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

Tannith said:

You can get a glucose tolerance test at the GP I believe. That should tell you how heathy or otherwise your beta cells are. There is plenty of anecdotal evidence on here eg the thread below and others. People doing low carb reporting eating this or that and finding their post prandial bg shoot up. An easier though less precise way of doing it would be just to eat a normal meal of say boiled potatoes peas and meat followed by rice pudding with a dollop of jam, and then test afterwards then at half hour intervals for a couple of hours. Then at 2 hours post prandial. People on here often report that they have had high bg spikes after high carb foods. That would be unlikely to happen if their beta cells were healed.
Which surprising foods spike your bg?

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GP's do not normally carry out Oral Glucose Tolerance Tests for Type 2 (particularly at the moment) as to do it properly involves sitting in the waiting room for 2 hours. Even if they did it is very difficult to know if the rise in blood glucose is due to poor insulin production or insulin resistance. If anyone has been on a low carb diet they are supposed to eat carbs for a few days before the test to re-accustom their pancreas to producing sufficient insulin. The same would apply to your boiled potatoes and rice pudding test. The Magnetic Resonance Imaging that Prof Taylor uses will show a picture of the fat accumulated in the pancreas but it does not show if the beta cells are working at their full capacity. With those diagnosed in later years, 68 in my case, it may be that the pancreas is just not working as well as it used to, after all eyesight deteriorates, muscles and joints are not what they were. Losing weight, by whatever means, probably helps by lessening the resistance to whatever insulin is being produced particularly if the loss is from fat in the liver or pancreas but you can't conclude that the beta cells are back to normal.

bulkbiker said:

Have you tried this and what were your results like?

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Not exactly that but I had an oral glucose test at the surgery once when they were doing a survey of some sort , and they just told me I was not diabetic.

Tannith said:

Not exactly that but I had an oral glucose test at the surgery once when they were doing a survey of some sort , and they just told me I was not diabetic.

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So what was your last HbA1c?

bulkbiker said:

So what was your last HbA1c?

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39

Tannith said:

39

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How high was your Hba1c when you were first diagnosed as diabetic or pre diabetic, and when was that?

Tannith said:

You can get a glucose tolerance test at the GP I believe. That should tell you how heathy or otherwise your beta cells are. There is plenty of anecdotal evidence on here eg the thread below and others. People doing low carb reporting eating this or that and finding their post prandial bg shoot up. An easier though less precise way of doing it would be just to eat a normal meal of say boiled potatoes peas and meat followed by rice pudding with a dollop of jam, and then test afterwards then at half hour intervals for a couple of hours. Then at 2 hours post prandial. People on here often report that they have had high bg spikes after high carb foods. That would be unlikely to happen if their beta cells were healed.
Which surprising foods spike your bg?

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No it doesn’t. It tells you how efficient your level of insulin is working. A poor response could be due to insulin resistance, low insulin, or if you have been low carb and not carbed up prior, it could simply be adaptive insulin resistance not pathological.
Did you have the link that defines type 2 duration or clarifies if it it the cellular fat loss or the specific diet that achieves the goal?

Tannith said:

" In fact one in 10 people have a ‘normal’ BMI at the time of diagnosis and in contrast around three quarters of people with BMI over 45 do not have type 2 diabetes.

The truth is that we are all individuals, and simple statistical categorisation by BMI is inappropriate. Those of us with a genetic set to live in a body of BMI 25 may well get type 2 diabetes if their weight rises to 28. And those who have normal metabolism with a BMI of 34 may get the disease if they put on weight to say, a BMI of 37. In other words, we all have a personal fat threshold above which mischief will start happening. This has been rather obscured by the present popularity of population level information to drive beliefs about what is relevant for individuals. But there is a clear bottom line: if a person has true type 2 diabetes, then they have become too heavy for their body."
Prof Taylor
https://inews.co.uk/opinion/type-2-diabetes-reversing-remission-diet-396640
TOFIs, as they have been dubbed, ie thin or normal BMI diabetics can lose weight to lose pancreatic fat in exactly the same way as overweight or obese subjects. Proportionately they have stored too much ectopic fat on their pancreas and that has clogged the beta cells, damaging them and causing them to stop producing insulin. Some nationalities in particular (eg south Asians) have a tendency to store fat on their pancreas and liver when they are only BMI 23 or even below. It's about being too fat for your own body's ability to cope with it, not about overall quantity of fat.

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Pragmatically, BMI is an exceptionally crude measure that only works for large populations studies, not individuals - ideally more direct visceral fat measures via Dexa or MRI, or at least waist / hip ratio can help determine an individual's actual risk.

HSSS said:

No it doesn’t. It tells you how efficient your level of insulin is working. A poor response could be due to insulin resistance, low insulin, or if you have been low carb and not carbed up prior, it could simply be adaptive insulin resistance not pathological.
Did you have the link that defines type 2 duration or clarifies if it it the cellular fat loss or the specific diet that achieves the goal?

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I am working on the assumption that a person's level of insulin is normal (without drugs or glucose reducing therapies such as a low carb diet) then their beta cells must be working properly. If you disagree with this then we are starting from different places. I should be interested to know why you believe that a person could have normal insulin if any material proportion of their beta cells were sick enough to make them diabetic. I am not refuting what you say, just asking.

lucylocket61 said:

How high was your Hba1c when you were first diagnosed as diabetic or pre diabetic, and when was that?

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FBG s of 7.2 to 7.5, August 2017

Tannith said:

I am working on the assumption that a person's level of insulin is normal (without drugs or glucose reducing therapies such as a low carb diet) then their beta cells must be working properly. If you disagree with this then we are starting from different places. I should be interested to know why you believe that a person could have normal insulin if any material proportion of their beta cells were sick enough to make them diabetic. I am not refuting what you say, just asking.

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I’m a little confused by this statement. If a person has normal Insulin levels (and one would assume bgl too) then I’d agree their beta cells are probably just fine. But how do you know their insulin is normal? The best the majority of us can do is check bgl. That is not the same thing at all.

Tannith said:

You can only assess their status if you have an ultra sensitive MRI scanner such as the one used by Prof Taylor or other means of testing them eg post mortem staining; or other indicators such as measuring their insulin production. Obviously I don't personally have any of this kit or access to these tests which are only available to world renowned scientific researchers such as Prof Taylor & his team. I just have to read the findings in their reports published in acclaimed scientific journals (such as the Lancet & Diabetologia) & take their word for it.
This evidence is good enough for the world's foremost diabetes experts so it is good enough for me.

"The study found, however, beta cells are not permanently damaged in early T2D and can be rescued by removing the metabolic stress of excess fat within the cells. The findings are the result of the examination of insulin production on a subgroup at baseline (starting weight), immediately after weight loss (five months), and upon follow up of one and two years."

https://www.diabetes.org/newsroom/press-releases/2019/insulin-producing-beta-cells

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Have you read Malcom Kendrick's book 'Doctoring Data'? It's a good read and shows just how much the medical profession follow each other and it's a sin to break ranks. Never just trust anything from any leading medical person or article in a leading journal. There are both real experts and charlatans amongst them. You have to put each thing into context with several experts and try to discern the best way forward.

Tannith said:

I am working on the assumption that a person's level of insulin is normal (without drugs or glucose reducing therapies such as a low carb diet) then their beta cells must be working properly.

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Indeed but you seem to have discounted overproduction of insulin combined with insulin resistance which is what most T2's seem to have.
It's not beta cells not working but working too hard.. the body has simply become "immune" to insulin production therefore it doesn't have the required effect hence blood glucose rises.

Beta cell dysfunction is I believe a symptom of T1 and its similar types LADA MODY etc and not T2.

HSSS said:

No it doesn’t. It tells you how efficient your level of insulin is working. A poor response could be due to insulin resistance, low insulin, or if you have been low carb and not carbed up prior, it could simply be adaptive insulin resistance not pathological.
Did you have the link that defines type 2 duration or clarifies if it it the cellular fat loss or the specific diet that achieves the goal?

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What is carbed up prior and why would someone do it? Also if you have been on a low carb diet and you then return to a normal diet containing about 50% carbs, not for the purposes of a test, but for say a month, what happens to your FBGs and/or postprandial BGs?

bulkbiker said:

Indeed but you seem to have discounted overproduction of insulin combined with insulin resistance which is what most T2's seem to have.
It's not beta cells not working but working too hard.. the body has simply become "immune" to insulin production therefore it doesn't have the required effect hence blood glucose rises.

Beta cell dysfunction is I believe a symptom of T1 and its similar types LADA MODY etc and not T2.

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"Type 2 diabetes is characterised by too much sugar in the blood when the body is unable to produce enough of the hormone, insulin, which should control blood sugar levels, and cells throughout the body stop responding effectively to the insulin they do receive."

https://www.dailymail.co.uk/news/ar...ains-revolutionary-discovery-change-life.html

The article is from Porf. Roy Taylor, it's strikes me as very self promotional. Taking time to reference his book, but also Mosley's book. To be fair, Mosley has played a big role in promoting Pro.Taylor's ideas and work. He also creates a bit of an image that he alone is coming up with ground breaking work and ideas as though he only has the answers. He is a good salesman imo.

Importantly. There is no focus on carb content, which is the hallmark of success like what we've seen with low carb diets including keto or carnivore. If he is going to sell this to the NHS (I believe the NHS has already said yes) as the way to go then he is smart enough to stay away from discussing carbs and focus on what the NHS and so many others blindly believe in which is calorie counting. And this is the big flaw imo.

His diet plan, includes eating stuff like wholegrain bread. Which appears to be a part of returning to normal eating. That will please the NHS and the food industry. Processed junk is clearly part of his diet plan when you see the contents of the commercial shakes and soups.

He also makes this comment , "if you eat too much and exercise too little" when talking about fat accumulation. This strikes me as playing the blame game, not unusual for people who adhere to dietary advice from diabetes specialists etc to keep gaining weight (for obvious reasons - eat your carbs, you need carbs) and then they blame the patient for not losing weight when the person has followed instructions and label them as non compliant.

I do agree with things he has said about fat in the pancreas and liver and too much glucose in the body, but he doesn't mention what causes too much glucose. We know it's the one thing t2's are highly intolerant too. He doesn't discuss how the pancreas and liver become this way. How they become full of fat. He believes T2 is caused by too much fat in the liver and pancreas. That's the cause. End of discussion.

I haven't read a lot of his work. So, I may have some bias there, but from what I've seen I just come to the conclusion he's a salesman with a calorie counting method that works, but the catch is you have to starve people for a long period of time to get the result. It's not hard to understand that if you starve people they will lose weight. I don't think people understand that in doing so they are also losing muscle mass. Not good. However, the implication is you are just losing body fat. Seems like a sales pitch to me.

The success of LC and Keto and various amounts of carbs for low carbing has been incredibly successful. The direct study of Prof.Taylor's isn't even finished yet and it's been lauded as magic. Well, he is promoting it as ground breaking. It just doesn't even come close to the success of carbohydrate restriction or limiting. Yet, somehow, an extreme crash diet takes precedent over LC where no such starvation is required. You can eat healthy (Yet another difference) and not have to endure such a restrictive approach.

I can see why the NHS would love this idea. It enables them to carry on with their calorie counting nonsense and keep pushing the same basic dietary advice. Low fat, eat carbs. Food industry is happy too. And nothing will change, the public will continue to get sicker, but the money will keep rolling in.

The problem is that T2D definition, treatment options and discussion remains largely glucose centric, instead of insulin centric.

Joseph Kraft already pointed out years ago that hyperinsulinemia is likely the driver of T2D. Lifestyle with chronic excessive insulin. As did Gerald Reaven https://pubmed.ncbi.nlm.nih.gov/3056758/ , Barbara Corkey https://pubmed.ncbi.nlm.nih.gov/22187369/ and others in their Banting lectures. Researchers generally know this as per the textbook presentation of the natural history of T2D http://journal.diabetes.org/clinicaldiabetes/V18N22000/pg80.htm , but don't discuss it either.

It is tragic how an obviously simple solution (insulin lite lifestyle) that can help millions becomes so obscured by the supposed complexity of the T2D condition when they consult the medical establishments. It seems that their strategy is to offer hundreds of glucose-lowering agents and lifestyle changes that do little but guarantees a lifetime dependency on carbs/medication/"innovative insulin", and progression of T2D complications.

Anything other strategies (carbs reduction/keto/fasting) that may reduce our demand for insulin, and possibly free us from a lifetime of medication is routinely dismissed as fad, unsustainable, and dangerous...

But clearly it helps that we T2D should learn to leverage on this... not fear it... and eat 5 or more meals a day...

"The shortage of insulin in the blood is the signal that the liver needs to liquidate its assets, sending its glucose stores back into the blood to keep the body well fed between meals and overnight."

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http://www.diabetesforecast.org/2012/feb/the-liver-s-role-how-it-processes-fats-and-carbs.html

And of course ketones... the controversial fuel of enlightenment when insulin is low...

Tannith said:

return to a normal diet containing about 50% carbs, not for the purposes of a test, but for say a month, what happens to your FBGs and/or postprandial BGs?

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Firstly who says a "normal diet" should contain 50% of energy from carbs? That's the nonsense of what we have been sold after the last 50 years which has proven so disastrous for global health

Secondly who cares.. why would anyone who has reversed a "chronic, progressive disease" wish to return to way of eating that likely caused it in the first place? It's beyond logic.

My major takeaway from the Direct 2 Year follow up was that how successful candidates regained the same maximal insulin output as a control group of non-diabetics, 936 pmol/min/m2 vs 1,016 pmol/min/m2.
https://care.diabetesjournals.org/content/early/2020/01/22/dc19-0371
The kicker however is that they only regained about 50% of the first phase insulin response 125 pmol/min/m2 vs 250 pmol/min/m2.
This would go some way to explaining the higher spikes which pre-diabetics & diabetics observe after eating carbs.
There are of course outliers where the highest post remission are almost the same as the lowest in the control, 201 pmol/min/m2 vs 226 pmol/min/m2 at 1 year.

I've seen other metrics from this Direct trial where the successful candidates Hba1c splipped from 5.8% to 6.0% over the 2 year period. Many would argue that they were still in a prediabetic state where beta cell damage may still be occuring.

Ronancastled said:

I've seen other metrics from this Direct trial where the successful candidates Hba1c splipped from 5.8% to 6.0% over the 2 year period. Many would argue that they were still in a prediabetic state where beta cell damage may still be occuring.

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That's the problem I feel with the criteria of "remission" in the trial.. just because they are under 48 mmol/m can't really, in my view, be called remission.
Not sure if the trial has ever published the anonymised individual HbA1c levels of the "successful" participants but would be some very interesting data to see. I wonder how many are in fact still pre-diabetic?
Yet the NHS seem happy to throw money at it.

bulkbiker said:

That's the problem I feel with the criteria of "remission" in the trial.. just because they are under 48 mmol/m can't really, in my view, be called remission.
Not sure if the trial has ever published the anonymised individual HbA1c levels of the "successful" participants but would be some very interesting data to see. I wonder how many are in fact still pre-diabetic?
Yet the NHS seem happy to throw money at it.

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Yeah, it's hardly a raging success story. I think the amount of successful participants also dropped by the second year.

Tophat1900 said:

Yeah, it's hardly a raging success story. I think the amount of successful participants also dropped by the second year.

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Apart from those concerned enough about their diabetes to participate in this forum, I wonder how long the public in general would keep to a low carb diet if it was advised by their doctor especially if it was supposed to be for the rest of their life. My DN, who is a low carb enthusiast, told me that a common reaction from her patients was that giving up bread and potatoes was ridiculous. "Haven't you got some pills I can take?" they would say. I imagine the appeal of the Newcastle Diet to the NHS is that patients might find a quick fix more attractive than a change of lifestyle. Whether it works or not is another question.