Newcastle Diet and Metformin

[Megan84]

Recently diagnosed with Type 2 and new to this forum so I am really sorry if I ask something already covered, but we are just getting our head around all this.
After reading "fast 800" and "The 8 week Blood Sugar diet" we were decided to follow Michael Mosley's approach with food. However, after a few weeks of confusion and introducing myself in the forum, I read from a few members that followed the New Castle diet (starting point of Michael Mosley's work) with Shakes, someone "very generously" sent me "the Newcastle diet booklet" (12 basic pages that summarise the diet, saying "it is very simple to follow"), so DH who likes "simple/clear"things decided to go for the approach of the shakes, "no confusions with food, no calorie counting, you know your nutritional needs are covered". So, we got Tesco's shakes and he will be following this approach, while I ( not diagnosed but in need of losing weight) will be following Michael Mosley's approach with the idea of transitioning to this type of eating once he finishes with the shakes.

We have one question though (before starting). I am guessing that a very big amount of people is taking Metformin. He has been put straight away from the beginning at 2x500mg (morning) and 2x500mg (night); according to the insert it is not advised to take Metformin following diets under 1000Cal, and this diet is 800Cal per day. Also, according to the insert, it is advised to have carbohidrates regularly throughout the day, this, the nurse said it was very important specially when having the tablets otherwise he might end up with an stomach ulcer. We are a bit confused as I told the nurse very clearly of our intention of following this diet, so I am now having two conflicting advises; the nurse AND the medication insert. What does normally people do? Is it ok to follow this diet with Metformin? Do you keep some carbs for when you take the tablets? Can anyone enlighten me on how they did it and how they got on please?

 

[ljshipley]

Hello Megan, my experience is recent and probably not relevant to you. I am 49 years old and located in the USA. On December 27th, 2021, I learned that I was a type 2 diabetic with an Hb1AC of 10.1%. At that time, I weighed 247 lbs. I made an appointment with a nurse practitioner since getting into a doctor wasn't possible for three months. (Covid pretty much screwed up the medical community.) The NP recommended the S.A.D diet, Standard American Diet, and prescribed to me metformin and glimepiride. I started on the medicines on January 5th. At the same time, I started reading every book that I could find. I found a book that is new here that I think has been available in the UK for some time. I read "Life without Diabetes" by Roy Taylor, MD. It basically posited the concept that every person has his own fat capacity and it recommended losing about 33 lbs. So I started losing weight by regularly exercising and calorie restriction. Okay, I also did at the same time low carb - high fat with low sodium. Turns out a low calorie, low carb, low sodium diet, while exercising too much really drops the weight. I weighed in today at 201.1 lbs.

Anyway, since I was checking my morning fasting blood glucose everyday, I was able to see my levels rather quickly drop from 199 mg/dl each morning to under 100 mg/dl. By the third week, my average morning fasting blood glucose level was 93 mg/dl. Since the side effects of glimepiride is weight gain and possibly long term damage to the panaceas, I decided to quit taking the medicines on January 17th. I made this decision on my own without consulting a physician. Here in the US, patients have the right to make these kinds of decisions, albeit much to the chagrin of medical professionals, since the patient pays for his own healthcare.

During my appointment with my doctor on March 10th, we reviewed an updated blood test that showed my Hb1AC down to 6.1%. Of course, I received a scolding from my doctor for stopping my medication without his direction. But he cancelled the prescriptions since it was clear that at this time, I do not need it. I have a follow up with him in June. We will do another blood test prior to that appointment.

Some things that I know about my situation/body that may or may not apply to you. One, I am controlling my diabetes by diet and exercise. Losing all of this weight (247lbs to 201lbs) coincided with the following markers:
Item Dec. 27th --> March 4th
Triglycerides 242 mg/dl --> 61 mg/dl
Cholesterol, Total 210 mg/dl --> 154 mg/dl
HDL Cholesterol 35 mg/dl --> 42 mg/dl
LDL Cholesterol 132 mg/dl --> 100 mg/dl
ALT 200 mg/dl --> 72 mg/dl
AST 90 mg/dl --> 49 mg/dl
Albumin/Globulin Ratio 2.1 --> 1.8

Two, despite my weight loss, I am still diabetic. I have done a couple carb loading tests to see how long it takes for my blood glucose level to get back to normal. If I eat a S.A.D. meal at 6pm, it takes until 1pm the following day for my blood level to drop back below 120 mg/dl. A healthy insulin sensitive man would do that in 2 hours. But I can mimic a healthy metabolism by restricting my dietary carbohydrate consumption and limiting my protein consumption.

By the way if no one has mentioned it to you yet, the root cause of your type 2 diabetes is that your muscle cells have become resistant to insulin. You are not suffering from an under performing pancreas... that's a type 1 problem. No one fully understands what causes insulin resistance. Just that your cells resist the efforts of insulin to move glucose from the blood stream into the cell for energy consumption or storage. (It's a lot more complicated than this.) This is why if you are type 2 diabetic and eventually are put onto insulin... you are screwed. Pushing more insulin into your blood just makes you more insulin resistant. Ironically, the medical community has known to prescribe a low carb high fat diet for all types of diabetes since the 1920s. Reference "A Primer for Diabetic Patients", published 1921, which explained how a diabetic should limit his carbohydrate consumptions to moderate his glucose as measured in his urine. It wasn't political nor profitable to sell insulin back then. I think that came in the late 1920s.

The Roy Taylor book recommends that one should not exercise while losing weight. I ignored this. I am glad that I did. I have found that my insulin sensitivity is improved (not normal, just improved) for about 10 - 20 hours after working out. If I quit working out daily, my morning fasting blood glucose starts edging upwards over 100 mg/dl.

Right now, I am experimenting with intermittent fasting as a way to improve insulin sensitivity long term and to "reset" my body.

Direct answers to your question:
1. I quit metformin because it wasn't needed in my judgment based on my regular blood glucose checks. You will need to make your own assessments.
2. Based on the frequency the your doctor prescribed metformin, I am guessing your blood sugar is really high, like greater than 170 mg/dl. While I am not a doctor and am NOT giving you medical advice, I bet metformin isn't going to cause you any issues until your morning fasting blood glucose levels are closer to 70 to 100 mg/dl.
3. I included the details of my own experiences to help you understand my direct answers to your question. Such as what was done and how long are we talking about. Hopefully, there will be a nugget or two that you can benefit from.

Best wishes.
John Shipley

 

[Hertfordshiremum]

Recently diagnosed with Type 2 and new to this forum so I am really sorry if I ask something already covered, but we are just getting our head around all this.
After reading "fast 800" and "The 8 week Blood Sugar diet" we were decided to follow Michael Mosley's approach with food. However, after a few weeks of confusion and introducing myself in the forum, I read from a few members that followed the New Castle diet (starting point of Michael Mosley's work) with Shakes, someone "very generously" sent me "the Newcastle diet booklet" (12 basic pages that summarise the diet, saying "it is very simple to follow"), so DH who likes "simple/clear"things decided to go for the approach of the shakes, "no confusions with food, no calorie counting, you know your nutritional needs are covered". So, we got Tesco's shakes and he will be following this approach, while I ( not diagnosed but in need of losing weight) will be following Michael Mosley's approach with the idea of transitioning to this type of eating once he finishes with the shakes.

We have one question though (before starting). I am guessing that a very big amount of people is taking Metformin. He has been put straight away from the beginning at 2x500mg (morning) and 2x500mg (night); according to the insert it is not advised to take Metformin following diets under 1000Cal, and this diet is 800Cal per day. Also, according to the insert, it is advised to have carbohidrates regularly throughout the day, this, the nurse said it was very important specially when having the tablets otherwise he might end up with an stomach ulcer. We are a bit confused as I told the nurse very clearly of our intention of following this diet, so I am now having two conflicting advises; the nurse AND the medication insert. What does normally people do? Is it ok to follow this diet with Metformin? Do you keep some carbs for when you take the tablets? Can anyone enlighten me on how they did it and how they got on please?

Hello

I was diagnosed type 1, 4 years ago, I was already eating low carb and less than 1000 kcal/day. Despite the fact that I needed insulin I was initially put on metformin slow release. The problem I had was it gave me upset stomach even when taking it after food. This is very common, however some people are fine with them, there are people on this site who take metformin and eat low carb In your situation it depends if your partner? is going to try and control this long term by diet alone ? In my opinion, I am not medically trained in any way, the metformin will lower his blood sugars now and depending on his HbA1c this might be really needed now but if a long term low carb diet is followed he might not have to take them for too long. Hopefully some type 2’s on metformin will step in?

 

[zerocarbisbest]

Hello Megan, my experience is recent and probably not relevant to you. I am 49 years old and located in the USA. On December 27th, 2021, I learned that I was a type 2 diabetic with an Hb1AC of 10.1%. At that time, I weighed 247 lbs. I made an appointment with a nurse practitioner since getting into a doctor wasn't possible for three months. (Covid pretty much screwed up the medical community.) The NP recommended the S.A.D diet, Standard American Diet, and prescribed to me metformin and glimepiride. I started on the medicines on January 5th. At the same time, I started reading every book that I could find. I found a book that is new here that I think has been available in the UK for some time. I read "Life without Diabetes" by Roy Taylor, MD. It basically posited the concept that every person has his own fat capacity and it recommended losing about 33 lbs. So I started losing weight by regularly exercising and calorie restriction. Okay, I also did at the same time low carb - high fat with low sodium. Turns out a low calorie, low carb, low sodium diet, while exercising too much really drops the weight. I weighed in today at 201.1 lbs.

Anyway, since I was checking my morning fasting blood glucose everyday, I was able to see my levels rather quickly drop from 199 mg/dl each morning to under 100 mg/dl. By the third week, my average morning fasting blood glucose level was 93 mg/dl. Since the side effects of glimepiride is weight gain and possibly long term damage to the panaceas, I decided to quit taking the medicines on January 17th. I made this decision on my own without consulting a physician. Here in the US, patients have the right to make these kinds of decisions, albeit much to the chagrin of medical professionals, since the patient pays for his own healthcare.

During my appointment with my doctor on March 10th, we reviewed an updated blood test that showed my Hb1AC down to 6.1%. Of course, I received a scolding from my doctor for stopping my medication without his direction. But he cancelled the prescriptions since it was clear that at this time, I do not need it. I have a follow up with him in June. We will do another blood test prior to that appointment.

Some things that I know about my situation/body that may or may not apply to you. One, I am controlling my diabetes by diet and exercise. Losing all of this weight (247lbs to 201lbs) coincided with the following markers:
Item Dec. 27th --> March 4th
Triglycerides 242 mg/dl --> 61 mg/dl
Cholesterol, Total 210 mg/dl --> 154 mg/dl
HDL Cholesterol 35 mg/dl --> 42 mg/dl
LDL Cholesterol 132 mg/dl --> 100 mg/dl
ALT 200 mg/dl --> 72 mg/dl
AST 90 mg/dl --> 49 mg/dl
Albumin/Globulin Ratio 2.1 --> 1.8

Two, despite my weight loss, I am still diabetic. I have done a couple carb loading tests to see how long it takes for my blood glucose level to get back to normal. If I eat a S.A.D. meal at 6pm, it takes until 1pm the following day for my blood level to drop back below 120 mg/dl. A healthy insulin sensitive man would do that in 2 hours. But I can mimic a healthy metabolism by restricting my dietary carbohydrate consumption and limiting my protein consumption.

By the way if no one has mentioned it to you yet, the root cause of your type 2 diabetes is that your muscle cells have become resistant to insulin. You are not suffering from an under performing pancreas... that's a type 1 problem. No one fully understands what causes insulin resistance. Just that your cells resist the efforts of insulin to move glucose from the blood stream into the cell for energy consumption or storage. (It's a lot more complicated than this.) This is why if you are type 2 diabetic and eventually are put onto insulin... you are screwed. Pushing more insulin into your blood just makes you more insulin resistant. Ironically, the medical community has known to prescribe a low carb high fat diet for all types of diabetes since the 1920s. Reference "A Primer for Diabetic Patients", published 1921, which explained how a diabetic should limit his carbohydrate consumptions to moderate his glucose as measured in his urine. It wasn't political nor profitable to sell insulin back then. I think that came in the late 1920s.

The Roy Taylor book recommends that one should not exercise while losing weight. I ignored this. I am glad that I did. I have found that my insulin sensitivity is improved (not normal, just improved) for about 10 - 20 hours after working out. If I quit working out daily, my morning fasting blood glucose starts edging upwards over 100 mg/dl.

Right now, I am experimenting with intermittent fasting as a way to improve insulin sensitivity long term and to "reset" my body.

Direct answers to your question:
1. I quit metformin because it wasn't needed in my judgment based on my regular blood glucose checks. You will need to make your own assessments.
2. Based on the frequency the your doctor prescribed metformin, I am guessing your blood sugar is really high, like greater than 170 mg/dl. While I am not a doctor and am NOT giving you medical advice, I bet metformin isn't going to cause you any issues until your morning fasting blood glucose levels are closer to 70 to 100 mg/dl.
3. I included the details of my own experiences to help you understand my direct answers to your question. Such as what was done and how long are we talking about. Hopefully, there will be a nugget or two that you can benefit from.

Best wishes.
John Shipley

The Roy Taylor book recommends that one should not exercise while losing weight. I ignored this. I am glad that I did. I have found that my insulin sensitivity is improved (not normal, just improved) for about 10 - 20 hours after working out. If I quit working out daily, my morning fasting blood glucose starts edging upwards over 100 mg/dl.

try to keep in mind lowering insulin should be your main goal, just because your blood glucose level is lower doesnt mean you are in the best optimum track. keep that insulin down and wonders will happen not just blood sugar level... long walks or very light stretching, slow paced weight lifting might help healthy weight loss, the reason i believe that book advises not to exercise is because when you push it a bit, your liver makes sugar and that sugar triggers insulin(which blocks body fat burn), just my thought.

 

[Oldvatr]

Recently diagnosed with Type 2 and new to this forum so I am really sorry if I ask something already covered, but we are just getting our head around all this.
After reading "fast 800" and "The 8 week Blood Sugar diet" we were decided to follow Michael Mosley's approach with food. However, after a few weeks of confusion and introducing myself in the forum, I read from a few members that followed the New Castle diet (starting point of Michael Mosley's work) with Shakes, someone "very generously" sent me "the Newcastle diet booklet" (12 basic pages that summarise the diet, saying "it is very simple to follow"), so DH who likes "simple/clear"things decided to go for the approach of the shakes, "no confusions with food, no calorie counting, you know your nutritional needs are covered". So, we got Tesco's shakes and he will be following this approach, while I ( not diagnosed but in need of losing weight) will be following Michael Mosley's approach with the idea of transitioning to this type of eating once he finishes with the shakes.

We have one question though (before starting). I am guessing that a very big amount of people is taking Metformin. He has been put straight away from the beginning at 2x500mg (morning) and 2x500mg (night); according to the insert it is not advised to take Metformin following diets under 1000Cal, and this diet is 800Cal per day. Also, according to the insert, it is advised to have carbohidrates regularly throughout the day, this, the nurse said it was very important specially when having the tablets otherwise he might end up with an stomach ulcer. We are a bit confused as I told the nurse very clearly of our intention of following this diet, so I am now having two conflicting advises; the nurse AND the medication insert. What does normally people do? Is it ok to follow this diet with Metformin? Do you keep some carbs for when you take the tablets? Can anyone enlighten me on how they did it and how they got on please?

When they did the studies that validated the Newcastle Diet, the entry conditions stpulated were that all diabetic meds were stopped. Seems sensible to do that.

 

[Dark Horse]

the reason i believe that book advises not to exercise is because when you push it a bit, your liver makes sugar and that sugar triggers insulin(which blocks body fat burn), just my thought.

I haven't read the book, but in this paper, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399621/ , Roy Taylor says:-

Increase in exercise during the weight loss phase was discouraged as this tends to be accompanied by compensatory eating. This phenomenon explains why a portion of people fail to lose weight under conventional care. However, a steady increase in physical activity was strongly encouraged during weight maintenance.
​

Note that his advice is not that people shouldn't exercise but that people shouldn't try increase the amount of exercise they do during the weight-loss phase.

 

[Dark Horse]

Recently diagnosed with Type 2 and new to this forum so I am really sorry if I ask something already covered, but we are just getting our head around all this.
After reading "fast 800" and "The 8 week Blood Sugar diet" we were decided to follow Michael Mosley's approach with food. However, after a few weeks of confusion and introducing myself in the forum, I read from a few members that followed the New Castle diet (starting point of Michael Mosley's work) with Shakes, someone "very generously" sent me "the Newcastle diet booklet" (12 basic pages that summarise the diet, saying "it is very simple to follow"), so DH who likes "simple/clear"things decided to go for the approach of the shakes, "no confusions with food, no calorie counting, you know your nutritional needs are covered". So, we got Tesco's shakes and he will be following this approach, while I ( not diagnosed but in need of losing weight) will be following Michael Mosley's approach with the idea of transitioning to this type of eating once he finishes with the shakes.

We have one question though (before starting). I am guessing that a very big amount of people is taking Metformin. He has been put straight away from the beginning at 2x500mg (morning) and 2x500mg (night); according to the insert it is not advised to take Metformin following diets under 1000Cal, and this diet is 800Cal per day. Also, according to the insert, it is advised to have carbohidrates regularly throughout the day, this, the nurse said it was very important specially when having the tablets otherwise he might end up with an stomach ulcer. We are a bit confused as I told the nurse very clearly of our intention of following this diet, so I am now having two conflicting advises; the nurse AND the medication insert. What does normally people do? Is it ok to follow this diet with Metformin? Do you keep some carbs for when you take the tablets? Can anyone enlighten me on how they did it and how they got on please?

Metformin is taken at or immediately after meals to reduce the risk of unpleasant gastro-intestinal side effects. https://www.mayoclinic.org/drugs-su...rmin should be taken with,, break, or chew it.

Each shake is a carbohydrate-containing meal https://www.tesco.com/groceries/en-GB/products/276141974 so to have carbohydrates regularly throughout the day, take the shakes on three separate occasions during the day rather than drinking all 3 shakes at the same meal.

This patient information leaflet for metformin says, "Overweight patients should continue their energy-restricted diet."
https://www.medicines.org.uk/emc/product/594/smpc#gref

 

[zerocarbisbest]

I haven't read the book, but in this paper, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399621/ , Roy Taylor says:-

Increase in exercise during the weight loss phase was discouraged as this tends to be accompanied by compensatory eating. This phenomenon explains why a portion of people fail to lose weight under conventional care. However, a steady increase in physical activity was strongly encouraged during weight maintenance.
​

Note that his advice is not that people shouldn't exercise but that people shouldn't try increase the amount of exercise they do during the weight-loss phase.

raise in insulin promote hunger.

 

[Oldvatr]

raise in insulin promote hunger.

I think you will find it has the opposite effect. The hunger hormone is Grehlin, which is produced mainly in the stomach but also small amounts from the small intestine and pancreas (but by somatostatin, not by insulin). It is triggered when the stomach is empty or sugar levels are low, and reduces shortly after eating a meal. It is the insulin release due to the meal that lowers grehlin.

Patients who have had gastric bypass do not have the pre meal hunger pangs which aids the weight loss associated with that intervention and this is due to the loss of grehlin release.

There are studies that show that aerobic exercise and HIIT can lead to hunger pangs, but circuit training and gentle exercises do not. This seems to be correlated with the reports on this site that intense exercise seems to increase blood sugar levels, and I postulate that the culprit is adrenaline (epinephrine) which supresses glucose and lipid storage so the sugar remains in the blood unless burnt off by the exercise.

One interesting 'fact' I encountered in my research is that grehlin is increased by cannabis, but only when taken orally but not when smoked. Pity that Hash Brownies are not LCHF.

 

[Dark Horse]

raise in insulin promote hunger.

Exercise doesn't increase insulin so not relevant.

 

[Ronancastled]

@Megan84 Great to see someone being so pro-active.
Although you probably appreciate the regiment of the shakes & the Newcastle diet Taylor himself was clear that it's the weight loss that's important, not how you achieve it.
Think of the maintenance phase once you achieve your weight loss goal, low carb is the way for most of us, read up on 16:8, IF & OMAD too if you really want to look at all future options.

@ljshipley Your bio above reads like my experience.
Like you I was diagnosed at 48 & weighed 273lbs, BMI 42.
I dropped 5.5st by low carb & moderate exercise & got down to 200lb which is still my lowest.
Like you I tried to reintroduce carbs early & got the shock of my life when I hit 13.3(240) on a single bowl of Shreddies early days.
I kept going however & things started to improve, documented here.
https://www.diabetes.co.uk/forum/threads/fbg-4-1-hba1c-33-and-passed-ogtt.175834/#post-2301412

You really need to give it a full 12 months of remission before you attempt to poke the bear.
Then once you've established a baseline you can work from there.

 

[zerocarbisbest]

Exercise doesn't increase insulin so not relevant.

moderate to heavy exercise, not sure where the threshhold is raises blood sugar by the liver, which raises insulin.

 

[zerocarbisbest]

I think you will find it has the opposite effect. The hunger hormone is Grehlin, which is produced mainly in the stomach but also small amounts from the small intestine and pancreas (but by somatostatin, not by insulin). It is triggered when the stomach is empty or sugar levels are low, and reduces shortly after eating a meal. It is the insulin release due to the meal that lowers grehlin.

Patients who have had gastric bypass do not have the pre meal hunger pangs which aids the weight loss associated with that intervention and this is due to the loss of grehlin release.

There are studies that show that aerobic exercise and HIIT can lead to hunger pangs, but circuit training and gentle exercises do not. This seems to be correlated with the reports on this site that intense exercise seems to increase blood sugar levels, and I postulate that the culprit is adrenaline (epinephrine) which supresses glucose and lipid storage so the sugar remains in the blood unless burnt off by the exercise.

One interesting 'fact' I encountered in my research is that grehlin is increased by cannabis, but only when taken orally but not when smoked. Pity that Hash Brownies are not LCHF.

Third, studies are covered in which direct manipulations of insulin level, controlling for blood glucose, are performed. These experiments show that elevations in insulin produce increased hunger, heightened perceived pleasantness of sweet taste, and increased food intake.

in one of dr robert lustig's video he says that insulin supresses the satiety hormone.

 

[Oldvatr]

moderate to heavy exercise, not sure where the threshhold is raises blood sugar by the liver, which raises insulin.

https://www.diabetes.org/healthy-living/fitness/why-does-exercise-sometimes-raise-blood-sugar

 

[Oldvatr]

Also, there is more to exercise than burning glucose.
The Krebs Cycle describes how we get our energy form either glucose or lipids in muscle tissue.
https://opentextbc.ca/anatomyandphysiologyopenstax/chapter/lipid-metabolism/

As far as I am aware, this information is still valid. Note that adrenaline counteracts the action of insulin.

 

[Oldvatr]

Also, there is more to exercise than burning glucose.
The Krebs Cycle describes how we get our energy form either glucose or lipids in muscle tissue.
https://opentextbc.ca/anatomyandphysiologyopenstax/chapter/lipid-metabolism/

As far as I am aware, this information is still valid. Note that adrenaline counteracts the action of insulin.

As an adjunct to previous post, the Randle Cycle describes how the switch between carb or lipid energy sources is controlled.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739696/

In one part of the paper it discusses a particular condition where excess lipids interfere with insulin action, and this leads to the liver producing excess glucose to compensate (see text following Fig 1.) I think the increased insulin aspect is due to the study done on T1D where they have to take extra insulin to overcome apparent insulin resistance. I can find no trigger for T2D doing this naturally.