Review of Prof. Taylor's Study in Medical Economics

[Biggles2]

Review of Professor Taylor's recent research study in Medical Economics:

'“While the results found in this study are remarkable and admirable for achieving significant weight loss in the intervention group, they represent the ideal of intensive primary care treatment that cannot always be replicated in today’s clinical health care settings,” Cefalu told Medical Economics.'​

http://medicaleconomics.modernmedic...ight-loss-results-diabetes-remission?page=0,0

 

[Guzzler]

Although it is a short piece it speaks volumes. The emphasis on weight loss, the mention of remission and finally Dr. Taylor's citing of dietary change being a success in terms of "a decade" which cannot be his own diet, surely?
Per weight loss, Taylor does not come right out and say that excess weight causes T2 but I have not read that he has clarified this point. And as for remission he cites maintaining weight after weight loss is a factor, or am I reading too much into all that I have read which isn't very much, granted?

 

[bulkbiker]

Just seems to confirm to me that Taylor has it all wrong...cherry picks his subjects and still doesn't have great successes.

I love the

"a type 2 diabetes diagnosis is not a permanent state and can be changed as a matter of choice and effort."

sounds like patient blaming to me although not a direct quote..

 

[Bluetit1802]

This is why I am so sceptical - improvement is not the same as remission, and 6.5% HbA1c is too generous.

William T. Cefalu, MD, chief scientific, medical and mission officer for the American Diabetes Association said the study confirms the effect weight loss has on improving glycemic control, adding that the study’s definition of remission at an A1C of less than 6.5% is more permissive that the ADA’s 5.6%. Ceflau cautioned that the study also used intensive nutritional interventions that are difficult to maintain.

 

[covknit]

Anyone with the determination to stick to such a dietary regime has the ability to introduce a lot of lifestyle changes that have the possibility of skewing the results. Insufficient data is available on the "successful" patients. Aspects of % of damaged beta cells, visceral fat, fatty liver, exercise, stress, pain management and fasting for anyone to clearly state the results are due purely to diet. The beta cells may be able to repair themselves but so far I can only see that positive results can only be obtained with early diagnosis (glucose bath theory) and whole life lifestyle changes.

 

[Tannith]

Just seems to confirm to me that Taylor has it all wrong...cherry picks his subjects and still doesn't have great successes.

I love the

"a type 2 diabetes diagnosis is not a permanent state and can be changed as a matter of choice and effort."

sounds like patient blaming to me although not a direct quote..

", more than 300 individuals enrolling 20 to 65 years of age who had been diagnosed with diabetes within the last six years. All of the individuals enrolled in the study had a body-mass index of between 27 and 45 kg/2" - I wouldn't call it "cherry picking" to test only a particular defined group of individuals, as long as you state which are the ones being tested. Prof Taylor did not, for example make any attempt to test people who had T2 of more than 6 years' duration. Nor did he claim to. Nor has he ever mentioned "fault" or blame" as you suggest. He concerns himself only with curing T2 or "reversing" it as he puts it, never with preventing it. Indeed it is he who pointed out that people have to reach their own "personal fat threshold" before their genes cause them to tip into diabetes. No one can know in advance what that weight is, nor can they know in advance that they have a genetic propensity to diabetes. So nobody is at fault for developing diabetes.

 

[bulkbiker]

He concerns himself only with curing T2

Which so far as I know he has never claimed either..
Do you have some connection with the study?
You seem very sensitive to any observations that are not completely supportive.

 

[AdamJames]

Just seems to confirm to me that Taylor has it all wrong...cherry picks his subjects and still doesn't have great successes.

I love the

"a type 2 diabetes diagnosis is not a permanent state and can be changed as a matter of choice and effort."

sounds like patient blaming to me although not a direct quote..

I'm starting to see why there is quite a negative slant about these studies in another thread. I'm not sure if it's just you or a lot of people have similar feelings.

It's just my perspective, but Roy Taylor seems like decent enough chap who wants people to be healthy. I think the unfortunate thing is that so many people with limited intellect like to blame Type 2's and look down on them, and Roy Taylor's findings very easily play in to that kind of mind set.

But here's an interesting question:

What, exactly, should Roy Taylor do?

Or, at which point did he go wrong in his thinking / experiments:

* Hmmm... Lots of bariatric patients seem to go into remission from Type 2.
* Hmmm... Some people think that has something to do with hormones, but what if the explanation is simpler?
* I know, let's simulate the diet of bariatric surgery patients and see what happens.
* Oh that's interesting, it looks like they get normal fasting readings pretty quickly
* Oh, even more interesting. Eventually their insulin response seems to improve as well
* Oh and look at this, it seems that the decrease in fat from the liver and pancreas may have something to do with it.
* Wow, look, a beta cell filled with fat doesn't work properly when studied under the microscope, but remove the fat then it does.
* Well this is all very interesting, a picture is starting to form.
* Let's do some more experiments.
* Let's publicise the resutls.
* Let's see if the findings can help people in the real world.

At what point in the process did he become a victim-blaming monster?

In what way is he any "worse" than a scientist who tells someone "If you want to reduce your risks of skin cancer, stay out of the sun". Is that scientist blaming people for skin cancer? Or just telling it like it is, offering information which can help people.

I say give the man a break. I mean, you know, he's possibly okay. A bit. Maybe.

Nobody's perfect, but I don't think we need to lock him up just yet

 

[Guzzler]

As a TOFI, some may question my slight lack of interest in Prof. Taylor's work but who, honestly, could blame me? His work is concentrated on excess weight which does not help me. What will possibly help me in the future is if his regime is found to be successful IRL as part of a primary care setting then maybe there will be further call for his zooped up MRI to be replicated within conurbations so that TOFIs could be scanned for visceral fats. So, in a roundabout fashion I think his work will pay dividends in the end. Whether the long term effects of ND are successful or not remains to be seen so I am of the opinion that alluding to permanent remission is jumping the gun a little. As has been said upthread, nothing has been reported on those who were not successful on ND so comparisons cannot be made.
My primary doubt, my only doubt, concerns the transition to an everyday diet. What does it look like and is it all about the calories?

 

[AdamJames]

As a TOFI, some may question my slight lack of interest in Prof. Taylor's work but who, honestly, could blame me? His work is concentrated on excess weight which does not help me. What will possibly help me in the future is if his regime is found to be successful IRL as part of a primary care setting then maybe there will be further call for his zooped up MRI to be replicated within conurbations so that TOFIs could be scanned for visceral fats. So, in a roundabout fashion I think his work will pay dividends in the end. Whether the long term effects of ND are successful or not remains to be seen so I am of the opinion that alluding to permanent remission is jumping the gun a little. As has been said upthread, nothing has been reported on those who were not successful on ND so comparisons cannot be made.
My primary doubt, my only doubt, concerns the transition to an everyday diet. What does it look like and is it all about the calories?

I agree about many of your concerns. To be clear the one and only thing I was defending Roy Taylor against was the accusation of being a victim-blamer!

Just one point about the TOFI thing, what about people such as Michael Mosley and particularly Richard Doughty? It does seem that the weight loss thing is worth giving a go for anyone so long as it doesn't make you dangerously thin and there are no other risks. That's a general comment about normal-weight T2s, I've no idea what you've tried and your weight etc!

Generally I agree with what you say, and I like the fact that one of the commentaries after the DiRECT study was they said they now need to see what the effects are long-term, i.e. they were interested to see whether it affected risk of complications (or even possibly introduced new ones).

I think your concerns about transition to a normal diet are also theirs (the study organisers).

There are lots and lots of question marks about the studies, and in particular I don't like the definition of remission for the DiRECT study, and would also like to know more info about those considered to be in remission and those not.

 

[Guzzler]

I agree about many of your concerns. To be clear the one and only thing I was defending Roy Taylor against was the accusation of being a victim-blamer!

Just one point about the TOFI thing, what about people such as Michael Mosley and particularly Richard Doughty? It does seem that the weight loss thing is worth giving a go for anyone so long as it doesn't make you dangerously thin and there are no other risks. That's a general comment about normal-weight T2s, I've no idea what you've tried and your weight etc!

Generally I agree with what you say, and I like the fact that one of the commentaries after the DiRECT study was they said they now need to see what the effects are long-term, i.e. they were interested to see whether it affected risk of complications (or even possibly introduced new ones).

I think your concerns about transition to a normal diet are also theirs (the study organisers).

There are lots and lots of question marks about the studies, and in particular I don't like the definition of remission for the DiRECT study, and would also like to know more info about those considered to be in remission and those not.

I was slim on diagnosis. I am now thin and so thin that I am being nagged by family to abandon LCHF. For a while I slipped into the underweight category on the BMI scale (yeah, even though it's a bit of a rubbish scale).
However, I have no idea how much visceral fat I may have lost, if any at all. All I can say is that along with thousands of others I have brought down my A1c and now have bg at a fairly robust level.
I do not doubt Pro. Taylor's motives and I am sure that no one thinks of him as anything but a caring doctor who seeks to better the lives and prognoses of his patients. Doubts have been expressed but not about his personal reasons for his research.

 

[AdamJames]

I am sure that no one thinks of him as anything but a caring doctor who seeks to better the lives and prognoses of his patients. Doubts have been expressed but not about his personal reasons for his research.

Just a reminder, my earlier post was in response to this:

sounds like patient blaming to me

And I've seen very similar comments elsewhere on this forum. I suspect it's not a majority view by any means, and it may actually be bulkbiker who made the other comments, I can't remember!

Anyway I felt the need to defend the chap.

The irony is, the way I see it, and I hope bulkbiker reads this because I've quoted him:

Bulkbiker and Roy Taylor are in the same business.

They have both found something which they think is great news for Type 2's, there is plenty of evidence for it, and they want to spread the word.

It wouldn't be fair to characterise Roy Taylor as someone who believes "Fat Type 2's made lifestyle choices which mean they deserve to be where they are. All they need to do is lose weight like any sensible person and everything will be fine."

Nor would it be fair to characterise bulkbiker as someone who believes "Type 2's with complications made lifestyle choices which mean they deserve to be where they are. All they need to do is eat VLCHF like a sensible person and everything will be fine."

There may be a part of all of our minds which thinks "if somebody had lived their lives in a way which I thought was better, maybe they'd have a better outcome". That's just human. But I don't think anyone is victim-blaming here.

 

[Guzzler]

Just a reminder, my earlier post was in response to this:



And I've seen very similar comments elsewhere on this forum. I suspect it's not a majority view by any means, and it may actually be bulkbiker who made the other comments, I can't remember!

Anyway I felt the need to defend the chap.

The irony is, the way I see it, and I hope bulkbiker reads this because I've quoted him:

Bulkbiker and Roy Taylor are in the same business.

They have both found something which they think is great news for Type 2's, there is plenty of evidence for it, and they want to spread the word.

It wouldn't be fair to characterise Roy Taylor as someone who believes "Fat Type 2's made lifestyle choices which mean they deserve to be where they are. All they need to do is lose weight like any sensible person and everything will be fine."

Nor would it be fair to characterise bulkbiker as someone who believes "Type 2's with complications made lifestyle choices which mean they deserve to be where they are. All they need to do is eat VLCHF like a sensible person and everything will be fine."

There may be a part of all of our minds which thinks "if somebody had lived their lives in a way which I thought was better, maybe they'd have a better outcome". That's just human. But I don't think anyone is victim-blaming here.

But you have to admit that putting "diet and lifestyle choices" and "weight loss" in, oftentimes, the same sentence does lead some to the conclusion that carrying excess weight is a choice that people make. Instead of emphasising that weight gain is a symptom of T2 the Prof. is feeding into the media's portrayal of the fat, lazy T2s costing *our* NHS squillions. And by saying that as long as xx amount of weight is lost and that then as long as an optimal weight be maintained he imo is further adding to the myth that being overweight causes T2. This is why I personally think he should be speaking more about how people develope T2 and then about the symptoms and then about the protocols in his teams diet.

 

[Safi]

Just one point about the TOFI thing, what about people such as Michael Mosley and particularly Richard Doughty? It does seem that the weight loss thing is worth giving a go for anyone so long as it doesn't make you dangerously thin and there are no other risks. That's a general comment about normal-weight T2s, I've no idea what you've tried and your weight etc!
.

I am an apparently healthy bmi (20) & bodyfat % (22) & whilst I could probably get away with dropping some weight I'm not sure I'd want to. I'm a middle-aged women with all that that entails hormonally so dropping my bodyfat much more could have very unpleasant & unhealthy consequences. Further, as we age we all become more susceptible to illness/disease & getting back to your fighting weight after illness can be tricky. As it stands I consider myself fit, strong & healthy & for me I believe this particular cure could be worse than the disease (which I manage happily & without any real drama so far )

Just thought I'd throw that into the ring re your question "why not give the weight loss thing a go"

 

[bulkbiker]

Just a reminder, my earlier post was in response to this:



And I've seen very similar comments elsewhere on this forum. I suspect it's not a majority view by any means, and it may actually be bulkbiker who made the other comments, I can't remember!

Anyway I felt the need to defend the chap.

The irony is, the way I see it, and I hope bulkbiker reads this because I've quoted him:

Bulkbiker and Roy Taylor are in the same business.

They have both found something which they think is great news for Type 2's, there is plenty of evidence for it, and they want to spread the word.

It wouldn't be fair to characterise Roy Taylor as someone who believes "Fat Type 2's made lifestyle choices which mean they deserve to be where they are. All they need to do is lose weight like any sensible person and everything will be fine."

Nor would it be fair to characterise bulkbiker as someone who believes "Type 2's with complications made lifestyle choices which mean they deserve to be where they are. All they need to do is eat VLCHF like a sensible person and everything will be fine."

There may be a part of all of our minds which thinks "if somebody had lived their lives in a way which I thought was better, maybe they'd have a better outcome". That's just human. But I don't think anyone is victim-blaming here.

If you listen to the audio of Prof Taylor in the Lancet you will see where I get my take on his views.

He is asked about the growth in Type 2 in the UK.
He makes such statements as "the weight of the population is steadily rising:"
"everyone is carrying a few extra pounds"
"people are 1 1/2 stone heavier than 30 years ago"
"this is completely shocking"
"its a matter of food consumption"
"not contents of food more the quantity"

This is where I think he is missing the point. People don't develop Type 2 because they are overweight.
Being overweight and/ or having visceral fat is another symptom of a deranged metabolism where insulin function is impaired. Get the insulin function under control and you stand a far better chance of "reversing"/ "putting Type 2 into remission" or however you want to put it.
Such statements as its about the quantity not the contents of food sound to me remarkably similar to Daily Mail type quotes.
I would say that it is all about the contents of the food. But then again I would....

 

[walnut_face]

FWIW I believe that Taylors' work make a significant contribution to the debate.
Do fat people get diabetic, or diabetic people get fat? It is the latter, but there is no doubt that weight reduction has a positive impact on BG.
Many people here skew their BGL's by adopting low carb dietary regimes. I would love to see some research that proves the eatwell guide causes diabetes, but it doesn't, else everyone would be T2.
Prof Taylor observed that those T2's who underwent bariatric surgery quickly returned to 'normal' BGL's and attempted to mimic that with his VLC Diet aka 'The Newcastle Diet', with some success.
I headed down the Low Carb route because I couldn't get the support of my GP to 'do a newcastle'
I have an HBA1c of 38, am I diabetic? According to my DN, possibly not.......I know different and have the stats to prove it

 

[Brunneria]

there is no doubt that weight reduction has a positive impact on BG.

Only for some.
I am extremely uncomfortable with any sweeping generalisations like this.

My own experience is that i have achieved a far better bg than Taylor claims as ‘evidence of success’ - and i’ve done it for years longer than he is recording - but without appreciable weight loss.

I think that if weight loss works for an individual, then that is a wonderful thing. They should be delighted. They are entitled to celebrate and encouage others. But there are surprising numbers (@Guzzler is one, and i am another, and i could name you 20 other regular posters on here who do not fit that mould) who do not get improved bgs from weight loss. For some of us, we need to do other things. Which also work.

 

[AdamJames]

But you have to admit that putting "diet and lifestyle choices" and "weight loss" in, oftentimes, the same sentence does lead some to the conclusion that carrying excess weight is a choice that people make.

Agreed. To quote myself earlier in this thread, "I think the unfortunate thing is that so many people with limited intellect like to blame Type 2's and look down on them, and Roy Taylor's findings very easily play in to that kind of mind set."

This is why I personally think he should be speaking more about how people develope T2 and then about the symptoms and then about the protocols in his teams diet.

That would be nice.

 

[AdamJames]

I am an apparently healthy bmi (20) & bodyfat % (22) & whilst I could probably get away with dropping some weight I'm not sure I'd want to. I'm a middle-aged women with all that that entails hormonally so dropping my bodyfat much more could have very unpleasant & unhealthy consequences. Further, as we age we all become more susceptible to illness/disease & getting back to your fighting weight after illness can be tricky. As it stands I consider myself fit, strong & healthy & for me I believe this particular cure could be worse than the disease (which I manage happily & without any real drama so far )

Just thought I'd throw that into the ring re your question "why not give the weight loss thing a go"

Please re-read what I wrote. I was trying to be helpful, passing on the real news that some normal-weight people have tried weight loss and it did work. I was very also careful to point out that it's only worth trying if it's safe to do so for other reasons. I have never once written flippantly "why not give weight loss a go", they question you quote is not my question and is out of context. I've read many posts in this forum saying that the Newcastle studies don't apply to them, and, just as I like it when people give me information when I may be missing something, I think it's appropriate to let people know, in case they've missed it, that this thing can get results for normal weight people.

 

[AdamJames]

If you listen to the audio of Prof Taylor in the Lancet you will see where I get my take on his views.

He is asked about the growth in Type 2 in the UK.
He makes such statements as "the weight of the population is steadily rising:"
"everyone is carrying a few extra pounds"
"people are 1 1/2 stone heavier than 30 years ago"
"this is completely shocking"
"its a matter of food consumption"
"not contents of food more the quantity"

This is where I think he is missing the point. People don't develop Type 2 because they are overweight.
Being overweight and/ or having visceral fat is another symptom of a deranged metabolism where insulin function is impaired. Get the insulin function under control and you stand a far better chance of "reversing"/ "putting Type 2 into remission" or however you want to put it.
Such statements as its about the quantity not the contents of food sound to me remarkably similar to Daily Mail type quotes.
I would say that it is all about the contents of the food. But then again I would....

It's certainly a very touchy subject, and it would be nice if people in a prominent position took great care in how they worded things. It's numbskulls with Daily Mail mentality who should be the first against the wall, however.

Roy Taylor can spend a whole day talking about thin people and Personal Fat Thresholds and people with Daily Mail mentality just won't get it, they'll hear what they want to hear, and really there's very little we can do about that.

I don't think any blanket statement about Type 2 is credible, there just isn't the data. "Being overweight is caused by Type 2" is great for generation snowflake, but is too general. "Type 2 is caused by being overweight" is great for Daily Mail readers, but is too general. Lost in that mess of hateful and defensive thinking there is real data which may actually be useful.

For me, being an overweight person with Type 2, it's *exactly* like being told that I have skin cancer, and it may be because I spend so often sunbathing. It's just data which may inform me about what to do and what to avoid.