Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

(Clare) #12

Hey Richard

You’re absolutely right on that.

Like I say - it’s not news to us but it is news that it’s finally on the news!

:wink:

(bulkbiker) #13

There have never been any long term follow up studies on the ND participants… as the first study results were published in 2011 I find this quite interesting… I have a sneaking suspicion that I know why there haven’t been any long term results published but that would make me a conspiracy theorist…

(Justin Jordan) #14

The study referenced in the original post is actually an attempt to see what happens longer term - in this case, twelve months.

Which at a year, the result were pretty consistent with the original study. But the study is meant to go on for several more years.

Taylor actually been applying a genuinely scientific approach to these studies - he followed the original study with a similar one using people who’d had diabetes for longer periods, and then moved into studies with more people, then studies over the longer term.

Which is actually impressive - that kind of rigor is actually pretty sadly lacking in a LOT of studies of nutrition (and exercise, for that matter).

(Justin Jordan) #15

“How many people dropped out of the study?
What support was being given to people once they transitioned back to real food?”

These are actually detailed in the original study papers, if you’re interested in looking it up.

(bulkbiker) #16

Possibly true however the studies have to date put fewer than 200 people through the Very Low Calorie Diet under Taylor’s auspices with a not great success rate 46% from cherry picked Type 2’s after 12 months… I am a skeptic… especially when you listen to his semi fat shaming eat less move more interview on the Lancet summary of the study. But of course that is just my opinion.

(Justin Jordan) #17

See, to me, 46% of people returned to normal metabolic function is an outstanding success. IF it were just ‘returned to normal blood sugar’ I’d be whatever - I can do that just by eating a keto diet. But that’s not what the diet did.

But I don’t care at all what Taylor’s views on fat people are. So there’s that.

(You've tried everything else; why not try bacon?) #18

It appears from the abstract, however, that they lost 21 of the participants originally recruited for the intervention group, so we’re talking about 58 or so of the original 149. What the abstract doesn’t say (and I can’t afford a subscription in order to read the full paper), is why the 21 participants withdrew from the study. In fact, the abstract doesn’t say that anyone withdrew from the study, but it’s a necessary conclusion from the numbers they do put in the abstract. And they have to all have withdrawn from the intervention group, because the same number of control participants is mentioned being evaluated as were originally recruited. So why did 14% of the intervention group fail to last through the study?

(Ken) #19

Of course you’ll be ketogenic when eating 120g of carbs. And yes, the substrate is the glycerol once the fat molecule is broken. Ketosis is a part of lipolysis, not the other way around.

Perhaps I missed something, but I though they were following a primarily Carb based diet. A lipogenic, insulin secreting one, but intermittantly dipping into lipolysis once dietary calories run out.

Keeping weight off for a year by following caloric restriction is difficult, but not impossible. One year is really nothing, and eventually leptin resistance begins to rise, beginning the fat gain process.

(Clare) #20

I simply don’t currently have time to go through the study at the moment and I’m not 100% sure I’m sufficiently scientifically literate to understand it if I did. I’m an accountant not a doctor.

I will say this - my understanding of the process was that these dieters were given an extraordinary amount of support for the duration of the trial and in then reintroducing foods. That’s great and it’s exactly what we should do for everybody with T2D… BUT BUT BUT…

How will this actually be rolled out, if it is rolled out, in general practise?

We all know that there simply aren’t sufficient resources to give everybody with T2D this level of personal support. So what will happen is, people will get prescribed these shakes and, for the most part, left to just get on with it then blamed when they fail.

Surely it’s better to teach people to eat well and fix themselves that way?

(You've tried everything else; why not try bacon?) #21

Clare, Clare, Clare! The shakes are a product you can sell to people! You can’t make any money telling them just to eat decent food! (shaking head) :grinning:

(Clare) #22

Duh!

What was I thinking? :joy:

(bulkbiker) #23

Also his criteria is not a return to “normal metabolic function” it is an HbA1c of 48 or less. So quite a few (all) could still be pre-diabetic and he would claim “success”. Now I wouldn’t say that was success would you?

(VLC.MD) #24

To view the original document … go to …

http://sci-hub.la
type in the URL

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

New URLs are posted on wikipedia
image

(Clare) #25

Er, no

(You've tried everything else; why not try bacon?) #26

Thanks, Doc! That was an interesting read. They are assuming that it was the weight loss that “reversed” the Type II diabetes (or rather made the subjects pre-diabetic), not the reduction of insulin resulting from the decreased intake of carbohydrate. I’d love to see any comments Dr. Phinney or Dr. Fung may have about this study. It seems to fall within the purview of each one’s research.

P.S.—I am glad to see such robust P numbers in this study, I have to say. It sounds as though, whatever the explanation of their results is, their observations are well-founded.

12 month RCT Ketogenic diet vs Standard of diabetic care (moderate carb low calorie)
(Mel Soule) #27

Incredible. Thank you my resourceful friend. My lips are sealed as Sargent Schultz would say “…I know nothing…I see nothing…”

#28

Uh no, not in my experience and that of most people I know who have lost weight. I lost 60 lbs in 2010 on a moderate carb no gluten or flour diet. I kept it off until 2013 and then gained all but 11 pounds back. I did not go back to deliberately eating sad but I did not care as much, stopped exercising and had stopped losing and would cheat a bit. My caterer lost 86 and gained it all back and then some

As for the study, why are they better at reversing T2 than fasting would be?

(You've tried everything else; why not try bacon?) #29

Because they can charge for the shake; fasting is free.

#30

It is good you are not cynical :grinning:

(You've tried everything else; why not try bacon?) #31

The check is in the mail.

This bridge is for sale, and I can get you a deal on it; I know the owner.

Of course those pants don’t make your butt look big!