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Could rapid weight loss being healthier sometimes?

magnusthenerdmagnusthenerd Posts: 855Member Member Posts: 855Member Member
So this thought has started to fester after listening to Diabetes Researcher Nicola Guess discuss the The Diabetes Remission Clinical Trial (DiRECT) study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/
In it, roughly half of people that lost 15kg or more in a few months put their Type 2 Diabetes into remission, meaning they no longer needed to use any of their medications. That's pretty incredible.
Of note, Dr. Guess pointed out that this result is not seen merely by losing 15kg, but only seems to show up when the weight loss is rather quick. It seems that the protocols necessary to cause it involve very low calorie diets - 900 calories a day. Obviously these are levels that should only be done with some kind of medical support. Yet it also seems concerning if the general tendency in the public's mind is to shun rapid weight loss and have stories out their about damaging metabolism if, in fact, it the way to treat diabetes, a disease that threatens to topple the health system at the rate it is growing globally.
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  • lemurcat2lemurcat2 Posts: 3,501Member Member Posts: 3,501Member Member
    Of note, Dr. Guess pointed out that this result is not seen merely by losing 15kg, but only seems to show up when the weight loss is rather quick. It seems that the protocols necessary to cause it involve very low calorie diets - 900 calories a day. Obviously these are levels that should only be done with some kind of medical support. Yet it also seems concerning if the general tendency in the public's mind is to shun rapid weight loss and have stories out their about damaging metabolism if, in fact, it the way to treat diabetes, a disease that threatens to topple the health system at the rate it is growing globally.

    This is interesting, and I wonder what the mechanism is. (I noticed that she's on SigmaNutrition as I subscribe to that podcast but am always behind, so will have to listen to it.)

    It does seem consistent with the fact that WLS seems to address T2D very effectively and quickly.

    I'm not as down on rapid weight loss as some here. I think there's something to be said for slow and steady allowing more time for changing habits (but if you have a lot to lose you can start with a fast loss and then transition to slower).

    I do think unsupervised 900 cal would be a dangerous thing for people to assume they should aspire to, as it's so easy to not get adequate nutrition, and unfortunately there's so often a tendency that if something is good for specific purposes people decide it might be a good choice for others (like vanity weight loss). See the various posts from people asking about following the pre WLS diet unsupervised and without intending to get WLS, because it must be safe if those other people do it.
    edited August 19
  • magnusthenerdmagnusthenerd Posts: 855Member Member Posts: 855Member Member
    lemurcat2 wrote: »
    Of note, Dr. Guess pointed out that this result is not seen merely by losing 15kg, but only seems to show up when the weight loss is rather quick. It seems that the protocols necessary to cause it involve very low calorie diets - 900 calories a day. Obviously these are levels that should only be done with some kind of medical support. Yet it also seems concerning if the general tendency in the public's mind is to shun rapid weight loss and have stories out their about damaging metabolism if, in fact, it the way to treat diabetes, a disease that threatens to topple the health system at the rate it is growing globally.

    This is interesting, and I wonder what the mechanism is. (I noticed that she's on SigmaNutrition as I subscribe to that podcast but am always behind, so will have to listen to it.)

    It does seem consistent with the fact that WLS seems to address T2D very effectively and quickly.

    I'm not as down on rapid weight loss as some here. I think there's something to be said for slow and steady allowing more time for changing habits (but if you have a lot to lose you can start with a fast loss and then transition to slower).

    I do think unsupervised 900 cal would be a dangerous thing for people to assume they should aspire to, as it's so easy to not get adequate nutrition, and unfortunately there's so often a tendency that if something is good for specific purposes people decide it might be a good choice for others (like vanity weight loss). See the various posts from people asking about following the pre WLS diet unsupervised and without intending to get WLS, because it must be safe if those other people do it.

    WLS is actually the impetus behind the study. The pre WLS involves a liver reducing diet to make the surgery safer, and it was wondered if the diet prep for WLS and immediately following it induce the changes, rather than the surgery itself.
  • magnusthenerdmagnusthenerd Posts: 855Member Member Posts: 855Member Member
    LyndaBSS wrote: »
    I'm calling bs on it needing to be fast weight loss.

    I've lost just shy of 30 pounds, 10 lbs between September and June and 20 lbs since I started mfp in June.

    I am a type 1 adult onset diabetic. I've gotten off insulin since I started a pescatarian diet which is plant based with seafood, eggs and some dairy.

    I do not consider my weight loss fast. I've been very sensible about it and know that slow weight loss is sustainable.

    Any doctor who suggests a quick loss diet on 900 calories per day is a doctor that I wouldn't trust.

    I've never heard of any type 1 diabetes being treatable by anything besides using insulin. I've never heard of there being type 1 adult onset. Type 2 is called adult onset.
    Type 2 is treatable early on with weight loss.
    CSARdiver wrote: »
    How would this compare to a group that lost weight at a standard rate ~1lb/week? How does this compare to a control group losing no weight?

    There is no "damaging metabolism" as metabolism is nothing more than a series of biochemical pathways.

    I question the long term effect as dramatic change adopted in the short term rarely leads to long term changes in behavior. In the long term it may actually cause harm as individuals feel the need for dramatic intervention instead of forming habits which promote health.

    Not sure the exact comparison, but the prognosis for anyone once they're on a medication to treated T2D is not good for recovery. Dr. Guess said something like a 5% loss in weight doesn't seem to do anything.
    I'm not saying one can damage metabolism - I'm saying it is a common lore put out there to discourage people from rapid weight loss.
    It doesn't matter if it causes long term changes in behavior. If doing it causes remission and that remission has a lasting protective effect, that's all that matters in terms of it being a treatment for T2D. And honestly, no, that's also a misnomer - I think people overstate the idea that the diet that induces weight loss has to be the one to maintain it. In a certain sense, it can't even be correct because any diet that causes weight loss is going at least need to be less food than the one that maintains it unless you accept maintenance as an asymptote.
    Damaging metabolism

    It bounces back once starting to refeed, unless there is long-term severe calorie restriction like in the case of eating disorders.

    Losing weight quickly for obese or morbidly obese people is important. It's literally a matter of life and death, regardless of their insulin issues.

    I would think that 900 calories per day plan is monitored by a doctor? I didn't read the link but if it's published on the NIH label, then it was a strictly monitored plan with a focus on electrolytes and basic nutrition. I'm sure the subjects were on supplements and guided nutrition.

    900 calories for you and I out there on our own? Not a good idea at all.

    Again, I'm not saying metabolic damage will happen, I'm talking about what gets bandied about. It could be doubly harmful for both being a false notion and for it being a mental barrier to people doing what could treat T2D.
    MikePTY wrote: »
    I'm not entirely sure where you see that in the results? The article is not very clear at all on anything. It seems like this experiment is still ongoing?

    I don't think that anyone denies that in certain cases, the benefits of rapid weight loss can outweigh the risks. For very obese people with health complications from it. Perhaps with T2D as well, although I am not sure if the research is there yet.

    However for most people just trying to lose some weight, slow and steady is still by the best way to do it.
    I listened to Dr. Guess on a podcast about the results (https://sigmanutrition.com/episode294/). The study is ongoing to see how long the remission lasts while the subjects are at maintenance, no longer losing weight. There is a 1 year follow up data that I think Guess said came out in December 2018.
    I'm not sure there is research to show slow and study is better for most people. There certainly is research that for people with a fair amount to lose, people who lose rapidly initially have the best results in terms of keeping off at least part of the loss.
    There is indeed such a thing as adult onset type 1. It’s sometimes called LADA. It’s not nearly as common as adult onset type 2, but it does happen, in a similar way to child onset type 1, through an autoimmune attack. However, it is distinguished from type 2 by weight loss, metformin and similar meds, and dietary changes having no effect on it. The usual course of lada is for it to be misdiagnosed as type 2 initially, then later when the person does not respond to the usual type 2 protocol and gets very ill, they are correctly diagnosed and put on insulin.

    There is no form of type 1 which can be helped by losing weight and eating better.

    I will argue semantics as important here and say no. There is type 1 diabetes that can happen when an adult - or could onset when an adult, but calling it Type 1 adult onset is bad terminology because it sounds like it is referencing type 2. That's why it is typically called LADA, also Type 1 in Adults, Adult-Onset Atypical Type 1 Diabetes, or Late Onset Type 1.
    As for the rest, yeah type 1 is a very different pathology from type 2. Frankly, I'm not sure type 2 is a monolithic disease itself - there's some differences in people having the insulin insensitivity in their liver versus in the muscle cells.
    Also agreed about the things unlikely to alter the course of T1D as an autoimmune disease. I suppose technically some people do follow diets to alleviate autoimmune symptoms, but I don't think that could truly halt the process going on in T1D.
  • rlfraustorlfrausto Posts: 23Member Member Posts: 23Member Member
    Please explain what adult onset type I diabetes is ?
  • rlfraustorlfrausto Posts: 23Member Member Posts: 23Member Member
    After reading all the threads it all makes sense and Web MD gives a pretty good explanation aswell.
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