Radical diet can reverse type 2 diabetes, new study shows | Hacker News Reader

Radical diet can reverse type 2 diabetes, new study shows

theguardian.com

423 pointslxm260 comments

I went on a medically-supervised, very low calorie and low carb (keto) diet after being diagnosed with diabetes. A few months and about 50lbs in, I had no signs of insulin resistance whatsoever, my A1C was down to completely normal values, and I was able to discontinue my medication entirely. That diagnosis, as hard as it was to hear, was one of the absolute best things to ever happen to me.

What does a "medically supervised" diet entail? You visit the doctor on a frequent basis and do it under their guidance?

Does this exist for non-diabetic patients? I recently had weight gain for the first time of my life after reaching 30yrs of age and always being underweight. I've been meaning to look into some diet-based approaches that would be supported by science, but Googling it has always been a deluge of pseudo-science.

> Does this exist for non-diabetic patients? I recently had weight gain for the first time of my life after reaching 30yrs of age and always being underweight. I've been meaning to look into some diet-based approaches that would be supported by science, but Googling it has always been a deluge of pseudo-science.

The Keto diet(s) are pretty popular for weight loss and general health too. The subreddit [1] is pretty active and has lots of people vouching for it. I don't know how scientifically sound or safe it is, because I haven't researched it, but you might find some answers there.

[1] https://www.reddit.com/r/keto

I'd recommend /r/science for a more scholarly view instead of the r/keto subreddit which seems almost cult-like in its worship of the keto diet.

Did you mean to recommend /r/ketoscience/ ?

It's a great sub. The keto diet helped me lose about 30 pounds this year, and I was only fully committed to it about 20% of the time.

I have to be picky here. If only 20% of your overall diet this year was keto, then really whatever you were doing the other 80% of the time is 80% (in other words, way more) responsible.

The other 80% is probably just what they were doing before they started the 20% of keto. I don't think that's what made the change.

If that were so, then I would've expected them to say "helped me lose X pounds in ~2 months".

I do strict Keto the first 6 days of the month, which is where I was getting the 20% from.

The rest of the time, I do my normal diet of mostly fast food, too much candy, and no exercise. I might drink a little more water than I used to in this period, but no major changes.

Sorry if there was a better way to phrase this.

You're fine. I don't think it was actually that hard to figure out what you meant. :)

just for the sake of warning, keto shows lots of results, but taps into a body mechanism that yields some form of withdrawal syndrom (keto flu IIRC)

Ketosis is the medical condition. It occurs when your body metabolizes fat for energy instead of glucose.

.. which initially lasts days to a few weeks but the length can be shortened by fasting or supplementing with MCT oil or beta hydroxy buterate

And taking some extra salt and water per day. 2 cups of broth does it for me. No more keto flu.

Note that keto flu only occurs when your body is switching from carbs to fat, but disappears when your body is keto-adapted.

I don't know what diet daeken followed, but the Lancet article described the diet in the study as follows:

"Weight loss was induced with a total diet replacement phase using a low energy formula diet (825–853 kcal/day; 59% carbohydrate, 13% fat, 26% protein, 2% fibre) for 3 months (extendable up to 5 months if wished by participant), followed by structured food reintroduction of 2–8 weeks (about 50% carbohydrate, 35% total fat, and 15% protein), and an ongoing structured programme with monthly visits for long-term weight loss maintenance."

Using the MyFitnessPal free iOS app has been helping me a lot. It gives you a calorie target, you enter everything you eat (and it has pretty much everything in its database), and it will help you get to a target weight.

It will also help provide warnings about sugar, etc.

Not a doctor, but know some people with weight issues.

My understanding is that you are using a diet plan that the literature warns as being dangerous, (for example losing more that three pounds a week in cases of morbid obeisity) and a doctor is monitoring your vitals and blood work to make sure you aren’t damaging your organs in the process. Essentially they are red-lining your weight loss.

In the most drastic case I’ve ever heard of (second hand) you can actually check into a hospital and they will literally meter your food. If you have a proper metabolic dysfunction they will know because your calories in doesn’t match your weight loss and they can prove it.

There are many documented cases of obese people not eating at all for weeks or months. As long as particular basic needs are taken care of (water, vitamins, minerals), you can live off your own body fat. That's what it's there for. Of course, as you're running out of it, things go downhill fast.

Could you please share some details? What did you eat? Do you think it is possible to reverse it, even if the person was diabetic for a long time?

From the article:

> "A radical low-calorie diet can reverse type 2 diabetes, even six years into the disease, a new study has found."

They may seem a little faddish sounding, but Joel Fuhrman has several books written for a popular audience on dietary interventions for a variety of health conditions, diabetes and heart disease among them. Eat for Life was his first book, and then he wrote The End of Diabetes. Both books lay out a fairly restrictive diet plan for improving health. His patients come of medications quite quickly and he provides anecdotal stories of several patients who have had long term conditions that were able to reverse the problems through diet.

Not faddish at all. I've read about fruitarians, people who eat only one food item at a time (mono meals) etc - all claim it worked for them.

Thank you for the book recommendations, ordering two of them.

https://www.reddit.com/r/keto/

I lost almost 80 lbs (and I'm only 5'5 on a good day) thanks to keto.

I'm not saying it's a miracle diet, in the end if you lose weight it's because you're consuming less calories.

What made keto work for me is that, because of it's very restrictive nature, I became acutely aware of everything I put in my mouth.

I could have only 20g of carbs max per day, so I started reading in detail all the nutritional sheets on every food I bought. Of course, I also stopped buying basically all processed food. Not because they where high on calories or because they were unhealthy, just because they had carbs.

It's been years since I went off keto, but I still read everything about the food I buy.

This is very true. Though I am no longer on keto, I've gotten to the point where I must know the ingredients and nutritional content of every single thing I eat.

Part of overeating/mindless eating is ignoring any data about what is being eaten. I am far more mindful now.

I was on the New Direction VLCD. 3 shakes (mocha only -- the rest were awful, but even months after stopping the diet, I still love the mocha) per day, 200 calories each. It's expensive as hell and only available via medical providers, but it worked exceptionally well. I saw my doctor every two weeks for a check-up and did monthly blood work to ensure that everything was still going well; there's a not insignificant risk of gallstones and other risks with such severe weight loss.

Overall, I went from somewhere over 400lbs (my scale wouldn't go above that) to 280lbs in around 9 months; my wife went from 258 to 198lbs in the same time. After she became pregnant, we fell off the bandwagon and both regained a decent amount (I'm around 330lbs now) but plan to start back on New Direction as soon as she gives birth, any day now.

I don't know if it would reverse diabetes for anyone but me -- there'd need to be more done to study this, for sure -- but I can absolutely say it saved my life. I frankly can't wait to get back on this diet.

But what did you actually eat?

Is it really that hard to google "low carb foods"

Generally people eat mostly fat if a keto diet is higher calorie.

Since OPs was lower calorie it would be mostly vegetables and protein.

For me (lost 90 pounds, went from 10.5 A1C to 5 A1C), it was:

- Removal of all beverages aside from water, unsugared coffee, tea - Removal of all rice, grains, potatoes, corn - Chicken, Pork, and Beef (in that order) became my primary food product. Sous Vide allowed for a more convenient method of food preparation that made it feasible for my schedule (throw it in in the morning, done when I get home from work) - Vegetables other than the ones above became my secondary source of food. - Don't care about fat, just about carb intake. My personal target goal was under 30 grams of carbs per day, which I was mostly able to adhere to. Now that I am stable under 6 A1C I have loosened it to about 45. - My caloric goal has been to stay under 1600 calories. I feel like all the other steps helped drop my A1C, but this alone was what made me actually lose the 90 pounds of weight itself.

Do you know how your blood pressure or cholesterol changed as a result of this diet? You were basically on a high cholesterol diet, so I'm interested.

GP describes the keto diet, which worked for me too. About the cholesterol, better read up on it. The hype about cholesterol has gone out of control. There are multiple types of it, and earlier research wasn't as conclusive as everybody thought. (Just like saturated fats by the way.)

[1]: https://www.amazon.com/Art-Science-Low-Carbohydrate-Living/d...

[2]: https://www.amazon.com/Art-Science-Low-Carbohydrate-Performa...

Cholesterol and saturated fats are good for you? So, what, carbs are clogging people's arteries? that's non-nonsensical.

And when you say "worked for [you]" do you mean lost weight or helped with your overall vitals?

From what I've gained, low carb diets are great short term strategies for burning fat but not healthy in the long-term for overall balanced health.

Carbs clogging arteries? That's not what I said.

Low carb diet lowered my weight by 25 lbs, made my GERD disappear, no more taking omeprazol 'for the rest of my life', my gallbladder stopped acting up, and I have more energy as if I was 10 years younger. This was enough to convince me that I'm not going back to eating carbs as I did before.

Sorry I wasn't clear. I was saying that if saturated fats and cholesterol are good for you, then what's clogging people's arteries?

Supposedly what happens is when your body isn't repairing some defects that occasionally happen, and scar tissue grows and other stuff sticks to it.

But typing on my phone, and too busy to provide more references. You can start in the publications I linked to earlier though.

Same. Pre-diabetic and all kinds of other health issues started creeping up (obesity, GERD, really bad heartburn, sleep apnea, etc). Most doctors would've just had me take medications, wear a mask that would breathe for me while I slept, and put my bed at an angle so I could sleep through the heartburn/reflux.

Started calorie restricting and eliminated grains and sugar from my diet almost entirely, and all pre-diabetic symptoms disappeared within a month or two. Zero GERD, zero heartburn, no longer obese, no more disturbed sleep, lots of energy.

I think in most cases type 2 diabetes (and most symptoms associated with obesity, metabolic syndrome, etc) is a disease people inflict on themselves through poor diet. Particularly by eating refined carbohydrates (especially wheat and sugar) and being genetically predisposed to not metabolizing those very well.

The food industry spends a lot of money skewing the research on this and pushing people toward exercise so they can wash their hands of it all, and they have the cooperation of the USDA (just look at that ridiculous pyramid ffs). So you kind of just have to explore this diet on your own through a lot of noise and people telling you you're wrong. In my case it was an outright cure for a lot of health problems, and it didn't take very long to confirm that either. I don't read public health journals or articles about nutrition anymore.

Great Work! that's awesome you could change your diet to a healthy one. These days there's such a huge stigma against eating healthily and responsibly, especially from friends and family.

Yeah, it’s bizarre. The topic of diet has a lot in common with religion. The research is so murky and poorly conducted and everything is a contradiction, so people have a tendency to just pick a “team” and form beliefs around that. Team Vegan, Team Vegetarian, Team Keto, Team Paleo.

If you’re on a different team, you’re an attack on their dietary beliefs. If you’re on any team, you’re a pain in the ass to anyone who hasn’t picked a team yet.

People also have a tendency to form part of their identity around how they eat. “I’m a ______.” So now you’re not just questioning their dietary beliefs, you’re casting judgment on their identity.

So I get why people are so sensitive about it. And like politics and religion, I try to keep it to myself.

To be absolutely fair, Team Keto and Team Paleo are almost the same team. Keto people avoid foods with grains and refined sugars just because they're high carb; Paleo people avoid them because they're toxic, and often naturally fall into a lower carb diet (not necessarily "true" Keto lowness, but still usually a lot lower carb than they were pre-Paleo).

tribalism.

it pops up everywhere, sports, operating systems, code editors, vehicle manufacturers.

and it is actively used by and encouraged by all sorts of power structures.

I am still trying to dial in my diet Right Now. I am a Type 2 diabetic and cardiac patient; it all came on very fast and furious. I've tried LCHF before and it didn't work as described with my chemistry. Same with vegan (low fat super high carb). What diet Team am I rooting for now? Team I-Don't-Want-To-Get-A-Bad-Case-of-the-Dead's-Right-Now. Not sure what form that is but I am still testing.

If you want to get the "team vegan" take on reversing type 2 diabetes with diet then watch Forks Over Knives on Netflix. Its actually not a purely vegan film like everyone claims, because the doctors talk about limiting meat (e.g. 5% meat intake), if not completely removing.

Try paleo?

By LCHF, just how low a C do you mean?

I had great success with what I considered low C, but what would be considered high C by the Atkins, paleo, and keto folks. I aimed for 40% of less of calories from carbs--low by the standards of the average American.

I was not even trying to cut calories. I just wanted to lower blood sugar, and was trying to see how much changing carbs affected that. However, I found that because the food was now more satisfying, I ended up cutting calories as a side effect.

I picked 40% because (1) it is significantly lower than what I was doing before, and (2) it is really easy to check on a nutrition label--take total calories, divide by 10, and if that number is larger not larger than the number of grams of carbs, the item is 40% or under calories from carbs.

If I wanted to eat something that was over 40%, I would fix it by adding fat or protein. For example, suppose I wanted a ham sandwich. Before I would have ordered that with cheese, assorted veggies, and mustard. No mayo to try to keep the calories down.

On the "40% or under" diet, I would order that ham sandwich as before, but would go ahead and add mayo (full fat mayo...none of that lite crap) and/or order it with double meat. That would raise the calories by about 50%, but it would bring the carb percentage down from about 45% to about 30%.

Not all foods could be tweaked easily to bring them under 40%, but if I ate such a food I would try to pair it with other foods that were enough under 40% to bring the total for the meal under 40%, and if a meal was a little off I'd fix it in the next meal.

You can pretty easily keep a running total of how you are doing, by on a food by food basis keeping track of how many grams over or under you are. So if I had something that was 300 calories and 20 grams of carbs, I'd mentally think "300/10 = 30 grams of carbs to be 40%. 20 grams is 10 under, so add -10g to my running total".

If at the end of the day the running total is not positive, I've met my 40% goal for the day.

To reduce the risk of getting to the last meal or snack of the day and being too far over to correct, I put in some effort to make sure breakfast put me a fair amount under 40%.

A nice thing about this approach is that 40% (I actually ended up at around 35% once I found a diet soda that I actually started to like, and so cut full-sugar Pepsi out) can be done without giving up most fast food restaurants. You might have to give up some items on their menus, but a lot of their main items can be brought under 40% by tweaks like I did for my sandwiches. E.g., if you want a burger and fries, you might be able to get the combo down to 40% of you go for the double burger and extra cheese and mayo. Pizza can be gotten under 40% with enough meat and cheese.

That makes it much easier to stick to it compared to diets where you have to plan ahead for all your meals away from home.

Result: over about 18 months, I lost 140 lbs, and then mostly leveled off. A1C went from 8.1 on 4 different diabetes medicines to 4.8 on no diabetes medicines. Also got completely off cholesterol medicines.

I saw a ted talk, I think, about the ideal diet. It really depended on how the individuals body responded to foods. Some people can eat rice all day wit minimal glucose spiking and others spike after very little rice. They suggested getting a blood glucose meter. They then suggest monitoring your response to various foods. Look for foods that cause the least spiking and most stable glucose levels.

Going vegan is definitely helpful.

Yup. And don't forget team "Eat whatever you want, cuz it doesn't matter" They're everywhere and give the rest of us weird looks when we eat Actual food. One guy was surprised to see me eating a tomato. I think, he thought it was just something that gets printed on a can.

Check NCBI and Pubmed. There's a lot going for ketosis and certain vegetarian diets, backed by good research.

Not saying there aren't an abundance of diet fads that find roosts the minds of uncritical hopefuls (like anything else, really), but being more conscious of what you eat and how you feel is a good thing. If the diet seems zany and tenuous but promotes portion control and variety to people who've been feeding themselves and their families out of cans and whatever is closest and cheapest, I'd tolerate if not encourage their new interest.

Some people's enthusiasms are just difficult to put up with day in and day out, whatever they might be. But in the grand scheme of it, I'd rather they be obsessed with salads than Scentsy.

While I wasn't overweight or obese I had definitely gained 10+KG a few years back, and was bordering on overweight (according to BMI, which is just one indicator, not the only one, and again, take it with a grain of salt and in moderation). For a while I completely stopped drinking alcohol, soft drink, wheat and refined sugar. Basically meat, vegies, fish, whole fruit (not juice). Lost all the extra weight within a few months, and enjoyed great energy. Being 100% honest, I now find that soda is very sweet, and I now no longer drink alcohol at all. I have re-introduced some wheat and refined sugar, but keep it to a very minimum and try and combine it with other ingredients. (e.g. banana avocado cacao mousse). Never going back to drinking all that soda and buying everything as a sandwich.

I started putting on some weight after beginning full time work after college (no longer walking around campus, always having a decent lunch--it made a difference!) Two years ago I decided to limit my consumption of refined sugar to two desserts a year. I cut out pop, fruit juice, don't drink alcohol or coffee, avoid white flours and aim for foods made of whole ingredients---fruits, vegetables, meats, nuts, etc. I'm at roughly 10lbs below where I was when that started, which is nice, but also it's transformed my feelings about sugar.

Like gergnz, pop is really sweet! Unbearably sweet. Actually most sweets are just overwhelming concentrations of sugar, and they feel weird to eat.

Sweetness is something that your body adjusts to. Once you're used to eating a brownie a day, brownies no longer seem so sweet to you. But go without sweets for six months and suddenly you'll realize just how pointlessly sweet they are.

The thing that really drives me crazy is how _so much_ food is sweetened, even things where it makes no sense. It's like everybody's palette is so accustomed to sugar that now restaurants have to add sugar to their savory foods just to make them taste normal. It's a disturbing trend.

Reminder: the US government spends $2 billion a year on sugar subsidies.

Because there's just not enough sugar!!

https://www.cbsnews.com/news/bitter-battle-over-sugar-subsid...

>The thing that really drives me crazy is how _so much_ food is sweetened, even things where it makes no sense.

Yeah.. thats restricted to US :) Visiting US from India, I ended up throwing away a loaf of bread cause it was as sweet as chocolate

Coming from The Netherlands to live in the US for a while, I found the same. It seems like just everything contains more high-fructose corm syrup, and tastes sweeter. Even all breads.

It's not all breads, just most of them, especially the shelf bread from big outside bakeries.

In most stores there will be a few choices in the bakery section that don't have added sugar.

> I now find that soda is very sweet

In a vaguely similar vein, I pretty much exclusively[1] drink "diet" drinks (i.e. sweeteners rather than sugar, not that I think they are particularly healthly). Now, whenever I have the non-diet versions (which is very rare), I prefer the taste somewhat, but find them to be unpleasantly sticky and syrupy. It almost feels like they need more water adding to them, even if it's from a can/bottle so presumably mixed correctly.

[1] Unless it's a mixed alcoholic drink, but those are so different anyway

About that mousse... One mental changed that helped me was to become a foodie. Eating used to be just a chore (simple fuel). Now I cook and eat because it's fun.

Also, people are so clever now, finding recipes like your mousse has been a great joy. I now mostly prefer the more wholesome alternatives. For instance, that mousse is a huge hit, and most people wouldn't know it's non-dairy.

The part almost no one goes into is, so what's your diet now that you've reached the baseline you'd like to keep? Total calorie intake (estimated)? Any food or food groups you still avoid? meal timing? Is it a sustainable lifestyle change?

My caloric intake while eating at a deficit was about 1200-1500 kcal. Maintenance is about 2200. I eat a lot of meat, poultry, fish, eggs. No restriction on fats, but I try to favor animal fats and olive oil. Unlimited vegetables. Fruit, but only raw (no dried fruit or juice), and favor berries over bananas. Nuts and cheese in moderation.

If I want carbs, favor sweet potato / regular potato over grains. Generally avoid that altogether though.

No beer, favor wine and liquor, all in moderation.

So that’s how I select, then from there I restrict to the calorie goal. If I do have pasta or cake, I go a little harder on myself the next day (or in the days prior). That’s rare though.

It’s been really easy. Hardest day was day 1, second-hardest day was day 2. Sustained for about a year so far, and I’m not struggling at all.

Is dried fruit bad?

It's not bad per se, but it contains a lot of sugar per unit volume. Some dried fruit even has extra sugar added (effectively fruit flavored candy). So it's easy to accidentally consume a lot of calories without feeling full.

And it's fructose (metabolized mostly by the liver as with alcohol) not glucose which can be used anywhere.

I'm not really sure, but it's a form of concentrated sugar, so I try to avoid it as part of my overall goal of limiting carbohydrates/sugar/calories.

It's also similar to nuts/cheese in that if I allow myself unrestricted access, I tend to overeat them.

They're probably not that bad though.

Dried fruit is basically candy. Fresh fruit has already been cultivated to be extra sweet, extra large, and extra tasty, so it's bad enough by itself. And then you concentrate it, now you can eat many multiple times more sugar in one sitting than the fruit you would see in the wild.

The only saving grace I see is that at least it still has the fiber, fruit juice discards with that and just leaves the sugar.

"Raisins are one of the most commonly consumed dried fruits... Compared to non-consumers, raisin consumers had a lower body weight (-4.2%), body mass index (-5.2%), and waist circumference (-3.8%), were 39% less likely to be overweight or obese, and had a 54% reduced risk of metabolic syndrome. In conclusion, raisin consumption was associated with better nutrient intake, diet quality, and weight parameters, and with lower risk of being obese and having metabolic syndrome in US adults."

Association of raisin consumption with nutrient intake, diet quality, and health risk factors in US adults: National Health and Nutrition Examination Survey 2001-2012. https://www.ncbi.nlm.nih.gov/pubmed/29056890

It’s more that you can over eat much more easily. The water’s removed making you have to eat more t feel the same fullness as raw fruit.

I've embraced the yo-yo, personally, but in my experiments with keto it usually takes me 2x to 3x the time length of the diet to put the weight back on as I revert to my prior eating habits. The longest I've maintained the diet for was about 3.5 months, though over the past year it's averaged closer to 1-2 months at a time. I suspect if I did it for longer or did it more extremely on the calorie-counting side my yo-yo peak would decrease -- I have a friend who went 5 months and lost 100 pounds, now he yo-yos too but his peak before he goes again is only +40 pounds instead of +100. The peak is similar to a baseline, in that if you do nothing different you'll probably remain there. (Of course that's the standard prediction if you look at it from a pure calories in / out model.)

Have you read "The Hacker's Diet"? It was written by the guy who founded Autodesk, and I found it very useful. My own weight control system now is a simplified and informal version of the one in the book, I used it to go from over 105kg down to my target weight of 90kg and then sustain that loss (staying between 88kg and 90kg) for most of a decade now. A couple of times I've let it creep up and the same methods got me relatively quickly and painlessly back into range.

The most important thing is to see your calorie intake, not as a goal in itself, but as the control variable in a feedback loop, with your weight as the process variable that you're trying to control. (If you really wanted to get hardcore about it, you could use a PID controller to set your daily calorie intake. :)

When you reach your target weight, keep doing whatever you were doing and just gradually increase your portion size until you stop losing weight. If you're gaining weight again, gradually reduce portion size until you get back to your target weight. If you're losing weight, gradually increase portion size until you get back to your target weight. That's literally all there is to maintaining a target weight.

Link: https://www.fourmilab.ch/hackdiet/

"A few months and about 50lbs in, I had no signs of insulin resistance whatsoever, my A1C was down to completely normal values, and I was able to discontinue my medication entirely."

...

"Started calorie restricting and eliminated grains and sugar from my diet almost entirely, and all pre-diabetic symptoms disappeared within a month or two. Zero GERD, zero heartburn, no longer obese, no more disturbed sleep, lots of energy."

A serious, well-intentioned[1] question for you and your parent:

How has this changed (or not changed) your views towards classifying obesity/diabetes/metabolic treatments (as opposed to your cure) as unnecessary medical interventions ?

How does this change, if at all, your perception of the responsibility of others to fund those treatments ?

[1] Congratulations on this achievement and your good health.

I lost 50 lbs and it didn't budge my blood glucose by a single point. So, not OP nor GP but I don't think we know enough to tell people to just figure it out.

What did work for me, a little, was increasing the amount of beans I eat, and with it grains (rice), and curries, and not eating meat for at least two days a week. My bloodwork got better across the board (cholesterol, glucose) despite gaining 10 lbs.

There's another component to all of this, and that's psychology. There are people who are anorexic/bulimic and it's a horrible affliction. There are also people on the other end who compulsively overeat, usually to cope with some kind of trauma or as a reaction to anxiety. Or just because they've been fed one way since they were children, and habits are really difficult to break.

Distinguishing those people from the people who can just decide to make it better is probably impossible.

So I see some validity to all approaches.

The problem with treating it as purely a medical issue though is that, by doing that, society is being more permissive of the poor decisions people make. People who can choose to eat better and improve their health that way might never find that out, if they're just told it's all medical and we're dust in the wind.

The problem with treating it entirely as a choice is your prescription becomes punitive toward people who genuinely can't control themselves.

So I think the right approach is a balance between the two. Having said that, I think the current climate favors the dust in the wind hypothesis too heavily, and I think a lot of people are hampered and harmed by a complete lack of criticism and concern as they make and keep themselves obese.

I spent many, many thousands of dollars on everything I needed -- and that's not including the tens of thousands my insurance covered. The vast, vast majority of the US population would not be able to afford this. I would very much support subsidizing medical care to a greater extent, but it's not just medical care. The diet (New Direction VLCD) I was on cost me $22 for a box of 7 shakes, of which I would have 3 per day -- $282/mo just for that. That alone puts it out of reach for many people, sadly.

Aside from just the economic side of it, it is exceptionally difficult to lose weight. It drove me to tears and severely impacted my mental state (despite also being treated for my mental illnesses) and that's even despite being very motivated to succeed. I don't look down on anyone looking for an easier route, whatever that may be; if I saw one, I would've taken it myself.

A whole food, plant based diet might be that easier route.

100% correct. It is a lifestyle disease and the reason your doctor won't tell you is because the health industry is built around treatment, not prevention, and so your doctor was never taught this. It's through no ill intent, it just never made good business since to teach doctors much about nutrition or to fund much of the research doctors may prefer to have before adopting new advice. Drug companies on the other hand do bury study results that don't help them, and the food industry does the same and intentionally misleads the public about making healthy diet choices.

Eating whole food plant based diet with moderate exercise usually reverses T2 diabetes and definitely prevents it.

This is a gross oversimplification. Diabetes (particularly type 2) is a complex disease with both environmental and genetic factors. I'm a T2 diabetic and was diagnosed while having a low BMI (20) and reasonably healthy lifestyle. There wasn't much I could actually change about my 'lifestyle' -- no weight to lose, etc. Medication was the only solution and not surprisingly made a significant impact.

> wear a mask that would breathe for me while I slept

Dude, that's a really bad misrepresentation and very unhelpful to all the people who do need one. Many of them already struggle with self-worth issues, and seeing (whether intentional or not) lies like that spread, or worse, parroted back at them by others later does not help that.

It's made a lot worse by the alternative being to gamble on suffocating in your sleep, or doing brain damage to yourself with prolonged apnea periods that drop your blood oxygen, or at the very least, having a shit life due to low energy levels every day from having been 8 hours with the blood oxygen level of a 90 year old.

You're still breathing entirely under your own power with CPAP devices. All they do is basically balloon you up a little to keep your throat from closing up in your sleep, by providing a continuous flow of air pressure higher than the ambient air pressure. Yes they have an up/down rhythm that matches your breathing, but that's not because it breathes for you, but because it literally matches your breathing patterns so it won't obstruct your own breathing.

> put my bed at an angle so I could sleep through the heartburn/reflux

Also, to be honest, this is ridiculous. Medicines to help your body regulate gastric acid exist and aren't particularly expensive.

FWIW, he didn't specify the type of mask. Something like a non-invasive ventilator is far closer to "a mask that would breathe for me while I slept" than CPAP. I used one for a time due to central sleep apnea - I'd go for 10s of seconds at a time without even _attempting_ to breathe (as opposed to obstructive apnea, where you attempt to breath but struggle due to the airway collapsing).

Unfortunately it didn't help me that much (even with it, I would still not breathe properly which was reflected in my O2 sat. IIRC) and it aggravated other health issues, so I stopped using it after 4-6 months (which, when one of the first things I read after diagnosis was along the lines of "Rarely, CSA may result in sudden death", isn't a choice I made lightly!).

Link to the exact device you were using? All of the "non-invasive ventilators" i found look exactly like CPAP.

And a lot of CPAP devices have a "encourage the user to breathe by doing some flutter" mode.

I don't think anyone is disparaging you for needing a CPAP. The goal is to get people to a point where they don't need one.

There are many other health devices that are (likely) obviated by proper health status in life, and maybe more importantly, in utero. Two that come to mind that affect me are glasses and braces.

Any pointers on methods for reducing the need for glasses and braces?

Indigenous people eating their traditional diet don’t really have crooked teeth. Their jaws are big enough to fit all their teeth, including wisdom teeth. They also don’t really have cavities but that’s another point.

For myopia, there is weak evidence that it is caused by lack of sun exposure at an early age.

So, you can blame your parents for giving you a bad diet low in fat soluble vitamins in your childhood, and not making you go outside. Other than that, you can try to prevent it in your own children.

Beyond nutrient deficiency it seems there may also be effects on teeth straightness from bottle feeding (chronically sucking on many types of baby bottles changes infant mouth shape) and from not chewing enough hard foods as a child. The cavities thing is mostly about sugar and to a lesser extent other processed food.

As for myopia the effect is probably due to some combination of lack of very bright light exposure and a infrequent need to focus far away or too much time spent focusing close without breaks. As you say the solution is to spend more time outdoors as a child, and alternate relatively shorter sessions of desk/screen work with more active interludes, making sure to glance around the room with some frequency.

It's not about me, i don't even give a shit. I am however aware that people who aren't me actually have feelings about this.

Also note, as i stated: "intentionally or not" It doesn't matter what the intent was when lies are spread. The end result matters.

And walterbell is exactly right. Would love to see an answer to that.

Down-voted for stating reality. Never fucking change, HN. It's better for you to remain a wooden puppet than to try and imitate a human being.

I did the same, as a side effect. My GF had gestational diabetes and was put on a diet to prevent having to take insuling, so I just ate the same food. Even as a non diabetic, it was so obvious how much better I felt. A lot less tired as well, less tired, even with the erratic sleep cycle of a newborn.

Far too many consumers are still craving the same old four major food groups:

Junk, Fast, Frozen, and Artificial :)

Sugar, salt, fat and caffeine. Which sensibly makes Chocolate nature's perfect food!

Imagine that. How much more evidence will it take before Dr. Atkins is given the credit he is due for his work on low carb, low sugar diets and obesity/diabetes?

Seriously.

I was under the impression that being in ketosis could be harmful to the organs of those with diabetes. Is this just a myth or were there medications that aided you?

the diet in the paper at 800cal/day is far from ketosis, so it seems one can enjoy the benefits of low cal without going to that extreme

Ketosis has nothing to do with calories in. It's dictated by whether your body has glucose/glycogen available to run itself. If not, your cells start using fat directly and your liver produces ketones for the brain, which it uses with the remaining glucose in the blood.

The person I was replying to specifically mentioned that they went on a keto diet.

Ketosis is different than ketoacidosis.

Right, but being in Ketosis is a precursor to ketoacidosis

You have to be doing it really wrong to get there though. OTOH it's always a good idea to research it before starting something.

That's ketoacidosis

This happened to me as well. I was diagnosed about 5 years ago, and I thought for sure this was the beginning of a descent into my early death. But after about a week of moping, I got off my ass. I'm down about 90 pounds now, I've cut most of my sources of sugar and carbs, and I'm down to normal A1C values and off of medication. I also feel better than I ever have in my entire life. I wish that I could go back in time 20 years and tell my teenage self what was going to happen, and how he could turn it around so much earlier than I did, and with so much less effort and heartache along the way.

Type 2 diabetes like MANY other diseases are entirely reversible. It is sad that people are not being told this. Keto certainly is one way to achieve these results, with the preferred way being a 10 to 40-day water fast (no you will not die. In fact you will in many cases be extending your lifespan by several years).

"But show me the clinical study"

Yeah yeah, keep on saying that folks. You must realize universities and pharma companies have very little incentive to put this to the test, because the LAST thing they want is to admit water fast cures diseases they tell you will need to be medically treated for the rest of your life.

"Modern science" when it comes to diseases such as T2D, Crohn's, IBS, arthritis, and many others is the biggest con in modern history.

You are using strong language and being downvoted, but there is plenty of research available on ketosis. Personally I think you are partly right too. Like the tobacco industry, which knew all to well about the damaging effects, but tried to cover it up, the food industry might well be doing something similar on sugar/carbs. (Anyone knows more examples?)

What this article fails to mention is if the subjects need to remain on a restricted diet.

I'm a type II diabetic (my A1C was 8.7 when diagnosed) who is technically "cured" (my A1C ranges between 5.8 and 6.0), but my doctor said to me, "Make no mistake, the minute you go back to eating the way you used to, all the symptoms will return."

I don't take any medication, but I remain on my diet. And I never cheat.

I don't practice calorie restriction, but I follow my doctor's and nutritionist's guidelines: I avoid the four horsemen of the diabetic apocalypse (bread, rice, potatoes, pasta), no desserts, no dried fruit or fruit juice.

I dropped 10 lbs. when I changed my diet (I'm at 150 lbs. now), and I've never really felt the same sense of fullness as I did when I ate carbs. I'm mildly hungry all the time.

I had the same problem (mildly hungry all the time) which is what caused me to stop the low-carb-ish restrictions. Thankfully I've kept most of the weight off (but still have a ton I need to lose).

I've been debating how else to tackle this problem. So far calorie restriction seems to be a way I can decrease my intake across the board (including the four horsemen, which unfortunately are all foods I love) and start losing weight again.

It's just become incredibly difficult to stick to any plan. My longest run was four months low carb.

I avoid the four horsemen of the diabetic apocalypse (bread, rice, potatoes, pasta), no desserts, no dried fruit or fruit juice.

When I was at school, we were taught, by full-time, qualified educational professionals, that if you were hungry you should bulk up your meals with these 4 because it's impossible to eat too much of them.

I totally get the willpower argument but I am also aware there are many people who try to eat right who are simply acting on bad information from supposed authority figures.

Can you share more specifics of the diet you went through? e.g. calories, type of food, when you were having meals, etc?

congrats and glad to hear it.

Could be equally as helpful to move away from a nonideal diet as it is to move toward an ideal one.

Kind of related: it's fun as a Type 1 Diabetic when people tell me that I should be able to manage my disease with just diet. Or when they get upset because I eat a bowl of ice cream or something (even though I bolused properly for the carbs).

It's really unfortunate that T1 and T2 diabetes have the same name, since they're completely different diseases that just happen to share some symptoms.

I guess it is an outcome of these things being names based on symptoms rather than causes.

Just look at cancer, depending on where it originates it can have a multitude of causes. But MSM is likely to report every new finding as just cancer, with zero details about the type involved.

“Diabetes” and even “Diabetes Mellitus” (the latter of which being what Type 1 and Type 2 are modifiers for) are originally just names of symptoms (essentially “frequent urination” and “frequent sweet-tasting urination" [17th century diagnostics were... interesting]) that got adopted with modifiers as disease names.

I was diagnosed as diabetic in my early 30s with an A1C of 13. I'm vegan and at the time weighed about 135 pounds (down from my normal weight of 165), ran 20-30 miles a week.

The doctors I saw immediately diagnosed me as Type 2 and treated with Metformin. Between that, starving myself, and exercising like a maniac I was able to keep my blood sugar roughly under control for another year or so.

Then everything really went to shit and additional tests were like, "Whoops, guess it was Type 1 after all."

With doctors having a hard time getting past their own biases and experience, it's no wonder the average person does, too.

Somewhat similar story, (though I weighed a bit more). Went on a keto diet and got my blood sugar down to non-diabetic levels in three months (also lost a lot of weight).

But the type 2 diagnosis didn't feel right, and I pressed them for more testing, and found out that I was actually type 1. However, it's been four years now and I'm still not on insulin. Apparently the honeymoon period for adult onset type 1 is highly variable, and they don't have much data on it. So who knows when I'll have to go on insulin, but have felt pretty lucky so far.

The only downside to insulin for me is the cost and I'm pretty lucky. I buy my testing strips and pen needles from Amazon and spend $200 or so every few months when I need to restock. I signed up for a Lantus (slow-acting insulin once a day) discount card and am fortunate to pay nothing for it. Humalog (fast-acting insulin taken with food) costs $75-100 a month.

I go to the doctor every few months and demand free insulin samples when I'm there. I also got them to fill out paperwork saying I'm disabled (this is technically true by the letter of the law in the US). I used that to get a reduced fare bus pass and free entrance into National Parks. Figured I got fucked over and am going to milk what I can out of it.

Overall though it's not that bad. It's more of a hassle dealing with the routine than anything else.

Yeah, I also got misdiagnosed as T2 (at 23). Too many doctors still immediately jump to a T2 diagnosis if you're not a kid anymore. There's a reason we don't call it "child onset diabetes" anymore.

Same thing happened to my mom at 45. Only she was overweight, worked really hard to get to a healthy weight and get off insulin. And then had to go right back on it. She was devastated.

I actually love it. I was pretty close to suicide with how poorly I was feeling mentally and physically and how nothing I did "worked" no matter how hard I tried.

Since starting insulin I've gotten a bit better. Able to run and train more than ever, better mental clarity, eat like a more or less normal person, etc.

I was diagnosed with type 2 about 4 years ago. I was 245 pounds. My daily fasting number was around 180. I was put on Metformin. Now, I am off the Metformin and down to about 180 pounds. Diet and exercise were key. I dont check my blood sugar anymore because my medical insurance doesn't cover the supplies. If I checked my sugar just twice a day it would run me almost $400 a month in supplies. $400 buys all of my food for the month.

But my dr mentioned to me that I might be leaking protein into my urine stream and that I need to lose even more weight and make my diet even more strict. If I continue to leak protein into my urine stream then I need to have my kidney and liver looked at. I already just eat vegetables and meat 90% of the time. I watch my sugar intake and I turn away anything with more than 1-2g of sugar per serving. I don't eat any treats except maybe an RxBar is I crave something sweet.

Can anyone explain if I could develop type 1 diabetes still?

why did I get down-voted for this?

Type 1 is an auto-immune disease. Type 2 is not and cannot become type 1, though you might become insulin dependent at some point.

and if I do become insulin dependent then I am basically needing to shoot insulin like a Type 1 user needs to? How does one realize they are becoming insulin dependent? I mean I usually don't see a Dr except 2-3 times per year. How would I know to see a Dr sooner?

Yes, being insulin dependent means you would require taking insulin like a type 1.

Only a doctor can tell you if you need to go that route though. I'm assuming they make that decision based on your HbA1c being high or going higher despite being on a metformin, diet and exercise regimen.

You want to avoid this.

As a very tired parent of a type 1 diabetic I beg you to do whatever you can about your situation. You are lucky to have type 2 because it's something you can do something about. You have choices. You should exercise those choices.

I am doing everything I can think of. Diet, exercise, as mentioned above. I hope that it is working well. I am off the meds now and 65 pounds lighter.

About your type 1 child....just realize that your efforts are important and your child will be better off because of them. Although they might not realize it now :-)

I am doing everything I can think of

Are you aware of the research linking diabetes and inflammation?

I know some about it. Enough to where I don't eat red meat or pork (maybe 1-2 times a month) and I eat a lot of leafy vegetables. I don't use butter or mayonnaise. I don't consume caffeine and I make my own cashew milk.

At the risk of giving medical advice, you probably want to confirm the "might" be leaking protein in the urine thing. It's obviously worth worrying about so it's worth being sure about.

indeed. I have another test in January to check the status.

Just off the top of my head, trying to be constructive here, I will suggest you add peanut oil to your list of foods to avoid.

good thought. I don't use it much at all when I cook. However, I should start asking if it is used when I go out.

Read labels. It is frequently used in roasted nuts, which are otherwise a healthy thing to add to your diet.

Chik-fil-a advertises that they use 100% peanut oil and I suspect Jack in the Box uses peanut oil. I don't eat at either one, not even to get salad.

I don't eat at any type of fast food at all and I haven't for maybe 18 months now. If I am going someplace for dinner, I often bring some of my own food, at least a salad or my own dressing. Usually people are understanding about it once I tell them why, My friends already know so it is no big deal to them.

Thanks for mentioning that peanut oil might be in nuts. I eat nuts everyday. I will check the labels.

> If I checked my sugar just twice a day it would run me almost $400 a month in supplies.

That's $6.66 per test! Here in Australia I recently purchased a blood glucose tester for approx $50 and 100 test strips for $50, that's full retail price. If I had a diagnosis from a doctor I would probably be entitled to a diabetes card thingo which gives a significant discount.

US prices are magnitude higher than other countries. I have frequent jumper's knee and use Voltaren Gel which my insurance won't cover. Out of pocket, it is $1200 per tube for generic. In Canada its $10.

Did you intend to write $1200? That's two order of magnitude greater. Astonishing.

This is very true. I take Prednizone 1-2 times per year for an allergy I have to nickel, cobalt and gold. In the U.S. a few days of pills (maybe 30 pills) is around $30usd with my insurance.

I am traveling in China right now and needed Prednizone after coming into contact with nickel. 100 pills was 4rmb which is only $0.64usd

Do people not just buy stuff online from Canada, if that's the case?

its not that easy. Your package could get intercepted or you might not even get the same stuff you wanted. I am not sure how often this happens but I know people that always seem to have bad luck doing this.

$1200?! The more concentrated version was about 17 EUR/100mL at a retail pharmacy in Germany, over the counter, no prescription.

https://www.goodrx.com/voltaren-gel

$60-100, maybe you meant $120

I use 2.5%+ version. Goodrx doesn't always have coupons.

https://www.goodrx.com/diclofenac-sodium?form=tube-of-gel&do...

Many kinds of test strips are less than $1 each here too.

Amen to this.

I'm a parent of a T1D and if I had a dollar for every time I've heard "My cousin cured his diabetes with diet!" I'd be a very rich man.

Or, and this may sound petty, but listening to someone equate their struggles as a type 2 with the struggle of a type 1 makes my blood boil. I would gladly swap my son's type 1 for type 2 any day of the week.

It's a real shame that they share the same name. I feel for you. One is a disease and one is a completely reversible condition bought about by eating decisions.

It is quite funny the relationship between the two types of diabetes. The guy who fitted my kitchen was diabetic, but was at pains to point out that he had "proper diabetes, not fat bastard diabetes."

> he diet was a formula of 825–853 calories per day for 3 to 5 months, followed by the stepped reintroduction of food over two to eight weeks.

That is going to be a brutal 3-5 months. Worth it in the end though.

Also, c'mon, a range of 825-853 calories? Nobody is counting calories that accurately and it would have been better to say "roughly 850 kCal per day".

It's tough not only to cut back the calories, but to pack needed nutrients into the few calories remaining. Over several months you could accidentally end up with a severe deficiency of something.

Soylent.

... is not designed for an 850 calorie diet.

Too much sugar (check the label). More like Ketochow (protein shake, vitamins, heavy whipping cream). Each of my servings is ~500 calories. Shed three pounds per week eating it 3 meals a day, no exercise.

I miss the pancake batter taste of Soylent, don’t miss being fat.

How bad is the taste?

Delicious. I eat the chocolate and peanut butter Ketochow flavors regularly.

That sounds better than Soylent, tbh. I might have to check this out. Thanks!

There's a pretty wide range of products out there right now in the "keto soylent" market:

http://Ketolent.com http://KetoOne.com http://KetoChow.com Keto Fuel http://superbodyfuel.com/shop/keto-fuel-sample/

Disclaimer that you make one of the products?

The sugar is mostly isomaltulose.

Carbs are carbs.

https://www.sciencedaily.com/releases/2016/02/160216111400.h...

I should’ve been more clear, my apologies. Even if isomaltulose is released more slowly in the bloodstream, it’s quantity is higher in Soylent than one would prefer.

Too many carbs are too many carbs.

Maybe not Soylent(TM) but a modified recipe with less carbs (maltodextrin and isomaltulose) would work.

Check out Ketochow

http://Ketolent.com http://KetoOne.com http://KetoChow.com Keto Fuel http://superbodyfuel.com/shop/keto-fuel-sample/

http://Ketolent.com

http://KetoOne.com

http://KetoChow.com

Keto Fuel http://superbodyfuel.com/shop/keto-fuel-sample/

Spinach can help a huge amount in that because it has soo many nutrients.

Here's my fasting plan: 1 Meal/day 100 cals - 1 lb of Spinach 60 cals of tuna (1/2 a small can) 1/2 lb of cauliflower

That total comes out to about 200 cals and meets aboout 100% of 1/2 of all the micronutrients and roughly 50 to 100% of all the other micronutrients. The Tuna (Selenium,b3,b12,b6) nicely complements the Spinach (high in A,C,E,K,Iron, Magnesium). And you get a relatively high amount of protein and fiber (normalized for cals)

Also, you can use something like Crono-meter to measure all your nutrients.

And btw, just because someone is eating 2000+ cals doesn't mean they're getting all their nutrients. Most of the foods people eat are so devoid of any nutrition, they minus well not even count.

Did I misread or are you eating a pound of spinach in one sitting? How do you fit that in your stomach?

Have you never cooked spinach? It turns into nothing by the time you're done.

He didn’t specify though. Cooked and raw spinach have very different nutritional properties, so it makes sense to eat both.

The minerals stay the same. It's just the vitamins that are decreased. But, spinach has such a vast amount of vitamin A,C,K to start with, it hardly matters.

The acid brought out in cooking doesn’t just decrease the nutrients, it allows some nutrients to be absorbed easier, so it’s a bit more complex.

It becomes a lot smaller after you boil it. But, it's fairly easy to eat all that, with my vast appetite. For anyone with weight problems, appetite and hunger tends to be way too large anyway.

True, but you should always listen to your body. It usually craves the things you need. If you of course discount the craving for sugars and the like.

In my experience "listen to your body" is most often an excuse that people use to continue making unhealthy choices about food. Is there any research data on the correlation between food cravings and actual nutritional deficiencies?

It's definitely true to some extent. People with mineral deficiencies sometimes start eating eat rocks and dirt.

A man[1] lost in an ocean suddenly developed an appetite for eyes of fish -- rich source of Vitamin C (which they had started to have depletion adrift in the sea)

1. https://www.theguardian.com/world/2014/feb/04/castaway-jose-...

The paper says:

> ... total diet replacement (825–853 kcal/day formula diet for 3–5 months), stepped food reintroduction (2–8 weeks) ...

That sounds to me like participants were given a professionally prepared formula to consume instead of food, so the calorie counts might be that accurate.

they had to drink shakes, basically. that's the only way to get that level of control.

I think in the previous post that was on HN about this they were interviewing a lady that said she was eating some powder that "had all the nutrients", which sounds like something similar to Soylent.

There's a keto version called keto chow. There are recipes online as well as pre-mixed packages to buy. I don't know that the study used this exactly, but it's the same idea.

Probably something like Optifast. Kevin Smith (the filmmaker) dropped a ton of weight on it, and it was like 850 calories per day with weekly doctor checkins.

You can get quite a lot of food in 850 calories. Vegetables are pretty low cal. Below is a plan I just created that is less than 850 calories

Total Cals - 836

Breakfast: 2 eggs - 156 calories

Lunch:

2 cups of spinach - 14 calories

1 cup of bell peppers - 39 calories

200 grams chicken breast - 226 calories

Snack:

1 banana - 105 calories

Dinner:

200 grams chicken breast - 226 calories

1 cup of broccoli - 31 calories

1 cup of bell peppers - 39 calories

That's very similar to a standard lunch for me.

That is certainly not what I would consider "quite a lot of food"! If I was forced to use your meal plan I'd eat it in a single sitting in the evening and fast the rest of the day.

This is why I hate the term "Two pizza teams". At best that is me and one other person. On a hungry day (say after training squats) I'd be working on my own.

While there are a few comments that this is a single meal. This is pretty much how I consume my food each day. The only exception is that I tend to add an Icelandic style yogurt to breakfast and some turkey sausage. Puts me around 1,000 calories.

who came with the idea of kCal, cal, Cal btw ?

That's not so brutal when consider that there are a group of people who purposefully consume less calories in order to prolong their lifespan:

https://www.crsociety.org

https://en.wikipedia.org/wiki/Calorie_restriction

> Also, c'mon, a range of 825-853 calories? Nobody is counting calories that accurately and it would have been better to say "roughly 850 kCal per day".

That range might represent the precision of data they have for the formula mixture (if e.g. macronutrient data is only given to the nearest gram or half-gram and you consider the possible rounding error in both directions).

This reminds me that we had a cat that developed diabetes. Besides the usual treatment, we changed the cat's diet "radically". Eventually the cat no longer required insulin shots, i.e. it was "cured". I remarked to my wife at the time that maybe the reason T2 diabetes is considered incurable is that it's all but impossible to get humans to radically change their diet.

That's pretty much it.

It's pretty common in cats for there to be a honeymoon period after treatment begins. The lower blood sugar levels allow the still viable ß cells to resume producing insulin.

After a time, however, the process that was killing them off in the first place often reappears and insulin is required again.

The biggest factor I've seen in previous cats with diabetes - dry vs wet food. Switch from free-feeding dry to measured, timed canned portions made a night/day difference.

Nice to see this hitting the mainstream. I vaguely recollect Robert Lustig of "Sugar: The Bitter Truth" [1] fame (or someone following/close to him) making a similar point a few years ago.

[1]: https://www.youtube.com/watch?v=dBnniua6-oM

All systems of the body follow a circadian rhythm. Following the body’s circadian rhythm and adhering to a time-restricted eating pattern (i.e. intermittent fasting) is even more important than explicitly only restricting calories. Secondly, avoiding processed carbs and sugars is more important than explicitly only restricting calories. Combined, those two principles directly impact your insulin sensitivity, which is very influential in telling your body how to process the calories you eat, when to feel hungry/full, and to what degree.

Of course, by following a time-restricted eating pattern, you naturally consume less calories, but in general, calories are largely irrelevant when you are adhering to a consistent circadian eating cycle and eating clean, whole foods. Healthy insulin resistance directly negates fat/weight gain by telling your body to simply dispose of the excess energy rather than storing it as fat. Calories-wise, the body only uses what it needs and gets rid of the rest. To keep insulin resistance in a healthy range though, you obviously need to not consume things that will spike it and reverse the feedback loop. Following the body’s natural circadian rhythm contributes to keeping it in a healthy range as well, and it is significantly easier to adhere to than restricting calories only.

For the curious, here are a few resources that I have found super helpful in learning to better control my diet and health.

The Obesity Code by Jason Fung, MD http://a.co/7MHTlmU

Found My Fitness Podcast with Dr. Rhonda Patrick https://itunes.apple.com/us/podcast/foundmyfitness/id8181983...

These guys are doing some interesting work around this - https://www.virtahealth.com/

Yeah, really looking forward to some of their results.

What will doctors do about this, though? They can't just tell their patients "well, you just have to lose weight".

People want easy solutions in forms of pills, and there is no money to gain from prescribing caloric restrictions.

Some great documentaries about this:

- That Sugar Film

- Fed Up (on netflix)

- Sugar Coated (on netflix)

- The Science of Fasting (Amazon Prime)

Another movie is "Forks Over Knives" on Netflix. That one is more about going to whole foods rather than just cutting out sugar.

My brother the doctor doesn't call it diabesity for nothing.

Was there really no research before this that showed that losing weight was beneficial for sufferers of Type II diabetes?

There definitely was. I remember telling this to my college roommate few years ago after he gradually gained lot of weight and was diagnosed as pre-diabetic.

There has been plenty.

I tried my first multi-day water only fast around 2005 after reading about it in a book written by an M.D. who used fasting to treat various illnesses. I can't remember the name though.

The article has some shocking statistics but most shocking to me was that the youngest person in the study was 20 years old, type 2 diabetic at 20.

I think the reason that drugs are the usual solution is simply that it is really really hard to get people to change their diets and/or fast.

That's the surprising thing. How can weight-loss and diet improvements to treat type II diabetes be some kind of revelation? Would diet approaches not have shown this correlation many decades ago?

I think the headline is accurate because that is indeed what the study shows, since it compared a control group to a group on a very low calorie diet.

But I'd really like to know if this is any _more_ beneficial than more normal, gradual weight loss, like a 2000 calorie diet that gets you down to the same weight.

A lot of people with sedentary lifestyles will gain weight on a 2000kcal diet.

Or if you're small. I'm 5'2, so even adjusting for physical activity my BMR is about 1600 cal. 2000 cal/day means I'm going to gain about a pound a month.

These are people who lost 15 kg or more (33+ pounds). Most likely they were pretty overweight to start with.

And the heavier you are, the easier it is to lose weight because it takes energy to just maintain all that extra body weight.

Point being, there are certainly some people would not lose weight on 2000 calories/day, but I would guess that isn't true for most of the people in this study.

> And the heavier you are, the easier it is to lose weight because it takes energy to just maintain all that extra body weight

Well, the higher a calorie intake you are likely to be able to maintain and still lose weight, which is very much not the same as “the easier it is to lose weight.”

OK, I've got to admit that what I wrote was a bit ambiguous. I meant physiologically, it's easier to lose weight. But when you are starting with a group of people who are overweight to begin with, there are other factors like behavior or psychology.

I have a hypothesis, though I haven't had a chance to dig through existing research to determine if it's an idea worth pursuing.

The basics of it are that there is a condition that has the same symptoms of type 2 diabetes, but isn't, and that "real" type 2 diabetes is a genetic defect that does not have as much of an impact as the type 1 defect. If correct you might say it's a nomenclature issue, which seems to happen from time to time in medicine.

If this hypothesis is correct, then people who are overweight and "cure" type 2 by losing weight are really just improving their health (which they should do). They never had diabetes to begin with. As I said before, I haven't done the research and only have anecdotal evidence from my own situation with diabetes. To elaborate, I've never been overweight and have always had fairly well balanced, low-sodium diet, yet was still diagnosed. Most men on my father's side of the family have been diagnosed with diabetes, so it seems genetics might come in to play. I manage my diabetes through diet, exercise, and medicine (not insulin).

I suppose the research I would like to see is a study of treatment controlled for the initial weight and lifestyles of the patients. If weight wasn't a factor to begin with, how did diagnoses take place and how did changes in diet and lifestyle affect it? I'm also curious of heart disease and kidney function actually correlates with diabetes only because of obesity (or in other words, actually only correlates with obesity).

Also, the article states, "Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments. Diet and lifestyle are touched upon, but diabetes remission by cutting calories is rarely discussed". Maybe that's true in the UK, but in my case, per doctor's orders I went to the diabetes control center and had a class on how to change my diet, which included meetings with a RN and registered dietitian who specializes in diabetes treatment.

Maybe I am repeating another comment, but... that's not something new. It's a well known thing (at least here, in Europe/Poland) that type 2 diabetes at early stage is mostly caused by bad lifestyle and can be easily reversed within few months.

The interesting thing here is what lifestyle is causing it/cures it.

In Denmark we call diabetes "sugar disease". I read a pamphlet from the The Diabetes Foundation where it said that it was 'a lifestyle disease' and made no connection with sugar or carbs. Rather, I got the impression it was still about reducing your weight, which has usually been a battle against fat contents. I asked my doctor about these statements and the connection with sugar, only to have him say "well, some studies make a connection but nothing official".

Which brings me back to the article. The point is the connection is becoming more clear: High carb diet (e.g. sugar) seems to trigger Type 2.

It's not news, but science is not about news - it's about rigorous testing to confirm our theory.

> The participants were all given support throughout, including cognitive behaviour therapy and were encouraged to exercise.

I wonder if there's also comorbidity of obesity and mental health troubles which is helped by both of these aside from the diet.

It is indeed so tiring to explain to people I'm not crazy skipping that dessert or pizza or pastry. Most of my peers still think bacon and butter are pure evil.

That's even skipping all the vegans.

The way I found out that for example, sugar and meat are among my enemies, was avoiding one of them for days, and writing down how I felt. One thing easy to forget is how different our metabolism can be when compared with others. But you have to make an effort to avoid just that one type of food, and keep eating everything else as usual. Even better is to repeat the experiment various times. And write everything down, do not trust your memory.

Confirms what I’ve known anecdotally.

I had a whole host of health problems before caloric restriction and cardio + weightlifting. High blood pressure, arthritis, and asthma all disappeared after an active lifestyle and CR.

I never took the Norvasc that was prescribed by my primary care doctor because my cardiologist told me I was too young to be taking any medications. Had an EKG and blood work and everything came back normal.

This is less about the diet and more about the weight loss.

Type 2 diabetes is basically overloading your body so your pancreas doesn't work effectively. Removing those stressors and improving insulin sensitivity allows your body to work normally.

You can achieve similar results from any diet that someone would stick to and lose a similar amount of weight.

I think this is what happened to me.

About 4-5 years ago I was very unhealthy and experiencing symptoms of type-2 diabetes. It scared the hell out of me and I cut out all sugar and started running multiple miles per day.

The result was significant and I lost something on the order of 60-70 pounds. After that, all of my symptoms subsided.

Wasn't this already demonstrated by the same people (Newcastle) 2 or 3 years ago?

Wait a sec. caloric restriction is a “radical diet” now? And how was this not the first thing that doctors tried before going straight to bariatric surgery? Nobody was like hey, maybe we should try to lose some weight first?

I'd also recommend the book Diabetes unpacked and, if you are interested in the deep story of a low-carb vs high-fat trial, the brand new book Lore of Nutrition by world-class scientist Tim Noakes and Marika Sboros

In one day this page has more commenters than there were study participants (149 participants) who were on the controlled diet. We could do our own study if we could have everyone post their numbers.

I created an email. Please send your 4 pieces of daily data t2diabetes.world.study@gmail.com

Your height, Your weight, Your daily calories, Diabetes status ie Blood glucose level with units.

I will create a webpage with anonymous data. That is no email addresses. Each participant will have an anonymous Participant #

I plan to post a table Participant # - Date - Height, Weight, Calories Eaten Today, BG level

https://www.reddit.com/r/keto/

This has been common knowledge for some time, but as with everything else in western medicine its "research evidence or bust".

Many things that were once "common knowledge" are now known to be false. That's why modern evidence-based medicine is increasingly effective and offers the only viable path forward. But it also makes me wonder what things we currently consider to be common knowledge today will be as thoroughly debunked as bloodletting 100 years from now.

Bloodletting has been an important and scientifically verified part of my father and aunt's medical treatment due to an excess absorption of iron (haemochromotosis).

Also some people find leaches useful for cleaning wounds.

Common knowledge is like a common cold. You just don't want it.

>Radical diet can reverse obesity, old study shows.

What a great news ! Now we should get rid of all overweight problems, right ?

Well I know what most assuredly can reverse type 2 diabetes at least in overweight people - metabolic surgery. I was 30+ BMI, in the category 1 obese - nothing serious like rolling downhill kind of obese, however for a 5'9" at nearly 210 lbs (and not really going down), I was big..it's just that I'm one of those people who hides his weight really well (or carries it, if you prefer).

I had a VSG procedure 6+ months ago.. prior to it my (bad) cholesterol was high, I felt like lethargic s__t most of the time physically/mentally, and I'm pretty sure I had metabolic syndrome.. was also borderline hypertensive.

As age increases, none of this gets better, and quite frankly, no amount of exercise is truly going to reverse weight. What's needed is resetting the metabolic set point we all have, and unless you dedicate a significant chunk of your time/life by paying attention to everything you eat (e.g. probably low carbs/high protein for most like me), coupled with keeping in shape (e.g. 30 mins/daily exercise, nothing strenuous but enough to break sweat)... 90% of the time you're going to go back up to your metabolic set point weight, or worse, rebound above it if you lost the weight too fast.

This was shown to be the case with more or less 80-90% of Biggest Loser winners, whom were monitored 5 years down the road and determined to have regained all the weight and worse, more in some cases.. The ones who kept it off do so at a great expenditure of time as I pointed out above.

Top this w/the fact if you have a FT job or a business to run and a family to take care of... you will see the impossibility of losing weight to stave off all the potential diseases (type 2 diab included).

I've got your answer - but you won't like it because you have to give up your food addiction - bariatric surgery.

I've lost nearly 40 pounds since my VSG and am at a weight at 40+ years of age that I was in my late teens. Blood pressure, cholesterol, all normalized... energy through the roof. Moderate exercise, and I only do it because I feel like it now whereas before I felt like I was forcing it when I was obese/heavy.

Please look into this (ASMBS.org), and make a life altering choice that will possibly extend and -definitely- improve your quality of life as well as reverse type 2 diabetes and many other diseases related to being over weight.

If insurance won't cover it because you are not TOO FAT (like 35+ BMI), bariatricpal.com has doctors from all over the world, Mexico included that have performed successful surgeries with glowing reviews from Americans and Canadians for less money than what you'd pay in the USA (e.g. obesitycontrolcenter.com being a prime example, where I had mine).

Life's short... don't let being overweight ruin it.

The concept of a metabolic set point is a myth based on a misinterpretation of research. Many overweight people — including those with families and jobs — have gotten down to a healthy weight and maintained it permanently purely though lifestyle changes. So please don't claim that it's impossible.

You are one of them, I assume? How much weight did you lose, over what period of time, and what is your weight right now? Are you a doctor by any chance?

Care to back up that claim? Can you point/link to research papers that demonstrate the misinterpretation?

I wouldn't call increasing chromium and vanadium and decreasing sugar 'radical'.

Type 2 diabetes is a solved problem, but pharmaceutical companies have yet to find a way to make money from a water fast, so no one tells people about it.

I don't know if it's a solved problem. It's very hard to get people to fast. It's even harder to get people to maintain a healthy lifestyle and body weight after going into remission.

Well, the problem is solved. People just don't want to take enough ownership over their health to actually do it.

Fasts are so hard on the body and mind that it's not at all difficult to imagine situations in which people can't afford to do it.

I wouldn't be able to do my job if I did an 850kcal fast for 3 months.

Well, fasts aren't the only solution here. Changing your and adjusting your carb intake in order to offset insulin requirements can gradually get things back on track.

Doing intermittent fasting isn't even that taxing once you adjust. I have been doing it for around 4 years and I work as a developer. My most productive hours are still in the morning, and I don't even eat until noon-1pm on most days.

But to your point, yes, a drastic implementation of a clinical approach can be impractical. Fortunately there're a lot of ways to fix type 2 with diet which aren't as taxing.

So the problem is solved. It's just that most people would rather take insulin than change their diet.

Depends on what you see as a problem. Is it: technically what is the method of getting rid of diabetes in a controlled setting, or is it: how do we cure billions of people from general population, given the existing conditions of their lifestyle? Because the second one is the harder question. Currently it's solved in the same way world hunger is solved: just grow some plants and eat them, right?

From the view of an individual with self control you're correct. From a societal view that doesn't help. A large percentage of the population has demonstrated a lack of self control in this area. This has lead to widespread health problems. Those problems are a burden on society. Simply saying it's your responsibility deal with it won't reduce that burden.

We found a similar problem with smoking. Numbers of smokers have reduced with public education plans and limitations on marketing. Perhaps there are similar things that can be done to help reduce the number of people suffering obesity related illness. Perhaps it's something that will have a net positive impact on society as a whole?

There is of course a balance interfering with individual dietary choices is a slippery slop, freedom must be preserved at all cost.

Legalize amphetamine microdosing, perhaps? :)

As someone who has several extended family members with type 2 diabetes, I'd love to read a write up of the clinical trials supporting this.

Google Jason Fung, he's a former urologist who's specialised in diabetes type 2 through fasting.

It's actually worse.

1/3rd of Americans (over 100 million people) have, or are well on their way to having, Type 2 Diabetes. This is one o the largest cash cows of Big Pharma.

They don't want to fix it, their bottom line depends on this never being fixed, and they will do anything in their power to make sure it is never fixed.

> They don't want to fix it

Bullshit. They want to solve it in a way that doesn't involve hard behavioural (exercise, dieting) or industrial changes (nutritional) for the average person. A very rational pursuit given the obvious difficulty in the other factors being slow changing.

There is nothing wrong with offering medication and personal health analysis tools (blood glucose level monitors) which help manage an illness which affects a huge percentage of Americans.

That doesn't mean they are actively making diabetes a widespread condition.

This is not really a helpful comment. It's hard to take your position seriously given the number of ads and gullible people who will tell you how everything is a big pharma conspiracy and you can cure everything from a cold to cancer with enough {prayers, vitamins, water, ...}. Any supporting study would be better.

As someone who has worked tangentially to drug discovery and who has many friends who work as scientists in pharma, I promise you this is outright false. No scientist or even evil business/lawyer person for pharma is out to suppress known cures for disease in order to make a buck.

This entirely leaves aside the notion that diabetes (abbreviating as DM2 for diabetes mellitus type 2) is a solved problem. If you can maintain a low calorie diet or a water fast, then yes you will improve and may not benefit from medication. The number of people who can do that sustainably is rather small, as evidenced by the number of people who get the disease in the first place. It's not like it's a mystery that excess caloric intake and weight gain are the major risk factors for DM2.

It's also not a mystery to the patient, they know they should probably cut back a little, but it turns out that diets are extremely difficult to maintain long term. See:

http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-...

So for those people who have difficulty maintaining drastic weight loss for whatever reason, I think it's ok to have a pharmaceutical industry that tries to find alternatives. If an individual patient can do without the drugs, that's great too. In the end, lives will be saved with both approaches, they are not in conflict.

https://sciencebasedmedicine.org/

The only reason this is news in 2017 is because the food and pharma industries have been so successful at suppressing this fact. smh

Let's not mention this to the "every body is beautiful" crowd. I had a similar journey in my 20s when my doctor let me know I was pre-diabetic. Weight loss and good diet now has me feeling better in my 30s then ever. It doesn't have to be complicated.

I've been on an almost all meat, egg and almost no plant matter, ketogenic diet for nearly 5 years. AMA on my diet.

This isn't a radical diet. This is our natural diet.

Carbs dissolve digest sugar and are unnecessary for human metabolism. If you stop poisoning yourself, you will find your health rebounds.

You aren't making sense. Take a moment to say something substantive, please.

I think the post is making the point that over the course of human history, low calorie, low sugar diets were the norm. Periods of fasting were the norm.

Many people make that claim, but it isn't backed by science.

Well fasting at times was normal. Everything enough though is questionable. We know that humans have been eating some high carb foods for ages. We also have every reason to believe that humans used to be more active than our "couch potato" current life. There were no office jobs, if you wanted to eat somebody had to chase down the food (sometimes a literal chase, sometimes just find it). Low sugar - there was plenty of fruit available at times. Of course this fruit did have a lot of complex carbs as well.

You touched on the 2nd part of this, exercise. Walking for transportation may seem "radical" today, particularly in the U.S. But this is only radical in a modern context. Walking is our "natural" mode of transportation.

Cognitive dissonance is a helluva drug.

I've always been slim and not eaten much. But a few years ago I started to develop a paunch! For the first time in my life, I started to check the sugar content of what I was eating. The results surprised me greatly. For example, I like chocolate protein drinks, and often have 4 or 5 per day. But the one that I liked had 10g sugar per serve. The different brand right next to it had <1g sugar/serve! So that was an instant save of ~45g sugar/day. I also had no idea of how much sugar is in orange juice. And the misleading labelling! One juice on our local shelves says: "NO ADDED SUGAR!" - but has absolute truckloads of sugar already. Results (a few months later): me 1, paunch 0!

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