Is Type 2 Diabetes Reversible at Scale?
peterattiamd.com> The entire intervention is managed by physicians and the nutritional approach is based on highly individualized carbohydrate restriction and nutritional ketosis (which I’ve written about extensively in the past and throughout this blog).
People like to hate on low-carb approach. They say things like "It causes liver problems" which don't have a basis in reality. Human beings survived for thousands of years on way fewer sugars and starches than we have today.
It's particularly bad in the US due to the availability of high fructose corn syrup, which means America products tend to contain more sugar than their overseas counterparts.
A few years ago I started going strong on a keto die, cutting out soda, pasta, bread, etc. and eating a lot more vegetables, meats, cheeses, etc. There an initial shock about two weeks in which some people can't get past, because your body has to get use to using fat as a primary fuel source instead of sugars/starches. Once I got past that though, I could cycling farther, my weight training sessions lasted longer with less fatigue, and I dropped from 72kg down to 63kg over the course of several months.
My lowest was 60kg for nearly two years! Moving back to America has been difficult. It's hard to find the same quality of ingredients and I just got burnt out on cooking my own food all the time. There is very little healthy stuff off the shelf here. In the past two years I've slowly rose back up to 67kg and it's upsetting.
I wish there were more low carb options when eating out. Salads at pubs are often loaded with croutons and fruits, there are lots of hidden carbs in salad dressing and there's just a lack of healthier options here.
The food industry pushed hard against the Adkins movement in the early 2000s. Imagine if we had kept going down the route. Would obesity have dropped significantly in the US? We'll never know. But this article goes with a lot of the current research: fat doesn't make you fat. Sugars and starch do. They have a much higher energy density and sugar is huge contributor to heart disease.
Fat + Carbs makes you fat. Cut out one and you lose weight. I'm on a plant based diet which is high carb (no highly-refined carbs) and I'm very fit.
If your body's glycogen stores are full from carbs then YES fat you consume goes straight to fat.
EDIT: and WFPB (whole food plant based) also reverses type 2 diabetes.
I've been on keto for a > 1 year now, but feeling like I want to cut out meat products.
Any resources that you can point to, to research the physiological effects behind WFPB, and for getting started?
Rich roll podcast has a lot about WFPB diet. He’s a lawyer turned athlete so his discussions are pretty good.
I enjoy this one about the benefits of ketosis in a plant based diet with Dr Kahn: http://www.richroll.com/podcast/joel-kahn-349/
Not OP, but https://old.reddit.com/r/vegan/wiki/veganscience#wiki_health... is a good starting point.
Thank you for being a voice of reason in all this. When this ketosis madness ends and we go back to eating plant based like our ancestors did the world will be a better place with healthier humans and no factory farms.
I think you can do either, and I should have added that to my post. Veganism isn't a health diet straight out; it's a political diet. But you can be very health (lots of plant, plant carbs and very little fat) or very unhealthy (nothing but Oreo cookies).
I agree with the poster that a high carb/low fat diet can also be pretty healthy, but you pretty much do have to do one or the other.
Both approaches are difficult, because the food supply/industry isn't really setup for it. There are a ton of unhealthy vegan meals in vegan restaurants as well, where they load up on refined sugar and not as many plants.
They keto stuff isn't madness though. It's just a different approach and it works for some people.
I've done numerous stints with keto and think some of the criticisms are valid, particularly in the first phase when you're often advised to stick below 20-25 net cards a day. That's nearly impossible to do unless you are eating predominantly meat, cheese, and eggs. There isn't much balance there. If you're eating vegetables w/ every meal, you can easily jump over 20 net carbs and I find that restriction absurd. You have to do a fair amount of supplements to get the vitamins and fiber you should be eating. However, in general, it works extremely well for me in cutting weight and eating better.
I think something in the range of 30-50 net carbs per day is far more realistic to keep balance in your diet. At some point, the benefits come more from having a quality diet, full of vegetables and balanced protein, free of added sugars and grains, rather than actually being in ketosis.
Yeah. You can eat a lot of calories of pure sugar and still not "feel" full. Whereas it's hard to overeat lettuce, you'll literally fill up before you go over your daily caloric intake.
Not that I'm advocating a lettuce only diet. But as I acquire more and more information about how we eat, what we eat, etc, I've become of the opinion that we do have way too much salt, oil, and sugar in our diets. We can even cut down our meat consumption greatly with no ill effect.
We're survivors who haven't had to survive for centuries now.
The same goes for oil which is all fat and no carb. Refined food is the real culprit, not just refined carbs.
There are some healthy and natural oils, but yes the vast majority of the oils we use are cheap, processed garbage. The real issue is that our bodies aren't designed to consume, for example, vegetable oil in mass quantity because the amount of actual vegetables you would need to consume to get that same amount of the oil is simply impossible to do.
Those refined oils aren't handled in the same way the healthy, natural ones are so it contributes to the metabolic damage.
Plain old lard contains over 100 calories per tablespoon.
It's not really a battle between processed and unprocessed. It's just simple math. Oil and sugar pack a lot of calories in a very small package.
We eat multiple times every day. We have the entire variety of food at our disposal multiple times every day. I can have a feast for every meal. Most people eat like royalty of the past. This is new. Most of us live post-scarcity. We're having a hard time adapting because our instincts and behaviors come from times of scarcity.
I respectfully disagree. Calories are not created equal.
https://www.health.harvard.edu/blog/theres-no-sugar-coating-...
https://www.webmd.com/diet/news/20120626/all-calories-not-cr...
"That’s just not what the unbiased studies have shown. Looking only at calories ignores the metabolic effects of each calorie; the source of the calorie changes how you digest it and how you retrieve energy from it."
The Harvard blog simply makes a statement without actually providing the proof.
And there's also the point that calories that "leave the body" aren't really calories consumed.
So if a portion of the raw caloric value of something gets expelled through waste because we aren't really able to process it in time, then it's not really a consumed calorie.
A large portion of the rage against Calorie In Calorie Out is really about our ability to accurately measure calories in any fashion.
We make estimates about the caloric value of a food because the means by which we can measure it is destructive. And we assume that every calorie that enters our body stays there until used as energy. Which may not be true either.
And the WebMD article specifically mentions that the low carb group was essentially stressed the whole time. And it's a study of 21 young people who lost 10% to 15% of their body weight. That's 10 - 20 pounds of an average person.
This guy lost weight eating 1800 calories of twinkies a day. https://www.huffingtonpost.com/david-katz-md/chewing-on-the-...
I think this is a much more interesting experiment as twinkies are roughly uniform. There may be some caloric variation, but none so great as to be relevant. Plus, the overs and unders should average out.
So watching the caloric content of your food is always a good idea if you're looking solely to lose weight. But instead of trying to figure out how many twinkies you can eat in a day, we should be trying to find out which foods we can eat a lot of and still maintain a caloric deficit.
Assuming the study is taking adults on a 2500 calorie diet down to 1600, an extra 300 calories from metabolic effects is not insignificant but the majority of variance is explained from a simple model of calories where fat calories ~ carb calories ~ protein calories.
If you want to lose weight then simply counting calories and eating less is an effective strategy.
All true, except the last part. Sugars and starches do not have a higher energy density. Fats are approximately 9 calories per gram. Everything else (proteins, sugars, starches, and carbs in general) are around 4.
> I wish there were more low carb options when eating out
It's impossible. If I go out to eat, I accept that I will very likely not be eating a nourishing meal.
It's pretty possible -- most restaurants have steak, fish, chicken, or other meats. Bars/Grills will serve you a burger without the bun, as will fast food restaurants. Sashimi at a Sushi place, Korma with no rice/naan at an Indian place, Tom Yum Soup or other options at Thai... etc.
how does sugar contribute to heart disease?
It's a factor in inflammatory response, and heart disease is an inflammatory disease which creates conditions where cholesterols can then bind and cause plaques.
Here's one good talk by Dr. Robert Lustig. https://www.youtube.com/watch?v=dBnniua6-oM
Here's an overview in a pop-sci article: https://www.kqed.org/bayareabites/85169/sweet-revenge-dr-rob...
This video has a entertaining overview of the effects sugar has on your body: https://www.youtube.com/watch?v=f_4Q9Iv7_Ao
"...based on highly individualized carbohydrate restriction and nutritional ketosis"
That's really the key to what is fixing the diabetes. And it's just a brief mention in the article. Nothing else about the nutritional aspects. This was extremely light on actual, real information.
That being said, I'm also not sure why this stuff is still considered news. Many people, myself included, have been saying for some years now that low-carb is the way to go. I'm glad this stuff is getting press, but I'm just surprised that people seem to be acting like this hasn't already been known for quite a while.
The real problem is that people can easily fix this themselves, but they either 1) don't know this information or 2) don't have the willpower. It's more of #2 though, because people generally know when they are eating garbage. There might be some foods that surprise people as having extremely high glycemic responses, but most of the time they know what they should be avoiding. The problem, I think, is that they don't quite know exactly how horrible what they are consuming really is for their metabolic processes. The one that seems to surprise people is potatoes. They know french fries are bad, but think it's because they are deep fried. When I tell them that a regular baked potato or red potatoes have glycemic index values of around 85-89 and that potato chips are around 50-55 they are stunned. I don't know why, but they are. If you are consuming the same mass of food for comparative purposes, the potato chips are loaded with fats where the regular potatoes are not so that makes sense to me that it would be lower. This tells me there is a serious lack of education on this topic and it is quite literally costing people their lives.
Lack of information is certainly a problem but food insecurity and habits are also very important. A lot of people would have a really hard time, logistically, maintaining a ketogenic diet [0]
I'm also somewhat skeptical of the evidence that the ketogenic diet can cure diabetes (or cancer / autism etc). I haven't looked into it in depth, so may be wrong, but all I've seen in the way of evidence are 1) anecdotal cases 2) hypotheses about a supposed biological mechanism (haven't seen any good studies validating this mechanism) and 3) appeals to evolution, i.e. "People ate low carb for most of human history etc", again with no rigorous science (that I've seen) to support this, just logical sounding claims
You'd need large randomized controlled trials to really test 1) whether it works, 2) whether it's safe and 3) whether the benefit is attributable to a low carb diet or to people just being on a diet in general. Unfortunately those are expensive so will probably never be done because no one requires them (like FDA for drugs)
Proponents of keto diet also cite the entrenched corporate financial interests that led the low-fat wave based on shoddy science. The same dynamic is at play with low carb. I asked a very well funded company marketing keto diet products about their clinical research efforts, and they said they don't have a clinical research arm -- all the clinical studies fall under the marketing department
I'm not saying it's pseudoscience, but based on the limited data I've seen I don't think we can rule that out
[0] https://www.google.com/amp/s/www.citylab.com/amp/article/560...
There are a ton of peer reviewed papers on Keto diets available on PubMed. Here's a collection and summary as a spreadsheet: https://docs.google.com/spreadsheets/d/1Ucfpvs2CmKFnae9a8zTZ...
Thanks, that's helpful
Based on skimming that it looks like low carb diet can be as effective or more effective than low fat diet at reducing triglycerides, blood glucose and other metabolic markers, may not be as good at reducing LDL as low fat, and may pose additional safety risks compared to low fat. Some articles say no difference in blood glucose between low fat and high carb. Some say Mediterranean diet is better at glucose control than low carb diet.
Of the studies that show low carb has better a1c reduction than low fat, the reduction is ~0.5%. Clinically meaningful but certainly not a reversal of diabetes
So low carb may be better than low fat diet at reducing blood glucsoe. However that isn't conclusive. Also the Mediterranean diet may be better than both at improving glucose. And some evidence suggests low carb is worse than low fat for LDL levels and heart disease
However i didn't see any studies that showed reversal of diabetes, cancer or autism or any other disease. I don't doubt that a low carb diet can help people lose weight or better control their diabetes. I do doubt whether it can "reverse diabetes at scale", cure cancer etc. using preliminary findings that low carb is better than other diets at a1c reduction to claim this can "reverse diabetes at scale" seems not far from snake oil to me
I think you then have to ask the question of "Is LDL cholesterol level a good measure of risk?" -- it seems like it is not. That spreadsheet is pretty focused on diabetes and weight, searching pubmed for Ketosis, or Ketogenic will yield many papers about the benefits for neurodegenerative diseases, cancer, etc. There's still a ton of research to be done, but it looks promising.
Virta Health has been doing that controlled trial, although it's not randomized.
https://clinicaltrials.gov/ct2/show/NCT02519309?term=virta&r...
There are several issues with that study design that leave it open to experimental bias:
* not randomized, as you mention
* the control is not great: "treatment as usual" is not a very good control in general and is a particular issue in psychiatric and behavioral research. with this design you cannot attribute any improvement specifically to the diet. improvement could be driven by better coaching, more frequent contact with health professionals, being part of a group, a psychological / placebo benefit, etc. a better control would be an active control where subjects get the exact same thing as the Virta patients, but are on a low-fat diet, or all-plant diet, etc instead of a low carb diet
* different endpoints for active vs control arm: only the virta arm's primary outcomes are measured at 3 months, while the control and virta arms are measured at 12 and 24 months. there are differences for other endpoints as well. this is not necessarily that big of an issue, and they may just be wanting to measure exploratory endpoints and dont want to spend the extra money following control patients. however for a primary endpoint it seems odd. a cynic could say that virta could claim success on a primary endpoint if the virta arm improves at 3 months even if it does not differ from control at 12 and 24 months. this study is just done by virta prob for marketing and no one is really overseeing this so wouldnt really call them out on it
* different inclusion criteria for active arm: only the active arm can enroll pre-diabetic subjects. the control arm cannot. if they don't pool these pts with others when analyzing results, maybe this is less concerning, otherwise its a pretty big deal in my opinion
> When I tell them that a regular baked potato or red potatoes have glycemic index values of around 85-89 and that potato ships are around 50-55 they are stunned
I'm frankly SHOCKED by the amount of people I encounter on a daily basis -- even my own damn significant other -- who have no idea what a carbohydrate even is. I love my SO to death, but I was appalled he had no idea grains and potatoes were carbs, and he is very well educated and works in tech.
If someone like my SO can't understand what a carb is, how do you expect your average American to get it?
Nutrition education in this country is so disappointing.
> They know french fries are bad, but think it's because they are deep fried. When I tell them that a regular baked potato or red potatoes have glycemic index values of around 85-89 and that potato ships are around 50-55 they are stunned.
Having T1D and a CGM I can say the normal potatoes are much easier to control compared to the french fries. The fat is really a huge problem if you dose your own insulin. It is guaranteed if I eat french fries that I don't need that much insulin right now, but the fatty food will raise my glucose levels in the next five hours. If I eat the fries for dinner, I can guarantee to be in the upper high levels at night when I sleep.
This is of course fixed with a closed loop system, but that doesn't help the T2Ds out there that much.
Yes, fats slow the absorption rate of carbs so that makes sense that you will see a longer, protracted amount of time for the elevated blood sugar levels. You don't get the same spike and subsequent crash because it's more drawn out.
I also don't know if the fact that you are Type 1 instead of Type 2 affects anything I said. I don't know enough about Type 1 to comment. Anything I said is specific to Type 2.
That's why I'm trying to comment with care. Just the facts how I can see fatty food with a CGM and a closed loop:
60g of carbs from french fries will mean you take insulin for about 40g of carbs now, then for 60g of carbs starting in one hour and divided to the next 2-3 hours.
For normal potatoes, 60g of carbs, you'd take insulin for the 60g right now and that's it.
You see how a combination of fat and carbs is really tricky when you need to keep a good control of your glucose values. There is good help for us T1 diabetics, algorithms such as oref1 with super micro boluses help to control the delay and additional raise of glucose when eating fatty food.
Ketosis is also something I'd never recommend to a T1D. It can lead to very nasty symptoms; cramps and headache. Can't say anything about T2Ds, people reading these should always consult a doctor before making any decisions of their treatment.
I have a dumb question. Can diabetes actually be "fixed" with a keto diet? What if a T2 diabetic does carb restriction and keto for a year and "reverses" their diabetes. If they eat cakes and cookies for a week at Christmas, does the T2D come crashing back?
I'm a T2D that has successfully dropped my a1c from 8.9% to 5.5%. I've "reversed" my diabetes. I put "reversed" in quotes because the underlying problem is still there. If I drop my low carb, intermittent fasting routine, my blood sugars shoot right back up. I'm not fixed, I'm just not making myself any worse.
There is hope that my pancreas will recover somewhat, since there is a theory out there that fat stored in the pancreas is part of the problem with how well beta cells function and intermittent fasting and low carb has decreased the amount of fat stored in my liver so it's possible it will work on the pancreas over time as well. That would really be a reversal of T2D if it happens.
People are confusing "managing" with "fixing".
Does a "keto" diet regenerate beta cells? Can someone with "reversed" T2D eat an isolated high carb meal and experience a normal glucose response? afaik, no and no.
As someone who has come quite close to reversing their T2D, I will say that as I've lowered my a1c (the main measure of diabetes) and dropped from 3 drugs to 1, I've noticed two things from blood sugar monitoring: not only have overall sugars gone down drastically, but the time to recover from "cheating" has greatly decreased as well. When I was at my worst, I couldn't even eat a piece of fruit without a huge sugar spike. After 3 years on a lower carb, calorie constrained diet (~130g carb/day and ~1900 calories), combined with some exercise, I can now eat an occasional small piece of cake or the like without a huge concern. My sugar will spike for an hour or two, but then normalize. Before i might be high for almost a day before I'd drop back to my baseline.
So it does improve, but it's unlikely to completely go away. In my case it's likely from improved insulin resistance.
To answer your question, I wouldn't say it "crashes" back. It's still a concern, but if it's controlled, you can eat some cake and cookies and you'll stabilize in a few days. It's when it's a long term habit, that it's uncontrollable (at least on my case study of one).
It depends a lot of the person metabolism and health history.
With drugs you have very accurate protocol.
But when it's about changing your life style, you need to learn about what you atr doing, and regularly adapt. It's not a passive process and it's why few people do it : you basically take responsability for the ride.
Yes and no. I'd say there is a difference between managing and fixing. All the current treatments by doctors are surrounding management. I do fully believe that Type 2 can be fixed in almost everyone with enough time on the proper diet.
From what I have seen/read, it seems to me that Type 2 is caused by a recurring assault on your metabolic processes through significant carbohydrate over-consumption. That damage accrues over time which is why it usually takes decades to become a full-blown Type 2 diabetic. It would therefore take years to fully "fix" it in a person - and that is assuming the accumulated damage is actually reversible. I believe there are some people who have damaged their bodies too much for it to actually be fixed. And on the other hand I rarely ever hear about anyone actually being full keto for years on end, providing the requisite time for their bodies to adapt and heal. It's not a quick process. The less damage, the quicker the improvement and the shorter the total time to "fix".
As to your original, direct question - I doubt it would come crashing back after just one week of bad habits. But that also has to do with the glycemic storage in your body. You muscles hold (I think it was) around 100-200 grams of potential glucose and your liver can hold something like 400-500 grams. If someone is low-carb for even a short amount of time, these "storage tanks" (as I refer to them) in the body are basically empty or close to it. As you consume garbage the excess that is not needed is added to these tanks. Once the tanks are full, the overflow goes into your blood, raising your blood sugar above normal levels. So you would have to consume somewhere between 500-700 grams in excess carbohydrates before you even started overflowing into your blood stream to have elevated levels. That's pretty hard to do in a single week. And the metabolic damage doesn't magically come back overnight. It's kind of like if you had a really bad sunburn and let it heal. The next time you went out into the sun you skin doesn't turn red immediately - the damage has to actually incur/accrue.
Boiled potatoes are becoming more popular as fuel for competitive endurance athletes specifically because they have a high glycemic index.
Yes, but those people are taking it because they have a specific, immediate need to use the energy. Starches are quick energy, so it's fine for these people to use because it's being put to immediate use and will not end up sloshing around in their blood stream, raising their blood sugar. Also, because of the nature of what they do, these athletes almost certainty have a near-zero store of glucose in their bodies at any given time. The muscles and liver combined can store anywhere between 500 and 700 grams of glucose for immediate use in the average person. But these athletes are consistently using it up, thereby having the ability to consume these starches with no ill effects.
Personally, I've seen this in myself when doing strenuous physical labor on hot days - for example, doing yard work in 90 degree heat or moving lots of heavy boxes when helping someone move. On these days, I can consume quite literally anything I want and my blood sugar will not budge an inch (I regularly test myself even though I don't have diabetes). It's essentially impossible for me to crack 110 on those types of days even if I consume a gigantic soda, gatorade, etc, with a garbage meal. I've actually tested this theory several times on myself and it has consistently held true.
Based on the length of this article, I was hoping it would actually, you know, describe the method used to reverse T2D, but I didn't see any such description other than vague references to "nutrition." Frustrating.
Also, I'm skeptical of the claim that obesity does not cause T2D. Is this backed up by good studies?
"the nutritional approach is based on highly individualized carbohydrate restriction and nutritional ketosis (which I’ve written about extensively in the past and throughout this blog)."
I think there's at least a 75% chance that the whole cure is essentially contained in that sentence.
I've been keeping a bit of an eye on this area for a while, and watching the studies fling back and forth and such. My current pet theory that I think explains a lot of observations is "Carbohydrate-restriction diets (such as Atkins) work well on obesity caused by insulin resistance and metabolic syndrome, and may even be able to reverse the underlying causes, but may be ineffective for other causes." Basically, if you damaged your pancreas to some degree (or convinced them to stop working, or whatever; "damaged" them in terms of end result not necessarily "harm to the pancreas"), carb restriction may work well for you, but if that's not the core problem, it may not work for you at all. This may explain the variance in studies, if there is an unaccounted for variance in the populations being studied and how affected by metabolic syndrome they are, and why for some people low-carb diets work great and for others they fail completely.
I've also noticed as I've been getting into some intermittent fasting and such that when I'm doing it, I seem to be more able to consume a higher degree of ("good") carbs without it going straight to my waistline, as if I'm actually repairing or healing some things that I broke in my teens. (Where I considered a Coke and a king-sized package of Skittles a good after-school snack; it wasn't bad for you, there was no fat in it!)
(Perhaps slightly less controversially, what if the term "obesity" is actually like the term "schizophrenia"? We know the term "schizophrenia" is a catch-all term for what is almost certainly multiple distinct disorders that we currently lack the technology or know-how to distinguish. What if "obesity" is actually several distinct problems, with several distinct cures? In some sense, we already know this is true, because for instance thyroid malfunctions can cause issues with weight. But what if what's "left over" after those other cases is still three or four distinct things we're currently lumping together, and that we lack the tech or know-how to distinguish? It wouldn't really be that shocking.)
But note I label this "pet theory" for a reason. I'm not claiming to have Truth here, just a pet theory.
More of a description of a symptom rather than a cause?
Pretty sure that article was an ad.
I do know at least one person who has Type 2 Diabetes with a regular BMI, but even the article points out the average BMI was 40 - I really hope that's not the average population's BMI. I guess you could argue chicken & egg (diabetes causes obesity... maybe?), but in this case the egg is rather fat.
Here are some videos about how to treat it - https://www.youtube.com/playlist?list=PL5TLzNi5fYd--uc9TA8ER...
Look for neal barnards books, including a cook book.
Regarding point 1: From the site linked in the article, it appears to be basically classic keto + heavy supervision and dietary advice.
Roughly, the method used is the ketogenic diet. Very low carb, very high fat.
It might not necessarily be high in fat - it's probably the calorie restriction that works, as in this trial:
https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-ma...
I mean the method used by Virta in this particular link. I am not suggesting that there are not other methods that work.
Personally, and anecdotally, I have tried calorie restriction dozens of times since childhood and it has never brought down my A1C.
It must be high fat. From the linked essay [1], the diet is 30g daily carbohydrates, 1.5g/Kg(body mass) protein. For an 80Kg individual, that results in 150*4=600Kcal. That means almost 2000Kcal in fat to reach the daily caloric intake.
[1] https://asset.jmir.pub/assets/a2c0047f60bd77156d22029b8bdd5c...
Yep, and this is the method used by Virta Health. They are attempting to use this diet and telemedicine to reverse diabetes at scale. Their 2 year clinical data should be out soon.
Perhaps the author is suggesting that T2D and obesity are usually caused by the same poor dietary habits, at least in the US. The obesity just tends to happen earlier, so it's assumed to be the cause of the diabetes, which happens later. I think the bit about gastric bypass literature is referring to the finding that physical modifications like gastric bypass are not effective in reversing the metabolic damage that results in T2D.
I don't have any studies for you though.
As it is Peter Attia I’m assuming it was some form of intermittent fasting with some version of Keto. He doesn’t really like giving one size fits all solutions so that’s probably why it isn’t mentioned here. Source joe Rogan podcast interview.
correlation doesn't mean causation, although I myself think insulin resistance happens to obese people because they are obese and not some underlying mysterious reason, but insulin resistance is not typically the only source of T2D, if it was, thin people would never get T2D, so I guess we still have ways to go before we solve this one.
Thin people with T2D are probably “TOFI” — thin on the outside, fat on the inside. There is a concept of the “personal fat threshold” which is how much fat you can pack into your fat cells, and how many new ones you can grow. This concept explains why Asia and India have high rates of T2D at a much lower BMI.
An interesting way to show that this is likely the case is people with lipodystophy - they have no subcutaneous fat, and they are almost all diabetic.
I might just be matter of being "skinny fat" - someone is an average weight, but because they opt completely out of physical activity, they have basically no muscle mass, and the majority of their structure is composed of fat tissue.
That's sort of what TOFI is, its the term used in medical literature.
Does this read like an ad to anyone else?
I can't help but notice their average BMI was 40. That's in the "extremely obese" category - pretty sure we're out of the "massively muscled" category (exception - monsters like Ronnie Coleman, but let's be honest here, his blood serum reading come back "minotaur" and the muscle is probably doing damage). I'd always assumed that for the majority of the population going from an obese BMI to a normal/overweight one largely does the trick.
Reads like an ad to me. I was diagnosed with T2D last November (Tuesday before Thanksgiving...bummer). At the time of my diagnosis I was certainly not obese and have lost weight since as I have become aware of sugar/carb intake whereas before I didn't pay any notice. My situation is due to genetics which may be outside the scope of the article, but there is no mention of that fact.
I came in with high hopes reading this but lost interest at "To date, the only clinically proven way to reverse T2D has been bariatric surgery". Nope.
Yeah, that's the unfortunate bit if you're regular weight already, you make the usual lifestyle adjustments and hope for the best. It's much easier to solve the T2D problem when it's co-morbid with obesity than someone with bad luck.
Doesn't do a thing for me - I'm underweight as it is.
When were you diagnosed / have you adjusted your lifestyle since? I'm curious as to the circumstances and how your life has changed.
There are credible reports of reversal of type 2 diabetes using a whole food plant based diet - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677007/
Meaning the symptoms get better and in some cases diabetes disappears.
Remission is more accurate term.
Remission is the state of absence of disease activity in patients with a chronic illness, with the possibility of return of disease activity.
I'm relatively sure that if patients quit their new lifestyle, they get to back to diabetes symptoms faster than those who didn't develop diabetes. It's also possible that they just delay the progress and after 5-10 years changes of nutrition is not enough anymore. Even then the results would be huge improvement.
I dropped my a1c to non-diabetic levels using low carb and intermittent fasting. If I drop the diet and eat badly, I'm right back where I was with regards to blood sugar levels. Getting back on the diet drops me back quickly, though. So, yes, it's remission and not a reversal. I'm hoping that keeping my blood sugars low for long enough will help my pancreas heal so that this isn't so much the case. Time will tell, I guess.
The article is incredibly light on details except advertising the startup he's working for.
The only link with some facts was this paper: https://asset.jmir.pub/assets/a2c0047f60bd77156d22029b8bdd5c...
I don’t think Peter works for Virta.
Depends how you define "works for":
Disclosure: I am an advisor to Virta Health and I have invested in the company, because I believe their approach is the best one to solve this problem—not the other way around.
Don't trust this guy: https://www.wired.com/story/how-a-dollar40-million-nutrition...
> At the end of December, Attia quietly resigned from the organization. Sources close to him say he was unhappy being a full-time fund-raiser; he wanted to get back to research.
What exactly makes him untrustworthy?
This is just a native ad for Virta, a company operating in the diabetes technology space.
Someone writing about something they’re involved with or excited about on their personal blog is a “native ad” now? The article even contains a disclaimer.
I do get what you are saying. I was at a startup operating in this space, so I want to counter your defense of this particular post.
You can read Virta's press releases and find all of this information. You can read many of Virta's competitor's press releases and also find similar information.
There isn't much he is adding here except his personal perspective on already well-promoted information.
This comes across a bit as using your own employees for some light "influencer marketing."
I have no problem with the author, the article, the writing, anything, other than to put out that its inclusion here in Hacker News is a bit off, considering the points I made above.
Within the confines of his own blog, the author should have every right to make this kind of post. Promoting any company to your audience means putting your reputation on the line. Any recommendation you make yourself is within this social contract, which is why it’s non-controversial.
“Native Ads” OTOH present themselves as something they are not. They are controversial precisely because they break the contract the author or editor have with their audience.
As to the inclusion on HN I suppose it is a little weird, but I think it can be explained by name recognition, for example from a recent Joe Rogan’s podcast, which I think is quite popular here.
I suppose your point is that the article doesn’t quite deliver on the title. I would agree, but my contention is with the pejorative connotation of calling something a “native ad”, which I think is undeserved.
Dr. Eric Berg has a great Youtube channel where he explains his take on how a ketogenic diet and also intermittent fasting (and the two together) can help to reduce insulin resistance (and type 2 diabetes) and improve metabolism. I personally find his explanations very helpful:
His channel: https://www.youtube.com/channel/UC3w193M5tYPJqF0Hi-7U-2g
One video: "Can Diabetes be reversed?" https://www.youtube.com/watch?v=NdpnAkYlWwo
Gary Taubes and Peter Attia where championing Ketogenic diets at a time when people where violently opposed to it. In fact, they are a big reason why my doctor now tells everyone working with weight loss to start there. There have been reports for years on /r/keto and other places of people "accidentally" forcing diabetes into remission. So none of this is surprising. Yes, there is a lot of marketing here, but Taubes and Attia have earned the right to try and change people's minds about things.
As I understand it, the story here is DM2 has recently been shown to be "put in remission"[1] by lifestyle changes and Virta Health pairs type 2 diabetics with doctors and a system to help patients make those changes. Primarily that involves a low-carbohydrate diet from what I read about the startup online. In my opinion, Virta can help people who (1) can afford it, and (2) are motivated to implement the changes long-term. This system could scale, for sure-- there are enough people with DM2 and enough of them will be motivated and affluent. Reaching the non-affluent would be harder, but not impossible with say, charity care or medicaid reimbursement. In my mind, seeing all the sequelae of diabetes in my patients, even moving the needle a little bit can do a great good. [1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
This seems like an ad for "virta health." Which itself seems to be a pile of supplements, a scale, and a Keto Diet plan.
Keto Diets (and intermittent fasting) have been shown to help "reverse" type-2 diabetes, since it moves people out of the medical criteria for the disease. But if the original lifestyle returned that individual may become classified as a type-2 diabetic again.
The article-writer states he is an investor in Virta Health because he actually believes their approach will work to reduce T2D at scale.
He has to believe that because he is financially vested on the outcome.
On the other hand, why would he financially invest in something that he didn't think would work; why would he put his reputation as a researcher on the line to back it?
Depends what the rate of return is.
My friend is a doctor. He works with patients to reverse T2D every day of the week. He's amazed that there's any debate whatsoever.
So, pro-tip from me: find a doctor who answers "yes" to the question and work with them, if you have T2D and want to reverse it.
(ignoring the "at scale" part of the OP question... for various reasons)
I'm starting to believe that calorie restriction is the key, with carbohydrate restriction playing a role as well.
For context, I'm a T2 diabetic, whose diabetes has "progressed" to the point that I take insulin. I'd recently had to adjust my dose to 100U / day (I only use a once a day, long-acting insulin at the moment).
Then a buddy of mine mentioned a book on fasting[1] and said that some diabetics had had great results from fasting. I ordered the book, but haven't read it yet. But I did start a sort of psuedo-fasting routine of my own design. Basically, I allow myself a normal sized meal, and then for the next 48 hours I an aggregate total of maybe 1000 calories. A typical meal during that time is a thin soup made of chicken broth, jalapeno peppers, banana peppers, cherry peppers, cactus and onion, with some spices thrown in for flavor. Note that jalapeno peppers, banana peppers, and cherry peppers, and cactus share a common trait: extremely low calorie content, and low carbohydrate content.
Anyway, after doing this for about 2 weeks, I can already see a pronounced difference (for the better) in my blood sugar numbers. And that's even after lowering my insulin dose a bit.
I don't know that the protocol I'm using is anything close to what the experts recommend or not. But it definitely seems to be having a positive impact. I'm really looking forward to seeing how this works out long-term. Especially once I can start lifting weights again (I hurt my arm a few weeks ago doing some bench presses and haven't been able to lift for a while). Resistance training has been shown to help with insulin resistance, so I'm hoping the combination of regular lifting and this dietary approach will yield some good results.
[1]: https://www.amazon.com/Complete-Guide-Fasting-Intermittent-A...
this is a thinly disguised ad for virta health! why is it on HN first page?