Paths to remission or control. Newcastle and Low Carb.

[bulkbiker]

People on the NHS Low Calorie Programme are absolutely not being "given 3 months supply of food replacement pouches and left to go it alone."

Could people please not spread misinformation about this programme??

Diabetes UK strongly supports this programme. Where is a DUK moderator when you need one?

I'm guessing that you haven't been on the receiving end of what passes for "treatment" for T2 in the NHS recently?

Whilst the programme may set out with the best of intentions, I think you'll find that over time my description will prove far more accurate than yours.

 

[AndBreathe]

One of the most significant aspects of the results of the Direct trial is that T2 diabetes does not necessarily have to be seen as inevitably progressive in all cases any longer.

Reversing Type 2 Diabetes

Discover how Newcastle University research by Professor Roy Taylor could reverse Type 2 diabetes and change lives. Read the full story.

from.ncl.ac.uk

“Most recently, the Newcastle research has shown that the small, shrunken pancreas found in Type 2 diabetes actually recovers to its normal size and shape over the two years.

Research trial​

One trial, DiRECT (Diabetes Remission Clinical Trial), found that almost nine out of 10 people taking part who lost 15kg or more put their Type 2 diabetes into remission. The study also found that almost half of those were still off all their Type 2 diabetes medication with normal blood glucose levels after one year [without medication].“

About Professor Taylor

Roy Taylor is professor of Medicine and Metabolism at Newcastle University. His work has shown that Type 2 diabetes is not inevitably progressive and life-long

Those findings are not isolated to the DiRECT programme. Having been in remission over 9 years, living a reduced carb diet, based on eating to my meter, I demonstrate that.

Whilst I am my own person, doing things the way I find work for me, I am no “black swan”.

 

[Dragonheart]

It's not addressing cause at all. Hyperinsulinemia and insulin resistance are the cause, visceral fat is a visible symptom of them.

Why do you think we deposit fat on the organs rather than in safer places or use it? And what happens when those organs are covered in fat?

 

[Dragonheart]

Taylor could call a cat a dog but it wouldn't make it one. Neither will calling Good Control 'reversal' or 'remission '.

Are you confusing the definition of remission/reversal with a cure? Remission is good control. Neither are a cure which appears to be what you are looking for.

 

[Burylancs]

Are you confusing the definition of remission/reversal with a cure? Remission is good control. Neither are a cure which appears to be what you are looking for.

If 'remission ' is Good Control, please use the term Good Control and not 'remission'. It's giving newbies false hopes that they can somehow escape it. With Type 2 Diabetes there us no remission for good behaviour only the daily task of maintaining control of the symptoms.

 

[Dragonheart]

If 'remission ' is Good Control, please use the term Good Control and not 'remission'. It's giving newbies false hopes that they can somehow escape it. With Type 2 Diabetes there us no remission for good behaviour only the daily task of maintaining control of the symptoms.

Perhaps you are unfamiliar with the medically accepted definition of remission for type 2 diabetes. It means achieving a non diabetic hba1c (<48) without the use of medication. That’s it. Nothing else. And you get there by having and keeping good control using your preferred and successful method.

As I said it seems you believe remission is “cured” - meaning it’s gone for good with not effort at all and it’s not that

 

[Dragonheart]

@Burylancs out of curiosity do you believe it’s possible to avoid progression or have you accepted that as inevitable, how do you choose to manage your t2 and have you achieved remission by the accepted definition?

 

[childofthesea43]

With Type 2 Diabetes there us no remission for good behaviour only the daily task of maintaining control of the symptoms.

This seems a very odd statement. How does it apply to, say, my own case? I took the steps two years ago to lose a bit of weight and return HbA1c to the normal range and since then have stayed the same. Many others have too. What is this daily task of maintaining control all about? I don’t do any such thing, unless you count not over-eating as a “task”. What are these symptoms I am supposed to have? I am not aware of ever having had any. Perhaps you only mean that T2s retain a susceptibilty to relapse, which is true. But your oft-repeated and adamant mantra “there is no remission” is in my view faintly ridiculous.

 

[Burylancs]

Perhaps you are unfamiliar with the medically accepted definition of remission for type 2 diabetes. It means achieving a non diabetic hba1c (<48) without the use of medication. That’s it. Nothing else. And you get there by having and keeping good control using your preferred and successful method.

As I said it seems you believe remission is “cured” - meaning it’s gone for good with not effort at all and it’s not that

Roy Taylor's definition of 'remission' actually was/is achieving a A1c under 48 without using anti-hyperglycemic medication or anti-hypertension medication. When in your vague definition of 'remission' you say 'without the use of medication' are you excluding the usual panoply of medication used to control the consequences of T2 such as Statins, Ace Inhibitors, Blood Pressure meds etc etc

@Burylancs out of curiosity do you believe it’s possible to avoid progression or have you accepted that as inevitable, how do you choose to manage your t2 and have you achieved remission by the accepted definition?

But there is no 'accepted definition' of 'remission. When Windy researched it a year ago or so she found half a dozen different definitions. Every researcher seemed to be making it up as they went along with for example in the example above Taylor excluding the control of High Blood Pressure by medication. Australia's account of 'remission' quoted by Eddie E last year restricted it to T2s of less than 5 years duration whereas Taylor and GB have 6 year limit and so it goes on. With the remaining outstanding question being 'why on Earth would anyone want to try manage a chronic lifetime condition without the help of modern medical and scientific knowledge?' It's a recipe for OCD.

 

[childofthesea43]

For the original poster these definitional quibbles are unlikely to be helpful. The priority is to give them the encouragement to adjust lifestyle to reduce their HbA1c, by whatever tactics work for them, and then maintain the new status thereafter. This is entirely achievable by most newly-diagnosed T2s, as large numbers here can testify from their own experiences. And the research backs it up.

 

[bulkbiker]

whereas Taylor and GB have 6 year limit

That was part of the exclusion criteria for the DRECT trial.. not sure it has anything to do with the now generally accepted definition of remission of under 48 mmol/mol HbA1c unmedicated for 2 consecutive tests (so far as I am aware) .
I agree that it's a nonsensical definition but even ViRTA seem to have accepted it.
Taylor used to talk about reversal but seems to have dropped that these days,

 

[Leadinglights]

What I find quite puzzling is that we are saying that somebody is pre-diabetic or 'at risk' if their HbA1C is between 42 and 47mmol/mol and they need to do something about it, yet we are quite happy to say that someone is in remission if their HbA1C their HbA1C is less than 48mmol/mol.
To me remission if we are going to use that terminology should be below 42 mmol/mol.

 

[bulkbiker]

What I find quite puzzling is that we are saying that somebody is pre-diabetic or 'at risk' if their HbA1C is between 42 and 47mmol/mol and they need to do something about it, yet we are quite happy to say that someone is in remission if their HbA1C their HbA1C is less than 48mmol/mol.
To me remission if we are going to use that terminology should be below 42 mmol/mol.

I always thought that 40 mmol/mol would be a nice round number to aim for.

 

[Burylancs]

This seems a very odd statement. How does it apply to, say, my own case? I took the steps two years ago to lose a bit of weight and return HbA1c to the normal range and since then have stayed the same. Many others have too. What is this daily task of maintaining control all about? I don’t do any such thing,

Ahem ...may I remind the Hon. Poster of the statement in their Sig .....

'Daily regimen is 2000 cals with about 130-150g carbs and two fast walks covering 3 miles'

That seems to constitute 4 daily tasks you set yourself in order to maintain Good Control.

 

[childofthesea43]

Ahem ...may I remind the Hon. Poster of the statement in their Sig .....

'Daily regimen is 2000 cals with about 130-150g carbs and two fast walks covering 3 miles'

That seems to constitute 4 daily tasks you set yourself in order to maintain Good Control.

I don’t see it that way. I avoid eating too much in order not to gain weight. I choose moderate carbs for gastronomic reasons but knowing that increasing them would not materially affect my blood glucose. I’ve done that walking for years prior to diagnosis. I don’t think that living a healthy lifestyle should be cast as a “task” to maintain “control”.

 

[AndBreathe]

Ahem ...may I remind the Hon. Poster of the statement in their Sig .....

'Daily regimen is 2000 cals with about 130-150g carbs and two fast walks covering 3 miles'

That seems to constitute 4 daily tasks you set yourself in order to maintain Good Control.

@Burylancs , when does a change made, for the better, that works, and is continued for the longer term become just part of day-to-day life?

When diagnosed, as a result of feedback from my meter, I gave up certain foodstuffs, including bread and cakes. I haven't had any since (I am no GF, following the direction of an Endo, for my thyroid challenges). I can confidently say I haven't had such foods for over 9 years.

When does that change become my way of life? For me, I would suggest over 9 years ago. (I have never used alternative baked goods products.)

 

[childofthesea43]

I always thought that 40 mmol/mol would be a nice round number to aim for.

I’m certainly with you there, a far better target. Could be 45 for those aged over 70 owing to the changed red cell turnover.

 

[Dragonheart]

Roy Taylor's definition of 'remission' actually was/is achieving a A1c under 48 without using anti-hyperglycemic medication or anti-hypertension medication. When in your vague definition of 'remission' you say 'without the use of medication' are you excluding the usual panoply of medication used to control the consequences of T2 such as Statins, Ace Inhibitors, Blood Pressure meds etc etc

But there is no 'accepted definition' of 'remission. When Windy researched it a year ago or so she found half a dozen different definitions. Every researcher seemed to be making it up as they went along with for example in the example above Taylor excluding the control of High Blood Pressure by medication. Australia's account of 'remission' quoted by Eddie E last year restricted it to T2s of less than 5 years duration whereas Taylor and GB have 6 year limit and so it goes on. With the remaining outstanding question being 'why on Earth would anyone want to try manage a chronic lifetime condition without the help of modern medical and scientific knowledge?' It's a recipe for OCD.

It’s not “my” definition. https://www.diabetes.org.uk/about_us/news/remission-new-definition A press release almost 2 yrs ago clarifying an agreed consensus definition. I missed the 3 month requirement, but in reality that really only means a second below diagnostic levels test.

The other medications are not diabetes medications. They are to control other issues. Yes those other conditions often come alongside (poorly controlled) diabetes but are not diabetes itself and can and do occur separately- so yes they are excluded.

I never said medicinal help wasn’t beneficial to those that find it impossible to manage without for whatever reason. The argument here is that relying solely on diabetes medicines does not avoid progression, the data clears shows that. A lifestyle only management (or predominantly) can both avoid complications, and side effects from the medications themselves. Eating well and avoiding particular foods is self care and a long way from OCD for the majority. If you find it so onerous and aren’t worried about long term complications then perhaps medication is the better option for you. For many of us we’d rather avoid having to manage multiple conditions and medications for decades caused by not taking a bit of extra care initially.

 

[Dragonheart]

Unfortunately with the argumentative tone of many posts on this thread from a small minority, I would be quite surprised if the OP ever felt able to risk posting again.

Another person denied the possible support and encouragement of the forum. It’s very disappointing.

I totally see your point about wandering off the original topic - but as a moderator why not spilt the thread and continue the valid side discussion on a new thread? Or should we allow erroneous statements to stand unchallenged and potentially mislead other readers in order not to side track the original post? Advice please

 

[everydayupsanddowns]

I totally see your point about wandering off the original topic - but as a moderator why not spilt the thread and continue the valid side discussion on a new thread? Or should we allow erroneous statements to stand unchallenged and potentially mislead other readers in order not to side track the original post? Advice please

This is done frequently.

And requests are repeatedly made to keep newcomer threads on-topic, and to not divert them into detailed arguments comparing different interpretations of research findings.

See this thread for details: https://forum.diabetes.org.uk/boards/threads/members-responding-to-newcomers-please-remember.104405/

To my mind the discussion here is not about erroneous or misleading statements - it seems to be people who to entirely reject Prof Taylor's work as a viable option for anyone. Even though it has sufficiently robust clinical trial data behind it to be adopted as an option being offered more widely - after the success of a pilot programme.

As far as I'm concerned there's nothing about the possibility of people having success with the Newcastle Diet / Soup & Shake diet that detracts from people having success with a low carbohydrate approach (also supported in the NHS eg the Freshwell Project and by Diabetes UK). There simply isn't any need to say it 'doesn't work' just because it isn't an option that you chose yourself.