[HN Gopher] South Asian people undergo type 2 diabetes remission...
       ___________________________________________________________________
        
       South Asian people undergo type 2 diabetes remission with low
       calorie diets
        
       Author : PaulHoule
       Score  : 175 points
       Date   : 2022-11-27 17:08 UTC (11 hours ago)
        
 (HTM) web link (medicalxpress.com)
 (TXT) w3m dump (medicalxpress.com)
        
       | chrisgd wrote:
       | I read a transcript of an endocrinologist suggesting intermittent
       | fasting (don't eat after 6 and wait as long as you can before
       | your first meal - start with 10am and keep pushing back as long
       | as you can). Then eat only veggies for your first meal, then
       | veggies and a deck of cards serving of meat for dinner.
       | 
       | Honestly, it sounds very difficult, but the doctor seemed very
       | confident that this works. I have started trying this (not T2,
       | but need to lose weight)
       | 
       | Anecdotally, a lot of people have suggested keto and low-carb
       | diets having been successful for them.
       | 
       | The source was Tegus (https://www.tegus.com/) which my company
       | had a free trial.
        
         | bitwize wrote:
         | C-f fasting
         | 
         | You never disappoint, Hackernews.
        
           | smcl wrote:
           | Fad diets like intermittent fasting or keto will pop up
           | _anywhere_ anyone's talking about weight loss or health
           | issues sometimes associated with being fat. It's not
           | particular to HN and it's sadly not going to go away :- /
        
             | uberduper wrote:
             | At what point would you stop considering intermittent
             | fasting or keto to be fad diets?
        
         | adrian_b wrote:
         | When losing weight, it is important to continue to eat a normal
         | amount of proteins, essential fatty acids, vitamins and
         | minerals.
         | 
         | Only either the carbohydrates or the (non-essential) fats or
         | both must be reduced. It does not matter which of them is
         | reduced, as long as the total calorie amount is restricted
         | enough. It may matter only due to personal preferences, which
         | may make one variant or the other easier to support.
         | 
         | One must use some digital scales for measuring the weight every
         | day at precisely the same moment, because the weight varies
         | during a day by much more than the difference between 2
         | successive days. An appropriate rate of losing weight is
         | between 100 grams and 200 grams per day, e.g. about 1 kg per
         | week. If the measurements show another rate, then the amount of
         | daily food must be increased or decreased until the rate is in
         | range.
         | 
         | Regardless with which diet you start, if you adjust the amount
         | of carbohydrates and fat according to the daily weight
         | measurements, in a week or so you will converge to the right
         | amount of daily food. However, this requires to measure by mass
         | or by volume all the food eaten. Those who do not succeed to
         | lose weight fail because they either do not measure what they
         | eat or they cannot abstain from eating more than what they have
         | planned to eat.
         | 
         | Losing the weight is the easier part. More important is to plan
         | a diet for after reaching the target weight, a diet that will
         | keep the weight constant, i.e. which must still be calorie-
         | restricted, but at a normal level, and which must be appealing
         | enough, so that one would never be tempted to eat again in the
         | way that caused the overweight in the beginning.
        
           | fock wrote:
           | > One must use some digital scales for measuring the weight
           | every day at precisely the same moment, because the weight
           | varies during a day by much more than the difference between
           | 2 successive days.
           | 
           | or just do a moving average over some days. Works better.
        
           | doliveira wrote:
           | Losing 1kg a week is not "about appropriate", it's pretty
           | much the maximum.
           | 
           | And water weight, fecal residues, etc vary so much day by
           | day. Were yours so constant insofar to be able to track it
           | accurately to the grams?
        
             | adrian_b wrote:
             | I have lost 1 kg per week during almost a year, with a
             | considerable health improvement at the end and no negative
             | effects, except obviously, the hunger.
             | 
             | At the time I have studied a lot the existing medical
             | literature, and this was the recommended rate, so I have
             | adjusted the diet so that the weight loss per day would
             | oscillate around 140 g per day.
             | 
             | The weight must be measured every day in the same
             | physiological conditions, i.e. in the same order
             | relationship with respect to the various activities that
             | modify the weight, like eating, drinking or eliminating
             | their products.
             | 
             | A good moment would be in the morning, immediately after
             | waking up and relieving yourself.
             | 
             | If one would eat in the evenings wildly varying amounts of
             | food, then the weight in the morning could be affected by a
             | noise due to variable amounts of food that is not
             | completely digested yet. However that would not happen when
             | one is eating a calorie-restricted diet for losing weight,
             | when one would have to eat about the same minimal amount of
             | food every day, which would be quickly digested.
             | 
             | While I was losing weight, I could see very well every day
             | its evolution to the grams, and the effect of any change in
             | the diet. Sometimes I succumbed to the temptation of eating
             | like before starting to lose weight, and after such days I
             | gained weight in a day almost as much as I was losing in a
             | week, which increased the time until reaching the target
             | weight.
        
         | ramraj07 wrote:
         | The consensus from the most sensible people is, do the diet you
         | can stick to, in the end just eat less. That's most important.
        
           | theduder99 wrote:
           | yep, same deal with exercise. Doesn't matter how, I just
           | wanted some type of movement that I could get into the habit
           | of. Tried a bunch of different activities but was not able to
           | form a habit until I got a rowing machine and even then I
           | still have days where I don't want to use it :)
        
             | balls187 wrote:
             | For those days, find something less, like light stretching,
             | outdoor walk, skipping rope etc.
        
           | imwillofficial wrote:
           | My Candy diet isn't having the results I desire. It is,
           | however, delicious.
        
             | uberduper wrote:
             | This isn't an exception. Eat less.
        
               | dpdpdp wrote:
               | This is definitely an exception, one would be deficient
               | in just about every (micro)nutrient and therefore expire
               | much faster than a normal human. While also being much
               | more miserable.
        
               | uberduper wrote:
               | Oh, I guess we're taking this candy diet suggestion far
               | more seriously than I originally thought.
               | 
               | It wouldn't require a whole lot of thought to come up
               | with an all candy diet that supplied the minimum
               | necessary nutrition. How broad is our definition of
               | "candy" for this? Are you willing to consider candied
               | fruits, vegetables, and bacon? Chocolate covered things?
               | How much dark chocolate would we have to add to something
               | to consider it candy?
        
               | throwaway821909 wrote:
               | Mostly agree but if your diet is particularly bad, just
               | eating less will mean existing nutrient deficiencies are
               | magnified and (probably for this reason) you'll feel more
               | hungry than you need to, increasing the chances you give
               | up. IMO.
        
           | chrisgd wrote:
           | Not sure I agree
        
         | yazaddaruvala wrote:
         | > Then eat only veggies for your first meal, then veggies and a
         | deck of cards serving of meat for dinner.
         | 
         | > lot of people have suggested keto and low-carb diets
         | 
         | Just always remember: while rice, pasta and bread are
         | vegetarian they are not vegetables.
        
       | panabee wrote:
       | 1. the conclusions were based on 25 adults. is this a valid
       | sample size?
       | 
       | 2. why is liver fat a driver for diabetes? the article and the
       | paper don't address this.
        
         | nradov wrote:
         | Fatty liver disease is closely linked to type-2 diabetes.
         | 
         | https://www.healthline.com/health/fatty-liver-disease-and-di...
        
           | panabee wrote:
           | interesting. thanks for sharing! the article unfortunately
           | doesn't delve into the mechanics beyond claiming an increase
           | in glucose from more liver fat.
           | 
           | why would more liver fat increase glucose production? if
           | anything, i would expect a negative correlation.
           | 
           | what hypotheses do you think are persuasive?
        
       | anon291 wrote:
       | South Asian diets are too high in carbs and seed oils and too low
       | in animal fat and meat.
       | 
       | I say this as a south Asian man.
        
       | wrycoder wrote:
       | Isn't this obvious?
        
         | yjftsjthsd-h wrote:
         | Why would it be obvious? For that matter, since I'm out of the
         | loop, what's the mechanism for losing fat to improve insulin
         | control?
        
           | chasebank wrote:
           | I thought this was common knowledge. Type 2 diabetes is 100%
           | reversible through diet.
        
             | Retric wrote:
             | Early Type 2 is generally reversible through diet, but
             | untreated you can suffer irreversible harm.
        
           | oaktrout wrote:
           | Simply put fat worsens insulin resistance. The mechanism is
           | complex, basically fat causes inflammation that causes cells
           | to not respond appropriately to insulin. This leads to
           | elevated blood glucose and all the effects of diabetes.
           | Remove the fat, decrease inflammation, improve insulin
           | resistance.
        
         | JPLeRouzic wrote:
         | > _Isn't this obvious?_
         | 
         | Please consider wondering why no doctors/scientist know how to
         | heal people with diabetes. Do they miss something obvious?
        
           | Vt71fcAqt7 wrote:
           | While not exactly obvious, this has been known for a while
           | now. It even became the position statement of the American
           | College of Lifestyle Medicine to restrict calories as a way
           | to induce remission:
           | 
           | > _Studies with therapeutic dosing typically used very low
           | energy diets (600-1100 kcal /day) with a weighted mean
           | remission rate of 49.4%, while studies with subtherapeutic
           | dosing typically used more moderate caloric restrictions
           | (reducing energy intake by 500-600 kcal/day) and the weighted
           | mean remission rate was 6.9%. Conclusions. Remission should
           | be the clinical goal in T2D treatment, using properly dosed
           | intensive lifestyle interventions as a primary component of
           | medical care for T2D patients._[0]
           | 
           | So while not exactly _obvious,_ it isn 't true that "no
           | doctors/scientist know how to heal people with diabetes." The
           | real issue is that people with DMT2 _generaly_ will not
           | accept low calorie diets. But those that do have a high rate
           | of remission and almost all have improved symptoms and
           | decreased progressions.
           | 
           | Edit: I should note that obviously the American College of
           | _Lifestyle_ Medicine would advocate for this. My point is
           | that there is sufficient liturature to back this up.
           | 
           | [0]Type 2 Diabetes Remission and Lifestyle Medicine: A
           | Position Statement From the American College of Lifestyle
           | Medicine (2020) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
           | 7692017/?report...
        
             | PuppyTailWags wrote:
             | Wait, how long are people expected to be on 600-1100
             | kcal/day? Just for a little worse than a coin flip? That
             | sounds really miserable. Isn't that basically a crash diet
             | and no one stfus about not doing those because they can
             | mess you up long term?
             | 
             | I'm really confused how T2D are special such that crash
             | dieting doesn't mess them up further and put them further
             | in a hole. They're already messed up because of the T2D,
             | aren't they?
        
               | Vt71fcAqt7 wrote:
               | VLCDs are very safe, much safer than say all the co-
               | morbidities of obesity. The important thing is to chose
               | the right things to eat for those few calories. It also
               | assumes a sedantary office lifestyle with only minimal
               | exercise. If you work out or run you will need more. With
               | these caveats it is safe and effective and works for
               | obesity, type-2 diabetes and some metabolism problems.
               | 
               | It really is that simple. The first law of thermodynamics
               | doesn't go away so simply. Combine that with the
               | evolutionary preassure that favors those who can save and
               | expend energy and this all makes perfect sense. For
               | example, increased insulin sensitivity on a low calorie
               | diet makes sense evolutionarily. The only drawback is
               | that muscle will be consumed as well. The amount varries
               | by person, diet and exercise but it is minimal with a
               | high protien diet. So say eating 500 kcal of chicken
               | brest everyday and the rest of the calories spilt between
               | carbs and lipids would be a good way to do this diet.
               | 
               | "Crash diets" _do_ work as long as you do it for a few
               | months. People generaly do a few days and then start
               | binging  >200 TDEE. Obviously that won't work:
               | 
               | > _The active stage is characterized by a very low-
               | calorie diet (600-800 kcal /day), low in carbohydrates (<
               | 50 g daily from vegetables) and lipids (only 10 g of
               | olive oil per day). The amount of high-biological-value
               | proteins ranged between 0.8 and 1.2 g per each Kg of
               | ideal body weight in order to preserve lean mass and to
               | meet the minimal daily body requirements. This stage is
               | further divided in 3 ketogenic phases: in phase 1, the
               | patients eat high-biological-value protein preparations
               | five times a day, along with vegetables with low glycemic
               | index. In phase 2, one of the protein servings is
               | replaced by natural proteins such as meat/egg/fish either
               | at lunch or at dinner. In the phase 3, a second serve of
               | the natural protein low in fat replaced the second serve
               | of biological protein preparation. Being a very low
               | caloric nutritional pattern, it is recommended to
               | supplement patients with micronutrients (vitamins, such
               | as complex B vitamins, vitamin C and E, minerals,
               | including potassium, sodium, magnesium, calcium; and
               | omega-3 fatty acids) according to international
               | recommendations. This active stage is kept until the
               | patient loses most of weight loss target, about 80%.
               | Therefore, the ketogenic phases are variable in time
               | depending on the individual and the weight loss target.
               | The active stage generally lasts between 8 and 12 weeks
               | in total._[0]
               | 
               | [0] _The management of very low-calorie ketogenic diet in
               | obesity outpatient clinic: a practical guide_ (2019)
               | 
               | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820992/
        
               | PuppyTailWags wrote:
               | They sound miserable, though, is what I'm saying. How are
               | VLCD people expected to do any sort of fitness or do any
               | sort of mentally taxing labor if they're hungry and
               | running on little nutrition basically all of the time for
               | months? That seems totally unreasonable unless we send
               | obese people to some kind of clinic like we do for
               | addicts, and then how do they adapt back into the real
               | world? Are there any actual studies of people doing this
               | long-term and how this affects their bodies?
               | 
               | I was always told crash diets fuck you up for years. How
               | can this be true and also people are apparently starving
               | for months and that's totally fine?
               | 
               | EDIT: Wait, is my understanding is that you have to
               | starve for up to 4 months for a worse-than-coinflip
               | chance at diabetes? Do we know if it stays off for 5
               | years? 10 years? Do you have to coinflip again? What
               | happens if it doesn't work?
        
               | uberduper wrote:
               | > I was always told crash diets fuck you up for years.
               | How can this be true and also people are apparently
               | starving for months and that's totally fine?
               | 
               | It is not true.
        
           | ddorian43 wrote:
           | Pretty easy to do it with low carb diets. See virtahealth
           | that is FDA approved
        
           | CyberDildonics wrote:
           | Robert Lustig has been giving the same presentation for over
           | a decade showing statistics that people who stop eating sugar
           | can reverse their type 2 diabetes.
           | 
           | https://www.youtube.com/watch?v=dBnniua6-oM
        
           | oaktrout wrote:
           | Most doctors know how to heal people with type 2 diabetes, at
           | least if you catch it early enough. It is well known that if
           | you lose weight and eat a healthy diet the insulin resistance
           | is reversible (some others in this thread have provided
           | citations showing this).
        
       | abadger9 wrote:
       | This happened to my grandmother! I frankly never believed it
       | because we're taught one cannot go into remission, but one day in
       | her 60s she no longer had to manager her diabetes.
        
       | deterministic wrote:
       | It has been known for a long time that low-carb diets (not low-
       | calorie diets) is an effective way to reverse type-2 diabetes.
        
       | lizardactivist wrote:
       | It always amazes me that all types of nutrition are folded into
       | the single "calorie" in these discussions.
        
       | nixcraft wrote:
       | In South India, they have a carbohydrate-rich diet. So when you
       | get hit badly with T2D, you switch to fish, limited brown/red
       | rice, and veggies. In most cases, all of your medication stop if
       | you maintain your weight and diet with exercise. Unfortunately,
       | only some maintain a diet and healthy weight. Even 10 kg weight
       | loss gives far better control for T2D.
        
       | myshpa wrote:
       | Low calorie diet is not the only way how to reverse diabetes.
       | 
       | https://www.youtube.com/watch?v=tAiXvrIMIIE Neal Barnard, MD | A
       | Nutritional Approach for Reversing Diabetes
       | 
       | https://www.youtube.com/watch?v=lSwL73evUdA Diabetes Reversal and
       | Weight-loss with Neal Barnard, M.D.
       | 
       | https://www.youtube.com/watch?v=EpRrD58Ah3Q Evidence-Based Weight
       | Loss: Dr. Michael Greger
       | 
       | https://www.youtube.com/watch?v=7rNY7xKyGCQ How Not To Die : Dr.
       | Michael Greger
        
         | MuffinFlavored wrote:
         | Eat to satiety while focusing on certain types of foods/drinks
         | instead of others?
        
           | myshpa wrote:
           | Yes.
           | 
           | I've removed that part of my comment, sorry - the linked
           | experts will explain it better.
        
       | knaik94 wrote:
       | The amount of calories per day caught my attention, 850kcal/day
       | with diet replacement products. I understand that with medical
       | supervision, there is less risk of malnourishment or nutrients
       | deficiencies.
       | 
       | The general advice, even from my primary care physician, has been
       | that anything less than 1200kcal/day is dangerous and is crash
       | dieting. Looking around, I found this other study studying total
       | diet replacement providing 810kcal/day as the sole food for 12
       | weeks, showed significantly greater weight loss compared to
       | standard counseling and modest energy restrictions. The
       | difference in weight loss was measured at 12 months. (BMJ
       | 2018;362:k3760 [1])
       | 
       | 25 BMI, which the diabetes study used in addition to T2D, is not
       | considered clinically obese in the US. 25 BMI is the line between
       | clinically normal and overweight. I wonder if crash dieting is
       | advised against on the assumption that most people will go back
       | to unhealthy eating habits instead of changing their diet, and
       | also become more likely to fall into binge-restrict cycles. It's
       | easy to imagine that if someone is able to make meaningful
       | changes, crash dieting is more effective than most other methods.
       | 
       | [1] https://www.bmj.com/content/362/bmj.k3760
        
         | xboxnolifes wrote:
         | > The general advice, even from my primary care physician, has
         | been that anything less than 1200kcal/day is dangerous and is
         | crash dieting.
         | 
         | Wouldn't this advise need to keep in mind absolute height? BMI
         | tracks the ratio between the height and weight, but it does
         | nothing to tell the difference between a short thin person and
         | a taller heavier (but same BMI) person. The latter which would
         | need more calories than the former. I know people who eat ~400
         | kcal less than me per day, because they are shorter and
         | similarly thinner. Following that why wouldn't their crash diet
         | threshold be sufficiently lower?
        
           | maximus-decimus wrote:
           | The argument I've heard is that the other nutriments needs
           | (vitamins, minerals, etc) don't scale as much with height. So
           | even a very short person would have a vitamins/mineral
           | deficit on less than 1200KCal per day.
           | 
           | How true is it? I don't know. But even then I don't see why
           | they couldn't take multivitamins.
        
             | throwaway09223 wrote:
             | Many American diets are calorie/energy rich and nutrient
             | poor. If you're eating 400 calories of healthy food you're
             | probably getting several times the vitamins and minerals of
             | the average American eating 2500 of fried, sugary food.
             | 
             | It's probably a mistake to connect the two.
        
               | dragontamer wrote:
               | Beef is very nutrient rich.
               | 
               | Yes, we Americans overeat beef / Hamburgers, but I don't
               | think anyone eating burgers is at huge risk of
               | malnutrition... as much as a risk of heart problems,
               | diabetes, cholesterol, etc. etc.
               | 
               | It turns out that a standard burger with beef, ketchup,
               | lettuce, onion, and bread covers most of your macro, and
               | even micro-nutrients. It also is way overboard on salt
               | and fats, but... that's not the particular problem here.
               | 
               | One of the bigger problems vegetarians have is finding a
               | proper replacement of meat and all of the easy nutrients
               | meat contains. All amino acids, various vitamins, iron,
               | etc. etc. There's a fair amount of nutrients here.
               | 
               | And even the worst McDonalds burger contains a variety of
               | lettuce / onions / ketchup that covers few nutrients that
               | beef is missing (ex: Ketchup has Vitamin A, Potatoes /
               | Fries has Vitamin C).
        
               | throwaway09223 wrote:
               | Yes, beef is an excellent nutrient, but my point is that
               | the majority of calories in a typical burger meal do not
               | come from sources like beef. A Big Mac meal only has 180
               | calories from beef, and 1320 calories total. The vast
               | majority of calories in the american diet are sugars and
               | oils.
               | 
               | If you eat only the beef and veggies from a Big Mac three
               | times a day you'll get plenty of vitamins and minerals
               | with minimal calories (~650 calories)
               | 
               | If you eat the three entire Big Mac meals you won't get
               | any more essential nutrients to speak of and you'll
               | consume far too many calories (3960 calories)
               | 
               | The average american has junk to cut from their diets
               | with no nutritional loss whatsoever. Typically fried and
               | sugary foods.
        
               | holbrad wrote:
               | "Yes, we Americans overeat beef / Hamburgers, but I don't
               | think anyone eating burgers is at huge risk of
               | malnutrition... as much as a risk of heart problems,
               | diabetes, cholesterol, etc. etc."
               | 
               | Pretty strongly disagree here. US Beef consumption is
               | about the same as in early 1900's, which was a time where
               | personal health in several metrics was far better.
               | (Weight being the obvious one)
               | 
               | Always very skeptical when people talk about cholesterol,
               | it's a really nuanced topic, but the average person seems
               | to be stuck in the 1970's with "cholesterol bad".
               | Thinking high ldl is always bad is only slightly better.
        
               | JamesianP wrote:
               | It can be frustrating how studies always lump in
               | processed meat with unprocessed meat. Unprocessed meat is
               | nearly google-proof, since every media outlet is busy
               | broadcasting the evils of "red and processed meat" like
               | they're inseparable. Seems like the cholesterol argument
               | regarding meat itself is basically the main one left.
        
               | carlmr wrote:
               | >And even the worst McDonalds burger contains a variety
               | of lettuce / onions / ketchup that covers few nutrients
               | that beef is missing (ex: Ketchup has Vitamin A, Potatoes
               | / Fries has Vitamin C).
               | 
               | The amount of lettuce, tomatoes and onions is so minimal
               | I doubt it contributes to your vitamin intake in any
               | useful manner. If you eat a salad you get 50x that amount
               | of those vitamins.
        
             | AmericanChopper wrote:
             | You can supplement all your micronutrients with barely any
             | impact on calories consumed, so this is going to depend
             | specifically on what you're eating/supplementing.
        
             | adrian_b wrote:
             | It is possible to have an adequate intake of proteins and
             | of most vitamins and minerals with only about 600 to 800
             | kcal.
             | 
             | Practically pure proteins can be provided by turkey breast
             | or chicken breast, adding e.g. around 300 kcal for an
             | adequate daily protein intake, and the rest of the food can
             | be composed of non-starchy non-sweet non-oily vegetables,
             | which provide only about 20 to 50 kcal per 100 grams. One
             | could eat more than 1 kg of various such vegetables without
             | exceeding 800 kcal.
             | 
             | There remain a few things that would have to be taken from
             | supplements, e.g. omega-3 fatty acids, vitamin B12, vitamin
             | D3 and vitamin E (which is abundant only in high-caloric
             | food, like olive oil or almonds). The simplest is just to
             | take one pill per day of those offered by various vendors,
             | which include all the essential vitamins and minerals, to
             | be sure that none of them is insufficient.
             | 
             | A little vegetable oil would be needed for linoleic acid.
        
           | knaik94 wrote:
           | My understanding is that 1200 kcal is independent of height
           | or weight. I was told that the rough calculation was based on
           | the lower estimate of basal metabolic rate and then
           | subtracting a couple hundred kcal.
           | 
           | We both come from a South Asian background and discussed how
           | the number would change for a home cooked vegetarian diet
           | which is more nutrient dense but low in protein, and I was
           | told that would lower it below 1200, but he didn't feel
           | comfortable recommending that diet unsupervised. He
           | emphasized that I should decrease calories by removing carbs,
           | then fats, then proteins. And that I should prioritize eating
           | proteins above fats and carbs, especially if I planned on
           | increasing the amount of exercise I did.
           | 
           | I asked him if the 1200kcal was net or gross. For example if
           | I did 2 hours of moderate exercise, should I eat back
           | 400kcal+ to maintain a net 1200kcal. He didn't have an answer
           | for me, other than saying, if I start to feel weak or
           | lightheaded I should immediately stop exercising. I don't
           | have pre-existing conditions related to blood glucose, but I
           | imagine that would would change many of these guidelines. I
           | was told to stay mindful of hydration.
           | 
           | The stories I hear of fasted work outs is the reason I asked
           | him about low calorie diets. My non professional intuition
           | makes me believe that even intense cardio should be okay, but
           | moderate or heavy resistance training should be avoided on a
           | low calorie diet.
        
             | nradov wrote:
             | Your understanding is incorrect, and not based on any
             | actual science. Energy needs are highly correlated with
             | body size (and other factors like activity level and
             | genetics).
             | 
             | There is no reason to avoid resistance training.
        
               | knaik94 wrote:
               | The few times I have tried to do intensive resistance
               | training, above 60% of my PR, I have started feeling weak
               | after the second or third day. I don't use caffeine for
               | pre-workout. This might not be common, but I personally
               | experienced a significant increase in exercise induced
               | syncope and near-syncope when fasted.
               | 
               | I also imagined that muscle recovery would be less
               | efficient or take longer from a fasted state. I have hit
               | rowing/ERG goals and made time improvements so I feel
               | comfortable saying that fasting doesn't hinder my cardio.
               | 
               | I understand that energy goals are correlated with body
               | size, we were discussing a general minimum kcal threshold
               | for unsupervised dieting. I am unsure why you feel
               | estimated BMR/RMR - 200 kcal is unscientific. I was told
               | that without supervision, it would be hard to ensure
               | proper nutrition on a very low calorie diet.
               | Additionally, he expected that some people would fall
               | into a binge-restrict cycle because they can't sustain
               | their usual energy level.
               | 
               | I was additionally curious because there have been days I
               | forget to eat, and thinking back I realized my total
               | calories for those 24 hours totaled less than 600 kcal.
        
         | ForrestN wrote:
         | My doctors have always said that losing weight too quickly
         | results in the metabolization of one's muscles and other
         | important, healthy tissue in addition to fat. Could it be that
         | crash dieting works narrowly to solve, for example, diabetes
         | via the loss of fat, but has other negative consequences for
         | the body? Maybe it's not a "doesn't work" thing, but a
         | "collateral damage" thing or a "makes it harder to keep the
         | weight off" thing, which is another old saw of why you
         | shouldn't lose weight too fast?
        
           | nradov wrote:
           | Weight loss always involves some loss of lean tissue in
           | addition to fat. Dieters can mitigate this to an extent by
           | protein intake high and maintaining an exercise program.
        
         | selimthegrim wrote:
         | For South Asians there has been debate about setting lower BMI
         | breakpoints
        
         | refurb wrote:
         | "Dangerous"? How?
         | 
         | I mean if you have some pre-existing disease sure. If you're on
         | certain diuretics you may screw up your blood chemistry, but an
         | otherwise healthy, overweight person eating less than 1200
         | kcal/day? Maybe not the most efficient way to lose weight but
         | it's far from "dangerous".
        
         | sacnoradhq wrote:
         | Evidence needed: define "dangerous" in terms of micromorts
         | based on what BMR and demographics (i.e., age, BMI, FFMI,
         | height, gender)?
         | 
         | There are risks to ponder about how critical (e.g., time vs.
         | dangers) it is to get to a healthy weight. If someone
         | dangerously obese maintains hydration, electrolytes, vitamins,
         | and enough lipids to empty the gallbladder, getting to a low
         | adipose tissue state, resetting insulin, ghrelin, and leptin
         | sensitivities, and reducing the likelier risks of cancer(s)
         | seems like a good tradeoff than either lap-band surgery or
         | slow/plateau weight reductions.
         | 
         | Intense hunger goes away after about 72-80 hours of
         | "starvation", however brain fog and low energy dominate.
         | Careful "starvation" dieting down to slightly underweight isn't
         | something one can do without several months of spare time,
         | ready access to healthcare, and immense self-control.
         | Afterwards, self-control is absolutely required to avoid binge
         | cycles.
         | 
         | GLP-1 agonists are expensive but interesting crutches to get
         | there slowly.
         | 
         | It is likely that over millions of years of natural selection,
         | the human body is far more tolerant of borderline starvation
         | conditions than being stuffed with HFCS. Many types of cancers
         | associated with Western diets are likely due to the human body
         | becoming more hospitable, whereas chemotherapy and starvation
         | add cellular stress that kills off malfunctioning cells. It's
         | likely no accident whereas CHD, gout, diabetes, high
         | cholesterol, and cancers are the consequent of unnatural diets
         | and lifestyles.
        
           | Scoundreller wrote:
           | > GLP-1 agonists are expensive but interesting crutches to
           | get there slowly.
           | 
           | Why stop at getting rid of glucose? Add some plasma donations
           | and orlistat. Now you've got balanced macro loss!
           | 
           | (don't do this)
        
         | wincy wrote:
         | Interesting, when I lost 80 pounds doing a ketogenic diet my
         | appetite leveled off at exactly 1200 calories per day. I wasn't
         | counting calories out of anything other than curiosity as I was
         | losing weight anyway. Getting even lower would have been pretty
         | difficult.
        
           | mmmpop wrote:
           | I did a lot of ketogenic diets when I was younger in an
           | attempt to shed all of the weight that comes with being
           | raised in Appalachia. It was my experience that it was a
           | great kickstart to a weight-loss plan for someone who was at
           | rock-bottom health and needed fast results while not feeling
           | like you're starving.
           | 
           | But I feel like it taught me to be bored with eating, and to
           | establish a more healthy relationship with food. High-fat,
           | mid-protein, low-carb sounds terrific for the first day or
           | two but once you're two weeks in, you're so sick of it all
           | that you'd just as soon drink some water and get back to
           | whatever you're doing.
        
             | wincy wrote:
             | Well I mean it worked for me because if I eat sugar I end
             | up consuming something on the order of 4000+ calories per
             | day. Something about carbohydrates makes me absolutely
             | ravenous for sugars.
             | 
             | Also if I don't eat right as I feel hungry I'll feel as if
             | someone has gut punched me. I get absurdly hungry.
        
               | JamesianP wrote:
               | Even artificial sweetener leads to craving carbs in my
               | case.
               | 
               | As for the "gut punch" though, sounds like gastritis or
               | something. Unless you're being metaphorical. For me,
               | water helps when I'm fasting and stomach pains start.
        
               | matthewdgreen wrote:
               | This feeling is so intense for me that I've come to
               | believe it's something to do with the carbs and my gut
               | microbiome changing. There's a 1-2 week delay between
               | changing diets and having these hunger pains start/stop
               | that makes this feel more credible to me than insulin
               | response changes or diet boredom. But: one should not
               | treat N=1 subjective experiences as having any real
               | value.
        
               | syntheweave wrote:
               | My "hunger pain" is tied to the some combination of the
               | gut biome and the blood sugar cycle. It initially insists
               | that I should eat frequently. If I persist through it,
               | then an hour or two later, it settles down.
               | 
               | Likewise, I've noticed an effect develop with artificial
               | sweeteners where I can have small amounts without
               | difficulty, but if I start consuming it several times in
               | a 48 hour span, I get cramps.
               | 
               | In periods where I've become addicted to carbs hunger
               | pain is much stronger, but I've been able to keep it down
               | for many years now. So if you're getting it intensely,
               | your gut is probably still reactivating to its old
               | profile.
               | 
               | I believe restriction in the regular diet is one way of
               | correcting it while staying in a routine. But I have also
               | experimented with fasting, intense exercise, hot/cold
               | contrast in the shower, and breathing exercises, and the
               | common theme to each is to challenge homeostasis in some
               | fashion. Obviously there's always some danger in going
               | too far, but if our norm is total comfort, we can
               | definitely drop some aspect of it from time to time.
        
             | eru wrote:
             | > It was my experience that it was a great kickstart to a
             | weight-loss plan [...]
             | 
             | Part of that might be from less water retention early on.
             | 
             | Your body holds on to more water when your diet is full of
             | carbs. As your liver runs down its glycogen stores and you
             | eventually go into ketosis, you lose a lot of water. That's
             | also there the early 'keto flu' comes from, which is a bit
             | like a hangover; plenty of fluids and electrolytes fix you.
             | 
             | Losing water looks great on the scale. On the one hand, it
             | doesn't actually do anything for you healthwise. On the
             | other hand, losing that water ain't bad for your health
             | either (assuming enough fluids and electrolytes), and is a
             | great motivator for the kickstart you described.
        
               | mmmpop wrote:
               | Yup.
        
         | MuffinFlavored wrote:
         | dumb question: how easy is it for the average person to go from
         | an "American" diet high in addictive things like bad fats, corn
         | syrups, processed foods, etc. etc. to a "clean" 1200kcal diet?
         | 
         | I was under the impression it was like trying to fight drug
         | addiction and the chances of you sustaining it and not
         | relapsing/making up the missed calories later as near
         | impossible for most once you've become addicted enough to
         | things like Diet Coke, Chik-Fil-A, etc.
        
           | abecedarius wrote:
           | I don't know. But instead of aiming for a calorie target I'd
           | suggest trying https://www.mostly-fat.com/eat-meat-not-too-
           | little-mostly-fa... for a month. Even if you decide not to
           | stick with it, it's a very palatable break from your
           | addictive foods. (I'm on basically that now, though I didn't
           | come to it directly from a "standard American diet".)
        
           | BirAdam wrote:
           | I lost about 50 pounds in ~3 months simply by cutting my carb
           | intake to about 20g/day (eating just non-starchy vegetables,
           | meats, sugarless dairy). This was moving from an "American"
           | diet overnight to an extremely low carb diet. My caloric
           | intake actually went up slightly.
           | 
           | As for being difficult... yeah. The transition sucked. Body
           | aches, headache, and very slight case of the blues. It took
           | willpower. After about 3 days, I was okay. It was similar to
           | quitting smoking for me, except that quitting smoking didn't
           | give me body aches.
        
           | lotsofpulp wrote:
           | How is Diet Coke related to the conversation? It has zero
           | calories.
        
             | thelittleone wrote:
             | Zero calories but some research suggests the sweeteners
             | still trigger an insulin response which is relevant.
        
               | lotsofpulp wrote:
               | I have seen this claim many times, but have never seen a
               | credible source claim it is conclusively known, at least
               | at the amount of low calorie sweetener that are in 1
               | service if 8oz to 20oz of Diet Coke.
               | 
               | It seems either this is extremely tricky to measure, or
               | it is a myth (like aspartame or MSG or yellow 5 cause
               | cancer or whatever).
        
           | mensetmanusman wrote:
           | Limit yourself to one meal per day; use caffeine as hunger
           | suppression.
           | 
           | The one meal per day limit makes it hard to over/eat.
        
           | knaik94 wrote:
           | It's not fair to assume every person is going to become
           | addicted to things like diet coke or fast food. "American"
           | diet has room for a lot of clean eating. Processed food
           | shouldn't be considered the same as "American" food in my
           | opinion. Convenience driven food choices is cultural in
           | America but that doesn't make the chosen food American.
           | 
           | I think something like Tex-Mex would easily allow for clean
           | eating. Avocado toast, with whole grain bread is fairly
           | healthy and was an absolute favorite of mine after workouts
           | and I would consider it "American" food. Tacos are a great
           | way to have good portion control and also feel filled.
           | Allowing non-traditional recipes opens many options. Avocado
           | grapefruit salad on tortillas with fried tortilla strips is a
           | recipe I came across recently that I really enjoyed. I think
           | non-traditional is the essence of true "American" food.
           | 
           | For fast food, Popeye's Blackened tenders are not breaded, a
           | 5 piece serving is listed at 280 kcal compared to the classic
           | tenders being 740 kcal. Nuts or apple slices with peanut
           | butter is a fairly filling snack and can easily fit within
           | 200 kcal. The main thing you would have to look out for is
           | sodium if cooking at home is difficult. I know most of my
           | bodybuilder friends go to a diet of chicken breast and brown
           | rice for dinner for months at a time when they want to cut.
           | It's around 400-500 calories depending on how you prepared
           | it.
           | 
           | Vegetarian and vegan recipes are good starting points for
           | cleaner eating too. Borrowing from other cuisine makes it a
           | lot easier as well. I love preparing vegetable side dishes
           | for dinner in the way it's prepared for Korean dishes. Miso
           | soup is fantastic for when I have food cravings late in the
           | night. It's not "American" but I'd argue there's nothing more
           | American than making microwave miso soup at 3 am in my star
           | wars mug. Coffee is popular too, and is very low calorie if
           | you can get used to no milk or sugar, or only sugar
           | alcohol/substitutes.
           | 
           | For some context, I grew up and live in one of the most
           | culturally diverse states and counties in the US. I know that
           | not everywhere in the US has the same diversity of food
           | options, but I would argue that Amazon has done a lot to make
           | food accessible.
        
             | thelittleone wrote:
             | I usually eat very well back home keto and 16hrs fasting
             | but I come to US and there's so many tasty temptations.
             | Takes another level of discipline.
        
           | andrekandre wrote:
           | for me, it was just eating rich flavorful foods that also
           | happen to be healthy
           | 
           | what i did was cook for myself so i can reduce vegetable
           | oils, salts, artificial flavorings etc, then cook things like
           | fresh tomato sauces with fresh basil/oregano, fresh fish
           | cooked slowly in plum sauce, chana masala curries with low
           | sodium and delicious spices etc etc
           | 
           | once you get used to healthy, satisfying and flavorful "good"
           | food, carbs, salt, oil and junk food cravings faded away and
           | buying snacks after that was just not satisfying at all...
           | 
           | n=1 and all that, but that was my experience fwiw
        
             | mjthrowaway1 wrote:
             | You're hitting the nail on the head. Sustainable dietary
             | changes require finding foods you like to eat. If you live
             | in West Hollywood there is no shortage of delicious healthy
             | meals you can go out and buy. Outside of similar
             | environments you need to learn how to cook or the healthy
             | meals available to buy at restaurants are going to taste
             | terrible.
        
           | LanceH wrote:
           | It's a lot harder if you listen to the people that say it is
           | impossible and you can't hope to do it because it is
           | addiction.
           | 
           | On the other side are people that say, "eat less, exercise
           | more".
           | 
           | Lots of people have chosen either one of these to be true. It
           | is certainly possible, though.
        
         | midhhhthrow wrote:
         | Going on less than 200 calorie diets for days or even weeks on
         | end was the norm in humanity for millions of years so how is it
         | unhealthy all the sudden? It was a time of constant mass feast
         | and famine alternating from one to other. The problem now is we
         | have the feast part down pat but no famine
        
           | chrisfosterelli wrote:
           | https://en.m.wikipedia.org/wiki/Appeal_to_nature
           | 
           | Being the norm historically does not imply it is healthy or
           | optimal, only that it is at least survivable on average.
        
           | harry8 wrote:
           | In general something being normal for humans for millennia
           | does not mean it was healthy. It was normal to have
           | incredibly painful teeth, probably not healthy. It was normal
           | to die before reaching adulthood.
           | 
           | It is entirely possible that something that was done for a
           | long time is a healthy thing just as it is entirely possible
           | that it was a terrible thing that we conquered with knowledge
           | and abundance. Evidence is what tells you if the thing falls
           | into one of those categories.
           | 
           | I like living in a time where we are outraged if children in
           | our community die and in cases where there was nothing that
           | could have been done we want to do research to find something
           | we can do in the future. That was not normal for millennia
           | until really very recently and it seems healthy to me?
        
             | remarkEon wrote:
             | > It was normal to have incredibly painful teeth, probably
             | not healthy.
             | 
             | Is this actually true? I thought archaic humans had much
             | better dental outcomes because their diets had a small
             | fraction of the sugars that modern diets do. Could be wrong
             | but I was definitely under the impression that poor dental
             | health was more a function of modern diet and not something
             | that necessarily existed throughout history.
        
               | lossolo wrote:
               | Yeah, this seems inaccurate, tribes in Africa that still
               | live hunter-gatherer lifestyle have good teeth without
               | cavities. It changed after humans moved from hunter-
               | gather to agriculture.
        
               | harry8 wrote:
               | I'm no expert, this could be wrong, what I was told by an
               | ancient historian was even the Pharohs with all their
               | wealth had terrible painful teeth from sand in food which
               | was ubiquitous until fairly recently. I have
               | recollections of dental records of pre-historic persons
               | being reported as pretty nasty.
               | 
               | Feel free to nit-pick that example, there are an absolute
               | plethora of others. When did surviving appendicitis
               | become a thing? What was the median life expectancy for a
               | newborn baby at various times in history? Calling out the
               | fetishism of humans in a "natural state" needs to be
               | done. Just as there are things we can learn from our pre-
               | historic existence. Evidence is obviously the required
               | thing not just amusing anecdote about how we have totally
               | "lost our way."
        
               | remarkEon wrote:
               | Yeah I should've made it clear in my comment that I agree
               | with you, I think the fetishism of pre-historic humans is
               | a little odd. Of course there's things to learn, but it's
               | strange to think that a period when you died from
               | something as trivial as a minor infection is somehow
               | ideal. I was only nitpicking on the dental thing, because
               | eating so much sugar really is relatively new in human
               | history and is the source of a number of health problems,
               | beyond bad teeth.
        
             | arriu wrote:
             | I agree but I think we're still working on understanding
             | what a healthy human actually is. Other than the obvious
             | signs, it's quite complicated.
        
         | gip wrote:
         | A proven treatment to reverse type 2 diabetes make use of the
         | keto diet, a low carbs diet (not low cal) which may be less
         | risky. For most patients with T2D, doctor supervision is
         | advised.
         | 
         | One company working to reverse diabetes in the US is
         | https://www.virtahealth.com/ (disclaimer: I work there).
        
         | browningstreet wrote:
         | David Goggins lost 100 lbs in 3 months on an 800ish calorie
         | diet. I'm not recommending that... but what you can accomplish
         | when you own it versus doing it for other reasons is probably
         | significant too. Especially for when the "diet" (or whatever
         | word is preferred, a la "intervention") ends.
         | 
         | I lost 60 lbs over a couple of years and set a state lifting
         | record for my age group. I love what I do and kept the excess
         | weight off. I got good at what I do and the intrinsic reward
         | still burns, even though I'm not lifting for records anymore. I
         | wake up every day ready to go hard for at least 50 minutes. It
         | doesn't take me more time than that to stay in shape, but I do
         | eat consistent with my goals.. which is the harder part.
         | 
         | I personally think someone needs to really own their desired
         | outcome and then there are many valid and healthy ways -- and
         | even more "effective" ones -- to get there. Hard to measure
         | "own" though. Measuring every different kind of modality is
         | generally missing the point. We actually know how people get in
         | shape and stay in shape. The problem is generally in the mind.
        
           | [deleted]
        
           | [deleted]
        
           | syrrim wrote:
           | 100 lbs in three months is ~1lb/day, thus a deficiency of
           | 3500Cal/day. His maintenance intake would have been
           | 4300Cals/day. That seems insanely high - what was his weight?
        
             | browningstreet wrote:
             | He started north of 275 lbs if I remember. He was working
             | out 3x a day. There are lots of videos out there about it.
             | He was also overweight when he started, and he was going
             | into hell week (military) so the first n lbs of weight
             | would come off "easy".
        
       | lhl wrote:
       | There's a long history of studies showing Low-Calorie Diets as
       | being effective for reversing T2D. The late Sarah Hallberg wrote
       | a narrative review that I liked a lot a couple years back (see
       | section 3.2 for the part on LCDs):
       | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/
       | 
       | Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing
       | Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients.
       | 2019 Apr 1;11(4):766. doi: 10.3390/nu11040766. PMID: 30939855;
       | PMCID: PMC6520897.
        
         | seltzered_ wrote:
         | https://www.ncl.ac.uk/magres/research/diabetes/reversal/#pub...
         | "Reversing Type 2 Diabetes and ongoing remission" was in my
         | bookmarks on this, there's a book written about it too.
        
         | 0xcde4c3db wrote:
         | > Furthermore, long-term achievement of diabetes remission,
         | adherence to the diet, and weight loss maintenance after the
         | diet remain a challenge. Studies have also suggested that
         | physiological and metabolic adaptation of the body in response
         | to caloric restriction may shift energy balance and hormonal
         | regulation of weight toward weight regain after weight loss
         | [67,68]. Thus, it is crucial that future studies are directed
         | towards assessing the long-term sustainability of diabetes
         | remission led by LCD and feasibility of this diet on the
         | physiological adaptation and body composition changes.
         | 
         | The basic problem, which has been unchanged for decades, is
         | that hardly anyone actually follows the "proper" diet on a
         | long-term basis without some kind of surgical or drug
         | treatment. Despite weight loss being a massive industry and a
         | very common goal, researchers routinely struggle to find study
         | subjects who have maintained significant long-term weight loss
         | without medical interventions, to the point that there's a
         | special registry to keep track of such people for scientific
         | purposes [1].
         | 
         | [1] http://www.nwcr.ws/
        
           | Vt71fcAqt7 wrote:
           | Most people don't announce to scientists that they've lost
           | weight. Lot's of people _do_ lose weight and stay that way,
           | it 's just that there are even more who don't.
           | 
           | Consider that the rate of obesity continues to increase in
           | the US. This shows that people are simply eating more and
           | doing less exercise. And of course those that are already
           | obese are the least likley to consume healthy ammounts of
           | food and exercise as needed.
           | 
           | In other words, yes, the issue with overeating is in fact
           | overeating. The only way to solve this problem for the whole
           | population (as in, not for a single individual) is to change
           | society and how it views unhealthy food. Off the top of my
           | head, fast food advertisments should be made illegal. The
           | entire point of those ads to get people to eat fast food.
           | This single step could reduce obesity in the US by a
           | noticable amount and requires no loss of freedom to any
           | individual. A sugar tax or the like is a more extreme
           | solution. But this idea is not unfounded:
           | 
           | > _Sugar, rum, and tobacco are commodities which are nowhere
           | necessaries of life, which are become objects of almost
           | universal consumption, and which are therefore extremely
           | proper subjects of taxation._
           | 
           | -Adam Smith
           | 
           | Book V: On the Revenue of the Sovereign or Commonwealth
           | Chapter III: On Public Debts
           | 
           | https://www.adamsmithworks.org/documents/chapter-iii-of-
           | publ...
        
             | kortilla wrote:
             | > Off the top of my head, fast food advertisments should be
             | made illegal
             | 
             | This is ridiculous. Nearly everyone I know who is
             | overweight eats hardly any fast food.
             | 
             | What I do see is lots of snacking throughout the day on
             | high carb things (chips, breads, etc) and just way too many
             | calories due to large serving sizes in both regular "slow
             | food" restaurants and meals made at home.
             | 
             | Fast food meals if you skip the sugared soda tend to be
             | closer to proper per meal calorie targets than sit down
             | restaurants because of how cheap they are.
             | 
             | At sit down restaurants the price is higher to support a
             | wait staff and lower throughput so they compensate with
             | ridiculously huge portions.
        
               | hombre_fatal wrote:
               | Apparently one major issue with fast food is the
               | hyperpalatability.
               | 
               | For example, when I visited my family in the states, I
               | ate two double cheeseburgers at a fast food joint at
               | 1000+ calories per burger, and I figured I could probably
               | eat two more in that sitting without issue.
               | 
               | In other words I ate 2000+ calories in a few minutes and
               | could have kept going. Even one burger has more calories
               | than I eat in a single meal.
               | 
               | Meanwhile, I couldn't eat 15 medium sweet potatoes (1000
               | calories) in one sitting.
        
               | JamesianP wrote:
               | But why would you do that? I think it's just calorie
               | density and behavior. You might just as well have eaten a
               | bucket of ice cream as fast as you could. I.e. before
               | your rising blood sugar has a chance to stop you.
               | 
               | Though I do think the public would be better off if they
               | replaced the bread with lettuce or something. It seems
               | like they're willing to do that anywhere I've gone.
        
               | syliconadder wrote:
               | It doesn't help that these calorie dense food are
               | hyperengineered to trigger our hunger more. A personal
               | prohibition seems to be the only way to tackle this.
        
               | Scoundreller wrote:
               | > I ate two double cheeseburgers at a fast food joint at
               | 1000+ calories per burger
               | 
               | Where was this? A double quarter pounder BLT at McD with
               | standard toppings is 830 calories. A McDouble is half
               | that.
        
               | kortilla wrote:
               | Yeah, this doesn't pass the smell test. I love
               | cheeseburgers and would be borderline sick after two
               | double quarter pounders.
        
               | AuryGlenz wrote:
               | I know there are people out there that could eat 2 double
               | quarter pounders, but I doubt any of them are at a
               | healthy weight - except for professional eaters and
               | possibly teenage boys.
               | 
               | One, along with fries, is enough to fill me up for
               | practically the whole day. I think fast food gets a bad
               | rap. It's calorie dense but with all of the fat it keeps
               | you pretty darn full.
               | 
               | Compare that burger with a few candy bars or not all that
               | much soda...
        
               | Vt71fcAqt7 wrote:
               | You are right that I should not have singled out fast
               | food. Included would be grain based desserts, soda,
               | alcohol and maybe others. Grain based desserts and soda
               | together make up 12% of caloric intake alone[0] and serve
               | almost no nutritional value while providing little
               | satiety.
               | 
               | Another point, while I did say that "The entire point of
               | those ads to get people to eat fast food" what I really
               | meant is that they make people want to eat in
               | general[note 1]. What this means is that fast food ads
               | can be harmful even if they do not cause the viewer to
               | buy fast food. What this does is contribute to a culture
               | of consumption which is part of what I meant when I said
               | "The only way to solve this problem for the whole
               | population [...] is to change society and how it views
               | unhealthy food." I did not mention sit down restaurants
               | because they generaly do not advertise. My suggestion was
               | "off the top of my head" and not fully thought out. I'm
               | glad you made your comment because I did not express my
               | reasoning clearly.
               | 
               | [0]https://epi.grants.cancer.gov/diet/foodsources/top-
               | food-sour... page 77
               | 
               | [note 1] That is, the "point" of the fast food ads
               | collectivly are to generate a demand for fast food from
               | the point of view of the advertisers, but the effect,
               | while more pronounced for fast food, generates a general
               | demand for caloric intake.
        
           | adrian_b wrote:
           | Seeing that there are more than 10 thousand US people in that
           | database, which is unlikely to be complete, I do not think
           | that "hardly anyone" is the right term.
           | 
           | Nevertheless, I agree that such people might be a very small
           | part of those who lose weight.
           | 
           | About 15 years ago, I have lost about one third of my initial
           | body weight during almost a year, and then I have kept my
           | desired weight until today, without any kind of medical
           | treatment, either surgical or drug-based.
           | 
           | Nevertheless it was not easy and it required a lot of thought
           | and experiments with the diet, until I have learned how to
           | control my weight, after many years during which I had
           | believed that this is impossible. It also required completely
           | dropping many bad habits, for example drinking commercial
           | juices or eating commercial mixes of yogurt with fruits or
           | eating various kinds of "breakfast cereals" or any other such
           | commercial products containing an excessive amount of sugar.
           | I have never eaten or drunk again any of the products that I
           | have blacklisted, even if they were among those that I had
           | eaten or drunk daily, for many years.
           | 
           | I believe that most people are not introspective enough to
           | succeed in changing so much their habits by themselves so
           | they need some kind of external help. The main obstacles for
           | weight control are psychological, not physiological, i.e.
           | those who need to control their weight must learn somehow to
           | love to eat food that is different from what they had been
           | eating, because if they will ever revert to their old eating
           | style, then they will certainly also revert to their previous
           | weight.
        
             | PuppyTailWags wrote:
             | > Seeing that there are more than 10 thousand US people in
             | that database
             | 
             | The census.gov says there are a little under 260 million
             | adults in the united states, and we know obesity is
             | something like approaching 40% of these adults, so 104
             | million.
             | 
             | 10,000 is not even one thousandth of a percentage point of
             | the obese people of the untied states.
             | 
             | For contrast, a disease is considered rare if it occurs 1
             | in every 1500 people in the united states. A person who un-
             | obesity's themselves into healthy weight is literally a
             | magnitude rarer than this.
        
       | ravenstine wrote:
       | Link to the actual published article:
       | https://www.thelancet.com/action/showPdf?pii=S2772-3682%2822...
       | 
       | What doesn't make sense to me is what this diet was actually
       | composed of.
       | 
       | > The programme induces weight loss with a period of formula low
       | energy TDR, providing all essential nutrients in around 850 kcal/
       | day, creating a sizable energy deficit and therefore substantial
       | weight loss.
       | 
       | Given that Counterweight Plus can be many things (judging by the
       | website), I don't know what this study actually demonstrates.
       | Maybe the weight loss and remission is associated with the lower
       | energy intake, or it may be associated with whatever diet may
       | have been eaten. What were the subject's diets before? We don't
       | know. Correct me if I'm wrong, but I'm not sure we can tell.
        
       | givemeethekeys wrote:
       | I'll add that reducing sugar, sweet fruits, intermittent fasting
       | (8 hour feeding window) and daily walks made a big difference for
       | a couple of South Asian senior citizens I personally know. They
       | still eat bread and rice and potatoes and consume dairy - but
       | even their relatively modest change in lifestyle has made a big
       | difference.
        
       | _JoRo wrote:
       | ;TLDR: Anecdotally, I've found it easier to lose weight / harder
       | to sustain weight after a few months of consistent exercise.
       | 
       | Mostly unrelated to this article and perhaps naive, but I found
       | it very difficult to gain weight (and even sustain my weight)
       | about 2 months after starting a 5/6 day cardio routine.
       | 
       | I started the routine walking at ~20 minute mile pace (3 mph) and
       | just incrementing the speed by 0.1 mph each session. At the 2
       | month mark I was ~8 minute mile (so about 7-8 miles a day).
       | 
       | At this point I was probably burning an additional 750-1k
       | calories a day from the running alone.
       | 
       | Combined with a slightly less calorie dense diet and I was
       | basically force feeding myself to try and maintain my weight.
       | 
       | Background: Late 20s 5'11" Male ~180 lbs (obviously a more ideal
       | situation)
        
       | dpbriggs wrote:
       | My parents, very much not South Asian, achieved the same thing as
       | per their doctor's recommendation.
        
         | oaktrout wrote:
         | Yes, this has been shown in other populations already. I think
         | the highlight of this study is that it worked in South Asians
         | also, as some might question if genetics/ culture play a
         | particular role. This adds to the evidence that weight loss
         | works for diabetes in all ethnicities.
        
           | PaulHoule wrote:
           | It's worth checking that "obvious" advice works in different
           | populations because it doesn't always.
           | 
           | For instance African Americans have high blood pressure at an
           | elevated rate and many of the medications that work well for
           | other Americans don't work well for them. It's important that
           | this population gets studies about treatments that work for
           | them.
        
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