Is Type 2 Diabetes Reversible at Scale? • Hacker News Board

Re: Is Type 2 Diabetes Reversible at Scale?

#71

Post by greggeter » Wed, Jul 25, 2018, 4:04 PM UTC

InTheArena wrote: post #59

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…

Absolutely. And others like Dr. Valter Longo. Some are in fact building companies around this because they believe it's important to create solutions for the masses. For the same reasons, dialysis clinics have built up over the years.

Hopefully the tide will shift. Look for resistance from the established clinics, though, as they've made HUGE investments in recent years.

Re: Is Type 2 Diabetes Reversible at Scale?

#72

Post by emcq » Wed, Jul 25, 2018, 4:15 PM UTC

turc1656 wrote: post #64

bena wrote: post #60

Earlier quoted context omitted.

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 p…

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. "

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.

Re: Is Type 2 Diabetes Reversible at Scale?

#73

Post by bena » Wed, Jul 25, 2018, 4:17 PM UTC

turc1656 wrote: post #64

bena wrote: post #60

Earlier quoted context omitted.

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 p…

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.

Re: Is Type 2 Diabetes Reversible at Scale?

#74

Post by devmunchies » Wed, Jul 25, 2018, 4:30 PM UTC

dhruvkar wrote: post #43

devmunchies wrote: post #30

Earlier quoted context omitted.

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/

Re: Is Type 2 Diabetes Reversible at Scale?

#75

Post by deno » Wed, Jul 25, 2018, 4:30 PM UTC

aaxe wrote: post #23

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?

Re: Is Type 2 Diabetes Reversible at Scale?

#76

Post by Someone1234 » Wed, Jul 25, 2018, 4:39 PM UTC

magic_beans wrote: post #50

Someone1234 wrote: post #9

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.

Re: Is Type 2 Diabetes Reversible at Scale?

#77

Post by nradov » Wed, Jul 25, 2018, 4:39 PM UTC

aaavl2821 wrote: post #68

turc1656 wrote: post #31

"...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…

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…

Virta Health has been doing that controlled trial, although it's not randomized.

https://clinicaltrials.gov/ct2/show/NCT02519309?term=virta&r...

Re: Is Type 2 Diabetes Reversible at Scale?

#78

Post by aaavl2821 » Wed, Jul 25, 2018, 5:36 PM UTC

nradov wrote: post #77

aaavl2821 wrote: post #68

Earlier quoted context omitted.

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…

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

Re: Is Type 2 Diabetes Reversible at Scale?

#79

Post by Floegipoky » Wed, Jul 25, 2018, 6:39 PM UTC

nemo1618 wrote: post #2

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?

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.

Re: Is Type 2 Diabetes Reversible at Scale?

#80

Post by virtuallynathan » Wed, Jul 25, 2018, 6:40 PM UTC

magic_beans wrote: post #45

djsumdog wrote: post #10

> 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 f…

> 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.