(2025-01-21) ZviM Sleep Diet Exercise And GLP-1 Drugs

Zvi Mowshowitz on Sleep, Diet and Exercise, and GLP-1 Drugs. As always, some people need practical advice, and we can’t agree on how any of this works and we are all different and our motivations are different, so figuring out the best things to do is difficult. Here are various hopefully useful notes.

Table of Contents

• Effectiveness of GLP-1 Drugs.
• What Passes for Skepticism on GLP-1s.
• The Joy of Willpower.
• Talking Supply.
• Talking Price.
• GLP-1 Inhibitors Help Solve All Your Problems.
• Dieting the Hard Way.
• Nutrients.
• Are Vegetables a Scam?.
• Government Food Labels Are Often Obvious Nonsense.
• Sleep.
• Find a Way to Enjoy Exercise.
• A Note on Alcohol.
• Focus Only On What Matters.*

Effectiveness of GLP-1 Drugs

In the college educated group the decline (in obesity) is about 20% already. This is huge.

What Passes for Skepticism on GLP-1s

Eliezer Yudkowsky offers caveats on GLP-1 drugs, saying by default you lose more lean muscle mass than under other weight loss

He also reports it did not work for him, causing the usual replies full of 101-level suggestions he’s already tried

I presume it would not work for me, either

My issue is a stupidly slow metabolism. Enjoying and craving food less wouldn’t help.

The Joy of Willpower

How much should we care about whether we are using willpower?

There are three reasons we could care about this.

• Use of willpower cultivates willpower or is otherwise ‘good for you.’
• Use of willpower signals willpower.
• The positional (status) advantage of willpower is shrinking and we might not like that.

There are two conflicting models you see on this.

• The more you use willpower, the more you build up your willpower.
• The more you use willpower, the more you run out of willpower.

I agree that there are some, especially in younger generations who don’t have the past experience of trying to diet via willpower, and who might decide they don’t need willpower, who might end up a lot worse off

But in general we should have a very high bar before we act as if introducing obstacles to people’s lives is net positive for them, or in this case that dieting is net worthwhile ‘willpower homework.’ Especially given that quite a lot of people seem to respond to willpower being necessary to not fail at this, by failing.

My claim is that most of being a healthy weight is an absolute good, not a positional good. The health benefits are yours. The physically feeling better and actually looking better and being able to do more things and have more energy benefits are absolute.

Talking Supply

We can’t get enough supply of those GLP-1s, even at current prices. The FDA briefly said we no longer had a shortage and people would have to stop making unauthorized versions via compounding, but intense public pressure they reversed their position two weeks later.

Talking Price

Tyler Cowen defends the prices Americans pay for GLP-1 drugs, saying they support future R&D and that you can get versions for as low as $400/month or do even better via compounding

this does not address several key issues.

The first key issue is that America is paying disproportionately, while others don’t pay their fair share.

At some point it is a sucker’s game, and we should pay partly on condition that others also pay. Are we at that point with prescription drugs, or GLP-1 inhibitors in particular?

the incentives this creates are good on the research side, but bad on the consumption side. Monopoly pricing creates large deadweight losses.

Since 40% of Americans are obese and these drugs also help with other conditions, it might make sense to put 40% of Americans on GLP-1 drugs, instead of the roughly 10% currently on them.

The solution remains obvious. We should buy out the patents to such drugs.

There are lots of obvious gains here, for on the order of $100 billion. Cut the check.

GLP-1 Inhibitors Help Solve All Your Problems

GLP-1 drugs linked to drop in opioid overdoses. Study found hazard ratios from 0.32 to 0.58, so a decline in risk of between roughly half and two-thirds

GLP-1 drugs also reduce Alzheimer’s 40%-70% in patients with Type 2 Diabetes? This is a long term effect, so we don’t know if this would carry over to others yet

This Nature post looks into theories of why GPL-1 drugs seem to help with essentially everything.

Dieting the Hard Way

If you don’t want to do GLP-1s and you can’t date a sufficiently attractive person, here’s a claim that Keto Has Clearly Failed for Obesity, suggesting that people try keto, low-fat and protein restriction in sequence in case one works for you. Alas, the math here is off, because the experimenter is assuming non-overlapping (independent) ‘works for me’ groups (if anything I suspect positive correlation!)... (intervention roulette)

Aella asks the hard questions. Such as:
Aella: I’ve mostly given up on trying to force myself to eat vegetables and idk my life still seems to be going fine. Are veggies a psyop? I’ve never liked them.

Psyop. You do need fiber one way or another. And there are a few other ways they seem helpful, and you do need a way to fill up without consuming too many calories. But no, they do not seem in any way necessary, you can absolutely go mostly without them. You’ll effectively pick up small amounts of them anyway without trying.

The key missing element in public health discussions of food, and also discussions of everything else, of course joy and actual human preferences and values.

Stian Westlake: I read a lot of strategies and reports on obesity and health, and it’s striking how few of them mention words like conviviality or deliciousness, or the idea that food is a source of joy, comfort and love.

Food is absolutely one of life’s top sources of joy, comfort and love. People downplay it, and some don’t appreciate it, but it’s definitely top 10, and I’d say it’s top 5. And maybe not overall but on some days, especially when you’re otherwise down or you put in the effort, it can absolutely 100% be top 1.

One potential fun way to get motivated is to date someone more attractive. Women who are dating more attractive partners had more motivation for losing weight, in the latest ‘you’ll never believe what science found’ study.

Nutrients

Carmen claims that to get most of the nutrients from produce what matters is time from harvest to consumption, while other factors like price and being organic matter little. And it turns out Walmart (!) does better than grocery stores on getting the goods to you in time, while farmers markets can be great but have large variance

This also suggests that you need to consume what you buy quickly, and that buying things not locally in season should be minimized. If you’re eating produce for its nutrients, then the dramatic declines in average value here should make you question that strategy, and they he say that on this front frozen produce does as well or better on net versus fresh. There are of course other reasons.

Are Vegetables a Scam?

My guess is Mu. It would be misleading to say either they were or were not a scam.

I have been mostly ‘vegetable-and-fruit-free’ for over 30 years, because: If I try to eat most vegetables or fruits of any substantial size, my brain decides that what I am consuming is Not Food, and this causes me to increasingly gag with the size and texture of the object involved....

The claims of big benefits or trouble seem based on correlations that could easily not be causal.

they fill up stomach space for very few calories and thus reduce overall caloric consumption, there’s going to be very positive correlations here.

Proposed actions in response to the problem tend to be completely insane asks. People will be like ‘we have these correlational studies so you should change your entire diet to things your body doesn’t tell you are good and that bring you zero joy.’

not eating vegetables and fruits means you risk having deficits in various places. The same is true of basically any exclusionary diet chosen for whatever reason, and especially true for e.g. vegans.

In practice, the only thing that seems to be an actual issue is fiber.

Government Food Labels Are Often Obvious Nonsense

Government assessments of what is healthy are rather insane on the regular, so this is not exactly news, but when Wagyu ground beef gets a D and Fruit Loops get a B, and McDonald’s fries get an A, you have a problem. (nutritionism)

Yes, this is technically a ‘category based system’ but that only raises further questions. Does anyone think that will in practice help the average consumer?

Sleep

Bryan Johnson suggests that eating too close to bed is bad for your sleep, and hence for your health and work performance.

As with all nutritional and diet advice, this seems like a clear case of different things working differently for different people

And I am confident Bryan is stat-maxing sleep and everything else in ways that might be actively unhealthy.

Measure your resting heart rate before bed. After years of working to master high quality sleep, my RHR before bed is the single strongest predictor of whether I’ll get high quality or low quality sleep. Eating earlier will lower your RHR at bedtime.

What about the other swords in the picture

Screen time has never bothered me, including directly before sleep. Indeed, watching television is my preferred wind-down activity for going to sleep.

I never drink alcohol so I don’t have any data

I never drink large amounts of caffeine either

Healthier food, and less junk food, are subjective descriptions

I don’t see a large enough effect to worry about this until the point where I’m getting other signals that I’ve eaten too much sugar or other junk food.

Going to bed early is great… when it works. But if you’re not ready, it won’t work. Mostly I find it’s more important to not stay up too late.

But also none of these effects are so big that you should be absolutist about it all.

Find a Way to Enjoy Exercise

Physical activity is declining, so people spend less energy, and this is a substantial portion of why people are getting fatter. Good news is this suggests a local fix.

between the late 1980s and 2018 using the IAEA DLW database. We show there has been a significant decline in adjusted TEE over this interval of about 7.7% in males and 5.6% in females.

What’s the best way to exercise and get in shape? Matthew Yglesias points out that those who are most fit tend to be exercise enjoyers, the way he enjoys writing takes, whereas he and many others hate exercising

Ultimately what did work were the times I managed to finally figure out how to de facto be an exercise enjoyer and want to do it. A lot of that was finding something where the benefits were tangible enough to be motivating, but also other things, like being able to do it at home while watching television.

As someone who is half a year into muscle building for health, yes it quite obviously makes you more attractive and helps you feel confident and sexy and that all helps you a lot on the dating market, and also in general.

The in general part is most important.

Whenever someone finally does start lifting heavy things in some form, or even things like walking more, there is essentially universal self-reporting that the returns are insanely great. Almost everyone reports feeling better, and usually also looking better, thinking better and performing better in various ways.

It’s not a More Dakka situation, because the optimal amount for most people does not seem crazy high. It does seem like not a hard decision.

A Note on Alcohol

A plurality of Americans (45%) now correctly believe alcohol in moderation is bad for your health, versus 43% that think it makes no difference and 8% that think it is good

Focus Only On What Matters

I call that Finkel’s Law. It applies here as much as anywhere.

My basic model is: Exercise and finding ways to actually do it matters. Finding a way to eat a reasonable amount without driving yourself crazy or taking the joy out of life, whether or not that involves Ozempic or another similar drug, matters, and avoiding acute deficits matters. Getting reasonable sleep matters. A lot of the details after that? They mostly don’t matter.

But you should experiment, be empirical, and observe what works for you in particular. (intervention roulette)