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Prof Roy Taylor hypothesis - DIRECT study & pancreatic fat

B

Begonia

Well-Known Member
Messages
120
Location
Yorkshire
Type of diabetes
Prediabetes
Treatment type
I do not have diabetes
The recent results of the DIRECT study show correlation between how much weight the participants lost and the percentage who have gone into 'remission' (86% in those who lost 15kg or more, 57% in those who lost 10-15kg and 34% in those who lost 5-10kg).

Does the study also look at the fat in the pancreas in participants who have gone into remission ? If so that would perhaps further support Prof Taylor's hypothses that the fat in the liver and most importantly fat in the pancreas is the problem. Then efforts could be focused on how to get rid of that pancreatic fat most effectively, whether by intermittent fasting, low calorie diet, low carb, exercise regimes or a combination.

I suspect they don't have the data due to the nature of the study being across multiple centres and the cost of doing the specialised MRI scans. Has anyone read the whole paper ?
 

No, not according to the abstract. Prof Taylor talks about the hypothesis in the acompanying podcast.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext
 
Begonia said:
how much weight the participants lost and the percentage who have gone into 'remission' (86% in those who lost 15kg or more, 57% in those who lost 10-15kg and 34% in those who lost 5-10kg).
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I note that their "recruits" were type 2 diabetes diagnosed within the past 6 years, having a body-mass index of 27–45 kg/m2. I could weigh as much as 142 kgs to be within that BMI range, but at twenty years I'm well outside that 6 year mark.

My personal experience proves nothing really but having escalated to 163 kgs thanks to Rosiglitazone, Citilapram and a GP who felt that my anxiety at gaining weight was more serious than the weight gain itself. Having now lost 35 kgs I show no signs of being in "remission" although a very low calorie diet which I have tried for 6 weeks performed miracles on my BG . . . . . until I returned to a low calorie diet of 1500 calories max, substantially less than my RMR of 2300. As I say it proves very little.
 
Begonia said:
Does the study also look at the fat in the pancreas in participants who have gone into remission ?
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Yes, I have read the full paper; the following quote answers your question:
“Changes in intra-organ fat content and beta-cell function in a subgroup of the DiRECT cohort will be reported separately.” p. 8
 
Biggles2 said:
Yes, I have read the full paper; the following quote answers your question:
“Changes in intra-organ fat content and beta-cell function in a subgroup of the DiRECT cohort will be reported separately.” p. 8
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Thanks @Biggles2 itll be really interesting to see whether the results support the pancreatic fat theory !
 
The cynic in me thinks in seperate report as to not take shine away from 48% only in remission after 5mths of starvation.
They will start craving carbs again. I wonder who will sustain their prognosis! If any.
All that suffering and in the longterm far less successful than bariatric surgery.
 
Just found this article by Dr Fung. I had not realised that he is fully in accord with Prof Taylor's thinking on pancreatic fat being the problem. He just has a different way of getting rid of the pancreatic fat, ie Intermittent Fasting rather than the Newcastle Diet. https://idmprogram.com/fatty-pancreas-t2d-9/
 
The NHS spends more on diabetic medications than any other ailment - £1 billion per year - see https://www.theguardian.com/society/2016/aug/03/diabetes-drugs-cost-nhs-1bn-a-year-presciption

Despite this huge cost the remission rate for type 2 diabetes is only about 4%. Complications from diabetes including amputations, strokes, blindness etc costs in the region of £10 billion per year. However, a diet based approach can result in very high levels of remission, which could save the NHS billions in future years in lower medication costs and less cost for hospital treatments.

It does appear from threads in this forum that most type 2 people who adopt a LCHF diet or undergo a Newcastle Diet get their blood glucose down to levels where medication is no longer required. This is a vastly better outcome than most type 2 patients in typical GP surgeries around the UK. My impression from talking to my diabetes nurse is that very few of her patients manage to get the type of results I found after going low carb. There needs to be education program for GPs and HCPs to tell them what is the most effective method to reverse type 2 diabetes. Otherwise the NHS will be overwhelmed with a tsunami of diabetic patients.
 

At my practice there is me and another. But I did it against the advice I was given by my dn. I think though that her way would have been kinder for me to follow. Ie being on meds and eating 'normally'.
 
Does the report define remission and state how.long it must be maintained to be considered a remission rather than just good control?

I was dx'd this year and have lost way more than 15%, still t2d. But my last hbalc was 39 and my bgl averages at about 5.6, so no complaints. But too many carbs and I am back on the way to retinopathy.

@woodywhippet61 , I went lchf and the nurse at my surgery doesn't want to see me again. Not because she disapproves, but I think because my numbers are now non d so she isn't interested. At least, I am assuming that, because nobody has spoken to me about it.

I love the fact that t2d can be stopped in some.people. it gives me hope that by the time.my kids are my age there will be a proper course of action that will.really help.
 
Kentoldlady1 said:
Does the report define remission and state how.long it must be maintained to be considered a remission rather than just good control?
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Yes, it defines it as an HbA1c of under 48 by the end of the 12 month exercise with no diabetes medication for at least the last 2 months of the exercise.

I find that definition far too generous. Under 48???? That is still pre-diabetic and at risk.

Co-primary outcomes were weight loss of 15 kg or more, and remission of diabetes, defined as glycated haemoglobin (HbA1c) of less than 6·5% (<48 mmol/mol) after at least 2 months off all antidiabetic medications, from baseline to 12 months.
 
@Kentoldlady1

I too agree with you it is wonderful that people with T2d can go into remission and eat what they want to again. I would hope that by the time your kids are your age (whatever that is ) there won't be so much pressure to eat carbs and sugars.
 
I think the point of the less than six years was that they were under the impression that after six years, there would be damage to the beta cells as a result of type 2 and therefore remission was less likely.
 


Thankyou. So, now they are pre diabetic!!! Not in remission?

I really want to believe that this approach has merit. But must admit the more I read about it the more confused I become.
 
woodywhippet61 said:
At my practice there is me and another. But I did it against the advice I was given by my dn. I think though that her way would have been kinder for me to follow. Ie being on meds and eating 'normally'.
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I used to eat "normally", i.e. what I thought was a healthy diet: country crisp breakfast cereal, lots of fruit, orange juice, potatoes, rice, brown bread. I did eat a few chocolate bars and the occasional pastry. However, I was obese with a BMI of over 33 and have been overweight for a long time and failed to lose weight or had yoyo weight loss/gain when I tried weight-watchers.

I now realise that my diet was unhealthy. I cut out the carbs to reduce blood sugars. I lost weight as a side effect - 16Kg lost since my peak weight. There is no way I would want to go back to eating as before, even if my blood sugars were under control. My wife is not diabetic, but she has also cut back on the carbs and has lost 11 Kg and now has a BMI of about 21.

Carbs are highly addictive and people find it hard to give them up. The good thing about eating low carb is that you don't have to make a huge effort to lose weight. It happens naturally. Intermittent fasting is also surprisingly easy once you try and can speed up normalisation of blood sugars.
 
tim2000s said:
I think the point of the less than six years was that they were under the impression that after six years, there would be damage to the beta cells as a result of type 2 and therefore remission was less likely.
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It's a difficult position for them to be in at the moment. They naturally want to give the research the very best chance of producing positive results hence their screening procedure. But at some point in time surely someone has to research whether there is a cut off point beyond which too much damage has been done to the beta cells.

The whole beta cells are they permanently damaged or can they recover issue just blows my mind slightly. I find it hard to get my head around a lot of the more scientific / technical aspects of diabetes.

The other things that I just don't understand at all is why at 41 I would be normal but at 42 I'd be pre-diabetic, at 47 I'd be pre-diabetic but at 48 I'd be diabetic. WHAT 1 point makes so much difference when we all know that these measurements are inaccurate to say the least.

Edited to remove the sad and pathetic drivel that I'd written.
 
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woodywhippet61 said:
The whole beta cells are they permanently damaged or can they recover issue just blows my mind slightly. I find it hard to get my head around a lot of the more scientific / technical aspects of diabetes.
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That's why reasearch and trials are so important. So someone linked last year's paper for me, and from reading that, the TL;DR version is.. Previously it was thought that the effects on pancreatic beta cells was permanent/irreversable. But following on from the ND, it looks like function's restored in the 'responders' group, potentially with the reduction in pancreatic fat. If the wider study shows the same thing, then it looks like it's reversable in some T2 diabetics, but presumably only if a 'healthy' diet is maintained to prevent fat accumulation and the cycle starting again.
 
Following healthy eating after the diet is crucial. It's 18 months since I did the Newcastle diet. It was against nhs advise and I had no support other from advise from this site. Last time I saw the doctor he used the word cured. I couldn't argue but without constant self funded blood monitoring I'd be back where I was. Hopefully these headlines will encourage more doctors to "allow" patients to self monitor and gain personal control.
 
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