The one show discussion

[first14808]

It's good old Paul the Priest!

Marketeers hit jackpot with him. A priest! Generally trustworthy!

/cynicism_off

My guess is he's not adhering to the NHS Eatwell plate, but the advice from his CWP consultant, who may be a bit more clued up. The brief shots at the end of the show, when they'd started re-introducing normal food, did give the impression it was much healthier than the EatWell plate type stuff.

That's the part that frustrates me the most, ie the EatWell diet is plain wrong for some of us, and an LCHF diet is far more effective. And changing the guidance would seem extremely simple, although likely to result in lobbying against that. For example:-

https://www.nutrition.org.uk/nutritioninthenews/headlines/pioppidiet.html

It is also important to note that the Scientific Advisory Committee on Nutrition (SACN) reviewed the available evidence and did not find an association between total carbohydrate intake and type 2 diabetes and obesity, Rather they found that dietary fibre – which wholegrains make an important contribution to in our diet – is associated with lower risk of type 2 diabetes.

For an institutonal slap-down of Dr Aseem Malhotra's book and advice. Personally, I think he's far more credible. I'm curious though if NHS dieticians are allowed to break ranks and suggest LCHF, or if they're forced to follow EatWell.

 

[AdamJames]

It's all a load of metabolics

My understanding is they're two different things. So do LCHF and we're forcing the body to either use stored fat, or dietary fat. That's a normal metabolic process and relatively easy to trigger by reducing carbs. They're easier to digest and convert to glucose, and because we typically only need 5-6g circulating glucose, excess glucose gets stored as fat. And excess carbs also means more insulin's produced, which increases the risk of insulin sensitivity. So becoming 'fat adapted' is realtively simple, especially if combined with some exercise.

Ketosis then goes a step further by reducing carb intake even more, ie <20g to force production of ketones. And because we're cunningly designed as a multi-fuel system, those could be from body fat, dietary fats or proteins.. Which is where I think it gets a bit riskier, ie the goal is to use fat rather than muscle. It's effective though, but needs more effort with diet and testing to see if you're in ketosis, or staying in ketosis. Oddly, even though ketosis is popular, none of the chemists I checked sold any ketone test kits or strips.

I think that we can only really know if we are 'in ketosis' if we accept an agreed definition, and we test our blood to see if we meet that criteria. Wikipedia says:

Ketosis is a nutritional process characterised by serum concentrations of ketone bodies over 0.5 mM, with low and stable levels of insulin and blood glucose.

Even by that definition, how many of us can know if we have low and stable levels of insulin? Even that attempt to define the state adds questions rather than answers them - what is a low level of insulin?

However I think most people use the term 'ketosis' loosely, and base it on how their body reacts to reducing carbs. For example, if someone reduces carbs dramatically, starts urinating a lot and feels like they have the flu, once that phase has passed they say they are "finally in ketosis" or "fat adapted".

So far I'm now even less certain what the definition is than an hour ago!

 

[Boo1979]

That level of carbs may not knock you personally out of ketosis, but we aren't all the same. It would certainly do that to me.

When they did blood tests on all perticipants they reported that circulating fat in the blood and specific fat in the heart had both sharpley increased increased after 1 or 2 weeks ( cant remember which) but at the same time the % body fat had decreased sharpley. They explained this as being the result of the body switching to using body fat rather than other sources for fuel - sounds like ketosis to me. The level of fat in the heart was reported to have dropped right down again when they redid the bloodwork at the end of the 9 weeks

 

[zand]

When they did blood tests on all perticipants they reported that circulating fat in the blood and specific fat in the heart had both sharpley increased increased after 1 or 2 weeks ( cant remember which) but at the same time the % body fat had decreased sharpley. They explained this as being the result of the body switching to using body fat rather than other sources for fuel - sounds like ketosis to me. The level of fat in the heart was reported to have dropped right down again when they redid the bloodwork at the end of the 9 weeks

I am not disputing what they found. I am just saying that 800 cals of carbs (200g) doesn't work for me.

 

[SueJB]

I think that we can only really know if we are 'in ketosis' if we accept an agreed definition, and we test our blood to see if we meet that criteria. Wikipedia says:

Ketosis is a nutritional process characterised by serum concentrations of ketone bodies over 0.5 mM, with low and stable levels of insulin and blood glucose.

Even by that definition, how many of us can know if we have low and stable levels of insulin? Even that attempt to define the state adds questions rather than answers them - what is a low level of insulin?

However I think most people use the term 'ketosis' loosely, and base it on how their body reacts to reducing carbs. For example, if someone reduces carbs dramatically, starts urinating a lot and feels like they have the flu, once that phase has passed they say they are "finally in ketosis" or "fat adapted".

So far I'm now even less certain what the definition is than an hour ago!

@AdamJames , the definition of ketosis is correct. My ketones are steadily around 0.5-0.8, can't remember if I had the "flu" but I'm happy as a T1 doing low carb, usually under 30g per day. It means that I don't need to do extra insulin, ie bolus for food which makes it much easier to maintain a stable BG level. Today for example, fbg5.6, before driving @ 10.30 -5.9 and just before lunch 13.30 =5.4. Dr B says being stable is important so I'm happy although it'd be nice to be a tadge lower.

 

[first14808]

I think that we can only really know if we are 'in ketosis' if we accept an agreed definition, and we test our blood to see if we meet that criteria. Wikipedia says:

There are blood test meters that work much the same as regular glucose meters, or you can get urine test strips. But as far as I know, you can't really tell if you're in ketosis unless you test for it. There can be a smell from breath or urine as well, but kinda hard to detect that unless you know what you're sniffing for. It can also come from the 'flu' stage.. I woke up one morning sweating a lot and the room had the kind of pear-drop smell, which was a bit odd till I figured out why.

Even by that definition, how many of us can know if we have low and stable levels of insulin? Even that attempt to define the state adds questions rather than answers them - what is a low level of insulin?

That I think is part of the problem with generalising diabetes and using simplified tests, ie HbA1c instead of insulin response testing and/or insulin:glucagon response. But those are more expensive tests.

However I think most people use the term 'ketosis' loosely, and base it on how their body reacts to reducing carbs. For example, if someone reduces carbs dramatically, starts urinating a lot and feels like they have the flu, once that phase has passed they say they are "finally in ketosis" or "fat adapted"

My experience mostly comes from training, where LCHF was the way to go to lose fat, then ketosis if you want to 'get ripped' and get fat levels even lower.. Which is also the way to get that six-pack look, ie remove the fat that often covers it. There was a fun example of this in one of Jason Statham's movies where he'd cut his body fat down to something like 12%.. then complaining about the diet and feeling cold all the time. Some body fat has it's benefits

 

[There is no Spoon]

A priest! Generally trustworthy!

Not sure the alter boys would agree with that.

 

[Tannith]

But that's exactly the premise of the Newcastle Diet at its core..which is why (yes I know I have said it multiple times before) I'm not a fan. It's also the core of the DUK literature about the ND which is why so many get misled about it.. and yes it is one of my bugbears...! Rant officially over... all smiles now..

On this programme Prof Taylor stated that Diabetes (T2) is caused by excess fat on the liver and the pancreas. On the latter it blocks the action of the beta cells. Why is that misleading? When people get rid of it (as shown by the magic scanner) they get rid of their T2. They do not get their T2 back unless they put their pancreatic fat back on. The liver feeds the pancreas with fat. Many people on here including myself have got rid of their pancreatic fat and with it their T2.

 

[bulkbiker]

On this programme Prof Taylor stated that Diabetes (T2) is caused by excess fat on the liver and the pancreas. On the latter it blocks the action of the beta cells. Why is that misleading? When people get rid of it (as shown by the magic scanner) they get rid of their T2. They do not get their T2 back unless they put their pancreatic fat back on. The liver feeds the pancreas with fat. Many people on here including myself have got rid of their pancreatic fat and with it their T2.

If you had read the post I was replying too @AdamJames said that it made it look as if Type 2 diabetes can be reversed by simply having Cambridge Diet shakes for 9 weeks. Do you think it is that simple? I think even you must admit it is slightly more complicated than that but a lot of the pro ND propaganda.. some of which was linked to by you in earlier postings makes it sound that easy.

 

[dbr10]

If you had read the post I was replying too @AdamJames said that it made it look as if Type 2 diabetes can be reversed by simply having Cambridge Diet shakes for 9 weeks. Do you think it is that simple? I think even you must admit it is slightly more complicated than that but a lot of the pro ND propaganda.. some of which was linked to by you in earlier postings makes it sound that easy.

Yes. What about me? A thin type 2. Nothing I can do.

 

[Guzzler]

Yes. What about me? A thin type 2. Nothing I can do.

Aye, the premise does seem to ignore the TOFI. And while I understand that ridding the liver and pancreas of fat is up there with lowering the bg the logic of ND would suggest that for a TOFI this would happen sooner and more easily therefore it follows that TOFIs would be the first and most likely to acheive remission (by their own criteria) but we don't.

 

[first14808]

They do not get their T2 back unless they put their pancreatic fat back on. The liver feeds the pancreas with fat. Many people on here including myself have got rid of their pancreatic fat and with it their T2.

That's the potentially dangerous part, ie an assumption that it's as simple as doing that. Hence the need for follow-up studies to see if people's diabetes stays 'in remission'. Otherwise there's a risk that if someone goes back to a high-carb diet, damage will be done if they're still fundamentally diabetic. Or carb intolerant, or have metabolic syndrome, or other factors that may get lumped together as diabetes. If following ND means a long-term normal response to a GTT, then that's great.. but it may not work for everyone.

 

[Guzzler]

That's the potentially dangerous part, ie an assumption that it's as simple as doing that. Hence the need for follow-up studies to see if people's diabetes stays 'in remission'. Otherwise there's a risk that if someone goes back to a high-carb diet, damage will be done if they're still fundamentally diabetic. Or carb intolerant, or have metabolic syndrome, or other factors that may get lumped together as diabetes. If following ND means a long-term normal response to a GTT, then that's great.. but it may not work for everyone.

It didn't work for half of those in the study, those who met the criteria and had the same counselling etc. So your statement is right in that people may think that weight loss alone 'cures' T2, this is giving far more credit to a regime than it deserves.

 

[There is no Spoon]

if they're still fundamentally diabetic.

No if aboot it.

aboot (just in case there are any Canadians in tonight want to make them feel welcome. )

 

[AdamJames]

I think it's important not to throw the baby out with the bath water re the science coming from Newcastle.

The first experiment showed something truly hopeful - that for people with T2 of no more than a few years duration, it is possible to dramatically restore glucose tolerance, due to lowered insulin resistance and an improved first-phase insulin response, and there was (and still is) strong evidence that removal of fat from the liver and pancreas were what lead to those things.

One of the better papers I've seen that pulls all the ideas together (the empirical observation of the first Newcastle Experiment, and a study of beta cells) is this:

http://care.diabetesjournals.org/content/39/11/2080.long

To discard that science is to want to discard that science rather than to be objective.

So yes, the caveats are important:

* After a certain duration of T2, the approach becomes less likely to work. It's not clear why. An obvious guess is that the beta cells have been dysfunctional for so long that they are dead or no longer able to function as beta cells once the fat is removed.

* The only current way to safely remove fat from beta cells is to lose overall body weight. So if someone with T2 doesn't have much overall body weight to lose, then the approach is much less attractive. It does seem to work for people who are considered of healthy weight to start with, but the extent of weight loss required may be uncomfortable or dangerous.

* Since overall weight loss is the only current way to remove fat from beta cells, the approach comes with all the pitfalls, as well as advantages, of weight loss. If significant weight loss is required for an individual, then they will have to overcome poor odds in order to get the weight off and keep it off long term.

* We don't know what we don't know. Just because the people conducting the study say the speed of weight loss is not important, doesn't mean they are right. They haven't performed a similar experiment with slow weight loss. Other experiments, however, have compared rapid with slow weight loss and found pros and cons with each - interestingly, rapid weight loss seemed better and improving insulin resistance and glucose tolerance.

* Very often the foods used on the 800 calorie a day approach are high in carbohydrates, so there are probably better eating plans for someone with T2.

* The goalposts have changed as the studies have progressed. The latest definition of remission isn't very satisfying to a lot of people.

But it's important to be objective:

* It's science. The statement 'rapid weight loss has been observed to result in removal of fat from the liver, and then fat from the pancreas, and that seems to coincide with a restoration of first-phase insulin response and therefore improve glucose tolerance' is a statement about what we see in the universe. It isn't a moral statement. People can choose to moralise about it and use it to fuel their judgementalism, and that is infuriating, but we mustn't let that detract from the science.

* There is no strong evidence to suggest that a rapid weight loss approach will have more adverse effects than a slower approach in the long run on things like resting metabolic rate.

* The term 'wrecked metabolism' is a weasel word/phrase. Yes, a lower resting metabolic rate isn't going to help someone who likes food to keep the weight off so it's a problem in that sense, but the metabolism isn't wrecked. In some contexts it can be seen as an advantage. Also, calorie restriction, even long term, seems to improve most health markers in most species.

I do think it's important, if we are actually interested in how the universe works, to avoid nailing our colours to a mast and looking for things to back our beliefs up, and pouring scorn on things which go against our beliefs.

Consider the following 2 statements:

* Calories are irrelevant
* All anyone with T2 needs to do is eat 800 calories a day for 8 weeks and they'll be cured

If you are more drawn to one statement than the other, I think that's a problem. Both statements are highly questionable, they are over-statements at best, and don't reflect what we actually see when we try to observe the universe.

 

[There is no Spoon]

There is no strong evidence to suggest that a rapid weight loss approach

However there is strong evidence to show that people can not or will not stick to a prolonged diet.

This is the reason for rapid/ crash diet it's not about the weight loss it's about the time people spend on the diet.

Obviously weight loss is the objective, but the rapid part is about time not weight.

 

[Guzzler]

One could argue that with regard to <6 years since diagnosis an insulin assay would negate the need for all of this catching people who still have A1c/bg within normal parameters but showing none of the symptoms which call for said A1c/bg etc. The NHS et al is really missing a trick with this one.

 

[dunelm]

Just watched the prog on catch up. A good conversation starter I thought.
Interesting reading this thread how scientific and doctory we all get about our medical conditions.
Not surprising thought, it’s what humans tend to do.
Just don’t get painted into a corner by your own facts.

 

[Guzzler]

Just watched the prog on catch up. A good conversation starter I thought.
Interesting reading this thread how scientific and doctory we all get about our medical conditions.
Not surprising thought, it’s what humans tend to do.
Just don’t get painted into a corner by your own facts.

Such as?

 

[Tannith]

It didn't work for half of those in the study, those who met the criteria and had the same counselling etc. So your statement is right in that people may think that weight loss alone 'cures' T2, this is giving far more credit to a regime than it deserves.

It worked for all the ones who lost the weight not the ones who didn't. It then worked for the half of those who kept the weight off, not the half who didn't. The METHOD works for everyone ie fat off = diabetes gone. The INDIVIDUALS even those who have the same counselling etc often fail. In fact half of them do. We need to find a way of helping the half who couldn't keep the fat off get the right kind of counselling to succeed in getting the fat off. And incidentally it doesn't have to be shakes or 9 weeks. Dr Taylor has said many times that if you can do it with real food so much the better. And it takes as long as it takes to lose the fat from the pancreas and liver. This will be on average 15% of the person's weight at diagnosis. Absolutely SIMPLE, albeit not easy to do. Why is is no one expects to have to do anything difficult any more? Can it be a generational thing? If I can do it and I am a little old lady in my seventies why can't big strong middle aged men?