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Reversing T2 versus lowering hba1c, LCHF versus low calorie

As that link states early reduction in sugar levels is the trick to Beta cell improvement, not massive weight loss, low carb achieves a huge blood sugar drop rapidly. The main problem with type 2 diabetes, is the lack of action when prediabetic. That is the time the medical profession should pull out all the stops. Not wait until the situation is worse.
Personally i think everyone over the age of 25 - 30 should have an annual Hba1c, that way a trend can be spotted long before it becomes a real problem.
 
You are suggesting that 100% of people who take part in a marathon finish it, because you only look at the ones who cross the finishing line.

This is classic survivor bias - "it was successful for everyone who made it through". No-one is suggesting that a small fraction (7%) of people on low-cal did not achieve and maintain remission in this study. But 93% dropped out, presumably because they could not maintain the lifestyle. We are not told about them. How realistic is it to recommend that sort of method as a route to managing a health condition?

Here's the actual figures.

Start of trial - 149 in each group (298 total) 40% of intervention participants were on meds compared to 84% in the control group.

after 1yr 68 of 149 (46%) in the intervention group were in remission
after 2yrs 53 of 149 (36%) in the intervention group were in remission
and
after 5yrs, of the 85 of the original 149 tracked for five years, 11 (23%) were in remission.

11 is 7% of the 149 original intervention cohort.
 
A calorie is a unit of energy, but this is not the whole story.
Our body is not a combustion engine. Thus calories from carbs will have different effects than calories from fat.
Fatty foods are more satiating and reduce hunger. Sugary food give a quick fix and then make you hungry again in two hours.
This is how many people here have lost weight by simply changing diet to low carb without counting calories.

Furthermore just reducing calories will reduce your metabolic base rate, thus you will burn fewer calories and after a while you stop losing weight. More importantly you will always feel hungry, become miserable and give up at some point. In my view eating a "low calorie diet" is not sustainable in the long term. This leads to the well known yoyo dieting. On the other hand there are many people here who can sustain a lower BG/HbA1c and lower weight by having switched to a low carb high fat diet.

To lose weight one should evaluate the diet and consider changing it just as much as looking at the overall calories. Most of us can lose weight with a crash diet, i.e. not eating a lot for a limited period of time. However losing weight is the "easy" part, keeping the the weight from increasing again afterwards is the challenge. Your body needs to get the correct amount of calories and for this you need a sustainable solution. As carby and sugary food are addictive, they increase hunger, thus by replacing carbs with fat it is typically much easier to not gain the weight back. Personally, I have banned anything low fat from my diet.

Finally I am a fan of intermittent fasting. I've successfully lost 10 kg and reduced my HbA1c to the 40s with this method. On fast days I restrict to 800 calories with no carby foods, but you can eat lots of vegetables and soup, so I don't feel hungry. In my view Intermittent fasting is based on evolution, i.e. when our ancestors had no luck hunting they switched to fat burning.
 
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Hi,

You’ve done pretty well lowering your HbA1c to 38. What was it when you were diagnosed?
 
Thanks but my BMI is 21 to start with. If I lost 8% that would put me on 60kg at 177cm, which I would not be able to achieve without losing some muscle mass ie not healthy. My problem is not caused by being fat, inside or out.
 
You are making some very definitive statements here, which do not all align with others' experiences, current theories in total or our understanding of human biology. At best, they are theories among some very diverse, and often poorly designed, research.

The old stories about fat consumption did not add up - eating fat does not raise cholesterol as we produce that ourselves.

Anecdotal evidence from hundreds of us is that we can successfully get into remission without cutting fats or counting calories. My low carb diet contained more calories than I was previously eating. The support from the NHS for low calorie diets ignored the fact that researchers imposed, as a by product, a low carb diet in order to go very low calorie.
I also, as do many others, resolved a fatty liver by eating more fats and fewer calories.
 

The naive calories in calories out theory was disputed then overturned years ago. Not all calories are the same.

And as I posted, many of us eat more calories but still lose weight. I'd tried too many low calorie diets before this and low carb plus extra fats was the only one where I lose so much and kept most of it off after a few years. My lipids improved, my fatty liver went back to normal and yet I included larger quantities of cheese, butter, double cream, olive oil, coconut milk, nuts, etc. etc.
 

it is apparent from the diagram that insulin resistance is a huge factor in T2 (and pre and early T2).
thankfully, lowering carb intake also reduces insulin resistance - with all the massive health benefits that brings. Excellent, eh? And not necessarily something that happens on low calorie diets…

Having said that, the diagram shown is very, very one dimensional, since it does not show the impact of T2 medications, or the effect of dietary changes, exercise, weight loss, etc. all of which can profoundly alter the T2 trajectory.

Looking at that diagram, one could very easily be mislead into thinking that all T2s are doomed (doomed, I say) to an inexorable escalation of insulin resistance, loss of insulin production, and loss of beta cells. Plus, apparently, all on a set schedule… Good job we know better, isn’t it?

Fortunately, there are many, many people here on the forum who have very, very different experiences.

My own experience is that carb restriction knocks calorie restriction out of the ball park, over the stands, and somewhere into the next county.
 
Again you are counting all the people "in the intervention group". The ones to count are ONLY the ones in the intervention group who lost the requisite amount of weight. The others who failed to lose the weight are not relevant to this count. You could hardly expect them to be in remission if they didn't do the diet, or didn't keep it up. As I asked earlier would you expect someone who didn't keep up the low carb diet to go into remission?
In the original cohort 87% of those who lost the required amount of weight were still in remission after a year
Personally I wold like to see further investigation into the unfortunate remainder - 13% who lost the necessary weight to find the reasons why. Were they a particular age group? Was it longer since their diagnosis? Did they have higher HBA1C at baseline? Did they have higher BMI at baseline? How could they be helped?
 
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Even Taylor supports low carb as a route to achieve remission. If the person behind the Direct study says its one way to do it why not accept it:


Note the irony of him saying people may find it hard to maintain, when most of his patients lose remission due to lack of a sustainable diet to move onto post weight loss. The low calorie diet is unsurvivable in the long term - humans can't live on 800 calories in the form of shakes. Going back to a normal diet is likely to lead to loss of remission as the higher carb intake - in my experience and also reflected in Taylors results - leads to rapid weight re-gain.

You are trying to separate remission into "true remission", and a category of "very good diet control". In reality its a spectrum. I can eat 130 - 150g of carbs OK, but as soon as I go above that it slips away, and I lost 30% of my body weight at peak.

Edit; read the study again. Most Direct patients who went into remission came back out of remission. They kept up the low calorie diet for the required period, but Taylor has no clue how to off-ramp his patients into a permanent stable safe diet that maintains that gain - if he did, he wouldn't have less and less in remission after each following year.
 
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If people have done well on low carb diets then I applaud that. We all have to choose the approach that works best for us -including drugs if people prefer to use those to lower their BGs.
What concerns me is that whilst low carb can be done at any time, eg after low cal has been tried and failed, low cal has to be done as immediately after diagnosis as possible. There is a time limit after which it's chances of working to improve beta cell function and thereby reverse T2, dwindle. So I think it is vital that Newbies should be told about it while they are in with a chance of having it work for them. I have two much loved family members with T2. None of us knew of the low cal reversal method at the time they were diagnosed, -indeed it may not even have been discovered at that time -and it now saddens me to watch them struggle with their T2.
 
This is getting repetitive.

What you mean is weight loss, particularly around the organs, to improve beta cell function, within a few years of diagnosis. That is what the Newcastle trial is about. They happened to use a low calorie method to achieve this. They have agreed any method of weight loss will do. You are fixed on method rather than the goal. They were not. So if you mean to reference that study you are getting the details wrong.

Then you have to decide what that weight loss actually achieves (IR reduction, beta cell recovery, something else?) and if it is sustainable by the method chosen (93% of the Newcastle trial didn’t find low enough calorie sustainable to achieve remission for 5yrs. Only 48% did at one year).
 
Low carb treatment was the gold standard worldwide, BEFORE Insulin was discovered. It's been around far far longer than low calorie. We get caught up in supposed progress, forgetting what our ancestors learnt. You keep banging on that ONLY low calorie can improve the Pancreatic function. The truth is, nobody has studied properly the effects of low carb, because there is no money to be made out of it. Virtually all modern medical research programs have a specific aim, which is rarely the headline that it's published under. But always with an angle of huge INCOME!
The vast majority is funded by Pharmaceutical companies, who are not interested in curing anything, just the next must have lifelong drug therapy. KERCHINGGGGGG.
The low calorie short sharp shock treatment does work, but it is itself actually low carb. The major problem is the patients don't learn what is good for them to eat, so the few that can actually last the course, afterwards are back at square one, albeit lighter in weight. And as soon as they start eating a normal diet, ie what gave them diabetes in the first place, we all know where that's heading. Still as so many have to, they can always have another go.
As you are maintaining your remission and weight i applaud you, BUT you are very much in the minority. As the study showed VERY few can actually last the course, and remain in remission, you are one of the lucky ones.
 
Yes. that is true. I am of course counting all the people who tried the intervention that was being tested. That is the point, and is the nature of scientific study - "We tested intervention X on 149 people, and at the end of five years we found 11 of the 149 (7%) to be in remission" is effectively just that.

People who do not comply with a low carb lifestyle or stay low carb may or may not stay in remission. If I followed your logic however I would be excluding all individuals who did not or could not comply and I would be claiming (as you have for low-calorie) high levels of success for low-carb. That would be (at best) junk science and faulty logic.

You, however, seem quite happy to count only the people for whom the intervention worked, and you claim that this is not a problem. You therefore want us to look at only the 11, out of the 149 starters, who crossed the marathon finish line. You are quite clear that you are excluding the 93% of the test subjects for whom low calorie was (on the evidence) not a sustainable option. I would say this is a classic case of survivor bias, but it is actually a bit unusual because you are fully aware of your conscious bias.

I don't expect you to agree with this because if you did your entire structure ( your quote - ...put diabetes, as opposed to just blood sugar, into remission, the only way is a calorie reduced diet) collapses.

The point of this is two-fold - personally , what works for an individual, and more widely, in terms of public health, what works for most people. The two may not be the same. It's the public health aspect that's in many ways most relevant - an intervention that sees 93% failure over 5 years is not one to recommend in general - while it may work for some individuals. On the evidence of this study, that would likely be a small (7%) proportion of the T2 population.
 
I would not expect merely joining a study to cause reversal. Just losing 15% of your weight. Whether on a study or not.
 
I would not expect merely joining a study to cause reversal. Just losing 15% of your weight. Whether on a study or not.
I don't recall anyone promoting the advantages of "merely joining a study" for either fat loss or glycaemic control. The point being made was that the intervention being studied failed to achieve remission at the five year mark for 93% of those in the low-calorie intervention group.

The question of whether a 15% weight loss triggers or would trigger "reversal" for everyone is separate. The evidence of several people (me included) on this thread is that blood glucose can be brought into normal range long before 15% weight loss has occurred. Since getting my blood sugar back in range, I have subsequently lost about 20% of body weight, having had a number of diabetic symptoms for some twelve years prior to my eventual diagnosis in 2019. The diabetic symptoms went as glycaemic control was achieved, not after fat loss.

Incidentally, what do you mean by reversal? Do you mean something different to remission? My working definition of remission (as used by my local GP practice) is blood sugars in normal range (that is, not above 42), for a continuous twelve month period, without medication use in that period. I don't use the term "reversal" as it carries an implication of a return to a former state.
 
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