T2 Newbie - hoping to reverse it

[Deleted member 21371]

And of course the fact that it works is the main thing! But knowing why helps a lot, especially for people (including some GPs) who are uncertain or sceptical.

Yes, there has been a lot more research into diabetes reversal in the last eight years!

 

[Eddy Edson]

Yup! That is *the* thing about the 'Newcastle diet': a very low calorie diet causes the body to shed visceral fat preferentially, whereas a moderate reduction in calories doesn't have that effect.

I'm interested in this - do you have a reference to a study or something?

Taylor has said that he doesn't think it matters how quickly you lose the weight, but some people will find it more practicable to quickly get it over & done with.

Personally, I old-schooled it, cutting 500 or so kcals per day and losing half a kilo a week over a few months to get to T2D reversal. That was partly because I didn't hear about the Newcastle stuff (from @travellor ) until I was pretty well reversed - but anyway, it worked.

 

[Deleted member 21371]

I'm interested in this - do you have a reference to a study or something?

Taylor has said that he doesn't think it matters how quickly you lose the weight, but some people will find it more practicable to quickly get it over & done with.

Personally, I old-schooled it, cutting 500 or so kcals per day and losing half a kilo a week over a few months to get to T2D reversal. That was partly because I didn't hear about the Newcastle stuff (from @travellor ) until I was pretty well reversed - but anyway, it worked.

I remember Prof Taylor saying that at some point, but I thought it was in the context of "Losing weight be be helpful to any type 2 diabetic that needs to" then it developed into the "thin outside, fat inside" as he did more research.

Hopefully he can do more research into this, as he's always said it's about a personal fat threshold, but some of the original subjects he studied were on the pre diet to bariatric surgery, and still would be classed as very obese when they reversed theirs.
That was the pointer to start his vlcd initially
So not entirely just weight loss maybe?
That was one of the drivers for me to try it anyway.
Did you diet until you lost enough weight to be comfortable, or until you got normal BG?
I looked unwell after I lost my final weight.

 

[WalkdontRun]

I'm reading the Blood Sugar diet by Michael Mosley promoting the Newcastle diet, he did say it was possible to use "normal" food (still the 800cal limit) as I note he has a cooking book related to it. Did anyone do that and achieve the remission they wanted? Its not that I would not consider the alternative diet foods (shakes etc) or the time (2-3 mths hopefully) but that were they able to cut the weight without relying on them. Perhaps its the total diet change itself (and the easier foodstuff metabolism it requires as well). Naturally its harder to insure you are only hitting this cal limit and its the weight loss needed/speed of loss and how you are progressing to the goal that is the metric outcome.
How were you all (who met remission and did the diet plan) in maintaining weight after (assuming you stopped having shakes as your regular meals!!). What weight gain meant you had to go back and try and reverse it just in case?

 

[Kreator]

I'm reading the Blood Sugar diet by Michael Mosley promoting the Newcastle diet, he did say it was possible to use "normal" food (still the 800cal limit) as I note he has a cooking book related to it. Did anyone do that and achieve the remission they wanted? Its not that I would not consider the alternative diet foods (shakes etc) or the time (2-3 mths hopefully) but that were they able to cut the weight without relying on them. Perhaps its the total diet change itself (and the easier foodstuff metabolism it requires as well). Naturally its harder to insure you are only hitting this cal limit and its the weight loss needed/speed of loss and how you are progressing to the goal that is the metric outcome.
How were you all (who met remission and did the diet plan) in maintaining weight after (assuming you stopped having shakes as your regular meals!!). What weight gain meant you had to go back and try and reverse it just in case?

Strangely enough, before I started my shakes, I bought the Blood Sugar Diet book and managed to 'Control' my Diabetes to a point and had relatativly stable but still in T2D territory HbA1C's...DN Nurse was happy at the time, but I knew more was needed...

It was only on starting with shakes that I saw real improvements to my fasting BG after only a week or so...

The shakes were also a lot easier as I didnt have to think about what meals I was going to have - take a shake and it's done...

it also 'reset' my whole thinking around food, which meant starting to understand what food is, what do I relly enjoy eating, what's good for my body etc. etc.

Michael Mosely is really only taking Roy Taylor's work and putting his own spin on it..however, I can't knock Michael Mosely as I've taken a lot of his own recipes for myself moving forward...his work helps, but more in a maintanence kind of way if that makes sense?

I'd recommend Roy Taylor's own book 'Life Without Diabetes' to have an understanding of the mechanics 😉

 

[trophywench]

Well it was the fact that Dr Mosley was told he was TOFI, after that was talked about by Roy Taylor, that spurred him on - and once he found for himself that losing the visceral fat made him both feel and perform better - he published exactly how he sorted himself out.

 

[Eddy Edson]

Well it was the fact that Dr Mosley was told he was TOFI, after that was talked about by Roy Taylor, that spurred him on - and once he found for himself that losing the visceral fat made him both feel and perform better - he published exactly how he sorted himself out.

Where he crosses over into grifter territory is when he implicitly starts to promote the idea that there is some kind of weight loss lifestyle approach which is intrinsically better than most others.

In fact, every lifestyle intervention looks like this:



Some people respond really well, some respond really badly, many hardly respond at all. Same is true for calorie counting, low carb, low fat, intermittent fasting, Weight Watchers (the best-studied & best-evidenced commercial program), Virta Health etc etc etc.

Claims for superiority of one approach over others almost invariably involve cherry picking useless anecdotes from the left-hand side responders and ignoring everybody else.

Mosely got to be one of the responders over on the left side of the chart with his approach. My circumstances were very similar to his, but I got to be one of the repsonders via old-school calorie counting.

Neither success means anything for how well the approaches would work for anybody else, and all the evidence suggests that on average, neither will work very well.

On the other hand, the new weight loss drugs - semaglutides, tirpezatide, potentially even better ones currently in testing - do an incredible, game-changing job of shifting most people over to the left in those charts.

 

[Spathiphyllum]

In fact, every lifestyle intervention looks like this: ...

On the Blood Sugar Diet website, Dr Mosley provides a link to evidence indicating that, the more rapid and greater your initial weight loss, the more likely you are to sustain long-term weight loss; and other studies have shown this too (for example, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039735/ ).

So Dr Mosley is certainly not "cherry picking useless anecdotes".

On the other hand, the new weight loss drugs - semaglutides, tirpezatide, potentially even better ones currently in testing - do an incredible, game-changing job ...

Just so no one is confused: (even) the new weight-loss drugs need to be taken *on top of* changes in diet and exercise, not instead of.

Tirzepatide looks to be the most promising. It was studied first for treatment of T2D-- in the strict sense of simply improving glycaemic control-- and seemed very effective; so it has now been authorised for use in the UK (as well as the EU and US) in treating T2D: https://www.pulsetoday.co.uk/news/c...-marketing-authorisation-for-type-2-diabetes/ .

The initial T2D studies showed tirzepatide also helped to support and maintain weight loss. So the manufacturer has done a number of clinical trials specifically on its use for weight loss, for people with and without T2D, and the results look very promising. For the main study so far, the article giving the results is behind a paywall, but a summary is here: https://www.acc.org/latest-in-cardiology/clinical-trials/2022/08/04/15/32/surmount-1 . And there is an open-access article about the full set of studies on tirzepatide for weight loss: https://onlinelibrary.wiley.com/doi/10.1002/oby.23612 .

All of these studies are using tirzepatide as an adjunct to 'lifestyle intervention'. First of all, you have to be willing to make significant changes to your diet and start exercising; *if* you are willing to do that, tirzepatide appears to help people to stick to it (by slowing the rate at which the stomach empties and reducing appetite).

 

[Eddy Edson]

On the Blood Sugar Diet website, Dr Mosley provides a link to evidence indicating that, the more rapid and greater your initial weight loss, the more likely you are to sustain long-term weight loss; and other studies have shown this too (for example, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039735/ ).

Just on that study, maybe I'm missing the point, but what it seems to say is that being an early responder was a good predictor of being a long-term responder.

So that could generate a hypothesis for the waterfall chart I showed for a typical lifestyle intervention at the 3-year mark: the left-hand side responders at 3 years perhaps tended to be also responders at much earlier stages.

I'm not sure that there's anything to be gleaned from this about whether one intervention is better than another.

Just so no one is confused: (even) the new weight-loss drugs need to be taken *on top of* changes in diet and exercise, not instead of.

I've seen this nice articulation: these meds allow lifestyle interventions to actually work well, whereas without them, they don't work very well at all, on average. So they allow (many) more people to shift to the left versus that typical waterfall chart I showed.

And as a result, they will allow many more T2D's to achieve remission/reversal. (Although I guess if you have to keep taking them you wouldn't fit the current definition for "remission" - dunno, don't really care.)

Tirpezatide/Mounjaro currently has FDA approval for T2D and is fast-tracked for possible obesity approval. I think people would be very surprised if ti didn't get it, and in the meantime it is being prescribed off-label for weight loss, to the extent that supply constraints allow.

Eric Topol has a useful overview piece from a few weeks ago: https://erictopol.substack.com/p/the-new-obesity-breakthrough-drugs

Just for weight loss, the results are huge:


With tirzepatide, in the most recent trial, average of 20%+ weight loss at 72 weeks at 10mg-15mg dose.

And Stephen Guyenet had an in-depth look at the development of these drugs last year: https://forum.diabetes.org.uk/boards/threads/guyenet-on-weight-loss-meds.95831/

The main issues at the moment are cost-effectiveness (borderline at best, at current prices, according to standard health economics analyses); supply issues; injections rather than pills; some gastro etc side-effects during ramp up.

Also, possible need to keep taking them forever, but that's basically the same for any chronic condition.

 

[Poppy460]

Type 2 is very much a lifestyle change. After only being diagnosed by accident, and been told that it was the menopause, I have now reduced my numbers from 93! To 54. I did get down to 49, but have gone back up again. I wasn’t particularly overweight but was obviously doing something wrong. I have lost several kilos without trying, now at 66kg. I daren’t lose any more weight otherwise I will look like a skeleton. I am now dealing with, poor circulation, always being cold, thin skin on feet and hands and now my cholesterol is up! Trying very hard to get into remission but finding the last few numbers hard. Exercise is difficult with time management. Any help and advice would be gratefully received.

 

[Deleted member 21371]

Type 2 is very much a lifestyle change. After only being diagnosed by accident, and been told that it was the menopause, I have now reduced my numbers from 93! To 54. I did get down to 49, but have gone back up again. I wasn’t particularly overweight but was obviously doing something wrong. I have lost several kilos without trying, now at 66kg. I daren’t lose any more weight otherwise I will look like a skeleton. I am now dealing with, poor circulation, always being cold, thin skin on feet and hands and now my cholesterol is up! Trying very hard to get into remission but finding the last few numbers hard. Exercise is difficult with time management. Any help and advice would be gratefully received.

Did you go low carb, and increase fats?

 

[Poppy460]

I cut out all sugars I could and went down 30 points in 3 months. Yes , I probably did take comfort with an increase in fats, hence the cholesterol. Finding it hard to find foods that are not fatty and fill me up. I don’t eat bread anymore, pasta very rarely, I am confused about basmati rice.

 

[Leadinglights]

I cut out all sugars I could and went down 30 points in 3 months. Yes , I probably did take comfort with an increase in fats, hence the cholesterol. Finding it hard to find foods that are not fatty and fill me up. I don’t eat bread anymore, pasta very rarely, I am confused about basmati rice.

A couple of things I find very filling are high protein yoghurts or Kvarg deserts which are both low carb and low fat
If you still want pasta then edamame or black bean pasta is far lower carb than standard pasta only about 15g carb per 100g dry weight, I find a 25g dry weigh is plenty for a portion.
You would only know if you can tolerate rice as it is high carb by testing its effect on your blood glucose with a home monitor.