[bad_user]

These are anecdotes.

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.

[rland]

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.

[bad_user]

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.

---

> "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.

[rland]

Overeating does contribute, of course.

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.

[partyboat1586]

I don't understand your conclusion on skinny people getting diabetes.

>People have a "personal fat threshold", when that threshold is reached there's nowhere for the excess to go

Ok with you so far

>and people develop diabetes

Then this leap. How does the fat having nowhere to go lead to diabetes? What's the middle step?

Skinny people can't have a calorie surplus or they would gain weight no?

[bad_user]

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.

Here are some references:

https://portlandpress.com/clinsci/article/128/7/405/71158/No...

https://diabetes.diabetesjournals.org/content/63/12/4369

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774584/

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.

https://www.pnas.org/content/106/42/17787

And the source of that excess doesn't matter, all macro nutrients can cause insulin resistance, even if via different pathways:

https://pubmed.ncbi.nlm.nih.gov/3421919/

https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2362....

https://pubmed.ncbi.nlm.nih.gov/11872656/

[redis_mlc]

In interviews I've read with nurses over the decades, they invariably say, "Don't get pear-shaped."

What they're referring to is visceral fat (around their organs), so in their experience treating thousands of patients, that's their primary advice.

Something to think about.