On my mother's side of the family they were practically vegetarian or normal as it was called back then. Vegetables all week and maybe on Sunday a roast probably fowl of some sort.
This was during the 1940s. There were nine children and the parents on a farm in a small rural area. So no extravagant purchases no pop, candy, etc. My mom told me one Christmas her present was an apple and she was excited! The apple came from the tree out back.
Sounds good? But all the women (grandmother and aunts) in the family developed diabetes, one male (uncle) too.
It is not currently established what the exact relationship is between sugar in your diet, obesity, diabetes. They are all basically risk factors for the next one, but they definitely don't cause (in the strict scientific meaning of the term) one another---there is nowhere near enough scientific evidence that would support that. There's enough uncertainty about the whole process that saying "avoid known risk factors" is about the best advice you can get.
> All carbohydrates become sugar, sugar elevates insulin, constantly elevated insulin leads to diabetes.
But my understanding is that some carbohydrates get turned into sugar more slowly, and this "flattens the curve" of blood sugar relative to consuming sugar.
1. it doesn't matter what you eat, what matters are the calories; you could eat whole plants all day, but add a lot of added fat to your meals (e.g. French fries) or sugar, and there's plenty of potential for caloric excess, even from salads. And I don't know about your family, but my family living in the country side drank a lot of alcohol.
2. People have a "personal fat threshold", when that threshold is reached there's nowhere for the excess to go and people develop diabetes; this is why some people develop diabetes sooner than others. So yes, it is possible even for skinny people to get diabetes and genetics definitely play a role.
I find it baffling that even on this site people don't understand the value of anecdotal evidence (near zero), or that evidence has to come from a clinical setting with a control group and that epidemiological data must "disprove the null hypothesis".
Before trusting your own anecdotes, are you sure you isolated the variables? Have you watched them day in, day out? You know, it's a curious thing but overweight people in public don't eat much, overeating happens in private.
You should read the evidence for "energy poisoning" and then take a more critical look at your family.
The evidence from clinicians and people who study this is pretty clear: genetics is a massive factor. There are monogenic forms: if you have the gene, you will get diabetes, often in your 20s or 30s, and there is nothing you can do about it.
Further, diet is one of many factors. Those factors are: multiple (possibly unknown) genes, environment, gut microbiome, weight, and yes, diet. Here is a nice diagram that illustrates how many genes touch this thing: https://i.imgur.com/STg7X74.png -- these are the most common 5-10% of markers!
I know we're talking about type 2 here, but it's actually a bit insulting to declare "energy poisoning" and that they're piggish in private. It's what my 10 year old classmates told me when I was diagnosed t1d.
Who said they are "piggish" in private? Certainly I did not and note that I myself am in this category.
What I said is that overweight people tend to overeat in private, not in public. This is a fact.
The cause of overeating can be debated of course. Eating is a primary instinct, we are not very rational when it comes to our primary drives and on the market there are certainly foods engineered to be overeaten. However it is undeniable that T2D happens because people eat too much. And before 1950, people did not get T2D so often because a majority of the population suffered from hunger and malnutrition.
Humanity has never dealt with an abundance of food, especially an abundance of food high in calories. It's also not wrong to say that binging happens most often in private. Even if the reasons for why that happens are debatable.
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> "The evidence from clinicians and people who study this is pretty clear: genetics is a massive factor. There are monogenic forms: if you have the gene, you will get diabetes, often in your 20s or 30s, and there is nothing you can do about it."
We agree that genetics play a big factor.
However we disagree on the inevitability — the super low, almost inexistant rates of T2D in the 19th century disagree with you and evolution doesn't happen this fast, it takes thousands, tens of thousands of years for a gene to spread throughout the population and this assuming that it confers a massive survival or reproductive advantage to influence selection (e.g. ability of adults to tolerate lactose in Europe), otherwise it can take hundreds of thousands of years.
Our genes did not change and we did not suffer from T2D before the 20th century, the far simpler explanation is that our environment changed, our genes cannot cope with it and the totality of evidence we have points to "energy poisoning", aka people eat too many calories.
I do think there are, again, many other confounding factors. Environment and diabetes are closely linked. Incidence of Type 1 Diabetes, for example, has increased five-fold in the past 50 years or so. As well as many other weird epigenetic diseases that seem to be linked to genes + our modern world somehow.
Off the top of my head, the super low rates of pre-modernity T2D could also be linked to:
- no antibiotics, which destroy huge swathes of gut bacteria
- very different, less sanitized environment
- far more time outdoors, sunlight, dirt, etc.
- fewer strong chemical soaps, antiseptics, etc.
- different diet, fewer processed foods
- different gut flora due to all of the above
- different physical lifestyle, more movement, etc.
- diagnosis criteria
Yes, being fat is a big problem for many reasons, but it is quite far from the only problem, and may even not be the causal problem. Just closely linked to some of the above. Sorry for being rash, I get testy when people hint at the diabetic = fat equivalence, for obvious reasons.
No. The adipocytes, aka the fat cells that can store energy, are in limited supply. Some people have a more flexible adipose tissue then others.
Some people can store very little or no subcutaneous fat at all, all of the accumulated fat is stored as visceral fat (around their organs), which is limited, so they look skinny on the outside, fit even, but suffer from T2D nonetheless.
Basically insulin resistance, high blood glucose and the ensuing loss of beta cell function in the pancreas happen as a result of adipocytes starting to reject excess energy, which then remains in the bloodstream and is being pissed away. Insulin resistance in many circles is understood as the cause of T2D, however insulin resistance is actually a defensive mechanism, in response to energy poisoning.
Nothing but vegtables, with meat once a week is not anywhere close a balanced diet. Veggies are mostly carbohydrate, which does not help either. But as most will point out, whith that many people affected in the family it is likely a genetic predisposition.
There's a solid argument to be made that when you eat, and how often you eat, is more important than what you eat.
Specifically, the thesis is that if you eat constantly, you constantly have a high level of insulin, which your body becomes used to, and then has to produce more to actively control your blood sugar. Insulin resistance is a runaway positive feedback process.
Insulin is particularly challenging because it actively causes sugar from your blood to be converted to fats and stored in your adipose tissue -- and blocks the release of fats from your adipose tissue. Eating frequently actively inhibits your ability to lose weight.
By creating long gaps between meals, your body re-establishes what baseline level of insulin should be. Studies are starting to bear this out, more are needed. I can dig up some more papers if you like, but this is a good place to start [1].
I got into it when I read https://www.nature.com/articles/nrn.2017.156. The thing is that a lot of nutrition research is rather low-quality compared to the rest of science (low n in studies, small effect sizes, low study power, high chance of finding false positives, etc.), and it gets even worse once you start reading sports science papers especially nutrition for sports performance. The best conclusion I found was that a lot of these things like intermittent fasting have small but noticeable effects, meaning that if you can follow IF easily then you may as well do it (like Pascal's wager!), but there is no solid evidence that you actually should do it because the effects are uncertain and small. One pitfall of a lot of these discussions is that people point to papers that show "an effect exists", but forget to ask "how big is the effect?".
I was okay with IF for uncertain small positive brain effects, because my brain is important to me, and it's kind of free, so IF will do. But I think people overstate the effects a bit compared with what's actually known by science.
Take the study you linked to, for instance. I can quite believe that IF would increase insulin resistance based on what I've read, and it's cool that they found lower blood pressure and higher insulin resistance in pre-diabetic men. But the study has 12 people (mid-50's pre-diabetic overweight men) in it, and I don't really know what to make of that? Is this type of study particularly expensive to conduct? Should I find it convincing because I already agree with the result?
My gut reaction to the study is even simpler (not scientific, just personal): Why on Earth would anybody eat dessert for breakfast (Honey Nut Cheerios, waffles with maple syrup, etc, in Figure 1)? If you're already overweight and pre-diabetic, why is the control diet making you eat that? But they get a boiled egg, I'm guessing one?, to, you know, control cholesterol levels or something, two eggs would be crazy. They were probably trying to separate the effect of IF from the effect of eating a normal diet, as compared to the standard American diet, so didn't include a normal diet at all.
> There's a solid argument to be made that when you eat, and how often you eat, is more important than what you eat.
Yes, there is good research suggesting that fasting can offset many (most?) of the ill effects of eating poorly.
> By creating long gaps between meals, your body re-establishes what baseline level of insulin should be.
One of the nice things about Keto is that you can get many (if not most) of the benefits of fasting without needing to fast. Some research suggests that some of the benefits of fasting likely come from being in ketosis during the fast.
It's starting to look like ketones do more than deliver fat to your cells. They are also treated sort of like a hormone, which has other beneficial effects on your health.
Keto (and to a degree, paleo) is a balanced diet. These diets, or something very much like them, were what humans were eating when we evolved into our present state.
The Western diet is highly unbalanced in favor of carbohydrates and sugar because these are easy to farm, store, transport, and sell. The food pyramid we all know and love is a product of over two centuries of industrial agriculture.
Keto is not a balanced diet -- by definition the goal is to place your body into ketosis (by removing carbohydrates from your diet). I'm not sure what definition of "balanced" you're using, but I wouldn't call removing an entire class of macronutrients "balanced".
Note that hunter-gatherer human societies didn't just eat meat, they almost certainly ate berries and fruits (both of which contain sugars and are thus excluded from Keto diets -- though to be fair, modern fruits are quite different to their ancient counterparts). And early human societies definitely consumed grains.
Don't get me wrong, feel free to have whatever diet you prefer. But Keto is by design not an example of a balanced diet, nor is it accurate to make an appeal to nature when discussing it.
> The Western diet is highly unbalanced in favor of carbohydrates and sugar
I don't disagree with the sentiment that modern western diets are on the whole incredibly unhealthy (though large quantities of unhealthy fats are hardly blameless). But carbohydrate consumption is not limited to the Western world, nor is it a new phenomenon.
Rice has been a food staple in Asia for an incredibly long time (having been domesticated in the Neolithic Period). And bread has existed in the Middle East and Europe for even longer.
> Note that hunter-gathers didn't just eat meat, they almost certainly ate berries and fruits (both of which contain sugars and are thus excluded from Keto diets).
One can safely eat berries and fruits on Keto, just not too much of them. It's entirely possible that those hunter-gatherers were in ketosis even if they sometimes at berries and possibly other fruit. Not to mention fruit wouldn't have been available all year, which means they were likely in ketosis for most of the year.
> by definition the goal is to place your body into ketosis
You say that like ketosis is somehow a strange state for your body to be in. But given that fat is a more efficient fuel source for your cells, it seems that ketosis might be the normal state for your body to be in, and running on carbs the uncommon state.
> but I wouldn't call removing an entire class of macronutrients "balanced".
You're not necessarily removing it, you're reducing it so that it's no longer your primary fuel source. It's also the only macronutrient humans can survive without consuming. Gluconeogenesis provides enough glucose for the parts of your body that require it, and everything else runs on fat, which is more efficient than using sugar.
> Rice has been a food staple in Asia for the vast majority of human history (having been domesticated in at least the Neolithic Period). And bread has existed in the Middle East and Europe for even longer.
Human evolution is much much longer than human history, which is just a blip in comparison.
The Neolithic period is around 12000 years ago. Anatomicaly modern humans have been around for 200,000 years plus and other hominids for millions of years before that. Carbohydrate consumption as a large portion of our diet is very new on an evolutionary time scale.
"Just eat a balanced diet" has been the advice given to Americans for my entire lifetime. A casual perusal of the statistics implies that this is not working.
Note that it is giving the advice itself that is not working, a casual perusal of statistics would show few people are actually doing it. The actual advice, if actually followed, is pretty sound though.
Are they not listening? I remember the fairly extreme measures we took to eliminate saturated fat and cholesterol from the public diet, including using margarine and eliminating egg yolks. Remember “I can’t believe it’s not butter”? That didn’t sell that well because Americans ignored the official advice.
The anti-fat push in the last few decades was the result of the sugar lobby actively pushing pseudoscience to argue that fats were responsible for the rising rates of heart disease rather than sugar[1]. This is somewhat reminiscent of the "science" funded by the tobacco lobby.
Ironically, margarine was arguably worse for your health than butter because it contained transfats (a side effect of the hydrogenation process on oil) which are now known to definitely cause heart disease[2]. In fact the link is so clear that a 2006 review flatly stated that "on a per-calorie basis, trans fats appear to increase the risk of [coronary heart disease] more than any other micronutrient"[3].
> Or, you know, you could resolve it by eating a balanced diet too.
This comment contains no actionable information. What is a balanced diet? Follow the food pyramid? That clearly isn't working.
Keto appears to be a balanced diet, i.e. it has the right balance of macronutrients for the human body to run well. Likely it's not the whole story, since there's still a lot we don't understand, but it certainly seems to be on the right path when compared to a standard western diet.
It's easy to eat a balanced diet that without starches. A steak with a double portion of vegetables and a side salad will still get you some carbs and sugars naturally. Keto/Paleo etc. all include veggies. its really not just meat.
This was during the 1940s. There were nine children and the parents on a farm in a small rural area. So no extravagant purchases no pop, candy, etc. My mom told me one Christmas her present was an apple and she was excited! The apple came from the tree out back.
Sounds good? But all the women (grandmother and aunts) in the family developed diabetes, one male (uncle) too.
Type 2 diabetes isn't always due to a poor diet.