Dilemma in losing weight for remission

[chrisjohnh]

After T2D diagnosis in late 2020 I followed the standard prescription “lose at least 15kg and you’ll very likely achieve remission”. So that’s what I did and sure enough dragged my hba1c from 74 to 42 in a few months, and have kept it at or below there ever since, and with no difficulty. Job done. BUT - this entailed bringing my weight down to 64kg (BMI of 21) and I have read in various places that, for a 75 year old, this is likely to make me die quite a lot sooner than if I were 84kg, having almost no fat reserves and probably a much weaker immune system. Stroke recovery, for instance, would be much poorer for me than for those carrying a good deal more weight. Meanwhile, we in remission are constantly warned that regaining just a few kg will propel us out of remission. Is there a way out of this dilemma? I thought about boosting my weight but by eating extra fats and protein only - would that be sensible? My diet already draws half my calories from fats. Perhaps it’s just a choice of how and when to die - diabetically at age 80 or non-diabetically at age 77, for example. Advice welcome!

 

[finzi1966]

I DO feel you’re probably over-thinking this, ChrisJohn. Population averages like this don’t really translate well to individual circumstances. As an example, a significant number of people who die are going to be underweight because they are ill. Diseases like cancer and Alzheimer’s will very frequently cause cachexia (extreme weight loss). While it is true that you would have fewer weight reserves to see you through an illness than someone with a higher BMI, I don’t think that would automatically translate to three years of extra life by putting some weight on.

I would have thought logically that if you wanted to gain some weight while eating healthily, perhaps gaining some muscle would be the best solution. Is that practical for you? I’m guessing it perhaps is a little harder for a 75 year old to gain muscle than a young man, but I don’t know.

 

[AndBreathe]

In my view, a BMI of 21 is about ideal. What makes you feel it is too light?

(I wholly accept that BMI is a flawed measure, it as a rule of thumb for most folks it isn't too dire.)

Have you had your body fat percentages calculated by a DEXA scan or even calculation by biomedical impedence?

 

[chrisjohnh]

I DO feel you’re probably over-thinking this, ChrisJohn. Population averages like this don’t really translate well to individual circumstances. As an example, a significant number of people who die are going to be underweight because they are ill. Diseases like cancer and Alzheimer’s will very frequently cause cachexia (extreme weight loss). While it is true that you would have fewer weight reserves to see you through an illness than someone with a higher BMI, I don’t think that would automatically translate to three years of extra life by putting some weight on.

I would have thought logically that if you wanted to gain some weight while eating healthily, perhaps gaining some muscle would be the best solution. Is that practical for you? I’m guessing it perhaps is a little harder for a 75 year old to gain muscle than a young man, but I don’t know.

Thank you very much for your view on this. Yes I have been thinking of building up some muscle. I think I did lose some muscle along with the fat. You are right that we cannot automatically compute our own outlook just from our weight alone. We have only statistics, with all their caveats. Perhaps not over-thinking these things would improve my longevity too! My thanks again.

 

[chrisjohnh]

In my view, a BMI of 21 is about ideal. What makes you feel it is too light?

(I wholly accept that BMI is a flawed measure, it as a rule of thumb for most folks it isn't too dire.)

Have you had your body fat percentages calculated by a DEXA scan or even calculation by biomedical impedence?

I thought 21 was pretty good too, whilst aware that it’s a very crude measure. But I have seen some studies indicating that my weight is under what the doctors would wish to see in someone my age. No, I have not had the benefit of the measures you mention, I will take a look at those. Thank you very much for raising that.

 

[HSSS]

I think this advice your quoting 15kg is based off the newcastle studies of obese individuals of whom (from memory) only about half achieved remission and even fewer kept it. There has been a follow up study for non obese individuals called retune, and the “required” weight loss is less. Many of us have found we achieve remission by controlling food intake of carbs rather than specifically worry about weight (which often becomes more desirable as a side effect anyway). I don’t see an issue per se of being at a bmi of 21 but as said above it’s a flawed and broad measure.

The usual advice for weight gain in an individual is to base it on proteins (especially true to build muscle) and fats, whilst limiting carbs so if weight gain is important to you I’d agree you’ve hit on the right way to do it, and try and maintain/improve muscle mass in the process.

 

[chrisjohnh]

I think this advice your quoting 15kg is based off the newcastle studies of obese individuals of whom (from memory) only about half achieved remission and even fewer kept it. There has been a follow up study for non obese individuals called retune, and the “required” weight loss is less. Many of us have found we achieve remission by controlling food intake of carbs rather than specifically worry about weight (which often becomes more desirable as a side effect anyway). I don’t see an issue per se of being at a bmi of 21 but as said above it’s a flawed and broad measure.

The usual advice for weight gain in an individual is to base it on proteins (especially true to build muscle) and fats, whilst limiting carbs so if weight gain is important to you I’d agree you’ve hit on the right way to do it, and try and maintain/improve muscle mass in the process.

I think in the Newcastle study it was about half of those losing 10kg got their A1c below 48 whilst nearly 90% of those losing 15kg did so. However that may be, I probably overdid it but had no means of knowing this at the time. My GP had just said the A1c typically reduced by 1 to 2 points for each 1kg lost, so with a starting value of 74, I inferred I’d need to lose at least 15kg, consistent with the Taylor rule of thumb. I wish the prescription had instead been framed in terms of carbs intake but we all know the history of this now. Many thanks for your views on the best approach to weight regain, should I experiment with that.

 

[Robbity]

@chrisjohnh: I've posted previously that I don't claim remission, but I've kept my glucose levels under control at low pre-diabetic-high normal levels for almost 9 years now (and without any diabetic meds since 2017) by eating a low carb/ketogenic style diet of under 50 carbs a day, often much less. I have lost a fair bit of weight, most of it - about 20 kilos - disappeared very fast early on, mainly as a result of my diet and nothing more than normal activities. More recently and without much at all in the way of any real activity, I've lost another 10 or so kilos. I'm currently a decrepit , still overweight and now very inactive , but at last check still alive and kicking , 80 year old T2 diabetic.

For me keeping my carbohydrate consumption low also keeps my glucose levels low, and balancing my fat consumption will handle my weight: enough and I don't need to burn body fat, less and I'll burn a bit of it off.

 

[AndBreathe]

I responded last night when my head was busy digesting a busy day of potentially very expensive purchases.

Anyway, I thinkcomparing your risk now versus when you weighed much more isn't helpful. It is also very noteworthy that when we lose a material amount of weight it can take our bodies a little while to redistribute the remaining fat resources. For example, I am very slight (never carried a lot of weight), but when I was initially diagnosed and went low carb, my love handles melted, but so did my upper arms and my neck and chest line - not that I was every incredibly pneumatic.

After a year, I realised things had evened out a bit, without adding or losing any weight. My visceral fat score has remained low.

Now, in your trimmer state, are you able to do more - long walks, gardening or other forms of exercise, that you were when heavier? Even if you don't, your joints will thank you for being lighter, which increases of changes of maintaining mobility, which I view as a key link to maintaining independence.

Some folks in older age find their appetites lessen a bit, but then they are could also be doing less and thereby realistically need less to maintain.

There are so many factors in the "old age thing". For me, I'd rather be an ancient whippet than an ancient bassett hound.

Each to their own, but be aware, few of us who have reached a point of remission know when that trigger point was (into then out of diabetes) was. Professor Taylor states he finds there is no universal BMI/weight or whatever that signifies "too fat", the but it does appear we have personal, but very difficult to pinpoint, weight/visceral fat point that renders us "too fat for OUR body".

Were you asking for it, my guidance to you would be to go into, or continue with a period of maintenance, after all that's the hard bit - maintaining those healthier eating patterns to protect our bodies. Nodoby benefots from going through the yo-yo of lose<>gain<>lose<>gain with weight.
If you want a really good MOT, then either ask your doctor for one, or volunteer for some research. There is a marvellous study running in the midlands, albeit focusing on cardiac health in those with T2 diabetes (criteria are an historic diagnosis of T2 and no confirmed cardiac failure). During that research project you have an amazing cardiac focused MOT, but the benchmarking covers many areas and tests.

 

[chrisjohnh]

@chrisjohnh: I've posted previously that I don't claim remission, but I've kept my glucose levels under control at low pre-diabetic-high normal levels for almost 9 years now (and without any diabetic meds since 2017) by eating a low carb/ketogenic style diet of under 50 carbs a day, often much less. I have lost a fair bit of weight, most of it - about 20 kilos - disappeared very fast early on, mainly as a result of my diet and nothing more than normal activities. More recently and without much at all in the way of any real activity, I've lost another 10 or so kilos. I'm currently a decrepit , still overweight and now very inactive , but at last check still alive and kicking , 80 year old T2 diabetic.

For me keeping my carbohydrate consumption low also keeps my glucose levels low, and balancing my fat consumption will handle my weight: enough and I don't need to burn body fat, less and I'll burn a bit of it off.

An impressive length of period having that level of control! I have wondered whether those who need to keep very low carb are in that position because of residual fat still in the pancreas. I’m pretty certain that my now very low weight means I have cleared out mine and perhaps enables me to keep control at 135g. But we don’t have our own scanners to check this out, and of course there are many other factors at play in the matter of carb tolerance. Thank you for your reply.

 

[onnecar]

After T2D diagnosis in late 2020 I followed the standard prescription “lose at least 15kg and you’ll very likely achieve remission”. So that’s what I did and sure enough dragged my hba1c from 74 to 42 in a few months, and have kept it at or below there ever since, and with no difficulty. Job done. BUT - this entailed bringing my weight down to 64kg (BMI of 21) and I have read in various places that, for a 75 year old, this is likely to make me die quite a lot sooner than if I were 84kg, having almost no fat reserves and probably a much weaker immune system. Stroke recovery, for instance, would be much poorer for me than for those carrying a good deal more weight. Meanwhile, we in remission are constantly warned that regaining just a few kg will propel us out of remission. Is there a way out of this dilemma? I thought about boosting my weight but by eating extra fats and protein only - would that be sensible? My diet already draws half my calories from fats. Perhaps it’s just a choice of how and when to die - diabetically at age 80 or non-diabetically at age 77, for example. Advice welcome!

Some years back I also went really low carb and also went into remission. I think I went down to around 50kg, although I wasn't big before. My blood glucose level was great. Think maybe similar to yours. However, I was later found to be anaemic so had to stop the diet. Don't think the diet was the cause but quite likely exacerbated it greatly, even though I was careful to include iron rich food. I personally didn't like being so thin. I can't go back on that diet anyway as the anaemia problem has not been resolved. I'm now on tablets, insulin and a sensible diet and exercise. I'm still slim but not thin as before. I think it is very much a personal choice of how you feel as it is your life to live. There does come a time with some of us where insulin supply drops even for Type 2, so management without aids becomes much more difficult. It depends on how far you want to go. I'd say, if your happy with the way you look and feel then keep going with your diet. I'm 70 by the way. I've not heard of being low weight leading to an earlier death. I do think as you age you have to be aware of brittle bones and muscle atrophy though.

 

[chrisjohnh]

I responded last night when my head was busy digesting a busy day of potentially very expensive purchases.

Anyway, I thinkcomparing your risk now versus when you weighed much more isn't helpful. It is also very noteworthy that when we lose a material amount of weight it can take our bodies a little while to redistribute the remaining fat resources. For example, I am very slight (never carried a lot of weight), but when I was initially diagnosed and went low carb, my love handles melted, but so did my upper arms and my neck and chest line - not that I was every incredibly pneumatic.

After a year, I realised things had evened out a bit, without adding or losing any weight. My visceral fat score has remained low.

Now, in your trimmer state, are you able to do more - long walks, gardening or other forms of exercise, that you were when heavier? Even if you don't, your joints will thank you for being lighter, which increases of changes of maintaining mobility, which I view as a key link to maintaining independence.

Some folks in older age find their appetites lessen a bit, but then they are could also be doing less and thereby realistically need less to maintain.

There are so many factors in the "old age thing". For me, I'd rather be an ancient whippet than an ancient bassett hound.

Each to their own, but be aware, few of us who have reached a point of remission know when that trigger point was (into then out of diabetes) was. Professor Taylor states he finds there is no universal BMI/weight or whatever that signifies "too fat", the but it does appear we have personal, but very difficult to pinpoint, weight/visceral fat point that renders us "too fat for OUR body".

Were you asking for it, my guidance to you would be to go into, or continue with a period of maintenance, after all that's the hard bit - maintaining those healthier eating patterns to protect our bodies. Nodoby benefots from going through the yo-yo of lose<>gain<>lose<>gain with weight.
If you want a really good MOT, then either ask your doctor for one, or volunteer for some research. There is a marvellous study running in the midlands, albeit focusing on cardiac health in those with T2 diabetes (criteria are an historic diagnosis of T2 and no confirmed cardiac failure). During that research project you have an amazing cardiac focused MOT, but the benchmarking covers many areas and tests.

Many interesting points here, thank you. My activity is quite good at the moment so although I do look very skinny I can do quite challenging physical tasks. I shall look into the research project you mention.

 

[chrisjohnh]

Some years back I also went really low carb and also went into remission. I think I went down to around 50kg, although I wasn't big before. My blood glucose level was great. Think maybe similar to yours. However, I was later found to be anaemic so had to stop the diet. Don't think the diet was the cause but quite likely exacerbated it greatly, even though I was careful to include iron rich food. I personally didn't like being so thin. I can't go back on that diet anyway as the anaemia problem has not been resolved. I'm now on tablets, insulin and a sensible diet and exercise. I'm still slim but not thin as before. I think it is very much a personal choice of how you feel as it is your life to live. There does come a time with some of us where insulin supply drops even for Type 2, so management without aids becomes much more difficult. It depends on how far you want to go. I'd say, if your happy with the way you look and feel then keep going with your diet. I'm 70 by the way. I've not heard of being low weight leading to an earlier death. I do think as you age you have to be aware of brittle bones and muscle atrophy though.

And very helpful observations here too, thank you. There are so many health reports out there of a disconcerting nature, and so lacking in consistency, that it’s possibly best not to be much swayed by any of them and, as you say, just set and adhere to one’s own lifestyle goals. The fact that insulin secretion can decline with age is a gloomy thought but then most other bits of oneself are also declining, and we can’t know which will eventually dominate and kill us off. Life!

 

[AndBreathe]

Many interesting points here, thank you. My activity is quite good at the moment so although I do look very skinny I can do quite challenging physical tasks. I shall look into the research project you mention.

There's some info here, but you can PM me if you want to know anything further.

 

[bulkbiker]

I have read in various places that, for a 75 year old, this is likely to make me die quite a lot sooner than if I were 84kg, having almost no fat reserves and probably a much weaker immune system. Stroke recovery, for instance, would be much poorer for me than for those carrying a good deal more weight.

Surely by making yourself healthier you have reduced the risk of stroke greatly?
I'd guess that even at a BMI of 21 you will still have thousands of calories of stored body fat.

 

[chrisjohnh]

Surely by making yourself healthier you have reduced the risk of stroke greatly?
I'd guess that even at a BMI of 21 you will still have thousands of calories of stored body fat.

Well, the probability should be reduced, but in the event of it happening the penalty might be greater, so the risk (as a product) may or may not have increased. I am interested by what you say about stored fat, I think I’d been wrongly assuming I’d driven it to near zero. I just don’t know enough human biology. Must read more! Thank you.

 

[bulkbiker]

Well, the probability should be reduced, but in the event of it happening the penalty might be greater, so the risk (as a product) may or may not have increased. I am interested by what you say about stored fat, I think I’d been wrongly assuming I’d driven it to near zero. I just don’t know enough human biology. Must read more! Thank you.

There a very interesting video from Zoe Harcombe at the PHC conference I think in 2017 or 2018 where she explains that a fit athlete carries about 40,000 calories in their body fat.. an obese person about 400,000 ( at least I think they were the numbers)
I'll try and find it for you.

 

[Mbaker]

Dr Gabrielle Lyons discusses and has seen first hand the importance on muscle mass during our mature years. This does not mean an Eddie Hall training program. You are clearly with your results and concerns motivated. My in-laws started a program in their 70's and 80's just before the first lock-downs (sadly stopped now), but it is possible to build muscle with consistency.

 

[chrisjohnh]

Dr Gabrielle Lyons discusses and has seen first hand the importance on muscle mass during our mature years. This does not mean an Eddie Hall training program. You are clearly with your results and concerns motivated. My in-laws started a program in their 70's and 80's just before the first lock-downs (sadly stopped now), but it is possible to build muscle with consistency.

Mmm, thank you for pointing me there, a whole new range of considerations to think about. I have just watched one of her presentations on this. Very many thanks.

 

[chrisjohnh]

There a very interesting video from Zoe Harcombe at the PHC conference I think in 2017 or 2018 where she explains that a fit athlete carries about 40,000 calories in their body fat.. an obese person about 400,000 ( at least I think they were the numbers)
I'll try and find it for you.

Thank you very much for this reference, I have just looked it up (was 2018), and I will study what she says about all this.