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Exercise increases number of immune cells in cancer patients (utu.fi)
216 points by _xerces_ on May 2, 2023 | hide | past | favorite | 134 comments


I am currently lying in hospital after a so far 7 night stay. I am post chemo for Hairy Cell Leukaemia treatment that commenced 17 days ago. I am doing well enough but it's a struggle. ( I previously was successfully treated for the same chronic condition 9 years ago). My normal weight is around 80kg (I'm a 59yo male). I think I got down to 79kg prior to treatment this time - we actively sought exercise in the prior weeks through bushwalking, walking my dog and just general DIY stuff at home. I certainly this chemo campaign a lot fitter than the first time.

Post the first 5 days of chemo this time I dropped a kilo - it's hard to maintain appetite. Managing the fever that got me hospital admission meant that I have to take in a lot of fluid via IV. I reached a quite bloated 83.5kg only 2 days ago. I then shed 1.7kg in 1 day (no vomiting involved) - I'm sure this is pretty hard to achieve through normal gym work. My goal yesterday for today's weigh-in is 81kg. Though my nurse just told me she administered 500ml (so 0.5kg overnight). I'm guessing being down to 81.4kg is more realistic now. I couldn't exercise much yesterday as I was also taking onboard a weekly chemo infusion. Hopefully I'll be able to do some laps of the hospital ward balcony with my trolley as I did two days ago. I definitely exercise in hospital (walking) as much as my capacity allows.


A lot of the daily fluctuations in weight, even in just everyday life for people not in hospitals, involves changes in water weight rather than actual changes in the tissue mass.

For example, I regularly fluctuate +/- 3lbs or so around my true weight over the course of a day.

Looking at daily values can give a distorted picture, but if you use those daily weighings to average into weekly numbers, you can track changes.


keep at it! I hope you come out the other end a survivor and a stronger person! You'll certainly have earned it.


Bless you, martyvis. Thank you for sharing your story.


For anyone interested further in this topic and generally the four horsemen(t2 diabetes, heart disease, cancer, and Alzheimer's disease), the book Outlive by Peter Attia is a very good general overview of factors that affect each, how medicine will need to evolve to a more preventative stance to move the needle on these diseases, what biomarkers are being discovered for these diseases.

His general stance is that by the time someone is diagnosed with any of these, it is far too late to have sustainable, effective treatment for many.

Its not exactly a short read, but is very eye opening.


Makes sense.

Metabolic processes and immune pathways are closely interlinked together (such as through the mTOR pathway).

Activate mTOR and you get the signal for T cells to proliferate as well as muscle growth, especially in the context of hypertrophy.


When I was undergoing chemotherapy to treat Hodgkin's lymphoma, I tried to keep up some exercise but it was just too difficult. I ended up needing to take a drug to boost my white blood cell production so that treatment could continue. White blood cells are produced in your bones and this drug made it feel like every bone in your body was broken. It was awful.

Had I known this at the time, I probably would've forced myself to ride my indoor stationary bike every day if it would've helped avoid that immune booster drug.


I take the same injections, but further take Claritin as recommended and I’ve not experienced any bone pain. I’m also younger so that may play a factor, idk.

I workout before & after chemo days (later days I’m mostly just walking to get 10k steps).

Off weeks I’m cycling and lifting.


Probably filgrastim. I have had a daily shot the last 6 days.


Interesting. I'm about to start chemotherapy in a month or so, and I've been told that I'm supposed to get it injected while pedalling on an exercise bike. Could it be for the same reason as mentioned in the article: better distribution of the cancer-fighting thing to where the cancer is?


My cancer centre only delivers chemo while ina comfy recliner. They encourage gentle exercise each day. For me this is walking with my dog and wife, and maybe a little safe DIY. I have low platelets and WCC at the moment so can't afford to do anything to rigourous.


Lance Armstrong still did hard training rides between chemotherapy sessions. While his reputation is tarnished by doping and legal disputes, if you look at his case purely from a medical standpoint it indicates that more rigorous exercise could benefit some cancer patients depending on their overall state. (I am just making a general comment, not about your particular case.)

https://www.theguardian.com/theobserver/1999/jul/18/focus.ne...


To be fair Lance largely benefited from cisplatin chemistry in his chemo mix —- which is highly effective in treating germ cell tumors. This effectiveness is limited to only certain cancers such as TC.



Interesting exception is that there have been a number of anecdotal reports of aerobic exercise during Covid recovery being a major contributor to chances of getting long Covid.


im not surprised

i've always opposed the "you're sick therefore you should rest" advice, your lymph nodes are mechanical pumps, maybe you shouldn't go run 10 miles or do heavy lifting but definitely walk around or ride a bike if you feel up to it


always opposing this advice is draconian and incorrect because resting is the correct advice for many ailments


Correct. rest is as important for recovery as exercise. gentle exercise, ie walking, to your energy capacity is good. Your brain also uses energy. I registered some domain names and obtained a business number during the wee hours yesterday ( not everyone is excited by this, but I can't really control my enthusiastic brain). I definitely need more rest than exercise at this point. I'm using my smartwatch to track my "body battery" which is helpful.


There are very few ailments for which complete bed rest is a good idea. Unless the patient is in an ICU or something it is almost always beneficial to get up and move around as much as possible. This prevents muscle atrophy and helps keep circulatory, lymphatic, and digestive systems working normally.

If you disagree then please provide medical journal citations.


It would be good to know how it affects various subsets of lymphocytes. Does it boost immunosuppressive lymphocytes, i.e. Tregs?

Could the transient boost result from a boost in Tregs which actually chase inflammation that is caused by exercise?


It would be nice if we could find what triggers the body's improved condition when doing exercise, and trigger it maximally without having to do hours of repetitive nonsense.

It's fine if you like to do it, but a lot of us obviously don't. I wonder how the progress is going in this sphere.


I understand where you're coming from. Recently I read someone saying that "it's just like brushing your teeth, it's what your body requires in order to keep functioning properly".

That rang a bell with me. After all, I suppose pretty much everyone on HN brushes their teeth at least twice a day. That's also something that you need to build into your routine, somehow.

The same goes for exercise. If you build up routines that involve exercise, then it should become easier over time as habits are formed.

Something that doesn't help in that regard is cities where car use is almost unavoidable for basic stuff. Ideally, you'd live somewhere where schools and shops are near the places where people live, and the streets are designed so it's safe to walk or cycle. Then you could get some exercise simply by dropping off the children at school or doing some grocery shopping. Street design also isn't some natural phenomenon but something that city councils can make conscious decisions on, so none of it is a given.


But exercise yields more benefit than just cancer prevention. Don't you want to maintain strength and mobility as you age? Sleep better? Build mental and physical resilience?

I'll wager that we won't see a substitution for exercise and its benefits. Ever. It's just part of human life, and embracing it is by far the healthiest mindset.


I'm saying, all of these. Why are they "body moving fast" activated?


Biology is complicated. If we start digging for mechanistic underpinnings, we'll uncover thousands of genes, variants, expression levels, metabolic pathways, epigenetic factors, etc etc etc. None of which will result in a cure-all pill or method to replace exercise and all its benefits. Just not gonna happen unfortunately


who's to say.


I agree, additionally from the POV that sensory attention is de facto focus-stealing wrt other functionalities. General or anecdotal benefits aside, it typically taxes other systems of attention very heavily.

It's also shortsighted to nail ourselves to the cross of "yep, always gonna be exercise, that's just what it takes" when that potentially isn't necessary, and even worse, may prevent huge steps forward in use of human potential.

Add to this the many cases in which exercise is not feasible or safe...

(GPT mentions the work of Dr. Mark Tarnopolsky but I'm not familiar)


What are the "many" cases in which exercise is not feasible or safe? Unless you're an ICU patient on life support or something you can always exercise more. You would have to get pretty far out on the exercise curve, like consistently over 30 hours per week, before safety starts to become a concern.

And as for focus stealing it taxing other systems of attention, that's just bullshit. You don't know what you're talking about. A rigorous exercise program actually enhances your ability to focus.

Dr. Mark Tarnopolsky is a competitive athlete who exercises a lot and also sells his own line of nutritional supplements. I think he would be the first to tell you that it's always going to be exercise, that's just what it takes. Drugs and nutritional supplements can help a little, especially for people with some underlying pathology, but they will never substitute for frequent hard exercise.


Sorry, it doesn't sound like you have much experience with the topic of needing to not exercise. Can't be much simpler put than that.

It's unfortunate that you've conflated this with what seems to be a passionate relationship with pro-exercise philosophies. Which is really out of scope.

The list of reasons why exercise may not be feasible is a really, really long one. Just because you can't think of it doesn't mean _anybody_ owes you an answer, particularly not when you throw around those accusatory beauty words like "bullshit". Seriously, that's the best you can do here? You are out of your depth and just raging about it, is how that looks.

Focus stealing means you must _always_ focus on the exercise to some degree, so something else loses that focus. Extended focus away from a process that requires energy is de facto energy loss. So, some processes will lose energy when exercise is performed. Simple logic.

Safety as a concern is _never_ bound solely to hours spent exercising--this should be obvious on its face.

Nobody's threatening to take your passion away, you can still feel free to rage against the perceived lazy people, etc. But come on. You owe the whole world better here in lowering the discourse to this my-horse-sense-must-apply level.


So you are basically just making up nonsense to justify your own laziness and lack of discipline. If you want to lie to yourself to feel better about your own failings then go ahead, but if you post misinformation on here then expect to get called out.

Passion and philosophy is irrelevant. Lack of exercise is a proven killer, worse than smoking. It also delivers cognitive benefits beyond just the physical stuff. That is medical fact.

https://peterattiamd.com/outlive/


You didn't read a word, really? This has nothing to do with lack of exercise being a problem.

Your crusade to inform me about exercise is wasted; my own before & after pics from extreme weight loss and advanced fitness are easily found online, lmao.

It's pretty clear so far that I could lecture you on aspects of exercise that are well beyond your experience level.

Exercise _can be a problem that people need to cope with_, can you admit that?

If not, then you are too obsessive and not experienced enough for the topic.

BTW I noticed every last detail that you sidestepped, too. So, naturally this makes you a BS artist who is getting called out as well, by your logic.


There are a tiny number of obsessive people who are essentially addicted to exercise and do it excessively to the point of harming themselves. But they are so rare as to be statistically insignificant. For everyone else, more and harder exercise is a solution, not a problem.

https://peterattiamd.com/ama38/

Your other details are irrelevant and I intentionally ignored them as being unworthy of a serious response.


You're not going to find a magic pill that allows you to get away with being lazy. Whether you like to exercise or not is irrelevant. Embrace the suck.


That's the way to make sure you're unhappy. Exercise, and life, should never be about "embracing the suck". Finding ways to exercise that you enjoy and that can fit in your schedule makes it a default state rather than something you avoid.


No, you're just completely wrong. That doesn't make people unhappy. Where did you come up with such a ridiculous notion? Do you lack experience in the real world? Have you never played competitive sports?


Idk I think I'm completely right, exercise is supposed to be fun and trying to willpower your way through something you hate is a surefire way to be unhappy


No, you're just completely wrong. Life in general isn't supposed to be fun. If you believe that then you really missed the point. Sticking to a consistent exercise program doesn't take willpower, it's just a matter of discipline.


There isn't one now, fine. But why shouldn't we be trying to invent one?


You're welcome to try. If you succeed even partially then you'll be a billionaire. But these are complex biological systems and it's a tremendously difficult problem. I guarantee you that within our lifetimes we won't see a safe and effective drug that produces health benefits equivalent to frequent hard exercise. Many of those benefits come from the physical motion which helps to keep blood and lymph circulating normally so I can't see any way to put that in a pill.


I'd suggest, from experience, that maybe doing "hours of repetitive nonsense" is what triggers it maximally.


As a chronic leukaemia patient (twice chemo campaign treated - currently in middle of one) I'd like to see this study done on my group. I have certainly tried to be fitter in advance of current treatment that started 17 days ago.


bioscience phd student. Why is this interesting?

Tl;dr from the article, they used flow cytometry to quantify different cell populations in the blood, and noted that the proportion of CD8+ T cells (cytotoxic, the kind of immune cells that recognize and kill cancer cells, among other things) increases after exercise and returns to baseline 30 min later.

Claiming that this supports the idea that cancer patients could benefit* from exercise is a pretty big overstep of scientific inference.

* = in the immune response to their cancer


Medical doctor. This is exactly what I thought.

There's simply not enough here to say if it's just an interesting artefact of exercise or an actual helpful response. It may be a useful starting point for further studies, but the comment section is frightening in how quickly people are jumping on this to confirm their biases on health and disease.

If we were to extrapolate from this logic, we would wrongly conclude that people with autoimmune diseases should never exercise.


If they return to baseline in 30 minutes, was there even an increase to begin with? What is the mean lifetime of those cytotoxic cells, and would one expect such a decay in so short a time?

I understand that it is a very dynamic system but 30 minutes seems very short to me. So is the return a die-off or where do they go?


The lifespan of T cells varies from months to years (memory T cells). T cell development begins in the bone marrow and continues in the lymphatic tissue and periphery. During their lifespan, these cells circulate in the body and migrate based on chemical gradients.

What happens when you exercise? Blood pressure increases, blood vessels dilate. I honestly would not be surprised if what these authors observed was just existing T cells in capillary beds being kicked up into circulation, only to adhere and begin to intravasate a couple minutes later.


Excellent explanation, thanks.

That seems to translate well to my layman intuition. Would there actually be a health benefit with respect to cancer (or pathogenic disease) from this "T cell migration"? Is there a sense in which migration of T cells spread information to different parts of the body or is this just not how it works?


Diet, exercise, enough sleep, and a good social support structure are pretty much the keys to good health in general.

The fact that we have so many health issues in western society are because its so easy to neglect these things.


Its even simpler.

Exercise (specifically, aerobic type) is the main thing you need. A good exercise regime gives you a lot of leeway in the diet aspect especially if you don't overeat (since your caloric burn will be high enough on the regular to not have to deal with issues like too much carbs). It also helps you sleep as you get tired and can fall asleep easier, and reduces stress levels, which is very important in regards to longevity.

There also have been studies that link brain function deterioration with lack of oxygen, and people with higher VO2max values are at a lower risk of cognitive decline.

Something as simple as cycling to the office instead of taking the car can have extremely positive effects.


I can totally vouch for this in my valueless opinion study of n=1.

I’ve always eaten “a little bad” diet. I don’t think I eat too much, and I keep things mostly balanced, but I tend to eat quite late, and carbs and calories was always something I’d just take down without considering totals for a day or week.

Was totally fine when I was walking to work every day, and doing a lot outside.

Early COVID era, with the same diet, I started ticking up in weight, and wasn’t feeling great. Once adding more exercise to my routine I slowly returned to my baseline. Maybe I could be doing better with a better diet, but I was kind of shocked by how much of an effect ~1hr of walking a day had on me.


You can’t outrun a bad diet. It takes a lot of exercise to burn off excess calories, and virtually no effort to simply not consume them. I understand that health is more than just calories, and you can come to the same conclusion about other bad things like trans fats, alcohol, etc.

If someone had to choose only one thing to do for health, a healthy diet is far more important than exercise.


> It takes a lot of exercise to burn off excess calories, and virtually no effort to simply not consume them.

> and virtually no effort to simply not consume them.

I don't think this is true. The executive function required to manage the dopamine cycle that food generates is incredibly taxing. I honestly think this is a result of our food systems being incredibly optimized to drive purchasing decisions...

Separately, this reminds me that I should eat some veggies.


I agree, but we need to stop with the one thing. A decent diet is important, and so is cardio. And, so is strength. A person will lose a % of muscle/strength each year after age 50 or so. The higher base you start with the more strength a person will have as they get older, which helps prevent falls and other old age issues.


Exercise moderates negative feelings and hormones and often causes people to maintain a better sleep and diet routine. Everything in life becomes easier with a light/moderate regular exercise routine. It's inseparable from diet.


While you can't easily burn off excess calories, a good amount of muscle mass can significantly increase your metabolic rate as well, so there are effects from repeated exercise beyond just calorie consumption.


Citation needed because “significantly”. Studies I have seen in this (not my field) indicate that the effect is measurable, but basically negligible.

The ancestor comment saying to do cardio is right. Strength training is also important for health, but for different reasons (motor function, bone density, etc.). The act of strength training also burns some calories, regardless of resultant muscle mass.


Yes, I do have a citation : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931407/#!po=8....

Every extra kg of muscle is estimated to contribute 21kcal/day to the RMR. If you put on, say, 15kg of muscle over a few years (quite doable if you are very sedentary and have low muscle mass), that's an extra 300kcal/day. Add in 30 mins of biking a day, and say 100 cal from strength training on average, that's a good 600-700 calories per day!


This is only true to a point. When I was cycling 20 miles 5x per week, I literally couldn't eat enough to avoid losing weight. (This was not a problem, I've never been thin.)


This is very common among endurance athletes. It's extremely difficult to consistently recover from a >1,000-2,000 calorie deficit every time you do a weekly long run or ride. Glycogen reabsorption is optimally effective for only a relatively brief time period post-exercise and there are upper limits on your rate of glycogen resynthesis.


Yes, when I switch into training mode, the fat melts off in short order (I've never accumulated more than 20 pounds of unwanted mass, and when I did it was following a broken leg and 2 years spent largely sedentary)

In the past I've toned my training down due to exhaustion, not from the physical output but from having to constantly be shoving calories down my throat.


Bad diet, as in Mcdonalds every day and lots of sugar, is going to be bad for you even with exercise, but thats because you probably aren't getting the nutrients that you need.

The big issue with diets is that people eat too much carbs, and if you aren't burning those carbs for energy, this is where problems happen. Healthy regiment of exercise will help greatly with this, giving you the option to eat tasty foods with carbs and maintain a good weight without any problems.


> You can’t outrun a bad diet.

It gets even worse, when the obese try to outrun a bad diet they not only fail but they often injure themselves in the process.

It always pains me to see obese people out on the trails beating themselves up in an obviously misguided but respectable effort to lose weight.


You can't outrun a bad diet, but a bad diet can give you the runs.


Switching to carnivore diet gives you 2lb/1kg weight loss a week without any exercise and any feeling of hunger or weakness (assuming you are overweight).


Don’t forget all the evidence suggesting adult neurogenesis specifically from running.

As for VO2max, Levitt had a longevity researcher on his podcast who found that a high VO2max (used as a proxy measure) is causally related with higher impacts on 5 year all cause mortality than smoking. In the good direction. As in: being in shape reduces your risk of death more than smoking increases it.

Sauce: https://freakonomics.com/podcast/adding-ten-healthy-years-to...


It's not just a longterm effect of VO2max improvements, which is a physiological metric that is quite slow to improve and realistically has upper limits based on your age and sex. It's also that aerobic exercise acutely improves brain function. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9256523/#:~:tex...


Figured that would be Peter Attia.

https://peterattiamd.com/podcast/

His podcast is amazing but can be dense and technical at times. He's evidence based and would probably fit in with the HN crowd.


I enjoy listening to Attia talk about his longevity research. He's why I finally started doing IF, and someone I looked to when I moved from power lifting (can't do it forever lol) to a more longevity based exercise program.

Then I randomly got really into jiu-jitsu because why not.


Peter Attia got me into having a weekly MRI and wearing a dexcom 24/7. Costly, but great stuff.


Weekly, seriously? What's the background with that?


I'm not disagreeing that aerobic exercise is important and beneficial, but to add: there is also data correlating other exercise behaviours (stretching, strength training) with positive health and longevity outcomes. Also, quite significant benefits can be achieved via HIIT, which is anything but aerobic.


Cycling has its own risks as it can reduce bone density if you cycle instead of walking or other forms of exercise.


How much Cycling do you have to do for that to become a credible risk though? I am imaging quite a bit more than a daily commute.


Cycling doesn't directly cause loss of bone mineral density. Ride as much as you like.

The issue is that some people use cycling as their only form of exercise. For bone health you need to mix in other high impact exercises such as running and weightlifting.


Make every other ride a mountain bike ride and you will have no issues with bone density.


I was walking 10+ miles every day when I was diagnosed with Stage 4 Lung Cancer, which means it was growing pretty much the entire time I was exercising. It’s not just Diet, exercise and sleep (and proper eating). Some of it is just plain luck.


34 year old triathlete here: colon cancer spread from my colon to my lung. That said, I do think continuing to do some amount of exercise during chemo definitely helped me recover, if not just stay sane mentally.

I'm about to have surgery to remove part of the lung and tumor and my surgeon/oncology team is making me wear a fitbit for three months to study my recovery.


What did you do for exercise? Do you mind me asking what your chemo was? Was it mutation-specific?

Good luck with the surgery!


I was on Folfirinnox + Avastin. 2 week cycle with three actual days of chemo, five shitty days and then a recovery week. Exercise was really dictated by my port surgically put into my right peck. After about four weeks I could deadlift, squat, all the compound lifts + run,bike,swim if I had the energy.

The surgery was supposed to be VATs, but the tumor was so large it turned into a general thoracotomy. It's fucking brutal. Easily the hardest thing i've had to do in life so far. But I'll get through it because there's no other choice. Forward. :)


Sorry that sucks and is doubly frustrating when you are doing everything right. Sort of the inverse of Richard Overton who would chain smoke cigars and drink Irish coffee well into his 100s.


I'm sorry to hear that. Theoretically, it could have progressed faster if you hadn't exercised?


And you don't need a gym membership or expensive equipment or any training for exercise. Even a tiny amount can make a huge difference.

If you're currently doing no exercise, try to walk five minutes at lunch time each day. Just five minutes. And when that's trivial to do, make it 10 minutes. Try to keep increasing this over the year. No rush. Take your time. But try to make it a habit. Even if some days it's back down to just 5 minutes.

If you're walking even just 15 minutes a day when you weren't before, you will be so much better off in ways that will be apparent. You might find that you feel happier, more alert, in a better mood overall. You might sleep a bit better. etc.

I'm not saying that a 15 min walk is a panacea that will cure all ills, but it's a multivitamin that works.


Also, carry a backpack: https://www.goruck.com/pages/what-is-rucking

I generally carry a small EDC backpack anyway for convenience and hydration, but having that 10 - 15 lbs on my back also adds a little bit of extra workout to my walks. Sometimes I'll put my backpack inside a bigger backpack with a few gallons of water or a couple 25lb plates added, which starts to feel like moderate intensity squatting or deadlifting (especially when it involves hills or stairs).


A backpack, and countless other upgrades, are great ideas. But I want to communicate that none of this stuff is necessary.

We love to make the simplest thing overly ridiculously complicated to the point that people don't even try.

Just start with a walk.


Or, if you're working in a multi story office or apartment, take the stairs instead of the elevator. It seems silly but it actually makes a big difference to go from mostly sedentary to walking up stairs.


A lot of people don't realize that muscle use helps pump blood. Movement is important for helping circulation.


Yeah but a 15min walk will get you nowhere.


For someone who used to drive everywhere, it may be a "gateway drug" to more walking.


It will get you more than 15 minutes on the couch watching TV. How disingenuous can you be.


"Social support structure" is often at odds with diet, exercise, and enough sleep.


It is absolutely critical to good mental health and having healthy coping mechanisms for stress.

Social support structure doesn’t necessarily mean staying out all night drinking and partying with your friends like a college student. It can also mean spending quality time with your family, neighbors, and acquaintances that you share hobbies and activities with.


Life is a series of endless choices.

I recently ran a 24hr relay. There were absolutely those who drank/partied while they participated. They posted slower times and probably slept less. I didn't sleep as much as usual (because I was waking up to run every 6hrs), but I slept more, didn't party, ran faster than them.

Neither of us was right/wrong in our choices. I would have felt like crap if I had their habits, but maybe it doesn't affect them.


Not sure about that. A few social activities are negative (nightlife, eating out maybe), but most seem to be neutral to me (hanging out, gaming, religion), and it's pretty easy to find positive activities (walking/hiking, sports, climbing).


It's because western culture jumped the shark long ago. Half of every longevity tips is basically "no modern life". Eat fresh, few, move a lot, sleep a lot, talk a lot.


Few what?


Eat few, in general. Don't force your body to store fat you won't need.

Even proteins, I just learned that unused proteins will be converted to fat.

Also, if you agree that gut microbiome is important, try to eat foods that will be benefitial to them, like https://en.wikipedia.org/wiki/Microbiota-accessible_carbohyd... (another thing I discovered recently).

Then there's fasting and autophagy but it's a bit harder (I'm just starting IF and it requires a bit of dedication tbh)


These are luxuries, not mandatories. That's why many people don't get them. They can't. I absolutely can't.


I have to disagree. That Western Society has systemically chosen to redefine them as luxuries and has forced its residents to treat them as luxuries, rather than the obligation for a healthy human experience that they are is a major source of the harm we experience every day.

We need to return to considering and treating them as the mandatories that they are or else we will continue to experience the cost of neglecting them, just like neglecting Vitamin C results in scurvy.


They are not luxuries. Modern society has just made it easy to neglect these things for various reasons. The lies we tell ourselves about it not mandatory until you burn out or need medical intervention.

Modern medicine will provide various interventions to help out such as trying to balance your brain chemistry, lowering obesity, blood pressure, etc. Many of the things prescribed to us today are due to lifestyle choices.

There's a growing corpus of evidence that diet has incredible potential for treating serious brain disorders (when done with a psychiatrist, especially if you're already medicated)[0].

At the end of the day, you are the only person who sets the priorities in your life. If you don't make maintenance of your body and mind a priority, the bill will come later.

[0]: https://www.goodreads.com/book/show/61129785-brain-energy


If you put diet, exercise, sleep, and social support on a sliding scale, can you honestly say that you're doing everything in your power to maximize each one?

I don't know your personal details, but most people who think this way are not actually trying their hardest in each category. Sure, some small percentage is going to face monumental challenges. But look at the data in the US for example. 70% of our deaths are caused by NCDs. Most of that 70% has enough control of these factors to reap their benefits


> Most of that 70% has enough control of these factors to reap their benefits

And yet they don't, so it suggests to me that "it's not that simple". It's better to imagine that people _are_ doing what they can and it's still not enough, so rather than victim blaming, we can discover what's actually going on in these people's lives that's stopping their ability to reach it.

Are they so downtrodden that it's not worth the effort anymore? Are they actually working 2-3 jobs and 100 hours of unexpected time a week so they literally don't have time? Do they live so far away from work because they can't afford to live close such that all their time is spent commuting and they have no extra time anymore?


I think for a lot of people it is that simple. Doing what’s right for your health is more difficult and requires sacrifice.

Dopamine is easy to get from doom scrolling on your phone, watching Netflix, or playing video games. You don’t even have to leave your chair. Exercise is hard. It requires you to exert yourself and it requires training over time to see tangible results.

Same thing with food. Going through a McDonald’s drive through is easy and the salt, fat, and sugar taste good to most of us. Cracking open a cook book, putting together a shopping list, and going to the grocery store is hard. It requires planning, it requires thought. Then you have to come home and cook the food, which requires even more effort. If you cook something healthy, it won’t be loaded up with all the salt, fat, and sugar that people have become accustomed to.

Getting enough sleep requires discipline and sacrificing time. Time you could be spending doing activities that release dopamine, such as playing video games, or watching videos.

Developing a healthy social support network is difficult too. It’s easy to post things or like things on Facebook or Hacker News. It’s much more difficult to get out there and be part of clubs or doing group activities and meeting and engaging with people in the real world. You have to leave your house. You have to put yourself out there and be a little bit vulnerable. It’s particularly hard if you’re an introvert. Nurturing strong family relationships takes a lot of effort too. You have to be the mean parent that kicks your kids off video games to play board games or go on a nature hike together. It’s a lot easier to let a screen babysit them all day.

I’m only talking about middle and upper class social dynamics of course. I’ve been fortunate enough to never experience poverty or food insecurity. I’m sure it’s not nearly that simple for people in that situation.


Our economic system has engrained in us that if you aren't doing your competitive advantage money earner, it's better to outsource that to someone who does.

That's extended to all facets of life and has bought us a lot of luxury time, which of course has led to a rise in dopamine factory applications, goods, and services to fill that time.

Many people honestly believe "why would i spend time grocery shopping if i can just pay someone else to cook for me?"

There's something to be said for the effort of doing things.


Let's be intellectually honest here.

It's not victim blaming to point out that "can't" isn't reasonable language. Life is hard. Doesn't mean we "can't" have some control over these variables. As I said, there are edge cases that deserve sympathy but they don't represent the bulk of scenarios.


> there are edge cases that deserve sympathy but they don't represent the bulk of scenarios.

You say this, but you also say, "Most of that 70% has enough control of these factors to reap their benefits"

70% and "most of 70%" are still either a majority or at the very least a plurality; so, I have to strongly disagree that they don't represent the bulk of the scenarios.

Is your argument that most people are lazy and should suck it up and get over it and fix themselves?


Within that 70%, most of them can:

- Afford to eat healthier foods. Rice, potatoes, bell peppers, onions, lentils, ground beef, pork chops, eggs, are not expensive. Time is a bigger factor but I don't buy the time argument in most cases either. Just need to prioritize.

- Improve their sleep. Most people have terrible sleep habits and there is a load of free information available for anyone who wants to make a positive change.

- Exercise. Walking 30 minutes each day yields most of the available benefit. Strength training is also available for most of the population. A secondhand kettlebell is like 20 dollars. Calisthenics are free. Some gym memberships go as low as 10/month.

>Is your argument that most people are lazy and should suck it up and get over it and fix themselves?

If you want to phrase it that way in order to paint me as the bad guy, then sure. But I would prefer to start with not giving up personal responsibility. Not throwing our hands up and blaming externalities, big food, and big pharma. If someone has that attitude, what hope do they have? Do you not believe in empowering people? If we validate every single persons' victim card, they will eventually believe they have no control over their lives. And that's just not true.


I don't think lazy is the best framing. I do think most people have bad habits around sleep, diet, and exercise. It's difficult to change these habits even if you have a good mentor, which most people don't. It's also very human to ignore advice and take the path of least resistance.

I have been in that place myself for most of my life and for able-bodied people it is possible to get 150 minites of low-intensity excercise a week, more sun, leafy greens, a can of sardines each day, and such low-effort interventions which have a high impact on health and well-being.

My advice to those people would be to start slow and not beat yourself up about having a milkshake and such. It takes time to build habits and good habits tend to cascade and encourage you, especially when you are happier with what you see in the mirror.


> Is your argument that most people are lazy

Yes most adults are extremely lazy and undisciplined.


>Yes most adults are extremely lazy and undisciplined.

If you do not believe this statement, ask the opinion of any medical provider you know.


I think it's important to note that they're luxuries in the modern society we've built for ourselves in the West. Long, long ago, small communities without access to high-speed travel provided social support; no cars and little white-collar work means exercise was baked into life with much walking and manual labor; diet was mostly unprocessed food farmed nearby; and no screens or even electricity meant sleep well before midnight till dawn.

Of course, there were plenty of problems back then, too - I'm not saying it was an idyllic utopia. But in our modern life, it seems like we've just traded one set of problems for another.


For the most profoundly addicted, the acutely dying, and those who are mentally ill to the point of being unable to participate in society these are luxuries.

For everyone else, they are mandatory.

Exercise is the easiest. Exercise isn't running and weightlifting, exercise is pushing your body to the limits so that its limits slowly increase over time. For 600lbs people exercise may be standing up and sitting down. For the elderly, like my 92 year old grandmother with COPD, exercise is curling and doing overhead presses with a heavy book while seated. People with cystic fibrosis exercise, and are usually exercise machines because if they stop they die. Patients in iron lungs exercise. The only people who can't exercise are those in hospice care. If you can stand, standing until you cannot stand anymore is exercise. If you can walk, 5 seconds more walking than you did yesterday is exercise. Wheelchair-bound patients with Osteogenesis Imperfecta can (and are highly encouraged to) exercise. Exercise costs $0.00.

If you are so ill that you cannot pick up a 1 lbs dumbbell, putting a rubber band around your fingers and opening and closing your hand is exercise and will have benefits. If you are not acutely dying, you can exercise.

All forms of exercise at all levels for all people has a benefit-- however small, it is a benefit.

Eating right is harder, but is accessible to any able-bodied, homed, person. Able-bodied doesn't mean healthy. Able-bodied means "able to turn on a hotplate and lift a bag of beans."

Social support is the hardest, but is doable for all but the most mentally ill. There are roughly 35,000 social support groups full of people looking for a social support network dotted across the country. Many of them meet online so anyone who can read HN can participate as a first step. I do not believe they are adequate. I do believe that online support groups are an outstanding and effective first step.

Lacking a social support network is often fatal to human beings, and those who lack support need to work extremely hard to obtain one, but it isn't impossible.

There are human being for who exercise, diet, and friends are luxuries.

Someone active on hacker news is PROBABLY not one of them.


No, no, everything is a personal failing. Pull yourself up by those bootstraps. What externalities?


I understand this is probably an uncomfortable topic, but I’d love to hear more from you on this.


Good food I can see as a luxury. How is exercise a luxury though? It seems like going for a walk or a run is available to almost everyone.

If anything it seems like those on the lower income level would be forced to be outside doing physical activity more than the wealthy.


> would be forced to be outside doing physical activity more

I have no citation, but I believe most low-income jobs in the US involve:

  * standing for long, long hours and not moving (cashiers)
  * sitting for long, long hours and not moving (call centers)


Is someone holding a gun to your head and preventing you from eating fruits and vegetables?


Couldn't agree more. Seems like a lot of people on here think that low-income earners eat off of the McD's dollar menu by choice.


I absolutely don't think that.

I think that company owners, share holders, "The Economy" have decided that low earners don't deserve healthy lives; and that many of those low earners have been tricked into agreeing that it's best to live "under foot" and that those things are luxuries.

It would be like cheering a factory on for all the missing arms its employees have, and then having all the factory employees mock the newcommers with two arms trying to protest losing an arm only to have the tenured ones laugh at them and think that's privilege.

We've brainwashed generations of self and systemic harm


Beans, rice, eggs and oats are cheaper, healthier and quicker than Mcdonalds. (Rice is not quicker). If McDonals were the only choice they wouldn't be spending millions on advertising.


They're also more emotionally taxing to create, and come with several externalities that aren't baked in to the price of the dollar menu:

  * dish washing (do they even have dishes?)
  * power usage of stove
  * time to clean up
  * a singular, large lump of time to go out and buy all those food
  * the necessary mental spoons to plan those numerous meals each week
  * a refridgerator that works (mine is currently broken, for example)
  * a willingness to accept the cost of losing a lot of food when the fridge inevitably breaks
And so on


  * a refridgerator that works (mine is currently broken, for example)
Other than eggs, and this is in the US not all countries, you don't need a refrigerator for the listed items. Beans, rice, and oats do not require refrigeration. Many fruits and vegetables also don't need refrigeration [0].

  * a willingness to accept the cost of losing a lot of food when the fridge inevitably breaks
This is mitigated by learning what does and does not need to be refrigerated and storing things properly.

[0] https://extension.purdue.edu/foodlink/includes/pubs/Storing%...


They are only that way because our society treats them as luxuries instead of baseline "these are needed to properly take care of yourself."

Apparently only the rich deserve things like this, according to US society.

You know, rich folks like Steve Jobs who definitely listen to their doctors and their support networks and definitely don't fall for quacky bullshit that means they die from a totally manageable type of cancer.


You forgot to add good genetics.


> You forgot to add good genetics.

Too many people lean on "bad genetics" as a scapegoat for their laziness/poor choices/lack of self-discipline...


"good genetics" (if we can even say that) might help give an edge for elite athletes, but really, for most able bodied people, it's not a factor you should be thinking about when it comes to exercise. Just get out there and use your body, it's amazing.


Those help but are completely out of your control.


Hopefully not for long.


Yeah, I can’t wait to live in a real life version of Rapture from the BioShock series. ;-)

I’m looking forward to Incinerate and Telekinesis myself.


Improving the odds is a great idea. But it's naive to think these are cures.

https://en.wikipedia.org/wiki/Terry_Fox was in better shape than most people despite having lost a leg to cancer. He died age 22.


Little weird to reply with a specific incident. I didn’t see anywhere this was broadcasted as a cure.


The top comment is currently saying that diet, exercise, and a good social network are basically a cure-all to all issues in western society. I'm being a bit reductive but so is the comment.


There is a wide gulf between "pretty much the keys to good health in general" and "a cure-all to all issues in western society"


Surprise twist: it's lymphoma


And breast cancer


How is that related? I think he meant lymphoma because that increases your WBC?




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