Weight loss rate and remission

[PerSpinasAdAstra]

Hi folks,

I've read a little bit about the association between rapid weight loss on a very low calorie diet, and remission. I'm also trying to read up on the causes of insulin resistance and the possible roles of visceral fat stored in adipose tissue (normal fat cells) around the liver and pancreas, and ectopic fat stored in the tissue of the organs themselves.

What I am unclear on is if rapid weight loss is necessary to achieve remission, or if gradual weight loss will do the trick just as well. The reason I ask is that rapid weight loss is associated with loss of muscle mass, which will cause a lowered basal metabolic rate (BMR) - the calories we burn daily just by surviving as opposed to burned during exercise. A lower BMR makes it a little harder to keep the weight off once you reach your target weight.

Is there any indication that losing weight fast is important if you want to burn off visceral fat and ectopic fat stored in the internal organs? Are there cases where people achieved remission following long, slow weight loss?

 

[Drummer]

@PerSpinasAdAstra
I did not aim for rapid weightloss as I had given up on ever losing any weight at the time of diagnosis. I can't lose weight on a high carb diet, yet it is the one option I was pushed into all the time by my GP and other HCPs, until I was almost spherical.
I ate low carb from the moment of diagnosis, but I ate anything else, even all the things which are supposed to be deadly - red meat, for instance, and lots of eggs. I did not restrict calories, I never counted them as CICO calculations never added up for me, not unless I can photosynthesise despite my pink complexion making that improbable.
All I focused on was keeping my blood glucose in the normal range - I worked on being under 8mmol/l at the 2 hour test. I can't tell you how fast the weightloss was as I had stopped weighing myself long before, and I refused to discus my weight with nurses.
My return to normal blood glucose was rapid. I was no longer diabetic at 80 days from diagnosis, and at the top end of normal at 6 months, which now seems normal for me even at the age of 72.
My recorded weightloss is 90lb, but it could be more.
I am definitely stronger now than at diagnosis as I can pick up the same knitting machines now which defeated me pre diagnosis.
As I have no idea of where I lost fat from (and I could still do with losing more if I am honest) I can't really give a scientific answer to your enquiry, but I feel so well on my simple ploy of glucose control and it has obviously done the trick of restoring my metabolism to something like normal plus it was just about effortless as well, I can only recommend low carb with a blood glucose meter to check what the individual can tolerate as a way to manage if one is an ordinary type two diabetic.

 

[harbottle]

I think the rapid weight loss thing was done to emulate what happens before bariatric surgery, where it's been seen that improvements to blood sugar levels start as soon as calories are restricted.

I did lose weight quite rapidly myself when I cut the carbs/calories - 3 stone in 3 months, but I did see improvements to blood sugar almost straight away as my symptom (Blurred eyesight) went away before I even started on the second metformin tablet. The initial weight loss was rapid, but it levelled out after a few weeks, which is a known consequence of low carb diet.

I do a lot of exercise (Walking + weights) to keep muscles in use.

 

[Eddy Edson]

Hi folks,

I've read a little bit about the association between rapid weight loss on a very low calorie diet, and remission. I'm also trying to read up on the causes of insulin resistance and the possible roles of visceral fat stored in adipose tissue (normal fat cells) around the liver and pancreas, and ectopic fat stored in the tissue of the organs themselves.

What I am unclear on is if rapid weight loss is necessary to achieve remission, or if gradual weight loss will do the trick just as well. The reason I ask is that rapid weight loss is associated with loss of muscle mass, which will cause a lowered basal metabolic rate (BMR) - the calories we burn daily just by surviving as opposed to burned during exercise. A lower BMR makes it a little harder to keep the weight off once you reach your target weight.

Is there any indication that losing weight fast is important if you want to burn off visceral fat and ectopic fat stored in the internal organs? Are there cases where people achieved remission following long, slow weight loss?

It's highly likely that the speed of weight loss doesn't matter much for remission. Anyway, I reversed my T2D by old-school grinding off about half a kilo per week on average. Both Roy Taylor and Mike Lean have commented that it shouldn't make a difference, except that it might be easier for some to achieve the necessary weight loss by doing it quickly and in a very diet-controlled fashion.

Your concerns about muscle mass are totally valid - I wish I'd been as thoughtful before I started to lose weight!

But I'd say that BMR concerns are a bit secondary. The biggest total BMR impact will likely be from fat mass loss, even if muscle mass contributes more to BMR per kg - just because you're lilely to lose far moss fat than muscle.

Losing muscle mass has many other fitness implications, obviously.

I'd recommend making sure you have a good resistance training plan in place and you're eating enough protein before embarking on any kind of weight loss program.

EDIT Coincidentally, SImon Hill just published this, which might be useful:

 

[nonethewiser]

Took my wife around 15 months to lose 5 stone, beforehand she was told by gp that she had borderline diabetes so told her about Newcastle Diet where weight loss sometimes reverses condition, she didn't do Newcastle Diet but did follow a calorie reduced diet to lose the weight.

It was worthwhile as all bloods since have been normal, so it can work for some people & losing weight fast may not be the only strategy.

 

[PerSpinasAdAstra]

It's highly likely that the speed of weight loss doesn't matter much for remission. Anyway, I reversed my T2D by old-school grinding off about half a kilo per week on average. Both Roy Taylor and Mike Lean have commented that it shouldn't make a difference, except that it might be easier for some to achieve the necessary weight loss by doing it quickly and in a very diet-controlled fashion.

Your concerns about muscle mass are totally valid - I wish I'd been as thoughtful before I started to lose weight!

But I'd say that BMR concerns are a bit secondary. The biggest total BMR impact will likely be from fat mass loss, even if muscle mass contributes more to BMR per kg - just because you're lilely to lose far moss fat than muscle.

Losing muscle mass has many other fitness implications, obviously.

I'd recommend making sure you have a good resistance training plan in place and you're eating enough protein before embarking on any kind of weight loss program.

EDIT Coincidentally, SImon Hill just published this, which might be useful:

Excellent video, thanks for that. It answers many questions as regards ideal rate of weight loss and protein intake, coming from someone who seems very knowledgeable on the subject.

It's a long video so if anyone is looking for the highlights that apply to the topic of this thread, here are the timestamps:

Protein intake for muscle retention during weight loss
Above 1.6g of protein per kilo of body weight certainly. 2.2g per kilo of body weight may be helpful.
44:02 to 49:51

Weight loss strategies, calorie deficits, ideal rate of weight loss, 'starvation mode' and diet breaks
1:32:15 to 1:48:30

 

[Kopiert]

When I was first diagnosed, I went on a lower-carb diet and lost about 12 Kg (almost 2 stone) very quickly, but I also combined it with a significant increase in exercise - just walking in my case - 5 to 8 miles per day. I walked everywhere!

One piece of advice that was given to me that I pass on is don't think about it as a diet, but think about it as a lifestyle change - a wellness regime where you start to look after all aspects of your life. A diet can feel temporary, a lifestyle change is something positive and much more permanent.

 

[AndBreathe]

Back in the day, when I was diagnosed, the Newcastle Diet and all that went with it was new. I had the same question as you.

I didn’t do the soups and shakes thing. I preferred to go low carb. After my first A1c, I wrote to Professor Taylor asking of the importance of rapid weight loss or method of losing weight. He satiated that was unimportant. The important things was reducing visceral fat, and maintaining it.

 

[Deb_l]

As others have already said, the aim is to reduce visceral fat around your organs. Whether this is achieved quickly or slowly I think is not that important.

My own personal opinion however is the importance of maintaining the weight loss long term. Soups and shakes and other 'short cut' diets are OK and have their place but you have to find a lifestyle and way of eating that can be maintained for years to come, not just a few weeks.

 

[PerSpinasAdAstra]

Thanks for all the responses so far, they're very helpful.

I completely agree about focusing on lifestyle changes rather than relying on a temporary diet. I want to build better habits that I can sustain indefinitely. That has been my approach and it's worked very well so far; perhaps a little too well. I've lost around 5Kg this past month, and that includes plenty of eating and drinking over Christmas.

I'm at a point where I want to balance my primary goal of achieving remission, if that turns out to be possible, with looking beyond that toward keeping the weight off in the long term and maintaining strength and mobility as I grow older.

Based on what I've read and seen so far, the more body fat you have the less muscle loss occurs when losing weight rapidly. I'm about to cross the threshold from 'obese' to 'overweight' in BMI terms, so I'm going adjust my target for weight loss from 1Kg per week to a rate of 0.7% of my body weight per week from this point forward. To that end I'll be experimenting with red lentil pasta and lower carb/higher protein bread this week, along with eating lots more tuna, as a way to up my protein intake while trying to hit the weekly 0.7%.

I'm also going to take resistance training more seriously. I have my set of little weights and it's high time to start using them 😉

 

[mhtyler]

Thanks for all the responses so far, they're very helpful.

I completely agree about focusing on lifestyle changes rather than relying on a temporary diet. I want to build better habits that I can sustain indefinitely. That has been my approach and it's worked very well so far; perhaps a little too well. I've lost around 5Kg this past month, and that includes plenty of eating and drinking over Christmas.

I'm at a point where I want to balance my primary goal of achieving remission, if that turns out to be possible, with looking beyond that toward keeping the weight off in the long term and maintaining strength and mobility as I grow older.

Based on what I've read and seen so far, the more body fat you have the less muscle loss occurs when losing weight rapidly. I'm about to cross the threshold from 'obese' to 'overweight' in BMI terms, so I'm going adjust my target for weight loss from 1Kg per week to a rate of 0.7% of my body weight per week from this point forward. To that end I'll be experimenting with red lentil pasta and lower carb/higher protein bread this week, along with eating lots more tuna, as a way to up my protein intake while trying to hit the weekly 0.7%.

I'm also going to take resistance training more seriously. I have my set of little weights and it's high time to start using them 😉

I'm in week 2 of the 8 week rapid weight loss as recommended by Prof Taylor. In my case, slow loss meant no loss, but in this program I'm right on target and my numbers are now normal, which blows me away I haven't seen consistent normal numbers in more than 7 years, so far I'm a fan. The reason I responded to you though is about your comment on muscle loss. Dr Jason Fung points out that muscle loss is avoided using fasting protocols. That's great, but Prof Taylor points out that muscle loss over the 8 week rapid program is about 4 per cent. Well, if I can dump 15 kilos, I'll work on the muscle later. That said, I have a theory that gaining muscle mass, especially fast twitch type 2 muscle mass could be the missing link in really normalizing metabolism after reversal...should we be lucky enough to get there.

 

[PerSpinasAdAstra]

I'm in week 2 of the 8 week rapid weight loss as recommended by Prof Taylor. In my case, slow loss meant no loss, but in this program I'm right on target and my numbers are now normal, which blows me away I haven't seen consistent normal numbers in more than 7 years, so far I'm a fan. The reason I responded to you though is about your comment on muscle loss. Dr Jason Fung points out that muscle loss is avoided using fasting protocols. That's great, but Prof Taylor points out that muscle loss over the 8 week rapid program is about 4 per cent. Well, if I can dump 15 kilos, I'll work on the muscle later. That said, I have a theory that gaining muscle mass, especially fast twitch type 2 muscle mass could be the missing link in really normalizing metabolism after reversal...should we be lucky enough to get there.

Congratulations on your numbers and I wish you continued success on the rapid loss program. Hopefully Professor Taylor's hypothesis on reaching a 'threshold' of stored body fat reduction resulting in remission comes true for you as I hope it does for me.

Dr. Fung may be right about fasting and muscle loss, to a point. A large person has a lot of muscle mass dedicated to keeping that person upright and mobile, and I think it likely that any large weight loss will result in a reduction in that kind of muscle mass. Short fasts do avoid the 'crashed metabolism' problem that I've read about (mainly on fitness websites). I can see from my Fitbit that I'm currently in that 'crashed' state - my resting heart rate this week is a steady 63 beats per minute on average, whereas it never dipped below 73 BPM over the Christmas period when I wasn't dieting. My body is reducing my heart rate at rest, trying to conserve energy as it 'thinks' I'm starving, and it is in that state (again according to fitness websites) that loss of muscle mass is accelerated.

I'm having to choose between losing weight fast to try for remission as soon as possible, or easing back on the rate of weight loss to try to conserve muscle. Contrary to what I posted earlier I've chosen to stick with my target of 1Kg per week until I hit the 'magic' 15Kg weight loss threshold mentioned in Professor Taylor's research (3Kg more to go) and I'll adjust my diet at that point for a much slower 0.7% of body weight per week target at that time. I'm looking forward to not being hungry all the time 😉

I am lifting my little weights regularly to try to conserve muscle though I'm unsure how successful that will be. I'll just have to worry about building back muscle after I reach my target weight. I'm not so advanced in years that building muscle is impossible - difficult yes, but not impossible. Hopefully.

 

[mhtyler]

Hi folks,

I've read a little bit about the association between rapid weight loss on a very low calorie diet, and remission. I'm also trying to read up on the causes of insulin resistance and the possible roles of visceral fat stored in adipose tissue (normal fat cells) around the liver and pancreas, and ectopic fat stored in the tissue of the organs themselves.

What I am unclear on is if rapid weight loss is necessary to achieve remission, or if gradual weight loss will do the trick just as well. The reason I ask is that rapid weight loss is associated with loss of muscle mass, which will cause a lowered basal metabolic rate (BMR) - the calories we burn daily just by surviving as opposed to burned during exercise. A lower BMR makes it a little harder to keep the weight off once you reach your target weight.

Is there any indication that losing weight fast is important if you want to burn off visceral fat and ectopic fat stored in the internal organs? Are there cases where people achieved remission following long, slow weight loss?

Hey PerSinasAdAstra, I'd hit Youtube if you haven't already and watch all of Prof Taylor's videos there. i've watched them over and over. He's quite clear on the point that fast or slow doesn't matter; if you can get below your personal fat threshold you'll reverse the fat in your liver and pancreas (recovery of pancreas is a different matter). The reason his program does weight loss fast is three-fold: first, he was trying to do a study on the effect of weight loss and he wanted to get it done sooner rather than later. Second, his research on fast weight loss taught him that its a myth that it's dangerous and without basis in fact or study, and finally, he figured that a quick trip to lower weight even with a severe diet might be easier for many rather than taking a year or two to get there. This is all the more important when you consider that a diabetic pancreas is a finicking thing; the sooner you lower weight and remove that dangerous ectopic fat the better your chances of full recovery. I also recommend Dr Mark Lustig videos, he's a professor of endocrinology, and quite a brilliant guy. His perspective is largely on the dangers of sugar and that fits right in with T2DM. And of course Dr Jason Fung is all over Youtube with fasting to reverse T2DM. I largely failed at fasting, where I'm succeeding with Prof Taylor's strategy. One more thing: when you lose weight you don't get to pick and choose where it happens on your body, but the good news is that visceral, and intra-organ fat will come off before subcutaneous, and that is very good news indeed.

 

[PerSpinasAdAstra]

One more thing: when you lose weight you don't get to pick and choose where it happens on your body, but the good news is that visceral, and intra-organ fat will come off before subcutaneous, and that is very good news indeed.

In my experience at least that does not appear to be entirely true. I agree that nobody gets to pick where the fat comes off, though I appear to have lost a large amount of subcutaneous fat, particularly belly fat, before losing very significant amounts of visceral fat. I am aware that waist measurement is correlated with visceral fat, however...

I am on medication for high blood pressure, but despite relatively high doses my BP was still well above the doctors target of 130/80. I assumed that as I lost weight my BP would fall, so I refused a further increased dose and took to measuring my BP twice daily and recording it along with my weight. The idea was that I could inform my doctor as to when my BP medication dose might need to be lowered.

I found that my BP hardly budged as I lost the first 10Kg. A very slight lowering, but nothing dramatic. Then, in the space of 2 weeks and correlated with a further 2Kg weight loss, my BP dropped like a stone to well within the target range. I can only assume that within those 2 weeks, during that 2Kg loss, I lost a significant amount of visceral fat around my kidneys. I would have thought that if I had been losing that visceral fat steadily from the beginning my BP would have fallen in a slow and steady way instead of dropping so far so quickly.

Interestingly, in that same 2 week period my averaged weekly fasting blood glucose readings fell from 5.8 to 5.55 mmol/L and my averaged evening readings taken just before eating fell from 6 to 5.46 mmol/L. The medications on I'm on make it difficult to take these numbers at face value, though it's possible this is indicative of losing some liver fat at around the same time.

It's something I intend to ask my doctor about at my next appointment - whether blood pressure readings might be a useful proxy for estimating visceral fat loss. If it is, I think it might be useful in estimating where my 'personal fat threshold' is, if such a thing does exist. The point at which my BP stops falling rapidly with weight loss may be the point at which I have lost the majority of my visceral fat, which may approximate the weight threshold I would need to stay well below in order to avoid accumulation of visceral fat in future. The 'staying in remission' threshold. Maybe.

 

[mhtyler]

In my experience at least that does not appear to be entirely true. I agree that nobody gets to pick where the fat comes off, though I appear to have lost a large amount of subcutaneous fat, particularly belly fat, before losing very significant amounts of visceral fat. I am aware that waist measurement is correlated with visceral fat, however...

I am on medication for high blood pressure, but despite relatively high doses my BP was still well above the doctors target of 130/80. I assumed that as I lost weight my BP would fall, so I refused a further increased dose and took to measuring my BP twice daily and recording it along with my weight. The idea was that I could inform my doctor as to when my BP medication dose might need to be lowered.

I found that my BP hardly budged as I lost the first 10Kg. A very slight lowering, but nothing dramatic. Then, in the space of 2 weeks and correlated with a further 2Kg weight loss, my BP dropped like a stone to well within the target range. I can only assume that within those 2 weeks, during that 2Kg loss, I lost a significant amount of visceral fat around my kidneys. I would have thought that if I had been losing that visceral fat steadily from the beginning my BP would have fallen in a slow and steady way instead of dropping so far so quickly.

Interestingly, in that same 2 week period my averaged weekly fasting blood glucose readings fell from 5.8 to 5.55 mmol/L and my averaged evening readings taken just before eating fell from 6 to 5.46 mmol/L. The medications on I'm on make it difficult to take these numbers at face value, though it's possible this is indicative of losing some liver fat at around the same time.

It's something I intend to ask my doctor about at my next appointment - whether blood pressure readings might be a useful proxy for estimating visceral fat loss. If it is, I think it might be useful in estimating where my 'personal fat threshold' is, if such a thing does exist. The point at which my BP stops falling rapidly with weight loss may be the point at which I have lost the majority of my visceral fat, which may approximate the weight threshold I would need to stay well below in order to avoid accumulation of visceral fat in future. The 'staying in remission' threshold. Maybe.

There is no way for you to tell if your belly fat is mostly visceral or sub. without an mri. but the belly is the first place visceral goes to. Sub. Fat is metabolically neutral, so when you lose enough weight to impact your diabetes you may depend on it being visceral...that's how fat comes off.

 

[Eddy Edson]

In my experience at least that does not appear to be entirely true. I agree that nobody gets to pick where the fat comes off, though I appear to have lost a large amount of subcutaneous fat, particularly belly fat, before losing very significant amounts of visceral fat. I am aware that waist measurement is correlated with visceral fat, however...

I am on medication for high blood pressure, but despite relatively high doses my BP was still well above the doctors target of 130/80. I assumed that as I lost weight my BP would fall, so I refused a further increased dose and took to measuring my BP twice daily and recording it along with my weight. The idea was that I could inform my doctor as to when my BP medication dose might need to be lowered.

I found that my BP hardly budged as I lost the first 10Kg. A very slight lowering, but nothing dramatic. Then, in the space of 2 weeks and correlated with a further 2Kg weight loss, my BP dropped like a stone to well within the target range. I can only assume that within those 2 weeks, during that 2Kg loss, I lost a significant amount of visceral fat around my kidneys. I would have thought that if I had been losing that visceral fat steadily from the beginning my BP would have fallen in a slow and steady way instead of dropping so far so quickly.

Interestingly, in that same 2 week period my averaged weekly fasting blood glucose readings fell from 5.8 to 5.55 mmol/L and my averaged evening readings taken just before eating fell from 6 to 5.46 mmol/L. The medications on I'm on make it difficult to take these numbers at face value, though it's possible this is indicative of losing some liver fat at around the same time.

It's something I intend to ask my doctor about at my next appointment - whether blood pressure readings might be a useful proxy for estimating visceral fat loss. If it is, I think it might be useful in estimating where my 'personal fat threshold' is, if such a thing does exist. The point at which my BP stops falling rapidly with weight loss may be the point at which I have lost the majority of my visceral fat, which may approximate the weight threshold I would need to stay well below in order to avoid accumulation of visceral fat in future. The 'staying in remission' threshold. Maybe.

BP can certainly be expected to fall with weight loss, but I don't know of any studies linking it to visceral fat specifically, rather than just overall adiposity?

 

[PerSpinasAdAstra]

BP can certainly be expected to fall with weight loss, but I don't know of any studies linking it to visceral fat specifically, rather than just overall adiposity?

There are a few that mention visceral adipose tissue (VAT) specifically as part of a wider study of hypertension causes, though this one examines VAT specifically:

https://www.ahajournals.org/doi/full/10.1161/01.HYP.0000137982.10191.0a

Renal ectopic fat also appears in a few studies though I tend to lump internal organ ectopic fat and visceral adipose tissue fat in together, as hopefully (and I can't find anything that states it one way or the other) if I burn off one I'll burn off the other. I very much hope.

 

[Jinty2001]

Hi folks,

I've read a little bit about the association between rapid weight loss on a very low calorie diet, and remission. I'm also trying to read up on the causes of insulin resistance and the possible roles of visceral fat stored in adipose tissue (normal fat cells) around the liver and pancreas, and ectopic fat stored in the tissue of the organs themselves.

What I am unclear on is if rapid weight loss is necessary to achieve remission, or if gradual weight loss will do the trick just as well. The reason I ask is that rapid weight loss is associated with loss of muscle mass, which will cause a lowered basal metabolic rate (BMR) - the calories we burn daily just by surviving as opposed to burned during exercise. A lower BMR makes it a little harder to keep the weight off once you reach your target weight.

Is there any indication that losing weight fast is important if you want to burn off visceral fat and ectopic fat stored in the internal organs? Are there cases where people achieved remission following long, slow weight loss?

I’ve taken the tourist route to weight loss I had put it back on again last year but in remission. I need to be more careful not to put it on again and I’m losing about 2 lbs/ week sometimes more sometimes less I think the fast weight loss is before the diabetes does us damage. I’m probably wrong

 

[mhtyler]

BP can certainly be expected to fall with weight loss, but I don't know of any studies linking it to visceral fat specifically, rather than just overall adiposity?

There are at least 3 studies all done by Prof. Roy Taylor of Un. Newcastle, but it is well understood that subcutaneous fat is metabolically neutral, in fact it's the way fat is supposed to be stored for energy. Visceral fat (both kinds) isn't supposed to be there at all. However, we each have a limit to how much subcutaneous fat we can store, so if we keep making fat, the body puts it where it isn't supposed to be. At first, that means around the organs, and later when that fills up it begins to store fat IN the organs. Therefore, losing subcutaneous fat isn't going to affect either diabetes or blood pressure. A case in point, if you have seen a show called, "my 600lb life" you will have seen that many of these morbidly obese people don't have diabetes. Why? Because they have an enormous capacity to create new subcutaneous fat. There is another kind of diabetic called a TOFI; this is someone with a very low ability to create new subcutaneous fat, and so it is stored viscerally, and diabetes follows even though the person scarcely seems overweight. Prof. Taylor's concept for this is, "the personal fat threshold" beyond which you can no longer store subcutaneously and began storing the kind of fat that does mischief.

 

[Eddy Edson]

There are at least 3 studies all done by Prof. Roy Taylor of Un. Newcastle, but it is well understood that subcutaneous fat is metabolically neutral, in fact it's the way fat is supposed to be stored for energy. Visceral fat (both kinds) isn't supposed to be there at all. However, we each have a limit to how much subcutaneous fat we can store, so if we keep making fat, the body puts it where it isn't supposed to be. At first, that means around the organs, and later when that fills up it begins to store fat IN the organs. Therefore, losing subcutaneous fat isn't going to affect either diabetes or blood pressure. A case in point, if you have seen a show called, "my 600lb life" you will have seen that many of these morbidly obese people don't have diabetes. Why? Because they have an enormous capacity to create new subcutaneous fat. There is another kind of diabetic called a TOFI; this is someone with a very low ability to create new subcutaneous fat, and so it is stored viscerally, and diabetes follows even though the person scarcely seems overweight. Prof. Taylor's concept for this is, "the personal fat threshold" beyond which you can no longer store subcutaneously and began storing the kind of fat that does mischief.

Just talking about blood pressure here. Yes, clearing visceral fat can reverse T2D as it did for me. But I haven't seen much on the extent to which visceral fat is a BP driver independent of overall body fat.