What do you think about the terms ‘Remission’ or ‘Reversal’ of T2D

[Eddy Edson]

think that’s one of the potential confusions/misconceptions. Reach ‘remission’ with a quick intense diet... and then you can go back to eating just like you did before.

I think it's pretty clear in Taylor's approach. Long-term, you have to restrict calories so you don't put the weight back on. But you don't have to restrict carbs in particular.

I think a lot of the confusion comes from confusing "crap" = high calorie/low nutrient with "carbs". If you eat a lot of crap you'll put on weight, and crap often has lots of carbs. Usually cutting calories involves cutting crap, which generally means you'll end up eating less carbs.

But cutting carbs isn't the focus: there are lots of non-crap carby foods (eg fruit).

 

[Brando77]

Remission or Reversal. It's a goal you strive for but just because the Doc says you are you still have a lifetime of watching what you eat and do. Getting diagnosed was a wake up call for me.
I prefer 'Controlled' 🙂

 

[Andy HB]

Reversed is the description of choice for my condition. To me it doesn't mean cured because, as I mentioned in another post, you can reverse a reversal (oh no, not that again!).

Remission works too, but that feels like the diabetes symptoms can reassert themselves at some point in the future no matter what you do and I choose to believe that isn't the case.

Cured? Definitely not! 🙂

 

[everydayupsanddowns]

I think it's pretty clear in Taylor's approach. Long-term, you have to restrict calories so you don't put the weight back on. But you don't have to restrict carbs in particular.

I think a lot of the confusion comes from confusing "crap" = high calorie/low nutrient with "carbs". If you eat a lot of crap you'll put on weight, and crap often has lots of carbs. Usually cutting calories involves cutting crap, which generally means you'll end up eating less carbs.

But cutting carbs isn't the focus: there are lots of non-crap carby foods (eg fruit).

It’s an interesting point to ponder, and until we have more people’s longer term experience, (and more research follow-up) I guess it will be difficult to tell. There is a school of thought among some HCPs that it is only ever calorie restriction that has any effect, and that ‘low carb’ is an illusion - but an approach that means that people simply eat fewer calories. I’m not sure that this fits with the observations I’ve made over the years on various forums among people who meet the criteria for ‘remission’ above, but then find BG rising because of what they describe as ‘carb creep’.

It reminds me of reading some early studies (still in the literature) on CHD problems associated with foods ‘high in saturated fat’ where that definition involved diets high in highly processed foods, biscuits, cakes, takeaways and the like, where sat fat was identified as being the problem in those foods, rather than any other aspect or component (trans fats... or whatever).

I wonder if it will depend on the extent to which metabolic function is restored by the weight loss / loss of visceral fat, and how much of the problem is down to other drivers connected with carb metabolism in different physiologies. Probably, in no small part connected with which ‘subtype’ of T2 an individual has.

 

[DebbieC]

its an interesting point to ponder, and until we have more people’s longer term experience, I guess it will be difficult to tell. There is a school of thought among some HCPs that it is only ever calorie restriction that has any effect, and that ‘low carb’ is an illusion - but an approach that means that people simply eat fewer calories. I’m not sure that this fits with the observations I’ve made over the years on various forums among people who meet the criteria for ‘remission’ above, but then find BG rising because of what they describe as ‘carb creep’.

It reminds me of reading some early studies (still in the literature) on CHD problems associated with foods ‘high in saturated fat’ where that definition involved diets high in highly processed foods, biscuits, cakes, takeaways and the like, where sat fat was identified as being the problem in those foods, rather than any other aspect or component (trans fats... or whatever).

I wonder if it will depend on the extent to which metabolic function is restored by the weight loss / loss of visceral fat, and how much of the problem is down to other drivers connected with carb metabolism in different physiologies. Probably, in no small part connected with which ‘subtype’ of T2 an individual has.

Yes it’s surely complex... I suppose eventually more studies will show but for James even though he has lost about 5 stone I think the results steer more towards lower carb than weight loss and calorie restriction: he had a carb heavy pub dinner last week with me and his BG was 8 after that... usually in 4s, 5s ...I felt guilty as had taken him out for dinner and let him have what he fancied... on the other hand maybe an 8 after sausage mash, pint lager , glass red wine and 2 spoonfuls cheesecake is not too horrendous...I was stupidly hoping that with the weight loss etc he would remain in 5-6s and have to say I was worried when I saw the 8... but this really was a one off and for the other 99 percent I make sure everything is healthy low carb etc...

 

[everydayupsanddowns]

his BG was 8 after that.

If I only get to 8 after a meal I am delighted! I don’t think any harm will come from an occasional foray into those sorts of numbers.

 

[Eddy Edson]

I’m not sure that this fits with the observations I’ve made over the years on various forums among people who meet the criteria for ‘remission’ above, but then find BG rising because of what they describe as ‘carb creep’.

Well, it would be consistent if the "carb creep" involved eating more crap => more calories => weight gain.

As you say, things are complex, but given the weight (so to speak) of expert evidence-based opinion behind the weight-linked view of metabolic dysfunction, it certainly shouldn't be dismissed out of hand or marginalised.

 

[Eddy Edson]

on the other hand maybe an 8 after sausage mash, pint lager , glass red wine and 2 spoonfuls cheesecake is not too horrendous

Non-diabetics routinely have that kind of reading.

 

[grovesy]

Personally I don't I think weight is the only factor. I think it is part of the puzzle. My weight has been more stable and lower than it has been for the last 5years or so, but what foods I can tolerate is not the same.

 

[zoombapup]

The way I understand Taylors work, its not the weight per-se, but the capacity available to transform carbohydrate into energy via insulin. So weight is basically eating up on the capacity because its damaging your ability to do the conversion. If you get under your threshold value, which appears to be different for everyone, then you regain some capacity and things begin to function as normal. So weight isn't the whole story, nor is carbs specifically, although the carbs clearly have a huge role to play in that balance.

 

[Docb]

When I had a proper job, one of the things I did was to look at process plants and try to work out how to minimise rejects. Not too dissimilar to trying to keep blood glucose under control.

If there was one thing I learned it was that in any system it was not a good idea to focus on one possible, even probable, important factor and study that to death. That's because there will be lots of other factors involved some of which may interact with the particular bee in your bonnet. Another thing we knew was that if you did not look at the system as a whole, sort out random factors from control factors and then do statistically based experiments to determine not only the effect of control variables, but the importance of interactions between them, all you finished up with was arguments between the proponents of the various mechanisms. Reality is invariably that all the factors put forward had some effect, with some being more important than others. Also that factors interact and if you don't have an understanding of those interactions then all get is arguments between the proponents and no agreement.

Informative experiments are far easier to do on large production plants than on people. For as start, there are no ethics involved and the plants themselves don't have an opinion.

 

[grovesy]

The way I understand Taylors work, its not the weight per-se, but the capacity available to transform carbohydrate into energy via insulin. So weight is basically eating up on the capacity because its damaging your ability to do the conversion. If you get under your threshold value, which appears to be different for everyone, then you regain some capacity and things begin to function as normal. So weight isn't the whole story, nor is carbs specifically, although the carbs clearly have a huge role to play in that balance.

Well I interpreted his work differently as they seem to focus on the weight loss.
They were trying replicate the weight loss that happens with baratric surgery. They also don't seem to know why it works for some and not others. I believe the next step is to look at those that are not classed as overweight.

 

[DebbieC]

Non-diabetics routinely have that kind of reading.

Really? 🙂 I thought getting to 8 was over the 7.8 ceiling? 🙂

 

[SueEK]

Really? 🙂 I thought getting to 8 was over the 7.8 ceiling? 🙂

I would have been happy with 8 after what he ate - very happy. Nothing wrong with having the odd splurge as long as it is just occasional x

 

[DebbieC]

I would have been happy with 8 after what he ate - very happy. Nothing wrong with having the odd splurge as long as it is just occasional x

Thanks @SueEK x

 

[DebbieC]

Non-diabetics routinely have that kind of reading.

Well @Eddy Edson you remain my hero as one night in early September after that visit to the nurse you messaged and said that her comments were nonsense.... we have so far proved thus and for that I remain grateful for the hope your one word invoked x

 

[Drummer]

I use the terms no longer diabetic for getting under 48 not on medication, and at the top end of the normal range at settling at 42.
I have had very little communication with the surgery, not seen the GP and only really been called in to be pushed to take statins since then, so the idea that my evil wicked and wilful refusal to become fit and heathy by eating carbs and training to run marathons would be punished was never really presented to me after diagnosis.
The concept of blame and shame is what needs changing - without that the actual terms used are far less loaded.

 

[Ralph-YK]

There is a school of thought among some HCPs that it is only ever calorie restriction that has any effect, and that ‘low carb’ is an illusion - but an approach that means that people simply eat fewer calories. I’m not sure that this fits with the observations I’ve made over the years on various forums among people who meet the criteria for ‘remission’ above, but then find BG rising because of what they describe as ‘carb creep’.

Getting into the area of what is weight management. And what is diabetes management. They are different things.

 

[Eddy Edson]

Really? 🙂 I thought getting to 8 was over the 7.8 ceiling? 🙂

Well @Eddy Edson you remain my hero as one night in early September after that visit to the nurse you messaged and said that her comments were nonsense.... we have so far proved thus and for that I remain grateful for the hope your one word invoked x

Awwww ... thanks! Glad I could help a bit.

From the data I benchmark against, the average daily peak BG for non-diabetics is 8.0 +/- 1.3. In other words, two-thirds of the time a non-diabetic will have a daily peak in the range 6.7 - 9.3.

From the same data, and looking at things another way, on average non-diabetics spend about 4% of their time above 7.8 - so about an hour per day. There's a lot of variability in that - some never go above 7.8, some spend a lot more time above it.

But anyway, BG poking it's nose above 8 is no big deal by itself.

 

[AndBreathe]

I read that the clinical definition of T2 remission is two Hba1c results below 48 six months apart, without medication. Also that remission is the preferred term because the diabetes can return, whereas reversal or cure suggests it's gone for good.

I managed the clinical definition recently but I know I have to maintain my diet regime, so I don't consider that I've reversed or cured my diabetes.

Martin

As I understand it, Martin, in UK, there is no "official" definition of any of these statuses.

My own status on my medical records is "Diabetes Resolved", which is more often used relating to gestational diabetes, however, my GP explained her rationale as I have not shown any diabetes markers for a number of years, and seem settled, living my life as I do. I can live with that, as I don't find my way of living as a bind at all.

Of course there are times when a fresh baguette torn, to eat with with pate would be lovely, but I am also medically GF, so that just not worth the hassle, even where bread is marketed as GF, I wouldn't trust it.

I think the US has some terminalolgy which changes over a period of non-diabetic scores, leading to something like "Operational Cure" at something like 5 or 6 years.

I think some internationally adopted definitions would be helpful.