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

Mr_Pot said:

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.

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The change away from carbs is not an easy change I feel. I take every day as it comes and I’m not perfect as I state on my posts, I do have fish and chips and the occasional cake. My carbs hover around 80 to 100 a day I guess

But this is a fraction of what I used to have, and I used to love pasta, pizza and carb laden foods, still do to be fair.

I have lost a lot of weight, bloods much improved but realistically it is a struggle to know that I am half way through my life (hopefully longer but let’s go for that) and I have to have a restricted diet for it. It’s not really surprising people look to alternatives

My experience when GP. Having read Mosley and others and asked GPs for assistance because all their books say so, I have up, did some research, started dieting and exercising. Lost 3.5 stone my medication is more than halved. Diet and weight and CGM (the latter will teach you more about diet and diabetes in a month than the GPs in 10 years.
The GPs patronise you, tell you to take more medication, Aves go and be a good boy. Oh, and don't eat more than a handful of fruit. The dieticians were as bad.
After 3 months and a reduction of A1C from 63 to 49 (it would have been lower had I kept the CGM for another month) I wondered how to get to the next stage.
Asked the GP on the phone, "what is a CGM said he". On being informed he replied that they are inaccurate. I replied that the share price should be a good clue.
As to diets, he said that there are a lot of fad diets. Mine is so faddy it's been around for 50,000 years at least.
But it works. The GP sadly, had no interest whatsoever and wouldn't refer me to an endocrinologist. So I got to pay to save the NHS more money despite this being advocated in the NHS/NICE report 2018 referring to T2D as an epidemic age serious cost centre for NHS. He also did not know anything about this report.
Lastly a dexa scan is useful to find out how much visceral fat remains.
Of you want to reverse T2D you will almost certainly have to fend for yourself, or be lucky.
But stay well away from Winchmore Hill.

zand said:

@Tannith I am pleased that you have reversed your T2 using the ND, but it doesn't work for all of us. I tried something similar at diagnosis in 2011 to no avail.

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No, I quite agree, it doesn't suit everyone, it's "horses for courses" and the most important thing for all of us is that one way or another we find a diet or drug regime that keeps our blood sugar down as this reduces the complications of this awful disease. My concern is that everyone should be in a position to make an informed decision in time. I would be very sad to hear that someone had not found out about ND in time for it to have a strong possibility of working for them. After ten years there is only about a 50% chance of the beta cells being restored to their normal function.

Mr_Pot said:

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.

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Maybe she should retrain at the Unwin low carb school.. most of his patients prefer to try the no medication route.. I expect it's all in the way it's being "sold" to them.
Telling people they have to give up certain things forever at the start might not be the best route. Maybe telling them they could avoid T2 medication "forever" would be a more productive start.

Tannith said:

After ten years there is only about a 50% chance of the beta cells being restored to their normal function.

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You keep on making this claim with absolutely zero evidence to back it up.

Please stop.. it's patently untrue as ViRTA have shown multiple times with many patients.

My opinion:

Newcastle diet, like any other diet of its type, only works because by severely reducing calories you also reduce carbs.

The weight loss is due to the carb reduction and just reduces the symptom (weight gain) of insulin resistance.

By itself and of itself it is nothing special or magical and does more harm than good as it throws out the necessary fats, and teaches people that their weight is a cause, not a symptom.

It also reinforces self blame for their condition, and the low fat/high carb mantra and prevents people looking elsewhere for effective treatment.

It's a perfect gaslighting technique to protect the real causes - manufacturers of high carb foods.

lucylocket61 said:

My opinion:

Newcastle diet, like any other diet of its type, only works because by severely reducing calories you also reduce carbs.

The weight loss is due to the carb reduction and just reduces the symptom (weight gain) of insulin resistance.

By itself and of itself it is nothing special or magical and does more harm than good as it throws out the necessary fats, and teaches people that their weight is a cause, not a symptom.

It also reinforces self blame for their condition, and the low fat/high carb mantra and prevents people looking elsewhere for effective treatment.

It's a perfect gaslighting technique to protect the real causes - manufacturers of high carb foods.

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In total agreement .

bulkbiker said:

You keep on making this claim with absolutely zero evidence to back it up.

Please stop.. it's patently untrue as ViRTA have shown multiple times with many patients.

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Are you questioning the 10 years (which I said is approximate), or are you questioning that ND restores beta cells to their normal function if done early enough after diagnosis? Incidentally Virta trial subjects continued with metformin so I wouldn't call them comparable even to other low carb dieters let alone ND.
"Here at Virta, we focus on Reversal. The reason for this is that we believe that it is not in every individual patient’s best interest to arbitrarily stop metformin. Patients who have a history of diabetes remain at increased risk of developing diabetes again, even after HbA1c normalizes, and metformin has been shown to decrease this risk⁸. Therefore, we discontinue metformin only due to side effects or patient request."

Tannith said:

Are you questioning the 10 years (which I said is approximate), or are you questioning that ND restores beta cells to their normal function if done early enough after diagnosis? Incidentally Virta trial subjects continued with metformin so I wouldn't call them comparable even to other low carb dieters let alone ND.
"Here at Virta, we focus on Reversal. The reason for this is that we believe that it is not in every individual patient’s best interest to arbitrarily stop metformin. Patients who have a history of diabetes remain at increased risk of developing diabetes again, even after HbA1c normalizes, and metformin has been shown to decrease this risk⁸. Therefore, we discontinue metformin only due to side effects or patient request."

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Did the Direct study trialists discontinue their metformin then?
I know that the studies had different populations in that Virta also took people who were on insulin (very established type 2) so it is hard to compare but this is rather Coxes versus Pippins not apples to pears.
As for beta cell insufficiency I wonder if that is contextual? That is when eating a high carb diet some people can no longer produce enough insulin to cope with that whereas others can and do so merely become fat. Both are insulin resistant but one has beta cell insufficiency. Both could reverse type 2 diabetes and lose weight respectively by restoring their insulin sensitivity by allowing the body to use up the fat around the liver. pancreas then muscles. Then the question is which is the best way to do this but I can't see why the low carb 800 cal diet offers any magic solution other than that it quickly proved the point that it is possible to reverse type 2. Naturally, commercial interests have swooped down upon this research of which Michael Mosley is one and Exante shakes are another (Diabetes UK have produced an informerical wth them). IMO both options should be on the table but not the Eatwell carb fest!

Tannith said:

are you questioning that ND restores beta cells to their normal function if done early enough after diagnosis?

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This is exactly what I am disagreeing with.. that only the ND can perform this magical trick.. assuming of course that beta cells are "malfunctioning" in the first place..
I doubt they are as overproduction of insulin would be quite hard with a malfunctioning pancreas don't you think?

Not quite sure of the relevance of metformin in ViRTA or why you raise it here .. their success is getting people off exogenous insulin.. again this would be a major difficulty if the patients beta cells were "malfunctioning".

bulkbiker said:

This is exactly what I am disagreeing with.. that only the ND can perform this magical trick.. assuming of course that beta cells are "malfunctioning" in the first place..
I doubt they are as overproduction of insulin would be quite hard with a malfunctioning pancreas don't you think?

Not quite sure of the relevance of metformin in ViRTA or why you raise it here .. their success is getting people off exogenous insulin.. again this would be a major difficulty if the patients beta cells were "malfunctioning".

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This describes beta cell malfunctioning and the wide range of tests of insulin production ,post prandial (or rather glucose drink) BG clearance etc etc in the subjects in the Direct study. Not the sort of thing you can do at home of course.
You have to be sure to pick up the last f to make the link work.
https://www.ncl.ac.uk/media/wwwncla...e/files/Taylor et al Cell Metabolism 2018.pdf

Tannith said:

file:///C:/Users/tannith/Desktop/Taylor%20et%20al%20Cell%20Metabolism%202018.pdf%20with%20figures.pdf This describes beta cell malfunctioning and the wide range of tests of insulin production ,post prandial (or rather glucose drink) BG clearance etc etc in the subjects in the Direct study. Not the sort of thing you can do at home of course.

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Again more theorising by Taylor? Link doesn't work.

bulkbiker said:

Again more theorising by Taylor? Link doesn't work.

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Not too surprised.... it's hardly hyper....

Tannith said:

No, I quite agree, it doesn't suit everyone, it's "horses for courses" and the most important thing for all of us is that one way or another we find a diet or drug regime that keeps our blood sugar down as this reduces the complications of this awful disease. My concern is that everyone should be in a position to make an informed decision in time. I would be very sad to hear that someone had not found out about ND in time for it to have a strong possibility of working for them. After ten years there is only about a 50% chance of the beta cells being restored to their normal function.

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Well we agree there, informed choice is everything and whilst it does work for some it doesn’t others. And there is no evidence that even the mechanism (fat shedding in cells) is unique to the ND if that’s even is what is required for any given patient given excess insulin is usually the issue not deficiency.

It’s often explained as deficient because it’s not enough to bring bgl down to normal in the normal time span. Actually even huge amounts way above normal levels of insulin aren’t enough due to insulin resistance. So yes it’s “insufficient“ or “deficient” to do it’s job but crucially not due to a lack of it but due to lack of response to it. Very different animal.

The nhs are plugging versions of the Newcastle diet, calorie restriction is everywhere too. So I doubt that the option subject to least offering is ND. In comparison far too many professionals know nothing or actively discourage low carb as another option.

hankjam said:

Not too surprised.... it's hardly hyper....

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Maybe a hypo link..?

What amazes me is that Roy Taylor's team managed to completely sidestep the role of ketosis and ketones in achieving/maintaining fat loss...

The simple fact is that when insulin remains low enough for long enough... that is when the T2D reversal magic begins.

Should we then choose to refeed with a carbs laden, insulin demanding lifestyle or seek to judiciously preserve the remaining beta cells that was salvaged with an insulin lite option?

Tannith said:

39

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That equates to an average glucose level of 6.5mmol/L. Borderline pre-diabetic and certainly indicates some insulin resistance. No judgement from me, but personally I'd not really call that reversal/remission without more data. A fasting insulin test would fill in the blanks. I would expect it to be elevated with a HbA1c of 39. If not then insulin production likely impaired.

Tannith said:

After ten years there is only about a 50% chance of the beta cells being restored to their normal function.

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Your fear is likely justified for those following the current dietary recommendation for T2D.

kokhongw said:

What amazes me is that Roy Taylor's team managed to completely sidestep the role of ketosis and ketones in achieving/maintaining fat loss...

The simple fact is that when insulin remains low enough for long enough... that is when the T2D reversal magic begins.

Should we then choose to refeed with a carbs laden, insulin demanding lifestyle or seek to judiciously preserve the remaining beta cells that was salvaged with an insulin lite option?

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In the very first set of trials for the ultra low calorie experiment they did indeed test for ketones (and more importantly found them). I'm guessing they didn't want to let on that the trial subjects (or maybe the more successful ones at least) were in ketosis or they simply didn't understand the mechanisms they had triggered.
My various few exchanges on twitter with Prof Mike Lean point me towards the former.

bulkbiker said:

In the very first set of trials for the ultra low calorie experiment they did indeed test for ketones (and more importantly found them). I'm guessing they didn't want to let on that the trial subjects (or maybe the more successful ones at least) were in ketosis or they simply didn't understand the mechanisms they had triggered.
My various few exchanges on twitter with Prof Mike Lean point me towards the former.

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Well certainly the calorie narrative fits the established paradigm, whereas few would want the word keto being painted in a positive light. Not saying that's what is happening but it would hardly be a surprise if it were. In my opinion only of course.