Quite cheery news

[Dragonheart]

Same as any other lifestyle weight-loss program. It's not a point against the NHS program. This data shows it working as well as or better than anything else.

That’s true and I didn’t mean it as a point against it. More putting it into context that it isn’t a one and done intervention as it is sometimes portrayed. And agreeing with your point that it’s difficult and people struggle. Also it means more hcp time if it’s supported in the same way the trial was.

Not all the options have been trialled in the same way.

 

[Deleted member 21371]

Lucky you. Agreed it makes no sense to cut people loose but that’s very common now and I don’t see a lot changing in the near future. On a population scale it’s highly unlikely they’d have the hcp’s needed to provide anything like the support these people got. Also remember by agreeing to be on the trial they are likely amongst the more motivated. Can you imagine that the wider public with less support will achieve the same 11%? I can’t unfortunately.

The trial was vitally important for two reasons though imo. The nhs accepts it has proven remission is possible, which opens a lot of doors away from a purely medicated approach. And obviously for those like you it does work for it puts them on a healthier path going forwards.

Also remember this only account for the subsection of type 2 that this approach works for. So that optimistic 11% isn’t 11% of all 4.2 million of us. I lost more than 20% (over 15kg) of my body weight, admitted not on this style program but low carb/keto (Professor Taylor is on record as having said it doesn’t matter how you lose the weight). Whilst I did achieve remission into normal not just pre diabetic levels without starving or drugs it did require me to maintain low carb eating rather than eat as “normal”. So it’s not the panacea to eat a “balanced” higher carb diet for all. Some of us have more causing our issues than just visceral or body fat. I didn’t even eat high carb in the first place as I don’t much like a lot of them and never had.

That was another that put me off the low carb path.
Of everyone that said it was the way to put diabetes into remission, they could all pass the OGTT, could all now eat carbs, how everything was reset, you are the first to actually say it didn't put you into remission, but you maintain BG by diet control, and eating carbs will still raise your BG.
But still the rest of the advocates avoid carbs as well, and still diet control even so.
That was never my goal.
I set out to reverse my diabetes, and eat anything again.

As to "starvation"?
Yes, that is a word that is bandied about a lot.
If 8 weeks on 800 calories a day is starvation to some, I just feel it's a bad few weeks for the hunter gatherer on the savanna, or forgetting to forage in the meat aisle at Tesco's before a long weekend.
Along with the fear of feeling hungry.
I'd rather feel hungry occasionally than lose my toes.

We all manage our diabetes differently.

 

[bulkbiker]

I'd rather feel hungry occasionally than lose my toes.

I'd rather lose the fear of losing my toes and not go hungry though..

 

[Deleted member 21371]

I'd rather lose the fear of losing my toes and not go hungry though..

Yes, both are fears you can choose your own way around.
We all manage our diabetes differently.
Today I managed mine with a 250g steak, a lot of assorted veg, a very nice baked potato, and a pepper sauce.
Sadly, nowhere near the 700g steak you eat by itself, but the veg and potato and sauce set the steak off for me.
We are all different.

 

[Dragonheart]

That was another that put me off the low carb path.
Of everyone that said it was the way to put diabetes into remission, they could all pass the OGTT, could all now eat carbs, how everything was reset, you are the first to actually say it didn't put you into remission, but you maintain BG by diet control, and eating carbs will still raise your BG.
But still the rest of the advocates avoid carbs as well, and still diet control even so.
That was never my goal.
I set out to reverse my diabetes, and eat anything again.

As to "starvation"?
Yes, that is a word that is bandied about a lot.
If 8 weeks on 800 calories a day is starvation to some, I just feel it's a bad few weeks for the hunter gatherer on the savanna, or forgetting to forage in the meat aisle at Tesco's before a long weekend.
Along with the fear of feeling hungry.
I'd rather feel hungry occasionally than lose my toes.

We all manage our diabetes differently.

I’m surprised everyone else you’ve spoken with claims they can now eat carbs and pass an OGTT. I’ve spoken to a couple like that but the majority need to maintain control with low carb, even if it can be more relaxed than initial stages. And it’s not just a few but many (go take a look on the red forum for example). And according to the now widely accepted definition of remission I have achieved it so I’m not sure why you say I didn’t. “Under 48mmol, without drugs” to paraphrase.

Conversely those that did the Newcastle method (which I qualified for by btw by virtue of the weight loss and maintenance as those actually are the only requirements according to Taylor) that I have spoke with still need to eat a reduced calorie/lower carb method than prior to the intervention, which concurs with the trials guidance ongoing. If you can eat anything you like without diabetic like rises I take my hat off to you and envy your results, but you don’t seen typical from what I’ve read.

Forgetting to forage the meat aisle before a sunny bank holiday is truly frightening.

Nothing I’ve said is meant to imply I think that this isn’t a valid option for some. All I’m trying to point out is that it doesn’t work for all even if they meet the criteria. There’s a thread somewhere this week talking about sub classes of type 2. I believe strongly we don’t all have the same trigger/cause and so we won’t all respond to the same treatment. To paraphrase you “we all need to manage our diabetes differently“

 

[Deleted member 21371]

I’m surprised everyone else you’ve spoken with claims they can now eat carbs and pass an OGTT. I’ve spoken to a couple like that but the majority need to maintain control with low carb, even if it can be more relaxed than initial stages. And it’s not just a few but many (go take a look on the red forum for example). And according to the now widely accepted definition of remission I have achieved it so I’m not sure why you say I didn’t. “Under 48mmol, without drugs” to paraphrase.

Conversely those that did the Newcastle method (which I qualified for by btw by virtue of the weight loss and maintenance as those actually are the only requirements according to Taylor) that I have spoke with still need to eat a reduced calorie/lower carb method than prior to the intervention, which concurs with the trials guidance ongoing. If you can eat anything you like without diabetic like rises I take my hat off to you and envy your results, but you don’t seen typical from what I’ve read.

Forgetting to forage the meat aisle before a sunny bank holiday is truly frightening.

Nothing I’ve said is meant to imply I think that this isn’t a valid option for some. All I’m trying to point out is that it doesn’t work for all even if they meet the criteria. There’s a thread somewhere this week talking about sub classes of type 2. I believe strongly we don’t all have the same trigger/cause and so we won’t all respond to the same treatment. To paraphrase you “we all need to manage our diabetes differently“

I think the difference is a maintenance diet is actually the calories I need not to gain weight, so I guess, yes, lower calories overall will mean lower carbs overall on the ratios.
As I was probably pigging out on three or four thousand calories at my peak, I doubt I'd maintain my weight loss going back on that.
I had my doubts initially on the fast/slow weigh loss, or if it's weight loss alone.
That's why I went for the Newcastle Diet by the book.
Time will tell if there is a different methodology.
But we all agree, weight loss by any method is always good.

 

[Dragonheart]

I think the difference is a maintenance diet is actually the calories I need not to gain weight, so I guess, yes, lower calories overall will mean lower carbs overall on the ratios.
As I was probably pigging out on three or four thousand calories at my peak, I doubt I'd maintain my weight loss going back on that.
I had my doubts initially on the fast/slow weigh loss, or if it's weight loss alone.
That's why I went for the Newcastle Diet by the book.
Time will tell if there is a different methodology.
But we all agree, weight loss by any method is always good.

Well Taylor himself has said the relevant factor is the weight loss rather than how you achieve it, and then maintaining that loss. If it were foolproof I would be in maintenance free remission (rather than having to maintain it actively) having done as required in 3 months, and then more in the next 3. My maintence method was to not increase my bgl (which incident did the same for my weight).

Wow that was a lot of calories. I believe I actually slightly increased calories whilst losing weight just by shifting where those calories came from. I certainly didn’t cut them. Oh my cholesterol improved a lot rather than got worse too. I never did overeat.

Yes being a sensible weight is good is so many ways.

 

[Deleted member 21371]

Well Taylor himself has said the relevant factor is the weight loss rather than how you achieve it, and then maintaining that loss. If it were foolproof I would be in maintenance free remission (rather than having to maintain it actively) having done as required in 3 months, and then more in the next 3. My maintence method was to not increase my bgl (which incident did the same for my weight).

Wow that was a lot of calories. I believe I actually slightly increased calories whilst losing weight just by shifting where those calories came from. I certainly didn’t cut them. Oh my cholesterol improved a lot rather than got worse too. I never did overeat.

Yes being a sensible weight is good is so many ways.

I was morbidly obese.
I probably lost 5 stone, so from 16 to 11 to fully reverse my diabetes.
So I just went full on for the result, and if it took more than the suggested percentage, there is more work to understand that.
But the final mop up to me was the final speed on the 800 calorie part, so maybe all diets weren't equal for me.

 

[Dragonheart]

I was morbidly obese.
I probably lost 5 stone, so from 16 to 11 to fully reverse my diabetes.
So I just went full on for the result, and if it took more than the suggested percentage, there is more work to understand that.
But the final mop up to me was the final speed on the 800 calorie part, so maybe all diets weren't equal for me.

Well your remission makes sense according to the hypothesis of the Newcastle approach. You met the criteria and got remission without maintenance required beyond only eating a reduced amount to match your reduced weight and can eat whatever carbs you want within that. I, immediately on diagnosis, also met the weight loss criteria and then some (well into normal bmi), only ate an amount that maintained my weight but still have a diabetic response to carbs if I eat a “normal“ amount. I was overweight but not obese.

I can only state yet again the author of the method has said that it doesn’t matter what diet/method you use to achieve the goals and has even said low carb is fine if it results in the weight loss and maintenance. The aim is to reduced visceral fat and the reason trial was very low calorie was designed to mimic the smaller food consumption seen after bariatric surgery as that was the inspiration for the whole thing. I’d love to know his explanation for people like me. (Or hear anyone else’s theories).

I don’t understand your last sentence.
What do you mean final speed?
And what is showing all diets not equal on your part as it’s me that fails the hypothesis, not you

 

[Burylancs]

So actually 11 / 98 = about 11% in remission at 5 years.

As with the 2 year result, the main thing determining this would have been how successful individuals have been at maintaining weight loss. The average weight loss from base line for these 11 in-remission folks at the 5 year mark was 8.9kg, down from the ~15kg for those in remission at 2 years.

It's not bad but it's not stellar and for me it just once again demonstrates how difficult it is for many, many people to maintain weight loss, even if it means losing T2D remission. Plenty of people can - eg me, you - but basically we're lucky. Others need more help.

An 89% failure rate ?
Nice try Roy but it's back to the drawing board
It's clearly not a viable approach for the vast majority of T2s. After losing the weight T2s need a better approach than spurning modern medical and scientific advances... Insulin pumps for example.

 

[Eddy Edson]

An 89% failure rate ?
Nice try Roy but it's back to the drawing board
It's clearly not a viable approach for the vast majority of T2s. After losing the weight T2s need a better approach than spurning modern medical and scientific advances... Insulin pumps for example.

It shows that maintaining substantial weight loss delivers long-lasting remission for a large proportion of T2D's.

It also adds to the overwhelming evidence that actually maintaining substantial weight loss long term is difficult/impossible for many/most people, even with a good support program. (No interest in discussing magic eat-all-you-want diets.)

The main implication as far as I can see is that weight management needs to be a core part of T2D treatment protocols (for the majority of cases), and meds like sema, tirpezatide etc need to be a part of this.

Food policy changes are a longer term thing which should also be pursued, but at the moment it's not at clear what those changes should be. Nobody as yet has an actual firm handle on what makes processed food hyperpalatable etc, despite everybody having opinions.

Once you get to the point where there is a good evidence base for policy changes, you then have to craft regs which the food companies cannot game. This is really difficult - gaming reg changes is a core competence for the big food companies.

Recent example: Some people are allergic to sesame. The FDA in the US mandated rigorous cleaning and inspection standards for processors if they want to *not* include sesame in ingredient lists on packaging. On the other hand, you can only include sesame in the ingredient lists if it is actually an ingredient.

After this regulation was introduced, parents noticed their sesame-allergic kids getting sick, even though they were eating the same branded products. It turned out that several big manufacturers had reformulated to include a small amount of sesame, so that they could include it on the labeling, rather than make the expensive changes to their processes required if they wanted to leave it off.

Parents didn't notice the tiny changes to the labeling & thought they were buying the same product. There was no avenue for regulatory action against the food companies: they had scrupulously complied with the new regs, and there is nothing requiring them to alert consumers to formulation changes (maybe there should be?).

 

[AndBreathe]

@Eddy Edson - I wonder if you missed my query? It relates specifically to the requirement for meds to maintain weight loss.

Thanks!

 

[bulkbiker]

Insulin pumps for example.

The absolutely last thing that hyperinsulinaemic T2's need..

 

[Spathiphyllum]

Lots of good points made in this thread, but also, I think, a couple of important misunderstandings. As I understand it:

Prof Taylor-- and the many other researchers who have done studies with essentially the same results-- do *not* say simply that weight loss will yield true reversal of T2D.

What *will* yield true reversal of T2D is loss of visceral fat, fat in and around the liver and pancreas. No matter how much weight you lose-- if all you lose is subcutaneous fat, you will not be able to reverse your T2D.

The problem is that it would be very expensive to give everybody who wants to try to reverse their T2D regular MRI scans to check their visceral fat!

So recommendations for people in general are made on the basis of what seems to work for most people in studies, where researchers have been able to scan the participants regularly and see what is actually going on with their visceral fat.

The initial phase of a very low calorie diet is recommended because this seems to get rid of visceral fat most effectively; and the recommendations regarding percentage of initial body weight one should lose are made on the basis of what seems to be associated with the best chance losing visceral fat.

Regarding the 'failure rate':

I'm not aware of any study showing that people who lose their visceral fat and keep it off nonetheless fail to reverse their T2D. But-- some people fail to lose enough visceral fat even initially, and lots of people fail to keep it off.

People clearly need a lot more support-- with psychology, with exercise, and with nutrition. Can we afford it? Yes. We can't afford not to.

The NHS itself says the cost of treating T2D currently is nearly 10% of the entire NHS budget. The total NHS budget for 2022/23 is £153 billion. Say cost of treating T2D currently is £15 billion p.a. And rising, as rates of T2D continue to rise.

Let's take a mere two billion of that. Let's recruit and train an army of specialist 'personal remission coaches'-- to provide psychological support and exercise support and nutrition support for people with T2D who are trying to achieve and maintain remission. And let's say we pay them a decent salary, say £40,000 a year.

For two billion pounds a year, we could get 50,000 of these people. If each of them was providing dedicated, intensive support to a group of 30 people with T2D-- they could be supporting 1.5 million people with T2D who genuinely want to try to achieve remission.

In the study this thread started with-- after the initial intensive phase, people were only getting support in the form of one appointment every three months, and still 23% of them managed to maintain remission after 5 years.

With the proposed army, people who really wanted to try to achieve and maintain remission could get support at least once a week and more often whenever they needed it. I bet much higher rates of remission could be achieved and maintained, leading to much lower costs for drugs and much lower costs for treating complications of T2D, such that the army would more than pay for itself.

Or we could just keep giving people with T2D more and more expensive drugs ...

 

[Eddy Edson]

View attachment 25473

View attachment 25474

@Eddy Edson - I wonder if you missed my query? It relates specifically to the requirement for meds to maintain weight loss.

Thanks!

Or bariatric intervention.

1. Review of weight loss interventions from earleir this year: https://forum.diabetes.org.uk/boards/threads/review-of-obesity-treatments.104802/

Say the target for "substantial" is >10% weight loss. Intensive lifestyle interventions in general deliver that for < 20% of participants. At the other end of the spectrum, the gold standard is bariatric surgery - practically everybody sees >10% weight loss. Sema+lifestyle works for 80%+, with tirpezatide+lifestyle doing a bit better.

2. Virta Health's 5 yr results show the same kind of thing, for an intensive low-carb program, as far as can be judged from their press release: https://forum.diabetes.org.uk/board...aybe-about-as-good-as-weight-watchers.100474/

3. Weight Watchers' RCT's and the gold-standard long-term Look AHEAD intensive lifestyle intervention trial, ditto.

4. Now this from DiRECT.

 

[Dragonheart]

Lots of good points made in this thread, but also, I think, a couple of important misunderstandings. As I understand it:

Prof Taylor-- and the many other researchers who have done studies with essentially the same results-- do *not* say simply that weight loss will yield true reversal of T2D.

What *will* yield true reversal of T2D is loss of visceral fat, fat in and around the liver and pancreas. No matter how much weight you lose-- if all you lose is subcutaneous fat, you will not be able to reverse your T2D.

The problem is that it would be very expensive to give everybody who wants to try to reverse their T2D regular MRI scans to check their visceral fat!

So recommendations for people in general are made on the basis of what seems to work for most people in studies, where researchers have been able to scan the participants regularly and see what is actually going on with their visceral fat.

The initial phase of a very low calorie diet is recommended because this seems to get rid of visceral fat most effectively; and the recommendations regarding percentage of initial body weight one should lose are made on the basis of what seems to be associated with the best chance losing visceral fat.

Regarding the 'failure rate':

I'm not aware of any study showing that people who lose their visceral fat and keep it off nonetheless fail to reverse their T2D. But-- some people fail to lose enough visceral fat even initially, and lots of people fail to keep it off.

People clearly need a lot more support-- with psychology, with exercise, and with nutrition. Can we afford it? Yes. We can't afford not to.

The NHS itself says the cost of treating T2D currently is nearly 10% of the entire NHS budget. The total NHS budget for 2022/23 is £153 billion. Say cost of treating T2D currently is £15 billion p.a. And rising, as rates of T2D continue to rise.

Let's take a mere two billion of that. Let's recruit and train an army of specialist 'personal remission coaches'-- to provide psychological support and exercise support and nutrition support for people with T2D who are trying to achieve and maintain remission. And let's say we pay them a decent salary, say £40,000 a year.

For two billion pounds a year, we could get 50,000 of these people. If each of them was providing dedicated, intensive support to a group of 30 people with T2D-- they could be supporting 1.5 million people with T2D who genuinely want to try to achieve remission.

In the study this thread started with-- after the initial intensive phase, people were only getting support in the form of one appointment every three months, and still 23% of them managed to maintain remission after 5 years.

With the proposed army, people who really wanted to try to achieve and maintain remission could get support at least once a week and more often whenever they needed it. I bet much higher rates of remission could be achieved and maintained, leading to much lower costs for drugs and much lower costs for treating complications of T2D, such that the army would more than pay for itself.

Or we could just keep giving people with T2D more and more expensive drugs ...

My claim was he said achieving the loss was what mattered, not the method of achieving it. I’m trying to find the original source that I’ve read on that and will come back with it when I find it. I’m not making it up because it’s convenient for my low carb position. I’m saying it because the man that devised the method said it.

The point you make about visceral fat is interesting. I am aware, that in this hypothesis, it is this particular fat is what’s required to achieve the remission. To suggest the failures (even in those that lose the required weight) might be down to where the loss occurs and that the typical response (15kg results in sufficient visceral fat loss) might not hold true for all is a sensible suggestion.

You make a compelling argument for better support in the nhs but when has common sense dictated nhs funding so far

 

[AndBreathe]

Or bariatric intervention.

1. Review of weight loss interventions from earleir this year: https://forum.diabetes.org.uk/boards/threads/review-of-obesity-treatments.104802/

Say the target for "substantial" is >10% weight loss. Intensive lifestyle interventions in general deliver that for < 20% of participants. At the other end of the spectrum, the gold standard is bariatric surgery - practically everybody sees >10% weight loss. Sema+lifestyle works for 80%+, with tirpezatide+lifestyle doing a bit better.

2. Virta Health's 5 yr results show the same kind of thing, for an intensive low-carb program, as far as can be judged from their press release: https://forum.diabetes.org.uk/board...aybe-about-as-good-as-weight-watchers.100474/

3. Weight Watchers' RCT's and the gold-standard long-term Look AHEAD intensive lifestyle intervention trial, ditto.

4. Now this from DiRECT.

I can see meds for remission, or very good control - however you want top phrase it, btu drugs for weight loss is a very, very slippery slope, in my view.

I am not a fan of bariatric surgery, having observed more than one person have it, only to find ways to eat themselves back to where they were - even with the restrictions their surgery imposed upon them Not to mention nutritional deficiencies, dumping syndrome, tachycardia, gastric bleeding and a host more.

I have a comprehensive .pdf outlining the major issues, but it is saved to my laptop. It doesn't contain the source, so unhelpful in that regard, but I would not have saved it had it not been from a source such as BMJ, Lancet or such like.

 

[Deleted member 21371]

Well your remission makes sense according to the hypothesis of the Newcastle approach. You met the criteria and got remission without maintenance required beyond only eating a reduced amount to match your reduced weight and can eat whatever carbs you want within that. I, immediately on diagnosis, also met the weight loss criteria and then some (well into normal bmi), only ate an amount that maintained my weight but still have a diabetic response to carbs if I eat a “normal“ amount. I was overweight but not obese.

I can only state yet again the author of the method has said that it doesn’t matter what diet/method you use to achieve the goals and has even said low carb is fine if it results in the weight loss and maintenance. The aim is to reduced visceral fat and the reason trial was very low calorie was designed to mimic the smaller food consumption seen after bariatric surgery as that was the inspiration for the whole thing. I’d love to know his explanation for people like me. (Or hear anyone else’s theories).

I don’t understand your last sentence.
What do you mean final speed?
And what is showing all diets not equal on your part as it’s me that fails the hypothesis, not you

I originally did a low fat diet for about a year, and lost a substantial amount of weight.
This did give me good numbers, but I still had a higher reaction to carbs than I would have liked.
At that stage the Newcastle Diet just broke into the news.
Originally Prof Taylor had noticed patients scheduled for bariatric surgery appeared to lose their diabetes, so instigated a trial using the same criteria, the 800 calorie shake based diet, and talked about a "personal fat threshold"
I figured I had nothing to lose, either I hadn't found mine yet, or the substantial calorie restriction led to a faster loss that maybe targeted different fat.
Either way I did it, it worked, and I lost about 30% of my weight overall, but only after the rapid loss in the last few weeks did I fully reverse my diabetes.
Since then many have tried to sell a similar diet, many have invented their own competing methods, and while Prof Taylor has always agreed any weight loss is good, and it works very well for some on here, really it's still only the original 800 calorie diet that has actually been studied.

 

[Eddy Edson]

I can see meds for remission, or very good control - however you want top phrase it, btu drugs for weight loss is a very, very slippery slope, in my view.

I am not a fan of bariatric surgery, having observed more than one person have it, only to find ways to eat themselves back to where they were - even with the restrictions their surgery imposed upon them Not to mention nutritional deficiencies, dumping syndrome, tachycardia, gastric bleeding and a host more.

I have a comprehensive .pdf outlining the major issues, but it is saved to my laptop. It doesn't contain the source, so unhelpful in that regard, but I would not have saved it had it not been from a source such as BMJ, Lancet or such like.

I've never really looked into it, but FWIW here's a detailed thread in support of bariatic surgery by an obesity practitioner:

https://twitter.com/x/status/1354498420187140097

 

[Spathiphyllum]

I can see meds for remission, or very good control - however you want top phrase it, btu drugs for weight loss is a very, very slippery slope, in my view.

I am not a fan of bariatric surgery, having observed more than one person have it, only to find ways to eat themselves back to where they were - even with the restrictions their surgery imposed upon them Not to mention nutritional deficiencies, dumping syndrome, tachycardia, gastric bleeding and a host more.

I have a comprehensive .pdf outlining the major issues, but it is saved to my laptop. It doesn't contain the source, so unhelpful in that regard, but I would not have saved it had it not been from a source such as BMJ, Lancet or such like.

Travellor's right; it was bariatric surgery that triggered Prof Taylor's interest.

In 1995, a study was published which became a landmark: obese patients with T2D had been given gastric bypass surgery and then followed for 14 years. Their T2D went into remission “with surprising speed, even before there was significant weight loss”, and, 14 years later, 91% of them were still in remission—they had effectively been cured of T2D. (https://www.nature.com/articles/d42859-021-00017-y ) And subsequent studies showed similar results.

Scientists floated a lot of complicated hypotheses about what was going on. But Taylor had the obvious, simple thought: Immediately after bariatric surgery, and for weeks after, there is of course a sudden and extreme drop in the amount of calories patients are consuming! And it was already well known that, with severe calorie restriction, the body first of all consumes ‘ectopic fat’, fat within organs like the liver.

Taylor hypothesised that this rapid decrease in liver fat would rapidly improve insulin sensitivity in the liver, kicking off the process of remission of T2D.

So he tried something very simple: putting a group of people with T2D on a very low calorie diet ('VLCD')—600 kcal a day—for 8 weeks, mimicking the sudden and severe calorie restriction after bariatric surgery.

“Within 7 days, liver fat decreased by 30%, becoming similar to that of the control group [people without T2D], and hepatic insulin sensitivity [i.e. the insulin sensitivity of the liver] normalized”; by the end of the 8 weeks, liver insulin sensitivity for the people on the VLCD was practically normal and their beta cells’ glucose sensitivity was practically normal—the latter being associated with a more gradual decline, over the whole 8 weeks, in pancreatic fat. (The quote is from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609491/pdf/1047.pdf , and see the original study, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168743/ .)

It may well be possible to lose liver/pancreatic fat without doing an initial VLCD-- especially if you exercise, which helps to shift visceral fat; but research shows VLCD gives you far the best chance.