The FastDay Forum

@Juliana.Rivers,

I can confirm that you are right about the mass market diet books. I have been publishing nonfiction since the 1980s. Some years ago I submitted a health book to a big publisher only to be told by the editor, that though in reading my book he had learned an immense amount he hadn't known before about a condition he personally had, he couldn't publish the book because publishers know that the people who buy health books are ignorant of science and dedicated to remaining that way. They won't buy books that don't dumb things down, eliminate all scientific terms, and make a simple point that can be easily summarized in a few sentences.

Unfortunately, there is no way to lose weight and keep it off while remaining that ignorant, which is why there is always a new magic, miracle weight loss book, with a sexy new hook, that oversimplifies things, published to pick the pockets of fat people. It's why we now have tens of thousands of imbeciles who believe they eating gluten free though they can't tell you what gluten is, who are taking the place of all the idiotic low fat dieters who used to buy sugary soda because it was labeled "Fat Free" or "Contains No Cholesterol!"

One exception to the stupidity of mainstream health books is are those of Dr. Richard K. Bernstein, whose books have saved the lives of a generation of people with diabetes. He also writes honestly about weight loss, which I find refreshing. His books have gone into three hardback editions so they must have done well, but they have never sold as well as some really putrid competitors, several of which are written by shady doctors, some non-practicing, who have never treated someone with diabetes in their lives but claim seductive miracle cures.

@Juliana.Rivers,

I don't have a copy of the book, as I got mine from the Public Library. But what I still remember was him saying something about how before he started his diet his fasting blood sugar was slightly elevated though not diabetic, then he reported his fasting glucose test value which was, in fact, fully diabetic--unless you were using the diagnostic criteria that were in use before they were revised, worldwide, in 1997.

This really surprised me because it would have taken half a minute to check this on Google. Elsewhere I believe there were other less glaring statements that made it clear that Dr. M is completely unaware of how blood sugar works or should be treated. Most importantly, while he said something mushy about how the diet might not be suitable for diabetics, he did not spell out WHY. In fact, it is only unsuitable for diabetics who are using a specific group of older oral drugs or injecting certain kinds of insulin because those drugs are dosed with the assumption that the person is eating a large amount of carbohydrate and without that carbohydrate they will hypo.

But anyone with diabetes using a whole other set of drugs approved after 1997 or who understands how to use the DAFNE insulin protocol (which has even spread to the UK a decade after it was used in the US) would be fine fasting.

OTOH, fasting alone is not the best dietary approach for people with diabetes. They really need to back off the carbs. So to suggest that the diet reversed his prediabetes (which was really diabetes) as his book does, again shows a lack of medical awareness.

My guess is that after a few years of maintaining with one fast a week, Dr. M's fasting blood sugar is very likely to rise again and over time his post meal numbers are likely to deteriorate, as that is what has happened to most people I've heard from who began to develop diabetes in the pattern he describes (fasting blood sugar elevated first) whether or not they lost weight. It's apparently a genetic thing. The appropriate dietary treatment is to cut down on carbs every day not just two days a week. This is more likely to preserve what insulin secreting ability the person still has.

Beyond that there were a few citations of the very few studies of non-intermittent fasting, on which the claims of its benefits were based, but non-intermittent fasting works quite differently from intermittent fasting. That's because a 4 day fast will completely drain glycogen and put people into a ketogenic state after day 2. Thus most of the benefits of that kind of fasting are the benefits you see from a strict low carb diet, but with 5:2 as he describes it you never get into a ketogenic state because it takes between 2 to 3 straight days of eating less than 100 g of carbs a day for that to happen.

And of course, what we are doing in 5:2 isn't even, technically, fasting, as we are eating, just not very much, on fast days. This, of course, is a benefit, not a problem with 5:2. Actual fasting often causes changes in thyroid function that we would all like to avoid (euthyroid syndrome, where T3 is present but not in its activated form, leading to exhaustion and slowed metabolism.)

The other thing I found annoying about the book was that it didn't go into any of the issues that arise when people attempt to fast, which are so well covered on this board. It really did seem like an opportunistic book written to cash in on the huge amounts of money available to anyone with an M.D. who comes up with a new Miracle Diet to be sold to the desperate people who have failed to lose weight on all the other miracle diets.

The advances for those kinds of books can be in the many hundreds of thousands of dollars and their earnings in the millions. So doctors are always coming up with new, and often fake twists with which to attempt to cash in. In this case, as I said before, the diet is a good one, though it is actually a tweak of the Johnson Up Day Down Day (JUDDD) diet which has been around for several more years and has been actively discussed all this time in another online diet board.

So to me this is another of those books that is written in a style that automatically would make any medical professional who knew anything about the topic completely discount it as hucksterism, just like the Atkins diet, which though it was an excellent diet was written up in such a hyperbolic, huckstery way that it took decades for it to get taken seriously. That approach while it makes money for the author makes it TOUGHER to get the concept into widespread use.

I can only speak for myself, but i had glucose numbers in the pre-diabetic range when I started ADF/JUDDD, and after doing IF and losing over 50lbs, my glucose number is now 89, and has been for the last two years. Don't know a lot about the science, I just know ADF/IF worked brilliantly for me and my glucose number, without me having the change the kinds of food I eat (love my carbs!).

@KateKat,

I am very glad to hear that weight loss and fasting worked so well for you!

But I know quite a lot about the science, and it suggests that weight loss does not reverse diabetes for about 95% of those who have it. Prediabetes diagnosed only with the fasting test is something else again. Your readings after eating carbs are much more predictive of long term health than fasting readings. If those post meal readings are still higher than what is truly normal you could still progress over time no matter what your weight. OTOH, it is possible to have the very slightly elevated fasting sugars that are diagnosed as prediabetic without ever progressing. There are much better tests than the fasting test for assessing blood sugar health.

Actual diabetic fasting sugars imply a far more serious level of dysfunction. I have a family member who was diagnosed with a diabetic fasting sugar, lost weight cutting calories, but declared himself a hopeless carb addict. His fasting blood sugar dropped after his diet, his doctor declared him nondiabetic,, but four years later not only his fasting but his post meal numbers were fully diabetic, though he had maintained his weight and exercised. Real diabetes is all about those carbs,

Although I'm guessing that some percentage of those 95% (it surprises me it's that high!) are people with type 1.5, as opposed to being insulin resistant. My sister was diagnosed with diabetes (I imagine with fasting glucose test), lost weight on Atkins, but never got over the diabetes. The type II drugs never worked on her, and she quickly became insulin dependent. I'm not sure she's had the tests for 1.5 done (she's a bit prickly about me getting involved in her medical care, which is understandable since I don't have medical training), but given her other autoimmunity problems, I'm convinced that is what she has. She continues to eat low carb and for her exercise is critical for blood sugar control, but she remains insulin dependent.

Most people with Type 2 also have some kind of secretory defect. It isn't just about IR. People who only have IR typically don't ever progress from pre- to full diabetes. An intersting study found on autopsy that obese non-diabetic people appeared able to grow a huge amount of new beta cells, while those with diabetes could not.

The genes that are most commonly found in Type 2 diabetics of Western European ethnicity are those that limit insulin secretion, too. Only a few cause IR.