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Reversing T2 versus lowering hba1c, LCHF versus low calorie

B

Bad paw

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33
Type of diabetes
Type 2
Treatment type
Diet only
[Moderator message: This thread was created by moving a long discussion from a different thread where it was off topic. Hence the odd start of this thread. The original thread can be found here: https://www.diabetes.co.uk/forum/th...s-how-quick-you-reversed-your-numbers.196686/]


You also need to decide whether you are only interested in getting your HBA1C, ie your blood sugar down, in which case using drugs together with low carb will be likely to work the fastest. Reducing blood sugar certainly helps prevent complications.
Or whether you want to reverse your T2 itself, as opposed to just the blood sugar, which is the symptom of T2, not the cause. The cause, in susceptible people like us, is fat blocking the pancreatic cells and stopping them from working properly. To restore Beta cells to normal function and put diabetes, as opposed to just blood sugar, into remission, the only way is a calorie reduced diet. The lowest safe calorie intake is 800cals daily. You normally have to lose about 15% of your weight at DX. So it will take as long as it takes to achieve tat amount of weight loss, which in turn will depend on your starting weight. We are all different.
 
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I think you're taking this from the Newcastle Diet. That's not how it worked for me. I was back in normal BG levels within 3-4 months on 20g carb/day, although I hadn't lost anywhere near the 15% bodyweight th Newcastle Diet people claim to be necessary.

I have been in T2 remission since April 2021, and I did not use any calorie restriction whatsoever. I think it's therefore wholly inaccurate to claim the "the only way is a calorie reduced diet".
 
And I’ll add that this method is not the guarantee you think it is. I lost 20% of my starting body weight - using low carb /keto not low calorie. I did achieve remission and kept it for 4 yrs but only because I kept the carbs low. As soon as I increased carbs the blood glucose levels began to rise - long before weight did. I gained weight because I lost glucose control, and insulin rose alongside these returning my insulin resistance.

Other life events have tipped me back over the diagnostic limit and some weight has been regained. And this time I know it’s the carbs that must be prioritised even through the weight loss will also be beneficial.
 
HSSS said:
I did achieve remission and kept it for 4 yrs but only because I kept the carbs low. As soon as I increased carbs the blood glucose levels began to rise - long before weight did.
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This is my point exactly. Low carb is good for keeping complications caused by high blood sugar at bay, But of course, as soon as you start eating carbs again your BGs will go up again. Low carb causes remission in BG levels only, not remission in the root cause of high BGs ie diabetes, with it's malfunctioning beta cells
Imagine filling two jugs with water. Then tipping a bag of sugar into one of them. The one you put the sugar in will test higher for sugar, obviously. Just like the blood of someone with T2 who is eating normal levels of carbs. Once you input sugar(carbs) again, your BGs will go up again. Because you have done nothing to improve the function of the beta cells that can deal with the sugar, low carb will stop working immediately you eat carbs again. Just as drugs to lower blood sugar will also stop working once you stop taking them.
However if you reduce the fat on the beta cells which prevents them from doing their job, they will start to work again and lower your blood sugar as they used to do before you became actively diabetic.
 
I think you are confused. Beta cells do not "deal with sugar". Pancreatic beta cells produce insulin. For T2s like me the problem is that we have plenty of insulin, but the metabolic system is insulin resistant. Following a low carb way of eating means that I can avoid the high blood sugar levels that do physical damage. It has absolutely nothing to do with improving the function of my beta cells, which were and are working fine already.
 
And you missed what I said. I did indeed lose the weight you claim solves the root problem. And it didn’t give me the magic cure of being able to eat anything.
 
I'm another who lost the 'magic weight amount' but still needs to keep keto.

Our bodies are complex. I don't think there us a one size fits all. All we can do is listen to others and work out what suits our body and life at the moment. This is why I am such a firm believer in a meter. The meter is the thing that lets you work out what different foods work for your body.

I was in normal range within 3 months and still am about 4 years later. I am able to do this at the moment by keeping keto. I can't predict whether I will be able to do so indefinitely. I hope I can but life throws us lots of curve balls. In my view the right solution is what can keep your levels in the correct range and is sustainable for you and with what challenges you have in your life at the moment.

I personally am not a believer that you can cure type 2 diabetes but I do believe that some of us can put it into remission.

Some find they can lose weight going keto others can't. As I said our bodies are complex.
 
HSSS said:
And you missed what I said. I did indeed lose the weight you claim solves the root problem. And it didn’t give me the magic cure of being able to eat anything.
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Sadly, losing 15% of your weight will only work for some. Mainly those who have been diagnosed in the previous 4 to 6 years. If you have been diagnosed with diabetes for longer than that when you start to lose weight, many or even most of your beta cells may already have actually died rather than just being damaged. That is why it is so important for newbies to know about it as soon after diagnosis as possible, while there is a much higher chance of it working for them.
Also many of us don't know how long we had T2 before we were diagnosed, so we can only tell approximately for whom the low cal diet will bring results. However many congratulations on losing so much weight. It will have lowered your risk a number of horrid health issues and also 12 types of cancer.
 
Mine was 20%. I did it immediately on diagnosis and I was not far over the diagnostic level, so at worst had been prediabetic for a while as some random glucose tests over the years were a bit raised (and I was not informed!) but nothing horrific. I lost most of it within 3 months and the rest in the few that followed.

Crucially as you identify it will only work for some and that doesn’t include some ideal candidates like me. And the stats aren’t great for how many it does work long term for. Less that 50% at one year, down to just 7% at 5 yrs on an ideally structured trial with motivated well supported participants.

You also assume all type 2 have a single cause (and that one is not yet proven, still a working hypothesis) which they very much don’t. It’s a catch all diagnosis encompassing all diabetes that doesn’t fall into another type. (1,LADA, mody, 3c etc).

Yes for a few it’s a useful tool. It’s importantly shows that diet is a powerful tool and medication isn’t the only route. But your initial comment was way too generalising and assumptive.
 
I went keto to bring my BG levels down, and lost the weight I needed to lose as a surprise but very welcome side effect. I've counted calories all my adult life, but I don't now, and my keto regime is definitely higher in calories. However, I can keep up what I'm doing for the rest of my life, whereas counting calories left me permanently wracked with hunger. Now I'm 2MAD sometimes 1, and hunger is only when I need to eat. That's me - others will be different - we are dynamic beings.
 
0110 said:
So low carbing has enabled me to loose 12KG in two months, the morning dawn phenom nos are coming down to from 7-8 to 5-6s. Is this indicating fat loss is taking place (Etopic Fat)?
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Low carbing, by itself, will bring down BGs quite dramatically. Drugs will also bring BG down. But both of these have to be kept up for life if you want to keep BGs down. However T2 is a progressive disease, and unless you get it into remission, over the years your BGs will keep on increasing and you will have to take more and more drugs and/or eat lower and lower levels of carbs to keep up. The UK Prospective Diabetes study found that T2's had usually lost about 40% to 50% of their beta cell function before they were even diagnosed, and that from then on they lost about a further 4% of beta cell function a year. Also, sadly, that "conventional treatments cannot reverse it's progress". Hence if you can restore the function of the beta cells with a low cal diet you will have a better chance of keeping BGs down permanently - or for at least as long as you don't regain the weight lost. The figure of only 50% success rate on Direct trials so often bandied about by their opponents is misleading. It was 50% of those who started the diet. But many dropped out or did not succeed in losing the requisite 15% of their weight. 87% of those who did went into remission. And though again some more failed to keep the weight off, all of those who did maintained their remission. Of course that still leaves a few for whom it didn't work. But at least they tried and gave themselves a chance. Possibly their beta cells were weaker out the outset - who knows? We are all different.

Keto, low carb, even the cabbage soup diet will all work equally well for weight loss as long as they contain fewer calories than you use. It is how much you eat that matters, not whether you eat any particular foods. I personally simply ate exactly what I had been eating before - just half as much. I thought reducing calories took up quite enough of my will power without actually changing my diet as well. Now that I have got the weight loss thing over with I am looking to improve my diet a bit, especially reducing saturated fat.
 
If you go very low calorie diet, you will reach the exact same place a low carb diet will get you. You WILL STILL BE TYPE 2 DIABETIC, but in control. If you start eating a lot of carbs, regardless of how you lost your weight, the situation will very quickly turn to ****.
Low calorie does nothing that low carb doesn't. It doesn't promote any increase in Beta cells, or there condition, that low carbing doesn't. It is the removal of Ectopic fat that helps, regardless of how you got rid of it.
The research has been done on low calorie, because there is money to be made from it. Since low carbing has a much much smaller income stream, no such research will ever be done.
Whichever way one chooses, it is the reduction in circulating Insulin, that is the positive driver.

[mod radio edit.]
 
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Bad paw said:
However T2 is a progressive disease, and unless you get it into remission,
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based in the historical medical treatment I agree.
Remission is maintaining lower than 48mmol for 3 months without drugs. no mention of how that needs to be achieved.
Bad paw said:
Hence if you can restore the function of the beta cells with a low cal diet you will have a better chance of keeping BGs down permanently - or for at least as long as you don't regain the weight lost.
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Prof Taylor has been on record more a once emphasising it’s the weight loss (enough in order to lose the visceral fat) that matters and not the method. So he doesnt care if you lose it via low cal, low carb or any other method that achieves the loss. They choose the shakes because they were easier to provide and monitor in a trial with fewer potential confounding factors. By the very nature of the low calories they were also low carb overall.
Bad paw said:
Direct trials so often bandied about by their opponents is misleading. It was 50% of those who started the diet. But many dropped out or did not succeed in losing the requisite 15% of their weight.
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So it’s a regime that many can’t complete or succeed at? That’s still failure.

I’m not against the principle that it can work, for a few. I agree weight loss is a good thing for multiple aspects of health. I’m overjoyed it’s proving there are better approaches none medicated than we’ve used in previous decades. I am against misreprentations of how few succeed on this method and that it will “cure” almost everyone who does stick with it.

There’s at least two of us just on this thread who met the criteria but didn’t achieve the results you claim (we needed to maintain low carb to keep remission, much as you need to maintain weight). And over the years there have been plenty in here that did not reduce their calories overall but did change the carb calories for fat and protein ones and that achieved remission.
 
You are absolutely right in saying that it is the removal of fat that helps. it doesn't produce any actual increase in Beta cells though it can restore those you have to near normal function.
There are two distinct low carb diets. One involves only restricting carbs without replacing the calories saved with calories from other nutrients. This one can be used like any other weight loss diet to lose pancreatic/liver fat. This one will produce a reduction in BG as well as in weight.

The other involves no calorie reduction as the calories lost from carbs are simply replaced by calories from elsewhere, (usually fat). This one will produce remission in blood glucose levels but nothing more. BGs will go straight back up again once the person starts eating normal levels carbs again.

To tell whether your BG remission is caused just by low carbs as opposed to weigh loss just eat 50% of your daily calories from carbs for 2/3 days then test.

Weigh loss from any low calorie diet you choose, including the first low carb one above, produces FAR wider improvements in diabetes and pancreatic function, of which lower BGs are only ONE basic indicator. See article below.

Paragraph 3 tells us that after only one week of calorie restriction:

Insulin suppression of hepatic glucose output improved; Hepatic triacylglycerol content fell; The first-phase insulin response increased and approached control values; Maximal insulin response became supranormal at 8 weeks; Pancreatic triacylglycerol decreased

Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol

Type 2 diabetes is regarded as inevitably progressive, with irreversible beta cell failure. The hypothesis was tested that both beta cell failure and insulin resistance can be reversed by dietary restriction of energy intake.Eleven people with type 2 ...
www.ncbi.nlm.nih.gov
 
Bad paw said:
it is the removal of fat that helps
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Bad paw said:
Weigh loss from any low calorie diet you choose, including the first low carb one above, produces FAR wider improvements in diabetes and pancreatic function, of which lower BGs are only ONE basic indicator. See article below.
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So you agree it’s weight loss that matters, not the method. Yet you apparently dismiss weight loss can occur on the second type of low carb diet you describe (increased fats to replace ditched carbs) despite many of us, and studies, showing it is possible. Me included. All 20kg.

What is your source that there are no improvements using low carb higher fats diets beyond bgl? Many metabolic markers are recorded as improving quickly on this diet. How about when weight has been lost by this method? I’m confused because your assertion it doesn’t work contradicts your primary source of your position, Taylor. See below.

Taylor himself says
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399621/

“Remission primarily depended upon degree of weight loss, with achievement increasing steadily from (7%) with only 0–5 kg weight loss to 86% who lost 15 kg or more.”

“Substantial weight loss achieved by any means can bring about remission of type 2 diabetes, and this has been observed most comprehensively in the Swedish obesity study”

****************

Nutritional basis of type 2 diabetes remission

Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the...
www.bmj.com

“The hypothesis was developed from emerging knowledge on the relation between liver fat and control of the constant flow of glucose into the blood as well as observation that normal insulin secretion returned after substantial weight loss in people with type 2 diabetes.” Make no mention of a particular methodology required

“Testing the hypothesis required a sure-fire way of achieving around 15 kg weight loss, and one of the most striking findings of the 2011 Counterpoint study was the acceptability of a low calorie liquid diet for a short planned period.1” demonstrates this choice was an option rather than a requirement and key was the loss itself

“Merely providing the information on the degree of weight loss required for remission can allow motivated people to achieve this for themselves using their preferred method.19” again focusing on loss not method

“Type 2 diabetes can be reversed by substantial weight loss in the early years after diagnosis, and the pathophysiological basis of this is now clear. Long term maintenance of weight loss brings about lasting remission, but this is more difficult to achieve than weight loss.” Again loss not method

****************

“These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal should be a goal in the management of Type 2 diabetes.” And again loss without mention of method.

****************
And within this (Reddit not twitter)

There’s no special protocol. The only essential is that total body fat is substantially decreased by any means to suit an individual.

Q Do you think a moderately calorie restricted ketogenic diet might be able to replicate the results?
A What we’re finding is it doesn’t matter how you achieve the weight loss – it’s losing the substantial amount – usually around 15% of body weight – that makes the difference. The really important matter is keeping the weight off long term.
It is very clear that the background insulin sensitivity is determined by genes. However, obesity and physical activity can modify this substantially.
Such people have clearly demonstrated that their constitution puts them at risk of diabetes and this risk still remains. However, if they decrease their weight below their personal fat threshold (a level at which blood sugar is normal for them) then they will remain free of Type 2 diabetes during their active life.”

**************

And finally
“And, happily, the data from these real experts confirmed the findings of Counterpoint. The average weight loss achieved by people just armed with the basic information was the same as in Counterpoint – 15kg. At home and at work, going about their daily lives, people had replicated our research findings. And what emerged was that it was the weight loss that mattered, not the particular diet the participants went on or how they did it. Around half of the group had used a liquid formula diet – as in Counterpoint – and the other half had merely cut back drastically on their normal eating. A high proportion had sought individual advice as advised on our website and had been told by their doctor or diabetes nurse in no uncertain terms not to try to lose weight rapidly. But they were so highly motivated to get rid of their diabetes that they had emailed me on hearing news reports, and understandably they had gone ahead anyway.

Prof Roy Taylor - Life Without Diabetes 2019


All emphasis in bold is mine not Taylor’s
 
I think you misinterpret what I say. I totally agree that sufficient weight loss by any method you choose will work to restore function to beta cells. I have no doubt whatsoever that weight loss by low carb or keto can work. What I am saying is that it is the weight loss aspect of these diets that works to restore beta cell function, rather than the low carb aspect. It is the amount or number of calories that you consume or rather don't consume, that helps the beta cells. If you choose low carb, both the lack of carbs and the reduction in calories will work together to lower BGs, but only the calorie reduction aspect will help restore the beta cells to normal.
Some would choose his as the best of both worlds, but I didn't, as I wanted to know whether and how fast the calorie restriction part, which brings about remission in beta cell function, as opposed to BG alone, was working. I didn't want to confuse the issue. I wanted to know if the calorie reduction diet was improving my beta cell function as I am not interested in BG remission alone, at least at this point. If BG remission is caused by low carb (or indeed drugs) it will go straight back up again in days or even hours after the low carb (or drug) is stopped. And I am looking for something semi permanent and more fundamental to improvement of beta cell function. Just as there are wo sorts of low carb diet with and without calorie restriction, so keto diets will also differ between those with calorie restriction and those without. Of course the calorie restricted version can restore beta cells to nearly normal function if weight loss is sufficient.

Having said that, if a person has had T2 for so long that weight loss will not reverse it, then I am all for any method that will reduce BGs including drugs if the person prefers those.
 
ajbod said:
I'm sorry to say you are claiming a cure, which everyone on here knows is utter bowlocks.
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No I am absolutely NOT claiming a cure. I am claiming reversal. Until such time as the person might put the excess weight back on. We were all born with a propensity to develop diabetes and that will remain with us for life. But the diabetes will not become activated until we have put on more weight than our particular bodies can cope with. And that is not necessarily in the obese or even the overweight range. 10% of type 2s are still in the normal range of BMI, just have unfortunate hereditary fat distribution patterns.
 
Bad paw said:
I think you misinterpret what I say. I totally agree that sufficient weight loss by any method you choose will work to restore function to beta cells. I have no doubt whatsoever that weight loss by low carb or keto can work.
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great we agree method isn’t important. But please remember it MAY restore beta cell function not “will“.
Bad paw said:
What I am saying is that it is the weight loss aspect of these diets that works to restore beta cell function, rather than the low carb aspect.
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Here is where you are making things confusing. You are saying the end result helps restore beta cells having just agreed the method doesn’t matter but then you again qualify the method used. Low carb can cause visceral weight loss, the same as low calorie can - they are the method not the result. You are saying lowering carbs doesn’t work but lowering calories does, even when the result is the same fat loss around the organs. That makes no sense.
no we agreed - it’s the weight loss not the calories. They are just the method you choose.
Bad paw said:
which brings about remission in beta cell function, as opposed to BG alone
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why do you think low carb only helps bgl and nothing else?
 
"Low carb can cause visceral weight loss, the same as low calorie can"
I think this is the fundamental error re low carb. Some do low carb and don't replace the calories with calories from other nutrients. In this case it can bring about weight loss. Others reduce their carbs but replace the calories saved with other foods. If the two completely different types of low carb are constantly misused interchangeably then people may begin to think that simply swapping the carbs calories with other calories will bring about weight loss. It won't. It can't. Because for weight loss you need to reduce energy intake so that energy used it taken from the body's fat stores. Carb reduction by itself can cause weight loss, but if the calories ae just replaced with calories from elsewhere the energy intake will remain as before and so will the weight.
Only eating fewer calories will achieve weight loss. Calories from all sources have the same effect on weight. It is absolutely not just calories from carbs that increase weight. Calories from other nutrients do so as well. Although of course they don't have the same direct effect on BGs.
 
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