Did you notice near the end....
You can also find guidance on the website of Diabetes UK, and we recommend that all people with diabetes should join Diabetes UK: https://www.diabetes.org.uk/home. (WARNING: Do NOT confuse this with a commercial website (....diabetes.co.uk) whose content may appear attractive, but which is often incorrect or misleading).
I have since discovered that dietary adherence was measured by the ketone levels of the participants.. they had to be in nutritional ketosis...So did ND work because the participants were in ketosis rather than because they were being starved.. hmmHere is an old...2009 news report on VLCD 800 calorie diet before Newcastle team formalized their 8-12 weeks
protocol...
http://edition.cnn.com/2009/HEALTH/12/15/very.low.calorie.diets/index.html
View attachment 29821
I have since discovered that dietary adherence was measured by the ketone levels of the participants.. they had to be in nutritional ketosis...So did ND work because the participants were in ketosis rather than because they were being starved.. hmm
Did you notice near the end....
You can also find guidance on the website of Diabetes UK, and we recommend that all people with diabetes should join Diabetes UK: https://www.diabetes.org.uk/home. (WARNING: Do NOT confuse this with a commercial website (....diabetes.co.uk) whose content may appear attractive, but which is often incorrect or misleading).
Thr Optifast shake manufacturer supplying the original studies also says that dietary ketosis may occur in some cases, but is not always present, They warn it MAY happen, but it is intended to be just above the trigger level for most followers of their 800 plan. I suspect the DIRECT plan is similar but they have set up their own production line to make more money out of DUK and the NHS in the longer term.Here is an old...2009 news report on VLCD 800 calorie diet before Newcastle team formalized their 8-12 weeks
protocol...
http://edition.cnn.com/2009/HEALTH/12/15/very.low.calorie.diets/index.html
View attachment 29821
Thr Optifast shake manufacturer supplying the original studies also says that dietary ketosis may occur in some cases, but is not always present, They warn it MAY happen, but it is intended to be just above the trigger level for most followers of their 800 plan. I suspect the DIRECT plan is similar but they have set up their own production line to make more money out of DUK and the NHS in the longer term.
How did you get this info since it is not mentioned in any formal report I have seen, and has also not been mentioned by those here who took part in some of the trials. I think that if they are indeed using ketosis intentionally, then this would kill their support from the NHS, nutritionists, doctors, and everyone providing care for diabetics, in the same way that LC diets get pilloried. They cannot afford to admit any link to ketosis,I have since discovered that dietary adherence was measured by the ketone levels of the participants.. they had to be in nutritional ketosis...So did ND work because the participants were in ketosis rather than because they were being starved.. hmm
How did you get this info since it is not mentioned in any formal report I have seen, and has also not been mentioned by those here who took part in some of the trials. I think that if they are indeed using ketosis intentionally, then this would kill their support from the NHS, nutritionists, doctors, and everyone providing care for diabetics, in the same way that LC diets get pilloried. They cannot afford to admit any link to ketosis,
The testing for ketosis on a regular basis is an expense that they did not need to control their protocol, and c-peptide tests or insulin clamp tests would be prohibitive for large scale rollout, and again it was not necessary for their protocol. Don't forget that originslly the aim was simply to mimic bariatric surgery to find a cheaper non invasive alternative for further research. They needed to show that diabetes symptoms are reduced by the protocol, but they were surprised at the success they had, Now DIRECT is the first chance they have of really getting to grips with it, but it seems that they are still just looking for the bariatric replacement, and a way to mass produce the protocol, hence setting up their own company to run it. They've sold out to commercial interests IMO
Agree. This first study was small scale and did indeed do a load of tests that I do not thinke were used in subsequent trials. They did full c-peptide tests, insulin clamps tests, OGTT, hepatic glucose with intravenous measurements of plasma blood levels etc. But only on 11 subjects (we do not know which group the dropouts occurred in) It looks like these tests were done in weeks 1,2, and 8 but not sure if this was the frequency for the ketone measurements too, since they could occur more frequently being less invasive. They also did the MRI scans in this trial.It was pointed out to me on twitter yesterday by Jan Vyjidak from this paper
https://link.springer.com/article/10.1007/s00125-011-2204-7
"Dietary adherence was assessed using capillary ketone levels (Xceed Optium; Abbott Diabetes Care, Maidenhead, UK). Three individuals failed to comply with the diet (two during the first week and one during weeks 4–8), and one left the study for an unrelated medical reason. Hence 11 individuals (nine male and two female, age 49.5 ± 2.5 years) completed the study."
This is the first trial for the ND experiment Counterpoint I think it is.. I get very confused with the naming ..
I wonder if the tests were indeed done in the later trials.. (to ensure compliance) but conveniently not noted in the write ups.. the more I read about this stuff the more my view that something very dodgy is going on with the Low Cal trials is reinforced.Agree. This first study was small scale and did indeed do a load of tetst that I do not thinke were used in subsequentltrils. They did full c-peptide tests, insulin clamps tests, OGTT, hepatic glucose with intravenous measurements of plasma blood levels etc. But only on 11 subjects (we do not know which group the dropouts occurred in) It looks like these tests were done in weeks 1,2, and 8 but not sure if this was the frequency for the ketone measurements too, since they could occur more frequently being less invasive. They also did the MRI scans in this trial.
Again, unlikely to have this level of scrutiny in a larger study population,
But it does seem that ketosis was intended and checked in this initial study. Interesting that the control group were not given these tests except at week 8. In fact there is very little said about the control group. I have always suspected that even a borderline VLCD close to trigger will give periods of ketosis during the activities of a normal day, so is similar to IF in this respect. Its just that they cannot admit it.
The conclusion does not involve the control group, except to say:
"Although pancreatic fat content was 30% higher in the diabetic group, the study was powered to demonstrate responses to the dietary intervention rather than to test differences from weight-matched non-diabetic individuals. No correlation was observed between pancreatic fat and BMI within the restricted range of BMI examined in this study."
One interesting point I picked up on this re-visit, and that was the comments that the IR response improvement was independant of changes to the peripheral IR in the muscles, but was solely due to hepatic fat reduction. Also noted the comment that bariatric banding does not produce remission, but the bypass surgery does.
Im guessing it was any at all... with 60g of carbs per day in the shakes I'm surprised they maintained ketosis at all..obviously starvation helped...From what I can see, there's little question that much delibrate effort was applied to obscure the role of ketosis in the Newcastle protocol. Surprise that the peer review don't bring up this aspect at all...what is the ketosis criteria they use to determine compliance.
I think you will find that it breaks no new wind. It is a re-run of the previous study but just using the weight loss program with minimal supervision and no significant changes to the protocol, It seems to be merely a trial to check that it can be applied to Primary care setting with minimum training (8 hours) and low resources. It uses the annual diabetic checkup as the 1 and 2 year followups, which is ok for a public rollout,I need to sit down and read all the new info on DiRECT.. sorry but just haven't had time yet..
Agree but they give a huge amount more detail of what the follow up post the 8 week starve is..I think you will find that it breaks no new wind.
It is hereAgree but they give a huge amount more detail of what the follow up post the 8 week starve is..
I think and fear it may end up being 1200 cals per day for life.. which considering the Minnesota Starvation Experiment was based on I believe 1570 cals ? then it's a pretty miserable way to try and live and doomed to failure from the start?
But I do need to read it in depth first..
Some mildly interesting numbers hereIt is here
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/
The maintenance phase is basically Eatwell with emphasis on reduced fat, There is built into this phase recovey plans to return to the shakes for a while or use Orlistat for heavy duty weight loss, Guess what? revolving door syndrome lives here. Got the T-shirt too.
Edit to add: There seems to be a subgroup that will undergo extra tests and monitoring, This seems to involve MRI scans and insulin clamp testing amongst others, so it would appear that this is part of the follow up yet to come and is the science bit.
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