# Very low calorie diet DiRECT trial results.



## travellor (Dec 4, 2018)

As a follow on from the thread on the NHS decision to prescribe a course of treatment aimed at reversing type 2 for a , by supporting a very low calorie diet, and following with a manageable food reintroduction and maintenance program, here are a few links to the actual DiRECT trial for anyone that is interested.


https://www.directclinicaltrial.org.uk/

https://www.directclinicaltrial.org.uk/Documents/AAA FINAL DiRECT 12m results for IDF 2017.pdf

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext


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## Eddy Edson (Dec 5, 2018)

It looks like they're still recruiting for the follow-on ReTUNE study, looking at non-obese T2's.

https://www.diabetes.org.uk/researc...yorkshire/retuneing-type-2-diabetes-remission

https://www.ncl.ac.uk/magres/research/diabetes/newstudy-retune/

And Taylor et al's fascinating 2015 paper on T2 remission/reversal/whatever for normal-weight T2's: https://www.ncl.ac.uk/media/wwwncla...cecentre/files/PersonalFatThreshold_Paper.pdf


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## Eddy Edson (Dec 5, 2018)

This is a pretty good interview with Taylor, at least for presenting his views: https://www.medpagetoday.com/endocrinology/diabetes/74142

_Diabetes [T2] can now be seen to be a very simple disorder of a person having more fat than they personally can deal with, so it's a simplification. It's a simple condition that, of course, is applied to individuals who are heterogeneous. That's where the complexity comes in and that's what's caused the confusion.

So for this one person sitting in front of me in the consultation, that person has acquired more fat than they can cope with. Get rid of their fat, and this disease goes away. Now, knowing the processes allows us to be definitive about that, and that is an enormously welcome message for people with diabetes ...

...

Does this put it more on the patient, that it's their fault for gaining weight that they have this disease?

Taylor: In fact, it makes it the reverse. One of the most poignant questions asked in the clinic is why me? Why have I got diabetes? All my friends are fatter than me and they don't have it. Well, unfortunately, we're all individuals. We all have tendencies one way, advantages other ways. Some people have beta cells that are just more susceptible to a moderate amount of fat than the average. And if we take it to the extreme, many people are completely resistant to the effects of fat in the beta cell. If we look at people with a body mass index over 40, almost three quarters of them don't have diabetes and are unlikely to get it. And so you see it's not any individual's fault. It's a matter of just having drawn a bit of a short straw with the genes that have set you up in this particular way.

So it takes away the pejorative aspect of type 2 diabetes -- you've been having a bad diet, you put on too much weight -- and really turns it back to the individual. You're unlucky. You're drawn the short straw, but the good news is you can deal with it.
_
...

_What they say is that hearing firstly, that it's reversible, and secondly, why it's reversible -- that's what allows them to be motivated to lose the weight and go on and do it. So studying the mechanisms is really important._


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## travellor (Dec 5, 2018)

Eddy Edson said:


> This is a pretty good interview with Taylor, at least for presenting his views: https://www.medpagetoday.com/endocrinology/diabetes/74142
> 
> _Diabetes can now be seen to be a very simple disorder of a person having more fat than they personally can deal with, so it's a simplification. It's a simple condition that, of course, is applied to individuals who are heterogeneous. That's where the complexity comes in and that's what's caused the confusion.
> 
> ...



It is the news that there is a chance to reverse it that provides the motivation.
Definitely in my case, I'd been overweight for years, but diabetes was the push I needed to actually lose weight.


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## Bloden (Dec 6, 2018)

travellor said:


> It is the news that there is a chance to reverse it that provides the motivation.
> Definitely in my case, I'd been overweight for years, but diabetes was the push I needed to actually lose weight.


Diabetes was a huge wake-up call health-wise for me too. I feel grateful in a way - diabetes saved me from myself and my not-so-healthy habits. Every cloud...


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## Eddy Edson (Dec 6, 2018)

Taylor's FAQ is also worth a look: https://www.ncl.ac.uk/media/wwwncla...ecentre/files/2018 Diabetes reversal info.pdf

According to this, the 800 calorie thing isn't an essential part of the approach. As a research matter, it was intended to mirror the rapid weight loss from bariatric surgery. If you can successfully use a slower approach to weight loss, he says it should work as well.


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## travellor (Dec 6, 2018)

Eddy Edson said:


> Taylor's FAQ is also worth a look: https://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/2018 Diabetes reversal info.pdf
> 
> According to this, the 800 calorie thing isn't an essential part of the approach. As a research matter, it was intended to mirror the rapid weight loss from bariatric surgery. If you can successfully use a slower approach to weight loss, he says it should work as well.



I'm not entirely convinced.
There is only proof of remission associated with rapid weight loss, and from a fairly carby, though low calorie diet.
I did a slower diet initially, and didn't have the results.
I followed it by the Newcastle diet, and did.

Maybe that just took me under my personal fat threshold at the very end.
Or maybe rapid weight loss burns a different fat.

The thing that persuaded me really was that slow weight loss was claimed to be seen by low carb diets, even to achieving a good BMI. But the majority seem to be on it as a maintenance diet after, and carbs still cause spikes after. So it didn't produce results. So not for me. I wanted a normal diet after.

And an assumption weight loss will always be good is fair enough, and I wouldn't argue, it's not bad advice for those that don't want to do the 800 calorie diet, but I went for the strict Newcastle diet, figuring I would really only have one shot, and didn't want to throw my hat into the wrong corner.
It worked, and I wouldn't do it differently.


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## Eddy Edson (Dec 6, 2018)

travellor said:


> I did a slower diet initially, and didn't have the results.



What was yr weight loss from this slow phase, approx - kg & percentage of start weight? 

I've lost 13.5 kg = 16% of start weight since DX. Considering whether to let the reduction run on for a bit. 

Downside is that I'm going to need another pants/belt replacement


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## travellor (Dec 6, 2018)

Eddy Edson said:


> What was yr weight loss from this slow phase, approx - kg & percentage of start weight?
> 
> I've lost 13.5 kg = 16% of start weight since DX. Considering whether to let the reduction run on for a bit.
> 
> Downside is that I'm going to need another pants/belt replacement



16 1/2 stone down to 12 1/2 over a year on a low fat diet.
But, eating to my meter., so no spikes.
Good, but no prize.
I finished with a way better BG figure, but the initial insulin response wasn't stunning.
Another stone lost down to 11 1/2 on the Newcastle diet, which did the trick.
So, the rapid weight loss was the winner for me.

I have put weight back on since, so I have my doubts on the personal fat threshold being a fixed number.
It has some hysteresis.

I would like to see some research on rapid weight loss, while being on a low calorie but carby diet.
My completely random gut feeling is the pancreas can clear fat from the islets, but only if it has to squirt out insulin. 
So, if you low carb, the pancreas isn't exercising, and doesn't recover.
If you target the right fat, but give it a work out at the same time, it's all good.
The question is, what happens if you do lose weight, but leave the islets plugged up?


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## Eddy Edson (Dec 6, 2018)

travellor said:


> 16 1/2 stone down to 12 1/2 over a year on a low fat diet.
> But, eating to my meter., so no spikes.
> Good, but no prize.
> I finished with a way better BG figure, but the initial insulin response wasn't stunning.
> ...



Thanks, that's really interesting.

As far as I can guess, I'd have similar comments re initial insulin at the moment.

I also have a similar feeling about needing to make the pancreas work a bit, but really based on nothing concrete.


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## travellor (Dec 6, 2018)

Eddy Edson said:


> Thanks, that's really interesting.
> 
> As far as I can guess, I'd have similar comments re initial insulin at the moment.
> 
> I also have a similar feeling about needing to make the pancreas work a bit, but really based on nothing concrete.



Just based entirely on hearsay, but it worked for me.


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## Madeline (Dec 7, 2018)

I’m on 1,200 cals a day, using My Fitness Pal. Wondering if I should ditch and switch to something like the dreaded Slimfast. At least I’d get chocolate.


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## mikeyB (Dec 8, 2018)

Your big problem, Madeline, is the same as mine. Lack of mobility. It’s much harder for the likes of us to get weight off, though I may go ultra low carb as part of a New Years resolution to lose a stone. Longer battery life on the scooter


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## Madeline (Dec 8, 2018)

It sure is, I’ll join you on the ultra low, I checked out Slimfast and it’s kind of a quarter sugar


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## Pine Marten (Dec 8, 2018)

Madeline said:


> It sure is, I’ll join you on the ultra low, I checked out Slimfast and it’s kind of a quarter sugar


I tried Slimfast for a while (years before D), but I gladly gave it up because of the sheer monotony of the shakes. My teeth *ached* for having something solid to chow down on


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## Madeline (Dec 8, 2018)

Pine Marten said:


> I tried Slimfast for a while (years before D), but I gladly gave it up because of the sheer monotony of the shakes. My teeth *ached* for having something solid to chow down on


Me too, it worked really well for getting the post pregnancy fat off, but then I was in my 20’s and very active. Now I think I’d just sit on the sofa and long for actual food.


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## travellor (Dec 8, 2018)

You'll have to report back on how effective it is for reversing type 2, like the low calorie diet here, or if it's just weight loss that it achieves.


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## Madeline (Dec 8, 2018)

I can’t see Slimfast being any use, not for me at 38g carbs a serving, 21g being sugar. My poor brain would be floating in sugar syrup.


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## travellor (Dec 8, 2018)

Madeline said:


> View attachment 10523 I can’t see Slimfast being any use, not for me at 38g carbs a serving, 21g being sugar. My poor brain would be floating in sugar syrup.



You must be different to me, and everyone that did the Newcastle diet who monitored their BG constantly.
As I said earlier, I suspect there is some element of exercising the pancreas during rapid weight loss that helps re start the process, but that's just a gut feeling. It will be interesting to see the results on here.


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## Madeline (Dec 8, 2018)

I’m just going on the effect white bread has on me - I think I’m still in the shock/scared stage, diabetes has always frightened me, my health is very poor already, and it feels like just one more thing.


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## travellor (Dec 8, 2018)

Madeline said:


> I’m just going on the effect white bread has on me - I think I’m still in the shock/scared stage, diabetes has always frightened me, my health is very poor already, and it feels like just one more thing.



That's bread plus other food though, not low calorie to the same degree. I'm sure 2400 calories a day in diet shakes wouldn't be good.


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