Indeed, but this is just a comment on the diet used to reach remission. No dispute there. The issue is to do with DiRECT’s post-remission-phase for maintaining the new weight, and that subsequent diet was not starvation, obviously.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.
What it does not tell us is whether that one person is keeping bg low only for the trivial reason that they are consuming low carbs or because their pancreas has improved by becoming less fatty. This matters, because if it’s only because of the former then the pancreas will slowly degrade further until a day is reached when for all one’s low carbing the A1c starts rising and then one is on the stony road of insulin and a permanently wrecked pancreas.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.
What it does not tell us is whether that one person is keeping bg low only for the trivial reason that they are consuming low carbs or because their pancreas has improved by becoming less fatty. This matters, because if it’s only because of the former then the pancreas will slowly degrade further until a day is reached when for all one’s low carbing the A1c starts rising and then one is on the stony road of insulin and a permanently wrecked pancreas.
This gets to the heart of the issue and the science will have to get the bottom of it. Although we are a large community of self-helpers, and ostensibly doing very well in many cases, it does not add up to a means of advancing objective knowlege.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.
So were the ND studies.. Only 11 underwent the MRI scans and the insulin studies that tracked Phase 1 insulin responses using the IVGTT technique that are used to justify the results for all diabetics. The ND study is in my opionion very overhyped. There is a lot of money being made from a very small study. The fact that DIRECT had to be repeated to get the current plan used by the NHS which is so far a two pass plan shows that starvation diets only work in the short term and are a revolving door. The remission is temporary. It is the same story for bariatric surgery which is what the ND study is trying to emulate.Mmmm … sample size a little on the low side perhaps !
I have sometimes seen people report that they’ve low-carbed for years but then had to go onto diabetes medicines for no reason that they can identify.Why would you think this?
I've never read anything suggesting this in people maintaining healthy BG by low carbing.
Indeed. My insulin response has improved measurably since I did LCHF. and I know this because when I was in hospital on Eatwell, my sugar levels remained in control even though I was getting high spikes from the carbs, they reduced back to baseline without diabetic meds or insulin. so my pancreas went from me requiring insulin (i.e. exhausted and clapped out pancreas stage) to wotking well to drop my bgl to the 4's and 5's on waking and I still have good output from my faithful pancreas some 5 years since. And I do not do keto. I am a low carber but not ultra low carb. I eat potatoes and two or three slices of bread a day and maintain a below diabetic HbA1c and daily average. But before you ask - I am in control but not in remission. I remain T2D.Why would you think this?
I've never read anything suggesting this in people maintaining healthy BG by low carbing.
Is this a fair summary of DiRECT? My understanding is that most of those who were in remission at 1 year had remained so at 2 years. This is not “temporary” remission for the majority - so far, anyway.So were the ND studies.. Only 11 underwent the MRI scans and the insulin studies that tracked Phase 1 insulin responses using the IVGTT technique that are used to justify the results for all diabetics. The ND study is in my opionion very overhyped. There is a lot of money being made from a very small study. The fact that DIRECT had to be repeated to get the current plan used by the NHS which is so far a two pass plan shows that starvation diets only work in the short term and are a revolving door. The remission is temporary. It is the same story for bariatric surgery which is what the ND study is trying to emulate.
IMHO ND is a useful tool, and can be used as a successful intervention, but long term does not seem to offer a solution to T2D alone. It is the follow on treatment that can extend the remission. Get that wrong and the T2D returns, the weight returns and you return to the starvation regime again. We have members on this forum who have had this experience, but who now use LCHF or a keto diet to control their blood sugars. By all means get the T-shirt, but it will not keep you warn through the winter.
If you are talking DIRECT then there was significant falloff at 2 years, If you are talking about Countepoint then there was a higher success rate initially, but I have not seen any 2 year results being published I think @bulkbiker mighrt have an anwer here. However, both studies only had approx 50% or less success rate anyway.Is this a fair summary of DiRECT? My understanding is that most of those who were in remission at 1 year had remained so at 2 years. This is not “temporary” remission for the majority - so far, anyway.
But then again only you have your diabetes.. so the sample size of one is the only important one to you?Mmmm … sample size a little on the low side perhaps !
I am talking about DiRECT. At 2 years the continued remission success rate was far more significant than the fall-off. Just under 80% of the remitters at 1 year were still in remission at 2 years, an impressive outcome I would say. And those people did it in the 2nd year without low carbing, all of them, keeping their new weight stable. And my original question was whether anyone on the forum has done similarly.If you are talking DIRECT then there was significant falloff at 2 years, If you are talking about Countepoint then there was a higher success rate initially, but I have not seen any 2 year results being published I think @bulkbiker mighrt have an anwer here. However, both studies only had approx 50% or less success rate anyway.
Nutritional basis of type 2 diabetes remission
Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the...www.bmj.com
The science is as important to me as my own diabetes.But then again only you have your diabetes.. so the sample size of one is the only important one to you?
Lots of people have their own definition of "low carb" though...low-carbed for years
And I too have “low carbed” (125-130g) for (two) years, with A1c stable so far. But with those who have had to keep stepping their carbs ever further down I would be curious to know whether they had not originally cleared their pancreatic fat to the maximum possible and thus had only been living on borrowed time. What does need acknowledging by the low carb believers is that the DiRECT two-year remitters maintained their remission without low carbing at all. This cannot be dodged.Lots of people have their own definition of "low carb" though...
There are forum members who have had some success reducing to 100g or so then over time HbA1c has slowly worsened.
They reduce carbs more and get yet more benefits.
I tend to suggest people try for ketogenic levels of 20g or so per day.
That is definitely "low carb".
Stress can make a dramatic difference particularly for me. Early days when I weighed and tested everything I suddenly found a after meal reading in double figures when haven eaten very few carbs. There had been a car crash right outside my house and I realized that had affected my blood sugars.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.
Yes, many influencing factors.Stress can make a dramatic difference particularly for me. Early days when I weighed and tested everything I suddenly found a after meal reading in double figures when haven eaten very few carbs. There had been a car crash right outside my house and I realized that had affected my blood sugars.
But there's no such thing as "the science".The science is as important to me as my own diabetes.
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