You make it sound like the intervention was carb elimination, rather than weight loss with a health coach. It was not.
I still like to eat but it's become more a number game. I eat once a day and structure my meal to hit my macros. Just figure out how many calories and protein / fat ratio and I can usually hit close to it with 1 meal and top up calories with butter coffee.
Also, I can instantly do a 1-day fast. It doesn't bother me at all. Every few days I stretch my intermittent fast to proper "just coffee and water today" fast. It's very refreshing.
Calorie restriction on carbohydrate heavy diet sounds like hell. Food cravings. Starvation.
Fasting on the other hand is a different story. Zen.
I'm not even that close to keto levels of carb intake[1], but I've been progressively minimizing any processed carbs since college (and I'm lucky enough to have been raised eating fairly healthy, so my baseline was decent). At this point, there are certain foods that all my friends feel are impossible not to crave and give into occasionally, that I simply just don't enjoy. One of the biggest examples is fat+grain in its various forms: pizza, grilled cheese, many pastas, funnel cakes, etc etc etc. Don't get me wrong: I'm not completely incapable of enjoying these categories of food. It just needs to actually be well-made and have some flavor: by contrast, most of the people I know enjoy the wireheading effect of this combo per se. To me, this seems like the difference between eating a nice dessert and eating a bowl of straight white sugar.
This is something I think about a lot: there's so many unhealthy food items that I find pretty gross at this point that most of my well-educated, high-income social circles have resigned themselves to being a completely unavoidable flaw in the human brain[2]. It's kind of eerie to think about; My diet isn't even amazingly healthy, and I've already found myself brushing up against the "eccentric abstemiousness" that pg mentions in his essay on addiction.
[1] every time I lift weights, I crave carbs too much to drop them entirely: most of my carbohydrates come from beans, pulses, and certain green veggies.
[2] IMHO, this is the source of the popular-on-HN sentiment that each and every one of us are hopelessly devoid of agency when it comes to resisting the power of corporations to exploit the way our brains' taste centers work. The theory isn't implausible to me, but my experience indicates that you really don't need superhuman self-control to change your diet: it just takes time and patience.
And you make it sound like the intervention was weight loss with a coach, rather than carb restriction made possible by continuous care.
The authors assert that carbohydrate restriction was the main cause of lowered blood glucose, weight, and medicine use (weight loss was not the cause of the improvements; rather, it was one effect among others). Continuous care was required for medicine management and in order to sustain the diet, as clearly stated in the summary (emphasis mine):
> Blood sugar in patients with T2D can improve quickly when patients eat significantly fewer dietary carbohydrates. However, this demands careful medicine management by doctors, and patients need support and frequent contact with health providers to sustain this way of living. [...] After 1 year, patients in the CCI, on average, lowered HbA1c from 7.6 to 6.3%, lost 12% of their body weight, and reduced diabetes medicine use. [...] This suggests the novel care model studied here using dietary carbohydrate restriction and continuous remote care can safely support adults with T2D to lower HbA1c, weight, and medicine use.
Well, to be fair, they didn't make any attempt to control for improvements due to weight loss alone. They compared their results with one "lifestyle change" study and one calorie restriction study (also with carbohydrate reduction, both of which references I didn't follow) and the difference in outcomes was not that groundbreaking, I'd say.
But I'm not a doctor, or a biologist and I can't really say for sure. I'd welcome some input from a specialist on this.
When someone says “carb restriction is the ticket,” they’re attributing the effectiveness -to the carb restriction-, explicitly, as having an effect on weight loss notably above and beyond that of calorie restriction.
Pretty much no decently structured studies have supported that. A couple animal studies suggest shit like HFCS has a much more severe short term effect on insulin than other foods, but they’re small, animal based, and “don’t eat junk food” is world away from “carb restrict.”
If you have a perfectly healthy relationship with food without having to constantly fight cravings, awesome, and nobody who needs to lose weight is like you.
I find fasting to be more in tune with my life nowadays.
The first week or so was really hard. Close to no carbohydrates and all I could think about was sweet things. Even after I reintroduced healthier sweet foods like fruit, it just didn't hit the same spots as a good sandwich or a bowl of pasta.
After I went back to regular food, I'd periodically do a month or so of paleo to try and the weight gain under control, but I got back up to 280. Currently I'm a couple of weeks into slimfast. I'm not hungry. I don't feel bad if grab a small piece of chocolate. Occasionally my evening meal is a small bowl of pasta, or a sandwich and I'm loosing a consistent amount of weight... for now.