Type 2 diabetes: NHS to offer 800-calorie diet treatment

https://www.bbc.com/news/health-46363869

by prostoalex • 8 years ago

164 196 8 years ago

arcticbull• 8 years ago

Makes sense, it is a diet related illness, so it should have a diet related treatment. Instead of treating the symptoms, treat the cause.

chosenbreed3• 8 years ago

Makes sense, it is a diet related illness, so it should have a diet related treatment. Instead of treating the symptoms, treat the cause.

If everyone starts that doing we're going to put the pharmaceuticals out of business. There'd be riots!

chimeracoder2• 8 years ago

Makes sense, it is a diet related illness, so it should have a diet related treatment. Instead of treating the symptoms, treat the cause.

Type 2 diabetes isn't caused by diet. Certain diets can increase the risk of Type 2 diabetes, but it's not a foregone conclusion, and it's not uncommon to develop Type 2 diabetes despite an otherwise healthy diet.

magnamerc• 8 years ago

T2D is caused by a combination of genetic and environmental factors such as diet, and you're correct that someone can get T2D based mostly on genetic factors alone. It is however very uncommon, and diet plays a role in the majority of cases. There are several studies that show this.

belltaco3• 8 years ago

Losing a lot of weight with very low calorie diets is hard, but not regaining it over the next couple of years is next to impossible.

Your body will try all the tricks in the book, it will reduce your metabolism to way below that of the person of the same weight, it will amp up your hunger hormones so much that you will think and dream about food 24/7.

Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.

philip12092• 8 years ago

Type II diabetes is a diet-related illness. If you cure the illness with diet, then switch back to what you were eating before - of course, diabetes will come back. These dietary changes need to be seen as new habits, not temporary changes.

pknopf2• 8 years ago

Exactly this. My A1C went from 8, to 4.9. My blood sugar rarely goes out of wack, even when abused.

I eat low carb, and fast intermittently. It's my life-style now.

After eating a while for an extended period of time, my blood sugar is much more stable, regardless what I eat.

lol768• 8 years ago

Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.

Are there any studies in this area I can read that discuss the figures you've mentioned?

cstansbury• 8 years ago

>Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.
Are there any studies in this area I can read that discuss the figures you've mentioned?

One example may be found in Dr. Jason Fung's book, "The Complete Guide to Fasting." Chapter 5 describes a case regarding the American TV show, "Biggest Loser", where overweight contestants lost loads of weight during the show with a low calorie diets and exercise. All except one contestant gain the weight back.

Below is the reference to the study cited in Fung's book. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21538

belltaco3• 8 years ago

I referenced some things in this comment https://news.ycombinator.com/item?id=18571376

SketchySeaBeast9• 8 years ago

And that's why weight loss techniques need to be treated like a new lifestyle, instead of a goal you hit and then finish. I lost 60 lbs a couple of years ago and found that 20 of those had recently crept back on, so I went on another shorter diet to get myself back on track. It's totally doable. You have to be aware and keep correcting.

chosenbreed3• 8 years ago

And that's why weight loss techniques need to be treated like a new lifestyle, instead of a goal you hit and then finish. I lost 60 lbs a couple of years ago ...

Firstly, fantastic achievement. I'm curious as to what motivated you enough to put in the effort (I'm assuming it required effort).

Secondly, I wonder if the speed/drastic nature of the weight-loss can be counter-productive. When you think about people don't become over-weight overnight. Perhaps a more gradual pace with some time for settling at various stages of the process...I'm thinking losing weight over a couple of years as opposed to over a couple of months.

striking• 8 years ago

Garry's blog post about this was particularly insightful.[0] He shares a graph of his progress and how it goes both forwards and backwards, as well as the things he's learned along the way.

0: https://garry.tv/2018/10/17/fatty/

quotemstr4• 8 years ago

Nostrums like "treat it like a new lifestyle" are easy to say, but do they actually address the current public health crisis? Proposing actions that, for whatever reason, people don't actually take isn't a useful way to spend time.

What's good is what works. And honestly, drugs work today. The likes of the FDA considers them too risky, but I think they're deciding wrong.

pknopf2• 8 years ago

I lost 40 pounds in 3 months, then another 20 in 3 months.

I've kept the weight off for another year.

I still eat healthy and in moderation (and occasionally fast).

I avoid sugars and high-carb foods and my body has been hovering at the same weight.

Maybe, for some people, it's harder to keep the weight off (assuming diet is the same)? Or, maybe some people don't have the mental will-power to stay on the diet that lost them the weight?

chosenbreed3• 8 years ago

Superb. Clearly in your case you summoned the necessary will to lose all that weight. But I think another important factor is that you established a new lifestyle/better eating habits.

drenvuk• 8 years ago

Citations for the 5 to 7% would be nice. Here's a meta analysis that states otherwise.

https://academic.oup.com/ajcn/article/74/5/579/4737391

dsp1234• 8 years ago

Per that study, "This analysis of 5-y weight-loss maintenance indicates, on average, that obese individuals maintained weight losses of 3.0 kg, representing a reduced weight of 3.2% below initial body weight. These individuals were successfully maintaining a weightloss averaging 23.4% of their initial weight loss at 5y"

Put another way, after 5 years, the average weight loss was ~3kg, with an average weight gain of 78.6% of the original lost weight.

Also, in general, an obese person who is obese before, and after 5 years has a weight that is ~3kg is likely still obese.

So this study basically just says that an average person isn't successful at keeping a large amount of weight, and gains most of it back. The specific statistics stated by the commenter above may not be correct, but the sentiment is definitely true.

That said, the study does confirm that very low energy diets (~800 meal replacement) beat out hypoenergetic balanced diet (~1200-1500 normal food) in long term weight maintence. Which is what the article is suggesting being implemented. So it's still not a great long term solution, but it's the better of the two non-exercise based solutions which this study evaluated.

belltaco3• 8 years ago

I am on mobile and I don't have a root source for the below paragraph, maybe someone can dig it up.

The statistics for dieters who lose weight rapidly, according to Wellsphere, a website sponsored by Stanford University, is worse. Only 5 percent of people who lose weight on a crash diet will keep the weight off. Crash diets include any unhealthy diet, from severe calorie-restriction diets to diets that consist of only a few kinds of foods.

Another study showing 5% looks like it was an old study from 1959.

Anyway, there are more modern studies proving the point. And that people gain even more weight back than they started with.

http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA...

Several studies indicate that dieting is actually a consistent predictor of future weight gain,” said Janet Tomiyama, a UCLA graduate student of psychology and co-author of the study. One study found that both men and women who participated in formal weight-loss programs gained significantly more weight over a two-year period than those who had not participated in a weight-loss program, she said.
Another study, which examined a variety of lifestyle factors and their relationship to changes in weight in more than 19,000 healthy older men over a four-year period, found that “one of the best predictors of weight gain over the four years was having lost weight on a diet at some point during the years before the study started,” Tomiyama said. In several studies, people in control groups who did not diet were not that much worse off — and in many cases were better off — than those who did diet, she said.

klmr2• 8 years ago

This new diet is specifically tailored to avoid this yoyo effect. It’s currently not yet clear whether this is indeed the case (hence this expanded epidemiological study) but preliminary results indicate that this is indeed the case.

In other words, this specific diet (severely limited calories as well as restriction of food to almost completely liquids) reportedly helps sustaining the weight loss long-term (and is allegedly effective for around 50% of patients).

jobigoud2• 8 years ago

Are you saying they stay on 800kcal/day for long-term? I'm skeptical. Usually the problem is when you switch to the maintenance diet.

DiffEq2• 8 years ago

That is why there needs to be some visible and lasting penalties...as in if you have a disease like diabetes that you can prevent or fix by simply eating better and not eating so much - then you are responsible for any and all medical costs associated with it. We don't allow insurance claims if you purposefully wreck your car or burn your house down; why do we allow this when it comes to your health?

vidarh• 8 years ago

If you think "simply eating better and not eating so much" is "simple", you don't understand people. All our evidence is that it is by no means simple for most people. It's a problem that's about as hard to deal with as drug addiction.

Furthermore, it is a social problem, in that we as a society allow businesses to exploit peoples weaknesses without covering the social costs of the problems they are causing, and given that how people around you act strongly influence how able people are to stick to a diet.

To then act as if this is down to some imaginary free will is irresponsible.

Brigadirk• 8 years ago

I thought I was getting too fat in 2015. I went on an "eat half" diet. Literally lost weight eating pizza and drinking beer, just less than I needed. Lost 12 kilos.

After this, I just ate as I felt like, with intermittent periods of damage control, where I'd revert to the diet for a few days here and there to either budget an upcoming event (e.g. Christmas), or pay for a recent one.

Works for me. Only note is to watch out with sugar & alcohol, as both can turn on the 'fuck it I WANT THIS NOW' mode, at least for me.

brandonmenc3• 8 years ago

Only 5 to 7% of people that lose a large amount weight are able to keep it off successfully in the medium and long term. Hope there is more research into this mechanism.

The mechanism = not staying on your "diet" permanently.

distant_hat• 8 years ago

This. I've known a bunch of people who lost a large part of weight (without surgery) and kept it off and they basically turned into different people (more fun though). They restricted their eating, they worked out, often went for hikes etc. But their lifestyle was completely different before and after. They didn't bitch about turning down dessert or things like that. They seemed to actually just be a different person.

philip12092• 8 years ago

Calories are not the core problem - carbohydrates are. The research from VirtaHealth.com makes this clear. They are getting T2 diabetics off of insulin within a week, while still giving patients the satiety they want from meals.

Nokinside• 8 years ago

Heh. Whole company launched based on single study with short duration, no control group and big drop-out rate.

But when you add long list of citations for medical literature it looks valid. Even when those studies don't directly validate your approach. People don't look at what the studies actually say.

hirundo2• 8 years ago

I think that this is effective because it reduces the carbohydrate load. Protein and fat consumption also increase insulin response but not nearly as much. Type 2 diabetics could get most of the blood sugar reducing benefit of this by just removing/replacing the carbs. That has been my N=1 experience with both fasting and carb restriction.

will_brown7• 8 years ago

Well reversing is different but most cases can be reveresed with dietary/lifestyle changes.

On the other hand prevention of type2 is N=100% with these changes. I know people, especially in the US consider it thier right/freedom to eat what they want and live how they want, but in my mind it’s deeply disturbing especially because children don’t have any choice (it’s parental).

I think as soon as a child is diagnosed with fatty liver disease...there should be some mandate on parents to “treat” their child with diet (which I know is probably equally disturbing to people, government dictated diet).

hirundo2• 8 years ago

In the US the official nutrition advice has been both wrong and corrupt since the 1970s. Gotten wrong by sincere hard working scientists with the best intentions. Corrupted by corporate capture of regulatory bodies and funding of exculpatory studies.

These same forces would choose what is mandated. That is horrifying. Not only could they give bad advice, they could compel ever larger fractions of the population to follow it.

Far better to let parents decide, so when they get it wrong we can learn from it, and don't all get it wrong at once.

vonmoltke2• 8 years ago

On the other hand prevention of type2 is N=100% with these changes.

It is absolutely not. While the vast majority of current cases are preventable (and in most cases, reversible) through proper lifestyle changes, between 5% and 10% of people with T2DM were going to develop it regardless of what they did.

Now, it's possible that some or all of those cases are not actually T2DM. In the past few decades researchers have been investigating additional forms of DM, such as Latent Autoimmune Diabetes in Adults, that may be the cause of some cases of DM that currently present as T2DM. It may be that once "true" T2DM is defined that your statement is correct, but as of right now it is not.

dmm2• 8 years ago

.there should be some mandate on parents to “treat” their child with diet

You're considering forcing parents to change, presumably with the threat of taking their children away. But consider this, in the past type-2 diabetes was extremely rare in children. Why is it now common?

Are parents just worse? Or are terrible diets more appealing? Maybe the sources of those terrible diets would be a better place to start imposing government violence.

SilasX3• 8 years ago

Did you see the diet? Another commenter posted it [1], and it has 132g carbohydrates. Doesn't seem like a small load (though it may be an improvement over what they're currently doing!). At 4 cal/carb [2], that's over half the diet's calories.

[1] https://news.ycombinator.com/item?id=18571000

[2] https://www.nal.usda.gov/fnic/how-many-calories-are-one-gram...

bad_user2• 8 years ago

AFAIK the standard American diet has about 250g of carbs. 132 grams of carbs is about the standard recommendation for T2 diabetes.

That said these recommendations are bullshit. If you have diabetes, you have an insulin problem and it's best to minimize it, so you need to eat the minimum amount of carbs you can get away with, prioritizing the complex carbs with fibers (e.g. spinach and other greens).

Btw, a low calories diet can work even if higher in carbs, because:

1. by losing weight insulin sensitivity goes up afaik

2. at 800 grams per day, that's not much to eat, so those people are probably fasting for much of that day

That's just a guess, but how you distribute your meals also matters just as much as what you eat.

isoskeles2• 8 years ago

How much of those carbs are fiber? I'm trying to find the direct quote and see if more information is there.

Although, given the description of it includes "fruit juice", I am guessing it is a lot of sugar, which seems weird but I can't admit to know enough to say this is bad.

I'd be interested in the efficacy of this sort of diet when applied to a large mass of people as opposed to a very low carb diet. The NHS can "prescribe" these diets, but people may not follow them. It's possible that having a moderate amount of carbs (as sugar) in the diet will actually decrease the chances of a person going in the complete opposite direction and binging on sugar after they get sick and tired of a very low carb diet. I'm curious if they study that effect and "risk" of diets.

a3n2• 8 years ago

When I was first diagnosed with T2 I did some reading around. Interesting history, especially pre- manufactured insulin.

For example, war is "good" for reducing incidence of diabetes, because famine.

pmiller2• 8 years ago

Two minor points: T2 isn’t controlled with insulin; it’s a syndrome of insulin resistance and other metabolic dysfunctions. And “manufactured insulin” came on the scene in 1922. Before that, T1 diabetes was universally fatal.

a3n2• 8 years ago

My T2 is not treated with insulin today, but it could be later if it gets worse. And I am indeed talking about history pre-20th century.

For example, diabetes used to be diagnosed by peeing on the ground and seeing if ants we attracted to it. According to whatever diabetes history book I checked out of a medical library on inter library loan.

known• 8 years ago

Could be feasible due to https://www.medicalnewstoday.com/articles/267241.php

jonteru• 8 years ago

This sounds pretty similar to some of the things Dr. Valter Longo has been mentioning in his book the longevity diet where a part of it are also occasional 5 day fasts with 800 calories, that (supposedly) have great benefits. Great to see this being tested with the general public.

gregf• 8 years ago

Ouch, this is going to be hard on me.

emersonrsantos2• 8 years ago

When people will realize that carbs are the only non-essential macronutrient? The sports community (especially bodybuilding) knows that for decades.

If an athlete says to me that a thing he does to his body work 95% of the time, I would consider to try it, and already did, some things against over-the-counter conventional medicine like this no-carb diet.

ryanwaggoner5• 8 years ago

Bodybuilders eat plenty of carbs.

sfotm2• 8 years ago

Not sure why this is being downvoted, bodybuilders do eat carbs - they just time them appropriately. If you're about to work out, carbohydrates will help you get through it. On the other hand, if you're going to be sedentary for a while, or you're really trying to prioritize fat loss, you probably wouldn't eat as many carbs.

Of course, Keto is a thing, but I haven't heard many stories of bodybuilders that actually target the keto-state. It's about getting the right amount of carbohydrates (hint: not as much as most people eat).

razakel• 8 years ago

No they don't. A bodybuilding diet is mostly protein, then certain fats, then starchy carbs at the right time (breakfast and post-workout).

barrow-rider• 8 years ago

Yeah brown rice is fairly popular. Chicken breast + broc + brown rice... for every meal. Oh and oatmeal.

i_cant_speel2• 8 years ago

Where is the connection you're making between carbs being unnecessary and bodybuilders coming from?

emersonrsantos2• 8 years ago

Bodybuilders use carbs restrictions (keto, intermittent, kind - complex vs simple carbs) to regulate muscle mass and fat, insulin and GH sensitivity, water retention mediated by glycogen, etc...

jlawson• 8 years ago

Traditional diets include lots of carbs. Bodybuilders realized early that protein is good for muscle growth. So they started eating tons of protein, and reducing other macronutrients. They realized after a while that carbs can actually be cut out totally and indefinitely (which is not true of protein and fat). They discovered this because nobody else had a reason to try to eat such a strange, protein-focused diet.

At least in modern societies. Of course the Inuit and other far-north peoples have known forever that one can live healthily off essentially nothing but meat.

have_faith3• 8 years ago

It's only non-essential because your body has backup mechanisms for when carbs aren't available, ketosis for instance. That doesn't mean it's an ideal state to be in constantly.

GordonS6• 8 years ago

That's an odd way to look at it - given we need fat and protein, I'd rather think that carbs were the 'backup' mechanism.

overgard2• 8 years ago

I'm dubious of the claim that ketosis is a "backup" system. If you think about primitive man, they probably wouldn't have had three regular meals a day. Lots of feast and famine.

I think people need to let go of the idea that ketosis is some sort of "special" state. It's just a metabolic state that's been suppressed by modern eating habits. Three meals a day and snacking is a cultural invention; not a biological necessity.

A lot of athletes prefer to exercise in a ketogenic state. I know personally I'm able to run farther if I've spent the day fasting than if I had a big meal at lunch. (I don't have the same initial burst, but I don't hit a wall either) (Not to mention that digestion is a very expensive process)

I think what's more unnatural is that modern eating habits are designed around blocking any sort of ketogenic state, which is where the easiest weight loss comes from. (Also, I need to lookup a reference for this, but I think I remember reading that fat burns a bit "cleaner" than sugars. Less free radicals I think? Something like that)

[For people unclear what I'm talking about with ketosis: basically, your body burns glucose first for energy. Then when there isn't sufficient glucose, it starts burning fat. The burning of fat for energy is what's known as ketosis. (I know I'm probably vastly oversimplifying). The thing about fat burning is it only kicks in at a significant level when glucose is depleted though. So if you're exercising while eating a chocolate bar and drinking a gatorade... well the exercise is good! But you won't lose weight)

nradov2• 8 years ago

The endurance sports community relies heavily on carbs, to the extent of often consuming sugar supplements during races and longer training sessions. Sure there are some endurance athletes who follow low-carb or even ketogenic diets, but they generally aren't able to compete at elite levels due to lower metabolic efficiency.

zackmorris• 8 years ago

I just want to second what you said. I started bodybuilding around 2000 and an old-school way to manage your insulin response is to separate your protein, fat and carbs into individual meals (and especially eat a high protein, high carb meal after working out).

That may have been a bit of a fad though. The single most important rule that I know of is to never mix an animal protein meal and sugar, because that creates triglycerides which harden your blood vessels. This single rule is why fast food is so bad. Cheeseburgers are fine, but add fries and a pop and you just blew it.

As I've gotten older, I've noticed that my need for carbs has diminished greatly. As a teenager, I frequently ate a bag of gummy worms and a 2 liter bottle of pop on weekends. That changed to a case of beer in college. Either of those sound untenable today though.

The single easiest bit of advice I could give someone to lose fat is to stop eating all white fluffies and all sugar. So eat peas, salads etc with each meal instead of corn/bread/potatoes. Then pump iron at least 3 times a week so your body is in a constant rebuilding mode.

You don't really need to watch your fat intake like they recommended 20 years ago either. Always opt for natural fats like avocado, peanut or almond butter and regular butter because you need those to rebuild your connective tissue.

The big secret that nobody ever tells young people is that bodybuilding is all about eating/exercising in ways that elevate your hormones, then strengthening your connective tissue. If you do those things, then muscle and endurance come automatically. If you don't do them, you'll always be emaciated and will eventually get injured.

noarchy• 8 years ago

The sports community (especially bodybuilding) knows that for decades.

While true, I would't say that everything bodybuilders are doing is worth following. Many pros do things that are extremely unhealthy. It isn't just the abuse of anabolics, but also insulin - which is relevant to what we're discussing here. There are bodybuilders with type 2 diabetes due to their unhealthy habits while trying to get bigger.

zavi• 8 years ago

How will they make sure people don't cheat and eat more anyways? 800 calories a day for an overweight person requires some serious will power.

rufus_2• 8 years ago

I found it easier to do via intermittent fasting and then eating all of my calories in one meal per day. Something about completely abstaining from food is easier for me psychologically than having multiple tiny meals and making myself stop eating when I'm not full.

sfotm2• 8 years ago

Thing is, 800 calories is a meal for a lot of people. Ever go to Chipotlé? Already over.

jobigoud2• 8 years ago

I was assuming these 800kcal were done through OMAD, are they not? I don't see how you could spread that over the day and keep your sanity.

tchaffee• 8 years ago

It's also easier for me. I have no problem skipping breakfast and then skipping lunch takes a little willpower but I'm often distracted by work. I have friends who find it easier to eat a big lunch as their only meal. Worth experimenting for each person to find what works best for them.

lilcorey102• 8 years ago

This sounds to be marketed as some scientific potion to cure diabetes or at least rid the need of medication. All it comes down to is cleaning up your diet (e.g. eating the right amount of calories for your body and eating nutrient rich foods). There's no one diet fits all but getting a good balance of proteins, carbs, and fats is all this is doing for these people. NHS is simply doing the leg work. I control my weight by counting calories and macro-nutrients. If people could figure out how to do that own their own we'd see a huge decrease in Type 2. It's true, a cleaner diet tends to be more expensive and requires more work than the convenience of a fast food diet - but at the the end of the day we're trading diabetes so we can be lazy with our diet and health.

ryanwaggoner5• 8 years ago

800 calories per day for three months is hardly just "cleaning up your diet".

SilasX3• 8 years ago

Exactly. This seems like an Onion headline: "We have your cure for diabetes! Just eat a ridiculously low amount of food, fatso."

I don't mean to sound like a whiner, but ... if it were that easy to cut down my food consumption, I wouldn't be going to a doctor in the first place!

It's like telling people with extreme loneliness or social anxiety to "just strike up a conversation with someone!" Or PTSD suffers: "Geez, just don't freak out so much, take a deep breath or something."

Or narcissists/sociopaths: "Just, you know, think more about how your actions hurt other people."

Given Herculean willpower, most diseases of civilization can be conquered. Don't pat yourself on the back for calling it "prescription".

lilcorey102• 8 years ago

Oh yes. Its a drastic cut in calories from what these participants consume normally. 800kcal is probably not sustainable long term unless you weigh 90lbs and are sedentary. This is just a quick fix. In the end these people need a lifestyle change and a diet they can stick to indefinitely.

ronreiter• 8 years ago

Or in other words: Type 2 Diabetes is a normal metabolic state of humanity (or at least some significant parts of it), it's just that we're too goddamn fat

make3• 8 years ago

? you mean, it's a consequence of being fat

megaman8• 8 years ago

It's great that they teach the idea that Diabetes (type 2) is preventable and even treatable with responsible eating habits. Too many people believe it's just something your doctor is supposed to treat with a pill.

Food companies often push the idea that all you need to do is exercise more. Whilst exercise might be a great thing: it alone can't fix the problem. You still need to learn how to eat.

acangiano3• 8 years ago

You absolutely don’t need such caloric restriction to revert diabetes. All it takes is a very low carb or keto diet. Even without exercise.

toddh• 8 years ago

At that calorie level it's basically a fast mimicking diet, so part of the benefit would be autophagy and the respawning of stem cells. It's hard to tell how much that helps however.

acangiano3• 8 years ago

That’s definitely a factor. That and the automatic reduction in carb intake with such a caloric restriction. I mean, if they fed them pure sugar, they’d still be getting “only” 200g of carbs per day which is still less than what a lot of people who developed diabetes used to eat. More realistically they are likely getting significantly less carbs per day with elements of fasting thrown in.

PerfectElement• 8 years ago

Or certain types of plant-based diets[1][2][3].

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/

2. https://www.omicsonline.org/open-access/diabetes-reversal-by...

3. https://www.ncbi.nlm.nih.gov/pubmed/20425575

onetimemanytime• 8 years ago

Problem is keeping it, as almost everyone can keep the diet for a few months. We all know what we should do but don't, sometimes until is too late.

The person that invents a pill to trick our genes not to seek what was once rare (fat, sweets, carbs etc) will be a trillionaire. When our current genes were stamped "we" maybe had to hunt for days to eat once. Now we drive to McDonalds, order our or open the fridge door. Maybe something that puts our metabolism on steroids?

acangiano3• 8 years ago

Right, but still significantly easier than staying on an 800 calorie diet.

RugnirViking• 8 years ago

Many drugs that put our metabolitism on steroids cause deaths from overheating - the energy has to go somewhere.

virtuallynathan• 8 years ago

The 800 calories they are eating doesn't seem terribly healthy: "patients were asked to follow either a ‘home-made’ milk- and fruit-juice-based diet (811 kcal/day, 64 g protein, 132 g carbohydrate, 6 g fat) with a multivitamin/mineral supplement (Forceval® [Alliance]), or a micronutrient-replete commercial LELD (832 kcal/day, 87 g protein, 120 g carbohydrate, 12 g fat).

I imagine these people are probably staving... I'd rather go low-carb myself.

This is the study, DiRECT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/

throwaway5752• 8 years ago

Cool. What about renal load?

vertline32• 8 years ago

So I guess back in the day, milk and bananas were considered an ideal food combination,

debacle• 8 years ago

A bowl of milk with bananas and about 1/4 cup of sugar. My grandpa ate that right up until he died. Man never gained a pound.

xd• 8 years ago

It's targeted at people with type 2 and are obese .. which is an ever increasing issue in the UK. The BBC don't like to rock the boat.

village-idiot6• 8 years ago

Generally agreed, but with a caveat: diabetics are at risk of ketoacidosis on low carb diets. They would need to measure their blood ketones and moderate carbohydrate intake to keep their levels down below dangerous thresholds.

Personally when I went low carb, I got blood (not urine) ketone levels up into the range that would kill a diabetic quickly, think in the 7.0 range. Even as someone well adapted I regularly hit the 3.0s when fasting.

Obligatory: I am not a doctor.

someone4543• 8 years ago

You dont get keto acidosis by eating low carb, that is misinformation.

cowpewter4• 8 years ago

Type 1 diabetics may be at risk for ketoacidosis if they screw up their insulin, but T2 diabetics are not at any risk from just a low-carb diet. The problem is having high blood sugar and high ketones simultaneously, not just having high ketones. And the nice thing about a low-carb diet is that you're not eating carbs, so your blood sugar does not become elevated. If your pancreas can still create insulin at all, you are highly unlikely to go into ketoacidosis.

Keto is a really good diet for both weight loss and correcting insulin resistance for a T2 diabetic.

(Source, I am a T2 diabetic that eats a ketogenic diet. I am losing weight and my A1c is dropping. My doctor is pleased with my diet choices.)

ng12• 8 years ago

ketone levels up into the range that would kill a diabetic quickly

That's not how it works. DKA happens because your body is burning fat because it's starving from a lack of insulin. Ketones from healthy weight loss are not dangerous.

epmaybe• 8 years ago

Usually type 1 diabetics (autoimmune, are more at risk for DKA. Type 2 diabetics can definitely be at risk for DKA, especially if insulin-dependent. However, they are at higher risk for hyperosmolar hyperglycemic coma, which is equally frightening.

It's definitely a risk, but not as much if your body is still making insulin to help provide your cells with at least some energy.

GordonS6• 8 years ago

It's going to be extremely difficult to confirm to 800 calories consisting almost entirely of carbs - very few people are going to succeed with this.

ryanwaggoner5• 8 years ago

Neither of those consist almost entirely of carbs.

cowpewter4• 8 years ago

This diet sounds miserable. You'd be hungry all the time. I would also much rather eat low-carb (and I do, I am a T2 diabetic that eats a ketogenic diet).

Which sounds more sustainable? Drinking 800 calories of milk and juice every day, or eating real food like steak and broccoli, or chicken with brussel sprouts, or bacon and eggs?

I am losing weight and reducing my A1c eating about 1300 calories of real food each day, and it doesn't leave me hungry at all. Keto is a very sustainable way of eating (in that you can keep doing it without misery). This "diet" looks like hell.

mattmanser• 8 years ago

A recent analysis posted here claimed that low carb, high animal protein/fat was the unhealthiest diet long term, resulting in a 4 year drop in life expectancy, compared to a 1 year drop with a high carb diet.

Low carb looks to be dangerous for your body long term if you have too much meat.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...

According to a recent documentary I saw on the BBC about this very diet, the point of the 800 diet is to lose weight asap and then introduce food back in gradually over 3 weeks (I think it was restoring one meal time a week, dinner, lunch, breakfast), in a controlled manner to teach you better food habits.

The documentary was focused on 4 normal people who had health problems due to weight, they all were trying this diet to see if it would help. One of them had just developed type 2. Wouldn't be surprised if that programme paved the way for this (it was on in June).

https://www.bbc.co.uk/programmes/b0b53xqs

wahern• 8 years ago

This diet sounds miserable. You'd be hungry all the time. I would also much rather eat low-carb (and I do, I am a T2 diabetic that eats a ketogenic diet).

Not eating anything, and only eating proteins and fats, are both difficult for me. And simply abstaining is actually easier. When I consume anything I begin craving not only carbs, but craving the stimulation of eating, period.

I think its finally uncontroversial to say that not all calories are the same. But eating is more than just the metabolic process; like smoking it's about the physical habits and stimulation. In that way eating chips is not much different than eating pork rinds, and for some people that's what matters most.

Remember the Master Cleanser and juice fast fads? People consuming nothing but raw sugar for days, weeks, and even months on-end derived similar benefits--weight loss, improved insulin sensitivity, etc. And for some people it was really easy because you could sip on your drink constantly throughout the day, which was in an important way the antithesis of abstinence. Not all calories are the same, but it's still the case that fewer calories are better. Just do whatever it takes to get you to fewer calories.

I'm not trying to equivocate diets--vitamins, minerals, and fiber still matter. But, again, calorie count is ultimately the most important metric. How you manage it is largely a matter of your personal tastes and lifestyle. Few people can manage a perfect diet, but there's a least bad diet for everyone, and they're often wildly different. And that's basically what the expert stated in the article--the powdered diet isn't for everybody, but it was important to begin offering alternatives to the "balanced diet" recommendations.

prrls• 8 years ago

A lot of people here are suggesting, like you, that a low-carbs diet or ketos can help your body "heal" from T2D. I just don't see why starving yourself from carbs, which is like the basis of life for your cells, is going to help. From what I gleaned here and there, T2D is more linked to fat-heavy diet, which clutters blood vessels and keeps yours cells from absorbing the insulin your body produces, thus preventing them from "disgesting" the carbs you sending to them, resulting in diabetes. Reducing all the cholesterol in your diet will help your body "cleanse" gradually from these plaques on your blood vessels.

I'm not doctor, nor a nutrionist, but this guy makes really good and sourced videos on these subjects:

On Keto: https://www.youtube.com/watch?v=MzHLAqyO7PQ

On carbs: https://www.youtube.com/watch?v=MyOACAdvAsE

I really recommend watching them. They're clearly oriented (duh), but still quite informative.

I'm sorry, my reply is a bit rushed and not that polished, but I really wanted to reply to see if anyone has something to say about this interpretation of carbs and T2D. (And it's damn late right now where I live!)

leroy_masochist• 8 years ago

Those videos were painful to watch (what's up with his intonation, it sounds like he's introducing prizefighters) and the guy looks anorexic and anemic; not someone from whom I'd take nutritional advice.

someone4543• 8 years ago

T2 is related to glucose ingestion(sugar, carbs) NOT fat. Glucose spikes your insulin, and the continued, extreme spiking of insulin is what causes T2.

LocalPCGuy• 8 years ago

Bodies can run on ketones (byproduct of breaking down fats) or glucose. I'm not sure where you got the information that T2 is related to fat heavy diet, that is not true at all. It can be related to bring fat, for to complications with obesity. It is related to glucose spikes, which causes insulin spikes, but the T2s body is insulin resistant and so sugar and insulin stay in the blood stream and can't be utilized. High sugar in the blood is the cause of most T2 chronic issues.

Also of note, a recent study has found that ingestion of cholesterol does not correlate with how much is in your blood.

raverbashing• 8 years ago

I'm betting that diet was vetted by a qualified dietitian/nutrition specialist.

GordonS6• 8 years ago

I've seen a qualified dietitian working for the NHS - she hadn't a clue about what kind of diet someone with blood sugar problems should eat. Unfortunately, this has been my (even more unfortunately) wide and varied experience of several NHS consultants across different specialisms - their knowledge hasn't been updated since they left medical school, and what they were taught at medical school was 20 years out of date when it was taught.

surge2• 8 years ago

Hasn't every study prior said fasting (especially combined with low carb diet in between) is far better than low calorie, because your body makes different adjustments to lack of food rather than some food and you actually end up worse on a low calorie diet because your body isn't getting the full amount of nutrients and calories it wants/needs but doesn't make the adjustments it'll make for brief periods of lack of food.

ak393• 8 years ago

I am not a doctor. This is what I have learned so far (there are no references here - sorry, I will need to dig up the material to substantiate this if you ask):

The upshot: Managing diet is not sufficient (for type 2) remission. The damage is at cellular level. That damage needs to be reversed. Therefore muscles need to be rebuilt. Even for the over 60 years!

The thinking: Diabetes Type 2 is the end point of years of abuse the body endures with elevated insulin and the _extent_ of insulin resistance the body progresses to. Diabetes therefore is a spectrum - the end point is when the pancreas bonks out and refuses to produce any more insulin. It's a tiny tiny organ and I think it's fragile. And it's threshold is also genetically determined. The interesting thing is that we all (including healthy folks) have levels and sometimes acute bouts of insulin resistance! The thing that made sense to me, reading about this, was that insulin resistance is a function of your muscle cells denying entry to glucose. And the insulin concentration in the bloodstream is a direct function of the concentration of free flowing glucose. Poor Pancreas is only doing its job but the muscles are not taking in any new glucose. They are refusing (resistant). Pancreas tries its best by pumping more insulin and for longer but the adamant muscles are the contract breakers in this arrangement - they don't open the gates for glucose.

The only way to change direction permanently in type 2 is to rebuild muscles which will have better insulin receptors to allow glucose to be shunted into the cells. For this to happen you have to do strength training. Lift sufficiently heavy. (No, not Arnie levels by any measure.)

(I recently read a study that administering testosterone to type 2 diabetics improved their insulin resistance. What happens with testosterone and anabolic steroids? New muscles, that's what.)

matt40773• 8 years ago

Yeah... Also get a lawyer, quit Facebook, and start dressing for the job you want!

ak393• 8 years ago

I don't quite understand.

garenp4• 8 years ago

About 3 years ago (late 2015 now) I was quite overweight, had a knee injury that limited my mobility (stairs mostly) and had a fasting glucose and post-meal readings that indicated I was nearly pre-diabetic (T2).

So, I cut out out all sugary drinks, refined carbs, late night eating (!!) and tried various intermittent fasting / time restricted feeding techniques (5:2, alternate day, one-meal-a-day) and after about 3.5 months my glucose readings returned to the "normal" range. (Which is WAY more tolerable than sticking to a low-calorie diet every single day IME. I still had pizza and cheeseburgers on occasion, just no soda, fries, "junk" etc.)

After around 6-7 months I'd lost 40+lbs, my knee stopped bothering me and no longer had to entertain the idea of fixing it with surgery. I'm now down well over 60+lbs without having put in hardly any effort to exercise (occasional walking) - pretty stunning to me.

illiac_1962• 8 years ago

Same thing here. Except I also refuse any refined flour, Co sidering it sugar. I only eat whole foods, no milk, very little cheese, barely any meat. Lots of vegetarian meals. Dropped 50+ lbs without much drama. I cycle extensively in the warm summer months.

costcopizza• 8 years ago

Congrats! What fasting method do you currently use, or do you switch between the ones listed?

garenp4• 8 years ago

Nowadays I mostly just do OMAD (one-meal-a-day) or close to it (eating window is about 1-3 hours) as it's simpler. Initially some will power was needed to stop myself from snacking in the evenings, but as long as I make sure I have a fair amount of protein in that one meal, it never seems to happen now. Occasionally I'll do alternate-day if I feel 'stuffed' or had a big day of lots of calories (holidays, social events) - whatever is more convenient at the time.

GFischer• 8 years ago

I'm also interested (about to start my own diet but I hate non-varied diets). Any fasting method worked better than others?

mevile• 8 years ago

That's great! That's actually very inspiring. Good work! I do think that exercise is really important and that's something everyone should do.

Sohcahtoa82• 8 years ago

I'm now down well over 60+lbs without having put in hardly any effort to exercise (occasional walking) - pretty stunning to me.

Losing weight despite not exercising isn't surprising. Exercise, even intense cardio, burns far fewer calories than most people think. I'm about 240 lbs, 5'8", 36 years old, and according to this calculator [0], if I ran a 5k at a fast-paced 10 mph (6 minute mile), I'd only burn about 250 calories. That wouldn't even be enough to burn the calories in the energy drink I might drink before it!

Great work on the weight loss. I was 255 lbs at the beginning of the year and switched out my sugary sodas for unsweetened tea or occasionally a diet soda and lost 15 lbs in 4 months. I plateaued because I haven't changed much else.

[0] https://www.freedieting.com/calories-burned

jaegerpicker• 8 years ago

Most exercise based weight loss isn't about the actual exercise it's about the changes the intense exercise makes to your body that causes you to burn more calories while resting. Exercise often tunes your body to burn calories at a higher rate as you gain muscle and / or increase muscle health which requires more energy to support even while resting. So while you don't NEED exercise to lose weight it certainly is a super important part of weight lose for most people.

nimmy2• 8 years ago

I was curious to check out your source because I'm 5'8, 130 ish pounds and my 10 min mile 5k only burns a little bit less than 250 calories, which I thought wasn't a big enough calorie difference for the difference in weight. I put your stats in for an 18 minute run and it came up as 350 calories. Am I putting something in wrong?

GeekyBear2• 8 years ago

I lost at least that much weight after cutting the sugar and refined carbs out of my diet, without any fasting or increase in physical activity.

I did take up cooking my food from scratch as a hobby, so I was avoiding processed foods and eating out as well.

parliament32• 8 years ago

It's ridiculous just how terrible refined carbohydrates are for people. There are countless accounts of people losing weight and getting healthier by simply reducing refined sugars in their diet. It's surprising that this isn't common knowledge yet, although I guess we're fighting Big Sugar here.

I field countless questions about diet on a regular basis, and honestly the #1 tip isn't about calorie reduction or low carb or any gimmicks... it just comes down to "start cooking your own food, from real ingredients". Buy fresh meat and produce and go from there. Weight loss and health will come naturally, because real food is far more satiating than the calorie-and-sugar-dense snacks the western world is used to eating.

msiyer2• 8 years ago

My mother suffered Type-2 diabetes for almost 20 years. I put her on an extremely strict raw food diet three months ago and stopped injecting insulin. Her fasting blood sugar level is now in the 90-110 mg/dL range. I now give her some steamed potatoes also.

I too follow the same diet to give her company.

Elimination of oil, sugar and dairy has helped, I believe. She is a vegetarian, so flesh was never in the picture. I do not have to restrict calories with raw food. Eat as much as you can.

No juicing, however. That is a totally not allowed.

nradov2• 8 years ago

I'm glad your mother is improving, but there's no real evidence that raw vegetables are better for blood sugar levels than cooked vegetables.

msiyer2• 8 years ago

Raw fruits are what I feed her. No vegetables at all. I started giving her some steamed potatoes recently. Bananas have become her staple food.

ryanwaggoner5• 8 years ago

Loving the broscience takedowns of this NHS pilot program about how "this won't work!", or "low carb / keto is the best way!"

If only doctors knew how to read internet forums, then they'd be as knowledgable as all the armchair docs here, few (none?) of whom seem to have any actual training or T2 diabetes themselves.

rkiyer• 8 years ago

The 800 calories number indicates that this might be related to the Fasting Mimicking Diet of Valter Longo. Since actual fasting has a "scary" reputation among some patients and doctors, Valter Longo developed a 5 day fasting like protocol with severely restricted calories that appears to have similar benefits to fully fasting for 5 days. It looks like this modified version of complete fasting is gaining popularity among the medical establishment.

https://en.wikipedia.org/wiki/Valter_Longo#Fasting_mimicking...

https://www.marksdailyapple.com/does-the-fasting-mimicking-d...

tacon2• 8 years ago

Type 2 diabetes is currently on track to bankrupt the world's healthcare system. Easily 60% of the US residents reading this comment are already insulin resistant, they just don't know it yet. Many of those will progress to full blown T2DM in ten to fifteen years. It used to take a very expensive sequence of blood tests involving injecting glucose and tracking the concentrations of glucose and insulin over a few hours. Lately the tech has improved and there is a single blood test that can give an "insulin-resistance score", LP-IR[0][1]. While Peter Attia showed this test in a blog post from 2012[2], it seems to be getting more attention lately[3]. Just because your blood glucose after fasting is "normal" does not mean you will not get T2DM. Just ask Tim Noakes, world class exercise scientist and medical doctor, who finished more than 70 marathons and still woke up one day with diabetes, just like his father.[4][5]

[0] https://www.labcorp.com/test-menu/31976/nmr-lipoprofile%C2%A...

[1] https://www.walkinlab.com/media/attachment/file/1/2/123810.p...

[2] https://peterattiamd.com/the-straight-dope-on-cholesterol-pa...

[3] https://www.managedcaremag.com/archives/2018/4/new-test-diag...

[4] https://www.diabetes.co.uk/in-depth/tim-noakes-challenging-d...

[5] https://www.amazon.com/Lore-Nutrition-Challenging-convention...

voidbip• 8 years ago

In July I was 203 pounds which for a 5'6" frame, put me in the "obese" category. It was the highest weight I had ever been, and I felt I occupied more space than I should in the world ( not in a good way ). I follow a youtuber on Indian cooking and for whatever reason this woman mentioned how she recently started eating in a more "Keto" way. This woman is thin as a rake. She mentioned she was doing this for mental clarity. On a whim, I decided to try it. I literally threw the little debbie box I had my hand in, in the garbage that day. Today, I am 166 pounds, still "overweight" but this is the most amount of weight I have ever lost. I feel so much better and healthier, and its true about the mental clarity. My unsubstantiated hypothesis is that it takes away the emotional swings insulin give you. I eat till I am full. Honestly. There is not a day that I "think" about what I am eating other than keeping sugar and carbs out my month. I could not be happier. I am a 38 yo technology professional, and I imagine many others here are similar. I have nothing to sell. I just want to make people aware of a lifestyle that may help many of us who sit all day for a living.

GreaterFool• 8 years ago

From what I've read about starving yourself vs fasting and my own experience 800-calories sounds like HELL.

I can fast for 2 weeks no problem (although that's kinda long and I wouldn't do it if I didn't have enough body fat to sustain it. If you're skinny and don't have fat to spare better not stretch it unnecessarily).

I'm eating keto and I usually only eat once a day.

Fasting feels good. Starving yourself feel horrible.

Type 2 diabetes: NHS to offer 800-calorie diet treatment

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