About 3 years ago (late 2015 now) I was quite overweight, had a knee injury that limited my mobility (stairs mostly) and had a fasting glucose and post-meal readings that indicated I was nearly pre-diabetic (T2).
So, I cut out out all sugary drinks, refined carbs, late night eating (!!) and tried various intermittent fasting / time restricted feeding techniques (5:2, alternate day, one-meal-a-day) and after about 3.5 months my glucose readings returned to the "normal" range. (Which is WAY more tolerable than sticking to a low-calorie diet every single day IME. I still had pizza and cheeseburgers on occasion, just no soda, fries, "junk" etc.)
After around 6-7 months I'd lost 40+lbs, my knee stopped bothering me and no longer had to entertain the idea of fixing it with surgery. I'm now down well over 60+lbs without having put in hardly any effort to exercise (occasional walking) - pretty stunning to me.
It's ridiculous just how terrible refined carbohydrates are for people. There are countless accounts of people losing weight and getting healthier by simply reducing refined sugars in their diet. It's surprising that this isn't common knowledge yet, although I guess we're fighting Big Sugar here.
I field countless questions about diet on a regular basis, and honestly the #1 tip isn't about calorie reduction or low carb or any gimmicks... it just comes down to "start cooking your own food, from real ingredients". Buy fresh meat and produce and go from there. Weight loss and health will come naturally, because real food is far more satiating than the calorie-and-sugar-dense snacks the western world is used to eating.
> I'm now down well over 60+lbs without having put in hardly any effort to exercise (occasional walking) - pretty stunning to me.
Losing weight despite not exercising isn't surprising. Exercise, even intense cardio, burns far fewer calories than most people think. I'm about 240 lbs, 5'8", 36 years old, and according to this calculator [0], if I ran a 5k at a fast-paced 10 mph (6 minute mile), I'd only burn about 250 calories. That wouldn't even be enough to burn the calories in the energy drink I might drink before it!
Great work on the weight loss. I was 255 lbs at the beginning of the year and switched out my sugary sodas for unsweetened tea or occasionally a diet soda and lost 15 lbs in 4 months. I plateaued because I haven't changed much else.
Most exercise based weight loss isn't about the actual exercise it's about the changes the intense exercise makes to your body that causes you to burn more calories while resting. Exercise often tunes your body to burn calories at a higher rate as you gain muscle and / or increase muscle health which requires more energy to support even while resting. So while you don't NEED exercise to lose weight it certainly is a super important part of weight lose for most people.
I was curious to check out your source because I'm 5'8, 130 ish pounds and my 10 min mile 5k only burns a little bit less than 250 calories, which I thought wasn't a big enough calorie difference for the difference in weight. I put your stats in for an 18 minute run and it came up as 350 calories. Am I putting something in wrong?
Nowadays I mostly just do OMAD (one-meal-a-day) or close to it (eating window is about 1-3 hours) as it's simpler. Initially some will power was needed to stop myself from snacking in the evenings, but as long as I make sure I have a fair amount of protein in that one meal, it never seems to happen now.
Occasionally I'll do alternate-day if I feel 'stuffed' or had a big day of lots of calories (holidays, social events) - whatever is more convenient at the time.
Same thing here. Except I also refuse any refined flour, Co sidering it sugar. I only eat whole foods, no milk, very little cheese, barely any meat. Lots of vegetarian meals. Dropped 50+ lbs without much drama. I cycle extensively in the warm summer months.
The 800 calories they are eating doesn't seem terribly healthy:
"patients were asked to follow either a ‘home-made’ milk- and fruit-juice-based diet (811 kcal/day, 64 g protein, 132 g carbohydrate, 6 g fat) with a multivitamin/mineral supplement (Forceval® [Alliance]), or a micronutrient-replete commercial LELD (832 kcal/day, 87 g protein, 120 g carbohydrate, 12 g fat).
I imagine these people are probably staving... I'd rather go low-carb myself.
This diet sounds miserable. You'd be hungry all the time. I would also much rather eat low-carb (and I do, I am a T2 diabetic that eats a ketogenic diet).
Which sounds more sustainable? Drinking 800 calories of milk and juice every day, or eating real food like steak and broccoli, or chicken with brussel sprouts, or bacon and eggs?
I am losing weight and reducing my A1c eating about 1300 calories of real food each day, and it doesn't leave me hungry at all. Keto is a very sustainable way of eating (in that you can keep doing it without misery). This "diet" looks like hell.
> This diet sounds miserable. You'd be hungry all the time. I would also much rather eat low-carb (and I do, I am a T2 diabetic that eats a ketogenic diet).
Not eating anything, and only eating proteins and fats, are both difficult for me. And simply abstaining is actually easier. When I consume anything I begin craving not only carbs, but craving the stimulation of eating, period.
I think its finally uncontroversial to say that not all calories are the same. But eating is more than just the metabolic process; like smoking it's about the physical habits and stimulation. In that way eating chips is not much different than eating pork rinds, and for some people that's what matters most.
Remember the Master Cleanser and juice fast fads? People consuming nothing but raw sugar for days, weeks, and even months on-end derived similar benefits--weight loss, improved insulin sensitivity, etc. And for some people it was really easy because you could sip on your drink constantly throughout the day, which was in an important way the antithesis of abstinence. Not all calories are the same, but it's still the case that fewer calories are better. Just do whatever it takes to get you to fewer calories.
I'm not trying to equivocate diets--vitamins, minerals, and fiber still matter. But, again, calorie count is ultimately the most important metric. How you manage it is largely a matter of your personal tastes and lifestyle. Few people can manage a perfect diet, but there's a least bad diet for everyone, and they're often wildly different. And that's basically what the expert stated in the article--the powdered diet isn't for everybody, but it was important to begin offering alternatives to the "balanced diet" recommendations.
A recent analysis posted here claimed that low carb, high animal protein/fat was the unhealthiest diet long term, resulting in a 4 year drop in life expectancy, compared to a 1 year drop with a high carb diet.
Low carb looks to be dangerous for your body long term if you have too much meat.
According to a recent documentary I saw on the BBC about this very diet, the point of the 800 diet is to lose weight asap and then introduce food back in gradually over 3 weeks (I think it was restoring one meal time a week, dinner, lunch, breakfast), in a controlled manner to teach you better food habits.
The documentary was focused on 4 normal people who had health problems due to weight, they all were trying this diet to see if it would help. One of them had just developed type 2. Wouldn't be surprised if that programme paved the way for this (it was on in June).
I've seen a qualified dietitian working for the NHS - she hadn't a clue about what kind of diet someone with blood sugar problems should eat. Unfortunately, this has been my (even more unfortunately) wide and varied experience of several NHS consultants across different specialisms - their knowledge hasn't been updated since they left medical school, and what they were taught at medical school was 20 years out of date when it was taught.
Hasn't every study prior said fasting (especially combined with low carb diet in between) is far better than low calorie, because your body makes different adjustments to lack of food rather than some food and you actually end up worse on a low calorie diet because your body isn't getting the full amount of nutrients and calories it wants/needs but doesn't make the adjustments it'll make for brief periods of lack of food.
Generally agreed, but with a caveat: diabetics are at risk of ketoacidosis on low carb diets. They would need to measure their blood ketones and moderate carbohydrate intake to keep their levels down below dangerous thresholds.
Personally when I went low carb, I got blood (not urine) ketone levels up into the range that would kill a diabetic quickly, think in the 7.0 range. Even as someone well adapted I regularly hit the 3.0s when fasting.
Type 1 diabetics may be at risk for ketoacidosis if they screw up their insulin, but T2 diabetics are not at any risk from just a low-carb diet. The problem is having high blood sugar and high ketones simultaneously, not just having high ketones. And the nice thing about a low-carb diet is that you're not eating carbs, so your blood sugar does not become elevated. If your pancreas can still create insulin at all, you are highly unlikely to go into ketoacidosis.
Keto is a really good diet for both weight loss and correcting insulin resistance for a T2 diabetic.
(Source, I am a T2 diabetic that eats a ketogenic diet. I am losing weight and my A1c is dropping. My doctor is pleased with my diet choices.)
Usually type 1 diabetics (autoimmune, are more at risk for DKA. Type 2 diabetics can definitely be at risk for DKA, especially if insulin-dependent. However, they are at higher risk for hyperosmolar hyperglycemic coma, which is equally frightening.
It's definitely a risk, but not as much if your body is still making insulin to help provide your cells with at least some energy.
> ketone levels up into the range that would kill a diabetic quickly
That's not how it works. DKA happens because your body is burning fat because it's starving from a lack of insulin. Ketones from healthy weight loss are not dangerous.
A lot of people here are suggesting, like you, that a low-carbs diet or ketos can help your body "heal" from T2D. I just don't see why starving yourself from carbs, which is like the basis of life for your cells, is going to help. From what I gleaned here and there, T2D is more linked to fat-heavy diet, which clutters blood vessels and keeps yours cells from absorbing the insulin your body produces, thus preventing them from "disgesting" the carbs you sending to them, resulting in diabetes. Reducing all the cholesterol in your diet will help your body "cleanse" gradually from these plaques on your blood vessels.
I'm not doctor, nor a nutrionist, but this guy makes really good and sourced videos on these subjects:
I really recommend watching them. They're clearly oriented (duh), but still quite informative.
I'm sorry, my reply is a bit rushed and not that polished, but I really wanted to reply to see if anyone has something to say about this interpretation of carbs and T2D. (And it's damn late right now where I live!)
Bodies can run on ketones (byproduct of breaking down fats) or glucose. I'm not sure where you got the information that T2 is related to fat heavy diet, that is not true at all. It can be related to bring fat, for to complications with obesity. It is related to glucose spikes, which causes insulin spikes, but the T2s body is insulin resistant and so sugar and insulin stay in the blood stream and can't be utilized. High sugar in the blood is the cause of most T2 chronic issues.
Also of note, a recent study has found that ingestion of cholesterol does not correlate with how much is in your blood.
Those videos were painful to watch (what's up with his intonation, it sounds like he's introducing prizefighters) and the guy looks anorexic and anemic; not someone from whom I'd take nutritional advice.
T2 is related to glucose ingestion(sugar, carbs) NOT fat. Glucose spikes your insulin, and the continued, extreme spiking of insulin is what causes T2.
I think that this is effective because it reduces the carbohydrate load. Protein and fat consumption also increase insulin response but not nearly as much. Type 2 diabetics could get most of the blood sugar reducing benefit of this by just removing/replacing the carbs. That has been my N=1 experience with both fasting and carb restriction.
Well reversing is different but most cases can be reveresed with dietary/lifestyle changes.
On the other hand prevention of type2 is N=100% with these changes. I know people, especially in the US consider it thier right/freedom to eat what they want and live how they want, but in my mind it’s deeply disturbing especially because children don’t have any choice (it’s parental).
I think as soon as a child is diagnosed with fatty liver disease...there should be some mandate on parents to “treat” their child with diet (which I know is probably equally disturbing to people, government dictated diet).
In the US the official nutrition advice has been both wrong and corrupt since the 1970s. Gotten wrong by sincere hard working scientists with the best intentions. Corrupted by corporate capture of regulatory bodies and funding of exculpatory studies.
These same forces would choose what is mandated. That is horrifying. Not only could they give bad advice, they could compel ever larger fractions of the population to follow it.
Far better to let parents decide, so when they get it wrong we can learn from it, and don't all get it wrong at once.
> On the other hand prevention of type2 is N=100% with these changes.
It is absolutely not. While the vast majority of current cases are preventable (and in most cases, reversible) through proper lifestyle changes, between 5% and 10% of people with T2DM were going to develop it regardless of what they did.
Now, it's possible that some or all of those cases are not actually T2DM. In the past few decades researchers have been investigating additional forms of DM, such as Latent Autoimmune Diabetes in Adults, that may be the cause of some cases of DM that currently present as T2DM. It may be that once "true" T2DM is defined that your statement is correct, but as of right now it is not.
> .there should be some mandate on parents to “treat” their child with diet
You're considering forcing parents to change, presumably with the threat of taking their children away. But consider this, in the past type-2 diabetes was extremely rare in children. Why is it now common?
Are parents just worse? Or are terrible diets more appealing? Maybe the sources of those terrible diets would be a better place to start imposing government violence.
Did you see the diet? Another commenter posted it [1], and it has 132g carbohydrates. Doesn't seem like a small load (though it may be an improvement over what they're currently doing!). At 4 cal/carb [2], that's over half the diet's calories.
AFAIK the standard American diet has about 250g of carbs. 132 grams of carbs is about the standard recommendation for T2 diabetes.
That said these recommendations are bullshit. If you have diabetes, you have an insulin problem and it's best to minimize it, so you need to eat the minimum amount of carbs you can get away with, prioritizing the complex carbs with fibers (e.g. spinach and other greens).
Btw, a low calories diet can work even if higher in carbs, because:
1. by losing weight insulin sensitivity goes up afaik
2. at 800 grams per day, that's not much to eat, so those people are probably fasting for much of that day
That's just a guess, but how you distribute your meals also matters just as much as what you eat.
How much of those carbs are fiber? I'm trying to find the direct quote and see if more information is there.
Although, given the description of it includes "fruit juice", I am guessing it is a lot of sugar, which seems weird but I can't admit to know enough to say this is bad.
I'd be interested in the efficacy of this sort of diet when applied to a large mass of people as opposed to a very low carb diet. The NHS can "prescribe" these diets, but people may not follow them. It's possible that having a moderate amount of carbs (as sugar) in the diet will actually decrease the chances of a person going in the complete opposite direction and binging on sugar after they get sick and tired of a very low carb diet. I'm curious if they study that effect and "risk" of diets.
I am not a doctor. This is what I have learned so far (there are no references here - sorry, I will need to dig up the material to substantiate this if you ask):
The upshot:
Managing diet is not sufficient (for type 2) remission. The damage is at cellular level. That damage needs to be reversed. Therefore muscles need to be rebuilt. Even for the over 60 years!
The thinking:
Diabetes Type 2 is the end point of years of abuse the body endures with elevated insulin and the _extent_ of insulin resistance the body progresses to. Diabetes therefore is a spectrum - the end point is when the pancreas bonks out and refuses to produce any more insulin. It's a tiny tiny organ and I think it's fragile. And it's threshold is also genetically determined. The interesting thing is that we all (including healthy folks) have levels and sometimes acute bouts of insulin resistance! The thing that made sense to me, reading about this, was that insulin resistance is a function of your muscle cells denying entry to glucose. And the insulin concentration in the bloodstream is a direct function of the concentration of free flowing glucose. Poor Pancreas is only doing its job but the muscles are not taking in any new glucose. They are refusing (resistant). Pancreas tries its best by pumping more insulin and for longer but the adamant muscles are the contract breakers in this arrangement - they don't open the gates for glucose.
The only way to change direction permanently in type 2 is to rebuild muscles which will have better insulin receptors to allow glucose to be shunted into the cells. For this to happen you have to do strength training. Lift sufficiently heavy. (No, not Arnie levels by any measure.)
(I recently read a study that administering testosterone to type 2 diabetics improved their insulin resistance. What happens with testosterone and anabolic steroids? New muscles, that's what.)
It's great that they teach the idea that Diabetes (type 2) is preventable and even treatable with responsible eating habits. Too many people believe it's just something your doctor is supposed to treat with a pill.
Food companies often push the idea that all you need to do is exercise more. Whilst exercise might be a great thing: it alone can't fix the problem. You still need to learn how to eat.
> Makes sense, it is a diet related illness, so it should have a diet related treatment. Instead of treating the symptoms, treat the cause.
Type 2 diabetes isn't caused by diet. Certain diets can increase the risk of Type 2 diabetes, but it's not a foregone conclusion, and it's not uncommon to develop Type 2 diabetes despite an otherwise healthy diet.
T2D is caused by a combination of genetic and environmental factors such as diet, and you're correct that someone can get T2D based mostly on genetic factors alone. It is however very uncommon, and diet plays a role in the majority of cases. There are several studies that show this.
Type 2 diabetes is currently on track to bankrupt the world's healthcare system. Easily 60% of the US residents reading this comment are already insulin resistant, they just don't know it yet. Many of those will progress to full blown T2DM in ten to fifteen years. It used to take a very expensive sequence of blood tests involving injecting glucose and tracking the concentrations of glucose and insulin over a few hours. Lately the tech has improved and there is a single blood test that can give an "insulin-resistance score", LP-IR[0][1]. While Peter Attia showed this test in a blog post from 2012[2], it seems to be getting more attention lately[3]. Just because your blood glucose after fasting is "normal" does not mean you will not get T2DM. Just ask Tim Noakes, world class exercise scientist and medical doctor, who finished more than 70 marathons and still woke up one day with diabetes, just like his father.[4][5]
Two minor points: T2 isn’t controlled with insulin; it’s a syndrome of insulin resistance and other metabolic dysfunctions. And “manufactured insulin” came on the scene in 1922. Before that, T1 diabetes was universally fatal.
My T2 is not treated with insulin today, but it could be later if it gets worse. And I am indeed talking about history pre-20th century.
For example, diabetes used to be diagnosed by peeing on the ground and seeing if ants we attracted to it. According to whatever diabetes history book I checked out of a medical library on inter library loan.
Readit News
So, I cut out out all sugary drinks, refined carbs, late night eating (!!) and tried various intermittent fasting / time restricted feeding techniques (5:2, alternate day, one-meal-a-day) and after about 3.5 months my glucose readings returned to the "normal" range. (Which is WAY more tolerable than sticking to a low-calorie diet every single day IME. I still had pizza and cheeseburgers on occasion, just no soda, fries, "junk" etc.)
After around 6-7 months I'd lost 40+lbs, my knee stopped bothering me and no longer had to entertain the idea of fixing it with surgery. I'm now down well over 60+lbs without having put in hardly any effort to exercise (occasional walking) - pretty stunning to me.
I did take up cooking my food from scratch as a hobby, so I was avoiding processed foods and eating out as well.
I field countless questions about diet on a regular basis, and honestly the #1 tip isn't about calorie reduction or low carb or any gimmicks... it just comes down to "start cooking your own food, from real ingredients". Buy fresh meat and produce and go from there. Weight loss and health will come naturally, because real food is far more satiating than the calorie-and-sugar-dense snacks the western world is used to eating.
Losing weight despite not exercising isn't surprising. Exercise, even intense cardio, burns far fewer calories than most people think. I'm about 240 lbs, 5'8", 36 years old, and according to this calculator [0], if I ran a 5k at a fast-paced 10 mph (6 minute mile), I'd only burn about 250 calories. That wouldn't even be enough to burn the calories in the energy drink I might drink before it!
Great work on the weight loss. I was 255 lbs at the beginning of the year and switched out my sugary sodas for unsweetened tea or occasionally a diet soda and lost 15 lbs in 4 months. I plateaued because I haven't changed much else.
[0] https://www.freedieting.com/calories-burned
I imagine these people are probably staving... I'd rather go low-carb myself.
This is the study, DiRECT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/
Which sounds more sustainable? Drinking 800 calories of milk and juice every day, or eating real food like steak and broccoli, or chicken with brussel sprouts, or bacon and eggs?
I am losing weight and reducing my A1c eating about 1300 calories of real food each day, and it doesn't leave me hungry at all. Keto is a very sustainable way of eating (in that you can keep doing it without misery). This "diet" looks like hell.
Not eating anything, and only eating proteins and fats, are both difficult for me. And simply abstaining is actually easier. When I consume anything I begin craving not only carbs, but craving the stimulation of eating, period.
I think its finally uncontroversial to say that not all calories are the same. But eating is more than just the metabolic process; like smoking it's about the physical habits and stimulation. In that way eating chips is not much different than eating pork rinds, and for some people that's what matters most.
Remember the Master Cleanser and juice fast fads? People consuming nothing but raw sugar for days, weeks, and even months on-end derived similar benefits--weight loss, improved insulin sensitivity, etc. And for some people it was really easy because you could sip on your drink constantly throughout the day, which was in an important way the antithesis of abstinence. Not all calories are the same, but it's still the case that fewer calories are better. Just do whatever it takes to get you to fewer calories.
I'm not trying to equivocate diets--vitamins, minerals, and fiber still matter. But, again, calorie count is ultimately the most important metric. How you manage it is largely a matter of your personal tastes and lifestyle. Few people can manage a perfect diet, but there's a least bad diet for everyone, and they're often wildly different. And that's basically what the expert stated in the article--the powdered diet isn't for everybody, but it was important to begin offering alternatives to the "balanced diet" recommendations.
Low carb looks to be dangerous for your body long term if you have too much meat.
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...
According to a recent documentary I saw on the BBC about this very diet, the point of the 800 diet is to lose weight asap and then introduce food back in gradually over 3 weeks (I think it was restoring one meal time a week, dinner, lunch, breakfast), in a controlled manner to teach you better food habits.
The documentary was focused on 4 normal people who had health problems due to weight, they all were trying this diet to see if it would help. One of them had just developed type 2. Wouldn't be surprised if that programme paved the way for this (it was on in June).
https://www.bbc.co.uk/programmes/b0b53xqs
Personally when I went low carb, I got blood (not urine) ketone levels up into the range that would kill a diabetic quickly, think in the 7.0 range. Even as someone well adapted I regularly hit the 3.0s when fasting.
Obligatory: I am not a doctor.
Keto is a really good diet for both weight loss and correcting insulin resistance for a T2 diabetic.
(Source, I am a T2 diabetic that eats a ketogenic diet. I am losing weight and my A1c is dropping. My doctor is pleased with my diet choices.)
It's definitely a risk, but not as much if your body is still making insulin to help provide your cells with at least some energy.
That's not how it works. DKA happens because your body is burning fat because it's starving from a lack of insulin. Ketones from healthy weight loss are not dangerous.
I'm not doctor, nor a nutrionist, but this guy makes really good and sourced videos on these subjects:
On Keto: https://www.youtube.com/watch?v=MzHLAqyO7PQ
On carbs: https://www.youtube.com/watch?v=MyOACAdvAsE
I really recommend watching them. They're clearly oriented (duh), but still quite informative.
I'm sorry, my reply is a bit rushed and not that polished, but I really wanted to reply to see if anyone has something to say about this interpretation of carbs and T2D. (And it's damn late right now where I live!)
Also of note, a recent study has found that ingestion of cholesterol does not correlate with how much is in your blood.
On the other hand prevention of type2 is N=100% with these changes. I know people, especially in the US consider it thier right/freedom to eat what they want and live how they want, but in my mind it’s deeply disturbing especially because children don’t have any choice (it’s parental).
I think as soon as a child is diagnosed with fatty liver disease...there should be some mandate on parents to “treat” their child with diet (which I know is probably equally disturbing to people, government dictated diet).
These same forces would choose what is mandated. That is horrifying. Not only could they give bad advice, they could compel ever larger fractions of the population to follow it.
Far better to let parents decide, so when they get it wrong we can learn from it, and don't all get it wrong at once.
It is absolutely not. While the vast majority of current cases are preventable (and in most cases, reversible) through proper lifestyle changes, between 5% and 10% of people with T2DM were going to develop it regardless of what they did.
Now, it's possible that some or all of those cases are not actually T2DM. In the past few decades researchers have been investigating additional forms of DM, such as Latent Autoimmune Diabetes in Adults, that may be the cause of some cases of DM that currently present as T2DM. It may be that once "true" T2DM is defined that your statement is correct, but as of right now it is not.
You're considering forcing parents to change, presumably with the threat of taking their children away. But consider this, in the past type-2 diabetes was extremely rare in children. Why is it now common?
Are parents just worse? Or are terrible diets more appealing? Maybe the sources of those terrible diets would be a better place to start imposing government violence.
[1] https://news.ycombinator.com/item?id=18571000
[2] https://www.nal.usda.gov/fnic/how-many-calories-are-one-gram...
That said these recommendations are bullshit. If you have diabetes, you have an insulin problem and it's best to minimize it, so you need to eat the minimum amount of carbs you can get away with, prioritizing the complex carbs with fibers (e.g. spinach and other greens).
Btw, a low calories diet can work even if higher in carbs, because:
1. by losing weight insulin sensitivity goes up afaik
2. at 800 grams per day, that's not much to eat, so those people are probably fasting for much of that day
That's just a guess, but how you distribute your meals also matters just as much as what you eat.
Although, given the description of it includes "fruit juice", I am guessing it is a lot of sugar, which seems weird but I can't admit to know enough to say this is bad.
I'd be interested in the efficacy of this sort of diet when applied to a large mass of people as opposed to a very low carb diet. The NHS can "prescribe" these diets, but people may not follow them. It's possible that having a moderate amount of carbs (as sugar) in the diet will actually decrease the chances of a person going in the complete opposite direction and binging on sugar after they get sick and tired of a very low carb diet. I'm curious if they study that effect and "risk" of diets.
The upshot: Managing diet is not sufficient (for type 2) remission. The damage is at cellular level. That damage needs to be reversed. Therefore muscles need to be rebuilt. Even for the over 60 years!
The thinking: Diabetes Type 2 is the end point of years of abuse the body endures with elevated insulin and the _extent_ of insulin resistance the body progresses to. Diabetes therefore is a spectrum - the end point is when the pancreas bonks out and refuses to produce any more insulin. It's a tiny tiny organ and I think it's fragile. And it's threshold is also genetically determined. The interesting thing is that we all (including healthy folks) have levels and sometimes acute bouts of insulin resistance! The thing that made sense to me, reading about this, was that insulin resistance is a function of your muscle cells denying entry to glucose. And the insulin concentration in the bloodstream is a direct function of the concentration of free flowing glucose. Poor Pancreas is only doing its job but the muscles are not taking in any new glucose. They are refusing (resistant). Pancreas tries its best by pumping more insulin and for longer but the adamant muscles are the contract breakers in this arrangement - they don't open the gates for glucose.
The only way to change direction permanently in type 2 is to rebuild muscles which will have better insulin receptors to allow glucose to be shunted into the cells. For this to happen you have to do strength training. Lift sufficiently heavy. (No, not Arnie levels by any measure.)
(I recently read a study that administering testosterone to type 2 diabetics improved their insulin resistance. What happens with testosterone and anabolic steroids? New muscles, that's what.)
Food companies often push the idea that all you need to do is exercise more. Whilst exercise might be a great thing: it alone can't fix the problem. You still need to learn how to eat.
If everyone starts that doing we're going to put the pharmaceuticals out of business. There'd be riots!
Type 2 diabetes isn't caused by diet. Certain diets can increase the risk of Type 2 diabetes, but it's not a foregone conclusion, and it's not uncommon to develop Type 2 diabetes despite an otherwise healthy diet.
[0] https://www.labcorp.com/test-menu/31976/nmr-lipoprofile%C2%A...
[1] https://www.walkinlab.com/media/attachment/file/1/2/123810.p...
[2] https://peterattiamd.com/the-straight-dope-on-cholesterol-pa...
[3] https://www.managedcaremag.com/archives/2018/4/new-test-diag...
[4] https://www.diabetes.co.uk/in-depth/tim-noakes-challenging-d...
[5] https://www.amazon.com/Lore-Nutrition-Challenging-convention...
For example, war is "good" for reducing incidence of diabetes, because famine.
For example, diabetes used to be diagnosed by peeing on the ground and seeing if ants we attracted to it. According to whatever diabetes history book I checked out of a medical library on inter library loan.