South Asian people undergo type 2 diabetes remission with low calorie diets

Many people experience that and scientists/doctors agree. In addition there is a risk of higher mortality.

https://journals.physiology.org/doi/full/10.1152/physiol.000...

"Many men and women in the United States diet to lose BW; however, most regain the weight they lost after the diet ends (73). Dr. Kelly D. Brownell coined the term “yo-yo dieting” to reflect BW fluctuations during repeated cycles of diet-induced weight loss and BW gain after the diet is terminated (74). Approximately 20–55% of women and 18–34% of men report weight cycling (75–77). What remains unclear is the impact of weight cycling on cardiovascular health.

Several large studies, including the Honolulu Heart Program (78), the Framingham Heart Study (79), and >9,500 participants in a Treating to New Targets trial (80), have shown a strong correlation between BW fluctuation and rate of cardiovascular events that are independent of traditional cardiovascular risk factors.

A recent meta-analysis of >440,000 participants from 23 studies showed that BW cycling was associated with a 1.4-fold higher relative risk of mortality due to all causes and to cardiovascular disease. The meta-analysis also revealed that BW cycling was associated with 1.4-fold and 1.5-fold higher relative risk of hypertension and CVD morbidity, respectively"

I have lost weight (from around 120 kg to around 76 kg) about 15 years ago.

Nevertheless, I believe that if care is taken so that the calorie-restricted diet still includes a normal amount of all nutrients except carbohydrates and non-essential fat, 4 kg per month, like I did, should not cause any health problems.

Unfortunately, I have seen too many suggestions about how to lose weight that do not pay enough attention to provide all nutrients. Such diets can be sustained for a few weeks, but not for longer durations, like a year or more, which are needed when the required weight loss is great.

My weight can vary from day to day exactly as much as yours, but nowadays it rarely does.

The main difference between how I eat now and how I was eating before losing weight is that previously I was eating until feeling sated, but now I always decide how much to eat before starting to eat, so for most days the energy intake is similar, so the weight oscillations are small. When I happen to eat a more copious meal, I compensate the next day, mainly by cutting the carbohydrates during that day.

To me, it seems obvious that sustaining a low calorie diet (LCD) long-term is basically impossible (from a maximal fat oxidation and, even a thermodynamics perspective). On the bio-mechanistic side, it's also important to note that hyperinsulemia inhibits lipolysis [2], which is one factor that is also usually not taken into consideration. Anyway, while a LCD may be effective for a while (maybe even years), it's probably quite miserable and almost by definition, can't be a sustainable lifestyle change. Even as a short term fix, it may not a very healthy and might be counter-productive long term... [3]

To me, the biggest problem is that T2D is in many (but, to be clear, not all) cases, the end stage of a metabolic patho-physiology that can be identified by other markers (as simple as WtHR, or cheap labs like fasting insulin, or NAFLD indices) that are cheap and easy to measure, but from my experience, most clinicians are completely unaware of this. Which is too bad, since the overwhelming majority of their patients in the US these days (over 80%) are suffering from metabolic diseases. [4]

Over the years (I moved a lot) I've had close to a dozen different primary care providers, and diligently did my annual health checks, all while slowly putting a couple pounds each year and none of them were able to give any useful treatment or even medical advice as my MetS markers crept up. I had to figure it out myself - in fact most gave bad advice and weren't even measuring or diagnosing the right markers. The real kicker to me is how cheap some of these tests are (fasting insulin is I'll also mention that both from the literature [5] and my personal experience [1], some of the worst damage can be reversed in a matter of weeks. I did labs right before I started my diet changes and 1-month in, and even in a single month my TGs and my liver numbers moved from unhealthy to healthy ranges.

As for sustainability, there are some lifestyle treatments like Virta's that have shown better than medication retention rates and efficacy, so it's possible to do... https://www.virtahealth.com/outcomes

How do they do it? A combination of responsive/actionable biomarker monitoring/feedback coupled long-term coaching and peer-support groups. Not impossible and way cheaper (and better quality of life!) than any pharmaceutical alternatives.

[1] https://randomfoo.net/2019/09/17/1-year-personal-health-inte...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753874/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/

[4] https://www.liebertpub.com/doi/10.1089/met.2018.0105

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813289/