9 ms·

Is Type 2 Diabetes Reversible at Scale?

59 points by toutouast 8y ago

nemo1618 8y ago
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?
- maskedinvader 8y ago
  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.
  - virtuallynathan 8y ago
    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.
    - SketchySeaBeast 8y ago
      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.
      - virtuallynathan 8y ago
        That's sort of what TOFI is, its the term used in medical literature.
- SketchySeaBeast 8y ago
  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.
- johnkpaul 8y ago
  Roughly, the method used is the ketogenic diet. Very low carb, very high fat.
  - virtuallynathan 8y ago
    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.
  - njs12345 8y ago
    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-may-help-reverse-type-2-diabetes/ https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-ma...
    - johnkpaul 8y ago
      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.
    - sergiosgc 8y ago
      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/a2c0047f60bd77156d22029b8bdd5ca3.pdf https://asset.jmir.pub/assets/a2c0047f60bd77156d22029b8bdd5c...
- Apfel 8y ago
  Regarding point 1: From the site linked in the article, it appears to be basically classic keto + heavy supervision and dietary advice.
- jerf 8y ago
  "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.
  - bena 8y ago
    More of a description of a symptom rather than a cause?
- mythas 8y ago
  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.
- vfc1 8y ago
  Here are some videos about how to treat it - https://www.youtube.com/playlist?list=PL5TLzNi5fYd--uc9TA8ERQbQqSmBcSpyj https://www.youtube.com/playlist?list=PL5TLzNi5fYd--uc9TA8ER... Look for neal barnards books, including a cook book.
- Floegipoky 8y ago
  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.
SketchySeaBeast 8y ago
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.
- drivingmenuts 8y ago
  Doesn't do a thing for me - I'm underweight as it is.
  - SketchySeaBeast 8y ago
    When were you diagnosed / have you adjusted your lifestyle since? I'm curious as to the circumstances and how your life has changed.
- elsporko 8y ago
  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.
  - SketchySeaBeast 8y ago
    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.
olieidel 8y ago
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/a2c0047f60bd77156d22029b8bdd5ca3.pdf https://asset.jmir.pub/assets/a2c0047f60bd77156d22029b8bdd5c...
- virtuallynathan 8y ago
  I don’t think Peter works for Virta.
  - olieidel 8y ago
    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.
Someone1234 8y ago
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.
- magic_beans 8y ago
  The article-writer states he is an investor in Virta Health because he actually believes their approach will work to reduce T2D at scale.
  - Someone1234 8y ago
    He has to believe that because he is financially vested on the outcome.
    - Floegipoky 8y ago
      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?
      - Someone1234 8y ago
        Depends what the rate of return is.
djsumdog 8y ago
> 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.
- bena 8y ago
  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.
jklinger410 8y ago
This is just a native ad for Virta, a company operating in the diabetes technology space.
- deno 8y ago
  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.
  - jklinger410 8y ago
    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.
    - deno 8y ago
      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.
jvagner 8y ago
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)
vfc1 8y ago
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/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677007/ Meaning the symptoms get better and in some cases diabetes disappears.
aaxe 8y ago
Don't trust this guy: https://www.wired.com/story/how-a-dollar40-million-nutrition-science-crusade-fell-apart/ https://www.wired.com/story/how-a-dollar40-million-nutrition...
- deno 8y ago
  > 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?
nabla9 8y ago
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.
- godshatter 8y ago
  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.
turc1656 8y ago
"...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.
- pimeys 8y ago
  > 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.
rcdmd 8y ago
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/PIIS0140-6736(17)33102-1/fulltext?elsca1=tlpr https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
tshanmu 8y ago
this is a thinly disguised ad for virta health! why is it on HN first page?
InTheArena 8y ago
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.
- greggeter 8y ago
  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.
mindcrime 8y ago
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-Alternate-Day/dp/1628600012 https://www.amazon.com/Complete-Guide-Fasting-Intermittent-A...
hyoogle 8y ago
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 https://www.youtube.com/channel/UC3w193M5tYPJqF0Hi-7U-2g One video: "Can Diabetes be reversed?" https://www.youtube.com/watch?v=NdpnAkYlWwo https://www.youtube.com/watch?v=NdpnAkYlWwo

59 points by toutouast 8y ago

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?

maskedinvader 8y ago
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.
- virtuallynathan 8y ago
  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.
  - SketchySeaBeast 8y ago
    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.
    - virtuallynathan 8y ago
      That's sort of what TOFI is, its the term used in medical literature.
SketchySeaBeast 8y ago
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.
johnkpaul 8y ago
Roughly, the method used is the ketogenic diet. Very low carb, very high fat.
- virtuallynathan 8y ago
  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.
- njs12345 8y ago
  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-may-help-reverse-type-2-diabetes/ https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-ma...
  - johnkpaul 8y ago
    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.
  - sergiosgc 8y ago
    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/a2c0047f60bd77156d22029b8bdd5ca3.pdf https://asset.jmir.pub/assets/a2c0047f60bd77156d22029b8bdd5c...
Apfel 8y ago
Regarding point 1: From the site linked in the article, it appears to be basically classic keto + heavy supervision and dietary advice.
jerf 8y ago
"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.
- bena 8y ago
  More of a description of a symptom rather than a cause?
mythas 8y ago
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.
vfc1 8y ago
Here are some videos about how to treat it - https://www.youtube.com/playlist?list=PL5TLzNi5fYd--uc9TA8ERQbQqSmBcSpyj https://www.youtube.com/playlist?list=PL5TLzNi5fYd--uc9TA8ER... Look for neal barnards books, including a cook book.
Floegipoky 8y ago
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.

SketchySeaBeast 8y ago

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.

drivingmenuts 8y ago
Doesn't do a thing for me - I'm underweight as it is.
- SketchySeaBeast 8y ago
  When were you diagnosed / have you adjusted your lifestyle since? I'm curious as to the circumstances and how your life has changed.
elsporko 8y ago
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.
- SketchySeaBeast 8y ago
  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.

olieidel 8y ago

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/a2c0047f60bd77156d22029b8bdd5ca3.pdf https://asset.jmir.pub/assets/a2c0047f60bd77156d22029b8bdd5c...

virtuallynathan 8y ago
I don’t think Peter works for Virta.
- olieidel 8y ago
  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.

Someone1234 8y ago

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.

magic_beans 8y ago
The article-writer states he is an investor in Virta Health because he actually believes their approach will work to reduce T2D at scale.
- Someone1234 8y ago
  He has to believe that because he is financially vested on the outcome.
  - Floegipoky 8y ago
    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?
    - Someone1234 8y ago
      Depends what the rate of return is.

djsumdog 8y ago

> 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.

bena 8y ago
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.

jklinger410 8y ago

This is just a native ad for Virta, a company operating in the diabetes technology space.

deno 8y ago
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.
- jklinger410 8y ago
  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.
  - deno 8y ago
    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.

jvagner 8y ago

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)

vfc1 8y ago

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/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677007/ Meaning the symptoms get better and in some cases diabetes disappears.

aaxe 8y ago

Don't trust this guy: https://www.wired.com/story/how-a-dollar40-million-nutrition-science-crusade-fell-apart/ https://www.wired.com/story/how-a-dollar40-million-nutrition...

deno 8y ago
> 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?

nabla9 8y ago

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.

godshatter 8y ago
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.

turc1656 8y ago

"...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.

pimeys 8y ago
> 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.

rcdmd 8y ago

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/PIIS0140-6736(17)33102-1/fulltext?elsca1=tlpr https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

tshanmu 8y ago

this is a thinly disguised ad for virta health! why is it on HN first page?

InTheArena 8y ago

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.

greggeter 8y ago
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.

mindcrime 8y ago

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-Alternate-Day/dp/1628600012 https://www.amazon.com/Complete-Guide-Fasting-Intermittent-A...

hyoogle 8y ago

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 https://www.youtube.com/channel/UC3w193M5tYPJqF0Hi-7U-2g One video: "Can Diabetes be reversed?" https://www.youtube.com/watch?v=NdpnAkYlWwo https://www.youtube.com/watch?v=NdpnAkYlWwo