Quite cheery news

[Deleted member 21371]

As we all know DiRECT wasn't randomised either...the patients all knew if they were being starved or not..

Whereas low carb must be accepted as randomised, as no one knows if they are going low carb or not

 

[Dragonheart]

Agree that there should be more "testing of diabetics to establish actual insulin production", to avoid misclassification of T1s as T2s. And not only when people initially become diabetic, but also if their 'clinical presentation' changes.

As I've said in another post: it seems the problem is that C-peptide tests used to be very expensive and difficult, they aren't anymore, but a lot of medics don't seem to have realised this yet.

But-- if, for you, "it needs close to keto to keep ... the weight off"-- that proves definitively that your body is producing enough insulin. If your body was not producing enough insulin, i.e. if you were T1, your weight would drop like a stone (if you'll pardon the pun), no matter what you ate, and in particular no matter how many carbs you ate.

The likeliest explanation is that, even if you're now relatively slim overall, you still have enough visceral fat that you're still T2. In principle, there is an easy and definitive way to find out-- by doing an MRI scan of your abdomen. Unfortunately, MRI scans are still very expensive!

Alternatively, you could actually try a VLCD-- the Newcastle Diet or the NHS programme-- as these have been proven to give you the best chance of losing visceral fat.

I wasn’t meaning to imply t1 as the alternative. More another version of non type 1, or that t2 is actually a collection of differing types. That I possibly do produce some insulin but not a full amount to cope with normal carbs, only lower levels maybe. Also for me the weight goes up after the glucose levels do and as a result of them not the other way around. The glucose in the blood has to go somewhere and it goes to my fat cells. In reverse levels come down then the weight does. Maybe that’s relevant.

Yes it’s possible I didn’t lose enough visceral fat, that same way that same thing is possible for those that did the newcastle method without hitting remission, even though I did.

I could try the diet when it comes out. I’m not at all convinced by it. I’ll decide nearer the time.

I’ve also not seen anything that says it’s best chance I have of losing visceral fat. I linked many quotes earlier in the thread that show the method doesn’t matter. The shakes were used in a study for controllability and ease not because they have any evidence, that I can see, that this method is “better“

 

[bulkbiker]

Whereas low carb must be accepted as randomised, as no one knows if they are going low carb or not

Don't believe anyone claimed that it was though...

@Eddy Edson made the claim...

"that only the DiRECT protocol has RCT-level evidence for remission"

 

[Dragonheart]

No specialist on this subject but wonder if going very low carb to achieve weight loss is why you & others are so sensitive to carbs years later, whereas people like my wife & others who achieve weight loss by other methods are less sensitive to carbs.

Obviously way wife did it meant reduction in fat, chicken & tuna over red meats & some carbs she didn't exclude carbs as she still ate pasta in tuna & salad dishes rice with veg for example, plus diet allowed for 1 slice of bread daily also small portion of cereals like granola, so it was calorie reduction tion diet rather than anything else.

Maybe way of mark but trying to reason why there's a difference.

On subject of choices for those newly diagnosed type 2 & prediabetic, yes they should be choices as no one size suits all.

It’s not an outrageous theory on the face of it. Maybe there’s something to it but nothing that’s been demonstrated anywhere. But it doesn’t make sense scientifically to me.

How would eating less of a thing make you react worse to it? How does reducing the amount of insulin circulating make you more resistant to it ? If the visceral organs are de clogged they are declogged however it’s done. If you weigh less you weigh less.

It also doesn’t explain all the other cases that don’t succeed despite losing weight by calorie control (89% ultimately or more than 50% in the first year). WHY they failed or failed to maintain is as relevant as why I have to take strong ongoing measures to maintain success and as relevant as why people in both the low cal and low carb have succeeded more easily.

 

[Deleted member 21371]

Here's a late draft of the paper: https://findresearcher.sdu.dk/ws/files/199865152/dom.14633.pdf

The only issue is it was completely uncontrolled, and relying on the participants to accurately record the food they ate?
And there was a wide variety of meds for BG, cholesterol, etc.
Without knowing what calories were in the mix, it's impossible to come to any conclusions.
We have low carbers on here that state they are never hungry, and sometimes eat just one meal a day, so that is going to be lower calorie as well.
Or a breakfast will fill them for the day, or they only eat after noon.

 

[Deleted member 21371]

You don't seem keen on the term remission, even though that is the terminology used by both Professor Taylor and Diabetes UK relating to this trial.

This is a quote from , in the article tagged in your original post:

".... New findings from a three-year extension of our landmark DIRECT study show that nearly a quarter (23%) of participants who were in remission from type 2 diabetes at two years in the original trial remained in remission at five years.

This means they no longer needed to use diabetes medications to manage their blood sugar levels...."

It doesn't say anywhere they can expect to go back to a diet fulled by Ginsters (or whatever).

Please.
Greggs.

 

[Eddy Edson]

As we all know DiRECT wasn't randomised either...the patients all knew if they were being starved or not..

It was cluster randomised, so it was in fact randomised, as at least some people understand.

 

[bulkbiker]

It was cluster randomised, so it was in fact randomised, as at least some people understand.

There was no "randomisation" of the support levels given to the participants though was there?
A surgery using the starvation method would have given huge encouragement to the trial participants where the "control groups" would have been left with the usual non-interference of standard care that we have all experienced because that was the point of the trial.
It's even outlined in the trial design.

 

[Deleted member 21371]

View attachment 25605

There was no "randomisation" of the support levels given to the participants though was there?
A surgery using the starvation method would have given huge encouragement to the trial participants where the "control groups" would have been left with the usual non-interference of standard care that we have all experienced because that was the point of the trial.
It's even outlined in the trial design.

Well who knows, we didn't do it.
But saying as that is what is being rolled out nationwide, it's going to be repeatable then wouldn't you say?
(If it was a "starvation" diet, does that put me in the same league as Gandhi?
Cool, I may change my name)

 

[Burylancs]

It was cluster randomised, so it was in fact randomised, as at least some people understand.

Yup, David Spiegalhalter, Cambridge University Statistician, understands. And he insists that if clusters are randomised then clusters must be the unit compared and reported on not the individuals within them. Five years on Taylor seems to be making the same error with his 11%>. The true report should be on the percentage of clusters ( medical practices in DiRECT ) that had a participant in Taylor's definition of 'remission ' at 5 years. And it shouldn't just be the surgeries in the intervention group but also the surgeries in the control group. It seems that as far as Taylor is concerned the Control Group disappeared down the plughole years ago. Bad, baaaad Science.

 

[Deleted member 21371]

Yup, David Spiegalhalter, Cambridge University Statistician, understands. And he insists that if clusters are randomised clusters must be the unit compared and reported on not the individuals within them. Five years on Taylor seems to be making the same error with his 11%>. The true report should be on the percentage of clusters ( medical practices in DiRECT ) that had a participant in Taylor's definition of 'remission ' at 5 years.

We've been here before.
Spiegelhalter (with an e) gave the study his blessing, as the response I have posted on here when I asked him directly confirmed.

 

[nonethewiser]

It’s not an outrageous theory on the face of it. Maybe there’s something to it but nothing that’s been demonstrated anywhere. But it doesn’t make sense scientifically to me.

How would eating less of a thing make you react worse to it? How does reducing the amount of insulin circulating make you more resistant to it ? If the visceral organs are de clogged they are declogged however it’s done. If you weigh less you weigh less.

It also doesn’t explain all the other cases that don’t succeed despite losing weight by calorie control (89% ultimately or more than 50% in the first year). WHY they failed or failed to maintain is as relevant as why I have to take strong ongoing measures to maintain success and as relevant as why people in both the low cal and low carb have succeeded more easily.

As said earlier not my field so its just a theory based on observations on this forum, whereby those who go very low carb seem to react badly to any carbs whereas those who don't low carb or are less strict low carbers seem to tolerate them easier when going above their daily average.

Certainly more to it than anyone knows, our bodies are complex things.

 

[Eddy Edson]

So conceptually maybe it would make sense to support a broad array of maintenance strategies - low carb, Med, whatever - in the hope of increasing the chances of each individual finding something that works.

But I have no idea how you would do that in a way which avoids lots of people bouncing from one approach to another & never finding anything which does work. Which is what happens

I see that DUK is funding a study "NewDAWN" to work up maybe 4 different weight-loss / maintenance diets. In discovery phase at the moment.

https://twitter.com/x/status/1651174861253869570

 

[Deleted member 21371]

I see that DUK is funding a study "NewDAWN" to work up maybe 4 different weight-loss / maintenance diets. In discovery phase at the moment.

https://twitter.com/x/status/1651174861253869570

Is there a definition of each term?

 

[Deleted member 21371]

As said earlier not my field so its just a theory based on observations on this forum, whereby those who go very low carb seem to react badly to any carbs whereas those who don't low carb or are less strict low carbers seem to tolerate them easier when going above their daily average.

Certainly more to it than anyone knows, our bodies are complex things.

That was my takeaway.
Low carb is strictly low carb, and its a lifetime commitment.
No give in the diet.

It would be interesting to find out why one day.

That was the sole reason I went full on Gandhi, starvation diet, and though that would maybe pop out the fat in my pancreas, and get the islets clear.

 

[nonethewiser]

That was my takeaway.
Low carb is strictly low carb, and its a lifetime commitment.
No give in the diet.

It would be interesting to find out why one day.

That was the sole reason I went full on Gandhi, starvation diet, and though that would maybe pop out the fat in my pancreas, and get the islets clear.

Didn't say that, besides isn't low carb under 130g so there is some give in the diet.

Think with any diet you have to be careful about watching your weight, more so if you've been prediabetic before or reversed type 2 through weight loss.

 

[Deleted member 21371]

Didn't say that, besides isn't low carb under 130g so there is some give in the diet.

Think with any diet you have to be careful about watching your weight, more so if you've been prediabetic before or reversed type 2 through weight loss.

Shouldn't any standard population have to careful on weight?

Two puddings aren't good for anyone.
A box of custard donuts between meals?
A family size quiche as a snack?
A family bucket of KFC?
A couple of steak kebabs after dinner?

However, I found I can do a few occasionally, as long as I don't get fat.
(OK I have lost my taste for donuts)

But my takeaway from the Newcastle diet was I was exercising my pancreas with all those carbs. (Popping out the fat hopefully)
Then the dialogue changes, and I was told it must be low carb, because the calories meant that.
It's much the same way low carb lowers cholesterol, and that's good.
Apart from when it doesn't, then we need cholesterol for our brain.

 

[AndBreathe]

As said earlier not my field so its just a theory based on observations on this forum, whereby those who go very low carb seem to react badly to any carbs whereas those who don't low carb or are less strict low carbers seem to tolerate them easier when going above their daily average.

Certainly more to it than anyone knows, our bodies are complex things.

It is of course quite likely that those who eat "normal" or even near "normal" carbs would react uncomfortably to a keto diet if the jumped right in.

Our bodies wave a bit of memory, so prepare many hormones and digestive enzymes based on recent activity. So if a person has been eating a carb fuelled diet, then switch to one requiring fat for fuel, they are probably going to run into a form of carb flu, or plain old indigestion. The person running on fat, then key switching to carbs will likely be inefficient in terms of digestive hormones and enzymes for digestion. That is why an one-off result is a frail way to make longer term judgements.

 

[Deleted member 21371]

It is of course quite likely that those who eat "normal" or even near "normal" carbs would react uncomfortably to a keto diet if the jumped right in.

Our bodies wave a bit of memory, so prepare many hormones and digestive enzymes based on recent activity. So if a person has been eating a carb fuelled diet, then switch to one requiring fat for fuel, they are probably going to run into a form of carb flu, or plain old indigestion. The person running on fat, then key switching to carbs will likely be inefficient in terms of digestive hormones and enzymes for digestion. That is why an one-off result is a frail way to make longer term judgements.

That's not the issue with me.
I can happily live on anything I can (mostly) digest.
My issue is trying to work on a menu without a written sheet is a country without any language I speak, and just eating whatever is in the bowl.
Stopping doing that is not what I want into give diabetes.

 

[Dragonheart]

As said earlier not my field so its just a theory based on observations on this forum, whereby those who go very low carb seem to react badly to any carbs whereas those who don't low carb or are less strict low carbers seem to tolerate them easier when going above their daily average.

Certainly more to it than anyone knows, our bodies are complex things.

Quite true we are indeed complex.

I see the groups as those that more easily reach remission and maintenance and those that struggle more, with the method making less difference.

So some seem to need less weight loss or a more moderate carb reduction eg to the typical nhs 30/40 carbs a meal being those that struggle less and maintain with less drastic actions. It doesn’t seem to correlate to how high the initial hba1c is, possibly the larger people fall into the this category though. This is purely observational watching the experiences of others over the last several years.

Anyone know what the 1yr follow up of the retune study for non obese people says - if it exists? Similar principle to Direct but several shorter rounds of 2-4weeks using shakes and non starchy (low carb!) veg then a 4-6 week maintenance repeated up to 3 times til at least 10-15% of weight had been lost.