Further, I don't know what it has to do with race - all humans respond to low calorie diets in the same way. There is the case of lactic intolerance due to loss of a particular gene. I'm not aware of any similar gene being involved in insulin intolerance.
Simply put fat worsens insulin resistance. The mechanism is complex, basically fat causes inflammation that causes cells to not respond appropriately to insulin. This leads to elevated blood glucose and all the effects of diabetes. Remove the fat, decrease inflammation, improve insulin resistance.
Most doctors know how to heal people with type 2 diabetes, at least if you catch it early enough. It is well known that if you lose weight and eat a healthy diet the insulin resistance is reversible (some others in this thread have provided citations showing this).
While not exactly obvious, this has been known for a while now. It even became the position statement of the American College of Lifestyle Medicine to restrict calories as a way to induce remission:
>Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%, while studies with subtherapeutic dosing typically used more moderate caloric restrictions (reducing energy intake by 500-600 kcal/day) and the weighted mean remission rate was 6.9%. Conclusions. Remission should be the clinical goal in T2D treatment, using properly dosed intensive lifestyle interventions as a primary component of medical care for T2D patients.[0]
So while not exactly obvious, it isn't true that "no doctors/scientist know how to heal people with diabetes." The real issue is that people with DMT2 generaly will not accept low calorie diets. But those that do have a high rate of remission and almost all have improved symptoms and decreased progressions.
Edit: I should note that obviously the American College of Lifestyle Medicine would advocate for this. My point is that there is sufficient liturature to back this up.
Wait, how long are people expected to be on 600-1100 kcal/day? Just for a little worse than a coin flip? That sounds really miserable. Isn't that basically a crash diet and no one stfus about not doing those because they can mess you up long term?
I'm really confused how T2D are special such that crash dieting doesn't mess them up further and put them further in a hole. They're already messed up because of the T2D, aren't they?
VLCDs are very safe, much safer than say all the co-morbidities of obesity. The important thing is to chose the right things to eat for those few calories. It also assumes a sedantary office lifestyle with only minimal exercise. If you work out or run you will need more. With these caveats it is safe and effective and works for obesity, type-2 diabetes and some metabolism problems.
It really is that simple. The first law of thermodynamics doesn't go away so simply. Combine that with the evolutionary preassure that favors those who can save and expend energy and this all makes perfect sense. For example, increased insulin sensitivity on a low calorie diet makes sense evolutionarily. The only drawback is that muscle will be consumed as well. The amount varries by person, diet and exercise but it is minimal with a high protien diet. So say eating 500 kcal of chicken brest everyday and the rest of the calories spilt between carbs and lipids would be a good way to do this diet.
"Crash diets" do work as long as you do it for a few months. People generaly do a few days and then start binging >200 TDEE. Obviously that won't work:
>The active stage is characterized by a very low-calorie diet (600–800 kcal/day), low in carbohydrates (< 50 g daily from vegetables) and lipids (only 10 g of olive oil per day). The amount of high-biological-value proteins ranged between 0.8 and 1.2 g per each Kg of ideal body weight in order to preserve lean mass and to meet the minimal daily body requirements. This stage is further divided in 3 ketogenic phases: in phase 1, the patients eat high-biological-value protein preparations five times a day, along with vegetables with low glycemic index. In phase 2, one of the protein servings is replaced by natural proteins such as meat/egg/fish either at lunch or at dinner. In the phase 3, a second serve of the natural protein low in fat replaced the second serve of biological protein preparation. Being a very low caloric nutritional pattern, it is recommended to supplement patients with micronutrients (vitamins, such as complex B vitamins, vitamin C and E, minerals, including potassium, sodium, magnesium, calcium; and omega-3 fatty acids) according to international recommendations. This active stage is kept until the patient loses most of weight loss target, about 80%. Therefore, the ketogenic phases are variable in time depending on the individual and the weight loss target. The active stage generally lasts between 8 and 12 weeks in total.[0]
[0]The management of very low-calorie ketogenic diet in obesity outpatient clinic: a practical guide (2019)
They sound miserable, though, is what I'm saying. How are VLCD people expected to do any sort of fitness or do any sort of mentally taxing labor if they're hungry and running on little nutrition basically all of the time for months? That seems totally unreasonable unless we send obese people to some kind of clinic like we do for addicts, and then how do they adapt back into the real world? Are there any actual studies of people doing this long-term and how this affects their bodies?
I was always told crash diets fuck you up for years. How can this be true and also people are apparently starving for months and that's totally fine?
EDIT: Wait, is my understanding is that you have to starve for up to 4 months for a worse-than-coinflip chance at diabetes? Do we know if it stays off for 5 years? 10 years? Do you have to coinflip again? What happens if it doesn't work?
> I was always told crash diets fuck you up for years. How can this be true and also people are apparently starving for months and that's totally fine?
"Many men and women in the United States diet to lose BW; however, most regain the weight they lost after the diet ends (73). Dr. Kelly D. Brownell coined the term “yo-yo dieting” to reflect BW fluctuations during repeated cycles of diet-induced weight loss and BW gain after the diet is terminated (74). Approximately 20–55% of women and 18–34% of men report weight cycling (75–77). What remains unclear is the impact of weight cycling on cardiovascular health.
Several large studies, including the Honolulu Heart Program (78), the Framingham Heart Study (79), and >9,500 participants in a Treating to New Targets trial (80), have shown a strong correlation between BW fluctuation and rate of cardiovascular events that are independent of traditional cardiovascular risk factors.
A recent meta-analysis of >440,000 participants from 23 studies showed that BW cycling was associated with a 1.4-fold higher relative risk of mortality due to all causes and to cardiovascular disease. The meta-analysis also revealed that BW cycling was associated with 1.4-fold and 1.5-fold higher relative risk of hypertension and CVD morbidity, respectively"
What that means is that if you crash diet and then eat at the exessive rate again your body won't be able to handle it. Eating at the excesive rate is already a risk for cardiovascular health. What the user here said is that "crash diets fuck you up for years" which is not true. There is a refeeding stage that is necessary after weight loss is completed. And even then one should never return to overeating.
To give an extreme parallel, when heroin adicts recover, if they go back they will die much faster becasue their dosage needed for a hit is almost as high it was at the peak but their liver is not strong enough because it shrunk durring their recovery as it wasn't abused as much.
Keeping the weight off requires a permanent change in diet, away from refined carbs. Especially avoid refined carbs combined with fat, e.g. corn chips along with soft drinks.
VLCD diet intervention is associated with improvement in glycaemia control in patients with Type 2 Diabetes. It does not mean it heals from diabetes.
If fasting was a solution, Muslims would experience less diabetes. Yet the prevalence of diabetes in several countries with large Muslim populations appears to be similar to the rates observed in western countries and increasing by 10% per year as a result of urbanization and socioeconomic development.
>>Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%,
If by "heal" you mean something else that is not remission, then you should not have taken issue with "isn't that obvious" as "that" was reffering to remission.
>If fasting was a solution, Muslims would experience less diabetes.
see Table 2 of your linked study:
type 1 type 2
Food intake
More 206 (20.3) 2,025 (18.6)
Less 234 (23.1) 3,284 (30.1)
Same 574 (56.6) 5,594 (51.3)
Fluid intake
More 228 (22.5) 2,210 (20.3)
Less 214 (21.1) 3,312 (30.4)
Same 573 (56.5) 5,356 (49.2)
Sugar intake
More 237 (23.4) 2,452 (22.7)
Less 211 (20.8) 2,677 (24.7)
Same 565 (55.8) 5,688 (52.6)
Weight changes
No change 562 (62.5) 5,286 (54.1)
Gain 161 (17.9) 1,861 (19.1)
Loss 176 (19.6) 2,628 (26.9)
Value of weight change (kg)
Overall population 332 (0.12 ± 3.79 ) 4,367 (−0.25 ± 3.25 )
Patients who fasted at least 1 day 235 (−0.51 ± 3.23 ) 4,152 (−0.32 ± 3.08 )
Patients who reported weight gain 159 (+3.24 ± 2.71 ) 1,811 (+2.78 ± 2.49 )
Patients who reported weight loss 173 (−2.74 ± 1.92 ) 2,556 (2.39 ± 1.61 )
Critically, the ramadan fast is not a very low calorie diet. It isn't a diet at all. A very low calorie diet is not a fast. So your whole point is invalidated.
Robert Lustig has been giving the same presentation for over a decade showing statistics that people who stop eating sugar can reverse their type 2 diabetes.
In South India, they have a carbohydrate-rich diet. So when you get hit badly with T2D, you switch to fish, limited brown/red rice, and veggies. In most cases, all of your medication stop if you maintain your weight and diet with exercise. Unfortunately, only some maintain a diet and healthy weight. Even 10 kg weight loss gives far better control for T2D.
From experience if you just try Keto for a couple of months you start to realize how much sugar/carbs are in absolutely everything in the western diet.
Even though I don't practice it religiously I still don't eat 90% of the arbitrary carbs I used to consume. Easiest: not drinking Coke/Juice or anything besides water or zero-carb flavoured carbonated drinks (buy a Sodastream + $50 citrus press and add your own fruit/Erythritol), coffee or tea with stevia, etc.
That plus Allulose simple syrup or those White Claw style drinks:
There's a long history of studies showing Low-Calorie Diets as being effective for reversing T2D. The late Sarah Hallberg wrote a narrative review that I liked a lot a couple years back (see section 3.2 for the part on LCDs): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/
Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients. 2019 Apr 1;11(4):766. doi: 10.3390/nu11040766. PMID: 30939855; PMCID: PMC6520897.
> Furthermore, long-term achievement of diabetes remission, adherence to the diet, and weight loss maintenance after the diet remain a challenge. Studies have also suggested that physiological and metabolic adaptation of the body in response to caloric restriction may shift energy balance and hormonal regulation of weight toward weight regain after weight loss [67,68]. Thus, it is crucial that future studies are directed towards assessing the long-term sustainability of diabetes remission led by LCD and feasibility of this diet on the physiological adaptation and body composition changes.
The basic problem, which has been unchanged for decades, is that hardly anyone actually follows the "proper" diet on a long-term basis without some kind of surgical or drug treatment. Despite weight loss being a massive industry and a very common goal, researchers routinely struggle to find study subjects who have maintained significant long-term weight loss without medical interventions, to the point that there's a special registry to keep track of such people for scientific purposes [1].
Seeing that there are more than 10 thousand US people in that database, which is unlikely to be complete, I do not think that "hardly anyone" is the right term.
Nevertheless, I agree that such people might be a very small part of those who lose weight.
About 15 years ago, I have lost about one third of my initial body weight during almost a year, and then I have kept my desired weight until today, without any kind of medical treatment, either surgical or drug-based.
Nevertheless it was not easy and it required a lot of thought and experiments with the diet, until I have learned how to control my weight, after many years during which I had believed that this is impossible. It also required completely dropping many bad habits, for example drinking commercial juices or eating commercial mixes of yogurt with fruits or eating various kinds of "breakfast cereals" or any other such commercial products containing an excessive amount of sugar. I have never eaten or drunk again any of the products that I have blacklisted, even if they were among those that I had eaten or drunk daily, for many years.
I believe that most people are not introspective enough to succeed in changing so much their habits by themselves so they need some kind of external help. The main obstacles for weight control are psychological, not physiological, i.e. those who need to control their weight must learn somehow to love to eat food that is different from what they had been eating, because if they will ever revert to their old eating style, then they will certainly also revert to their previous weight.
> Seeing that there are more than 10 thousand US people in that database
The census.gov says there are a little under 260 million adults in the united states, and we know obesity is something like approaching 40% of these adults, so 104 million.
10,000 is not even one thousandth of a percentage point of the obese people of the untied states.
For contrast, a disease is considered rare if it occurs 1 in every 1500 people in the united states. A person who un-obesity's themselves into healthy weight is literally a magnitude rarer than this.
Most people don't announce to scientists that they've lost weight. Lot's of people do lose weight and stay that way, it's just that there are even more who don't.
Consider that the rate of obesity continues to increase in the US. This shows that people are simply eating more and doing less exercise. And of course those that are already obese are the least likley to consume healthy ammounts of food and exercise as needed.
In other words, yes, the issue with overeating is in fact overeating. The only way to solve this problem for the whole population (as in, not for a single individual) is to change society and how it views unhealthy food. Off the top of my head, fast food advertisments should be made illegal. The entire point of those ads to get people to eat fast food. This single step could reduce obesity in the US by a noticable amount and requires no loss of freedom to any individual. A sugar tax or the like is a more extreme solution. But this idea is not unfounded:
>Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.
-Adam Smith
Book V: On the Revenue of the Sovereign or Commonwealth
Chapter III: On Public Debts
> Off the top of my head, fast food advertisments should be made illegal
This is ridiculous. Nearly everyone I know who is overweight eats hardly any fast food.
What I do see is lots of snacking throughout the day on high carb things (chips, breads, etc) and just way too many calories due to large serving sizes in both regular “slow food” restaurants and meals made at home.
Fast food meals if you skip the sugared soda tend to be closer to proper per meal calorie targets than sit down restaurants because of how cheap they are.
At sit down restaurants the price is higher to support a wait staff and lower throughput so they compensate with ridiculously huge portions.
Apparently one major issue with fast food is the hyperpalatability.
For example, when I visited my family in the states, I ate two double cheeseburgers at a fast food joint at 1000+ calories per burger, and I figured I could probably eat two more in that sitting without issue.
In other words I ate 2000+ calories in a few minutes and could have kept going. Even one burger has more calories than I eat in a single meal.
Meanwhile, I couldn’t eat 15 medium sweet potatoes (1000 calories) in one sitting.
But why would you do that? I think it's just calorie density and behavior. You might just as well have eaten a bucket of ice cream as fast as you could. I.e. before your rising blood sugar has a chance to stop you.
Though I do think the public would be better off if they replaced the bread with lettuce or something. It seems like they're willing to do that anywhere I've gone.
It doesn't help that these calorie dense food are hyperengineered to trigger our hunger more. A personal prohibition seems to be the only way to tackle this.
I know there are people out there that could eat 2 double quarter pounders, but I doubt any of them are at a healthy weight - except for professional eaters and possibly teenage boys.
One, along with fries, is enough to fill me up for practically the whole day. I think fast food gets a bad rap. It’s calorie dense but with all of the fat it keeps you pretty darn full.
Compare that burger with a few candy bars or not all that much soda…
You are right that I should not have singled out fast food. Included would be grain based desserts, soda, alcohol and maybe others. Grain based desserts and soda together make up 12% of caloric intake alone[0] and serve almost no nutritional value while providing little satiety.
Another point, while I did say that "The entire point of those ads to get people to eat fast food" what I really meant is that they make people want to eat in general[note 1]. What this means is that fast food ads can be harmful even if they do not cause the viewer to buy fast food. What this does is contribute to a culture of consumption which is part of what I meant when I said "The only way to solve this problem for the whole population [...] is to change society and how it views unhealthy food." I did not mention sit down restaurants because they generaly do not advertise. My suggestion was "off the top of my head" and not fully thought out. I'm glad you made your comment because I did not express my reasoning clearly.
[note 1] That is, the "point" of the fast food ads collectivly are to generate a demand for fast food from the point of view of the advertisers, but the effect, while more pronounced for fast food, generates a general demand for caloric intake.
> I did not mention sit down restaurants because they generaly do not advertise.
They do in the US. TV adverts are littered with ads for national chains (Olive Garden, Buffalo Wild Wings, Red Robin, etc).
Media that allows more targeted local stuff (Facebook, billboards, newspaper, Google maps, etc) is plastered with ads for local sit down restaurants. If anything these ones advertise even more because they don’t have an established mindshare.
I actually have a different take on what the "basic" problem is, having done a fair amount of research (reading a lot of biomed research & studies over the past few years) and personally effecting (and more or less maintaining) a huge improvement in my own metabolic health. [1]
To me, it seems obvious that sustaining a low calorie diet (LCD) long-term is basically impossible (from a maximal fat oxidation and, even a thermodynamics perspective). On the bio-mechanistic side, it's also important to note that hyperinsulemia inhibits lipolysis [2], which is one factor that is also usually not taken into consideration. Anyway, while a LCD may be effective for a while (maybe even years), it's probably quite miserable and almost by definition, can't be a sustainable lifestyle change. Even as a short term fix, it may not a very healthy and might be counter-productive long term... [3]
To me, the biggest problem is that T2D is in many (but, to be clear, not all) cases, the end stage of a metabolic patho-physiology that can be identified by other markers (as simple as WtHR, or cheap labs like fasting insulin, or NAFLD indices) that are cheap and easy to measure, but from my experience, most clinicians are completely unaware of this. Which is too bad, since the overwhelming majority of their patients in the US these days (over 80%) are suffering from metabolic diseases. [4]
Over the years (I moved a lot) I've had close to a dozen different primary care providers, and diligently did my annual health checks, all while slowly putting a couple pounds each year and none of them were able to give any useful treatment or even medical advice as my MetS markers crept up. I had to figure it out myself - in fact most gave bad advice and weren't even measuring or diagnosing the right markers. The real kicker to me is how cheap some of these tests are (fasting insulin is <$10 more to test even if you're paying out of pocket and is required for useful indices like HOMA/2-IR and NAFLD LFS, but most GP's won't request this test even if you ask them too)...
I'll also mention that both from the literature [5] and my personal experience [1], some of the worst damage can be reversed in a matter of weeks. I did labs right before I started my diet changes and 1-month in, and even in a single month my TGs and my liver numbers moved from unhealthy to healthy ranges.
As for sustainability, there are some lifestyle treatments like Virta's that have shown better than medication retention rates and efficacy, so it's possible to do... https://www.virtahealth.com/outcomes
How do they do it? A combination of responsive/actionable biomarker monitoring/feedback coupled long-term coaching and peer-support groups. Not impossible and way cheaper (and better quality of life!) than any pharmaceutical alternatives.
Yes, this has been shown in other populations already. I think the highlight of this study is that it worked in South Asians also, as some might question if genetics/ culture play a particular role. This adds to the evidence that weight loss works for diabetes in all ethnicities.
It's worth checking that "obvious" advice works in different populations because it doesn't always.
For instance African Americans have high blood pressure at an elevated rate and many of the medications that work well for other Americans don't work well for them. It's important that this population gets studies about treatments that work for them.
I read a transcript of an endocrinologist suggesting intermittent fasting (don’t eat after 6 and wait as long as you can before your first meal - start with 10am and keep pushing back as long as you can). Then eat only veggies for your first meal, then veggies and a deck of cards serving of meat for dinner.
Honestly, it sounds very difficult, but the doctor seemed very confident that this works. I have started trying this (not T2, but need to lose weight)
Anecdotally, a lot of people have suggested keto and low-carb diets having been successful for them.
yep, same deal with exercise. Doesn't matter how, I just wanted some type of movement that I could get into the habit of. Tried a bunch of different activities but was not able to form a habit until I got a rowing machine and even then I still have days where I don't want to use it :)
This is definitely an exception, one would be deficient in just about every (micro)nutrient and therefore expire much faster than a normal human. While also being much more miserable.
Oh, I guess we're taking this candy diet suggestion far more seriously than I originally thought.
It wouldn't require a whole lot of thought to come up with an all candy diet that supplied the minimum necessary nutrition. How broad is our definition of "candy" for this? Are you willing to consider candied fruits, vegetables, and bacon? Chocolate covered things? How much dark chocolate would we have to add to something to consider it candy?
Mostly agree but if your diet is particularly bad, just eating less will mean existing nutrient deficiencies are magnified and (probably for this reason) you'll feel more hungry than you need to, increasing the chances you give up. IMO.
When losing weight, it is important to continue to eat a normal amount of proteins, essential fatty acids, vitamins and minerals.
Only either the carbohydrates or the (non-essential) fats or both must be reduced. It does not matter which of them is reduced, as long as the total calorie amount is restricted enough. It may matter only due to personal preferences, which may make one variant or the other easier to support.
One must use some digital scales for measuring the weight every day at precisely the same moment, because the weight varies during a day by much more than the difference between 2 successive days. An appropriate rate of losing weight is between 100 grams and 200 grams per day, e.g. about 1 kg per week. If the measurements show another rate, then the amount of daily food must be increased or decreased until the rate is in range.
Regardless with which diet you start, if you adjust the amount of carbohydrates and fat according to the daily weight measurements, in a week or so you will converge to the right amount of daily food. However, this requires to measure by mass or by volume all the food eaten. Those who do not succeed to lose weight fail because they either do not measure what they eat or they cannot abstain from eating more than what they have planned to eat.
Losing the weight is the easier part. More important is to plan a diet for after reaching the target weight, a diet that will keep the weight constant, i.e. which must still be calorie-restricted, but at a normal level, and which must be appealing enough, so that one would never be tempted to eat again in the way that caused the overweight in the beginning.
> One must use some digital scales for measuring the weight every day at precisely the same moment, because the weight varies during a day by much more than the difference between 2 successive days.
or just do a moving average over some days. Works better.
I have lost 1 kg per week during almost a year, with a considerable health improvement at the end and no negative effects, except obviously, the hunger.
At the time I have studied a lot the existing medical literature, and this was the recommended rate, so I have adjusted the diet so that the weight loss per day would oscillate around 140 g per day.
The weight must be measured every day in the same physiological conditions, i.e. in the same order relationship with respect to the various activities that modify the weight, like eating, drinking or eliminating their products.
A good moment would be in the morning, immediately after waking up and relieving yourself.
If one would eat in the evenings wildly varying amounts of food, then the weight in the morning could be affected by a noise due to variable amounts of food that is not completely digested yet. However that would not happen when one is eating a calorie-restricted diet for losing weight, when one would have to eat about the same minimal amount of food every day, which would be quickly digested.
While I was losing weight, I could see very well every day its evolution to the grams, and the effect of any change in the diet. Sometimes I succumbed to the temptation of eating like before starting to lose weight, and after such days I gained weight in a day almost as much as I was losing in a week, which increased the time until reaching the target weight.
The average recommended amount is usually about 2 kg a month, actually. 4 kg is absolutely massive and I don't think it's sustainable for most people.
I eat the same stuff every day, weighing myself after going to the bathroom, etc, yet my weight easily varies at least 500 g from one day to the other. And if I eat just a little bit more carbs in a weekend, then well, it's like 2 kg of extra water weight on Monday.
The recommended rate of losing weight might have changed meanwhile.
I have lost weight (from around 120 kg to around 76 kg) about 15 years ago.
Nevertheless, I believe that if care is taken so that the calorie-restricted diet still includes a normal amount of all nutrients except carbohydrates and non-essential fat, 4 kg per month, like I did, should not cause any health problems.
Unfortunately, I have seen too many suggestions about how to lose weight that do not pay enough attention to provide all nutrients. Such diets can be sustained for a few weeks, but not for longer durations, like a year or more, which are needed when the required weight loss is great.
My weight can vary from day to day exactly as much as yours, but nowadays it rarely does.
The main difference between how I eat now and how I was eating before losing weight is that previously I was eating until feeling sated, but now I always decide how much to eat before starting to eat, so for most days the energy intake is similar, so the weight oscillations are small. When I happen to eat a more copious meal, I compensate the next day, mainly by cutting the carbohydrates during that day.
Fad diets like intermittent fasting or keto will pop up anywhere anyone’s talking about weight loss or health issues sometimes associated with being fat. It’s not particular to HN and it’s sadly not going to go away :-/
Sorry to say but you're mistaken, these are all fad diets and it's not really disputed. If you think they become elevated to something greater because of a few hangers on who haven't switched to Dr McFuck's Green Purée diet (or whatever the next one is) then you're mistaken - there are still people on Atkins, for example, a classic fad diet.
The pattern is that a miracle diet is announced that promises guaranteed results, over the course of a few years a load of people get on board, each individual loses a lot in the first few weeks but most gain it back (true for all diets). In the meantime people make bank selling courses and books and pitching it as the central component of their Success Win Lifestyle, until the next one comes along and the cycle repeats.
If one of those fad diets are working for you, great - stick with it. But don't worry, there will always be another one around the corner.
Low-calorie diets are a poor gateway to weight loss and health, where low-carb counts tends to do the real work. Calorie-counting typically leaves people hungry when they should just be eating better food.
Mediterranean, paleo, vegetarian, low-calorie etc diets almost always achieve the same low-carb goals, but low-calorie is the least practical...while sadly also being the most popular.
Just telling people to "eat less" is never an effective solution. There's a severe lack of good studies showing low-calories actually lowers weight long-term. The fact this study has 25 people is typical.
If you can eat a stable amount of food until satiety (still not-excessive amounts) while still achieving the same health/weight goals then obviously that would be the best solution.
I've asked before on HN to send me a study showing low-calorie diets are effective at reducing weight longterm and I still haven't seen one. Yet low-carb and type 2 diabetes go hand-in-hand with other treatments (most importantly pre-diabetics which is critical).
This happened to my grandmother! I frankly never believed it because we're taught one cannot go into remission, but one day in her 60s she no longer had to manager her diabetes.
The amount of calories per day caught my attention, 850kcal/day with diet replacement products. I understand that with medical supervision, there is less risk of malnourishment or nutrients deficiencies.
The general advice, even from my primary care physician, has been that anything less than 1200kcal/day is dangerous and is crash dieting. Looking around, I found this other study studying total diet replacement providing 810kcal/day as the sole food for 12 weeks, showed significantly greater weight loss compared to standard counseling and modest energy restrictions. The difference in weight loss was measured at 12 months. (BMJ 2018;362:k3760 [1])
25 BMI, which the diabetes study used in addition to T2D, is not considered clinically obese in the US. 25 BMI is the line between clinically normal and overweight. I wonder if crash dieting is advised against on the assumption that most people will go back to unhealthy eating habits instead of changing their diet, and also become more likely to fall into binge-restrict cycles. It's easy to imagine that if someone is able to make meaningful changes, crash dieting is more effective than most other methods.
Interesting, when I lost 80 pounds doing a ketogenic diet my appetite leveled off at exactly 1200 calories per day. I wasn’t counting calories out of anything other than curiosity as I was losing weight anyway. Getting even lower would have been pretty difficult.
I did a lot of ketogenic diets when I was younger in an attempt to shed all of the weight that comes with being raised in Appalachia. It was my experience that it was a great kickstart to a weight-loss plan for someone who was at rock-bottom health and needed fast results while not feeling like you're starving.
But I feel like it taught me to be bored with eating, and to establish a more healthy relationship with food. High-fat, mid-protein, low-carb sounds terrific for the first day or two but once you're two weeks in, you're so sick of it all that you'd just as soon drink some water and get back to whatever you're doing.
Well I mean it worked for me because if I eat sugar I end up consuming something on the order of 4000+ calories per day. Something about carbohydrates makes me absolutely ravenous for sugars.
Also if I don’t eat right as I feel hungry I’ll feel as if someone has gut punched me. I get absurdly hungry.
Even artificial sweetener leads to craving carbs in my case.
As for the "gut punch" though, sounds like gastritis or something. Unless you're being metaphorical. For me, water helps when I'm fasting and stomach pains start.
This feeling is so intense for me that I’ve come to believe it’s something to do with the carbs and my gut microbiome changing. There’s a 1-2 week delay between changing diets and having these hunger pains start/stop that makes this feel more credible to me than insulin response changes or diet boredom. But: one should not treat N=1 subjective experiences as having any real value.
My "hunger pain" is tied to the some combination of the gut biome and the blood sugar cycle. It initially insists that I should eat frequently. If I persist through it, then an hour or two later, it settles down.
Likewise, I've noticed an effect develop with artificial sweeteners where I can have small amounts without difficulty, but if I start consuming it several times in a 48 hour span, I get cramps.
In periods where I've become addicted to carbs hunger pain is much stronger, but I've been able to keep it down for many years now. So if you're getting it intensely, your gut is probably still reactivating to its old profile.
I believe restriction in the regular diet is one way of correcting it while staying in a routine. But I have also experimented with fasting, intense exercise, hot/cold contrast in the shower, and breathing exercises, and the common theme to each is to challenge homeostasis in some fashion. Obviously there's always some danger in going too far, but if our norm is total comfort, we can definitely drop some aspect of it from time to time.
> It was my experience that it was a great kickstart to a weight-loss plan [...]
Part of that might be from less water retention early on.
Your body holds on to more water when your diet is full of carbs. As your liver runs down its glycogen stores and you eventually go into ketosis, you lose a lot of water. That's also there the early 'keto flu' comes from, which is a bit like a hangover; plenty of fluids and electrolytes fix you.
Losing water looks great on the scale. On the one hand, it doesn't actually do anything for you healthwise. On the other hand, losing that water ain't bad for your health either (assuming enough fluids and electrolytes), and is a great motivator for the kickstart you described.
> The general advice, even from my primary care physician, has been that anything less than 1200kcal/day is dangerous and is crash dieting.
Wouldn't this advise need to keep in mind absolute height? BMI tracks the ratio between the height and weight, but it does nothing to tell the difference between a short thin person and a taller heavier (but same BMI) person. The latter which would need more calories than the former. I know people who eat ~400 kcal less than me per day, because they are shorter and similarly thinner. Following that why wouldn't their crash diet threshold be sufficiently lower?
The argument I've heard is that the other nutriments needs (vitamins, minerals, etc) don't scale as much with height. So even a very short person would have a vitamins/mineral deficit on less than 1200KCal per day.
How true is it? I don't know. But even then I don't see why they couldn't take multivitamins.
Many American diets are calorie/energy rich and nutrient poor. If you're eating 400 calories of healthy food you're probably getting several times the vitamins and minerals of the average American eating 2500 of fried, sugary food.
Yes, we Americans overeat beef / Hamburgers, but I don't think anyone eating burgers is at huge risk of malnutrition... as much as a risk of heart problems, diabetes, cholesterol, etc. etc.
It turns out that a standard burger with beef, ketchup, lettuce, onion, and bread covers most of your macro, and even micro-nutrients. It also is way overboard on salt and fats, but... that's not the particular problem here.
One of the bigger problems vegetarians have is finding a proper replacement of meat and all of the easy nutrients meat contains. All amino acids, various vitamins, iron, etc. etc. There's a fair amount of nutrients here.
And even the worst McDonalds burger contains a variety of lettuce / onions / ketchup that covers few nutrients that beef is missing (ex: Ketchup has Vitamin A, Potatoes / Fries has Vitamin C).
>And even the worst McDonalds burger contains a variety of lettuce / onions / ketchup that covers few nutrients that beef is missing (ex: Ketchup has Vitamin A, Potatoes / Fries has Vitamin C).
The amount of lettuce, tomatoes and onions is so minimal I doubt it contributes to your vitamin intake in any useful manner. If you eat a salad you get 50x that amount of those vitamins.
"Yes, we Americans overeat beef / Hamburgers, but I don't think anyone eating burgers is at huge risk of malnutrition... as much as a risk of heart problems, diabetes, cholesterol, etc. etc."
Pretty strongly disagree here. US Beef consumption is about the same as in early 1900's, which was a time where personal health in several metrics was far better. (Weight being the obvious one)
Always very skeptical when people talk about cholesterol, it's a really nuanced
topic, but the average person seems to be stuck in the 1970's with "cholesterol bad". Thinking high ldl is always bad is only slightly better.
It can be frustrating how studies always lump in processed meat with unprocessed meat. Unprocessed meat is nearly google-proof, since every media outlet is busy broadcasting the evils of "red and processed meat" like they're inseparable. Seems like the cholesterol argument regarding meat itself is basically the main one left.
Yes, beef is an excellent nutrient, but my point is that the majority of calories in a typical burger meal do not come from sources like beef. A Big Mac meal only has 180 calories from beef, and 1320 calories total. The vast majority of calories in the american diet are sugars and oils.
If you eat only the beef and veggies from a Big Mac three times a day you'll get plenty of vitamins and minerals with minimal calories (~650 calories)
If you eat the three entire Big Mac meals you won't get any more essential nutrients to speak of and you'll consume far too many calories (3960 calories)
The average american has junk to cut from their diets with no nutritional loss whatsoever. Typically fried and sugary foods.
You can supplement all your micronutrients with barely any impact on calories consumed, so this is going to depend specifically on what you’re eating/supplementing.
It is possible to have an adequate intake of proteins and of most vitamins and minerals with only about 600 to 800 kcal.
Practically pure proteins can be provided by turkey breast or chicken breast, adding e.g. around 300 kcal for an adequate daily protein intake, and the rest of the food can be composed of non-starchy non-sweet non-oily vegetables, which provide only about 20 to 50 kcal per 100 grams. One could eat more than 1 kg of various such vegetables without exceeding 800 kcal.
There remain a few things that would have to be taken from supplements, e.g. omega-3 fatty acids, vitamin B12, vitamin D3 and vitamin E (which is abundant only in high-caloric food, like olive oil or almonds). The simplest is just to take one pill per day of those offered by various vendors, which include all the essential vitamins and minerals, to be sure that none of them is insufficient.
A little vegetable oil would be needed for linoleic acid.
My understanding is that 1200 kcal is independent of height or weight. I was told that the rough calculation was based on the lower estimate of basal metabolic rate and then subtracting a couple hundred kcal.
We both come from a South Asian background and discussed how the number would change for a home cooked vegetarian diet which is more nutrient dense but low in protein, and I was told that would lower it below 1200, but he didn't feel comfortable recommending that diet unsupervised. He emphasized that I should decrease calories by removing carbs, then fats, then proteins. And that I should prioritize eating proteins above fats and carbs, especially if I planned on increasing the amount of exercise I did.
I asked him if the 1200kcal was net or gross. For example if I did 2 hours of moderate exercise, should I eat back 400kcal+ to maintain a net 1200kcal. He didn't have an answer for me, other than saying, if I start to feel weak or lightheaded I should immediately stop exercising. I don't have pre-existing conditions related to blood glucose, but I imagine that would would change many of these guidelines. I was told to stay mindful of hydration.
The stories I hear of fasted work outs is the reason I asked him about low calorie diets. My non professional intuition makes me believe that even intense cardio should be okay, but moderate or heavy resistance training should be avoided on a low calorie diet.
Your understanding is incorrect, and not based on any actual science. Energy needs are highly correlated with body size (and other factors like activity level and genetics).
The few times I have tried to do intensive resistance training, above 60% of my PR, I have started feeling weak after the second or third day. I don't use caffeine for pre-workout. This might not be common, but I personally experienced a significant increase in exercise induced syncope and near-syncope when fasted.
I also imagined that muscle recovery would be less efficient or take longer from a fasted state. I have hit rowing/ERG goals and made time improvements so I feel comfortable saying that fasting doesn't hinder my cardio.
I understand that energy goals are correlated with body size, we were discussing a general minimum kcal threshold for unsupervised dieting. I am unsure why you feel estimated BMR/RMR - 200 kcal is unscientific. I was told that without supervision, it would be hard to ensure proper nutrition on a very low calorie diet. Additionally, he expected that some people would fall into a binge-restrict cycle because they can't sustain their usual energy level.
I was additionally curious because there have been days I forget to eat, and thinking back I realized my total calories for those 24 hours totaled less than 600 kcal.
Basal or resting metabolic rate varies tremendously between individuals, primarily based on body size. There is no scientific support for your claim of "1200 kcal is independent of height or weight".
Fortunately it's fairly cheap and easy for people in developed countries to obtain an RMR test. This can then be used as a personal baseline to calibrate diet plans.
Evidence needed: define "dangerous" in terms of micromorts based on what BMR and demographics (i.e., age, BMI, FFMI, height, gender)?
There are risks to ponder about how critical (e.g., time vs. dangers) it is to get to a healthy weight. If someone dangerously obese maintains hydration, electrolytes, vitamins, and enough lipids to empty the gallbladder, getting to a low adipose tissue state, resetting insulin, ghrelin, and leptin sensitivities, and reducing the likelier risks of cancer(s) seems like a good tradeoff than either lap-band surgery or slow/plateau weight reductions.
Intense hunger goes away after about 72-80 hours of "starvation", however brain fog and low energy dominate. Careful "starvation" dieting down to slightly underweight isn't something one can do without several months of spare time, ready access to healthcare, and immense self-control. Afterwards, self-control is absolutely required to avoid binge cycles.
GLP-1 agonists are expensive but interesting crutches to get there slowly.
It is likely that over millions of years of natural selection, the human body is far more tolerant of borderline starvation conditions than being stuffed with HFCS. Many types of cancers associated with Western diets are likely due to the human body becoming more hospitable, whereas chemotherapy and starvation add cellular stress that kills off malfunctioning cells. It's likely no accident whereas CHD, gout, diabetes, high cholesterol, and cancers are the consequent of unnatural diets and lifestyles.
I was thinking about grafting on a rapidly-dividing, malignant neoplasm.
(I actually donate whole blood and platelets often.)
If someone were carrying around an extra 250 Mcal in adipose tissue, multiple factors determine what their risk budget could/should be to downsize to a suitable homeostatic state.
David Goggins lost 100 lbs in 3 months on an 800ish calorie diet. I’m not recommending that… but what you can accomplish when you own it versus doing it for other reasons is probably significant too. Especially for when the “diet” (or whatever word is preferred, a la “intervention”) ends.
I lost 60 lbs over a couple of years and set a state lifting record for my age group. I love what I do and kept the excess weight off. I got good at what I do and the intrinsic reward still burns, even though I’m not lifting for records anymore. I wake up every day ready to go hard for at least 50 minutes. It doesn’t take me more time than that to stay in shape, but I do eat consistent with my goals.. which is the harder part.
I personally think someone needs to really own their desired outcome and then there are many valid and healthy ways — and even more “effective” ones — to get there. Hard to measure “own” though. Measuring every different kind of modality is generally missing the point. We actually know how people get in shape and stay in shape. The problem is generally in the mind.
100 lbs in three months is ~1lb/day, thus a deficiency of 3500Cal/day. His maintenance intake would have been 4300Cals/day. That seems insanely high - what was his weight?
He started north of 275 lbs if I remember. He was working out 3x a day. There are lots of videos out there about it. He was also overweight when he started, and he was going into hell week (military) so the first n lbs of weight would come off “easy”.
> David Goggins lost 100 lbs in 3 months on an 800ish calorie diet.
Losing weight that fast generally means it comes back pretty quickly as well.
> I lost 60 lbs over a couple of years
That's a much more reasonable timeframe. It's almost like we have to trick our bodies into finding a new metabolic balance. Do it too quickly and it just rebounds. Do it more slowly and it seems to be more sustainable.
dumb question: how easy is it for the average person to go from an “American” diet high in addictive things like bad fats, corn syrups, processed foods, etc. etc. to a “clean” 1200kcal diet?
I was under the impression it was like trying to fight drug addiction and the chances of you sustaining it and not relapsing/making up the missed calories later as near impossible for most once you’ve become addicted enough to things like Diet Coke, Chik-Fil-A, etc.
I lost about 50 pounds in ~3 months simply by cutting my carb intake to about 20g/day (eating just non-starchy vegetables, meats, sugarless dairy). This was moving from an “American” diet overnight to an extremely low carb diet. My caloric intake actually went up slightly.
As for being difficult… yeah. The transition sucked. Body aches, headache, and very slight case of the blues. It took willpower. After about 3 days, I was okay. It was similar to quitting smoking for me, except that quitting smoking didn’t give me body aches.
for me, it was just eating rich flavorful foods that also happen to be healthy
what i did was cook for myself so i can reduce vegetable oils, salts, artificial flavorings etc, then cook things like fresh tomato sauces with fresh basil/oregano, fresh fish cooked slowly in plum sauce, chana masala curries with low sodium and delicious spices etc etc
once you get used to healthy, satisfying and flavorful "good" food, carbs, salt, oil and junk food cravings faded away and buying snacks after that was just not satisfying at all...
You’re hitting the nail on the head. Sustainable dietary changes require finding foods you like to eat. If you live in West Hollywood there is no shortage of delicious healthy meals you can go out and buy. Outside of similar environments you need to learn how to cook or the healthy meals available to buy at restaurants are going to taste terrible.
It's not fair to assume every person is going to become addicted to things like diet coke or fast food. "American" diet has room for a lot of clean eating. Processed food shouldn't be considered the same as "American" food in my opinion. Convenience driven food choices is cultural in America but that doesn't make the chosen food American.
I think something like Tex-Mex would easily allow for clean eating. Avocado toast, with whole grain bread is fairly healthy and was an absolute favorite of mine after workouts and I would consider it "American" food. Tacos are a great way to have good portion control and also feel filled. Allowing non-traditional recipes opens many options. Avocado grapefruit salad on tortillas with fried tortilla strips is a recipe I came across recently that I really enjoyed. I think non-traditional is the essence of true "American" food.
For fast food, Popeye's Blackened tenders are not breaded, a 5 piece serving is listed at 280 kcal compared to the classic tenders being 740 kcal. Nuts or apple slices with peanut butter is a fairly filling snack and can easily fit within 200 kcal. The main thing you would have to look out for is sodium if cooking at home is difficult. I know most of my bodybuilder friends go to a diet of chicken breast and brown rice for dinner for months at a time when they want to cut. It's around 400-500 calories depending on how you prepared it.
Vegetarian and vegan recipes are good starting points for cleaner eating too. Borrowing from other cuisine makes it a lot easier as well. I love preparing vegetable side dishes for dinner in the way it's prepared for Korean dishes. Miso soup is fantastic for when I have food cravings late in the night. It's not "American" but I'd argue there's nothing more American than making microwave miso soup at 3 am in my star wars mug. Coffee is popular too, and is very low calorie if you can get used to no milk or sugar, or only sugar alcohol/substitutes.
For some context, I grew up and live in one of the most culturally diverse states and counties in the US. I know that not everywhere in the US has the same diversity of food options, but I would argue that Amazon has done a lot to make food accessible.
I have seen this claim many times, but have never seen a credible source claim it is conclusively known, at least at the amount of low calorie sweetener that are in 1 service if 8oz to 20oz of Diet Coke.
It seems either this is extremely tricky to measure, or it is a myth (like aspartame or MSG or yellow 5 cause cancer or whatever).
I don't know. But instead of aiming for a calorie target I'd suggest trying https://www.mostly-fat.com/eat-meat-not-too-little-mostly-fa... for a month. Even if you decide not to stick with it, it's a very palatable break from your addictive foods. (I'm on basically that now, though I didn't come to it directly from a "standard American diet".)
Going on less than 200 calorie diets for days or even weeks on end was the norm in humanity for millions of years so how is it unhealthy all the sudden? It was a time of constant mass feast and famine alternating from one to other. The problem now is we have the feast part down pat but no famine
In general something being normal for humans for millennia does not mean it was healthy. It was normal to have incredibly painful teeth, probably not healthy. It was normal to die before reaching adulthood.
It is entirely possible that something that was done for a long time is a healthy thing just as it is entirely possible that it was a terrible thing that we conquered with knowledge and abundance. Evidence is what tells you if the thing falls into one of those categories.
I like living in a time where we are outraged if children in our community die and in cases where there was nothing that could have been done we want to do research to find something we can do in the future. That was not normal for millennia until really very recently and it seems healthy to me?
> It was normal to have incredibly painful teeth, probably not healthy.
Is this actually true? I thought archaic humans had much better dental outcomes because their diets had a small fraction of the sugars that modern diets do. Could be wrong but I was definitely under the impression that poor dental health was more a function of modern diet and not something that necessarily existed throughout history.
I'm no expert, this could be wrong, what I was told by an ancient historian was even the Pharohs with all their wealth had terrible painful teeth from sand in food which was ubiquitous until fairly recently. I have recollections of dental records of pre-historic persons being reported as pretty nasty.
Feel free to nit-pick that example, there are an absolute plethora of others. When did surviving appendicitis become a thing? What was the median life expectancy for a newborn baby at various times in history? Calling out the fetishism of humans in a "natural state" needs to be done. Just as there are things we can learn from our pre-historic existence. Evidence is obviously the required thing not just amusing anecdote about how we have totally "lost our way."
Yeah I should’ve made it clear in my comment that I agree with you, I think the fetishism of pre-historic humans is a little odd. Of course there’s things to learn, but it’s strange to think that a period when you died from something as trivial as a minor infection is somehow ideal. I was only nitpicking on the dental thing, because eating so much sugar really is relatively new in human history and is the source of a number of health problems, beyond bad teeth.
Probably not so modern in regions with native sugar cane? E.g. doesn't jaggery (unrefined cane sugar reduced to a semi-solid block) production in India and thereabouts go back centuries?
Certain palms are also (and have been for... Again I don't know, but I believe 'a very long time') 'milked' for a sugary sap that's drunk fresh or fermented.
Yeah, this seems inaccurate, tribes in Africa that still live hunter-gatherer lifestyle have good teeth without cavities. It changed after humans moved from hunter-gather to agriculture.
My doctors have always said that losing weight too quickly results in the metabolization of one's muscles and other important, healthy tissue in addition to fat. Could it be that crash dieting works narrowly to solve, for example, diabetes via the loss of fat, but has other negative consequences for the body? Maybe it's not a "doesn't work" thing, but a "collateral damage" thing or a "makes it harder to keep the weight off" thing, which is another old saw of why you shouldn't lose weight too fast?
Weight loss always involves some loss of lean tissue in addition to fat. Dieters can mitigate this to an extent by protein intake high and maintaining an exercise program.
And sleep. It's rarely mentioned, but the difference between good and bad sleep may mean the difference of 80/20 fat/muscle loss, and 20/80. If the numbers are true (I know of at least one study, but no meta stuff) it means that crash dieting with bad sleep is actually counter productive, as you lose a lot more muscle than fat.
I mean if you have some pre-existing disease sure. If you’re on certain diuretics you may screw up your blood chemistry, but an otherwise healthy, overweight person eating less than 1200 kcal/day? Maybe not the most efficient way to lose weight but it’s far from “dangerous”.
A proven treatment to reverse type 2 diabetes make use of the keto diet, a low carbs diet (not low cal) which may be less risky. For most patients with T2D, doctor supervision is advised.
interesting. thanks for sharing! the article unfortunately doesn't delve into the mechanics beyond claiming an increase in glucose from more liver fat.
why would more liver fat increase glucose production? if anything, i would expect a negative correlation.
Depends on the results. A blinded study which has a strong enough effect can definitely be solid indicator.
> Without diet treatment none of 12 participants in the control group had remission, but after they had also received the diet program, 10 out of a total of 23 participants (43%) were free from diabetes, without need for medication.
That's very unlikely to be due to chance - a difference of 0/12 vs 10/23. Of course, this doesn't protect us from failure modes where the study was set up badly or someone just plain cheated, which is why we do want more than one study, but as far as predictive power goes, this is solid.
And fortunately this is already confirmatory research, not exploratory - we've either known or strongly suspected this for quite a while. Now we're just in the stage where it goes mainstream. And speaking of what we know/strongly suspect, adding muscle building into the mix also helps. Living with 800 calories per day is not sustainable, but losing weight once, then building (a lot of) muscle then maintaining a reasonable body fat is hard, but doable.
Lately I wonder if 3 months on semaglutide, low dose steroids, protein and gym is actually an intervention well worth its risks, at least for some categories. Replacing 10kg of fat with 10kg of muscle is much less likely to yoyo than just losing weight.
What doesn't make sense to me is what this diet was actually composed of.
> The programme induces weight loss with a period of formula low energy TDR, providing all essential nutrients in around 850 kcal/ day, creating a sizable energy deficit and therefore substantial weight loss.
Given that Counterweight Plus can be many things (judging by the website), I don't know what this study actually demonstrates. Maybe the weight loss and remission is associated with the lower energy intake, or it may be associated with whatever diet may have been eaten. What were the subject's diets before? We don't know. Correct me if I'm wrong, but I'm not sure we can tell.
;TLDR: Anecdotally, I've found it easier to lose weight / harder to sustain weight after a few months of consistent exercise.
Mostly unrelated to this article and perhaps naive, but I found it very difficult to gain weight (and even sustain my weight) about 2 months after starting a 5/6 day cardio routine.
I started the routine walking at ~20 minute mile pace (3 mph) and just incrementing the speed by 0.1 mph each session. At the 2 month mark I was ~8 minute mile (so about 7-8 miles a day).
At this point I was probably burning an additional 750-1k calories a day from the running alone.
Combined with a slightly less calorie dense diet and I was basically force feeding myself to try and maintain my weight.
Background: Late 20s 5'11" Male ~180 lbs (obviously a more ideal situation)
I burn about the same amount of calories walking at my desk every day. Just like you say, I’m able to eat what I want and not gain weight - or even lose it.
I'll add that reducing sugar, sweet fruits, intermittent fasting (8 hour feeding window) and daily walks made a big difference for a couple of South Asian senior citizens I personally know. They still eat bread and rice and potatoes and consume dairy - but even their relatively modest change in lifestyle has made a big difference.
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[ 2.6 ms ] story [ 206 ms ] threadFurther, I don't know what it has to do with race - all humans respond to low calorie diets in the same way. There is the case of lactic intolerance due to loss of a particular gene. I'm not aware of any similar gene being involved in insulin intolerance.
Please consider wondering why no doctors/scientist know how to heal people with diabetes. Do they miss something obvious?
>Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%, while studies with subtherapeutic dosing typically used more moderate caloric restrictions (reducing energy intake by 500-600 kcal/day) and the weighted mean remission rate was 6.9%. Conclusions. Remission should be the clinical goal in T2D treatment, using properly dosed intensive lifestyle interventions as a primary component of medical care for T2D patients.[0]
So while not exactly obvious, it isn't true that "no doctors/scientist know how to heal people with diabetes." The real issue is that people with DMT2 generaly will not accept low calorie diets. But those that do have a high rate of remission and almost all have improved symptoms and decreased progressions.
Edit: I should note that obviously the American College of Lifestyle Medicine would advocate for this. My point is that there is sufficient liturature to back this up.
[0]Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine (2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692017/?report...
I'm really confused how T2D are special such that crash dieting doesn't mess them up further and put them further in a hole. They're already messed up because of the T2D, aren't they?
It really is that simple. The first law of thermodynamics doesn't go away so simply. Combine that with the evolutionary preassure that favors those who can save and expend energy and this all makes perfect sense. For example, increased insulin sensitivity on a low calorie diet makes sense evolutionarily. The only drawback is that muscle will be consumed as well. The amount varries by person, diet and exercise but it is minimal with a high protien diet. So say eating 500 kcal of chicken brest everyday and the rest of the calories spilt between carbs and lipids would be a good way to do this diet.
"Crash diets" do work as long as you do it for a few months. People generaly do a few days and then start binging >200 TDEE. Obviously that won't work:
>The active stage is characterized by a very low-calorie diet (600–800 kcal/day), low in carbohydrates (< 50 g daily from vegetables) and lipids (only 10 g of olive oil per day). The amount of high-biological-value proteins ranged between 0.8 and 1.2 g per each Kg of ideal body weight in order to preserve lean mass and to meet the minimal daily body requirements. This stage is further divided in 3 ketogenic phases: in phase 1, the patients eat high-biological-value protein preparations five times a day, along with vegetables with low glycemic index. In phase 2, one of the protein servings is replaced by natural proteins such as meat/egg/fish either at lunch or at dinner. In the phase 3, a second serve of the natural protein low in fat replaced the second serve of biological protein preparation. Being a very low caloric nutritional pattern, it is recommended to supplement patients with micronutrients (vitamins, such as complex B vitamins, vitamin C and E, minerals, including potassium, sodium, magnesium, calcium; and omega-3 fatty acids) according to international recommendations. This active stage is kept until the patient loses most of weight loss target, about 80%. Therefore, the ketogenic phases are variable in time depending on the individual and the weight loss target. The active stage generally lasts between 8 and 12 weeks in total.[0]
[0]The management of very low-calorie ketogenic diet in obesity outpatient clinic: a practical guide (2019)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820992/
I was always told crash diets fuck you up for years. How can this be true and also people are apparently starving for months and that's totally fine?
EDIT: Wait, is my understanding is that you have to starve for up to 4 months for a worse-than-coinflip chance at diabetes? Do we know if it stays off for 5 years? 10 years? Do you have to coinflip again? What happens if it doesn't work?
It is not true.
Many people experience that and scientists/doctors agree. In addition there is a risk of higher mortality.
https://journals.physiology.org/doi/full/10.1152/physiol.000...
"Many men and women in the United States diet to lose BW; however, most regain the weight they lost after the diet ends (73). Dr. Kelly D. Brownell coined the term “yo-yo dieting” to reflect BW fluctuations during repeated cycles of diet-induced weight loss and BW gain after the diet is terminated (74). Approximately 20–55% of women and 18–34% of men report weight cycling (75–77). What remains unclear is the impact of weight cycling on cardiovascular health.
Several large studies, including the Honolulu Heart Program (78), the Framingham Heart Study (79), and >9,500 participants in a Treating to New Targets trial (80), have shown a strong correlation between BW fluctuation and rate of cardiovascular events that are independent of traditional cardiovascular risk factors.
A recent meta-analysis of >440,000 participants from 23 studies showed that BW cycling was associated with a 1.4-fold higher relative risk of mortality due to all causes and to cardiovascular disease. The meta-analysis also revealed that BW cycling was associated with 1.4-fold and 1.5-fold higher relative risk of hypertension and CVD morbidity, respectively"
To give an extreme parallel, when heroin adicts recover, if they go back they will die much faster becasue their dosage needed for a hit is almost as high it was at the peak but their liver is not strong enough because it shrunk durring their recovery as it wasn't abused as much.
In my case, what works is a low glycemic diet.
If fasting was a solution, Muslims would experience less diabetes. Yet the prevalence of diabetes in several countries with large Muslim populations appears to be similar to the rates observed in western countries and increasing by 10% per year as a result of urbanization and socioeconomic development.
https://diabetesjournals.org/care/article/27/10/2306/23219/A...
>>Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%,
If by "heal" you mean something else that is not remission, then you should not have taken issue with "isn't that obvious" as "that" was reffering to remission.
>If fasting was a solution, Muslims would experience less diabetes.
see Table 2 of your linked study:
Food intake Fluid intake Sugar intake Weight changes Value of weight change (kg) Critically, the ramadan fast is not a very low calorie diet. It isn't a diet at all. A very low calorie diet is not a fast. So your whole point is invalidated.https://www.youtube.com/watch?v=dBnniua6-oM
From experience if you just try Keto for a couple of months you start to realize how much sugar/carbs are in absolutely everything in the western diet.
Even though I don't practice it religiously I still don't eat 90% of the arbitrary carbs I used to consume. Easiest: not drinking Coke/Juice or anything besides water or zero-carb flavoured carbonated drinks (buy a Sodastream + $50 citrus press and add your own fruit/Erythritol), coffee or tea with stevia, etc.
That plus Allulose simple syrup or those White Claw style drinks:
https://www.wholesomeyumfoods.com/shop/syrups/simple-syrup/
https://www.amazon.com/s?k=Allulose (closest thing to sugar around for people who are picky, otherwise Monk Fruit is cheaper and widely available)
Food is much easier. Just don't eat lots of bread, noodles, and pasta.
Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients. 2019 Apr 1;11(4):766. doi: 10.3390/nu11040766. PMID: 30939855; PMCID: PMC6520897.
The basic problem, which has been unchanged for decades, is that hardly anyone actually follows the "proper" diet on a long-term basis without some kind of surgical or drug treatment. Despite weight loss being a massive industry and a very common goal, researchers routinely struggle to find study subjects who have maintained significant long-term weight loss without medical interventions, to the point that there's a special registry to keep track of such people for scientific purposes [1].
[1] http://www.nwcr.ws/
Nevertheless, I agree that such people might be a very small part of those who lose weight.
About 15 years ago, I have lost about one third of my initial body weight during almost a year, and then I have kept my desired weight until today, without any kind of medical treatment, either surgical or drug-based.
Nevertheless it was not easy and it required a lot of thought and experiments with the diet, until I have learned how to control my weight, after many years during which I had believed that this is impossible. It also required completely dropping many bad habits, for example drinking commercial juices or eating commercial mixes of yogurt with fruits or eating various kinds of "breakfast cereals" or any other such commercial products containing an excessive amount of sugar. I have never eaten or drunk again any of the products that I have blacklisted, even if they were among those that I had eaten or drunk daily, for many years.
I believe that most people are not introspective enough to succeed in changing so much their habits by themselves so they need some kind of external help. The main obstacles for weight control are psychological, not physiological, i.e. those who need to control their weight must learn somehow to love to eat food that is different from what they had been eating, because if they will ever revert to their old eating style, then they will certainly also revert to their previous weight.
The census.gov says there are a little under 260 million adults in the united states, and we know obesity is something like approaching 40% of these adults, so 104 million.
10,000 is not even one thousandth of a percentage point of the obese people of the untied states.
For contrast, a disease is considered rare if it occurs 1 in every 1500 people in the united states. A person who un-obesity's themselves into healthy weight is literally a magnitude rarer than this.
Consider that the rate of obesity continues to increase in the US. This shows that people are simply eating more and doing less exercise. And of course those that are already obese are the least likley to consume healthy ammounts of food and exercise as needed.
In other words, yes, the issue with overeating is in fact overeating. The only way to solve this problem for the whole population (as in, not for a single individual) is to change society and how it views unhealthy food. Off the top of my head, fast food advertisments should be made illegal. The entire point of those ads to get people to eat fast food. This single step could reduce obesity in the US by a noticable amount and requires no loss of freedom to any individual. A sugar tax or the like is a more extreme solution. But this idea is not unfounded:
>Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.
-Adam Smith
Book V: On the Revenue of the Sovereign or Commonwealth Chapter III: On Public Debts
https://www.adamsmithworks.org/documents/chapter-iii-of-publ...
This is ridiculous. Nearly everyone I know who is overweight eats hardly any fast food.
What I do see is lots of snacking throughout the day on high carb things (chips, breads, etc) and just way too many calories due to large serving sizes in both regular “slow food” restaurants and meals made at home.
Fast food meals if you skip the sugared soda tend to be closer to proper per meal calorie targets than sit down restaurants because of how cheap they are.
At sit down restaurants the price is higher to support a wait staff and lower throughput so they compensate with ridiculously huge portions.
For example, when I visited my family in the states, I ate two double cheeseburgers at a fast food joint at 1000+ calories per burger, and I figured I could probably eat two more in that sitting without issue.
In other words I ate 2000+ calories in a few minutes and could have kept going. Even one burger has more calories than I eat in a single meal.
Meanwhile, I couldn’t eat 15 medium sweet potatoes (1000 calories) in one sitting.
Though I do think the public would be better off if they replaced the bread with lettuce or something. It seems like they're willing to do that anywhere I've gone.
Where was this? A double quarter pounder BLT at McD with standard toppings is 830 calories. A McDouble is half that.
One, along with fries, is enough to fill me up for practically the whole day. I think fast food gets a bad rap. It’s calorie dense but with all of the fat it keeps you pretty darn full.
Compare that burger with a few candy bars or not all that much soda…
Another point, while I did say that "The entire point of those ads to get people to eat fast food" what I really meant is that they make people want to eat in general[note 1]. What this means is that fast food ads can be harmful even if they do not cause the viewer to buy fast food. What this does is contribute to a culture of consumption which is part of what I meant when I said "The only way to solve this problem for the whole population [...] is to change society and how it views unhealthy food." I did not mention sit down restaurants because they generaly do not advertise. My suggestion was "off the top of my head" and not fully thought out. I'm glad you made your comment because I did not express my reasoning clearly.
[0]https://epi.grants.cancer.gov/diet/foodsources/top-food-sour... page 77
[note 1] That is, the "point" of the fast food ads collectivly are to generate a demand for fast food from the point of view of the advertisers, but the effect, while more pronounced for fast food, generates a general demand for caloric intake.
They do in the US. TV adverts are littered with ads for national chains (Olive Garden, Buffalo Wild Wings, Red Robin, etc).
Media that allows more targeted local stuff (Facebook, billboards, newspaper, Google maps, etc) is plastered with ads for local sit down restaurants. If anything these ones advertise even more because they don’t have an established mindshare.
To me, it seems obvious that sustaining a low calorie diet (LCD) long-term is basically impossible (from a maximal fat oxidation and, even a thermodynamics perspective). On the bio-mechanistic side, it's also important to note that hyperinsulemia inhibits lipolysis [2], which is one factor that is also usually not taken into consideration. Anyway, while a LCD may be effective for a while (maybe even years), it's probably quite miserable and almost by definition, can't be a sustainable lifestyle change. Even as a short term fix, it may not a very healthy and might be counter-productive long term... [3]
To me, the biggest problem is that T2D is in many (but, to be clear, not all) cases, the end stage of a metabolic patho-physiology that can be identified by other markers (as simple as WtHR, or cheap labs like fasting insulin, or NAFLD indices) that are cheap and easy to measure, but from my experience, most clinicians are completely unaware of this. Which is too bad, since the overwhelming majority of their patients in the US these days (over 80%) are suffering from metabolic diseases. [4]
Over the years (I moved a lot) I've had close to a dozen different primary care providers, and diligently did my annual health checks, all while slowly putting a couple pounds each year and none of them were able to give any useful treatment or even medical advice as my MetS markers crept up. I had to figure it out myself - in fact most gave bad advice and weren't even measuring or diagnosing the right markers. The real kicker to me is how cheap some of these tests are (fasting insulin is <$10 more to test even if you're paying out of pocket and is required for useful indices like HOMA/2-IR and NAFLD LFS, but most GP's won't request this test even if you ask them too)...
I'll also mention that both from the literature [5] and my personal experience [1], some of the worst damage can be reversed in a matter of weeks. I did labs right before I started my diet changes and 1-month in, and even in a single month my TGs and my liver numbers moved from unhealthy to healthy ranges.
As for sustainability, there are some lifestyle treatments like Virta's that have shown better than medication retention rates and efficacy, so it's possible to do... https://www.virtahealth.com/outcomes
How do they do it? A combination of responsive/actionable biomarker monitoring/feedback coupled long-term coaching and peer-support groups. Not impossible and way cheaper (and better quality of life!) than any pharmaceutical alternatives.
[1] https://randomfoo.net/2019/09/17/1-year-personal-health-inte...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753874/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/
[4] https://www.liebertpub.com/doi/10.1089/met.2018.0105
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813289/
For instance African Americans have high blood pressure at an elevated rate and many of the medications that work well for other Americans don't work well for them. It's important that this population gets studies about treatments that work for them.
Honestly, it sounds very difficult, but the doctor seemed very confident that this works. I have started trying this (not T2, but need to lose weight)
Anecdotally, a lot of people have suggested keto and low-carb diets having been successful for them.
The source was Tegus (https://www.tegus.com/) which my company had a free trial.
It wouldn't require a whole lot of thought to come up with an all candy diet that supplied the minimum necessary nutrition. How broad is our definition of "candy" for this? Are you willing to consider candied fruits, vegetables, and bacon? Chocolate covered things? How much dark chocolate would we have to add to something to consider it candy?
Only either the carbohydrates or the (non-essential) fats or both must be reduced. It does not matter which of them is reduced, as long as the total calorie amount is restricted enough. It may matter only due to personal preferences, which may make one variant or the other easier to support.
One must use some digital scales for measuring the weight every day at precisely the same moment, because the weight varies during a day by much more than the difference between 2 successive days. An appropriate rate of losing weight is between 100 grams and 200 grams per day, e.g. about 1 kg per week. If the measurements show another rate, then the amount of daily food must be increased or decreased until the rate is in range.
Regardless with which diet you start, if you adjust the amount of carbohydrates and fat according to the daily weight measurements, in a week or so you will converge to the right amount of daily food. However, this requires to measure by mass or by volume all the food eaten. Those who do not succeed to lose weight fail because they either do not measure what they eat or they cannot abstain from eating more than what they have planned to eat.
Losing the weight is the easier part. More important is to plan a diet for after reaching the target weight, a diet that will keep the weight constant, i.e. which must still be calorie-restricted, but at a normal level, and which must be appealing enough, so that one would never be tempted to eat again in the way that caused the overweight in the beginning.
or just do a moving average over some days. Works better.
And water weight, fecal residues, etc vary so much day by day. Were yours so constant insofar to be able to track it accurately to the grams?
At the time I have studied a lot the existing medical literature, and this was the recommended rate, so I have adjusted the diet so that the weight loss per day would oscillate around 140 g per day.
The weight must be measured every day in the same physiological conditions, i.e. in the same order relationship with respect to the various activities that modify the weight, like eating, drinking or eliminating their products.
A good moment would be in the morning, immediately after waking up and relieving yourself.
If one would eat in the evenings wildly varying amounts of food, then the weight in the morning could be affected by a noise due to variable amounts of food that is not completely digested yet. However that would not happen when one is eating a calorie-restricted diet for losing weight, when one would have to eat about the same minimal amount of food every day, which would be quickly digested.
While I was losing weight, I could see very well every day its evolution to the grams, and the effect of any change in the diet. Sometimes I succumbed to the temptation of eating like before starting to lose weight, and after such days I gained weight in a day almost as much as I was losing in a week, which increased the time until reaching the target weight.
I eat the same stuff every day, weighing myself after going to the bathroom, etc, yet my weight easily varies at least 500 g from one day to the other. And if I eat just a little bit more carbs in a weekend, then well, it's like 2 kg of extra water weight on Monday.
I have lost weight (from around 120 kg to around 76 kg) about 15 years ago.
Nevertheless, I believe that if care is taken so that the calorie-restricted diet still includes a normal amount of all nutrients except carbohydrates and non-essential fat, 4 kg per month, like I did, should not cause any health problems.
Unfortunately, I have seen too many suggestions about how to lose weight that do not pay enough attention to provide all nutrients. Such diets can be sustained for a few weeks, but not for longer durations, like a year or more, which are needed when the required weight loss is great.
My weight can vary from day to day exactly as much as yours, but nowadays it rarely does.
The main difference between how I eat now and how I was eating before losing weight is that previously I was eating until feeling sated, but now I always decide how much to eat before starting to eat, so for most days the energy intake is similar, so the weight oscillations are small. When I happen to eat a more copious meal, I compensate the next day, mainly by cutting the carbohydrates during that day.
> lot of people have suggested keto and low-carb diets
Just always remember: while rice, pasta and bread are vegetarian they are not vegetables.
You never disappoint, Hackernews.
The pattern is that a miracle diet is announced that promises guaranteed results, over the course of a few years a load of people get on board, each individual loses a lot in the first few weeks but most gain it back (true for all diets). In the meantime people make bank selling courses and books and pitching it as the central component of their Success Win Lifestyle, until the next one comes along and the cycle repeats.
If one of those fad diets are working for you, great - stick with it. But don't worry, there will always be another one around the corner.
Mediterranean, paleo, vegetarian, low-calorie etc diets almost always achieve the same low-carb goals, but low-calorie is the least practical...while sadly also being the most popular.
Just telling people to "eat less" is never an effective solution. There's a severe lack of good studies showing low-calories actually lowers weight long-term. The fact this study has 25 people is typical.
If you can eat a stable amount of food until satiety (still not-excessive amounts) while still achieving the same health/weight goals then obviously that would be the best solution.
I've asked before on HN to send me a study showing low-calorie diets are effective at reducing weight longterm and I still haven't seen one. Yet low-carb and type 2 diabetes go hand-in-hand with other treatments (most importantly pre-diabetics which is critical).
The general advice, even from my primary care physician, has been that anything less than 1200kcal/day is dangerous and is crash dieting. Looking around, I found this other study studying total diet replacement providing 810kcal/day as the sole food for 12 weeks, showed significantly greater weight loss compared to standard counseling and modest energy restrictions. The difference in weight loss was measured at 12 months. (BMJ 2018;362:k3760 [1])
25 BMI, which the diabetes study used in addition to T2D, is not considered clinically obese in the US. 25 BMI is the line between clinically normal and overweight. I wonder if crash dieting is advised against on the assumption that most people will go back to unhealthy eating habits instead of changing their diet, and also become more likely to fall into binge-restrict cycles. It's easy to imagine that if someone is able to make meaningful changes, crash dieting is more effective than most other methods.
[1] https://www.bmj.com/content/362/bmj.k3760
But I feel like it taught me to be bored with eating, and to establish a more healthy relationship with food. High-fat, mid-protein, low-carb sounds terrific for the first day or two but once you're two weeks in, you're so sick of it all that you'd just as soon drink some water and get back to whatever you're doing.
Also if I don’t eat right as I feel hungry I’ll feel as if someone has gut punched me. I get absurdly hungry.
As for the "gut punch" though, sounds like gastritis or something. Unless you're being metaphorical. For me, water helps when I'm fasting and stomach pains start.
Likewise, I've noticed an effect develop with artificial sweeteners where I can have small amounts without difficulty, but if I start consuming it several times in a 48 hour span, I get cramps.
In periods where I've become addicted to carbs hunger pain is much stronger, but I've been able to keep it down for many years now. So if you're getting it intensely, your gut is probably still reactivating to its old profile.
I believe restriction in the regular diet is one way of correcting it while staying in a routine. But I have also experimented with fasting, intense exercise, hot/cold contrast in the shower, and breathing exercises, and the common theme to each is to challenge homeostasis in some fashion. Obviously there's always some danger in going too far, but if our norm is total comfort, we can definitely drop some aspect of it from time to time.
Part of that might be from less water retention early on.
Your body holds on to more water when your diet is full of carbs. As your liver runs down its glycogen stores and you eventually go into ketosis, you lose a lot of water. That's also there the early 'keto flu' comes from, which is a bit like a hangover; plenty of fluids and electrolytes fix you.
Losing water looks great on the scale. On the one hand, it doesn't actually do anything for you healthwise. On the other hand, losing that water ain't bad for your health either (assuming enough fluids and electrolytes), and is a great motivator for the kickstart you described.
Wouldn't this advise need to keep in mind absolute height? BMI tracks the ratio between the height and weight, but it does nothing to tell the difference between a short thin person and a taller heavier (but same BMI) person. The latter which would need more calories than the former. I know people who eat ~400 kcal less than me per day, because they are shorter and similarly thinner. Following that why wouldn't their crash diet threshold be sufficiently lower?
How true is it? I don't know. But even then I don't see why they couldn't take multivitamins.
It's probably a mistake to connect the two.
Yes, we Americans overeat beef / Hamburgers, but I don't think anyone eating burgers is at huge risk of malnutrition... as much as a risk of heart problems, diabetes, cholesterol, etc. etc.
It turns out that a standard burger with beef, ketchup, lettuce, onion, and bread covers most of your macro, and even micro-nutrients. It also is way overboard on salt and fats, but... that's not the particular problem here.
One of the bigger problems vegetarians have is finding a proper replacement of meat and all of the easy nutrients meat contains. All amino acids, various vitamins, iron, etc. etc. There's a fair amount of nutrients here.
And even the worst McDonalds burger contains a variety of lettuce / onions / ketchup that covers few nutrients that beef is missing (ex: Ketchup has Vitamin A, Potatoes / Fries has Vitamin C).
The amount of lettuce, tomatoes and onions is so minimal I doubt it contributes to your vitamin intake in any useful manner. If you eat a salad you get 50x that amount of those vitamins.
Pretty strongly disagree here. US Beef consumption is about the same as in early 1900's, which was a time where personal health in several metrics was far better. (Weight being the obvious one)
Always very skeptical when people talk about cholesterol, it's a really nuanced topic, but the average person seems to be stuck in the 1970's with "cholesterol bad". Thinking high ldl is always bad is only slightly better.
If you eat only the beef and veggies from a Big Mac three times a day you'll get plenty of vitamins and minerals with minimal calories (~650 calories)
If you eat the three entire Big Mac meals you won't get any more essential nutrients to speak of and you'll consume far too many calories (3960 calories)
The average american has junk to cut from their diets with no nutritional loss whatsoever. Typically fried and sugary foods.
Practically pure proteins can be provided by turkey breast or chicken breast, adding e.g. around 300 kcal for an adequate daily protein intake, and the rest of the food can be composed of non-starchy non-sweet non-oily vegetables, which provide only about 20 to 50 kcal per 100 grams. One could eat more than 1 kg of various such vegetables without exceeding 800 kcal.
There remain a few things that would have to be taken from supplements, e.g. omega-3 fatty acids, vitamin B12, vitamin D3 and vitamin E (which is abundant only in high-caloric food, like olive oil or almonds). The simplest is just to take one pill per day of those offered by various vendors, which include all the essential vitamins and minerals, to be sure that none of them is insufficient.
A little vegetable oil would be needed for linoleic acid.
We both come from a South Asian background and discussed how the number would change for a home cooked vegetarian diet which is more nutrient dense but low in protein, and I was told that would lower it below 1200, but he didn't feel comfortable recommending that diet unsupervised. He emphasized that I should decrease calories by removing carbs, then fats, then proteins. And that I should prioritize eating proteins above fats and carbs, especially if I planned on increasing the amount of exercise I did.
I asked him if the 1200kcal was net or gross. For example if I did 2 hours of moderate exercise, should I eat back 400kcal+ to maintain a net 1200kcal. He didn't have an answer for me, other than saying, if I start to feel weak or lightheaded I should immediately stop exercising. I don't have pre-existing conditions related to blood glucose, but I imagine that would would change many of these guidelines. I was told to stay mindful of hydration.
The stories I hear of fasted work outs is the reason I asked him about low calorie diets. My non professional intuition makes me believe that even intense cardio should be okay, but moderate or heavy resistance training should be avoided on a low calorie diet.
There is no reason to avoid resistance training.
I also imagined that muscle recovery would be less efficient or take longer from a fasted state. I have hit rowing/ERG goals and made time improvements so I feel comfortable saying that fasting doesn't hinder my cardio.
I understand that energy goals are correlated with body size, we were discussing a general minimum kcal threshold for unsupervised dieting. I am unsure why you feel estimated BMR/RMR - 200 kcal is unscientific. I was told that without supervision, it would be hard to ensure proper nutrition on a very low calorie diet. Additionally, he expected that some people would fall into a binge-restrict cycle because they can't sustain their usual energy level.
I was additionally curious because there have been days I forget to eat, and thinking back I realized my total calories for those 24 hours totaled less than 600 kcal.
Fortunately it's fairly cheap and easy for people in developed countries to obtain an RMR test. This can then be used as a personal baseline to calibrate diet plans.
https://www.bodyspec.com/what-is-rmr
There are risks to ponder about how critical (e.g., time vs. dangers) it is to get to a healthy weight. If someone dangerously obese maintains hydration, electrolytes, vitamins, and enough lipids to empty the gallbladder, getting to a low adipose tissue state, resetting insulin, ghrelin, and leptin sensitivities, and reducing the likelier risks of cancer(s) seems like a good tradeoff than either lap-band surgery or slow/plateau weight reductions.
Intense hunger goes away after about 72-80 hours of "starvation", however brain fog and low energy dominate. Careful "starvation" dieting down to slightly underweight isn't something one can do without several months of spare time, ready access to healthcare, and immense self-control. Afterwards, self-control is absolutely required to avoid binge cycles.
GLP-1 agonists are expensive but interesting crutches to get there slowly.
It is likely that over millions of years of natural selection, the human body is far more tolerant of borderline starvation conditions than being stuffed with HFCS. Many types of cancers associated with Western diets are likely due to the human body becoming more hospitable, whereas chemotherapy and starvation add cellular stress that kills off malfunctioning cells. It's likely no accident whereas CHD, gout, diabetes, high cholesterol, and cancers are the consequent of unnatural diets and lifestyles.
Why stop at getting rid of glucose? Add some plasma donations and orlistat. Now you've got balanced macro loss!
(don't do this)
(I actually donate whole blood and platelets often.)
If someone were carrying around an extra 250 Mcal in adipose tissue, multiple factors determine what their risk budget could/should be to downsize to a suitable homeostatic state.
I lost 60 lbs over a couple of years and set a state lifting record for my age group. I love what I do and kept the excess weight off. I got good at what I do and the intrinsic reward still burns, even though I’m not lifting for records anymore. I wake up every day ready to go hard for at least 50 minutes. It doesn’t take me more time than that to stay in shape, but I do eat consistent with my goals.. which is the harder part.
I personally think someone needs to really own their desired outcome and then there are many valid and healthy ways — and even more “effective” ones — to get there. Hard to measure “own” though. Measuring every different kind of modality is generally missing the point. We actually know how people get in shape and stay in shape. The problem is generally in the mind.
Source: https://youtube.com/watch?v=GdHW1YipmVo
Losing weight that fast generally means it comes back pretty quickly as well.
> I lost 60 lbs over a couple of years
That's a much more reasonable timeframe. It's almost like we have to trick our bodies into finding a new metabolic balance. Do it too quickly and it just rebounds. Do it more slowly and it seems to be more sustainable.
I was under the impression it was like trying to fight drug addiction and the chances of you sustaining it and not relapsing/making up the missed calories later as near impossible for most once you’ve become addicted enough to things like Diet Coke, Chik-Fil-A, etc.
As for being difficult… yeah. The transition sucked. Body aches, headache, and very slight case of the blues. It took willpower. After about 3 days, I was okay. It was similar to quitting smoking for me, except that quitting smoking didn’t give me body aches.
what i did was cook for myself so i can reduce vegetable oils, salts, artificial flavorings etc, then cook things like fresh tomato sauces with fresh basil/oregano, fresh fish cooked slowly in plum sauce, chana masala curries with low sodium and delicious spices etc etc
once you get used to healthy, satisfying and flavorful "good" food, carbs, salt, oil and junk food cravings faded away and buying snacks after that was just not satisfying at all...
n=1 and all that, but that was my experience fwiw
I think something like Tex-Mex would easily allow for clean eating. Avocado toast, with whole grain bread is fairly healthy and was an absolute favorite of mine after workouts and I would consider it "American" food. Tacos are a great way to have good portion control and also feel filled. Allowing non-traditional recipes opens many options. Avocado grapefruit salad on tortillas with fried tortilla strips is a recipe I came across recently that I really enjoyed. I think non-traditional is the essence of true "American" food.
For fast food, Popeye's Blackened tenders are not breaded, a 5 piece serving is listed at 280 kcal compared to the classic tenders being 740 kcal. Nuts or apple slices with peanut butter is a fairly filling snack and can easily fit within 200 kcal. The main thing you would have to look out for is sodium if cooking at home is difficult. I know most of my bodybuilder friends go to a diet of chicken breast and brown rice for dinner for months at a time when they want to cut. It's around 400-500 calories depending on how you prepared it.
Vegetarian and vegan recipes are good starting points for cleaner eating too. Borrowing from other cuisine makes it a lot easier as well. I love preparing vegetable side dishes for dinner in the way it's prepared for Korean dishes. Miso soup is fantastic for when I have food cravings late in the night. It's not "American" but I'd argue there's nothing more American than making microwave miso soup at 3 am in my star wars mug. Coffee is popular too, and is very low calorie if you can get used to no milk or sugar, or only sugar alcohol/substitutes.
For some context, I grew up and live in one of the most culturally diverse states and counties in the US. I know that not everywhere in the US has the same diversity of food options, but I would argue that Amazon has done a lot to make food accessible.
The one meal per day limit makes it hard to over/eat.
https://peterattiamd.com/donlayman/
It seems either this is extremely tricky to measure, or it is a myth (like aspartame or MSG or yellow 5 cause cancer or whatever).
On the other side are people that say, "eat less, exercise more".
Lots of people have chosen either one of these to be true. It is certainly possible, though.
Being the norm historically does not imply it is healthy or optimal, only that it is at least survivable on average.
It is entirely possible that something that was done for a long time is a healthy thing just as it is entirely possible that it was a terrible thing that we conquered with knowledge and abundance. Evidence is what tells you if the thing falls into one of those categories.
I like living in a time where we are outraged if children in our community die and in cases where there was nothing that could have been done we want to do research to find something we can do in the future. That was not normal for millennia until really very recently and it seems healthy to me?
Is this actually true? I thought archaic humans had much better dental outcomes because their diets had a small fraction of the sugars that modern diets do. Could be wrong but I was definitely under the impression that poor dental health was more a function of modern diet and not something that necessarily existed throughout history.
Feel free to nit-pick that example, there are an absolute plethora of others. When did surviving appendicitis become a thing? What was the median life expectancy for a newborn baby at various times in history? Calling out the fetishism of humans in a "natural state" needs to be done. Just as there are things we can learn from our pre-historic existence. Evidence is obviously the required thing not just amusing anecdote about how we have totally "lost our way."
Certain palms are also (and have been for... Again I don't know, but I believe 'a very long time') 'milked' for a sugary sap that's drunk fresh or fermented.
I mean if you have some pre-existing disease sure. If you’re on certain diuretics you may screw up your blood chemistry, but an otherwise healthy, overweight person eating less than 1200 kcal/day? Maybe not the most efficient way to lose weight but it’s far from “dangerous”.
One company working to reverse diabetes in the US is https://www.virtahealth.com/ (disclaimer: I work there).
2. why is liver fat a driver for diabetes? the article and the paper don't address this.
https://www.healthline.com/health/fatty-liver-disease-and-di...
why would more liver fat increase glucose production? if anything, i would expect a negative correlation.
what hypotheses do you think are persuasive?
> Without diet treatment none of 12 participants in the control group had remission, but after they had also received the diet program, 10 out of a total of 23 participants (43%) were free from diabetes, without need for medication.
That's very unlikely to be due to chance - a difference of 0/12 vs 10/23. Of course, this doesn't protect us from failure modes where the study was set up badly or someone just plain cheated, which is why we do want more than one study, but as far as predictive power goes, this is solid.
And fortunately this is already confirmatory research, not exploratory - we've either known or strongly suspected this for quite a while. Now we're just in the stage where it goes mainstream. And speaking of what we know/strongly suspect, adding muscle building into the mix also helps. Living with 800 calories per day is not sustainable, but losing weight once, then building (a lot of) muscle then maintaining a reasonable body fat is hard, but doable.
Lately I wonder if 3 months on semaglutide, low dose steroids, protein and gym is actually an intervention well worth its risks, at least for some categories. Replacing 10kg of fat with 10kg of muscle is much less likely to yoyo than just losing weight.
https://www.youtube.com/watch?v=tAiXvrIMIIE Neal Barnard, MD | A Nutritional Approach for Reversing Diabetes
https://www.youtube.com/watch?v=lSwL73evUdA Diabetes Reversal and Weight-loss with Neal Barnard, M.D.
https://www.youtube.com/watch?v=EpRrD58Ah3Q Evidence-Based Weight Loss: Dr. Michael Greger
https://www.youtube.com/watch?v=7rNY7xKyGCQ How Not To Die : Dr. Michael Greger
I've removed that part of my comment, sorry - the linked experts will explain it better.
What doesn't make sense to me is what this diet was actually composed of.
> The programme induces weight loss with a period of formula low energy TDR, providing all essential nutrients in around 850 kcal/ day, creating a sizable energy deficit and therefore substantial weight loss.
Given that Counterweight Plus can be many things (judging by the website), I don't know what this study actually demonstrates. Maybe the weight loss and remission is associated with the lower energy intake, or it may be associated with whatever diet may have been eaten. What were the subject's diets before? We don't know. Correct me if I'm wrong, but I'm not sure we can tell.
Mostly unrelated to this article and perhaps naive, but I found it very difficult to gain weight (and even sustain my weight) about 2 months after starting a 5/6 day cardio routine.
I started the routine walking at ~20 minute mile pace (3 mph) and just incrementing the speed by 0.1 mph each session. At the 2 month mark I was ~8 minute mile (so about 7-8 miles a day).
At this point I was probably burning an additional 750-1k calories a day from the running alone.
Combined with a slightly less calorie dense diet and I was basically force feeding myself to try and maintain my weight.
Background: Late 20s 5'11" Male ~180 lbs (obviously a more ideal situation)
I say this as a south Asian man.