The CarbScale

[beating_my_betes]

Remission is the clinical term for keeping hba1c normal without medication for at least 3 months. With weight loss, low calorie diet, or weight loss.

In a medical context, clinicians used to use the term 'Reversed' just to mean levels had returned to normal (Due to some intervention, like diet, surgery and in some cases even medication) and with no consideration of length of time they had been normal. (Many papers talk about 'reversal' after bariatric surgery, but only a small percentage gaining 'remission' and keeping it normal for a longer period).

The use of remission was favoured because some people misunderstood what this meant and also some used it to imply that they could cure it. Certainly Dr Unwin never used the term to mean it was cured, and Taylor also used an analogy of reversing a car into a garage and then driving back out again to show how the high glucose could return.

Seems a strange analogy by Taylor, given the almost inevitability that the car will indeed once again leave the garage - perhaps even by the next morning.

Also, I'm not sure your qualification of the clinical definition of remission clarifies why it's distinct from cure/reversal.

 

[beating_my_betes]

What misinformation?

If any moderator(s) could confirm that this is the right thread to expand on this, then perhaps we could go through it.

 

[Alan44]

If any moderator(s) could confirm that this is the right thread to expand on this, then perhaps we could go through it.

Yep, I'm happy for you to continue

 

[everydayupsanddowns]

If any moderator(s) could confirm that this is the right thread to expand on this, then perhaps we could go through it.

I’m not really sure there’s much to expand on?

Diabetes UK prefers the term remission rather than reversal as explained here:

What is type 2 diabetes remission?

Jump to: What is remission?

www.diabetes.org.uk

Is remission the same as 'reversing' my diabetes?​

We know many people say 'reversing' their type 2 diabetes instead of remission but we, and the NHS, say remission of type 2 diabetes.​

​

But when you’re in remission your diabetes has not gone away completely so you still need your checks. There are two main reasons for this:​

​

1. Being in type 2 remission stops the diabetes from doing any new damage to you and your body. But you may have damage caused by high sugar levels from before you went into remission. Diabetes eye screening and checks for kidney disease are ways to check for signs of diabetes-related problems.
2. Staying in remission can be hard. Some people stay in remission for years but others find that their blood sugars rise again after a time, and they come out of remission. Your doctor or diabetes nurse will monitor your blood sugar levels to help you take action if your blood sugar levels do rise again.

BUT

The Internet, and newspapers, and journalists, and books, and people down the pub, and various other sources sometimes use the term reversal. So some people look for information on the topic of ‘reversing diabetes’. And it’s important that reliable information by organisations like Diabetes UK is available to people making those searches, so that the nuances of why remission is actually a better term can be explained. And for that the pages need to feature the word ‘reversal’. That’s how internet search engines work. It’s not anything conspiratorial or deliberately confusing the issue, to my mind it’s just ensuring that the right information gets provided to people even if they are using what some here consider the wrong terminology.

 

[harbottle]

Seems a strange analogy by Taylor, given the almost inevitability that the car will indeed once again leave the garage - perhaps even by the next morning.

Also, I'm not sure your qualification of the clinical definition of remission clarifies why it's distinct from cure/reversal.

If you find his e-mail address, you can take up the use of analogy with the man himself.

Remission is a clinical diagnosis with specific criteria.
"Reversal" was ambiguous and hijacked by charlatans, even though clinicians didn't see 'reversal' as a cure.

 

[beating_my_betes]

I’m not really sure there’s much to expand on?

Diabetes UK prefers the term remission rather than reversal as explained here:

What is type 2 diabetes remission?

Jump to: What is remission?

www.diabetes.org.uk

Is remission the same as 'reversing' my diabetes?​

We know many people say 'reversing' their type 2 diabetes instead of remission but we, and the NHS, say remission of type 2 diabetes.​

​

But when you’re in remission your diabetes has not gone away completely so you still need your checks. There are two main reasons for this:​

​

1. Being in type 2 remission stops the diabetes from doing any new damage to you and your body. But you may have damage caused by high sugar levels from before you went into remission. Diabetes eye screening and checks for kidney disease are ways to check for signs of diabetes-related problems.
2. Staying in remission can be hard. Some people stay in remission for years but others find that their blood sugars rise again after a time, and they come out of remission. Your doctor or diabetes nurse will monitor your blood sugar levels to help you take action if your blood sugar levels do rise again.

BUT

The Internet, and newspapers, and journalists, and books, and people down the pub, and various other sources sometimes use the term reversal. So some people look for information on the topic of ‘reversing diabetes’. And it’s important that reliable information by organisations like Diabetes UK is available to people making those searches, so that the nuances of why remission is actually a better term can be explained. And for that the pages need to feature the word ‘reversal’. That’s how internet search engines work. It’s not anything conspiratorial or deliberately confusing the issue, to my mind it’s just ensuring that the right information gets provided to people even if they are using what some here consider the wrong terminology.

I don't see it as a conspiracy at all. I just don't think I agree that there's really any distinction, even given the extra detail provided. If there is anything meaningful to distinguish them, it's certainly not as clear as to illicit cries of charlatanism etc. by using one over the other.

This actually wasn't the part I was looking to expand on. I was asked to explain why I thought the intro to the book was misleading and contained misinformation. But perhaps I'll also take some time to clarify my thoughts on this, also.

 

[beating_my_betes]

If you find his e-mail address, you can take up the use of analogy with the man himself.

Remission is a clinical diagnosis with specific criteria.
"Reversal" was ambiguous and hijacked by charlatans, even though clinicians didn't see 'reversal' as a cure.

I don't think the criteria for remission go far enough. Either way, the supposed ambiguity and charlatan-enticing-ness of 'reversal' seems baseless, unless you can make a very clear case why it differs from remission. This is something that I don't think has been done yet, despite your efforts.

So far it seems that the confusion exists because there's the assumption that the words reversal/cure imply that such a state is irreversible. But that doesn't seem to be true.

One can be cured of an infection, but that doesn't mean that in the future we can't once again become infected. We don't say that the infection is in remission.

 

[everydayupsanddowns]

One can be cured of an infection, but that doesn't mean that in the future we can't once again become infected. We don't say that the infection is in remission.

Yes, that’s true. And yet the term ‘reversal’ is highly emotive for some members here. Diabetes was once believed to be inevitably progressive. Now it has become clear that it can be held in stasis (at least for a while - several years, even a decade or more).

For me it’s along the lines of the Language Matters project.

It’s obliquely akin to the differences between ‘diabetic’ or ‘person with diabetes’, of ‘diabetes control’ vs ‘management’. And many other terminological options.

There are subtle differences, nuances in the way some of these terms are understood, and what they convey, or may be believed to be conveying or implying.

And the terms we use do have a pervasive power to affect our thinking, and even in some cases our actions.

 

[Burylancs]

Yes, that’s true. And yet the term ‘reversal’ is highly emotive for some members here. Diabetes was once believed to be inevitably progressive. Now it has become clear that it can be held in stasis (at least for a while - several years, even a decade or more).

Citation needed !!!

For me it’s along the lines of the Language Matters project.

It’s obliquely akin to the differences between ‘diabetic’ or ‘person with diabetes’, of ‘diabetes control’ vs ‘management’. And many other terminological options.

There are subtle differences, they convey, or may be believed to be conveying or implying.

And the terms we use do have a pervasive power to affect our thinking, and even in some cases our actions.

 

[Burylancs]

I’m not really sure there’s much to expand on?

Diabetes UK prefers the term remission rather than reversal as explained here:

What is type 2 diabetes remission?

Jump to: What is remission?

www.diabetes.org.uk

Is remission the same as 'reversing' my diabetes?​

We know many people say 'reversing' their type 2 diabetes instead of remission but we, and the NHS, say remission of type 2 diabetes.​

​

But when you’re in remission your diabetes has not gone away completely so you still need your checks. There are two main reasons for this:​

​

1. Being in type 2 remission stops the diabetes from doing any new damage to you and your body.

Citations needed !!!!

1. But you may have damage caused by high sugar levels from before you went into remission. Diabetes eye screening and checks for kidney disease are ways to check for signs of diabetes-related problems.
2. Staying in remission can be hard. Some people stay in remission for years but others find that their blood sugars rise again after a time, and they come out of remission. Your doctor or diabetes nurse will monitor your blood sugar levels to help you take action if your blood sugar levels do rise again.

BUT

The Internet, and newspapers, and journalists, and books, and people down the pub, and various other sources sometimes use the term reversal. So some people look for information on the topic of ‘reversing diabetes’. And it’s important that reliable information by organisations like Diabetes UK is available to people making those searches, so that the nuances of why remission is actually a better term can be explained. And for that the pages need to feature the word ‘reversal’. That’s how internet search engines work. It’s not anything conspiratorial or deliberately confusing the issue, to my mind it’s just ensuring that the right information gets provided to people even if they are using what some here consider the wrong terminology.

 

[everydayupsanddowns]

Please email helpline@diabetes.org.uk @Burylancs

They will be able to put you in contact with the website content team, who can let you know the sources used for those pages.

 

[everydayupsanddowns]

@Burylancs …

Yes, that’s true. And yet the term ‘reversal’ is highly emotive for some members here.

Please see the report you made earlier about this thread, and your objection to the term reversal.

Diabetes was once believed to be inevitably progressive. Now it has become clear that it can be held in stasis (at least for a while

Prof Taylor. Several times. Including:
“Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the disease. We now know that the processes that cause type 2 diabetes can be returned to normal functioning by restriction of food energy to achieve weight loss of around 15 kg.”

Nutritional basis of type 2 diabetes remission

Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the...

www.bmj.com

- several years, even a decade or more).

@Drummer a member here has been living with an HbA1c at or below 48mmol/mol for several years (8 or 9 I think) using a low carb diet and with no medication.
A number of members have used the Newcastle approach with good success. Including @Kreator and @pjgtech
Former member Alan Shanley who’s post Test Review Adjust has been living with diabetes that meets the criteria for remission (at or below 48mmol/mol without medication) for approx 10-15 years I think.

 

[Burylancs]

@Burylancs …

Please see the report you made earlier about this thread, and your objection to the term reversal.


Prof Taylor. Several times. Including:
“Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the disease. We now know that the processes that cause type 2 diabetes can be returned to normal functioning by restriction of food energy to achieve weight loss of around 15 kg.”

Nutritional basis of type 2 diabetes remission

Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the...

www.bmj.com

@Burylancs …

Please see the report you made earlier about this thread, and your objection to the term reversal.


Prof Taylor. Several times. Including:
“Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the disease. We now know that the processes that cause type 2 diabetes can be returned to normal functioning by restriction of food energy to achieve weight loss of around 15 kg.”

Nutritional basis of type 2 diabetes remission

Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the...

www.bmj.com

@Drummer a member here has been living with an HbA1c at or below 48mmol/mol for several years (8 or 9 I think) using a low carb diet and with no medication.
A number of members have used the Newcastle approach with good success. Including @Kreator and @pjgtech
Former member Alan Shanley who’s post Test Review Adjust has been living with diabetes that meets the criteria for remission (at or below 48mmol/mol without medication) for approx 10-15 years I think.

@Drummer a member here has been living with an HbA1c at or below 48mmol/mol for several years (8 or 9 I think) using a low carb diet and with no medication.
A number of members have used the Newcastle approach with good success. Including @Kreator and @pjgtech
Former member Alan Shanley who’s post Test Review Adjust has been living with diabetes that meets the criteria for remission (at or below 48mmol/mol without medication) for approx 10-15 years I think.

Your quotation from Taylor is just more assertions with no citations, sweeping claims with no references to peer reviewed RCTs or Cochrane reports. Modern Medicine has to be securely evidenced based, you can't just say Type 2 is not 'progressive' off the top of your head.

Last we heard about Alan Shanley was that he was on a standard dose of Metformin like most of us.

If you look at the lifestyles of the handful of members on here who claim to be 'in remission' from Type 2 you will see that they are actually slaves to the condition and building their whole diets and regimes around managing it. Living with Type 2 Diabetes is unremitting and for life as things stand.

 

[Burylancs]

Please email helpline@diabetes.org.uk @Burylancs

They will be able to put you in contact with the website content team, who can let you know the sources used for those pages.

You know the drill - 'extraordinary claims need extraordinary evidence' - if there is any evidence for Diabetes UK's specious claims belittling Type 2 it should be footnoted appropriately.

 

[everydayupsanddowns]

Modern Medicine has to be securely evidenced based, you can't just say Type 2 is not 'progressive' off the top of your head.

And Taylor has done that. In peer reviewed published studies over more than a decade, and follow-on commentary. In conference presentations that dig into the evidence the studies uncovered. In establishing hypotheses (personal fat threshold, twin cycle etc etc). In testing those hypotheses. In extending initial premise for those in other circumstances (eg those at lower weight at diagnosis).

I’m not sure what peer reviewed evidence you would be prepared to accept when you reject all the peer reviewed evidence that Taylor has published so far. And the peer reviewed evidence of others who have extended the work.

Personally, (and not with my ‘mod hat’ on), I also find it rather insulting that you describe the lived experience of multiple forum members who are in remission from their T2 as ‘specious’.

I also think it is unfairly demotivating to newcomers.

Remission from T2 IS possible. There are non-responders who may not be able to achieve it, but I don’t think it is helpful or supportive of this community to insist that it can’t happen. Especially to people who are working at managing their diabetes and have achieved remission, or are working towards it.

 

[harbottle]

I seem to recall on another thread @Burylancs had not even read any of Taylor's work and wasn't aware that the research showed that first phase insulin response partially returned in 'responders' after weight loss.

 

[harbottle]

One can be cured of an infection, but that doesn't mean that in the future we can't once again become infected. We don't say that the infection is in remission.

That's a false comparison.

An infection is not the same a metabolic condition like type 2 diabetes.

 

[JITR]

The Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes was published in 2021. It explains why 'remission' and 48 mmol/mol were chosen. Roy Taylor and Douglas Twenefour (Diabetes UK) were members of the international expert group.

Quote: The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.

 

[Burylancs]

I seem to recall on another thread @Burylancs had not even read any of Taylor's work and wasn't aware that the research showed that first phase insulin response partially returned in 'responders' after weight loss.

Untrue. I certainly have read Taylor's work even in the early days. And praised his assertion even before DiRECT that a diagnosis of Type 2 should be treated as a medical emergency. Last year I simply asked JITR for a list of Taylor's work so I could check out some points again.

 

[beating_my_betes]

That's a false comparison.

An infection is not the same a metabolic condition like type 2 diabetes.

Why does that matter?

The argument for making a distinction between remission and reversal seems to hinge on the idea that curing/healing/reversing something will last forever, whereas remission is a more temporary affair. Thus far, I've not seen any compelling arguments as to why this should be the case.