Tannith's views on reversing T2

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lucylocket61

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Ps I also think you are not taking into account your age and it's affect on body functions.
 
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lucylocket61

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lucylocket61

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After extensive googling of Newcastle diet and DIRECT study I can't find anything which says it is possible to stop being diabetic prone.

In fact, the articles say the opposite. They also say that diabetes type 2 is progressive, implying that the weight loss to achieve remission is not a fixed point and, as the diabetes progresses, more intervention will be needed.

None of which makes logical sense to me as this diet is being touted as a cure, but the small print says it is, at best, a temporary halt in a progressive disease.

I can find nothing concrete about beta cells regeneration, just some vague hypothesis based on no actual science.

Anyone got any other research on this last point with solid evidence please?
 
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Oldvatr

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Especially as in the initial Counterpoint trial they tested for ketones...
In this particular case the subjects were likely in ketosis due to starvation but the production of ketones is the same.
Not sure how this is relevant. The study did not draw any conclusions regarding any ketone results obtained. Are they even reported on the study? From what I remember from the Optifast shake manufacturer, their own 600 cal shake-only diet might possibly lead to ketosis in a small sample, but was designed specifically so as to be above the threshold for most people using the product. The inclusion of 200g of normal food should ensure this did not happen to any significant degree during the ND trial. This analysis also applies to the Cambridge Diet shakes which the follow-on DIRECT study used.
 

HSSS

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There is a page somewhere with literally dozens of coloured charts
In all likelihood all based on the same defined levels just presented differently. 5.7% is 38.8mmol so as we keep saying yes your 39 is JUST into some countries prediabetic level, but not others including WHO.

I think you are distorting what Jim said. Have a read back over his comments. You are the only person that said it’s not good enough. He also said repeatedly that insulin levels are relevant to assessment and you didn’t and still don’t have that piece of the jigsaw puzzle (neither do many of us I know).

I’d agree middle point in all three scales would indicate a non diabetic status. I just don’t agree weight loss will necessarily get you or anyone else there, is achievable for all or even most people and comes at an acceptable collateral cost.

Potentially of interest to you and relevant to @lucylocket61’s post above : hb1ac increases with age even in non diabetics and the charts do not take this into account.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551641/
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-019-0338-7

This says age should be considered in diagnosis and management http://www.diabetesincontrol.com/hba1c-increases-with-age/

also as this article discusses we need to consider the benefits of tight control against any potential pitfalls (be they hypo’s, excessive medication, osteoporosis, malnutrition, general wellbeing etc etc) where age and expected duration of the disease are very relevant https://www.health.harvard.edu/blog...-for-older-adults-with-diabetes-2018091714772


So perhaps it’s relevant first to decide what the target should be and why?

Undereating and undernutrition have their own risks so please be aware of these too, for example and not exhaustive
  • osteoporosis and bone fractures.
  • a weakened immune system.
  • malnutrition.
  • Poor healing
  • Muscle weakness
  • increased risk of surgical complications.
  • anemia.
  • chronic fatigue.
 

Oldvatr

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In all likelihood all based on the same defined levels just presented differently. 5.7% is 38.8mmol so as we keep saying yes your 39 is JUST into some countries prediabetic level, but not others including WHO.

I think you are distorting what Jim said. Have a read back over his comments. You are the only person that said it’s not good enough. He also said repeatedly that insulin levels are relevant to assessment and you didn’t and still don’t have that piece of the jigsaw puzzle (neither do many of us I know).

I’d agree middle point in all three scales would indicate a non diabetic status. I just don’t agree weight loss will necessarily get you or anyone else there, is achievable for all or even most people and comes at an acceptable collateral cost.

Potentially of interest to you and relevant to @lucylocket61’s post above : hb1ac increases with age even in non diabetics and the charts do not take this into account.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551641/
https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-019-0338-7

This says age should be considered in diagnosis and management http://www.diabetesincontrol.com/hba1c-increases-with-age/

also as this article discusses we need to consider the benefits of tight control against any potential pitfalls (be they hypo’s, excessive medication, osteoporosis, malnutrition, general wellbeing etc etc) where age and expected duration of the disease are very relevant https://www.health.harvard.edu/blog...-for-older-adults-with-diabetes-2018091714772


So perhaps it’s relevant first to decide what the target should be and why?

Undereating and undernutrition have their own risks so please be aware of these too, for example and not exhaustive
  • osteoporosis and bone fractures.
  • a weakened immune system.
  • malnutrition.
  • Poor healing
  • Muscle weakness
  • increased risk of surgical complications.
  • anemia.
  • chronic fatigue.
Here is a paper discussing the benefits of tight glycemic control in managing DM for both insulin users and oral users.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348983/
It is a US paper, so uses US measurements.
it does discuss tight control vs regular control and the drawbacks involved.

There have been some studies that show that tight control by T1D is not actually beneficial, and there is a higher all-cause mortality rate for that cohort compared to regular control. It is the hypo experience that seems to be the problem. Indeed, my GP has told me recently that I need to aim for an average bgl of 7.5 mmol/l, and that my last HbA1c of 40 is too low. Then again, most of his patients are elderly and insulin users, so I ignore him in this matter.

Since we seem to be concentrating on T2D in this thread, i am including a treatise on older T2D patients of long standing.
https://www.webmd.com/diabetes/news/20190605/tight-diabetes-control-may-not-help-heart-long-term
 
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FantomPoet

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@Tannith I appreciate your comment 'I had become really terrified that I would be stuck with T2 for life, and was getting depressed by it.' I think many if not all of us on this thread have had the same emotions. You have chosen a dedicated pathway of weight control and to be honest good on you it is far better than sitting in denial and hoping Metformin will compensate for Fish and Chips. The advice in this thread is heavy on low carb as it has worked to maintain the BG levels of many of us including myself.

Roy Taylor during his studies have had the luxury of multiple approaches to measure what was happening to his test subjects. Literally to the point of an MRI scanner managing to image a pancreas that until recently was near impossible to image. In addition you can imagine the number of bloods that were taken, not just for glucose but c peptide etc.

This full vision approach has allowed him to distil a hypothesis down to some relatively simplified advice which would suit a good percentage of the population nearing or sat in diabetic levels (whichever number you may use). It is not however a panacea it will though give you time, it will also give you a discipline in relation to food.

On my diagnosis I went full charge into the Newcastle Diet arguably too hard and too long (down 49Kg but hey) I then moved across to low carbing as I saw on this forum, and others it worked to help maintain where I was. I knew where I was from my HbA1c, as mentioned in posts above I have no idea if that is to do with beta cells, resistance, or just not eating carbs.

My diet has changed, I eat differently now (from prior to diagnosis) and maintain an HbA1c that is deemed healthy by those supporting me. The fear is no longer there as now I can see a way to manage, its a different way of life to pre diagnosis but it is now my normal, so not really any effort. I know not to swig a pint of orange juice as my Libre 2 would reject me. A few days after my diagnosis many years ago I was in Terminal 5 at Heathrow off to god knows where for work and was in near tears wondering what I could eat at the terminal and then on the plane. Now I just do life.
 

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@Tannith I appreciate your comment 'I had become really terrified that I would be stuck with T2 for life, and was getting depressed by it.' I think many if not all of us on this thread have had the same emotions. You have chosen a dedicated pathway of weight control and to be honest good on you it is far better than sitting in denial and hoping Metformin will compensate for Fish and Chips. The advice in this thread is heavy on low carb as it has worked to maintain the BG levels of many of us including myself.

Roy Taylor during his studies have had the luxury of multiple approaches to measure what was happening to his test subjects. Literally to the point of an MRI scanner managing to image a pancreas that until recently was near impossible to image. In addition you can imagine the number of bloods that were taken, not just for glucose but c peptide etc.

This full vision approach has allowed him to distil a hypothesis down to some relatively simplified advice which would suit a good percentage of the population nearing or sat in diabetic levels (whichever number you may use). It is not however a panacea it will though give you time, it will also give you a discipline in relation to food.

On my diagnosis I went full charge into the Newcastle Diet arguably too hard and too long (down 49Kg but hey) I then moved across to low carbing as I saw on this forum, and others it worked to help maintain where I was. I knew where I was from my HbA1c, as mentioned in posts above I have no idea if that is to do with beta cells, resistance, or just not eating carbs.

My diet has changed, I eat differently now (from prior to diagnosis) and maintain an HbA1c that is deemed healthy by those supporting me. The fear is no longer there as now I can see a way to manage, its a different way of life to pre diagnosis but it is now my normal, so not really any effort. I know not to swig a pint of orange juice as my Libre 2 would reject me. A few days after my diagnosis many years ago I was in Terminal 5 at Heathrow off to god knows where for work and was in near tears wondering what I could eat at the terminal and then on the plane. Now I just do life.
Many congratulations on your huge weight loss. I was shocked when I heard first that I was T2, as I know many people are, and again when Jim said that he thought my HBA1C was poor. That sent me to the charts which proved he was right & said I was still in the prediabetic range despite having lost weight. Then to an OGT test where the results were appalling and showed me well into the actual diabetic range, despite having lost much of my overweight. I also knew that the window of opportunity for losing the weight to reverse diabetes was a short one. Some lucky people have managed it at longer duration of T2 but your chances keep reducing with time. By 10 years there is only a 50/50 chance that weight loss will work. Most of us cannot be sure how long we have had T2. Some aren't diagnosed until they have had it 10 years or even more, and have to go onto insulin almost straight away. Taylor's people had sophisticated tests that show their good results more effectively than the tests ordinary people can get outside the labs/scanners. It seems to me that any sensible person would want to aim for the middle range of normal for almost any medical test. Isn't that where everyone would normally prefer to be? So I have made that my target to be in mid range of normal for all of the set of 3 of the tests accessible to me, which all show sufficiently different aspects of BG to give a good estimate when taken together. My OGT is still well above that, so as I see it I shall have to keep going till I get there. Why not? I don't need a life threatening, life changing disease, especially when it can often be reversed by something as simple as weight loss done in time.
PS I think some of the carnivores normally expect to get their HBA1Cs way down into the 20s, even below the middle of normal.
 
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lucylocket61

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again when Jim said that he thought my HBA1C was poor.

Some aren't diagnosed until they have had it 10 years or even more, and have to go onto insulin almost straight away.
I have been nearly 10 years since diagnosis with a HbA1c of 71. I am still diet only control, as are many on here.

I don't need a life threatening, life changing disease, especially when it can often be reversed by something as simple as weight loss done in time.
No, it cant often be reversed. Some people have been able to get in remission to HbA1c of 48 using weight loss. Thats all. They are still diabetics, as per Prof Taylors own research and conclusions linked to and quoted in previous posts.

This thinking is circular. What is being challenged is not being listened to. I dont know why.
 

lucylocket61

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The bottom line is this: weightloss may (or may not) affect blood sugar levels temporarily while the diet is followed. The diabetes type 2 is still there. The only way to control the type 2 diabetes is lowering carb intake, medications, or a combination of the two.

Remission, as per Prof Taylors own definition, is not cure.
 
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HSSS

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Here is a paper discussing the benefits of tight glycemic control in managing DM for both insulin users and oral users.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348983/
It is a US paper, so uses US measurements.
it does discuss tight control vs regular control and the drawbacks involved.

There have been some studies that show that tight control by T1D is not actually beneficial, and there is a higher all-cause mortality rate for that cohort compared to regular control. It is the hypo experience that seems to be the problem. Indeed, my GP has told me recently that I need to aim for an average bgl of 7.5 mmol/l, and that my last HbA1c of 40 is too low. Then again, most of his patients are elderly and insulin users, so I ignore him in this matter.

Since we seem to be concentrating on T2D in this thread, i am including a treatise on older T2D patients of long standing.
https://www.webmd.com/diabetes/news/20190605/tight-diabetes-control-may-not-help-heart-long-term
This might be relevant to those controlled by medications with the associated risk of hypos and underlying progression of the disease (eg hyperinsulemia in type 2 for example regardless of bgl being masked by drug therapy). Not so sure it applies to diet only diabetics managing both bgl and insulin levels.
 

Oldvatr

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This might be relevant to those controlled by medications with the associated risk of hypos and underlying progression of the disease (eg hyperinsulemia in type 2 for example regardless of bgl being masked by drug therapy). Not so sure it applies to diet only diabetics managing both bgl and insulin levels.
Good point. However, we are in comparative infancy when looking at control by ND or LCHF type of diets, so we have not much in the way of a user base to sample. Don't forget that these diets are not in majority use yet, and represent a very small proportion of T2D using diets successfully to get tight control over bgl without medication. The majority of T2D will probably be on their progressive journey to insulin therapy and old age going by the prevalence of T2D vs age charts. It is easy to forget in a forum such as this that it is only accessed by a small percentage of the T2D clientele in the big wide world out there. There are approx 1m forum readers here total, and 3.8,m T2D in UK alone (and rising).for a start.
 

HSSS

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Good point. However, we are in comparative infancy when looking at control by ND or LCHF type of diets, so we have not much in the way of a user base to sample. Don't forget that these diets are not in majority use yet, and represent a very small proportion of T2D using diets successfully to get tight control over bgl without medication. The majority of T2D will probably be on their progressive journey to insulin therapy and old age going by the prevalence of T2D vs age charts. It is easy to forget in a forum such as this that it is only accessed by a small percentage of the T2D clientele in the big wide world out there. There are approx 1m forum readers here total, and 3.8,m T2D in UK alone (and rising).for a start.
Totally accept we are a minority. But a growing one thankfully.

Still doesn’t mean the predictions for complications and mortality based on drug therapy alone apply to us and with time the data should show this (well I really hope it does or if it doesn’t I’ll take the drugs and the cake thanks:wacky:)
 

Tannith

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The bottom line is this: weightloss may (or may not) affect blood sugar levels temporarily while the diet is followed. The diabetes type 2 is still there. The only way to control the type 2 diabetes is lowering carb intake, medications, or a combination of the two.

Remission, as per Prof Taylors own definition, is not cure.

Prof Taylor, World Renowned Diabetologist would beg to differ: he says
"....a series of studies has introduced a paradigm shift in our understanding of the condition. Gradual accumulation of fat in the liver and pancreas leads eventually to beta cell dedifferentiation and loss of specialised function. The consequent hyperglycaemia can be returned to normal by removing the excess fat from liver and pancreas. At present this can be achieved only by substantial weight loss, and a simple practical and efficacious method for this has been developed and applied in a series of studies. For those people who used to have type 2 diabetes, the state of post-diabetes can be long term provided that weight regain is avoided."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399621/

Calorie restriction for long-term remission of type 2 diabetes


https://www.ncbi.nlm.nih.gov › articles › PMC6399621
 
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Oldvatr

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Totally accept we are a minority. But a growing one thankfully.

Still doesn’t mean the predictions for complications and mortality based on drug therapy alone apply to us and with time the data should show this (well I really hope it does or if it doesn’t I’ll take the drugs and the cake thanks:wacky:)
Agree, but how much of the aetiology of Type 2 is due to the glucose levels alone, and how much is due to other factors associated with the disease itself. If we can control bgl to give remission levels, but cannot guarantee reversal or cure, then are we actually avoiding the projected outcome. According to the paper from Newcastle ac that I posted Roy Taylor says good BGL control is insufficient to guarantee that there are no complications later. This is what he finds with the bariatric surgery patients, so will probably continue to find with the diet. LCHF may be the same. The Heart paper I posted says the same thing, that tight bgl control does not affect cardiac outcomes but does reduce CVD events in severity at least. Sorry to be a party pooper, but we need to accept that we have not yet reached Nirvana or Shangri La. We have better tools to control bgl levels nowadays, and a cure may be in the effing, but it is still a waiting game.
 

Oldvatr

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Prof Taylor, World Renowned Diabetologist would beg to differ: he says
"....a series of studies has introduced a paradigm shift in our understanding of the condition. Gradual accumulation of fat in the liver and pancreas leads eventually to beta cell dedifferentiation and loss of specialised function. The consequent hyperglycaemia can be returned to normal by removing the excess fat from liver and pancreas. At present this can be achieved only by substantial weight loss, and a simple practical and efficacious method for this has been developed and applied in a series of studies. For those people who used to have type 2 diabetes, the state of post-diabetes can be long term provided that weight regain is avoided."

Calorie restriction for long-term remission of type 2 diabetes


https://www.ncbi.nlm.nih.gov › articles › PMC6399621
He is wearing blinkers made of money. He has a research department to fund, and a potential money-spinner here, so he is milking it, Sorry, but in his other works I have read he acknowledges that this same effect is also noted in post-surgery bariatric patients that he has treated. It is also not the only way of stripping that fat from the adipose cells, but that would be an inconvenient truth.

The problem I have with this theory and his diet plan is that it only addresses the insulin resistance aspect of diabetes, so is incomplete thus far. It is also only 40% effective. It is not a plan that is safe to continue as a lifestyle change since the diet itself is nutrient deficient.
 

zand

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Prof Taylor, World Renowned Diabetologist would beg to differ: he says
"....a series of studies has introduced a paradigm shift in our understanding of the condition. Gradual accumulation of fat in the liver and pancreas leads eventually to beta cell dedifferentiation and loss of specialised function. The consequent hyperglycaemia can be returned to normal by removing the excess fat from liver and pancreas. At present this can be achieved only by substantial weight loss, and a simple practical and efficacious method for this has been developed and applied in a series of studies. For those people who used to have type 2 diabetes, the state of post-diabetes can be long term provided that weight regain is avoided."

Calorie restriction for long-term remission of type 2 diabetes


https://www.ncbi.nlm.nih.gov › articles › PMC6399621
It's a pity that such a World Renowned Diabetologist doesn't even mention hyperinsulimia and insulin resistance as a problem and therefore a hurdle to weight loss. I was diagnosed T2 in 2011 when my pancreas started to give up the fight. However, I had a problem losing weight using low cal diets for some 25 years before T2 diagnosis. All those years of having too much insulin in my body will have caused havoc. I had many doctors telling me to lose weight, but none could tell me how to do so. I stumbled on not eating the big carb items myself and actually lost 7 pounds the first year I did this (having been putting on 7 pounds a year for several years before that).

Calorie restriction does not work for me and it doesn't matter how many doctors or professors tell me it will, my body hasn't read the same manual as them. My body does have experience of being insulin resistant and having T2 though, which most of these doctors don't.

I'll listen to my body thanks.
 

HSSS

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Agree, but how much of the aetiology of Type 2 is due to the glucose levels alone, and how much is due to other factors associated with the disease itself. If we can control bgl to give remission levels, but cannot guarantee reversal or cure, then are we actually avoiding the projected outcome. According to the paper from Newcastle ac that I posted Roy Taylor says good BGL control is insufficient to guarantee that there are no complications later. This is what he finds with the bariatric surgery patients, so will probably continue to find with the diet. LCHF may be the same. The Heart paper I posted says the same thing, that tight bgl control does not affect cardiac outcomes but does reduce CVD events in severity at least. Sorry to be a party pooper, but we need to accept that we have not yet reached Nirvana or Shangri La. We have better tools to control bgl levels nowadays, and a cure may be in the effing, but it is still a waiting game.
I accept there may be limitations. But I don’t think low carb only controls bgl. Insulin is also vastly reduced from typically very high levels. Many other metabolic markers are significantly improved too, often the same ones as predict cardiac outcomes like BMI, visceral fat, NAFLD, BP, Triglycerides and HDL.

Indeed it is these factors identified in the 2nd webmd link you provide that seem as much if not more predictive than bgl. The papers assume medication control of bgl, and the risks of hypoglycaemia rather than overall metabolic improvement. I do not believe we can assume the same outcomes as a result.

Bariatric surgery is also relatively new and quite different to low carb so outcomes of one methodology are not necessarily the same as the other.

As you say a waiting game but I’m playing the best odds I can see right now. If evidence changes then so will my methods.
 
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