Why won't the NHS tell you the secret to treating diabetes?

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Tannith

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@Tannith Here is a study you may find interesting.
Previous T2's who achieved full remission through weight loss were followed up for 2 years.
https://diabetes.diabetesjournals.org/content/68/Supplement_1/66-OR

They recovered over 90% of their Beta Cell function in comparison to a non-diabetic control group.
0.94 nmol/min/m2 at 24 months vs 1.02 nmol/min/m2.
The current thinking is that Beta Cells are not permentantly destroyed at least in the aerly stages of T2.
They've either become exhausted, dormant or impaired.
The removal of the excess glucotoxity returns normal function within 12 months.

Unless of course the route to T2 is through another pathway which such as genetic factors.
"The current thinking is that Beta Cells are not permentantly destroyed at least in the aerly stages of T2.
They've either become exhausted, dormant or impaired.
The removal of the excess glucotoxity returns normal function within 12 months."
What they actually do, according to Prof Taylor, is differentiate. That is they change from beta cells which can produce insulin to normal alpha pancreatic cells which can't produce insulin, but are still alive. Originally it had been thought that they died. It is the removal of lipotoxicity (damage by fat) that specifically restores normal function. People do that by losing weight, as T2s, because of their particular genetics, store excessive amounts of their fat stores on the visceral organs, in particular the pancreas but also the liver, rather than under their skin which is where normoglycaemics store it.
 

Tannith

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His findings are only one study? Would need to be replicated in many additional studies under different researchers to be considered dogma. But I agree the idea that significant Beta cell destruction due to insulin resistance and subsequent cell exhaustion can happen before overt BG symptoms sounds sadly too plausible. What is much more interesting are possible mechanisms to reverse such destruction before it becomes irreversible as mentioned above by @Ronancastled. Certainly when I was first diagnosed, my endocrinologist wanted me on injected insulin for 3 months before assessing me for c-peptide (the standard insulin level proxy test), in the hope my beta cells recovered from fatigue - unfortunately I'm T1 so they did not.
]His findings are only one study?
"At least 2 studies I think. One by him, one by another researcher whom he names in the article. One found the 80% and the other the 50% as I recall.
 

lucylocket61

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"The current thinking is that Beta Cells are not permentantly destroyed at least in the aerly stages of T2.
They've either become exhausted, dormant or impaired.
The removal of the excess glucotoxity returns normal function within 12 months."
What they actually do, according to Prof Taylor, is differentiate. That is they change from beta cells which can produce insulin to normal alpha pancreatic cells which can't produce insulin, but are still alive. Originally it had been thought that they died. It is the removal of lipotoxicity (damage by fat) that specifically restores normal function. People do that by losing weight, as T2s, because of their particular genetics, store excessive amounts of their fat stores on the visceral organs, in particular the pancreas but also the liver, rather than under their skin which is where normoglycaemics store it.
How do you explain those of us on here who are obese, sometimes severely so, have Not lost weight, and remain the weight we had when diagnosed, but maintain, year after year, normal blood glucose levels due to low carbing only?
 

Ronancastled

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"December 2020 Passed a Rapilose 75g OGTT 3.0 @ 2 Hours " Excellent! Well done you!

Thanks. I've still got about 3 stone to loose to achieve a normal BMI.
Once I get there I intend repeating the test to see if my insulin sensitivity has improved further.
 

lucylocket61

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This week's FBG results: Fri 4.8; Sat4.7; Sun 4.6;Mon 4.4; Tue 5.4; Wed 5.4 Thur 4.8. Average 4.87 - a drop on last week albeit a small one. I'm obviously moving in the right direction. Starting back on low cal diet today. I am also pleased that I have only put on half a pound over Christmas. I have a bit further to go yet.

As the figures are dropping by not dieting, how is your dieting helping?
 

kokhongw

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Great article. But as far as I know there is no way ordinary people can do an insulin test at home? So we are still left with the FBG and OGT. I have also looked up the other guy you mention - Dr De Fronzo. Interesting stuff also. I wholeheartedly agree that the NHS does not take prediabetes seriously enough. Or early diabetes either. I stopped the v.l.cal diet I was doing in 2017/18 too early because the NHS told me I was no longer diabetic. I was not only still well into the prediabetic range but also into the fully diabetic range by many scoring systems. That could have cost me not only my health but potentially even my life. I am also shocked to see that, (according to Dr De Fronzo, prediabetics have lost 50% beta cell function and diabetics 80% beta cell function. I had not realised that it was nearly as bad as that. Thank you for your very useful post.

Glad you found it helpful. Cheers.
 

Richard'63

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How do you explain those of us on here who are obese, sometimes severely so, have Not lost weight, and remain the weight we had when diagnosed, but maintain, year after year, normal blood glucose levels due to low carbing only?
Treating the symptoms and not the disease.
 

Tannith

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How do you explain those of us on here who are obese, sometimes severely so, have Not lost weight, and remain the weight we had when diagnosed, but maintain, year after year, normal blood glucose levels due to low carbing only?
I have never disputed that low carb lowers blood sugar. Why wouldn't it? If you eat less sugar(carbs) there will obviously be less in your bloodstream for your meter to measure.
 

bulkbiker

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]His findings are only one study?
"At least 2 studies I think. One by him, one by another researcher whom he names in the article. One found the 80% and the other the 50% as I recall.
It's this study
https://diabetes.diabetesjournals.org/content/52/1/102.short
Based on a total of 91 autopsies because the only way to accurately measure beta cell volume is when the subject is dead.
Average age of obese T2 subjects was about 63.. of the 41 T2 obese subjects 23 had been on either insulin or medication.
Maybe that could explain their beta cell volume reductions. The other problem is we don't really know what the average beta cell volume in living healthy people is because so far as I'm aware we can't measure it until the subject is dead...which causes a slight issue all round.
 
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kokhongw

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How do you explain those of us on here who are obese, sometimes severely so, have Not lost weight, and remain the weight we had when diagnosed, but maintain, year after year, normal blood glucose levels due to low carbing only?

But was there a change in body composition? Although my weight remain fairly constant, there were obvious waist loss... 2 inches...

The obsession with weight loss seems to be another common misdirection. It is fat loss that we are after, and as Dr Roy Taylor's studies indicated, targeted fat loss in the pancreas, so weight loss is just a very blunt measurement...losing lean mass is not a good thing either.
 

lucylocket61

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I have never disputed that low carb lowers blood sugar. Why wouldn't it? If you eat less sugar(carbs) there will obviously be less in your bloodstream for your meter to measure.
So why are you not lowering your carbs instead of, or as well as your calories to reduce your blood sugar levels?
 

Tannith

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As the figures are dropping by not dieting, how is your dieting helping?
The low cal diet is a long term one. In the study quoted by @ Ronancastled it lasted 5 months and in other similar studies a minimum of 3 months. " maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months, 0.94 (0.57 to 1.24) (p=0.017 from baseline) at 12 months, "
This is a diet where you have to patiently wait for results and not expect them the minute you reduce your calories. I would not expect my exhausted beta cells to leap up from their sick beds and immediately start dancing.
 
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lucylocket61

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The low cal diet is a long term one. In the study quoted by @ Ronancastled it lasted 5 months and in other similar studies a minimum of 3 months. " maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months,"
This is a diet where you have to patiently wait for results and not expect them the minute you reduce your calories. I would not expect my exhausted beta cells to leap up from their sick beds and immediately start dancing.
I give up.
 

Tannith

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So why are you not lowering your carbs instead of, or as well as your calories to reduce your blood sugar levels?
For the same reason, I imagine, that YOU are not doing the low cal diet that I chose. We chose different diets. At least as a first choice. That is our privilege. If mine doesn't work because I left it too late as I have now had T2 for 4 years at least, then I should consider the other 2 choices available to me ie metformin or low carb in that order.
 

Andydragon

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For the same reason, I imagine, that YOU are not doing the low cal diet that I chose. We chose different diets. At least as a first choice. That is our privilege. If mine doesn't work because I left it too late as I have now had T2 for 4 years at least, then I should consider the other 2 choices available to me ie metformin or low carb in that order.
I have had type 2 diabetes since 2008 and managed to turn it around with low carb and exercise. Whether lowering calories or carbs had the most impact on weight loss I can’t say but in this year I have moved from 78 to non diabetic hba1c and 1000mg metformin a day (maybe zero in 3 months time) from double that and other drugs and also lost 30kg weight

but I do know that higher carbs causes my bloods to go higher. So I do believe a type 2 diet does need carbs to be considered

I don’t believe there is such a thing as leaving it too late
 
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Oldvatr

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I have had type 2 diabetes since 2008 and managed to turn it around with low carb and exercise. Whether lowering calories or carbs had the most impact on weight loss I can’t say but in this year I have moved from 78 to non diabetic hba1c and 1000mg metformin a day (maybe zero in 3 months time) from double that and other drugs and also lost 30kg weight

but I do know that higher carbs causes my bloods to go higher. So I do believe a type 2 diet does need carbs to be considered

I don’t believe there is such a thing as leaving it too late
Until a year or so ago, the NHS had only one known outcome - premature death from organ failure caused by diabetes, There was only one main treatment offered by the NHS, namely inevitable progression via increasing medication towards insulin dependency. Then the NHS delayed this inevitable outcome by (a) weight loss by limb amputation or (b) weight loss by bariatric surgery.

Then Prof Taylor came online with his study which was to emulate option (b) through severe dietary means. That was the purpose of the ND diet, just a cost-saving exercise. Serendipity occurred, and they found a way to use the diet to control and give Remission from T2D like what they used to offer by surgery. That is what the ND diet achieved, and it is now able to be offered as an NHS approved treatment.

Low carb so far has not had the same recognition by the NHS, hence the question that started this topic in the OP. There are many here using LC diets to gain remission from T2D but the only scientific study to date has been the one run by David Unwin in his Southport surgery. There have been moves to add LC diet to the guidelines by NICE, and in the USA the ADA and AHA have both adopted LC. But here in the UK, neither of the formal bodies have accepted it, mainly because the BDA and nutritionists will not accept it as a valid diet.
 

oldgreymare

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The low cal diet is a long term one. In the study quoted by @ Ronancastled it lasted 5 months and in other similar studies a minimum of 3 months. " maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months,"
This is a diet where you have to patiently wait for results and not expect them the minute you reduce your calories. I would not expect my exhausted beta cells to leap up from their sick beds and immediately start dancing.

Hi @Tannith , a few points -
I Googled the nutritional breakdown of the typical Newcastle diet plan and believe the first three months protocol of 800 cal (500-600 from liquid shakes and 200 from greens) should be approximately 50% carbs, but at this level of food intake the absolute amount of carbs pretty much falls into low carb territory anyway. Then next two transitional months gradually adding back more calories/different foods until you find your personal "sweet" (pun intended) spot of cal/carb tolerance that will keep both weight and BG levels stable. Is this what you are planning?

But from what I understand of Prof Taylor's results even after 5 months this only normalises BG levels for the future PROVIDED THAT your post "formal diet" eating habits are modified to prevent ANY regain of weight and even then will not necessarily 100% guarantee no increase in insulin resistance and possible T2 in any given individual's future. If it works for you, brilliant!

But do you have a plan B? You have done enough research to see what might be the timeline to potentially maximise your beta cell recovery, but what do you plan to do to ensure they do not immediately start to degrade from your diet changes in the future, post next Newcastle round? Pragmatically this dilemma is the source of health and soul destroying yoyo dieting for almost everyone.

Also, who diagnosed your beta cells as "exhausted" (apologies if this was in a much earlier post)? For me this was a diabetic endocrinologist specialist after reviewing a clinically administered OGTT on diagnosis, followed by 3 months of exogenous insulin reducing my AcHb1 to semi respectable levels - sadly his hope was wrong - my C-peptide (very accurate marker for our own pancreatic insulin production) was too low, but antibodies too high - my pancreas wasn't suffering burnout - it was under autoimmune attack. Hopefully you never need to deal with this. But C-peptide is a critical test for T2 as well, as it is the main clinical test for endogenous insulin levels and very helpful to identify insulin resistance. Try to get this test if you haven't already had it. Direct insulin levels are almost never measured outside of formal clinical research trials (maybe sign up to one if you can?).

You are spot on in identifying that it is visceral fat (especially pancreatic fat and liver fat) that are most dangerous and very much more so than subcutaneous fat. I have plenty of the latter that I hate! But also sadly some of the former - fatty liver diagnosed through ultrasound. You seem to be very focused on measurements - have you been able to access any visceral fat assessments? There are no good home users proxies, but could be highly motivational if you can afford abdominal ultrasounds and body fat Dexascans.

You appear to put a lot of energy into managing your health. But in your research efforts for what to do next please be very careful about 'confirmation bias' = only focusing on data that supports your current opinion - this is really hard for anyone to neutralise!!! Also 'false precision' - biological science is horribly complex and horrendously messy to measure - applied (clinical) science is even worse - results may be okay at estimating likely effects in a population of a million, there are zero hard and fast rules at the individual level.

Finally, perhaps consider starting a new thread under the Low Calorie Forum to share how you get on with your second attempt using the Newcastle Diet - I suspect this could have an appreciative audience on how this diet works in practice.

Good luck and best wishes.
 
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oldgreymare

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Until a year or so ago, the NHS had only one known outcome - premature death from organ failure caused by diabetes, There was only one main treatment offered by the NHS, namely inevitable progression via increasing medication towards insulin dependency. Then the NHS delayed this inevitable outcome by (a) weight loss by limb amputation or (b) weight loss by bariatric surgery.

Then Prof Taylor came online with his study which was to emulate option (b) through severe dietary means. That was the purpose of the ND diet, just a cost-saving exercise. Serendipity occurred, and they found a way to use the diet to control and give Remission from T2D like what they used to offer by surgery. That is what the ND diet achieved, and it is now able to be offered as an NHS approved treatment.

Low carb so far has not had the same recognition by the NHS, hence the question that started this topic in the OP. There are many here using LC diets to gain remission from T2D but the only scientific study to date has been the one run by David Unwin in his Southport surgery. There have been moves to add LC diet to the guidelines by NICE, and in the USA the ADA and AHA have both adopted LC. But here in the UK, neither of the formal bodies have accepted it, mainly because the BDA and nutritionists will not accept it as a valid diet.
Pragmatically the NHS was set up to deal with acute infectious diseases in the mid 20th century and it has had a great track record on this. But tragically it has never evolved to deal with preventive medicine (and dentistry) which is why so many opportunities re diabetes and so other conditions are only managed reactively on symptoms. :(
 
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