Type 2 diabetes: New treatment eliminates insulin for 86% of patients
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If you catch type 2 diabetes before it gets so bad that it has killed off the beta cells, then your best treatment is to fast for a while. After a couple of days, you should notice a massive improvement in glucose control. A week of fasting a couple of times a year might be all it takes to give you a complete cure. YMMV, but in my opinion (and that of a whole load of people who know what they're talking about) it's better than filling yourself with drugs.
After the beta cells have been killed off by overwork, yeah, you need insulin. But you can still reduce the amount you need by losing weight.
I was diagnosed with type 2 diabetes about two and a half years ago. After doing some research, I put myself on a strict keto diet. Within about a month, my A1C went from over 13 to hovering around 6 and has stayed there. Never took any diabetes medication.
I do give myself a "vacation" from the diet about once a month, which I usually reserve for a special occasion.
Eating out isn't as bad as you think when in that position. Get a steak with some low-carb vegetables on the side. You can still have blackberries and raspberries and if you really need to "cheat" you can find some deserts that are no carb. Although best to limit those types of sugars. Use an app / website to track carbs for the first few months.
Just remember you're either in ketosis or not. There's no such thing as a "cheat" day on Keto as going over carb amount can kick you out.
Also the binary nature of either being in ketosis or not is somewhat disappointing. I unfortunately find it impossible to be on a keto diet for long periods of time due to social situations and eating out. Do you have any advice?
Societal pressures can be challenging but it's really not that bad. We ate out quite a bit because of birthdays and such. If you're at a nice restaurant, get a steak and a low-carb vegetable. At Ruth's Chris we did Tomahawk steak with mushrooms. Drink club soda with lime or lemon. Chipotle is a good meal. Chicken steak, guac, cheese, salsa (check their site)
Wingstop was also goto for us. They have quite a few sauces that have no carbs. Eating out is planning. Check the menu; if it's not a chain, you might have to call. We did that a few times. Ask if they put sugar in certain things. Burger with bacon and cheese no bun is also an option. You have to be careful with chicken dishes because they might put a sauce on it.
Remember, it's low-carb, not no-carb, so if you accidentally eat a few pieces of bacon with sugar in it, it's not the end of the world. It's probably not going to be enough to kick you out.
When I'm on my deathbed, I'm far more likely to regret the things that I did eat opposed to the ones I didn't
I actually think this is an important part of cultivating healthy relationships with food. I needed to stop thinking about boring meals as missed opportunities for consumption.
A diner breakfast of eggs and bacon or sausage will do as well. Just don't eat the starches.
I'm much less strict now than I was, because I am comfortable going into ketosis and losing a few pounds if my clothes start getting tight. But in the beginning, I aimed for 10 g of carbs, assuming that due to wrong estimates and "hidden carbs" (anything with less than 0.5 g per serving can be listed as 0 carbs) I'd still likely be under 20 and definitely under 40.
Some would say that's not a varied diet. I would argue that eating a different dessert at every meal isn't all that much variation except in taste - which is not to be laughed at, but I've always been the kind of person who would rather have more steak or hollandaise than a dessert. Poached eggs on ham, covered in hollandaise, is not exactly an ascetic diet.
I stayed on this for seven years until I finally had to go on insulin.
And maybe the secret is the no sugar nor simple carbs
Try a book like "fiber fueled". That's a diet that is actually sustainable.
Prehistoric humans however (that is, before the agricultural revolution) consumed most of their carbs through fruits, nuts, and vegetables. It's estimated their diet probably consisted of around 100 grams of fiber a day, as opposed to the typical 2 grams people eat today. Fiber slowly the blood glucose elevation by quite a lot.
I don't think simply cutting out carbs is the answer or even sustainable. I think it makes much more sense to gravitate towards a diet of more whole food, which contain more fiber and thus don't raise blood glucose as severely. Carbs are important, and we've been eating them forever.
For virtually all of human history, the human diet was whatever people could get their hands on. That meant as much meat as they could hunt or raise plus whatever else. Most regular people barely stayed ahead of starvation and they couldn't afford to be picky. Insulin resistance only becomes a problem when consuming excessive amounts of carbs over a long period, which only even became widely possible after 1913 due to the Haber-Bosch process making farming more productive.
Your baseless claim that cutting out carbs isn't the answer or even sustainable is directly contradicted by clinical research. Many patients have literally put type-2 diabetes into remission through nutritional ketosis. That diet isn't recommended for everyone, just patients who already have insulin resistance (with appropriate medical supervision). Regardless of what you "think", that is the reality. After the patient's metabolism has been somewhat repaired it may be possible to reintroduce limited carb intake without triggering a relapse. Fiber is certainly helpful in this, and no one is seriously suggesting to eliminate fiber.
The human diet has been a very, very small minority meat. Because meat is hard to get.
And prehistoric game meat is also not the same as farm meat. Beef and pork contain high amount of saturated fat, but game antelope would contain much less and would have unsaturated fat. Meat of that time is really closer to avocado than meat of our time.
> Regardless of what you "think", that is the reality
I'm glad to see everyone is being civil.
But if we come back down to Earth, you'll realize diabetes is reversed 95% of time when Ozempic is used.
Do those people eat carbs? Yes, they do. Is 95% a higher success rate than whatever pathetic adherence rate a miserable existence like ketosis has? Yes, it is.
If for 99.9999% of all of human history our diets consisted of almost exclusively carbohydrates, I don't think we're following the right path here.
Just because ketosis reversed diabetes DOES NOT mean it address the root cause. It could be purely incidental. And it's also a piss-poor treatment. Because it sucks, and nobody wants to do it, so they try it and then lose a foot or two.
We should stick to real medications, such as insulin and Ozempic. The granola-brained can continue their keto.
Wild meats have very different ratios of fats that farmed meats, but mostly in the opposite direction you are saying. Because (especially non-ruminant) animals take most of their fat from their diet, rather than synthesizing it directly, farmed meat closely mirrors the ratios of fats fed to them via diet- and using seed oils in animal feed makes them have much more omega-6 polyunsaturated fat, and much less saturated, monounsaturated, and omega-3 fats.
Overall a high omega-6 intake is a huge problem as it alters our cellular lipids in a way that impairs a lot of systems, as is eating muscle meat only which has weird amino acid ratios compared to our needs. Weird amino acid ratios in diets have different usually undesirable drug like effects. Both are major issues for anyone trying to do a 'high meat' diet in modern times. As with vegans, if you deeply understand this stuff and have the time and money you can probably make it work.
> whatever pathetic adherence rate a miserable existence like ketosis has
Ketosis seems pretty effective for some people and not for others. I did it for many years and felt amazing- it was in no way "miserable" but eventually got into competitive sports where my performance just wasn't as good with a restricted diet. If I were diabetic, there is no way I'd rather be insulin dependent than do a ketogenic diet, assuming it actually worked that way for me. I know several people that permanently solved major mental health issues that didn't respond to other treatments by staying on ketogenic diets.
For many people, I do thing higher carb diets actually are better for diabetics, because low carb induces extra insulin resistance and raises blood sugar levels. The most effective diets I have seen in peer reviewed research for diabetes treatment seem to be something like "high carb paleo" diets with lots of starchy root vegetables. However, if it makes it easier to lose weight and eat less for someone, ketogenic diets will help.
Moroeover- and this is little known I think- ketosis and low carb are really totally independent things. Ketosis occurs anytime there are excessive acetyl groups in the TCA cycle, which happens under various conditions unrelated to carb intake.
Most people on low carb diets never get into ketosis unless they also severely restrict protein, because we make a ton of glucose from protein (via gluconeogenesis). People eating mostly lean wild animals are unlikely to ever reach ketosis- you'd have to be eating mostly things like seal blubber.
However, many people on high carb diets, especially things like raw vegan diets or diets with lots of resistant starch, e.g. from potatoes and rice are in ketosis, because resistant starch gets ultimately metabolized as ketones. The so called "keto diet" is probably not actually a ketogenic diet but "raw veganism" and the "potato diet" probably often are ketogenic diets.
I don't really have a high vs low carb bias or preference but think it is fascinating how adaptable metabolism is (and it is what I research professionally).
Which is rather a short time in our evolution, compared to virtually all of human pre-history. During which the human diet was most likely not mainly carbohydrates.
Because that’s accurate. Someone following this treatment plan is still at elevated risk of recurrence. Once you’re cured of the flu, your ex ante chances of catching it again are no higher. (We don’t have a cure for diabetes per se. Insulin controls but doesn’t cure it.)
By “a week of fasting” you mean a week of intermittent fasting or something else? Can you give an example of such a regime (and are there different ways?)?
Don’t have type 2 yet but has family history and it spiked to 6.1 one right after a hospitalisation so I have been spooked since (been 2 years). I get super stressed even at the thought of sugar related tests.
You don’t have to try for 7 days on the first attempt, though for most people the first two days are the most difficult so riding it out past the third actually gets easier.
I'm ending my 5th day of this cycle today, and this morning my fasting blood glucose was 77. Usually it's around 100.
Do you know of other sources of information?
Counting calories has always been such magic to me, given all my meals are homemade and I don't made them.
Can confirm. My wife had surgery ~3 years ago. I supported her by eating the same things she was for prep and throughout the surgery. We lost about the same amount of weight, through ~1600cal a day and exercise. I wanted to get down about 25lbs lower than my lowest during that time. But, a year ago my wife was diagnosed with cancer, and that process totally screwed with our plans, and we both gained weight, her quite a bit less than me.
The last ~6 weeks I've been restricting calories again, and have started the journey back to where I want to be. I will say that the surgery really impacted her hair badly, which she didn't love. Despite taking all the best vitamins, her hair went from thick to somewhat thin.
If you can get rid of the things that trigger you and stick to low calories and exercise, you'll lose weight. The surgery helps, but committing to low calories is going to get the results. And a friend who got bariatric surgery but wasn't committed to lifestyle changes, within a year was back to her original weight.
Hope you wife is doing better.
We regularly take a multi-day drive to her parents, and on one I noticed she had to use the bathroom a lot more frequently than usual. Another friend lost his wife a couple years ago to pancreatic cancer, that started with some lower back pain. The moral of the story: Don't ignore changes you notice in your body.
I first felt the tiny lump in her breast and then she couldn’t find it. I had to nag her for a few months to go get it looked at. She just waited for her routine appointment which was 4-6 months after I nagged her. In hindsight, I wish I was more insistent as I think it could have been removed without needing chemo earlier on. She was early 30s, and at that age at least, she’s of the opinion the double mastectomy and reconstructive surgeries were a breeze compared to chemo.
I knew it was not good when I felt it the first time (in college I worked in a pathology lab, have handled a lot of cancers and I knew she had brca genetics) Who knows really if chemo could have been avoided but my point and learning was, you are with this person more than anyone, if you notice something and are concerned for them you need voice it and create action.
I'm sure it was hard to watch your wife wait out the next Dr appointment. I have a friend and they decided to "pray the cancer away", and didn't seek medical treatment until there were skin lesions visible. The nurse at that appointment had to leave the room to vomit it was so bad. They went through surgery+chemo+rad and she's been in remission for a number of years now. So, even in fairly bad cases of waiting it out, there can still be good outcomes.
Definitely don't wait though. In my wife's case, they were confident that surgery would resolve it. But when they got in there, it was "acting weird"; it had grown much, much faster than it should have over that time. Initial diagnosis was stage 1, after surgery they called it stage 3+.
I had to do battle with the insurance company, because our company was changing insurance, with the new insurance becoming active 4 days before her scheduled surgery. We have a "benefits advisor" that always says "if you have any questions, ask us and we'll take care of you", but they've been fairly useless. In this case, they were telling us that we needed to wait until we had the new insurance cards, which would happen sometime within a few weeks after the new policy became active, then we'd have to submit for pre-approval, which could take another few weeks. And the specialized surgeon was scheduling like 6 weeks out...
We eventually found that we could personally guarantee payment, and the doctor was confident that insurance basically never denies coverage in situations like ours, so we went ahead with this course and got everything paid for. Which was good, because as I said, the cancer was "acting weird" and in the 2 weeks between initial location of the growth and the surgery that we were lucky enough to be able to get in due to someone else needing to reschedule, the growth doubled in size. Another 4-8 weeks very likely could have resulted in spread to the lymph nodes and much worse outcome.
Another moral of the story: Don't let the insurance company push you around. With cancer, time is always of the essence.
When it’s cancer, you have to move quick. I knew that from my experience in the clinical setting. That was over 20 years ago now but I still remember when a biopsy or specimen tested positive they’d want to know STAT and would then be calling the patient back in to discuss options immediately. The OR schedule would change to accommodate new cases and such. Outside the ER and Code events, most things in the hospital seemed to move slow especially the outpatient stuff. But as soon as C was involved doctors everyone wanted everything done yesterday.
It’s a good point on insurance as that’s the most common delay/blocker from how doctors would want to proceed. My wife’s young age (denser breast tissue) required a special type of imaging to detect. Insurance didn’t want to pay for it and it was something like 20x more expensive than the normal type. We went ahead and paid, thankfully we could, and her oncologist fought with the insurance a bit about why he justified it. Eventually we got reimbursed. The doctors apparently used her case to help build a new insurance-approved standard for imaging of young high risk patients, which is pretty cool byproduct of our stress.
It was a similar scary high growth type cancer, between the time the imaging was confirmed and a week or two later when it was surgically removed it had growth from 1.8mm to 3.5mm diameter. Which was still considered extremely early detection from what we were told. If she was not already aware of her brca risk and seeing an oncologist annually, it might have been much larger and likely metastasized possibly in the lymph nodes by the time it was discovered. Scary stuff, you guys did the right thing acting quickly for sure. I spent a good portion of my career in healthcare finance, and see how decisions are made regarding capitalistic agendas and have experience the patient side of these decisions as well, needless to say I’m strongly in favor of socializing healthcare and even removing the profit motive entirely. Some things shouldn’t be investments. It bothers me that all those against it are just ignorant to the existence of these kinds of issues and have been fear mongering. I think we have current resources to “do it right” if we put the proper thought and execution into it.
I had to get out of Healthcare altogether after COVID and the Boardroom conversations I was a part of. The worst was we wanted to close ICU's because uptick in nursing labor was making profit margins lower than usual, never mind the fact we had a ton of cash on the balance sheet the government had given us for emergency funds - I luckily was able to win that battle and we remained open - but yeah, hedge fund owned ICU's during a pandemic...
What we put in our bodies means everything!
- Drank zero water before... now a gallon a day which flushes my system many times a day
- My nephrologist told me to avoid all medications best as possible which i do and have done. When I must take meds then in my monthly to bi-monthly CMP (comprehensive metabolic panel labwork) i see my kidney function go down albeit temporarily. For example I took a new drug recently out on the market and it dropped my function to under 60% in Nov/Dec last year. Back to 75% as of my last test received this week. Prior test showed function was 82%.
- I ate beef (steak) many times a week prior and lots of fried food (cut that down to once or every other month)... i still eat out always at Cava (simple rice and chicken bowl), grilled nuggets at Chic Fil A and a fruit cup with unsweet tea/splash of lemonade, salads at Panera (Fuji Apple), pasta (spaghetti with marina from local pizzerias), maybe a Chix/rice burrito from Chipolte or a mini turkey and provolone sub from Jersey Mikes... for breakfast if I eat it at all healthy cereal with no preservatives or egg whites with potatoes and wheat toast (no bacon or pork) at a local diner.
- I weigh myself daily and count my calories in my head. I recently been enjoying using chatGPT to do so, as it knows calories of all the places i go, counts them up and remembers them so i can add more later. I keep it between 1500 to 1800 calories a day(eat two meals a day and healthy snacks here/there) which i think isnt a lot for a dude my age (late 40s) and my size (5'11 170 to 175). I almost never drink calories ... unsweet tea and splash of lemonade for flavor is minimal.. water is zero. Rarely drink alcohol maybe one or two gin and tonics in a month.
- Ive always been obsessed with fitness prior to kidney function diagnosis as i enjoy looking my best I can on the beach and elsewhere :) So im doing some type of exercise almost daily (hike, bike, gym, swim laps, weights)
I think the amount of water i intake, changing my diet as noted above, maintaining my lifestyle of fitness ive always had & avoiding all/any meds are the keys to my kidney function success. My nephrologist who i still see a year later or so changed her tune and now advocates for the lifestyle i live to help with kidney function health.
I see people here talking about fasting and im not eating a ton a day. Maybe that's an overall good thing for our bodies not eating a ton ant things that aren't healthy/natural (processed foods are really bad i thnk).. not stressing it to break down more stuff (just a thought/guess).
My lifestyle isnt for everyone and the fitness portion is something ive always done to try and be the best I can be as well look the best i possibly can. Again im a bit obsessed with such and is a driver to my lifestyle.. ive never dieted i guess my lifestyle is a diet to others.
My theory is that overeating is basically an addictive behavior- a way to escape from stress, negative feelings, and emotional trauma. It is actually the mental discomfort of fasting that gives you confidence that you can deal with mental pain and discomfort without trying to escape it, that leads to eating less. This is likely the same mechanism behind weight loss drugs like semaglutide that also help with non food related addictions.
Overall I think people are missing the emotional and psychological mechanisms behind the obesity epidemic, and looking too much at things like calories and nutrient content, which is why the whole phenomenon has been eluding understanding.
This is not true. For me at least the effect of fasting for several days is purely physiological, not psychological, emotional or spiritual. There's no extra "confidence" to deal with "discomfort," your body simply needs drastically less food. You also drastically increase your feelings of being satiated after eating.
So after fasting (and its probably the same on GLP-1 meds) you don't get very hungry and when you do eat you feel very content and full after only a few bites.
Lots of research shows that overstimulation of the reward system, e.g. from high satiety foods overrides the feeling of fullness in a way that integrates both what you and I were saying in a coherent way - especially if you think of "mild discomfort" as a state of low stimulation of the reward system [1]. This is probably why so many different seemingly mutually exclusive diet protocols work equally well- anything that restricts some foods and not others, regardless of what they are, lowers the total reward system stimulation from food.
For me, I am still hungry while fasting, but the hunger becomes easier to handle over time. I also notice afterwards that I am full with less food like you noticed, in addition to the other things I mentioned. It is also easier for me to stop eating while still a little hungry after fasting.
In my case years of logging my bodyweight on a digital scale show I only gain weight during stressful events, but then keep it the rest of the time... and if I'm consistently taking cold showers or doing regular short fasts, it prevents that effect and causes gradual weight loss on top of it. So I have fairly convincing data that what I am saying is true for me, but it may not be true for everyone.
[1] https://boingboing.net/2012/03/09/seduced-by-food-obesity-an...
Another thing is consumption. All of my metrics start moving immediately in the positive direction when I'm on a calorie restricted diet, even before I start seeing results on the scale.
I could be unique but I doubt it.
The problem, of course, is that just like CICO, observing the relationship between weight and health is educational but useless as a strategy. If it were that easy there would be no overweight people in the world.
Is type 2 a permanent disease? Or is like when you lifestyle is bad and your sugar remains high/etc you are suffering from type 2 diabetes, but when your lifestyle and weight and great and sugar is well under control you don’t have type 2 diabetes, but if that changes you can get it again? Or it’s like - once “marked with type 2” no matter the sugar marker results you are a type 2 patient forever?
During type 2, your body becomes resistant to the effects of insulin produced by the beta cells and they go into over drive providing insulin. Eventually, the beta cells become over stimulated and reduce effectiveness, but they don't die.
There's no reversing type 1. You can have remission of type 2 and your beta cells return to normal. Neither outcome depend on "how many are left
Some autoimmune disease are significantly improved with regular exercise
> Recellularization via electroporation therapy (ReCET) is a novel endoscopic procedure that uses electroporation to induce cellular apoptosis and subsequent reepithelization.
GLP-1s baseline eliminate insulin for about ~40% of people. This boosts that number to 86%.
Note that Tirzepatide also reduces the chance of developing type 2 in the first place by 94%, and I suspect that newer generation receptor agonists will see higher insulin discontinuation rates in general.
Very cool stuff all around. Might finally be able to put this whole obesity-and-diabetes thing to bed.
Make sure you are getting sufficient calories and you won't lose any weight.
The caveat is that it slows digestion down and this effectively reduces your capacity to eat a lot of food. So maintaining a high calorie diet may require some changes to increase the energy density of your food.
Folks should follow medical advice and do what works for them, but be aware that these guidelines were established prior to the obesity epidemic. I’d be highly surprised if someone weighing 300lbs vs. the same person weighing 190lbs should be losing weight at the same rate per week.
I imagine these will be updated to be body weight (or fat) adjusted as time goes on, like some doctors are already doing.
This study says you may get a better body composition if you do it slowly, but also resistance training during weight loss helps prevent 93% of muscle mass loss. [1, 2]
This study says fast loss means more loss, and is actually better for long-term maintenance. [3]
Due to the risk profile of obesity, and this is not medical advice, I think there's a lot of room to take more risk if it helps get you back to a normal weight. The consequences of not are just too high.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC5702468/
Anecdotally, I lost 130lbs in 1 year, and have now lost 140lbs (1 year 4 months).
Initially, I was 330lbs and lost weight at a rate of 3.5lbs per week. Slowly decreasing weight per week to stabilize at around 1% of body weight per week.
During the entirety of this time, I had, and still maintain, a rigorous resistance training program. My muscle mass is significantly higher than it was when I was 330lbs.
The important part of losing weight is to know what your goals are, and to adjust all aspects of your life accordingly. Not just cutting calories, unless your goal is to lose weight, vs lose fat.
The biggest thing afterwards is, if your lifestyle doesn't support the maintenance of your new weight, and when you hit your goal you eat like you used to and revert activity to your old sedimentary ways, all of that weight will come back incredibly fast.
Whole life changes are needed. Going slow helps with these changes, as they become habits. This is why the success rate of achieving a healthy weight for someone who is morbidly obese is only 1-1266 (men) and 1-677 (women) [1].
[1] https://www.ncbi.nlm.nih.gov/books/NBK362452/#:~:text=In%20p....
It is best described by me turning the volume down on your desire for a dopamine hit. You’ll eat what you need, vs going for the helping of comfort food. Many people see a more active libido, less alcohol desire and other factors.
We’ll see lots of other indications I’m sure. This drug is like the Keytruda of self control.
I am in a pretty close knit community of 100s of people on the subject and while the side effects should not be discounted, figuring out ways to properly take the medication more or less eliminates them completely for nearly everyone.
The current dosing and schedules of the drug (and all GLP-1s for that matter) are largely an effect of what was tested during trials and not what will end up being most effective a decade from now. The rest of it is patient compliance and liability from drug manufacturers.
The most obvious two things to point at are that the half life of Tirzepatide is 5 days while the prescriptions are for 7 day intervals for ease of use. The other would be the rather large jumps in dosing (2.5mg per step) available in injector pen forms and prescribed.
Some bleeding edge doctors are willing to take the risk to go outside dosing and schedule guidelines, but not many.
Even then, the side effects seem to be rather minor compared to obesity or T2D and few and are far between.
I also had similarly reactions to the topic before I started to really look into it and dig deeper. I firmly believe these medications will change society at a level only antibiotics have so far.
That said, there is nothing magic about aligning the half-life and interval. 50% isn't a minimum concentration threshold for efficacy. depending on the product, it can be anything. Sometimes area under the curve is the relevant parameter. Sometimes you want the product to go under a limit before redosing.
The one part I disagree with is about bleeding edge doctors. Maybe it is my field, but I find doctors to be readily willing to completely ignore the labeling. Statutory protections are high for clinicians operating off label. If someone is interested, I suggest they raise it with their doctor. For most medications, the dosing is far from the individual optimum.
Re: the half-life, I generally agree - however at low dosing, a half-life calculator seems to coincide with some folks experience with side effects - especially starting out initially. Once the dosing levels go up, the impact is much less - but even I at my peak weight loss at a mid-dosing level could tell a difference in hunger levels if I had to wait a few days due to travel or whatnot.
I was on Rybelsus for about a year and a half. It changed my life, and frankly, being able to skip a dose of I wasn’t feeling great eliminated bad belly side effects.
There was a promising example in China where Scientists cured a single woman who had T1D. It's n=1, but the first step to a cure is curing someone :)
No doubt, the current T1D market players will have created some legal moat, so it might be best for the patients if these companies are the ones to bring the treatment to the market. But we shall see - the current big pharma in diabetes space is heavily invested in drug production rather than implantation procedures. It is a very different business model requiring very different facilities, management, and technology.
[0] https://www.diabetes.org.uk/our-research/get-involved/take-p...
Once a treatment reaches stage 3 trials, it often becomes generally available within 2 years.
Stage 3 is expensive for regular drugs but for treatments like these, the cost of one trial may exceed $100M. The fact it’s happening in several places around the world means there is very high confidence that the treatment is working and the race to market has started.
Most of the times, when people are saying the treatment is 10 years away, they are being very optimistic. Usually it’s after some research shows a new pathway to treatment, usually in mice or other mammals. This is far before human trials and even when human trials start, there is only about 2-7% probability of the treatment making to market. So some mammal responding to treatment in a lab means the chance this treatment will make it through trials for humans is probably in the range of 1%. Saying with certainty it will come in 10 years is a joke.
But contrast this with a treatment in stage 3 clinical trials, where for diabetes treatments specifically, the success rate is between 65% and 70%. And some real snake oil has gotten to stage 3, which this is not. I think it’s quite likely we will see a treatment soon. 10 years is a pessimistic estimate for this.
Stage 3 diabetes treatments are so easy to test, too. If they lower HbA1c, then they work. If they are safe enough that for at least one population of diabetes patients they will significantly extend their life, then the treatment is safe enough. And stem cell implants have the hallmarks of all this.
It’s important to look at the evidence and not be cynical. The treatment can fail onstage 3, but at the current time, it is far more likely to make it to market.
I agree with this.
As for the rest, I appreciate your optimism but I think this recent discussion [1] captures how dire the situation remains for t1d. For example, GLP-1 drugs are not approved for treatment for t1d despite overwhelming evidence that they are useful. Or “We’re really just starting to figure out how to safely and effectively manage weight with lifestyle changes for Type 1 diabetics.” Stem cell miracles have been promising for years [2] and I don’t agree that the situation today is meaningfully different. The recent success with implanted cells is hopeful but the patient was already on immunosuppressants, so the result doesn’t generalize. Despite the overwhelming amount of money thrown at this, a cure is always just around the corner.
[1] https://publichealth.jhu.edu/2024/type-1-diabetes-research
Cell transplant once every 5 years can be done globally, right? We can do it in China if the laws are better there.
With the trials, I’m also not so pessimistic. This is much larger scale and its stage 3 — not one offs in a lab.
Open your mind to the possibility that maybe things are a bit more optimistic than you believe. I remember when closed loop pumps were about 5 years away for decades ;)
It's frustrating, as Type 2 diabetes is 100% manageable through diet. You don't even have to exercise, just eat healthy. Today, with the use of continuous glucose monitors, you have all the data you need to make informed diet decisions - you know exactly what "eat healthy" means for your body.
Why do you suspect it changes energy expenditure?
Most people don't actually say it out loud, but this is all directly implied by the "personal responsibility" retort that is wildly popular among people who don't actually suffer from a given malady, in response to attempts to address it collectively.
However, I dont agree with your supposition following from that.
I think that obesity is a symptom of a cultural problem worth solving, not an individual moral failing, and there are better ways to learn than death.
There are lots of things in our culture that result in physical and mental sickness. It is good to treat the symptoms, but we should also pay attention to the cause.
Culture operates both at the individual and collective level. One can not exist without the other. One can not change without changing the other. Personal beliefs and actions shape collective culture, and culture shapes personal beliefs.
It is the natural consequence of the human body's strategy for finding enough sustenance to drive that big brain over an evolutionary timeline that was mostly dominated by scarcity.
We like to call it a disease because we want to live longer. But all of the consequences happen after most humans have procreated, so there is no evolutionary pressure[0] to change it.
[0] Yes, I understand evolution isn't quite that simple
The agriculture revolution only happened 10,000 years ago. This is all very new to us.
It is a disinvitation to solutions, and the rest follows naturally from that. I think a lot of people are using this as a thought-terminating cliche without actually considering how hostile the stance is.
A widespread lack of individual agency and self-determination is both a cultural problem and should be viewed as a call to action.
The question of why this is the case and what we can do about it is the interesting part.
People do have personal problems. Ignoring that is like blinding one eye before assessing the situation
That was practically the consensus social position forty years ago.
We didn't have an obesity crisis. Now we have an obesity crisis. Did the human race just become less responsible? Or are they enduring a new, situational, societal-level problem that affects many people collectively based on the socioeconomic & cultural conditions they were born into? Conditions that didn't exist 20,000 or 1,000 or even 60 years ago.
This is a longstanding conservative trope that excuses us from dealing with any and all social problems because we don't owe anything to each other. It is a declaration of social atomization.
The implication here is that somewhere along the way in the last 50-ish years people just lost the ability to have discipline. All at once. Across the entire globe.
Does that sound reasonable to you? Keep in mind 50 years ago almost everyone smoked.
Personal responsibility has not changed. I don't understand how people can say this when the problem is to such a widespread degree.
> "when _you_ believe the solution is trivial" (emphasis mine)
> "But you could also consider..."
Travel to Italy or France and the difference is shocking — both in terms of the look of the people and the quality of the food.
The average American is 50% richer than the average French, and have access to everything they need to eat like one if they choose.
In fact, much of the difference is the French choosing not to eat - both in terms of frequency and quantity.
Healthy food attitudes can absolutely be learned and taught. If you see a 200lb 10 year old, the difference between them and their classmates isn't the contents of the supermarket. Its what is going on at home, the actions of their parents, and what they are learning.
I say this not to blame or pass judgement, but to demonstrate that induvial behavior and actions matter.
As programmers, we usually prefer to remove code to fix a bug than adding patches on top of buggy code. Let's not pretend that the same logic does not apply here.
That's clearly double unhealthy behavior and will bring unintended consequences. Which might be better than the current predicament but still let's not pretend this is not a "monkeypatch".
Consider: GPL-1 inhibitors are actually root-cause solutions, and diet/exercise are not root cause solutions.
That's because the cause of obesity is not eating. The cause of obesity is a propensity to overeat. The cause begins in your brain and automatic responses, not on the table or the gym.
That's why you and I can eat, be satisfied, and not be obese.
Diet/exercise doesn't address the root cause. It fixes the symptom - obesity. But those people are still addicts, and if they fall off then they're off and will become obese again, much like an alcoholic. This diet "rubber banding" is extremely common.
Ozempic and others address the root cause, by lowering the desire or propensity to eat, perhaps closer to that of someone with a normal brain and normal regulation.
Who said so?! I have been obese (clinically, BMI) multiple times. And all the time I got back to overweight then normal weight by exercising and eating less (than what I wanted! Because eating until I feel like exploding is so good).
> Consider: GPL-1 inhibitors are actually root-cause solutions, and diet/exercise are not root cause solutions.
False. Overeating is caused by lack of movement and bad diet. There is no point in discuss the rest starting from a completely wrong point.
Is this some kind of joke? A bad diet doesn't cause overeating - overeating IS the bad diet. Also not moving doesn't cause overeating, because how could it? What, I sit down and suddenly a burrito appears in my hands?
The cause of overeating is a propensity to overconsume, i.e. you have an addiction. Diet and exercise address the SYMPTOMS, but not the ROOT CAUSE. You STILL have an addiction. In the exact same way someone who is sober is STILL an alcoholic.
Because drinking alcohol is not actually the root cause of alcoholism. The root cause is an addiction to alcohol. You can't get rid of the addiction, but you can treat the symptoms - by never drinking, by being sober. But you did not address the root cause.
By my logical analysis, I conclude GLP-1 inhibitors better address the root cause than diet and exercise. To further strengthen my point, you've more or less admitted this by pointed out you've been obese "multiple times". If you had addressed the root cause this would be impossible! But you did not address the root cause but merely the symptoms via diet and exercise. You still had the addiction, so when you slipped you became obese again. This cannot happen while taking a GLP-1 inhibitor because you no longer have the extreme desire to eat. Even when you lost weight, you still had the extreme desire to eat.
Semaglutide is ozempic. By itself it can be enough to help people get their A1C down through healthier diets.
For me to find the study especially interesting, I'd have to see a comparison between ReCET + semaglutide vs just semaglutide. And upon re-reading I see that's their plan.
> “We are currently conducting the EMINENT-2 trial with the same inclusion and exclusion criteria and administration of semaglutide, but with either a sham procedure or ReCET. This study will also include mechanistic assessments to evaluate the underlying mechanism of ReCET.”
You, sir, are a modern messiah. Well done.
Still popular opinion is that eating meat and fat is bad for you (heart attack) but no many understand that eating sugar and carbs is a highway to diabetes).
In fact many people who go on keto and reverse diabetes report that doctors instead of congratulating them and telling other patients to do the same, tell them that keto diet (i.e. eating lots of meat) will give them heart attacks.
Most people don't know how bad sugar and carbs are because no one tells them.
I point this out because I've gotten the impression that many seem to view keto and veganism as opposite sides of a "culture war", and use that to justify reacting to one or the other with hostility. In reality, they're entirely orthogonal. One is a range of macros while the other is an ethical philosophy, and they aren't in any way mutually exclusive.
*: To preempt the usual comments on this, my current LDL is 54 and HDL is 57. At its lowest point a few years ago, my total cholesterol was exactly 100. I don't buy that saturated fat is necessarily unhealthy at all.
Not Sarcasm:
1) We simply don't know. Effects seem durable while people take the drug, but we have limited long term data. We dont have large populations that have taken it for 10 or 20 years
2) When people go off GLP-1 drugs, about 50% of them bounce back to their original weight or gain more. about 50% of people hold steady or go on to lose more weight.
This demonstrates that individual behavior and actions play a critical role, even for people who have taken the drug.
I agree they can be a game changer for managing the condition though and, for me, it's money well spent.
Just want to call this out, as it is very demoralizing to hear this sort of message when it does not apply to you.
https://diabetesjournals.org/care/article/39/12/2254/31913/E...
Hint: You can substitute for that with sheer willpower.