Remission vs Reversal

[EdMac]

So do you think you reversed your type 2 diabetes and if so how flexible are you with your diet now?

 

[britishpub]

IMHO you can only claim to be in either state if you can honestly eat a completely "normal" diet whilst maintaining normal BG levels. Other than that you only have either good or bad control.

I have had 2 HbA1c readings of 32 over the last 9 months and lost a ton of weight, but I cannot eat a lot of Carbs without losing control.

So I am neither.

Of course if anyone wants to claim that they are, it makes no difference to me so I won't be bothered to argue the point.

 

[Enclave]

I have lost a ton of weight .. and much to my surprise I can eat high carb meals and treats without my sugars going above the stated normal levels for a non diabetic. But and this is the but ... I know if I put my 5st back on .. I will feel like rubbish again and have high blood sugars .. so I still eat low carb high fat foods with the odd treat thrown in.

 

[AndBreathe]

@EdMac - Whilst I'd hate to rain on anyone's BBQ, the phrase, ".... Currently she has regained all of the weight she worked hard to lose but her fasting readings remain in the non-diabetic range. ...." could be considered akin to someone saying they can keep their weight under 10 st (or whatever), provided they stand on the scales on one leg, doing a fair impression or Margot Fonteyne or Rudolph Nureyev. It's such a small part of the equation.

It appears the key to the holy grail (title of your choice) is breaching the individual's Personal Fat Threshold (PFT), by de-fatting the internal organs, which usually involves a reduction in visceral fat at the same time.

That your friend has regained weight; she may not have regained it all, or merely not enough to the important places to influence a diabetic style blood glucose response. Perhaps her beta cells had taken a real beating in the years leading up to her weight loss and the weight loss regime allowed them respite to recover and regain decent functionality. Who knows.

I personally wrote to Professor Taylor, at Newcastle some time after I had returned a couple of decent, non-diabetic HbA1c scores to ask kif he could describe the criteria used to describe reversal. He stated that serial non-diabetic HbA1c scores would do it for him, or passing an OGTT, if the patient preferred that route, but he also did state it is key the individual doesn't revert to their Day 1 state as that would likely re-trigger diabetic responses, in time.

There is also no understanding as to why an individual's PFT is where it is, or if indeed it remains at that level long term. Indeed, there is a school of thought feeling the PFT may lower, over time, and with age, so make a re-breeching of the PFT more likely with age and/or a lower than previously experienced visceral/organ fat percentage.

On a similar note, my GP, when recording my own case as "Resolved" admitted each GP decides for themselves what this means for each individual patient, but that she had no qualms in doing so for me, such was (and remains, I hope!) my margin from pre-diabetes blood scores over multiple tests. She did however ask that I continue to have annual HbA1c tests as I am likely to remain "at risk" to a degree for the balance of my lifetime. I'm happy to comply with that request.

 

[ickihun]

I'm just wondering. Is that the reason why not all bariatric surgery patients stay diabetic?

 

[brettsza]

After ND I have maintained my weight and my levels continue to behave. I eat low carb high fat but I do put in occasional treats and I have managed to keep my weight constant. I have had days when I eat **** all day and I will be honest, I might have options to go lchf but I just feel like eating and the levels behave, but having said all that I do exercise or I try to as much as I can and I do 16:8 IF, may be that helps. I am normally low 4's when I break my fast which is in afternoon and then when i reach home I do before dinner and I am low 4's then too. After dinner if I have sweet I could go in 6's but I dont remember seeing any 7 on my meter, mostly my dinner is steamed veggies with proteins and salad and I behave on my glucose levels after that.

 

[AndBreathe]

Yes @AndBreathe it could in deed be considered lots of things even - at full stretch - accommodating your rather fanciful comparison. So let me clarify my intention in including information about that individual.

It was merely to point out that here is someone who was well and truly into the diabetic range. And, unlike so many other people who achieve non-diabetic readings, has thrown caution to the wind and allowed herself any diet she wants. I am not making (or for that matter particularly inviting) any evaluation of that strategy - I'm merely stating it is a fact.

It is relevant because having been diagnosed as diabetic she has taken a course of action, achieved a result and sustained that result over a period of a couple of years now despite poor diet. Irrespective of whether that is a sensible strategy or whether it is one that may lead her back on a highway to diabetes or how close she is to her personal fat threshold - it is one piece of evidence that it may be possible to resolve diabetes and sustain that result without compromising diet to the extent many type 2 diabetics have to.

It is of course possible to set out all sorts of provisions about why her results may not be indicative of anything significant or to decry her personal choices as 'wrong' or unsafe. But my intention is not to get into a debate about a single specific example. It's to hear from other people who feel they have reversed their diabetes and to what extent they have had to manage their dietary choices.

The thing is, if I am being completely honest here, with a margin of Devil's Advocate thrown into the equation, we have no idea how many people do exactly as your acquaintance has done. I don't believe there has been a long term study on that. Professor Taylor has followed his subjects up, but that in itself could be applying a margin of rigour not present in many day to day lives.

Similarly, none of us know when we might re-cross that line to the big D, so we each, individually tackle the next steps in the way we feel most comfortable. I do eat more cabs than when I was losing and reducing my bloods. For example, last night's dinner was a particularly disappointing affair on Planet Breathe. We ate as a local bistro where the food is often very reasonable, in terms of both quality and price. Last night I chose their cheeseburger. I rarely choose burger because it's just not my style. I left the bun (rarely bother with the stodge of bread), but had the thrice cooked chips, salad and mayo. The burger tasted extraordinarily sweet and it was only when I rechecked the menu I realised it had an "onion jam" on it. Anyway, two hours later, my bloods were 0.2 above my starting point, which at that time of the evening is scarily commonly 4.1. So, 4.3 post.

I'm not bothered about puddings, and where we are now, it's difficult to acquire decent fresh cream, so I don't even bother with berried and cream.

My weight, when I got here two weeks ago was 47.5 kg. Friends commented I looked slighter than ever, but my weighing scales memory from my leaving date last year (1st May) put me at 47.4kg. Pretty stable I'd say?

What I do know is everyone reacts differently to reaching their goal. We've seen many folks here achieve it, then disappear into the ether (which is absolutely fine and their choice), but we do sometimes see folks reappear to try again. Fair play to them too. I don't have any criticism of those folks. They've chosen how to run their lives and unfortunately, it's gone a bit off plan. Perhaps my off plan days will meet me before I'm ready to meet them!

All we can do is do our best, or if our best seems like too big an ask, do as well as we can muster at any given time. Life has a habit of throwing in curved balls when we least can cope with them.

 

[Roytaylorjasonfunglover]

I'm just wondering. Is that the reason why not all bariatric surgery patients stay diabetic?

What do you mean? In my experience many bariatric surgery go into diabetic remission, but not all, and that could be becuase some people need to reach a lower bmi than others in order to reverse their diabetes. typical weightloss with bariatric surgery, some types, is 30% of bodyweight. Depending on your bmi before you have the operation, some may still carry to much weight, for them to get into remission of their diabetes, so everything depends on peoples individual fat threshold.

 

[AndBreathe]

What do you mean? In my experience many bariatric surgery go into diabetic remission, but not all, and that could be becuase some people need to reach a lower bmi than others in order to reverse their diabetes. typical weightloss with bariatric surgery, some types, is 30% of bodyweight. Depending on your bmi before you have the operation, some may still carry to much weight, for them to get into remission of their diabetes, so everything depends on peoples individual fat threshold.

".... In your experience of bariatric surgery...." What experience is that?

 

[Neohdiver]

I'm just wondering. Is that the reason why not all bariatric surgery patients stay diabetic?

My personal guest is that there are many variations of what we currently refer to as Type 2 diabetes. Some go into remission with a 10% weight loss - some don't. My grandfather (from whence comes my diabetes) was skinny as a rail when he acquired it - and for the remainder of his life. Some are likely triggered by weight gain, others trigger weight gain, and yet other varieties may be totally disconnected from weight. Some may more easily reverse or go into remission - others may be more stubborn, and still others may never be anything but controlled. Someday we'll sort them all out.

I'm currently at close to 20% loss, and no sign of a decrease in insulin resistance. I've got about 14% more lose. When I get to my maintenance weight, I'm hoping for, but not counting on, a slight decrease in insulin resistance so I can occasionally enjoy a piece of bread (the one thing I really miss). On the flip side, within 3 days of changing what I put into my mouth, my blood sugar was in the non-diabetic normal range and has stayed there consistently more than 97% of the time. I like to say mine seems to depend on what I put into my mouth in the last few hours, not what I've put into it for the past several years. I could happily run along at the same weight I have been and have perfect control - as long as I limit the number of carbs I eat.

So I strongly suspect I would be in the "bariatric surgery doesn't work for me" group - since the primary hypothesis for who bariatric surgery work is that it lowers insulin resistance by lowering weight. Not that I would have been inclined to try it in the first place.

 

[DaveNN]

The Michael Moseley write up of the Newcastle Diet - 'The 8 Week Blood Sugar Diet' claims that type 2 Diabetes can be reversed. This is obviously a very attractive proposition to anyone who has recently been diagnosed.

I've seen some people on this forum who are clearly happier using the term Remission. I'm interested in people's experiences following success on either the Newcastle or 8WBS diets (or AN Other diet) - where I would define success (purely for the purposes of my own interest) as achieving and sustaining BG readings in the non diabetic range post diet. Others clearly will have their own subjective definitions of success.

I spoke to someone a few days ago who had had fasting readings in the high teens several years ago. Her Doc told her to lose weight quickly. Her mother had diabetes and plenty of complications so she was keen and spent several months losing 3 stone. Her fasting readings returned to the normal range and.... she started eating a poor diet again.

Currently she has regained all of the weight she worked hard to lose but her fasting readings remain in the non-diabetic range. Anecdotally, to my mind, this supports the notion of reversal - but I'm not really interested in discussing the semantics of remission vs reversal (and no doubt those readings will begin to creep up again at some point if she stays on her current track). Instead I'm interested in exploring what scope there is, for those who achieve success, to return to a healthy but less fastidious diet management regime.

So do you think you reversed your type 2 diabetes and if so how flexible are you with your diet now?

An excellent question and post.
I've asked Muzza if he would consider taking a glucose test for the very same reason.

 

[muzza3]

Hi All

Great topic @EdMac

It is my opinion that if you take the emotion out of this the Gold Plated Guideline is the HbA1c tests. When I did this test they said I have diabetes. When I did it a year later they said it was worse and I had to take medication. When I do it and if it shows I am in the Non Diabetic range then I am not a diabetic I am cured.

Simplistic I know but if I go to a doctor who has never met me before and present a HbA1c that says normal guess what? He says I do not have diabetes.

@AndBreathe it would appear that your doctor believes that you are cured. @brettsza you didn't make a call on where you think you are at

I think because we are all aware of foods that affect us and measure those spikes and we are unaware of what those spikes can also be for "normal" people (I'm sure much higher than 7's) we are (and quite correctly) hypersensitive to those readings.

I don't think I could go back to my previous diet if I got the all clear 10 times in a row because of my awareness of what damage those carbs have done to me in the post. But it doesn't mean I am not cured

I don't have a problem with the cured word but I think many do because of the fear of losing control again in the futue

Whatever the results I can't see myself not testing once or twice a week for the rest of my days

 

[muzza3]

An excellent question and post.
I've asked Muzza if he would consider taking a glucose test for the very same reason.

Hi Dave

Went to my quack today will be doing testing next week. Forgot about the Glucose Test will call him to check if it is included

 

[bobrobert]

Personally speaking I don't want to be told that I am "cured" because I would probably back to my old habits and regain the 20 kilos I lost. The weight loss was the "bonus" of being told that I was type 2.

 

[muzza3]

Personally speaking I don't want to be told that I am "cured" because I would probably back to my old habits and regain the 20 kilos I lost. The weight loss was the "bonus" of being told that I was type 2.

I absolutely agree and for that very reason many people would reject the idea of a cure but that doesn't mean that they are not cured if their HbA1c is normal over successive tests

 

[ickihun]

What I'm understanding is that type 2 insulin resistance could be in all of us but only triggered (too high a personal fat threshold) in some.
Could it be that simple?
Type 2 may be increasing due to lack of appetite suppressants which were readily available from the GP, years gone by. Deemed no longer safe due to heart palpatations and further problems.
It would be cheaper for the NHS to fund a safer appetite suppressant. Herbal maybe and slimming clinics than all the meds we guinea pig currently?

 

[Sirmione]

My personal take on it like lot of things in life is "one day at time". -- a bit like Hollywood blockbusters there is always a chance of a sequel.

 

[Roytaylorjasonfunglover]

".... In your experience of bariatric surgery...." What experience is that?

Really bad english, all the scientific literature shows that bariatric surgery is the most effective weightloss for random people, This study insipired Roy Taylor to do his research on reversing diabetes. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234815/pdf/annsurg00043-0139.pdf

It shows the results of 600 people undergoing bariatric surgery in a 14 year old follow up. 150 of these people had diabetes and 150 had impaired glucose tolerance. 14 years after the operation 80% were free of their diabetes, and all the prediabetes, 98%, still had normal sugars. That is quite a result.

I am also related to a doctor who does a subspeciality of medicine that has a lot of work with the complications of diabetes. Most people who get well and of their medications have done so through surgery, some expcetions are mostly lowcarb.

But I have not personally done a bariatric surgery on myself no.

 

[AndBreathe]

Really bad english, all the scientific literature shows that bariatric surgery is the most effective weightloss for random people, This study insipired Roy Taylor to do his research on reversing diabetes. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234815/pdf/annsurg00043-0139.pdf

It shows the results of 600 people undergoing bariatric surgery in a 14 year old follow up. 150 of these people had diabetes and 150 had impaired glucose tolerance. 14 years after the operation 80% were free of their diabetes, and all the prediabetes, 98%, still had normal sugars. That is quite a result.

I am also related to a doctor who does a subspeciality of medicine that has a lot of work with the complications of diabetes. Most people who get well and of their medications have done so through surgery, some expcetions are mostly lowcarb.

But I have not personally done a bariatric surgery on myself no.

I didn't think you had dabbled with bariatric surgery, but I had to clarify that this was your informed belief, through research, not experience. Bearing in mind your user name, in particular, new users could consider you have some connection with Prof Taylor and Dr Fung, other than your respect and groupie-dom.

Pedancy? It's just one of those things I excel in.

 

[Mep]

Here's my line of thinking..... if you have diabetes solely because of poor diet and being overweight (eg. you have no other precursors to the disease such as other medical conditions, genetics, etc) then you probably can get very good control and keep it that way. Although fasting BGL's is one thing, but what does the BGL's do post prandial? Do they spike at all? All these things would need to be factored in before you can truly say you're in remission if you want to call it that or reversal if you want to call it that. But my words would be you have "good control" for various reasons... eg. you're still eating a good diet, you're still exercising, you've maintained weight loss, etc..... whatever works for you.

There is no cure for diabetes though so I would think if you've been diagnosed then you are still at risk even if you do get good control. You're at risk of high BGLs if you get stressed out, you get sick, you gain weight, you develop insulin resistance, etc. There are so many variables. You're probably still at risk of complications as good control doesn't guarantee no complications ( I think of a family member of mine when I say that... she's dealing with leg ulcers because of diabetes but she has had excellent BGL's... just got a scratch and it got infected, etc).

So to me to say you're in remission or you've reversed diabetes is saying you are no longer at risk of high or low BGL's and you are no longer at risk of complications.