Numbers looking good at last, but now what?

[Fox]

For almost all practical purposes, I agree. Actual interventions don't change either way. Even substances under investigation for restoring beta cell function seem to act on islet cells in general. Very little changes. It's more of a possible explanation for why some people can lose remission before gaining weight. I am curious, and keeping an open mind, about the possibility.

What it might do, and I think this is important, is remove some of the stigma from those who are diabetic and overweight. If being overweight causes diabetes, then there will be those who falsely blame the diabetic person for becoming diabetic by allowing themselves to become overweight, or lacking the willpower to lose weight, or something equally oversimplistic. It's wrong both morally and factually, but we know it's all too common. If diabetes causes some diabetic people to become overweight, that accusation falls.

 

[Dragonheart]

Was the original remission just owed to going low carb? Throwing less fuel on the fire is bound to reduce the flames but not necessarily reduce any fat in the pancreas. There is certainly a need for greater clarity about the mechanisms.

I cut the carb which reduced both glucose levels and weight loss followed. So yes I achieved what Taylor recommends 15kg/15% weight loss so should have achieved remission by that basis. However adding carbs (but not calories or weight) pretty much immediately increases both glucose levels and then weight. That says to me type 2 is more than about weight loss alone for at least some of us.

And for the record he’s also said it doesn’t matter how you lose it so long as you do. The shakes just made the studies more manageable.

 

[Dragonheart]

I think that Taylor would be very interested in your experience - perhaps you could ask for his view?

Oddly I don’t happen to have his phone number. And I don’t do X / twitter

 

[Dragonheart]

@Dragonheart

You say, "Whereas I lost remission then regained weight" and "I achieved normal glucose then lost weight". Have you detailed the sequence of events and HbA1 levels in another post?

Not that I recall offhand but possibly. But I do know what happened to my own body.

 

[childofthesea43]

Oddly I don’t happen to have his phone number. And I don’t do X / twitter

Nor do I - I just emailed him at Newcastle Uni.

 

[Dragonheart]

Interesting. How did you lose remission? Did you try to return to a 'normal' diet after getting it under control?

I ate more carbs (not huge amounts but more than before), but not more food/calories just for ease of daily life and hba1c started to creep up and then weight did. Then I was hospitalised with Covid and things got worse and never got back to where they were beforehand.

 

[JITR]

I ate more carbs (not huge amounts but more than before), but not more food/calories just for ease of daily life and hba1c started to creep up and then weight did.

The extra carbs would put up your blood glucose, and so your hba1c over 3 months. Sounds like they also led to your weight gain.

 

[childofthesea43]

The extra carbs would put up your blood glucose, and so your hba1c over 3 months. Sounds like they also led to your weight gain.

Although I don’t think weight gain could proceed very far without calorie (ie energy, ultimately mass) increase unless one were expending fewer calories one way or another, for otherwise we’d have to deconstruct physics.

 

[JITR]

R

Although I don’t think weight gain could proceed very far without calorie (ie energy, ultimately mass) increase unless one were expending fewer calories one way or another, for otherwise we’d have to deconstruct physics.

Exactly, I thought that would go without saying. But, as a distinguished Judge once said, it always pays to spell things out.

Even so, it's probably not so easy to measure calories in and out while taking the vagaries of metabolism into account.

 

[Dragonheart]

I think that Taylor would be very interested in your experience - perhaps you could ask for his view?

I thought about this a bit more. I’m sure he’s aware as I’ve read that bariatric patients show a positive response glucose wise long before they loose the weight post surgery.

 

[Dragonheart]

The extra carbs would put up your blood glucose, and so your hba1c over 3 months. Sounds like they also led to your weight gain.

Yes that’s what happens

As a type 2 eating more carbs I can’t utilise/process/access the glucose in my blood for energy in the same way a non diabetic does. (Anyone remember tiredness as a symptom too?) So although the calories may remain the same the ability to use/burn them is affected. Calories unable to be burned have little choice but to be stored, as body fat. Those extra carbs also raise insulin levels which in itself is a fat storage hormone that hinders fat burning. It kind of messes up the CICO oversimplification many resort to. Swap those same calories to fat or protein and a type 2 body retains the ability to process those calories the way a text book says they should and can burn them not get them stuck in storage.

Although I don’t think weight gain could proceed very far without calorie (ie energy, ultimately mass) increase unless one were expending fewer calories one way or another, for otherwise we’d have to deconstruct physics.

No need to deconstruct physics. Just find a way to establish what is happening to the various differently sourced calories. My body isn’t a test tube, and things other than the single factor of how fast/hot the food burns in one effects the way they are processed in a human.

I’m by far not alone in experiencing this “glucose then weight” effect. Most everyone that goes low carb experiences it and see it if they measure bgl (often against the advice they’ve been given that there’s no need). It’s widely reported in the other forum and I’ve seen it in here too that bgl can mostly normalise within days, whereas it takes some time for the weight to come off. Sure the amount of calories you eat will have an influence too but it’s not the only one.

 

[childofthesea43]

Yes that’s what happens

As a type 2 eating more carbs I can’t utilise/process/access the glucose in my blood for energy in the same way a non diabetic does. (Anyone remember tiredness as a symptom too?) So although the calories may remain the same the ability to use/burn them is affected. Calories unable to be burned have little choice but to be stored, as body fat. Those extra carbs also raise insulin levels which in itself is a fat storage hormone that hinders fat burning. It kind of messes up the CICO oversimplification many resort to. Swap those same calories to fat or protein and a type 2 body retains the ability to process those calories the way a text book says they should and can burn them not get them stuck in storage.

No need to deconstruct physics. Just find a way to establish what is happening to the various differently sourced calories. My body isn’t a test tube, and things other than the single factor of how fast/hot the food burns in one effects the way they are processed in a human.

I’m by far not alone in experiencing this “glucose then weight” effect. Most everyone that goes low carb experiences it and see it if they measure bgl (often against the advice they’ve been given that there’s no need). It’s widely reported in the other forum and I’ve seen it in here too that bgl can mostly normalise within days, whereas it takes some time for the weight to come off. Sure the amount of calories you eat will have an influence too but it’s not the only one.

If it were the case that bg normalised within a short period prior to weight loss then one would have no need to restrict how much one ate afterwards. Remission would have been achieved and completed in a fortnight. How can this be squared with trials like Direct and the dependence they demonstrate of remission success upon amount of weight lost?

 

[JITR]

I thought about this a bit more. I’m sure he’s aware as I’ve read that bariatric patients show a positive response glucose wise long before they loose the weight post surgery.

Yes, you are right.

Given your weight, condition and medication at the time, diet controls HbA1c results. Eat more carbs, higher HbA1c; eat less, lower HbA1c. Tweaks that could take you in and out remission.

The sole purpose of Roy Taylor's weight loss, as you will know, is to eliminate excess fat from the liver and (when possible) the pancreas. When the pancreas recovers normal blood glucose control is restored. This has nothing to do with the weight/BMI of the person.

It is conceptually possible to devise a method of eliminating the excess fat without losing so much weight. For example some form of intermittent fasting such as 5:2 might do the trick. This idea relies on Roy Taylor's observations that fat comes out of the liver first but typically accumulates over a decade or so. In other words regular small bites at the cherry might add up over time. This would have to be put to the test, unless it is obviously wishful thinking.

 

[JITR]

If it were the case that bg normalised within a short period prior to weight loss then one would have no need to restrict how much one ate afterwards. Remission would have been achieved and completed in a fortnight. How can this be squared with trials like Direct and the dependence they demonstrate of remission success upon amount of weight lost?

Roy Taylor answered that question in this talk:
Achieving T2D remission (May 2023)

 

[harbottle]

I ate more carbs (not huge amounts but more than before), but not more food/calories just for ease of daily life and hba1c started to creep up and then weight did. Then I was hospitalised with Covid and things got worse and never got back to where they were beforehand.

I did the same, as well as stopping Metformin, and it went from 36 to 39 (Last one was 37). Just small amounts of carbs with meals.
Although my fasting levels are fine, post-meal does go high if I eat carbs, so the bacon sandwiches are still a no-no.

 

[Dragonheart]

If it were the case that bg normalised within a short period prior to weight loss then one would have no need to restrict how much one ate afterwards. Remission would have been achieved and completed in a fortnight. How can this be squared with trials like Direct and the dependence they demonstrate of remission success upon amount of weight lost?

Blood glucose can begin to normalise within hours based solely on food intake. It’s dynamic. Keeping it so for prolonged periods results in hba1c falling. The two measures are not the same thing. Once that excess glucose supply is removed, and excess insulin begins to fall, then the body can utilise the rest of what goes in afterwards and begin burning the excess body and visceral fat off showing as weight loss.

Remission is defined by decent enough glucose control to get a normal hba1c, not by weight loss. That’s just a tool to help achieve it. But not the only one. Some definitions require a maintenance for a set period of time. Others just reaching that number however quickly.

Again I’m not saying weight loss doesn’t help achieve remission but if it’s done by cutting all food groups then that involves cutting carbs too as well as relieving fat from the organs enabling better function. Those trials by virtue of the restriction of food overall restrict carbs too btw.

I’m pretty confused by your comment. Surely you aren’t suggesting one low carb day, one set of good bgl for the day and the problem is solved - or thinking that I am doing so. Of course you need to keep doing the right thing and cutting the carbs or else you’re just turning the glucose tap back on. Low carb isn’t about restricting intake overall or even calories. It’s about reducing blood glucose and insulin to normal levels by removing some of the carbs going in. That in turn allows the visceral and body fat to fall.

 

[Drummer]

Once I reduced the carbs so that I was under 8mmol/l after eating something definitely started to change, and went on changing as I ate the same meals - weighed and measured out, so the same, but my levels dropped lower and lower, through the 7s, down into 6's and after a year I could eat a meal with higher carbs and not go high. Actually two Christmas dinners on consecutive days gave exactly the same reading afterwards.
My clothes were falling off me - I had stopped weighing long before diagnosis, could not stand to know my weight had gone up yet again, and I just thought that the elastic in the waist had given up - all my clothes were old and my body practically spherical.
I don't want to start to eat a 'normal' diet, as it is not normal for me, and I would far rather eat as I do now at the age of 73 and dance around like a spring lamb than go back to where I was at the age of 65.

 

[childofthesea43]

Blood glucose can begin to normalise within hours based solely on food intake. It’s dynamic. Keeping it so for prolonged periods results in hba1c falling. The two measures are not the same thing. Once that excess glucose supply is removed, and excess insulin begins to fall, then the body can utilise the rest of what goes in afterwards and begin burning the excess body and visceral fat off showing as weight loss.

Remission is defined by decent enough glucose control to get a normal hba1c, not by weight loss. That’s just a tool to help achieve it. But not the only one. Some definitions require a maintenance for a set period of time. Others just reaching that number however quickly.

Again I’m not saying weight loss doesn’t help achieve remission but if it’s done by cutting all food groups then that involves cutting carbs too as well as relieving fat from the organs enabling better function. Those trials by virtue of the restriction of food overall restrict carbs too btw.

I’m pretty confused by your comment. Surely you aren’t suggesting one low carb day, one set of good bgl for the day and the problem is solved - or thinking that I am doing so. Of course you need to keep doing the right thing and cutting the carbs or else you’re just turning the glucose tap back on. Low carb isn’t about restricting intake overall or even calories. It’s about reducing blood glucose and insulin to normal levels by removing some of the carbs going in. That in turn allows the visceral and body fat to fall.

For myself, now with remission maintained for almost four years, it is the case that this has no dependence at all upon how many carbs I eat. I think that somewhere there is a disconnect between your model of diabetic pathology and remediation and the model espoused by the scientists who conducted Direct and associated trials. They don’t mention or consider carbs as having any role at all to play in all this and when I mentioned that their low cal regimen was also low carb they described that observation as facile and that the low carb advocates “only half understood the science of metabolism”. For me the jury is out at present but in the end I think that science will have to be the decider eventually, not a chorus of personal anecdotes, however ostensibly persuasive they may be. So meanwhile the issue is in a kind of limbo and God help the poor newbies trying to make sense of it all.

 

[BobbleHat]

If it were the case that bg normalised within a short period prior to weight loss then one would have no need to restrict how much one ate afterwards. Remission would have been achieved and completed in a fortnight. How can this be squared with trials like Direct and the dependence they demonstrate of remission success upon amount of weight lost?

For myself, now with remission maintained for almost four years, it is the case that this has no dependence at all upon how many carbs I eat. I think that somewhere there is a disconnect between your model of diabetic pathology and remediation and the model espoused by the scientists who conducted Direct and associated trials. They don’t mention or consider carbs as having any role at all to play in all this and when I mentioned that their low cal regimen was also low carb they described that observation as facile and that the low carb advocates “only half understood the science of metabolism”. For me the jury is out at present but in the end I think that science will have to be the decider eventually, not a chorus of personal anecdotes, however ostensibly persuasive they may be. So meanwhile the issue is in a kind of limbo and God help the poor newbies trying to make sense of it all.

I'm a newbie (diagnosed end of July!) so thanks for the thoughts and prayers!
I seem to be what I've seen @Drummer describes a your basic type 2 (albeit with a strong family history of T2). I was largely externally asymptomatic upon diagnosis but obese with a fatty liver.
As you say the most terrifying thing about being new is hearing all the different theories, some of which are in direct contradiction to each other and almost all go against my surgery's advice of eat brown rice and less potatoes. It really does feel you 'pay your money and take your chance'.

For me, actually the choice was easy, I wasn't going to calorie count as, after years of yo-yo dieting and disordered eating, that's the way madness lies for me
.
So, low carb and IF have been my choice. It seems to be working. My blood sugars, based on finger pricks, have never gone below 4 nor above 8.5 and I've lost 20lbs without remotely trying (which with my chequered past around diets is a really big deal). I feel -amazing. My digestion is better, my sleep is better, my menopause symptoms are better, I have energy that I didn’t have before. Plus, I really love the food I've been eating for the past 2 months!

I've come to the conclusion that I'm just not very carb tolerant anyway (even without diabetes - I was pre-diabetic at 42 mmol, 12 months before diagnosis so I know I haven't been living with years of undiagnosed diabetes to explain 'carb sickness').

I'm presumptious, I know, posting in the remission section when the absolute earliest I could claim remission, if everything is straightforward, would be February 2026. I suppose I'm just echoing the idea that I would love to be able to say I was 'cured' eventually, with my beta cells dancing the tango and doing their thing but I think lower carb suits me irrelevant of diabetes and I'm not in a hurry to resume a way of eating that patently didn’t work for me even my metabolism supposedly wasn't broken.

 

[everydayupsanddowns]

So, low carb and IF have been my choice. It seems to be working. My blood sugars, based on finger pricks, have never gone below 4 nor above 8.5 and I've lost 20lbs without remotely trying (which with my chequered past around diets is a really big deal). I feel -amazing. My digestion is better, my sleep is better, my menopause symptoms are better, I have energy that I didn’t have before. Plus, I really love the food I've been eating for the past 2 months!

I've come to the conclusion that I'm just not very carb tolerant anyway

Great stuff @BobbleHat

It’s wonderful reading that you have found a system that works for you, that you find workable and enjoyable, and which has improved symptoms in so many aspects of your life.

Well done you!