Evidence based review of popular diet aids

Given the strong connection between excess body fat and insulin resistance as a factor in type 2 diabetes, weight loss is commonly on the agenda for many type 2 diabetics. For those looking for a shortcut past the time proven diet and exercise method, there are a large number of companies out there offering a quick way to lose your pounds, and, not least, your money.
Before you rush off to respond to some coupon ad or infomercial promising quick and easy reduction (of your bank account, primarily) of weight, you may find it useful to read this evidence based review of the most popular products. It is compliments of the Kris Gunnar nutrition web site.

I wish it were that simple. In my support group, 1/4 of the participants are overweight. Most are not.

If your support group members are type 2 diabetics, they are not typical since usually more than 95 percent of type 2s are overweight, at least at the time of diagnosis. If they are type 1 that is a completely different story. Since there is such a close connection between the onset of type 2 diabetes and being overweight, anything that can help these folks lose weight would increase their potential to manage their diabetes without meds or insulin.

There tends to be a lot of confusion about information on the connection between being overweight and diabetes. There is this misconception that being overweight causes diabetes when in fact we don't know that. It may well be that the majority of people became overweight because of their diabetes.

And we have some really twisted definitions. It is true that the CDC has published results from the NHANES study showing that 85% of T2s are overweight or obese. But the definition of overweight is BMI>25. I am technically overweight and I suspect that most of the patients in your support group are overweight according to that measure.

Despite those claims, there are many of us here who by any reasonable measure are not overweight and have never been overweight. I actually do not want to lose weight because studies show that the optimal BMI for living the longest is between 25 to 30, yes overweight. We always have to be sensitive that some of us struggle with misconceptions and stigma associated with weight. The governments "silver bullet" to "prevent" diabetes is based on the myth that obesity causes diabetes. But sadly research has not shown that to be the case. We all struggle because stuff is broken in our bodies and while our blood sugar control may well improve with weight loss it doesn't fix what is broken.

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Although the specific gene that makes some people susceptible to type 2 diabetes has not yet been identified, most researchers believe that it exists based on overwhelming anecdotal evidence. That would explain why among two persons with the same lifestyle, the same environmental factors and the same bmi, one develops diabetes type 2 and one doesn't. On the other hand, there is overwhelming anecdotal evidence of the connection between weight and diabetes type 2. The most significant is the enormous surge in new cases of type 2 (currently approximately 350 million worldwide whereof about 30 million in the US of A). If it were only a matter of genes the parents of those 30 million in the US should also have type 2 but mostly they do not. That coincides with the surge in body weight, with more than 50 percent of Americans now being obese (bmi of 30 or greater). It's a bit like smoking; those who smoked for a lifetime and had the wrong gene got lung cancer, those who smoked for a lifetime but didn't have the gene, didn't develop lung cancer.

The genetic link in T2 diabetes is strong, stronger than T1. If one parent has T2 you have a 1 in 7 chance. If your twin has T2, your chances are 3 in 4. As of 2011 36 separate genes contributing to T2 genetic risk had been identified. However this number will likely rise by a lot as only 10% of the genetic risk is explained by those 36 genes.

And we must remember while there is an association between weight and T2 we must apply sound principles of science to demonstrate cause. Efforts to do so have not been successful. The Diabetes Prevention Program spent many millions of dollars getting people to lose weight in efforts to "prevent" diabetes. While many patients had delays before they ended up being diagnosed with full diabetes in the end that vast majority still went on to be diagnosed.

Sadly, diabetes is very complex and views that personal lifestyle failures that lead to obesity are the actual cause of diabetes are misguided and I think as a community we should advocate for the truth.

I believe strongly that as usual the truth is somewhere in between the extremes of "there is no connection between excess body fat and diabetes type 2" and "diabetes type 2 is caused by obesity". Somewhere in that in-between grey zone is where a combination of genes, lifestyle choices and environmental factors meet to create the perfect storm, the storm that results in escalating blood sugars and all the other symptoms associated with diabetes type 2.
I also believe it is a fact for all to see (except those that choose to wear blindfolds) that there has been a correlation between the worldwide increase in obesity and worldwide increase in type 2 diabetes, also witnessed on a micro-scale anytime you are in the waiting room of a diabetes clinic where they do training for newly diagnosed type 2 diabetics.

Acknowledging those correlations may be difficult for those who associate it with the "it's my fault" guilt syndrome. However, feeling guilty is not productive, but knowledge about one's disease and what one can do to manage it more effectively, is.

A study published in the British journal Diabetic Medicine sheds further light on the causes of type 2 diabetes.

302-study.pdf (178 KB)

IMO, there is an assumed connection between obesity & T2. All of the 22 participants in my group are T2. And, in my own case, my A1c was 9.0 at diagnosis. After changing my diet & lifestyle & losing the first 40 lbs, (photo) it was 6.0, so I started to believe there was a connection. After losing the next 40 lbs. it went up to 7.5.

I have seen doctors test some very obese individuals & they seemed surprised when their blood sugar was 86. They are surprised because they assume obesity = diabetes. Perhaps the assumption comes from the fact that obesity is a growing epidemic, so they are likely to see more obese diabetics.

Another Assumption Example: "Diabetics have more gum disease." My former dentist was trying to get me to come in for more-frequent checkups & he told me "We have many patients who are diabetic & they all have gum disease." Well, I brought up the question in my support group & none have gun disease. In my own family - all diabetic....my sister has been diabetic for 26 years - with poor blood sugar control - no one has gum disease. I saw my new dentist last week for a crown replacement. He said, "You have very healthy gum tissue for someone who rarely sees a dentist."

An "Assumed Connection" may not be a factual connection.

Yes assumptions can be misleading or even dangerous. The question is when does an assumption go from being guesswork to being a working hypothesis? In other words, how much anecdotal evidence is required before we can make a safe assumption? Obviously there are many here at this site who would choose to disagree with me on this subject, but I particularly feel that the correlation between the worldwide rise in diabetes (at last count close to 350 million patients), particularly in developing countries like China and India, with an equally marked increase in the frequency of obesity in those countries, is evidence enough to move from assumptions to a fair degree of certainty about the correlation being no coincidence.

Huh? This is a news article. It reports on a study that collected information on a small group of young children who had T2. It appears to be a very small information collection study, not even what they would call an observational study.

My position is that while obesity and T2 has been found to be associated, the cause has not been established. And most alarming a connection between sugar and refined carb intake has been found to be associated with both obesity and T2. Could it actually be that sugar and refined carbs are the "cause" of both obesity and T2? After all we have lots of studies that show that if you eliminate sugar and refined carbs obesity and T2 are improved.

Penicillin never had to go through rigorous scientific testing, you gave it to a patient and it worked. Low carb also hasn't had to got through that testing, for many of us you do low carb and it obviously works. Obesity, that is not so clear there are so many of us that lost weight and we still have diabetes. It just doesn't hold up and I think we need and deserve scientific evidence before going on an inquisition after people who are obese.

I suspect poor eating habits (mainly processed foods) may be more of a factor with diabetes than obesity. Or, maybe poor eating habits leads to obesity, then when an overweight person is diagnosed with diabetes, the connection is made to obesity rather than poor eating habits.

I am sure that poor eating habits and processed foods are part of the diabetes equation and something anyone working on managing their diabetes type 2 needs to focus on. However, the link between obesity and diabetes type 2 has already been long since established, it is called insulin resistance. I.e. the normal process of converting and storing excess blood sugars as fat becomes increasingly difficult as there are fewer and fewer fat cells available for storage, and the glucose stays in the blood stream, followed by increasingly higher releases of insulin and eventually what has been called a pooped out pancreas. Maybe my explanation was not scientific but that is basically the facts of it.

The Joslin Diabetes Center Website also has some information on that topic.




This issue reminds me of the flu shot. The person who runs our diabetes support group repeats the same, tired line: "Diabetics have compromised immune systems, so they should always get a flu shot." She then asks us, "Everyone had their flu shot?" Then everyone looks at ME - the only participant who never misses a meeting due to illness.

They look at me because they know I've never had a flu shot & never will. And it's been 32 years since I've had the flu. There is that same "assumed" connection; "Get your flu shot & you'll be protected from the flu."

Uh....yeah....OK, what about those crowded waiting rooms in the ER every time there is a flu "epidemic?" Almost everyone there who has the flu had a flu shot. If it were effective, that couldn't possibly happen.

Really amusing: Several years ago during a flu epidemic, a reporter (wearing a mask) interviewed people in the crowded waiting room (some people were lying on the floor because all the chairs were taken). Everyone there was angry because they followed their doctor's advice & got their flu shot. Then the reporter asked a doctor why the flu shot was such a failure for so many people. The Dr. was obviously uncomfortable with the reporter's question & answered, "Uh....uh.....well....you know....it's really challenging...to know which strain of flu virus we're dealing with...."

He could have been honest & said, "Well, any flu vaccine that isn't used has to be thrown away because it can't be saved for next year, so we don't want to end up with a bunch of unused vaccine....it's a waste of money, so we resort to this fear campaign...ya know...telling people tales like, "This year's flu epidemic is the worst yet....Ya know how many people die of the flu....etc. Of course when we do report flu deaths, we leave out other pertinent medical information about the deceased's other medical issues, or the fact that they were 90-100 years old, & OF COURSE we NEVER mention that they've had a flu shot."

My family doctor 10 years ago advised me that the flu shot was all about protecting you against last year’s strain of the flu. I haven’t taken the shot since nor have I had the flu. She also said that for the most part folks who were young in the 1950s, i.e. today’s seniors, would have been exposed to just about every existing strain of the flu and immunized for life… Interesting, considering that seniors are a prime target group of the pharma pedllers promoting the flu shots.