Weight loss, cholesterol, and diabetes

Sleep apnea is also the thing that weight loss is good at addressing out of that list, at least to the best of my understanding.

I don't think there is a lot of good quality research linking weight loss in and of itself to improving cholesterol, that one really comes down to the content of your diet far more than quantity of food or weight.

Not to mention that how cholesterol relates to your health is far more complex than "big number bad," but the way we talk about cholesterol and health often gets boiled down to measuring your blood serum concentration and reporting the result as a number that is either above or below a healthy target, mostly because framing it in that way is useful to pharmaceutical companies that sell medications that make the number go down.

Statins are what are usually prescribed, and they are good at making the number go down, but that's about it. There is lots of clinical data supporting findings that show statins are effective at reducing cholesterol levels, but they have a lot of nasty side effects and have questionable efficacy at improving the long term health outcomes of patients that get prescribed them.

The reality is that cholesterol is far more complex than big number bad smaller number good. Cholesterol is important for a wide variety of bodily functions, with some of the most important being keeping your nails, skin, and hair healthy (maybe also your eyes? don't quote me on that one though). And where cholesterol can be detrimental to your health is not necessarily a function of how high your cholesterol levels are, but whether or not that cholesterol is building up on your arteries as plaque.

Plaque formation isn't really tied to how much cholesterol you have in your blood, it happens as a result of damage caused by inflammation of the vessel walls. When this damage occurs, cholesterol will build up in a similar process to how a cut will scab over.

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What causes this inflammation can vary, but common risk factors include stress and extended periods of elevated blood sugar levels, usually related hormone system regulation dysfunction caused by conditions such as diabetes. To my understanding, the actual concentration of cholesterol in the blood isn't a risk factor in and of itself, and if your arteries start to experience damage caused by inflammation then plaque build up will start occurring regardless of how high or low your cholesterol is. In fact, rapid weight loss will tend to spike your cholesterol levels very high because the process through which your body metabolizes fat dumps a lot of cholesterol into your blood as a result. So if you went to go get a blood test done in the next week or so I'd be willing to be that your cholesterol levels are actually much higher than they were before you got the procedure done. But to my knowledge this spike in cholesterol levels has never been linked to any long term adverse health effects.

I believe the reason why there's a link between measured blood cholesterol levels and heart health is primarily because the same kind of diets that result in insulin resistance and eventually hormone dysregulation conditions such as diabetes also tend to result in higher cholesterol levels. This correlation has been jumped on and used as the basis for decades of fat-free and cholesterol-free food marketing but the link between measured blood cholesterol and heart health/overall health as an independent and isolated marker of health is not well supported by more recent medical research.

And that brings everything down to the last risk factor, which is diabetes. Like I alluded to above, diabetes is a hormone dysregulation condition. Insulin is the hormone that acts as the "on signal" more or less to start dumping excess blood sugar that hasn't been metabolized after a meal and start the processes where that energy will be stored as fat. When this metabolic process is functioning properly, your body will release insulin in response to blood sugar concentrations being elevated over a period of time, that insulin then initiates the process to start pulling that glucose out of the blood, and then as those concentrations return to normal insulin will start to dissipate and get filtered out of the blood.

One thing that happens during this process is that since the biological mechanism used to store blood glucose as fat is the same mechanism to release that "stored fuel" to be used as energy, it is possible to experience periods of lethargy some time after a meal because there can be a period where most of the freely available food energy in the form of glucose has been taken out of the blood, but the insulin levels in the blood have not yet returned to a low enough level to start allowing the processes that release stored fat to be used as energy to start up again. Our fat cells are designed to either accept fuel to be stored for later or to release fuel to be used for energy, they can't do both at the same time.

This drop in energy can be resolved either by waiting for insulin levels to fall again, or by eating something else so that new blood glucose enters into circulation. However, the second option doesn't allow your insulin levels to return back to a normal level and instead keeps it elevated. Keeping those levels elevated over extended periods of time and having your body make continuous "calls" to the regulation systems in your body that produce insulin puts stress on those systems over time. Whether or not that stress results in developing a dysregulation condition like diabetes is partly down to genetics, but the content of your diet also plays a factor. Foods that have a high glycemic index, and therefore trigger a much larger insulin spike, are much more likely to result in this cycle of lethargy that makes you feel like you need to immediately have something to eat again in order to get your energy back. That cycle of insulin spike, followed by energy crash/lethargy, followed by eating something again to regain that post crash energy is also likely to effect the hormonal regulation systems that regulate the release of the hormones that signal hunger and satiety, such as ghrelin and leptin. Dysregulation of the hormones that signal hunger and satiety also make it that much more difficult to regulate your appetite, making it much more likely that this is a cycle that continues regardless of how much will power you put in to try and change those habits because your will power will be in constant opposition biological processes that we are hardwired to listen to. You can't overcome millions of years of evolutional programming through will power alone, that is a battle of endurance that you're almost guaranteed to lose.

With all of that "statement of the problem" out of the way, what then are the best things to do to lower your risk of developing those issues in the future? One, you can change your diet to avoid high glycemic index foods that will spike your insulin. That would basically be any very sugary or very starchy foods. Y'know, "the fun stuff." These are also gonna be the foods that raise your blood cholesterol the most. The idea that the cholesterol in your food and the cholesterol in your blood have any relation to each other is complete nonsense. Turns out, the stuff in your food gets broken down during digestion, and then your body produces its own stuff from the products of that digestion. Any cholesterol that is in your food gets broken down during digestion, and the foods that cause your body to produce more cholesterol and that can result in higher blood cholesterol levels are foods that are very sugary or very starchy, so those are the foods you want to avoid anyway if you're worried about your cholesterol levels. Complex carbs are much less likely to result metabolic and hormonal dysregulation issues, because they are digested more slowly and release energy in circulation much more gradually. This also means that your body's insulin response should be much more gradual as well, without the sudden insulin spike and later feeling of lethargy once all the glucose has more or less left circulation but insulin levels are still too elevated to let all that stored energy be released again. A slow rise and gradual fall of insulin is likely to result in much more steady energy levels throughout the day.

The other option if you don't want to completely remove fun from your life is to try doing something like intermittent fasting, where you allow yourself more freedom in the foods you allow yourself to eat and enjoy but restrict when you eat to a certain window of time during the day.  Doing this helps mitigate some of the risk of developing a metabolic disorder simply by allowing your metabolic regulatory systems time to rest and return to a normal baseline each day instead of placing them under constant stress and demand throughout the day until something breaks (either by insulin production no longer functioning properly or by cells developing insulin resistance and no longer responding to insulin that is developed). Intermittent fasting can also be useful because you can still allow yourself to have very carby meals in the evening, and use the lethargy that can result from that to your benefit as a sleep aid to make sure you are tired once your bed time comes around to help regulate your sleep better.

The primary downside of trying to stick with intermittent fasting is that if you have issues with appetite regulation it can turn into a battle of will power that you are again likely to fail if the signals your body is sending are fighting against you. And here I actually think using an appetite suppressant in the same way you talked about your ADHD meds working as an appetite suppressant is a good approach addressing that problem so that you can be more successful in sticking with a dietary change like that for long enough for your body's regulatory systems to adapt so that they aren't fighting against you the whole time. I think the obvious alarm bells that go off when talking about using an appetite suppressant to skip meals is the association with disordered eating and anorexia, but I would argue that there's a pretty significant difference between struggling with body dysmorphia and engaging in self-harm/self-punishment via disordered eating is an entirely different ball park from taking steps to have better control over how you regulate your appetite. What determines whether that is healthy or unhealthy is whether you are providing yourself with the nutrition your body needs to function each day, or whether you are denying yourself that nutrition as a form of self-harm/self-punishment.

Besides, referring to not eating during specific times of the day as "skipping meals" is incredibly misleading, because the times of day that we eat our meals is primarily a result of culture. The standard of 3 meals a day was not introduced because of any nutritional guideline, the meal times we observe in the US are a result of cultural norms that primarily originate from Christianity, and were spread around the world via colonization. All of which could be its own separate essay post, but the point of it is to say "It's all made up bullshit, do what you want with your nutrition and your body."

Probably the best thing that getting a gastric sleeve done will do for you is simply giving your body time to take a little bit of a "forced break" from your regular daily habits so that your body has time to "reset" all of those metabolic processes and regulation systems that are constantly cycling throughout the day, and hopeful getting them to a point where you try to create a different relationship with food as you put it, without that attempt being constantly sabotaged by those regulatory systems and turning into a prolonged battle of will power. And that is a lot of pressure to take off when trying to figure out what relationship is gonna be the most sustainable for you in the long term.

I don't know if you actually want this long-ass info dump, but I know worrying about your health can be stressful, and I'm a wordy fucker who already had all this information ready to go.