Tannith's views on reversing T2

[zand]

I have found this obsession by Tannith to be very depressing. Through no fault of my own I now realise I have been insulin resistant for at least 35 years. How lucky is Tannith to be only just prediabetic and to have been advised of this as recently as 4 years ago. No one told me. I have strived to lose weight and be healthy, but to no avail. Do you know what? I give up. This daily wringing of hands by Tannith is very wearing to those of us who having tried our best for decades are still in a much worse situation than her.

What's worse is that Tannith keeps raising her BGs above the 7.8 danger level on purpose doing these ridiculous OGTTs. I don't get it. I'm out of this thread now it is damaging to my mental health.

 

[Jo123]

This looks interesting https://www.medscape.com/viewarticl...421_MSCPEDIT&uac=405215MK&impID=3324807&faf=1

 

[zand]

This looks interesting https://www.medscape.com/viewarticl...421_MSCPEDIT&uac=405215MK&impID=3324807&faf=1

Yes the participants had an average BMI of 34. Tannnith is not overweight.

 

[Oldvatr]

This looks interesting https://www.medscape.com/viewarticl...421_MSCPEDIT&uac=405215MK&impID=3324807&faf=1

This is Diabetes UK (DUK i.e. the other lot) who funded the Newcastle Diet Paper and the research banging their own drum. They are postulating the cardiovascular improvement as a "possibility", i.e. not proven. It is assuming that the improvement of HDL from 1.1 to 1.3 mmol/l will do that magic, but this improvement is not that spectacular.

As has been pointed out there was only a 41% remission success, and it does not mention the regression that occurred in the 2nd year that followed the end of the trial. So, as mentioned in other posts here, it is only a partial success. I note the date it was published was 21/4/ 2021, i.e. today. I wonder why? This article seems to have no new data to present.

 

[HSSS]

This is Diabetes UK (DUK i.e. the other lot) who funded the Newcastle Diet Paper and the research banging their own drum. They are postulating the cardiovascular improvement as a "possibility", i.e. not proven. It is assuming that the improvement of HDL from 1.1 to 1.3 mmol/l will do that magic, but this improvement is not that spectacular.

As has been pointed out there was only a 41% remission success, and it does not mention the regression that occurred in the 2nd year that followed the end of the trial. So, as mentioned in other posts here, it is only a partial success. I note the date it was published was 21/4/ 2021, i.e. today. I wonder why? This article seems to have no new data to present.

My hba1c started at 55mmol, HDL cholesterol went from 1.26 to 1.63, bmi from 31 to 23, lost 19kg and I was diagnosed immediately prior to changes made. No medication. So I exceeded all the necessary criteria.

I should have been a shoe in for remission by Tanniths measures (mid normal range and normal eating possible) even though I used low carb/keto not very low calorie. I didn’t reach anywhere near this.

I did make it by Professor Taylor’s under 48mmol standards though at 44 initially at 3 months and 40-45 since.

 

[Tannith]

Yes the participants had an average BMI of 34. Tannnith is not overweight.

But I was when I first started, in terms of BMI, and even last Nov/ Dec I was above my Personal Fat Threshold. According to the OGT at that time I was well into the diabetic range. Though FBG was prediabetic as was HBA1C. OGT is the most significant test as it measures beta cell function albeit not as well as lab tests.

 

[Ronancastled]

The name of the game is the reduction of diabetic complications.
The best known 20 year study is the Swedish Obesity Subjects which followed 1,000s of patients post bariatric surgery.
The data on prevalence of microvascular complications can be found here
https://pubmed.ncbi.nlm.nih.gov/28237791/

As you can see the incidents of microvascular events was vastly reduced in the normoglycemic group. Even the pre-diabetic group faired way better than those who still remained diabetic post surgery.

Better sugars = Less complications

No data on of severity of complications vs glycemic control

 

[Oldvatr]

Coming back to the Belfast Diet Study that I mentioned in an earlier post
The diet plan is a severe calorie-restricted diet and zero sucrose. It was a 10-year study under medical supervision.

Here are some of the research findings that came out of it

https://pubmed.ncbi.nlm.nih.gov/9585393/
https://pubmed.ncbi.nlm.nih.gov/9272593/
https://www.belfasttelegraph.co.uk/...t-ulster-university-study-finds-39493258.html
Amd a precis abstract:
https://onlinelibrary.wiley.com/doi/10.1002/(SICI)1096-9136(199804)15:4<290::AID-DIA570>3.0.CO;2-M

Note that the original study started in 1970, so does not reflect recent dietary advances, nor changes in the standard diet and processed foods.

This study and the UKPDS study is what the understanding of Diabetes being a progressive disease leading to insulin therapy was founded on. The Newcastle Diet is a modern version of this diet using processed shakes to provide essential mineral and vitamin balance in a structured way. But I surmise that if one were to repeat the Belfast Study using the modern tools like ND then the same results may appear after a few years (see the last link above for a precis of the timeline)

@Tannith please note that prolonged use of a Vlcal diet is not going to guarantee you beta-cell protection it would seem.

 

[lucylocket61]

The name of the game is the reduction of diabetic complications.
The best known 20 year study is the Swedish Obesity Subjects which followed 1,000s of patients post bariatric surgery.
The data on prevalence of microvascular complications can be found here
https://pubmed.ncbi.nlm.nih.gov/28237791/

As you can see the incidents of microvascular events was vastly reduced in the normoglycemic group. Even the pre-diabetic group faired way better than those who still remained diabetic post surgery.

Better sugars = Less complications

No data on of severity of complications vs glycemic control

Thank you. Could you or someone put this information into easy words please?

 

[Oldvatr]

Thank you. Could you or someone put this information into easy words please?

Basically, changing the plumbing of your gut by bypass surgery has a benefit for patients identified as having or threatening to have Type 2 diabetes. (T1D were excluded) They found that the reduction was strongest for those who started with a prediabetic HbA1c and steadily worsened the higher the baseline HbA1c. They were testing for microvascular events (long term complications involving the small blood vessels, such as retinopathy, kidney damage, neuropathy)

My observation is that the basic surgery they are screening is not the one that leads to the best outcome for diabetics (apparently the Roux-Y procedure is more successful)

 

[Ronancastled]

Thank you. Could you or someone put this information into easy words please?

I'll try anyway
Take this graphic

So the Kaplan-Meier estimate on the Y-axis is the probability of an event occuring vs time on the x-axis.
So after 20 years a T2 diabetic, who didn't achieve remission through bariatric surgery, looks to have a 0.52(52%) chance of a microvascular complication.
For those in the control group, who didn't have surgery, that risk increased to 0.78(78%).

What the data doesn't show is how severe the complications were & how good the patients glycemic control was over that 20 year period.
What I'd take from the graph above is that the surgery improved sugars enough to reduce their risk by 26% over 20 years even though they never gained remision.

 

[Ronancastled]

As @Oldvatr points out above the big winners here were the pre-diabetics who underwent bariatric surgery.

Their chances of a diabetic microvascular complication were the same, <10% @ 20 years, as the non-diabetic cohort. In fact they were even less likely than the non-diabetic control group who did not undergo surgery.

Now you can see where the prevalance of increased retinopathy became the A1c cutoff point for diagnosing diabetes.
That >6.5% is where the graph starts to go up.

 

[Oldvatr]

As @Oldvatr points out above the big winners here were the pre-diabetics who underwent bariatric surgery.

View attachment 49052

Their chances of a diabetic microvascular complication were the same, <10% @ 20 years, as the non-diabetic cohort. In fact they were even less likely than the non-diabetic control group who did not undergo surgery.

Now you can see where the prevalance of increased retinopathy became the A1c cutoff point for diagnosing diabetes.
That >6.5% is where the graph starts to go up.

I see another useful takeaway from that graph. The Euglycemic group (bgl less than 14 mmol/l ie in control) is running close to those having the surgery. So, if you don't need it for obesity correction, don't go under the knife. Wonder how the ND cohort would compare.

 

[Ronancastled]

For those wondering about the % weight loss in that study here's the data

 

[Oldvatr]

For those wondering about the % weight loss in that study here's the data

PS VBG = Vertical Banding Group
GPB = Gastric Bypass Group
Banding = Gastric Banding, presumably different from vertical banding?

 

[NicoleC1971]

FYi to broaden the discussion out beyond bariatric surgery:
https://www.fiercebiotech.com/medte...g-to-expand-reach-diabetes-reversing-platform
Virta Health (proponents of low carb to manage diabetes) with some useful research already completed, are going to roll their model out. Research (Sarah Hallenberg) here:
https://link.springer.com/article/10.1007/s13300-018-0373-9
The outcomes looked at inflammation, weight, blood sugar readings , lipids, kidney function as this is not a long term prospective study.
I accept that gastric surgery reduces blood sugars by taking fat out of the liver (the seat of insulin resistance) but this can't be a solution for all diabetics/pre diabetics evidently. Also it is possible that some obese people won't get metabolic problems and the chronic life shortening problems that arise so perhaps the target of such surgery should be to reduce the burden of the disease rather than obesity in itself?
I wondered if there's been a similar reduction in marcro vascular issues when hyperinsulinemia is resolved via bariatric surgery?

 

[Ronancastled]

Here they colate the total data for micro & macrovascular complications

There's a lot more data in this paper
https://jamanetwork.com/journals/jama/fullarticle/1878719

 

[Oldvatr]

The OP is aware of Low Carbing and rejects it as a solution to their requirements. They are strongly proposing to do Vlcal diet instead, Their chosen vehicle ie the Newcastle Diet Plan. Promoting other solutions here does not seem to help the OP.

The discussion on gastric surgery is relevant since this was what prompted the research that produced the Newcastle Diet Plan. It is aiming to be a chemical equivalent to bariatric surgery and is easily applied to the general population without surgery. However, as has been discussed here neither ND nor the surgery seems to end up with the results that the OP is seeking.

The OP would be advised to continue their research, and they have a decision to make - to either double down on their choice of diet, with any associated risks considered, or to seek a different solution. It is their choice.

 

[lucylocket61]

I'll try anyway
Take this graphic

View attachment 49051

So the Kaplan-Meier estimate on the Y-axis is the probability of an event occuring vs time on the x-axis.
So after 20 years a T2 diabetic, who didn't achieve remission through bariatric surgery, looks to have a 0.52(52%) chance of a microvascular complication.
For those in the control group, who didn't have surgery, that risk increased to 0.78(78%).

What the data doesn't show is how severe the complications were & how good the patients glycemic control was over that 20 year period.
What I'd take from the graph above is that the surgery improved sugars enough to reduce their risk by 26% over 20 years even though they never gained remision.

Hmmm.....I wonder how the results over time would compare for those of us who are controlling our diabetes through low carbing?

 

[Ronancastled]

Hmmm.....I wonder how the results over time would compare for those of us who are controlling our diabetes through low carbing?

That was one of my early thoughts too. The Swedish study dates back to the mid 80s & ran to the noughties. Remission was self reported in most cases and was defing by an FBG of <110mg/dl, either on a lab result or finger prick. I would assume that without the dietary advice we have today most would have continued eating carbs, probably in lesser amounts due to the banding.

I suppose what the data gives you is proof that long term glycemic control yields less complications.
How you achieve that control is up to the patient.