Comment by supertofu | Hacker News Reader

Comment by supertofu | Hacker News Reader

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I'm prediabetic with two T2 parents and a T2 grandparent and my primary care doctor is entirely unconcerned about it.

My lowish tech solution to delay (and hopefully prevent!) the onset of T2 is to use a glucose monitor every 2 hours, every day, and create a database of foods with my postprandial blood sugar reaponse at 1.5 and 2 hours. I also keep track of how exercise affects my blood sugar.

Over the last couple years, I have gotten great data on the foods which spike me and the foods which are neutral to my blood glucose.

A lot of foods doctors/the internet tout as "diabetic friendly" (like beans, lentils, corn in any form, brown rice, buckwheat groats, non-granny-smith apples) spike me like crazy. Other foods are totally fine (bananas, snap peas, nuts, steel cut oatmeal, fermented dairy, fish).

Having an autoimmune disorder on top of the prediabetes, I've learned that the only one who cares about my health and longevity is me. My doctors care about my inflammatory markers and nothing else.

Just anecdotal. Was T2 and getting kidney stones every two or three months (cause not related but treatment was). Cut out oxalates which restricted diet. Monitored sugar 3-5 times daily. Switched to carnivore diet + onions and mushrooms and went on Metformin. All at the same time. Did this for 2.5 months with no additional exercise. This dropped me down below T2 level. Went off Metformin and am maintaining with same daily testing. Off carnivore for paleo minus anything with oxalates after the 2.5 months strict carnivore.

Strict carnivore for me was steak, hamburger, stew meat fried in butter, mushrooms and onions in butter, bacon, and very sharp cheddar (only on burgers or raw). Eat every bit of gristle and fat. It is very hard to get enough fat.

Brain fog lasted for 10-11 days. Felt fantastic after that.

To keep your carnivore costs down I would recommend stew meat from Costco fried with onions and mushrooms when you can't stand steak or plain burgers.

This has worked for me for the last 6 months. I have no idea what it will be long term. Maybe someone will find something useful in it.

Sumo wrestlers kind of fascinate me in this regard. It's very rare to find a professional who is diabetic, even though they eat one big carb-heavy meal a day and are morbidly obese. IIRC, this is explained by their low visceral fat levels, which are driven by high adiponectin levels that are themselves driven by their intense workouts and consistent sleep habits. Their high subcutaneous fat proportion is actually thought to be protective. T2D catches up to them after they retire and stop exercising and sleeping well.

Their experience touches on 3 factors:

>Exercise volume (which, according to newer research, should be spread out over the course of the day)

>Diet (which should be focused not just on maintaining steady, low blood sugar levels, but on dietary factors that encourage subcutaneous rather than visceral fat deposition)

>Sleep quality

The last, I think, is extremely undervalued. My father developed T2 in his 30s, and it progressed consistently until he was diagnosed with sleep apnea and received treatment. Around the same time, his work schedule finally became more reasonable after a career of early mornings and late nights. This is someone who had to pass annual physical fitness exams for his job, cooked and ate relatively healthily, etc. I'm convinced it was the years of poor sleep that set him up for insulin resistance.

Check the work of David Unwin from NHS, who has reversed T2D in many patients using dietary interventions: https://www.diabetes.co.uk/blog/2015/08/dr-david-unwin-publi...

This publication is a good starting point to his approach. Early time-restricted eating of low sugar and low starch meals is the key: https://nutrition.bmj.com/content/bmjnph/early/2023/01/02/bm...

Other researchers have also achieved T2D remission in many patients through nutritional ketosis (carbohydrate restriction).

https://doi.org/10.1007/s13300-018-0373-9

And here I am following a WFPB diet with high carbs and reversing my A1C + some other markers.

My philosophy is that many diets work, you just can not have a cocktail. Our body is not a hybrid car. It takes time to switch/

Choose what you can live with - high carb, low carb, keto - and stay focused.

There is of course substantial variability in individual patient response to treatments. But a high-carb diet is unlikely to work out well for someone who is already insulin resistant. If that's the only diet that they can live with then their life is likely to be drastically shortened.

As for plant based versus animal based diets, we don't have any high quality RCTs to indicate that one or the other has a different impact on insulin resistance (assuming the same macros). So that's unlikely to be directly relevant for most patients, except to the extent that it impacts ease of living permanently maintaining carb restriction.

Sure but 1) there are many of us who are helped by WFPB and 2) Whole Foods plant based != plant based. High carbs was just my paraphrasing of what we do - lots of greens, lots of raw, elimination of meat, oil and sugar. And a bunch of other things. And while it helps reverse a few things, I agree it may not work in some or many scenarios.

I'm WFPB (plus salmon and eggs) myself. I grew up as a vegetarian and the carnivore diet is too unpalatable to me, even though it would probably work. WFPB can work to stave off T2D, but at least for me, I have to be vigilant about my choices and always pair carbs with proteins and fats.

I've found I do best with a very similar diet... mostly meat and eggs, some cheese and sometimes onions, mushrooms etc. I notice that some starchy foods hit me worse than others. Legumes are pretty bad on how I feel, and spike me to no end. Similar with wheat products. Corn, rice and potatoes spike my glucose, but I don't feel physically ill the next day like with many other foods.

It sucks, and I wind up cheating 2-3x a week (I live with people that eat different than I do).

I like to add that the reason why the carnivore diet seems to work really well is a couple of things.

- compliance is straightforward

- on average, will tick all the boxes for nutritional needs. (ie. vegans eating only oreos would not be very healthy, while vegans eating 5 colors a day would be far better off)

What have you used as a source for low oxalate foods? My husband has to avoid them for the same reason but it seems like superficially reliable sources disagree on which foods to avoid.

Sounds like a good way to trade one problem for another.

Which is why I went paleo after 2.5 months minus oxalates. I honestly have concerns about stomach cancer (family tree) and it allowed my to substitute coconut oil for a lot of the animal based fat I needed to consume for those 2.5 months. It is hard to do 20% of your calories in animal fat (male) and 30% (female) to maintain hormone levels. I don't know if those are hard and fast rules but they were the generic guidelines given to my by my PA.

Which problem?

What is your weight situation?

Eat less, exercise more, and you may delay T2D. Reduce or avoid fast carbohydrates. Reduce carbohydrates.

Get a continuous glucose monitor. You should be able to convince your doctor to write you a prescription for it. If not, there brands that will do the prescription for you after a quick video call with a doctor (but they're more expensive).

Also the FDA cleared at least one brand of CGM to be sold without a prescription, starting "summer 2024": https://www.dexcom.com/stelo

You should expect to pay $80 - $200 per device, and they last one 14 days, but the insight they give is really worth it.

I was diagnosed with T2 last year, and started a CGM (Freestyle Libre 3) like you did. I started off with lists of foods I could eat, but the monitor let me see actual data on what was happening. Its not very accurate, but the absolute numbers don't matter as much as seeing the actual trend effect on my own body. I never let it go over 150, ever. I can eat some legumes in moderation, but your specific body may be different. I initially took Metformin, but discontinued. My last A1C was 5.1 and and endocrinologist I was consulting with put in his notes that my diabetes is "remission." So, if you're prediabetic, keep at what you're doing. I eat very little meat, btw, so while that might work for some people, its not strictly necessary.

Is it conclusively proven that glucose spikes influence the risk of T2D by a big margin? Like imo calorie balance is more influential than glucose spike. This is all assuming that you are currently healthy. I don't think spiking blood glucose is a good idea of you are diabetic

There is no conclusive proof that occasional blood glucose spikes by themselves significantly increase the risk of T2D. In particular we know that the stress hormones produced during high intensity exercise cause temporary spikes by stimulating glucose release from the liver. But we have fairly good evidence that such exercise actually decreases the risk of T2D. Insulin resistance seems to be triggered more by chronic elevation of blood glucose and not clearing the spikes quickly enough.

I already mentioned some of this in another response, but I'll include it here as well: you can take measures to not have to take medication / insulin if you have type 2 diabetes. The number one thing to avoid it is to stay lean and not be over-weight, but some other things which can greatly help out:

- Exercise: 'Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, GDM, type 2 diabetes, and diabetes-related health complications. Both aerobic and resistance training improve insulin action, at least acutely, and can assist with the management of BG levels, lipids, BP, CV risk, mortality, and QOL, but exercise must be undertaken regularly to have continued benefits and likely include regular training of varying types. ' - Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/

- Intermittent fasting: there's great evidence that IF (intermittent fasting) can put it in remission: https://www.endocrine.org/news-and-advocacy/news-room/2022/i...

- Minimally processed and ketogenic diet: avoid foods which have sugar or high-fructose corn-syrup and mostly stick to low-glycemic index minimally processed foods. 'Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes.' - Source: https://www.thelancet.com/journals/landia/article/PIIS2213-8...

- Take a teaspoon with turmeric + black-pepper daily: 'Clinical trials and preclinical research have recently produced compelling data to demonstrate the crucial functions of curcumin against T2DM via several routes. Accordingly, this review systematically summarizes the antidiabetic activity of curcumin, along with various mechanisms. Results showed that effectiveness of curcumin on T2DM is due to it being anti-inflammatory, anti-oxidant, anti-hyperglycemic, anti-apoptotic, anti-hyperlipidemia and other activities. In light of these results, curcumin may be a promising prevention/treatment choice for T2DM.' - Source: https://www.preprints.org/manuscript/202404.1926/v1

>My doctors care about my inflammatory markers and nothing else

They care about your payments, more likely...

They're doctors, not CEOs. They are advising based on the behaviors they see from most of their patients, who probably come in asking for quick solutions and are unable to make lifestyle changes stick. Patients who are educated about their own conditions, willing to listen to advice, and able to keep to that advice over the long haul are a very small proportion. Not that doctors shouldn't offer this sort of advice anyway, I am just asking you to please try to understand why they behave in such a way.

I was talking to my physical therapist this morning about my experience with the recent exercises he'd given me, and I pulled up my Garmin workout calendar to show him my inconsistency. He'd told me to do a particular stretch every 3 hours or 6x/day, and I'd been having several days a week where I'd only completed the routine 4 or 5 times.

He said that level of consistency was fantastic, that at least a third of his patients flat-out told him they hadn't done any of the exercises at all, another third showed no improvements above baseline and he suspected they had lied about it, and the remainder had moderate compliance. When he'd told me 6x/day, he was anticipating 2x on the high end. We adjusted to 4x/day, where morning, lunch break, after work, and before bed were easier habits to stick to than trying to drop and do press-ups in the middle of my 9:00 meetings.

And that's at a sports and fitness-focused PT organization, not an average general practitioner working with median diets and advising a society that by default trends towards diabetes.

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