> When the researchers used an antibody to neutralize fabkin in mice, the animals did not develop diabetes. When the antibody was given to obese, diabetic mice, they reverted to a healthy state.
This sounds awesome. For anyone with relevant expertise in the field: How significant is this? It seems pretty significant but we often hear about some amazing results from mice studies that turn out to not work in the real world.
As a diabetic and former diabetes researcher, I’ve seen diabetes cured in mice a few times. It’s cool but too early to tell how significant. Stem cell treatment seems the most promising at the moment for a human cure.
I wonder myself whether the identification of this cluster of proteins could lead to other novel mechanisms we don’t know about, or whether the cluster is similar to others we know about? What’s the chances we find a lot more of them?
So they essentially did fabkin knock out on the mice. I would expect that fabkin actually has a function. But maybe we can just intercept the issue farther up the chain to pull you out of a diabetes.
The interesting paragraph regarding that is half way down the article. Fabkin is a complex of already known proteins and seems to help cells communicate how much energy is available.
Type II is caused by chronic ingestion of excess carbohydrates, which leads to insulin resistance in those who are genetically susceptible to it. The mechanism is that the carbohydrates are broken down into glucose in your blood, which must be removed because high blood glucose for an extended period causes severe disease. Higher insulin levels drives glucose into your muscles until they can't take any more, your other cells until they can't take any more, your liver until it can't take any more, and then stored as body fat until your fat cells can't take any more. When everything is full, higher and higher levels of insulin are needed to stuff more and more glucose wherever it can be stuffed. That's Type II diabetes.
You're kind of oversimplifying a lot of things and making strong (potentially unfounded) assumptions. "chronic ingestion of excess carbohydrates" can't be the cause because plenty of people do that and do not get diabetes, therefore it is just a contributing factor. We do not know exactly what goes wrong and where to lead to this condition.
While true not everyone who consumes carbs/refined sugars will get T2D, there isn’t a single case of T2D where the patient didn’t over consume carbs/refined sugars.
Similarly, there isn’t a patient that has reversed their T2D that didn’t make changes to their diet that reduced or entirely eliminated carbs/refined sugars to control their blood sugars levels/insulin spikes.
It is a truth that all cases of T2D are preventable through diet/lifestyle, it is that simple. Though there maybe some other issues at play, it’s probably best to avoid the nasty disease altogether based on the available information and allow the research to continue so maybe one day people can eat all the sugar they want without risk of T2D, but then they would still be at risk for every other metabolic disease including obesity, fatty liver disease, and heart disease.
It is crazy how he was shocked he could have gotten metabolic disease by following the food pyramid.
Honestly, I thought everyone, but especially MDs, knew the food pyramid is complete and total bullshit in terms of health and was created by the food industry itself. Granted the food pyramid is now the food plates, but that too I thought was generally recognized as bullshit in terms of health and created by the food industry.
I also don’t understand as a practicing physician how he initially concluded diabetes is caused by obesity. Sure there is a strong correlation, but as everyone loves to point out, plenty of skinny people have T2D and plenty of obese people do not, maybe he just didn’t see that very often in his practice and his patients were skewed to mostly/only diabetics with obesity.
It’s also not lost on me that changing ones diet and removing sugars/carbs is simple but that doesn’t make it easy, which is just as much a part of his new study as diet.
I don’t understand people that admit removal of carbs/sugar can prevent 100% of T2D case even reverse some existing cases, but don’t advocate for those dietary changes because there may be some other cause to the T2D. Take Attia, he talks about reversing his metabolic disease/pre-diabetes through dietary changes, we all know what they were (any physician will tell you how that is done), but he doesn’t state once in the TED Talk what those changes were. The reason he doesn’t say it is probably the same reason I was down voted above, people don’t want to hear it. I’d love to see a study on why people get turned off, angry, anonymously downvote online anytime they hear the specific dietary changes that can prevent T2D or reverse disease/pre-diabetes/T2D like Attia did.
> Honestly, I thought everyone, but especially MDs, knew the food pyramid is complete and total bullshit in terms of health and was created by the food industry itself.
In respect of the carbs in particular, why would you think that?
Most countries have similar advice. For example, the UK NHS says a third of your diet should be starchy carbohydrates: "Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates". This is broadly similar to the US food pyramid, despite no food industry funding.
The British Heart Foundation says try to eat "plenty of starchy foods such as bread, rice, potatoes and pasta".
People on HN say this stuff all the time and quote poor quality obscure studies, but high quality meta-analyses frequently find that diets that are 50%-60% carbs are healthy.
What is the alternative, credible source backing up this idea that carbs are harmful? It's only recently that the medical industry was saying all fat is bad - and much of it still is.
Clearly something is wrong with the standard western diet and processed foods. Refined sugars, carbs etc. may play a role in that, but the idea that everyone knows what's wrong and what we need to do to fix it is absolutely clearly NOT the case. Dietary studies are, by and large, low quality observational studies. Many doctors have little to no dietary training and operate largely on anecdata and educated guesses. The average member of public will know even less.
But it's far from clear that refined grains or sugars or anything else are causing the problem, and if they are, why they are. We know removing them sometimes helps, but that could be incidental, and if they are bad, why do we want to eat them so much? Plenty of diets were heavily based on carbs and refined sugar in the past and few people got fat or developed diabetes. Meanwhile some diets are very heavily fat and protein based yet they struggle enormously with T2D (see Tonga where spam, mutton flaps and other low quality meats are heavily implicated in their awful obesity problems). Some people blame fructose in HFCS, but Europe doesn't use fructose to nearly the same extent and is suffering the same epidemic of metabolic syndrome (albeit a decade or two behind the USA). Sugar intake has actually been decreasing for decades in the UK, while obesity/metabolic syndrome/T2D is continuing to rise enormously. For all we know at this point, it could be plastic pollution or a virus causing this problem.
FWIW I have cut out carbs as much as I can from my diet due to the doctor saying my carb based diet was damaging my liver, and started eating cheese, as my diet of whole foods and beans/chickpeas/lentils cooked from scratch has triggered a gut disease. I've had to stop being vegan as a consequence, despite many other vegans I know being healthy, happy and thin on a similar diet to what I had before. Yet other doctors in the past commended me on making the healthy decision to be vegan. I'm relatively certain nobody knows what's going on. Maybe food is just tastier now so we eat more of it...
> What is the alternative, credible source backing up this idea that carbs are harmful?
I didn’t say that, you read that in.
However, as it relates to T2D as I stated there is not a single case where the patient did not chronically spike their insulin levels through consumption of carbs/sugars. I’d welcome you to find any study or record of a single T2D patient that did not consume carbs/refined sugars.
Similarly, I would welcome you to present a single study or patient on record successfully reversing their diabetes without changing their diet to reduce, if not eliminate, carbs/refined sugar.
There are hundreds if not thousands of studies on reversing diabetes, I’m link just one. The study notes that reversing T2D isn’t a goal in modern medicine rather management. But it’s also noted that prior to development of insulin, low carb diets were the prescribed treatment/management of T2D and it shouldn’t come as a surprise it is the very thing modern studies are finding reverses T2D. So low carb diets go back at least 100 years to pre-insulin treatment and are not new as many like to pretend.
If it were plastics like you suggest, I find it odd that T2D can both be avoided and reversed with similar dietary approaches minimizing carbs/refined sugars. But maybe it is, again that can continued to be studied, but in the meantime we have a working solution to avoid 100% of cases.
Still I am not demonizing carbs, it’s possible that at least some people can manage them just fine. However, on the other end of the spectrum dating back thousands of years, first documented by Egyptians, carbs/grains/sugars have been used as tools to fatten up live stock. They cause high blood sugar, they overwhelm and fatten the liver, and they trigger the production/release of insulin which is a hormone that tells the body to enter a catabolic state and store energy in fat cells.
Excess carbs ≠ excess calories. You’re conflating the two. How do you achieve one but not the other? Eat carbs and nothing else - which is surprisingly common. My father is quite thin, yet drank soda religiously my entire life, and is now struggling with metabolic disease.
> "chronic ingestion of excess carbohydrates" can't be the cause because plenty of people do that and do not get diabetes, therefore it is just a contributing factor
You can smoke every day of your life and never get lung cancer. Doesn't mean the one doesn't cause the other.
This is in fact a commonly told story about how diabetes comes about. It matches with some of the science. But it's also clearly incomplete, as there are numerous cultures around the world that live on lots and lots of carbohydrates without developing diabetes, such as much of Asia eating mostly white rice, and hunter gatherer tribes that live off honey, and others.
Incomplete is correct, asian cultures eat a lot of carbs but until recently a lot of the carbs weren't refined. Rice was eaten with the husk, and it was a luxury so people didn't consume as much of it as they do now. People also didn't have the luxury of 3 meals a day.
So the point is that its easy to over indulge with our modern conveniences and thus developing type 2 diabetes is a lot easier today.
Oversimplification. Brown rice and fructose, for example, are metabolized very differently from one another. I do agree that pinpointing a lower-level MOA other than just “insulin” will be a valuable discovery. But that MOA, whatever it is, isn’t the root of the problem. Is anyone suggesting we ought to devise a pharmaceutical treatment for broken behavioral patterns, income inequality, and mass production of processed foods?
> Is anyone suggesting we ought to devise a pharmaceutical treatment for broken behavioral patterns, income inequality, and mass production of processed foods?
Is it the most effective treatment? Then yes.
That does not preclude also trying to avoid the problem in the first place. But fixing behavioural patterns is one of the things we are worst at. Fixing diabetes won't fix all of the other issues of a bad diet, so it's not like the incentive to improve peoples diets will go out the window, though it might reduce the individual incentives for some people.
But that's true for all kinds of things - we can't withhold treatment options because some people will take the availability of treatment as a reason not to be cautious.
Given the fact that there are thin / normal weight people with type 2 diabetes, I think saying "ingestion of excess carbohydrates" is the primary cause is a bit misleading. You'd have to define "excess carbohydrates" as "enough to cause type 2 diabetes in that person", which leads to it almost being a tautology.
There's still a large number of gaps in our understanding of the condition and it's causes.
"skinny fat" exists, and there may be a wide range of tolerances. Perhaps some people only need to ingest an excess for a very short time while others can do it longer or indefinitely.
This is incorrect, or at least very misleading. Excess carbohydrate consumption exacerbates insulin resistance but the cause is an excess of intramyocellular lipids.
+1 I came here to type something similar. I've also observed that it has been described as "carbohydrate intolerance" which seems to make a lot of sense.
Well, it’s all good and nice and shit, but doesn’t explain how there are thin type IIs, and doesn’t explain how there exist lean mofos who guzzle down sugary coke and eat ultraprocessed junk food all the time and don’t get diabetic at all.
HN when facing literally anything else that doesn't have a simple answer: oh wow so intriguing. So interesting.
HN when facing anything related to people with diabetes type 2, or having issues with their weight: lol eat less.
This is such a stupid fucking discourse because it prevents us from actually looking critically and seeing if there are causes beyond "lol u just eat a lot fatty" and treatments beyond "eat less lol".
This view is also why diabetes type 2 is very undercovered with health insurance, compared to type 1.
Doug, you are doing harm with this discourse that you are not a professional in, and you do not understand or can claim to understand all the complexity that goes into humans.
You are doing active harm, and take this as a callout on stopping this behavior.
Your comments in this thread have broken several of the site guidelines egregiously. In particular: name-calling; sneering (including at the community); personal attack; snark; and more. Not cool.
Plenty of type II diabetics are thin. Fat mass is corollary but excess carb intake is causal. You’re conflating excess carbs and excess calories. One is a macronutrient and the other is a unit of energy.
The answer is simple… like most things, it won’t map to every individual diabetic but it certainly maps to the population at large.
The knee jerk reaction, feigning fat martyrdom, is what’s actually preventing us from looking critically at the causes behind type II diabetes. Our priors regarding what an acceptable human diet should look like have been shaped by a fifty+ year insurgence of processed food in the supply chain and marketing.
American health is in dire straights and we refuse to look in the mirror.
Have you ever considered that the bodily want and need to consume more carbs might not be something that's just inherent in us and might be caused by external factors?
Do you understand not everyone experiences hunger in the same way?
Have you also considered the fact that carb heavy food is generally so much cheaper than when it's not?
This is what I mean by its complex.
Carb addiction is real and the solution isn't to make people feel like shit about it and actually help them overcome it and then study why the addiction is becoming more common place. We've added so much random crap to our bodies and food intake, and any number of them can interfere with our natural hunger and food-seeking process.
So yeah, even if carbs are causal, telling people to eat less is not helpful.
Thankfully, we are now getting medication that directly addresses this feeling of extreme hunger that a lot of obese people experience. The causes of those feelings is still being studied.
The comment isn't saying that excess carb consumption is causal but that it is a link in the chain of causality. We don't know what causes the increase in feeding behavior and choice of food.
Free will is an illusion, the faster we admit this the faster we can examine this sort of chain of causality critically
1. Delaying real solutions to a huge international health crisis
2. Mentally harming people who are in that situation and self-hate for having binge eating disorders, or other various conditions causing weight gain and excessive carb consumption.
3. Giving a pass to insurance companies to under cover, or not cover, diabetes 2 patients.
So, yeah, that sentiment is at least harming people, and at most killing people. I don't consider that over the top of a response and it's something an individual can think critically about and change their opinion on.
Did I say anything that was in contradiction to this? Actual solutions isn't exclusive to medical remedies.
> This type of thinking fares much better on Twitter. Good luck.
Maybe you should care more about the mental wellbeing of people.
> Sure let’s continue to further subsidize the ill-effects of processed food. Save money on cheap food today, spend it on healthcare later. Makes sense.
Again. You're assuming that I said we shouldn't do full solutions to this problem. However, there are also people who are sick and need help right now.
You’re doing a lot of projecting. No one here is pointing at fat people and saying “fix yourself”. I outlined the external factors. The high availability of those foods alone is a major problem. Marketing normalizes it. And economics frames it as a necessity. That system is broken. And we are the casualties of that broken system.
Very bizarre watching people scratch their heads as if the cause of elevated hunger is a mystery. Eat a steak and watch your hunger disappear. I ate a cookie this morning and now I want six more. Again, none of this is a mystery. The food is performing exactly as its creator intended. Are their individuals who are extremely hungry outliers? Of course. Is 40% of the American population outliers? No.
I was overweight in childhood and still experience unwieldy hunger to this day. I am very aware that my hunger is not the same as someone else’s. My saving grace has been a decade of resistance training plus periods of intermittent fasting. In fact, the IF is pretty much the only method I’ve found that controls my hunger and shapes my behavioral patterns for the better. Otherwise I would certainly take full advantage of our empty-calorie-saturated environment. That’s my story and at no point am I suggesting that every individual has the means or will to do what I do. But what you’re suggesting is we ought not to discuss the core nature of the disease, but rather search for clandestine solutions in a pill, less someone infer that conversation as a personal attack.
Your comments in this thread have been breaking the site guidelines. Please don't do that, regardless of how wrong another commenter is or you feel they are.
