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Remission - What Works

I

ianf0ster

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Location
Harpenden, Herts, England
Type of diabetes
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Diet only
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exercise, phone calls
I feel that there is a lot of debate/confusion about Type 2 remission. There are many definitions used for remission in different studies , studies are of vastly differing robustness, duration etc. And I have seen several focusing on health in general that appear to flatly contradict each other - though these tend to be the epidemiological ones relying on just a 'food questionnaire' answers.

So to avoid me being asked to provide (plausible) proof of some of the things I say in the Forums (perhaps it's just me), I thought it a good idea to have a place where we could have descriptions of studies (conclusions, type, quality, length etc.) together with a link to the study or a link to a report on it which itself contains a link to the original study.

I will start this off with a recent on moderate weight loss and T2 remission:
A Cambridge University study:
Length 5yrs
Quality high (but method of weight loss and support required was not considered, though other factors were included).
Findings 30% T2 remission (HbA1C ,48 on no diabetes medication , not even Metformin) for those (newly diagnosed T2s) who achieved a >10% weight loss at the 5yr mark. Twice that of those who didn't achieve a 10% weight loss.
Link: https://www.cam.ac.uk/research/news...e-with-achievable-weight-loss-say-researchers
 

And a link to the study being discussed..

https://onlinelibrary.wiley.com/doi/full/10.1111/dme.14122
 
Sustainability after a crash diet approach.
The study was on the 'Newcastle Diet' or Very Low Calorie Diet (VLCD)
Abstract:
"In the DiRECT trial, Michael Lean and colleagues (Feb 10, p 541) report diabetes remission after very low calorie diets (VLCDs). Numerous studies of VLCDs have shown diabetes improvement and remission, but much of the effect, as this trial confirms, is correlated to weight loss. Unfortunately, weight loss from VLCD with behavioural therapy has proven to be unsustainable in 1-year to 5-year follow-up studies. Metabolic adaptation driving regain in response to caloric restriction is well documented, supporting the paradigm that weight regain after VLCD is more related to energy regulatory mechanisms than willpower"

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31889-0/fulltext
 
On topic, but a slight detour. Here is a recording of a presentation at the recent PHC conference.
It is mostly about weight Loss - so does not cover the 'cholesterol theory', just the Insulin theory.
It has many, many references, too many and to unclear for me to read in order to list all of the studies.

However sever of our forum's members were at this conference (including Dr David Unwin who gave a talk there), so perhaps they took some notes.


I'm unsure if I'm allowed to name the members who I know attended, or if I need to get their permission first.
This may be sensitive because one of them is a moderator.
 
One problem about looking at remission is that, from personal experience - type twos who throw out the tablets and achieve normal levels are studiously avoided by the diagnosing doctor, with NFA on their notes, so it is as though they do not even exist.
 
According to my GP and a CDE I spoke to at Diabetes Queensland, that there is no such thing a remission or reversed with T2 diabetes in Queensland or Australia most probably.

This why I am saying I have my T2 under very good control, now if I start eating rubbish food again I will revert back to where I was nearly three years ago and not under control.

I am a T2 in recovery mode if you like, the same as a alcoholic that has not had a drink for a year or more.

The last three months I have slightly higher fbgl readings as it now six months since I have stopped taking metformin.

My daily averages are reasonable as are my three monthly bgl average.
 
My GP and DN at the local surgery do not have a view on when I got into remission, or exactly what it means, as I appear to be their only patient who achieved this. They have said that after two years of HbA1c tests within the normal range they will reduce monitoring, but have no plans to drop testing completely at the moment.
 
Adding to the data - no study references , but names of lead researchers are mentioned.
This Podcast examines how Metabolic effects (such a in Diabetes) are likely to cause more Heart Attacks than does plaques in the Arteries. Thus casting doubt on the usefulness of Stents or of Statins.
https://podcasts.apple.com/gb/podca...t-cancer-so-rare/id1453181214?i=1000458752867

Having listened to more of it I see that it also covers the following:
The heart muscle cells preferred energy source is Fat based.
Heart Cancers are very rare
Cancer is caused by damage to the mitochondria in a cell rather than the genetic nucleus of a cell having a pre-disposition to cancer.
A theory as to why heart cancer is rare is that the mitochondrial damage triggers a heart attack before cancer has had long enough to develop.

This in turn may provide supporting scientific theory to the current anecdotal evidence that cancer patients do better on a Keto diet.
 
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An interesting Tweet:
Dr David Unwin Retweeted




Ian Lake

@idlake

Low carb, reduced DKA(Ludwig), SGLT2 inhibitors increased DKA(Depict1). Low carb 4 years evidence of benefit ( Neilsen), not recommended by NICE in fact excluded from evidence search. SGLT2 inhibitors 46 weeks evidence inT1, lifetime endorsement by NICE. Science is so confusing.
8:04 AM · Dec 7, 2019·Twitter for Android

Another one:

Dr David Unwin

@lowcarbGP

I had not heard of this before or the CORONA and UNIVERSE studies
@DrScottMurray
what do you make of this ? Statin-Associated Cardiomyopathy Responds to Statin Withdrawal and Administration of Coenzyme Q10 https://thepermanentejournal.org/issues/2019/fall/43-the-permanente-journal/original-research-and-contributions/7225-statin-associated-cardiomyopathy-responds-to-statin-withdrawal-and-administration-of-coenzyme-q10.html


And another:


Dr David Unwin Retweeted




DiscoStew

@DiscoStew66

Replying to
@Dmozaffarian
Eating red meat increases your risk of diabetes? Riiiiiiight
@bigfatsurprise
 
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This would seem to show the exact opposite of my posts where I claim that all diets have a roughly similar weight loss and T2 remission effect in those who are able to maintain then over the longer term. I was taking 2yrs as a reasonable length of time.


But.
Please note that what I didn't say is "All Diets/'Ways Of Eating' are equally sustainable (on average) for those who try them."
 
You can spot Dr David Unwin in the audience for this older video.
It deals with the big myths about Saturated Fat, and Fat in general, Low Carbs, Cholesterol, CVD, Diabetes, PUFAs and 'The Public Health England Dietary Guidelines.

 
ianf0ster said:
what do you make of this ? Statin-Associated Cardiomyopathy Responds to Statin Withdrawal and Administration of Coenzyme Q10
Click to expand...
OMG this is quite horrifying. I had no idea that statins could cause Cardiomyopathy and Heart Failure. I had severe myalgia caused by statins and Coenzyme Q10 really helped. Good to know that science backs up the use of Q10 to help resolve statins damage.

ianf0ster said:
Eating red meat increases your risk of diabetes? Riiiiiiight
Click to expand...

Thank you for posting this - I had been a bit worried about eating too much meat - even though I knew that most of the research on red meat lumped red meat and highly processed meat together which is a bit bonkers.
 
Evidence that both Low Carb and Saturated Fat (at a level of 50% of Calorific intake) are your friends so far as CVD and Insulin Resistance (Type 2 Diabetes) are concerned: https://peterattiamd.com/the-straight-dope-on-cholesterol-part-ix/

Note that as Dr Peter Attia says, there has not yet been a 'dream trial' of long term Low Carb (Higher Fat) diet vs the standard American Diet measured for 'hard' outcomes - death/disease rather than of assumed indications of risk.
 
Thanks to Cocosilk for this.
Dr Paul Mason on Weight Loss, Obesity and Type2 Diabetes


Though several studies are referenced, there aren't as many as I would like.
 
The same comments also apply to this video from Paul Mason's practice partner Dr Doron Sher..
As well as talking about Arthritis and weight loss he talks about the short-term success (and longer -term lack of it) from Bariatric Surgery for both weight loss and Type 2 Diabetes.

 
Here is another video from DR Doron Sher.
This time there are more references, but he highlights problems with both 'funding bias' and with inconsistency between the conclusion and the actual study results for the majority of studies in this field!


His conclusion appears to be that Artificial Sweeteners may even increase Obesity and come with extra risks for those without a healthy metabolism - just the people more likely to rely on them!

One commenter pulled out 2 of the actual studies quoted:
Intense Sweetness Surpasses Cocaine Reward
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931610/

"Here we report that when rats were allowed to choose mutually-exclusively between water sweetened with saccharin–an intense calorie-free sweetener–and intravenous cocaine–a highly addictive and harmful substance–the large majority of animals (94%) preferred the sweet taste of saccharin. The preference for saccharin was not attributable to its unnatural ability to induce sweetness without calories because the same preference was also observed with sucrose, a natural sugar"

Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235907/
 
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