This is a much watch for all of us and our families

[Oldvatr]

I am confused. 87% of those who lost 15kg so is that 87% of the 46% who met their targets? How many people does this equate to? I blummin' hate statistics, you can bend em and shake em up to say owt.

Considring we are exiting the EU on a 2% margin vote, then 87% of 46% works out at a tad over 40%, which means it was a minority and so is by no means conclusive. It is of interest and a pointer to future possibilities, but it seems the fine tuning that DIRECT was meant to demonstrate was actually a failure.

 

[Guzzler]

Considring we are exiting the EU on a 2% margin vote, then 87% of 46% works out at a tad over 40%, which means it was a minority and so is by no means conclusive. It is of interest and a pointer to future possibilities, but it seems the fine tuning that DIRECT was meant to demonstrate was actually a failure.

Thank you.

 

[Boo1979]

As with most things statistical, it depends a) what hypothesis you were setting out to prove / disprove and b) largely as a result of the first question, how you go on to cut the data cake.
With this study
if your hypothesis is that losing over x% of starting weight ( clustered around 15kg), will result in the desired outcome ( ie the specified reduction in hba1c for a specified period of time etc), then all you are really interested in is the group who achieved that weight loss target and the outcome i.e. the 87% figure in this study
If your hypothesis is that following a vlc diet will achieve improved weight loss and glycemic control,then you are interested in how many people lost weight, how much and with what impact on glyceamic markers i.e. in this study, the 46% figure
If your hypothesis is that vlc is an inferior approach to, say, lchf then what you are really interested in is what % of people do not achieve weight loss and / or improved glyceamic control, i.e. 54% -60% figures in this study
Stats can be used ( and abused ) to do many things

 

[Bluetit1802]

87% of those on the Direct study WHO LOST SUFFICIENT WEIGHT ie 15 to 20%, succeeded. I call that "virtually certain". Its not for everyone, many people as I said before are happy not to attempt to reverse their T2. In the UK as a whole (rather than the people on here), I understand that the great majority prefer to just keep their diabetes and swallow a pill to treat their T2, and continue eating as they did before.Either drugs or low carb will get the BGs down and stop/reduce the complications.

At the end of the 12 month reporting period only 46% succeeded in achieving an HbA1c of under 48 with no meds. (And that, to me, is not reversal.) So diabetes has not necessarily been lost even in that 46%, and definitely not lost in the remaining 54%. Your words "virtually certain" are incorrect.

 

[Sue192]

87% of those on the Direct study WHO LOST SUFFICIENT WEIGHT ie 15 to 20%, succeeded. I call that "virtually certain". Its not for everyone, many people as I said before are happy not to attempt to reverse their T2. In the UK as a whole (rather than the people on here), I understand that the great majority prefer to just keep their diabetes and swallow a pill to treat their T2, and continue eating as they did before.Either drugs or low carb will get the BGs down and stop/reduce the complications.

Where are the statistics that back up your assertion that 'many people are happy not to attempt to reverse their T2'. And also that the 'great majority prefer just to keep their diabetes and swallow a pill'. How on earth do you know those assertions are actually true? I find them bordering on insults.

 

[Oldvatr]

As with most things statistical, it depends a) what hypothesis you were setting out to prove / disprove and b) largely as a result of the first question, how you go on to cut the data cake.
With this study
if your hypothesis is that losing over x% of starting weight ( clustered around 15kg), will result in the desired outcome ( ie the specified reduction in hba1c for a specified period of time etc), then all you are really interested in is the group who achieved that weight loss target and the outcome i.e. the 87% figure in this study
If your hypothesis is that following a vlc diet will achieve improved weight loss and glycemic control,then you are interested in how many people lost weight, how much and with what impact on glyceamic markers i.e. in this study, the 46% figure
If your hypothesis is that vlc is an inferior approach to, say, lchf then what you are really interested in is what % of people do not achieve weight loss and / or improved glyceamic control, i.e. 54% -60% figures in this study
Stats can be used ( and abused ) to do many things

You make good points here. From my POV, the 87% statistic represents those that maintained their bgl goals a year after the trial, i.e. while on maintenance follow on. What is not included in that is what the follow on diet was that they used to keep low. The ND is a time limited quick zap, but it only controls diet intake during this period. So do we assume that those 87% went back to their old ways and hence high carb, which if true is impressive, but we have no clue as to whether they were stressing the limits again. Also, I am not aware that they had a re-take of the MRI scans to prove their adipose tissue was unchanged from the result obtained in the trial.

Does anyone have a copy of the study follow on report? I thought that the info was still being kept under wraps, apart from a back slapping session just before Xmas. When it goes public, then it will be studied by all and sundry, myself included, but at the moment all we have to go by seems to be the Dec symposium summary data.

Edit to add correction: The DIRECT Results report is apparently available in the public domain now.

 

[Bluetit1802]

Where are the statistics that back up your assertion that 'many people are happy not to attempt to reverse their T2'. And also that the 'great majority prefer just to keep their diabetes and swallow a pill'. How on earth do you know those assertions are actually true? I find them bordering on insults.

@Tannith is the mistress of the sweeping statements.

 

[britishpub]

It seems quite often that those who followed the ND/Very Low Calorie route love to claim that it is the only true route to redemption, and those who follow other routes are doomed to failure.

Makes me glad I didn’t do it, cos I would hate to end up like that.

Losing a lot of weight, quickly especially losing the fat that is constricting your pancreas and liver will quite obviously be a major help to those whose T2D is caused by the fat build up in that area.

How that is achieved is irrelevant, and claiming that there is only one way is risible, especially in light of the obvious evidence to the contrary.

I lost a lot of weight rapidly by following a low carb diet, and appear to be in the same position now that many ND followers claim to be.

Everybody is unique, and how their body responds to intervention will also be unique.

 

[Tannith]

As with most things statistical, it depends a) what hypothesis you were setting out to prove / disprove and b) largely as a result of the first question, how you go on to cut the data cake.
With this study
if your hypothesis is that losing over x% of starting weight ( clustered around 15kg), will result in the desired outcome ( ie the specified reduction in hba1c for a specified period of time etc), then all you are really interested in is the group who achieved that weight loss target and the outcome i.e. the 87% figure in this study
If your hypothesis is that following a vlc diet will achieve improved weight loss and glycemic control,then you are interested in how many people lost weight, how much and with what impact on glyceamic markers i.e. in this study, the 46% figure
If your hypothesis is that vlc is an inferior approach to, say, lchf then what you are really interested in is what % of people do not achieve weight loss and / or improved glyceamic control, i.e. 54% -60% figures in this study
Stats can be used ( and abused ) to do many things

I am not interested in how many of a particular group of individuals happened to succeed in losing weight, but in whether those that DID succeed & lost the fat off their pancreas/liver thus lost their diabetes. Nor am I interested in how many of those 87% also happened to be willing or able to stick with the follow up diet for a year, ie the 45%. That would just be a comment on those individuals , not on the diet. What matters is that those who DID choose to stick with the follow up diet and keep the pancreatic/ liver fat off (as shown by MRI scans), thereby kept their diabetes in remission. It is whether the method works that counts, not whether Joe Bloggs and Mary Smith happened to be willing or able to do it. There are plenty of others that would be. As to where I found the statistics about the majority of T2s in the UK being happy to just swallow a pill and keep their diabetes, I did find that among some other statistcs on T2s, I didn't keep it as it seemed so very obvious that no one would want proof. I have also seen reports (including on here) that a lot of GPs do not even bother to try to persuade T2s to lose weight because so few of them are willing to try it. I will look for it The GP guidlines for treatment of T2 recommend metformin initially, and also weight loss advice.

 

[Tannith]

Where are the statistics that back up your assertion that 'many people are happy not to attempt to reverse their T2'. And also that the 'great majority prefer just to keep their diabetes and swallow a pill'. How on earth do you know those assertions are actually true? I find them bordering on insults.

". In 2013, metformin prescribing peaked at 83.6% (95% CI 83.4% to 83.8%), while sulfonylureas prescribing reached a low of 41.4% (95% CI 41.1% to 41.7%). Both remained, however, the most commonly used pharmacological treatments as first-line agents and add-on therapy. http://bmjopen.bmj.com/content/6/1/e010210?utm_source=TrendMD&utm_medium=cpc&utm_campaign=BMJ
This is not where I originally saw the statistic (which I can't find), but it iis a BMJ article saying more or less the same thing re metformin/other pills being the most common treatment used for T2s. The GP advisory booklet on treatment of T2 also recommends advising t2s to lose 5 to 10% of their weight. Certainly unlikely to get them to their personal fat threshold which is estimated at 15 to 20%. It's also fairly obvious if you look around you. How many T2s ( apart from the low carbers on this forum who are in the minority nationally) do you know who do anything other than use drugs for their t2, and if they diet at all don't do it anywhere near seriously enough to be the equivalent of a Newcastle type diet?

 

[Boo1979]

I am not interested in how many of a particular group of individuals happened to succeed in losing weight, but in whether those that DID succeed & lost the fat off their pancreas/liver thus lost their diabetes. Nor am I interested in how many of those 87% also happened to be willing or able to stick with the follow up diet for a year, ie the 45%. That would just be a comment on those individuals , not on the diet. What matters is that those who DID choose to stick with the follow up diet and keep the pancreatic/ liver fat off (as shown by MRI scans), thereby kept their diabetes in remission. It is whether the method works that counts, not whether Joe Bloggs and Mary Smith happened to be willing or able to do it. There are plenty of others that would be. As to where I found the statistics about the majority of T2s in the UK being happy to just swallow a pill and keep their diabetes, I did find that among some other statistcs on T2s, I didn't keep it as it seemed so very obvious that no one would want proof. I have also seen reports (including on here) that a lot of GPs do not even bother to try to persuade T2s to lose weight because so few of them are willing to try it. I will look for it The GP guidlines for treatment of T2 recommend metformin initially, and also weight loss advice.

I agree but dont see why you think its a reply to my post which was saying something about a different issue

 

[Tannith]

At the end of the 12 month reporting period only 46% succeeded in achieving an HbA1c of under 48 with no meds. (And that, to me, is not reversal.) So diabetes has not necessarily been lost even in that 46%, and definitely not lost in the remaining 54%. Your words "virtually certain" are incorrect.

What is normal HbA1c for diabetics?
"HbA1c test for diabetes diagnosis
An HbA1c test does not directly measure the level of blood glucose, however, the result of the test is influenced by how high or low your blood glucose levels have tended to be over a period of 2 to 3 months.

Indications of diabetes or prediabetes are given under the following conditions:

• Normal: Below 42 mmol/mol (6.0%)
• Prediabetes: 42 to 47 mmol/mol (6.0 to 6.4%)
• Diabetes: 48 mmol/mol (6.5% or over)"

https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html
So this forum agrees with Prof Taylor that non diabetic is 48mmol/mol or under. In any case the 48 mmol/mol was his ceiling figure. Many were below.

 

[Oldvatr]

I am not interested in how many of a particular group of individuals happened to succeed in losing weight, but in whether those that DID succeed & lost the fat off their pancreas/liver thus lost their diabetes. Nor am I interested in how many of those 87% also happened to be willing or able to stick with the follow up diet for a year, ie the 45%. That would just be a comment on those individuals , not on the diet. What matters is that those who DID choose to stick with the follow up diet and keep the pancreatic/ liver fat off (as shown by MRI scans), thereby kept their diabetes in remission.>>>>>>>>

Once again some sweeping statements here. The main one I picked up was the one about losing pancreatic fat as shown by MRI scans. This statement was true for some(but not all) in the pilot study done a couple of years ago, but the DIRECT study did not measure these parameters, or use MRI scanners. The intervention and monitoring was all done in the GP practices.

The second point is that during the 12 month study period, there was evidence that weight losses were maintained , but the report does show that several of the "success" group had to have emergency re-intervention (presumanly by re-introducting the vlcal diet again) just after the vlcal stage ended, and it seems these were holding their breath until the end of term, then let it all hang out with a "proper" normal diet again. So how permanent is it? Only while teacher is watching?

PS the diet plan used in DIRECT was the old Cambridge Weight Loss plan which gained notoriety as being ineffective for weight loss. as well as being expensive, I am surprised it is still active and available.

PPS: One point made in the report is the side effect of normoglucolysation after the vlcal diet ends can trigger macular myopathy and degeneration and anyone doing this kind of diet at home should go for retinopaty scans when the diet has ended. This has not been discussed in the Forum before, and I was not aware of this possiblity. It is apparently a higher risk if there is macular damage present at the start of the diet.

This is what Wikipedia says:
https://en.wikipedia.org/wiki/The_Cambridge_Diet

 

[Boo1979]

I think the issues re eye health, specifically retinopathy, are the same for any intervention that produces rapid changes in blood sugars
https://www.ncbi.nlm.nih.gov/pubmed/1464975

 

[Tannith]

as shown by MRI scans

https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html "as shown by MRI scans" Apologies Oldvatr, they did the MRI scans to show pancreatic fat loss in the earlier study. The 15% overall fat loss discovered and tested by MRI in the earlier study and found to be needed to achieve pancreatic fat loss was however used again in the DIRECT study

 

[Oldvatr]

https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html "as shown by MRI scans" Apologies Oldvatr, they did the MRI scans to show pancreatic fat loss in the earlier study. The 15% overall fat loss discovered and tested by MRI in the earlier study and found to be needed to achieve pancreatic fat loss was however used again in the DIRECT study

It is a pity they did not close the circle on this. Yes the pilot study showed that the vlcal diet reduced pancreatic fat, and also reduced bgl levels, but they did not prove that the bgl levels drop was due to the fat loss, or that this particular fat was responsible for high insulin levels or IR, and that this was snbsequently shown to recover directly as a result of the diet plan. They did show a possible link, but not causes, There were too many variables going on to be able to isolate cause from effect. So IMHO the pilot study opened the door, and they should have used DIRECT to walk in and nail the beggar down. But they do not appear to have done that. There was no measurements of body composition or of insulin levels or any atttempt to correlate the two in a larger population.

That is all they seem to have achieved - that the diet works with a larger population, and could be taken out of the research lab into GP surgeries. It still does not really establish that the changes seen are permanent or that T2D is cured by the process.

 

[Tannith]

It is a pity they did not close the circle on this. Yes the pilot study showed that the vlcal diet reduced pancreatic fat, and also reduced bgl levels, but they did not prove that the bgl levels drop was due to the fat loss, or that this particular fat was responsible for high insulin levels or IR, and that this was snbsequently shown to recover directly as a result of the diet plan. They did show a possible link, but not causes, There were too many variables going on to be able to isolate cause from effect. So IMHO the pilot study opened the door, and they should have used DIRECT to walk in and nail the beggar down. But they do not appear to have done that. There was no measurements of body composition or of insulin levels or any atttempt to correlate the two in a larger population.

That is all they seem to have achieved - that the diet works with a larger population, and could be taken out of the research lab into GP surgeries. It still does not really establish that the changes seen are permanent or that T2D is cured by the process.

The diet protocol for the study was peer reviewed in the scientific press including the Lancet to verify Prof taylor's claims for it. That's good enough for me. He is a renowned diabetologist, a medical doctor, with the interests of diabetic patients at heart, not one of these people trying to sell a book. I believe him. Also it worked for me. I now have HBAC1a of 40 and FBG of 5.3. Its very early days to say how long I shall be able to keep the pancreatic fat off but so far in over 2 months I have not put any weight back. I find it much easier than I expected to keep the weight off - I think my stomach must have shrunk.
http://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible/
http://www.ncl.ac.uk/press/articles/archive/2015/12/pancreasstudy/

 

[Oldvatr]

The diet protocol for the study was peer reviewed in the scientific press including the Lancet to verify Prof taylor's claims for it. That's good enough for me. He is a renowned diabetologist, a medical doctor, with the interests of diabetic patients at heart, not one of these people trying to sell a book. I believe him. Also it worked for me. I now have HBAC1a of 40 and FBG of 5.3. Its very early days to say how long I shall be able to keep the pancreatic fat off but so far in over 2 months I have not put any weight back. I find it much easier than I expected to keep the weight off - I think my stomach must have shrunk.
http://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible/
http://www.ncl.ac.uk/press/articles/archive/2015/12/pancreasstudy/

I have no qualms with either his credentials, nor those of the studies themselves, which do seem to be set up properly with safeguards and cautions as one would expect of a significant research project, I am not saying to people don't do it, and as I said earlier I accept it as being another spanner in the toolbox.

But I am not convinced it is either a cure, or even a permanent solution to T2D, since the data has a short track record so far, and is only for a relatively small selected subset of patients. I do not think it is suitable for everyone with a metabolic syndrome, and I will dispute those claims being made. You say it was peer reviewed. Yes, and so it should be, but I do not regard the press as a suitable forum for review. I currently receive a media ezine which includes articles on health and diabetes, but so far its level of journalism leaves much to be desired, and it contains a load of trashy blogs and stories too. Unfortunaely it provides a mouthpiece for Jason Fung who regularly blogs in it, and I fear it reduces his reputation in my eyes. Even the Lancet has been known to publish incorrect and misleading articles. I would not accept the ND press releases as being totally independant either,

The main tenet behind scientific proof is that an experiment should be easily reproducible by others, and that the results from both agree and correlate. So far ND is the only study in the running, and so there is no independant correlation other than the anecdotal evidence provided in social media and bloggers in health magazines. And forums such as this one. The other tenet is that the sample size needs to be representative of the target population (i.e. diabetics in this case) and also of a significant number to produce reliable data suitable for proper analysis by observers outside the study group. ND fails these criteria too.

 

[derry60]

@derry60 i have not watched this but I wanted to thank you for posting it. I hope the experience will not stop you posting in the future. Whether I agree with the content or not - it is great to be informed of different perspectives. I am going to give it a go.

It looked to me as if you were getting a little disheartened by some of the feedback you got. Don't be. Keep posting - be open minded to the pro's and con's and maintain your integrity! I just think it is so important that a wealth of data and ideas are posted here so it doesn't become closed and sterile.

Keep posting - I have been away from here for about four months and it looks like things are the same as they were when I left. I feel another break coming on already and I have only been back really two days...

Thank You Feegle

 

[derry60]

I agree which is why I find it incredibly sad to see the media, as well as otherwise reputable sites holding out the illusion of a simple cure for diabetes rather than the more realistic / accurate / honest outcome of excellent control. Vlc and LCHF / keto are equally guilty
https://www.dietdoctor.com/how-to-cure-type-2-diabetes

I am finding that the Low Carb and Keto is now becoming very commercialised, making magical claims. The word cure is far to simplistic. I prefer the word "Control" Everywhere on the net now, and YouTube everybody seems to be jumping on the bandwagon making fairyland claims that we are all going to be cured if we eat this way or that. Oh and low and behold if we say that we are eating a vegetable that perhaps another person cannot, they can make you feel as if you are committing a sin. "You cannot eat that its not Keto they cry" lol..I am not talking about here but other places on the net. It all seems to be getting cosmetic.