Type 2 diabetes: NHS to offer 800-calorie diet treatment

I field countless questions about diet on a regular basis, and honestly the #1 tip isn't about calorie reduction or low carb or any gimmicks... it just comes down to "start cooking your own food, from real ingredients". Buy fresh meat and produce and go from there. Weight loss and health will come naturally, because real food is far more satiating than the calorie-and-sugar-dense snacks the western world is used to eating.

Keto is a really good diet for both weight loss and correcting insulin resistance for a T2 diabetic.

(Source, I am a T2 diabetic that eats a ketogenic diet. I am losing weight and my A1c is dropping. My doctor is pleased with my diet choices.)

That's not how it works. DKA happens because your body is burning fat because it's starving from a lack of insulin. Ketones from healthy weight loss are not dangerous.

It's definitely a risk, but not as much if your body is still making insulin to help provide your cells with at least some energy.

Low carb looks to be dangerous for your body long term if you have too much meat.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...

According to a recent documentary I saw on the BBC about this very diet, the point of the 800 diet is to lose weight asap and then introduce food back in gradually over 3 weeks (I think it was restoring one meal time a week, dinner, lunch, breakfast), in a controlled manner to teach you better food habits.

The documentary was focused on 4 normal people who had health problems due to weight, they all were trying this diet to see if it would help. One of them had just developed type 2. Wouldn't be surprised if that programme paved the way for this (it was on in June).

https://www.bbc.co.uk/programmes/b0b53xqs

Not eating anything, and only eating proteins and fats, are both difficult for me. And simply abstaining is actually easier. When I consume anything I begin craving not only carbs, but craving the stimulation of eating, period.

I think its finally uncontroversial to say that not all calories are the same. But eating is more than just the metabolic process; like smoking it's about the physical habits and stimulation. In that way eating chips is not much different than eating pork rinds, and for some people that's what matters most.

Remember the Master Cleanser and juice fast fads? People consuming nothing but raw sugar for days, weeks, and even months on-end derived similar benefits--weight loss, improved insulin sensitivity, etc. And for some people it was really easy because you could sip on your drink constantly throughout the day, which was in an important way the antithesis of abstinence. Not all calories are the same, but it's still the case that fewer calories are better. Just do whatever it takes to get you to fewer calories.

I'm not trying to equivocate diets--vitamins, minerals, and fiber still matter. But, again, calorie count is ultimately the most important metric. How you manage it is largely a matter of your personal tastes and lifestyle. Few people can manage a perfect diet, but there's a least bad diet for everyone, and they're often wildly different. And that's basically what the expert stated in the article--the powdered diet isn't for everybody, but it was important to begin offering alternatives to the "balanced diet" recommendations.

Also of note, a recent study has found that ingestion of cholesterol does not correlate with how much is in your blood.

These same forces would choose what is mandated. That is horrifying. Not only could they give bad advice, they could compel ever larger fractions of the population to follow it.

Far better to let parents decide, so when they get it wrong we can learn from it, and don't all get it wrong at once.

It is absolutely not. While the vast majority of current cases are preventable (and in most cases, reversible) through proper lifestyle changes, between 5% and 10% of people with T2DM were going to develop it regardless of what they did.

Now, it's possible that some or all of those cases are not actually T2DM. In the past few decades researchers have been investigating additional forms of DM, such as Latent Autoimmune Diabetes in Adults, that may be the cause of some cases of DM that currently present as T2DM. It may be that once "true" T2DM is defined that your statement is correct, but as of right now it is not.

You're considering forcing parents to change, presumably with the threat of taking their children away. But consider this, in the past type-2 diabetes was extremely rare in children. Why is it now common?

Are parents just worse? Or are terrible diets more appealing? Maybe the sources of those terrible diets would be a better place to start imposing government violence.

That said these recommendations are bullshit. If you have diabetes, you have an insulin problem and it's best to minimize it, so you need to eat the minimum amount of carbs you can get away with, prioritizing the complex carbs with fibers (e.g. spinach and other greens).

Btw, a low calories diet can work even if higher in carbs, because:

1. by losing weight insulin sensitivity goes up afaik

2. at 800 grams per day, that's not much to eat, so those people are probably fasting for much of that day

That's just a guess, but how you distribute your meals also matters just as much as what you eat.

Although, given the description of it includes "fruit juice", I am guessing it is a lot of sugar, which seems weird but I can't admit to know enough to say this is bad.

I'd be interested in the efficacy of this sort of diet when applied to a large mass of people as opposed to a very low carb diet. The NHS can "prescribe" these diets, but people may not follow them. It's possible that having a moderate amount of carbs (as sugar) in the diet will actually decrease the chances of a person going in the complete opposite direction and binging on sugar after they get sick and tired of a very low carb diet. I'm curious if they study that effect and "risk" of diets.

For example, diabetes used to be diagnosed by peeing on the ground and seeing if ants we attracted to it. According to whatever diabetes history book I checked out of a medical library on inter library loan.

Of course, Keto is a thing, but I haven't heard many stories of bodybuilders that actually target the keto-state. It's about getting the right amount of carbohydrates (hint: not as much as most people eat).

At least in modern societies. Of course the Inuit and other far-north peoples have known forever that one can live healthily off essentially nothing but meat.

I think people need to let go of the idea that ketosis is some sort of "special" state. It's just a metabolic state that's been suppressed by modern eating habits. Three meals a day and snacking is a cultural invention; not a biological necessity.

A lot of athletes prefer to exercise in a ketogenic state. I know personally I'm able to run farther if I've spent the day fasting than if I had a big meal at lunch. (I don't have the same initial burst, but I don't hit a wall either) (Not to mention that digestion is a very expensive process)

I think what's more unnatural is that modern eating habits are designed around blocking any sort of ketogenic state, which is where the easiest weight loss comes from. (Also, I need to lookup a reference for this, but I think I remember reading that fat burns a bit "cleaner" than sugars. Less free radicals I think? Something like that)

[For people unclear what I'm talking about with ketosis: basically, your body burns glucose first for energy. Then when there isn't sufficient glucose, it starts burning fat. The burning of fat for energy is what's known as ketosis. (I know I'm probably vastly oversimplifying). The thing about fat burning is it only kicks in at a significant level when glucose is depleted though. So if you're exercising while eating a chocolate bar and drinking a gatorade... well the exercise is good! But you won't lose weight)

I eat low carb, and fast intermittently. It's my life-style now.

After eating a while for an extended period of time, my blood sugar is much more stable, regardless what I eat.

> Are there any studies in this area I can read that discuss the figures you've mentioned?

One example may be found in Dr. Jason Fung's book, "The Complete Guide to Fasting." Chapter 5 describes a case regarding the American TV show, "Biggest Loser", where overweight contestants lost loads of weight during the show with a low calorie diets and exercise. All except one contestant gain the weight back.

Below is the reference to the study cited in Fung's book. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21538

Firstly, fantastic achievement. I'm curious as to what motivated you enough to put in the effort (I'm assuming it required effort).

Secondly, I wonder if the speed/drastic nature of the weight-loss can be counter-productive. When you think about people don't become over-weight overnight. Perhaps a more gradual pace with some time for settling at various stages of the process...I'm thinking losing weight over a couple of years as opposed to over a couple of months.

0: https://garry.tv/2018/10/17/fatty/

What's good is what works. And honestly, drugs work today. The likes of the FDA considers them too risky, but I think they're deciding wrong.

Put another way, after 5 years, the average weight loss was ~3kg, with an average weight gain of 78.6% of the original lost weight.

Also, in general, an obese person who is obese before, and after 5 years has a weight that is ~3kg is likely still obese.

So this study basically just says that an average person isn't successful at keeping a large amount of weight, and gains most of it back. The specific statistics stated by the commenter above may not be correct, but the sentiment is definitely true.

That said, the study does confirm that very low energy diets (~800 meal replacement) beat out hypoenergetic balanced diet (~1200-1500 normal food) in long term weight maintence. Which is what the article is suggesting being implemented. So it's still not a great long term solution, but it's the better of the two non-exercise based solutions which this study evaluated.

> The statistics for dieters who lose weight rapidly, according to Wellsphere, a website sponsored by Stanford University, is worse. Only 5 percent of people who lose weight on a crash diet will keep the weight off. Crash diets include any unhealthy diet, from severe calorie-restriction diets to diets that consist of only a few kinds of foods.

Another study showing 5% looks like it was an old study from 1959.

Anyway, there are more modern studies proving the point. And that people gain even more weight back than they started with.

http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA...

>Several studies indicate that dieting is actually a consistent predictor of future weight gain,” said Janet Tomiyama, a UCLA graduate student of psychology and co-author of the study. One study found that both men and women who participated in formal weight-loss programs gained significantly more weight over a two-year period than those who had not participated in a weight-loss program, she said.

>Another study, which examined a variety of lifestyle factors and their relationship to changes in weight in more than 19,000 healthy older men over a four-year period, found that “one of the best predictors of weight gain over the four years was having lost weight on a diet at some point during the years before the study started,” Tomiyama said. In several studies, people in control groups who did not diet were not that much worse off — and in many cases were better off — than those who did diet, she said.

Furthermore, it is a social problem, in that we as a society allow businesses to exploit peoples weaknesses without covering the social costs of the problems they are causing, and given that how people around you act strongly influence how able people are to stick to a diet.

To then act as if this is down to some imaginary free will is irresponsible.

I don't mean to sound like a whiner, but ... if it were that easy to cut down my food consumption, I wouldn't be going to a doctor in the first place!

It's like telling people with extreme loneliness or social anxiety to "just strike up a conversation with someone!" Or PTSD suffers: "Geez, just don't freak out so much, take a deep breath or something."

Or narcissists/sociopaths: "Just, you know, think more about how your actions hurt other people."

Given Herculean willpower, most diseases of civilization can be conquered. Don't pat yourself on the back for calling it "prescription".