Fat loss to remission

My sister in law had weight loss surgery to address her T2 diabetes around ten years ago. It went into remission but eventually she developed it again - she worked in a bakery so it was challenging for her to stay low carb! The pre-surgery shake diet she had to do improved her diabetes even before the operation from memory.
As I understand it, when you go low carb, the liver gradually empties itself of glycogen (excess sugar/carb) and burns the fat that's stored there by turning it into ketones. This effect of losing visceral fat, ie: the fat stored around the organs, is what helps people's diabetes improve or go into remission.
Whether you lower your calories significantly as might happen after weight loss surgery or a shake and soup diet, fast, or do a low enough carb diet this same process happens with losing visceral fat. So there's more than one way to skin that cat.
I'm so sorry if you're a kitty lover lol, but you know what I mean, I hope!

My understanding is, all carbs eaten are converted to Glucose, this enters the bloodstream, and the Insulins job is to put that Glucose into any cell throughout the body that can replenish its own store within the cell. The cell converts the Glucose to Glucogen to store it. and converts it back to Glucose when needed. Due to Insulin resistance, many cells refuse the Glucose, so it travels around the body until it gets to the Liver. The Liver holds a supply of Glucogen that it makes from the excess Glucose, this is what it uses to raise our blood sugars when they drop, by converting it back into Glucose and releasing it into the bloodstream. This is the quick energy store.
When the Liver is too full, it has to store it around the other organs, as Visceral fat, this is the stuff that affects our blood pressure, and the effectiveness of the organs it surrounds. Once this avenue is closed, due to too much Visceral fat. It then stores it as Subcutaneous fat, ironically this fats only down side, is the extra pressure on joints and the cardio vascular system due to lugging about so much extra weight.
On a Calorie restricted diet, the Liver will convert fat into Glucose and release it into the bloodstream, so it slowly depletes the store, but as our bodies are burning Glucose as fuel, we get hunger pangs when energy is needed, and we still have the problem of Insulin resistance getting in the way.
When we eat a low enough level of carbs, to enter Dietary Ketosis, our bodies switch to burning Keto bodies as fuel, something we evolved to do naturally, but because we eat too many carbs in the modern diet, they forget how to do this. In Ketosis our Livers convert the Glucogen into Keto bodies instead of Glucose, some Glucose is produced, mainly to satisfy certain brain functions that require Glucose. This is what we refer to as fat adapted. In this state we require very little Insulin, which enables easier access to the fat stored away.
Because there is no such thing as Ketone resistance, our cells hoover up all the Ketones they can, hence oodles of energy when running on Ketones. And since the conversion from Glucogen appears to be quicker than converting to Glucose, we don't suffer hunger pangs. This is probably due to low levels of circulating Insulin.
Thankfully it appears that whichever route taken, either Calorie or Ketosis, the first fat store used, is usually the Visceral fat. This means Blood sugar levels normalise quite quickly, because the Visceral fat is reducing. The Livers store reduces before this, but due to how it works, it's a constant in out, to maintain the day to day running of the body.
This means that"Remission" is reached BEFORE any meaningful weight loss. But takes longer when Calorie restricted, because whilst running on Glucose, the higher Insulin levels restrict the access to the fat stores.
The Subcutaneous fat has no bearing on Diabetes, only the Visceral fat.
When eating Keto levels of carbs, with no hunger pangs, we often find ourselves missing meals, as we simply don't need them, we have loads in store with easy access, so we're often in Calorie deficit by accident.

There's the personal fat threshold hypotheses too. That's where our genetic makeup dictates how much fat we can store safely, i.e. subcutaneously (under the skin). When that storage reaches its capacity, fat gets stored viscerally (around internal organs) which is less safe, which leads to various health conditions, including type 2 diabetes.

Ro9998 said:

I’m not sure that if you’re damaged you can’t always do remission but you just go try health life food. I’m not sure if diet too tough.

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Hi there. Yeah, I've been quite happy trotting myself out as a type two diabetic where dramatic and longterm weight loss has not amounted to remission/reversal. I wish it did! Oh boy do I. But no.

So I must come to the conclusion that I have damage in my blood glucose system that I can't detect. In this case it's probably reasonable to say - it's damage at cell level, as that's pretty all encompassing!

I don't find the longterm LCHF/Keto diet too tough. I can't imagine the state of my health if I wasn't low-carbing in the context of a broken blood glucose system. (The very definition of type two diabetes, I hasten to add.) Especially now that I'm getting wear and tear on my aging body complications too.

I understand that it's very important for me to keep an eye on my kidney and heart health (yeah, and gums and feet), as that's where the killers come in. I'm lucky that I have a longterm doctor that I can access from time to time who understands this, and understands that I understand this, in the context of self-management and self-care. Which is good because I couldn't afford her longer than 15 minutes every six months or a year!

KennyA said:

It would be almost impossible to achieve the 800 calories/day that the Taylor approach requires and not automatically be low-carbing at the same time. 5 kcals per gram of carb means that the maximum carb intake (assuming zero kcals from protein or fat) would be 160g/day. He also thinks that after the inital intervention a low-carb diet is fine, which begs the question of why not start it immediately - but then you wouldn't be able to sell your intervention programme and your shakes.

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A point, as was the whole post to my mind, very well made .

KennyA said:

I don't think your quote (wherever it's from, the link isn't working) means quite what you think it means. I think you may be confusing the transport mechanism with what is being transported.

This is from Zimmermann's An Introduction to Nutrition. https://med.libretexts.org/Bookshelves/Nutrition/An_Introduction_to_Nutrition_(Zimmerman)/05:_Lipids/5.04:_Digestion_and_Absorption_of_Lipids#:~:text=In the stomach fat is,fats through the lymph system.

One way the body stores fat involves the body transforms carbohydrates into glycogen that is in turn stored in the muscles for energy. When the muscles reach their capacity for glycogen storage, the excess is returned to the liver, where it is converted into triacylglycerols and then stored as fat.

In a similar manner, much of the triacylglycerols the body receives from food is transported to fat storehouses within the body if not used for producing energy. The chylomicrons are responsible for shuttling the triacylglycerols to various locations such as the muscles, breasts, external layers under the skin, and internal fat layers of the abdomen, thighs, and buttocks where they are stored by the body in adipose tissue for future use. How is this accomplished? Recall that chylomicrons are large lipoproteins that contain a triacylglycerol and fatty-acid core. Capillary walls contain an enzyme called lipoprotein-lipase that dismantles the triacylglycerols in the lipoproteins into fatty acids and glycerol, thus enabling these to enter into the adipose cells. Once inside the adipose cells, the fatty acids and glycerol are reassembled into triacylglycerols and stored for later use. Muscle cells may also take up the fatty acids and use them for muscular work and generating energy. When a person’s energy requirements exceed the amount of available fuel presented from a recent meal or extended physical activity has exhausted glycogen energy reserves, fat reserves are retrieved for energy utilization.

As the body calls for additional energy, the adipose tissue responds by dismantling its triacylglycerols and dispensing glycerol and fatty acids directly into the blood. Upon receipt of these substances the energy-hungry cells break them down further into tiny fragments. These fragments go through a series of chemical reactions that yield energy, carbon dioxide, and water.

On the other hand, if you're correct, I will need to find that >30kg of bodyfat I lost on the high fat diet because I clearly shouldn't have.

This graphic is the one I mentioned from Bilous and Donnelly's Handbook of Diabetes.

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My post are this post are not at odds. They say the same thing. The image you posted illustrates glucose metabolism, not fat metabolism.

You can eat a high-fat diet and still lose body fat. Fat stored in adipose tissue (fat cells) will grow in in caloric surplus, and shrink in caloric deficit. If you eat enough cheese, you will get fat, and the fat in the cheese can go directly from intestine to adipose tissue through the bloodstream. If you eat less than your daily energy needs for any length of time the fat will come back out of adipose tissue faster than it goes in, even if you're eating cheese.

KennyA said:

This is the old calories in, calories out model, which is still the simple one the media promote and which doesn't work in a low-carb world. It certainly doesn't apply to me in terms of what I've been eating since late 2019. I have no idea what my "calorific" intake has been but it's certainly been way more than would account for the over 30kg loss.

I would suggest that you read some of those authors that you have been avoiding. Or even find an encyclopaedia published before 1980. I can still recall being taught "dietary fat is not stored as bodyfat" as very basic human nutrition back in the early 1970s for my O level biology. But that was before fat was thoroughly vilified as the sole cause of heart disease etc.

I'm sorry to have confused you with the graphic. It's one I referred to earlier in post#9.

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Calories in and calories out is much too simplistic a way to describe energy but it can be a useful concept because it's simple. For example - the body expends much more energy metabolising protein than it does carbohydrates, and a certain amount of protein eaten daily goes toward building new cells. Protein calories go 'missing' - you can't compare carb, protein and fat calories on a like-for-like basis. As a rough measure of energy consumed though it works well enough to be useful. I've used the concept successfully to aim for and hit a weekly rate loss target using calories to plan my shopping list. Professional athletes use the concept to plan meals that suit the amount of energy they expend training. It's far from a perfect concept, but it's good enough to be useful.

You're right - it doesn't work well in the low carb world because a low carb diet is high in protein and/or fat. The protein calorie numbers can be way off for the reasons described above, and there's ketosis to consider. When ketone levels in the blood are high a portion of them will be expelled via the urine. In ketosis, you pee calories, at least until such time as you become fat adapted and blood ketone levels in the blood drop to lower levels.

I will continue to avoid books by authors who might, for example, criticise calories in vs calories out as a concept without explaining in detail the circumstances when it is and isn't useful. I will also continue to read the current state of scientific knowledge over anything written before the invention of the technology that might make the current state different from what went before.

Calories in - calories out is still valid in a low carb context in my opinion. Yes 30% of protein calories are consumed in digestion, but that is part of the calories out equation. The human body cannot defy the laws of physics.

The human body is not a calorific chamber, so the laws of physics cannot be applied , due to many losses, inability to utilise, insoluble fibre, and many foods we don't all have the gut microbiome to digest fully.
Calories in is relevant, but only in a minor way, unless you seriously pig out.

... although I would never say "pig out"! I say this as someone with a very hearty appetite and well functioning hunger signals! .

Thank goodness for the new theories of weight loss and gain,that I had access to because of the internet, and this DCUK. And a fabulous free library when I was newly diagnosed.

I will just pop in my 2 cents worth - a law of physics does not apply to nutrition and the human body (or any mammal's I would add) because the central idea that ' a calorie is just a calorie' regardless of the food or drink the energy comes from (which is coca cola's argument), does not account for the fact that our bodies deal with different macronutrients differently.

Which is central to this thead - ie how to lose weight best, I take it, in order to achieve remission, or at least get a shot at it. (I did in fact get a shot at it.)

Many of us here in this Forum, particularly those of us who have indeed lost a lot of weight, and kept it off, and kept abreast of the theories of weight gain and loss, as type two diabetics, or originally diagnosed as such, say, and keep saying - the new theories say our bodies deal with fat and protein in a significantly different way to carbs, or excess carbs if you like.

And yeah - there are gorgeous graphics indicating this. Especially, perhaps, with a type two diagnosis your body has proven, shall we say, to have an excess carb intolerance - always in the presence of fats - needing to eat healthy fats is a given. And this means that we will respond wonderfully to limiting or at least dropping those carbs. So the theory goes. And one's fat storage pathway is highly indicative of excess carb intolerance - ie one puts fat on majorly around the digestive organs - the gut, the belly, the tummy etc etc. And, most of all - if you get metabolically sick. Too many too sick fat cells for your body type. (The sick fat cell theory and type two is very convincing. The scientists behind this talk of is as a fact - take a look online....).

The new (old) theories of weight gain indicate, if you are dairy tolerant, it's the bread and crackers, especially the new ultra processed food bread and crackers, that folks eat the cheese with that is causing the weight gain problems - not the limited amount of cheese the average Jill and Joe can possibly eat! (Fats and protein are very filling, as a rule, I thought....)

Certainly is my own experience. The late 70s nutritional advice did horrors to my own metabolism, and I am not alone. Eat less animal fats, way less, eat lots of starchy veg and oh yes - eat lots of bread. Lots of high fibre crackers. Lots and lots and lots of bread. (And bread was such a lovely comfort food.) Oh yes - and sugar is a plant, right? So it can't be toxic in too high doses. Yeah, right.

ajbod said:

The human body is not a calorific chamber, so the laws of physics cannot be applied , due to many losses, inability to utilise, insoluble fibre, and many foods we don't all have the gut microbiome to digest fully.
Calories in is relevant, but only in a minor way, unless you seriously pig out.

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The laws of physics apply everywhere in the universe . To say they don't apply to humans is a bit absurd.

The "due to many losses, inability to utilise, insoluble fibre, and many foods we don't all have the gut microbiome to digest fully" are just possible scenarios of 'calories in/out'.

aris said:

The laws of physics apply everywhere in the universe . To say they don't apply to humans is a bit absurd.

The "due to many losses, inability to utilise, insoluble fibre, and many foods we don't all have the gut microbiome to digest fully" are just possible scenarios of 'calories in/out'.

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This is true - energy is energy, but calories are not a great way to represent it in the context of food and managing weight. It is currently the simplest way to compare one food product with another but I think something better could replace it.

Consider for example if the energy expended during the process of metabolising carbs, protein or dietary fat, and getting that energy stored as body fat, were considered a bit like an 'income tax' on calories-in. Consider a food package labelling system that used net values - calories minus 'tax' - instead of or in addition to calories - the raw energy in the food. Call the net value 'Metabolic Energy Units' or whatever. The result would be numbers on food packages that are much closer to the mark in answering the question that most people actually care about - the likely effect of that product on their weight. It still wouldn't be perfect, but it would perhaps be a step in the right direction.