Is a very low calorie diet better than gastric bypass surgery?

By Benedict Jephcote
7th April 2016
In Depth
 
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On 21 Mar 2016, preliminary results of a potentially groundbreaking British study showed remarkable results.

40% of trial participants had achieved a reversal (remission) of their type 2 diabetes six months after completing an 8-week very low calorie diet (VLCD) intervention.

A remission rate this high is very impressive for a diet-only intervention and even rivals the results of weight loss surgery.

The study is being run by Professor Roy Taylor’s team at Newcastle University. The diet involves meal shakes and non-starchy vegetables which result in a diet of between 600-700 kcal per day.

The study involved 30 participants with type 2 diabetes. They were asked to stop taking their diabetes medication prior to starting the diet. The VLCD was followed for 8 weeks and then they went on to a weight maintenance diet.

Six months after completing the initial VLCD intervention, 13 of the participants had achieved normal blood glucose numbers without requiring diabetes medication.

How does VLCD compare with bariatric surgery?

To get an idea of how impressive these results are, let’s review how the results compare with weight loss surgery.

A recent study into gastric bypass surgery involved 32 people with type 2 diabetes, who were assigned into one of two groups. One group received lifestyle intervention which involved following a low calorie diet (note: not a very low calorie diet). The other group had gastric bypass operations. Remission rates were reviewed after 12 months.

6% of the intervention group and 60% of the gastric bypass group achieved remission after 12 months.

This tells us two things. One, it appears as though VLCD is much better than simply a low calorie lifestyle intervention at bringing on diabetes remission (40% compared with 6%).

The second point is that VLCD appears to be nearly as good as even gastric bypass surgery at bringing on remission. Gastric bypass surgery involves a series of cuts and joins in the digestive tract that shrinks the size of the stomach and allows food to bypass part of the small intestine.

Whilst the results for gastric bypass surgery are more impressive, we should take into account the disadvantages of weight loss surgery too, which include:

  • The risks of surgery – such as the possibilities of internal bleeding, organ damage and post-surgery infection
  • Being only able to eat small meals for the rest of one’s life
  • Needing to take vitamin supplements for life

By comparison, there are no longer term disadvantages of a VLCD.

How achievable is it to reverse type 2 diabetes with a VLCD?

Results will vary by the individual. People may fall into one of the following groups.

  • Adapts well to the VLC diet and the maintenance diet
  • Adapts well to the VLC diet but has some trouble with the maintenance diet
  • Has some trouble with the VLC diet but adapts well to the maintenance diet
  • Has trouble with both the VLC and a maintenance diet

Some people will naturally be committed and take well to the diet. However, not everyone is cut out for such a restricted diet.

What we can learn from this is that VLCDs definitely can work wonders for a significant proportion of people. For those that have a strong urge to kick back against type 2 diabetes, a VLCD could represent a good option that presents no long term side effects.

For those that do not have success on a VLCD, other options such as GLP-1 medication and weight loss surgery would still be available as options.

Whilst this is jumping the gun a bit, if a VLCD was to be routinely offered as an intervention for type 2 diabetes, people will need close support from the NHS to maximise success.

For example, regular contact with a dedicated lifestyle counsellor could ensure people have good practical and motivational support through the VLCD.

If you would like to try a VLCD, it’s important that you contact your doctor first. This is important to ensure that you are following the diet safely and that your medical history and use of medications are accounted for.

What do you think?