The BBC. Don't know whether to laugh or cry.

Until we get to the bottom of why either protocol works then it will be tricky for people to decide the best route for them. As I understand it the reason it works to a drop carbs drastically b) drop calories including carbs drastically is that the liver and pancreas are rapidly stripped of their fat thus making the body a lot more insulin sensitive and able to burn off its' excess stores of fat. Roy Taylor was keen to perform detailed scans to show this happening and the experience of bariatric patients who are required to strip down their liver fat prior to the op to faciitate the surgeon's access to their intestines provides evidence for this too (they mainly lose their type 2 diabetes quickly and long before they have lost most of their weight).
So it it is the same mechanism that causes remission, the question then might be how would people like to achieve the same result? For some I imagine rapid weight loss is very appealing as is the implication that they are on a short and sharp diet but not a future in which all of their favourite foods are off the menu. It is known that drastic diets do cause metabolic slowdown greater than what would be expected by merely weighing less so post ND, people would have to accept a life long discipline to be able to eat pasta and bread etc. without regaining weight and liver fat.
I am not type 2 but as a lazy type 1 I'd rather adapt to low carb so that I can be freer with what I eat but I do understand how difficult giving up those foods is and am certainly not perfect at it!
The beeb will take the official line promoted by DUK which having funded the Direct study, will be confident about promoting it. Whilst I think the study did a great job of establishing the principle that remission is possible, I think the low carb option should also be a legitimate choice given all the Virta Health and anecdotal clinical evidence, as the BBC acknowledges in their comment re insulin management. However I suspect the elephant in the room is the question of meat and fat hence the false dichotomy of shall I cure my diabetes but give myself heart disease? Until that one's cleared up, I think low carb will be a tricky sell to the GPs at the coal face of dia-obesity and the answer will be a change to the medical orthodoxy around causes of diabetes and the dietary orthodoxy perpetuated by EatWell plates. Lets see what the 2020 US dietary guidelines come up with!

bulkbiker said:

Anecdote is the real world my friend..real people telling real stories.

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It may be a subset of the real world but it alone doesn't tell you much about what treatment should or shouldn't be recommended. It is why anecdote is indeed part of the scientific method. Scientists listen to anecdotes and then perform properly monitored studies to decide whether these anecdotes are meaningful.

Out of interest, how do you decide which anecdote is correct?
i) anecdotes that you read here
ii) anecdotes, say on Facebook, where people say you shouldn't vaccinate because 'my baby got ill afterwards'.

By your definition above (ii) is a 'real world person telling a real story'. Does that mean then we shouldn't vaccinate? And if not, why not? Why is your anecdote of more merit than the anti-vac anecdote?

Or is that too, "just a piece of evidence that you don't like".

Anecdote is why bloodletting survived for thousands of years (incidentally killing George Washington). Fortunately, science has moved on from relying on anecdote alone.

Jim Lahey said:

Anecdotes are pieces of evidence that other people don't like.

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You seem to be unaware that anecdote is an important part of science (we call it observation). It is in fact often the first stage of scientific discovery. The smallpox vaccine came about through anecdotal evidence regarding milkmaids' stories about never getting smallpox. So, it's actually the opposite of what you say. But for it to become proper evidence it needs follow up stories to prove whether that anecdote is actually real..

But the insistence of one's own anecdotal evidence being special and being 'real world' without it being backed up by properly monitored studies is simply anti-science and no better than the anti-vac brigade who too insist that their anecdotes are special.

With the DiRECT study, we at least have meaningful data. 36% with no medication is reasonable. But we can look at the data, and discover that perhaps the protocol is better for newly diagnosed only in the first year or 2. Also, the results are significantly better for those who keep the weight off meaning that future advice can stress that better improving the results. In other words, a proper analysis of the data helps us to improve on the protocol. For example, a particular subset may have a much higher percentage of success. Such studies rarely end there - they are constantly improved.

How does that compare with your protocol? Well, your protocol has no rigorous data, so all we can say is the success rate is somewhere between perhaps 10% and 90%. You cannot say what the percent is because you simply don't know (and it would be scientifically dishonest to pretend that you do know). Hopefully, there will be a study done. Dr. Fung perhaps can do one himself.

alienskin said:

You seem to be unaware that anecdote is an important part of science

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An odd thing to say as you were quite happy to dismiss it out of hand earlier...

"Anecdote is not data" etc etc...

I presume you have heard of ViRTA and their health results?

alienskin said:

You seem to be unaware that anecdote is an important part of science

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I can assure you that I am not

bulkbiker said:

An odd thing to say as you were quite happy to dismiss it out of hand earlier...

"Anecdote is not data" etc etc...

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Not odd at all. Anecdote is not data - as scientists understand it. But it can be an important first step to gathering rigourous data. I'll dismiss it if it's all you've got, and you are saying that "it means treatment X is better". On the other hand, if you say, "it's all I've got, and it looks promising but frankly I have no idea yet. I believe further research will give us a better picture" then cool, we're in agreement.

bulkbiker said:

I presume you have heard of ViRTA and their health results?

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Yes, and that looks promising too because it's not based on anecdote alone. But costing $249/month for statistically similar results after 1 year. I'd be happier recommending the free Taylor protocol than one costing $3000/year (and if you were prepared to pay an extra $3000 a year for personalized care combined with Taylor's approach then it may be superior). When studies carried out by a company that profits from the success of said study, there is always a possible conflict of interest.

alienskin said:

Not odd at all. Anecdote is not data - as scientists understand it. But it can be an important first step to gathering rigourous data. I'll dismiss it if it's all you've got, and you are saying that "it means treatment X is better". On the other hand, if you say, "it's all I've got, and it looks promising but frankly I have no idea yet. I believe further research will give us a better picture" then cool, we're in agreement.


Yes, and that looks promising too because it's not based on anecdote alone. But costing $249/month for statistically similar results after 1 year. I'd be happier recommending the free Taylor protocol than one costing $3000/year (and if you were prepared to pay an extra $3000 a year for personalized care combined with Taylor's approach then it may be superior). When studies carried out by a company that profits from the success of said study, there is always a possible conflict of interest.

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Try 24 months..
https://blog.virtahealth.com/2yr-t2d-trial-outcomes-virta-nutritional-ketosis/
No cherry picking of participants either

No need to pay $249 per month to follow a ketogenic diet though ... the info is freely available all over the internet.
And as ViRTA is US based then that will aways be a paid for service. Although insurance may cover that cost for many...

"Not every T2 has to eat low carb to have normal numbers."

I can see why this statement has gotten such an ongoing response. I reread this thread from the beginning this morning, and it's still very interesting. We're all on the frontline here, and this level of discussion is very healthy I feel.

I don't want to get weighed down by defining 'low carb' and even normal carb levels. My own understanding of human physiology is that since the industrial revolution we have been eating way in excess of carbs what our bodies evolved for, and since the last 50-60 years - hugely so. Some lucky folks can take it, but many of us can't. Couldn't. I personally think the new dwarf wheat has played absolute havoc with a huge number of people's health, as has hormone laden dairy products, and of course - the new ghastly vege oils. The amount of sugar in our diets - I don't need to mention it? But I should?

According to my understanding, suggesting a 50% (was it?) carb level in their diet as healthy to someone trying to get better or go into/stay in remission with type two is like suggesting a cut down a percentage of your normal cigarette consumption to someone with lung disease. I don't understand how you can get better from a disease caused from an excess of a potentially toxic plant agent (in this case sugar, for argument's sake, and tobacco of course) in we humans whilst still imbibing toxic levels. Eating 50% of your diet as carbs - doesn't there have to be the biggest carb-puncher and liver destroyer of all - sugar - in there? And as we know, oh so well, there is so much sugar out there in the food environment it is nigh impossible to keep it out altogether if eating outside of your own sugar-free kitchen. (And I am including other people's kitchens as well as the usual culprits.)

In my own life when I am trying to help friend and family folks who come to me with prediabetes, and ask me to help them (which I am very moved and pleased by), the biggest challenge is trying to get them to see sugar as a toxin, and respond to that practically in their lives, and to eat lower carb generally. This is something that is an enormous challenge for many people, lest we forget. But do I think it is absolutely essential? Oh yes. Like the smoker person suffering from lung disease - you ain't going to get better if you keep imbibing the toxic levels of tobacco in your lungs. Our bodies just can't take it.

On the lest we forget level, my two friends with lung disease are dead too young (one gave up three packs a day too late, his own words, and my friend who wouldn't face the need to give up smoking tobacco died within two years of diagnosis), and the prediabetics who have come to me keep eating and drinking lots of carbs, they get fatter, and stop calling me for advice, but tell me their prediabetes is resolved at the social occasions we meet up. Without exception they do not know their HBA1c number (I always ask, and ask them to come back to me with it.). NZ's stats for prediabetes and type two are very high, and the stats on how many with prediabetes go on to get diabetes is about 70% in an unspecified time period, if my memory serves me correctly. I am coming to the conclusion that I am being lied to, as giving up sugar and yummy carby food and drink is just so hard. How do I know? Who is not eating and drinking at social occasions? Anecdotal yes. Do I think I am right? Yes. (I hope I am not! These are my friends and family members. But you can't miss an expanding waist while downing beer and eating pizza.) But to quote Spock, it [just) isn't logical, [otherwise]. And to quote House, everybody lies.

And of course my own waist would expand and my level of blood glucose along with it if I was drinking beer and eating carby pizza.

How can we get away from the fact? that for those with type two not caused from surgeries or medications, too high carbs are the cause! For our blood glucose system, including the hormones and the digestive enzymes, gut biome, and absolutely the fat cells, to cope with.

(It is understood imho that too high carbs over time is spiking insulin production and therefore resistance.)

Not advocating lowering carbs, and absolutely sugar, to my mind, to pre/diabetics, is like not advocating giving up smoking to those with obstructive lung disease.

So to answer the question re the potatoes and pasta in the BBC publishing recipes for those with type two diabetes - we don't laugh. We cry. And we cry loudly! With speech!