ND research - the view from ‘the other side’ ( as some see them)

[ringi]

Edit not to mention the 400 dollers a month cost for the first year!
https://diatribe.org/virta-health-launches-to-reverse-type-2-diabetes-with-low-carb-diets-coaching

This does include 24/7 doctor support and being the USA a lot of their clients save more than this on their "co-payments" for insulin etc. They are taking on the type of people we tell to talk to their GP before doing low carb, knowing they will not get the needed support from their GP.....

Mostly their services are being paid for by a few large employers who "self-insure" for their employee's health care, as far as I can tell, this is based on "payment by results" often saving more drug costs in the first year then the cost of the program. Even without the benefits of scale, the NHS could get, VirtaHealth's program costs less than Bariatric surgery, we need long-term results to know if VirtaHealth's program gives as good results.

Let's remember that some of the best information on "low carb" is in the books their directors wrote and we all benefit from, but they found that without active support most people could not make "low carb" a lifelong option.

Dr David Unwin (a UK GP) gets about 25% "diet control of Type2" at a much lower cost, but he gets to see people before they are at the stage of needing insulin. However, unlike Virta Health or the ND, Dr David Unwin patients have not made an informed choice, and therefore some of them are not committed. (And this is why the NHS will never be able to repeat the results we see on this forum......)

 

[Boo1979]

No arguement there but if 24 hr physician availibilty, intensive coaching etc are a necessary part of the package, then theres no way the nhs woulduse it.
I was a head of profession within the nhs prior to retirement and talking to nhs managers and AMDs about the need to “speculate to accumulate” in order to change clinical outcomes often felt about as productive as talking to a 3 year old about the benefits of negotiation as opposed to throwing tantrums as a communication style

 

[ringi]

The NHS does use Bariatric surgery justified on saved costs of complications of Type2 and Bariatric surgery costs a lot more......

Clearly, you would start with the methods that Dr David Unwin use and only move onto the more intensive methods Virta Health use if needed. I expect part of the reasons that Virta Health costs so much, is that the "easy cases" finds out what Virta Health is doing, and then do it themselves leaving Vitra Health with the people who need the most support. (Anyone who wishes to find out about low-carb diets for Type2 will hit this website from google!)

Dr David Unwin is working as an NHS GP with no additional funding, so just think what he could do if he had the funding to run support groups etc. He is not even allowed to prescribe BG testing strips! Virta Health is using an app that tracks people progress based on their BG testing and ketone testing - this can be done without the huge cost of the support level Virta Health provides.

A lot of the cost of Virta Health is having to support people who are being told by "everyone" that they must eat carbs, with high carb food being the default "healthy" food option on offer. Hence I expect that the cost per person will get a lot lower once "low carb" becomes "normal"....... (Virta Health also has high marketing and sales costs that the NHS will not have.)

As Virta Health is paid based on saved drug costs, they must take on the people who already are on the most expensive drugs. The NHS could refer someone to a supported low card program when the 1st drug does not work, therefore people would not need the medical support to reduce drug doses on low carb.

My wife works in the NHS (costing accountant, runs the PLC/SLR team), and is often asked to do work based on “speculate to accumulate”. (For example looking at the costs of the 50 people who use A&E the most, and seeing what can be learned from them about preventing issues before they happen.) The NHS is changing but very slowly. For example, the X-PERT Health Type2 education courses now present low-carb as an option, with "low carb" being strongly pushed at their "train a trainer" events. These courses are justified based on the improved AC1 result of people who go on them.

 

[Boo1979]

Senior management in my ex trust used to compare change in the nhs like being akin to turning around a huge oil tanker and then by the time youve achieved it, finding that things have changed and you're facing the wrong way again

 

[Paul_Sheffield]

>But what does remission actually mean? It’s when blood glucose (or blood sugar) levels are in a normal range again.

>In this study, the team defined remission as having blood glucose levels (HbA1c) below 6.5% (48mmol/mol) after 12 months, with at least 2 months without any Type 2 diabetes medications.

Um is being below 48 mmol in the normal range? Doesn't pre-diabetes mean anything? I thought that normal range was below 42 mmol. Has the definition changed? Have the numbers gone up?

Actually looking at the site there is no mention of pre-diabetes at all. If it doesn't exist why did my gp diagnosed me with it 3 years ago?

My South Yorkshire GP diagnosed me as T2 diabetic about 3 months ago on a hba1c of 44 & 6.2%. The eye & feet tests were OK and my BP is normal. They don't formally do pre-diabetes apparently. I'm not on any meds for it.

I suppose its at least been caught early so I can have a go a reducing those numbers with a lower carb diet, cutting out the high GI sugary stuff & 5 or 6% weight loss. That's my cunning plan anyway.

 

[AdamJames]

A paper is due to be published by VirtaHealth showing their 1-year results, from what they have posted on their blog, the results are closer to 75% then 40%. They use very low carb with a high level of daily support, but unlike the ND study do not exclude people based on low BMI or having had Type2 for a long time.

Unless I've missed something on their website, I find that study as underwhelming as the DiRECT study.

As far as I can tell, the measure of success is that, by reducing carbs hugely, your blood sugar lowers so you get a better A1c. Why wouldn't it? Diabetes is a metabolic disorder in which the body struggles to process carbohydrates without elevating your blood sugar. So you give it less carbs and your A1c improves.

As an analogy, if I lost an arm and somebody converted my car so I could drive it with one arm, I'd be very grateful. But I'd still have one arm, and I would be bemused if the medical community told me that I have two just because I can still drive.

 

[ringi]

But VirtaHealth is not a research study, its “real life”, they are taking on everyone with Type2 who is willing regardless of how long they have had Type2. Some employers are paying for all their staff who have Type2 to take park and “pressuring” the staff to do so.

If VirtaHealth can for example half the average cost of medical care for people with Type2 and roll it out on a large scale in the USA, it is very impressive. We are not talking about 1 or 2 very motivated people per month like we get on this site…….

The problem I have with the DiRECT study is that they are depending on people keeping the weight lose while eating the "eat well plate", I don't believe many people can do this long term. But we know that "low carb" is stainable long term once someone has learned how to do it.

 

[DCUKMod]

If we'rre looking at comparisons now, The Low Carb Programme from here has some has some impressive results.

This presentation is now 6 months old, so the numbers will likely have changed a bit.

 

[Guzzler]

In my opinion ND is another tool in box. For every individual who fell into the 46% of those who successfully lowered there bg, lost weight etc then it was worth doing for *them*. As I find the whole notion of reversal/remission/cure a matter of interpretation it follows that such a label is unimportant when compared to the success of an individual who, possibly after having tried other methods, has had a measure of success with ND. I feel for those who havn't seen such success and for those (and there will be some) who at a later stage might regress. My only concern is the transition after ND to a maintenance regime without the access to medics above and beyond standard NHS treatment/advice.

 

[AdamJames]

But VirtaHealth is not a research study, its “real life”, they are taking on everyone with Type2 who is willing regardless of how long they have had Type2. Some employers are paying for all their staff who have Type2 to take park and “pressuring” the staff to do so.

If VirtaHealth can for example half the average cost of medical care for people with Type2 and roll it out on a large scale in the USA, it is very impressive. We are not talking about 1 or 2 very motivated people per month like we get on this site…….

The problem I have with the DiRECT study is that they are depending on people keeping the weight lose while eating the "eat well plate", I don't believe many people can do this long term. But we know that "low carb" is stainable long term once someone has learned how to do it.

Absolutely, the taking on everyone is a great thing compared to the DiRECT study.

And I think both studies are very impressive in terms of the difference they are likely to make to quality of life for masses of people. Furthermore I think that's the only really important thing.

And I also agree about it looking like low carb is probably more sustainable long term, based on my own problems with carb addiction! I'm expecting a life time of low-carbing.

In fact I agree with all you've just said.

But I am pedantic about the definition of remission, that's all. Because it has been shown that it is possible to literally restore your insulin response to practically normal, and that for me is very solid remission: Something wasn't working, now it is. The measurements used in these studies, however, don't even check for diabetes. Whether or not you have diabetes isn't important compared to whether you are being damaged by it because of your diet, but, still, I'm curious. I'd like to know. And the result could inform an individual about what they can and cannot eat.

 

[AdamJames]

But VirtaHealth is not a research study, its “real life”, they are taking on everyone with Type2 who is willing regardless of how long they have had Type2. Some employers are paying for all their staff who have Type2 to take park and “pressuring” the staff to do so.

If VirtaHealth can for example half the average cost of medical care for people with Type2 and roll it out on a large scale in the USA, it is very impressive. We are not talking about 1 or 2 very motivated people per month like we get on this site…….

The problem I have with the DiRECT study is that they are depending on people keeping the weight lose while eating the "eat well plate", I don't believe many people can do this long term. But we know that "low carb" is stainable long term once someone has learned how to do it.

I've just got your distinction between one being a study and one not, sorry! When I posted that I'd just read the link posted by Boo1979, which mentioned a 10 week study by the same people. Anyway I'm sure you get the principle of what I was trying to say!

 

[ringi]

VirtaHealth is very into AI tools using all their data. They are developing a tool that can recommend how much someone is likely to be able to increase their carb intake based on the person's BG and ketones data. (They are already using machine learning to find the people who are most likely to drop out, and prompt their couches to take action. Along with predicting AC1 result etc)

VirtaHealth did the 10 week study based on a pilot before they went public with their website etc. (However remember that the two people who have published the most research on low carb over the last 30 years are their founders along with the person that started PayPal. A lot of the funding come from selling PayPal. They wrote the “The Art And Science Of Low Carb” and “A New Atkins For a New You” books.)

 

[ringi]

One issue with the low carb program’s data is that people who do well are more likely to respond to the emails asking for test results. The low carb program also only gets people who are motivated enough to investigate their diabetes and go beyond what their GP recommend. Hence we can’t use the data to predict the outcomes of rolling it out to all NHS GPs.

(As the program has to tell people who are on drugs/insulin to get their GP’s approval, it is limited mostly to people who have not had diabetes for long. The ND proving it is safe to just stop most drugs and let BG get upto 20 in the first few weeks could help with this.)

I would love to know how many of the 4% reversal in the control group of the ND study did the low carb program…….. (Personally I gave up on it within an hour as I don’t like a computer controlling the rate I can access information.)

Clearly if the 700 people per day who are diagnosed with Type2 in the UK were told about program by their GPs, with it being promoted as much as the eye testing is, the outcomes in the UK would be a lot better.

It would be interesting to see the results if half the GPs in a CCG were to actively promote the low carb program, while not contradicting “low carb”. Maybe also seeing what effect providing test strips and getting people to test before and after meals have.

What if for a £100 deposit people were provided access to the program and given 2 months usage of CGM, with the £100 being refunded if they engage and explained to their GP what they have learned from using a CGM…….

 

[ringi]

As to the “definition of remission”, if I remember correctly a reduction of 11 in AC1 results in 40% less people getting eye problems. Therefore I don’t care much about remission as such.

 

[Guzzler]

One issue with the low carb program’s data is that people who do well are more likely to respond to the emails asking for test results. The low carb program also only gets people who are motivated enough to investigate their diabetes and go beyond what their GP recommend. Hence we can’t use the data to predict the outcomes of rolling it out to all NHS GPs.

(As the program has to tell people who are on drugs/insulin to get their GP’s approval, it is limited mostly to people who have not had diabetes for long. The ND proving it is safe to just stop most drugs and let BG get upto 20 in the first few weeks could help with this.)

I would love to know how many of the 4% reversal in the control group of the ND study did the low carb program…….. (Personally I gave up on it within an hour as I don’t like a computer controlling the rate I can access information.)

Clearly if the 700 people per day who are diagnosed with Type2 in the UK were told about program by their GPs, with it being promoted as much as the eye testing is, the outcomes in the UK would be a lot better.

It would be interesting to see the results if half the GPs in a CCG were to actively promote the low carb program, while not contradicting “low carb”. Maybe also seeing what effect providing test strips and getting people to test before and after meals have.

What if for a £100 deposit people were provided access to the program and given 2 months usage of CGM, with the £100 being refunded if they engage and explained to their GP what they have learned from using a CGM…….

I was with you all the way until you mentioned £100. Even if refundable this would mean thousands of poorer people left with not a chance of accessing information.

 

[Grateful]

... and prompt their couches to take action.

A neat trick! (Sorry, your post was great, but sometimes a dose of unintended humor is nice, given the severity of the subject!)

 

[DCUKMod]

One issue with the low carb program’s data is that people who do well are more likely to respond to the emails asking for test results. The low carb program also only gets people who are motivated enough to investigate their diabetes and go beyond what their GP recommend. Hence we can’t use the data to predict the outcomes of rolling it out to all NHS GPs.

(As the program has to tell people who are on drugs/insulin to get their GP’s approval, it is limited mostly to people who have not had diabetes for long. The ND proving it is safe to just stop most drugs and let BG get upto 20 in the first few weeks could help with this.)

I would love to know how many of the 4% reversal in the control group of the ND study did the low carb program…….. (Personally I gave up on it within an hour as I don’t like a computer controlling the rate I can access information.)

Clearly if the 700 people per day who are diagnosed with Type2 in the UK were told about program by their GPs, with it being promoted as much as the eye testing is, the outcomes in the UK would be a lot better.

It would be interesting to see the results if half the GPs in a CCG were to actively promote the low carb program, while not contradicting “low carb”. Maybe also seeing what effect providing test strips and getting people to test before and after meals have.

What if for a £100 deposit people were provided access to the program and given 2 months usage of CGM, with the £100 being refunded if they engage and explained to their GP what they have learned from using a CGM…….

I don't believe for a moment that the ND proves it is safe to just give up drugs. This study may have demonstrated that it was safe for those accepted to participate were able to safely give up their drugs. That is a very different thing.

Anyone going onto a trial will be vetted, although in DIRECT study, that may well have been via their GP. In the work that I do with the NIHR, one of the huge wins often cited by people volunteering as trialists is the medical going over they get, prior to embarking on any trial or study. They will often have tests and investigations they would never be exposed to in their usual GP environment.

Those looking to embrace the LCProg are advise to seek their GP's support to ensure they are not going to endanger themselves.

I don't for a moment consider the LCP is suitable or desirable for everyone, any more than the ND, Blood Sugar Diet, general low carbing or Eat Well Guide is right for everyone, but for sure all of those foregoing examples suit some people.

 

[Boo1979]

I don't believe for a moment that the ND proves it is safe to just give up drugs. This study may have demonstrated that it was safe for those accepted to participate were able to safely give up their drugs. That is a very different thing.

Anyone going onto a trial will be vetted, although in DIRECT study, that may well have been via their GP. In the work that I do with the NIHR, one of the huge wins often cited by people volunteering as trialists is the medical going over they get, prior to embarking on any trial or study. They will often have tests and investigations they would never be exposed to in their usual GP environment.

Those looking to embrace the LCProg are advise to seek their GP's support to ensure they are not going to endanger themselves.

I don't for a moment consider the LCP is suitable or desirable for everyone, any more than the ND, Blood Sugar Diet, general low carbing or Eat Well Guide is right for everyone, but for sure all of those foregoing examples suit some people.

Part of the research protocol also dealt with proceedures to follow if research participants became hyperglyceamic during the trial - which meds to restart and when

 

[Fleegle]

https://www.diabetes.org.uk/researc...hrough&utm_campaign=Enewsletter+December+2017

I really admire your persistence @Boo1979 keep going!

Do you think there is a forum like this anywhere that is more ND balanced? - the other obvious one is too anti low carb. It would be nice to find a balance somewhere. I am finding it hard to find a place where there is a lot of sharing of their experiences on the ND as there is here on low carbing.

 

[Fleegle]

It's all crackers. Until I see the actual HbA1c levels of the 46% after 12 months, and the results of their liver scans/insulin resistance tests, and details of their "normal" diet, I will continue to be sceptical.

I am pleased to see that extra money has been made available for the study to continue for a longer period.

I think it is a good idea to keep an eye on what data is published and I to would like to see more data though I suspect it unlikely to get the detailed data you are looking for which I agree is a shame.

However - if you look on the web site there is a collection of data where people have tried the ND and reported things like HBA1C after a year OGTT results and all sorts of other data. It also shows things like how long people were diagnosed before attempting it.

There is a ton of general data - though not on the 40 odd percent yet I do agree.

I remain really open minded.