't seem to battle a ravenous "Western" hunger.
Section: 1, Chapter: 12
Ultra-processed foods undermine our natural satiety (feeling of fullness) in at least 7 ways:
- We chew them less so fullness signals are delayed
- The potent combo of sugar, fat and carbs activates primal drives to overeat
- They lack protein and fiber which help trigger satiety
- They flood us with hunger-triggering sugar spikes and crashes
- Artificial sweeteners paradoxically make us hungrier
- Flavoring additives overrides natural "nutritional wisdom"
- They damage diversity of gut bacteria that help regulate appetite
Section: 1, Chapter: 2
Ozempic starkly reveals that hunger isn't just about the body's physical need for sustenance. The author identifies at least 5 other "hungers" that drive overeating:
- Pleasure hunger: Seeking the sensory/emotional delights of food
- Soothing hunger: Eating to numb or escape painful emotions
- Childhood hunger: Replicating dysfunctional childhood eating patterns
- Protective hunger: Using fat/overeating to insulate from sexual attention, expectations, stressors
- Habit hunger: Eating on autopilot due to ingrained routines
When Ozempic removes physical hunger, these hidden emotional/behavioral hungers stand out in stark relief. Only by identifying and addressing them can the obesity epidemic be truly solved.
Section: 1, Chapter: 8
The author wonders if by trumpeting his Ozempic-driven weight loss so proudly, he's undermining the message of body positivity he wants to impart to his niece's generation. He worries he's promoting the idea that thinness is worth any cost, that "it's better to be thin than to eat." If he loses weight and then gains it back, will he be an even more demoralizing role model? The author realizes there's a direct tension between the message "love yourself at any size" and "medicate yourself to shrink." He has to find a way to resolve this cognitive dissonance, both for himself and the young people watching him.
Section: 1, Chapter: 9
After a lifetime of disembodied eating, the author realizes that to heal his relationship with food, he must first actually learn to cook. He starts with comically basic lessons from a patient friend - things like how to chop vegetables or sear meat. It's a revelation to actually participate in making his own meals from scratch. He realizes that his previous "food coma" eating was a way to numb and disembody himself. Cooking, by contrast, is an act of presence, of consciously tending to the body's real needs. It's awkward at first, even embarrassing, but it's an essential first step in growing up and into his body.
Section: 1, Chapter: 9
Iceland's Youth in Iceland program got teens to exercise far more via free access to sports/dance/music. It dramatically cut teen smoking, drinking, drugs...yet obesity continued rising. Why?
- You can't outrun a bad diet - the calorie burn of exercise is small vs modern food
- One sugary drink can undo an hour of running
- People often unconsciously "compensate" by eating more when they exercise
However, this doesn't mean exercise is pointless - it still massively reduces disease risk. But diet is the main driver of obesity. You can be fat and fit, but you can't outrun a bad food environment.
Section: 1, Chapter: 6
Every Japanese workplace has a shocking anti-obesity ritual - mandatory annual weigh-ins and waistline checks for every employee. It's a group accountability practice unthinkable in the individualistic West. At first glance it seems dystopian, even unethical - a violation of body privacy and autonomy.
But the results are undeniable - Japan boasts stunning population-level leanness and health even as other rich nations balloon in weight. There may be a lesson here in hacking "social contagion" for good - making healthy choices the "easy" default through shared commitment, support, and positive peer pressure. What if we stopped framing body size as a purely personal, private affair and started treating it as a collective, public health responsibility?
Section: 1, Chapter: 12
An analysis of 2000 diet studies found that despite the intuitive appeal of "eat less, move more," diets simply don't work long-term for most people. The findings are stark:
- 2 years after starting a diet, people weigh on average only 2 lbs less than when they started
- 5 years out, the average loss is still only 6.6 lbs
- At most 20% of people maintain a 10% weight loss for a year
- Up to 66% of people actually gain fat mass despite exercising
This dismal track record is not due to individual failings, but to biological and environmental factors that doom most diets.
Section: 1, Chapter: 6
The mTOR enzyme is emerging as a central regulator of aging, and a key target of anti-aging interventions:
- mTOR acts as a control center, sensing nutrient levels and shifting the cell between growth and maintenance.
- When nutrients are plentiful, mTOR promotes growth and reproduction. When nutrients are scarce, it dials down growth and ramps up cell cleanup and recycling.
- Inhibiting mTOR (either through CR or rapamycin) seems to put the cell in a more youthful, resilient state - improving autophagy, stress resistance, mitochondrial function and more. These are the same hallmarks of longer-lived animals.
- Rapamycin powerfully inhibits mTOR. That suggests it could be used as an anti-aging drug. Animal studies show rapamycin extends lifespan and healthspan.
- Early human studies hint that rapamycin may actually enhance immune function, protect the heart and prevent age-related diseases, though more research is needed.
mTOR is one example of how understanding the mechanisms of aging could lead to targeted interventions to slow the entire aging process. That's a paradigm shift from just treating individual age-related diseases reactively.
Section: 1, Chapter: 5
The author outlines three distinct eras in the history and evolution of medicine:
- Medicine 1.0 (Hippocrates to 19th century) - Conclusions based on observation and guesswork. Some insights were correct (e.g. benefits of exercise) while others were misguided (e.g. theory of bodily "humors"). Limited by lack of scientific method.
- Medicine 2.0 (Mid-19th century onward) - Based on germ theory, leading to sanitation, antibiotics, vaccines. A long, difficult transition that met significant resistance from the medical establishment. Highly successful at treating infectious disease and acute conditions. Less successful with chronic diseases of aging.
- Medicine 3.0 (the future) - Aims to prevent chronic disease and extend healthspan, not just lifespan. Uses a more personalized, proactive, risk-focused approach to keep people healthy rather than just reacting once disease has already progressed. Focuses on root causes and early interventions.
Section: 1, Chapter: 2
To make progress against chronic diseases, the author argues we need a proactive instead of reactive approach in medicine:
- Intervene as early as possible to prevent people from developing diseases in the first place
- Change the mindset from patching people up to preventing the onset of disease
Section: 1, Chapter: 2
Longevity is not just about maximizing lifespan. It's also critical to extend healthspan - the period of life lived in good health. The author breaks healthspan down into three domains:
Cognitive function - Preventing decline in memory, processing speed, executive function
Physical function - Maintaining strength, stamina, balance, avoiding frailty and disability
Emotional health - Ensuring mental well-being and avoiding emotional suffering
A long life is not very meaningful if cognitive and physical function are poor. Declining health in later years robs people of joy and autonomy. The author calls this period the "marginal decade." In contrast, by extending healthspan, we can achieve a "bonus decade" - extra years lived with vitality and good quality of life.
Section: 1, Chapter: 3
To understand the potential of human longevity, the author examines centenarians - the rare individuals who live 100+ years. Key insights:
- Centenarians tend to be in remarkably good health for their age. They experience a "compression of morbidity" - staying healthy longer, with a shorter period of decline at the very end of life.
- They delay the onset of major chronic diseases by decades compared to the general population. For example, the age at which 20% have been diagnosed with cancer is 100 for centenarians vs 72 for everyone else.
- More than just living longer, they seem to be aging more slowly their entire lives. An 80-year old centenarian has the health profile of an average 60-year old.
- Super-centenarians (110+) are often in even better health than "regular" centenarians
This suggests it's possible to extend healthspan, not just lifespan. We want to emulate centenarians' "rectangularized" survival curve - living well for longer, not just hanging on for more years of sickness. Studying how centenarians achieve this is instructive for the rest of us.
Section: 1, Chapter: 4
Atherosclerosis, the buildup of plaques in the arteries, is a lifelong process:
- It begins when LDL particles penetrate the endothelial lining of the artery and get stuck in the subendothelial space.
- Retained LDL undergoes oxidation, triggering an inflammatory response. Macrophages engulf the oxidized LDL, becoming foam cells.
- Smooth muscle cells migrate and proliferate, laying down collagen and other fibers to form a fibrous cap over the lipid-rich plaque.
- The plaque grows slowly over decades. Some become calcified, others remain 'soft'.
- Rupture of the fibrous cap can trigger a clot, leading to heart attack or stroke.
This process can begin in adolescence and progress silently for decades before causing symptoms. Early intervention is key as advanced plaques are harder to stabilize.
Section: 2, Chapter: 7
"The fundamental problem, I believe, is classic Medicine 2.0: guidelines for managing cardiovascular risk are based on an overly short time horizon, compared to the time line of the disease. We need to begin treating it, and preventing it, much earlier."
Section: 2, Chapter: 7
Use a continuous glucose monitor (CGM) to personalize your diet in real-time. A CGM gives feedback on how your blood glucose responds to specific meals and lifestyle factors, allowing you to modify your diet to optimize metabolic health. Aim to keep glucose stable and avoid large spikes, with a target average glucose less than 100 mg/dL and a standard deviation less than 15 mg/dL.
Section: 3, Chapter: 15
Sleep is essential for cognitive function and long-term brain health. During deep sleep, the brain clears out accumulated metabolic waste and misfolded proteins like amyloid-beta. Chronic poor sleep is strongly linked to increased Alzheimer's risk. To optimize sleep:
- Aim for 7-9 hours per night. Give yourself a generous sleep opportunity.
- Maintain a consistent sleep schedule, even on weekends.
- Avoid blue light exposure (screens) for 2 hours before bed. Install blue-blocking filters on devices.
- Keep the bedroom cool (65°F/18°C) and completely dark. Consider blackout curtains or an eye mask.
- Avoid alcohol, large meals, and intense exercise close to bedtime.
- Consider a hot bath or sauna before bed to facilitate the body's natural cooling response and melatonin release.
- If you can't sleep, get up and do a relaxing activity until you feel sleepy. Don't just lie in bed anxious.
For high-risk individuals like APOE4 carriers, optimizing sleep may be one of the most important modifiable risk factors for preventing Alzheimer's. Protect your brain with the power of sleep.
Section: 1, Chapter: 9
Stability starts with breathing - proper 360 degree expansion of the rib cage and activation of the diaphragm to pressurize the abdomen. Then we progress to:
- Rooting the feet - maintaining 3 points of contact, short foot position
- Bracing - gently engaging the anterior core
- Aligning the spine - ribs down, neutral pelvis
- Packing the shoulders - setting them down and back
- Hip hinging - maintain a neutral spine with hips back Master these basics before adding speed or load.
Section: 3, Chapter: 13
Key tips for optimizing sleep:
- Restrict the bedroom to only sleep and sex
- Keep the room cool (60-68°F/15-20°C) and completely dark
- Get bright light exposure in the morning; dim lights at night
- Limit caffeine intake, especially after noon
- Avoid alcohol, large meals, and intense exercise close to bedtime
- Establish consistent sleep and wake times; aim for 8-9 hours in bed
- Turn off screens at least 1 hour before bed; use blue light blocking glasses if needed
Section: 3, Chapter: 16
The debate over the optimal diet is rife with contradictions, competing dogmas, and ideological battles not rooted in science. Adherents of low-fat, vegan, carnivore, paleo, and keto diets all passionately proclaim theirs as the One True Way, despite a lack of conclusive evidence. The key problem: believing there is one perfect diet for all people.
Section: 3, Chapter: 14
The amyloid hypothesis has dominated Alzheimer's research for decades. It posits that accumulation of amyloid-beta in the brain is the primary cause of the disease.
However, numerous drugs targeting amyloid have failed in clinical trials, leading many to question this theory.
Alternative theories are gaining ground, implicating other potential drivers:
- Vascular dysfunction: Reduced blood flow to the brain may starve neurons of oxygen and nutrients. Vascular risk factors like hypertension and diabetes are strongly linked to AD risk.
- Metabolic dysfunction: Impaired glucose metabolism in the brain, often linked to insulin resistance, may lead to neuronal dysfunction and death.
- Inflammation: Chronic inflammation in the brain, driven by factors like obesity and poor diet, may accelerate neurodegeneration.
- Tau tangles: Accumulation of abnormal tau protein in neurons correlates more closely with cognitive decline than amyloid. Tau may be the real culprit.
Section: 0, Chapter: 9
Sleep deprivation takes a toll on cardiovascular health, increasing risk of:
- Hypertension (high blood pressure)
- Coronary heart disease, Heart attack, Stroke
- Heart failure
Sleeping less than 6 hours per night leads to a 200% increased risk of having a fatal heart attack or stroke in your lifetime. The mechanisms include:
- Increased heart rate and blood pressure
- Reduced heart rate variability (sign of unhealthy heart)
- Increased inflammation
- Impaired blood vessel function
- Increased calcification and blockage of coronary arteries
Section: 2, Chapter: 8
eep deprivation alters appetite hormones, leading to increased hunger and food cravings, especially for high-calorie foods. This is caused by:
- Increased ghrelin, a hormone that triggers hunger
- Decreased leptin, a hormone that provides satiety signals
- Increased endocannabinoids, which stimulate appetite Sleep deprived individuals consume 300+ more calories per day on average. Sleeping 5 hours per night for just one week can lead to 2 pounds of weight gain. Over a year, this could theoretically lead to 70+ pounds of weight gain if diet and exercise are unchanged. Sleep loss also reduces impulse control and ability to resist tempting foods. Getting sufficient sleep is a critical yet underappreciated factor for maintaining a healthy weight.
Section: 2, Chapter: 8
Food doesn't just satisfy physical hunger - it also provides entertainment, pleasure, and emotional comfort. Ultraprocessed foods are expertly engineered to fulfill all those needs too well.
Compared to whole foods, highly processed products are hyperpalatable, calorie dense, quickly digested, and portable and long-lasting. To defend yourself:
- Aim for single-ingredient foods 80% of the time. Don't keep tempting ultraprocessed snacks in the house.
- Stick to a structured meal schedule. Don't graze all day - give yourself a chance to feel true hunger.
- Pile your plate with fiber-rich foods first - salad, fruit, whole grains. They keep you full on fewer calories.
- Beware of "health halos." Organic/vegan/keto junk food is still junk food!
Section: 1, Chapter: 8
"We found that people ate the ultra-processed meals a lot quicker...This could be because the Tsimane foods led the participants' brains to pump out more of a hormone called PYY, which reduced their appetite. They also decreased a hormone called ghrelin, which made them hungry. The Tsimane foods even took more work to physically chew. The ultra-processed diet, meanwhile, did the opposite. It cut those natural brakes that help us find enough." - Kevin Hall, Researcher
Section: 1, Chapter: 5
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