
Is Type 2 Diabetes Reversible at Scale? - toutouast
https://peterattiamd.com/type-2-diabetes-reversible-scale/
======
djsumdog
> 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.

~~~
aborington
how does sugar contribute to heart disease?

~~~
oppositelock
It's a factor in inflammatory response, and heart disease is an inflammatory
disease which creates conditions where cholesterols can then bind and cause
plaques.

Here's one good talk by Dr. Robert Lustig.
[https://www.youtube.com/watch?v=dBnniua6-oM](https://www.youtube.com/watch?v=dBnniua6-oM)

Here's an overview in a pop-sci article:
[https://www.kqed.org/bayareabites/85169/sweet-revenge-dr-
rob...](https://www.kqed.org/bayareabites/85169/sweet-revenge-dr-robert-
lustig-explains-how-to-cut-sugar-lose-weight-and-turn-the-tables-on-processed-
foods)

------
turc1656
_"...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.

~~~
magic_beans
I have a dumb question. Can diabetes actually be "fixed" with a keto diet?
What if a T2 diabetic does carb restriction and keto for a year and "reverses"
their diabetes. If they eat cakes and cookies for a week at Christmas, does
the T2D come crashing back?

~~~
godshatter
I'm a T2D that has successfully dropped my a1c from 8.9% to 5.5%. I've
"reversed" my diabetes. I put "reversed" in quotes because the underlying
problem is still there. If I drop my low carb, intermittent fasting routine,
my blood sugars shoot right back up. I'm not fixed, I'm just not making myself
any worse.

There is hope that my pancreas will recover somewhat, since there is a theory
out there that fat stored in the pancreas is part of the problem with how well
beta cells function and intermittent fasting and low carb has decreased the
amount of fat stored in my liver so it's possible it will work on the pancreas
over time as well. That would really be a reversal of T2D if it happens.

------
nemo1618
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?

~~~
johnkpaul
Roughly, the method used is the ketogenic diet. Very low carb, very high fat.

~~~
njs12345
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-
ma...](https://www.nhs.uk/news/diabetes/radical-low-calorie-diet-may-help-
reverse-type-2-diabetes/)

~~~
johnkpaul
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.

------
SketchySeaBeast
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.

~~~
elsporko
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
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.

------
vfc1
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.

------
nabla9
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
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.

------
olieidel
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/a2c0047f60bd77156d22029b8bdd5c...](https://asset.jmir.pub/assets/a2c0047f60bd77156d22029b8bdd5ca3.pdf)

~~~
virtuallynathan
I don’t think Peter works for Virta.

~~~
olieidel
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.

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

~~~
deno
> 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?

------
jklinger410
This is just a native ad for Virta, a company operating in the diabetes
technology space.

~~~
deno
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
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
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.

------
hyoogle
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)

------
InTheArena
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.

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

------
Someone1234
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
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
He has to believe that because he is financially vested on the outcome.

~~~
Floegipoky
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
Depends what the rate of return is.

------
jvagner
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)

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

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

