Doc says it's for good?

[vit90]

First post! Hello everyone

Three months ago a blood test showed I had elevated blood glucose; it was not a fasting test (although it was first thing in the morning and I had not had breakfast yet) so no fasting glucose figure, but my A1c was 80/9.5%. I only found this out three weeks ago but immediately started a low carb diet and a regime to lose some weight. At that time I was 13 stone 4lbs, my height is 5 foot 10.5 and my BMI was 26.6. I'm male, 53 years old. BP is normal and total cholesterol is 3.6 although I could improve my HDL a bit. I'm not on any medication.

I don't look overweight and indeed I lost 2 stone after being advised to 8 years previously and my weight settled at around 13st 4lbs for the last 5-6 years. I am not very sporty but I'm not sedentary either but I do enjoy food and large portions although I do go for 'healthy' options and am not into desserts that much; we actually don't bother with desserts much at home. I have half south Asian (Chinese) parentage on my mother's side and she did have late onset Type 2 diabetes and she was overweight in middle age. I don't have any obvious diabetes symptoms like abnormal thirst, lethargy or excessive need to pee. However, my original blood test was due to a routine eye test that discovered a couple of tiny retinal bleeds in one eye. After three months I had a follow up scan and this was fine.

Until this week I had not had a consultation from my GP but I had another blood test in advance of this last week, this time with a fasting glucose level of 4.5 - which I understand is normal. A1c is now 64/8.0%, still too high but improved.

Rather depressingly the doctor almost immediately declared that once a diabetic always a diabetic. Regardless of the debate that might ensue from such a statement I intend to at the very least control whatever I can to normalise the situation as much as I can. Of course it's hard to miss the research at Newcastle University and I'm now embarking on a strict very low calorie diet (and to pre-empt any concerns I do realise this needs care) with the aim of reducing visceral fat which might be affecting my pancreas and liver.

The diet is going well and I have definitely improved my fitness with some gentle running and 'brisk' walking.

So cutting to the chase - if my interpretation of what's being called the 'Newcastle diet' works and I can get my blood chemistry back to normal (next test is in 6 months) and I reduce my weight to under 12 stone and so have a BMI of 21.8 (bang in the middle of the target BMI range) - hypothetically speaking - would I still be categorised as diabetic? I guess the supplementary question would be - was the doc right to say that I will be diabetic for life?

 

[Squire Fulwood]

So cutting to the chase - if my interpretation of what's being called the 'Newcastle diet' works and I can get my blood chemistry back to normal (next test is in 6 months) and I reduce my weight to under 12 stone and so have a BMI of 21.8 (bang in the middle of the target BMI range) - hypothetically speaking - would I still be categorised as diabetic? I guess the supplementary question would be - was the doc right to say that I will be diabetic for life?

Yes and yes and sorry about that. You will probably maintain your good weight and numbers but only if you stay in control of what you eat and what you do. Non diabetics can do all that without dieting.

 

[vit90]

It's true that some overweight people, even obese, are not diabetic (although they run the risk of becoming so) but if I get to my target weight and the numbers are normal I hope I won't need to diet any more too. After I reduced from 16 stone to 13.5 stone my weight was stable without needing to diet.

 

[Bluetit1802]

I'm afraid your doctor is right. With an HbA1c like yours, you are a diabetic and will have to eat accordingly for the rest of your life, unless you are very lucky. You can lose weight and improve your insulin resistance, and you can keep your blood glucose levels within a normal non-diabetic range, but once you digress from a suitable diet for Type 2 diabetics long term, you will end up where you started. In other words, type 2 can be controlled at non-diabetic levels, but only by diet and medication (if appropriate). The Newcastle Diet has had good results, and there are some people on this forum that will testify to that, but that isn't the end of the story. Much depends on how much damage has already been done to your pancreas, and your own personal metabolism..

When we, on this forum, talk about "diet" we are not generally talking weight loss diet. We are talking type 2 diabetic diet.

I personally had an HbA1c of 53 when diagnosed, so less than yours. I have lost 4 stones to reach a BMI of 21. My blood sugar levels are well controlled. Yet if I eat 2 slices of bread my levels rocket. They wouldn't if I were "cured".

 

[LittleGreyCat]

So, a slightly different spin.

From the Newcastle Study, if you act quickly and lose enough weight in a short enough time you have a roughly 65% chance of reversing your diabetes in the short term.
That is, as well as having HbA1c results in the non-diabetic range you can also pass a Fasting Glucose Tolerance Test.
This tests if your insulin system can process glucose as swiftly and effectively as a non-diabetic.
If you pass you are non-diabetic.

However you have demonstrated that you can become diabetic, so that means that you can become diabetic again under similar circumstances.

I think the difference between very good control and a cure is how your body handles the 'bad' things on a day to day basis.

Whatever, the implications are very much the same.
Even if you are cured in the short term, you need to maintain dietary control to avoid becoming diabetic again.

Cheers

LGC

 

[vit90]

Thanks Bluetit and LittleGreyCat; good food for thought. I am cheered by the fact that even after just a couple of weeks of a moderate low carb diet my fasting glucose is normal. Certainly it will be the litmus test once I come off the extreme Newcastle style diet, which I only started after the blood test, and I have reached my weight goal. I certainly understand the contexts of the word 'diet'; I aim to modify my routine diet permanently and consume smaller portions. I don't typically eat a lot of high GI foods anyway; I much prefer wholemeal bread, don't eat desserts regularly, I eat plenty of fruit and veg as well as fish, etc.

Being obese for 5-6 years in my early to mid-40s was obviously not great for me and largely down to portion sizes although at the height of my weight hike I was not diabetic (this was when I was advised to lose weight by my then doctor as I had just had a medical for insurance purposes and all the test results were OK).

My hope (which is not at all guaranteed, I understand) is that I have a normal pancreas obstructed by long term visceral fat which is what I am now trying to get rid of. While I concede there is no guarantee, I still think there is a possibility of success. With that hope I am motivated to do what's needed

 

[Squire Fulwood]

When we, on this forum, talk about "diet" we are not generally talking weight loss diet. We are talking type 2 diabetic diet.

I was about to retread this point but I see that @Bluetit1802 has already done it better than I would have done.

"Diet" and "slimming diet" are not the same thing.

Slimming diets are what you do to lose weight and according to Dr Briffa they do not work.

Diet is what you eat all the time to sustain life and for diabetics some foods are necessarily excluded. Oddly, you can lose weight doing this but this is a by-product.

 

[Daibell]

Hi. I agree with Bluetit. Yes, it's for life but many find that having the right low-carb diet they can maintain blood sugar levels for many years. This assumes what you have is typical insulin resistant T2 and not Late onset T1. I'm not a great fan of the newcastl diet althouhg it does help a lot. It still works on calorie count whereas diabetics need to count carbs not calories. I've also seen some hints of food indsutry funding of some of the Newcastle research work which might explain the focus on calories not carbs but that might just be the cynic in me

 

[vit90]

Hi. I agree with Bluetit. Yes, it's for life but many find that having the right low-carb diet they can maintain blood sugar levels for many years. This assumes what you have is typical insulin resistant T2 and not Late onset T1. I'm not a great fan of the newcastl diet althouhg it does help a lot. It still works on calorie count whereas diabetics need to count carbs not calories. I've also seen some hints of food indsutry funding of some of the Newcastle research work which might explain the focus on calories not carbs but that might just be the cynic in me

I'm doing a low carb and low calorie diet - so am aiming for under 800 calories and as little carbs as possible. Yesterday it was roughly 25g carbs and 700 calories, today about the same (according to my spreadsheet!) - am also counting fibre which is about 9g a day, so eating walnuts, raw broccoli and raw carrots (luckily I really like raw veg like these), tinned tuna and boiled egg with a little extra virgin olive oil and yesterday my evening meal was home made chilli (no rice or cheese) - ingredients all carb, calorie, fat and fibre counted. I'm also taking a cod liver oil and a vitamin/minerals supplement. I do miss fruit but that's quite high in carbs and calories in relation to what I'm currently consuming. I can get a bit blinkered like this!

We do need to be on our guard for baseless or biased research but at least Newcastle University is a reputable scientific institution and there are consistently positive, albeit unscientific, anecdotes from ordinary people who have reported success from it.

I am not feeling unwell from the regime and am doing much more exercise now than I usually do.

 

[phoenix]

I've also seen some hints of food indsutry funding of some of the Newcastle research work which might explain the focus on calories not carbs but that might just be the cynic in me

please give some references , Professor Taylor as far as I can see has an impeccable reputation.
He was incidentally the person who introduced the concept of the retinal screening programme in the UK which was unique . His thinking and perseverance on this helped change outcomes in UK . Now diabetes is no longer the leading cause of blindness in people of working age .It isn't necessarily the same elsewhere.
( but maybe he was motivated by funding from the makers of optical screening cameras )
Here is the declaration from his most recent paper. The paper before that was funded by diabetes UK (it was their lecture)

The research was supported by the National Institute for Health Research Newcastle Biomedical Research Centre.
The funder played no role in the conduct of the study, collection of data, management of the study, analysis of data, interpretation of data, or preparation of the manuscript.
No potential conflicts of interest relevant to this article were reported

As to the original question. If you had asked me whether T2 diabetes was for life a few years ago then I would have said yes. There was thought to be a 50%+ loss of beta cells and it was thought that there was no possibility of this changing. Bariatric surgery though had surprising results with many almost overnight remissions , even before the weight loss .This changed thinking and is what Professor Taylor set out to replicate with his diet. ie what was it that occurred ? Lots of people suggested complicated answers in that the operations switched off various signals to the pancreas.
He used Ockam's razor, the simplest plausible mechanism. Immediately before and after surgery a massive reduction in calories.

I agree though with Little Grey Cat that if you do switch things round and put it into remission then you still have the predisposition for it to occur again. If you become ill, insulin needs increase . If you put on weight again insulin needs increase If you become sedentary, insulin needs increase and unfortunately as you become older , beta cells may die off with aging and you may reach the tipping point again.
Lastly, though a large proportion of type 2 may be caused by fat deposited in the wrong place it probably isn't the case for all people diagnosed with T2 where they may be other mechanisms at work to cause the hyperglycemia.


.

 

[jack412]

I'm probably more concerned with what way of eating you will do in 8 weeks, I would do the research now, so you don't slip back into old habits
http://www.dietdoctor.com/lchf it’s a long page and a video

http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm For me, the more carbs we eat the more carbs we want. they don’t give up easy.

http://lowcarbdiets.about.com/od/lowcarb101/a/firstweek.htm

dietician lc plan
http://www.lowcarbdietitian.com/blog/carbohydrate-restriction-an-option-for-diabetes-management


blood testing
http://www.phlaunt.com/diabetes/14045524.php
http://www.homehealth-uk.com/medical/blood_glucose_monitor_testing.htm

food counting
http://www.myfitnesspal.com/

American diabetic association ( http://www.professional.diabetes.org/)
http://www.professional.diabetes.org/admin/UserFiles/0 - Sean/dc132042 FINAL.pdf

Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes;
therefore, goals should be individualized; fat quality appears to be far more important than quantity.
In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may benefit
glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern.

 

[vit90]

Still feeling surprisingly good four days into the sub-700 calorie Newcastle-style regime. Then again I coped well when I dropped 2 stone when I was almost 16 stone a few years back.

Have also done some more reading and people like me with south east Asian heritage can apparently have a different type of haemoglobin that can make standard H-A1c tests unreliable. Yes, I am a half glass full person but my fasting glucose is normal so I will be mentioning heritage to the DN when I meet her for the first time on Monday. To be fair, if do have the different haemoglobin it could make my A1c reading either higher or lower than the correct figure! But it will be interesting to see if they think I need further testing.

 

[vit90]

Calorie restriction has survived the weekend although today that meant fasting until supper and a Sunday roast (I'm the cook, too!). Very modest portion for me too... Now under 13 stone for the first time for a long while.

Granted my initial H-A1c measurement was high in August and improved but still too high last week (although fasting BG of 4.5 was good) but not had any post fasting testing . Wonder if this might be discussed when I meet the DN for the first time tomorrow morning?

 

[jack412]

please give some references , Professor Taylor as far as I can see has an impeccable reputation.
He was incidentally the person who introduced the concept of the retinal screening programme in the UK which was unique . His thinking and perseverance on this helped change outcomes in UK . Now diabetes is no longer the leading cause of blindness in people of working age .It isn't necessarily the same elsewhere.
( but maybe he was motivated by funding from the makers of optical screening cameras )
Here is the declaration from his most recent paper. The paper before that was funded by diabetes UK (it was their lecture)


As to the original question. If you had asked me whether T2 diabetes was for life a few years ago then I would have said yes. There was thought to be a 50%+ loss of beta cells and it was thought that there was no possibility of this changing. Bariatric surgery though had surprising results with many almost overnight remissions , even before the weight loss .This changed thinking and is what Professor Taylor set out to replicate with his diet. ie what was it that occurred ? Lots of people suggested complicated answers in that the operations switched off various signals to the pancreas.
He used Ockam's razor, the simplest plausible mechanism. Immediately before and after surgery a massive reduction in calories.

I agree though with Little Grey Cat that if you do switch things round and put it into remission then you still have the predisposition for it to occur again. If you become ill, insulin needs increase . If you put on weight again insulin needs increase If you become sedentary, insulin needs increase and unfortunately as you become older , beta cells may die off with aging and you may reach the tipping point again.
Lastly, though a large proportion of type 2 may be caused by fat deposited in the wrong place it probably isn't the case for all people diagnosed with T2 where they may be other mechanisms at work to cause the hyperglycemia.


.

he didn't really care that much about the diet, he was more concerned with the total calories, and the best way of making sure it was limited to 800 and followed the after care diet of gut surgery....optifast donated their supplement and that was good enough. [I guess that is used in the hospital for after op care]
on one of the site links he says he doesn't care what supplement and that 1200 cal is ok too and real food, all he is focused on is getting rid of visceral fat
http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm

 

[jack412]

has everyone seen his lecture?
http://www.fend-lectures.org/index.php?menu=view&id=94

 

[vit90]

I'm not taking the shakes - I am calorie counting real food as well as limiting carbs to around 25g per day (and no sugar or other fast action carbs). Also trying to maximise the proportion of my fat intake to the better quality fats, so am eating unprocessed nuts, oily fish and using extra virgin olive oil where I can. Am also taking a vitamin and minerals supplement plus cod liver oil capsules. Got my first appointment with the DN this morning but am a bit worried about the NHS industrial action today but the surgery has not contacted me so fingers crossed.

 

[jack412]

I'm not taking the shakes - I am calorie counting real food as well as limiting carbs to around 25g per day (and no sugar or other fast action carbs). Also trying to maximise the proportion of my fat intake to the better quality fats, so am eating unprocessed nuts, oily fish and using extra virgin olive oil where I can. Am also taking a vitamin and minerals supplement plus cod liver oil capsules. Got my first appointment with the DN this morning but am a bit worried about the NHS industrial action today but the surgery has not contacted me so fingers crossed.

best I can get it is, 60g fat = 540c, 60g protein=240c.. plate of veg carb 20g=80c total 860cal
you are getting your min healthy fat and protein and a plate of veg for fibre, the optifast way is 80g carb a day, far too much because it cuts into normal fat and protein RDA

 

[vit90]

This morning I had 30g of walnuts - eaten very slowly, savouring every morsel That's 196 caloreis, 4g carbs, 19.5g fat (mostly good fats) and 2g fibre.

For lunch I will have one tin of tuna which, when drained is 100g of tuna (despite the tin saying 130g!) and that's 130 calories, negligible fat and no carbs and no fibre. I might include a boiled egg (108 calories, 7.4g fat, no carbs and no fibre. I might add a tsp of extra virgin olive oil (4.5g of mainly good fats, 40 calories and no carbs or fibre). To this I'd add 50g of raw broccolli (3.4g carbs, 17 calories, no fat, 1.3g fibre) and a couple of stick of celery (2.4g carbohydrate, 1.2g fibre, no fat, 12 calories).

For dinner I will have a very small portion of what the I'm cooking for the family, excluding potato and rice and maybe replacing these with more helpings of veg, but strictly limited to 200 calories.

I estimate that adds up for the day to roughly 700 calories. 20-25g carbs, 50g fat and 7g fibre.

I know this is not for everyone and some might say I'm nuts but I've been successful with controlling calories in the past and almost a week into my new regime I'm still feeling great and am typing this after a brisk 90minute round trip walk to my local surgery for my DN appointment (little to say about that except that she is pleased with my attitude and test figures and wants to see me again in a months time).

 

[jack412]

This morning I had 30g of walnuts - eaten very slowly, savouring every morsel That's 196 caloreis, 4g carbs, 19.5g fat (mostly good fats) and 2g fibre.

For lunch I will have one tin of tuna which, when drained is 100g of tuna (despite the tin saying 130g!) and that's 130 calories, negligible fat and no carbs and no fibre. I might include a boiled egg (108 calories, 7.4g fat, no carbs and no fibre. I might add a tsp of extra virgin olive oil (4.5g of mainly good fats, 40 calories and no carbs or fibre). To this I'd add 50g of raw broccolli (3.4g carbs, 17 calories, no fat, 1.3g fibre) and a couple of stick of celery (2.4g carbohydrate, 1.2g fibre, no fat, 12 calories).

For dinner I will have a very small portion of what the I'm cooking for the family, excluding potato and rice and maybe replacing these with more helpings of veg, but strictly limited to 200 calories.

I estimate that adds up for the day to roughly 700 calories. 20-25g carbs, 50g fat and 7g fibre.

I know this is not for everyone and some might say I'm nuts but I've been successful with controlling calories in the past and almost a week into my new regime I'm still feeling great and am typing this after a brisk 90minute round trip walk to my local surgery for my DN appointment (little to say about that except that she is pleased with my attitude and test figures and wants to see me again in a months time).

you are doing very well...while you are dieting is the time to workout what you are going to eat for the rest of your life

you can eat LCHF for the rest of your life and you need to stay below your trigger point with carbs that will start putting back on weight
http://www.dietdoctor.com/lchf it’s a long page and a video

Another dietician site
http://www.lowcarbdietitian.com/blog/carbohydrate-restriction-an-option-for-diabetes-management

 

[vit90]

has everyone seen his lecture?
http://www.fend-lectures.org/index.php?menu=view&id=94

Had a view the other day and was impressed - the thinking behind the research so far is clearly deeper than I had assumed.

Now down to 12st 7lbs (from 13st 4lbs in 12 days since starting my Newcastle-style diet) and past my original pre-Newcastle target to reach by Christmas as I am losing a pound every two days. If I can keep this up (and it hasn't really been that challenging) I don't see why I can't get under 12 stone by Christmas. Also now have a glucose tester and results so far are fine although I will be doing a more definitive test after a mince pie... 11 stone is now the ultimate goal by the time of my birthday in March.

Just to respond to those warning about the post weight-loss challenges, I did maintain my weight without difficulty after I lost 2 stone 5 or so years ago. I am much more aware of the key nutritional factors in food and am enjoying the changes in my, albeit very small portions, 700 calorie diet. I'm also enjoying exercise more than ever and will aim to keep that up - in fact my legs are getting some good exercise, it's my upper body which needs some attention now

Ultimately I would like to be able to eat the occasional treat and not worry about it and that would be the measure of best case success but even if that isn't attainable at least I am aware of potential problems and now well-armed to deal with them.