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Comment by nemo1618 | Hacker News Reader

Based on the length of this article, I was hoping it would actually, you know, describe the method used to reverse T2D, but I didn't see any such description other than vague references to "nutrition." Frustrating.

Also, I'm skeptical of the claim that obesity does not cause T2D. Is this backed up by good studies?

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"the nutritional approach is based on highly individualized carbohydrate restriction and nutritional ketosis (which I’ve written about extensively in the past and throughout this blog)."

I think there's at least a 75% chance that the whole cure is essentially contained in that sentence.

I've been keeping a bit of an eye on this area for a while, and watching the studies fling back and forth and such. My current pet theory that I think explains a lot of observations is "Carbohydrate-restriction diets (such as Atkins) work well on obesity caused by insulin resistance and metabolic syndrome, and may even be able to reverse the underlying causes, but may be ineffective for other causes." Basically, if you damaged your pancreas to some degree (or convinced them to stop working, or whatever; "damaged" them in terms of end result not necessarily "harm to the pancreas"), carb restriction may work well for you, but if that's not the core problem, it may not work for you at all. This may explain the variance in studies, if there is an unaccounted for variance in the populations being studied and how affected by metabolic syndrome they are, and why for some people low-carb diets work great and for others they fail completely.

I've also noticed as I've been getting into some intermittent fasting and such that when I'm doing it, I seem to be more able to consume a higher degree of ("good") carbs without it going straight to my waistline, as if I'm actually repairing or healing some things that I broke in my teens. (Where I considered a Coke and a king-sized package of Skittles a good after-school snack; it wasn't bad for you, there was no fat in it!)

(Perhaps slightly less controversially, what if the term "obesity" is actually like the term "schizophrenia"? We know the term "schizophrenia" is a catch-all term for what is almost certainly multiple distinct disorders that we currently lack the technology or know-how to distinguish. What if "obesity" is actually several distinct problems, with several distinct cures? In some sense, we already know this is true, because for instance thyroid malfunctions can cause issues with weight. But what if what's "left over" after those other cases is still three or four distinct things we're currently lumping together, and that we lack the tech or know-how to distinguish? It wouldn't really be that shocking.)

But note I label this "pet theory" for a reason. I'm not claiming to have Truth here, just a pet theory.

More of a description of a symptom rather than a cause?

Pretty sure that article was an ad.

I do know at least one person who has Type 2 Diabetes with a regular BMI, but even the article points out the average BMI was 40 - I really hope that's not the average population's BMI. I guess you could argue chicken & egg (diabetes causes obesity... maybe?), but in this case the egg is rather fat.

Here are some videos about how to treat it - https://www.youtube.com/playlist?list=PL5TLzNi5fYd--uc9TA8ER...

Look for neal barnards books, including a cook book.

Regarding point 1: From the site linked in the article, it appears to be basically classic keto + heavy supervision and dietary advice.

Roughly, the method used is the ketogenic diet. Very low carb, very high fat.

Yep, and this is the method used by Virta Health. They are attempting to use this diet and telemedicine to reverse diabetes at scale. Their 2 year clinical data should be out soon.

It might not necessarily be high in fat - it's probably the calorie restriction that works, as in this trial:

https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-ma...

I mean the method used by Virta in this particular link. I am not suggesting that there are not other methods that work.

Personally, and anecdotally, I have tried calorie restriction dozens of times since childhood and it has never brought down my A1C.

It must be high fat. From the linked essay [1], the diet is 30g daily carbohydrates, 1.5g/Kg(body mass) protein. For an 80Kg individual, that results in 150*4=600Kcal. That means almost 2000Kcal in fat to reach the daily caloric intake.

[1] https://asset.jmir.pub/assets/a2c0047f60bd77156d22029b8bdd5c...

Perhaps the author is suggesting that T2D and obesity are usually caused by the same poor dietary habits, at least in the US. The obesity just tends to happen earlier, so it's assumed to be the cause of the diabetes, which happens later. I think the bit about gastric bypass literature is referring to the finding that physical modifications like gastric bypass are not effective in reversing the metabolic damage that results in T2D.

I don't have any studies for you though.

As it is Peter Attia I’m assuming it was some form of intermittent fasting with some version of Keto. He doesn’t really like giving one size fits all solutions so that’s probably why it isn’t mentioned here. Source joe Rogan podcast interview.

correlation doesn't mean causation, although I myself think insulin resistance happens to obese people because they are obese and not some underlying mysterious reason, but insulin resistance is not typically the only source of T2D, if it was, thin people would never get T2D, so I guess we still have ways to go before we solve this one.

Thin people with T2D are probably “TOFI” — thin on the outside, fat on the inside. There is a concept of the “personal fat threshold” which is how much fat you can pack into your fat cells, and how many new ones you can grow. This concept explains why Asia and India have high rates of T2D at a much lower BMI.

An interesting way to show that this is likely the case is people with lipodystophy - they have no subcutaneous fat, and they are almost all diabetic.

I might just be matter of being "skinny fat" - someone is an average weight, but because they opt completely out of physical activity, they have basically no muscle mass, and the majority of their structure is composed of fat tissue.

That's sort of what TOFI is, its the term used in medical literature.

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