A number of people wanted me to see this yesterday, and I can understand why. A couple of hot takes on this:

The Junior Woodchuck’s Guide To Diabetes

Diabetes is a series of conditions linked by the major effect, that the body does not produce enough insulin. Insulin is what the body uses to break down glucose in your blood into energy, so if you don’t have enough insulin, a) your body doesn’t get enough energy, and b) the glucose builds up in your blood.

In some of these cases the body doesn’t produce any insulin at all, but in Type 2, it is usually that either the Pancreas can’t produce enough for the amount of body you have, or the insulin is not of sufficient strength to get through the fat around your organs.  (This is a Very Simplified Explanation, and is therefore Importantly Wrong in some respects on the details)

Your Pancreas Doesn’t Work As It Should, is the big takeaway.

The treatments are varied depending a lot on exactly what your body is doing or not doing correctly, but generally start with medication that reduces the sugar in your blood by adjusting how it’s absorbed during digestion, and then advance to further. Alongside this, you are advised to adjust your diet to attempt to lose any extra weight you’re carrying, because that will reduce the problems the insulin has getting to the right places if that’s the problem, and also by reducing the amount of insulin your body needs, simply because there is less of you for it to have to go to.

In fact, on average, if you can lose 15% of your body-weight from the time your diabetes starts to become an actual issue, it can go into remission, because your shitty pancreas is now producing enough insulin to do all it needs to.

Second takeaway: Eating sugar doesn’t cause diabetes, overloading your pancreas does, and some people’s pancreas isn’t that great to start with.

A) You’re not cured, though. It’s remission. Your pancreas isn’t going to get any better. In fact, the likelihood is that as you get older, it’s going to fail – along with everything else. Also if you put on weight again – as people who lose weight quickly tend to do – it’s going to come back again.

B) The symptoms of diabetes can range from pissing a lot, through feeling tired, being bitten more often, more skin infections (because your sweat has sugar in it which bacteria feed on), more bug bites (because same) and escalate to heart problems (because you have sugar syrup for blood). Or it could look like nothing at all for a long time. Unless you’re getting blood tests every few years (and, if you have a family history in it, you should) (I am not a good example in this respect), it’s hard to catch early. By the time you know, the losing weight goal may have already passed.

The cure is diet and exercise!

So this is why I think Tom Watson’s advice is dangerous. 

First, good on the chap. Losing that amount of weight is hard, because you’re fighting against your own model of how food works as well as your body’s expectations of energy levels. It’s an impressive achievement.

I did the NHS Diabetes Education session (Diabetes2Gether) last week

But generalising it isn’t great. An emphasis on diet is already in the NHS education training for people newly diagnosed, and while it was fantastically useful once I got on the course, because it explained in simple terms exactly what the problem was, it still ended up mixing the concepts of “Things that are bad because of the disease you have” and “You should avoid these things because they’re bad for your health”. For example, Carbs turn into glucose. It’s not _sugar_ that is bad, but they are the “worst” kind of carbs. So in a perfect world, cutting out carbs completely would be the solution. Sadly everything else contains stuff that’s also bad for you without moderation, and the eduction pieces have to mention that, so you end up with a message of “This is bad for your condition, but these things are bad for you anyway, and don’t do this (for condition), don’t smoke (for health), eat five portions of fruit and veg a day for health (but not too much fruit because of the condition).

And the public announcement that Mr Watson has “reversed” his diabetes with a strict diet and new exercise regime is something to be congratulated, but it’s also something that, in his position on a decent salary with a job that gives him a lot of freedom over his own schedule, is not available to everyone. It’s a lot like the apocryphal TED talk by a multi-millionaire who did it by winning the lottery, recommending everyone give up working and buy lottery tickets instead. It worked for them, it’ll work for some people, but it’s advice as part of a general set of solutions.

TL;DR.

So I’ll stick with my stack of mediation and my lower calorie diet – plateaued though it is – and the advice of my doctor. Which is, incidentally, that congratulating yourself overmuch for rapid weight loss makes it a lot harder to admit when you can’t sustain it long term.