8 ms·
The headline is a bit misleading. We have previously known diabetes is reversible with low calorie diets. This study was notable for two things: (1) finding th
by arkades 9y ago
The headline is a bit misleading. We have previously known diabetes is reversible with low calorie diets. This study was notable for two things:
(1) finding that this holds true even six years into mild diabetes (previous studies were on much more recent diagnoses). This is useful information because of the widely held misconception that type 2 diabetes is just a disease of insulin insensitivity. Actually, over time, islet amyloid peptide is deposited in the pancreas where it slowly kills off beta cells and removes your ability to actually produce insulin. In effect (though not literally nor in every particular), type 2 dm slowly transitions into type 1. So it’s useful to know that six years out the pancreas is functioning well enough to allow dietary reversal.
(2) being funded by a private company pushing a meal replacement-and-weight loss coaching program, which used this private program as the intervention arm. Turns out that, yes, if you live on slimfast for 3 months you’ll lose weight and your diabetes will calm down.
That Lancet didn’t exactly lead with that latter point, oddly enough. The co is pushing for the NHS to fund their program in more locations, under the argument that bariatric surgery isn’t available to everyone. This is part of their PR push.
- throwaway5752 9y agoBariatric surgery (not personal experience, but secondhand) is not a picnic and requires a large/equal amount maintenance/discipline post-op to not harm yourself or regress. Again, admittedly 2nd hand and would love to be corrected.
- arkades 9y agoThe more recent generation of bari surgery approaches are more gentle than the first generation. That said, I agree, it’s not a free pass. Thing is, we have about half a century of consistent clinical findings saying, without exception, no diet-based approach shows long term weight reduction. The most successful have zero effects by 5-10 years out. Bari surgery is the first and only intervention we’ve had that has shown sustained weight loss over 10 years. I don’t mean to in any way understate its dangers or its difficulty. But from a medical standpoint, I have to raise a red flag when someone says “hey, instead of using the only treatment that’s ever been shown to have a sustained effect, you should use a variant of a treatment we’ve spent half a century proving doesn’t generally work.” The linked article phrased it as being for people for whom bari isn’t an option, but even the Lancet article proper - iirc, as I read it at the beginning of the week - phrased it as, “there aren’t enough bari surgeons to go around, so in the meantime...”
- throwaway5752 9y agoThank you!
- brooklyn_ashey 9y agoYes, the problem is (i am someone who was put on a VLCD of 800 calories a day- and didn't lose that much weight from it) that your body has a set metabolism that keeps slowing down as you lower calories over the years. I had no problem going on the vlcd besides fatigue. The reason is I was already only consuming 1200 calories a day. These diets don't work over the long haul. I realize my case isn't the most common, but they are now looking into microbiome therapy as a possible solution. This resetting of metabolism plagued the biggest losers from "the biggest loser" as well. I do hope more research is done, because in my case, following diets (and perhaps other medical factors like igg)slowed my metabolism to a ridiculous level. And I don't have diabetes or high blood pressure, luckily.
- nradov 9y agoThe notion of a metabolic set point is mostly a myth. The actual changes in resting metabolic rate from mild caloric restriction are very small. Most people underestimate how many calories they consume unless they carefully weigh and log everything.
- vevoo 9y agoMy reading of the last 3 years of findings regarding changes in resting metabolic rate due to caloric restriction is that they could become big enough to explain the pattern of weight regain. Now, the specific quantification of the relationship between amount, lenght of caloric restriction and resting metabolic rate is, in my opinion, waiting for a trove of data we do not have yet.
- brooklyn_ashey 9y agowell, my doc is head of bariatric surgery at nyu, so I'll pass on what you said. Btw, I do weigh and log everything.
- dnautics 9y agoWe don't have solid evidence that amylin is killing islet cells, just circumstantial and in vivo work.
- arkades 9y agohttp://m.jbc.org/content/271/4/1988.short http://m.jbc.org/content/271/4/1988.short It’s not like we can do much more than show “if I introduce this amyloid, beta cells die” in the lab. No one is going to experimentally administer the amyloid to real life patients to see if it kills their pancreas.
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- dnautics 9y agoYou could do it in mice. I mean, you can't but that's because mice have funny amylin, but people haven't really put in the work to suss that out.