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The one show discussion

DavidGrahamJones said:
Depends on the person. It's all very well the dieticians saying you should eat 500 to 1,000 calories a day less than your BMR to lose one to two pounds but what advice do they have when that stops working? None really. Exercise? yep, done that.

Like NewTD2 I have my version of the Newcastle diet and I eat loads of veg, I can resort to several different "shakes" as well, but find the ones I have are a bit high in carb. I am doing it with my GP's approval (she actually said I was one of the few people she could trust) after a decent discussion and the fact that she has another patient who has done the same with great success.

As for coping with VLCDs in general, it was easier for me because I cut down over a period of years. From eating about 2600 calories a day (my BMR as per Harris Benedict) I started with the recommended 500 calories less and nothing happened, then 800 less and nothing happened. A brief encounter with a bariatric surgery support group where they were liquidising chocolate and ice cream to get their calorie intake up to 1200 calories made me think "From 1800, I'm almost there". Then I lowered carb intake without adding fat, which accounted for another 600 calories less, so I was at the magic 1200 calories. Approximately.

The next leap to VLCD was therefore not so tricky, I eat no meat during the week and try to avoid cheese, some days good, some days not so good. Sometimes I feel that I've accidentally ended up on low carb weekday vegan 5:2 diet. Sometimes I do feel like "cheating" and I have been known to have pork ribs for Saturday lunch (decadent) as well as meat for dinner. For me the point of eating normally at the weekend is an incentive to get through the week. Still work in progress.
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The fewest number of calories you mention is 1200, is that right? And you lowered your intake gradually?
Forgive me but this is quite different to the experience that NewTD2 speaks of, that being an extremely low calorie crash diet of 300-400 cpd for three months from what seems to be a standing start.
 
I had another look at the TV programme. Some things are puzzling me a bit..
Just as I found when I followed ND, after a few days it became evident that the 4 participants were showing ketones in their blood tests. This is what some of us aimed for in the recent May fast, and many others aim for as their choice of dietary regime. So how is this different? Is VLCD with meal replacemrnt shakes a ketogenic diet?

Also, one of the TV researchers / presenters is Prof Susan Jebb. A few years ago she was extolling the virtues of Weight Watchers diet. So, does this mean her research has caused a paradigm shift for her? Is she being open to the idea that we have discussed here, i.e., that there is no one single way to suit everyone in the quest to lose weight? Or, for the more cynical, is she influenced by wherever the research funding is sourced?
https://www.telegraph.co.uk/news/he...tchers-really-does-work-scientists-claim.html
 
Pipp said:
Is VLCD with meal replacemrnt shakes a ketogenic diet
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The Optifast website, providers of the diet plan for the first Newcastle experiment, say the diet aims for "mild ketosis". I found, when doing it, that I did get detectable ketones using ketostix but only during the night.
 
Guzzler said:
Forgive me but this is quite different to the experience that NewTD2 speaks of, that being an extremely low calorie crash diet of 300-400 cpd for three months from what seems to be a standing start.
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I appreciate the difference, I was just trying to say that I managed it by doing it slowly. The 300 - 400 cpd you mention is even lower than the 800 cpd of the Newcastle Diet. Diet is a very strange thing, I'm married to a woman who swears by WeightWatchers, because it works for her. Everything I ever heard during my many years of dieting was crash diets are a no no, but if conventional dieting doesn't work, what are you supposed to do.

The fact that the dieter is also diabetic makes things different because they're also trying to straighten out BG. Even though my weight isn't falling my BG is generally pretty good. Just have to be careful about pork ribs, my body happily converts protein and fat to glucose.
 
AdamJames said:
The Optifast website, providers of the diet plan for the first Newcastle experiment, say the diet aims for "mild ketosis". I found, when doing it, that I did get detectable ketones using ketostix but only during the night.
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Yes, it was a condition for my medically supervised VLCD with meal replacements that I should remain in ketosis for the duration. The meal replacement products were considered a 'medical supply' at that time, and issue of them was on the condition that keyones were tested rwice weekly. I think it was to make sure I wasn't 'cheating'.
 
Indy51 said:
For those interested in resting metabolic rate:

Resting metabolic rate of obese patients under very low calorie ketogenic diet:
https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-018-0249-z
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You get a 'winner' for that just based on the sense of optimism it's given me :)

The most positive study I'd seen prior to that was where a lot of resistance training was done. But I don't think even that got such spectacular results.

So in summary people lost about 20kg, and had a reduction in RMR of about 200 cal/day, most of that expected due to lowered BMI. The final RMR was only 60 cals/day less than someone of the target weight who had never been obese.

I was worried by the line near the start that read "These three steps were maintained until the patient lost the target amount of weight, ideally 80%" but I'm glad I carried on reading!

I couldn't see the exact foods used, but they give enough detail to possibly come up with a similar meal plan. Do you know if the detail of the foods is available anywhere?
 
AdamJames said:
I'd be fascinated to know if anyone feels they have gone from obese to normal weight but have anything like the kind of 'maintenance calories' predicted, e.g. 2,500 a day for men.
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My average for 2017 and so far this year has been about 2,300 cals (this looks lower due to a few extended fasting periods where I have fewer than 400 cals per day) . I would say that I was eating more during my first low carb year when I lost the majority of my weight so yes I think I have gone from extremely fat (morbidly obese BMI 43) to overweight (BMI 28) while eating about the right number of calories (and sometimes even more).
 
Pipp said:
Yes, it was a condition for my medically supervised VLCD with meal replacements that I should remain in ketosis for the duration. The meal replacement products were considered a 'medical supply' at that time, and issue of them was on the condition that keyones were tested rwice weekly. I think it was to make sure I wasn't 'cheating'.
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And that of course is what the pre Bariatric surgery diet is. According to Guys and Thomas's they aim to get their patients into ketosis for 4 weeks pre op to "shrink the liver" I reckon they should just keep them there and forget th surgery altogether. What a shame that Prof Taylor didn't try that method (or in fact is he... but just using Opitfast/Cambridge Diet shakes rather than a well formulated ketogenic real food way of eating...).
 
bulkbiker said:
My average for 2017 and so far this year has been about 2,300 cals (this looks lower due to a few extended fasting periods where I have fewer than 400 cals per day) . I would say that I was eating more during my first low carb year when I lost the majority of my weight so yes I think I have gone from extremely fat (morbidly obese BMI 43) to overweight (BMI 28) while eating about the right number of calories (and sometimes even more).
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You get a winner too. This is very good news. Hopefully I've been horribly pessimistic. Do you think that most studies that have looked into this subject were carried out before keto diets became popular? The study @Indy51 links to was published just this year. Maybe there's going to be a whole raft of good news re keto and resting metabolism in the pipeline. Or is already there but I missed it?

What's even more encouraging about the VLCK diet just linked to is that, if I'm reading it right, they aimed for <50g carbs a day for the first 3 'ketogenic' stages. I was worried they might have needed to go lower than 20g to get a magical effect, and I'd struggle with that. But nope, if they allowed up to 50g then it's something a lot of people could comfortably do, and are already doing. One way of interpreting the results is to say 1) You don't need to get too strict with the carb reduction and 2) You can lose weight at any speed within reason without shooting yourself in the foot in terms of resting metabolism.

I need to read through the article again when I'm awake tomorrow - I can't remember what exercise they told the participants to do. I guess there was resistance training. But if the exercise regime was as modest as the definition of a keto diet in terms of carb levels then this is all very promising.
 
bulkbiker said:
And that of course is what the pre Bariatric surgery diet is. According to Guys and Thomas's they aim to get their patients into ketosis for 4 weeks pre op to "shrink the liver" I reckon they should just keep them there and forget th surgery altogether. What a shame that Prof Taylor didn't try that method (or in fact is he... but just using Opitfast/Cambridge Diet shakes rather than a well formulated ketogenic real food way of eating...).
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Is it perhaps for some the VLCD is more rapid loss, which is what Tayor et al were testing originally to emulate the bariatric surgery, but without the truma of going under the knife? Would be interesting to see a study comparing VLCD and no calorie restriction keto diet. Perhaps studies some already exist and I just need to search more.
 
Pipp said:
Is it perhaps for some the VLCD is more rapid loss, which is what Tayor et al were testing originally to emulate the bariatric surgery, but without the truma of going under the knife? Would be interesting to see a study comparing VLCD and no calorie restriction keto diet. Perhaps studies some already exist and I just need to search more.
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There's been a huge amount of research done on bariatric surgery. While going under the knife sounds drastic to most people (across the board, not just obese) the patient and doctor need to weigh the options for the individual case.

Being say, 30-40 stone in weight carries severe risk of "trauma" from life threatening morbidities itself. Patients at the highest levels of BMI do have to use VLCD before surgery is safe for them, but if they were considering surgery vs calorie restriction, in their case it may well be safer and more effective to have the surgery. I assume this is well supported by research.

I was never that obese, maxing out at about BMI 43 and being about BMI 40 now (I'm working on it, no need to encourage me).

At my level of obesity I am borderline for being eligible under current NZ funding for bariatric surgery. I don't think I will need it as long as I keep working hard on my food choices.

There certainly is a place for bariatric surgery though, given the very strong research findings across multiple studies that few morbidly obese people can control their obesity without it. I am thrilled for those who can and wish to support those who haven't yet been able to.
 
Jenny15 said:
There certainly is a place for bariatric surgery though, given the very strong research findings across multiple studies that few morbidly obese people can control their obesity without it. I am thrilled for those who can and wish to support those who haven't yet been able to.
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Do you have any links for the multiple studies with the 'very strong research findings' you have quoted, please @Jenny15?
Also, in UK a BMI of 40+ is considered to be 'severe obesity' , sometimes called 'morbid obesity'.

Edit to add:
My local Clinical Commissioning Group has been offering bariatric surgery to people with BMI 40+ or 35 if there are other co-morbidities.
 
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Pipp said:
Do you have any links for the multiple studies with the 'very strong research findings' you have quoted, please @Jenny15?
Also, in UK a BMI of 40+ is considered to be 'severe obesity' , sometimes called 'morbid obesity'.

Edit to add:
My local Clinical Commissioning Group has been offering bariatric surgery to people with BMI 40+ or 35 if there are other co-morbidities.
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I don't have specific links because I have been aware of the research for years from reading articles, guidelines and watching documentaries etc. It would take me quite a while to find some and I'm not well today. They do exist. The leading UK surgeons who do this surgery have talked about it in docos, plus I have read them saying it in the media. In the US and in NZ the top specialists also say it is the most effective long term treatment for people above a certain BMI. Having yo-yo dieted since my teens, I can see why the research showed this.

I am aware that BMI 40+ is severe morbid obesity.

Your local CCG criteria seem fairly standard and similar to my own DHB's but the process of getting approved is so involved that I haven't considered doing it for now. I'm happy with the approach I'm taking atm. Was talking generally about the population as a whole.
 
Pipp said:
Genius. Thank you @Indy51 . So according to the research you quote it seems making sure that there is no loss of muscle mass during the diet? Resistance / strength exercise rather than cardio workouts might have an influence then?
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Ah, it's the freezer diet! :)

So the paper talks about thermogenesis, which is the body producing heat. So NEAT for Non-Exercise Adaptive Thermogenesis and EAT for Exercise Adaptive Thermogenesis. Muscle is a big energy user, even at rest and also for warming, ie shivering. Then during EAT, we produce more energy and also need to dump it via sweating. And I assume fat also plays a part given it's a way to insulate the body as well as an energy store. Someone also linked a presentation discussing brown vs white fat, which plays a big part in thermogenesis as well.

But loss of muscle would mean a corresponding loss in energy usage, ie affect BMR/RMR. Resistance training's a quicker way to build muscle mass than cardio, but cardio also includes some resistance work as it uses muscles. Combining the two is best for efficiency. And I guess overdoing it also drastically alters calorie requirements, ie the amount serious body builders and heavyweights have to eat to build and maintain muscle.
 
I wonder if the amazing results in that recent VLCK diet could be due to something as simple as preserving muscle mass. Certainly the most positive results I'd seen before this study was all about making every effort to preserve muscle mass via resistance exercise. It compared just weight loss, weight loss with cardio exercise, and weight loss with resistance exercise. Adding cardio exercise did little to preserve RMR, but adding resistance exercise did a huge amount to help.

The authors of this most recent VLCK study report seem to be very modest in admitting they are not at all sure why it worked so well to avoid RMR reduction, and speculate on various possibilities including hormones. They also suggest that maintaining lean mass is likely to a big part.

I find it hard to get my head around the possibility that a VLCD consisting of 100g of carbs a day can be drastically different than a VLCD consisting of 50g carbs a day when it comes to preserving RMR if both are combined with resistance exercise. Still, this is new territory, the study was only published this year and the authors say they believe they are the first to find a way to avoid RMR reduction long term. Presumably this is exciting enough for similar studies to be funded to explore further.

I wish they would specify the exact food used, as if it is something to do with hormones, who knows, the magical effect could be all in the detail.
 
Remember that if inslin levels are too high the body can not access as much of its own fat, so must access the muscle mass for energy. This will very much depend on each persons level of inslin resistance.

Thankfully once the liver fat is lost, inslin restanance drops a lot, there is also a nice drop after the first few days once most of the glycogen in the liver is used up. Hence it can take a few weeks before keystones are detectable. (Also way these diets should not be used for too short a time.)
 
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