The anti-establishment is failing people!

[beating_my_betes]

https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(24)00808-8/fulltext

 

[JITR]

For those of us lucky enough to have no other complications, I'd say losing sufficient weight and keeping it off by any sensible means will enable us to stay in remission for years.

Quoting averages in studies like these is all very well. What really matters is what those who succeeded and failed did, and did not do.

 

[beating_my_betes]

What really matters is what those who succeeded and failed did, and did not do.o

I disagree. Of course, success leaves clues, and modelling behaviour from those who are succeeding is a good idea. But none of that will make up for not wanting to do something in the first place.
And evidently, the people who dropped off last had enough knowledge and awareness to have been successful for the first four years.

 

[Eddy Edson]

As Gil says, yet another demonstration that most diets don't work over more than the shortest timeframes for most people. And anecdotes are pretty much worthless as a clue to whether something will work for you. That's true even if the message is "this is something that works for many people" (eg, the Freshwell type messaging), because it generally results just from the collected anecdotes of minorities for whom something was successful ading their voices together.

Keto - fine. Low fat - fine. Mediterranean/DASH/UK guideliens - fine. Youc an eat healthily with any of these patterns; none is particularly better than the others; for many people, in the current environment, it's just not possible to stick to any of them.

(Gil really is a rare Internet treasure.)

 

[beating_my_betes]

As Gil says, yet another demonstration that most diets don't work over more than the shortest timeframes for most people. And anecdotes are pretty much worthless as a clue to whether something will work for you. That's true even if the message is "this is something that works for many people" (eg, the Freshwell type messaging), because it generally results just from the collected anecdotes of minorities for whom something was successful ading their voices together.

Keto - fine. Low fat - fine. Mediterranean/DASH/UK guideliens - fine. Youc an eat healthily with any of these patterns; none is particularly better than the others; for many people, in the current environment, it's just not possible to stick to any of them.

(Gil really is a rare Internet treasure.)

Exactly! The data, along with countless anecdotes, verify that all diets will work for a certain proportion of people. Unfortunately, the current prevailing voices and rhetoric flies contrary to this truth. A tremendous disservice has been done and continues to be done to countless thousands of people due to ignorance and/or profit.

And yes, Gil is one of a handful (or two) of people involved in the more popular side of the current nutrition movement who has the integrity (scientific or otherwise) and epistemic standards to be worth listening to.

 

[Satan’s little helper]

Unfortunately, the current prevailing voices and rhetoric flies contrary to this truth.

Hello, I’d like to also add from some of my T1 camp. Blind virtue signalling. Even the rhetoric switches narrative to suit the post or topic. However. Where do you see yourself in five years?

 

[JITR]

Exactly! The data, along with countless anecdotes, verify that all diets will work for a certain proportion of people. Unfortunately, the current prevailing voices and rhetoric flies contrary to this truth.A tremendous disservice has been done and continues to be done to countless thousands of people due to ignorance and/or profit.

@beating_my_betes,

An exploratory question. How do you think we/they can we redress this disservice?

 

[beating_my_betes]

@beating_my_betes,

An exploratory question. How do you think we/they can we redress this disservice?

The simple answer would be (Re)education for doctors, with the intention of facilitating (somewhat) patient-led plans.

Unfortunately there are so many obstacles to this as to make such a top-down approach nigh on impossible. A bottom-up approach would perhaps have a slight possibility, but my experience, and that of many others, suggests that to be a Sisyphean and Brandolini-induced nightmare.

 

[JITR]

The simple answer would be (Re)education for doctors, with the intention of facilitating (somewhat) patient-led plans.

I agree, more to come ...

 

[beating_my_betes]

I agree, more to come ...

No need to rush. Pretty snowed under at the mo 🙂

 

[JITR]

The simple answer would be (Re)education for doctors, with the intention of facilitating (somewhat) patient-led plans.

I agree. Off the top of my head, based on my experience, some elements of the way to redress the current situation (relating to 'dietary T2D') include:

1. General recognition that developing a fatty liver is the precursor to many conditions and diseases, notably cardiovascular and T2D. Common signs of fatty liver are an increase in waist size and HbA1c rising from the 30s into the 40s (mmol/mol).
2. Persuading everyone to pay attention to their waist size and HbA1c test results. This means tests must be available on demand, say annually.
3. Publication of 'official guidance' on diet, exercise and lifestyle measures, especially weight loss and maintenance, to avoid reverse their condition as soon as they can, whether pre-diabetic or T2D. This guidance to be prepared in a 'concerted action' by experts with up to date knowledge in their field and first rate publishers of printed and online media. Dietary guidance to cover a range of healthy sustainable diets. These publications to be aimed at the public and health care professionals alike. Regular updates, say annually.
4. Recognition by the public and professionals that everyone is responsible for their diet and health. This means the current model of professionals delivering treatment (and pills) to patients should be extended to one of partnership in recovering and maintain their health. Wherever possible, the WHO ' Hearts' protocol of agreeing targets for diet, exercise and lifestyle programmes before medication is considered

 

[beating_my_betes]

Thanks for your thorough an considered answer!

1. General recognition that developing a fatty liver is the precursor to many conditions and diseases, notably cardiovascular and T2D. Common signs of fatty liver are an increase in waist size and HbA1c rising from the 30s into the 40s (mmol/mol).

I agree. However, efforts will need to combat the various false narratives surrounding certain supposed causes of NAFLD as well as the misinformation given to explain increasing waist size.

2. Persuading everyone to pay attention to their waist size and HbA1c test results. This means tests must be available on demand, say annually.

Agree! I'd suggest HbA1c and OGTT are far more important measures than meal BG testing and cgm use. Not that home testing can't be informative, but the results are extremely flawed and reductionist, and within the current nutritional environment can lead to similar false narratives

3. Publication of 'official guidance' on diet, exercise and lifestyle measures, especially weight loss and maintenance, to avoid reverse their condition as soon as they can, whether pre-diabetic or T2D. This guidance to be prepared in a 'concerted action' by experts with up to date knowledge in their field and first rate publishers of printed and online media. Dietary guidance to cover a range of healthy sustainable diets. These publications to be aimed at the public and health care professionals alike. Regular updates, say annually.

The guidance is already there, but imo it's not explicit enough in certain areas and perhaps overly so in others. And the more I think about it, the more I think it's about diet and not dietS. That's not to say there is ONE DIET to feed them (us) all, but that we should leverage everything that is known about human behavioural psychology as it pertains to diets/dieting, to guide people to what they're most likely to succeed with, while offering the tools to accomodate any change at any time. As I said: patient led.

4. Recognition by the public and professionals that everyone is responsible for their diet and health. This means the current model of professionals delivering treatment (and pills) to patients should be extended to one of partnership in recovering and maintain their health. Wherever possible, the WHO ' Hearts' protocol of agreeing targets for diet, exercise and lifestyle programmes before medication is considered

I generally agree. Though I think medication can play a fundamentally useful role, especially in the beginning, by way of a safety-net. What does need to change is the idea that certain medications need to outstay there need. But within a system change in which pharma, doctors and patients work together this would presumably be a natural result. Its quite the change, though 😉

 

[JimmyBlue]

I found the video interesting and can see that the issue of continuing a diet is likely to result in a drop off over time as people become bored or some guru comes along and offers you the chance to eat what you want without impacting your BG levels.At the same time both the video and some of the comments also act as a false narrative. While the exception, not all diabetes patients have a weight or waist problem and the suggestions that they move to low carb diets really needs to be supported with help on what that means in terms of the need to include more fats and possibly increase the amount of protein so as to mitigate the loss of the carbs.
From my perspective the other big issue is that this is talking about diets, but what is a diet is it simply an exercise in weight management? Or is it actually moving people into a new lifestyle where their food choices and tastes are changed to become the new norm?
For me moving to low carb (<130g/day) has been beneficial and in doing so I have worked with my wife to identify meals that I will enjoy eating on a regular basis going forward. I believe I can maintain my new lifestyle as I have a desire to continue living relatively healthily to enjoy my retirement and I am not on a diet simply moving to a new set of meals that I enjoy that replace the old ones that weren't doing me any favours.
What I still need is the nutritional guidance that helps me maintain (or even add to) my weight as the weight loss due to not understanding the low carb diet has caused me some issues. Whether I get this from a doctor, diabetes nurse or nutritionist I just want someone who can present the right options without feeling the need to push their particular agenda as to what they think is good for me, rather let me determine what works for me so I can build it into my life so it becomes second nature.

 

[JITR]

What I still need is the nutritional guidance that helps me maintain (or even add to) my weight as the weight loss due to not understanding the low carb diet has caused me some issues. Whether I get this from a doctor, diabetes nurse or nutritionist I just want someone who can present the right options without feeling the need to push their particular agenda as to what they think is good for me, rather let me determine what works for me so I can build it into my life so it becomes second nature.

After my diagnosis and reading Prof Roy Taylor's book, I decided to adopt a <= 800 cal/day real food diet to get my blood glucose back to normal. Problem was I had not the slightest idea about macro and micro nutrients. So I downloaded the free version of Cronometer to record what I was eating and keep them on track.That did the trick for me. Now I am in weight maintenance. Together with some '5:2' fasting it helps me keep my weight in the target range and my nutrients in balance.

There is a pro version of Cronometer for professional dieticians, nutritionists and other professionals to monitor their patients. For an example, see Marty Kendal's Optimising Nutrition

 

[beating_my_betes]

I found the video interesting and can see that the issue of continuing a diet is likely to result in a drop off over time as people become bored or some guru comes along and offers you the chance to eat what you want without impacting your BG levels.

On the whole, peope don't really like being forced into restrictions, especially if they're being told those restrictions need to be for the rest of their lives.

At the same time both the video and some of the comments also act as a false narrative.

Such as...?

While the exception, not all diabetes patients have a weight or waist problem and the suggestions that they move to low carb diets really needs to be supported with help on what that means in terms of the need to include more fats and possibly increase the amount of protein so as to mitigate the loss of the carbs.

The theory is that the level of overweight necessary before it starts getting stored ectopically, is different for everyone i.e the "personal" part of 'persona; fat threshold'. And whole eaistline might give a rough indication, only medical testing would be able to really determine the existence and extent of NAFD.

Either way, unless you're walking 'round with a physique like this:



you'll likely have more than enough fat surplus to carry through small bouts of famine. And it's certainly possible. in such a case, to exceed one's own pft

Also, it's possible to use fat and protein to mitigate the loss of carbs. Carbs are very much their own thing, and are very important.

From my perspective the other big issue is that this is talking about diets, but what is a diet is it simply an exercise in weight management? Or is it actually moving people into a new lifestyle where their food choices and tastes are changed to become the new norm?

Although the word has become synonymous with weight-loss, a 'diet' is just a way of describing a way of eating
e.g low-fat, ketogenic, plant-based etc. These are all just diets. Of course, one can be doing a weight-loss or weight-gain diet, and any of the aforementioned diets can form the basis of such a thing.

For me moving to low carb (<130g/day) has been beneficial

Great! You might be one of the many who finds it sustainable. But i'm curious: Are you crediting the reduction of carbs for the benefits?

I believe I can maintain my new lifestyle as I have a desire to continue living relatively healthily to enjoy my retirement and I am not on a diet simply moving to a new set of meals that I enjoy that replace the old ones that weren't doing me any favours.

Not to take aything away from your success, but the sentiment you've expressed here is no different to what most people want. Wanting it doesn't guarantee the success. If it did, nobody would have ongoing issues.

What I still need is the nutritional guidance that helps me maintain (or even add to) my weight as the weight loss due to not understanding the low carb diet has caused me some issues. Whether I get this from a doctor, diabetes nurse or nutritionist I just want someone who can present the right options without feeling the need to push their particular agenda as to what they think is good for me, rather let me determine what works for me so I can build it into my life so it becomes second nature.

You've aready been recommended Cronometer, which is a great way to get an expanded view on nutrition. And despite the huge amount of mi/disinformation in the nutrition space(s) there are a few people who you could follow to get agenda-less advice.

 

[CliffH]

On the whole, peope don't really like being forced into restrictions, especially if they're being told those restrictions need to be for the rest of their lives.



Such as...?



The theory is that the level of overweight necessary before it starts getting stored ectopically, is different for everyone i.e the "personal" part of 'persona; fat threshold'. And whole eaistline might give a rough indication, only medical testing would be able to really determine the existence and extent of NAFD.

Either way, unless you're walking 'round with a physique like this:

View attachment 32927

you'll likely have more than enough fat surplus to carry through small bouts of famine. And it's certainly possible. in such a case, to exceed one's own pft

Also, it's possible to use fat and protein to mitigate the loss of carbs. Carbs are very much their own thing, and are very important.



Although the word has become synonymous with weight-loss, a 'diet' is just a way of describing a way of eating
e.g low-fat, ketogenic, plant-based etc. These are all just diets. Of course, one can be doing a weight-loss or weight-gain diet, and any of the aforementioned diets can form the basis of such a thing.



Great! You might be one of the many who finds it sustainable. But i'm curious: Are you crediting the reduction of carbs for the benefits?



Not to take aything away from your success, but the sentiment you've expressed here is no different to what most people want. Wanting it doesn't guarantee the success. If it did, nobody would have ongoing issues.



You've aready been recommended Cronometer, which is a great way to get an expanded view on nutrition. And despite the huge amount of mi/disinformation in the nutrition space(s) there are a few people who you could follow to get agenda-less advice.

On the whole, peope don't really like being forced into restrictions, especially if they're being told those restrictions need to be for the rest of their lives.



Such as...?



The theory is that the level of overweight necessary before it starts getting stored ectopically, is different for everyone i.e the "personal" part of 'persona; fat threshold'. And whole eaistline might give a rough indication, only medical testing would be able to really determine the existence and extent of NAFD.

Either way, unless you're walking 'round with a physique like this:

View attachment 32927

you'll likely have more than enough fat surplus to carry through small bouts of famine. And it's certainly possible. in such a case, to exceed one's own pft

Also, it's possible to use fat and protein to mitigate the loss of carbs. Carbs are very much their own thing, and are very important.



Although the word has become synonymous with weight-loss, a 'diet' is just a way of describing a way of eating
e.g low-fat, ketogenic, plant-based etc. These are all just diets. Of course, one can be doing a weight-loss or weight-gain diet, and any of the aforementioned diets can form the basis of such a thing.



Great! You might be one of the many who finds it sustainable. But i'm curious: Are you crediting the reduction of carbs for the benefits?



Not to take aything away from your success, but the sentiment you've expressed here is no different to what most people want. Wanting it doesn't guarantee the success. If it did, nobody would have ongoing issues.



You've aready been recommended Cronometer, which is a great way to get an expanded view on nutrition. And despite the huge amount of mi/disinformation in the nutrition space(s) there are a few people who you could follow to get agenda-less advice.

.... and Bruce Lee died at the age of 32 😱

 

[JimmyBlue]

@beating_my_betes Thanks for your response and your informative commentary in response to my original post. I think that there is a common ground between us in that telling people they need to go on a diet as opposed to talking to them about changing what they eat leads to possible negativity and resistance particularly when taking away everything they enjoy. However, receiving guidance and how to change what you eat and leaving in the options to occasionally have what you enjoy may have a more positive response.

As for the false narrative, the presenter referred to Keto diets (<50g of carbs per day or lower) and low carb diets (<130g carbs per day) throughout the video but clearly there is a big difference between the two types of diet. Additionally reading through a blog from 2019, the researchers seemed to imply that in calculating their success rates, they used the total number of participants from day one deeming those who dropped out as not meeting remission or recovery. It would seem odd to change this approach at the end of five years as it would massively skew the results. However without seeing the full final report I cannot really state categorically whether the results at 5 years used the starting total or the number who were left.

While I am certainly targeting a Bruce Lee like physique, at 63 I am not sure I have it in me to do the level of exercise to achieve it. That said diabetes is not a one size fits all illness and therefore the steps to be taken to get to remission will be different for everyone. However, the suggestion from my medical team is that moving to a low carb (not Keto) diet has resulted in positive results. And reading through comments on this site, it certainly appears that weight loss (for those who need it) can improve their health position even if it does not lead to remission.

With regards to my own position, it would be fairer to say that through ignorance and lack of knowledge about what being on a low carb diet means and how to adjust the amounts of what I eat to reflect the lower volume of carbs, my move to a low carb diet actually created new problems for me. I could have done without losing the extra stone, my ketone levels might not have triggered a suite of additional invasive tests and I might have maintained my initial burst of energy.

Apps are only as good as the input and output. And while a calorie counter is useful, if like me you don't know what all the numbers mean in terms of the objective then you end up in no better situation. In my case the issue was that I cut out the carbs, worried about how many I was eating and didn't address the need to replace them with fat and protein. Hence my ketone issue and weight loss. On the benefits side of the equation I have seen steady improvements in the level of BG before and after meals and the two CGMs I have used have both showed that in the main my BG is between 5.4 and 6.5. I'd like to think that is a big improvement from the HbA1c of 10.6% that I saw in my blood test back in September but until my next HbA1c in January, all I can do is keep working at what I have been doing for the last couple of months.

In terms of maintaining what I am doing, I substitute what I can (pasta for red lentil pasta, black bean noodles for rice or egg noodles, etc.) which allows me to eat many of the meals I have been eating for the past 25 years or more. Potato went as a carb back in the 80s.

What does annoy me and means that some aspect of my eating habits might not be sustainable, is having to count calories, protein, fats, etc. But if I don't have to do that and know that by not eating certain food stuffs I can continue to avoid it then the pressure and hassle of sticking to a certain diet becomes much easier. Making the healthy substitutes more common and less expensive is also a plus, not necessarily for me but for many people in the world who don't have access or incomes to support such changes.

As for Bruce, his death spawned a significant number of conspiracy theories but apparently he died of an allergic reaction to medication (painkillers and muscle relaxant), but who knows?

 

[CliffH]

@beating_my_betes Thanks for your response and your informative commentary in response to my original post. I think that there is a common ground between us in that telling people they need to go on a diet as opposed to talking to them about changing what they eat leads to possible negativity and resistance particularly when taking away everything they enjoy. However, receiving guidance and how to change what you eat and leaving in the options to occasionally have what you enjoy may have a more positive response.

As for the false narrative, the presenter referred to Keto diets (<50g of carbs per day or lower) and low carb diets (<130g carbs per day) throughout the video but clearly there is a big difference between the two types of diet. Additionally reading through a blog from 2019, the researchers seemed to imply that in calculating their success rates, they used the total number of participants from day one deeming those who dropped out as not meeting remission or recovery. It would seem odd to change this approach at the end of five years as it would massively skew the results. However without seeing the full final report I cannot really state categorically whether the results at 5 years used the starting total or the number who were left.

While I am certainly targeting a Bruce Lee like physique, at 63 I am not sure I have it in me to do the level of exercise to achieve it. That said diabetes is not a one size fits all illness and therefore the steps to be taken to get to remission will be different for everyone. However, the suggestion from my medical team is that moving to a low carb (not Keto) diet has resulted in positive results. And reading through comments on this site, it certainly appears that weight loss (for those who need it) can improve their health position even if it does not lead to remission.

With regards to my own position, it would be fairer to say that through ignorance and lack of knowledge about what being on a low carb diet means and how to adjust the amounts of what I eat to reflect the lower volume of carbs, my move to a low carb diet actually created new problems for me. I could have done without losing the extra stone, my ketone levels might not have triggered a suite of additional invasive tests and I might have maintained my initial burst of energy.

Apps are only as good as the input and output. And while a calorie counter is useful, if like me you don't know what all the numbers mean in terms of the objective then you end up in no better situation. In my case the issue was that I cut out the carbs, worried about how many I was eating and didn't address the need to replace them with fat and protein. Hence my ketone issue and weight loss. On the benefits side of the equation I have seen steady improvements in the level of BG before and after meals and the two CGMs I have used have both showed that in the main my BG is between 5.4 and 6.5. I'd like to think that is a big improvement from the HbA1c of 10.6% that I saw in my blood test back in September but until my next HbA1c in January, all I can do is keep working at what I have been doing for the last couple of months.

In terms of maintaining what I am doing, I substitute what I can (pasta for red lentil pasta, black bean noodles for rice or egg noodles, etc.) which allows me to eat many of the meals I have been eating for the past 25 years or more. Potato went as a carb back in the 80s.

What does annoy me and means that some aspect of my eating habits might not be sustainable, is having to count calories, protein, fats, etc. But if I don't have to do that and know that by not eating certain food stuffs I can continue to avoid it then the pressure and hassle of sticking to a certain diet becomes much easier. Making the healthy substitutes more common and less expensive is also a plus, not necessarily for me but for many people in the world who don't have access or incomes to support such changes.

As for Bruce, his death spawned a significant number of conspiracy theories but apparently he died of an allergic reaction to medication (painkillers and muscle relaxant), but who knows?

Perhaps a Carl Douglas physique would be healthier: he's still going strong