DiRECT intervention looks like Liberal Low Carb...

pdmjoker

Well-Known Member
Messages
417
Type of diabetes
Prediabetes
Treatment type
Diet only
In David Unwin's paper (written with D Haslam and G Livesey) "It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited"
(found here https://insulinresistance.org/index.php/jir/article/view/8/11) they say:

A carbohydrate-restricted diet in diabetes therapy has the main objective of reducing patient exposure to too high a post-prandial blood glucose response to carbohydrate foods.22 This is achieved with a low-carbohydrate diet, which has been defined as one supplying ≤ 130 g carbohydrate a day. A long history of research led to a scientific case for their adoption in diabetes and obesity therapy (Box 3).
----
@Dark Horse kindly provided this link to a presentation from Professor Roy Taylor on DiRECT (Diabetes REmission Clinical Trial): https://www.directclinicaltrial.org.uk/Documents/AAA FINAL DiRECT 12m results for IDF 2017.pdf

However, from slide 13 of the DiRECT pdf, the 12-20 weeks meal replacement for weight loss has energy distribution:

"830 kcal: 61%E carbohydrate, 13% fat, 26% protein"
Now, 61% of 830 is 506.3 and as carbs have 4 calories per gram, that makes 101.26g carbs daily.

Which is, actually, Liberal Low Carb, and well within the Unwin, Haslam and Livesey specification.

Perhaps this has already been pointed out somewhere, but DiRECT seems to be smuggling in Low Carb under the guise of mere calorie-restriction. (Although I agree it looks like carbs go to 150g daily after another 6-9 weeks...)
 

ianf0ster

Moderator
Staff Member
Messages
2,399
Type of diabetes
Type 2 (in remission!)
Treatment type
Diet only
Dislikes
exercise, phone calls
I know that the carbs considered to be the Low carb cut off is 120gms per day.
Personally I would consider over 100gms carbs per day to be Moderate carb, but then my personal tolerance of carbs means I need to be in the 20gms to 40gms per day region in order to keep my BG under control.
Many go lower than that.
 
  • Like
Reactions: pdmjoker

Oldvatr

Expert
Messages
8,470
Type of diabetes
Type 2
Treatment type
Tablets (oral)
In the pre DiRECT trials they tested people for ketones.. go figure!
Optifast as used on the first 2 trials before DIRECT showed on their website that the 800kcal meal plan can induce dietary ketosis. It is not intended or marketed as a keto diet, but the warning was there.

Edit to add: The Optifast brand is still going, having been bought up by Nestle. Their website does carry a treatise on keto diets, and they now market a VLCD diet plan to that end As it is a commercial product I will leave the website details out.
 
Last edited:
  • Like
Reactions: pdmjoker

pdmjoker

Well-Known Member
Messages
417
Type of diabetes
Prediabetes
Treatment type
Diet only
Or to use Phinney and Volek's famous (and in my opinion misguided graphic) more likely starvation ketosis!
Do you mean this graphic? Interested to know how you consider it misguided...
KetoneLevels.png
 

bulkbiker

BANNED
Messages
19,576
Type of diabetes
Type 2
Treatment type
Diet only
Do you mean this graphic? Interested to know how you consider it misguided...
KetoneLevels.png

Because so many people think that a blood ketone reading of 0.3 mmol/l means they are not "in ketosis".. whereas of course if you are producing ketones then by definition you have to be "in ketosis".

Plus when fasting my ketones are often over 3.. so I think the "starvation ketosis" classification is slightly pejorative (and reflects Phinney's fear of fasting).

And thirdly I hate graphs that have breaks in the axes... really annoys me.
 
  • Like
Reactions: Schmoukes

pdmjoker

Well-Known Member
Messages
417
Type of diabetes
Prediabetes
Treatment type
Diet only
Because so many people think that a blood ketone reading of 0.3 mmol/l means they are not "in ketosis".. whereas of course if you are producing ketones then by definition you have to be "in ketosis".

Plus when fasting my ketones are often over 3.. so I think the "starvation ketosis" classification is slightly pejorative (and reflects Phinney's fear of fasting).

And thirdly I hate graphs that have breaks in the axes... really annoys me.
Helpful, thanks! :)
 
  • Like
Reactions: bulkbiker

Oldvatr

Expert
Messages
8,470
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Because so many people think that a blood ketone reading of 0.3 mmol/l means they are not "in ketosis".. whereas of course if you are producing ketones then by definition you have to be "in ketosis".

Plus when fasting my ketones are often over 3.. so I think the "starvation ketosis" classification is slightly pejorative (and reflects Phinney's fear of fasting).

And thirdly I hate graphs that have breaks in the axes... really annoys me.
Actually we all produce some small amount of ketone bodies simply from burning glucose. Ketones occur when there is incomplete oxidation of the acetyl CoA molecules in the mitochondria and the waste products from that are low level ketones and acetoacetic acid, acetone and pyruvate. Cortisone use and co-cortisoid meds also increase urinary ketones. Diets high in fats also produce increase but this is not a considered to be keto diet High blood glucose blood sugar levels also increases ketones before DKA occurs according to Encyclopedia Britannica
 
Last edited:

pdmjoker

Well-Known Member
Messages
417
Type of diabetes
Prediabetes
Treatment type
Diet only
Actually we all produce some small amount of ketone bodies simply from burning glucose. Ketones occur when there is incomplete oxidation of the acetyl CoA molecules in the mitochondria and the waste products from that are low level ketones and acetoacetic acid, acetone and pyruvsate. ....
I was going to say all that! ;) Not!