I feel no physical discomfort when doing the standard 16/8 schedule these days and only feel slight discomfort on a 22/2 schedule. I'd much rather do this than have to meal plan and have anxiety over what restaurant my friends chose for the night.
But I also understand that it's not for everyone and wouldn't push judgement on anyone who chooses some alternative method of controlling weight/insulin sensitivity
You make it sound like the intervention was carb elimination, rather than weight loss with a health coach. It was not.
I still like to eat but it's become more a number game. I eat once a day and structure my meal to hit my macros. Just figure out how many calories and protein / fat ratio and I can usually hit close to it with 1 meal and top up calories with butter coffee.
Also, I can instantly do a 1-day fast. It doesn't bother me at all. Every few days I stretch my intermittent fast to proper "just coffee and water today" fast. It's very refreshing.
Calorie restriction on carbohydrate heavy diet sounds like hell. Food cravings. Starvation.
Fasting on the other hand is a different story. Zen.
I'm not even that close to keto levels of carb intake[1], but I've been progressively minimizing any processed carbs since college (and I'm lucky enough to have been raised eating fairly healthy, so my baseline was decent). At this point, there are certain foods that all my friends feel are impossible not to crave and give into occasionally, that I simply just don't enjoy. One of the biggest examples is fat+grain in its various forms: pizza, grilled cheese, many pastas, funnel cakes, etc etc etc. Don't get me wrong: I'm not completely incapable of enjoying these categories of food. It just needs to actually be well-made and have some flavor: by contrast, most of the people I know enjoy the wireheading effect of this combo per se. To me, this seems like the difference between eating a nice dessert and eating a bowl of straight white sugar.
This is something I think about a lot: there's so many unhealthy food items that I find pretty gross at this point that most of my well-educated, high-income social circles have resigned themselves to being a completely unavoidable flaw in the human brain[2]. It's kind of eerie to think about; My diet isn't even amazingly healthy, and I've already found myself brushing up against the "eccentric abstemiousness" that pg mentions in his essay on addiction.
[1] every time I lift weights, I crave carbs too much to drop them entirely: most of my carbohydrates come from beans, pulses, and certain green veggies.
[2] IMHO, this is the source of the popular-on-HN sentiment that each and every one of us are hopelessly devoid of agency when it comes to resisting the power of corporations to exploit the way our brains' taste centers work. The theory isn't implausible to me, but my experience indicates that you really don't need superhuman self-control to change your diet: it just takes time and patience.
And you make it sound like the intervention was weight loss with a coach, rather than carb restriction made possible by continuous care.
The authors assert that carbohydrate restriction was the main cause of lowered blood glucose, weight, and medicine use (weight loss was not the cause of the improvements; rather, it was one effect among others). Continuous care was required for medicine management and in order to sustain the diet, as clearly stated in the summary (emphasis mine):
> Blood sugar in patients with T2D can improve quickly when patients eat significantly fewer dietary carbohydrates. However, this demands careful medicine management by doctors, and patients need support and frequent contact with health providers to sustain this way of living. [...] After 1 year, patients in the CCI, on average, lowered HbA1c from 7.6 to 6.3%, lost 12% of their body weight, and reduced diabetes medicine use. [...] This suggests the novel care model studied here using dietary carbohydrate restriction and continuous remote care can safely support adults with T2D to lower HbA1c, weight, and medicine use.
Well, to be fair, they didn't make any attempt to control for improvements due to weight loss alone. They compared their results with one "lifestyle change" study and one calorie restriction study (also with carbohydrate reduction, both of which references I didn't follow) and the difference in outcomes was not that groundbreaking, I'd say.
But I'm not a doctor, or a biologist and I can't really say for sure. I'd welcome some input from a specialist on this.
When someone says “carb restriction is the ticket,” they’re attributing the effectiveness -to the carb restriction-, explicitly, as having an effect on weight loss notably above and beyond that of calorie restriction.
Pretty much no decently structured studies have supported that. A couple animal studies suggest shit like HFCS has a much more severe short term effect on insulin than other foods, but they’re small, animal based, and “don’t eat junk food” is world away from “carb restrict.”
If you have a perfectly healthy relationship with food without having to constantly fight cravings, awesome, and nobody who needs to lose weight is like you.
I find fasting to be more in tune with my life nowadays.
The first week or so was really hard. Close to no carbohydrates and all I could think about was sweet things. Even after I reintroduced healthier sweet foods like fruit, it just didn't hit the same spots as a good sandwich or a bowl of pasta.
After I went back to regular food, I'd periodically do a month or so of paleo to try and the weight gain under control, but I got back up to 280. Currently I'm a couple of weeks into slimfast. I'm not hungry. I don't feel bad if grab a small piece of chocolate. Occasionally my evening meal is a small bowl of pasta, or a sandwich and I'm loosing a consistent amount of weight... for now.
Additionally, it's quite common for those embracing a keto/atkins diet to use it as a warrant to eat copious amounts of red meat or any meat at every meal. There's substantial evidence suggesting such a diet increases risks of a number of serious cancers.
A friend of mine has been using the keto diet to try lose weight for a few years now. He burns through bulk cases of SlimJim beef sticks on a weekly basis. I am not looking forward to the future hospital visits. The last time I tried going on a hike with him he nearly collapsed on the first climb. I'm not trying to suggest keto diets are inherently bad for you, but it certainly seems more likely to be problematic than calorie restriction when viewed through the lens of how the average American is going to apply the keto concepts.
[1] https://www.nih.gov/news-events/nih-research-matters/calorie...
Another consequence of bad health on low-carb diets can come from high intake of linoleic acid (omega-6). This is found in "vegetable" oils such as canola, sunflower and nut (even though they are actually not vegetables) [3]. We're told to take this fatty acid for our health, but we only need trivial amounts when our diet is optimal, and too much can disrupt the way that cell mitochondria work.
One fact I find absolutely amazing is that in cancer studies with rats, tumour formation is heavily influenced by levels of linoleic acid in their diet [4].
[1] https://en.wikipedia.org/wiki/Morton's_toe
[2] https://www.sciencedirect.com/science/article/pii/S030698771...
Besides the fishy smell emanating from this, and to address your comment directly, the quoted study compared the proposed treatment against "usual care", i.e. ordinary diabetes treatment.
More specifically, the study did not directly compare the proposed treatment to other dietary or lifestyle interventions and particularly not to calorie restriction diets. It does, however, quote the results of such studies:
The CCI [Continuous Care Intervention] reduced HbA1c by 14 mmol mol−1 (1.3%) at 1 year. HbA1c reductions up to 7 mmol mol−1 (0.6%) via intensive lifestyle intervention [25] and 11 mmol mol−1 (1.0%) via an energy-restricted low-carbohydrate diet with partial food provision delivered via an outpatient setting [26] were previously reported.
So the difference between this and one selected calorie restriction diet (which was also a low-carbohydrate diet) was small (3%). These are just two studies, so it's hard to draw a conclusion.
Anyway, I'm not a doctor or a biologist so I don't know just by looking at the studies to say what is significant and what isn't. For instance, sulfonylurea treatment was reduced in the "CCI" group, like you note, but that group already had ~24% lower use of sulfonylureas than the baseline to begin with. What does that mean? And what does it mean that people took less medicine at the end of a study? Did they absolutely need all the medicine they were taking at the start? Do you know how to answer those questions? Because I certainly don't.
A single study, quoted by someone who isn't a doctor to people who also aren't doctors over the internet, doesn't really mean anything.
You don't need to starve yourself or go on some ridiculous diet. You just need to eat low carb and eat clean (a.k.a. "real" food) and your body will begin to heal in nearly every case. I suspect the few test cases that didn't improve were so far gone they were too metabolically impaired to achieve any positive results. The damage was likely too extensive and age possibly played a factor. For everyone else, it appears they can get rid of diabetes...if they actually care enough to do so.