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VLCD - Liquid vs Solid

Discussion in 'Diabetes Research' started by AdamJames, Dec 28, 2017.

  1. AdamJames

    AdamJames Type 2 · Well-Known Member

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    I've always thought it was a "curious coincidence" that the first Newcastle experiment in 2011 used largely liquid foods.

    I gather the "liquid" aspect wasn't deemed important at the time - it was just a controlled way of ensuring people had a known calorie intake. Optifast meal replacement was offered for free, and Optifast happens to
    be liquid, and the Optifast website even suggests making the extra vegetables into soup as an option.

    People seem to think that the energy restriction is the all-important aspect, and whether the food is solid or liquid is irrelevant. It seems reasonable.

    But since the diet had remarkable success, and was remarkably similar to the diet which bariatric surgery patients are forced to consume for weeks (low calorie and liquid), I've always thought "we don't know what we don't know - just because we can't think of a reason why liquids may be better, doesn't mean they aren't".

    And if we are going to try to copy the experiment for ourselves, we might as well do things exactly as they were done, regardless of the theory.

    I can't find many articles online which try to tackle the question of liquid-vs-solid. There are a few, often not related to diabetes, and the results seem mixed.

    I did find one interesting study here:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511220/

    ...where two calorie-restricted diets were used, one liquid the other solid. The liquid one was used with a view to helping people with portion control. However, one interesting thing noticed was that it was only in the group on the liquid diet that fasting blood glucose and insulin levels both dropped.

    I suppose it's pretty meaningless unless you know the overall nutritional content of both diets.

    But in the interest of good science, I'm going to clutch at it as an example of something or other which I haven't properly thought through yet, and ignore any other findings which go against it :)
     
  2. bulkbiker

    bulkbiker Type 2 · Oracle

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    Questionable statement.
    There are fewer than 200 people who have completed the study under Prof Taylor and even with cherry picked participants he has achieved somewhere between 40 and 46% success rate in the three iterations of his experiment.
    His criteria for success being lowering HbA1c to sub 48 mmol/mol.
    Not great really and certainly less than remarkable if judged by the standards of low carb eating?
     
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  3. AdamJames

    AdamJames Type 2 · Well-Known Member

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    Well of course, any use of the word 'remarkable' is open to question!

    I find the results remarkable. I mean, wind back the clock ten years, and ask yourself: would you *expect* the results found in the first experiment, for example? I'm pretty sure most people found it remarkable, because most people who were made aware of it remarked on it!

    Re cherry picking: fair comment and the criteria was made clear by the experimenters, but unfortunately not always by the press!

    And the cherry picking from one experiment to the next was done quite wisely, I think:

    * First time, pick people who haven't been diagnosed for many years, to see if the idea yields results worth pursuing and get a feel for what is going on.
    * Second time, pick two groups: people who haven't been diagnosed for long, and those who have, to see what difference that makes.
    * Third time, less focus on whether the process works, and more on whether it works in a practical setting, i.e. partly ask: will people stick to the process?

    Seems like good science to me, though of course any experiment is going to have critics - anything can always be done better.

    Re the success rate you quote - are *you* cherry picking there, i.e. picking the trial with the least success, and even then only a sub-group of that trial? Because a more accurate representation of the stats I think would be to say that the idea that weight loss is linked to remission still has a very good stat - much better than the 40-46% you quote. As I say, the third experiment was partly asking: how many people will stick to it.

    Re the criteria for remission (again, to be specific, in the third trial - you don't mention what you feel about the first experiment for example, I'm not sure whether you find any positives there), I share your disappointed in that - I don't think that says much about whether people's metabolism has improved, or whether they are eating to work around a poor metabolism.

    So yes there's plenty to criticise, but really, to react to the Newcastle / Glasgow experiments without mentioning a single positive thing is just a little bit skew and suggests an agenda, albeit I suspect a very well-intentioned one.

    I'm guessing since you mention LCHF that that is the agenda - you feel sure that would have even better results and should be getting explored and publicised at least as much as this Newcastle stuff.

    I'm inclined to agree, and I wouldn't be at all surprised if the results were even better. If and when that takes the scientific and medical world by storm as the new best way to deal with diabetes, I'll look at that with the same open eyes as, for just one example, the Newcastle stuff.
     
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  4. DCUKMod

    DCUKMod I reversed my Type 2 · Master
    Staff Member Administrator

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    Personally, I see the ND approach as a decent option for a good old kick-start-for-change, forr those who may be particularly impatient, as an alternative to immediate reduced carbing.

    At the point I appear to have effectively reversed (or whatever you want to call it) my own T2, I corresponded with Professor Taylor about my approach (reduced carb), results and looking to the future, and he was incredibly relaxed about the how to of the whole thing.

    Since then (early/mid 2014) we know so much more about T2 and other ways to skin this particular metaphoric cat have come forward (such as LC, IF) with greater success, so it is much easier to be critical. Back in the day 2013/4, there appeared far fewer options to achieve these staggering outcomes. I use staggering to describe the outcomes in context of the times, as they were.
     
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  5. AdamJames

    AdamJames Type 2 · Well-Known Member

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    Just another thought on the 'LCHF' vs 'Newcastle / weight loss' debate (if that's what you are getting at, I may have misinterpreted!)

    They aren't necessarily 'competing' ideas. They are possibly two very different tools, and may work very well in combination for some people.

    Based on my own weight loss campaign and various experiments I've been doing in the recent months, I'm finding that, as an obese (now 'just' overweight after some considerable loss!) Type 2, I don't seem to be able to 'maintain weight' regardless of whether I eat 40g of carbs or 300g carbs a day. Either way, I get high fasting readings, and funnily enough, the *same* high fasting readings.

    However it seems that after losing a fair bit of weight, those fasting readings, while still too high, have come down. Again, it doesn't seem to matter too much how I pack myself full of maintenance calories, in terms of carb levels.

    So right now, it seems that weight loss is a very good idea for me. Heck it's a good idea even if you remove diabetes from the equation.

    I suspect that for a lot of overweight people with Type 2, it's worth trying the fairly rapid weight loss idea (either ND style or LCHF style), and THEN seeing how they get on with a LCHF approach to eating for the rest of their life.
     
  6. AdamJames

    AdamJames Type 2 · Well-Known Member

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    Thanks for that. I was typing something very much along those lines when you posted! I definitely think that the two approaches are different tools / ways of skinning the cat. Or perhaps one is for skinning the cat, and the other is for stuffing it and preserving it for life :)
     
  7. bulkbiker

    bulkbiker Type 2 · Oracle

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    That's where we agree completely.. I just found that by doing a very LCHF diet I lost a lot of weight (8 stones so far) fairly quickly and far more importantly in a sustainable way whilst bringing my blood sugars down quite dramatically. This way of eating, which I shall indeed try to continue for the rest of my days, leaves me feeling full on one or two meals a day with no hunger pangs. So I eat real food, not chemical shakes, don't get hunger and can have eggs and bacon whenever I feel the need. This is why I don't quite understand why the ND (just another restricted calorie diet) has so many fans. We have almost all tried it at some time and for most (all?) it has failed miserably in the longer term.
     
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  8. AdamJames

    AdamJames Type 2 · Well-Known Member

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    Again, LCHF and the ND are probably best viewed as different things for different purposes. I've never been aware of anyone reporting that they intend to adopt the ND as a way of life. It's a way of losing weight quickly, and I imagine a lot of the appeal is psychological: people doing it can feel that they are following a process which seemed to get great results particularly in the first experiment. The longer-term, i.e. ongoing effect, is still unknown, and will never be known until people in the studies develop/don't develop complications and/or die, then we can get some retrospective data.

    I question whether we have almost all tried it at some point. I haven't yet. I've lost over 3 stone via various means. Nothing amazing has happened to my carb tolerance in that time. I may still try it. I'm not a fan, I just look at what has worked for people and that informs me of things to try. LCHF is also very much at the top of the list. I don't understand why *any* diet has fans in the sense people try to push them. It's best just to report on what's worked in a scientific setting, what has worked for us personally, and that's information for other people to try.
     
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  9. bulkbiker

    bulkbiker Type 2 · Oracle

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    You've never tried a low calorie diet?
     
  10. AdamJames

    AdamJames Type 2 · Well-Known Member

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    It depends on how low you mean. If we are talking circa 800 calories, then only for about week. I prefer more calories and more exercise in general.
     
  11. AdamJames

    AdamJames Type 2 · Well-Known Member

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    There could be a mis-communication here.

    You wrote that we've almost all tried the ND diet. My impression is that not a great many people have - generally if someone starts a thread on it here, they get a lot of support for a process that is recognised to be challenging and not a lot of people have done.

    If you just meant a low calorie diet, then that's clearly different and much more common. The ND is regarded as both VLCD and strict.
     
  12. Mbaker

    Mbaker Type 2 (in remission!) · Well-Known Member

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    Professor Taylor makes it very clear that the ND is low calorie and that the criticisms that that don't work are confounded with the guidance during the re-introduction to food phase, so @bulkbiker is right in his classification, as this is verbalised by Professor Taylor directly.

    A while back I said in another thread that I would have performed the ND first followed by LCHF. I use my reservation to change my mind now I have more detail. If I were to go down the low calorie root it would be with real LCHF food from the start, a customised version of the blood sugar diet.

    I now would not follow the ND protocol unless I was devoid of the knowledge I now have, as I have recently seen the data that showed that the latest version of 830 calories used 61% carbs. For me this is counter intuitive and if anything in my opinion hobbles and reduces the potential of the trial - imagine the results on say 20% carbs or 10%, especially the insulin curve. Whilst it could be argued that the small intake of food made the 61% carbs relatively smaller than "normal", as a carb intolerant Type 2 why give me more?

    http://directclinicaltrial.org.uk/Documents/AAA FINAL DiRECT 12m results for IDF 2017.pdf

    I respect Professor Taylor, but it saddens me that he sticks to the low calorie methodology, when he would have been aware of say what Akins has achieved and that his subjects are carb challenged to start with. I suspect Professor Taylor is sold on the status quo legacy arguments about saturated fat, which he would be entitled to do. A lot of money has been spent when frankly this could have serviced a real food trial. Maybe it was the politics that a funded trial had to follow the current eating guidelines but just cut down. A LCHF trial could look something like this perhaps:

    3 months clinical and or out patient versions:
    • General one size fits all LCHF - which is then tailored to the individual (based on taste, insulin resistance, etc)
    • Variations of the drinks and meal plan delivered in a clinical setting by experts on either 3 or 2 meals a day protocol
    • A focus on gut bacteria, anti-inflammatory foods
    • Food procurement and education (carbs, protein, fats). Practical teaching of how to self prepare the meals
    • Psychology of understanding the lifestyle changes and resolving conflicts for example regarding bread, potatoes etc
    • Exercise and meditation and sleep plans that are sustainable and individualised
    • Notes / videos for both participants and family members which are easy to consume, for during and after
    • Regular meetings to tease out issues and improve the protocol - listen to the participants and make changes
    • All of the above and more geared towards leaving the subjects with all of the tools required to confidently understand the technical aspects of the different types of diabetes particularly their own, and how to practically from start to finish manage all aspects of food purchase, cooking, social eating, parties etc.
    • Follow up services to learn lessons
    • Rollout plan
    I believe that Eric Wiseman, Jason Fung, Sarah Halberg, David Unwin, The Diet Doctor and this site can produce stats on clients / patients on LCHF and IF which are superior than the ND (i.e. with remission levels below the non-diabetic range) and with larger numbers and significantly less clinical controls .

    Don't get me wrong the ND is a viable option for some, especially if you can't get your head around full fat, but we are at the critique stage, so questions will be raised. I for one would like to know, why he did not use real food in this latest trial, surely in a clinical setting it would have been possible to (why line the pockets of sachet producers for when this rolls out). And being able to show a plate of attractive food to potential candidates has to be improved marketing). Again why low calorie (my view Eatwell guide light). What is the food in the maintenance phase, I have not seen anything yet, but could guess, and what are the blood panel results especially fasting insulin. What was the remission rate in the UK and ADA non-diabetic ranges.

    At least remission is talked about seriously with a protocol which the "establishment" can accept and is a closer cousin to LCHF than drugs.
     
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  13. AdamJames

    AdamJames Type 2 · Well-Known Member

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    All sources I've just looked at from a quick Google say that VLCD = circa 800 calories. Some even say less than 1000 calories is VLCD. Anyway the important distinction, which I was trying to make sure I'd understood properly from what bulkbiker wrote, is whether he meant approx 800 calories, ND style, or any old calorie restriction which could for example be over twice that or more!

    He'd asked me a question about whether I'd tried a calorie restricted diet, referring to ND in the same sentence, and to answer accurately I needed to know what he meant.

    I share your interest and wish that a DiRECT-style trial would involve real food and LCHF.

    I'm particularly interested in this. What would you expect the results to be, and are there any trials which give some insight into what one might expect?
     
  14. Mbaker

    Mbaker Type 2 (in remission!) · Well-Known Member

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    I would expect that if the carbs were dropped from 60% to 20% of the energy intake and for healthy fat to make up the difference, for blood sugars to be normalised quicker, for triglycerides to be reduced quicker, for faster potential weight loss, due to insulin being required less.

    I still credit Professor Taylor as he is on the right side of the fence, has received alot of stick from the establishment, given a credible explanation for how Type 2 can be reversed, provided for me the perfect "personal fat threshold" theory. I just wish he would have given a nod to low carb as well, like Micheal Mosley has who has many times lamblasted low calorie / low fat.
     
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  15. bulkbiker

    bulkbiker Type 2 · Oracle

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    What I meant was we have all (mostly there will be exceptions) tried a calorie restricted diet at some time and most of us have failed miserably at it. Yes I confess I did Herbalife when I was much younger and yes put it all back on again once I stopped the hideous tasting shakes.
    The ND is another calorie restricted diet at heart with all the attendant problems of calorie restriction.. i.e. slowing of metabolic rate leading to weight regain (sometimes even more than was lost) etc etc etc..
    There is nothing magic about Optifast shakes or Prof Taylor..when I see his results after 5 years and they show proper remission not just down to pre diabetes levels like the DiRECT study then I'll be convinced he has found something new.
    There never seems to have been any follow up done on the people who were the in the first 2 trials (or at least I haven't seen anything published) to see how they are after a more extended period of time.. I get the feeling that their early successes are not sustained otherwise I hope we would be hearing it shouted from the rooftops so I am afraid that I remain very much a Taylor/ND sceptic.
     
  16. bulkbiker

    bulkbiker Type 2 · Oracle

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    I hasten to add I am full of admiration for people who try it.
    I just don't expect it will work long term.
     
  17. AdamJames

    AdamJames Type 2 · Well-Known Member

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    I also have a big question mark over the long-term results, simply because they don't exist yet. I also think it's a **** shame that the 11 people in the original trial haven't been followed since. I think it was just a 3-month followup and by that time already 4 were "on their way back to diabetes" or somesuch, I can't find the reference now.

    Your concerns are clearly shared by the people at Newcastle/Glasgow. On the site it states of the first experiment "This caused international interest, but the study was very short as it was only eight weeks and the question remained whether the diabetes would stay away."

    The DiRECT study aimed to tackle that, and for all its failings (particularly I feel the definition of remission), at least it is getting that part right, and so far the check-a-year-later bit has got some positive results.

    They seem to have additional concerns over the ones you've stated, such as the very sensible one of "Okay they are now getting much better HbA1Cs, but is that actually going to reduce complications in future?". Those findings will be interesting and it's a pity we have to wait a very long time to see any patterns. It's a great question though, and in some way side-steps the problem of the definition of remission: After all, what really matters? If people can greatly reduce the chances of complications by taking certain actions, who cares what the definition of remission is?

    I suspect whether any approach works long-term will all boil down to the same thing for any individual: genetics, luck and, importantly, self-discipline with food - which is the same whether you are doing life-long LCHF, or if you are lucky enough to manage to restore your metabolism with weight loss then try to ensure you never re-gain weight.

    The thing that I find genuinely exciting about the first Newcastle experiment is how clearly it showed the restoration of metabolic function, and how it provided a new and simple way of defining Type 2 diabetes (fat in beta cells, in particular). I strongly suspect it's overly-simplistic - all scientific understanding is looked back on as being overly-simplistic once enough time has passed. But if that line of enquiry isn't worth pursuing, I don't know what is. And if LCHF eating isn't worth similar efforts to study, I don't know what is. It's all knowledge that helps us build a picture.
     
  18. bulkbiker

    bulkbiker Type 2 · Oracle

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    Sounds like we are agreeing again.

    The problem I have is that there are some people on the forum who have invested a whole load of time and energy into trying the ND. Some have made claims that even Roy Taylor doesn't make to imply that it is a "cure". This I think may lead to great expectations for the ND which will not be borne out after the 8 weeks. The reporting of it in the press also usually leaves a whole lot to be desired too. This all tends to generate a hysteria about the effectiveness of what is at its heart simply a very low calorie diet. But as I said before that's my view and until we see some long term follow up I'll just keep calm and keto on.
     
  19. AdamJames

    AdamJames Type 2 · Well-Known Member

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    That shouldn't be a surprise should it? We are both intelligent people who can read and interpret data! :)

    I have a problem whenever data is not represented properly, or when people give in to confirmation-bias and decide to 'take sides' rather than just absorb all data as an ongoing way to build a picture.

    I totally agree with your frustration about how the ND is presented in the press and this perception some people have that it's a cure-all.

    I also find some of your posts which entirely highlight negatives about this particular study equally frustrating. I suspect you do this as a reaction to the above, which is understandable.

    And at least you say you'll wait for the long term results, so I'll let you off :)
     
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  20. ringi

    ringi Type 2 · Well-Known Member

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    The BG results from people doing ND on this site, makes me think the benfit of lower carb when on VLCD would only be in the first few weeks (maybe even only the first 2 or 3 weeks). As after that BG drops back to normal levels quickly with the high carb shakes. (The shakes do not have that high combined carb and protain contant as they do not have much of anything.)

    There is a Garman liver doctor who produces very low carb shakes for vlcd, but they are not on sale othern then to the Garman health care system - real shame. He cares that low carb VLCD removes the fat from the liver quicker, and his clients have a LOT of liver fat to remove. (He has not been funded to do research with Type2.)

    I however question if as well as removing fat from the bate cells, if they need to be exposed to short and high BG peaks to wake them up. This will remain a open questions until people doing very low carb have access to testing for “first insulin response”. (Without Type2 there is a very fast increase in insulin within 10 minutes of IV glucose, the insulin level then drops down again. With Type2 it takes a lot longer for the insulin level to increase, but it remains high for much longer.)
     
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