> Makes sense, it is a diet related illness, so it should have a diet related treatment. Instead of treating the symptoms, treat the cause.
Type 2 diabetes isn't caused by diet. Certain diets can increase the risk of Type 2 diabetes, but it's not a foregone conclusion, and it's not uncommon to develop Type 2 diabetes despite an otherwise healthy diet.
T2D is caused by a combination of genetic and environmental factors such as diet, and you're correct that someone can get T2D based mostly on genetic factors alone. It is however very uncommon, and diet plays a role in the majority of cases. There are several studies that show this.
It is not very uncommon, and in fact the most recent (last ~decade of) research has actually caused us to question the extent to which people genetically predisposed to diabetes can mitigate their risk through diet and lifestyle choices.
My Dad and his brother both have T2D. My Dad is 75 and my uncle is going on 60. They are both very active, in shape, and not overweight at all. e.g., My Dad was playing tennis 4 times a week when he was diagnosed. He's probably cut down some since, um, he's 75, and has had two hip replacements, but he's in way better shape than I am.
Neither were significantly overweight when they were diagnosed. In fact, my Dad has been trim for decades, and while I don't see my uncle often, he was always thin and very fit-looking when I have seen him.
There _has_ got to be a genetic component independent of lifestyle and diet choices. Me? I have no excuse. I'm overweight and not active and I know I need to change that.
Losing a lot of weight with very low calorie diets is hard, but not regaining it over the next couple of years is next to impossible.
Your body will try all the tricks in the book, it will reduce your metabolism to way below that of the person of the same weight, it will amp up your hunger hormones so much that you will think and dream about food 24/7.
Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.
Type II diabetes is a diet-related illness. If you cure the illness with diet, then switch back to what you were eating before - of course, diabetes will come back. These dietary changes need to be seen as new habits, not temporary changes.
>Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.
Are there any studies in this area I can read that discuss the figures you've mentioned?
>>Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.
> Are there any studies in this area I can read that discuss the figures you've mentioned?
One example may be found in Dr. Jason Fung's book, "The Complete Guide to Fasting." Chapter 5 describes a case regarding the American TV show, "Biggest Loser", where overweight contestants lost loads of weight during the show with a low calorie diets and exercise. All except one contestant gain the weight back.
And that's why weight loss techniques need to be treated like a new lifestyle, instead of a goal you hit and then finish. I lost 60 lbs a couple of years ago and found that 20 of those had recently crept back on, so I went on another shorter diet to get myself back on track. It's totally doable. You have to be aware and keep correcting.
> And that's why weight loss techniques need to be treated like a new lifestyle, instead of a goal you hit and then finish. I lost 60 lbs a couple of years ago ...
Firstly, fantastic achievement. I'm curious as to what motivated you enough to put in the effort (I'm assuming it required effort).
Secondly, I wonder if the speed/drastic nature of the weight-loss can be counter-productive. When you think about people don't become over-weight overnight. Perhaps a more gradual pace with some time for settling at various stages of the process...I'm thinking losing weight over a couple of years as opposed to over a couple of months.
It was my health. My snoring was bothering my wife, and I was exhibiting sleep apnea so I knew I either had to lose weight or go to a doctor, and I hate visiting the doctor.
And the time is certainly a factor - people have to set up weight loss scenarios that are sustainable over the long term. My weight loss goal was 1-2 lbs a week, so that was aggressive, but I am large enough that I can lose weight on enough calories to not feel deprived. By counting calories and making sure I had enough to enjoy myself it was a relatively easy process, once I got used to the counting and accountability.
For some people, I think they shouldn't be given the false hope that "enough to lose weight" and "enough to enjoy myself" go together. Part of losing weight is a fundamental rewiring of what is "enjoying myself".
Oh yeah. As a sweet freak, for me "enjoying myself" is a cup of frozen yogurt at the end of a day full of chicken breasts, not a plate of nachos or a whole pizza.
Not a doctor, and this is just anecdotal, but I lost 60 pounds in 3 months, a couple years ago (6'4" -- went from 260lbs to 200). So that was about 0.6lbs a day. (I think that's actually on the low range of metabolism -- some people can do more like 1-2lbs a day fasting).
Honestly, there were no side effects other than my back problems went away, I stopped snoring, and I felt better. Even with fasting, I just think your body has enough time to catch up when it's just a pound a day or whatnot. (Btw, you know what the world record for fasting is? 382 days. I'm not recommending that, I like food, but, as long as you get enough nutrients not to get something like scurvy and you consult with a doctor the human body is a lot more adaptable than people realize)
Garry's blog post about this was particularly insightful.[0] He shares a graph of his progress and how it goes both forwards and backwards, as well as the things he's learned along the way.
> When you’re weighing yourself every day you need to understand that you’re creating a weekly/monthly average. What you ate yesterday isn’t going to show up on the scales the next day. If you ran around the park yesterday, don’t expect to have lost weight today.
I only weighed myself once a week for this reason. Every day can be demoralizing if you have a bloat day, but once a week gives enough to have a pretty regular drop. Whatever behaviour you do can't be considered on a day by day basis, it needs to be considered as a week of good behaviour, and then weeks and then months. You gotta stay consistent every day over the long term to expect results.
I think daily weighing is important because it is hundreds of daily decisions to not eat that need to be made. Our current society makes food available at all times, and daily weighing is one part in actually thinking about our body and being mindful for at least twenty or thirty seconds each day. With the ridiculous calorie density of modern processed foods, a few minutes of mindless eating can add an enormous calorie load, without even beginning to feel full.
We hackers can geek out on the math in the Hacker's Diet[0], which goes into various smoothing algorithms and plotting styles to show the daily weight and smoothed trends.
That's fair, if that needs to happen. I found my caloric considerations where my tracking - I built a spreadsheet where I input values so I could track my daily allotment as I ate. I always tracked it before I ate it.
I worry that daily tracking could be discouraging or introduce maldaptive behaviour - you went up a lbs since yesterday, but that's because your morning poop wasn't as productive as it usually is, and now you feel like you need to go more extreme to make up for it the rest of the day.
Nostrums like "treat it like a new lifestyle" are easy to say, but do they actually address the current public health crisis? Proposing actions that, for whatever reason, people don't actually take isn't a useful way to spend time.
What's good is what works. And honestly, drugs work today. The likes of the FDA considers them too risky, but I think they're deciding wrong.
Seriously though, the problem is that, regardless of cause, we're fat and lazy. Throwing more drugs to take care of diabetes and heart disease is robbing Peter to pay Paul.
I'm watching my boomer parents realize that medicine isn't going to help everything, and they are going to have to be accountable for their help. They've gotten much more physically active and lost weight because they are seeing that my grandfather's heart medication may be stopping the heart attacks but it isn't stopping his diabetes or inability to climb the stairs, and the gamut of surgeries are just making him more and more crippled. A pill won't solve our problems. It may solve the current health crises, but it won't stop the next one. Losing weight, eating better, and being active will solve the whole set of problems.
One problem afflicting us now is that people eat too much, consequently weigh too much, damage their health, and balloon healthcare expenses society-wide. If a pill can make people eat less, why reject it? If a medication solves a problem, it solves a problem. You can't say "X doesn't work" when X does, in fact, work, and then expect people to take you seriously.
You're adopting a moralizing stance here, one that says that gain without pain is illegitimate. This approach has broad appeal, but it just doesn't work. For decades people have been making the same argument you're making, and it hasn't worked. It's time we try something else.
> You can't say "X doesn't work" when X does, in fact, work, and then expect people to take you seriously.
> You're adopting a moralizing stance here, one that says that gain without pain is illegitimate.
No, I'm saying that a pill won't solve the root problem. You make people skinny with a pill, you just end up with unhealthy, malnourished skinny people who insulin is all out of wack and who will still get heart attacks.
> For decades people have been making the same argument you're making, and it hasn't worked. It's time we try something else.
Are you suggesting that "throw a pill at it" hasn't been a solution for decades? We've had this belief that medical science can cure us of all our ills, and I think we are no realizing we can't. I've seen family members become shells of themselves after surgery after surgery causes them to lose as much as they got back. Pills always have trade offs, surgery always leaves scars. Maybe one day that'll be the case where a pill will solve all our problems, but it's not today.
Nevertheless, telling people they should eat better and exercise more does not convince them to do these things. The approach you're advocating does not work. What is your alternative? More of the same?
Many of the most effective medications were banned due to medical risks --- for example, DNP. Efficacy isn't in doubt here; safety is. IMHO, given that all other public health interventions have failed, we should relax the safety constraints on these existing medications and mitigate the risks however we can. Demanding perfection in drug development has left us with nothing, and something is better than nothing.
"Acute oral exposure to DNP has resulted in increased basal metabolic rate, nausea, vomiting, sweating, dizziness, headache, and loss of weight. Chronic oral exposure to DNP can lead to the formation of cataracts and skin lesions and has caused effects on the bone marrow, central nervous system, and cardiovascular system.
...
Case reports have shown that an acute administration of 20–50 mg per kilogram of body weight in humans can be lethal. The lowest published fatal ingested dose is 4.3 mg/kg. Concerns about dangerous side-effects and rapidly developing cataracts resulted in DNP being discontinued in the United States by the end of 1938. DNP, however, continues to be used by some bodybuilders and athletes to rapidly lose body fat. Fatal overdoses include cases of accidental exposure, suicide, and excessive intentional exposure (overdose). The substance's use as a dieting aid has also led to a number of accidental fatalities."[1]
I would argue that's an entirely unsafe medication. That's not a drug that's short of perfection, it seems to be the sort of medication that will solve the obesity crises by actively killing people instead.
I lost 40 pounds in 3 months, then another 20 in 3 months.
I've kept the weight off for another year.
I still eat healthy and in moderation (and occasionally fast).
I avoid sugars and high-carb foods and my body has been hovering at the same weight.
Maybe, for some people, it's harder to keep the weight off (assuming diet is the same)? Or, maybe some people don't have the mental will-power to stay on the diet that lost them the weight?
Superb. Clearly in your case you summoned the necessary will to lose all that weight. But I think another important factor is that you established a new lifestyle/better eating habits.
> But I think another important factor is that you established a new lifestyle/better eating habits.
How is it not a given that you need to do this? Your lifestyle and eating habits got you to that overweight state in the first place. Of course you will return to that state eventually if you don't permanently change them.
"Summoned" implies it's only possible for people who know the arcane secrets, I'm not personally a fan of removing people's agency when talking about something like this.
Removing agency is exactly what you should do when you're talking about a widespread problem. If I have a personal friend I'm absolutely going to tell them they can make the right choices and overcome their problems, but you can't do that with a society. You have to look at incentives and environment and change those to change widespread behavior.
Per that study, "This analysis of 5-y weight-loss maintenance indicates, on average, that obese individuals maintained weight losses of 3.0 kg, representing a reduced weight of 3.2% below initial body weight. These individuals were successfully maintaining a weightloss averaging 23.4% of their initial weight loss at 5y"
Put another way, after 5 years, the average weight loss was ~3kg, with an average weight gain of 78.6% of the original lost weight.
Also, in general, an obese person who is obese before, and after 5 years has a weight that is ~3kg is likely still obese.
So this study basically just says that an average person isn't successful at keeping a large amount of weight, and gains most of it back. The specific statistics stated by the commenter above may not be correct, but the sentiment is definitely true.
That said, the study does confirm that very low energy diets (~800 meal replacement) beat out hypoenergetic balanced diet (~1200-1500 normal food) in long term weight maintence. Which is what the article is suggesting being implemented. So it's still not a great long term solution, but it's the better of the two non-exercise based solutions which this study evaluated.
One consideration is that obesity has a snowball effect. I think I remember reading once that the average annual weight gain at midlife is 3 pounds. So over a 5-year period, those who made the attempt may have actually been down 15 pounds, plus the 3kg, from where they might have been if they'd continued on their trajectory.
I am on mobile and I don't have a root source for the below paragraph, maybe someone can dig it up.
> The statistics for dieters who lose weight rapidly, according to Wellsphere, a website sponsored by Stanford University, is worse. Only 5 percent of people who lose weight on a crash diet will keep the weight off. Crash diets include any unhealthy diet, from severe calorie-restriction diets to diets that consist of only a few kinds of foods.
Another study showing 5% looks like it was an old study from 1959.
Anyway, there are more modern studies proving the point. And that people gain even more weight back than they started with.
>Several studies indicate that dieting is actually a consistent predictor of future weight gain,” said Janet Tomiyama, a UCLA graduate student of psychology and co-author of the study. One study found that both men and women who participated in formal weight-loss programs gained significantly more weight over a two-year period than those who had not participated in a weight-loss program, she said.
>Another study, which examined a variety of lifestyle factors and their relationship to changes in weight in more than 19,000 healthy older men over a four-year period, found that “one of the best predictors of weight gain over the four years was having lost weight on a diet at some point during the years before the study started,” Tomiyama said. In several studies, people in control groups who did not diet were not that much worse off — and in many cases were better off — than those who did diet, she said.
This new diet is specifically tailored to avoid this yoyo effect. It’s currently not yet clear whether this is indeed the case (hence this expanded epidemiological study) but preliminary results indicate that this is indeed the case.
In other words, this specific diet (severely limited calories as well as restriction of food to almost completely liquids) reportedly helps sustaining the weight loss long-term (and is allegedly effective for around 50% of patients).
That is why there needs to be some visible and lasting penalties...as in if you have a disease like diabetes that you can prevent or fix by simply eating better and not eating so much - then you are responsible for any and all medical costs associated with it. We don't allow insurance claims if you purposefully wreck your car or burn your house down; why do we allow this when it comes to your health?
If you think "simply eating better and not eating so much" is "simple", you don't understand people. All our evidence is that it is by no means simple for most people. It's a problem that's about as hard to deal with as drug addiction.
Furthermore, it is a social problem, in that we as a society allow businesses to exploit peoples weaknesses without covering the social costs of the problems they are causing, and given that how people around you act strongly influence how able people are to stick to a diet.
To then act as if this is down to some imaginary free will is irresponsible.
Well I "simply" don't eat the stuff or over eat. O.k so maybe I am some anomaly but I don't think so. Sure some people take a little more incentive and that is why I propose to provide them with some incentive - which would be that if they knew, or saw, that their health care costs are no longer covered if they cause their health issues then a large amount of people would start changing their ways. People need to be made responsible for their decisions; this means they must pay for their actions - if they are not held accountable then they, in general, will not act in a responsible way. Making people responsible will turn the social tide.
I thought I was getting too fat in 2015. I went on an "eat half" diet. Literally lost weight eating pizza and drinking beer, just less than I needed. Lost 12 kilos.
After this, I just ate as I felt like, with intermittent periods of damage control, where I'd revert to the diet for a few days here and there to either budget an upcoming event (e.g. Christmas), or pay for a recent one.
Works for me. Only note is to watch out with sugar & alcohol, as both can turn on the 'fuck it I WANT THIS NOW' mode, at least for me.
> Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.
The mechanism = not staying on your "diet" permanently.
This. I've known a bunch of people who lost a large part of weight (without surgery) and kept it off and they basically turned into different people (more fun though). They restricted their eating, they worked out, often went for hikes etc. But their lifestyle was completely different before and after. They didn't bitch about turning down dessert or things like that. They seemed to actually just be a different person.
Calories are not the core problem - carbohydrates are. The research from VirtaHealth.com makes this clear. They are getting T2 diabetics off of insulin within a week, while still giving patients the satiety they want from meals.
Heh. Whole company launched based on single study with short duration, no control group and big drop-out rate.
But when you add long list of citations for medical literature it looks valid. Even when those studies don't directly validate your approach. People don't look at what the studies actually say.
Dr. Michael Greger, Dr. McDoughall are my heros. Carbs and starch are not the problem, animal fats and proteins are. Whole food plant based diet are the best
It's interesting that once I cut out grains, potatoes, pasta, fruit/sweets, starches and continued to eat beef, chicken, fish, Organ meat, low carb vegetables and foods filled with fat (nuts, cheese, olives, etc) caused a 100lb weight loss that I have kept off over 3 years. This was without any exercise or extra activity.
I think that's pretty normal. Carbohydrate-heavy foods are good for over-loading your body with enegy. It's fine if you're working on a farm 10 hours a day, less so if you're sitting in an office.
The reality is 2k calories of lean meat, fruits, and veggies is A LOT more food than 2k calories worth of cereals. It's physically difficult to overeat when your diet looks like that.
Greger's "How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers" has lots of data while remaining quite entertaining:
I think that this is effective because it reduces the carbohydrate load. Protein and fat consumption also increase insulin response but not nearly as much. Type 2 diabetics could get most of the blood sugar reducing benefit of this by just removing/replacing the carbs. That has been my N=1 experience with both fasting and carb restriction.
Well reversing is different but most cases can be reveresed with dietary/lifestyle changes.
On the other hand prevention of type2 is N=100% with these changes. I know people, especially in the US consider it thier right/freedom to eat what they want and live how they want, but in my mind it’s deeply disturbing especially because children don’t have any choice (it’s parental).
I think as soon as a child is diagnosed with fatty liver disease...there should be some mandate on parents to “treat” their child with diet (which I know is probably equally disturbing to people, government dictated diet).
In the US the official nutrition advice has been both wrong and corrupt since the 1970s. Gotten wrong by sincere hard working scientists with the best intentions. Corrupted by corporate capture of regulatory bodies and funding of exculpatory studies.
These same forces would choose what is mandated. That is horrifying. Not only could they give bad advice, they could compel ever larger fractions of the population to follow it.
Far better to let parents decide, so when they get it wrong we can learn from it, and don't all get it wrong at once.
>Far better to let parents decide, so when they get it wrong we can learn from it, and don't all get it wrong at once.
The problem is the disease is growing in epidemic proportions, no one is learning from mistakes.
The government got it wrong sure, but let the doctors prescribe the diet and government won’t dictate the diet only mandate following doctor prescribed treatment/diet (and this too I know has flaws).
But here is the thing, say a child does get diabeties and the doctor prescribed insulin, but the parents think they know better and refuse the treat their child. Should government be able to step in or allow the parent to withhold insulin treatment based on their freedom? Legally parents can refuse (life saving) treatment on religious grounds, and that arguement comes into play in diet, but I’ve also been involved in a case where a 13 year old was pregnant with HIV and was refusing court ordered treatments so the baby would be born without HIV, legally and morally they are complex issues.
Americans have by and large followed the recommendations of the government: meat and saturated fat consumption is down, and we eat way more “heart healthy” whole grains and polyunsaturated seed (excuse me, “vegetable”) oils.
Lots of people followed the advice, because lots of people wanted to be healthy. The advice was just garbage.
I was under the impression that parents could not decline life saving treatments for minors, and that the state had the right to step in.
>Americans have by and large followed the recommendations of the government
I agree with you the old food pyramid(s) were shit and even Obama’s revised food plates are shit advice. Still I don’t know of any statistics of people actually following it and think by and large most peoples diets in the US are even worse than what the government suggestions have been/are.
As to the parental consent on treatment...Yes children die because parents decline life saving blood transfusions for their children on religious grounds. Most cases are upheld but from time to time there is intervention. In the case I referred to forced HIV treatments, the only reason that was legal for the unborn child, was because the 13 year old mother was already declared a dependent on the State. Again scary a state dependent subjected to force medical treatment for an unborn baby...but the alternative is scary too a 13 year old with hiv refusing treatment because she thought the HIV tests were “lies by the state” and having a dependent of the state give birth to another child with HIV which could have been prevented with treatment.
And that's where the government constantly fails us. It makes enough mistakes that people start treating everything is says with skepticism, and often rightly so. But it's not a big step to doubting government recommendations for diet to doubting government recommendations for vaccinations, even though the two subjects are not equivalent at all. Things get even more complicated when the government does things like subsidize corn, which has a negative effect on the diet of Americans through the increased use of corn syrup in practically everything.
People make fun of the anti-vaxxers, and they certainly are wrong, but we in this discussion are criticizing the government's diet recommendations as being misguided, it's not hard to see where people would view other government recommendations and mandates with suspicion.
Honestly, I think self experimentation is the trick. Find someone who seems to be an expert, adopt one of their recommendations for a few weeks. Do you feel better? If yes, continue and pick a new recommendation. If no, reverse course and try something or someone else.
I personally recommend experts who both cite science, and are willing to reverse course when proven wrong.
You’re initial steps depend on your starting point/goals.
Are you a body builder trying to go from 10-12% body fat to 7% for competition.
Are you obese? Do you have chronic diseases or metabolic issues caused by diet?
I personally focus on ATP/krebs cycle, cellular health, dietary inflammation, liver/kidney function...I experiment and consume information mostly from athletes. I myself am a ultra runner but only started running 5 years ago and wanting to be a better runner is what got my to begging taking nutrition seriously. I was 192 4 years ago, I’ve been down as low as 133. I experiment a lot but it’s hard because I feel you must commit months to a diet to really have insight on the effects on your body combined with lifestyle. That seems to be the same conclusion as the other reply to your comment, but whereas they say give is weeks/I’d say give it months.
It's not just that the science of nutrition is still in a state of heavy churn... I'm sure everyone remembers when high-carb, low-fat diets were supposed to be the best thing ever, and we still suffer from the effects of that with tons of "fat-free" products that are full of sugar and unsatisfying.
It's also the governments fault for things like corn subsidies that assure that every processed food product is pumped full of corn syrup, because it's cheaper than air and making things sweeter is the cheapest way to get people to consume more.
The food industry is also working against the health of people because so many of the things that make their products more appealing also make them worse for you.
I cook a lot, so I eat less processed food than the average person probably does, and I know I need to cut down on carbs, but I eat rice with most meals. If I could eliminate some bad habits, I don't think my diet is that bad, but eating healthy is also expensive. For all the talk of childhood hunger in the U.S., obesity is more of a problem for the poor than hunger. Cheap food is often really bad for you, and busy people with more than one job can't afford the time (leave alone the money) to cook decent meals unless they are really dedicated and make an effort to educate themselves.
I cook a lot because it's fun and relaxing, and usually make a bunch of food on the weekend so my family and I don't have to cook during the week. One of my problems is that I get bored easily, especially at work, and I eat when I'm bored.
> On the other hand prevention of type2 is N=100% with these changes.
It is absolutely not. While the vast majority of current cases are preventable (and in most cases, reversible) through proper lifestyle changes, between 5% and 10% of people with T2DM were going to develop it regardless of what they did.
Now, it's possible that some or all of those cases are not actually T2DM. In the past few decades researchers have been investigating additional forms of DM, such as Latent Autoimmune Diabetes in Adults, that may be the cause of some cases of DM that currently present as T2DM. It may be that once "true" T2DM is defined that your statement is correct, but as of right now it is not.
>between 5% and 10% of people with T2DM were going to develop it regardless of what they did.
One I’ve never seen a study or heard a physician make that statement. It’s always 100% prevention. But treatment of diet to prevent 90-95% of cases isn’t bad.
> .there should be some mandate on parents to “treat” their child with diet
You're considering forcing parents to change, presumably with the threat of taking their children away. But consider this, in the past type-2 diabetes was extremely rare in children. Why is it now common?
Are parents just worse? Or are terrible diets more appealing? Maybe the sources of those terrible diets would be a better place to start imposing government violence.
I don't know how life was in the Western countries while growing up in Romania.
Being born in 1982, in the eighties as kids we received sweets only on holidays. I remember chinese chocolate (which was really good btw), a locally made soda and oranges and bananas. Even now when it smells like oranges, I feel like it smells like Christmas, because that's when we were getting oranges.
Then in the nineties, after the revolution, we got an explosion in the junk food consumed. People importing Coca Cola from Turkey made a fortune. The result is that at this point we are in the top countries in Europe when it comes to heart disease and diabetes.
It's easy to see what happened if you follow the trends:
1. sugar (sucrose, HCFS) consumption going up
2. snaking ... when we were little, we were only eating 3 meals per day at most
3. stress
Also if you believe the hyperinsulinemia theory of obesity, well, there are indications that mothers that developed insulin resistance will pass that resistance to the child. Which is one explanation, besides genes, for why children born of overweight parents also have a tendency to get fat.
And yes, we eat too much. Unfortunately thin people have always blamed fat people of gluttony, not thinking that the hunger and satiety signals might be broken in some people, for various reasons, including insulin resistance, or maybe because the junk we eat doesn't contain the nutrients the body needs.
Well luckily the US is not a vacuum and you can see the pattern of the explosion of type 2 and other chronic conditions in other countries, even in Okinawa which used to have the best life expectancy but now is riddled with chronic diseases and type 2.
I see. I agree the industry should change, but like alcohol/tobacco they won’t without government mandates and regulation (ie age of consumption laws; warnings; child advertising)...each one of those were lengthy hard fought battles.
Did you see the diet? Another commenter posted it [1], and it has 132g carbohydrates. Doesn't seem like a small load (though it may be an improvement over what they're currently doing!). At 4 cal/carb [2], that's over half the diet's calories.
AFAIK the standard American diet has about 250g of carbs. 132 grams of carbs is about the standard recommendation for T2 diabetes.
That said these recommendations are bullshit. If you have diabetes, you have an insulin problem and it's best to minimize it, so you need to eat the minimum amount of carbs you can get away with, prioritizing the complex carbs with fibers (e.g. spinach and other greens).
Btw, a low calories diet can work even if higher in carbs, because:
1. by losing weight insulin sensitivity goes up afaik
2. at 800 grams per day, that's not much to eat, so those people are probably fasting for much of that day
That's just a guess, but how you distribute your meals also matters just as much as what you eat.
How much of those carbs are fiber? I'm trying to find the direct quote and see if more information is there.
Although, given the description of it includes "fruit juice", I am guessing it is a lot of sugar, which seems weird but I can't admit to know enough to say this is bad.
I'd be interested in the efficacy of this sort of diet when applied to a large mass of people as opposed to a very low carb diet. The NHS can "prescribe" these diets, but people may not follow them. It's possible that having a moderate amount of carbs (as sugar) in the diet will actually decrease the chances of a person going in the complete opposite direction and binging on sugar after they get sick and tired of a very low carb diet. I'm curious if they study that effect and "risk" of diets.
Not a lot. The recommendation is mostly liquid calories (think milk and juice), so this is mostly going to be high glycemic fructose, not a lot of fiber.
Two minor points: T2 isn’t controlled with insulin; it’s a syndrome of insulin resistance and other metabolic dysfunctions. And “manufactured insulin” came on the scene in 1922. Before that, T1 diabetes was universally fatal.
My T2 is not treated with insulin today, but it could be later if it gets worse. And I am indeed talking about history pre-20th century.
For example, diabetes used to be diagnosed by peeing on the ground and seeing if ants we attracted to it. According to whatever diabetes history book I checked out of a medical library on inter library loan.
This sounds pretty similar to some of the things Dr. Valter Longo has been mentioning in his book the longevity diet where a part of it are also occasional 5 day fasts with 800 calories, that (supposedly) have great benefits. Great to see this being tested with the general public.
When people will realize that carbs are the only non-essential macronutrient? The sports community (especially bodybuilding) knows that for decades.
If an athlete says to me that a thing he does to his body work 95% of the time, I would consider to try it, and already did, some things against over-the-counter conventional medicine like this no-carb diet.
Not sure why this is being downvoted, bodybuilders do eat carbs - they just time them appropriately. If you're about to work out, carbohydrates will help you get through it. On the other hand, if you're going to be sedentary for a while, or you're really trying to prioritize fat loss, you probably wouldn't eat as many carbs.
Of course, Keto is a thing, but I haven't heard many stories of bodybuilders that actually target the keto-state. It's about getting the right amount of carbohydrates (hint: not as much as most people eat).
Bodybuilders typically consume about ~30% protein. Where did you get the idea that it is mostly protein? Not to say that there aren't outliers obviously.
Umm, no. If you're eating 1.5 grams of protein per pound of bodyweight (which is on the high end) and you weigh 200 pounds, that's about 1200 calories from protein, out of diet that's likely 3000 - 3500 calories. A common recommendation I see is for about 20-25% to come from fat, and the remaining from carbs, preferably complex carbs.
Bodybuilders use carbs restrictions (keto, intermittent, kind - complex vs simple carbs) to regulate muscle mass and fat, insulin and GH sensitivity, water retention mediated by glycogen, etc...
Leading up to a competition and getting into single digit BF%, yes. But throughout most of the year they are generally consuming a good amount of carbs. I don't think using bodybuilders as an example translates well to good habits for the general population.
Traditional diets include lots of carbs. Bodybuilders realized early that protein is good for muscle growth. So they started eating tons of protein, and reducing other macronutrients. They realized after a while that carbs can actually be cut out totally and indefinitely (which is not true of protein and fat). They discovered this because nobody else had a reason to try to eat such a strange, protein-focused diet.
At least in modern societies. Of course the Inuit and other far-north peoples have known forever that one can live healthily off essentially nothing but meat.
Inuit and other far north people will eat vegetables by preference when they can get them. Sure you can survive on none, I will contend that to thrive you need a balance.
Note than balance does not mean soda is the bulk of your calories (that should be a straw man, but I see many people who drink that much soda).
It's only non-essential because your body has backup mechanisms for when carbs aren't available, ketosis for instance. That doesn't mean it's an ideal state to be in constantly.
My subjective opinions on the matter: Ketosis only kicks in when carbs are sufficiently low, ketosis is required because protein as an energy source cannot pass the blood brain barrier and so needs to be converted to ketones before it can be utilised. This to me indicates the direction of ketosis being the backup system instead of the norm but I am not trained on the subject and definitely welcome being educated further.
Note that this doesn't effect my opinion of fat as a great energy source. I personaly eat a relatively low carb (not keto), high-ish fat, high-ish protein, moderate carb diet. I'm also very active and this seems to work for me so far.
I'm dubious of the claim that ketosis is a "backup" system. If you think about primitive man, they probably wouldn't have had three regular meals a day. Lots of feast and famine.
I think people need to let go of the idea that ketosis is some sort of "special" state. It's just a metabolic state that's been suppressed by modern eating habits. Three meals a day and snacking is a cultural invention; not a biological necessity.
A lot of athletes prefer to exercise in a ketogenic state. I know personally I'm able to run farther if I've spent the day fasting than if I had a big meal at lunch. (I don't have the same initial burst, but I don't hit a wall either) (Not to mention that digestion is a very expensive process)
I think what's more unnatural is that modern eating habits are designed around blocking any sort of ketogenic state, which is where the easiest weight loss comes from. (Also, I need to lookup a reference for this, but I think I remember reading that fat burns a bit "cleaner" than sugars. Less free radicals I think? Something like that)
[For people unclear what I'm talking about with ketosis: basically, your body burns glucose first for energy. Then when there isn't sufficient glucose, it starts burning fat. The burning of fat for energy is what's known as ketosis. (I know I'm probably vastly oversimplifying). The thing about fat burning is it only kicks in at a significant level when glucose is depleted though. So if you're exercising while eating a chocolate bar and drinking a gatorade... well the exercise is good! But you won't lose weight)
The endurance sports community relies heavily on carbs, to the extent of often consuming sugar supplements during races and longer training sessions. Sure there are some endurance athletes who follow low-carb or even ketogenic diets, but they generally aren't able to compete at elite levels due to lower metabolic efficiency.
I just want to second what you said. I started bodybuilding around 2000 and an old-school way to manage your insulin response is to separate your protein, fat and carbs into individual meals (and especially eat a high protein, high carb meal after working out).
That may have been a bit of a fad though. The single most important rule that I know of is to never mix an animal protein meal and sugar, because that creates triglycerides which harden your blood vessels. This single rule is why fast food is so bad. Cheeseburgers are fine, but add fries and a pop and you just blew it.
As I've gotten older, I've noticed that my need for carbs has diminished greatly. As a teenager, I frequently ate a bag of gummy worms and a 2 liter bottle of pop on weekends. That changed to a case of beer in college. Either of those sound untenable today though.
The single easiest bit of advice I could give someone to lose fat is to stop eating all white fluffies and all sugar. So eat peas, salads etc with each meal instead of corn/bread/potatoes. Then pump iron at least 3 times a week so your body is in a constant rebuilding mode.
You don't really need to watch your fat intake like they recommended 20 years ago either. Always opt for natural fats like avocado, peanut or almond butter and regular butter because you need those to rebuild your connective tissue.
The big secret that nobody ever tells young people is that bodybuilding is all about eating/exercising in ways that elevate your hormones, then strengthening your connective tissue. If you do those things, then muscle and endurance come automatically. If you don't do them, you'll always be emaciated and will eventually get injured.
>The sports community (especially bodybuilding) knows that for decades.
While true, I would't say that everything bodybuilders are doing is worth following. Many pros do things that are extremely unhealthy. It isn't just the abuse of anabolics, but also insulin - which is relevant to what we're discussing here. There are bodybuilders with type 2 diabetes due to their unhealthy habits while trying to get bigger.
I found it easier to do via intermittent fasting and then eating all of my calories in one meal per day. Something about completely abstaining from food is easier for me psychologically than having multiple tiny meals and making myself stop eating when I'm not full.
It's also easier for me. I have no problem skipping breakfast and then skipping lunch takes a little willpower but I'm often distracted by work. I have friends who find it easier to eat a big lunch as their only meal. Worth experimenting for each person to find what works best for them.
This sounds to be marketed as some scientific potion to cure diabetes or at least rid the need of medication. All it comes down to is cleaning up your diet (e.g. eating the right amount of calories for your body and eating nutrient rich foods). There's no one diet fits all but getting a good balance of proteins, carbs, and fats is all this is doing for these people. NHS is simply doing the leg work. I control my weight by counting calories and macro-nutrients. If people could figure out how to do that own their own we'd see a huge decrease in Type 2. It's true, a cleaner diet tends to be more expensive and requires more work than the convenience of a fast food diet - but at the the end of the day we're trading diabetes so we can be lazy with our diet and health.
Exactly. This seems like an Onion headline: "We have your cure for diabetes! Just eat a ridiculously low amount of food, fatso."
I don't mean to sound like a whiner, but ... if it were that easy to cut down my food consumption, I wouldn't be going to a doctor in the first place!
It's like telling people with extreme loneliness or social anxiety to "just strike up a conversation with someone!" Or PTSD suffers: "Geez, just don't freak out so much, take a deep breath or something."
Or narcissists/sociopaths: "Just, you know, think more about how your actions hurt other people."
Given Herculean willpower, most diseases of civilization can be conquered. Don't pat yourself on the back for calling it "prescription".
It's not like that because it's all about how you approach the problem. It's easy to do all those things if you have the right mindset. Creating that mindset isn't easy, but wording everything in the worst possible manner is a sure way to make it more difficult.
In the case of diabetes, it's saying: here's an alternative prescription that will cure you, we have good evidence it will work, you can afford it, here are the steps to follow, each of which looks easy by itself...
>In the case of diabetes, it's saying: here's an alternative prescription that will cure you, we have good evidence it will work, you can afford it, here are the steps to follow, each of which looks easy by itself...
We had "just eat less, weak-willed fatso" fifty years ago. This isn't progress.
Oh yes. Its a drastic cut in calories from what these participants consume normally. 800kcal is probably not sustainable long term unless you weigh 90lbs and are sedentary. This is just a quick fix. In the end these people need a lifestyle change and a diet they can stick to indefinitely.
Or in other words: Type 2 Diabetes is a normal metabolic state of humanity (or at least some significant parts of it), it's just that we're too goddamn fat
It's great that they teach the idea that Diabetes (type 2) is preventable and even treatable with responsible eating habits. Too many people believe it's just something your doctor is supposed to treat with a pill.
Food companies often push the idea that all you need to do is exercise more. Whilst exercise might be a great thing: it alone can't fix the problem. You still need to learn how to eat.
At that calorie level it's basically a fast mimicking diet, so part of the benefit would be autophagy and the respawning of stem cells. It's hard to tell how much that helps however.
That’s definitely a factor. That and the automatic reduction in carb intake with such a caloric restriction. I mean, if they fed them pure sugar, they’d still be getting “only” 200g of carbs per day which is still less than what a lot of people who developed diabetes used to eat. More realistically they are likely getting significantly less carbs per day with elements of fasting thrown in.
Problem is keeping it, as almost everyone can keep the diet for a few months. We all know what we should do but don't, sometimes until is too late.
The person that invents a pill to trick our genes not to seek what was once rare (fat, sweets, carbs etc) will be a trillionaire. When our current genes were stamped "we" maybe had to hunt for days to eat once. Now we drive to McDonalds, order our or open the fridge door. Maybe something that puts our metabolism on steroids?
The 800 calories they are eating doesn't seem terribly healthy:
"patients were asked to follow either a ‘home-made’ milk- and fruit-juice-based diet (811 kcal/day, 64 g protein, 132 g carbohydrate, 6 g fat) with a multivitamin/mineral supplement (Forceval® [Alliance]), or a micronutrient-replete commercial LELD (832 kcal/day, 87 g protein, 120 g carbohydrate, 12 g fat).
I imagine these people are probably staving... I'd rather go low-carb myself.
Yeah I think I had it backwards it was nutrients that mixed perfectly, I was editing my post as you wrote that about weight gain. I thought Norman Rockwell used it to try and join the war.
Nothing wrong with that kind of diet for people without a genetic predisposition for diabetes (or lactose intolerance) and who are otherwise eating moderately.
Generally agreed, but with a caveat: diabetics are at risk of ketoacidosis on low carb diets. They would need to measure their blood ketones and moderate carbohydrate intake to keep their levels down below dangerous thresholds.
Personally when I went low carb, I got blood (not urine) ketone levels up into the range that would kill a diabetic quickly, think in the 7.0 range. Even as someone well adapted I regularly hit the 3.0s when fasting.
That's a case study of a single patient. Main takeaway:
>Benign dietary ketosis resulting from restricting carbohydrates could, theoretically, cause ketoacidosis in persons with a predisposition to the condition.
Also, I said that it’s a risk to be managed. People are acting like I said that it’s a certainty and that not eating sugar constantly as a diabetic will kill you instantly or something.
I made it very clear that it’s high ketones while diabetic that causes it. If you’d like to correct that in a more constructive way, that would be helpful.
Type 1 diabetics may be at risk for ketoacidosis if they screw up their insulin, but T2 diabetics are not at any risk from just a low-carb diet. The problem is having high blood sugar and high ketones simultaneously, not just having high ketones. And the nice thing about a low-carb diet is that you're not eating carbs, so your blood sugar does not become elevated. If your pancreas can still create insulin at all, you are highly unlikely to go into ketoacidosis.
Keto is a really good diet for both weight loss and correcting insulin resistance for a T2 diabetic.
(Source, I am a T2 diabetic that eats a ketogenic diet. I am losing weight and my A1c is dropping. My doctor is pleased with my diet choices.)
> ketone levels up into the range that would kill a diabetic quickly
That's not how it works. DKA happens because your body is burning fat because it's starving from a lack of insulin. Ketones from healthy weight loss are not dangerous.
Usually type 1 diabetics (autoimmune, are more at risk for DKA. Type 2 diabetics can definitely be at risk for DKA, especially if insulin-dependent. However, they are at higher risk for hyperosmolar hyperglycemic coma, which is equally frightening.
It's definitely a risk, but not as much if your body is still making insulin to help provide your cells with at least some energy.
This diet sounds miserable. You'd be hungry all the time. I would also much rather eat low-carb (and I do, I am a T2 diabetic that eats a ketogenic diet).
Which sounds more sustainable? Drinking 800 calories of milk and juice every day, or eating real food like steak and broccoli, or chicken with brussel sprouts, or bacon and eggs?
I am losing weight and reducing my A1c eating about 1300 calories of real food each day, and it doesn't leave me hungry at all. Keto is a very sustainable way of eating (in that you can keep doing it without misery). This "diet" looks like hell.
A recent analysis posted here claimed that low carb, high animal protein/fat was the unhealthiest diet long term, resulting in a 4 year drop in life expectancy, compared to a 1 year drop with a high carb diet.
Low carb looks to be dangerous for your body long term if you have too much meat.
According to a recent documentary I saw on the BBC about this very diet, the point of the 800 diet is to lose weight asap and then introduce food back in gradually over 3 weeks (I think it was restoring one meal time a week, dinner, lunch, breakfast), in a controlled manner to teach you better food habits.
The documentary was focused on 4 normal people who had health problems due to weight, they all were trying this diet to see if it would help. One of them had just developed type 2. Wouldn't be surprised if that programme paved the way for this (it was on in June).
I eat reasonable portions of meat, not excessively large ones. Most of your calories on a ketogenic diet come from fat, not protein, both dietary fat and fat your body burns off if you're also losing weight at the same time.
I would also rather live 4 less years and be healthy til the end of my lifespan, than live 4 extra years post-foot-amputation and on dialysis because of complications from diabetes. My father was also a T2 diabetic, tried to follow the ADA recommended diet, but still wound up insulin-dependent and eventually on dialysis before his death. I do not plan to follow in his footsteps.
I feel better on this way of eating than I have at any point in my life. My body has never metabolized carbs well. When I was younger, I was reactive-hypoglycemic, meaning that eating too many carbs would actually cause my body to over-respond with insulin, causing my blood sugar to plummet. I blacked out multiple times in high school from low blood sugar. Eating carbs (other than green veggies of course) is not for me.
Obviously that publication didn't go over well with the keto crowd, and they found a lot to pick apart (See 1 and 2). The most relevant critiques:
Methodology-wise, the prospective study seemed pretty poor
* Those people filled out questionnaires on their eating patterns on two occasions, six years apart. Their health was followed up for 25 years, allowing for factors that might alter the results, such as smoking, income and diabetes. (the assumption presumably being that they ate the same for the rest of their lives? IMO this seems to make any results pretty much worthless)
* low carb in this study is defined as "low carbohydrate consumption (<40%)" - typically LCHF is understood to be 50-100g, so typically 10-20%, and keto is even lower (5%)
* The PURE study was cited as part of the meta-analysis but another analysis in the Lancet actually came to the findings that: "Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality." https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
* The "years in life expectancy" is very unusual - usually what's presented is relative risk or hazard ratio and absolute risk. This can be found in the data - from the ARIC study, the HR for high carb was 1.16 and for "low" carb was 1.37 - the annual death rate was 1.63%, so the absolute risk was a difference from 1.38% vs 1.88%. These calculations, and a full analysis of the article is available here: http://www.zoeharcombe.com/2018/08/low-carb-diets-could-shor...
* I noticed that one of the authors listed is Willett, who invented the Mediterranean diet as we know it, and Sarah Seidelmann, the lead author is an outspoken vegan advocate, so it's worth keeping bias in mind when looking at the results. Sadly, the world of nutritional science (especially the epidemiological arm seems to really be as much about personalities as science (part of Ancel Keys' legacy, I suppose)
Actually, since I'm a bit tired of listing out points here are a few other interesting rebuttals that are primarily interesting because they point to all the pitfalls of coming to conclusions from observational studies and meta-analyses (and why nutritional reporting is simply the worst):
The study categorized everyone who ate below 40% of their calories into the low carb group. That's a lot of people who simply eat SAD. It would be much more interesting if they grouped the subjects into more categories. But I suspect the data for that simply isn't good enough.
> This diet sounds miserable. You'd be hungry all the time. I would also much rather eat low-carb (and I do, I am a T2 diabetic that eats a ketogenic diet).
Not eating anything, and only eating proteins and fats, are both difficult for me. And simply abstaining is actually easier. When I consume anything I begin craving not only carbs, but craving the stimulation of eating, period.
I think its finally uncontroversial to say that not all calories are the same. But eating is more than just the metabolic process; like smoking it's about the physical habits and stimulation. In that way eating chips is not much different than eating pork rinds, and for some people that's what matters most.
Remember the Master Cleanser and juice fast fads? People consuming nothing but raw sugar for days, weeks, and even months on-end derived similar benefits--weight loss, improved insulin sensitivity, etc. And for some people it was really easy because you could sip on your drink constantly throughout the day, which was in an important way the antithesis of abstinence. Not all calories are the same, but it's still the case that fewer calories are better. Just do whatever it takes to get you to fewer calories.
I'm not trying to equivocate diets--vitamins, minerals, and fiber still matter. But, again, calorie count is ultimately the most important metric. How you manage it is largely a matter of your personal tastes and lifestyle. Few people can manage a perfect diet, but there's a least bad diet for everyone, and they're often wildly different. And that's basically what the expert stated in the article--the powdered diet isn't for everybody, but it was important to begin offering alternatives to the "balanced diet" recommendations.
True, I don't disagree. Keto is just the easiest way I've found to eat at a caloric deficit without feeling deprived, hangry, or succumbing to cravings and eating half a cake in one sitting.
Once you get past the first couple weeks, carb cravings fade, and it's not nearly as difficult. It's just far easier for me to say no entirely to carbs than for me to eat them in moderation, much like it's a bad idea for an alcoholic to try to have "just one" beer.
A lot of people here are suggesting, like you, that a low-carbs diet or ketos can help your body "heal" from T2D. I just don't see why starving yourself from carbs, which is like the basis of life for your cells, is going to help. From what I gleaned here and there, T2D is more linked to fat-heavy diet, which clutters blood vessels and keeps yours cells from absorbing the insulin your body produces, thus preventing them from "disgesting" the carbs you sending to them, resulting in diabetes. Reducing all the cholesterol in your diet will help your body "cleanse" gradually from these plaques on your blood vessels.
I'm not doctor, nor a nutrionist, but this guy makes really good and sourced videos on these subjects:
I really recommend watching them. They're clearly oriented (duh), but still quite informative.
I'm sorry, my reply is a bit rushed and not that polished, but I really wanted to reply to see if anyone has something to say about this interpretation of carbs and T2D. (And it's damn late right now where I live!)
Those videos were painful to watch (what's up with his intonation, it sounds like he's introducing prizefighters) and the guy looks anorexic and anemic; not someone from whom I'd take nutritional advice.
T2 is related to glucose ingestion(sugar, carbs) NOT fat. Glucose spikes your insulin, and the continued, extreme spiking of insulin is what causes T2.
Bodies can run on ketones (byproduct of breaking down fats) or glucose. I'm not sure where you got the information that T2 is related to fat heavy diet, that is not true at all. It can be related to bring fat, for to complications with obesity. It is related to glucose spikes, which causes insulin spikes, but the T2s body is insulin resistant and so sugar and insulin stay in the blood stream and can't be utilized. High sugar in the blood is the cause of most T2 chronic issues.
Also of note, a recent study has found that ingestion of cholesterol does not correlate with how much is in your blood.
I've seen a qualified dietitian working for the NHS - she hadn't a clue about what kind of diet someone with blood sugar problems should eat. Unfortunately, this has been my (even more unfortunately) wide and varied experience of several NHS consultants across different specialisms - their knowledge hasn't been updated since they left medical school, and what they were taught at medical school was 20 years out of date when it was taught.
Hasn't every study prior said fasting (especially combined with low carb diet in between) is far better than low calorie, because your body makes different adjustments to lack of food rather than some food and you actually end up worse on a low calorie diet because your body isn't getting the full amount of nutrients and calories it wants/needs but doesn't make the adjustments it'll make for brief periods of lack of food.
I am not a doctor. This is what I have learned so far (there are no references here - sorry, I will need to dig up the material to substantiate this if you ask):
The upshot:
Managing diet is not sufficient (for type 2) remission. The damage is at cellular level. That damage needs to be reversed. Therefore muscles need to be rebuilt. Even for the over 60 years!
The thinking:
Diabetes Type 2 is the end point of years of abuse the body endures with elevated insulin and the _extent_ of insulin resistance the body progresses to. Diabetes therefore is a spectrum - the end point is when the pancreas bonks out and refuses to produce any more insulin. It's a tiny tiny organ and I think it's fragile. And it's threshold is also genetically determined. The interesting thing is that we all (including healthy folks) have levels and sometimes acute bouts of insulin resistance! The thing that made sense to me, reading about this, was that insulin resistance is a function of your muscle cells denying entry to glucose. And the insulin concentration in the bloodstream is a direct function of the concentration of free flowing glucose. Poor Pancreas is only doing its job but the muscles are not taking in any new glucose. They are refusing (resistant). Pancreas tries its best by pumping more insulin and for longer but the adamant muscles are the contract breakers in this arrangement - they don't open the gates for glucose.
The only way to change direction permanently in type 2 is to rebuild muscles which will have better insulin receptors to allow glucose to be shunted into the cells. For this to happen you have to do strength training. Lift sufficiently heavy. (No, not Arnie levels by any measure.)
(I recently read a study that administering testosterone to type 2 diabetics improved their insulin resistance. What happens with testosterone and anabolic steroids? New muscles, that's what.)
I admit that it does sound crackpotish [sic] - I am the OP.
Is this better? ->
The common understanding of T2DM is that it is a problem of sugar and therefore diet. That's only half of the equation of the physiology leading to T2DM. We have to also understand the cause of excess free circulating blood sugar and excess calories: muscle cells that have lost their ability to receive sugar. Muscle atrophy and poor muscle composition has to be the second half of understanding and therefore part of management of T2DM.
About 3 years ago (late 2015 now) I was quite overweight, had a knee injury that limited my mobility (stairs mostly) and had a fasting glucose and post-meal readings that indicated I was nearly pre-diabetic (T2).
So, I cut out out all sugary drinks, refined carbs, late night eating (!!) and tried various intermittent fasting / time restricted feeding techniques (5:2, alternate day, one-meal-a-day) and after about 3.5 months my glucose readings returned to the "normal" range. (Which is WAY more tolerable than sticking to a low-calorie diet every single day IME. I still had pizza and cheeseburgers on occasion, just no soda, fries, "junk" etc.)
After around 6-7 months I'd lost 40+lbs, my knee stopped bothering me and no longer had to entertain the idea of fixing it with surgery. I'm now down well over 60+lbs without having put in hardly any effort to exercise (occasional walking) - pretty stunning to me.
Same thing here. Except I also refuse any refined flour, Co sidering it sugar. I only eat whole foods, no milk, very little cheese, barely any meat. Lots of vegetarian meals. Dropped 50+ lbs without much drama. I cycle extensively in the warm summer months.
Nowadays I mostly just do OMAD (one-meal-a-day) or close to it (eating window is about 1-3 hours) as it's simpler. Initially some will power was needed to stop myself from snacking in the evenings, but as long as I make sure I have a fair amount of protein in that one meal, it never seems to happen now.
Occasionally I'll do alternate-day if I feel 'stuffed' or had a big day of lots of calories (holidays, social events) - whatever is more convenient at the time.
Eggs really are quite incredible - a great mix of fat, protein and micronutrients. I can eat just 2 eggs and not even think about eating again for 5-8 hours.
Note! This won't work if you have bread with your eggs, or anything else that raises your blood sugar.
As far as I can tell they all work (N=1 and all that), so I'd say that whatever you find easier to actually do is what you should do - just keep it up as often as you can over time.
If you wanna get a little geeky about it like I was, could consider buying a Precision Xtra to measure your glucose and ketone levels. For me this was helpful because I could see changes in the numbers after changing my eating habits. Had I not seen that, I would have only my scale to see body weight, and would've just looked at that and thought "looks like nothing changed, maybe this isn't working / doing anything at all." This also allowed me to "gamify" the whole process a bit ("I wonder how low I can get these numbers to go? how long I can stay there?" ... etc).
> I'm now down well over 60+lbs without having put in hardly any effort to exercise (occasional walking) - pretty stunning to me.
Losing weight despite not exercising isn't surprising. Exercise, even intense cardio, burns far fewer calories than most people think. I'm about 240 lbs, 5'8", 36 years old, and according to this calculator [0], if I ran a 5k at a fast-paced 10 mph (6 minute mile), I'd only burn about 250 calories. That wouldn't even be enough to burn the calories in the energy drink I might drink before it!
Great work on the weight loss. I was 255 lbs at the beginning of the year and switched out my sugary sodas for unsweetened tea or occasionally a diet soda and lost 15 lbs in 4 months. I plateaued because I haven't changed much else.
Most exercise based weight loss isn't about the actual exercise it's about the changes the intense exercise makes to your body that causes you to burn more calories while resting. Exercise often tunes your body to burn calories at a higher rate as you gain muscle and / or increase muscle health which requires more energy to support even while resting. So while you don't NEED exercise to lose weight it certainly is a super important part of weight lose for most people.
Contestants on an extreme weight loss television reality show saw their resting metabolism drop after a rigorous program of exercise.
>The group as a whole on average burned 2,607 calories per day at rest before the competition, which dropped to about 2,000 calories per day at the end.
Six years later, calorie burning had slowed further to 1,900 per day, as reported in the journal Obesity.
Another recent study showed that diet effected metabolism.
>a large new study published on Wednesday in the journal BMJ found that overweight adults who cut carbohydrates from their diets and replaced them with fat sharply increased their metabolisms.
After five months on the diet, their bodies burned roughly 250 calories more per day than people who ate a high-carb, low-fat diet
That research on the biggest loser participants has since been disproven. Sorry can't pull up those studies easily by mobile do I'll try to update wheni can.
Every time the Biggest Loser study (PMC4989512) gets cited someone pops up and mentions that it's been disproven but I've never seen any citation or followup. In fact, from my research I've seen lots of studies that show that there are long term metabolic changes (PMC6033771) related to adaptive thermogenesis/fat oxidization that is a fat-free mass independent effect on REE (doi: 10.3945/ajcn.115.109173).
Other studies seem to show that the lowered RMR doesn't seem to happen either doing a ketogenic diet (PMC5816424) or with ADF (PMC5042570) vs CR. I also think that the Biggest Loser results are in large part so unsuccessful due to their "crash diet" nature and the lack of any healthy habits being built for maintenance.
I was curious to check out your source because I'm 5'8, 130 ish pounds and my 10 min mile 5k only burns a little bit less than 250 calories, which I thought wasn't a big enough calorie difference for the difference in weight. I put your stats in for an 18 minute run and it came up as 350 calories. Am I putting something in wrong?
It's ridiculous just how terrible refined carbohydrates are for people. There are countless accounts of people losing weight and getting healthier by simply reducing refined sugars in their diet. It's surprising that this isn't common knowledge yet, although I guess we're fighting Big Sugar here.
I field countless questions about diet on a regular basis, and honestly the #1 tip isn't about calorie reduction or low carb or any gimmicks... it just comes down to "start cooking your own food, from real ingredients". Buy fresh meat and produce and go from there. Weight loss and health will come naturally, because real food is far more satiating than the calorie-and-sugar-dense snacks the western world is used to eating.
This always surprises me as cutting out refined and/or unrefined carbohydrates has no effect on my weight.
The only thing that moves my weight down is reducing calories or increasing activity while maintaining the same caloric intake. I suppose it's entirely possible these people are doing the former and just don't know it.
I think that quite often reducing refined carb intake is quite likely to result in a reduction in calorie intake - when our blood sugar rises and then falls, it triggers feelings of hunger, making snacking more likely. With unrefined carbs, the GI is typically much less, resulting in a slower rise of blood sugar to a lesser peak.
It's certainly common knowledge that sugar is fattening (but many people don't know that carbs are relatively bad too), but carbs are cheap and tasty so hard to quit.
My mother suffered Type-2 diabetes for almost 20 years. I put her on an extremely strict raw food diet three months ago and stopped injecting insulin. Her fasting blood sugar level is now in the 90-110 mg/dL range. I now give her some steamed potatoes also.
I too follow the same diet to give her company.
Elimination of oil, sugar and dairy has helped, I believe. She is a vegetarian, so flesh was never in the picture. I do not have to restrict calories with raw food. Eat as much as you can.
No juicing, however. That is a totally not allowed.
Loving the broscience takedowns of this NHS pilot program about how "this won't work!", or "low carb / keto is the best way!"
If only doctors knew how to read internet forums, then they'd be as knowledgable as all the armchair docs here, few (none?) of whom seem to have any actual training or T2 diabetes themselves.
The 800 calories number indicates that this might be related to the Fasting Mimicking Diet of Valter Longo. Since actual fasting has a "scary" reputation among some patients and doctors, Valter Longo developed a 5 day fasting like protocol with severely restricted calories that appears to have similar benefits to fully fasting for 5 days. It looks like this modified version of complete fasting is gaining popularity among the medical establishment.
Type 2 diabetes is currently on track to bankrupt the world's healthcare system. Easily 60% of the US residents reading this comment are already insulin resistant, they just don't know it yet. Many of those will progress to full blown T2DM in ten to fifteen years. It used to take a very expensive sequence of blood tests involving injecting glucose and tracking the concentrations of glucose and insulin over a few hours. Lately the tech has improved and there is a single blood test that can give an "insulin-resistance score", LP-IR[0][1]. While Peter Attia showed this test in a blog post from 2012[2], it seems to be getting more attention lately[3]. Just because your blood glucose after fasting is "normal" does not mean you will not get T2DM. Just ask Tim Noakes, world class exercise scientist and medical doctor, who finished more than 70 marathons and still woke up one day with diabetes, just like his father.[4][5]
In July I was 203 pounds which for a 5'6" frame, put me in the "obese" category. It was the highest weight I had ever been, and I felt I occupied more space than I should in the world ( not in a good way ). I follow a youtuber on Indian cooking and for whatever reason this woman mentioned how she recently started eating in a more "Keto" way. This woman is thin as a rake. She mentioned she was doing this for mental clarity. On a whim, I decided to try it. I literally threw the little debbie box I had my hand in, in the garbage that day. Today, I am 166 pounds, still "overweight" but this is the most amount of weight I have ever lost. I feel so much better and healthier, and its true about the mental clarity. My unsubstantiated hypothesis is that it takes away the emotional swings insulin give you. I eat till I am full. Honestly. There is not a day that I "think" about what I am eating other than keeping sugar and carbs out my month. I could not be happier. I am a 38 yo technology professional, and I imagine many others here are similar. I have nothing to sell. I just want to make people aware of a lifestyle that may help many of us who sit all day for a living.
From what I've read about starving yourself vs fasting and my own experience 800-calories sounds like HELL.
I can fast for 2 weeks no problem (although that's kinda long and I wouldn't do it if I didn't have enough body fat to sustain it. If you're skinny and don't have fat to spare better not stretch it unnecessarily).
I'm eating keto and I usually only eat once a day.
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[ 5.0 ms ] story [ 255 ms ] threadIf everyone starts that doing we're going to put the pharmaceuticals out of business. There'd be riots!
Type 2 diabetes isn't caused by diet. Certain diets can increase the risk of Type 2 diabetes, but it's not a foregone conclusion, and it's not uncommon to develop Type 2 diabetes despite an otherwise healthy diet.
It is not very uncommon, and in fact the most recent (last ~decade of) research has actually caused us to question the extent to which people genetically predisposed to diabetes can mitigate their risk through diet and lifestyle choices.
Neither were significantly overweight when they were diagnosed. In fact, my Dad has been trim for decades, and while I don't see my uncle often, he was always thin and very fit-looking when I have seen him.
There _has_ got to be a genetic component independent of lifestyle and diet choices. Me? I have no excuse. I'm overweight and not active and I know I need to change that.
edit: Didn't proofread.
Your body will try all the tricks in the book, it will reduce your metabolism to way below that of the person of the same weight, it will amp up your hunger hormones so much that you will think and dream about food 24/7.
Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.
I eat low carb, and fast intermittently. It's my life-style now.
After eating a while for an extended period of time, my blood sugar is much more stable, regardless what I eat.
Are there any studies in this area I can read that discuss the figures you've mentioned?
> Are there any studies in this area I can read that discuss the figures you've mentioned?
One example may be found in Dr. Jason Fung's book, "The Complete Guide to Fasting." Chapter 5 describes a case regarding the American TV show, "Biggest Loser", where overweight contestants lost loads of weight during the show with a low calorie diets and exercise. All except one contestant gain the weight back.
Below is the reference to the study cited in Fung's book. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21538
Firstly, fantastic achievement. I'm curious as to what motivated you enough to put in the effort (I'm assuming it required effort).
Secondly, I wonder if the speed/drastic nature of the weight-loss can be counter-productive. When you think about people don't become over-weight overnight. Perhaps a more gradual pace with some time for settling at various stages of the process...I'm thinking losing weight over a couple of years as opposed to over a couple of months.
And the time is certainly a factor - people have to set up weight loss scenarios that are sustainable over the long term. My weight loss goal was 1-2 lbs a week, so that was aggressive, but I am large enough that I can lose weight on enough calories to not feel deprived. By counting calories and making sure I had enough to enjoy myself it was a relatively easy process, once I got used to the counting and accountability.
Honestly, there were no side effects other than my back problems went away, I stopped snoring, and I felt better. Even with fasting, I just think your body has enough time to catch up when it's just a pound a day or whatnot. (Btw, you know what the world record for fasting is? 382 days. I'm not recommending that, I like food, but, as long as you get enough nutrients not to get something like scurvy and you consult with a doctor the human body is a lot more adaptable than people realize)
0: https://garry.tv/2018/10/17/fatty/
I only weighed myself once a week for this reason. Every day can be demoralizing if you have a bloat day, but once a week gives enough to have a pretty regular drop. Whatever behaviour you do can't be considered on a day by day basis, it needs to be considered as a week of good behaviour, and then weeks and then months. You gotta stay consistent every day over the long term to expect results.
We hackers can geek out on the math in the Hacker's Diet[0], which goes into various smoothing algorithms and plotting styles to show the daily weight and smoothed trends.
[0] https://www.fourmilab.ch/hackdiet/
I worry that daily tracking could be discouraging or introduce maldaptive behaviour - you went up a lbs since yesterday, but that's because your morning poop wasn't as productive as it usually is, and now you feel like you need to go more extreme to make up for it the rest of the day.
What's good is what works. And honestly, drugs work today. The likes of the FDA considers them too risky, but I think they're deciding wrong.
def: A medicine
>drugs work today
....
Seriously though, the problem is that, regardless of cause, we're fat and lazy. Throwing more drugs to take care of diabetes and heart disease is robbing Peter to pay Paul.
I'm watching my boomer parents realize that medicine isn't going to help everything, and they are going to have to be accountable for their help. They've gotten much more physically active and lost weight because they are seeing that my grandfather's heart medication may be stopping the heart attacks but it isn't stopping his diabetes or inability to climb the stairs, and the gamut of surgeries are just making him more and more crippled. A pill won't solve our problems. It may solve the current health crises, but it won't stop the next one. Losing weight, eating better, and being active will solve the whole set of problems.
You're adopting a moralizing stance here, one that says that gain without pain is illegitimate. This approach has broad appeal, but it just doesn't work. For decades people have been making the same argument you're making, and it hasn't worked. It's time we try something else.
No, I'm saying that a pill won't solve the root problem. You make people skinny with a pill, you just end up with unhealthy, malnourished skinny people who insulin is all out of wack and who will still get heart attacks.
> For decades people have been making the same argument you're making, and it hasn't worked. It's time we try something else.
Are you suggesting that "throw a pill at it" hasn't been a solution for decades? We've had this belief that medical science can cure us of all our ills, and I think we are no realizing we can't. I've seen family members become shells of themselves after surgery after surgery causes them to lose as much as they got back. Pills always have trade offs, surgery always leaves scars. Maybe one day that'll be the case where a pill will solve all our problems, but it's not today.
...
Case reports have shown that an acute administration of 20–50 mg per kilogram of body weight in humans can be lethal. The lowest published fatal ingested dose is 4.3 mg/kg. Concerns about dangerous side-effects and rapidly developing cataracts resulted in DNP being discontinued in the United States by the end of 1938. DNP, however, continues to be used by some bodybuilders and athletes to rapidly lose body fat. Fatal overdoses include cases of accidental exposure, suicide, and excessive intentional exposure (overdose). The substance's use as a dieting aid has also led to a number of accidental fatalities."[1]
I would argue that's an entirely unsafe medication. That's not a drug that's short of perfection, it seems to be the sort of medication that will solve the obesity crises by actively killing people instead.
[1] https://en.wikipedia.org/wiki/2,4-Dinitrophenol
I've kept the weight off for another year.
I still eat healthy and in moderation (and occasionally fast).
I avoid sugars and high-carb foods and my body has been hovering at the same weight.
Maybe, for some people, it's harder to keep the weight off (assuming diet is the same)? Or, maybe some people don't have the mental will-power to stay on the diet that lost them the weight?
How is it not a given that you need to do this? Your lifestyle and eating habits got you to that overweight state in the first place. Of course you will return to that state eventually if you don't permanently change them.
https://academic.oup.com/ajcn/article/74/5/579/4737391
Put another way, after 5 years, the average weight loss was ~3kg, with an average weight gain of 78.6% of the original lost weight.
Also, in general, an obese person who is obese before, and after 5 years has a weight that is ~3kg is likely still obese.
So this study basically just says that an average person isn't successful at keeping a large amount of weight, and gains most of it back. The specific statistics stated by the commenter above may not be correct, but the sentiment is definitely true.
That said, the study does confirm that very low energy diets (~800 meal replacement) beat out hypoenergetic balanced diet (~1200-1500 normal food) in long term weight maintence. Which is what the article is suggesting being implemented. So it's still not a great long term solution, but it's the better of the two non-exercise based solutions which this study evaluated.
> The statistics for dieters who lose weight rapidly, according to Wellsphere, a website sponsored by Stanford University, is worse. Only 5 percent of people who lose weight on a crash diet will keep the weight off. Crash diets include any unhealthy diet, from severe calorie-restriction diets to diets that consist of only a few kinds of foods.
Another study showing 5% looks like it was an old study from 1959.
Anyway, there are more modern studies proving the point. And that people gain even more weight back than they started with.
http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA...
>Several studies indicate that dieting is actually a consistent predictor of future weight gain,” said Janet Tomiyama, a UCLA graduate student of psychology and co-author of the study. One study found that both men and women who participated in formal weight-loss programs gained significantly more weight over a two-year period than those who had not participated in a weight-loss program, she said.
>Another study, which examined a variety of lifestyle factors and their relationship to changes in weight in more than 19,000 healthy older men over a four-year period, found that “one of the best predictors of weight gain over the four years was having lost weight on a diet at some point during the years before the study started,” Tomiyama said. In several studies, people in control groups who did not diet were not that much worse off — and in many cases were better off — than those who did diet, she said.
In other words, this specific diet (severely limited calories as well as restriction of food to almost completely liquids) reportedly helps sustaining the weight loss long-term (and is allegedly effective for around 50% of patients).
Furthermore, it is a social problem, in that we as a society allow businesses to exploit peoples weaknesses without covering the social costs of the problems they are causing, and given that how people around you act strongly influence how able people are to stick to a diet.
To then act as if this is down to some imaginary free will is irresponsible.
After this, I just ate as I felt like, with intermittent periods of damage control, where I'd revert to the diet for a few days here and there to either budget an upcoming event (e.g. Christmas), or pay for a recent one.
Works for me. Only note is to watch out with sugar & alcohol, as both can turn on the 'fuck it I WANT THIS NOW' mode, at least for me.
The mechanism = not staying on your "diet" permanently.
But when you add long list of citations for medical literature it looks valid. Even when those studies don't directly validate your approach. People don't look at what the studies actually say.
Perhaps I am an outlier.
The reality is 2k calories of lean meat, fruits, and veggies is A LOT more food than 2k calories worth of cereals. It's physically difficult to overeat when your diet looks like that.
Still mad about eating breakfasts of skim milk and unsweetened shredded wheat for years.
Now it is whole milk with bacon and eggs every morning.
https://www.youtube.com/watch?v=lXXXygDRyBU&t=2m11s
For more information, search the nutritionfacts.org site for "diabetes".
The whole-food plant-based diet is the healthiest diet for humans.
On the other hand prevention of type2 is N=100% with these changes. I know people, especially in the US consider it thier right/freedom to eat what they want and live how they want, but in my mind it’s deeply disturbing especially because children don’t have any choice (it’s parental).
I think as soon as a child is diagnosed with fatty liver disease...there should be some mandate on parents to “treat” their child with diet (which I know is probably equally disturbing to people, government dictated diet).
These same forces would choose what is mandated. That is horrifying. Not only could they give bad advice, they could compel ever larger fractions of the population to follow it.
Far better to let parents decide, so when they get it wrong we can learn from it, and don't all get it wrong at once.
The problem is the disease is growing in epidemic proportions, no one is learning from mistakes.
The government got it wrong sure, but let the doctors prescribe the diet and government won’t dictate the diet only mandate following doctor prescribed treatment/diet (and this too I know has flaws).
But here is the thing, say a child does get diabeties and the doctor prescribed insulin, but the parents think they know better and refuse the treat their child. Should government be able to step in or allow the parent to withhold insulin treatment based on their freedom? Legally parents can refuse (life saving) treatment on religious grounds, and that arguement comes into play in diet, but I’ve also been involved in a case where a 13 year old was pregnant with HIV and was refusing court ordered treatments so the baby would be born without HIV, legally and morally they are complex issues.
Lots of people followed the advice, because lots of people wanted to be healthy. The advice was just garbage.
I was under the impression that parents could not decline life saving treatments for minors, and that the state had the right to step in.
I agree with you the old food pyramid(s) were shit and even Obama’s revised food plates are shit advice. Still I don’t know of any statistics of people actually following it and think by and large most peoples diets in the US are even worse than what the government suggestions have been/are.
As to the parental consent on treatment...Yes children die because parents decline life saving blood transfusions for their children on religious grounds. Most cases are upheld but from time to time there is intervention. In the case I referred to forced HIV treatments, the only reason that was legal for the unborn child, was because the 13 year old mother was already declared a dependent on the State. Again scary a state dependent subjected to force medical treatment for an unborn baby...but the alternative is scary too a 13 year old with hiv refusing treatment because she thought the HIV tests were “lies by the state” and having a dependent of the state give birth to another child with HIV which could have been prevented with treatment.
People make fun of the anti-vaxxers, and they certainly are wrong, but we in this discussion are criticizing the government's diet recommendations as being misguided, it's not hard to see where people would view other government recommendations and mandates with suspicion.
Honestly, I think self experimentation is the trick. Find someone who seems to be an expert, adopt one of their recommendations for a few weeks. Do you feel better? If yes, continue and pick a new recommendation. If no, reverse course and try something or someone else.
I personally recommend experts who both cite science, and are willing to reverse course when proven wrong.
Are you a body builder trying to go from 10-12% body fat to 7% for competition.
Are you obese? Do you have chronic diseases or metabolic issues caused by diet?
I personally focus on ATP/krebs cycle, cellular health, dietary inflammation, liver/kidney function...I experiment and consume information mostly from athletes. I myself am a ultra runner but only started running 5 years ago and wanting to be a better runner is what got my to begging taking nutrition seriously. I was 192 4 years ago, I’ve been down as low as 133. I experiment a lot but it’s hard because I feel you must commit months to a diet to really have insight on the effects on your body combined with lifestyle. That seems to be the same conclusion as the other reply to your comment, but whereas they say give is weeks/I’d say give it months.
It's also the governments fault for things like corn subsidies that assure that every processed food product is pumped full of corn syrup, because it's cheaper than air and making things sweeter is the cheapest way to get people to consume more.
The food industry is also working against the health of people because so many of the things that make their products more appealing also make them worse for you.
I cook a lot, so I eat less processed food than the average person probably does, and I know I need to cut down on carbs, but I eat rice with most meals. If I could eliminate some bad habits, I don't think my diet is that bad, but eating healthy is also expensive. For all the talk of childhood hunger in the U.S., obesity is more of a problem for the poor than hunger. Cheap food is often really bad for you, and busy people with more than one job can't afford the time (leave alone the money) to cook decent meals unless they are really dedicated and make an effort to educate themselves.
I cook a lot because it's fun and relaxing, and usually make a bunch of food on the weekend so my family and I don't have to cook during the week. One of my problems is that I get bored easily, especially at work, and I eat when I'm bored.
It is absolutely not. While the vast majority of current cases are preventable (and in most cases, reversible) through proper lifestyle changes, between 5% and 10% of people with T2DM were going to develop it regardless of what they did.
Now, it's possible that some or all of those cases are not actually T2DM. In the past few decades researchers have been investigating additional forms of DM, such as Latent Autoimmune Diabetes in Adults, that may be the cause of some cases of DM that currently present as T2DM. It may be that once "true" T2DM is defined that your statement is correct, but as of right now it is not.
One I’ve never seen a study or heard a physician make that statement. It’s always 100% prevention. But treatment of diet to prevent 90-95% of cases isn’t bad.
You're considering forcing parents to change, presumably with the threat of taking their children away. But consider this, in the past type-2 diabetes was extremely rare in children. Why is it now common?
Are parents just worse? Or are terrible diets more appealing? Maybe the sources of those terrible diets would be a better place to start imposing government violence.
Being born in 1982, in the eighties as kids we received sweets only on holidays. I remember chinese chocolate (which was really good btw), a locally made soda and oranges and bananas. Even now when it smells like oranges, I feel like it smells like Christmas, because that's when we were getting oranges.
Then in the nineties, after the revolution, we got an explosion in the junk food consumed. People importing Coca Cola from Turkey made a fortune. The result is that at this point we are in the top countries in Europe when it comes to heart disease and diabetes.
It's easy to see what happened if you follow the trends:
1. sugar (sucrose, HCFS) consumption going up
2. snaking ... when we were little, we were only eating 3 meals per day at most
3. stress
Also if you believe the hyperinsulinemia theory of obesity, well, there are indications that mothers that developed insulin resistance will pass that resistance to the child. Which is one explanation, besides genes, for why children born of overweight parents also have a tendency to get fat.
And yes, we eat too much. Unfortunately thin people have always blamed fat people of gluttony, not thinking that the hunger and satiety signals might be broken in some people, for various reasons, including insulin resistance, or maybe because the junk we eat doesn't contain the nutrients the body needs.
It’s not the mystery you suggest.
[1] https://news.ycombinator.com/item?id=18571000
[2] https://www.nal.usda.gov/fnic/how-many-calories-are-one-gram...
That said these recommendations are bullshit. If you have diabetes, you have an insulin problem and it's best to minimize it, so you need to eat the minimum amount of carbs you can get away with, prioritizing the complex carbs with fibers (e.g. spinach and other greens).
Btw, a low calories diet can work even if higher in carbs, because:
1. by losing weight insulin sensitivity goes up afaik
2. at 800 grams per day, that's not much to eat, so those people are probably fasting for much of that day
That's just a guess, but how you distribute your meals also matters just as much as what you eat.
Although, given the description of it includes "fruit juice", I am guessing it is a lot of sugar, which seems weird but I can't admit to know enough to say this is bad.
I'd be interested in the efficacy of this sort of diet when applied to a large mass of people as opposed to a very low carb diet. The NHS can "prescribe" these diets, but people may not follow them. It's possible that having a moderate amount of carbs (as sugar) in the diet will actually decrease the chances of a person going in the complete opposite direction and binging on sugar after they get sick and tired of a very low carb diet. I'm curious if they study that effect and "risk" of diets.
For example, war is "good" for reducing incidence of diabetes, because famine.
For example, diabetes used to be diagnosed by peeing on the ground and seeing if ants we attracted to it. According to whatever diabetes history book I checked out of a medical library on inter library loan.
If an athlete says to me that a thing he does to his body work 95% of the time, I would consider to try it, and already did, some things against over-the-counter conventional medicine like this no-carb diet.
Of course, Keto is a thing, but I haven't heard many stories of bodybuilders that actually target the keto-state. It's about getting the right amount of carbohydrates (hint: not as much as most people eat).
Unless they're prepping for a contest, which is not what they spend the majority of their time doing.
Bodybuilders typically consume about ~30% protein. Where did you get the idea that it is mostly protein? Not to say that there aren't outliers obviously.
Just about every bodybuilder slams carbs, all day long.
At least in modern societies. Of course the Inuit and other far-north peoples have known forever that one can live healthily off essentially nothing but meat.
Note than balance does not mean soda is the bulk of your calories (that should be a straw man, but I see many people who drink that much soda).
Note that this doesn't effect my opinion of fat as a great energy source. I personaly eat a relatively low carb (not keto), high-ish fat, high-ish protein, moderate carb diet. I'm also very active and this seems to work for me so far.
I think people need to let go of the idea that ketosis is some sort of "special" state. It's just a metabolic state that's been suppressed by modern eating habits. Three meals a day and snacking is a cultural invention; not a biological necessity.
A lot of athletes prefer to exercise in a ketogenic state. I know personally I'm able to run farther if I've spent the day fasting than if I had a big meal at lunch. (I don't have the same initial burst, but I don't hit a wall either) (Not to mention that digestion is a very expensive process)
I think what's more unnatural is that modern eating habits are designed around blocking any sort of ketogenic state, which is where the easiest weight loss comes from. (Also, I need to lookup a reference for this, but I think I remember reading that fat burns a bit "cleaner" than sugars. Less free radicals I think? Something like that)
[For people unclear what I'm talking about with ketosis: basically, your body burns glucose first for energy. Then when there isn't sufficient glucose, it starts burning fat. The burning of fat for energy is what's known as ketosis. (I know I'm probably vastly oversimplifying). The thing about fat burning is it only kicks in at a significant level when glucose is depleted though. So if you're exercising while eating a chocolate bar and drinking a gatorade... well the exercise is good! But you won't lose weight)
That may have been a bit of a fad though. The single most important rule that I know of is to never mix an animal protein meal and sugar, because that creates triglycerides which harden your blood vessels. This single rule is why fast food is so bad. Cheeseburgers are fine, but add fries and a pop and you just blew it.
As I've gotten older, I've noticed that my need for carbs has diminished greatly. As a teenager, I frequently ate a bag of gummy worms and a 2 liter bottle of pop on weekends. That changed to a case of beer in college. Either of those sound untenable today though.
The single easiest bit of advice I could give someone to lose fat is to stop eating all white fluffies and all sugar. So eat peas, salads etc with each meal instead of corn/bread/potatoes. Then pump iron at least 3 times a week so your body is in a constant rebuilding mode.
You don't really need to watch your fat intake like they recommended 20 years ago either. Always opt for natural fats like avocado, peanut or almond butter and regular butter because you need those to rebuild your connective tissue.
The big secret that nobody ever tells young people is that bodybuilding is all about eating/exercising in ways that elevate your hormones, then strengthening your connective tissue. If you do those things, then muscle and endurance come automatically. If you don't do them, you'll always be emaciated and will eventually get injured.
While true, I would't say that everything bodybuilders are doing is worth following. Many pros do things that are extremely unhealthy. It isn't just the abuse of anabolics, but also insulin - which is relevant to what we're discussing here. There are bodybuilders with type 2 diabetes due to their unhealthy habits while trying to get bigger.
I don't mean to sound like a whiner, but ... if it were that easy to cut down my food consumption, I wouldn't be going to a doctor in the first place!
It's like telling people with extreme loneliness or social anxiety to "just strike up a conversation with someone!" Or PTSD suffers: "Geez, just don't freak out so much, take a deep breath or something."
Or narcissists/sociopaths: "Just, you know, think more about how your actions hurt other people."
Given Herculean willpower, most diseases of civilization can be conquered. Don't pat yourself on the back for calling it "prescription".
In the case of diabetes, it's saying: here's an alternative prescription that will cure you, we have good evidence it will work, you can afford it, here are the steps to follow, each of which looks easy by itself...
We had "just eat less, weak-willed fatso" fifty years ago. This isn't progress.
Food companies often push the idea that all you need to do is exercise more. Whilst exercise might be a great thing: it alone can't fix the problem. You still need to learn how to eat.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/
2. https://www.omicsonline.org/open-access/diabetes-reversal-by...
3. https://www.ncbi.nlm.nih.gov/pubmed/20425575
2. 3-days study with only 55 patients
3. Questionable observational (selection bias) studies and more Neal D. Barnard.
The person that invents a pill to trick our genes not to seek what was once rare (fat, sweets, carbs etc) will be a trillionaire. When our current genes were stamped "we" maybe had to hunt for days to eat once. Now we drive to McDonalds, order our or open the fridge door. Maybe something that puts our metabolism on steroids?
I imagine these people are probably staving... I'd rather go low-carb myself.
This is the study, DiRECT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/
Personally when I went low carb, I got blood (not urine) ketone levels up into the range that would kill a diabetic quickly, think in the 7.0 range. Even as someone well adapted I regularly hit the 3.0s when fasting.
Obligatory: I am not a doctor.
https://www.nejm.org/doi/full/10.1056/nejmc052709
>Benign dietary ketosis resulting from restricting carbohydrates could, theoretically, cause ketoacidosis in persons with a predisposition to the condition.
Keto is a really good diet for both weight loss and correcting insulin resistance for a T2 diabetic.
(Source, I am a T2 diabetic that eats a ketogenic diet. I am losing weight and my A1c is dropping. My doctor is pleased with my diet choices.)
That's not how it works. DKA happens because your body is burning fat because it's starving from a lack of insulin. Ketones from healthy weight loss are not dangerous.
It's definitely a risk, but not as much if your body is still making insulin to help provide your cells with at least some energy.
Then it's not quite as bad as I thought, but fat is still much more filling than protein:
fat > protein > carbs
Which sounds more sustainable? Drinking 800 calories of milk and juice every day, or eating real food like steak and broccoli, or chicken with brussel sprouts, or bacon and eggs?
I am losing weight and reducing my A1c eating about 1300 calories of real food each day, and it doesn't leave me hungry at all. Keto is a very sustainable way of eating (in that you can keep doing it without misery). This "diet" looks like hell.
Low carb looks to be dangerous for your body long term if you have too much meat.
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...
According to a recent documentary I saw on the BBC about this very diet, the point of the 800 diet is to lose weight asap and then introduce food back in gradually over 3 weeks (I think it was restoring one meal time a week, dinner, lunch, breakfast), in a controlled manner to teach you better food habits.
The documentary was focused on 4 normal people who had health problems due to weight, they all were trying this diet to see if it would help. One of them had just developed type 2. Wouldn't be surprised if that programme paved the way for this (it was on in June).
https://www.bbc.co.uk/programmes/b0b53xqs
I would also rather live 4 less years and be healthy til the end of my lifespan, than live 4 extra years post-foot-amputation and on dialysis because of complications from diabetes. My father was also a T2 diabetic, tried to follow the ADA recommended diet, but still wound up insulin-dependent and eventually on dialysis before his death. I do not plan to follow in his footsteps.
I feel better on this way of eating than I have at any point in my life. My body has never metabolized carbs well. When I was younger, I was reactive-hypoglycemic, meaning that eating too many carbs would actually cause my body to over-respond with insulin, causing my blood sugar to plummet. I blacked out multiple times in high school from low blood sugar. Eating carbs (other than green veggies of course) is not for me.
Methodology-wise, the prospective study seemed pretty poor
* Those people filled out questionnaires on their eating patterns on two occasions, six years apart. Their health was followed up for 25 years, allowing for factors that might alter the results, such as smoking, income and diabetes. (the assumption presumably being that they ate the same for the rest of their lives? IMO this seems to make any results pretty much worthless)
* low carb in this study is defined as "low carbohydrate consumption (<40%)" - typically LCHF is understood to be 50-100g, so typically 10-20%, and keto is even lower (5%)
* The PURE study was cited as part of the meta-analysis but another analysis in the Lancet actually came to the findings that: "Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality." https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
* The "years in life expectancy" is very unusual - usually what's presented is relative risk or hazard ratio and absolute risk. This can be found in the data - from the ARIC study, the HR for high carb was 1.16 and for "low" carb was 1.37 - the annual death rate was 1.63%, so the absolute risk was a difference from 1.38% vs 1.88%. These calculations, and a full analysis of the article is available here: http://www.zoeharcombe.com/2018/08/low-carb-diets-could-shor...
* I noticed that one of the authors listed is Willett, who invented the Mediterranean diet as we know it, and Sarah Seidelmann, the lead author is an outspoken vegan advocate, so it's worth keeping bias in mind when looking at the results. Sadly, the world of nutritional science (especially the epidemiological arm seems to really be as much about personalities as science (part of Ancel Keys' legacy, I suppose)
Actually, since I'm a bit tired of listing out points here are a few other interesting rebuttals that are primarily interesting because they point to all the pitfalls of coming to conclusions from observational studies and meta-analyses (and why nutritional reporting is simply the worst):
* https://cluelessdoctors.com/2018/08/17/when-bad-science-can-...
* https://www.linkedin.com/pulse/low-carbs-mortality-john-scho...
* https://www.psychologytoday.com/us/blog/diagnosis-diet/20180...
* https://anhinternational.org/2018/08/22/scientific-attack-on...
* https://asianwithoutrice.com/making-low-carb-a-murderer-part...
1: owlmirror ↗ The study categorized everyone who ate below 40% of their calories into the low carb group. That's a lot of people who simply eat SAD. It would be much more interesting if they grouped the subjects into more categories. But I suspect the data for that simply isn't good enough.
Not eating anything, and only eating proteins and fats, are both difficult for me. And simply abstaining is actually easier. When I consume anything I begin craving not only carbs, but craving the stimulation of eating, period.
I think its finally uncontroversial to say that not all calories are the same. But eating is more than just the metabolic process; like smoking it's about the physical habits and stimulation. In that way eating chips is not much different than eating pork rinds, and for some people that's what matters most.
Remember the Master Cleanser and juice fast fads? People consuming nothing but raw sugar for days, weeks, and even months on-end derived similar benefits--weight loss, improved insulin sensitivity, etc. And for some people it was really easy because you could sip on your drink constantly throughout the day, which was in an important way the antithesis of abstinence. Not all calories are the same, but it's still the case that fewer calories are better. Just do whatever it takes to get you to fewer calories.
I'm not trying to equivocate diets--vitamins, minerals, and fiber still matter. But, again, calorie count is ultimately the most important metric. How you manage it is largely a matter of your personal tastes and lifestyle. Few people can manage a perfect diet, but there's a least bad diet for everyone, and they're often wildly different. And that's basically what the expert stated in the article--the powdered diet isn't for everybody, but it was important to begin offering alternatives to the "balanced diet" recommendations.
Once you get past the first couple weeks, carb cravings fade, and it's not nearly as difficult. It's just far easier for me to say no entirely to carbs than for me to eat them in moderation, much like it's a bad idea for an alcoholic to try to have "just one" beer.
I'm not doctor, nor a nutrionist, but this guy makes really good and sourced videos on these subjects:
On Keto: https://www.youtube.com/watch?v=MzHLAqyO7PQ
On carbs: https://www.youtube.com/watch?v=MyOACAdvAsE
I really recommend watching them. They're clearly oriented (duh), but still quite informative.
I'm sorry, my reply is a bit rushed and not that polished, but I really wanted to reply to see if anyone has something to say about this interpretation of carbs and T2D. (And it's damn late right now where I live!)
Also of note, a recent study has found that ingestion of cholesterol does not correlate with how much is in your blood.
The upshot: Managing diet is not sufficient (for type 2) remission. The damage is at cellular level. That damage needs to be reversed. Therefore muscles need to be rebuilt. Even for the over 60 years!
The thinking: Diabetes Type 2 is the end point of years of abuse the body endures with elevated insulin and the _extent_ of insulin resistance the body progresses to. Diabetes therefore is a spectrum - the end point is when the pancreas bonks out and refuses to produce any more insulin. It's a tiny tiny organ and I think it's fragile. And it's threshold is also genetically determined. The interesting thing is that we all (including healthy folks) have levels and sometimes acute bouts of insulin resistance! The thing that made sense to me, reading about this, was that insulin resistance is a function of your muscle cells denying entry to glucose. And the insulin concentration in the bloodstream is a direct function of the concentration of free flowing glucose. Poor Pancreas is only doing its job but the muscles are not taking in any new glucose. They are refusing (resistant). Pancreas tries its best by pumping more insulin and for longer but the adamant muscles are the contract breakers in this arrangement - they don't open the gates for glucose.
The only way to change direction permanently in type 2 is to rebuild muscles which will have better insulin receptors to allow glucose to be shunted into the cells. For this to happen you have to do strength training. Lift sufficiently heavy. (No, not Arnie levels by any measure.)
(I recently read a study that administering testosterone to type 2 diabetics improved their insulin resistance. What happens with testosterone and anabolic steroids? New muscles, that's what.)
Is this better? ->
The common understanding of T2DM is that it is a problem of sugar and therefore diet. That's only half of the equation of the physiology leading to T2DM. We have to also understand the cause of excess free circulating blood sugar and excess calories: muscle cells that have lost their ability to receive sugar. Muscle atrophy and poor muscle composition has to be the second half of understanding and therefore part of management of T2DM.
So, I cut out out all sugary drinks, refined carbs, late night eating (!!) and tried various intermittent fasting / time restricted feeding techniques (5:2, alternate day, one-meal-a-day) and after about 3.5 months my glucose readings returned to the "normal" range. (Which is WAY more tolerable than sticking to a low-calorie diet every single day IME. I still had pizza and cheeseburgers on occasion, just no soda, fries, "junk" etc.)
After around 6-7 months I'd lost 40+lbs, my knee stopped bothering me and no longer had to entertain the idea of fixing it with surgery. I'm now down well over 60+lbs without having put in hardly any effort to exercise (occasional walking) - pretty stunning to me.
Note! This won't work if you have bread with your eggs, or anything else that raises your blood sugar.
He treats a lot of diabetic patients. I've integrated his stuff into my keto diet and lost a ton of weight.
If you wanna get a little geeky about it like I was, could consider buying a Precision Xtra to measure your glucose and ketone levels. For me this was helpful because I could see changes in the numbers after changing my eating habits. Had I not seen that, I would have only my scale to see body weight, and would've just looked at that and thought "looks like nothing changed, maybe this isn't working / doing anything at all." This also allowed me to "gamify" the whole process a bit ("I wonder how low I can get these numbers to go? how long I can stay there?" ... etc).
Losing weight despite not exercising isn't surprising. Exercise, even intense cardio, burns far fewer calories than most people think. I'm about 240 lbs, 5'8", 36 years old, and according to this calculator [0], if I ran a 5k at a fast-paced 10 mph (6 minute mile), I'd only burn about 250 calories. That wouldn't even be enough to burn the calories in the energy drink I might drink before it!
Great work on the weight loss. I was 255 lbs at the beginning of the year and switched out my sugary sodas for unsweetened tea or occasionally a diet soda and lost 15 lbs in 4 months. I plateaued because I haven't changed much else.
[0] https://www.freedieting.com/calories-burned
Contestants on an extreme weight loss television reality show saw their resting metabolism drop after a rigorous program of exercise.
>The group as a whole on average burned 2,607 calories per day at rest before the competition, which dropped to about 2,000 calories per day at the end.
Six years later, calorie burning had slowed further to 1,900 per day, as reported in the journal Obesity.
https://www.scientificamerican.com/article/6-years-after-the...
Another recent study showed that diet effected metabolism.
>a large new study published on Wednesday in the journal BMJ found that overweight adults who cut carbohydrates from their diets and replaced them with fat sharply increased their metabolisms.
After five months on the diet, their bodies burned roughly 250 calories more per day than people who ate a high-carb, low-fat diet
https://www.nytimes.com/2018/11/14/well/eat/how-a-low-carb-d...
Other studies seem to show that the lowered RMR doesn't seem to happen either doing a ketogenic diet (PMC5816424) or with ADF (PMC5042570) vs CR. I also think that the Biggest Loser results are in large part so unsuccessful due to their "crash diet" nature and the lack of any healthy habits being built for maintenance.
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033771/
* https://www.ncbi.nlm.nih.gov/pubmed/26399868
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816424/
* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042570/
I did take up cooking my food from scratch as a hobby, so I was avoiding processed foods and eating out as well.
I field countless questions about diet on a regular basis, and honestly the #1 tip isn't about calorie reduction or low carb or any gimmicks... it just comes down to "start cooking your own food, from real ingredients". Buy fresh meat and produce and go from there. Weight loss and health will come naturally, because real food is far more satiating than the calorie-and-sugar-dense snacks the western world is used to eating.
The only thing that moves my weight down is reducing calories or increasing activity while maintaining the same caloric intake. I suppose it's entirely possible these people are doing the former and just don't know it.
I too follow the same diet to give her company.
Elimination of oil, sugar and dairy has helped, I believe. She is a vegetarian, so flesh was never in the picture. I do not have to restrict calories with raw food. Eat as much as you can.
No juicing, however. That is a totally not allowed.
If only doctors knew how to read internet forums, then they'd be as knowledgable as all the armchair docs here, few (none?) of whom seem to have any actual training or T2 diabetes themselves.
https://en.wikipedia.org/wiki/Valter_Longo#Fasting_mimicking...
https://www.marksdailyapple.com/does-the-fasting-mimicking-d...
[0] https://www.labcorp.com/test-menu/31976/nmr-lipoprofile%C2%A...
[1] https://www.walkinlab.com/media/attachment/file/1/2/123810.p...
[2] https://peterattiamd.com/the-straight-dope-on-cholesterol-pa...
[3] https://www.managedcaremag.com/archives/2018/4/new-test-diag...
[4] https://www.diabetes.co.uk/in-depth/tim-noakes-challenging-d...
[5] https://www.amazon.com/Lore-Nutrition-Challenging-convention...
I can fast for 2 weeks no problem (although that's kinda long and I wouldn't do it if I didn't have enough body fat to sustain it. If you're skinny and don't have fat to spare better not stretch it unnecessarily).
I'm eating keto and I usually only eat once a day.
Fasting feels good. Starving yourself feel horrible.