Prof Taylor on BBC4 soon this lunchtime

[AdamJames]

AT this stage of my progress I don't really know whether conversion to LCHF is going to have got me off the weight roller coaster either . I am still capable of binges and I suspect falling off the wagon. Only time ( a lot of time ) will show me the answer . I hope I have enough of it to see.

I hope you have enough of it to see, too!

I did initially think I'd find it easier to keep the weight off when I switched to LCHF, because I was under the impression that I found carbs particularly addictive. It didn't take long for me to realise that no, really, it's food that I find addictive. Most of us who are overweight seem to agree that for whatever reason, losing weight is a good idea, and I know that's going to be a battle for me no matter what the diet is!

 

[walnut_face]

.

One thing is clear: It would be preposterous to think that an ND approach is *optimal* for reversing T2. The shakes and veg meal plan wasn't carefully tailored to that purpose by people in Newcastle, it was created by Optifast for rapid weight loss for any reason.

@ickihun posted a few days ago reminding us what the objective of the original ND Counterpoint study was, and I think in the heat of other debates it has been missed.

Prof. Taylor had looked at the FBG data of morbidly obese T2's in the week(s) following bariatric surgery. This showed a dramatic fall within 7 days even though there was little weight loss at that stage. His study aimed to discover if such FBG results could be achieved purely by severe food restriction, as is required after surgery, without the surgery. The optifast involvement was irrelevant, and chosen because a) The calorie consumption was controlled, and b)the product was free.
That initial study was never about long term solutions. The DiRECT study has started to address that, but remember the sponsor is a supporter of the eatwell guide.....................

From a personal prospective, I have gone down the Lower Carb route, and while my Blood Sugars are far lower than they used to be I am still greeted with FBG's >7 in the morning, which tells me that the automatic checks and balances no longer function, and I have to "think my diabetes out loud" Would following an ND style regime alter that? Only one way to find out

 

[AdamJames]

@ickihun posted a few days ago reminding us what the objective of the original ND Counterpoint study was, and I think in the heat of other debates it has been missed.

Prof. Taylor had looked at the FBG data of morbidly obese T2's in the week(s) following bariatric surgery. This showed a dramatic fall within 7 days even though there was little weight loss at that stage. His study aimed to discover if such FBG results could be achieved purely by severe food restriction, as is required after surgery, without the surgery. The optifast involvement was irrelevant, and chosen because a) The calorie consumption was controlled, and b)the product was free.
That initial study was never about long term solutions. The DiRECT study has started to address that, but remember the sponsor is a supporter of the eatwell guide.....................

From a personal prospective, I have gone down the Lower Carb route, and while my Blood Sugars are far lower than they used to be I am still greeted with FBG's >7 in the morning, which tells me that the automatic checks and balances no longer function, and I have to "think my diabetes out loud" Would following an ND style regime alter that? Only one way to find out

I think I was making the same point about the unimportance of Optifast; maybe it didn't come across that way! I was aware that it was a free and simple way of controlling intake, that's all. Hence my point about it being absurd to think it was in any way engineered to be optimal for reversing T2.

My understanding of the 3 main studies is this, from memory:

1st: See what happens when overweight T2 people of short duration diabetes (<4 years, from memory?) go on a radical calorie-restricted diet, bariatric-patient-surgery style. The observations showed rapid drop in fbg over a week down to normal range. This coincided with an observed loss in liver fat. Over 8 weeks, the insulin response, esp. first phase, gradually improved to almost normal levels. This coincided with an observed loss in pancreas fat, and was the finding of most interest. By all usual measures, at 8 weeks, all 11 participants were non-diabetic. At a 3 month followup, 7 were still non-diabetic.

2nd: See what difference the duration of T2 diagnosis makes. Main finding was that the longer you've had T2, the harder it will be to "reverse". The correlation is not understood, and may not be linear. It could suddenly get much harder at about the 10 year range, for example.

3rd (DiRECT): See what happens if the approach is rolled out in standard medical practice, and compare that with current "best" medical practice. Patients with T2 diagnosis of <6 years (memory?) were asked to perform rapid weight loss phase, followed by GP/nurse help with maintaining weight thereafter. Patients would be deemed in "remission" if, at one year from start, their HbA1c was less than 6.5%. Patients will be followed-up even longer term, I believe, not just for HbA1cs but also for complications. Main finding (so far), in spite of rather disappointing definition of remission(!), is that no weight loss = no remission, and there's a very strong correlation between weight loss and remission.

 

[CherryAA]

Great analysis . The only part I would clarify further is that in my experience switching to an LCHF diet of about 1200 calories did a very similar initial rapid glucose job as did the ND protocol .

 

[Tannith]

I think I was making the same point about the unimportance of Optifast; maybe it didn't come across that way! I was aware that it was a free and simple way of controlling intake, that's all. Hence my point about it being absurd to think it was in any way engineered to be optimal for reversing T2.

My understanding of the 3 main studies is this, from memory:

1st: See what happens when overweight T2 people of short duration diabetes (<4 years, from memory?) go on a radical calorie-restricted diet, bariatric-patient-surgery style. The observations showed rapid drop in fbg over a week down to normal range. This coincided with an observed loss in liver fat. Over 8 weeks, the insulin response, esp. first phase, gradually improved to almost normal levels. This coincided with an observed loss in pancreas fat, and was the finding of most interest. By all usual measures, at 8 weeks, all 11 participants were non-diabetic. At a 3 month followup, 7 were still non-diabetic.

2nd: See what difference the duration of T2 diagnosis makes. Main finding was that the longer you've had T2, the harder it will be to "reverse". The correlation is not understood, and may not be linear. It could suddenly get much harder at about the 10 year range, for example.

3rd (DiRECT): See what happens if the approach is rolled out in standard medical practice, and compare that with current "best" medical practice. Patients with T2 diagnosis of <6 years (memory?) were asked to perform rapid weight loss phase, followed by GP/nurse help with maintaining weight thereafter. Patients would be deemed in "remission" if, at one year from start, their HbA1c was less than 6.5%. Patients will be followed-up even longer term, I believe, not just for HbA1cs but also for complications. Main finding (so far), in spite of rather disappointing definition of remission(!), is that no weight loss = no remission, and there's a very strong correlation between weight loss and remission.

Both ND and LCHF diets "work". But they "work" for doing different things. LCHF works to control diabetes by lowering blood sugars. As do drugs (though not everyone can tolerate metformin). ND on the other hand "works" to put diabetes T2 into permanent remission, as long as the person keeps the weight off. Potentially for life. Its horses for courses. Not everyone wants to lose weight.

 

[CherryAA]

Both ND and LCHF diets "work". But they "work" for doing different things. LCHF works to control diabetes by lowering blood sugars. As do drugs (though not everyone can tolerate metformin). ND on the other hand "works" to put diabetes T2 into permanent remission, as long as the person keeps the weight off. Potentially for life. Its horses for courses. Not everyone wants to lose weight.

I think that's where we disagree - I think LCHF works to achieve exactly the same remission as ND by allowing a clear out of fat in vital organs and that comes from lowering insulin as a result of lower glucose, even if there is a slower rate of weight loss in those actually wanting to lose weight and of course for those not wanting to lose weigh LCHF must be a better way to go than extreme calorie restriction .
.
I think for both LCHF and ND one can be in permanent remission if you stay at the same weight you got to to achieve remission in the first place. ( in my case that seems to be 90 kg - at last for a year + now) . Remission itself probably comes from the point that one has cleared out the fatty liver by whatever means.

https://www.nature.com/articles/s41387-017-0006-9?platform=hootsuite

This study gives a good comparison between what happens on an LCHF diet versus a calorie restricted moderate calorie diet. The LCHF diet shown, is actually achieving parameters as good as those outlined in the ND diet. i.e. it is possible to get as good results from eating considerably more calories and thus reversal of diabetes does not have to be entirely weight driven - which is of course great news for those who have been diagnosed and are not overweight in the first place.

 

[DCUKMod]

Both ND and LCHF diets "work". But they "work" for doing different things. LCHF works to control diabetes by lowering blood sugars. As do drugs (though not everyone can tolerate metformin). ND on the other hand "works" to put diabetes T2 into permanent remission, as long as the person keeps the weight off. Potentially for life. Its horses for courses. Not everyone wants to lose weight.

Tannith - I have no vested interest or axe to grind in terms of how any given individual chooses to address their diabetes, but I feel bound to comment that I have never done the ND, I reduced carbs. I didn't pay much heed to fats, until I had to stop losing weight, but my diabetes was put into and appears to have remained in a good place, within 4 months of diagnosis. (Four months in was the first I was available for retest, due to sustained overseas travel.)

My HbA1c seems to flicker between 31 and 33 (literally, bizarrely) and I performed well in an OGTT a few months ago (starting, fasted at 3.9, 6.9 at 1 hour, and 3.5 at 2 hours. My body self-helped at 135 minutes when I reached 3.2, then I had a cup of tea whilst I prepared breakfast).

Diabetes is one of those things that is incredibly personal, with personal responses varying; sometimes dramatically. I'm my view there is no single solution, but if any given person fancies trying given approach, then they should satisfy their curiosity - provided it is safe for them to do so. Those with co-morbidities should proceed with caution, whichever approach they choose.

 

[ickihun]

Because type2 is metabolic disease then only when the metabolic system is right can more than good management improve the disease. Or reverse its influence on bgs.
I did milkdrinks and fasting to improve my undiagnosed diabetes but had severe signs of insulin resistance in the 80s. I did not maintain my status. I ducked and dived blood tests and only go gp tests when my diet and exercise were at top form in the 90s (awaiting ivf). I only got diagnosed after xmas and new year drinking and sweets/chocolates/cakes at the festive time. Shift work didnt help either.
The way to reverse is intensive diet and exercise change. A shock to the metabolism. However I never sustained any possible reversal throughout my 40yrs of having insulin resistance/type2. IR came after thrush or at least the proven health diagnosises. Diabetes last but only all metabolic syndrome conditions werent evident til heavy pregnancy. When no extreme exercise is ever recommended.

 

[JohnEGreen]

I am a little confused now I cannot decide whether it was eating less than 800 calories a day for over a year or reducing my carbohydrates to less than 80 mostly less than 50 grams aday for the same period that has put me in remission or if it more a combination of both. Are ND and LC mutually exclusive somehow.

 

[CherryAA]

I am a little confused now I cannot decide whether it was eating less than 800 calories a day for over a year or reducing my carbohydrates to less than 80 mostly less than 50 grams aday for the same period that has put me in remission or if it more a combination of both. Are ND and LC mutually exclusive somehow.

I don't think they are mutually exclusive at all. Under both scenarios you would be mainly burning fat, In both scenarios you are eating relatively less carbs than in general. If as a result of being able to stick to 800 calories a day you have now achieved where you want to be weight wise, then you can relax in the knowledge that if you continue with generally low carb eating then you are likely to continue to improve your metabolic health and if you have no further weight to lose, you can probably add more fats and proteins .

If you are anything like me, you will probably find that eating real foods, which is naturally generally LCHF, plus the occasional treat, allows you to maintain diabetic control and generally enjoy life. Whether you are in remission or not, a reversion to the diet that gave you the illness in the first place is unlikely to be on your agenda!

It hardly matters why you got to the state you did, the fact is you did and now you can reap the rewards.

 

[AdamJames]

From a personal prospective, I have gone down the Lower Carb route, and while my Blood Sugars are far lower than they used to be I am still greeted with FBG's >7 in the morning, which tells me that the automatic checks and balances no longer function, and I have to "think my diabetes out loud" Would following an ND style regime alter that? Only one way to find out

Recently I found a similar thing. Hard to get FBGs below 7 in morning while *maintaining* weight, regardless of diet. When I go into weight loss mode, they come down, again regardless of diet. The interesting question is going to be, will fbg get to a safe level by the time I've lost all the weight it's safe to lose!

 

[AdamJames]

Great analysis . The only part I would clarify further is that in my experience switching to an LCHF diet of about 1200 calories did a very similar initial rapid glucose job as did the ND protocol .

Snap. I did the 'blood sugar diet', which is supposed to be 800 cals a day, but in reality I started at about 900 and it crept up to about 1200 pretty quickly. Either way, my fbgs plummeted.

 

[AdamJames]

Tannith - I have no vested interest or axe to grind in terms of how any given individual chooses to address their diabetes, but I feel bound to comment that I have never done the ND, I reduced carbs. I didn't pay much heed to fats, until I had to stop losing weight, but my diabetes was put into and appears to have remained in a good place, within 4 months of diagnosis. (Four months in was the first I was available for retest, due to sustained overseas travel.)

My HbA1c seems to flicker between 31 and 33 (literally, bizarrely) and I performed well in an OGTT a few months ago (starting, fasted at 3.9, 6.9 at 1 hour, and 3.5 at 2 hours. My body self-helped at 135 minutes when I reached 3.2, then I had a cup of tea whilst I prepared breakfast).

Diabetes is one of those things that is incredibly personal, with personal responses varying; sometimes dramatically. I'm my view there is no single solution, but if any given person fancies trying given approach, then they should satisfy their curiosity - provided it is safe for them to do so. Those with co-morbidities should proceed with caution, whichever approach they choose.

Congratulations on your remission and extraordinary results. Do you have a thread about your road to remission that you could link to?

Failing that would you mind giving a brief overview, e.g. HbA1c on diagnosis, typical foods you used, rough estimate of daily calories while trying to achieve remission, and since remission?

 

[Biggles2]

3rd (DiRECT): See what happens if the approach is rolled out in standard medical practice, and compare that with current "best" medical practice. Patients with T2 diagnosis of <6 years (memory?) were asked to perform rapid weight loss phase, followed by GP/nurse help with maintaining weight thereafter.

I agree with your points above @AdamJames and would add the following observation: According to the study protocol for the DiRECT study, one of the goals of the study was to determine whether a 'structured, intensive, weight management programme, delivered in a routine Primary Care setting, is a viable treatment for achieving durable normoglycaemia.'

The Optifast shakes (or any VLC restricted diet) work in the short term to achieve the desired weight loss, there is no question about that. However, it is the durability of the weight loss and the normaglycaemia that may be difficult to sustain in the long term in the resource-constrained primary care setting. A study looking at the intensity and cost of the support needed to sustain the ND results (and they used the Counterweight Plus weight management programme as part of their protocol) in the Primary Care setting would be in order.

On a more general note, it will also be helpful to see long-term outcomes. According to the study, the intervention group will continue to be followed for at least 4 years, and Professor Taylor and his team plan to report separately on the 'changes in intra-organ fat in a subgroup of the DiRECT cohort'. This will be very useful information.

 

[AdamJames]

The Optifast shakes (or any VLC restricted diet) work in the short term to achieve the desired weight loss, there is no question about that. However, it is the durability of the weight loss and the normaglycaemia that may be difficult to sustain in the long term in the resource-constrained primary care setting.

Definitely. While giving patients regular access to support for weight maintenance is probably vital considering what we all know about the reality of weight loss and re-gain, it's questionable whether it's affordable enough to persuade the NHS to do it. I mean for example I think I was costing the NHS about £30 a year when I was on Metformin. I think the regular consultations to help with weight maintenance are likely to cost a heck of a lot more than that.

That's probably another tick in the box for LCHF; if it turns out the general populace can get their head around the principles and, as many people do, find it both satisfying and good for keeping the weight off, then the NHS might end up pushing it just to keep the consultations down! The recent change in dietary advice re things like saturated fats being okay, might have come at just the right time.

On a more general note, it will also be helpful to see long-term outcomes. According to the study, the intervention group will continue to be followed for at least 4 years, and Professor Taylor and his team plan to report separately on the 'changes in intra-organ fat in a subgroup of the DiRECT cohort'. This will be very useful information.

It's so frustrating having to wait, isn't it?

And there could be some surprises, good and bad. It's known rapid lowering of HbA1C can be bad news in terms of retinopathy for some people - what else may be discovered among all these people who have just achieved wonderful remission in a short period?

For me the complications monitoring really is everything, although it's not often discussed. For all the talk about insulin resistance, glucose tolerance, fasting glucose levels, spikes after meals, HbA1cs etc, all that really matters is trying to avoid complications. While there's good evidence that a diabetic should try to mimic the glucose patterns of a non-diabetic in order to achieve the best outcomes, I think there's a whole big gap in our knowledge there.

 

[Biggles2]

I think the regular consultations to help with weight maintenance are likely to cost a heck of a lot more than that.

Agreed! I am all for 'disruption' in health care to increase capacity and improve actual outcomes for individuals! So, for me, that begs the question, why does support have to be located in primary care/GP's offices?

I would say that this forum (as a great example) does more in terms of providing great support, with very positive results for many, than a rushed 5-10 minute consultation in primary care no matter how well it is done - and, even if more funds were to be allocated to primary care/GP practices to provide this support, the nursing literature shows that this type of 'invisible' support is always vulnerable to being omitted downstream due to competing demands on a busy nurse's time. The risk of 'missed nursing care' becomes even more acute if the prevailing wisdom in an individual GP surgery is that T2DM is a progressive disease, and is compounded by a reward system where early introduction and escalation of medications is incentivised, such as through the QOF framework.

We need a lot of disruption all around! Perhaps this is the perfect project for the upcoming 75th Anniversary of the NHS!

 

[DCUKMod]

Congratulations on your remission and extraordinary results. Do you have a thread about your road to remission that you could link to?

Failing that would you mind giving a brief overview, e.g. HbA1c on diagnosis, typical foods you used, rough estimate of daily calories while trying to achieve remission, and since remission?

Thanks Adam. I don't have a thread where I documented my progress. I just did my thing.

At diagnosis HbA1c of 73, reducing to 37 at 4 months, then reducing further until my present toggling 31/33 state. There's actually a fair bit of diabetes in my family of both major types, but my asymptomatic diagnosis was still a bit of a shocker.

I chose to tackle my condition by eating to my meter, with a sole focus on achieving improved blood scores. I concluded I'd rather have love handle with good blood scores than be skinny with rampant diabetes. I chose to eat to my meter, which then guided me to reduce my carbs.

I trimmed up, but have no idea by how much as I didn't weigh myself on diagnosis (and wasn't weighed by the medics) or for the initial 4 months, but by 4 months I was pretty trim. I'm a very slight 47/48kg (at 160cm), six 6 clothing, with size 3 tootsies, so my current maintenance regime is as much about ensuring I don't lose, rather than gain. My current visceral fat score is 3 and body fat percentage is 16%, as measured by my Karada Scanner scales. I wouldn't complain if I saw 50kg on the scales, but wouldn't care to go much beyond that.

I've never really counted carbs, but stuck with eating to my meter. These days I can get away with plenty carbs, but prefer not to go OTT. Most carbs are pretty tasteless, so I stick with the tasty stuff, plus loads of veg, which I have always enjoyed. I won't count today's carb intake as we're having a curry this evening, and I'll likely have some rice, although by "normal" standards a modest portion. I'm also gluten-free.

In terms of calories, I may not be a very big person, but I pack away my food. I'm rarely below 2000 calories a day and quite often can be nearer 2500, so for me it is clear not all calories are equal, as I'm pretty certain I didn't consume that much pre-diagnosis.

We're all different and I feel I was fortunate to be diagnosed when I was fit and otherwise healthy and had the energy and time to invest in my health.

As I have said, ad nauseum, people should try what they want to, but in this life, unfortunately there are to guarantees. I aim to keep my health in a good place for as long as I can, but should I ever find myself having to have meds, or adopt a different way of living, I guess I'll just have to get on with it. The only certainty in life is change.

Just for full disclosure, before I adopted the DCUKMod role, my user ID was AndBreathe which still exists, so I have posts all over the place from my time of joining in late 2013.

 

[Tannith]

It's known rapid lowering of HbA1C can be bad news in terms of retinopathy for some people - what else may be discovered among all these people who have just achieved wonderful remission in a short period?

Could you kindly enlarge on this?

 

[AdamJames]

Could you kindly enlarge on this?

I won't use my own words here as it's serious enough to not want to spread misinformation by using my rubbish memory!

From the 'information for doctors' pdf at

http://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation

"It is most important to consider the individual’s microvascular complications before embarking upon major dietary change. If there is no retinopathy, or only early changes (scattered micro aneurysms with few blot haemorrhages) then no additional precaution is required other than an annual screening. However, if moderate or more severe retinopathy is present then arrangements should be made to re-screen the eyes within six months of achieving a substantial improvement in blood glucose control. The reason for this is that the sudden normalisation (reduction) in retinal blood flow associated with the return of normal blood glucose control can disadvantage areas of the retina in areas of marginal circulation with resulting deterioration in retinopathy."

 

[Tannith]

Thanks Adam. I don't have a thread where I documented my progress. I just did my thing.

At diagnosis HbA1c of 73, reducing to 37 at 4 months, then reducing further until my present toggling 31/33 state. There's actually a fair bit of diabetes in my family of both major types, but my asymptomatic diagnosis was still a bit of a shocker.

I chose to tackle my condition by eating to my meter, with a sole focus on achieving improved blood scores. I concluded I'd rather have love handle with good blood scores than be skinny with rampant diabetes. I chose to eat to my meter, which then guided me to reduce my carbs.

I trimmed up, but have no idea by how much as I didn't weigh myself on diagnosis (and wasn't weighed by the medics) or for the initial 4 months, but by 4 months I was pretty trim. I'm a very slight 47/48kg (at 160cm), six 6 clothing, with size 3 tootsies, so my current maintenance regime is as much about ensuring I don't lose, rather than gain. My current visceral fat score is 3 and body fat percentage is 16%, as measured by my Karada Scanner scales. I wouldn't complain if I saw 50kg on the scales, but wouldn't care to go much beyond that.

I've never really counted carbs, but stuck with eating to my meter. These days I can get away with plenty carbs, but prefer not to go OTT. Most carbs are pretty tasteless, so I stick with the tasty stuff, plus loads of veg, which I have always enjoyed. I won't count today's carb intake as we're having a curry this evening, and I'll likely have some rice, although by "normal" standards a modest portion. I'm also gluten-free.

In terms of calories, I may not be a very big person, but I pack away my food. I'm rarely below 2000 calories a day and quite often can be nearer 2500, so for me it is clear not all calories are equal, as I'm pretty certain I didn't consume that much pre-diagnosis.

We're all different and I feel I was fortunate to be diagnosed when I was fit and otherwise healthy and had the energy and time to invest in my health.

As I have said, ad nauseum, people should try what they want to, but in this life, unfortunately there are to guarantees. I aim to keep my health in a good place for as long as I can, but should I ever find myself having to have meds, or adopt a different way of living, I guess I'll just have to get on with it. The only certainty in life is change.

Just for full disclosure, before I adopted the DCUKMod role, my user ID was AndBreathe which still exists, so I have posts all over the place from my time of joining in late 2013.

I would call any weight loss diet that removes your pancreatic fat and liver fat, and takes you down to your personal fat threshold, "ND". Prof Taylor says you can use any diet you like as long as its low in calories. A Low carb diet will do perfectly well as long as you don't compensate for the missing carbs with too much fat. I personally am currently doing a low carb with low fat diet, of just under 1000 cals which I describe as Newcastle because I am prioritising the low calorie aspect in order to achieve the 15% weight loss (minimum). As long as you lost sufficient weight that's what counts.