Professor Taylor teaches me to hope

[mhtyler]

Here is a chart from Professor Taylor's Counterbalance study. This is the study that immediately preceded his large scale DIRECT study.

The triangles represent non-responders, and the black dots the responders. What are they? Well, only a little less than half of the subjects (responders) who managed 33 pounds or 15 kilos of weight loss went into remission. Why? Because many had T2D so long that their pancreas function didn't recover. Those who recovered tended to have had T2D for less than 6 years, but at 10 years remission became rare. What Professor Taylor doesn't point out, since it isn't germane to his study is the definition of pancreas recovery. Intrinsic to the study it means those whose A1c fell below 7. The average in remission was actually 6.2. VLCD stands for Very Low Calorie Diet, and the gray bar starts at the 8-week mark after weight loss when everyone in the study began to return to a normal diet. Apparently, like many other organs and systems in the body, the pancreas has a lot of spare capacity. So much so, that you can lose 80 per cent of your ability to produce insulin and still produce enough for normal function. Apparently also, by the time someone is pre diabetic they may have already lost as much as 60% of pancreas function. That is why one of the key points of the study is that if you've been diagnosed with pre or T2D, you'd better get on your horse and do something about it ASAP.

In going thru the Counterbalance study I saw that there was one subject that appeared to be a non-responder, but over 6 months moved into the responder category. I asked Professor Taylor if anyone in the study had appeared in the first 8 weeks to be a responder but after return to a normal diet moved into the non-responder category. This AM he responded that none had done so. This rather confirms that if you go onto his VLCD diet for even a week or two and monitor your glucose you can get a broad hint as to whether you are still capable of remission thru weight loss. It does strike me though that even in remission you are, "riding on the rims" because if your pancreas gets worn out you are well and truly scr.....

On a personal note, I've just passed the 20 Lb weight loss mark. It appears I'll be in the responder category, but I can tell you that even though my glucose levels are normal (actually high normal) at this point I don't seem to have gained ANY extra insulin sensitivity that I can measure. Of course, I haven't reached the 33 Lb mark, and maybe the magic will happen then, but I have a feeling that this situation is a little less binary than responder/non-responder. If I don't respond as I first hoped, I take solace that this serious level of weight loss will have many other positives for me. No more fatty liver, lower risk of CVD, all sorts of things really, and here in the U.S. normal weight is becoming as rare as hens teeth, especially when you're pushing 70 as I am. So, even if you're not interested in doing the Newcastle diet, you could give it a short term trial just to see if you are a responder.

 

[JITR]

Yes, I agree, far more advantage could be taken of 1-4 weeks on shakes then switch to a less demanding weight loss diet. That's the short version of a longer story.

 

[mhtyler]

Yes, I agree, far more advantage could be taken of 1-4 weeks on shakes then switch to a less demanding weight loss diet. That's the short version of a longer story.

Yes, as much as I admire Prof. Taylor's work, he's a scientist (and doctor) whereas we're the ones on the front line. 33 pounds may resolve the diabetes even if you're still obese, but we all understand that obesity is still a monkey on our backs. I also think that a long term lower carb approach is better for people in remission, better for keeping weight low, better for your numbers, better for long term remission.

 

[JITR]

Yes, as much as I admire Prof. Taylor's work, he's a scientist (and doctor) whereas we're the ones on the front line. 33 pounds may resolve the diabetes even if you're still obese, but we all understand that obesity is still a monkey on our backs. I also think that a long term lower carb approach is better for people in remission, better for keeping weight low, better for your numbers, better for long term remission.

Yes but Professor Taylor was the first to call for research into diets for long term remission. I think a long term (low carb), weight loss and maintenance could kick in after the first 1-4 weeks on shakes. Once it's demonstrated that such a diet could also bring glucose levels rapidly from the start, there might be no more need for the shakes, except for convenience.

 

[mhtyler]

Yes but Professor Taylor was the first to call for research into diets for long term remission. I think a long term (low carb), weight loss and maintenance could kick in after the first 1-4 weeks on shakes. Once it's demonstrated that such a diet could also bring glucose levels rapidly from the start, there might be no more need for the shakes, except for convenience.

I meant no denegration of the good professor, only that his interests are broader and scientific. Ours are personal.

 

[JITR]

I meant no denegration of the good professor, only that his interests are broader and scientific. Ours are personal.

Our National Health Service treats patients. Helping people to look after themselves would be a better model for T2D, it would align professional and personal interests.

 

[childofthesea43]

For those of who get into remission, a useful possible guide as to whether one’s pancreas has recovered normal first-phase response is to experiment with carb levels. In my own case multiple 3-month experiments established that my fasting bg and A1c were unaltered even by tripling carbs intake provided the reduced weight were maintained. This is exactly what Prof Taylor confirmed to me a year or so ago.

 

[Eddy Edson]

In my own case multiple 3-month experiments established that my fasting bg and A1c were unaltered even by tripling carbs intake provided the reduced weight were maintained.

Me also.

 

[childofthesea43]

But whether a recovered pancras is a permanently weakened one that will eventually lead to loss of remission despite weight constancy is the great unknown.

 

[mhtyler]

Our National Health Service treats patients. Helping people to look after themselves would be a better model for T2D, it would align professional and personal interests.

For the record, doctors everywhere else treat patients too.

 

[mhtyler]

For those of who get into remission, a useful possible guide as to whether one’s pancreas has recovered normal first-phase response is to experiment with carb levels. In my own case multiple 3-month experiments established that my fasting bg and A1c were unaltered even by tripling carbs intake provided the reduced weight were maintained. This is exactly what Prof Taylor confirmed to me a year or so ago.

This was after you completed your weight loss, yes? What was the procedure?

 

[mhtyler]

But whether a recovered pancras is a permanently weakened one that will eventually lead to loss of remission despite weight constancy is the great unknown.

Yes, I've certainly come to understand that even if you accomplish remission, your pancreas is a perishable article, and it behooves you to treat it with kid gloves diet wise.

 

[JITR]

But whether a recovered pancras is a permanently weakened one that will eventually lead to loss of remission despite weight constancy is the great unknown.

Yes, but is there any reason to suppose that is likely, given a reasonable diet.

 

[mhtyler]

Here is an example of the world of science vs the real world. Prof. Taylor recommends that weight maintenance should include eating 75 percent of the calories you used to. I'm certain that advice is accurate, but the devil is in the details. It is my observation that any successful long-term diet, and now I'm using that word in the context of normal eating, involves eating to satiety. Going hungry is something you can do for a time, but not indefinitely. It seems prudent then to interpret that advice as finding a way to eat fewer calories and still be satisfied. A higher-fat diet is more satisfying than a low fat one, and protein has an even higher satiety than fat, so that sort of diet is my goal now, and once I reach my optimal weight as well.

Yes, but is there any reason to suppose that is likely, given a reasonable diet.

What is reasonable? A low carb diet seems to be the most diabetic friendly long term and won't stress the pancreas ability to produce insulin.

 

[childofthesea43]

This was after you completed your weight loss, yes? What was the procedure?

Yes, after completing weight loss and stabilising it. I then constructed, for each of six three-monthly periods, an eating regimen with pre-calculated level of daily carbs for that period and fixed level of daily cals for all periods (so cals never altered, at about 1950). The six carb levels varied from 65g to 180g. Throughout all periods I measured weight, waist and fasting bg every fortnight, and had an A1c test at the end of each period. A1c was always in range 38-42, currently 40 on 150g carbs. I suppose all that faff could have been avoided by a proper oral glucose test but they are expensive. My regimens have all also included two fast-paced walks, morning and evening, every day for 3.5 years.

 

[JITR]

Here is an example of the world of science vs the real world. Prof. Taylor recommends that weight maintenance should include eating 75 percent of the calories you used to. I'm certain that advice is accurate, but the devil is in the details. It is my observation that any successful long-term diet, and now I'm using that word in the context of normal eating, involves eating to satiety. Going hungry is something you can do for a time, but not indefinitely. It seems prudent then to interpret that advice as finding a way to eat fewer calories and still be satisfied. A higher-fat diet is more satisfying than a low fat one, and protein has an even higher satiety than fat, so that sort of diet is my goal now, and once I reach my optimal weight as well.

What is reasonable? A low carb diet seems to be the most diabetic friendly long term and won't stress the pancreas ability to produce insulin.

I agree with your conclusion. Marty Kendall's (optimisingnutrition.com) data shows people who prioritise protein and the fat that goes with it, and so low carb, eat significantly less than those who don't, due to satiety. Still there's the possibility of weight gain to deal with. Zoe Harcombe has provided the best answer to that I have seen so far: eat to satiety, don't eat fat and carbs together, and allow enough time between meals for the body to digest carbs (via insulin) and then burn some fat (via glucagon). I'd be interested in your comments on that and any other ways of maintaining weight.

 

[mhtyler]

I agree with your conclusion. Marty Kendall's (optimisingnutrition.com) data shows people who prioritise protein and the fat that goes with it, and so low carb, eat significantly less than those who don't, due to satiety. Still there's the possibility of weight gain to deal with. Zoe Harcombe has provided the best answer to that I have seen so far: eat to satiety, don't eat fat and carbs together, and allow enough time between meals for the body to digest carbs (via insulin) and then burn some fat (via glucagon). I'd be interested in your comments on that and any other ways of maintaining weight.

First let me say, that any advice about maintaining weight on my part is purely theoretical. I'm not good at it. However, it is profoundly important to me to get good at it. The 4 weeks I spent at 700 calories per day taught me to keep my total carbs in the 50's, and my sugar sank to normal levels. However, when I couldn't maintain that low of a caloric intake and ultimately decided to settle on 1500-1600 for weight loss I was faced with a problem: How to have that many calories and STILL keep my carb intake in the 50's. At first I failed, and my sugar rose. but because I'd already proved that I could have normal sugar at that level I set about trying to figure out how to do it, and I did. Yesterday for example I had 1500 calories, 47g carbs, and 100g of protein. My diet is quite carnivore, but I still try to have as many salads as possible. Non starchy vegetables after all are more protein than carbs, leafy greens especially. I've also found excellent bread and pasta replacements. I still have chocolate pretty much every day!....but not much. I buy 70% cocoa bars. One square is 65 calories, 4 carbs, and 4 protein. Easy. How am I losing weight, and how do I plan to maintain? Simple and rather old fashioned; I count calories, carbs, and protein. I count calories because even though not all calories are equal they are still a general clue to whether you're eating too much. I count carbs to keep my sugar low, and also because it helps ensure that the calories I'm eating will do the least damage. I monitor protein to make sure I stay above my minimum. I also walk at least 10,000 steps a day, and I break it up into about 8 walks including after meals. It helps with glucose control, and doing so many keeps me active. When I reach optimal weight I'll go back to the gym and weight lift, because the older you get the more muscle mass you lose, and sarcopenia is one of the enemies of the diabetic. Now I've probably gone on too long, but there it is. ...and now its time for a walk.

 

[Drummer]

Decades before diagnosis with type 2 I needed Thyroxine as my thyroid stopped working. I took 200 micrograms daily for a long time - then another hormone deficiency, type 2 was finally diagnosed.
In both cases I had shown symptoms before but it was either ignored or the test missed it.
I started eating low carb all the time, having burnt the diet sheets the day after being told I was diabetic.
Gradually I began to show symptoms of hyperthyroid, my need for Thyroxin is way down - when I can see the GP I will ask for it to be reduced below the 125 micrograms prescribed last year as I had to reduce it for myself due to heart palpitations and an irregular heartbeat.
The rules and advice in the Harcombe diet are not what I follow, nor advise, to deal with type 2 if it is the plain and ordinary problem - it seems to be trying too hard.
Simply avoiding high carb foods seems to really help the endocrine system. I eat natural fats as they are the raw materials for hormones and many structures within the body. I changed one thing in the nanosecond after being given the diagnosis. No rules and regulations required.
I am really good at not regaining weight, and my shape is still wandering back to something younger looking and I really don't mind having to remake or buy new clothes as I become more ) ( rather than the ( ) I became following the usual advice.

 

[JITR]

Decades before diagnosis with type 2 I needed Thyroxine as my thyroid stopped working. I took 200 micrograms daily for a long time - then another hormone deficiency, type 2 was finally diagnosed.
In both cases I had shown symptoms before but it was either ignored or the test missed it.
I started eating low carb all the time, having burnt the diet sheets the day after being told I was diabetic.
Gradually I began to show symptoms of hyperthyroid, my need for Thyroxin is way down - when I can see the GP I will ask for it to be reduced below the 125 micrograms prescribed last year as I had to reduce it for myself due to heart palpitations and an irregular heartbeat.
The rules and advice in the Harcombe diet are not what I follow, nor advise, to deal with type 2 if it is the plain and ordinary problem - it seems to be trying too hard.
Simply avoiding high carb foods seems to really help the endocrine system. I eat natural fats as they are the raw materials for hormones and many structures within the body. I changed one thing in the nanosecond after being given the diagnosis. No rules and regulations required.
I am really good at not regaining weight, and my shape is still wandering back to something younger looking and I really don't mind having to remake or buy new clothes as I become more ) ( rather than the ( ) I became following the usual advice.

I would be really interested to know why you would not advise people to eat carbs and fat in separate meals, eat nutrient dense foods like meat to satiety, and allow enough time between 2 or 3 meals per day to allow for digestion of carbs (insulin) to be followed by fat burning (glucagon).

 

[JITR]

First let me say, that any advice about maintaining weight on my part is purely theoretical. I'm not good at it. However, it is profoundly important to me to get good at it. The 4 weeks I spent at 700 calories per day taught me to keep my total carbs in the 50's, and my sugar sank to normal levels. However, when I couldn't maintain that low of a caloric intake and ultimately decided to settle on 1500-1600 for weight loss I was faced with a problem: How to have that many calories and STILL keep my carb intake in the 50's. At first I failed, and my sugar rose. but because I'd already proved that I could have normal sugar at that level I set about trying to figure out how to do it, and I did. Yesterday for example I had 1500 calories, 47g carbs, and 100g of protein. My diet is quite carnivore, but I still try to have as many salads as possible. Non starchy vegetables after all are more protein than carbs, leafy greens especially. I've also found excellent bread and pasta replacements. I still have chocolate pretty much every day!....but not much. I buy 70% cocoa bars. One square is 65 calories, 4 carbs, and 4 protein. Easy. How am I losing weight, and how do I plan to maintain? Simple and rather old fashioned; I count calories, carbs, and protein. I count calories because even though not all calories are equal they are still a general clue to whether you're eating too much. I count carbs to keep my sugar low, and also because it helps ensure that the calories I'm eating will do the least damage. I monitor protein to make sure I stay above my minimum. I also walk at least 10,000 steps a day, and I break it up into about 8 walks including after meals. It helps with glucose control, and doing so many keeps me active. When I reach optimal weight I'll go back to the gym and weight lift, because the older you get the more muscle mass you lose, and sarcopenia is one of the enemies of the diabetic. Now I've probably gone on too long, but there it is. ...and now its time for a walk.

You do pretty much what I do now for maintenance. Enough protein and a lot of vegetables plus berries, Greek style yogurt and some oats, barley, beans, seeds and nuts from time to time. Protein key in the range 1.2-2.0 g/kg body weight per day.