Study: Type 2 diabetes can be cured through weight loss | Hacker News Reader

Study: Type 2 diabetes can be cured through weight loss

telegraph.co.uk

117 pointsValentineC169 comments

THANK YOU for putting "Type 2" in the title. Type 1 and Type 2 diabetes are unrelated diseases. They were given the same name because they have the same symptoms. It is critically important to specify which disease you are talking about in any situation, otherwise you might as well conflate cancer and tuberculosis.

I never thought about this, and google searches just confirmed, but a person can have type 1 and 2.

I wonder if the conclusions of the OP would still apply in such a person. Would losing weight cure their type II, but not their type I? Are their two forms of diabetes coupled and this would not make a difference?

Basically the difference is that Type I your body is no longer able to produce insulin. Type II means that your body is not using the insulin it produces properly, and eventually your body will not be able to produce enough insulin to keep your blood sugar at reasonable levels.

There is absolutely no coming back from Type I diabetes at the moment. But Type II should be reversible for anyone with both Type I & II.

Type I is (usually) an immune disorder where the immune system destroys the cells that normally produce insulin. I don't want to make an absolute statement about that not reversing, but it would be incredibly unusual.

(There are cases of Type I with no evidence of immune activity being the cause, but they are a minority)

But they are related somehow? Like Java and JavaScript?

I suspect you're joking, but I'll go ahead and answer here anyway, because I find it interesting and think others might as well.

The term "diabetes" refers specifically to the production of large amounts of urine. The diseases most people are familiar with are fully known as Diabetes Mellitus, type I and type II. The word "mellitus" is latin with roots in the word for honey and means sweet or sweetened with honey. So really both diseases are named for the fact that the produce the symptom of large amounts of sweet urine. Biologically this is because uncontrolled type I and type I sufferers have extraordinarily high blood sugars. Some of this excess glucose is excreted in the urine and osmotically pulls fluid along with it increasing the total urine volume.

It's worth noting that diabetes (the symptom) can have multiple other causes. Diabetes Insipidus is caused simply by the excess ingestion of fluids. (i.e. you urinate a lot when you drink too much water)

No, diabetes insipidus can be caused by hormonal problems, kidneys failing to respond to hormones, and pregnancy.

Fair enough, perhaps I should have said "can be caused by"

DI (technically Dipsogenic DI) can be caused by neurological dysfunction or psychiatric illness without any hormonal disregulation.

Sure. Type one means you don't make insulin, and in type two you're either not making enough (for one of a number of reasons) or —most commonly these days— you've been running on a 30-year sugar high and now your cells just ignore insulin at any level.

The article is talking about "re-sensitising" cells to insulin by starvation diet.

I was diagnosed with Type 2 diabetes this year (at 34). It was not a surprise really, I knew I was fat and too sedentary, but I didn't expect to get this sick so young.

It's weird, because I was so apathetic about being healthy and stuff, but the moment I got diagnosed something clicked inside my head and I thought "I don't want to die".

So I changed my habits drastically and started exercising and eating healthier. I've lost around 35 pounds and my glucose levels from 300+ to ~100. Most of the symptoms are gone and I feel great. I still take meds, but I'm confident that if I keep this pace of life it will be reverted or, at least, I'll got to live longer.

Congratulations, that trigger in your mind shows character. I suspect most people capitulate (obesity stats as a reference) and just take medicine. I have found that creating activity goals for myself such as races has been a real motivation to jump in a pool when it's a cold night so that when spring and summer comes I am ready.

Why does that trigger in his mind show character, and what does character mean in this context?

I'm asking seriously, not facetiously.

It means that his decision and commitment overcame the tendency to eat (I assume) excessively and unhealthily, which most people appear to be incapable of without extreme external intervention.

You said it better than I could:

Character : one of the attributes or features that make up and distinguish an individual.

And what you said makes our friend here an outlier compared to the norm since he took the effort to grab his disease by the neck, shake it around, and making it tell him whose his daddy is. ;-)

I just figured that's the way it has to go if you don't want to die. I'm surprised to see other people (like my father-in-law) that eat and drink like if they were not sick.

And I like food. A lot. I'm mexican and I can eat tortillas and candies all day long. Just last year, it was not rare for me to eat ~1/2kg of corn tortillas with every meal.

This. I ran my first 5k race last september and I plan to run a 10k early next year.

I love how the "advice" is to not drink, no soda/sweet drink, eat greens, whole-wheat and limit fatty red meat.

I do all of that.

I systematically consume more calories than I use and am on the path to becoming a type 2 diabetic (and recently started corrective changes).

#1 piece of advise should be to not run a systemic calorie excess.

It's a lot easier to consume excess calories through sodas, alcohol and junky food, and a lot worse for you.

A shocking number of people are quite ignorant about the nutrition of the food they consume.

That is one set of recommendations, but it's not necessarily the best. Under a ketogenic diet (high-fat, low-carbs), nearly all Carbs should be eliminated---including whole wheat, and fatty meats (red or not) should be consumed to satiety.

Such high-fat low-carbs diets have been shown to be particularly effective in insulin resistant individuals.

Actually, everything you wrote besides "eat greens" is outdated incorrect information according to current first class research.

Soda and sweet drinks?

Yeah, posted too quickly, that is of course known and proven. The bits that he got wrong were the avoid fatty red meat and eat whole wheat (full of antinutrients as are all seeds meant for birds and not mammals) and the old calorie hypothesis which has since been soundly disproven but is probably the most common fallacy out there today.

I wasn't aware caloric restriction was disproven. See, for example: http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor

What's the old calorie hypothesis?

Care to provide citations for the claims that fatty red meat is at all healthy (last I checked, saturated and trans fat cause cardiovascular disease, diabetes, obesity, atherosclerosis - just to name a few problems), or that whole wheats contain antinutrients, or are somehow unhealthy?

Again, your basic scientific knowledge is lacking. There is no meaningful transfat in red meat, fatty or otherwise.

> There are two broad types of trans fats found in foods: naturally-occurring and artificial trans fats. Naturally-occurring trans fats are produced in the gut of some animals and foods made from these animals (e.g., milk and meat products) may contain small quantities of these fats.

http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter...

> Because trans fats are unavoidable on ordinary, non-vegan diets, getting down to zero percent trans fats would require significant changes in patterns of dietary intake.

http://www.worldcat.org/title/dietary-reference-intakes-for-...

> Processed foods and oils provide approximately 80 percent of trans fats in the diet, compared to 20 percent that occur naturally in food from animal sources.

http://health.gov/dietaryguidelines/dga2005/document/html/ch...

20 percent is not meaningful? Next, are you going to try and convince me that trans fat is good for you?

I can't reply in-context to noondip's reply here yet, but note that he now says meat has "small amounts" of transfats where he previously wrote "laden with".

I haven't downvoted you, man (it isn't possible to downvote direct child comments, as far as I can tell). Why are you being so hostile? You're also quoting me out of context; I wrote, "laden with cholesterol, saturated and trans fats" which isn't an exaggeration.

By the way, you can reply directly by clicking on the timestamp (e.g. n minutes ago).

  which isn't an exaggeration

Suppose, then, that you quote for the class the specific average quantity of transfats in, say, a 6 ounce steak serving... and how that qualifies as "laden with".

Well, the only "safe" intake of trans fat is exactly zero, so again I assert what I've said wasn't exaggerated.

We all different which is why studies involve many people and statistics, control groups, etc. I'm glad you found something that's working for you, but it is faulty logic to generalize it to other people based on your personal experience.

https://en.wikipedia.org/wiki/Anecdotal_evidence

> #1 piece of advise should be to not run a systemic calorie excess.

Sure, but that specific advice you quibble over is just a suggestion on how to achieve that result. A quote in the article from one of the professors expressly says:

> So if you ask how much weight you need to lose to make your diabetes go away, the answer is one gram. But that gram needs to be fat from the pancreas. At present the only way we have to achieve this is by calorie restriction by any means, whether by diet or an operation.

It's worth emphasising the last bit: surgery is a much more effective way to restrict caloric intake than lifestyle changes alone. A very low percentage of people with obesity are able to lose weight and then maintain a healthy body composition without surgery, and the risks of gastric bypass seem completely justified in cases where it allows a patient to be "cured" of Type 2 Diabetes.

I don't count calories anymore. I feel it's a waste of time and frustrating at times.

Instead, I focus on nutritional quality including density and variety. I find it leads to better health at a lower calorie count. Yes, you have to adjust for your lifestyle like working out, etc. However, it's much easier to manage and squeeze in those indulgences.

"Scientists at Newcastle University have shown the disease is caused by fat accumulating in the pancreas and losing less than one gram from the organ can reverse the life-limiting illness and restore insulin production."

That vaguely implies to me they have proven that pancreatic beta-cell burnout is always caused by inter-organ fat, and that losing just 1g (9kcal) of said inter-organ fat will always result in complete regeneration of the pancreatic beta-cells in a short period of time.. happy to hear that for all T2D's if that were indeed the case, still I'm slightly doubtful.

Over the long run of course, barring other chronic conditions, hormonal mega-mess or organ malfunction, the pancreas should be able to regenerate just like the liver and other crucial organs, given nutrients time rest and absence of undue stressors. Well that's a long list of "if"s already. By the time a T2D is usually diagnosed, shockingly chronically elevated insulin has been doing quite a bit of damage on their bodies all while still performing the job of keeping blood sugars stable. By the time this is no longer possible and "high sugar" is finally diagnosed, a lot will be well out of whack and healthy regeneration will be a lengthy slow process.

OTOH, I'm not a medical professional.

People need to pay attention to the extremely narrow scope of the study - ALL subjects were gastric-band patients. Given the subsequent findings that stomach-reducing surgeries have significant favorable effects on hormonal balance unrelated to reduced food consumption, I don't see this generalizing well to other populations who lost similar amounts of weight via other means.

"2.2 stone" is 13.97 Kg. I really dislike how the UK uses half metric system and half imperial. Such a mess.

I wonder how much exercise which works on internal organs would help compared to drastic weight loss? For example, yoga. Of course weight loss has lots of other benefits, but I'd guess doing exercise which concentrates on internal organs might help sooner. This might help skinny-fat people too, who have internal fat but not that much weight.

i would guess not much. you don't get to pick where fat is burned. So, for example, doing lots of situps won't burn belly fat. Bodies will pick whichever fat cell is handy and consume that. some % will come from the belly of course, but it's more like a table of all fat cells in the body where you pick a random row.

it's kind of like electricity production. A power plant might be built right on top of one of the richest veins of coal in the world, but the power plant burns whatever it can get it's hands on, not necessarily what's closest.

If its any consolation we're slowly growing out of our mixed measures phase. Medical professionals all think and talk in kilos now, and people of my generation and younger trend towards doing so as well. I know that any time somebody starts talking stone to me I have to put some effort into translating it to more sensible measures.

A related gripe of mine is when precision magically appears when conversions occur. 2.2 stone is 14 Kg if you maintain the same precision.

I think in part that contributes to the metric system being perceived as complicated.

- "Keep heater 3 feet (0.91 meter) away from flammable items"

vs.

- "Keep heater 3 feet (1 meter) away from flammable items"

I didn't think there was really anyone who actually thinks that the metric system is more complicated than the imperial one.

Yes good point. Especially when the difference is not significant.

I wonder if this is what caused the error in the article?

Where they use 0.6 grams in one place, and 1 gram in another place. That's quite a difference.

> "2.2 stone" is 13.97 Kg. I really dislike how the UK uses half metric system and half imperial. Such a mess.

Do all stones in the UK weigh 6.35kg?

This is not new news, but people really don't want to hear that being fat is bad in the sense of greatly raising the risk of all common age-related disease and reducing life expectancy.

E.g. here is news from 2011, covering a demonstration of reversing type 2 diabetes via low calorie diets:

http://www.bbc.com/news/health-13887909

Note that the diabetes you create through your negligence is not the same as the diabetes you develop by being old and suffering an age-altered immune system:

http://www.salk.edu/news-release/blocking-immune-cell-treats...

They may also not want to hear they're fat in the first place.

#bigboned

This is fascinating. I can't believe I didn't hear about this in 2011. That second article is extremely well written, and I had no idea there was more than 2 types of diabetes either.

Edit: Really appreciate links to articles

"people really don't want to hear that being fat is bad in the sense of greatly raising the risk of all common age-related disease and reducing life expectancy."

Surely there are very few people denying these risks. Do you have evidence that this is a widespread trend, or have you just taken that viewpoint by choice?

Any attempt to deny fat risks could be construed as a misguided strategy by fat people to be treated with respect. If they explain away the health risks, then they're less open to shaming. Anyway, this is the empathetic viewpoint I choose to take on the issue, and I suspect it's better for everyone. https://www.washingtonpost.com/news/to-your-health/wp/2014/0...

Indeed. Not to politicize these findings, but the travesty of socialized healthcare is the moral hazard implicit in universally treating lifestyle diseases such as type II diabetes, (most) lung cancer, alcoholism, etc.

We're enabling destructive and expensive health pandemics to spare people their precious feelings.

> Not to politicize these findings, but the travesty of socialized healthcare is the moral hazard implicit in universally treating lifestyle diseases such as type II diabetes

In socialized medicine, its more likely that the treatment for those will be early and effective behavior interventions treating the lifestyle problem.

> We're enabling destructive and expensive health pandemics to spare people their precious feelings.

That would be more credible of an argument if the places with socialized medicine and universal treatment had more of these problems than the place in the OECD with the least degree of socialized medicine and universal access to healthcare.

The problem isn't so much that you've politicized the findings as that in your drive to do so, you've completely ignored the facts on the ground.

This is a fair rebuttal, but pointing out US vs EU/Japan obesity does not in any way establish causality. We're both merely arguing correlation:

Me: Healthcare access is positively correlated across time with lifestyle disease.

You: Healthcare access is negatively correlated across space with lifestyle disease.

I wonder if it is just a given or obvious, but it is rarely mentioned that glucose is stored in the liver and muscles as glycogen.

Insulin signals for uptake of glucose by the muscles and liver. It appears obvious that glucose absorption/insulin sensitivity would be directly affected by the glycogen storage capacity of the muscles. So it makes sense that increasing muscle mass, increasing energy use (physical activity/muscle recovery), or decreasing glucose intake (caloric deficit/ketogenic diet) would have dramatic effects on the symptoms of diabetes.

Ultimately, addressing diabetes is an issue of handling glucose storage through increasing capacity, increasing energy and/or reducing high-glycemic intake of glucose.

> Ultimately, addressing diabetes is an issue of handling glucose storage through increasing capacity, increasing energy and/or reducing high-glycemic intake of glucose.

Am I going crazy or did you just outline the standard clinical type-2 diabetes treatment?

IANAD - I am not a doctor.

I was told I was type 2 about 2 years ago. I was 36 and weighed about 240 pounds the heaviest I had every been. My daily fasting number was 188-200

Now, I am 195 pounds and my daily fasting number is 116-120. I did through diet and exercise. I stopped bread, soda, bought low sugar soy milk, major meal changes. I also started to exercise by buying a home gym.

This has also helped my wife. We now work out together.

At 195 pounds my dr still says I am overweight (although I don't look it) and next wants me under 180.

If anyone wants advice on how I adjusted my meals, ask. I am not perfect, but I have experience.

Chuckles. I am 165 with 15% body fat at 5'6" which puts me at overweight based on BMI.

You can be "heavier" as long as the weight is in muscle rather than lipids (fat).

Yep, BMI is pretty much useless. Body fat percentage FTW.

BMI is far from useless. Unless you're sporting a six-pack, over 6'4 or under 5'1; BMI will fairly accurately gauge your overall fitness level. The range for a normal adult is absolutely huge. Small-fat and body-builders are the only people who have any reason to be skeptical of their own BMI.

I'm always curious to see the plans people followed, if you wouldn't mind sharing.

Link to the study http://care.diabetesjournals.org/content/early/2015/11/29/dc...

Well, not really surprising (though the part about fat in the organ is surprising)

But people will keep demanding a pill to solve their problems and not move their fat bottoms and continue to splurge so

That sounds harsh, I bet numerous freshly diagnosed and devastated T2D sufferers told by doctors "incurable, a progressive disease" would be thrilled at this very glimmer of hope that just showed up.

True but the association of T2D and Obesity is not new

Exactly. It's been common practice for a while to recommend T2Ds lose weight to help control their disease. In fact, if you're just starting to show signs of insulin resistance, pretty much every doctor will tell you to lose weight. It's quite reversible at that stage.

It sounds a bit harsh, but the fact that this treatment hasn't been obvious and recognized for some time is an indicator of how unlikely it is for people suffering from T2D to lose weight.

Someone in my family was recently diagnosed as pre-diabetic, but ate just as lavishly at Thanksgiving. I don't actually blame him, but I blame his doctor. It's obvious from discussions with him that he doesn't understand how important it is to take pre-diabetes seriously. Of course, it's also very difficult to grapple with making those serious changes after 50 years of not worrying about it.

I occasionally wonder if people that say that the doctor said it was their metabolism are poorly characterizing a diagnosis of metabolic syndrome (which is at least somewhat related to pre diabetes).

I guess more severe language might help, but it also seems like prediabetes should set off alarms. Maybe something like 'weight related health crisis' would work better.

I've put on too much weight in the last two years - having our first child and expecting our 2nd has an adverse effect on my waistline.

Recently I tested borderline for pre-diabetes: 6.1 on a test where 6.0 is under diabetes and >6.9 is diabetes.

I don't want a pill for diabetes. An appetite suppresser for the first months of having the baby would be nice. It's damage limitation.

The cure, however, is to get back to doing weights at the gym. That more effective than drugs at cutting snacking, plus I'm have systemic cardio (45mins cycling at a good speed every day).

Well, breast-feeding is natures perfect post-childbirth weight loss tool...

Sadly it doesn't work for me :) It's quite common for men to put on weight when their wife is pregnant (mine constantly snacking, sending me out to buy maltesers, ben and jerrys etc..).

If it's during pregnancy, isn't it gestational diabetes, which apparently is not quite type 2 diabetis? (I just recently learned this is a thing, which is scary.)

EDIT: Oh, wait, you're not the pregnant one. Then I'm wrong, sorry.

Yes you are right, gestational diabetes is 'something else'

> having our first child and expecting our 2nd

Just to be clear: my wife was doing the hard work :)

How about a pill that makes them want to move their fat bottoms?

Caffeine and/or energy drinks will help, but the motivation bit is tricky

Motivation isn't a solution, it comes and goes and one has little to no control over it.

Discipline is where it's at. Holy crap is it hard though. Mainly because it takes constant lifelong vigilance.

I get my motivation through discipline.

Some days, I really don't feel like going to the gym. I go with the idea of taking it easy but once I get started, I give it my all.

I wonder if there's study data available on the prevalence of Type 2 diabetes among methamphetamine users.

Its hard to outrun a bad diet...

> move their fat bottoms

I wish people would stop repeating this myth.

You cannot outrun the fork.

Being overweight is primarily an eating issue, not an exercise issue. The calories burned while exercising are minuscule compared to food intake.

Daily recommended calorie intake averages ~2000 calories. I was going over that by ~1000 per day before adjusting my habits, and I don't think I was unusual.

A marathon is estimated to burn 2600 calories. The hardest 30-minute CrossFit workouts burn ~300 calories. So every day I should have run 1/3 of a marathon, or completed 3.3 max-effort CrossFit workouts.

You cannot outrun the fork. I've lost over 60 pounds in the last year by changing my eating habits. I started doing regular Freeletics (like CrossFit) 8 weeks ago, and actually stopped losing weight.

Move their fat bottoms away from the table when they’re done eating.

On a more serious note, you are of course correct, though I can imagine that having a link between somewhat-abstract calories and a timespan that you know you need to work out to get rid off these calories might help to restrict yourself? As in, “This cake has 600 calories” doesn’t sound like a lot, “I have to work out for an hour on a level that will leave me entirely crushed if I eat this cake” may be more relatable?

You cannot outrun the fork

I've never heard it said this way. I learned this lesson the hard way.

I struggled with weight for a few years after highschool. No matter how much more activity I added, I couldn't lose the fat.

Then about 6 years ago I drastically changed my diet for just 4 months (paleo) and dropped from 240lbs to 185lbs. At that point, I was almost sedentary but still eating at least 1-2 very large meals a day, every day. Even though I've recently been less disciplined about my diet and exercise I've still kept most of that weight off.

I mean it in a generic sense of 'doing something' (like having a better diet)

And high-performance athletes (like Michael Phelps or The Rock) eat around 5k calories per day

Adding muscle mass decreases insulin resistance. You can still have an unhealthy bodyfat percentage at a "healthy" BMI level.

That is because you are gaining muscle mass. Which is not bad at all.

I think BMI should be correlated with the the body fat percentage in order to estimate how many calories one should eat daily (because you are right, you cannot outrun the fork, but you can adjust a bit how many calories you can eat based on how many you burn). And, by extension, have a good indicator of a healthy energy balance.

> The calories burned while exercising are minuscule compared to food intake.

Not at all true; since I've started tracking my burn rate, my high-exercise days are about 50% higher than my low-exercise days (at not even at the extreme ends of either; high extreme is about 100% higher than the low extreme.)

> Being overweight is primarily an eating issue, not an exercise issue.

Being overweight (at least, insofar as its a particular health concern, which is mostly about body fat rather than weight) is a complicated issue that varies between individuals and can involve lifestyle -- particularly both eating and exercise -- and other health conditions. The most valuable intervention -- whether its dietary changes, exercise changes, medication, surgical intervention, or otherwise -- may be different for different people.

> Daily recommended calorie intake averages ~2000 calories.

That's the standard used for the bases for percentages of daily recommended intake of various nutrients in FDA-mandated labels, for a variety of reasons [0], but its not actually the average recommendation for maintenance intake. [1]

> I was going over that by ~1000 per day before adjusting my habits, and I don't think I was unusual.

So, you were eating about maintenance level for a young adult male, but probably living a sedentary lifestyle. Either increasing activity to an active lifestyle or reducing eating could correct that.

> You cannot outrun the fork.

Repeating that multiple times doesn't make it true.

> I've lost over 60 pounds in the last year by changing my eating habits.

And after stabilizing my weight by altering my eating habits, I lost over 60 pounds in a year by altering my exercise habits (a combination of twice-weekly 1-hour gym workouts and something like 15 hours a week of dance class/parties/practice.)

> I started doing regular Freeletics (like CrossFit) 8 weeks ago, and actually stopped losing weight.

If you didn't ramp up your eating, the most likely reason is because you've been gaining lean body mass at the expense of body fat. That's at least as good as just losing body fat (and better than losing weight if it isn't body fat that is being lost.)

[0] http://www.theatlantic.com/health/archive/2011/08/why-does-t...

[1] http://www.webmd.com/diet/estimated-calorie-requirement

I agree with your post, so thank you for your reply (and congratulations on your habit changes!).

I admit my comment was over-stated; intentionally so to combat the popular notion that fat people just need to go to the gym more.

It's interesting that the article says "18 people" were cured. Was that a 100% yield? Or was it from a larger group? Overall, not a wonderfully written article, and I didn't see a link to the original study text :-/

I was shocked, shocked, to hear that 18 people with gastric band surgery lost weight and improved their blood sugar control. Again, how well that generalizes to the general no-surgery public is the question.

Dr Mark Hyman explained in this video from 2011 https://www.youtube.com/watch?v=abGeRIEyEoE how to cure diabetes. He also explained that you do not have to be large to be "fat" since thin people with diabetes have fat around the organs which has the same effect as the belly fat. A very interesting video where Mark Hyman also explains how functional medicin works and what diet is best.

Went to functional medicine website. Says it integrates traditional medicine plus things like [mind body spirit etc, supplements, detoxification, holism]. Sounds like a few mds wanted to start a brand and get on the supplement train. Choo choo!

From WebMD: "Holistic medicine is a form of healing that considers the whole person -- body, mind, spirit, and emotions -- in the quest for optimal health and wellness."

There are doctors aboard the woo-woo tinfoil hat train, for sure, but from what I've experienced it's more of a trend towards going "Huh, so you're not sleeping well, let's see if that might be caused by stress in your life or lots of coffee in your diet" instead of going "Can't sleep eh? Here have these drugs!"

I agree with your trend and think it's a good one.The first consideration on the medical differential for sleep anormalities is poor sleep hygiene, as in caffeine in evening, poor environment for sleep, change in daily schedule, acute stress, etc.

Doctors who jump to pushing pills first do not do so because they are doctors, but because they are bad/lazy doctors. The non-medical holistic supplement camp has created a false dichotomy in care considerations to win market share. Functional medicine appears to be a means of reversing that trend, but with its branding and endorsement of things like detoxifixation I start to worry.

Unfortunately, as you mentioned, there do appear to be too many docs pushing pills to get people in and out quickly, and for those shitty docs the dichotomy is not very false.

MD Anderson in Houston, Texas, the number one cancer treatment center in the world (gets the hardest cases with the best outcomes), does holistic treatment in addition to clinical treatment.

What's the diet he advocates?

Wait... I thought type 2 diabetes was caused by too much insulin in the blood leading to insulin resistance in the rest of the body, weight gain, metabolic syndrome, etc. Am I confused?

As I understand it's the other way round. Your body's cells become resistant the the presence of insulin which encourages the pancreas to create more insulin in order to process sugar in the blood. Eventually resistance is great enough that blood sugar levels become high enough to cause damage.

- While the study is interesting, it was conducted on only 18 people. It will be more interesting to see the result of their 200-person study in a few years.

- "Just" losing weight appears misleading since we're talking about pancreatic fats, which may be present in non-obese people.

I am 142 lbs now. Not much weight, and eat very less fat, mostly from olive oil, which helps regulate my sugar levels well than other veg oil or corn oil. I measure a lot my levels. But still I am type 2 diabetic and I believe it will stay with me forever. Wonder what exercise I need to do to get the pancreatic fats out. Update: Loosing about 13% of the body weight helps loose 0.6 grams of pancreatic fat. Maybe that should be my goal to become Type 2 free.

>Wonder what exercise I need to do to get the pancreatic fats out.

The only thing that makes it happen is a calorie deficit. It is easier to avoid eating them than training them away afterwards.

This appears to be the paper: http://care.diabetesjournals.org/content/early/2015/11/29/dc...

I tried reading it but couldn't figure out which panel corresponded to what group in figure 2B/C so I stopped.

Here's a very interesting paper from a year ago that popped up elsewhere today. Note the effect of TRF even when calories and macronutrients are kept constant:

http://www.pnas.org/lens/pnas/111/47/16647

I'm not sure why this is news? Every endodrinologist has been saying this forever (my wife is one) and she said that this article has needlesly spread. It's like saying: Study finds eating less causes weight loss! It's also why doctors sometimes recommend weight loss surgery.

Speaking out of absolutely zero personal experience with diabetes, I have always been under the impression that Type 2 was basically solvable through weight loss and changes in diet. Is this study telling us anything new?

It is frequently believed to be preventable by those things. Systematic study is uncommon, I believe.

Of course, this is at least a terrible summary article, not clear if it's a good study.

I doubt weight loss will fix https://en.m.wikipedia.org/wiki/Insulin_resistance

Can someone recommend an exercise app?

I need something simple that will tell suggest random exercises and serve as a timer, e.g. `say "do 20 push ups"; say "now do 30 sit-ups";` etc.

Hoora ... uh, I'm 6'5 and weigh 185. Houston, we have a small problem here.

See the comment from mhkool above. (specifically the part about fat in the organs themselves, not the "functional medicine" part)

I think the Rockets could use you about now.

Losing 100 pounds and a ketogenic diet basically cured me. The main thing was cutting out all refined carbohydrates from my diet, but I just feel better when I replace nearly all carbs with fats. Putting on some muscle in the weightroom also made me substantially more insulin sensitive. My bloodwork has never been better, and I'm off my bipolar medication. From what I've read, it's most likely because of the slightly nootropic effect that ketones have on the brain.

I'm not diabetic, but I completely agree with the subjective improvement that comes with a low-carb diet. Even a light-ish carby meal -- say, penne with pesto -- makes me feel substantially heavier and more bloated than eating a steak slathered with butter.

Another vote of confidence here. Keto makes a huge difference.

What signs made you know it was safe to go off your bipolar meds?

I don't think this is standard-of-care yet, though some docs I know will go this route. There is a good amount of emerging research of the positive effects of the keto diet on brain health, including bipolar disorder:

https://scholar.google.com/scholar?hl=en&q=ketogenic+diet+bi...

https://scholar.google.com/scholar?q=ketogenic+diet+neuropro...

My psychologist decided they weren't needed any more.

I'm curious how your psychologist came to that conclusion. Was it your suggestion to come off the meds and they agreed?

For anyone reading: Please consult your doctor before altering your dosage of mind-altering medications. Some of them, for example, have to be stepped down in dosage gradually, lest bad side effects happen.

Paleo here. Can confirm it's been great for me as well. And I just wrapped up a month with no sugar (drinks, candy, added sugar, etc).

Diabetes isn't about sugar specifically, it's about carbohydrates. I'm sure you didn't have a "no carb" month -- which means your point is kinda meaningless. You may have avoided the 38 grams of sugar in that can of coke, but did you compensate by eating 4 handfuls of grapes?

To a diabetic, all carbs are bad, not just the ones that rot your teeth.

I believe you're meaning to allude to refined carbohydrates, like the ones found in soda drinks. "No carbs" would mean consuming no fruit or vegetables, at all - not exactly a practical strategy for healthful eating. (Note: grapes are especially high on the glycemic index and not an ideal representation of healthy carbohydrate, so your likening them to a can of soda isn't entirely inaccurate)

> The vegetarian diet (~60% of energy from carbohydrates,15% protein and 25% fat) consisted of vegetables, grains,legumes, fruits and nuts. Animal products were limited to amaximum of one portion of low-fat yogurt a day.

> In conclusion, a vegetarian diet led to a greater improve-ment in quality of life and mood. Patients consuming a vegetarian diet felt less constrained than those consuming the conventional diet. Disinhibition decreased with a vegetarian diet. The decrease in feelings of hunger tended to be greater in the vegetarian group. All these results suggest that a vegetarian diet is sustainable in the long term and may exhibit desired improvements not only in physical, but also in mental health of patients with Type 2 diabetes.

https://www.ncbi.nlm.nih.gov/pubmed/23050853

Never said it was. The topic just made me think of it is all. And I didn't substitute with a ton of fruits. I barely ate any. I also eat very little carbs.

Anecdotally, my father didn't develop the disease until after he went on a ketogenic diet, but the doctors believe chronic lack of sleep caused his diabetes so diet probably was not a factor either way.

That's unfortunate. Type 1 or 2 diabetes? My mother is T1 and she cannot do a low-carb diet because of the possibility of ketoacidosis, which she's already been hospitalized once for.

I would suggest she tries the program created by Dr. Neil Barnard in this case as he actually uses a low fat high carb diet in order to reverse diabetes. Both my father and father-in-law got rid of the medications (my inlaw even had to take insulin before the program) and have overall improved their health, lost weight and are feeling much more energetic. My father was able to be out of his medications after two months and my father-in-law in 4 months.

Here's the Amazon link for book about the program and you can also read the reviews of many people who have successfully changed their for the better as well: http://www.amazon.com/Neal-Barnards-Program-Reversing-Diabet...

+1 more anecdote, I was never diabetic, but doing keto for a year helped me lose 60 lbs and regain my insulin sensitivity.

Even now if I eat keto for breakfast and lunch and moderate carb for supper. Even when I have the occasional high-carb meal, I feel dramatically different than I did before keto/weight loss.

I don't know about the pancreas, but both abstaining form alcohol and keto are shown to dramatically reduce the amount of fat stored in the liver.

Is there any way to quickly induce ketosis?

Stop eating.

No, this just puts your body into starvation mode.

You should eat proteins, vegetables (especially leafy green ones) and a moderate amount of fruit. Natural fats like animal fats are ok too, depending on other health factors.

I am not a doctor but a ketogenic diet helped me lose weight and feel great. 230lb back down to 165lbs, but I am healthiest it seems around 183lbs.

Semi-strenuous exercise to deplete available glucose, immediately followed by fasting.

Cardio works well for this. Options aren't limited to running. Speed walking or slow walking at a 5-15% incline on a treadmill for some amount of time can achieve the necessary glycogen depletion.

Consuming coconut milk as a fat source with its high level of medium chain triglycerides also generates more ketones per fat ingested then other fat sources

Since glycogen storage requires lots of water, losing 1-5lbs in water weight after exercising is a good sign that the glycogen stores have been depleted enough for the body to start looking for other sources of energy. One should be able to hit the scale, go exercise and sweat a ton, then go back to the scale 30mins to an hour later and see the water depletion. For myself I will hit the treadmill walking at 15% incline @ 2-4mph for 45mins to an hour while profusely sweating from the 3min mark till I stop.

Low-intensity exercise uses free fatty acids, not glucose/glycogen, as its primary fuel.

This is not a binary thing, as intensity increases the substrate gradually shifts from FFAs to glucose. If one has been starving, fasting or eating very low carb for a while, the muscles will also use ketone bodies in place of glucose.

Eat less than 25g of carbohydrates per day, you will be in ketosis in about 24 hours when your liver glycogen is depleted. Drink lots of water, and suppliment electrolytes (sodium, magnesium, potasium -- drinking a cup of beef broth every day and using a "No-Salt" substitute on nearly all my food is what I do) to avoid the dreaded "keto flu".

Not really, ketosis starts when the liver is depleted of glycogen. While you can try to use vigorous exercise to speed this along, vigorous exercise will primarily target the glycogen stored in your muscle which does not effect ketosis. If you simply start eating < 25g of net carbs you will be in ketosis in 18-36 hours, no magic or pain needed. Do keep in mind that insulin (which you will not be producing much of) also controls electrolyte retention so you may need to increase your intake or supplement (see r/keto for details and advice) .

i'm a keto True Believer[tm] but removing carbs also just immediately removes a ton of calories which directly contributes to weight loss. you can eat a surprising amount of protein and fat and veg and won't replace the calories lost.

a hamburger bun, and a plate of french fries is honestly like a thousand calories. one thousand! that's like a huge ribeye steak.

you don't even want to know how many calories are in a mission-style burrito tortilla. it's completely out of control. that kind of food is meant for hard labor, not internet finger tapping.

Removing fat and alcohol would do you much more good, if calories are your primary concern -

    Fat: 1 gram = 9 calories 
    Alcohol: 1 gram = 7 calories 
    Carbohydrates: 1 gram = 4 calories
    Protein: 1 gram = 4 calories

these discussions always devolve into a bunch of numbers by diet pedants who seemingly have no passion for cuisine.

i'm sorry but all the numbers in the world will not make me give up a nice fatty spiced chicken shawarma, or a juicy sausage and kraut, or a nice ribeye steak with a glass of pinot noir. i'd rather be dead and in the ground.

on the other hand, i'm fine skipping the bread and eating just a couple of fries.

The incredible thing is, our tastes physically change in just a matter of several weeks. You're encouraged to try healthy eating as an experiment for just three weeks - I think you may change your mind on consuming unhealthy foods.

> An inability to perceive low concentrations of fatty acids in foods was associated with greater consumption of fatty foods, specifically butter, meat, dairy, and increasing BMI.

https://www.ncbi.nlm.nih.gov/pubmed/21757270

> Within a behavioral economic perspective, the reinforcement value of low-fat foods may increase following a low-fat dietary intervention, whereas the reinforcing properties of high-fat foods may decline. This is desirable as low-fat foods hold many advantages over high-fat foods in terms of weight maintenance.

https://www.ncbi.nlm.nih.gov/pubmed/12725716

> The preference results of this study demonstrate a steady, progressive decline in liking for salt in soup following dietary intervention and monitoring activities aimed at reducing sodium intake. Approximately 3 mo were required for preferences to stabilize at a significantly lower salt level, which was maintained at 1 yr. This may be of relevance in clinical settings where low-sodium diets are used for treatment or prevention of hypertension.

https://www.ncbi.nlm.nih.gov/pubmed/3728360

> Alterations in the fat content of the diet modulated taste sensitivity to C18:1 among lean subjects, which was increased following a 4-week period of fat restriction and attenuated following the high-fat diet. The failure of the high-fat diet to alter fatty acid taste thresholds among OW/OB subjects suggests that these individuals were 'adapted' to high-fat exposure, perhaps because of differences in habitual fat consumption. Taken together, these data suggest that excessive dietary fat attenuates nutrient sensing epithelia response in the oral cavity, which could be associated with changes in diet and weight status.

https://www.ncbi.nlm.nih.gov/pubmed/21829156

> This same condition, ketosis, occurs naturally when people are literally starving to death or seriously ill. During starvation this metabolic state is a kindness of nature allowing the victim to suffer much reduced pains of hunger while dying. During illness the suppression of the appetite frees the person to rest and recuperate, rather then be forced by hunger to gather and prepare food. Because ketogenic diets simulate this metabolic state seen with serious illness, I refer to them as “the make yourself sick diets.” As we will see below, another reason low-carbohydrate, high-protein diets deserve this title is they contain significant amounts of the very foods — the meats — that the American Cancer Society and the Heart Association tell us contribute to our most common causes of death and disability.

https://www.drmcdougall.com/health/education/health-science/...

> A plant-based diet beat out the conventional American Diabetes Association diet in a head-to-head randomized controlled clinical trial, without restricting portions, no calorie or carb counting. A review of all such studies found that individuals following plant-based diets experience improved reductions in blood sugars, body weight, and cardiovascular risk, compared with those following diets that included animal products.

http://nutritionfacts.org/video/plant-based-diets-for-diabet...

What appears to work best on the scale of a clinical study may not work so well for some subsets of the population. I've yet to find any sort of plant-based meal that makes me nearly as energetic and satisfied as one that includes animal protein of some kind.

Please check my related comment below about adjusting taste preferences. While it's true a greater amount of non-animal foods are necessary on account of them being generally less calorically dense (while at the same time being more nutrient dense), you can certainly find meals to satisfy your desires with patience and resolve. Start small - replace the beef patty with a black bean patty, for instance.

Do you realize that most people that "do keto" end up eating more veggies that they did before? There are tons of keto friendly veggies.

You can eat a ketogenic diet and eat nearly unrestricted amounts (except by satiety) amounts of things like cabbage, cauliflower, radishes (great cooked btw), brussel sprouts, spinach, green onions, broccoli, kohlrabi, lettuce, avocado, sprouts, green beans, rutabaga, leeks, yellow squash, zucchini, mushrooms, herbs.

Add that with some fish, meat, nuts and/or cheese and you have a very healthy diet.

Between the satiety of fat/protein and high-fiber foods above, its very easy to hit one's caloric goals and have a minimal blood glucose level.

Thanks - I wasn't aware of such diets, and I'm glad to hear people are eating their greens regardless of which diet they follow.

However, you're incorrect to assume adding meats and dairy products - even so-called "lean" ones - which are laden with cholesterol, saturated and trans fats - is at all healthy. All credible evidence suggests quite the opposite. If you have any studies which contradict my assertion, I would love for us to examine them together.

I mean you no offense, but to me it sounds like your understanding of nutrition science is 10 years in the past.

I do want to point out naturally occurring transfat has very different properties than the artificial common forms. I have never seen a well designed study show a low-fat diet to be superior to a high-fat-moderate-protien-very-low-carb one (usually referred to as VHFLC). I'd be interested if you know of any.

It is no longer generally accepted that dietary cholesterol is dominate factor unless you have mutation such as some of the PCSK9 mutations. Your body syntheses much more cholesterol everyday than you actually eat. The latest US government dietary guidelines has drastically shifted its position on cholesterol, write-up: https://www.washingtonpost.com/news/wonk/wp/2015/02/10/feds-...

We have since learned many things such as the importance of HDL/LDL ratio as being predictive over just LDL for example.

This is a very complex topic and I would recommend this series written by a MD: http://eatingacademy.com/nutrition/the-straight-dope-on-chol...

This is a 5 part series befitting the complexity of the issue at hand.

No offense taken, I hear what you're saying quite frequently.

Regarding the 2015 DGAC - the report did no original research to exonerate cholesterol, but rather deferred to a 2014 report by the American Heart Association, which has a financial incentive to label cholesterol-laden foods as, "heart healthy". Of course the media has chosen to play them up to stir up controversy and give the illusion there is vast disagreement in nutrition science, but that's simply not the case.

What has happened "in the last 10 years" is intense pressure from food industry lobbying to dilute research, confuse the public and distract from messages warning of saturated fat and cholesterol. Please, check out these short videos to see what exactly I'm talking about:

http://nutritionfacts.org/video/bold-indeed-beef-lowers-chol...

http://nutritionfacts.org/video/how-the-egg-board-designs-mi...

http://nutritionfacts.org/video/eggs-and-cholesterol-patentl...

http://nutritionfacts.org/video/debunking-egg-industry-myths...

http://nutritionfacts.org/video/who-says-eggs-arent-healthy-...

http://nutritionfacts.org/video/the-problem-with-the-paleo-d...

http://nutritionfacts.org/2015/08/18/dietary-cholesterol-aff...

http://nutritionfacts.org/video/big-food-using-the-tobacco-i...

(I apologize if this seems biased, coming from a single source, but if you check the videos, each has links to cited studies discussed - I simply favor the format the material is presented in)

The Eating Academy articles you've linked are by Peter Attia, a co-founder of NuSI. Please do watch the earlier review of their work I suggested - http://plantpositive.com/warning-signs-nusi-guys-1/

The healthful HCLF diets you're seeking out are known as plant-based (usually vegan, but not exclusively) diets, and are always lauded as health-promoting, albeit supposedly "unpalpable".

Low-fat meaning, low in or void of saturated- and trans-fatty acids, high (10-15% of caloric intake) in essential polyunsaturated omega-3 and omega-6 fatty acids (in the right ratio, ideally 1:1, but more practically, 1:3 or 1:5). Yet, many media outlets and conflict of interest research have no shame in claiming a diet as high as 30, 40, even 50 percent fat (always from animal products) are "low". This is simply nonsense! Your body needs only a little bit of fat, for example to increase vitamin absorption at each meal, or convert it to EPA/DHA.

High-carb meaning, the majority of calories are derived from whole, unrefined, plant-based foods, such as vegetables, fruit, legumes and whole grains, especially ones low on the glycemic index (e.g. brown rice, whole grain pasta, beans, dark green leafy veg, colorful fruit variation, etc.)

Heck, I challenge you to find me a study which says a high-carb, low-fat diet as I've described is not a great recipe for human nutrition. Unfortunately, so many people find such a diet unreasonable for practical, social and other, personal reasons. Also unfortunate is the fact there's little money to be made in promoting these simple and unprocessed foods, so the academic world is not determined to research them.

Anyway, if you're interested in reading more about these sort of diets, check out the work by Colin Campbell, John McDougall, Neal Barnard, Dean Ornish, to name a few. I've fully embraced the dietary lifestyle recommended by them and others, and can only praise the mental clarity, increased energy and satiation experienced as a result. I really believe the "trick" is to cut out processed and animal product foods altogether (at least to the degree you can sustainably practice and at the pace you find to be reasonable) - they're just unnecessary! Sure, it's anecdotal evidence, but I figure it's worth sharing with you.

I wonder if we are operating with different ideas of what a VLCHF diet might look like.

Lets talk specifics, let me give an an example of what I might eat in a day on such a diet:

Breakfast: Scamble: 2 eggs with 1 clove of garlic, one or two green onion strands, 3 diced radishes, mushrooms and cabbage (majority by volume). Coffee with cream.

Lunch: Salad: Raw salmon, spinach, watercress, 1/4 an onion, sliced radishes, sliced almonds, avocado, sunflower seeds with a whole fat greek yogurt + olive oil dressing. Water.

Supper: Medium rare steak with mushrooms, grilled kohlrabi and steamed asparagus. Unsweetened Iced green tea.

As you can see this would be a day low in processed foods, high in greens with both a low glycemic index and glycemic load, weighing in at a reasonable 1800 kcal. It blows my mind that the video's you shared calls something like this dangerous?! Not only is it far better than the average American diet, unlike a high-carb diet this no chance of leading to insulin resistance, metabolic syndrome and eventually type II diabetes.

No doubt your meal plan is already miles ahead of SAD (the standard American diet), and you deserve to pat yourself on the back. Avoiding fast food, added sugar beverages, eating organic foods (low in pesticide and higher in nutritional yield) is a huge leap in the right direction.

You've also packed a heavy dose of antioxidants, vitamins and minerals from the great veggies, healthy fats (avocado, sunflower seeds - note, not oil!). What's more, the salmon is high in EPA and DHA content, further reducing inflammation in the body and promoting the health of so many vital bodily functions. You've even correctly recognized a 1800 calorie daily allowance as being near optimal. It even appears you're meeting the World Health Organization's recommendation to get at least 55% of calories from carbohydrates and probably getting enough fiber (which only 3% of Americans do!)

Now, the bad news - by breakfast time, you've already exceeded the daily recommended intake for cholesterol (300 mg; each egg contains approximately 250 mg). The meats (even if local, wild-caught, or raised "naturally") most certainly contain questionable levels of persistent organic pollutants, which bioaccumulate at alarming rates in fat-soluble tissue of animals, estrogen, antibiotics, and possibly even harmful bacteria which will upset your gut glora and inflame the liver, colon and kidneys. The cooked steak has a dangerous amount of acrylamide and other carcinogens produced when flesh is cooked at high temperatures. Olive oil is just empty calories - just unnecessary fat with the majority of nutritional benefits destroyed by the extraction process. High amount of sodium from red meat is also known to increase blood pressure and cause insulin resistance. Nitrites and nitrates have also been shown to increase insulin resistance and to impair the function of the pancreatic beta cells. Finally, there is the heme iron found in the meat which is quite damaging if consumed in excess.

Now, I really don't think you need to worry, especially if your genetics don't predispose you to any chronic illness. But, I am of the opinion the outlined meals are not ideal. Maybe you're not interested in pursuing a gold nutrition standard each day and at each meal, and that's perfectly understandable! However, let's agree there is room for improvement, especially if you struggle with BMI, high blood pressure, high cholesterol, mood problems, attention defecit, or other ills, many of which are caused or at least exacerbated by the foods I've recommended avoiding.

On a slight tangent, have you used the website, Cronometer? It basically tallies up all the foods consumed in a day and gives a highly detailed report of what you ate, right down to each amino acid profile and the like. It's free - I really recommend checking it out!

I fear we may have to agree to disagree; ironically, I think we have a lot of common ground. I would like to point out of couple of closing thoughts:

>It even appears you're meeting the World Health Organization's recommendation to get at least 55% of calories from carbohydrates and probably getting enough fiber (which only 3% of Americans do!)

This doubtful; while the total carbs of this diet might reach this threshold- Most designers of well formed teratogenic diets are targeting net carbs (<30g). I would imagine this fiber portion of the carbs (well over 50% in this case) does not really count towards caloric carbs.

>you've already exceeded the daily recommended intake for cholesterol (300 mg; each egg contains approximately 250 mg)

Unless you have the right (wrong?) mutations, I think the jury is still out on this. Would you be surprised if I told you my serum cholesterol has not been negatively impacted?

>Nitrites and nitrates have also been shown to increase insulin resistance and

These meals should be limited to what naturally occurs- which is minimal compared to processed meat.

>However, let's agree there is room for improvement, especially if you struggle with BMI, high blood pressure..

This diet made it easy (satiety perspective) to shed 60 lbs and take my blood pressure from 138/75 -> 112/66. So while I cannot speak for others I really must disagree for my own account.

>On a slight tangent, have you used the website, Cronometer?

Very cool website, thanks for the share.

Thanks for the interesting conversation.

dude, just stop. the guy is firmly in the anti-fat camp, probably a vegan, and his mind is made up. did you notice his smarmy and condescending tone?

his frame of reference is so incompatible with what you're trying to communicate that he literally can't even talk to you like an adult.

you might as well try to convince him gravity pulls things up.

While I will concede I failed to convince him, I think he was polite and civil, which amongst those who disagree is rare these days.

i don't think condescension is polite.

Coming from someone who earlier proclaimed, "i'm a keto True Believer[tm]", it's quite ironic seeing you say this. I wonder why I've struck such a chord with you?

"However, you're incorrect to assume adding meats and dairy products - even so-called "lean" ones - which are laden with cholesterol, saturated and trans fats"

Oh, dear.

First of all, meat and dairy don't HAVE meaningful amounts of transfat. Problematic transfats are man-made.

Secondly, there is NO proven link at all between dietary cholesterol and blood cholesterol absent carbs, Essentially all blood cholesterol is manufactured by the liver.

By all means, display your "credible evidence" to the contrary.

> meat and dairy don't HAVE meaningful amounts of transfat

In fact, they absolutely do. It's no doubt hydrogenated oils found in processed snack foods add trans fat as well, hence my emphasis on whole plant foods.

> The major dietary sources of trans fats listed in decreasing order. Processed foods and oils provide approximately 80 percent of trans fats in the diet, compared to 20 percent that occur naturally in food from animal sources

> #1 Cakes, cookies, crackers, pies, bread, etc.

> #2 Animal products

> #3 Margarine

http://health.gov/dietaryguidelines/dga2005/document/html/ch...

> there is NO proven link at all between dietary cholesterol and blood cholesterol

Surely you jest?

> Serum cholesterol concentration is clearly increased by added dietary cholesterol but the magnitude of predicted change is modulated by baseline dietary cholesterol.

https://www.ncbi.nlm.nih.gov/pubmed/1534437

Or do you suppose this is all just a grand conspiracy by the fruit and vegetable industries?

">>there is NO proven link at all between dietary cholesterol and blood cholesterol > >Surely you jest?

Here's a clear example of your intellectual dishonesty. You specifically cut out the "absent carbs" term when quoting me and then rattled off studies that specifically did not control for carb consumption.

Sorry, I'm not sure I understand what you've meant. What does carbohydrate intake have to do with dietary cholesterol? The paper I had linked was a review of many other studies, all of which had defined diets. Can you explain and cite any links between blood cholesterol and carbohydrate intake?

>there is NO proven link at all between dietary cholesterol and blood cholesterol absent carbs

I would change "NO proven link" to "only a weakly correlated link (assuming the patient is not a member of the 8-15% of the population estimated to have a mutation related to improper cholesterol homeostasis)"

The diets most keto advocates support is not high protein; rather, it is high fat, moderate protein, very low carb (< 25 net grabs daily). The science to date supports that as being a very healthy diet, especially if your fat source is not omega-6 polyunsaturated fat, but is instead dominated by monounsaturated, omega-3 polyunsaturated and yes, saturated fat.

http://authoritynutrition.com/23-studies-on-low-carb-and-low...

Oh, dear.

First study:

> Dr. Hill reports having received consulting fees from HealtheTech, Johnson & Johnson, Procter & Gamble, Coca-Cola

Second study:

> This study proves a principle and does not provide clinical guidance; given the known benefits of fat restriction, future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed.

Third study:

> The study was designed to compare weight loss and cardiovascular risk in the short term; our long-term results, although appearing successful, must be considered as anecdotal, and further long-term follow-up studies must be conducted to confirm these findings.

Fourth study:

> Although advocates for very low carbohydrate diets are likely to embrace the results of this study, several points of caution need to be emphasized. First, a single study of a specific dietary regimen cannot provide a full assessment of safety and efficacy. Despite this study being the longest randomized, controlled trial of a very low carbohydrate diet reported, our results are still limited by the 6-month time frame. Whether the very low carbohydrate diet will produce sustained weight loss and continued improvement in cardiovascular risk factors over longer periods of time remains to be determined; the gradual increase in carbohydrate consumption in the final 3 months of the study suggests that some degree of recidivism is likely in persons on this diet. In addition, increased dietary fat has been linked to certain types of cancer and may have effects on cardiovascular health beyond the risk factors assessed in this study.

Fifth study:

> Financial Interest: Dr Hennekens is funded by the Agatston Research Institute, a nonprofit foundation, as Director of Research.

Sixth study:

> Participants were healthy and were followed for only 24 weeks, factors that limit generalization of our results. The low-carbohydrate diet has not been studied extensively in patients with chronic illness, and certain patients may require close medical supervision when following this diet. Furthermore, weight loss resulting from the low-carbohydrate diet may be difficult to maintain after 24 weeks.

> Potential Financial Conflicts of Interests: Grants received: E.C. Westman (Robert C. Atkins Foundation); Grants pending: E.C. Westman and W.S. Yancy Jr. (Robert C. Atkins Foundation)

Seventh study:

> This study was supported by a grant from The Dr. Robert C. Atkins Foundation, New York, NY.

Eight study:

> There were initially 20 subjects enrolled in each experimental group [...] Over the course of the study, four subjects dropped out of the LF group and five dropped out of the LC group.

Ninth study:

> 28 overweight premenopausal women consumed either a low-carb or a low-fat diet for 6 weeks. The low-fat group was calorie restricted. [calorie restriction does not work in the long term, period]

Tenth study:

> Carbohydrate restriction was an effective method of achieving short-term weight loss compared with standard advice, but this was at the expense of an increase in relative saturated fat intake. [saturated fat causes CVD and other chronic illness]

Eleventh study:

> Mood and other symptoms were evaluated by participant self-report using the Atkins Health Indicator Test [I'm sure that's not at all biased /s]

Twelfth study:

> Limitations included the lack of a valid and comparable assessment of individual adherence to the 4 different diets, the lack of data on whether participants had familiarity using any of the specific study diets prior to enrolling in the trial, and the lack of assessment of satiety.

Thirteenth study:

> Whether either of these diets would produce similar outcomes over longer periods and under ad libitum conditions or in populations that are more vulnerable to adverse effects, such as persons with specific psychological difficulties, requires further investigation.

Seriously, I had to stop at that. I'm sure the rest are also short-sighted and cannot be generalized as a healthful diet.

Care to explain why the many people who post their bloodwork every week on r/keto have lowered body weight, improved lipid panels, better fasting glucose scores? Its easy to say these are anecdotal, but when it happens weekly for years- (That of course not to say its well controlled, because of course its not, or that there may not be some sampling bias).

I gave it a try myself and judged it by all the objective and subjective measures at my disposal. It works (at least for me).

I can respect your skepticism, are the pending studies being done by http://nusi.org/ well enough designed to be considered weighty by you?

You've basically nailed it - the evidence is anecdotal and, coming from a keto echo-chamber, is obviously subject to confirmation bias. Therefore, these findings cannot be trusted as statistically significant.

By the same measure, we could argue smoking cigarettes is a reasonable, even healthful thing to do (on a slight tangent: exactly that was suggested by doctors in the 50's and 60's) - after all, we all know heavy smokers who haven't dropped dead, but on the contrary seem alive and thriving.

I'm glad it worked for you, but have you also fairly and objectively evaluated a plant-based, high-carb, low-fat diet? I think only then can the two be compared without bias, at least as I see it.

Regarding NuSI - I could write many paragraphs about the organization. If you have some time, please do check out these critical, detailed videos: http://plantpositive.com/warning-signs-nusi-guys-1/ and let me know what you think.

"During starvation this metabolic state is a kindness of nature allowing the victim to suffer much reduced pains of hunger while dying."

I hope you have a cite for that, as it ignores the basics of natural selection.

There is no way "nature" would select for a means to reduce the discomfort of starving to death, as death would remove that being from the gene pool, leaving that mechanism out of the gene pool as well.

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