South Asian people undergo type 2 diabetes remission with low calorie diets
medicalxpress.com
medicalxpress.com
The general advice, even from my primary care physician, has been that anything less than 1200kcal/day is dangerous and is crash dieting. Looking around, I found this other study studying total diet replacement providing 810kcal/day as the sole food for 12 weeks, showed significantly greater weight loss compared to standard counseling and modest energy restrictions. The difference in weight loss was measured at 12 months. (BMJ 2018;362:k3760 [1])
25 BMI, which the diabetes study used in addition to T2D, is not considered clinically obese in the US. 25 BMI is the line between clinically normal and overweight. I wonder if crash dieting is advised against on the assumption that most people will go back to unhealthy eating habits instead of changing their diet, and also become more likely to fall into binge-restrict cycles. It's easy to imagine that if someone is able to make meaningful changes, crash dieting is more effective than most other methods.
But I feel like it taught me to be bored with eating, and to establish a more healthy relationship with food. High-fat, mid-protein, low-carb sounds terrific for the first day or two but once you're two weeks in, you're so sick of it all that you'd just as soon drink some water and get back to whatever you're doing.
Also if I don’t eat right as I feel hungry I’ll feel as if someone has gut punched me. I get absurdly hungry.
As for the "gut punch" though, sounds like gastritis or something. Unless you're being metaphorical. For me, water helps when I'm fasting and stomach pains start.
Likewise, I've noticed an effect develop with artificial sweeteners where I can have small amounts without difficulty, but if I start consuming it several times in a 48 hour span, I get cramps.
In periods where I've become addicted to carbs hunger pain is much stronger, but I've been able to keep it down for many years now. So if you're getting it intensely, your gut is probably still reactivating to its old profile.
I believe restriction in the regular diet is one way of correcting it while staying in a routine. But I have also experimented with fasting, intense exercise, hot/cold contrast in the shower, and breathing exercises, and the common theme to each is to challenge homeostasis in some fashion. Obviously there's always some danger in going too far, but if our norm is total comfort, we can definitely drop some aspect of it from time to time.
Part of that might be from less water retention early on.
Your body holds on to more water when your diet is full of carbs. As your liver runs down its glycogen stores and you eventually go into ketosis, you lose a lot of water. That's also there the early 'keto flu' comes from, which is a bit like a hangover; plenty of fluids and electrolytes fix you.
Losing water looks great on the scale. On the one hand, it doesn't actually do anything for you healthwise. On the other hand, losing that water ain't bad for your health either (assuming enough fluids and electrolytes), and is a great motivator for the kickstart you described.
Wouldn't this advise need to keep in mind absolute height? BMI tracks the ratio between the height and weight, but it does nothing to tell the difference between a short thin person and a taller heavier (but same BMI) person. The latter which would need more calories than the former. I know people who eat ~400 kcal less than me per day, because they are shorter and similarly thinner. Following that why wouldn't their crash diet threshold be sufficiently lower?
How true is it? I don't know. But even then I don't see why they couldn't take multivitamins.
It's probably a mistake to connect the two.
Yes, we Americans overeat beef / Hamburgers, but I don't think anyone eating burgers is at huge risk of malnutrition... as much as a risk of heart problems, diabetes, cholesterol, etc. etc.
It turns out that a standard burger with beef, ketchup, lettuce, onion, and bread covers most of your macro, and even micro-nutrients. It also is way overboard on salt and fats, but... that's not the particular problem here.
One of the bigger problems vegetarians have is finding a proper replacement of meat and all of the easy nutrients meat contains. All amino acids, various vitamins, iron, etc. etc. There's a fair amount of nutrients here.
And even the worst McDonalds burger contains a variety of lettuce / onions / ketchup that covers few nutrients that beef is missing (ex: Ketchup has Vitamin A, Potatoes / Fries has Vitamin C).
The amount of lettuce, tomatoes and onions is so minimal I doubt it contributes to your vitamin intake in any useful manner. If you eat a salad you get 50x that amount of those vitamins.
Pretty strongly disagree here. US Beef consumption is about the same as in early 1900's, which was a time where personal health in several metrics was far better. (Weight being the obvious one)
Always very skeptical when people talk about cholesterol, it's a really nuanced topic, but the average person seems to be stuck in the 1970's with "cholesterol bad". Thinking high ldl is always bad is only slightly better.
If you eat only the beef and veggies from a Big Mac three times a day you'll get plenty of vitamins and minerals with minimal calories (~650 calories)
If you eat the three entire Big Mac meals you won't get any more essential nutrients to speak of and you'll consume far too many calories (3960 calories)
The average american has junk to cut from their diets with no nutritional loss whatsoever. Typically fried and sugary foods.
Practically pure proteins can be provided by turkey breast or chicken breast, adding e.g. around 300 kcal for an adequate daily protein intake, and the rest of the food can be composed of non-starchy non-sweet non-oily vegetables, which provide only about 20 to 50 kcal per 100 grams. One could eat more than 1 kg of various such vegetables without exceeding 800 kcal.
There remain a few things that would have to be taken from supplements, e.g. omega-3 fatty acids, vitamin B12, vitamin D3 and vitamin E (which is abundant only in high-caloric food, like olive oil or almonds). The simplest is just to take one pill per day of those offered by various vendors, which include all the essential vitamins and minerals, to be sure that none of them is insufficient.
A little vegetable oil would be needed for linoleic acid.
We both come from a South Asian background and discussed how the number would change for a home cooked vegetarian diet which is more nutrient dense but low in protein, and I was told that would lower it below 1200, but he didn't feel comfortable recommending that diet unsupervised. He emphasized that I should decrease calories by removing carbs, then fats, then proteins. And that I should prioritize eating proteins above fats and carbs, especially if I planned on increasing the amount of exercise I did.
I asked him if the 1200kcal was net or gross. For example if I did 2 hours of moderate exercise, should I eat back 400kcal+ to maintain a net 1200kcal. He didn't have an answer for me, other than saying, if I start to feel weak or lightheaded I should immediately stop exercising. I don't have pre-existing conditions related to blood glucose, but I imagine that would would change many of these guidelines. I was told to stay mindful of hydration.
The stories I hear of fasted work outs is the reason I asked him about low calorie diets. My non professional intuition makes me believe that even intense cardio should be okay, but moderate or heavy resistance training should be avoided on a low calorie diet.
There is no reason to avoid resistance training.
I also imagined that muscle recovery would be less efficient or take longer from a fasted state. I have hit rowing/ERG goals and made time improvements so I feel comfortable saying that fasting doesn't hinder my cardio.
I understand that energy goals are correlated with body size, we were discussing a general minimum kcal threshold for unsupervised dieting. I am unsure why you feel estimated BMR/RMR - 200 kcal is unscientific. I was told that without supervision, it would be hard to ensure proper nutrition on a very low calorie diet. Additionally, he expected that some people would fall into a binge-restrict cycle because they can't sustain their usual energy level.
I was additionally curious because there have been days I forget to eat, and thinking back I realized my total calories for those 24 hours totaled less than 600 kcal.
Fortunately it's fairly cheap and easy for people in developed countries to obtain an RMR test. This can then be used as a personal baseline to calibrate diet plans.
There are risks to ponder about how critical (e.g., time vs. dangers) it is to get to a healthy weight. If someone dangerously obese maintains hydration, electrolytes, vitamins, and enough lipids to empty the gallbladder, getting to a low adipose tissue state, resetting insulin, ghrelin, and leptin sensitivities, and reducing the likelier risks of cancer(s) seems like a good tradeoff than either lap-band surgery or slow/plateau weight reductions.
Intense hunger goes away after about 72-80 hours of "starvation", however brain fog and low energy dominate. Careful "starvation" dieting down to slightly underweight isn't something one can do without several months of spare time, ready access to healthcare, and immense self-control. Afterwards, self-control is absolutely required to avoid binge cycles.
GLP-1 agonists are expensive but interesting crutches to get there slowly.
It is likely that over millions of years of natural selection, the human body is far more tolerant of borderline starvation conditions than being stuffed with HFCS. Many types of cancers associated with Western diets are likely due to the human body becoming more hospitable, whereas chemotherapy and starvation add cellular stress that kills off malfunctioning cells. It's likely no accident whereas CHD, gout, diabetes, high cholesterol, and cancers are the consequent of unnatural diets and lifestyles.
Why stop at getting rid of glucose? Add some plasma donations and orlistat. Now you've got balanced macro loss!
(don't do this)
(I actually donate whole blood and platelets often.)
If someone were carrying around an extra 250 Mcal in adipose tissue, multiple factors determine what their risk budget could/should be to downsize to a suitable homeostatic state.
I lost 60 lbs over a couple of years and set a state lifting record for my age group. I love what I do and kept the excess weight off. I got good at what I do and the intrinsic reward still burns, even though I’m not lifting for records anymore. I wake up every day ready to go hard for at least 50 minutes. It doesn’t take me more time than that to stay in shape, but I do eat consistent with my goals.. which is the harder part.
I personally think someone needs to really own their desired outcome and then there are many valid and healthy ways — and even more “effective” ones — to get there. Hard to measure “own” though. Measuring every different kind of modality is generally missing the point. We actually know how people get in shape and stay in shape. The problem is generally in the mind.
Losing weight that fast generally means it comes back pretty quickly as well.
> I lost 60 lbs over a couple of years
That's a much more reasonable timeframe. It's almost like we have to trick our bodies into finding a new metabolic balance. Do it too quickly and it just rebounds. Do it more slowly and it seems to be more sustainable.
I was under the impression it was like trying to fight drug addiction and the chances of you sustaining it and not relapsing/making up the missed calories later as near impossible for most once you’ve become addicted enough to things like Diet Coke, Chik-Fil-A, etc.
As for being difficult… yeah. The transition sucked. Body aches, headache, and very slight case of the blues. It took willpower. After about 3 days, I was okay. It was similar to quitting smoking for me, except that quitting smoking didn’t give me body aches.
what i did was cook for myself so i can reduce vegetable oils, salts, artificial flavorings etc, then cook things like fresh tomato sauces with fresh basil/oregano, fresh fish cooked slowly in plum sauce, chana masala curries with low sodium and delicious spices etc etc
once you get used to healthy, satisfying and flavorful "good" food, carbs, salt, oil and junk food cravings faded away and buying snacks after that was just not satisfying at all...
n=1 and all that, but that was my experience fwiw
I think something like Tex-Mex would easily allow for clean eating. Avocado toast, with whole grain bread is fairly healthy and was an absolute favorite of mine after workouts and I would consider it "American" food. Tacos are a great way to have good portion control and also feel filled. Allowing non-traditional recipes opens many options. Avocado grapefruit salad on tortillas with fried tortilla strips is a recipe I came across recently that I really enjoyed. I think non-traditional is the essence of true "American" food.
For fast food, Popeye's Blackened tenders are not breaded, a 5 piece serving is listed at 280 kcal compared to the classic tenders being 740 kcal. Nuts or apple slices with peanut butter is a fairly filling snack and can easily fit within 200 kcal. The main thing you would have to look out for is sodium if cooking at home is difficult. I know most of my bodybuilder friends go to a diet of chicken breast and brown rice for dinner for months at a time when they want to cut. It's around 400-500 calories depending on how you prepared it.
Vegetarian and vegan recipes are good starting points for cleaner eating too. Borrowing from other cuisine makes it a lot easier as well. I love preparing vegetable side dishes for dinner in the way it's prepared for Korean dishes. Miso soup is fantastic for when I have food cravings late in the night. It's not "American" but I'd argue there's nothing more American than making microwave miso soup at 3 am in my star wars mug. Coffee is popular too, and is very low calorie if you can get used to no milk or sugar, or only sugar alcohol/substitutes.
For some context, I grew up and live in one of the most culturally diverse states and counties in the US. I know that not everywhere in the US has the same diversity of food options, but I would argue that Amazon has done a lot to make food accessible.
The one meal per day limit makes it hard to over/eat.
It seems either this is extremely tricky to measure, or it is a myth (like aspartame or MSG or yellow 5 cause cancer or whatever).
On the other side are people that say, "eat less, exercise more".
Lots of people have chosen either one of these to be true. It is certainly possible, though.
Being the norm historically does not imply it is healthy or optimal, only that it is at least survivable on average.
It is entirely possible that something that was done for a long time is a healthy thing just as it is entirely possible that it was a terrible thing that we conquered with knowledge and abundance. Evidence is what tells you if the thing falls into one of those categories.
I like living in a time where we are outraged if children in our community die and in cases where there was nothing that could have been done we want to do research to find something we can do in the future. That was not normal for millennia until really very recently and it seems healthy to me?
Is this actually true? I thought archaic humans had much better dental outcomes because their diets had a small fraction of the sugars that modern diets do. Could be wrong but I was definitely under the impression that poor dental health was more a function of modern diet and not something that necessarily existed throughout history.
Feel free to nit-pick that example, there are an absolute plethora of others. When did surviving appendicitis become a thing? What was the median life expectancy for a newborn baby at various times in history? Calling out the fetishism of humans in a "natural state" needs to be done. Just as there are things we can learn from our pre-historic existence. Evidence is obviously the required thing not just amusing anecdote about how we have totally "lost our way."
Certain palms are also (and have been for... Again I don't know, but I believe 'a very long time') 'milked' for a sugary sap that's drunk fresh or fermented.
I mean if you have some pre-existing disease sure. If you’re on certain diuretics you may screw up your blood chemistry, but an otherwise healthy, overweight person eating less than 1200 kcal/day? Maybe not the most efficient way to lose weight but it’s far from “dangerous”.
One company working to reverse diabetes in the US is https://www.virtahealth.com/ (disclaimer: I work there).
Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients. 2019 Apr 1;11(4):766. doi: 10.3390/nu11040766. PMID: 30939855; PMCID: PMC6520897.
The basic problem, which has been unchanged for decades, is that hardly anyone actually follows the "proper" diet on a long-term basis without some kind of surgical or drug treatment. Despite weight loss being a massive industry and a very common goal, researchers routinely struggle to find study subjects who have maintained significant long-term weight loss without medical interventions, to the point that there's a special registry to keep track of such people for scientific purposes [1].
Nevertheless, I agree that such people might be a very small part of those who lose weight.
About 15 years ago, I have lost about one third of my initial body weight during almost a year, and then I have kept my desired weight until today, without any kind of medical treatment, either surgical or drug-based.
Nevertheless it was not easy and it required a lot of thought and experiments with the diet, until I have learned how to control my weight, after many years during which I had believed that this is impossible. It also required completely dropping many bad habits, for example drinking commercial juices or eating commercial mixes of yogurt with fruits or eating various kinds of "breakfast cereals" or any other such commercial products containing an excessive amount of sugar. I have never eaten or drunk again any of the products that I have blacklisted, even if they were among those that I had eaten or drunk daily, for many years.
I believe that most people are not introspective enough to succeed in changing so much their habits by themselves so they need some kind of external help. The main obstacles for weight control are psychological, not physiological, i.e. those who need to control their weight must learn somehow to love to eat food that is different from what they had been eating, because if they will ever revert to their old eating style, then they will certainly also revert to their previous weight.
The census.gov says there are a little under 260 million adults in the united states, and we know obesity is something like approaching 40% of these adults, so 104 million.
10,000 is not even one thousandth of a percentage point of the obese people of the untied states.
For contrast, a disease is considered rare if it occurs 1 in every 1500 people in the united states. A person who un-obesity's themselves into healthy weight is literally a magnitude rarer than this.
Consider that the rate of obesity continues to increase in the US. This shows that people are simply eating more and doing less exercise. And of course those that are already obese are the least likley to consume healthy ammounts of food and exercise as needed.
In other words, yes, the issue with overeating is in fact overeating. The only way to solve this problem for the whole population (as in, not for a single individual) is to change society and how it views unhealthy food. Off the top of my head, fast food advertisments should be made illegal. The entire point of those ads to get people to eat fast food. This single step could reduce obesity in the US by a noticable amount and requires no loss of freedom to any individual. A sugar tax or the like is a more extreme solution. But this idea is not unfounded:
>Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.
-Adam Smith
Book V: On the Revenue of the Sovereign or Commonwealth Chapter III: On Public Debts
https://www.adamsmithworks.org/documents/chapter-iii-of-publ...
This is ridiculous. Nearly everyone I know who is overweight eats hardly any fast food.
What I do see is lots of snacking throughout the day on high carb things (chips, breads, etc) and just way too many calories due to large serving sizes in both regular “slow food” restaurants and meals made at home.
Fast food meals if you skip the sugared soda tend to be closer to proper per meal calorie targets than sit down restaurants because of how cheap they are.
At sit down restaurants the price is higher to support a wait staff and lower throughput so they compensate with ridiculously huge portions.
For example, when I visited my family in the states, I ate two double cheeseburgers at a fast food joint at 1000+ calories per burger, and I figured I could probably eat two more in that sitting without issue.
In other words I ate 2000+ calories in a few minutes and could have kept going. Even one burger has more calories than I eat in a single meal.
Meanwhile, I couldn’t eat 15 medium sweet potatoes (1000 calories) in one sitting.
Though I do think the public would be better off if they replaced the bread with lettuce or something. It seems like they're willing to do that anywhere I've gone.
Where was this? A double quarter pounder BLT at McD with standard toppings is 830 calories. A McDouble is half that.
One, along with fries, is enough to fill me up for practically the whole day. I think fast food gets a bad rap. It’s calorie dense but with all of the fat it keeps you pretty darn full.
Compare that burger with a few candy bars or not all that much soda…
Another point, while I did say that "The entire point of those ads to get people to eat fast food" what I really meant is that they make people want to eat in general[note 1]. What this means is that fast food ads can be harmful even if they do not cause the viewer to buy fast food. What this does is contribute to a culture of consumption which is part of what I meant when I said "The only way to solve this problem for the whole population [...] is to change society and how it views unhealthy food." I did not mention sit down restaurants because they generaly do not advertise. My suggestion was "off the top of my head" and not fully thought out. I'm glad you made your comment because I did not express my reasoning clearly.
[0]https://epi.grants.cancer.gov/diet/foodsources/top-food-sour... page 77
[note 1] That is, the "point" of the fast food ads collectivly are to generate a demand for fast food from the point of view of the advertisers, but the effect, while more pronounced for fast food, generates a general demand for caloric intake.
They do in the US. TV adverts are littered with ads for national chains (Olive Garden, Buffalo Wild Wings, Red Robin, etc).
Media that allows more targeted local stuff (Facebook, billboards, newspaper, Google maps, etc) is plastered with ads for local sit down restaurants. If anything these ones advertise even more because they don’t have an established mindshare.
To me, it seems obvious that sustaining a low calorie diet (LCD) long-term is basically impossible (from a maximal fat oxidation and, even a thermodynamics perspective). On the bio-mechanistic side, it's also important to note that hyperinsulemia inhibits lipolysis [2], which is one factor that is also usually not taken into consideration. Anyway, while a LCD may be effective for a while (maybe even years), it's probably quite miserable and almost by definition, can't be a sustainable lifestyle change. Even as a short term fix, it may not a very healthy and might be counter-productive long term... [3]
To me, the biggest problem is that T2D is in many (but, to be clear, not all) cases, the end stage of a metabolic patho-physiology that can be identified by other markers (as simple as WtHR, or cheap labs like fasting insulin, or NAFLD indices) that are cheap and easy to measure, but from my experience, most clinicians are completely unaware of this. Which is too bad, since the overwhelming majority of their patients in the US these days (over 80%) are suffering from metabolic diseases. [4]
Over the years (I moved a lot) I've had close to a dozen different primary care providers, and diligently did my annual health checks, all while slowly putting a couple pounds each year and none of them were able to give any useful treatment or even medical advice as my MetS markers crept up. I had to figure it out myself - in fact most gave bad advice and weren't even measuring or diagnosing the right markers. The real kicker to me is how cheap some of these tests are (fasting insulin is <$10 more to test even if you're paying out of pocket and is required for useful indices like HOMA/2-IR and NAFLD LFS, but most GP's won't request this test even if you ask them too)...
I'll also mention that both from the literature [5] and my personal experience [1], some of the worst damage can be reversed in a matter of weeks. I did labs right before I started my diet changes and 1-month in, and even in a single month my TGs and my liver numbers moved from unhealthy to healthy ranges.
As for sustainability, there are some lifestyle treatments like Virta's that have shown better than medication retention rates and efficacy, so it's possible to do... https://www.virtahealth.com/outcomes
How do they do it? A combination of responsive/actionable biomarker monitoring/feedback coupled long-term coaching and peer-support groups. Not impossible and way cheaper (and better quality of life!) than any pharmaceutical alternatives.
[1] https://randomfoo.net/2019/09/17/1-year-personal-health-inte...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753874/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/
https://www.youtube.com/watch?v=tAiXvrIMIIE Neal Barnard, MD | A Nutritional Approach for Reversing Diabetes
https://www.youtube.com/watch?v=lSwL73evUdA Diabetes Reversal and Weight-loss with Neal Barnard, M.D.
https://www.youtube.com/watch?v=EpRrD58Ah3Q Evidence-Based Weight Loss: Dr. Michael Greger
https://www.youtube.com/watch?v=7rNY7xKyGCQ How Not To Die : Dr. Michael Greger
I've removed that part of my comment, sorry - the linked experts will explain it better.
From experience if you just try Keto for a couple of months you start to realize how much sugar/carbs are in absolutely everything in the western diet.
Even though I don't practice it religiously I still don't eat 90% of the arbitrary carbs I used to consume. Easiest: not drinking Coke/Juice or anything besides water or zero-carb flavoured carbonated drinks (buy a Sodastream + $50 citrus press and add your own fruit/Erythritol), coffee or tea with stevia, etc.
That plus Allulose simple syrup or those White Claw style drinks:
https://www.wholesomeyumfoods.com/shop/syrups/simple-syrup/
https://www.amazon.com/s?k=Allulose (closest thing to sugar around for people who are picky, otherwise Monk Fruit is cheaper and widely available)
Food is much easier. Just don't eat lots of bread, noodles, and pasta.
Honestly, it sounds very difficult, but the doctor seemed very confident that this works. I have started trying this (not T2, but need to lose weight)
Anecdotally, a lot of people have suggested keto and low-carb diets having been successful for them.
The source was Tegus (https://www.tegus.com/) which my company had a free trial.
It wouldn't require a whole lot of thought to come up with an all candy diet that supplied the minimum necessary nutrition. How broad is our definition of "candy" for this? Are you willing to consider candied fruits, vegetables, and bacon? Chocolate covered things? How much dark chocolate would we have to add to something to consider it candy?
Only either the carbohydrates or the (non-essential) fats or both must be reduced. It does not matter which of them is reduced, as long as the total calorie amount is restricted enough. It may matter only due to personal preferences, which may make one variant or the other easier to support.
One must use some digital scales for measuring the weight every day at precisely the same moment, because the weight varies during a day by much more than the difference between 2 successive days. An appropriate rate of losing weight is between 100 grams and 200 grams per day, e.g. about 1 kg per week. If the measurements show another rate, then the amount of daily food must be increased or decreased until the rate is in range.
Regardless with which diet you start, if you adjust the amount of carbohydrates and fat according to the daily weight measurements, in a week or so you will converge to the right amount of daily food. However, this requires to measure by mass or by volume all the food eaten. Those who do not succeed to lose weight fail because they either do not measure what they eat or they cannot abstain from eating more than what they have planned to eat.
Losing the weight is the easier part. More important is to plan a diet for after reaching the target weight, a diet that will keep the weight constant, i.e. which must still be calorie-restricted, but at a normal level, and which must be appealing enough, so that one would never be tempted to eat again in the way that caused the overweight in the beginning.
or just do a moving average over some days. Works better.
And water weight, fecal residues, etc vary so much day by day. Were yours so constant insofar to be able to track it accurately to the grams?
At the time I have studied a lot the existing medical literature, and this was the recommended rate, so I have adjusted the diet so that the weight loss per day would oscillate around 140 g per day.
The weight must be measured every day in the same physiological conditions, i.e. in the same order relationship with respect to the various activities that modify the weight, like eating, drinking or eliminating their products.
A good moment would be in the morning, immediately after waking up and relieving yourself.
If one would eat in the evenings wildly varying amounts of food, then the weight in the morning could be affected by a noise due to variable amounts of food that is not completely digested yet. However that would not happen when one is eating a calorie-restricted diet for losing weight, when one would have to eat about the same minimal amount of food every day, which would be quickly digested.
While I was losing weight, I could see very well every day its evolution to the grams, and the effect of any change in the diet. Sometimes I succumbed to the temptation of eating like before starting to lose weight, and after such days I gained weight in a day almost as much as I was losing in a week, which increased the time until reaching the target weight.
I eat the same stuff every day, weighing myself after going to the bathroom, etc, yet my weight easily varies at least 500 g from one day to the other. And if I eat just a little bit more carbs in a weekend, then well, it's like 2 kg of extra water weight on Monday.
I have lost weight (from around 120 kg to around 76 kg) about 15 years ago.
Nevertheless, I believe that if care is taken so that the calorie-restricted diet still includes a normal amount of all nutrients except carbohydrates and non-essential fat, 4 kg per month, like I did, should not cause any health problems.
Unfortunately, I have seen too many suggestions about how to lose weight that do not pay enough attention to provide all nutrients. Such diets can be sustained for a few weeks, but not for longer durations, like a year or more, which are needed when the required weight loss is great.
My weight can vary from day to day exactly as much as yours, but nowadays it rarely does.
The main difference between how I eat now and how I was eating before losing weight is that previously I was eating until feeling sated, but now I always decide how much to eat before starting to eat, so for most days the energy intake is similar, so the weight oscillations are small. When I happen to eat a more copious meal, I compensate the next day, mainly by cutting the carbohydrates during that day.
> lot of people have suggested keto and low-carb diets
Just always remember: while rice, pasta and bread are vegetarian they are not vegetables.
You never disappoint, Hackernews.
The pattern is that a miracle diet is announced that promises guaranteed results, over the course of a few years a load of people get on board, each individual loses a lot in the first few weeks but most gain it back (true for all diets). In the meantime people make bank selling courses and books and pitching it as the central component of their Success Win Lifestyle, until the next one comes along and the cycle repeats.
If one of those fad diets are working for you, great - stick with it. But don't worry, there will always be another one around the corner.
Mediterranean, paleo, vegetarian, low-calorie etc diets almost always achieve the same low-carb goals, but low-calorie is the least practical...while sadly also being the most popular.
Just telling people to "eat less" is never an effective solution. There's a severe lack of good studies showing low-calories actually lowers weight long-term. The fact this study has 25 people is typical.
If you can eat a stable amount of food until satiety (still not-excessive amounts) while still achieving the same health/weight goals then obviously that would be the best solution.
I've asked before on HN to send me a study showing low-calorie diets are effective at reducing weight longterm and I still haven't seen one. Yet low-carb and type 2 diabetes go hand-in-hand with other treatments (most importantly pre-diabetics which is critical).
2. why is liver fat a driver for diabetes? the article and the paper don't address this.
https://www.healthline.com/health/fatty-liver-disease-and-di...
why would more liver fat increase glucose production? if anything, i would expect a negative correlation.
what hypotheses do you think are persuasive?
> Without diet treatment none of 12 participants in the control group had remission, but after they had also received the diet program, 10 out of a total of 23 participants (43%) were free from diabetes, without need for medication.
That's very unlikely to be due to chance - a difference of 0/12 vs 10/23. Of course, this doesn't protect us from failure modes where the study was set up badly or someone just plain cheated, which is why we do want more than one study, but as far as predictive power goes, this is solid.
And fortunately this is already confirmatory research, not exploratory - we've either known or strongly suspected this for quite a while. Now we're just in the stage where it goes mainstream. And speaking of what we know/strongly suspect, adding muscle building into the mix also helps. Living with 800 calories per day is not sustainable, but losing weight once, then building (a lot of) muscle then maintaining a reasonable body fat is hard, but doable.
Lately I wonder if 3 months on semaglutide, low dose steroids, protein and gym is actually an intervention well worth its risks, at least for some categories. Replacing 10kg of fat with 10kg of muscle is much less likely to yoyo than just losing weight.
For instance African Americans have high blood pressure at an elevated rate and many of the medications that work well for other Americans don't work well for them. It's important that this population gets studies about treatments that work for them.
What doesn't make sense to me is what this diet was actually composed of.
> The programme induces weight loss with a period of formula low energy TDR, providing all essential nutrients in around 850 kcal/ day, creating a sizable energy deficit and therefore substantial weight loss.
Given that Counterweight Plus can be many things (judging by the website), I don't know what this study actually demonstrates. Maybe the weight loss and remission is associated with the lower energy intake, or it may be associated with whatever diet may have been eaten. What were the subject's diets before? We don't know. Correct me if I'm wrong, but I'm not sure we can tell.
Mostly unrelated to this article and perhaps naive, but I found it very difficult to gain weight (and even sustain my weight) about 2 months after starting a 5/6 day cardio routine.
I started the routine walking at ~20 minute mile pace (3 mph) and just incrementing the speed by 0.1 mph each session. At the 2 month mark I was ~8 minute mile (so about 7-8 miles a day).
At this point I was probably burning an additional 750-1k calories a day from the running alone.
Combined with a slightly less calorie dense diet and I was basically force feeding myself to try and maintain my weight.
Background: Late 20s 5'11" Male ~180 lbs (obviously a more ideal situation)
I say this as a south Asian man.
Further, I don't know what it has to do with race - all humans respond to low calorie diets in the same way. There is the case of lactic intolerance due to loss of a particular gene. I'm not aware of any similar gene being involved in insulin intolerance.
Please consider wondering why no doctors/scientist know how to heal people with diabetes. Do they miss something obvious?
>Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%, while studies with subtherapeutic dosing typically used more moderate caloric restrictions (reducing energy intake by 500-600 kcal/day) and the weighted mean remission rate was 6.9%. Conclusions. Remission should be the clinical goal in T2D treatment, using properly dosed intensive lifestyle interventions as a primary component of medical care for T2D patients.[0]
So while not exactly obvious, it isn't true that "no doctors/scientist know how to heal people with diabetes." The real issue is that people with DMT2 generaly will not accept low calorie diets. But those that do have a high rate of remission and almost all have improved symptoms and decreased progressions.
Edit: I should note that obviously the American College of Lifestyle Medicine would advocate for this. My point is that there is sufficient liturature to back this up.
[0]Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine (2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692017/?report...
I'm really confused how T2D are special such that crash dieting doesn't mess them up further and put them further in a hole. They're already messed up because of the T2D, aren't they?
It really is that simple. The first law of thermodynamics doesn't go away so simply. Combine that with the evolutionary preassure that favors those who can save and expend energy and this all makes perfect sense. For example, increased insulin sensitivity on a low calorie diet makes sense evolutionarily. The only drawback is that muscle will be consumed as well. The amount varries by person, diet and exercise but it is minimal with a high protien diet. So say eating 500 kcal of chicken brest everyday and the rest of the calories spilt between carbs and lipids would be a good way to do this diet.
"Crash diets" do work as long as you do it for a few months. People generaly do a few days and then start binging >200 TDEE. Obviously that won't work:
>The active stage is characterized by a very low-calorie diet (600–800 kcal/day), low in carbohydrates (< 50 g daily from vegetables) and lipids (only 10 g of olive oil per day). The amount of high-biological-value proteins ranged between 0.8 and 1.2 g per each Kg of ideal body weight in order to preserve lean mass and to meet the minimal daily body requirements. This stage is further divided in 3 ketogenic phases: in phase 1, the patients eat high-biological-value protein preparations five times a day, along with vegetables with low glycemic index. In phase 2, one of the protein servings is replaced by natural proteins such as meat/egg/fish either at lunch or at dinner. In the phase 3, a second serve of the natural protein low in fat replaced the second serve of biological protein preparation. Being a very low caloric nutritional pattern, it is recommended to supplement patients with micronutrients (vitamins, such as complex B vitamins, vitamin C and E, minerals, including potassium, sodium, magnesium, calcium; and omega-3 fatty acids) according to international recommendations. This active stage is kept until the patient loses most of weight loss target, about 80%. Therefore, the ketogenic phases are variable in time depending on the individual and the weight loss target. The active stage generally lasts between 8 and 12 weeks in total.[0]
[0]The management of very low-calorie ketogenic diet in obesity outpatient clinic: a practical guide (2019)
I was always told crash diets fuck you up for years. How can this be true and also people are apparently starving for months and that's totally fine?
EDIT: Wait, is my understanding is that you have to starve for up to 4 months for a worse-than-coinflip chance at diabetes? Do we know if it stays off for 5 years? 10 years? Do you have to coinflip again? What happens if it doesn't work?
It is not true.
Many people experience that and scientists/doctors agree. In addition there is a risk of higher mortality.
https://journals.physiology.org/doi/full/10.1152/physiol.000...
"Many men and women in the United States diet to lose BW; however, most regain the weight they lost after the diet ends (73). Dr. Kelly D. Brownell coined the term “yo-yo dieting” to reflect BW fluctuations during repeated cycles of diet-induced weight loss and BW gain after the diet is terminated (74). Approximately 20–55% of women and 18–34% of men report weight cycling (75–77). What remains unclear is the impact of weight cycling on cardiovascular health.
Several large studies, including the Honolulu Heart Program (78), the Framingham Heart Study (79), and >9,500 participants in a Treating to New Targets trial (80), have shown a strong correlation between BW fluctuation and rate of cardiovascular events that are independent of traditional cardiovascular risk factors.
A recent meta-analysis of >440,000 participants from 23 studies showed that BW cycling was associated with a 1.4-fold higher relative risk of mortality due to all causes and to cardiovascular disease. The meta-analysis also revealed that BW cycling was associated with 1.4-fold and 1.5-fold higher relative risk of hypertension and CVD morbidity, respectively"
To give an extreme parallel, when heroin adicts recover, if they go back they will die much faster becasue their dosage needed for a hit is almost as high it was at the peak but their liver is not strong enough because it shrunk durring their recovery as it wasn't abused as much.
In my case, what works is a low glycemic diet.
If fasting was a solution, Muslims would experience less diabetes. Yet the prevalence of diabetes in several countries with large Muslim populations appears to be similar to the rates observed in western countries and increasing by 10% per year as a result of urbanization and socioeconomic development.
https://diabetesjournals.org/care/article/27/10/2306/23219/A...
>>Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%,
If by "heal" you mean something else that is not remission, then you should not have taken issue with "isn't that obvious" as "that" was reffering to remission.
>If fasting was a solution, Muslims would experience less diabetes.
see Table 2 of your linked study:
type 1 type 2
More 206 (20.3) 2,025 (18.6)
Less 234 (23.1) 3,284 (30.1)
Same 574 (56.6) 5,594 (51.3)
More 228 (22.5) 2,210 (20.3)
Less 214 (21.1) 3,312 (30.4)
Same 573 (56.5) 5,356 (49.2)
More 237 (23.4) 2,452 (22.7)
Less 211 (20.8) 2,677 (24.7)
Same 565 (55.8) 5,688 (52.6)
No change 562 (62.5) 5,286 (54.1)
Gain 161 (17.9) 1,861 (19.1)
Loss 176 (19.6) 2,628 (26.9)
Overall population 332 (0.12 ± 3.79 ) 4,367 (−0.25 ± 3.25 )
Patients who fasted at least 1 day 235 (−0.51 ± 3.23 ) 4,152 (−0.32 ± 3.08 )
Patients who reported weight gain 159 (+3.24 ± 2.71 ) 1,811 (+2.78 ± 2.49 )
Patients who reported weight loss 173 (−2.74 ± 1.92 ) 2,556 (2.39 ± 1.61 )