The one show discussion

[AdamJames]

obviously he was pre-diabetic, or I have not read that graph properly.

I've just been reading up on the subject, and interestingly according to the WHO guidelines:

Currently HbA1c is not considered a suitable diagnostic test for diabetes or intermediate hyperglycaemia. The following Table summarises the 2006 WHO recommendations for the diagnostic criteria for diabetes and intermediate hyperglycaemia.

Not only that, but:

The Group recommends using the term Intermediate Hyperglycaemia to describe glycaemic levels between ‘normal’ glucose tolerance and diabetes. Use of ‘pre-diabetes’ is discouraged to avoid any stigma associated with the word diabetes and the fact that many people do not progress to diabetes as the term implies. In addition this focus on diabetes may divert attention from the important and significantly increased cardiovascular risk.

So HbA1c and the term 'pre-diabetes' don't seem to be of much concern to them.

They divide the results of an OGTT into four categories, from best to worst:

* normal
* impaired fasting glucose
* impaired glucose tolerance
* diabetes

So I suppose, according to that set of rules, good old Paul could be said to "not have diabetes" and maybe I should swallow humble pie. But he was at level 3 of 4 on the road to diabetes so it's hardly a rosy picture and I think we'd all agree he should be thinking and living like a diabetic.

Also, I really don't think the 0 and 2 hours points are enough info. I think there are basically 3 shapes of graph for an OGTT from all the looking around I've done, and the shape, and rise between 0 and 2 hours are very important when it comes to analysing somebody's metabolic state. I'm going to put my neck on the line and say the shapes could be put into these 3 categories:

1) A big rise which stays high for a long time - I think uncontrolled T2s can expect this.
2) A similarly big rise which comes down quite sharply before the 2 hour point - I think a lot of T2s on this forum who are controlling their T2 well and don't have a lot of fat in their livers can expect this.
3) A small rise and back close to the starting point by 2 hours - I think people who are not diabetic can expect to get this. I also suspect some people who were diabetic but who caught it in time and managed to undergo some fundamental internal change, such as de-clogging their pancreas, may be able to get this result.

 

[bulkbiker]

all you have to do to cure diabetes is go on a crash diet for 9 weeks

But that's exactly the premise of the Newcastle Diet at its core..which is why (yes I know I have said it multiple times before) I'm not a fan. It's also the core of the DUK literature about the ND which is why so many get misled about it.. and yes it is one of my bugbears...! Rant officially over... all smiles now..

 

[Daibell]

But that's exactly the premise of the Newcastle Diet at its core..which is why (yes I know I have said it multiple times before) I'm not a fan. It's also the core of the DUK literature about the ND which is why so many get misled about it.. and yes it is one of my bugbears...! Rant officially over... all smiles now..

Like you I haven't any time for the ND and Prof Taylor. It no doubt helps but Prof Taylor keeps on about pancreatic fat when insulin resistance is usually caused by fat around many internal organs not just the pancreas. He also is fixated about calories when they are largely irrelevant. Going down to 800 calories will help but lowering the fats rather than carbs makes that easier to achieve but is not optimal. Why not just go low-carb which focusses on the main cause of weight gain i.e. the carbs and it becomes a diet 'for life'. The ND makes good media fodder and DUK can be seen to be funding something specific rather than generalised 'low-carb'

 

[bulkbiker]

Like you I haven't any time for the ND and Prof Taylor. It no doubt helps but Prof Taylor keeps on about pancreatic fat when insulin resistance is usually caused by fat around many internal organs not just the pancreas. He also is fixated about calories when they are largely irrelevant. Going down to 800 calories will help but lowering the fats rather than carbs makes that easier to achieve but is not optimal. Why not just go low-carb which focusses on the main cause of weight gain i.e. the carbs and it becomes a diet 'for life'. The ND makes good media fodder and DUK can be seen to be funding something specific rather than generalised 'low-carb'

Agree 100% and he seems to have missed the bit in the pre bariatric surgery diet literature when patients are expected to get into ketosis to shrink their liver pre surgery... If only they could continue to remain in ketosis the operation could well be avoided completely.

Edit to add.. ok rant went on a bit longer than expected.. sorry

 

[ringi]

It was what Prof. Taylor said that I didn't understand, the bit about ridding the pancreas of excess fat. I will have to rewind then do some research into that because of the small (!) issue of hyperinsulinaemia.

He explains it well in some of his 1hr talks that are on YouTube. Removing the fat from the liver makes the liver much more inslin sensitive, so the mean inslin level goes down. Then once the fat is removed from the pancreas, the rate of increase in inslin goes up just after meals (or GTT).

Research into low carb diets have shown they can remove most liver fat in a few weeks, the Newcastle diet does it within two weeks for lots of people. But the fat comes back unless the diet is kept to unless someone loses a lot of weigh and dose not regain it.

 

[ringi]

Agree 100% and he seems to have missed the bit in the pre bariatric surgery diet literature when patients are expected to get into ketosis to shrink their liver

There is no need to limit carbs for ketosis, it can be done with 100% carbs if calories are limited enough. Read his research papers and you will see he did measure ketosis and everyone who got good results had reasonable levels of ketones after the first week or so.

Remember he only used the shakes as a way to study how fat was removed from the liver and pancreas and what the result was, so that he could study what happened when the fat came back. Very unexpectivtly he found it did not come back for some people and that they did not regain type2 at the end of the experiment.

He thinks it makes no difference how the fat is lost, but only had funding to test using the shakes, as otherwise it is very expensive to get his test subjects to all keep to the same diet.

Next weeks program covers low carb diets and I expect will be a lot ore to our liking.. ...

 

[rab5]

If I eat carbs it knocks me out of ketosis

 

[ringi]

If I eat carbs it knocks me out of ketosis

Not if you limit yourself to only having 3 diet shakes a day and nothing else. (But as I like low carb food, I chose low carb as a much nicer option.)

 

[zand]

Not if you limit yourself to only having 3 diet shakes a day and nothing else. (But as I like low carb food, I chose low carb as a much nicer option.)

That level of carbs may not knock you personally out of ketosis, but we aren't all the same. It would certainly do that to me.

 

[ringi]

That level of carbs may not knock you personally out of ketosis, but we aren't all the same. It would certainly do that to me.

Try it while keeping to a limit of 800 calories a day..... Clearly without the multyweek carrot limit the carbs would kick anyone out of ketosis.

 

[zand]

Try it while keeping to a limit of 800 calories a day..... Clearly without the multyweek carrot limit the carbs would kick anyone out of ketosis.

I have lol, that's why I replied.

 

[AdamJames]

Clearly without the multyweek carrot limit the carbs would kick anyone out of ketosis.

Sign me up for the diet where limiting carrots sorts everything out. I'm in.

 

[lucylocket61]

This programme fulfilled all my expectations - unfortunately.

and now more us us overweight type 2's are going to have to face further escalated vilification and condemnation.

 

[AdamJames]

I've always found the idea of ketosis a bit confusing.

Some people refer to it as if it's a switch - you stop burning glucose for fuel and start using fat, and that means the ketones in your blood will increase.

But I'm pretty sure it's a sliding scale, not an on-off switch.

The Optifast website, which provides an eating plan which is basically the ND, say that they are aiming for "mild ketosis". That seemed true for me when I was on an ND style plan for a few days - I couldn't detect ketones with ketostix during the day but they were detected during the night.

I think our levels of ketones change all the time and can increase in various circumstances. Fasting (even while sleeping) will do it, exercise will do it, not eating carbs will do it. Ketosis has a technical definition of there being over a certain level of ketones in the body, but that's just a naming convention.

I was once under the impression that you could say "if you are losing weight (body fat) then you are in ketosis" but that's probably not quite true. However I suspect you must be producing more ketones when you burn body fat, just it may not be enough to qualify for the label "ketosis"?

 

[first14808]

The weight regain was after following NHS dietician advice on healthy carbs and portion size. Then being demoralised because not only did it not work for me weightwise, but also the feeling that I was being regarded as a liar and judged when the recommendation didn't work.

My conclusion is that no one method suits everyone, and if we decry or discredit any particular method we could be denying folks of finding the way that works for them.

I think this is a huge part of the problem, and part of the vicious circle of obesity, ie not just the physical effects and risks of weight gain, but also the psychological. So everything from 'fat shaming' to just losing self-confidence and then perhaps comfort eating, and ending up housebound. And thanks to modern technology, food can be delivered right to your door.

I don't know what support is offered to obese people, but there does seem to be a problem with an official one-size fits all approach, ie the Eatwell guidance. So do the ND, lose some weight, get advice about Eatwell, gain weight again. Then it should be obvious that that diet does not work for that person. Which means dieticians need the flexibility to suggest alternative options and meal plans. And ideally be able to order tests like insulin response, GTT and prescibe CGMs to refine dietary advice. And also provide encouragement and psychological support. Losing a lot of weight is hard, but even harder if you're given bad advice and little support.

But that costs money. But then so does the obesity 'epidemic' in terms of people's lives. And to me, the 'cure' seems pretty simple, ie better nutritional advice and more flexibility to offer it. One bizarre aspect of obesity was some reporting of a morbidly obese man who's benefits had been increased to support his overeating.. Which seemed crazy, especially as there's no support for people who're struggling to find the money to eat healthy. Which is a problem, especially as supermarkets seem to put a price premium on healthy foods. Currently it's a lot cheaper to eat badly. Currently there's some pressure for things like sugar taxes, and revenues from that could go towards increased support for obesity and diabetes.

But with that rant out of the way, the programme seems to be what I feared when people mentioned it was 'supported' by the promoters of ND. Which could be problematic given the BBC's not supposed to run product placements or sponsored content. Especially if that means promoting a possible medical solution, because the regulations around health products are even stricter. And of course if it provides false hope, and perpetuates the myth that obesity causes diabetes, rather than it being a symptom of diabetes and/or metabolic syndrome.

I think there's a danger that commercial pressure to sell a 'Newcastle Diet' either directly, or indirectly via prescription may be distorting the effectiveness, especially if it can be sold backed by clinical trials. I've not seen the programme, but it seems to have been a bit of a sales pitch, and used some marketing tricks like the OGTT slide. To me, the idea that all obesity/diabetes could be cured with a reasonably priced box of shakes is very much in false hope territory, and dangerous to people's health.

 

[jayney27]

Well I watched it and don’t understand! The priest guy was told his Diabetes had gone into remission, that he no longer had it! They didn’t cite his exact HbA1c but the graph on the computer screen clearly showed him in the pre-diabetic range. At the start of the show they said he was on medication but didn’t mention whether he was still on them at the end of the show!

Edit to add when they showed the computer screen, the Dr said something like, you are clearly below the diabetic range.

I thought the same regarding the graph, maybe they had it upside down on the screen, hehe.
When he was talking on the one show he mentioned that in total he has lost 6 stone and no longer takes any medication at all for the diabetes. The narrative in the programme was a little conflicting and yes it would have been good to have known his HbA1c readings before and after, the other participants tests were a little more detailed, before and after readings and images.

 

[first14808]

I was once under the impression that you could say "if you are losing weight (body fat) then you are in ketosis" but that's probably not quite true. However I suspect you must be producing more ketones when you burn body fat, just it may not be enough to qualify for the label "ketosis"?

It's all a load of metabolics

My understanding is they're two different things. So do LCHF and we're forcing the body to either use stored fat, or dietary fat. That's a normal metabolic process and relatively easy to trigger by reducing carbs. They're easier to digest and convert to glucose, and because we typically only need 5-6g circulating glucose, excess glucose gets stored as fat. And excess carbs also means more insulin's produced, which increases the risk of insulin sensitivity. So becoming 'fat adapted' is realtively simple, especially if combined with some exercise.

Ketosis then goes a step further by reducing carb intake even more, ie <20g to force production of ketones. And because we're cunningly designed as a multi-fuel system, those could be from body fat, dietary fats or proteins.. Which is where I think it gets a bit riskier, ie the goal is to use fat rather than muscle. It's effective though, but needs more effort with diet and testing to see if you're in ketosis, or staying in ketosis. Oddly, even though ketosis is popular, none of the chemists I checked sold any ketone test kits or strips.

 

[AdamJames]

I think this is a huge part of the problem, and part of the vicious circle of obesity, ie not just the physical effects and risks of weight gain, but also the psychological. So everything from 'fat shaming' to just losing self-confidence and then perhaps comfort eating, and ending up housebound. And thanks to modern technology, food can be delivered right to your door.

I don't know what support is offered to obese people, but there does seem to be a problem with an official one-size fits all approach, ie the Eatwell guidance. So do the ND, lose some weight, get advice about Eatwell, gain weight again. Then it should be obvious that that diet does not work for that person. Which means dieticians need the flexibility to suggest alternative options and meal plans. And ideally be able to order tests like insulin response, GTT and prescibe CGMs to refine dietary advice. And also provide encouragement and psychological support. Losing a lot of weight is hard, but even harder if you're given bad advice and little support.

But that costs money. But then so does the obesity 'epidemic' in terms of people's lives. And to me, the 'cure' seems pretty simple, ie better nutritional advice and more flexibility to offer it. One bizarre aspect of obesity was some reporting of a morbidly obese man who's benefits had been increased to support his overeating.. Which seemed crazy, especially as there's no support for people who're struggling to find the money to eat healthy. Which is a problem, especially as supermarkets seem to put a price premium on healthy foods. Currently it's a lot cheaper to eat badly. Currently there's some pressure for things like sugar taxes, and revenues from that could go towards increased support for obesity and diabetes.

But with that rant out of the way, the programme seems to be what I feared when people mentioned it was 'supported' by the promoters of ND. Which could be problematic given the BBC's not supposed to run product placements or sponsored content. Especially if that means promoting a possible medical solution, because the regulations around health products are even stricter. And of course if it provides false hope, and perpetuates the myth that obesity causes diabetes, rather than it being a symptom of diabetes and/or metabolic syndrome.

I think there's a danger that commercial pressure to sell a 'Newcastle Diet' either directly, or indirectly via prescription may be distorting the effectiveness, especially if it can be sold backed by clinical trials. I've not seen the programme, but it seems to have been a bit of a sales pitch, and used some marketing tricks like the OGTT slide. To me, the idea that all obesity/diabetes could be cured with a reasonably priced box of shakes is very much in false hope territory, and dangerous to people's health.

I'd go along with most of that.

Your cynicism is supported very well if you visit the 'Cambridge weight plan' website. There's currently 4 sliding images on the front page. If you'd watched the program you'd recognise the first face (you can click the first white dot in the bottom left of the sliding image panel to get to the first one).

It's good old Paul the Priest!

Clicking to read his story also gives some background behind the show which is quite interesting. It mentions having a diet consultant provided by CWP.

On the plus side however, it does seem the weight loss has continued quite dramatically after the show. He's apparently lost 6 stone at this point.

My guess is he's not adhering to the NHS Eatwell plate, but the advice from his CWP consultant, who may be a bit more clued up. The brief shots at the end of the show, when they'd started re-introducing normal food, did give the impression it was much healthier than the EatWell plate type stuff.

 

[jayney27]

The whole Diabetes issue was way over simplified and I keep thinking of that poor guy thinking he’s cured. I wonder what his HbA1c is now. It looks like it was filmed last autumn.

Hi he did say on the One Show that he has had further weight loss and takes no medication now.

 

[Rachox]

I thought the same regarding the graph, maybe they had it upside down on the screen, hehe.
When he was talking on the one show he mentioned that in total he has lost 6 stone and no longer takes any medication at all for the diabetes. The narrative in the programme was a little conflicting and yes it would have been good to have known his HbA1c readings before and after, the other participants tests were a little more detailed, before and after readings and images.

@AdamJames pointed out in post #54 that the graph is a GTT which would explain why the line sloped up. However the end result was still in the prediabetic range. The other participants did seem to get more detailed investigations