For type-2 diabetes, various forms of dietary therapy such as nutritional ketosis have proven extremely effective in reducing or even eliminating many patients' need for exogenous insulin. But we usually refer to that as putting the condition into remission rather than a "cure".

https://doi.org/10.1530/EDM-22-0295

This.

I was diagnosed with type 2 diabetes about two and a half years ago. After doing some research, I put myself on a strict keto diet. Within about a month, my A1C went from over 13 to hovering around 6 and has stayed there. Never took any diabetes medication.

I do give myself a "vacation" from the diet about once a month, which I usually reserve for a special occasion.

Do you find that this requires an unusual amount of self-control? I have no reason to manage my food intake, but in the limited times where I have I've found it quite difficult

I did keto for almost a year, and it wasn't that bad. My wife lost 50 lbs and I lost 45lbs. 190 > 145 (I had to put on weight afterward). First of all, you can eat things you enjoy, and you don't have to limit your intake. Basically, eat until you're full. When you're fully in ketosis (~2 weeks) you'll naturally not feel hungry. This is what makes keto great because you're never in a situation where you're hungry (at least after a few weeks).

Eating out isn't as bad as you think when in that position. Get a steak with some low-carb vegetables on the side. You can still have blackberries and raspberries and if you really need to "cheat" you can find some deserts that are no carb. Although best to limit those types of sugars. Use an app / website to track carbs for the first few months.

Just remember you're either in ketosis or not. There's no such thing as a "cheat" day on Keto as going over carb amount can kick you out.

Is there a recommended amount (or formula) of carb intake on keto? I use an app called MacroFactor and it suggests up to 45 grams of carbs per day, but I find it too low. I’m somewhat struggling to stay under that limit.

Also the binary nature of either being in ketosis or not is somewhat disappointing. I unfortunately find it impossible to be on a keto diet for long periods of time due to social situations and eating out. Do you have any advice?

45 seems like a lot, honestly. I think we did 20 at first. The ketones blood test kit is a must have. You have to know if you're actually in ketosis. People can do it at different carb amounts.

Societal pressures can be challenging but it's really not that bad. We ate out quite a bit because of birthdays and such. If you're at a nice restaurant, get a steak and a low-carb vegetable. At Ruth's Chris we did Tomahawk steak with mushrooms. Drink club soda with lime or lemon. Chipotle is a good meal. Chicken steak, guac, cheese, salsa (check their site)

Wingstop was also goto for us. They have quite a few sauces that have no carbs. Eating out is planning. Check the menu; if it's not a chain, you might have to call. We did that a few times. Ask if they put sugar in certain things. Burger with bacon and cheese no bun is also an option. You have to be careful with chicken dishes because they might put a sauce on it.

Remember, it's low-carb, not no-carb, so if you accidentally eat a few pieces of bacon with sugar in it, it's not the end of the world. It's probably not going to be enough to kick you out.

Many restaurants don’t have great options though. I find it really easy to do keto when I only eat at home but if I have to travel I fail almost instantly.

Yeah, travel would be really hard. We didn't go anywhere more than a night when we were on. You would have to pack food to do it successfully, but yea keto is best when you're fixing most of your food.

That's the optimization problem. I find one can't always have it all. Sometimes health means have a less than delicious meal or skipping a restaurant.

When I'm on my deathbed, I'm far more likely to regret the things that I did eat opposed to the ones I didn't

I actually think this is an important part of cultivating healthy relationships with food. I needed to stop thinking about boring meals as missed opportunities for consumption.

I mean, there aren't great choices at Sonic, but it's not too hard to find a burger at most restaurants, and a steak at the ones that don't (and just don't eat the bun).

A diner breakfast of eggs and bacon or sausage will do as well. Just don't eat the starches.

I'm much less strict now than I was, because I am comfortable going into ketosis and losing a few pounds if my clothes start getting tight. But in the beginning, I aimed for 10 g of carbs, assuming that due to wrong estimates and "hidden carbs" (anything with less than 0.5 g per serving can be listed as 0 carbs) I'd still likely be under 20 and definitely under 40.

Some would say that's not a varied diet. I would argue that eating a different dessert at every meal isn't all that much variation except in taste - which is not to be laughed at, but I've always been the kind of person who would rather have more steak or hollandaise than a dessert. Poached eggs on ham, covered in hollandaise, is not exactly an ascetic diet.

I have done over a year of keto on two separate occasions and found it VERY easy to maintain. I contribute this to a high level of satiety while consuming foods high in healthy fats and protein. I rarely had cravings. My go-to fat is coconut oil which I put in my morning coffee and can add to just about any cooking and soups (coming up on soup season so bone broth and coconut oil is my go to). Just about anywhere you go out to eat you can find something that is keto-friendly. Anecdotally, during both of these stints I did not need to take my long term asthma medication and my frequency of use for my emergency inhaler was considerably lower.

I heard about keto diet and tried severely limiting sugar and other carbs intake. I instantly felt better and lost 6kg in two months. Sticking to the new diet was pretty easy. Now after 6 months I have constant headache, painkillers don't work, constantly tired and no further weight loss whatsoever. Every test was ok, sugar perfect, just insulin in upper bound of range. Limiting sugar is not panacea. Sometimes it works, sometimes it doesn't.

No, I do not. My father was a diabetic who did not take good care of himself. He died quite young, so I have a negative model that I'm trying to avoid.

Same. Except then I subsequently found that I actually had adult-onset Type 1 diabetes. But I was still in the "honeymoon" phase, so my pancreas was producing enough insulin to get by still.

I stayed on this for seven years until I finally had to go on insulin.

I need someone who control his type 2 diabetes with the ornish diet which is fat vegetarian no sugar or simple carbs...

And maybe the secret is the no sugar nor simple carbs

The secret is lots of veggies, fruits, and whole grains. The calorie density is low so it's easy to stay in a normal calorie range or even a deficit which is key for reducing risk of type 2 diabetes. Fat, especially Saturated fat causes insulin resistance. Many studied show this. Please show me any long term studies or a culture that are metabolically healthy on long term keto diets. Take a look at Virta health. Tons of money spent on low carb diets that achieved very little.

Try a book like "fiber fueled". That's a diet that is actually sustainable.

There is no "secret" here. While saturated fat might play some role in type-2 diabetes (there appears to be a genetic factor for some patients), the immediate cause of insulin resistance is excessive carbohydrate intake. The Virta Health approach of nutritional ketosis appears to be quite effective and sustainable for many patients.

https://doi.org/10.1007/s13300-018-0373-9

https://doi.org/10.1016/j.nut.2014.06.011

To me, this just doesn't add up. For virtually all of human history, the human diet is mostly carbohydrates. If anything, we eat less carbs than we used to - instead, we now eat more saturated fats and protein, due to ready access to farm meats.

Prehistoric humans however (that is, before the agricultural revolution) consumed most of their carbs through fruits, nuts, and vegetables. It's estimated their diet probably consisted of around 100 grams of fiber a day, as opposed to the typical 2 grams people eat today. Fiber slowly the blood glucose elevation by quite a lot.

I don't think simply cutting out carbs is the answer or even sustainable. I think it makes much more sense to gravitate towards a diet of more whole food, which contain more fiber and thus don't raise blood glucose as severely. Carbs are important, and we've been eating them forever.

You're not adding correctly. Carbs aren't important. They are not an essential nutrient. People can live indefinitely without them.

For virtually all of human history, the human diet was whatever people could get their hands on. That meant as much meat as they could hunt or raise plus whatever else. Most regular people barely stayed ahead of starvation and they couldn't afford to be picky. Insulin resistance only becomes a problem when consuming excessive amounts of carbs over a long period, which only even became widely possible after 1913 due to the Haber-Bosch process making farming more productive.

Your baseless claim that cutting out carbs isn't the answer or even sustainable is directly contradicted by clinical research. Many patients have literally put type-2 diabetes into remission through nutritional ketosis. That diet isn't recommended for everyone, just patients who already have insulin resistance (with appropriate medical supervision). Regardless of what you "think", that is the reality. After the patient's metabolism has been somewhat repaired it may be possible to reintroduce limited carb intake without triggering a relapse. Fiber is certainly helpful in this, and no one is seriously suggesting to eliminate fiber.

> That meant as much meat as they could hunt or raise plus whatever else

The human diet has been a very, very small minority meat. Because meat is hard to get.

And prehistoric game meat is also not the same as farm meat. Beef and pork contain high amount of saturated fat, but game antelope would contain much less and would have unsaturated fat. Meat of that time is really closer to avocado than meat of our time.

> Regardless of what you "think", that is the reality

I'm glad to see everyone is being civil.

But if we come back down to Earth, you'll realize diabetes is reversed 95% of time when Ozempic is used.

Do those people eat carbs? Yes, they do. Is 95% a higher success rate than whatever pathetic adherence rate a miserable existence like ketosis has? Yes, it is.

If for 99.9999% of all of human history our diets consisted of almost exclusively carbohydrates, I don't think we're following the right path here.

Just because ketosis reversed diabetes DOES NOT mean it address the root cause. It could be purely incidental. And it's also a piss-poor treatment. Because it sucks, and nobody wants to do it, so they try it and then lose a foot or two.

We should stick to real medications, such as insulin and Ozempic. The granola-brained can continue their keto.

> And prehistoric game meat is also not the same as farm meat. Beef and pork contain high amount of saturated fat, but game antelope would contain much less and would have unsaturated fat. Meat of that time is really closer to avocado than meat of our time.

Wild meats have very different ratios of fats that farmed meats, but mostly in the opposite direction you are saying. Because (especially non-ruminant) animals take most of their fat from their diet, rather than synthesizing it directly, farmed meat closely mirrors the ratios of fats fed to them via diet- and using seed oils in animal feed makes them have much more omega-6 polyunsaturated fat, and much less saturated, monounsaturated, and omega-3 fats.

Overall a high omega-6 intake is a huge problem as it alters our cellular lipids in a way that impairs a lot of systems, as is eating muscle meat only which has weird amino acid ratios compared to our needs. Weird amino acid ratios in diets have different usually undesirable drug like effects. Both are major issues for anyone trying to do a 'high meat' diet in modern times. As with vegans, if you deeply understand this stuff and have the time and money you can probably make it work.

> whatever pathetic adherence rate a miserable existence like ketosis has

Ketosis seems pretty effective for some people and not for others. I did it for many years and felt amazing- it was in no way "miserable" but eventually got into competitive sports where my performance just wasn't as good with a restricted diet. If I were diabetic, there is no way I'd rather be insulin dependent than do a ketogenic diet, assuming it actually worked that way for me. I know several people that permanently solved major mental health issues that didn't respond to other treatments by staying on ketogenic diets.

For many people, I do thing higher carb diets actually are better for diabetics, because low carb induces extra insulin resistance and raises blood sugar levels. The most effective diets I have seen in peer reviewed research for diabetes treatment seem to be something like "high carb paleo" diets with lots of starchy root vegetables. However, if it makes it easier to lose weight and eat less for someone, ketogenic diets will help.

Moroeover- and this is little known I think- ketosis and low carb are really totally independent things. Ketosis occurs anytime there are excessive acetyl groups in the TCA cycle, which happens under various conditions unrelated to carb intake.

Most people on low carb diets never get into ketosis unless they also severely restrict protein, because we make a ton of glucose from protein (via gluconeogenesis). People eating mostly lean wild animals are unlikely to ever reach ketosis- you'd have to be eating mostly things like seal blubber.

However, many people on high carb diets, especially things like raw vegan diets or diets with lots of resistant starch, e.g. from potatoes and rice are in ketosis, because resistant starch gets ultimately metabolized as ketones. The so called "keto diet" is probably not actually a ketogenic diet but "raw veganism" and the "potato diet" probably often are ketogenic diets.

I don't really have a high vs low carb bias or preference but think it is fascinating how adaptable metabolism is (and it is what I research professionally).

> For virtually all of human history, the human diet is mostly carbohydrates.

Which is rather a short time in our evolution, compared to virtually all of human pre-history. During which the human diet was most likely not mainly carbohydrates.

Human pre-history was also mainly carbohydrates. The idea that humans lived off of primarily meat is fantasy - we eat more meat now than we ever have. Prehistorically, humans ate primarily gathered foods - nuts, fruits, and vegetation. I believe it's something like the average prehistoric human ate 100 grams of fiber a day. As opposed to the US ~ 2 grams of fiber a day, caused by our diets high in meats, saturated fats, and ultra-processed foods.

> But we usually refer to that as putting the condition into remission rather than a "cure"

Because that’s accurate. Someone following this treatment plan is still at elevated risk of recurrence. Once you’re cured of the flu, your ex ante chances of catching it again are no higher. (We don’t have a cure for diabetes per se. Insulin controls but doesn’t cure it.)

> A week of fasting a couple of times a year

By “a week of fasting” you mean a week of intermittent fasting or something else? Can you give an example of such a regime (and are there different ways?)?

Don’t have type 2 yet but has family history and it spiked to 6.1 one right after a hospitalisation so I have been spooked since (been 2 years). I get super stressed even at the thought of sugar related tests.

A week of fasting is a 7 days of consuming nothing but water, salts and possibly some vitamins.

You don’t have to try for 7 days on the first attempt, though for most people the first two days are the most difficult so riding it out past the third actually gets easier.

The fasting mimicking diet works too. (https://www.cell.com/cell-metabolism/fulltext/S1550-4131(15)...).

I'm ending my 5th day of this cycle today, and this morning my fasting blood glucose was 77. Usually it's around 100.

Was excited to read this, but disappointed tjere was no information on the actual human diet, other tha a few hugh-level sentences.

Do you know of other sources of information?

It's really just 1050 calories the 1st day, and 750 calories on day 2-5. The exact balance of protein / carb / fat doesn't seem critical.

Is how it is spread throughout the day important? Can it be in one meal, any time of day?

Counting calories has always been such magic to me, given all my meals are homemade and I don't made them.

>the fasting required for bariatric surgery actually provides a large proportion of the benefit of the procedure

Can confirm. My wife had surgery ~3 years ago. I supported her by eating the same things she was for prep and throughout the surgery. We lost about the same amount of weight, through ~1600cal a day and exercise. I wanted to get down about 25lbs lower than my lowest during that time. But, a year ago my wife was diagnosed with cancer, and that process totally screwed with our plans, and we both gained weight, her quite a bit less than me.

The last ~6 weeks I've been restricting calories again, and have started the journey back to where I want to be. I will say that the surgery really impacted her hair badly, which she didn't love. Despite taking all the best vitamins, her hair went from thick to somewhat thin.

If you can get rid of the things that trigger you and stick to low calories and exercise, you'll lose weight. The surgery helps, but committing to low calories is going to get the results. And a friend who got bariatric surgery but wasn't committed to lifestyle changes, within a year was back to her original weight.

Gosh, what a journey.

Hope you wife is doing better.

Thanks, she is. She's officially in remission.

We regularly take a multi-day drive to her parents, and on one I noticed she had to use the bathroom a lot more frequently than usual. Another friend lost his wife a couple years ago to pancreatic cancer, that started with some lower back pain. The moral of the story: Don't ignore changes you notice in your body.

My wife’s hair thinned a bit too with chemo and she never got her eyebrows back. She been drawing them on for almost 10 years now.

I first felt the tiny lump in her breast and then she couldn’t find it. I had to nag her for a few months to go get it looked at. She just waited for her routine appointment which was 4-6 months after I nagged her. In hindsight, I wish I was more insistent as I think it could have been removed without needing chemo earlier on. She was early 30s, and at that age at least, she’s of the opinion the double mastectomy and reconstructive surgeries were a breeze compared to chemo.

I knew it was not good when I felt it the first time (in college I worked in a pathology lab, have handled a lot of cancers and I knew she had brca genetics) Who knows really if chemo could have been avoided but my point and learning was, you are with this person more than anyone, if you notice something and are concerned for them you need voice it and create action.

Glad your wife's treatment seemed to work out well.

I'm sure it was hard to watch your wife wait out the next Dr appointment. I have a friend and they decided to "pray the cancer away", and didn't seek medical treatment until there were skin lesions visible. The nurse at that appointment had to leave the room to vomit it was so bad. They went through surgery+chemo+rad and she's been in remission for a number of years now. So, even in fairly bad cases of waiting it out, there can still be good outcomes.

Definitely don't wait though. In my wife's case, they were confident that surgery would resolve it. But when they got in there, it was "acting weird"; it had grown much, much faster than it should have over that time. Initial diagnosis was stage 1, after surgery they called it stage 3+.

I had to do battle with the insurance company, because our company was changing insurance, with the new insurance becoming active 4 days before her scheduled surgery. We have a "benefits advisor" that always says "if you have any questions, ask us and we'll take care of you", but they've been fairly useless. In this case, they were telling us that we needed to wait until we had the new insurance cards, which would happen sometime within a few weeks after the new policy became active, then we'd have to submit for pre-approval, which could take another few weeks. And the specialized surgeon was scheduling like 6 weeks out...

We eventually found that we could personally guarantee payment, and the doctor was confident that insurance basically never denies coverage in situations like ours, so we went ahead with this course and got everything paid for. Which was good, because as I said, the cancer was "acting weird" and in the 2 weeks between initial location of the growth and the surgery that we were lucky enough to be able to get in due to someone else needing to reschedule, the growth doubled in size. Another 4-8 weeks very likely could have resulted in spread to the lymph nodes and much worse outcome.

Another moral of the story: Don't let the insurance company push you around. With cancer, time is always of the essence.

Glad you wife’s outcome was good as well.

When it’s cancer, you have to move quick. I knew that from my experience in the clinical setting. That was over 20 years ago now but I still remember when a biopsy or specimen tested positive they’d want to know STAT and would then be calling the patient back in to discuss options immediately. The OR schedule would change to accommodate new cases and such. Outside the ER and Code events, most things in the hospital seemed to move slow especially the outpatient stuff. But as soon as C was involved doctors everyone wanted everything done yesterday.

It’s a good point on insurance as that’s the most common delay/blocker from how doctors would want to proceed. My wife’s young age (denser breast tissue) required a special type of imaging to detect. Insurance didn’t want to pay for it and it was something like 20x more expensive than the normal type. We went ahead and paid, thankfully we could, and her oncologist fought with the insurance a bit about why he justified it. Eventually we got reimbursed. The doctors apparently used her case to help build a new insurance-approved standard for imaging of young high risk patients, which is pretty cool byproduct of our stress.

It was a similar scary high growth type cancer, between the time the imaging was confirmed and a week or two later when it was surgically removed it had growth from 1.8mm to 3.5mm diameter. Which was still considered extremely early detection from what we were told. If she was not already aware of her brca risk and seeing an oncologist annually, it might have been much larger and likely metastasized possibly in the lymph nodes by the time it was discovered. Scary stuff, you guys did the right thing acting quickly for sure. I spent a good portion of my career in healthcare finance, and see how decisions are made regarding capitalistic agendas and have experience the patient side of these decisions as well, needless to say I’m strongly in favor of socializing healthcare and even removing the profit motive entirely. Some things shouldn’t be investments. It bothers me that all those against it are just ignorant to the existence of these kinds of issues and have been fear mongering. I think we have current resources to “do it right” if we put the proper thought and execution into it.

The proposal of making smaller healthcare groups so that healthy people aren't paying for sick people to make it more fair is exactly the wrong direction to go as a society, IMHO. And I say that as a person who has spent fairly small amounts over my life. We can basically guarantee that with the exception of early, cheap deaths, that everyone is going to need healthcare. Spreading it out among everyone just makes sense to me.

I'm of similar opinion. Tying it to employer makes no sense in our current world. People change jobs all the time. And I've seen boardroom decisions where we decide not to cover a drug on insurance because only 1 person takes it and it is very expensive and we only employ 100 people. Meanwhile, we all know damn well exactly who that one person is. It's Pam down in Accounting, she's open with her battle with MS/Cancer/etc. And, that's not insurance! The fact that it's done by CIGNA/United/etc who has millions to spread it across and the risk should have been baked into the rates we already were paying. It's just maddening.

I had to get out of Healthcare altogether after COVID and the Boardroom conversations I was a part of. The worst was we wanted to close ICU's because uptick in nursing labor was making profit margins lower than usual, never mind the fact we had a ton of cash on the balance sheet the government had given us for emergency funds - I luckily was able to win that battle and we remained open - but yeah, hedge fund owned ICU's during a pandemic...

Plot twist, my wife is an RN and she dropped out of nursing a bit before COVID because of similar shenanigans from the boardrooms: too many patients per nurse, not enough CNAs per nurse. Add to that patient families being jerks.

Similar with kidney disease ... caught mine at 55% kidney function in 2018. The neuphrologist told me prepare to go on dialysis i said ha whatever doctor not listening to you! Changed my diet .. no steak/beef or pork, no preservative laden foods (anything bought in store has only a few natural ingredients), more fruits, a gallon of water a day (some unsweet tea and splash of lemonade but never sugar or soda drinks.. why drink calories.. not for me), avoid all medications (only if dire ill take them) and maintain same weight of 170 (5'11) through daily exercise. My function within 6 months or so of doing such rose to 70% and years later i maintain it at 75 to 85% percent. It goes down when if and when I get sick due to taking meds but goes back up.

What we put in our bodies means everything!

Congratulations!! That's amazing! Keep going!

That's great! Care to share the rationale of any of those specific interventions?

Rationale possibly...

- Drank zero water before... now a gallon a day which flushes my system many times a day

- My nephrologist told me to avoid all medications best as possible which i do and have done. When I must take meds then in my monthly to bi-monthly CMP (comprehensive metabolic panel labwork) i see my kidney function go down albeit temporarily. For example I took a new drug recently out on the market and it dropped my function to under 60% in Nov/Dec last year. Back to 75% as of my last test received this week. Prior test showed function was 82%.

- I ate beef (steak) many times a week prior and lots of fried food (cut that down to once or every other month)... i still eat out always at Cava (simple rice and chicken bowl), grilled nuggets at Chic Fil A and a fruit cup with unsweet tea/splash of lemonade, salads at Panera (Fuji Apple), pasta (spaghetti with marina from local pizzerias), maybe a Chix/rice burrito from Chipolte or a mini turkey and provolone sub from Jersey Mikes... for breakfast if I eat it at all healthy cereal with no preservatives or egg whites with potatoes and wheat toast (no bacon or pork) at a local diner.

- I weigh myself daily and count my calories in my head. I recently been enjoying using chatGPT to do so, as it knows calories of all the places i go, counts them up and remembers them so i can add more later. I keep it between 1500 to 1800 calories a day(eat two meals a day and healthy snacks here/there) which i think isnt a lot for a dude my age (late 40s) and my size (5'11 170 to 175). I almost never drink calories ... unsweet tea and splash of lemonade for flavor is minimal.. water is zero. Rarely drink alcohol maybe one or two gin and tonics in a month.

- Ive always been obsessed with fitness prior to kidney function diagnosis as i enjoy looking my best I can on the beach and elsewhere :) So im doing some type of exercise almost daily (hike, bike, gym, swim laps, weights)

I think the amount of water i intake, changing my diet as noted above, maintaining my lifestyle of fitness ive always had & avoiding all/any meds are the keys to my kidney function success. My nephrologist who i still see a year later or so changed her tune and now advocates for the lifestyle i live to help with kidney function health.

I see people here talking about fasting and im not eating a ton a day. Maybe that's an overall good thing for our bodies not eating a ton ant things that aren't healthy/natural (processed foods are really bad i thnk).. not stressing it to break down more stuff (just a thought/guess).

My lifestyle isnt for everyone and the fitness portion is something ive always done to try and be the best I can be as well look the best i possibly can. Again im a bit obsessed with such and is a driver to my lifestyle.. ive never dieted i guess my lifestyle is a diet to others.

Thanks!

Do you deal with kidney stuff or know people who do?

Yes, I have a family member with some concerning kidney labs I am trying to help them with.

Good luck to them ... not sure at what stage of the disease its slightly reverse-able (was at stage 3 i think when they caught it for me). I think im in stage 4 now and have been since 2019 ... stage 5 is 90 percent and above.

oops rather its stage 1 .. im at stage 2 CKD but was at stage 3 when initially diagnosed. Stage 4 is 15 to 30 percent function remaining .. 15 percent and below is the last stage.

Fasting during Ramadan improves my sugar levels significantly. That’s 30 days of no food/water during daylight hours. And controlled eating at sunset and dawn. And lots of water during the night hours.

Dr. Fung basically said that beta cell death is likely related to fatty deposits on the pancreas. So there is a fatty liver/pancreas cycle that requires a significant time duration of fasting. Eventually beta cells continue to produce normal amounts of insulin. T2D is not a death sentence, it just requires motivation from the patients and up-to-date knowledge of the treatment physician.

I’ve noticed for me fasting has a long lasting effect on reducing overeating with leads to sustained weight loss way beyond the calorie deficit- and deliberately doing other mildly mentally and physically uncomfortable activities like cold showers and weightlifting have similar effects also.

My theory is that overeating is basically an addictive behavior- a way to escape from stress, negative feelings, and emotional trauma. It is actually the mental discomfort of fasting that gives you confidence that you can deal with mental pain and discomfort without trying to escape it, that leads to eating less. This is likely the same mechanism behind weight loss drugs like semaglutide that also help with non food related addictions.

Overall I think people are missing the emotional and psychological mechanisms behind the obesity epidemic, and looking too much at things like calories and nutrient content, which is why the whole phenomenon has been eluding understanding.

>It is actually the mental discomfort of fasting that gives you confidence that you can deal with mental pain and discomfort without trying to escape it, that leads to eating less. This is likely the same mechanism behind weight loss drugs like semaglutide that also help with non food related addictions.

This is not true. For me at least the effect of fasting for several days is purely physiological, not psychological, emotional or spiritual. There's no extra "confidence" to deal with "discomfort," your body simply needs drastically less food. You also drastically increase your feelings of being satiated after eating.

So after fasting (and its probably the same on GLP-1 meds) you don't get very hungry and when you do eat you feel very content and full after only a few bites.

Your experience being different than mine does not make mine "not true" nor is what you are saying mutually exclusive with what I am saying. There's most likely a lot of things going on at the same time here- that are interrelated in complex ways, and likely somewhat different in different people.

Lots of research shows that overstimulation of the reward system, e.g. from high satiety foods overrides the feeling of fullness in a way that integrates both what you and I were saying in a coherent way - especially if you think of "mild discomfort" as a state of low stimulation of the reward system [1]. This is probably why so many different seemingly mutually exclusive diet protocols work equally well- anything that restricts some foods and not others, regardless of what they are, lowers the total reward system stimulation from food.

For me, I am still hungry while fasting, but the hunger becomes easier to handle over time. I also notice afterwards that I am full with less food like you noticed, in addition to the other things I mentioned. It is also easier for me to stop eating while still a little hungry after fasting.

In my case years of logging my bodyweight on a digital scale show I only gain weight during stressful events, but then keep it the rest of the time... and if I'm consistently taking cold showers or doing regular short fasts, it prevents that effect and causes gradual weight loss on top of it. So I have fairly convincing data that what I am saying is true for me, but it may not be true for everyone.

[1] https://boingboing.net/2012/03/09/seduced-by-food-obesity-an...