# Calorie restriction for long-term remission of type 2 diabetes



## Eddy Edson (Jan 26, 2019)

New paper by Roy Taylor.

http://m.clinmed.rcpjournal.org/content/19/1/37.full.pdf

_Starting with a hypothesis which postulated a simple explanation arising from the basic cause of type 2 diabetes, a series of studies has introduced a paradigm shift in our understanding of the condition. Gradual accumulation of fat in the liver and pancreas leads eventually to beta cell dedifferentiation and loss of specialised function. The consequent hyperglycaemia can be returned to normal by removing the excess fat from liver and pancreas. At present this can be achieved only by substantial weight loss, and a simple practical and efficacious method for this has been developed and applied in a series of studies. For those people who used to have type 2 diabetes, the state of post-diabetes can be long term provided that weight regain is avoided. The implications for personal health and for national health economics are considerable._


----------



## mikeyB (Jan 26, 2019)

Not exactly groundbreaking, though.


----------



## Eddy Edson (Jan 26, 2019)

mikeyB said:


> Not exactly groundbreaking, though.



More of a review, I think, but maybe a useful summary.

And it does introduce a term new to me: "post-diabetes".


----------



## Drummer (Jan 26, 2019)

I do think that if I had been left alone to follow a low carb diet from my early 20s I would not have gained weight and become diabetic 50 years later - but all the pressure to eat those healthy carbs, the mockery, the threats - the screaming of insults - it does wear down resistance in the end.


----------



## Madeline (Jan 26, 2019)

My DSN hadn’t heard of the Newcastle diet when I broached the subject. She’s still full of healthy grains taking up a third of my plate, and why don’t I have porridge for breakfast.


----------



## trophywench (Jan 26, 2019)

Just smile at her and tell her that her advice is rather out of date.


----------



## Madeline (Jan 26, 2019)

I did explain it, I was kind of shocked she’d not heard about it, I thought there would’ve been some kind of requirement to keep up to date, and (I think) this is a prescription diet! Not in our area, sadly.


----------



## Madeline (Jan 26, 2019)

She’d be happy though, I had a baked potato with my sausages. I’m not happy, I’ve peed 6 times since dinner


----------



## Eddy Edson (Jan 27, 2019)

Madeline said:


> My DSN hadn’t heard of the Newcastle diet when I broached the subject. She’s still full of healthy grains taking up a third of my plate, and why don’t I have porridge for breakfast.



I think the Newcastle idea is that after you've achieved "remission" or "post-diabetes" or whatever, if you do, this kind of standard heart-healthy nutritional advice (lots of fruit, veggies, whole grains etc) is what you should follow - because your pancreas starts working again and carbs become a non-issue. You'll only go back to being diabetic and particularly carb sensitive if you stack the weight back on again.

Personally, I think I've probably gotten to "post diabetic" status, after losing a bunch of weight (but grinding it off at a classical ~0.5kg per week, not via the 800 calorie thing).  Generally my BG levels are pretty insensitive to carbs.

Except that I'm still quite sensitive to grains. I experimented with a piece of wholewheat toast this morning, first time I've eaten any grains in weeks.  Went from 4.8 before b'fast, peaked at ~9 after (versus normally ~6.5). And by past experience, BG will remain a little elevated versus my usual for the rest of the day.  This peak is within "normal" levels, as shown by CGM studies and ignoring the old 7.8-after-meals advice (which was never based on any real evidence) - but still striking enough for me to stick to my seeds-instead-of-grains strategy for the long term.

I wouldn't be surprised to find that I've been grain-sensitive forever, even before the D-fairy sprinkled me with D-dust. It seems to be fairly common.


----------



## Madeline (Jan 27, 2019)

Oh no, she’s not that advanced. She still firmly believes that T2 should be ‘filling up on healthy carbohydrates like grains and starchy vegetables’ (her words) and low fat. She hadn’t heard of the Newcastle diet at all. 

I’m still ignoring her advice. My smaller, much smaller than a fist sized potato that I ate around 7.30pm is still putting me at 10.6 at midnight.


----------



## Eddy Edson (Jan 27, 2019)

Madeline said:


> ‘filling up on healthy carbohydrates like grains and starchy vegetables’



The rationale for this still-standard advice is that whole grains and starchy veggies are better than donuts and cake, which is absolutely valid for anybody, as far as it goes.  And better than bacon and saturated fats, which is absolutely valid for non-diabetics.  The difficulty for nutritional advice is how to fit diabetes into the picture.  

Replacing good carbs with saturated fats might be OK at getting BG down but is almost certain to be sub-optimal for CV outcomes, once BG is under a bit of control.  

All credible, expert, mainstream guidelines these days are just fine with replacing carbs in general with unsaturated fats - so avocados, nuts, seeds. I don't think any of the expert bodies worth listening to are pushing a low-fat (as against low-satfat) agenda these days.

Just wish that the field in general was doing a better job of pushing these simple, massively well-supported strategies into primary care settings.


----------



## Madeline (Jan 27, 2019)

I’m eating plenty of vegetables and meat like chicken or fish, red meat once a week, liver once a fortnight. Plus full fat yoghurt for breakfast, eggs, and cheese, but not masses. I’ve lost 6kg since November so I’m happy. 

I’ve also discovered that proper ice cream, made with cream, doesn’t affect me, so that’s my occasion treat.


----------



## trophywench (Jan 27, 2019)

The trouble with 'avocados nuts and seeds' is the air miles, should you happen to live in the Northern Hemisphere, Eddy!

I utterly loathe the texture of avocados and the taste isn't much better, so I don't eat any by choice,


----------



## Eddy Edson (Jan 27, 2019)

trophywench said:


> The trouble with 'avocados nuts and seeds' is the air miles, should you happen to live in the Northern Hemisphere, Eddy!
> 
> I utterly loathe the texture of avocados and the taste isn't much better, so I don't eat any by choice,



Shame! That sounds as bizarre to me as me loathing tomatoes and mushrooms must sound to everybody else 

But in terms of cost: I see a large avocado sells for a quid at Tesco, about Oz $1.90, versus $2.50 at Woolies here.  Food is pretty expensive in Oz - small pop, long distances and supply chains stitched up by a couple of big players.


----------



## Sharron1 (Jan 27, 2019)

Madeline said:


> I’m eating plenty of vegetables and meat like chicken or fish, red meat once a week, liver once a fortnight. Plus full fat yoghurt for breakfast, eggs, and cheese, but not masses. I’ve lost 6kg since November so I’m happy.
> 
> I’ve also discovered that proper ice cream, made with cream, doesn’t affect me, so that’s my occasion treat.


Ohhh, what brand of proper ice cream - and how much do you allow yourself? This is my next move but after my 6 month review!!!


----------



## Madeline (Jan 27, 2019)

Kelly’s clotted cream works for me, as does Waitrose pistachio. I have a tub of Waitrose 1 chocolate arriving tomorrow, I’ll report back on that.


----------



## Madeline (Jan 27, 2019)

I hate avocados and mushrooms too. Also celery and coriander


----------



## trophywench (Jan 27, 2019)

I like mushrooms, tomatoes, cooked celery, not keen on coriander and loathe the seeds with a passion gimme parsley any day, like capers, hate tarragon, chervil, pernod and anything else that tastes of aniseed eg Ouzo - but take me to Crete and home-brewed Raki and I'll drink it neat.  Only thing is I don't have any worry beads, have never developed stubble anywhere you can usually see and can't play backgammon !  LOL


----------



## Madeline (Jan 27, 2019)




----------



## mikeyB (Jan 27, 2019)

I hate avocado. The reason why birds never eat avocados is because it is deadly poisonous to birds - that’s the tree’s defence. The Guatemalan variety, which is the main one sold in the UK, is particularly poisonous. It’s a substance called persin that kills them.

Persin is a fat soluble fungicide that leaches into the fruit from the seed. It kills rabbits, and makes many domestic animals ill, plus horses, cows, pigs and presumably any animals in the wild that eat it. In rabbits they die due to cardiac arrhythmia, the other animals get mastitis and bowel problems. Never ever allow your dog or cat to eat any avocado, or the skin, you’ll have a house full of poo and vets bills.

It’s allegedly considered safe for humans, though as it is fat soluble,  you won’t wee it out. Don’t know where it goes. 

Anyway, it’s cytotoxic, so they are trying to make an additive from Persin to go with Tamoxifen in breast cancer. 

All toxic substances have an LD50 - the dose that kills half the population. It’s usually tested on animals. I can’t find an LD50 for persin, presumably because it kills every animal they test it on. 

But don’t mind me, enjoy your avocados. I, along with most of the animal kingdom, don’t think it is food. I’m not pushing my luck eating cytotoxic chemicals, thank you very much.


----------



## Drummer (Jan 27, 2019)

Real ice cream is made like real custard, from cream and eggs, warmed until it thickens and then cooled and beaten to the point it is about to set, then flavour or sweeten, or mix in some frozen fruit and watch it set - a small amount of alcohol makes for a softer set. You can use the stuff you put in icing - begins with g - can't remember the name, I've a head full of cotton wool from the feel of it, which also keeps it softer - colourless liquid. It is actually low carb - but expensive to make.


----------



## silentsquirrel (Jan 27, 2019)

Drummer said:


> Real ice cream is made like real custard, from cream and eggs, warmed until it thickens and then cooled and beaten to the point it is about to set, then flavour or sweeten, or mix in some frozen fruit and watch it set - a small amount of alcohol makes for a softer set. You can use the stuff you put in icing - begins with g - can't remember the name, I've a head full of cotton wool from the feel of it, which also keeps it softer - colourless liquid. It is actually low carb - but expensive to make.



glycerine?


----------



## Drummer (Jan 27, 2019)

silentsquirrel said:


> glycerine?


That's it - I kept thinking glycol - but knew it was wrong.


----------



## Eddy Edson (Jan 28, 2019)

mikeyB said:


> I hate avocado. The reason why birds never eat avocados is because it is deadly poisonous to birds - that’s the tree’s defence. The Guatemalan variety, which is the main one sold in the UK, is particularly poisonous. It’s a substance called persin that kills them.
> 
> Persin is a fat soluble fungicide that leaches into the fruit from the seed. It kills rabbits, and makes many domestic animals ill, plus horses, cows, pigs and presumably any animals in the wild that eat it. In rabbits they die due to cardiac arrhythmia, the other animals get mastitis and bowel problems. Never ever allow your dog or cat to eat any avocado, or the skin, you’ll have a house full of poo and vets bills.
> 
> ...



More for us! You can have my bacon.

I guess you won't be wanting those nuts either? Full of cyanide and aflatoxins!


----------



## Madeline (Jan 28, 2019)

I’ve got an ice cream maker stashed away at the back of a cupboard somewhere, I’m really glad I didn’t get rid, it’s amazing being able to eat ice cream.

@mikeyB that is just about the best excuse ever for not eating avocados


----------



## mikeyB (Jan 28, 2019)

Eddy Edson said:


> More for us! You can have my bacon.
> 
> I guess you won't be wanting those nuts either? Full of cyanide and aflatoxins!


Indeed. Though with Almonds, it’s the devastation of the Californian water table - it takes 15 litres to grow one almond, and that’s where 80% of world production is. They should have stuck with oranges.

Aflatoxin, a fungus that grows on nuts, causes liver cancer. It’s destroyed by heating.

I’m not totally convinced by eating seeds, either. Plants that have exposed seeds are expecting birds to eat them, and poo them out elsewhere to distribute the plant. We can’t digest tomato seeds - that’s why you see tomato plants growing around sewage outlets. You would have to eat a pint glass full of seeds to gain any nutritional benefit, and even then about a third will wend it’s way out the rear end. That’s how nature works. Playing the percentages.

If you don’t believe me, find a virgin piece of earth in the garden, and bury some poo in a hole, not too deep to see what grows.


----------



## mikeyB (Jan 28, 2019)

Forgot to add, Eddy. Sloths consume avocados with no ill effects.


----------



## Madeline (Jan 28, 2019)

I vividly remember one delightful school trip to the local sewage farm (Why? Why would you subject 30 bored and immature kids to an afternoon talking about poo?), they told us they fought a constant battle against rogue tomato plants.


----------



## Madeline (Jan 28, 2019)

Also, v fond of sloths. Only the two toed ones though, the three toed are sort of sinister serial killer looking.


----------



## Northerner (Jan 28, 2019)

So, my aversion to avocados is a defence mechanism?  Only tried them once, a similar number to the times I have eaten tripe


----------



## silentsquirrel (Jan 28, 2019)

Several times over the past few years I have bought an avocado when on offer, feeling I ought to try and acquire a taste for them, healthy fats and all that.  I then spend a couple of weeks trying to summon up courage to try it, then chuck it in the bin with relief when it is obviously mush........


----------



## Eddy Edson (Jan 29, 2019)

mikeyB said:


> Forgot to add, Eddy. Sloths consume avocados with no ill effects.



As do we. There is zero evidence & zero reason to suspect that persin from avocados is a risk for humans.  See eg every competent body which has offered an opinion on the matter.

On Californian almonds: I probably don't really know any more about this than you do, but I really doubt that the water burden is as great as it would be for similar nutrient loads from alfalfa->hay->meat/dairy or from fruits (_pace_ Mother Jones).

The bigger issue IMO is whether so much agriculture of any type should happen in most of California. Same for where I live.

This table from the recent EAT-Lancet study is interesting:



(Table 7 in the SI). In light of that, it's seems quite likely that replacing fruit orchards with almond growing would be positive for water burden, but anyway AFAIK the major shift has been alfafa (->hay->meat/dairy)->almonds, which would almost certainly be a big positive.

For seeds: obviously, some you need to grind for digestibility, some you don't.  Eg: Flax grind, chia no need. From personal experience, I get 300 - 450 cals per day from chia seeds. If I wasn't digesting their nutrients, I'd be wasting away, which I'm not. And if seeds in general were not a good nutrition source, it wouldn't be the case that they are recommended by many (all?) expert nutritional bodies, unless you believe they are in the pay of the Global Seed Lobby 

No idea about tomato seeds. Don't recall ever seeing them recommended as a food?

PS: The EAT-Lancet study  https://www.thelancet.com/action/showPdf?pii=S0140-6736(18)31788-4 

Free access.


----------



## Madeline (Jan 29, 2019)

I’ve got snow peas and sunflower seeds arriving soon, I’m going to have a go at growing some microgreens on the kitchen windowsill


----------



## Eddy Edson (Jan 29, 2019)

Madeline said:


> I’ve got snow peas and sunflower seeds arriving soon, I’m going to have a go at growing some microgreens on the kitchen windowsill



Snow peas are triffic - munch on them all day!


----------



## Madeline (Jan 29, 2019)

Can’t wait for them to get going! Never tried sunflower greens, they’re supposed to be quite nutty


----------



## mikeyB (Jan 29, 2019)

Yes, they are extra rich in chlorophyll. Great if you are a plant, but taste great and hardly any carbs.


----------

