T2 Diabetes remission success rate for Low Calorie diets?

[Oldvatr]

The Direct study at least proved a principle that stripping away pancreatic and liver fat reversed insulin resistance and hence type 2 diabetes and that doing this early in diagnosis was less effective than later on but I'd agree that there are more pleasant ways such as low carb!
The 2nd stage of research looked at numbers who maintained remission and found that a declining percentage had remained in remission but that was still better than the control group. The study group had received dietary advice about how to maintain their weight loss.
Practices were randomly assigned (1.1) via a computer-generated list to an integrated structured weight management programme (intervention) or best-practice care by guidelines
At 24 months, 53/149 (35·6%) of those commencing the intervention and 5/149 (3·4%) in the control group (adjusted odds ratio 25·8, 95% CI 8·3,80·8; p<0·0001) had remission, and 11·4% (17/149 of intervention and 2·0% (3/149) of the control group (adjusted odds ratio 8·2 (2·2,30·0), p=0·002) had weight loss ≥15k

The main thing that Prof Taylor et al did with their work was to provide scientific proof and evidence that there is a direct and measurable link between Diabetic Insulin resistance, and NAFLD thus opening the door to better and more refined treatments becoming possible. As a secondary benefit IMHO, he provided the general populace with a viable tool for resetting their metabolism that can be almost universally applied and which is acceptable to the Establishment thus allowing immediate introduction.

 

[Oldvatr]

Here is some forward looking research being proposed for keto diets
https://www.frontiersin.org/articles/10.3389/fneur.2019.00585/full

We may yet get some science funding. This may link into what is now being nicknamed T3D

 

[pdmjoker]

he provided the general populace with a viable tool for resetting their metabolism that can be almost universally applied

The low calorie meal replacement with 30 mins daily exercise?

 

[Oldvatr]

The low calorie meal replacement with 30 mins daily exercise?

Exactly. If you look at what The Newcastle team Mission Statement declared was a goal - to find if there was a diet that could emulate the effects of Bariatric Surgery, which, at the time, was the only official cure for T2D and Obesity that the NHS had to offer at great expense and use of resources.

At that time it was known that Bariatric Surgery (but only one variant of it) provided a 'permanent' solution, so that defined their Holy Grail quest, and it is why they got funding from NHS and DUK to explore the effect on the liver and pancreas in such detail. They did a great job in that and were surprised at the evidence they found so strongly on their first pass.

DIRECT is a new initiative to provide the NHS with a turnkey solution. There was nothing in the ND diet that had not been done before for weight loss and that type of diet had already achieved NHS approval. It was just a vehicle which allowed them to control intake in a formal trial. It in itself is nothing new. What was new was the using of MRI Scanners to provide the evidence and the laboratory testings they carried out. The possibility of remission was actually a serendipitous moment, the icing on the cake, the hook to grab the public's attention.

 

[pdmjoker]

Exactly. If you look at what The Newcastle team Mission Statement declared was a goal - to find if there was a diet that could emulate the effects of Bariatric Surgery, which, at the time, was the only official cure for T2D and Obesity that the NHS had to offer at great expense and use of resources.

At that time it was known that Bariatric Surgery (but only one variant of it) provided a 'permanent' solution, so that defined their Holy Grail quest, and it is why they got funding from NHS and DUK to explore the effect on the liver and pancreas in such detail. They did a great job in that and were surprised at the evidence they found so strongly on their first pass.

DIRECT is a new initiative to provide the NHS with a turnkey solution. There was nothing in the ND diet that had not been done before for weight loss and that type of diet had already achieved NHS approval. It was just a vehicle which allowed them to control intake in a formal trial. It in itself is nothing new. What was new was the using of MRI Scanners to provide the evidence and the laboratory testings they carried out. The possibility of remission was actually a serendipitous moment, the icing on the cake, the hook to grab the public's attention.

That's helpful, thank you. Sadly, I'm one of the people who cannot do 30 mins daily exercise, for health reasons, which is one reason why "Eat less, move more" wasn't effective for me... (and, yes, I got blamed for the failure! )

 

[Tannith]

The low calorie meal replacement with 30 mins daily exercise?

It has to be a low calorie diet (suggested 800 cals). It certainly doesn't have to be meal replacements, though they were used in the trial for ease of comparing results. I did it with normal food and about 1000 cals per day. Taylor's diet does NOT recommend any exercise in the initial few months indeed he suggests that might be too much and could derail the diet. Some exercise is suggested but only for the maintenance phase.
Edited to add. I didn't do ANY exercise in the initial or maintenance phases of the diet. Nor have I done any since.

 

[pdmjoker]

It has to be a low calorie diet

In what sense does it have to be low calorie? Puzzled...

 

[Oldvatr]

In what sense does it have to be low calorie? Puzzled...

Very Low Calorie (VLCD).

 

[pdmjoker]

Very Low Calorie (VLCD).

Thank you. Yes, but why does it have to be? ie Do you mean 800kcal has to be (well, clearly) or for some practical reason? Why not a Low Carb? Am I being dim?

 

[loiphamp]

The low calorie meal replacement with 30 mins daily exercise?

30 mins walk that all you need

 

[Oldvatr]

Thank you. Yes, but why does it have to be? ie Do you mean 800kcal has to be (well, clearly) or for some practical reason? Why not a Low Carb? Am I being dim?

Simple. The Establishment accepts and understands Low Calorie, It hates and loathes Low Carb, It would be dim to call the ND diet low carb in any way. We here can see that in practicality it treads the borderline of Low Carb, but shouting it from the rooftops will deter the investors from supporting it and close the door to a useful tool. There are reasons why it does not mention low carb or ketosis.

 

[Tannith]

Thank you. Yes, but why does it have to be? ie Do you mean 800kcal has to be (well, clearly) or for some practical reason? Why not a Low Carb? Am I being dim?

The principle of Newcastle diet is to reduce the fat clogging the pancreas which causes it to not work properly. Hence the low cal diet,as to get the fat off the pancreas you have to lose a lot of fat from elsewhere first, particularly from the liver, as fat loss cannot be selective. Once you have done the diet and got the fat off the pancreas it can work efficiently again, and you no longer have to do the low cal diet. But you DO have to make sure you don't eat excess calories and put the fat back on or you will undo your good work.After the Newcastle weight loss you have to eat a normal diet that does not cause weight gain.

 

[DCUKMod]

Simple. The Establishment accepts and understands Low Calorie, It hates and loathes Low Carb, It would be dim to call the ND diet low carb in any way. We here can see that in practicality it treads the borderline of Low Carb, but shouting it from the rooftops will deter the investors from supporting it and close the door to a useful tool. There are reasons why it does not mention low carb or ketosis.

My understanding of "why low cal" was the initial studies were attempting to mimic bariatric surgery, which is almost certainly low cal - especially in the early days.

 

[pdmjoker]

Simple. The Establishment accepts and understands Low Calorie, It hates and loathes Low Carb, It would be dim to call the ND diet low carb in any way. We here can see that in practicality it treads the borderline of Low Carb, but shouting it from the rooftops will deter the investors from supporting it and close the door to a useful tool. There are reasons why it does not mention low carb or ketosis.

Thanks! What I kind of guessed...

The principle of Newcastle diet is to reduce the fat clogging the pancreas which causes it to not work properly. Hence the low cal diet,as to get the fat off the pancreas you have to lose a lot of fat from elsewhere first, particularly from the liver, as fat loss cannot be selective.

Low Carb is v effective at burning off liver fat etc, which is why I questioned your assertion that low calorie was essential...

 

[Oldvatr]

Thanks! What I kind of guessed...

Low Carb is v effective at burning off liver fat etc, which is why I questioned your assertion that low calorie was essential...

You make a very assertive claim in your post which I am forced to question.
"Low Carb is v effective at burning off liver fat etc,"
Where is the scientific proof? What Prof Taylor was able to do with his funding was to develop a tool (MRI) that demonstrated the before and after conditions of the liver and pancreas that proved that his diet was removing NAFLD from these organs in vivo in other words in test subjects that were living before, during, and after the study ended. The evidence that LC diets do the same uses animal studies, and post mortem analysis to conjecture that humans gain the same effect. The proof is therefore weaker,

The other thing I have noted is that human LC trials use modified Mediterranean diets which are open to introducing confounding variants and are not tightly controlled. In the VLC trials the use of meal replacements produced less chance of variables and just as importantly from a scientific point of view, permitted repeatable experimentation to be performed if necessary. Yes I suspect that a similar trial could be run to demonstrate the same efficacy in an LC trial, if you can get the funding and a standardised LC meal plan that the nutritionists will accept. Till that day, we remain in a backwater.

And, yes, I did use LCHF myself and for short period was able to claim reversal. But it did not last, and I am back on low level medication.

 

[zand]

You make a very assertive claim in your post which I am forced to question.
"Low Carb is v effective at burning off liver fat etc,"
Where is the scientific proof? What Prof Taylor was able to do with his funding was to develop a tool (MRI) that demonstrated the before and after conditions of the liver and pancreas that proved that his diet was removing NAFLD from these organs in vivo in other words in test subjects that were living before, during, and after the study ended. The evidence that LC diets do the same uses animal studies, and post mortem analysis to conjecture that humans gain the same effect. The proof is therefore weaker,

Whilst not as good as a tool as MRI, surely the ALT liver count gives us an idea as to whether Low Carb works to remove fat from the liver too? With low carb an improved ALT count can happen without weight loss. If this blood test isn't a scientific guide as to how fatty the liver is, then how come doctors use it to help diagnose fatty liver?

 

[Oldvatr]

Whilst not as good as a tool as MRI, surely the ALT liver count gives us an idea as to whether Low Carb works to remove fat from the liver too? With low carb an improved ALT count can happen without weight loss. If this blood test isn't a scientific guide as to how fatty the liver is, then how come doctors use it to help diagnose fatty liver?

Looking at how NAFLD is normally diagnosed it is either by imaging or biopsy. ALT does not seem to figure in the diagnosis. I think ALT gives an indication of something wrong, but is not specific. ALT just indicates some liver damage is occurring.

 

[zand]

Looking at how NAFLD is normally diagnosed it is either by imaging or biopsy. ALT does not seem to figure in the diagnosis. I think ALT gives an indication of something wrong, but is not specific. ALT just indicates some liver damage is occurring.

Well my GP read my ALT count and felt my liver and said 'You have fatty liver' so I assumed he was right.

 

[pdmjoker]

You make a very assertive claim in your post which I am forced to question.
"Low Carb is v effective at burning off liver fat etc,"
Where is the scientific proof?

Does this constitute proof? https://pubmed.ncbi.nlm.nih.gov/21367948/
It says

Conclusions: Two weeks of dietary intervention (≈4.3% weight loss) reduced hepatic triglycerides by ≈42% in subjects with NAFLD; however, reductions were significantly greater with dietary carbohydrate restriction than with calorie restriction. This may have been due, in part, to enhanced hepatic and whole-body oxidation.​

 

[Mbaker]

I had been low carbs for few years, now I can eat anything I want(ice cream,pasta,pizza...etc) for at least 6 months .HbA1C in normal range.

I would be cautious and not take it too far. Diabetes seems to have a memory. I have added butternut squash and carrots from the start of my remission about 5 years ago. Over the last 6 months beetroot has also been added at the same time as celery - 2 HbA1c's in a row have been essentially the same. I will not ever add the grains, potatoes or processed foods.