Doing the Newcastle

[ringi]

I have been thinking about this over the last few days. As well as slowing down weight lose, by using “too much” insulin you risk starving your body, as you are preventing it from using your fat stores. This can result in your body reducing your metabolic rate, and hence using less energy. (Your metabolic rate does not automatikly increase at the end of the diet.)

This is the reasons that most people with Type2 can’t keep up weight lose with moderate low fat diets, as their body just reduces energy usage to match the calories they are eating. (But high protein diets increase metabolic rate, hence the level of protein in the shakes, and the rapid weight lose limits the time the body has to reduce metabolic rate.)

Exercise also increases metabolic rate, even a 10 minutes’ walk has been shown to increase the metabolic rate for a few hours. Resistance training and HIIT have been proven to have the greatest effect.

As too “what is too high” for BG, Professor Taylor says in some of his information for doctors that he relaxed about BG of up to 20 (due to stopping drugs with a risk of Hypos) provided they come down within a few weeks. Dr. Jason Fung says that people should reduce their drugs/insulin to get close to 10 before starting fasting, as us to reduce the risk of Hypos. There is no good evidence yet to base this on, but personally above 10 makes me think that action should be considered, and above 20 makes me think that action should be taken within hours. (With much lower levels if someone is not on a radical diet, and hence in a “steady state”.)

Stopping all insulin at the start will give the “mother of all liver dumps” along with the effect of the high sugar shakes! Dr. Jason Fung seems too often start people by halving their insulin and getting them to do a 72hr fast with bone broth. (Remember the ND is closer to fasting then it is a normal moderate diet.) It’s a real shame that there are no low carb shakes on the market, as it would make it a lot easier for people to adjust their drugs/insulin in the first few weeks.

 

[AlcalaBob]

But we know about the power of low carb and "eating to your meter" to retain the level of control and stop regaining the weight. If only Taylor promoted the same methods for poeple who had complete the ND........

Pretty sure I've seen him saying things very close to that in an interview. I remember him mentioning occasional fasting, low carb, and checking levels regularly to ensure good overall control following completion of the diet. I guess he's more concerned with passing on information to GPs and clinicians, getting his research recognised, and focusing his efforts on where the results can be amplified to affect more people. I don't mind where the message comes from as long as it's backed by evidence and good science. I've been on low carb for ages but never lost enough weight to trigger the sort of change produced by the ND so perhaps the message needs to be more nuanced and backed by trials data and a good explanatory theory. Room for everyone I think as long as they respect the science.

 

[ringi]

I recall he has saying the above in responce to quesions at his talks. But the guildance for the lastest study talk about the "Eatwell Plate", I expect due to him not having proof that other options are good.

 

[ringi]

ost enough weight to trigger the sort of change produced by the ND so perhaps the message needs to be more nuanced and backed by trials data and a good explanatory theory. Room for everyone I think as long as they respect the science.

Virtahealth is getting great results helping people with Type2 on as much as 400 units of inslin, get drug/inslin free using VERY low carb with a high level of 24/7 "GP" surport. Their first year results are due to be published soon. I think the issue is that protain needs to be limited as well as carbs being close to 0, and that can't be done without increasing "good" fats, and hence is very hard for most people without surport. (I just need to advoid most carbs to get good results, so have it easy.)

 

[AlcalaBob]

Virtahealth is getting great results helping people with Type2 on as much as 400 units of inslin, get drug/inslin free using VERY low carb with a high level of 24/7 "GP" surport. Their first year results are due to be published soon. I think the issue is that protain needs to be limited as well as carbs being close to 0, and that can't be done without increasing "good" fats, and hence is very hard for most people without surport. (I just need to advoid most carbs to get good results, so have it easy.)

It'll be interesting to see those results. With such a dramatic change to the diet there must be a fairly high risk of hypos initially. Perhaps that's why they need the GP support 24/7. It would be interesting to know the occurrence of hypos. It would certainly shock the liver into dumping its lipids but I wonder what it does to the patients over the first few days. Still worth it if they end up in remission or even just re-establish very good control. Have to say I'm glad I didn't go through that draconian process.

 

[ringi]

Nearly everyone doing very low carb, started with "no sugger", then went into "low carb", before going onto "very low carb". The risk of hypos is no more then with the ND, but very few doctors would consider the ND for anyone with Type2 using that level of inslin.

Remember you have the skill to measure your own BG, and control your own Inslin. In the USA it seems often that the doctor increase in inslin dose as the A1C is bad, and then the "vitim" increases the carbs due to Hypos....... (With no training to improve the understanding the "vitim" has of what is going on.)

 

[AlcalaBob]

I've just noticed that my levels during the day are a little lower than the equivalents yesterday and that's with 20 units of insulin compared to 30 yesterday. Cutting the insulin hasn't pushed the levels up. I'll see what the FBG is tomorrow morning but unless it's high, I'll stick to 20 units and then see about dropping it again later in the week. It's clear that I have much less need of it. I was expecting the levels to be up so I'm very pleased about that. This is the best confirmation that something really has changed in the way my liver functions.

 

[NewTD2]

Fabulous!

Happy New Year!

 

[ickihun]

My bgs were far better on low carb eating on insulin and I too lost weight as I could reduce my insulin need.
Unfortunately not enough to get rid of my huge insulin needs. How much toujeo300 are you now needing?
On low carbing I only needed 50-60units of novarapid but 72units of toujeo300.
I'm now on 53units toujeo300 and 80-90units of novarapid due to xmas carbs, which was only increased to prevent very high bgs. I've added a few lbs on xmas extra insulin for carbs.

I'm enjoying your thread. Well done. Keep going.

 

[AlcalaBob]

Week 4 Day 25 Thursday 4th January. FBG 7.1 Weight 101.1kg

No surprise that the blood is a little raised but I'm pleased it's not raised by much. As my wife just told me, I'd have been delighted with that number just six months ago. I dropped the insulin from 30 units to 20 units yesterday but the FBG only went up by 0.4 so although it's confirmation that the insulin dose is having some effect, it's also clear that it's a small effect. Which also confirms that the liver insulin sensitivity is a lot better. So I'll keep the insulin at 20 units for a few more days. I was on 56 units plus metformin and vildaglyptin at the start so I'm still very pleased with the progress - the only medication is now the 20 units. I suspect that the weight loss is stalled at present because of the continued presence of the insulin so unless the BG rises 'too high', I'll cut the insulin some more. Hopefully that will enable the weight loss. I think, as @ringi says, my metabolic level has probably dropped to compensate for the lower energy intake. I don't feel tired or out of energy, and I'm still maintaining the same activity level, but it's the most likely explanation of what's going on. Still very positive and totally committed.

 

[Tabbyjoolz]

@AlcalaBob - wow! Just wow! I am so impressed with your commitment and patience, especially with calculating your insulin needs.

Hunger almost drove me to quit yesterday, but it seems to be abating today. I haven't needed my mid-morning cup of miso soup today and I feel quite energised and back on track.

 

[ringi]

A UK GP will not even consider someone to have diabetes unless there FBG is over 7.0 mmol/l, or their 2hr post meal BG is over 11.1 mmol/l, or their average BG is over about 7.8mmol/l (A1C of 48) (In the UK insulin will not be considered unless the levels are much higher. )

Also remember that the ACCORD study found that when BG is control with insulin, aiming for a target A1C of below 6% the long term outcomes where worse when the target was 7% to 7.9%. (A A1C of 7.5% is a average blood glucose of 9.5 mmol/l)

Therefore have you reach the point when you should be radical on the insulin reduction?

 

[AlcalaBob]

A UK GP will not even consider someone to have diabetes unless there FBG is over 7.0 mmol/l, or their 2hr post meal BG is over 11.1 mmol/l, or their average BG is over about 7.8mmol/l (A1C of 48) (In the UK insulin will not be considered unless the levels are much higher. )

Also remember that the ACCORD study found that when BG is control with insulin, aiming for a target A1C of below 6% the long term outcomes where worse when the target was 7% to 7.9%. (A A1C of 7.5% is a average blood glucose of 9.5 mmol/l)

Therefore have you reach the point when you should be radical on the insulin reduction?

Those levels for GPs in the UK are pretty awful as the evidence is solid that FBG of over 6 nearly always leads to secondary complications. I've seen the ACCORD study before and, as I understand it, their results showed that patients treated with multiple high does of medications faired worse than people tolerating a slightly higher BG on less medications. That now fits perfectly with Taylor's analysis because if liver lipid levels are the problem, then even if the BG is reduced using high doses of insulin etc, the metabolic syndrome is still there pushing up the risk factors for CVD and other complications. The increased insulin level is part of the vicious cycle. I know there are other trials that report different results but I'm inclined to go along with the ACCORD results given what I now know about the liver lipids. It just makes a lot of sense in the context of Taylor's results and the Twin Cycles hypothesis, almost obvious now.

I think that if there's no further rise tomorrow in FBG, or only a little, I'll chop the insulin again, probably to 10 and then see if I can eliminate it altogether over the next few days. The thing that concerns me a little is that perhaps I may need to give the liver time to respond. I have little to gain by cutting all the insulin in one go. If the adjustment works, it'll happen in a few days anyway.

Thanks for taking the time to think about this and comment. Much appreciated.

 

[ickihun]

From what I'm taking from these experiences are food preparation or should I say meal preparation and 'broth' are the key to real food ND experiments.

Also @AlcalaBob are you going to go straight onto low carb eating after your ND ?

 

[ickihun]

Those levels for GPs in the UK are pretty awful as the evidence is solid that FBG of over 6 nearly always leads to secondary complications. I've seen the ACCORD study before and, as I understand it, their results showed that patients treated with multiple medications faired worse than people tolerating a slightly higher BG on less medications. That now fits perfectly with Taylor's analysis because if liver lipid levels are the problem, then even if the BG is reduced using high doses of insulin etc, the metabolic syndrome is still there pushing up the risk factors for CVD and other complications. The increased insulin level is part of the vicious cycle. I know there are other trials that report different results but I'm inclined to go along with the ACCORD results given what I now know about the liver lipids. It just makes a lot of sense in the context of Taylor's results and the Twin Cycles hypothesis, almost obvious now.

I think that if there's no further rise tomorrow in FBG, or only a little, I'll chop the insulin again, probably to 10 and then see if I can eliminate it altogether over the next few days. The thing that concerns me a little is that perhaps I may need to give the liver time to respond. I have little to gain by cutting all the insulin in one go. If the adjustment works, it'll happen in a few days anyway.

Thanks for taking the time to think about this and comment. Much appreciated.

I think if gp gets 6s as a result then 3 tests should be done to provide definite confirmation. Like blood pressure tests.

 

[AlcalaBob]

My bgs were far better on low carb eating on insulin and I too lost weight as I could reduce my insulin need.
Unfortunately not enough to get rid of my huge insulin needs. How much toujeo300 are you now needing?
On low carbing I only needed 50-60units of novarapid but 72units of toujeo300.
I'm now on 53units toujeo300 and 80-90units of novarapid due to xmas carbs, which was only increased to prevent very high bgs. I've added a few lbs on xmas extra insulin for carbs.

I'm enjoying your thread. Well done. Keep going.

At the start of the ND I was on 56 units of Toujeo plus vildaglyptin and metformin. I cut the pills straight away but kept the insulin, worrying perhaps too much about liver dumping. In the event, even when I started cutting the insulin, I didn't see the liver dumping. I've been on a low carb diet for years but my numbers were creeping up and even reducing intake didn't change much. I was on around 1300-1500 calories per day and my weight was stuck at 106-107kg when I started the ND and my GP was only interested in increasing meds, so something needed to change.

 

[ringi]

Those levels for GPs in the UK are pretty awful as the evidence is solid that FBG of over 6 nearly always leads to secondary complications. I've seen the ACCORD study before and, as I understand it, their results showed that patients treated with multiple medications faired worse than people tolerating a slightly higher BG on less medications.

There is a more recent study that was done in the UK looking at GP records; it showed when drugs “with no risk of Hypos” where used, lower A1C were always better, but confirmed the Accord results for “drugs with a risk of Hypos” (including insulin.) (Firstly let’s remember this is length of life, so you may decide that not going blind is more important to you then living longer. Long-term higher A1C clearly increase the risk of eye problems. One of the drugs that were common in the Accord study is no longer in use, due to it clearly reducing length of life compared to insulin.)

My take on it, is that drugs that work by lowering insulin resistance are worth it regardless of BG level, but that drugs that work by increasing insulin levels are only worth it when BG are clearly too high.

Hence I am planning to take Metformin for life regardless of how low my A1C gets unless I start to get side effects that negatively impact my qualify of life. Metformin is now even being shown to reduce the risk of censor, and being an old drug has very well understood risks, with the risks being very low unless poor kidney functions.

 

[AlcalaBob]

Also @AlcalaBob are you going to go straight onto low carb eating after your ND ?

I've been on low carb for a long time so that won't change. And I won't be making any major changes until I've seen a lot of weight loss and very stable BG. If that means extending the ND then fine. I don't want to stop too early as Taylor warns about the consequences of insufficient weight loss and levels that are still around 7. I'm focused day by day, week by week at the moment. Worth thinking about it, of course.

 

[AlcalaBob]

Week 4 Day 26 Friday 5th January. FBG 6.7 Weight 101.2kg

Very pleased with the BG because I've been two days on only 20 units of insulin. Earlier in the diet I had levels in the 5s and even 4s but with a lot more insulin, over forty units. Having cut the insulin right down, the BG has not increased very much at all. My weight loss has stalled and quite likely it's because of the continued presence of unnecessary insulin. I cut the insulin again today down to only 10 units and expect to eliminate it altogether this weekend unless the levels rise substantially. With the insulin eliminated, I expect the weight loss to start up again and that would be good news for the liver and pancreas. It's a bit of an uncontrolled experiment but I really can't see a downside. Two more days and I'm half way through the eight weeks. I have almost eliminated all the meds, I have plenty of energy, I'm active and the BG is fairly good. And I've already lost 5kg in weight. What's not to like?

 

[ringi]

One option (and I can't decide if it is a good option) would be to restart the metformin if you can do so without getting the side effects - confirm your GP is happy for you to do so first. I am assuming you are having solid/vag along with the shakes once a day.

Metformin is known to help with weight lose, and is likely to lower FBG a bit, however, it has not been tested to see if it affects the rate of fat loss from the pancreas. (Clearly, it does not stop fat loss from the liver and may even speed it up.)