[turc1656]

"...based on highly individualized carbohydrate restriction and nutritional ketosis"

That's really the key to what is fixing the diabetes. And it's just a brief mention in the article. Nothing else about the nutritional aspects. This was extremely light on actual, real information.

That being said, I'm also not sure why this stuff is still considered news. Many people, myself included, have been saying for some years now that low-carb is the way to go. I'm glad this stuff is getting press, but I'm just surprised that people seem to be acting like this hasn't already been known for quite a while.

The real problem is that people can easily fix this themselves, but they either 1) don't know this information or 2) don't have the willpower. It's more of #2 though, because people generally know when they are eating garbage. There might be some foods that surprise people as having extremely high glycemic responses, but most of the time they know what they should be avoiding. The problem, I think, is that they don't quite know exactly how horrible what they are consuming really is for their metabolic processes. The one that seems to surprise people is potatoes. They know french fries are bad, but think it's because they are deep fried. When I tell them that a regular baked potato or red potatoes have glycemic index values of around 85-89 and that potato chips are around 50-55 they are stunned. I don't know why, but they are. If you are consuming the same mass of food for comparative purposes, the potato chips are loaded with fats where the regular potatoes are not so that makes sense to me that it would be lower. This tells me there is a serious lack of education on this topic and it is quite literally costing people their lives.

[aaavl2821]

Lack of information is certainly a problem but food insecurity and habits are also very important. A lot of people would have a really hard time, logistically, maintaining a ketogenic diet [0]

I'm also somewhat skeptical of the evidence that the ketogenic diet can cure diabetes (or cancer / autism etc). I haven't looked into it in depth, so may be wrong, but all I've seen in the way of evidence are 1) anecdotal cases 2) hypotheses about a supposed biological mechanism (haven't seen any good studies validating this mechanism) and 3) appeals to evolution, i.e. "People ate low carb for most of human history etc", again with no rigorous science (that I've seen) to support this, just logical sounding claims

You'd need large randomized controlled trials to really test 1) whether it works, 2) whether it's safe and 3) whether the benefit is attributable to a low carb diet or to people just being on a diet in general. Unfortunately those are expensive so will probably never be done because no one requires them (like FDA for drugs)

Proponents of keto diet also cite the entrenched corporate financial interests that led the low-fat wave based on shoddy science. The same dynamic is at play with low carb. I asked a very well funded company marketing keto diet products about their clinical research efforts, and they said they don't have a clinical research arm -- all the clinical studies fall under the marketing department

I'm not saying it's pseudoscience, but based on the limited data I've seen I don't think we can rule that out

[0] https://www.google.com/amp/s/www.citylab.com/amp/article/560...

[virtuallynathan]

There are a ton of peer reviewed papers on Keto diets available on PubMed. Here's a collection and summary as a spreadsheet: https://docs.google.com/spreadsheets/d/1Ucfpvs2CmKFnae9a8zTZ...

[aaavl2821]

Thanks, that's helpful

Based on skimming that it looks like low carb diet can be as effective or more effective than low fat diet at reducing triglycerides, blood glucose and other metabolic markers, may not be as good at reducing LDL as low fat, and may pose additional safety risks compared to low fat. Some articles say no difference in blood glucose between low fat and high carb. Some say Mediterranean diet is better at glucose control than low carb diet.

Of the studies that show low carb has better a1c reduction than low fat, the reduction is ~0.5%. Clinically meaningful but certainly not a reversal of diabetes

So low carb may be better than low fat diet at reducing blood glucsoe. However that isn't conclusive. Also the Mediterranean diet may be better than both at improving glucose. And some evidence suggests low carb is worse than low fat for LDL levels and heart disease

However i didn't see any studies that showed reversal of diabetes, cancer or autism or any other disease. I don't doubt that a low carb diet can help people lose weight or better control their diabetes. I do doubt whether it can "reverse diabetes at scale", cure cancer etc. using preliminary findings that low carb is better than other diets at a1c reduction to claim this can "reverse diabetes at scale" seems not far from snake oil to me

[virtuallynathan]

I think you then have to ask the question of "Is LDL cholesterol level a good measure of risk?" -- it seems like it is not. That spreadsheet is pretty focused on diabetes and weight, searching pubmed for Ketosis, or Ketogenic will yield many papers about the benefits for neurodegenerative diseases, cancer, etc. There's still a ton of research to be done, but it looks promising.

[nradov]

Virta Health has been doing that controlled trial, although it's not randomized.

https://clinicaltrials.gov/ct2/show/NCT02519309?term=virta&r...

[aaavl2821]

There are several issues with that study design that leave it open to experimental bias:

* not randomized, as you mention

* the control is not great: "treatment as usual" is not a very good control in general and is a particular issue in psychiatric and behavioral research. with this design you cannot attribute any improvement specifically to the diet. improvement could be driven by better coaching, more frequent contact with health professionals, being part of a group, a psychological / placebo benefit, etc. a better control would be an active control where subjects get the exact same thing as the Virta patients, but are on a low-fat diet, or all-plant diet, etc instead of a low carb diet

* different endpoints for active vs control arm: only the virta arm's primary outcomes are measured at 3 months, while the control and virta arms are measured at 12 and 24 months. there are differences for other endpoints as well. this is not necessarily that big of an issue, and they may just be wanting to measure exploratory endpoints and dont want to spend the extra money following control patients. however for a primary endpoint it seems odd. a cynic could say that virta could claim success on a primary endpoint if the virta arm improves at 3 months even if it does not differ from control at 12 and 24 months. this study is just done by virta prob for marketing and no one is really overseeing this so wouldnt really call them out on it

* different inclusion criteria for active arm: only the active arm can enroll pre-diabetic subjects. the control arm cannot. if they don't pool these pts with others when analyzing results, maybe this is less concerning, otherwise its a pretty big deal in my opinion

[magic_beans]

> When I tell them that a regular baked potato or red potatoes have glycemic index values of around 85-89 and that potato ships are around 50-55 they are stunned

I'm frankly SHOCKED by the amount of people I encounter on a daily basis -- even my own damn significant other -- who have no idea what a carbohydrate even is. I love my SO to death, but I was appalled he had no idea grains and potatoes were carbs, and he is very well educated and works in tech.

If someone like my SO can't understand what a carb is, how do you expect your average American to get it?

Nutrition education in this country is so disappointing.

[pimeys]

> They know french fries are bad, but think it's because they are deep fried. When I tell them that a regular baked potato or red potatoes have glycemic index values of around 85-89 and that potato ships are around 50-55 they are stunned.

Having T1D and a CGM I can say the normal potatoes are much easier to control compared to the french fries. The fat is really a huge problem if you dose your own insulin. It is guaranteed if I eat french fries that I don't need that much insulin right now, but the fatty food will raise my glucose levels in the next five hours. If I eat the fries for dinner, I can guarantee to be in the upper high levels at night when I sleep.

This is of course fixed with a closed loop system, but that doesn't help the T2Ds out there that much.

[turc1656]

Yes, fats slow the absorption rate of carbs so that makes sense that you will see a longer, protracted amount of time for the elevated blood sugar levels. You don't get the same spike and subsequent crash because it's more drawn out.

I also don't know if the fact that you are Type 1 instead of Type 2 affects anything I said. I don't know enough about Type 1 to comment. Anything I said is specific to Type 2.

[pimeys]

That's why I'm trying to comment with care. Just the facts how I can see fatty food with a CGM and a closed loop:

60g of carbs from french fries will mean you take insulin for about 40g of carbs now, then for 60g of carbs starting in one hour and divided to the next 2-3 hours.

For normal potatoes, 60g of carbs, you'd take insulin for the 60g right now and that's it.

You see how a combination of fat and carbs is really tricky when you need to keep a good control of your glucose values. There is good help for us T1 diabetics, algorithms such as oref1 with super micro boluses help to control the delay and additional raise of glucose when eating fatty food.

Ketosis is also something I'd never recommend to a T1D. It can lead to very nasty symptoms; cramps and headache. Can't say anything about T2Ds, people reading these should always consult a doctor before making any decisions of their treatment.

[magic_beans]

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

[godshatter]

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

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

[brandonmenc]

People are confusing "managing" with "fixing".

Does a "keto" diet regenerate beta cells? Can someone with "reversed" T2D eat an isolated high carb meal and experience a normal glucose response? afaik, no and no.

[t2dthrowaway]

As someone who has come quite close to reversing their T2D, I will say that as I've lowered my a1c (the main measure of diabetes) and dropped from 3 drugs to 1, I've noticed two things from blood sugar monitoring: not only have overall sugars gone down drastically, but the time to recover from "cheating" has greatly decreased as well. When I was at my worst, I couldn't even eat a piece of fruit without a huge sugar spike. After 3 years on a lower carb, calorie constrained diet (~130g carb/day and ~1900 calories), combined with some exercise, I can now eat an occasional small piece of cake or the like without a huge concern. My sugar will spike for an hour or two, but then normalize. Before i might be high for almost a day before I'd drop back to my baseline.

So it does improve, but it's unlikely to completely go away. In my case it's likely from improved insulin resistance.

To answer your question, I wouldn't say it "crashes" back. It's still a concern, but if it's controlled, you can eat some cake and cookies and you'll stabilize in a few days. It's when it's a long term habit, that it's uncontrollable (at least on my case study of one).

[sametmax]

It depends a lot of the person metabolism and health history.

With drugs you have very accurate protocol.

But when it's about changing your life style, you need to learn about what you atr doing, and regularly adapt. It's not a passive process and it's why few people do it : you basically take responsability for the ride.

[turc1656]

Yes and no. I'd say there is a difference between managing and fixing. All the current treatments by doctors are surrounding management. I do fully believe that Type 2 can be fixed in almost everyone with enough time on the proper diet.

From what I have seen/read, it seems to me that Type 2 is caused by a recurring assault on your metabolic processes through significant carbohydrate over-consumption. That damage accrues over time which is why it usually takes decades to become a full-blown Type 2 diabetic. It would therefore take years to fully "fix" it in a person - and that is assuming the accumulated damage is actually reversible. I believe there are some people who have damaged their bodies too much for it to actually be fixed. And on the other hand I rarely ever hear about anyone actually being full keto for years on end, providing the requisite time for their bodies to adapt and heal. It's not a quick process. The less damage, the quicker the improvement and the shorter the total time to "fix".

As to your original, direct question - I doubt it would come crashing back after just one week of bad habits. But that also has to do with the glycemic storage in your body. You muscles hold (I think it was) around 100-200 grams of potential glucose and your liver can hold something like 400-500 grams. If someone is low-carb for even a short amount of time, these "storage tanks" (as I refer to them) in the body are basically empty or close to it. As you consume garbage the excess that is not needed is added to these tanks. Once the tanks are full, the overflow goes into your blood, raising your blood sugar above normal levels. So you would have to consume somewhere between 500-700 grams in excess carbohydrates before you even started overflowing into your blood stream to have elevated levels. That's pretty hard to do in a single week. And the metabolic damage doesn't magically come back overnight. It's kind of like if you had a really bad sunburn and let it heal. The next time you went out into the sun you skin doesn't turn red immediately - the damage has to actually incur/accrue.

[nradov]

Boiled potatoes are becoming more popular as fuel for competitive endurance athletes specifically because they have a high glycemic index.

https://gearjunkie.com/bike-team-race-food

[turc1656]

Yes, but those people are taking it because they have a specific, immediate need to use the energy. Starches are quick energy, so it's fine for these people to use because it's being put to immediate use and will not end up sloshing around in their blood stream, raising their blood sugar. Also, because of the nature of what they do, these athletes almost certainty have a near-zero store of glucose in their bodies at any given time. The muscles and liver combined can store anywhere between 500 and 700 grams of glucose for immediate use in the average person. But these athletes are consistently using it up, thereby having the ability to consume these starches with no ill effects.

Personally, I've seen this in myself when doing strenuous physical labor on hot days - for example, doing yard work in 90 degree heat or moving lots of heavy boxes when helping someone move. On these days, I can consume quite literally anything I want and my blood sugar will not budge an inch (I regularly test myself even though I don't have diabetes). It's essentially impossible for me to crack 110 on those types of days even if I consume a gigantic soda, gatorade, etc, with a garbage meal. I've actually tested this theory several times on myself and it has consistently held true.