Basics: why subreddit mods are wrong

Once I was kicked out of the subreddit /r/diabetes_t2, the mods went through all my comments to add their own reply. To every one of them. That comment said:

diabetes_t2-ModTeamMODS
T2 Diabetes can’t be cured or reversed. Put into remission, yes. Controlled, absolutely… but once a diabetic, always a diabetic. It never just goes away. Don’t take your meds, eat tons of carbs, etc. and all the hard work of your so called “reversed” or “cured” disease is out the window.

Let’s unpack that because it tells a lot of important things about the people who wrote it:

• First of all, you’ll notice that they don’t give their sources. They never cite a scientific publication or even a book from a qualified person. Everything they say is therefore opinion. When I post, I cite my sources so that you can go and read them and decide if you interpret them the same way I do. That’s basic intellectual honesty. These people think their opinion has the same value as scientific research.
• “T2 diabetes can’t be cured or reversed“: we can’t know what they understand by “cure” or “reversed” since they don’t explain the terms and don’t cite any source that would. But we can safely assume that they bet that the average person will understand them from basic English understanding, i.e. that they mean that you can get rid of any trace of the disease, including long term effects such as cell damage. That isn’t what reversal means. Reversal means that you change the direction of the disease to go toward a state of non-disease. Eventually, you could reach a state of post-diabetes.
  Secondly, we know that the main source of T2 diabetes is diet. There is nothing permanent in diet. You can change it at any time. Why would something caused by something that isn’t permanent necessarily be permanent itself? There is no inevitability there.
• “Put in remission, yes“: here, remission refers to a state where the disease is essentially absent, but most people will understand it from the domain where it’s mostly used: cancer treatment. In cancer treatment, “remission” means that cancer isn’t detectable anymore, but it can come back out of the blue at any time. So you’re never free of it for sure. They plan on people understanding it that way to send the message that diabetes is the same and therefore you can never be free of it for sure. There is no evidence that it is the case for diabetes and it’s not the case for most diseases.
• “Once a diabetic, always a diabetic. It never goes away“: there is no evidence that this is true. The first signs that this wasn’t the case appeared in bariatric surgery studies in the early 90s. In fact, recent studies have shown that you can get rid of diabetes through diet (also here or here) and recent bariatric surgery studies (or here and here) have shown that drastic reduction in calorie intake reverses diabetes. It leads to normalisation of both beta cell function and insulin sensitivity.
  Some caveats apply, though. For example, the Counterbalance study has shown that after 10 years or so of living with diabetes, the beta cells pass beyond a state of reversible de-dedifferentiation to a relatively irreversible loss of ability to make insulin. That implies that drastic action needs to be taken immediately after diagnosis. Waiting will lower the probability of succeeding in reversing diabetes.
  I applied that idea and within 6 months I was free of medication and I show no sign of diabetes (which in fact could have been less if my doctor hadn’t insisted on keeping medication for another 3 months). My fasting sugar is usually < 90mg/dl (from home tester and lab test), my HbA1c has been between 5.0% and 5.44% for 9 months (from lab test), I extremely rarely spike after a meal above 130mg/dl, even when I eat pizza or pasta. I no longer have a fatty liver (from echography), my HDL and LDL are right in the middle of the range (lab test), my blood pressure hovers between 117/75 and 125/82 depending on stress levels (home test and doctor). If I came to you and you measured these numbers, would you think I’m supposed to be diabetic? Would you even guess that I had been diagnosed with diabetes a year ago? What the mods of /r/diabetes_t2 say is that despite these number, they’d know I’m supposed to be diabetic because I should be diabetic forever. It’s of course nonsense.
• “Don’t take your meds […] and all the hard work of your so called “reversed” or “cured” disease is out the window“: first of all, you need to understand that the meds you take don’t treat your diabetes, they treat its symptoms. Taking insulin after a meal to keep your glycaemia within a reasonable range (which is usually quite high) isn’t going to make your diabetes go away. Most of the medication you’re given only keeps the side-effects of the disease in check so that you can live a normal life. It has been shown that medication-only doesn’t treat diabetes, it only turns it into a progressive disease. Only a change of lifestyle (with the helpful effect of medication if needed) can treat the disease. Obviously, don’t stop taking your medication, it’s a decision you need to take with your doctor. And medication can be useful to avoid secondary symptoms of diabetes: neuropathy, infections, even amputations.
• “[…] eat tons of carbs, etc. and all the hard work of your so called “reversed” or “cured” disease is out the window“: ah, the “if you eat bad again the disease will come back because it’s not really cured” argument. You’ll hear that one everywhere in the diabetes subreddits. That’s the silver bullet of those who like to live with their diabetes. Firstly, it makes no logical sense: if eating a bad diet generates diabetes in a diabetes-free, healthy body, why would it be different once you’re free of diabetes again? How could the original cause of your diabetes be an argument against your recovery if your body reacts in strictly the same way? Wouldn’t that imply that you had diabetes from birth? That’s simply idiotic.
  In fact, it has been shown that reversal of diabetes can be long term provided that there is no weight gain. Several studies (Counterpoint, Counterbalance, DiRECT) have reported patients maintaining a post-diabetes status for many years (15+ for some).
  Secondly, if you catch covid-19, then cure it, i.e. you show none of the physical signs of it and it can’t be detected by any of our medical tests, would you say that you weren’t really cured if you catch it again? We know some people have caught covid-19 several times, sometimes the same strain. Would you say that you were never cured of covid-19 in the first place? Would you say that covid-19 is therefore incurable and permanent? Of course not, that would be ridiculous. Why would that argument be valid for diabetes?
  Thirdly, lots of people will tell you it’s genetics and hide behind that idea to not do any effort. As health professionals now talk of “epidemic” of diabetes, if it was genetics it would mean that the gene that would allegedly cause diabetes is spreading like crazy in the population. That’s of course nonsense. There is no diabetes gene spreading across the planet. What has changed in the last century is food intake and availability. It has become very easy to access carbs and to have a high calorie diet. It’s easily proven: during WWII, the incidence of diabetes went down significantly all over the planet. Why? Because of food restrictions. People couldn’t eat high carb/high calorie diets, and diabetes occurred a lot less.

Everything that moderators’ paragraph, posted over and over again in /r/diabetes_t2, is false and/or dishonest. It’s like the moderators of that subreddit want to keep their diabetes going and want you to keep yours. I guess it’s good for their business: if you keep maintaining a strong diabetes, you’ll keep coming to their reddit to talk about it.