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Doing the Newcastle

MikeTheFid said:
I am brand new to this site. I have Type 2. I have been following your diary here because I am very interested in the ND. I am very impressed with your discipline and knowledge and wish to offer you my sincere encouragement.
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If my experience is anything to go on, it is well worth doing. Loads of positives and the only negative I can think of is that you're on a restricted diet - what a tiny price to pay for the better BG control, reduction in secondary complications, weight loss, reduction in meds, smaller clothes... Of course, the biggy is whether or not the condition can be put into remission or even reversed. That's a long-term thing but I think even the short-term gains easily justify the effort. I've tried all sorts of things over the years but that initial shocking of the liver with very low energy intake is what marks this out as different - and for me, the first time I've seen something really effective straight away. Best of luck if you have a go.
 
Week 7 Day 46 Thursday 25th January. FBG 5.2 Weight 98.4kg

Weight and blood almost completely stable which looks as though the tendency for weight loss caused by the energy deficit is exactly balanced by the tendency for insulin to deposit fat. But another possible explanation is that I am still losing fat but also building some muscle back up. Of course it could be a bit of both. So no change of plan until I can see what's happening to the weight. It still seems to be heading down albeit slowly. Just staying patient a little while longer before considering a further small reduction in the meds. Only ten days till the end of the diet though I'll give it another week to make up for the lost week when I reduced my meds too much and stalled everything. Light at the end of the tunnel.
 
@AlcalaBob You need to consider what you will do next, and how to direct your great commitment.

Given you have been limiting corries and not eating real food, I expect you would enjoy something very different. Two options that come to mind.
  • “The New Atkins for a New You”, while allowing yourself to eat as much of the foods in each stage of the diet as you feel like. (Eat small meals slowly, repeat the meal if you wish after half an hour.)
  • Or something really radical like the “egg and steak diet” when you eat as much egg and steak as you feel like. Each meal should be a small steak and no more than 2 eggs, if you feel like eating more after 30 minutes, you can repeat as many times as you like. (Green veg or green salad are allowed but optional, homemade burgers from 20% fat mince can be used instead of the steak.)
It’s likely that the liver fat you have lost doing the ND will make either of the above much easier than it would have been before you did the ND. Given the great skill you have in adjusting your insulin dose, either could be combined with 23hr fasting, or restricted hours eating. I expect that either will result in kick-starting your body metabolism back up to a faster rate.

Whatever you do, expect to regain at least a little weight, most people do after the ND, this may just be water weight. If you decide to go back to normal food, aim to eat about 1/3 less then you did before the ND, and to limit most carbs.
 
Thanks @ringi, that's incredibly useful practical advice. I have been a little apprehensive about what comes next. I think I'll be sticking mostly to the ND for at least another month or so to keep the weight coming down to my target (but I won't keep posting each day) and it'll be interesting to see how much of my previous low carb diet will still work. We have some of the best steak in the world here in Andalucia and it's on my 'must do' list but we also get fresh prawns and langostines which are quite a delicacy. I'll stop salivating now over the thought, and just thank you again.
 
Some people decide to keep to the ND for a few days a week, with real food on the other days, for example, start with having real food every third day. The risk of doing the ND for too long is that your metabolism keeps slowing down, you will have already read about this in Dr. Jason Fung writings. (The problem is that there is little research on people using low-calorie diets for longer than about 8 weeks, so we just don't know when it becomes an issue. Clearly, on moderate (high carb) calorie control diets, it is an issue for most people with insulin resistance.)
 
Week 7 Day 47 Friday 26th January. FBG 5.8 Weight 98.2kg

Quite funny that seeing a high five for the blood now looks a bit odd. Just a couple of months ago I would have been over the moon to see a number that low. I suppose it shows how much more control I have these days. It's convinced me to leave the insulin level as it is as there's still some small weight loss. Psychologically a 97 would be very welcome - maybe over the weekend - as it puts the target of 96 within reach. For me, despite all the other progress, 10kg weight loss has become something of a success indicator and I feel I need to get there. I'm sure I will.
 
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Week 7 Day 48 Saturday 27th January. FBG 5.6 Weight 98.2kg

Everything very stable. I had only about 700 calories yesterday but didn't dwell on it because I was very busy. I've found that keeping busy is quite important, and doubtless helps metabolic activity and mental attitude. I am starting to notice a bit of hunger now and again which I haven't had since the first few days of the ND and I'm wondering if it might be psychological, anticipating going back to some real food. That'll be in two week's time at the end of week 9 but I'll still keep the calorie count way down to lose the rest of the weight. My target is still 86kg but it'll be over the next few months.
 

Lower fbgs, returning sensation to feet, loss of body fat - all good, congratulations!

I'm no longer doing the ND 'with you' I'm sad to say. I quickly realised that, yes, after 2-3 days you start to feel good and I was even going on 1 hour walks in the evening. But I didn't feel I had the energy (nor would it be safe) to go on bigger walks at weekends and certainly not into the mountains.

I've started the 5:2 fasting idea, and already had my first 600 calorie day (all in one go) with no further calories till the next morning. Went well, and by the evening my bg was down to 3.7. A bit scary, so rather than go to sleep on that, I lifted some kettle bells just to see if my liver remembered what to do when bgs get low - it probably hasn't had to cope with that situation for years! Sure enough it climbed again. Went to bed, and woke up with a 3.9. Previously, I'd been getting similar fbgs to you.

The diet is LCHF and I'm aiming to quickly transition to keto, so it will be a 5:2 keto diet.

All I know so far is that, after the fasting day, then a couple of days of normal feeding (I did calorie count, and hit about 2,200 each day), I then had plenty of energy for a big, strenuous (i.e. often steep) walk lasting 5.5 hours. Felt very good at the end of it.

Obviously fasting isn't a great idea if you are on insulin, but you seem very in control and able and willing to switch the parameters, so just letting you know, as someone in a similar position to you, that there are other options to explore if you feel you've exhausted the potential of the ND at any point. I've never seen an fbg of 3.9 in the morning until I tried fasting. I'm hopeful the approach will lead to weight loss also, the idea being that the full-calorie days keep your metabolism up, plus will enable me to do the kind of hobby I enjoy which happens to burn a ton of fat.

I wish you continued improvements till the end of the ND, and with whatever you try after that!
 
Very good luck, @AdamJames, with your changed diet and thanks very much for encouraging me. What you're doing makes very good sense to me because you have to have the energy to do what you want. I suppose I've scaled down my energy expenditure though I still do a very hilly walk every day, but only about 30 minutes or so. And yes, anything more would probably floor me. I did once try fasting just for a day without reducing the insulin and generated a hypo so it wasn't a smart thing to do. I guess if I was taking metformin instead, since it doesn't produce hypos, I'd have been OK. Adjusting the insulin during fasting would necessarily be tricky which is presumably why Fung supervises his patients closely when introducing them to this. I'll certainly have a look at the LCHF diets.

As I come towards the end of the ND, I'm very positive about my level of control now. I can adjust my diet sensibly and I could always repeat a phase of ND dieting at any point. Since the liver will have recovered a lot of its sensitivity, and since the pancreas recovery takes longer, repeating the ND is a clear option but there are now many different ways of getting there. Thanks for your very helpful suggestions and all the best for your future recovery.
 
With fasting, Fung gets people to first reduce their insulin so their BG is in the high single digits, then reduces insulin more to keep BG up to that sort of level. He considers that the risk of BG at those levels for a short time is much less than the benefits from fasting.

Unless you are willing to "be high" at the start of fasting, I can't see a safe way of controlling insulin while fasting.
 
Yes, I agree. The problem I see is the difficulty assessing the appropriate reduction in insulin. Fung, with his extensive clinical experience, has a lot of case histories to draw on. For someone like me, it would be rather hit and miss. It would probably be possible for me to figure it out bit by bit but I think it would be fairly bumpy. I chose the more gradual route of maintaining lower weight loss with insulin set at a sufficient level to keep low BG. I think the end result should be the same and I hope to reduce the insulin over time if/when the pancreas recovers functionality. The weight loss would probably be quicker with lower insulin and fasting but without some medical monitoring like blood tests at least weekly, which I don't have, I wouldn't have the necessary degree of control. I can see the benefits of Fung's approach but I can't sensibly follow it myself. This insulin business makes it quite a bit more complicated to control.
 
I expect you could just not take the insulin the night before a fasting day, and not take a dose while fasting, clearly monitoring your BG carefully. By doing a 23hr fast with the meal before bed, you reduce the risk of an overnight hypo.

But the other set of experts on very low-carb is against fasting, due to the reasons you list. However, I like the concept of skipping (or delaying) breakfast, so as to increase the length of the overnight fast, but only if it does not result in having a snack.
 
Week 7 Day 49 Sunday 28th January. FBG 5.4 Weight 98.4kg

It looks as though my energy expenditure / metabolic rate pretty much balances the energy intake since there's little if any weight loss. That might mean I won't lose more weight without reducing the insulin further and that depends on if/when my pancreas begins to recover more functionality. That in turn, of course, means accepting higher BG during the process without any guarantee that after all this time it can recover. It's a sort of metabolic catch-22. The other variables are increasing energy expenditure which will leave me very tired, or reducing intake even further - ditto. The fasting option suggested by @ringi has its own factors to take into account. So all in all, it's quite a complicated set of decisions at this point. I think I'll stick with my current insulin level and simply try missing a meal. As I'm on slow-release insulin, it's more difficult to attempt an adjustment of dose to match a particular event so it's test sticks and being careful. If that leaves me too tired, the next option will be dropping the insulin a couple of units - not enough to bomb the FBG. Small changes seems to be the best option.

I'll see my GP in a couple of weeks though I'm not optimistic that he'll be all that supportive. My, perhaps cynical, guess is that he'll just say well done, weight loss and a bit of exercise improves your BG. I'm translating some Taylor materials to give him and I hope he'll take it seriously. In any case, in the end it's our responsibility to manage the condition.
 
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Agreed. As I'm on slow-release insulin, not taking a dose isn't really a workable option. I tried that a few weeks ago with poor results. I couldn't sensibly depend on the pancreas recovering functionality to compensate. That's a clinical judgement it's difficult for me to take without medical support. I like the idea of meal-skipping so I might give that a go. Thanks for the advice. Appreciated.
 
Week 8 Day 50 Monday 29th January. FBG 6.0 Weight 98.0kg

Into the last week finally. Slight blip with the BG but otherwise all good. It would be nice to hit a 96 this week but not the end of the world if it takes a little longer. I'll stay on the ND until the end of week 8 and then take stock of the overall process and what I've learned from it, then plan a careful transition to real food again. Once I know I can keep stable BG and weight with real food and my current meds, I think I'm likely to repeat the ND in the near future as a means of further weight loss but this time I won't log the results here. I'm in a much better place now than I was seven weeks ago, so thanks everyone for the support, encouragement, information and advice. It's not a walk in the park but you guys have made it a lot less arduous for me, so thanks.
 
This business certainly isn't a walk in the park, is it?

Since abandoning the ND and going VLCHF and doing a ton of walking this weekend, I haven't lost weight (well it's hard to rely on measurements just on a 3 day period, but it's gone up a bit according to the scales, as has my stomach girth!).

I did all the exercise I wanted (it didn't feel like exercise, it was just doing my hobby of walking in the hills), which added up to 10 hours, and tried the idea of eating all the VLCHF food I wanted, regardless of calories.

It turns out, I find fatty food just as moreish as carby foods. Plus the classic thing happened - I naturally over-compensated for the exercise.

A crude estimate of calories burned was 10,500, and my food log (I counted calories, just didn't let that dictate when to stop eating) says I had 11,700 calories.

I just thought, as someone who was doing the ND with you at one point then switched to a different approach, you may like to know that you still have a partner in crime struggling to lose weight! I don't think there are any free rides, just approaches that may or may not suit our lifestyles / biologies better.

We will get there in the end, by fair means or foul!
 
Week 8 Day 51 Tuesday 30th January. FBG 5.6 Weight 97.8kg

At last, a 97. Down another kilo and it'll be almost there, half way to my target weight. I have to confess I'm generally feeling pretty tired much of the time now and I think it's the result of a sustained energy deficit. If I had to continue on this regimen for another four weeks, I'm not sure I'd do it without some additional intake, simply because of feeling too tired overall. Mornings seem to be fine but by early evening, it's catching up with me. I've spaced out the intake and even pushed it to 40:60 morning:evening and I haven't missed any meals. It could just be psychological but I think not. It's likely to be the consequence of the insulin since that influences the energy available for metabolism.

When there's an energy deficit but also lots of insulin, the body can respond by cutting the metabolic rate. This is actually an interesting demonstration of the falsity of the energy in = energy out line of thinking, the one that says obesity is the result of gluttony, sloth or both... So eat less, exercise more and you lose weight. Nope, not so simple. Still, I'll stick with it until the end of week 8 and then gradually substitute in some real food. Looking forward to that point but want to see a 96 first.
 
I’m drinking my breakfast in Starbucks this morning and scrolling through your thread to catch up. When I saw your last entry I let out a gasp of surprise and joy for you. Those weight loss milestones are just the thing that keeps us going.

I can fast for over a week with no problems but the ND will be such a challenge and I wanted to tell you that your posts help me no end. I’m another T2 with raging insulin resistance that keeps me in the overweight category. My BS are perfect, but only just and I survive on very little food/energy intake, to lose more weight I need to maintain levels that would starve another human.
10 years in June and I’m still learning.

Will you carry on posting after you’ve finished ND?
 
@wiflib, it's very good to hear that and congratulations on taking and keeping control. I think few non-diabetics can really understand quite how difficult a struggle that is. I think the tiredness on the ND might be a significant factor for some people, especially those who need a certain level of metabolic activity to function effectively in their daily lives. I'm retired and so I can simply customise my level of activity but many people are not in that position.

During the last seven weeks or so, I've had to understand much more clearly how the insulin affects weight loss and metabolic rate and I've had to effectively calibrate my dose to permit some weight loss without losing BG control. The overall effect is that it has reduced metabolic activity, particularly towards the latter stages of the ND. For me, it's a price worth paying for the duration of the diet. According to Taylor et al, it's the reduction in weight that is crucial for giving the pancreas a chance to recover so that in turn places very tight constraints on what can be eaten. If/when my pancreas recovers, then I'll be able to reduce the insulin some more which will facilitate further weight loss but increasing energy intake to reduce tiredness would possibly stall the process. Since this is a long-term programme for us long-standing T2s, I'm not keen on accepting any raised BG levels so I'm looking for a balance that works all round.

So for us T2s on insulin, we need to carefully manage the process so that we maintain a negative energy balance sufficient to provide some weight loss but without too much tiredness. It's a long-term trade off which I think you've achieved admirably. If/when the pancreas recovers, energy intake can be increased without loss of BG control, then we're laughing! Your story is quite inspirational and thanks for sharing it. It really helps me make sense of what I'm seeing in my own case.

I don't know about continuing to post after the end of my ND but I'll certainly check in from time to time. The regular postings were partly to give me a discipline and keep me focused.
 
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Let's remember that none of this affects anyone who has only had Type2 for only a few years, and is not using insulin. There is a reason that the most recent ND study excluded most people who have had Type2 for a long time. (They are wanting to get big wins by improving the BG control of a lot of people with Type2 before they need costly health care and insulin etc.)

@AlcalaBob I am very impressed with your level of commitment, most people would have given up long ago.
 
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