Prof Roy Taylor's work on reversing type 2 diabetes

[ringi]

I agree partially , but not entirely. if one accepts the premise ( as I do ) that the ability to lose weight is a function of how much insulin -( the fat making hormone) you have in your body, then it would seem likely that ANY diet that reduces circulating insulin quickly, will also reduce weight quickly. As such the composition of the diet IS important.

You are missing an important point, on 800 calories a day the carbs will be fully utilised quickly even if the diet is 100% carbs! Fat then gets removed from the liver within about 1week, and then at least overnight insulin will drop to a low level as BG drops a lot after the first week.

The shakes that are used for the ND results in people testing positive to ketos, proving that insulin levels must be getting low at least for a few hours each day.

“Low Carb”is very important for normal diets that tent to be closer to 1200 calories a day, as otherwise insulin may not drop enough. Very Low Calories diets are closer to fasting then to a normal diet in how the body responds.

 

[CherryAA]

You are missing an important point, on 800 calories a day the carbs will be fully utilised quickly even if the diet is 100% carbs! Fat then gets removed from the liver within about 1week, and then at least overnight insulin will drop to a low level as BG drops a lot after the first week.

The shakes that are used for the ND results in people testing positive to ketos, proving that insulin levels must be getting low at least for a few hours each day.

“Low Carb”is very important for normal diets that tent to be closer to 1200 calories a day, as otherwise insulin may not drop enough. Very Low Calories diets are closer to fasting then to a normal diet in how the body responds.

Whilst you may be right, about ketosis with VLC that would not explain the phenomenon reported on here of increasing blood sugars on a vlc shake diet compared to an LCHF diet.

Adopting the low insulin one meal a day diet of real foods, of 1000-1100 calories has sent my own ketones soaring to a level of 2.0 within a couple of days of adopting it and staying at high levels for 20 odd hours day. I have rarely gone above 0.5 on an LCHF diet, even with very low calories. My personal belief is that it is the fasting part that sends the insulin down just as much if not more than the low calorie aspect. i.e. eating one nice meal a day of real foods is just as likely to be as effective as adopting a more restricted three shakes a day 800 calorie protocol for losing weight and for reducing fasting insulin.

My blood sugars are already down by 20%. This accords fairly closely with the teachings of Dr Jason Fung on the effect of intermittent fasting
.
In the end I guess I will find out soon enough as that is the diet I am currently trying out !

 

[Oldvatr]

You are missing an important point, on 800 calories a day the carbs will be fully utilised quickly even if the diet is 100% carbs! Fat then gets removed from the liver within about 1week, and then at least overnight insulin will drop to a low level as BG drops a lot after the first week.

The shakes that are used for the ND results in people testing positive to ketos, proving that insulin levels must be getting low at least for a few hours each day.

“Low Carb”is very important for normal diets that tent to be closer to 1200 calories a day, as otherwise insulin may not drop enough. Very Low Calories diets are closer to fasting then to a normal diet in how the body responds.

I am sorry, where did you get the info that the ND diet was keto regardles of intake composition? The report clearly states that one of the factors that distinguished the non-responders to those that the diet succeeded was that non responders had higher ketone levels, so it seems ketosis is not a requirement for the diet to work. Anyway the reported ketone levels that indicated failure were approx 0.2 mmol/l which is not indicative of a fat burning ketogenic diet.

Reading the Optifast website, it seems that a diet of only 2 or less shakes can produce mild ketosis, but the ND diet is 3 shakes a day plus extra veg, so should avoid ketosis by design. At 3 shakes a day, carb intake is over 50g, of which 12g is added sugar.

 

[Tannith]

I am sorry, where did you get the info that the ND diet was keto regardles of intake composition? The report clearly states that one of the factors that distinguished the non-responders to those that the diet succeeded was that non responders had higher ketone levels, so it seems ketosis is not a requirement for the diet to work. Anyway the reported ketone levels that indicated failure were approx 0.2 mmol/l which is not indicative of a fat burning ketogenic diet.

Reading the Optifast website, it seems that a diet of only 2 or less shakes can produce mild ketosis, but the ND diet is 3 shakes a day plus extra veg, so should avoid ketosis by design. At 3 shakes a day, carb intake is over 50g, of which 12g is added sugar.

Could you refer me to the details of ketosis in subjects on ND please

 

[Oldvatr]

Could you refer me to the details of ketosis in subjects on ND please

It is in the formal report published by the team. It was published in the Diabetes Care periodical Issue 39. It is available for view in the Pubmed archive ref 27002059. If you seach the article using "keto" then you will find there are only 2 references made in the whole report. So ND #2 was not intended as a keto diet.

 

[CherryAA]

It is in the formal report published by the team. It was published in the Diabetes Care periodical Issue 39. It is available for view in the Pubmed archive ref 27002059. If you search the article using "keto" then you will find there are only 2 references made in the whole report. So ND #2 was not intended as a keto diet.

As far as I understand it Ketosis it not a " diet" per se . Instead it is a state where there are so few calories feeding the body in the form of glucose, that the body has to turn to ketones. Thus ketosis is a result of long term calorie restriction of any diet.

The body will produce glucose itself by glucogenesis which occurs when insulin is high - hence insulin being the fat making hormone and why it is hard to lose weight when on become diabetic ( and even harder if you are prescribed insulin ) . This is also why getting rid of excess insulin is a good idea.

My bloods on diagnosis, showed I was already in nutritional ketosis, and I had been eating a low fat high carb diet beforehand, I did however have an enormous fasting insulin score- and that was coming from all the effort to process the carbs . So I was losing weight but my diabetes was actually getting worse.

Keto diets are simply designed to achieve the same effect without calorie restriction but instead with carb restriction.
In both instances one will end up in ketosis.

This dynamic is why I believe it must be better to follow a low carb keto diet for the 800 calories because that maximises the potential of getting down insulin levels and lowing weight faster as a result.

 

[Chook]

The other big plus about following a very low carb / keto way of eating while following the ND is that hunger isn't much of an issue. I think its fairly commonly accepted that eating carbs make us hungry - do away with the carbs and hunger generally lessens or disappears. I am on Day 1 of Week 8 and I only felt really hungry on the first two days.... I have, however, felt completely bored very often.

 

[badcat]

I am sorry, where did you get the info that the ND diet was keto regardles of intake composition? The report clearly states that one of the factors that distinguished the non-responders to those that the diet succeeded was that non responders had higher ketone levels, so it seems ketosis is not a requirement for the diet to work. Anyway the reported ketone levels that indicated failure were approx 0.2 mmol/l which is not indicative of a fat burning ketogenic diet.

Reading the Optifast website, it seems that a diet of only 2 or less shakes can produce mild ketosis, but the ND diet is 3 shakes a day plus extra veg, so should avoid ketosis by design. At 3 shakes a day, carb intake is over 50g, of which 12g is added sugar.

There is a difference between elevated ketones during nutritional ketosis and elevated ketones approaching / in ketoacidosis
For T2 diabetics where insulin production by the body has decreased to very low levels, there is a significant danger of rising ketones and ultimately DKA when sugars rise above 11/12ish, particularly with low cal intake. / fasting. Given that the study reports initial increased blood sugars above an average of 9mmol in all participants during the first week and much lower recovery of first stage insulin response in the non responder group ( predominantly longer term T2's), then the higher ketone levels in the non responder group tho not initially great are not surprising and prob underly the reason why meds were restarted for some of that group if sugars remained high after 2 weeks off meds

 

[Indy51]

The Optifast ads (regularly shown on TV here in Oz) always talk about ketosis being the key to their success.

 

[Fleegle]

I am doing the ND using shakes and I have to say I spike more than I would like.
The carb values of the shakes I use are not much more than those on the ND and I reduce the amount of mile which evens the whole thing out.

I hate the shakes - but the reason I chose them was because that was the protocol and if I was to use real food I would still be looking for a similar macro nutrient as the shakes in case protein or fat are also an issue.

I will see how my weight goes - I haven't got tons more to lose having already lost over 20KGs before the diet - but I am expecting to start losing fat and more importantly visceral fat on the ND.

 

[Oldvatr]

The Optifast ads (regularly shown on TV here in Oz) always talk about ketosis being the key to their success.

Yes, but their website says 2 or less shakes may give mild ketosis, but the ND diet is 3 so is not the standard Optifast diet for weight loss. It seems that the ND team kept the carb level just above the level for ketosis to happen, and indeed deemed it a fail if ketones registered above 0,1.

 

[CherryAA]

There is a difference between elevated ketones during nutritional ketosis and elevated ketones approaching / in ketoacidosis

For T2 diabetics where insulin production by the body has decreased to very low levels, there is a significant danger of rising ketones and ultimately DKA when sugars rise above 11/12ish, particularly with low cal intake. / fasting. Given that the study reports initial increased blood sugars above an average of 9mmol in all participants during the first week and much lower recovery of first stage insulin response in the non responder group ( predominantly longer term T2's), then the higher ketone levels in the non responder group tho not initially great are not surprising and prob underly the reason why meds were restarted for some of that group if sugars remained high after 2 weeks off meds

I agree entirely with this analysis, however I'm not clear just how much analysis is done to prove that insulin production is actually low ( maybe it was for this study ) but I doubt that many of the people with T2 diabetes here, have the slightest idea if that is because they have enormous levels of fasting insulin and huge insulin resistance or if they have reached the stage where the insulin production has ceased which takes many years.

The study includes people eating more carbs than they would on an LCHF diet, so we do not know if those non -responders would have responded had they been given dietary advice to eat only 800 carbs the LCHF way

From the perspective of the newly diagnosed t2 - the symptoms of high blood sugars are increasingly hard to miss, so its unlikely they will have reached the low insulin production stage.

This does then raise the spectre, that if treating the disease involves adding more insulin load, the actually one is making the problem worse rather than better by such treatments.

Dr Jason Fung sets out the effects of drugs and which ones work best for T2 diabetes in these two blogs
https://idmprogram.com/not-treat-diabetes-t2d-38/
https://idmprogram.com/medications-actually-work-type-2-diabetes-t2d-40/

 

[Tannith]

It is in the formal report published by the team. It was published in the Diabetes Care periodical Issue 39. It is available for view in the Pubmed archive ref 27002059. If you seach the article using "keto" then you will find there are only 2 references made in the whole report. So ND #2 was not intended as a keto diet.

Thank you Oldvatr

 

[badcat]

I agree entirely with this analysis, however I'm not clear just how much analysis is done to prove that insulin production is actually low ( maybe it was for this study ) but I doubt that many of the people with T2 diabetes here, have the slightest idea if that is because they have enormous levels of fasting insulin and huge insulin resistance or if they have reached the stage where the insulin production has ceased which takes many years./

For the non responder group, disproportionatly containing people having had T2 for over 10 years and (again disproportionally tho not absolutely) being a group on multiple medications),combined with the existing research on declining beta cell functionality, total mass etc over the life course of T2, I think it is inconceivable that they were not producing v low insulin evels. For many, but again not all, T2 diabetics the disease may well start with insulin resistence in the context of hyperinsuleamia and glucose toxicity but thats not so for all and it cetainly doesnt end there.
Im looking at it from the perspective of someone who has been diagnosed as T2 for 21 years and apparently undiagnosed for a further 15-20 but still on the same meds (Gliclizide) at the same low dose as I was initially? ive been told Im an anomoly as glic "usually" doesnt work for so long and that has led to a least one Dr questioning if I might have monogenic rather than T2 diabetes which is interesting and fits some aspects of my condition but not too many others - I put the longevity of Glic as being related to my aggressive dietary management

 

[Syd]

The shakes which are available on the Cambridge Weight Plan each seem to contain about 2 to 3 grams of fat and 14 to 15 grams of carbohydrates. That is the basis of the "Total Replacement Diet" for the first 12 weeks of the study in which the calorie intake of each individual is restricted to about 840 KCal per day.

We then move on to the second stage which is the "Food Reintroduction" phase, where there is a food-based diet based on the Eatwell plate guidelines promoted by the NHS. The Eatwell plate is well known. This is a stepped transitional phase in which 'proper' food is re-introduced and last between the weeks 12 and 18 of the study.

The final phase is the "Weight Loss Maintenance" phase which lasts between weeks 19 and 104 (i.e 2 years from the commencement of the study). In this phase, the participants follow an individually tailored diet designed to maintain weight loss. In the event of relapse, the participant will have individualised dietary advice, again based on the Eatwell plate guidelines.

The above is a brief summary of the "Newcastle Diet" as found in the ten-page study protocol produced by Prof Taylor and his colleagues. Nowhere in this protocol can I find reference to LCHF or to Ketosis or Ketoacidosis or Ketones or Keto diet and so I have concluded that these have nothing to do with Prof Taylor's work on this particular study.

 

[bulkbiker]

Nowhere in this protocol can I find reference to LCHF or to Ketosis or Ketoacidosis or Ketones or Keto diet and so I have concluded that these have nothing to do with Prof Taylor's work on this particular study.

Yes unfortunately that is true..

 

[Fleegle]

Yes unfortunately that is true..

I thought the point was as if you went into ketosis on this diet your success rate dropped?

 

[bulkbiker]

I thought the point was as if you went into ketosis on this diet your success rate dropped?

I don't think the ND and ketosis are really compatible at all.. nothing to do with success rate just too many carbs in the shakes. My comment was more that Prof Taylor doesn't even think of a ketogenic diet as maybe helping he's all about the calories..

 

[Pipp]

I didn't even know what ketosis was when I embarked on a VLCD / ND six years ago.
GP had contacted the Newcastle team, and together approved a regime using Lipotrim products as a substitute for the Optifast, which was not available in UK.
I was monitored twice a week, and remained in ketosis from day 2. I believe the ketosis to be the reason why I felt so well, not hungry, and successful weight loss and BG reduction.
As the Newcastle research was in the early stages, and I was not in the controlled experiment, my results were not valid for to be included in the early of study. Perhaps there will be further research opportunities following publication of the current research report. There certainly is plenty for researchers to consider in the design of any new study. Evidenced by the different experiences and findings of individuals like the member reports here.

 

[Guzzler]

The transition from low cal diet with shakes to low cal without seems as though it might be a big step to climb. One would have to be highly motivated to stick to that at home. Almost as if a 'new' diet was to be embarked upon.
I ponder the question that if ND proves optimal, how many people choosing the bariatric pathway would then change their minds seeing some success with ND which, imo, would be better than invasive surgery? I look upon all of this from the human perspective of course.