Spiralling. Talk to me about Freshwell

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BobbleHat

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I do mean this in good faith. I'm still learning to pick through the good and bad science around diabetes.

But I read an old thread earlier today and it's sent my head in the wrong direction. I've been coping with my diagnosis but it was provably inevitable I'd wobble at some point and this is it, apparently.

There was a post critiquing the Freshwell approach - no specifics just a general thought that it was questionable.

I've grasped the Freshwell approach really enthusiastically. After reading around, it felt like the approach that made the most sense to me with my fatty liver and new T2 diagnosis. More importantly, it seems like a tasty, sustainable way to eat.

But, if there are negatives to choosing this approach, I feel like I need to know. It might not change my mind about eating this way (I recognise we all have different things that work) but I'm a health care professional (DEFINITELY NOT a diabetes specialist!) and I'm passionate about people being informed about the choices made in their healthcare. (Plus, I'm fixating and I know my own brain well enough to know that's not a good thing!)
Thanks in advance.
 
The only one I can think of is that eating too low carb can make you more insulin resistant and can mean you have more difficulty eating carbs in future ie your bgs go high because your body isn’t used to eating them.

If you aren’t doing anything too extreme though, you’re getting plenty of veg and a balanced diet, and if it’s working for you, then I’d stick to what’s working.
 
Lucyr said:
The only one I can think of is that eating too low carb can make you more insulin resistant and can mean you have more difficulty eating carbs in future ie your bgs go high because your body isn’t used to eating them.

If you aren’t doing anything too extreme though, you’re getting plenty of veg and a balanced diet, and if it’s working for you, then I’d stick to what’s working.
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Thank you for the reply. I feel like I'm eating better this way - lots more water, easily getting more veggies into my diet. There are things I need to watch - cholesterol for example but my focus first is learning to lower my hba1c, then I can tweak it (if needed, fingers crossed it's not) to better manage that.
 
Oddly, I've been reading papers on low carb diets and Lucy is right, there is evidence that they do cause insulin resistance, but the stuff I've been reading was in people without diabetes and a normal weight. The reasons might be down to more free fatty acids in the blood stream (I think this interferes with insulin receptors) and the central nervous system - it's quite well known that on a low carb diet the pancreas/beta cells become less responsive, hence why 3 days of carb loading is required before a OGTT as it can give a false positive.

This page is an overview of low carb diets:


There's quite a lot of hypothesis, but I don't think much long term research has been done. There was a thought that the high protein content of low carb diets was a problem, but there's been no evidence for that.
 
That page seems a well balanced review of the current state of knowledge, and lack of knowledge, at a first quick reading. For diabetics and prediabetics with no compiications, the overriding aim should be to get their liver back to normal, signalled by HbA1c in the 30s or as near to that as possible. A low carb diet is a good starting point for many people.
 
harbottle said:
Oddly, I've been reading papers on low carb diets and Lucy is right, there is evidence that they do cause insulin resistance, but the stuff I've been reading was in people without diabetes and a normal weight. The reasons might be down to more free fatty acids in the blood stream (I think this interferes with insulin receptors) and the central nervous system - it's quite well known that on a low carb diet the pancreas/beta cells become less responsive, hence why 3 days of carb loading is required before a OGTT as it can give a false positive.

This page is an overview of low carb diets:


There's quite a lot of hypothesis, but I don't think much long term research has been done. There was a thought that the high protein content of low carb diets was a problem, but there's been no evidence for that.
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That's an excellent summary and, although it is- like you say- a lot of hypothesis, it was still reassuring that this is a valid approach for glycaemic control.
 
JITR said:
That page seems a well balanced review of the current state of knowledge, and lack of knowledge, at a first quick reading. For diabetics and prediabetics with no compiications, the overriding aim should be to get their liver back to normal, signalled by HbA1c in the 30s or as near to that as possible. A low carb diet is a good starting point for many people.
Click to expand...
My fasting BG are going down, eating this way. When I first tested, I was usually in the 6s first thing. The last few days have been high 5s. If I've understood correctly that might be down to the low carb approach helping my fatty liver.
 
Yes, according to Prof Roy Taylor, when you burn fat it comes out of the liver first. Do you know he and his team showed in c.2008 that fatty liver reverses, and T2 goes into remission for many, on a weight loss diet?

In case not, here is the story in two of his videos (shorter and longer):
- Information for Doctors
- Roy Taylor, Achieving T2D remission (May 2023)

Also, you might find the section on weight loss in this article interesting:
- What should we eat?

I followed Roy Taylor's Newcastle Diet as I wanted to get my HbA1c down to normal before treatment for another condition. The advice in What should we eat? has helped me with weight maintenance, though it was my last port of call. I now wish I had known of it before I started.

Too much to find out for oneself in short order at the outset. Thanks for Dr Google.
 
www.diabetes.org.uk

Liver fat directly raises risk of type 2 diabetes

Is liver fat causing type 2 diabetes? Researchers, funded by us and led by our research fellow Dr Hanieh Yaghootkar, at Brunel University, explored whether liver and pancreas size and fat content could play a direct role in causing type 2 diabetes. They used Mendelian randomisation – a...
www.diabetes.org.uk www.diabetes.org.uk
 
Isn't it extraordinary that neither the Diabetes UK article (above) nor Haninteh Yaghootkar's research paper mention the groundbreaking c.2008 Counterpoint study (also funded by Diabetes UK)? This proved, by first class scientifc experiment, that fatty liver is the precursor to metabolic/dietary T2 diabetes. Beyond any reasonable doubt, IMHO.

The DiRECT study, which is mentioned, stemmed from the c.2008 Counterpoint study. DiRECT was the feasibility trial for the managed NHS "Soups & Shakes" programme. Counterpoint pointed a way forward for huge numbers pre-diabetics, newly diagnosed T2 diabetics, and even some long term T2 diabetics who have to manage for themselves.

Diabetes UK comment on Haninteh Yaghootkar's findings:
“We know from Diabetes UK’s landmark research on type 2 remission that liver and pancreas fat and size are linked to type 2 diabetes, but until now, it was unclear whether either of these factors played a direct role in causing type 2 diabetes.
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On the contrary, Roy Taylor's book 'Life without Diabetes Type 2' explains how liver and pancreas fat lead to type 2 diabetes, in great detail supported by MRI measurements. His team also discovered the pancreas shrinks just before the onset of T2.

diabetesjournals.org

Estimating the Effect of Liver and Pancreas Volume and Fat Content on Risk of Diabetes: A Mendelian Randomization Study

OBJECTIVE. Fat content and volume of liver and pancreas are associated with risk of diabetes in observational studies; whether these associations are causa
diabetesjournals.org diabetesjournals.org
 
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Taylor's work was funded by Diabetes UK.
His book is based on that research.

It's been known for some years that people with T2D have a shrunken pancreas - mainly from post-mortems of people with T2D. The link between weight and T2D diabetes has been known for years as well.

 
Lucyr said:
The only one I can think of is that eating too low carb can make you more insulin resistant and can mean you have more difficulty eating carbs in future ie your bgs go high because your body isn’t used to eating them.

If you aren’t doing anything too extreme though, you’re getting plenty of veg and a balanced diet, and if it’s working for you, then I’d stick to what’s working.
Click to expand...
The lifestyle nurse at my surgery said that to me Lucyr and I wondered that myself. I was pre-diabetic then returned for a number of years to the higher side of normal but now it has crept back to 42. I had overdone the carbs probably and wondered if my body now not being used to having too many if that had caused the trouble.

I am back trying to keep the carbs lower but having the occasional "treat" within reason. My GP and the DN have both said it is OK to treat yourself sometimes. I suppose that is common sense though for most people unless they are extremely active.
 
Several have mentioned low carb increasing IR. It can, temporarily and is reversible within days of increasing carbs again. It’s called adaptive glucose sparing or physiological insulin resistance (as opposed to pathological typically seen in type 2) and not considered harmful in the same way. It can also result in marginally higher fasting levels - yet sustained lower day long levels and better hba1c despite the small fasted rise.

If those who refer to this as if it were a problem and without context have any literature that supports a pathological response or something that lasts beyond days of returning to more typical carb levels I wish they’d attach a link or two to this as I can’t find anything.
 
As to the original question about the Freshwell diet, the reasons I chose not to adopt that approach are that: 1: It's not specifically a rapid weight-loss diet, 2: It recommends some food choices that may not be ideal for the purposes of controlling cholesterol, and 3: The website does indeed make some questionable claims about what 'healthy' food is. References to 'real food' for example as being 'naturally healthy'. Natural doesn't always imply healthy. Arsenic in apple seeds for example - 'naturally' poisonous. One claim on the site for example - 'Excess Sugar is turned straight into triglyceride (fat) in the liver'. This appears in a little yellow box on the website as if it was notable and important. This is accurate, in a sense, though a more accurate statement would be 'excess calories' in place of 'excess sugar', because that's how it actually works in reality.

As a simplified moderate-carb diet approach though I have no problem with Freshwell. Personally I went all-in on rapid weight loss via calorie counting and the Freshwell people don't seem to take that seriously enough in my view. After that I did (and still do) all kinds of messing with blood glucose testing and CGMs to adjust my diet and 'dial in' my carb intake - not too much such that my BG levels go much higher than those of a healthy person most days (and not extremely high ever, if I can avoid it) but not so low on carbs that I'm eating more protein and fat than I strictly need to be. In this way I avoid the issues mentioned above in the thread associated with insulin resistance due to low carb dieting. I can eat in McDonalds if I'm travelling and I really need to and the result isn't catastrophic according to the CGM testing. (A big portion of white rice is worse in my case than a Quarter Pounder with cheese and large fries). I take a low-dose statin to counteract issues associated with the saturated fats in my diet, and that's working well. I'm on meds inc. Metformin, which counteracts the negative effects that the statin might be having on insulin resistance levels. You could say that now that the weight loss is done I'm on a more conservative version of Freshwell, but with precautions. Also, the occasional ice cream, because it's delicious and looks better on a CGM than you might imagine. The Freshwell people wouldn't like that idea at all! Doesn't fit with their 'natural = healthy' worldview I try to take a 'middle path', balancing genuine and strongly suspected risks against one another, while avoid extremes in all their forms.
 
I don't go as strict on complex carbs as Freshwell advocate (I look for lower carb higher fibre higher protein options usually seeded bread, but I do like a slice of toast with fried eggs of a weekend for breakfast) and I don't like that they push sweeteners instead of sugar. I prefer to have lower sugar in treats by just putting less sugar in rather than substituting with chemicals (and even the more "natural" sweeteners are often extracted via a chemical process or even just recreated via chemical reactions). Or as @PerSpinasAdAstra says I'll also just have the occasional treat because it's nice to have the occasional treat, and doesn't push my HbA1c up noticeably if it is occasional
 
Going back to low carb and insulin resistance, it's possibly apparently due to the first phase of insulin being stopped - in effect, low carb meal in non-diabetics has a similar result to people with T2 diabetes in that the first phase is stopped or blunted.

And it can happen after a single meal - tea of < 50g of carbs can leads to an oral glucose test the following day giving a post-prandial result after two hours that would diagnose diabetes.

Causes are not known, but it might by a physiological mechanism that a stops beta cells responding, or an increase in FFA in the bloodstream causing slower clearance of glucose in muscles and the liver.
 
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