I don’t care about the mechanism as long as it works

[BarbaraG]

I’ve had T2 for more than 25 years, currently on metformin and Trulicity. Over 10 years ago I lost a ton of weight and got off all medication, and HbA1C stayed in the prediabetic range for a few months. Unfortunately I couldn’t keep it up. About 8 years ago I tried again with LCHF, then keto, and did some intermittent fasting. All very effective, but again, I couldn’t keep it up long term.

So here we are again - with an HbA1C which had shot up (I believe largely due to the statin I started last year, now stopped) and a prescription for a 3rd diabetes med. I haven’t taken it. Instead I have gone back to low carb (not keto), resumed regular exercise, and in the last week, resumed fasting.

I have read Jason Fung’s diabetes code, and quite a bit of Roy Taylor’s work on reversing type 2 diabetes. For Fung, it’s all about too much carb intake over time, converted into fat in the liver. The way to allow that fat to leave is by reducing insulin levels. Low carb does that, but fasting does it quicker.

For Roy Taylor, it’s all about caloric excess over many years which leads to fat being deposited with the liver, and then within the pancreas in susceptible people. Remove that fat, by losing weight overall, and liver insulin sensitivity is restored (so fasting BG returns to normal), and then more gradually, beta cell function is restored, so post-meal spikes are reduced.

This week I’ve done 3 days of 18:6 - basically, skip breakfast and stick to non-caloric liquids between evening meal one day and lunch the next. It hasn’t been hard. My BG overnight has come down from 7ish to 6ish, and dawn phenomenon rise is not as great. In 3 days!

Obviously I have more to do, and that’s fine.

So, who’s right? Dr Fung - (you have to cut carbs) or Prof Taylor (you have to lose weigh, doesn’t matter how).

Personally, I don’t care! I’ve (re) discovered that I can fast, and it does amazing things for my BG, so I’m going to carry on doing it.

Now, like most people, I want to have my cake and eat it. Obviously I’m not actually eating cake at the moment! Well, hardly ever. But my hope is that, once the LCHF/IF regime has got my weight down sufficiently, my liver and pancreas have shed some/most/all of the fat they’re carrying, and my insulin resistance is greatly reduced - then I will be able to tolerate a higher carb intake than I’m currently having. Just to give me the flexibility to have that cake once in a while. Not every day, or even every week, but sometimes.

The promise seems to be that, with insulin sensitivity restored, then I will be able to do that - so long as the weight doesn’t creep up again.

Here’s the thing - LCHF makes it easy to eat great tasting food and feel full. Fasting provides a quick, powerful way to get BG (and insulin, and weight) down. You can adjust how long and how often you fast for, to get the results you want.

I’m feeling hopeful!

 

[EllieM]

I'm T1 so not really in a position to post here but I do have a bit of insulin resistance and a bit of extra weight (and a T2 dad).

I have no idea who's right (or if either of them are) but I have a problem with Roy Taylor's approach because it assumes that all T2s are fat when there seem to be a significant (if much smaller) number of thin people out there with T2. What are they supposed to do under Prof Taylor's approach?

 

[ATB123]

I'm T1 so not really in a position to post here but I do have a bit of insulin resistance and a bit of extra weight (and a T2 dad).

I have no idea who's right (or if either of them are) but I have a problem with Roy Taylor's approach because it assumes that all T2s are fat when there seem to be a significant (if much smaller) number of thin people out there with T2. What are they supposed to do under Prof Taylor's approach?

Do you think it's possible that the 10% of lean Type 2 at diagnosis actually end up being LADA? I read some work the other day that said that that subset of people (and I'm in that subset, low normal bodyweight, no insulin resistance, quick progression to insulin compared to a T2)? It's interesting isn't it?

 

[EllieM]

Do you think it's possible that the 10% of lean Type 2 at diagnosis actually end up being LADA? I read some work the other day that said that that subset of people (and I'm in that subset, low normal bodyweight, no insulin resistance, quick progression to insulin compared to a T2)? It's interesting isn't it?

Some of them, yes. But I thought/hoped that being thin at diagnosis made it more likely for you to get the LADA tests? I believe we have a significant number of long term diet controlled thin T2s on these forums. @ianf0ster?

I suspect (from reading these forums) that there are a number of different types of T2 that get bundled together in a very big basket (disclaimer, not a doctor so this is a personal opinion only).

 

[ianf0ster]

Well, I am/was a thin T2 and have been in remission for very nearly 4yrs. I think if I was misdiagnosed (over 5yrs ago now) that my BG would no longer be controlled by diet alone, especially since I'm not doing Keto, just low/very low carb 20gms to 40gms per day.
However, I've not had any LADA tests.

My views on merits of the different approaches of Taylor, Fung, Unwin are just my personal non-medical views from personal experience and from being active in both this and the Diabetes.org.uk forums for nearly 5yrs. All 3 approaches have at least some merit, and between them allow a majority of people to find something suitble for them!

Taylor says you have to lose weight in order to reduce BG and by inference that all T2D's are fat, neither of which are true in my case! My BG dropped as soon as I reduced carbs - it just took time for my HbA1C to follow because 1). That is a 3 month average and 2). At first, I didn't know how low carb I needed to go for 'remission'. 3). Reducing meals (once I was 'fat adjusted' also really helped - I'm now OMAD 2 days per week and TMAD the other 5.

I don't know that much about Fung's hypothesis, however if you fast (just don't eat for days) then eventually your BG will drop after your liver starts giving up on a prolonged (several day) Dawn Phenomenon - at least that's what happen to me after 2 and a half to 3 days.

Unwin's approach was right for my case, I'm in remission with no desire to ever test if I'm 'cured' as some followers of Taylor claim. Being 'cured' would be no big advantage to me because I don't find Low Carb a problem since I love protein and fat - though I do miss icecream, mango and beer just not that much and in any case prefer steaks and cheese.

I really don't understand all this stuff about 'Insulin Resistance', what I see is that most people have plenty of sub-cutaneous fat cells which fill up as insulin shunts excess blood glucose into them. People like me (and south Asians etc.) don't have so many of them and so put on visceral fat without getting fatter arms, legs, faces. This means that the get all their fat cells full up sooner and so are diagnosed as Diabetic while they are still around normal weight.

 

[ATB123]

Some of them, yes. But I thought/hoped that being thin at diagnosis made it more likely for you to get the LADA tests? I believe we have a significant number of long term diet controlled thin T2s on these forums. @ianf0ster?

I suspect (from reading these forums) that there are a number of different types of T2 that get bundled together in a very big basket (disclaimer, not a doctor so this is a personal opinion only).

You would have thought so and the paper I read recommended testing for all thin T2 at diagnosis but I didn't get tested then. With hindsight I probably needed testing/start insulin around 4 years ago but it took 3 years of failing every med then getting sick before I was. I should have guessed right back at the beginning when I stuck religiously to a keto diet for a few months to be unable to get my hba1c below 62, it kept my blood sugars stable without spikes but at a base level that was much too high - between 9-13. Hindsight is a wonderful thing, it allows us to beat ourselves up about not pushing earlier. You're right I know type 2s who are slim but def type 2, 1 of those is only recently diagnosed but the other has been diagnosed 15 years.

 

[AndBreathe]

I'm T1 so not really in a position to post here but I do have a bit of insulin resistance and a bit of extra weight (and a T2 dad).

I have no idea who's right (or if either of them are) but I have a problem with Roy Taylor's approach because it assumes that all T2s are fat when there seem to be a significant (if much smaller) number of thin people out there with T2. What are they supposed to do under Prof Taylor's approach?

Professor Taylor still recommends some weight loss for those in normal BMI, although not as much. That was something in his more recent (as opposed to early days) papers.

 

[AndBreathe]

Some of them, yes. But I thought/hoped that being thin at diagnosis made it more likely for you to get the LADA tests? I believe we have a significant number of long term diet controlled thin T2s on these forums. @ianf0ster?

I suspect (from reading these forums) that there are a number of different types of T2 that get bundled together in a very big basket (disclaimer, not a doctor so this is a personal opinion only).

I had luuuurve handles when diagnosed, but didn’t carry massive over poundage. The Endo I see (for my errant thyroid)is certain I am LADA.

Each time I see him, I remind him how long my remission is. He just winks and tells me diabetes is a sneaky monster and to remain vigilant.

I think I got a bit unlucky in the weight area I was diagnosed, but can’t do anything bout that now.

 

[AndBreathe]

@BarbaraG - my steer to you would be that you strive to embed a lifestyle you can live with. It doesn’t need a label, and can be a hybrid of multiple methods, provided your blood chemistry etc get to and stay in a decent place - with or without medication.

As you have proven, there is little long term benefit of going into a revolving door of yo-yo diet and blood sugars. That’s hard on you; physically, mentally and on your wallet (thinking wardrobe here).

I have never striven to live keto for any length of time. Sure, I’ve experimented (because I could), and have gome carnivore for very short periods, in preparation for long haul travel where my choice was to fast throughout (Korean airline food doesn’t tend to attract too many stars), but my day-to-day approach is what I term “reduced carb”. I tend not to count my carbs, unless I think I’m hitting them a bit harder than I should, I just keep the spuds and rice to a minimum and never eat baked goods anyway (I’m gluten free, and not eating bread etc, is just simpler). I don’t have a very sweet tooth, although I’m in SEAsia at the moment, where our eating style tends to be very low carb, but to maintain my weight (upwards), I have a very small tub of ice cream most evenings, and enjoy it.

im not saying my way is THE way but encouraging you to find YOUR way, irrespective of what the labelling might call it. If it means you live a stable life, but take a bit of medication to support that, so be it. There is zero shame in taking medication. It is an additional tool in your toolkit.

Take your time. This is for the long haul.

 

[Deleted member 532959]

I have no idea who's right (or if either of them are) but I have a problem with Roy Taylor's approach because it assumes that all T2s are fat when there seem to be a significant (if much smaller) number of thin people out there with T2. What are they supposed to do under Prof Taylor's approach?

Perhaps I'm wrong, but I think that's Taylor's position. He talks of a personal fat threshold, which, being personal, is different for everyone. When that threshold is passed fat is stored as ectopic fat. Thin is a relative term, especially in our current world. So it's possible that while someone would be not even close to obese they may still be insulin resistant due to this ectopic fat.

 

[BarbaraG]

I'm T1 so not really in a position to post here but I do have a bit of insulin resistance and a bit of extra weight (and a T2 dad).

I have no idea who's right (or if either of them are) but I have a problem with Roy Taylor's approach because it assumes that all T2s are fat when there seem to be a significant (if much smaller) number of thin people out there with T2. What are they supposed to do under Prof Taylor's approach?

It doesn’t assume all T2’s are fat. He gives examples of people who had BMI’s in the normal range, with T2 - who were found to also have fat deposited within their liver and pancreas. He suggested they try losing some weight (about 10%) and the diabetes resolved.

As a result of this, he now talks about a ”personal fat threshold”, which if you exceed it, will allow T2 to develop if you are susceptible. He explains that it’s not about BMI, or whether you are fatter than other people. It’s whether you are carrying too much fat for YOUR body.

One beef I have with his material is that he talks repeatedly about people who have gained weight over their adult life, and if they revert to the weight they were at 21 or 25, they wouldn’t develop T2D. Gaining weight gradually as you age is a common pattern, to be sure. But it’s not the only one. I’ve been overweight since the age of 8 and obese since my teens, with an exception of a period of less than a year in my early twenties.

 

[BarbaraG]

@BarbaraG - my steer to you would be that you strive to embed a lifestyle you can live with. It doesn’t need a label, and can be a hybrid of multiple methods, provided your blood chemistry etc get to and stay in a decent place - with or without medication.

As you have proven, there is little long term benefit of going into a revolving door of yo-yo diet and blood sugars. That’s hard on you; physically, mentally and on your wallet (thinking wardrobe here).

I have never striven to live keto for any length of time. Sure, I’ve experimented (because I could), and have gome carnivore for very short periods, in preparation for long haul travel where my choice was to fast throughout (Korean airline food doesn’t tend to attract too many stars), but my day-to-day approach is what I term “reduced carb”. I tend not to count my carbs, unless I think I’m hitting them a bit harder than I should, I just keep the spuds and rice to a minimum and never eat baked goods anyway (I’m gluten free, and not eating bread etc, is just simpler). I don’t have a very sweet tooth, although I’m in SEAsia at the moment, where our eating style tends to be very low carb, but to maintain my weight (upwards), I have a very small tub of ice cream most evenings, and enjoy it.

im not saying my way is THE way but encouraging you to find YOUR way, irrespective of what the labelling might call it. If it means you live a stable life, but take a bit of medication to support that, so be it. There is zero shame in taking medication. It is an additional tool in your toolkit.

Take your time. This is for the long haul.

Oh, thank you. That’s kind of the conclusion I was coming to.

it’s several years since I first came across Taylor’s work, and to be honest, when I did, I was very angry with him. Because of his emphasis on low calorie without mentioning carbs and the low cal diet shakes thing. Why does that make me angry? Because I am a veteran (victim) of the diet industry, and all the (internalised) prejudice that goes with it. Because I have battled for years with binge eating, which “dieting” makes worse.

Its a shame I got so angry and didn’t look deeper. If I had, I’d have read about the twin cycle hypothesis and seen how much sense it makes….. and I’d also have seen him say that any method of weight loss works so long as you keep it off, and that a lower carb diet can be very helpful, and that low fat diet foods don’t help.

Anyway - here I am. Enjoying lower carb eating, and intermittent fasting. Watching my BG’s steadily improve (and my weight come down). Still taking the tablets (and the injection) - and will do, as long as needed to get and then keep my BG as close to normal as is compatible with living a full and enjoyable life.

I am very, very tired of the rollercoaster. I want off it. So I am going to give it a good go to put my diabetes into remission. I accept it may not be possible. In fact, the odds are stacked against me - although the fact that it did happen briefly 11 years ago is a ray of hope. Plus, I have had several times since then when I have lost the sort of weight Taylor is talking about. So presumably at those times my liver insulin resistance improved and my pancreas got at least some respite from the fat choking it. Maybe that will be enough to have kept those islet cells alive, if still dormant. And a sustained weight loss (he’s talking about 2 years) might allow them to recover - at least to a useful degree.

We will see. But my aim this time is NOT to regain the weight. I’d rather lose 2 stone and keep it off for ever than lose 6 stone and put 4 back on.

 

[AndBreathe]

Oh, thank you. That’s kind of the conclusion I was coming to.

it’s several years since I first came across Taylor’s work, and to be honest, when I did, I was very angry with him. Because of his emphasis on low calorie without mentioning carbs and the low cal diet shakes thing. Why does that make me angry? Because I am a veteran (victim) of the diet industry, and all the (internalised) prejudice that goes with it. Because I have battled for years with binge eating, which “dieting” makes worse.

Its a shame I got so angry and didn’t look deeper. If I had, I’d have read about the twin cycle hypothesis and seen how much sense it makes….. and I’d also have seen him say that any method of weight loss works so long as you keep it off, and that a lower carb diet can be very helpful, and that low fat diet foods don’t help.

Anyway - here I am. Enjoying lower carb eating, and intermittent fasting. Watching my BG’s steadily improve (and my weight come down). Still taking the tablets (and the injection) - and will do, as long as needed to get and then keep my BG as close to normal as is compatible with living a full and enjoyable life.

I am very, very tired of the rollercoaster. I want off it. So I am going to give it a good go to put my diabetes into remission. I accept it may not be possible. In fact, the odds are stacked against me - although the fact that it did happen briefly 11 years ago is a ray of hope. Plus, I have had several times since then when I have lost the sort of weight Taylor is talking about. So presumably at those times my liver insulin resistance improved and my pancreas got at least some respite from the fat choking it. Maybe that will be enough to have kept those islet cells alive, if still dormant. And a sustained weight loss (he’s talking about 2 years) might allow them to recover - at least to a useful degree.

We will see. But my aim this time is NOT to regain the weight. I’d rather lose 2 stone and keep it off for ever than lose 6 stone and put 4 back on.

It can happen.

I lost weight. No idea how much because I wasn’t and didn’t weigh at diagnosis. I didn’t set out to trim up, but it happened when I cut the carbs back. I only weighed, in a hardware store, in Antigua, with the scales in that shrink wrap, when my shorts were just getting too loose.

i am a little lighter than that now usually, although I gained a modest amount last year, following the loss of a very good chum. My A1c was unchanged, just the scales nudged up.

I’m 10 years skinny. I just plod along, but crucial to me was finding a way I was not yearning for lots of “treats”. Without a sweet tooth it might have been easier for me, of course.

I’m not saying, if I can, you can, but what I am saying is give it another go. If you miss treats, try to find alternatives.

Fingers crossed fo you.

 

[BarbaraG]

Thank you again.

You say you didn’t set out to trim up….. have you ever deliberately tried to lose weight? I have, many times. I think that makes a difference psychologically at the very least. Maybe physiologically as well, I don’t know.

 

[AndBreathe]

Thank you again.

You say you didn’t set out to trim up….. have you ever deliberately tried to lose weight? I have, many times. I think that makes a difference psychologically at the very least. Maybe physiologically as well, I don’t know.

If you were asking me,@BarbaraG , yes I have deliberately tried to lose weight. In terms of full disclosur,I have also experienced anor, which clearly an unhealthy, potentially lethal state.

Our bodies are complex things, doing incredibly tricky things every moment of the day. I was lucky that mine managed to recover from my anorexia, but has also done well following my T2 diagnosis.

dont be too hard on yourself and take your time to find the right way forward for you.

 

[BarbaraG]

@AndBreathe Yes, I meant you.

With a history of anorexia, I imagine weighing is best avoided. I also have a history of disordered eating, but in my case it is binge eating disorder. Suffice it to say that my relationship with food and weight is tortured, to say the least. Been living with it for 50 years, half of those with diabetes. It is, in some ways, like being an alcoholic or drug addict - however long you’ve been sober, the vulnerability is still there. Although when food is your substance of choice, complete abstinence is not an option.

But hey, at the moment, I am feeling very positive.

 

[AndBreathe]

@AndBreathe Yes, I meant you.

With a history of anorexia, I imagine weighing is best avoided. I also have a history of disordered eating, but in my case it is binge eating disorder. Suffice it to say that my relationship with food and weight is tortured, to say the least. Been living with it for 50 years, half of those with diabetes. It is, in some ways, like being an alcoholic or drug addict - however long you’ve been sober, the vulnerability is still there. Although when food is your substance of choice, complete abstinence is not an option.

But hey, at the moment, I am feeling very positive.

Never say never, but I’m 30+ years on from my anorexic days, although at diagnosis, and for a period afterwards, I worried conscious changes to my ways of eating had the potential to set it off again. Thankfully that didn’t happen.

I can honestly say that my relationship with food now is better than before, but I honestly think a significant factor in that is having found ways of eating that I enjoy, don’t leave me hungry, and rarely have me eyeing up more when more is really not required.

We’re overseas at the moment, nearing the end of a long trip and, as always here, I find myself a bit light, but that’ll normalise itself when we’re home in the UK routines.

 

[AloeSvea]

Hi there @BarbaraG.

My own approach is to take on board the best of both these magnificent On-Diabetes-dudes.

I really like the Personal Fat Threshold theory, certainly in terms of getting insulin resistance in the first place, which fits neatly with the Fat Cells Theory (or, Adipose theory) behind T2D. And Prof Taylor's graphics describing the blood glucose fatty acid cylce (in terms of being a couple of bicycles!) is quite wonderful.

Dr Fung too has great metaphors for describing what has gone wrong with our blood glucose system, and I am totally on board with his inflated balloons (with glucose, and insulin) to explain what happens at cell level with insulin-resistance based T2D.

Both of them are remission focussed, as are many of the great docs and profs writing on the subject. As I went all out for remission via both of those On-Diabetes-Dudes, and got incomplete remission (ie in the prediabetic range) for some years, but popped out of it in some other amount of years, I have come to appreciate the incredible complexity of our blood glucose regulation system, and, all the things that can go seriously wrong in it at various junctures and in various organs and organ-like mechanisms.

Some folks do, BarbaraG, go into complete remission and can even start to eat a lot more carbs than some poor hapless T2er like myself. But my understanding is it is very rare. I have seen it in this forum, but only with a couple of T2ers. And they have either died, or disappeared from the Forum now so who knows if it was for the rest of their personal duration?. For myself, I see myself as having time test proven I am excess-carb intolerant. Definely wheat intolerant. Being excess-carb intolerant may be where you are at? More than likely, if it is OK for me to say that? If you are not one of the rare cases.

Only one way to tell! And that is to experiment with these methods to remission. And how wonderful to have all of us to share these experiments with methods with!