Prof Roy Taylor hypothesis - DIRECT study & pancreatic fat

[Guzzler]

That's why reasearch and trials are so important. So someone linked last year's paper for me, and from reading that, the TL;DR version is.. Previously it was thought that the effects on pancreatic beta cells was permanent/irreversable. But following on from the ND, it looks like function's restored in the 'responders' group, potentially with the reduction in pancreatic fat. If the wider study shows the same thing, then it looks like it's reversable in some T2 diabetics, but presumably only if a 'healthy' diet is maintained to prevent fat accumulation and the cycle starting again.

If that proves to be the case then the non responders would, logically, have to follow a strict lower carb diet for life rather than risk further damage needing medication etc. This tells me that ND may prove to be another weapon in the arsenal and should, therfore not be ruled out so quickly before longer term studies have been done.

 

[woodywhippet61]

Following healthy eating after the diet is crucial. It's 18 months since I did the Newcastle diet. It was against nhs advise and I had no support other from advise from this site. Last time I saw the doctor he used the word cured. I couldn't argue but without constant self funded blood monitoring I'd be back where I was. Hopefully these headlines will encourage more doctors to "allow" patients to self monitor and gain personal control.

Well done on your success.

What kind of 'healthy eating' are you now doing? Have you put on any weight? I thought weight was considered to be the key rather than glucose levels? If that is the case then they still won't fund us testing.

 

[first14808]

Following healthy eating after the diet is crucial. It's 18 months since I did the Newcastle diet. It was against nhs advise and I had no support other from advise from this site. Last time I saw the doctor he used the word cured. I couldn't argue but without constant self funded blood monitoring I'd be back where I was. Hopefully these headlines will encourage more doctors to "allow" patients to self monitor and gain personal control.

I'm new to this, but I think the monitors are invaluable. Otherwise the advice from my GP was pretty much 'lose a bit of weight and we'll do another HbA1c in a few months'. Having a meter's let me experiment with my diet and see what works for me.

As for cure, I guess that's the contentious bit, and why there's understandable caution. So why some responded and some didn't, and if people 'catch' T2 again if they gain weight or pile into the carbs. And for me, if this is any improvement over the low carb diets suggested and followed by people here.

 

[Biggles2]

But following on from the ND, it looks like function's restored in the 'responders' group, potentially with the reduction in pancreatic fat. If the wider study shows the same thing, then it looks like it's reversable in some T2 diabetics, but presumably only if a 'healthy' diet is maintained to prevent fat accumulation and the cycle starting again.

So, the disease can be stopped in its tracks by a certain amount of weight loss. That is certainly good. But the only healthy maintenance diet for a T2 is a low carb diet (with eating to the meter to determine which carbs an individual with T2 should absolutely avoid), otherwise the cycle starts all over again.

 

[bulkbiker]

So, the disease can be stopped in its tracks by a certain amount of weight loss.

Hmmm well 46% of the subjects in the trial and they only got to an HbA1c of 48 or lower to be considered "successful"....
if you call that stopping Type 2 in its tracks.....

 

[OrsonKartt]

Well done on your success.

What kind of 'healthy eating' are you now doing? Have you put on any weight? I thought weight was considered to be the key rather than glucose levels? If that is the case then they still won't fund us testing.

I follow a low carb diet. As many veg as I can get away with while maintaining a fasting blood sugar level of under 6. Plus proteins ( meat fish etc) Maybe 30 grams of carb per day For a year I recorded every scrap of food, when it was eaten and how it affected blood sugars and blood pressure the same with activity ( exercise)

I had a notion that after a year or so I might be able to eat higher carb again but I've tried a few things and it spiked my sugars alarmingly

My bmi before diagnosis was 25 now it is 19 . My weight fluctuates by around a kilo for no discernible reason. I'm certainly not overweight , at my last check up I was told I was under.

To be honest it's a constant battle. I can go many many weeks with fasting blood sugars of low fives ... If I get a six fasting for a day or two ( 500 Cals per day) brings my fasting blood sugar levels down. In this cold weather it's a real challenge. My last a1c a couple of weeks ago was 43.

Personally I find the blood sugar level testing motivating and a great guidance. Everyone and the doctors dog has a belief system about what I should eat. The science in my hands despite the cost and inconvenience is in my option worth it.

 

[Biggles2]

if you call that stopping Type 2 in its tracks.....

I was trying to be kind @bulkbiker . Actually I have a number of issues with the findings, not least of all their definition of remission. But I appreciate the time and effort put into this study, and kudos to the team on being published. At least it adds to the body of knowledge that T2 does not have to a progressive disease and that dietary approaches do have value.

 

[Bluetit1802]

At least it adds to the body of knowledge that T2 does not have to a progressive disease and that dietary approaches do have value.

I think that is about all it proves. I am very unhappy with the definition of remission, lack of information on the 54% that "failed", the relatively low numbers that "passed", and lack of information on the follow up diets.

 

[woodywhippet61]

I follow a low carb diet. As many veg as I can get away with while maintaining a fasting blood sugar level of under 6. Plus proteins ( meat fish etc) Maybe 30 grams of carb per day For a year I recorded every scrap of food, when it was eaten and how it affected blood sugars and blood pressure the same with activity ( exercise)

I had a notion that after a year or so I might be able to eat higher carb again but I've tried a few things and it spiked my sugars alarmingly

My bmi before diagnosis was 25 now it is 19 . My weight fluctuates by around a kilo for no discernible reason. I'm certainly not overweight , at my last check up I was told I was under.

To be honest it's a constant battle. I can go many many weeks with fasting blood sugars of low fives ... If I get a six fasting for a day or two ( 500 Cals per day) brings my fasting blood sugar levels down. In this cold weather it's a real challenge. My last a1c a couple of weeks ago was 43.

Personally I find the blood sugar level testing motivating and a great guidance. Everyone and the doctors dog has a belief system about what I should eat. The science in my hands despite the cost and inconvenience is in my option worth it.

Thank you and I totally agree with you about testing. It gave me back control after I was diagnosed. It makes me so cross that most of us aren't encouraged to test by our HCP's and also that we don't get the equipment to do it.

Congratulations on the control that you have achieved for so long.

 

[snowmonkey]

what i dont understand is whether those in remission could eat (say) a bag of chips and have a normal insulin response.... or are they just in remission because they no longer eat many carbs. the difference is quite important

 

[gardengnome42]

The NHS spends more on diabetic medications than any other ailment - £1 billion per year - see https://www.theguardian.com/society/2016/aug/03/diabetes-drugs-cost-nhs-1bn-a-year-presciption

Despite this huge cost the remission rate for type 2 diabetes is only about 4%. Complications from diabetes including amputations, strokes, blindness etc costs in the region of £10 billion per year. However, a diet based approach can result in very high levels of remission, which could save the NHS billions in future years in lower medication costs and less cost for hospital treatments.

It does appear from threads in this forum that most type 2 people who adopt a LCHF diet or undergo a Newcastle Diet get their blood glucose down to levels where medication is no longer required. This is a vastly better outcome than most type 2 patients in typical GP surgeries around the UK. My impression from talking to my diabetes nurse is that very few of her patients manage to get the type of results I found after going low carb. There needs to be education program for GPs and HCPs to tell them what is the most effective method to reverse type 2 diabetes. Otherwise the NHS will be overwhelmed with a tsunami of diabetic patients.

I'm prediabetic and am trying to arm myself with as much information as I can. One thing stands out a mile is the stubborn and out of date attitude of the NHS and Diabetes UK [the other site, not this one] who refuse to accept that a high carb and low fat diet is fueling the diabetes epidemic.

 

[OrsonKartt]

what i dont understand is whether those in remission could eat (say) a bag of chips and have a normal insulin response.... or are they just in remission because they no longer eat many carbs. the difference is quite important

In my experience it's the latter

 

[Bluetit1802]

I follow a low carb diet. As many veg as I can get away with while maintaining a fasting blood sugar level of under 6. Plus proteins ( meat fish etc) Maybe 30 grams of carb per day For a year I recorded every scrap of food, when it was eaten and how it affected blood sugars and blood pressure the same with activity ( exercise)

I had a notion that after a year or so I might be able to eat higher carb again but I've tried a few things and it spiked my sugars alarmingly

My bmi before diagnosis was 25 now it is 19 . My weight fluctuates by around a kilo for no discernible reason. I'm certainly not overweight , at my last check up I was told I was under.

To be honest it's a constant battle. I can go many many weeks with fasting blood sugars of low fives ... If I get a six fasting for a day or two ( 500 Cals per day) brings my fasting blood sugar levels down. In this cold weather it's a real challenge. My last a1c a couple of weeks ago was 43.

Personally I find the blood sugar level testing motivating and a great guidance. Everyone and the doctors dog has a belief system about what I should eat. The science in my hands despite the cost and inconvenience is in my option worth it.

Your story is not too dissimilar to mine, although I dropped my BMI from 31 to 21 and it doesn't fluctuate more than a pound up or down. I am also on around 30g carbs and I eat to my meter. I never see a post meal 2 hour rise much above 6.5 and my fastings are low 5s. I often see 4s before lunch and before tea. I can manage some foods I had previously abandoned due to spikes, but have to have strict portion control on these particular carbs. My HbA1cs have been under 48 since June 2014. I would easily have passed the ND exercise with my data ......... but I am not in remission.

(I also find frequent testing and recording on a spreadsheet very motivational, and I learn from it all the time, even after all this time. I am also a part time user of the Libre sensor. This self management costs me a small fortune!)

 

[OrsonKartt]

Your story is not too dissimilar to mine, although I dropped my BMI from 31 to 21 and it doesn't fluctuate more than a pound up or down. I am also on around 30g carbs and I eat to my meter. I never see a post meal 2 hour rise much above 6.5 and my fastings are low 5s. I often see 4s before lunch and before tea. I can manage some foods I had previously abandoned due to spikes, but have to have strict portion control on these particular carbs. My HbA1cs have been under 48 since June 2014. I would easily have passed the ND exercise with my data ......... but I am not in remission.

(I also find frequent testing and recording on a spreadsheet very motivational, and I learn from it all the time, even after all this time. I am also a part time user of the Libre sensor. This self management costs me a small fortune!)

I'm jealous of your libre ( I'm on eBay buying up out of date strips) and have to thank you for advice / thoughts you gave me when I first found this site. Best thoughts ....

 

[Biggles2]

I think that is about all it proves. I am very unhappy with the definition of remission, lack of information on the 54% that "failed", the relatively low numbers that "passed", and lack of information on the follow up diets.

I agree with you @Bluetit1802 . However, we are not on the editorial board of the Lancet. And the truth is, if you contribute new knowledge to the body of literature you will be published. That is just how it works. I think what we all find frustrating is that many of us on this forum are individually reporting much better results with our own very similar approaches (low carb/eating to the meter) to dietary management. So it is frustrating that a method we find to be inferior to ours is published - and in the Lancet no less!

 

[first14808]

Getting published isn't exclusive to trade, or trade sponsors. Challenge is meeting the standards for peer-review, or in this case, any formal medical study. Which is the good thing about the ND stuff, ie it's a formal, controlled version of a low carb diet and the effects on T2 diabetes. But that's also why the detail matters, and why the mainstream reporting hasn't been great as they've been promoting the idea that T2 could be 'cured' by simple weight loss.

From my reading into T2 since diagnosis, it's far more complicated, ie there can be a number of potential triggers for T2, some might be 'cureable', some not. Which may also be why some people responded better than others. Some may be lucky and once visceral fat's reduced, insulin resistance or beta cells recover, in others, that may not be possible. But that also opens up other lines of study to figure out why. The big thing for me is it doesn't automatically mean T2 is a permanent, degenerative condition, if you're fortunate and sensible enough to cut the carbs.

 

[Daibell]

Getting published isn't exclusive to trade, or trade sponsors. Challenge is meeting the standards for peer-review, or in this case, any formal medical study. Which is the good thing about the ND stuff, ie it's a formal, controlled version of a low carb diet and the effects on T2 diabetes. But that's also why the detail matters, and why the mainstream reporting hasn't been great as they've been promoting the idea that T2 could be 'cured' by simple weight loss.

From my reading into T2 since diagnosis, it's far more complicated, ie there can be a number of potential triggers for T2, some might be 'cureable', some not. Which may also be why some people responded better than others. Some may be lucky and once visceral fat's reduced, insulin resistance or beta cells recover, in others, that may not be possible. But that also opens up other lines of study to figure out why. The big thing for me is it doesn't automatically mean T2 is a permanent, degenerative condition, if you're fortunate and sensible enough to cut the carbs.

Sadly it isn't a controlled version of a low-carb diet but low-calorie diet and I find that not very useful in the same way measuring calories isn't very useful. It may also we well-controlled but it appears to be incomplete and what is derived is questionable.

 

[first14808]

Ah, there are always questions.. Especially when outcomes get badly reported. But then most of the mainstream media don't have any real science reporters. So the BBC hyped ND, but the other day ran a story about 'fad' diets to avoid. Like Keto..

It's also why I'd like to see open-access to results rather than hiding them behind prestigious paywalls. From ND's 2016 trial, the meal replacements were these-

https://www.nestlehealthscience.co.uk/brands/optifast/optifast

A lot of sugar relative to the meal size, but perhaps not compared to a 'normal' meal. Also shows the high margins available in producing 'health' products..

 

[bulkbiker]

Ah, there are always questions.. Especially when outcomes get badly reported. But then most of the mainstream media don't have any real science reporters. So the BBC hyped ND, but the other day ran a story about 'fad' diets to avoid. Like Keto..

It's also why I'd like to see open-access to results rather than hiding them behind prestigious paywalls. From ND's 2016 trial, the meal replacements were these-

https://www.nestlehealthscience.co.uk/brands/optifast/optifast

A lot of sugar relative to the meal size, but perhaps not compared to a 'normal' meal. Also shows the high margins available in producing 'health' products..

I think in fact the 2016 study that we are getting the write ups for now used the Cambridge Diet shakes

https://www.cambridgeweightplan.com/userfiles/file/Nutritional info/Shakes and soups.pdf

27g of carbs per serving...a lot more than i would choose to ingest.

 

[first14808]

The paper I was looking at is this one-

http://www.ncl.ac.uk/media/wwwnclac...ancecentre/files/low-calorie-diet-article.pdf

Very low calorie diet in Type 2 Diabetes
Clinical trial number ISRCTN88634530

Experimental protocol
The VLCD consisted of a liquid diet formula (43% carbohydrate, 34% protein and 19.5% fat; 2∙6 MJ/day [624 kcal/day]; Optifast; Nestlé Nutrition, Croydon, UK) taken as 3 shakes per day. In addition, up to 240g of non-starchy vegetables was consumed, making total energy intake 624-700 kcal/day.

But the precise diet shake is possibly something of a red herring, ie the mechanism for 'remission' appears to be the reduction in visceral/pancreatic fat.. which is something that can be achieved by other methods, ie the low carb and/or exercise route a lot of people here are using successfully. If the 'cure' is fat reduction, then I don't think it's going to work for every T2, and that's reflected in the results with only 46% in remission from the latest trial.