Calorie restriction for long-term remission of type 2 diabetes

[Eddy Edson]

New paper by Roy Taylor.

http://m.clinmed.rcpjournal.org/content/19/1/37.full.pdf

Starting with a hypothesis which postulated a simple explanation arising from the basic cause of type 2 diabetes, a series of studies has introduced a paradigm shift in our understanding of the condition. Gradual accumulation of fat in the liver and pancreas leads eventually to beta cell dedifferentiation and loss of specialised function. The consequent hyperglycaemia can be returned to normal by removing the excess fat from liver and pancreas. At present this can be achieved only by substantial weight loss, and a simple practical and efficacious method for this has been developed and applied in a series of studies. For those people who used to have type 2 diabetes, the state of post-diabetes can be long term provided that weight regain is avoided. The implications for personal health and for national health economics are considerable.

 

[mikeyB]

Not exactly groundbreaking, though.

 

[Eddy Edson]

Not exactly groundbreaking, though.

More of a review, I think, but maybe a useful summary.

And it does introduce a term new to me: "post-diabetes".

 

[Drummer]

I do think that if I had been left alone to follow a low carb diet from my early 20s I would not have gained weight and become diabetic 50 years later - but all the pressure to eat those healthy carbs, the mockery, the threats - the screaming of insults - it does wear down resistance in the end.

 

[Madeline]

My DSN hadn’t heard of the Newcastle diet when I broached the subject. She’s still full of healthy grains taking up a third of my plate, and why don’t I have porridge for breakfast.

 

[trophywench]

Just smile at her and tell her that her advice is rather out of date.

 

[Madeline]

I did explain it, I was kind of shocked she’d not heard about it, I thought there would’ve been some kind of requirement to keep up to date, and (I think) this is a prescription diet! Not in our area, sadly.

 

[Madeline]

She’d be happy though, I had a baked potato with my sausages. I’m not happy, I’ve peed 6 times since dinner

 

[Eddy Edson]

My DSN hadn’t heard of the Newcastle diet when I broached the subject. She’s still full of healthy grains taking up a third of my plate, and why don’t I have porridge for breakfast.

I think the Newcastle idea is that after you've achieved "remission" or "post-diabetes" or whatever, if you do, this kind of standard heart-healthy nutritional advice (lots of fruit, veggies, whole grains etc) is what you should follow - because your pancreas starts working again and carbs become a non-issue. You'll only go back to being diabetic and particularly carb sensitive if you stack the weight back on again.

Personally, I think I've probably gotten to "post diabetic" status, after losing a bunch of weight (but grinding it off at a classical ~0.5kg per week, not via the 800 calorie thing). Generally my BG levels are pretty insensitive to carbs.

Except that I'm still quite sensitive to grains. I experimented with a piece of wholewheat toast this morning, first time I've eaten any grains in weeks. Went from 4.8 before b'fast, peaked at ~9 after (versus normally ~6.5). And by past experience, BG will remain a little elevated versus my usual for the rest of the day. This peak is within "normal" levels, as shown by CGM studies and ignoring the old 7.8-after-meals advice (which was never based on any real evidence) - but still striking enough for me to stick to my seeds-instead-of-grains strategy for the long term.

I wouldn't be surprised to find that I've been grain-sensitive forever, even before the D-fairy sprinkled me with D-dust. It seems to be fairly common.

 

[Madeline]

Oh no, she’s not that advanced. She still firmly believes that T2 should be ‘filling up on healthy carbohydrates like grains and starchy vegetables’ (her words) and low fat. She hadn’t heard of the Newcastle diet at all.

I’m still ignoring her advice. My smaller, much smaller than a fist sized potato that I ate around 7.30pm is still putting me at 10.6 at midnight.

 

[Eddy Edson]

‘filling up on healthy carbohydrates like grains and starchy vegetables’

The rationale for this still-standard advice is that whole grains and starchy veggies are better than donuts and cake, which is absolutely valid for anybody, as far as it goes. And better than bacon and saturated fats, which is absolutely valid for non-diabetics. The difficulty for nutritional advice is how to fit diabetes into the picture.

Replacing good carbs with saturated fats might be OK at getting BG down but is almost certain to be sub-optimal for CV outcomes, once BG is under a bit of control.

All credible, expert, mainstream guidelines these days are just fine with replacing carbs in general with unsaturated fats - so avocados, nuts, seeds. I don't think any of the expert bodies worth listening to are pushing a low-fat (as against low-satfat) agenda these days.

Just wish that the field in general was doing a better job of pushing these simple, massively well-supported strategies into primary care settings.

 

[Madeline]

I’m eating plenty of vegetables and meat like chicken or fish, red meat once a week, liver once a fortnight. Plus full fat yoghurt for breakfast, eggs, and cheese, but not masses. I’ve lost 6kg since November so I’m happy.

I’ve also discovered that proper ice cream, made with cream, doesn’t affect me, so that’s my occasion treat.

 

[trophywench]

The trouble with 'avocados nuts and seeds' is the air miles, should you happen to live in the Northern Hemisphere, Eddy!

I utterly loathe the texture of avocados and the taste isn't much better, so I don't eat any by choice,

 

[Eddy Edson]

The trouble with 'avocados nuts and seeds' is the air miles, should you happen to live in the Northern Hemisphere, Eddy!

I utterly loathe the texture of avocados and the taste isn't much better, so I don't eat any by choice,

Shame! That sounds as bizarre to me as me loathing tomatoes and mushrooms must sound to everybody else 🙂

But in terms of cost: I see a large avocado sells for a quid at Tesco, about Oz $1.90, versus $2.50 at Woolies here. Food is pretty expensive in Oz - small pop, long distances and supply chains stitched up by a couple of big players.

 

[Sharron1]

I’m eating plenty of vegetables and meat like chicken or fish, red meat once a week, liver once a fortnight. Plus full fat yoghurt for breakfast, eggs, and cheese, but not masses. I’ve lost 6kg since November so I’m happy.

I’ve also discovered that proper ice cream, made with cream, doesn’t affect me, so that’s my occasion treat.

Ohhh, what brand of proper ice cream - and how much do you allow yourself? This is my next move but after my 6 month review!!!🙄

 

[Madeline]

Kelly’s clotted cream works for me, as does Waitrose pistachio. I have a tub of Waitrose 1 chocolate arriving tomorrow, I’ll report back on that.

 

[Madeline]

I hate avocados and mushrooms too. Also celery and coriander

 

[trophywench]

I like mushrooms, tomatoes, cooked celery, not keen on coriander and loathe the seeds with a passion gimme parsley any day, like capers, hate tarragon, chervil, pernod and anything else that tastes of aniseed eg Ouzo - but take me to Crete and home-brewed Raki and I'll drink it neat. Only thing is I don't have any worry beads, have never developed stubble anywhere you can usually see and can't play backgammon ! LOL

 

[Madeline]

 

[mikeyB]

I hate avocado. The reason why birds never eat avocados is because it is deadly poisonous to birds - that’s the tree’s defence. The Guatemalan variety, which is the main one sold in the UK, is particularly poisonous. It’s a substance called persin that kills them.

Persin is a fat soluble fungicide that leaches into the fruit from the seed. It kills rabbits, and makes many domestic animals ill, plus horses, cows, pigs and presumably any animals in the wild that eat it. In rabbits they die due to cardiac arrhythmia, the other animals get mastitis and bowel problems. Never ever allow your dog or cat to eat any avocado, or the skin, you’ll have a house full of poo and vets bills.

It’s allegedly considered safe for humans, though as it is fat soluble, you won’t wee it out. Don’t know where it goes.

Anyway, it’s cytotoxic, so they are trying to make an additive from Persin to go with Tamoxifen in breast cancer.

All toxic substances have an LD50 - the dose that kills half the population. It’s usually tested on animals. I can’t find an LD50 for persin, presumably because it kills every animal they test it on.

But don’t mind me, enjoy your avocados. I, along with most of the animal kingdom, don’t think it is food. I’m not pushing my luck eating cytotoxic chemicals, thank you very much.