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Mainstream Type 2 Diabetes Advice

Being a self-admitted advocate of fasting, I do despair at some of the persistent mainstream advice when it comes to dealing with type 2 diabetes. For example, on the one hand, the British Medical Journal published a study in 2017 which showed how men used IF to reverse their condition in weeks (one subject in 5 days). These guys were past the metaformin stage and were using insulin - and this was the results on IF where they were still ingesting food.

Fast forward three years and this is the current diet advice from the NHS for type 2 sufferers:

"There’s nothing you cannot eat if you have type 2 diabetes, but you’ll have to limit certain foods.

You should:

  • eat a wide range of foods – including fruit, vegetables and some starchy foods like pasta

  • keep sugar, fat and salt to a minimum

  • eat breakfast, lunch and dinner every day – do not skip meals"

It sadly forecasts that this is a “life condition” and that you will be put on metaformin, and then possibly insulin after a few years when the drugs cease to be effective.

So there you have it, you can have your cake and eat it, in moderation, but, more importantly, just make sure you do so and don’t skip those meals!

Why is that wrong though?

Those are solid recommendations that will do a fair bit of good if not taken to extremes.

Now if some numbnut hears that and thinks “Oh, I can eat starchy foods!” and proceeds to pound 3500 calories of buttery baked potatoes down his piehole every day, then it isn’t the recommendations that are fucked up, is it?

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I think OP is frustrated because the medical leaders are essentially telling people how to manage the condition, instead of approaching T2DM with the goal of reversing/curing through diet and exercise interventions.

I.E. their expectation is that you live with it forever, despite the fact that insulin resistance is reversible.

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Probably part frustration and part conspiracist mindset that ‘fasting doesn’t sell’ compared to the multi-billion dollar pharma trade.

I have witnessed registered dietitians advise pregnant women with gestational diabetes to “eat whatever they like” and “you must eat carbs” and “don’t worry, the minute you give birth the diabetes will go away.” To me, it is borderline medical malpractice.

Type 2 is a huge issue for society now but unless we move away from the mainstream it’s not going to get any better anytime soon.

This is a difference between a laymen understanding of medicine and a physicians.

I have CHF, and was diagnosed with it in June after a big STEMI.

I can run further and faster than I’ve been able to for 20 years, but I still have CHF.

Same with da’ beetus. Once diagnosed it goes to management.

I don’t actually know the nuances or the actually why of this nomenclature or course of treatment though, as I too am a laymen.

Yes, conventional medicine will put you into a ‘management’ position. Which is resigning you to a long-term dependency on metaformin and, in some cases, other drugs when complete or, worst case scenario, partial, reversal can be acquired simply through bouts of not eating.

It’s like heroin addicts being given methadone. No one wants to do the hard bit, i.e. stops taking the drugs, go cold turkey. Best manage it for a bit by prescribing methadone. Or ADHD, let’s give them pyschostimulants to manage it. Then they can still eat and drink what they like and have a ‘normal’ life.

Good story regarding your own circumstances, nice to hear.

many recommendations are driven by $$$, healthy people don’t feed the pharma machine $$.sad but true such health issues are caused by you + a look around you can see overweight to plain obese people everywhere!!! i pray that individuals help theirselves get better thru better eating

I had gestational diabetes and I can assure you they don’t encourage you to eat what I liked. They aren’t concerned with the woman as much as the baby. My experience as a nurse correlates this. Also, mainstream medicine doesn’t have a fucking clue about diet. And how would they make their money if you’re cured?

Well, I was invited to sit in on a clinic with a group of pregnant women, some of whom were grossly overweight, and heard that with my own ears. The dietary advice that followed confirmed to me I wasn’t hearing things. Of course, this is just one instance and may not accurately reflect the general advice from NHS dieticians.

Babies themselves are effectively born into a ketogenic state. I’m not sure why carbs is somehow necessary for pre-natal health.

when I say the baby it affects intrauterine growth causing larger for gestational age fetuses and potentially more difficult births, risk of shoulder dystocia, head injuries, fetal stress, ripping mom a new one, pelvis injuries, obvious need for C-section etc. After birth these babies blood sugars crash. Too low sugar means lethargic baby, breathing probs, feeding probs, leading to more lethargy blah blah. The weird thing is a woman who is gestational diabetic for one pregnancy might not be for the next. kinda fucked.

Eating wide varieties of food undoubtedly beneficial

Avoiding sugar is advisable unless you’re talking about using it to prime the release of insulin prior to protein consumption. Also sugar from fruits isn’t the same as other sugars

Fat can actually be rather healthy for you in moderation and I don’t just speak on things like omega-3 fish oils either. Of course moderation is necessary but fat isn’t as bad as the diet industry would like you to believe

As far as your last point I whole heartedly agree with regular meals. Of course it keeps the digestive system moving and keeps from stalling in your digestive system. I was a chubby kid when I was younger. Not obese but definitely chubby as fuck, most of the problem came from having asthma and being forced on steroids like prednisone, shit is horrible. Thank god asthma went away when hit puberty around 14~, crazy as it sounds? I think the asthma came from or was exacerbated by lactose intolerance. However, the other portion of it came from the fact that I never at regular meals with regular portions. I would eat massive meals and do so as little as possible. Definitely got me messed up on top of not staying hydrated enough either as a kid.

Is it? Why? Given the myriad of allergens, I would argue the opposite.

This is not necessary at all and there is quite a bit of evidence now showing this.

Keto dieters and other low carb folks have been living on HIGH fat diets for a long time now. There are a lot of positive health markers linked to such diets.

I don’t agree with this at all, hence my point about fasting.

Which, if true, would tie into my first point about allergens. Fasting and other similar protocols, e.g. zero carb eating, is the ultimate elimination diet.

  1. It’s difficult to get the right amount of nutrients without variety and trust the vitamins you buy out the bottle are not as good as the ones you find in food, this is just one example. Though I will say anecdotally for me that the more variety in my diet the less messed up my stomach feels. If I endless eat the same thing my stomach doesn’t like that shit

  2. no point in responding you offered no study but I’ll just say that sugar is carbohydrate. Most every food group can turn into carbohydrate. The difference is? Especially when we talk processed sugar? Come on bro

  3. cool

  4. bro intermittent fasting is not even something that you can say stands outside of that. Intermittent fasting accomplishes specific goals the op was talking about generalities and best for everyone.

  5. what you say about allergens undeniably true particularly in today’s day and age. Lactose intolerance isn’t considered an allergy. Some medical facilities inappropriately call it that sure. Except it’s a natural body process for the body to stop producing the enzymes that digest lactose as the baby moves out of infancy and stops breast feeding. For this particular subject, it is so highly variant and they call it intolerance which is all encompassing for everyone due to the fact that everyone is lactose intolerant to some degree. The severity of it is just extremely variable. I’m not allergic to milk if I drink milk I just drink lactose free. My lactose intolerance isn’t bad though so although I try to avoid? If I want to grind an xl cheese pizza I’ll suck up the fact that I’m going to pass gas all night long and by the next be fine.

Why medical facilities call lactose intolerance an allergy? God only knows it seems most things I see don’t make sense to me because milk allergy is a real thing and a separate issue.

Back to your point? Man it’s all about how cheaply Food can be made and how convenient it is. Food found on most grocery shelves is likely the cause for so many health issues it’s unreal but of course no one talks about it so fuck it.

I think the issue is that the mainstream concept of type 2 diabetes is that being fat causes T2D, not the other way around. Therefore eating a moderate diet with the goal of losing weight by lowering calories is the “proper” way of treating T2D. Lose fat, be healthy. There have been plenty of studies that show losing weight fixes T2D, and the only way to lose weight is caloric reduction in their opinions

OK, that’s true. CICO is the overarching principle to losing weight. I won’t argue that. But IF / TRF is ultimately one more way to reduce calories when done properly. A lot of medical people think that coming off a fast is automatically a “feast” where all the calories are consumed again, so IF / TRF cannot possibly work. They have a lot to learn.

I always believed a significant factor to the benefits of IF / TRF in treating T2D was the eustress (good stress?) on the body by not having to deal with food and higher blood glucose levels for extended periods of time. In theory, this should help normalize hyperinsulinemia. Whether that’s true or not, I don’t know.

Also, the fasting eustress should allow more time for a damaged intestinal track and liver to heal themselves. Imagine having fructose run through your liver every couple hours, versus having that happen only once every couple days. I think a fatty liver would benefit, no?

I did just read a study linked to on the /r/ketoscience reddit that showed insulin follows a pulsatile profile throughout the day, even when fasting, but the insulin levels drop when fasting. Lowered insulin should reduce triggering the insulin receptors on cells, which should return sensitivity to insulin, right? It might not be good for increasing muscle mass, but otherwise I think that would be a good thing.

Indeed, the science does show that calorie restriction lengthens lifespan. So far, so good: there are obvious health benefits to that approach.

But, the associated benefits of actual fasting go much, much further than this, e.g. autophagy, DNA repair, down regulation of inflammation. This appears to occur due to adaptive stress responses while fasting. Now, what is patently clear also while in this state is the cells improved sensitivity to insulin, i.e. because it is low. This is the message from guys like Dr Jason Fung, who are medical professionals by trade but have since made the connection. He admits how idiotic it was to prescribe insulin to patients who had poor insulin sensitivity - due to chronic elevated insulin levels!

In terms of your point about muscle mass, you will not find many folks brave enough to disregard the role of insulin. But, the common mistake here is assuming increased insulin is contingent on the ingestion of carbs. Wrong. Protein, especially leucine, can elevate insulin very effectively on its own. This is why folks on zero carb diets can also be jacked. In fact, there is some research backing this up, e.g. Paoli’s work with gymnasts on keto diets, where the group leaned out AND gained some LBM (classic body recomp).

What we call type 2 diabetes is complicated. Strictly speaking, it means non-insulin dependent diabetes, but more commonly it is thought of as a form of diabetes that is not due to the immune system destroying the insulin producing cells of the pancreas.

There are major flaws in those descriptions. First, type II diabetes can progress to destruction of the beta cells of the pancreas, first by overworking them, and actually in the late stages by the immune system destroying beta cells which have been overworked and over-secreting insulin. Type 2 might also be mediated by allergens or enteroviruses that get through a permeable gut. Gut permeability can be reversed fast with IF. Type II and type I often run in the same families, and Type 2 is far more genetically linked than type 1 (If one twin has type two the other will have it like 85% of the time versus around 30% for twins and type I).

Type II also has several probably unrelated forms.
There can be insulin resistance caused by buildup of fat/fatty liver that makes the liver not respond to insulin, so that it tries to release glucose into the blood stream. This is generally caused by obesity but linked to fructose and alcohol intake.

There can be type II where the cell receptors for insulin are flawed, or there are not enough of them, and so even if insulin is release, cells don’t respond.

There can be type II where the pancreas is naturally deficient in its ability to produce insulin, but there is not destruction of beta cells, however, it should be noted that pancreatic cells are among the first to die in the presence of high blood sugar and rapid blood sugar changes, so high blood sugar alone will destroy the pancreas.

Technically, when the pancreatic beta cells are mostly gone, diabetes should be referred to as type I or insulin dependent diabetes whether it was caused by a juvenile autoimmune reaction or by chronic hyperglycemia. It appears now that even after beta cells are killed, they can regenerate, or that a few resilient cells can stay alive and produce more if the metabolic and immunological conditions improve.

It has been pretty clearly established in the last 10 years that over the course of a week, the amount of insulin you secrete, or need to inject does not depend largelyon the macro-nutrient breakdown, but rather the total calories. Lower carb, higher fat diets require more insulin per gram of carbs because the body makes less enzymes to burn up carbs for fuel. (In fact, insulin is MORE important in signalling cells to make glucose burning enzymes over a 2 day to 2 week period than it is at moing glucose into muscle cells). Protein requires almost as much insulin as carbs per gram over the course of 24 hours. (The metabolic fate of ALL protein is either glucose or ketones, and most amino acids end up as glucose-see glucogenic and ketogenic amino acids).

Type II diabetics need to inject less insulin with lower carb, higher fat diets because the rise in glucose is slower, and their pancreas can still make enough over 4 hours or so. By the way, Al Dente Pasta raises blood sugar very slowly, not fast as I expected. Same for really crusty wheat based starches and starches mixed with fat.

At a certain point, a type II diabetic does not make enough insulin to even keep their liver from raising their blood sugar to hyperglycemic state even in a fasted state. About 30% of a normal persons daily insulin release is simply to keep the liver from releasing glucose and blood sugar will tend to rise about 25-40 points an hour without insulin even if someone doesn’t eat, if they have no insulin. Ketones will accumulate and terminal DKA can be reached in 12-18 hours. Ketones cause insulin resistance so that even more insulin is needed to manage blood sugar in the presence of ketones.

So its important to describe the state of the type II diabetic. There is insulin resistance. There is insulin resistance where the individual’s pancreas can not manage post meal glucose without additional insulin. There is insulin resistance where the individual’s pancreas cannot manage meals OR even their liver output (basal insulin), and there is insulin resistance/pancreatic insufficiency where runaway ketoacidosis will occur without injected insulin. The degree to which this is causes by fatty buildup, by genetic cell receptor flaws, or by pancreatic destruction has to be assessed to determine the effects of diet.

I suspect that the form that results in a latent onset pancreatic destruction might respond fast to IF. Others simply require not overeating, others require agents to make cells more sensitive.

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Let me add something about the role of insulin in type 2 diabetes. There is a myth that high insulin levels make people insulin resistant. This does happen at very high levels probably, since insulin receptors primarily in liver cells may get desensitizes, or possibly because the pancreas starts to make more glucagon, OR simply because high insulin levels promote liver fat accumulation, BUT in fact LOW insulin levels cause insulin resistance. This is proven because muscle cells will virtually stop making any glucose burning enzymes when they are not exposed to insulin, since insulin is a signal to a healthy cell that glucose is available. A low calorie diet will improve insulin sensitivity by clearing out space in the liver and muscles to deposit glucose but on a maintenance level diet, lower carbs actually cause acute insulin resistance because muscles start to make fat burning enzymes instead, and they also get filled up with more fatty acids leaving less space for glycogen.

This is why you should not go from a ketogenic diet to a carb up. It tends to produce hyperglycemia and the carbs are not stored better. Again this is to be distinguished from a hypocaloric diet which may reduce glucose burning but also creates space to put glucose.

Insulin then has four main functions and most people only think about the third one.
First, it signals muscle cells to make glucose burning enzymes and less fat burning enzymes over a 2-14 day period. The effects are on the scale of a week or two. Second, insulin hold glucose in the liver that would be released at a rate of about 30 mg/dl per hour around the clock even in the absence of food, and also keeps the liver from turning to ketongenesis. Third, it speeds the movement of glucose into the liver after a meal in the first 2 hours. FOURTH, it increases the entry of glucose into muscle cells, though glucose will enter muscle cells with the concentration gradient without insulin roughly to the levels of blood concentration through non-insulin mediated glucogenesis.

Regarding IF, the primary benefit is in putting intestinal bacteria into their normal 24 hour cycle where they have a feeding cycle and a resting cycle. This works best on a 16:8 fast. Autophagy may increase from 14-36 hours but ketogenesis is the process of stopping autophagy. Flat out, that is its role! Autophagy is the process of activating the immune system to break down malformed cellular proteins to make glucose to supplement the glucose deficiency. Ketosis is the process of switching over from glucose to ketones as the primary energy/survival source for “glucose dependent” tissues. There is no reason and it is actually counterproductive to turn cellular proteins into glucose when glucose dependent tissues are being provided all they need in the form of ketones. Ketosis is a way of preventing autophagous muscle breakdown.

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