Type 2 Diabetes: NHS to offer 800 cal diet

Brunneria

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Hi @NicoleC1971

I am VERY interested in this statement of yours.
bariatric patients universally reverse their diabetes in the immediate weeks after surgery and long before they've lost lots of weight.

I knew that some bariatric surgery subjects ‘reverse’, but hadn’t come across any info on it being universal.
Do you have any links for this? I would love to read more.
 

Oldvatr

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Oldvatr

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Counterpoint it was called published in 2013..I still have the e-mail from Prof Taylor but have never seen any follow up..
77 participants all from home not much extra support.. Significant success but wouldn't a 5 year follow up have been great?

Some light reading for you. Enjoy or bookmark for later

https://www.ncbi.nlm.nih.gov/pubmed/21656330
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5320825/
https://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible/
https://www.dietdoctor.com/need-talk-reversal-type-2-diabetes
http://care.diabetesjournals.org/content/30/2/435
 

lucylocket61

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Hi @NicoleC1971

I am VERY interested in this statement of yours.


I knew that some bariatric surgery subjects ‘reverse’, but hadn’t come across any info on it being universal.
Do you have any links for this? I would love to read more.
I cant find the link, but there was a YouTube video showing how the process of bypassing meant that certain digestive processes didnt happen, including one affecting insulin.
 

bulkbiker

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Yeah but none of those shows a 5 years after "remission" follow up to show if it is sustainable.. this is something that Prof Taylor must be in a unique position to assess.. call in all the people who were in remission 5 years ago and take another HbA1c. Wouldn't that be worth doing? Unless of course....
 

Pipp

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@KK123 - if you google "Richard Doughty", you'll see what. Can happen to slim T2s adopting this approach, and the span of his personal years required efforts.

Whatever the "solution", no one size fits all.

It wouldn't be my choice, but my colleague @Pipp sid very well on it several years ago now.
My opinion, for what it is worth, because I see many who haven't tried it quick to condemn it...
Very low calorie diets are just another tool in the box. Used correctly, can give good results. My own experience was a loss of 49kg, of which around 25 have remained lost. Blood glucose returned to non-diabetic levels and remained so for almost 7 years, until I had several courses of steroid meds for another health condition.

The current decision to make it available to newly diagnosed is, in my opininion, based on a panic / knee jerk reaction to rising obesity and T2 diagnoses. I hope that it is not used as a stick to beat obese people, either by media or HCPs. I certainly hope that those following this route are given better follow on advice and support than I had, and not reintoduced to the carbs with every meal mantra.

Of course there is the vexed question... can this very low calorie dieting have an adverse effect on metabolism. Possibly, again in my opinion, but that is why the advice is to eat 30% less than previously. By weighing less your body most likely needs less fuel anyway.

It seems that the 'tool' is often misused causing a botched result.
 

bulkbiker

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My opinion, for what it is worth, because I see many who haven't tried it quick to condemn it...
Very low calorie diets are just another tool in the box. Used correctly, can give good results. My own experience was a loss of 49kg, of which around 25 have remained lost. Blood glucose returned to non-diabetic levels and remained so for almost 7 years, until I had several courses of steroid meds for another health condition.

The current decision to make it available to newly diagnosed is, in my opininion, based on a panic / knee jerk reaction to rising obesity and T2 diagnoses. I hope that it is not used as a stick to beat obese people, either by media or HCPs. I certainly hope that those following this route are given better follow on advice and support than I had, and not reintoduced to the carbs with every meal mantra.

Of course there is the vexed question... can this very low calorie dieting have an adverse effect on metabolism. Possibly, again in my opinion, but that is why the advice is to eat 30% less than previously. By weighing less your body most likely needs less fuel anyway.

It seems that the 'tool' is often misused causing a botched result.
I couldn't agree more ... I doubt that many of the GP's prescribing this will have the first clue about what to advise when starting and especially for maintenance after the 8 weeks ends. This will as you say lead to even more blaming of people for not being "in control". This is why I think it's a very bad idea indeed.
 

Pipp

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I couldn't agree more ... I doubt that many of the GP's prescribing this will have the first clue about what to advise when starting and especially for maintenance after the 8 weeks ends. This will as you say lead to even more blaming of people for not being "in control". This is why I think it's a very bad idea indeed.
I would be much more supportive of it if instead of a quick consultation, where neither HCP or patient has understanding of the issues, both would get themselves fully informed, and apply knowledge to the individuals' unique circumstances. Some obese newly diagnosed T2 or pre-diabetes, may find getting quick results with weight loss gives them the start they need. In recent TV programmes featuring very low calorie diets, the impression given was that a quick 8 weeks of food replacement products, and a lowering of HbA1c to what is regarded as pre-diabetes levels and the job is complete. That is dangerous mis-information. I don't want to see the baby thrown out with the bathwater, because, as I mentioned already, in the right circumstances very low calorie diets have value. It is not a cure all that is being touted.

What I believe would be a better solution would be to have HCPs properly educated about all alternative methods of control. That would include LCHF, IF, keto, etc, so that the knowledge can be shared with T2 and pre-diabetic patients, allowing them to make informed choices. (Incidentally, I wonder how many GPs or people with T2 are aware that they can have DCUK Low Carb Programme on presciption?) What I fear we will get with current proposals is that people will be bullied into meal replacement VLCDs, regardless of whether that is a suitable choice for them. The shame will be heaped on those who cannot tolerate them.Those that do succeed, will be given the false hope that they have no more to do, or be advised the usual low fat carb at every meal that the HCPs can't see beyond, and the whole exercise will have been in vain, and demoralising for the poor gullible patient as they regain lost weight and see increasing blood glucose all over again.
 
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bulkbiker

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Those that do succeed, will be given the false hope that they have no more to do, or be advised the usual low fat carb at every meal that the HCPs can't see beyond, and the whole exercise will have been in vain,
That I believe (as do many others on twitter it seems) is the key problem.. do ND for 8 weeks then go back to Eatwell and you'll be royally screwed..
Agreed 100% with all you have said here. I really do wonder who the training will be given to and if the GP's get it will they just pass responsibility on to the Diabetes Nurses who won't have had the training so get everything second hand...
I fear its a disaster in the making especially for the poor souls who get abandoned if it doesn't "work" for them.
 

Diawara

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that only works if you actually were overeating before.
i agree i was over eating .... good home cooked food and too many carby snacks ,sweets cakes biscuits etc. etc as well ..but wake up call re. diagnosed type 2...changed my life.. the eight week diet thing put me towards eating properly how my body needs it
only after ditching the carbs did i started thinking clearer and take control of things.......a good kick start to the rest of your life......
 

Guzzler

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The 800 cpd diet excludes a growing group of people for whom weight loss to the extent needed by those who have a BMI >30 is innapropriate esp those of Asian/Far Asian descent.
Much is said on the subject of losing excess weight, not so much is said on maintaining weight but nowt is said about the problem of maintaining or gaining weight.
As Dr. Malhotra infers in the video upthread no one size fits all and while I applaud the NHS for this new approach (which now gives patients two options, the traditional pathway of drugs or the weight loss pathway (although GPs are now said to have been given the go ahead to prescribe the URL for this website it would be interesting to see what the provider numbers are)) I cannot but think that there is absolutely nothing new in this approach. Yes, Prof. Taylor has been instrumental in his research as to how the mechanism works and in developing the scan that can actually allow the progress to be mapped but ND still imo is based on CICO/2nd law of thermodynamics. One could argue if it works then don't knock it but for many it cannot work and for some it might prove a fruitless task.

Edited to add.

I do apologise but I overlooked bariatric surgery as an option but again this is not appropriate for some people.
 
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Oldvatr

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The 800 cpd diet excludes a growing group of people for whom weight loss to the extent needed by those who have a BMI >30 is innapropriate esp those of Asian/Far Asian descent.
Much is said on the subject of losing excess weight, not so much is said on maintaining weight but nowt is said about the problem of maintaining or gaining weight.
As Dr. Malhotra infers in the video upthread no one size fits all and while I applaud the NHS for this new approach (which now gives patients two options, the traditional pathway of drugs or the weight loss pathway (although GPs are now said to have been given the go ahead to prescribe the URL for this website it would be interesting to see what the provider numbers are)) I cannot but think that there is absolutely nothing new in this approach. Yes, Prof. Taylor has been instrumental in his research as to how the mechanism works and in developing the scan that can actually allow the progress to be mapped but ND still imo is based on CICO/2nd law of thermodynamics. One could argue if it works then don't knock it but for many it cannot work and for some it might prove a fruitless task.
The trials did show that only around 50% of patients actually had success on this diet so it comes with no guarantees. It is hoped that the follow on study (DIRECT) will help to identify why, and to fine tune things so a better success rate can be squeezed out of the protocol. The NHS effort is another trial, so it is not yet set in concrete, and not yet a turnkey solution,
 

Guzzler

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The trials did show that only around 50% of patients actually had success on this diet so it comes with no guarantees. It is hoped that the follow on study (DIRECT) will help to identify why, and to fine tune things so a better success rate can be squeezed out of the protocol. The NHS effort is another trial, so it is not yet set in concrete, and not yet a turnkey solution,

The trials are at least a step in the right direction but my points stand i.e 800 cpd is not the breakthrough it was hailed to be and is inappropriate in some cases. The real breakthrough imo would be in finding preventative measures centering on tests to guage risk before any symptoms indicate a problem.
 

Resurgam

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I did storage testing on the Cambridge diet products in the late 70s, when working for Allied Lyons in Market Harborough - after a day tasting high carb foods I would often not want to eat, but I used the Cambridge diet samples as I knew that they had vitamins and minerals in them without a lot of starches and sugars.
As far as I can remember all the ones which were set with gelatin dessert types were nice, and there was - I think - mushroom soup which was rather good.
 

Oldvatr

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I did storage testing on the Cambridge diet products in the late 70s, when working for Allied Lyons in Market Harborough - after a day tasting high carb foods I would often not want to eat, but I used the Cambridge diet samples as I knew that they had vitamins and minerals in them without a lot of starches and sugars.
As far as I can remember all the ones which were set with gelatin dessert types were nice, and there was - I think - mushroom soup which was rather good.
Contains gelatin, so not suitable for vegans then.
 

Fleegle

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According to a mild twitter spat with Partha Kar yesterday that's not true! Although he didn't come up with any evidence and I have struggled to find any concrete data.
My own views on ND are fairly well known but if anything can be considered a "fad diet" then surely replacing food with artificially concocted shakes must be a prime contender. Yes the results have been promising but I still haven't seen any 5 year follow up data even though the initial trials started in 2011? It does make me wonder why?

Yes @bulkbiker your view on ND are well and truly well known. In 4 years I will be able to let you know how it is going. So far so good.
 

DCUKMod

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The trials are at least a step in the right direction but my points stand i.e 800 cpd is not the breakthrough it was hailed to be and is inappropriate in some cases. The real breakthrough imo would be in finding preventative measures centering on tests to guage risk before any symptoms indicate a problem.

Guzzler, I'm not a massive fan of the ND, but I can't let the assertion that it wasn't an important breakthrough stand without comment. I think one of the greatest impacts of the ND was it's challenge to the belief that T2 diabetes was chronic, progressive, irreversible and all that jazz.

When it became clear that the process of "reversing" (and let's not get into a squabble about what reversal/remission is, please) was repeatable in a material number of candidates, it began to help prize some very closed minds towards opening.

That for me is a fundamental breakthrough.