Carbs-independent remission

[MrsA2]

Maybe I'm misunderstanding, but my target was, and remains, to keep my bg low.
My weight loss was a welcome side effect of that.
Equally maintaining my bg at under the prediabetic level requires eating low carb and subsequently my weight is remaining stable
Am I alone in not concentrating on weight, but on bg?

 

[chrisjohnh]

The thing is though, I got down to a Hba1c of 41 at 6 months from diagnosis eating a low carb diet. That is my new normal.

If I wanted to eat carbs freely by maintaining my weight I wouldn't be able to eat anything freely - I would constantly be weighing myself, going for long walks or taking other exercise for hours every day, eating a bit of salad rather than a meal - fretting my life away in order to try to maintain my weight against what is the natural course of my metabolism.

These days I spend exactly zero minutes concerned about my diet, I don't weigh myself, I do have to spend time in making clothes in smaller sizes, usually when the season changes. I don't do exercise as such, I just live my life without concerns about diabetes or diet.

Now that’s a very interesting perspective on the tradeoffs we need to consider, I shall remember this, thank you.

Maybe I'm misunderstanding, but my target was, and remains, to keep my bg low.
My weight loss was a welcome side effect of that.
Equally maintaining my bg at under the prediabetic level requires eating low carb and subsequently my weight is remaining stable
Am I alone in not concentrating on weight, but on bg?

Low bg is the shared goal of us all, yes. Interesting that you see your weight loss as an incidental, not as the fundamental and inescapable imperative that enabled you to get the bg lowered in the first place.

 

[Claudia 1961]

I think I will find the same too, as even after freeing the pancreas from fat it may no longer respond as quickly and precisely in all of us as it once did, hence the bind we are in. They do not claim 100% success in remission - it was only about 45% at one year and about 35% at two. What they are claiming is 100% of those still in remission at two years had not needed a low carb diet during the second year; they had eaten what they liked BUT kept their weight stable.

My endocrinologist years ago said if I kept my weight low and exercised 30 minutes most days I should be okay . I had horrendous gestational diabetes. Ok so I did. But even very slim now and fit, I still got into high numbers lately . It is not just about visceral fat, it’s about genetics.

 

[Tamarillo]

I can tell you that their unswerving belief is that if T2Ds clear out all their ectopic fat soon after diagnosis then most of them will get their A1c below 48 (I know, not the biggest deal) and can keep it there indefinitely by carefully not regaining weight whilst otherwise eating what they like. They would argue that with a well-resurrected pancreas one should not produce excess insulin in response to a high dollop of carbs and therefore should not suffer an adverse effect such as weight regain. I think their view is that if you’ve still not cleared your ectopic fat then keeping your A1c low merely by low carbing is just a “poor man’s kind of remission”, just a trivial demo of the obvious that you won’t get high flames from the fire in your innards simply by desisting from throwing fuel on it, even though it’s still smouldering underneath and will eventually create a crisis. Now I don’t know what the reality is here because the research is still too sparse and low scale. But I may do my own n=1 non-RCT experiment before long.

So they're suggesting compromised pancreatic beta cells regain some function with enough weight loss?
There's early research showing promise for beta cell regeneration with fasting - still rodent studies at this stage I think. Those studies were using a fasting mimicking diet so I guess if a diet was using any of the core FMD principles (IE: low sugars, low calories, low protein - specifically leucine, and some other amino acid tweaks) then something more than a "poor man's" remission might be attainable.
Before I was confident enough to try water fasting, I followed a fasting mimicking diet a few times. It was not difficult and I was surprised to be able to eat 60ish grams of carbohydrates each day, spread out over three meals and still get into a decent level of ketosis.

 

[chrisjohnh]

My endocrinologist years ago said if I kept my weight low and exercised 30 minutes most days I should be okay . I had horrendous gestational diabetes. Ok so I did. But even very slim now and fit, I still got into high numbers lately . It is not just about visceral fat, it’s about genetics.

Yes, the genes have their role too. How much and for how many people is unclear.

 

[lovinglife]

There many reason why we are insulin resistant and develop T2, I have polycyclic ovary syndrome so my chances of developing T2 were always high, it’s also on both sides of my family with my dad and his siblings all developing T2 in their late 40s - all very skinny. My mum never developed it but 6 of her siblings did, all normal weight.

I was slim until a few years before diagnosis then I pilled on weight at a rate of knots without any change in my lifestyle, no one would believe me that I wasn’t overeating etc - T2 made me fat not the other way round. I have lost a huge amount of weight but I’m still very much diabetic. 13 years on keto diet with metformin only I would never try to introduce more carbs after all my hard work, why would I? I know what got me here today why mess with what works

 

[bulkbiker]

Interesting that you see your weight loss as an incidental, not as the fundamental and inescapable imperative that enabled you to get the bg lowered in the first place.

My blood sugars stabilised and I achieved remission before the largest part of my weight loss.
That is precisely why I think that Taylor's hypothesis.. (and it really is nothing more than that) is severely flawed.
My HbA1c hovers around 30 mmol/mol after 7 years..I have passed an OGTT test without recarbing beforehand.

Am I "cured" .. not if I go back to eating what made me sick in the first place but as I no longer consider carbs to be "food" then I don't see that happening.

 

[Antje77]

There many reason why we are insulin resistant and develop T2, I have polycyclic ovary syndrome so my chances of developing T2 were always high, it’s also on both sides of my family with my dad and his siblings all developing T2 in their late 40s - all very skinny. My mum never developed it but 6 of her siblings did, all normal weight.

I was slim until a few years before diagnosis then I pilled on weight at a rate of knots without any change in my lifestyle, no one would believe me that I wasn’t overeating etc - T2 made me fat not the other way round. I have lost a huge amount of weight but I’m still very much diabetic. 13 years on keto diet with metformin only I would never try to introduce more carbs after all my hard work, why would I? I know what got me here today why mess with what works

Off topic, sorry, but with so many T2's in the family, have any of you had genetic testing for MODY?

 

[chrisjohnh]

My blood sugars stabilised and I achieved remission before the largest part of my weight loss.
That is precisely why I think that Taylor's hypothesis.. (and it really is nothing more than that) is severely flawed.
My HbA1c hovers around 30 mmol/mol after 7 years..I have passed an OGTT test without recarbing beforehand.

Am I "cured" .. not if I go back to eating what made me sick in the first place but as I no longer consider carbs to be "food" then I don't see that happening.

I would prefer to say that Taylor’s hypothesis is not only that. It sits above decades of highly educated and dedicated thinking and scientific discourse on his part as well as experimentation. Its status would exceed, for example, my hypothesis that T2D is caused by wearing my socks inside out - that’s what “just a hypothesis” looks like. But, it may well be the case that his hypothesis is incomplete or less universal than proposed.

 

[bulkbiker]

I would prefer to say that Taylor’s hypothesis is not only that. I

But in the early days of his diet studies they tested for ketones in the trial participants.
If they got into ketosis by eating fewer carbs then it could be that causing the weight loss and remission.

That they failed to do this whilst carrying out DiRECT was interesting in itself.

 

[chrisjohnh]

I would prefer to say that Taylor’s hypothesis is not only that. It sits above decades of highly educated and dedicated thinking and scientific discourse on his part as well as experimentation. Its status would exceed, for example, my hypothesis that T2D is caused by wearing my socks inside out - that’s what “just a hypothesis” looks like. But, it may well be the case that his hypothesis is incomplete or less universal than proposed.

I would add that it’s a pity that the complete picture of what the DiRECT remitters were eating during their second year has not been fully published, and may not have been even fully ascertained. This gap so far makes it hard for the rest of us to make an incisive assessment of the trial and of its implications for our own future T2D management. But I may do my own little experiment as I mooted earlier in the thread.

 

[chrisjohnh]

But in the early days of his diet studies they tested for ketones in the trial participants.
If they got into ketosis by eating fewer carbs then it could be that causing the weight loss and remission.

That they failed to do this whilst carrying out DiRECT was interesting in itself.

I agree there, yes it left that ambiguity in interpretation.

 

[chrisjohnh]

So they're suggesting compromised pancreatic beta cells regain some function with enough weight loss?
There's early research showing promise for beta cell regeneration with fasting - still rodent studies at this stage I think. Those studies were using a fasting mimicking diet so I guess if a diet was using any of the core FMD principles (IE: low sugars, low calories, low protein - specifically leucine, and some other amino acid tweaks) then something more than a "poor man's" remission might be attainable.
Before I was confident enough to try water fasting, I followed a fasting mimicking diet a few times. It was not difficult and I was surprised to be able to eat 60ish grams of carbohydrates each day, spread out over three meals and still get into a decent level of ketosis.

Certainly they believe that functional beta cell mass almost fully recovers once the pancreatic fat has been dispersed; but not necessarily all its former efficacy, which is a different thing.

 

[MrsA2]

Low bg is the shared goal of us all, yes. Interesting that you see your weight loss as an incidental, not as the fundamental and inescapable imperative that enabled you to get the bg lowered in the first place.

Yes, my meter is my guide, not my scales.
I'm sure all the slim T2s don't see weight loss as fundamental and imperative. There are lots of posts from people who feel they need to put on weight, or who drop too low.

If I start increasing carbs I know my meter would rise beyond safety. I'm not prepared to take that risk just to see if my weight remains the same.
I shall be interested to see how you get on.

 

[KennyA]

Maybe I'm misunderstanding, but my target was, and remains, to keep my bg low.
My weight loss was a welcome side effect of that.
Equally maintaining my bg at under the prediabetic level requires eating low carb and subsequently my weight is remaining stable
Am I alone in not concentrating on weight, but on bg?

I think I'm in this camp. My priorities were firstly stop the nasty symptoms I'd had for ten years - neuropathy, oedema, kidney problems, wounds not healing etc. etc.

To achieve that I had to reduce my BG.

To reduce my BG I went (and have stayed at) ~20g carbs/day. Took four months. I was somewhere over 120kg when I started, and was still about 110kg when my A1c was back at 36 (down from 50).

I've lost a further >15kg since, still losing, and my BG has stayed around 36-38 in the intervening two and a half years. Weight loss (fat loss, strictly speaking) is to my mind a by product, not the cause, of my BG reduction.

 

[Antje77]

Interesting that you see your weight loss as an incidental, not as the fundamental and inescapable imperative that enabled you to get the bg lowered in the first place.

Easiest experiment validates thinking weight loss is not a fundamental and inescapable imperative to lower BG:

Day 1:
Take a diabetic.
Feed it carbs.
Measure BG.

Day 2:
Take a diabetic.
Feed it no or fewer carbs, same calories.
Measure BG.

Et voilá, BG lowered in a day without weight loss.
Mind, this doesn't prove anything long term, but it is a strong incentive to eat to your meter, weight loss or no.

 

[chrisjohnh]

Easiest experiment validates thinking weight loss is not a fundamental and inescapable imperative to lower BG:

Day 1:
Take a diabetic.
Feed it carbs.
Measure BG.

Day 2:
Take a diabetic.
Feed it no or fewer carbs, same calories.
Measure BG.

Et voilá, BG lowered in a day without weight loss.
Mind, this doesn't prove anything long term, but it is a strong incentive to eat to your meter, weight loss or no.

Mmmm … sample size a little on the low side perhaps !

 

[Oldvatr]

If you look at the nutrient listing for the Optifast shakes used in the original Newcastle study, or the Exante and Cambridge Diet plan shakes used in the DIRECT study, then the ND intervention is not only VLC diet, but is also low carb as in LCHF but without the HF part. So it is indeed a starvation diet.

 

[chrisjohnh]

Yes, my meter is my guide, not my scales.
I'm sure all the slim T2s don't see weight loss as fundamental and imperative. There are lots of posts from people who feel they need to put on weight, or who drop too low.

If I start increasing carbs I know my meter would rise beyond safety. I'm not prepared to take that risk just to see if my weight remains the same.
I shall be interested to see how you get on.

The latter para misinterprets my intent, which is to see whether raising carbs will raise my A1c. My weight will remain constant because I will make it so by other adjustments.

 

[Antje77]

Mmmm … sample size a little on the low side perhaps !

Works with any diabetic not in remission (and many in remission as defined by hba1c), regardless of type.
Just find a random one to experiment on and I'll guarantee their BG will be higher after a high carb meal than after a low carb meal.

It's why T1's calculate their insulin doses based on carbs.