Comment by kcplate | Hacker News Reader

Comment by kcplate | Hacker News Reader

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People are different, and due to individual needs and desired outcomes, one size fits all dieting isn’t the best thing.

I have type 2 diabetes. For the first 7 years after my diagnosis I stuck to the ADA diet I was told to follow and to use insulin to manage my blood glucose. My insulin requirements increased every year…10-15%. My weight stayed the same, trying to lose was difficult to maintain for a long period, and when you have a lot of weight to lose…you need to maintain caloric restriction for a long period.

5 years ago I switched to keto. Within 4 months I was off all diabetes meds and have been off since. I have lost 170lbs. Does the diet alone give me all the nutrition I need? Nope. So I take a supplement or two to get what I need. That is better for me and my blood sugar maintenance than consuming beans and root vegetables. Keto enabled the change I needed to make, because one thing the diet does well is create satiety, which ultimately leads to caloric restriction which led to weight loss which led to the glucose control I needed to stop damaging my body.

Here is the main thing though. Eating the ADA diet and using insulin to control my blood glucose was ultimately a losing game. My life expectancy was likely lower eating that ADA diet than eating keto, thanks to all the keto created benefits. Diabetes might have killed me at 65, keto might kill me at 75. I’ll take the 10 years and whatever issues keto decides to deal to me.

This is just my individual story.

Your anecdote is supported by clinical evidence. Virta Health has been conducting clinical studies over the past few years on treating T2D with nutritional ketosis with a high rate of success in putting T2D into remission leading to many patients coming off of their meds and insulin entirely.

The ADA has quietly acknowledged these studies in their Standard of Care and more recently has adopted a position of endorsing low-carb, but they're still ignoring keto despite the clinical evidence.

As you said, the ADA's guidelines are focused on managing T2D as a progressive disease which inevitably leads to increased medical requirements over time. Although T2D remains incurable, there's enough clinical evidence to conclude that for many people it's treatable with nutritional ketosis.

I like to think I'm a rational person and don't subscribe to conspiracy theories in general, but something about the ADA and their relationship with pharmaceutical companies just rubs me wrong. To my knowledge, their largest financial sponsor is Eli Lilly which also happens to be one of the world's largest manufacturers of diabetes drugs, including insulin.

> something about the ADA and their relationship with pharmaceutical companies just rubs me wrong

Well when your go to published eating strategy for 35 years is designed to maximize the amount of insulin that is to pumped into bodies…it’s hard not to notice coincidences.

Well, 2 things - you are very much an outlier and general advice usually don't work in such a case. Great you found what works for you. It might not be transferable success to any other human being out there, at least not with some side effects you may not be experiencing.

Second point - you confirm OP's claim if I understood correctly - people go from one extreme (with having 170 pounds to lose that's some extreme obesity category, you get there by fucking up something properly and for long time and thats a kind language I am trying to use) to another extreme.

Extremes might be good for treating extremes, if it somehow magically clicks. For general population, some middle path is, as usually, the best choice. If there should be just 1 single rule and not a set of them, it should be: eat less. Of course there are many more good advices, but this should be first foundational step to any improvement.

> you are very much an outlier What makes you think he is? Why wouldn't other insulin-resistant people benefit from a diet that's all about managing your insulin response?

Your comment near the end feels like you're facing information that heavily conflicts with what you're used to hearing and are instinctively reaching for the middle ground fallacy. I've yet to hear about someone on the keto diet getting anywhere near dangerously low weight. Most people just complain about plateauing at a slightly higher weight than desired before they start putting any effort into eating before they feel full.

> you are very much an outlier

Am I? That is interesting as I know others managing their T2 this way. Actually I know more people managing their diabetes this way than any other dietary strategy (short of the tried and true eat whatever in moderation and push insulin to counteract it approach which is basically just resigning yourself to the inevitability of the disease). It could just be that it’s a new enough strategy that it hasn’t received the widespread medical adoption yet in your area. My own doctor advised against me doing it until he saw what it did for me. Then, coincidentally that is right around when the ADA added the low carb dietary strategy to their approval list and now the medical office advises the approach as one they know can create some success. I’d say anyone using diet only to control T2 is an outlier, but using keto or low carb for those folks using diet alone…it’s likely moving to becoming the majority.

As to your second point, yes extreme to extreme, gotcha and thanks for the punctuation on the point too—but that has little to do with the fact that if your body cannot effectively process excess glucose you either need more insulin to handle it, some way to make your insulin more effective, or you need a strategy that creates less glucose that your body needs to handle. Whether you are 170lbs overweight or 1lb overweight and T2 if you limit carb intake (and protein to a degree) you can solve the excess glucose problem.

I’d also argue that considering just about every foodstuff in my local supermarket has some form of keto alternative marketed alongside it and for at least the last 4 years, we have moved away from extreme and into the realm of yet another mainstream eating strategy that has been adopted by the public.

> just 1 single rule and not a set of them, it should be: eat less

That is the dirty little secret of keto—higher fat diets tends to trigger the satiety faster and people tend to eat less calories because of it. People assume keto means things like “all you can eat bacon” and think that people on keto are packing away 10k calories a day of bacon. Try and eat a pound of bacon...bet you can’t.

My calories were cut in half when I first moved to keto, and I never ever felt hungry which is way way different than every other calorie restricted diet I ever attempted.

Rather dismissive. The Keto subreddit is overflowing with success stories, to the point that they’re spammy. Keto is a resounding weight loss success.

Keto worked for the two people I know who tried it, one of whom had been trying other weight loss diets for 10 years without success

Good for you! Glad to hear you found something that works!

How much protein do you consume, and do your doctors do anything to monitor your kidneys?

given your diabetes dx seems like one area to monitor.

My target protein is around 125g. I’m usually within 10% +/- of that number

Doc does standard blood tests on me twice yearly now (used to be quarterly). To date, no issues with my kidneys.

Keto is not really protein heavy. I ate much more protein pre keto.

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