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Can you provide any evidence that diabetes precedes dietary changes? My understanding is that there’s a pretty clear well-understood progression from obesity t

by skohan 7y ago

Can you provide any evidence that diabetes precedes dietary changes? My understanding is that there’s a pretty clear well-understood progression from obesity to pre-diabetes (which is measurable in terms of resting blood glucose, but usually not symptomatic) to diabetes. Insulin resistance is also reversible to some extent via dietary changes. So I am having difficulty understanding how it could be that diabetes would proceed dietary changes in this scenario.

toast0 7y ago
If a person were insulin resistant (type 2 diabetes), but did not consume a lot of carbohydrates, how would you know they were insulin resistant? Their blood sugar (fasting or otherwise) would most likely look fine, and you wouldn't subject them to a glucose tolerance test, because it's unpleasant to drink the glucose solution, and you have to sit in the lab for two hours before the second blood sugar test --- you wouldn't do that for an apparently healthy person. If they changed their diet, and began to show symptoms of diabetes, and led to a diagnosis of type 2 diabetes, would you say the change in diet caused the disease? If glucose tolerance tests were regularly administered to (apparently) healthy people, we could have some data or anecdotes about people having good insulin response, then changing their diet and no longer having good insulin response as 'eating too much candy gives you diabetes' suggests. I 100% agree that there's a correlation between obesity, increased carbohydrate content in diets, and increased diagnosis of insulin resistance. I'm just not convinced that there's a correlation between those things and insulin resistance. I suspect that without the increased carbohydrates, many people would have asymptomatic insulin resistance and go undiagnosed -- after all, dietary changes are a preferred treatment once insulin resistance is diagnosed.
- skohan 7y ago
  Do you have any evidence behind what you are saying, or is this pure speculative reasoning? > Their blood sugar (fasting or otherwise) would most likely look fine, and you wouldn't subject them to a glucose tolerance test, because it's unpleasant to drink the glucose solution, and you have to sit in the lab for two hours before the second blood sugar test --- you wouldn't do that for an apparently healthy person. Why do you think this test is never performed on apparently healthy individuals? Do you think they never established a baseline for these tests using a large number of healthy individuals?
  - toast0 7y ago
    How about this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603306/#S3title https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603306/#S3titl... > These findings suggest that the vast majority of Pima Indians susceptible to diabetes were already developing the disease in the early years of the study, and the increasing obesity in youth combined with a nearly 4-fold increase in the frequency of exposure to diabetes in utero [7] simply shifted the onset of diabetes to younger ages in the most susceptible individuals [6]. This wording suggest to me that while diet (and changes in diet), can change the onset of diagnosis, it does not cause the disease, it's a trigger for the disease in people that are susceptible. This is a big difference in my mind, because it can change blanket advice of 'don't eat too much candy or you'll get diabetes', into 'if you're susceptible to (type 2) diabetes, don't eat too much candy or you'll show symptoms of diabetes'. The first option undermines trust in the advice giver, because there are many examples of people who eat too much candy and don't get diabetes; the second example isn't super actionable, because it's hard to know if you're susceptible, but a history of diagnosis in your family or other genetic grouping is a sign. This is the same with the blanket war on obesity as a health risk. A large portion of the comorbidity with obesity comes from type 2 diabetes; but the distributed health advice is that all persons with obesity have higher risks, despite evidence that persons with obesity but not type 2 diabetes have pretty similar risks to those without both obesity and type 2 diabetes.

by skohan 7y ago

toast0 7y ago

If a person were insulin resistant (type 2 diabetes), but did not consume a lot of carbohydrates, how would you know they were insulin resistant? Their blood sugar (fasting or otherwise) would most likely look fine, and you wouldn't subject them to a glucose tolerance test, because it's unpleasant to drink the glucose solution, and you have to sit in the lab for two hours before the second blood sugar test --- you wouldn't do that for an apparently healthy person. If they changed their diet, and began to show symptoms of diabetes, and led to a diagnosis of type 2 diabetes, would you say the change in diet caused the disease? If glucose tolerance tests were regularly administered to (apparently) healthy people, we could have some data or anecdotes about people having good insulin response, then changing their diet and no longer having good insulin response as 'eating too much candy gives you diabetes' suggests. I 100% agree that there's a correlation between obesity, increased carbohydrate content in diets, and increased diagnosis of insulin resistance. I'm just not convinced that there's a correlation between those things and insulin resistance. I suspect that without the increased carbohydrates, many people would have asymptomatic insulin resistance and go undiagnosed -- after all, dietary changes are a preferred treatment once insulin resistance is diagnosed.

skohan 7y ago
Do you have any evidence behind what you are saying, or is this pure speculative reasoning? > Their blood sugar (fasting or otherwise) would most likely look fine, and you wouldn't subject them to a glucose tolerance test, because it's unpleasant to drink the glucose solution, and you have to sit in the lab for two hours before the second blood sugar test --- you wouldn't do that for an apparently healthy person. Why do you think this test is never performed on apparently healthy individuals? Do you think they never established a baseline for these tests using a large number of healthy individuals?
- toast0 7y ago
  How about this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603306/#S3title https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603306/#S3titl... > These findings suggest that the vast majority of Pima Indians susceptible to diabetes were already developing the disease in the early years of the study, and the increasing obesity in youth combined with a nearly 4-fold increase in the frequency of exposure to diabetes in utero [7] simply shifted the onset of diabetes to younger ages in the most susceptible individuals [6]. This wording suggest to me that while diet (and changes in diet), can change the onset of diagnosis, it does not cause the disease, it's a trigger for the disease in people that are susceptible. This is a big difference in my mind, because it can change blanket advice of 'don't eat too much candy or you'll get diabetes', into 'if you're susceptible to (type 2) diabetes, don't eat too much candy or you'll show symptoms of diabetes'. The first option undermines trust in the advice giver, because there are many examples of people who eat too much candy and don't get diabetes; the second example isn't super actionable, because it's hard to know if you're susceptible, but a history of diagnosis in your family or other genetic grouping is a sign. This is the same with the blanket war on obesity as a health risk. A large portion of the comorbidity with obesity comes from type 2 diabetes; but the distributed health advice is that all persons with obesity have higher risks, despite evidence that persons with obesity but not type 2 diabetes have pretty similar risks to those without both obesity and type 2 diabetes.