A hair-brained and scary thought about weight loss

[AdamJames]

The personal background to this:

I've lost a lot of weight over the last few months, fairly rapidly. Based on the various "Newcastle Studies" I'm kind of hoping that at some point some beta cells that weren't functioning as beta cells because of fat in them, will come back online, and my metabolism will get markedly better.

This doesn't seem to have happened yet in tests I've done when I'm sitting still and just letting carbs do their thing: no noticeable change from when I started losing fat.

But one thing I *had* noticed in recent weeks is that the effect of exercising straight after eating carbs seemed to be getting more pronounced. I could eat a fair old load of carbs, I'm going to say about 100g, and an hour of fast walking, including some small but steep ups and downs with a heavy rucksack, and my 2 hour postprandial readings were literally in the non-diabetic range.

But after recently spending a week overdoing the carbs and calories, and not always exercising straight after the big carb loads, I seem to have lost my new superpower. Crucially during that period, my average blood sugar was high, all day and night, in spite of the spikes being dealt with more quickly when exercising.

I've also noticed some people report that, for example, they have been on a rapid weight loss diet, "Newcastle Style", then had a lapse over Christmas, and found it had a lasting negative effect.

I've wondered something in the past, based on two bits of science, and am now wondering if I'm experiencing it...

The latest research "From Newcastle", in a nutshell, is suggesting that "The", or at least "A Big Part Of" the explanation of what Type 2 is, is that it's beta cells no longer functioning as beta cells because they have fat in them. If someone with Type 2 loses enough overall fat, that will give them a chance of removing fat from their pancreas, and some of the beta cells start working again.

Other studies, on beta cells outside of the body, or transplanted into mice for example, have shown that if you expose them to high glucose levels for long enough, they die. And the level's aren't that high: we're talking about 7 to 8 mmol/l.

So I've had this concern for a long time:

Presumably, when rapidly losing weight, using the "Newcastle Diet" or similar, your beta cells don't suddenly all start functioning at once. And also, those that are not functioning due to fat, may in effect be protected from the toxic effect of glucose.

So you lose weight, some cells come online. Lose more weight, more come online. Keep going, and if you're lucky, you end up with a metabolism that works rather well.

But what if you have a "lapse", like I did, and suddenly spend days with elevated blood sugar levels. You may have a few newly-functioning beta cells which are now able to produce insulin, but there aren't enough of them to lower your blood glucose to safe levels. So the poor newly-awakened ones, now also exposed to glucose, sit in this hostile environment for a long time and they die.

Could it be that, if one is going to try to lose weight for this purpose, you really do need to commit, and stick it out, and be very careful never to have prolonged periods of elevated blood sugars, until there are enough beta cells functioning to quickly deal with a big intake of carbs?

I.e. weight loss could get great results, but your beta cells are also very vulnerable during that process?

 

[JohnEGreen]

You could be right. So maybe the thing is to lose the weight keep it off and avoid carbs. maintaining reversal or remission requires a life long change in habits. Or you end up with a relapse possibly.

 

[DCUKMod]

@AdamJames - When it comes to the future, all any one of us can do is to educate ourselves as well as we can and match our approach to both our condition and our appetite for risk.

In other words, if a T2 who achieved great results low-carbing, say (approach unimportant for this really), then wants to go back to eating as before diagnosis, they are risking a reversion to a less healthy state, versus a wider/more relaxed way of living.

We all run loads of, often unconscious, risk assessments a day, when we cross a road, go up a step ladder or whatever. Only you can decide where to hedge your bets.

 

[Guzzler]

It is widely accepted that dietary changes that result in loss of visceral fat from the liver can have an almost immediate (starting within a number of days in some people) effect but not so the pancreas. The loss of fat from the pancreas is known to take a helluva lot longer and unless you have access to expensive MRIs such as the zooped up machine at Newcastle University the you cannot be absolutely sure how much fat has been lost or, indeed, how long and how much damage has been done. As has been said, all we can do is maintain good management and accept that this good management can only come with lifelong changes. If someone wants to reverse their condition with a view to returning to a western diet then in my opinion they may be on a hiding to nothing as (again, just my personal opinion) who in their right mind would run the risk of harm to the 'recovered' beta cell function?
It is oft repeated but nevertheless important that management of T2 is a marathon not a sprint. I am just now reminded of a comedian telling of shopping with his wife, carrying dozens of full bags and muttering through gritted teeth 'Just to the next lamp post, just to the next lamp post'. This for me is the equivalent of attaining better control until I can say 'I'm home'.

 

[Oldvatr]

One effect that may be at play here is Liver Dump. When you get lower bgl levels by exercise or diet, then the liver starts to use up its stored Glucogen and dumps it into the blood, so raising the bgl levels. Over a short time this will deplete these stores, and then the liver starts to convert stored fat into glucose instead, and it is this mechanism that ND triggers to reduce the liver and pancreas fat. But this does not happen overnight, it can take several weeks to start on the pancreas and beta cell fat.

So initially it is glucose and water that is being used up, then lipid fats. However, if you start carbing it up again, then these excess carbs get stored back into the liver as glucose, so the liver never depletes, and continues to dump glucose to sustain the high levels it has grown accustomed to. So as pointed out above, don't binge on carbs and then expect bgl to behave properly. It is actually a well known effect called yo-yo dieting.

 

[Resurgam]

I can't really comment on what has happened to your insides - but you stopped eating to your meter.
The same meals as six months ago now do not spike my BG as high - and a few times I have taken advantage of that, but just for one meal and being abstemious before and after.
I don't know what changes I have made - so I can only advise - eat to your meter.
After all the work you did it seems such a pity to have ignored those high readings for a whole week.
It rather reminds me of someone I knew quite a while ago now. He spent weeks carefully rebuilding an old car, and as soon as it was running he took it on the motorway to see if it would 'do the ton' - he blew up the engine.

 

[AdamJames]

You could be right. So maybe the thing is to lose the weight keep it off and avoid carbs. maintaining reversal or remission requires a life long change in habits. Or you end up with a relapse possibly.

I'm wondering if it's even more critical to avoid carbs *during* the weight loss compared to afterwards?

In other words, if a T2 who achieved great results low-carbing, say (approach unimportant for this really), then wants to go back to eating as before diagnosis, they are risking a reversion to a less healthy state, versus a wider/more relaxed way of living.

Agreed on that, and I'm wondering if I cast a certain impression from another thread where I banged on about the definition of remission! I certainly can't eat what I ate before, otherwise I get unhealthy again, and I also suspect, in my case, even if I tried to eat the same-but-less as before, I could overdo it. Though the complete cutting out of alcohol may make a huge difference there.

Anyway, just to be clear, this is purely a sort of technical question / thought which I'm interested in people's thoughts on, regardless of any long-term goals I have, which I am quite open-minded about!

The loss of fat from the pancreas is known to take a helluva lot longer

That's what makes me think that only a few beta cells will be getting de-fatted(!) at a time; combine that with the fact that glucose appears to be toxic to them at fairly low levels, that's why I'm thinking that haphazard weight loss with periods of overdoing the carbs could be a very bad idea. Purely speculation, but interesting I think.

Gastric bypass patients are sort of forced to be disciplined; the participants in the first Newcastle Experiment were checked for cheating, and they both have some pretty good stats for remission.

I should probably go back to check this, but I don't think equally tight controls, and booting people out if they cheated, was a protocol for the DiRECT study, and those stats weren't as great.

One effect that may be at play here is Liver Dump.

I was wondering that. It may be that my liver is all nicely stocked up and I need to deplete it again before feeling sure that my new superpower has disappeared! It is actually quite recently that I stopped the increased carbs, so it's too soon to feel absolutely sure that I've lost my superpower, but the difference is currently quite dramatic! When I did 800-calories-a-day it did indeed take a few days for morning bgs to bottom out.

Anyway that's the personal bit; regardless of whether I can get my superpower back, I'm interested in possible best-practice for weight loss, if the goal for weight loss is the restoration of beta-cell function.

This complete speculation is having quite a good effect on my determination never to get carried away with carbs again, so I might adopt it as a pet theory just to scare me into discipline every day!

 

[AdamJames]

I don't know what changes I have made - so I can only advise - eat to your meter.
After all the work you did it seems such a pity to have ignored those high readings for a whole week.
It rather reminds me of someone I knew quite a while ago now. He spent weeks carefully rebuilding an old car, and as soon as it was running he took it on the motorway to see if it would 'do the ton' - he blew up the engine.

That's how I'm feeling about it at the moment, to be honest. It did *start* as eating and exercising to my meter, because I could eat a fair amount of carbs and get great readings straight afterwards through exercise. But a) it got addictive, b) the 'background level' of glucose crept up, and c) it wasn't possible to exercise one day.

Anyway I'm over it in terms of giving myself a good talking to. I'm still fascinated by the question of whether a strict approach to weight loss is key, however!

 

[Oldvatr]

That's how I'm feeling about it at the moment, to be honest. It did *start* as eating and exercising to my meter, because I could eat a fair amount of carbs and get great readings straight afterwards through exercise. But a) it got addictive, b) the 'background level' of glucose crept up, and c) it wasn't possible to exercise one day.

Anyway I'm over it in terms of giving myself a good talking to. I'm still fascinated by the question of whether a strict approach to weight loss is key, however!

IMO the weight loss is only an indication that fat reserves are being used up, and not the cause of 'remission'. So, at present, and until I am proven otherwise, I will say that it is the reduction of bgl by either carb or calorie reduction that is key, and that the low food intake is similar to fasting in that the body is probably becoming 'fat burning' i.e. keto in a small way, and this is driving the weight loss and possible pancreas repairs(?).

Some of us using Low Carb diets find that fasting is a useful adjunct to the diet that seems to show some success in enabling a better beta cell response (or reduction of Insulin Resistance). But I find personally that while I am now able to eat the occasional higher carb meal without weeping, nonetheless I would suffer high bgl if I revert back to my old eating ways.

 

[AdamJames]

IMO the weight loss is only an indication that fat reserves are being used up, and not the cause of 'remission'. So, at present, and until I am proven otherwise, I will say that it is the reduction of bgl by either carb or calorie reduction that is key, and that the low food intake is similar to fasting in that the body is probably becoming 'fat burning' i.e. keto in a small way, and this is driving the weight loss and possible pancreas repairs(?).

Some of us using Low Carb diets find that fasting is a useful adjunct to the diet that seems to show some success in enabling a better beta cell response (or reduction of Insulin Resistance). But I find personally that while I am now able to eat the occasional higher carb meal without weeping, nonetheless I would suffer high bgl if I revert back to my old eating ways.

I think the evidence is mounting for the fat-in-beta cell theory. Not enough to convince me, but right now I think it's the best game in town, as they say. I'd love to be able to take my pancreas out and see what's going on, but my limited understanding of biology tells me that might not go the way I'd like!

Re being in keto on a reduced calorie diet, the Optifast website describes the aim of their diet plan as being to cause "mild ketosis". I tried 800-calories-a-day on a very similar plan (Tesco Ultraslim & veg), and was curious about ketones. I got some Ketostix and found that they showed nothing throughout the day, I'd be getting up several times a night to pee, and each time they got a bit darker. I think I maxed out at 4 mmol/l, generally the colour matched more like 1.5 mmol/l at its highest. I guess that would be considered mild ketosis? Especially considering it wasn't happening all day.

 

[Resurgam]

If it is of any interest - I have had a weight problem all my adult life and started to low carb in my early 20s - but doctors went ballistic when they found out, so I was put on healthy diets and my weight would go up - so I'd go back to low carbing and lose it bit by bit until another doctor noticed. The amount of carbs I can eat now and have normal glucose readings is exactly the same as for the few times I was at a sensible weight.
The same amount of carbs will most likely be how I eat from now on, ignoring all doctors advice on the health giving properties of starches as I rather suspect it is utter rubbish.

 

[chalup]

What I am wondering about is the idea that there is beta cell dysfunction at all. Most T2's start out with extremely high insulin levels and it is not until later in the course of the disease that the pancreas can no longer produce normal amounts of insulin. How can someone be trying to heal the pancreas or know if it is healed if there is no way of knowing whether or not it is broken?

 

[AdamJames]

What I am wondering about is the idea that there is beta cell dysfunction at all. Most T2's start out with extremely high insulin levels and it is not until later in the course of the disease that the pancreas can no longer produce normal amounts of insulin.

Good points. So far RE the fat-in-beta-cells idea, I think what we have are two things: a correlation (fat in pancreas reduces and insulin response improves), and observations of beta cells in the lab which show that if there is fat in a beta cell it does not behave like a beta cell; remove that fat and it does. I find the combination of these two findings to be very compelling, but that, really, is it.

I think the basic observations far more compelling than the theory. We can see that the remission rate in gastric bypass patients is surprisingly high, and the remission rate (meaning here, the restoration of insulin response) in the first Newcastle experiment was shockingly high. What have both got in common? A sustained, continuous weight loss journey, largely involving liquid foods, and with no let-ups and carb binges along the way. In some ways attempting to work out why that works is like trying to explain gravity - interesting, but the important thing is it works.

How can someone be trying to heal the pancreas or know if it is healed if there is no way of knowing whether or not it is broken?

That's a very very good question.

Edit: And it's just made me change the term "pancreatic function" to "insulin response" in my previous statement!

 

[Alison Campbell]

Oh, I think it is definately broken, diagnosis of prediabetes up to 50% dysfunction, type 2 diagnosis up to 80%. The functioning beta cells are over producing for a long time , it can start years before your blood glucose starts to rise.

 

[LittleGreyCat]

One thought - if you measure the level of insulin in your blood and the level of glucose than you should know if you are producing loads of insulin but it isn't working properly, or if you are only producing a tiny amount of insulin but it is doing the best it can.

 

[Guzzler]

The comment about gastric bypass patients upthread reminds me of a lecture I viewed (can't remember by whom) that led to speculation about the possibility that the duodenum could be considered an organ in its own right because of the hormonal/sensitivity levels found. I wish I had a better memory, those are the only details I recall.

 

[AdamJames]

Just another thought about the potential importance of never having prolonged periods of elevated blood sugars while losing weight (if beta cell restoration is your goal):

I can't find it now, but when I was searching for 'success stories' months ago, before I joined this site, I found an interesting one on this forum by, I think it was user (now moderator I think, sorry if I've got the username wrong) 'andcol'.

His result, from memory, was that his carb tolerance did increase quite dramatically. His approach to dieting used solid, real food, and wasn't religiously 800 calories by any means, so this was not at all the 'Newcastle Diet'. But I remember being impressed that he paid close attention to blood glucose levels throughout - e.g. doing exercise to deal with elevated levels, and in particular, one thing stuck with me was that he said he never went to sleep if it was over a certain level.

 

[Oldvatr]

Good points. So far RE the fat-in-beta-cells idea, I think what we have are two things: a correlation (fat in pancreas reduces and insulin response improves), and observations of beta cells in the lab which show that if there is fat in a beta cell it does not behave like a beta cell; remove that fat and it does. I find the combination of these two findings to be very compelling, but that, really, is it.

I think the basic observations far more compelling than the theory. We can see that the remission rate in gastric bypass patients is surprisingly high, and the remission rate (meaning here, the restoration of insulin response) in the first Newcastle experiment was shockingly high. What have both got in common? A sustained, continuous weight loss journey, largely involving liquid foods, and with no let-ups and carb binges along the way. In some ways attempting to work out why that works is like trying to explain gravity - interesting, but the important thing is it works.



That's a very very good question.

Edit: And it's just made me change the term "pancreatic function" to "insulin response" in my previous statement!

For me the compelling evidence comes from the ND report which showed they used a new method of interpretation of MRI scans taken before and after the diet plan that showed reduction in fatty tissue of both the liver and the pancreas. This is a clincher in my eyes.They also measured insulin levels using the insulin clamp technique to show that the diet reduced residual insulin levels. The ND study did its best to.use modern in vivo techniques to demonstrate their hypotheses to have merit, which is why for me ND is worthy study. I do not believe it is the only way of skinning the cat, but it does seem to have significant importance in the fight against T2D.

 

[Oldvatr]

What I am wondering about is the idea that there is beta cell dysfunction at all. Most T2's start out with extremely high insulin levels and it is not until later in the course of the disease that the pancreas can no longer produce normal amounts of insulin. How can someone be trying to heal the pancreas or know if it is healed if there is no way of knowing whether or not it is broken?

I would tend to suggest that the evidence of T2D on insulin actually using diet to be able to stop taking insulin and get good bgl is a demonstration of the beta cell recovery, although it could just be due to extreme high IR being reversed. I think that the C-peptide test shows if T2D have high or low insulin levels, and this is often the test used to initiate insulin replacement therapy. I am not a doctor, but I believe that insulin is given if c-peptide shows low insulin, as in the case of beta cell failure, but not when insulin is high. I know this is anecdotal evidence, and not proof per se.

 

[chalup]

I was diagnosed 12 years ago and have most likely been diabetic for far far longer. I have a c-peptide test every 3 months along with my A1c. My fasting insulin production is 3 times the upper limit of normal but is slowly coming down. My A1c is 37 and I eat less than 20 grams carb per day in a short eating window. I am also coeliac and completely gluten free. From what I have seen both online and in person, insulin is often handed out like aspirin to any who simply want to eat what they like and have meds deal with it. It is even being advertised on TV. It is also very commonly prescribed without ever testing for endogenous insulin production. People are left eating to cover their insulin and gaining weight, sometimes on enormous doses. Even for people who are clearly showing signs of being type 1 things are handled haphazardly. Some get excellent care, others get almost none. I have a friend who is on max dose metformin, both basal and bolus insulin, and victoza. He cannot feel his feet and is showing a lot of other signs of complications. He has been consistently told to eat low fat, 55% carb blah blah blah. Now that they have almost killed him they are suddenly telling him to eat low carb so he can go off his insulin. ?????????? Really? He has never had a c-peptide or a fasting insulin test and these tests are easy to get here in Canada. I do realize that all this is just my opinion and most definitely anecdotal.