Recommanded readings
https://nutrition.bmj.com/content/early/2020/11/02/bmjnph-20...
https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-20...
https://nutrition.bmj.com/content/early/2023/12/14/bmjnph-20...
Those papers are the most read papers of BMJ nutrition whole history, and this is the top journal of the field
What makes this work groundbreaking? It seems like one doctor talked about how at his practice he started telling people to go low carb and noticed they were improving.
But his data doesn’t compare the 27% of his patients who opted in to the low carb diet to those who chose another option.
The low carb diet has been around for a while? Has there not been a RCT looking at how it works for treating diabetes?
He makes an argument on why RCTs aren’t so good that is unconvincing to me.
> However, when it comes to actual clinical implementation, RCTs have a problem. So many variables have been removed that the studies no longer represent real people leading ordinary lives outside of a tightly controlled trial. For example, in our National Health Service (NHS) clinic, very few patients with hypertension do not have a weight problem. Many of them are also on drugs for joint pain, reflux or depression. This is why the results seen in RCTs often do not roll out into real-world, clinical practice. For this to occur we need interventions that have a high degree of ‘external validity’—approaches for that better represent the ‘ordinary’ people who populate our clinics. Away from the carefully controlled conditions of clinical trials, results can be very different in the messy, complex world of everyday general practice.
I noticed that he mentioned a RCT on the low carb diet showing good results and read it, but it seems to be p-hacked. They don’t even mention the mean change in weight between the two groups, but only the percent that achieved a 5 or 10% reduction in weight at some point during the study. The also said that 55% of patients lost weight and 45% gained weight.
https://www.ncl.ac.uk/magres/research/diabetes/reversal/#pub...
Even though calorie restriction works great in lab rats as the researcher can control what the rat eats and the rat can't do anything about it regardless of how hungry it becomes, it's not that simple with humans, particularly after a year or two, once the initial willpower is lost.
So, rather than fixating on lowering calories without further considerations, a more effective approach is maximizing the satiety obtained per calorie consumed. It's harder than it sounds! One might be tempted to simply consume large quantities of leafy vegetables, but that will only lead to them learning how hunger is a multidimensional experience. What do I mean by that? You can feel your stomach stretched out and full, and still feel hungry, because satiety isn't only triggered by how far your stomach has stretched, nor by the precise number of calories you have consumed.
In practice, in order to maximize satiety one must strike a balance between the volume of the food consumed, its protein content, and the amount of insulin-raising carbohydrates it contains. That's the reason so many people find success in low-carbohydrate diets, which emphasize these three satiety factors rather than the excessively simplistic calorie count approach.
If you call yourself the "American Diabetes Association", (why) aren't there regulations against such stuff? For eg in some countries you cannot use the name of the city/state/country unless you're a government entity.
I wonder what percent of Americans think that the American Diabetes Association is a government-ran organization. My guess is that it's quite high. You'd have to design a poll correctly (e.g. "From the following list, select which ones are government-ran organizations") to not give the answer away, but I imagine it's a high percentage.
Why does "Bank of America" get to call itself that? Growing up there was a "USA Federal" credit union [1] too, with a stylized American flag logo.
Similarly there's a historic "New Yorker" hotel in New York City, and the totally separate "New Yorker" magazine, neither of which have any official affiliation with the city.
The short answer is that no, there don't seem to be regulations against it. Why any business seems to be able to take the name of a country or state or city, and therefore gain an aura of authenticity or approval, and then prevent any other from doing the same (since the name got taken, you can't have two Bank of Americas) -- I've never understood why the government allows these things.
Part of the First is that the government cannot ban you from using a word unless there is a very good reason do so. "American" is a word that is not associated exclusively with the government, nor was it ever used that way historically. In fact, the word "American" predates the US Government.
Since the word does not now, nor has it ever, implied governmental affiliation, it would be illegal for the US Government to attempt to obtain a monopoly on the word by banning others from using it.
Too often it feels like bribing politicians is cheaper than paying employees!
[1] https://www.irs.gov/charities-non-profits/definition-of-an-a...
This is news to me. I was under the impression that: 1) artificial sweeteners were a safe substitute for sugar for people with diabetes and 2) diabetes came from excess sugar consumption which wasn't a problem with artificial sweeteners.
[1] https://www.who.int/news/item/15-05-2023-who-advises-not-to-...
If a sweetener behaves like sugar as far as taste is concerned, that is it fools one part of your body into reacting as though it is sugar, it seems plausible that it might also fool other parts of the system.
Zero calorie sweeteners by definition cannot cause insulin responses.
I can easily verify this by using my families blood glucose monitors before and after I’ve had a diet soda. I’ve done this several times and I have zero increase in blood glucose levels from a Diet Coke. It actually goes down since time passes between me starting the drink and finishing it.
The obsession from even purportedly good doctors with trying to find reasons to vilify anything that might taste good while not spiking glycemic loads is horrifying to witness.
I’m extremely upset, especially as someone with two diabetic parents and a history of diabetes. Both parents are diabetic because they’re fat as hell.
That is what you expect if you raise your insulin, insulin reduce blood glucose, so if the sweetener increased insulin without adding sugar then it reduces blood glucose.
> goes down since time passes between me starting the drink and finishing it.
Blood sugar levels are stable unless you eat sugar, they don't go down over time, unless you do something to add insulin to make it go down or add sugar to make it go up. Here it sounds like you adding insulin when drinking that and thus making it go down.
It has been shown for decades that this association exists, it's establishing cause, and causal direction that's hard. Does consuming artificial sweeteners cause diabetes? Or does having diabetes cause the consuming of artificial sweeteners?
Not all diabetes is from sugar.
This is a common misconception. Type 1 diabetes cases are more often acquired with no family history, there are some genetic associations but it is actually less strong than Type 2 (insulin resistance/diet related diabetes) where family history is a substantial risk factor. Pregnancy (gestational) diabetes isn’t just pregnancy related either as it is more likely in those with metabolic syndrome/obesity and is associated with type 2 as well, so it is also partially diet related.
> Not all diabetes is from sugar.
I would go further and just say no diabetes is “from sugar”, it’s just a completely uselessly simplistic way of looking at it (I know this was in response to GP comment). It’s not like low carb diets even prevent some people from getting type 2.
Type 2 diabetes is a disease of acquired insulin resistance for which excessive consumption of high glycemic index food (eg processed food with high sugar content) is a major risk factor, but not the only one.
They can get founded in the genuine interests of some cause (and often are), but each transition in leadership tends to find itself more professionalized in some way and more divorced from the founding cause, with process (and/or corruption) becoming their effective mandate instead.
Unions, sadly, have shown no exception, which is what allowed public opinion to eventually swing against the post-war batch of them. We could use some fresh unions in many industries for sure, but there's no truth in putting them on a pedestal. They're prone to devolve and corrupt just like everything else, and there are people who still carry the experience of having seen them do so.
Secondly, there will be those dedicated to the organization itself. Examples are many of the administrators in the education system, many professors of education, many teachers union officials, much of the NASA headquarters staff, etc.
The Iron Law states that in every case the second group will gain and keep control of the organization. It will write the rules, and control promotions within the organization. "
It's the Iron Law of Bureaucracy https://www.jerrypournelle.com/reports/jerryp/iron.html
This isn’t more complete and historically evidenced. This is a Law Named After Person/Dilbert Quip, which is the pit of cliches that a lot of HN comments fall into on sociology.
What, other than just cynicism,[1] have these Stated Truisms contributed to? These rules are so rigid (so they can be pithy, snappy) that they sound immutable. Is the point only to, say, feel smug about how the manager directly above you has been promoted to his level of incompetence?
[1] Cynicism is fine and good. But just-cynicism has no way of moving beyond itself to a better state. The difference between critique and throwing your arms up.
> They can get founded in the genuine interests of some cause (and often are), but each transition in leadership tends to find itself more professionalized in some way and more divorced from the founding cause, with process (and/or corruption) becoming their effective mandate instead.
Nothing in history is ever just a downward spiral of corruption and rigidity. Outside things happen, revolts happen, things are replaced, systems are overturned.
Since the 1980s, evolution via bureaucracy and golf clubs, court cases and election results seem to have been more the driving force.. people can only get so fat before their eyes start to glaze over and trivial concerns take the airtime.
One day a union rep stopped by. He was very well-dressed, and he had this beaming smile. He gave me a t-shirt. That pretty much summed up the benefits I experienced.
I remain pro-union, but every time the subject comes up I think there’s a lot more nuance there than people would like to admit. My Dad, for example, has worked at a union job for over 30 years. Ironically, he’s a Republican. He makes decent money now, but the job is very labor intensive, and the healthcare sucks. He’s repeatedly turned down a promotion into management because he’d be out of the union and earning a salary that is not that much higher than what he currently earns per hour. He’s also told me repeatedly that kids just don’t want to work anymore because the turnover rate is high. Many starting out, especially those with dependents, complain that it’s not worth it for what they earn. He holds that although it’s not great it’s enough. Recently, in an attempt to persuade him to take a promotion, he learned that the healthcare plans offered to management are 2-3x cheaper for better benefits than what the union has negotiated. It’s been pretty crazy to watch his opinion slowly begin to shift.
For new entrants into the labor market, as you've flagged, now they have to successfully negotiate between two overly large entities with predictably unfortunate results. Labor is best served as a competitive market and unions should only be used in the few limited circumstances where they are otherwise unavoidable.
Even worse, they might request your dismissal if you don't join. Here is a direct quote from the Union agreement of a major university, where I teach part-time: "The Union may request that a Part-time Faculty Member who fails to join the Union, maintain Union membership, pay an agency fee, or make a charitable contribution in lieu of an agency fee shall be dismissed. If the Union makes such a request, the Employer shall comply... If the Part-time Faculty Member fails to pay within that time period, and the Union so verifies, the Part-time Faculty Member’s employment will be terminated at the Union’s request".
If anything, unions are only acting in their own interest.
The point of that decision by a right-wing court was to make it harder for public sector workers to stand together in unions. Unions are democratic institutions, with dues and leadership decided by the membership, and the idea that some people pay and some don't even though the entire unit is represented doesn't make a ton of sense. Just like it wouldn't make sense if 2 people in a unit of 1000 wanted to be in a particular union to just say those 2 can bargain collectively.
The weird "speech" argument was basically that their worksite issues are inherently political. I disagree. Unions have separate political funds from the worksite stuff that are optional.
The Founding Fathers would be deeply ashamed of us, I think.
Probably by federalism, the focus on the presidency, Senate elections by the general populace, the role and power of the Supreme court, and a pile of other things.
Sorry, but the founding fathers who held other humans in bondage for all sorts of free labor?
Those founding fathers, or did I wake up in a parallel universe this morning? Let me check wikipedia…
https://arstechnica.com/tech-policy/2018/04/curing-disease-n...
Somehow both people consuming and producing stuff are powerless nowadays.
I'm pretty convinced that unless you're an athlete, everyone should be on a low carb diet (<100g a day for moderately active). Our bodies aren't equipped to deal with the speed-ball you get each meal with the standard american diet. Aside from diabetes and obesity, the is growing data on keto-diets improving psychiatric, neurological, or even cancer outcomes.
There's a chance that I'm misremembering this or confabulating details from multiple publications from different organizations, but skimming the current website ("eatright.org", lol) has done nothing to make me doubt the general vibe.
If you want to see something really hilarious, look up Pepin Tuma, their former government affairs guy. Total jerk. There are countless videos of him threatening and berating government committees over their skepticism of the license. He was finally fired a couple of years ago.
For type 2 diabetes, research had shown that many patients can put the condition into remission through lifestyle changes alone. Nutritional ketosis is very effective in reversing insulin resistance.
Carbs are necessary macronutrient for everybody.
If you mean certain foods that also have a high percentage of carbs then sure but carbs are not the problem.
Take this line from the article itself, for example.
> It can be challenging for many people with diabetes to forgo the breads, sweets, pastas and starches that form the basis of many diets.
What’s common about these foods isn’t that they’re high in carbs. It’s that they’re nutritionally deficient foods that have been stripped of all their fibers and basically reduced to sugars.
Further, the diets promoted as low carb popularly are not good diets either for diabetics or for non diabetics.
is like saying
"nothing about waves themselves that are bad for boats"
kinda sorta true...but turns out sailing in calm waters is a hell of a lot safer than heading into rough seas
(type 1 for 28 years)
This is a wild claim to make and doesn't seem to hold true scientifically. Humans require fat, protein, and various vitamins usually received from vegetables. There is no requirement that comes from carbohydrates as they effectively are just empty calories.
That is untrue. A Type 1 diabetic requires insulin proportional to the amount of carbohydrates they eat. The larger the insulin dose, the higher the potential error in the dose compared to the carbs (it’s inexact). If the error is on the “too much” side it can drive blood sugar fatally low. This happens, unfortunately often.
> Meat is considered a complete protein source, meaning it contains all nine essential amino acids that your body cannot produce on its own
Do carbs?
> Carbohydrates primarily provide energy for your body and are not a significant source of amino acids. Essential amino acids, which your body cannot produce on its own, are primarily found in protein-rich foods such as meat, dairy, eggs, and some plant-based sources like quinoa and soy
So you're 100% wrong: carbs do not provide essential amino acids and meat does.
The mechanism behind type 2 diabetes is well known and it's all about eating too much carbs.
Sugars and carbs are converted to glucose in your blood.
You can't have too much (or too little) glucose in blood.
Some of it is burned as fuel but the rest has to be removed somehow so body starts producing insulin to push glucose into cells where it's get converted into fat.
If you can't produce insulin, you have type 1 diabetes and need insulin injections.
If you overeat carbs you store more and more fat. You become over-weight and insulin gets worse at moving glucose from your bloodstream.
The diagnostic test for diabetes is literally: do you have too much glucose in your blood (compared to what is healthy range) or related test a1c which tests for elevated levels of insulin in your blood.
If you know the above, then how in the world can you claim that carbs are not the problem? It is literally the thing that causes diabetes.
The simple solution to reversing type 2 diabetes is therefore to stop eating carbs. That's low carb diets like keto or carnivore.
You make very wrong assertions (carbs are not the problem; carbs have all macronutrients; low carb diets are bad) without a single supporting argument or reference.
Stem cell therapy to restore beta cell functionality (for T1) would threaten and disrupt that sweet regular cash flow. So I imagine companies will fight hard to keep diabetics purchasing their regular consumables until the end if time if possible
The insurance companies that pay for a lot of the supplies you talk about would prefer a one stop solution if it costs less. The big expense due to diabetics for insurance companies is not those consumables, it’s the consequences of dialysis and amputations.
If you don't get T2 diabetes in the first place, because you got good advice, you will never get to the needles and insulin stage at all.
It seems strange it would only cost 1 million to make the association a corporate shrill for Stevia when diabetes as an issue costs billions to the US.
If you're going to forgo your princibles and be corrupt then at least get higher price for doing so!
https://professional.diabetes.org/sites/default/files/media/...
> This content is brought to you by Splenda, a proud supporter of the American
> Diabetes Association
> A Message from Splenda
> Splenda® is committed to helping people achieve their health goals by making it
> easier for people to reduce the amount of added sugar in their diet. You likely know
> Splenda Original Sweetener (“the yellow packet”), but did you know we also make
> Splenda Stevia? Splenda Stevia is a plant-based sweetener made from the
> sweetest part of the leaves of the stevia plant. And just like Splenda Original,
> Splenda Stevia contains zero calories and zero sugar. The people you see can use
> Splenda Stevia to make a variety of delicious recipes from appetizers and drinks to
> entrées and desserts.
> Check out the ADA's Diabetes Food Hub® for recipes that use Splenda Stevia, like
> these Slow-Cooker Sweet & Spicy Turkey Meatballs, which are perfect for a football
> party, and these Gluten-Free Mini Eggnog Cupcakes which add cheer to any holiday
> gathering!
WHY??!!! I get upset enough with tech YouTubers making misleading claims about VPN sponsors, but the American Diabetes Association allowing sponsors that sell products that several studies link with causing and worsening diabetes to write parts of their newsletters is an entirely different degree of unethical behavior. No, the link between artificial sweeteners and diabetes has not been firmly established and more research is needed, but it's a likely enough connection that the CDC and WHO[1] have expressed concern and have noted the potential links.
[1.] https://www.who.int/news/item/15-05-2023-who-advises-not-to-...
I get it, organizations have to get funding somehow. But if the American Lung Association started allowing vape companies to write part of their newsletters, I think people would rightfully be outraged. Sure, vaping is less bad for you than cigarettes, and may even be a helpful way of quitting for some, but allowing them to be a sponsor is a major conflict of interest and causes you to lose credibility.
The study above references 4 different studies that indicate that artificial sweeteners can affect glucose tolerance through changes in the microbiota composition:
- https://www.nature.com/articles/nature13793
(free PDF here: https://d1wqtxts1xzle7.cloudfront.net/44081512/Artificial_Sw... )
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363527/
- https://www.cell.com/cell/fulltext/S0092-8674(22)00919-9
- https://www.cell.com/cell/fulltext/S0092-8674(22)00994-1
The article also references 4 studies that indicate that artificial sweeteners have side effects in terms of obesity, cardiovascular disease, and mortality.
- https://www.bmj.com/content/378/bmj-2022-071204
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538252/
So about 4x as many deaths per year as homicide, twice as many as suicide, twice as many as car crashes, twice as many as accidental falls, and a multiple of plenty of other preventable causes of death. Obviously some of these other types of deaths take far more years off people's lives than diabetes, but I think the author is right to call it an urgent national scandal.
> Her meticulous account depicts the world’s most important diabetes patient advocacy organization as a cynical fund-raising machine, anxious to please its corporate overlords at the expense of the millions of people with diabetes it is supposed to be trying to help. “The defendant’s conduct shows that they were party to a scheme to defraud the American people by approving and endorsing recipes submitted by Splenda to be lauded by the ADA as a healthy choice for people with diabetes, when the ADA knew that those recipes were contrary to the ADA’s guidelines and well-established and emerging scientific principles,” the complaint reads. In case you’re curious, the ADA and Splenda appear to be still at it. As I write this, the ADA’s Diabetes Food Hub web page still features no fewer than 203 recipes – some marked “sponsored”, some not – that include Splenda, whose parent company’s $1m contribution has brought to light the utter insanity of our diabetes epidemic.
I really wish this could have gone to the discovery phase. Hopefully there will be investigations.
> And although type-2 diabetes is often reversible through a low-carbohydrate diet, the ADA and the pharmaceutical industry don’t seem very interested in acknowledging that. Instead, they promote a laundry list of corporate deals and pharmaceutical treatments that have failed to stem the disease’s lethal and expensive impact on American life.
I'm not naïve enough to think that all (or even most) of the tens of thousands of people dying from type 2 diabetes each year would be saved if the ADA didn't give poor advice, but I also think it's wrong to think that it'd have had no impact: insulin has been infamously expensive for many years in the US, and insulin pumps are thousands of dollars. I certainly think some of the millions of people who ended up dying from type 2 diabetes would have made lifestyle changes had it been made clear that it's often reversible with diet changes, if for no other reason than to save money. If you don't have a pump, having to take insulin shots throughout the day is a pain the ass, so again, I think some people would have made lifestyle changes to avoid that had it been made clear that it was an option.
But I suppose "if you aren't paying, you're not the customer" applies as well to nutrition and medicine as it does to free webmail.
One of those work, the other is what people that say they "did their own research" usually do.
Does anybody say that? I see a lot of "some guy making a convincing-seeming argument on youtube is not doing your own research unless you fact check it by legitimately looking for omitted or incorrect statements, because there's a million crazy echo chambers out there".
"Do your own research" can be a red flag, but only because so many people are bad at research, not because research is bad. It's important to look for comprehensive information and not just search for what you already think is correct.
other comment> The "trust the authorities" perspective currently en vogue is certainly not that "doing your own research works." It's that one needs an MD or PhD in a medical field in order to evaluate research, and hence should defer judgment on personal decisions to such qualified individuals (or more often, in practice, to institutions which purport to speak for them like the AMA, AAP, or American Diabetes Association).
It's not that you need it, it's that you'd better put serious effort in to make up for it, and you need to take scientific consensus very seriously (Which is not the same as listening to the most prominent voices. But if almost every expert top to bottom is saying the same thing, they're almost certainly right.)
And for 95% of things, you're not going to put in enough research to understand from base principles. So if you're outsourcing, outsource to someone competent.
These two are not the same. It is dishonest to combine the two.
https://www.chicagotribune.com/2016/07/29/prediabetes-the-ep...
I'm not quite ready to publish my hypothesis that prediabetes is a scam. I need to research it a little more. But a statistician friend of mine responded:
A handful of years ago, I looked into the National Health and Nutrition Evaluation Survey, NHANES. To first order, the 1AC level defining pre-diabetes, 6.5, is rather close to the median level. So that's scam-adjacent. Every once in a while, my doctor thanks me for giving him this NHANES table.
https://docs.google.com/spreadsheets/d/1g3Icgu0ixLtYCjscYoiC...
As soon as you say this, someone will respond "My father has diabetes and he had his foot amputated!" This is not minimizing diabetes; it's questioning whether prediabetes is a thing.
How is it different from saying "Men over 60 have pre-prostate cancer?" Or, "we all have pre-death?"
You should have a regular blood test and your doctor should be monitoring a lot of things, including blood sugar. If the level is close to diabetes, he or she should warn you. But that's different from saying, "you have a disease."
That the cutoff for prediabetes is close to the median level is a statement that much of the population is actually unhealthy in this regard.
The essence of type 2 diabetes is insulin resistance. Like many medical conditions it exists on a spectrum. The specific HbA1c thresholds of 5.7% for pre-diabetes and 6.5% for diabetes are inherently arbitrary and serve mainly to make communication easier. But there is a clear correlation between elevated HbA1c levels and higher all-cause mortality.
https://doi.org/10.1136/bmjopen-2017-015949
Also note that HbA1c tests aren't perfect for diagnosing type 2 diabetes and can have false positives or false negatives. If there is reason to suspect diabetes then it would be wise to conduct additional tests to get a better understanding of the patient's metabolic condition.
When we do workups on pts suspected of diabetes, we use the following criteria.
- Iron deficiency anemia workup to confirm accuracy of HbA1C
- HbA1C ≥6.5%
- FPG ≥126mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least eight hours
- Two-hour plasma glucose ≥200mg/dL (11.1 mmol/L) during an oral glucose tolerance test
- In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200mg/dL (11.1 mmol/L)
I would like to redo the diagnostic criteria to include their BMI.
since you know nothing about him, that's hardly called for. I could doxx him but he didn't consent to that. And he said his doctor thanked him for it.
And you have fuzzed the difference between "a disease" and "something to watch for." If ~50% of the US population needs to be watched, the doctor learns nothing by having a label put on their HbA1c level. The word added nothing to their understanding.
> If there is reason to suspect diabetes then it would be wise to conduct additional tests to get a better understanding of the patient's metabolic condition.
And finally, you just confirmed what I said. It's not "a disease" -- it's a risk factor. Like smoking, drinking, obesity, or sedentariness.
The more everyone objects without any logical argument, the more it's confirmed:
"if that biomarker, all by itself, predicts type 2 diabetes better than random chance, in the absence of any other risk factor, we're entitled to call it a disease."
but according to the NIH, 30.7% of Americans are overweight, and 42.4% are obese. as the median American is overweight, it doesn't seem a stretch to claim that the median American is also pre-diabetic? I don't know whether it's true or not, but your evidence seems a bit thin.
https://www.cdc.gov/diabetes/data/statistics-report/index.ht...
No, it's your evidence that's thin. You seem to have started from the premise ("Americans are unhealthy") and derived a pre-diabetes level from that.
I already avoid sugar and bread. I work out nearly every day. I'm very active and my BMI is on point. My blood sugar was fine. It was another metric that I can't recall at the moment - but it seemed weird. Regardless, a very obese nurse sat me down and gave me tips for changing my diet.
Just because you feel healthy doesn’t necessarily mean you are healthy. You may have, for example, a pancreas condition. Or it may be nothing at all, and just something to track, which is why you never base any medical decisions off a single test.
Your last sentence is nonsense. People can provide exceptional (and correct) advice without necessarily following it themselves, and for all you know this nurse has spent the last year actively trying to improve their health.
