
Type 2 diabetes can be reversed with a low-calorie diet - DanBC
https://discover.dc.nihr.ac.uk/portal/article/4000931/type-2-diabetes-can-be-reversed-with-a-low-calorie-diet?utm_content=bufferf8b4a&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
======
arkades
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
Bariatric 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
The 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...”

~~~
taneq
> Thing is, we have about half a century of consistent clinical findings
> saying, without exception, no diet-based approach shows long term weight
> reduction.

This baffles me, because these results are trivially disproved. It's not
particularly rare for people to lose weight and keep it off long term by
changing their diets. Are the studies poorly constructed or are they just
being misinterpreted?

~~~
arkades
You’re begging the question. You assert it’s not particularly rare for people
to lose weight and keep it off long term, and therefore it’s trivially obvious
to prove that it’s not particularly rare. Except that all studies to date show
that it -is- rare, especially for the group of people that are candidates for
an intensive intervention like medically managed weight reduction or bari
surgery.

The data show that over ten years average sustained weight loss in diet-and-
lifestyle interventions is zero (actually, there’s usually weight gain). That
doesn’t rule out particular rare exceptions, but they’re just that, and not
useful for evaluating the intervention as a whole.

~~~
taneq
That's not what 'begging the question' means. If you say "iron doesn't rust"
and I show you a rusty piece of iron, that's not 'begging the question'
regardless of how many studies you can cite that show iron not rusting under
various conditions.

And 'average sustained weight loss over a cohort' is the wrong measure,
especially if your cohort are candidates for bariatric surgery (ie. pre-
selected for being medically recognized as incapable of losing weight
voluntarily) rather than just overweight people in general (a fair few of whom
_do_ choose do get back in shape.)

------
turc1656
...or you could not starve yourself on <900 calories a day and instead be a
sane person and just eat low carb:
[https://link.springer.com/article/10.1007%2Fs13300-018-0373-...](https://link.springer.com/article/10.1007%2Fs13300-018-0373-9)
_" Insulin therapy was reduced or eliminated in 94% of users; sulfonylureas
were entirely eliminated in the CCI. No adverse events were attributed to the
CCI."_ Wow, that's pretty extraordinary, isn't it? Every single person in the
non-control group eliminated the need for sulfonylureatic compounds and a
massive 94% reduced their insulin level or completely got off insulin
altogether. All with no adverse affects being recorded.

You don't need to starve yourself or go on some ridiculous diet. You just need
to eat low carb and eat clean (a.k.a. "real" food) and your body will begin to
heal in nearly every case. I suspect the few test cases that didn't improve
were so far gone they were too metabolically impaired to achieve any positive
results. The damage was likely too extensive and age possibly played a factor.
For everyone else, it appears they can get rid of diabetes...if they actually
care enough to do so.

~~~
arkades
Repeated studies have shown that weight loss plays a bigger role than carb
restriction. The article you linked showed a 12% weight loss in the
experimental group, which also had continued support by a health coach
throughout its duration, which was the actual intervention.

You make it sound like the intervention was carb elimination, rather than
weight loss with a health coach. It was not.

~~~
GreaterFool
I've been on keto (carb restriction) diet (lifestyle?). Just some thoughts
learned from the experience: it is _incredibly_ easy to lose weight on carb
restriction since hunger goes away and relationship with food changes.

I still like to eat but it's become more a number game. I eat once a day and
structure my meal to hit my macros. Just figure out how many calories and
protein / fat ratio and I can usually hit close to it with 1 meal and top up
calories with butter coffee.

Also, I can instantly do a 1-day fast. It doesn't bother me at all. Every few
days I stretch my intermittent fast to proper "just coffee and water today"
fast. It's very refreshing.

Calorie restriction on carbohydrate heavy diet sounds like hell. Food
cravings. Starvation.

Fasting on the other hand is a different story. Zen.

~~~
wutbrodo
Yea, the shift in your eating habits is really kind of astounding.

I'm not even that close to keto levels of carb intake[1], but I've been
progressively minimizing any processed carbs since college (and I'm lucky
enough to have been raised eating fairly healthy, so my baseline was decent).
At this point, there are certain foods that all my friends feel are impossible
not to crave and give into occasionally, that I simply just don't enjoy. One
of the biggest examples is fat+grain in its various forms: pizza, grilled
cheese, many pastas, funnel cakes, etc etc etc. Don't get me wrong: I'm not
completely incapable of enjoying these categories of food. It just needs to
actually be well-made and have some flavor: by contrast, most of the people I
know enjoy the wireheading effect of this combo per se. To me, this seems like
the difference between eating a nice dessert and eating a bowl of straight
white sugar.

This is something I think about a lot: there's so many unhealthy food items
that I find pretty gross at this point that most of my well-educated, high-
income social circles have resigned themselves to being a completely
unavoidable flaw in the human brain[2]. It's kind of eerie to think about; My
diet isn't even amazingly healthy, and I've already found myself brushing up
against the "eccentric abstemiousness" that pg mentions in his essay on
addiction.

[1] every time I lift weights, I crave carbs too much to drop them entirely:
most of my carbohydrates come from beans, pulses, and certain green veggies.

[2] IMHO, this is the source of the popular-on-HN sentiment that each and
every one of us are hopelessly devoid of agency when it comes to resisting the
power of corporations to exploit the way our brains' taste centers work. The
theory isn't implausible to me, but my experience indicates that you really
don't need superhuman self-control to change your diet: it just takes time and
patience.

------
stephenhess
We've known that low-calorie dieting has this effect for some time; unless I'm
missing something, this looks like solid confirmation of this point but isn't
adding much knew to our understanding of diabetes prevention. The big
challenges in this space are adherence, scaling access to treatment and
creating long-term lifestyle change that will help the patient maintain the
weight that is lost.

There's good evidence that ketogenic diets have an additive metabolic effect
beyond pure calorie restriction which is exciting. Virta Health is doing some
interesting work here and just published some results that speak to this:
[https://link.springer.com/article/10.1007%2Fs13300-018-0373-...](https://link.springer.com/article/10.1007%2Fs13300-018-0373-9)

~~~
YeGoblynQueenne
Well, the more the merrier is as true for scientific studies as for sex
parties. The point is that no two studies are going to be set up in the exact
same way, so it's interesting to examine the results of slightly different
experiments.

But probably more importantly, because there is no study that can claim 100%
certainty for anything, having many studies confirm the same effect is always
a good thing.

------
pascalxus
Sticking to a very low calorie diet is super hard. You'r body starts producing
all kinds of hormones to get you to eat more. I fight against this every day.
So, I've created a tool that shows me all the lowest caloric density foods and
ranks. It also ranks foods by nutrients too: highest nutrients per calorie:
[https://kale.world/c](https://kale.world/c)

------
Greenisus
It seems that a keto diet/lifestyle does this in a far more enjoyable way than
restricting calories to such a low level. Mixing in restricting to zero
calories (aka fasting) also helps. Either way I'm so happy to see people start
to attack this problem with smarter food choices.

------
nradov
Nutritional ketosis was also recently shown to reverse type 2 diabetes. That
approach might be more sustainable for some patients.

[https://blog.virtahealth.com/one-year-clinical-trial-
outcome...](https://blog.virtahealth.com/one-year-clinical-trial-outcomes-
provide-evidence-for-changing-the-way-we-care-for-patients-with-
type-2-diabetes/)

------
loeg
(2017) (At least the study itself: "Published on 10 December 2017.")

Previous article: [https://www.theguardian.com/society/2017/dec/05/radical-
diet...](https://www.theguardian.com/society/2017/dec/05/radical-diet-can-
reverse-type-2-diabetes-new-study-shows)

And discussion:
[https://news.ycombinator.com/item?id=15873389](https://news.ycombinator.com/item?id=15873389)

~~~
vonmoltke
> (2017) (At least the study itself: "Published on 10 December 2017.")

So, two months ago? Who cares if it's on the other side of an arbitrary point
in time?

~~~
DanBC
loeg is politely pointing out a large, recent, discussion. That's a useful
thing to do.

~~~
vonmoltke
I quoted the specific portion because if the propensity of people here to
immediately jump in and "tag" articles with the year they were published. If
loeg had left the quoted line out if its post I would not have mentioned
anything.

------
fernly
Does anyone know what the UK NHS means by a 'formula diet'? The overview says,

> The program involved... going on a formula replacement diet. This consisted
> of 825 to 853 calories per day...

and the published abstract also refers to

> ...825-853 kcal/day formula diet...

So what's the formula? Was it a commercial feeding formula such as Ensure? Or
a dietician's list of approved foods? What was the macronutrient ratio?

~~~
fernly
I found this announcement of a follow-up study [1], which

> will see 140 people with Type 2 diabetes spend between eight and 20 weeks
> consuming just 800 calories per day, mainly in the form of nutritionally-
> complete formula shakes.

The phrase "nutritionally-complete" indicates a meal replacement; probably not
Slimfast or Ensure, neither of which is suitable for 100% meal replacement,
but something like Huel or Soylent, which are. However, being a medical
operation, I would bet it will be some hospital-approved TPN [2] such as
Jevity [3].

[1]
[https://www.diabetes.org.uk/About_us/News_Landing_Page/Low-c...](https://www.diabetes.org.uk/About_us/News_Landing_Page/Low-
calorie-liquid-diet-study-launched)

[2]
[https://en.wikipedia.org/wiki/Parenteral_nutrition](https://en.wikipedia.org/wiki/Parenteral_nutrition)

[3]
[https://nutrition.abbott/uk/product/jevity](https://nutrition.abbott/uk/product/jevity)

------
originalsimba
I think the conclusion is false and the real culprit is low-sugar, not low-
calorie.

Insulin production is directly influenced by sugar levels. It is not
influenced by caloric intake. I didn't read the whole article but I bet their
method is flawed and further study is required.

~~~
vevoo
I did read it. They might have other method issues, but not that one you
mention. In this analysis the did not focus on insulin secretion or
sensibility.

You are right in a sense. The authors used to say that it does not matter what
you eat, as far as is a lot of caloric restriction. That was back in 2016,
when I interviewed them. I hope now they will disagree if someone comes with a
800 calorie diet made of sugar only.

------
spodek
> Weight loss of 15kg or more was achieved by 24% of the intervention group
> compared to none of the usual care group.

> Diabetes remission occurred in 46% of the intervention group compared to 4%
> of the usual care group. It only occurred in people who had lost weight.

Unless the people with type 2 diabetes were fit and going underweight for the
experiment, instead of implying overweightness is normal, could we say that a
high calorie diet can maintain or accelerate diabetes?

This rephrasing suggests prevention.

~~~
hawkice
Fair, but I think there's something to the opposite tone. A lot of people know
that if you're healthy, you can generally avoid type 2 diabetes. Saying it
basically 1:1's with weight issues is... important. Prevention is important,
but there's this idea weight loss is impossible, or keeping weight off is
impossible, and boy howdy that isn't true.

------
Someone1234
That's fantastic news.

I do have a question, how safe is 830 calories/day for a diabetic? For an
otherwise healthy person I can see it being safe with medical supervision but
for an individual already seeing blood sugar spikes due to diabetes, I wonder
about the dangers?

I guess what I am getting at is that this intervention for diabetes might only
be safe enough to try in early stage even if it would work for more progressed
diagnosis.

~~~
a3n
The subjects were under medical supervision ...

~~~
Someone1234
I never claimed they weren't.

I asked about the safety of diabetics on low calorie diets. I have no idea how
stringent the entry criteria was for this study, they could have picked the
[otherwise] healthiest diabetics they could find.

Which brings us back to the question I asked, which was how this could scale
to older or in worse health individuals suffering from type 2 diabetes? Even
with medical supervision.

~~~
maloney
It would only be a problem if you took insulin and then did not eat. Given
that type two diabetics cell’s are stuffed full of sugar from insulin
resitance, not eating or eating less can only help.

------
gorsh
I lost 60kg in the last year after being diagnosed with type 2 diabetes,
following a moderated carb and low calories diet, with 1h of gym almost every
day of the week.

The latest HbA1c was 5.5%, which is inside the range for 'normal' people
([https://en.wikipedia.org/wiki/Glycated_hemoglobin](https://en.wikipedia.org/wiki/Glycated_hemoglobin))

------
mirimir
I gained ~50 kg after quitting tobacco. But I'm not sure that it'd work the
other way around. I do recall that "feeling hungry" and "needing a cigarette"
were quite fungible. But then, smoking is obviously a huge cancer risk factor.
Maybe vaping isn't so bad.

And for what it's worth, testosterone supplementation disappeared my
prediabetes. Also less white hair, and better muscle health.

------
will_brown
And Type 2 diabetes can be entirely prevented thru low sugar diets.

------
rexstjohn
Hello,

I see many people on here deriding low calorie diets as “starving.” As someone
who was 100+lbs overweight I can attest that low-carb, diet, exercise, weight
training were not sufficient to help.

For whatever reason, genetics combined with work and lifestyle, I was
unsuccessful with any commonly recommended diet for reducing body mass, I
tried for years.

Recently, I lost 40lbs using intermittent fasting and then continuos fasting.
The experience was night and day, I have written about my experience here:
[http://rexstjohn.com/thoughts-fasting-part-iv-lost-40-lbs-
tw...](http://rexstjohn.com/thoughts-fasting-part-iv-lost-40-lbs-two-months-
now-want-answers/).

Starving is the wrong way to frame this diet approach. I want people to change
their minds about how they frame the problem of obesity. If you have 10 lbs of
excess body fat, that represents 35,000 stored calories. Your body is used to
doing much more work and exerting much more energy to locate food than what we
do in modern society. If you wanted an Apple 100 years ago, chances are you
had to walk for 30 minutes.

Furthermore, our bodies are adapted to numerous days of fasting. If you are
hunting a wounded deer over rough terrain, you don’t have room to carry a
refrigerator with you - you burn stored reserves. If your crop fails and you
have to wait three months to eat again subsisting off of grass and worms for
vitamins, your body can do that too (I don’t recommend it).

In my research I have found numerous examples, personal blog accounts and
scientific studies backing them of people fasting for a week or greater and
suffering no ill effects. The real issues with fasting occur only after many
weeks, with low vitamin / potassium / electrolyte consumption or when you fast
while having low body fat resulting in true starvation.

In the example of the man who fasted 360 days and lost 350+lbs, doctors had
him eating supplements and brewers yeast (protein, low calories) and they
documented very few noticeable negative side effects which were addressed by
adjustments to supplementation.

Starvation is when your body consumes itself. This happens when you completely
exhaust your stored fats. Fasting becomes riskier after the first 21 days, the
really dangerous effects such as referring syndrome only occur in extreme
situations where you had indeed been starving for a period of time before
eating.

I have lost 40lbs in the last year using these approaches and recommend them
to everyone I meet. Fasting is a skill anyone can learn.

I believe fasting is the best way to lose weight, don’t call it starving.

------
aviv
Water fasting. But people don't want to listen.

~~~
sethrin
Flat assertions of efficacy unadorned by empirical support may not be well
received. However, I am sure that the idea is taken seriously by most, and
that supporting evidence would be of great interest.

~~~
aviv
I used to back it up by quite a bit of data but I get downvoted to oblivion
regardless of all the effort. Why bother anymore. I put it here, whoever is
interested can research on their own.

------
known
TL;DR

If pancreases produces less insulin, eat less calories.

