Doing the Newcastle

ringi said:

This has not been researched enough, but it is possible that adding some olive oil or coconut oil would increase weight loss by reducing the metabolic slowdown.

This is one of the reasons that I would love to see how you got on with a diet like "A New Atkins for a New You" once you have had a break and increased your metabolic rate. Maybe even do a week or two of a "fat feast" to see if it quickly increases your metabolic rate.

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Forgive me but I always feel the sceptic coming over me when I hear suggestions about various substances like olive oil, coconut oil, etc, affecting the metabolic process. I'd have to question the concentrations required, the magnitude of the effect, the circumstances under which the measurements are taken and which ones are thought to be significant and why, and so on. Although I don't completely dismiss the anecdotal side of evidence, I do give it a lot less weight than controlled trials and good explanatory scientific mechanisms and as yet, I haven't seen anything that really strikes me as solid evidence that these things work, nor any plausible biochemical explanation of why they might work. I could try a whole host of possible substances on an ad hoc basis, including vinegar, cinnamon, etc which have also been suggested, and many people do, but unless there's some plausible scientific basis from properly controlled trials, I'm not going down that route because it wouldn't really tell me very much. I'm going to stay focused on losing the rest of the weight. Having said that, if enough people report their own empirical evidence of efficacy of these approaches, then that should stimulate more detailed and controlled research. Maybe the ND will stimulate clinical scientists to start researching some of these important ancillary topics.

ringi said:

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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Yes, that's true. The Counterbalance trial did include long-standing diabetics, hence the discovery that the remission and recovery rates were lower for that group. But it's clear that clinicians would want to focus on the group where there's the most chance of success. I remain guardedly hopeful about my own case but have to recognise that the odds aren't all that good.

Week 8 Day 52 Wednesday 31st January. FBG 4.6 Weight 97.6kg

Weight continues to creep downwards and the blood is good so this looks like a workable level of insulin for me at present. I'll stick with it till the end of the week now and see where we end up. Hopefully I 'll see a 96 figure and that would mean around 10kg of weight loss over the eight weeks. Only half my overall target loss but still something I can be pleased with and the blood is stable with 4s and 5s.

ringi said:

If you read “The Art and Science of Low Carb Living” book you will see details of a lot of studies that cover this, however, I know none that are done with a very low-calorie diet.

There have also been other studies that have shown a reduction in weight and improved A1C for people who were asked to have a few tablespoons of olive oil a day. This study gave both groups of people the same standard diet advice, but half the people were also told to have the olive oil. (Coconut oil had a bigger effect then olive oil in a recent study, but it was very short-term and small scale. The leading low carb experts think coconut oil is as good or better than olive oil)

Sadly the people who research “very low-calorie diets” will not work with the people who research “low carb” diet. There has also so far no funding for large high profile studies of “very low carb” diets to reverse Type2. The small-scale studies show results that are at least as good as “very low-calorie diets” along with more people being able to stick to it long term. But the “very low-calorie diets” shakes makes it easy for people by removing the need to think about food, hence they also get good results.

“Fat feasts” where you eat a lot of fat for a few days (no more than 2 weeks) seem to work well for very motivated people who have found that their current diet has stopped working for weight loss. Hence they will never be able to be tested in a formal study.

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Yes, for me this stuff isn't really worth arguing about but it does touch on some important issues. As I said, I've seen no scientific evidence that these things actually work though I have seen many 'scientific studies' making such claims. Even reputable scientific journals have published low grade studies that purport to provide evidence but when you look at these papers, they are often uncontrolled, not randomised, small sample size, based on questionnaires, and often use unjustified statistical techniques. Frequently they give inadequate information about the composition of the samples and also about the regimen followed, the compliance rate, and so on. I don't doubt the benefits of low carb and even very low carb diets but the diet industry frequently makes unsubstantiated quasi-scientific claims and I'm concerned with distinguishing those that are actually justified from those that aren't, those with serious science behind them and those that are unwarranted.

Over the years, I have had occasion to read in some detail literally hundreds of clinical papers and there are some things that tend to stand out which indicate poor science, such as those I mentioned above. As in your example, if two groups in a study differ only in that one group had a few spoonfuls of olive oil a day, how is it ensured that they did nothing else different, that that difference is the only difference? Are there other influencing pertinent differences not controlled in the study? If that can't be assured, no claims can be made from the trial about the efficacy of the olive oil. It's mainstream methodological issues like that that cast serious doubt on these studies.

If these things work, great, there'll be accumulating high grade evidence on the way. But I think it needs a well-controlled serious scientific study before these claims can be taken seriously and, as I said, I haven't seen any that come close, and I do generally make time to look. One point I would make is that you can spend a lot of time trying to chase down the references cited in books by Fung, Mosely, Taubes, and other dietary authors (and I've done some of that) only to find that either the paper doesn't make the claim asserted, or else that there are very many scientific caveats making the claim much less secure. Often you simply can't read the text of the paper because it is behind some journal paywall. I've also come across cases where a paper (in this case cited by Lustig) didn't actually support the point being made but its opposite. It's quite hard work checking up this stuff and of course we have limited access and time, let alone the challenge of the content, to deal with. I think the best we can do is to be careful and critical of claims that don't have a reasonable explanation and to demand high quality evidence before accepting them. I'm willing to be convinced - by the science.

Of course @ringi and @bulkbiker, sorting out the evidence is no easy task, and I'm sure we all realise that there are serious difficulties in designing this type of research. Everyone is, I'm sure, well aware that clinical studies are not physics experiments (though you might be surprised by how similar the methodological issues are in practice) but if you look at the design of randomised, controlled, double-blind studies you'll see how serious attempts can be made to address the methodological issues that face all trials involving people. The quality of that work to address the methodological issues is precisely what distinguishes the serious quality science produced by scientists like Prof Taylor, and the reams of lower quality papers that aim to show, for example, that A is 'statistically associated with' B. We can all recall the very many books urging us to eat low-fat diets, to eat less and exercise more, which had pages and pages of such references, often lamentably published in mainstream scientific publications. How easily 'is associated with' became converted into 'causes'. Scientific papers should, like all evidence, be treated skeptically and evaluated critically. Not easy to do, of course.

The conclusion I draw is that the volume of the references cited is no guarantee at all of the quality of the research or evidence, or even of the presence of any evidence at all. A few well-designed trials can can provide all the hard evidence required whereas reams of papers may never provide anything substantial at all. We have no choice but to assess the claims and the evidence for ourselves, and sometimes that means reading these papers and critically evaluating them. Of course, not all of us are in a position to do that, but we all do the best we can. I've done quite a lot of that (but never enough) and believe me, it is not easy, but does help to sort out unjustified claims from those deserving serious consideration.

Taylor produced not just empirical data though, but a detailed biochemical analysis and a plausible mechanism of action, and also a model which could generate testable predictions and he designed trials precisely to test them. He's made that work public. That's high quality science we can have some real confidence in. If someone proposes that olive oil has the properties you have suggested @ringi and produces similar high quality evidence, I think we'd all be convinced. In the meantime... For me, claims don't get off the ground until they have a body of reliable and plausible evidence. I don't discount them, I just leave them in the category 'possible but as yet lacking convincing evidence'.

ringi said:

Because one group was told to have olive oil and the other was not, and the study was trying to find out if doctors should tell people to have olive oil! So the only difference between what the doctors did between people in the two groups was telling them to have olive oil.

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It only makes sense to tell people to take olive oil if the olive oil is what produces the beneficial effect. Unless we can be sure that nothing else they did might have had a similar effect, eating olives for example or perhaps eating cheese or whatever, we cannot conclude that it was definitely the olive oil that had the effect. If the trial cannot show that, then there can be no justification for GPs telling their patients to take it. The actual point of a trial is to establish whether or not the olive oil and not something else has the beneficial effect. We really do care if a GP is giving advice on the basis of nothing more than a hunch. If a GP is offering advice, it has to be based on clinical medicine.

ringi said:

It is possible that the olive oil resulted in people not wanting to eat as many snacks for example, there are also biochemical analysis and a plausible mechanism of action showing how it could be of benefit.

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Agree it's possible, like many things. Equally there are very many possible reasons why people might decide to eat less, participating in a study for example. The question is how to determine if the olive oil claim is true. I've never yet seen any biochemical analysis that offers a plausible mechanism of action, nor can I think of one, so I'll be interested to see that. I'll keep my eyes open for it.

ringi said:

And he says it is the weight loss that is important, with the loss of fat from the liver being the first stage of reversing Type2. His trails proved nothing about "very low carb" compared to "very low calorie" as he was not testing it. He also only included people who show the level of commitment needed to do his diet.

He proved 100% that type2 is reversible and what the biochemical process in the liver etc is. As to getting normal people to remove fat from their liver, Dr. David Unwin gets better results, yet no one will fund a large-scale study to see if Dr. David Unwin methods come be repeated by "normal" GPs. (The most recent ND study showed that the shakes works when used in a GP setting with committed people, but only compared them to the hopeless current NHS standard of care.)

Until governments are willing to fund studies to the same levels as drug companies we will not get large-scale long-term studies on diet. Even then most studies on drugs are not repeated by independent teams.

The one hope we have for a large-scale set of results is Virtahealth who is a USA company doing medically supported low carb based on "payment on result" calculated on the savings on drug costs. But all their results will prove is that they are 100 times better then what most doctors are doing at present, it will not show their way is best, or what works best for people without that level of medical support.

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Totally agree. There are a number of tracks of very good clinical practice getting very positive results but mostly starved of funding and support. You can see why drug companies would be less than enthusiastic about supporting treatments that potentially reverse diabetes and don't involve increasing medication... Almost every source of evidence would be viewed very dimly by their accountants...

bulkbiker said:

More like 46% maybe? I know what you are saying but it wasn't exactly a universal success was it?. And only down to pre-diabetes levels.
And yes I know I am a ND sceptic and will freely admit it. I really do doubt the results will be maintainable long term.
@AlcalaBob I am however full of admiration for your determination and approach.

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I really think you are absolutely right to be skeptical, especially about scientific claims. It's the only healthy attitude to these things. And I think you're right, that the ND trial success was around 46% of his sample of patients. It's hard to generalise across a population without large-scale trials and even then there'd have to be caveats. In terms of success though, given that us T2s are told we'll never overcome the condition, that it will inevitably worsen, that we will end up with secondary complications, showing that a sizeable group of patients can see the condition reversed and even disappear is, to me, a resounding success. Universal? No, not yet, but Taylor has identified the mechanisms, and demonstrated an effective treatment in close to half of patients provided they can stick to the protocol. That alone ought to get him a Nobel Prize.

I'm a hardened skeptic, scientifically trained and also with a lot of years of studying scientific methodology and the philosophy of science, but I'm also a T2 who was told simply to accept it and just take the pills, so naturally I come to these things with relatively low expectations. I've been through the diabetic mill but I have to say, Taylor's work is the first that I have come across with clearly justified grounds for optimism. And my experience so far has confirmed that. There are lots of clinical studies pointing in the same direction, but Taylor gives the biochemical reasons, as Fung acknowledges. I'm sure there will be other approaches consistent with the twin cycles hypothesis, that produce the same or similar effects and that will give rise to a range of treatment regimes converging on the fat reduction. It looks like the long-term outcomes, once the diabetes is overcome, are very much determined by life-style choices and control of our own food intake and that's not really down to the ND or any specific diet. I tend to think of the ND now as just one way to take the necessary step to getting diabetes under control and in reversal.

It's true that I am very determined to get the results but I think that's because of years and years of serious consistent attempts at various diets and medications which have failed. It inevitably left me despondent, angry, frustrated, but also determined to pursue it. I haven't failed to follow instructions, or dropped out, or cheated, or stuff like that. These approaches have simply failed for me. I now see that they had little or no chance of success because they were based on an inadequate understanding of the science of diabetes - they were largely addressing consequences and not causes, and not even those effectively. On the one hand, nothing previously had worked, and on the other, this was very solid science from Taylor. And it's clearly working so far for me. It's not yet the complete answer but I think we'll now see a lot of collaborations and an opening up of the science. It should get public funding because no pharmaceutical corporation will want to turn off the money tap of diabetes medications.

I think you should remain skeptical. Skeptics are absolutely vital to helping us make sense of all this stuff.