Why Very Low Calorie Diets (VLCD) won’t solve the diabetes crisis

by Hannah Sutter

What’s the best way to eat if you want to stay a healthy weight and lower your risk of various chronic disorders? That’s the big question behind the long running diet war between an embattled low-fat establishment and those in my gang – the low carb/high fat rebels.

My lot scored a notable hit last week when a senior American cardiologist had an article published in the BMJ entitled “Low saturated fat diets don’t curb heart disease risk or help you live longer”. The establishment produced what might have been a successful riposte with a study that claimed failing to keep your protein intake pretty low (it’s easy to eat a lot of protein on a high fat diet) was as dangerous as smoking. I’m obviously biased but several experts showed it to be seriously flawed, especially Zoe Harcombe here.

This can all get pretty confusing for civilians who often have to make important life-style decisions based on the way they interpret these skirmishes. That’s why I want to take a close look at the decision by Diabetes UK earlier this year to give £2.5million (the largest research grant ever made by the charity) to fund a 5-year study into the possibility of reversing type 2 diabetes with a Very Low Calorie Diet (VLCD) . A diet based on calorie counting.

Diabetes is the big prize in this diet war. In fact you could say it was what it is all about. Essentially it comes down to this. People with diabetes have too much sugar in their blood. So is the best way to treat it with a diet that raises blood sugar – low fat/high carbs – or one that lowers blood sugar – high fat/low carbs?

VLCD been around for 40 years

I fully acknowledge my bias but it is clear to me that the grant to fund this study reflects the blinkered approach to weight loss and obesity by a continuing focus on calorie counting and physics rather than biochemistry.  Let us not forget that this approach to dieting that has been around for 40 years and has major shortcomings and no evidence that it cuts obesity long-term. Those involved running VLCDs have demonstrated an alarming lack of understanding of human biochemistry and the whole project seems driven more commercial interests than patient benefit.

At first sight this new study, headed by Professor Mike Lean of Glasgow University and Professor Roy Taylor of Newcastle University doesn’t look like being about either high carbs or high fat instead it might look as if it involved a third way that they are calling a Very Low Energy Diet (VLED) that cuts the intake of both of them. The big idea is that if a diabetic loses at least 15 kilograms, they can reverse diabetes. This is what the summary provided by Diabetes UK says:

“Substantial weight loss achieved following bariatric surgery can reverse type 2 diabetes in 70-80% of patients. However research has proved that it can also be reversed by a strict energy restricted diet with around 15 kg weight losses” So Diabetes UK’s support seems to be based on the theory that only weight loss is required and providing it is significant – diabetes will be solved. Blimey it does make you ask competency questions.

The study that triggered this grant was small, lasted 8 weeks and was carried out by Prof Roy Taylor a couple of years ago. It involved 11 adults with type 2 diabetes who followed an 800 calorie-a-day diet that came from low-calorie shakes provided by Nestle.  Guess what –if you starve people they will lose weight fast. I am not sure you need a study to show that but what you really want is a study that shows what happens after they have been on a starvation diet.

Why was ketosis not considered?

“We believe this shows that Type 2 diabetes is all about energy balance in the body,” explained Professor Taylor, “if you are eating more than you burn, then the excess is stored in the liver and pancreas as fat which can lead to Type 2 diabetes in some people. What we need to examine further is why some people are more susceptible to developing diabetes than others.”

Clearly Prof Taylor did not think that the lack of carbohydrate in the diet was in any way relevant – only weight loss and keeping it off. Even though the low carbs would mean that the patients’ blood sugars were regularised.  We know they went into a state known as ketosis when the body switches from burning glucose from carbohydrates to using fat from the diet and from storage for energy.

Some of this gets turned into energy packets called ketones in the liver.  It is the state of ketosis that results in fast and substantial weight loss. What is really odd is that at no point did Prof Taylor or Diabetes UK ask whether the critical issue was the low calories or the ketosis or the lack of carbohydrate. This lack of critical thinking may be linked to the fact that weight-loss shakes maker Optifast part funded the original study and may not want people to know that you can get into a state of ketosis with just food from the local store.

Hannah Sutter

Hannah Sutter

Hannah Sutter was a lawyer for 17 years before becoming involved in the low carb diet and obesity. See her book ‘Big Fat Lies’. She runs a specialist service for people wanting to use the diet to reverse obesity, treat diabetes and for general wellbeing. www.bigfatlies.co.uk. Clinical trials are being run on her range of completely natural low carb high protein foods.
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  • Of course it won’t but neither will spending £70 a week on food delivered to your house. That buys alot of food! Conflict of interest!

  • Diabetes UK is not a charity although it may be registered as such for regulatory purposes – look at the money trail and their opaque accounts

    As a medical herbalist outside of the UK, I have reversed diabetes. A ‘sugar’ ie carbs from saccharides control is fundamental and not expensive to implement but you do also need plants to rectify the damage and missing nutrients to the body’s organs. Sadly, it is illegal in the UK for Medical herbalists to treat diabetes.
    However it does not stop those who wish to ameliorate their condition from visiting a Medical Herbalist.
    The three main causes of death Cancer Diabetes and from 2020 Alzheimers are all huge money makers – medicine is a business and ethics do not apply sadly – so it is left to the patient to be pro active or when government costs are so huge they have to be reduced. Insulin is cheap. Cancer drugs are not.

  • Amazingly, these Newcastle researchers have chosen to ignore the outcome of a TV trial their diet took part in. Although not a scientific trial, their low calorie diet got trounced by a 40:30:30 diet which the participants had no trouble in keeping to. Scroll down to Extreme Diet Ward August 2013 for, from what I recall, is an accurate review.


    Below is part of the review.

    “The first diet was a very restrictive 800 calories a day, consisting of 3 shakes formulated by Newcastle University researchers, and one portion of vegetables. The women who followed this diet found it a real struggle. They suffered mood-swings, energy crashes, and faintness. My personal view is that such restricted diets are totally pointless, and counterproductive.

    The second diet was double the calories of the mega-restrictive diet, at 1,600 calories per day, divided into 4 meals. This diet was called the 40/30/30 diet, as the calorie proportions were 40% carbs, 30% protein, and 30% fat. However, the carbs were all in the form of vegetables, salad, and some fruit. The 3 women on this diet were surprised by the large quantity of veg and salad, and pleased to see steak, bacon, eggs and other real foods included, much to the resentment of the 3 women restricted to the shakes.

    After the 56 day diet, the 3 women on the higher calorie diet (the 40/30/30 diet) showed far better results, two of whom were diabetes-free as a result. The women on the excessively restricted ‘shakes’ diet made less progress, but their weight did reduce and their diabetes became less severe. None of the women on the lower calorie diet became diabetes-free.”

  • Thanks for this. I had no idea. Some countries such as Canada have banned them but we are actually going to encourage them.. We live in sad times.

  • As I just posted on another blog, avoiding beige or white foods (carbs) in the evening worked for me. I think type 2 diabetes is best described as a process where the body just gets inured to high sugar levels and says what the heck. If you can reduce these for at least part of the diurnal cycle you can get the body working again. What worked for me may not work for everyone. If all else fails, changing your life partner may be the only solution. That also worked for me, in that I have gained 10kg and notwithstanding, my diabetes has not returned.

  • I find this three page diatribe less than convincing because the author is listed as having a diet products business – unless I have misunderstood.

    “She runs a specialist service for people wanting to use the diet to reverse obesity, treat diabetes and for general wellbeing. http://www.naturalketosis.co.uk. Clinical trials are being run on her range of completely natural low carb high protein foods.”

    Most of the post seems to be attacking the Cambridge diet and promoting the author’s ketogenic diet.

    No “Wow – they reversed diabetes!”.

    The way I heard this study developed is a follows:

    (1) Promising results were being seen for reversal of diabetes in obese patients after bariatric surgery.
    (2) Further investigation showed that the improvement was seen BEFORE the surgery.
    (3) This was thought to be due to the starvation diet the patients were put on prior to surgery to reduce the size of the liver, which otherwise blocked surgical access to the stomach.

    So full marks to whoever thought outside the box and noticed this.

    The next step should be to investigate this interesting effect further with a much larger study.

    So full marks to Diabetes UK for providing some funding.

    If it can be established that a starvation diet low in total calories can have a dramatic and immediate effect on diabetes then this needs more detailed study to establish what is happening and why. This should hopefully cover both the mechanisms involved and alternative nutritional approaches for the short term diet.

    Long term weight loss is a different and much more complex issue which continues to support a ?bloated? diet industry.

    So, please, two separate issues; firstly a starvation diet over a short period and then secondly a long term weight loss and maintenance plan.

    The two don’t have to (probably shouldn’t)use the same products or, hopefully, lack of products.

  • As explained by the professors behind the Newcastle trial, the belief is that the starvation diet “cures ” diabetes as a result of the rapid and significant weight loss and the fast and significant weight loss is achieved because starvation diets trigger the state of ketosis. This state of ketosis can be triggered with just real food and without starvation and without all the challenges that a starvation diet gives rise to. In addition the Newcastle trial which triggered the £2mil research grant is a tiny study compared to the many peer reviewed studies over the past 10 years that delivered the same results using a low carb high protein diet. Putting aside my declared interest, I think that solving problems with artificial shakes that can be easily solved with whole food seems most strange and reflects both poor reasoning and understanding by Diabetes UK and the professors behind these studies.

    • “This state of ketosis can be triggered with just real food and without starvation and without all the challenges that a starvation diet gives rise to.”

      So – the (modified?)Atkins diet it is, then :-)

      Please note that I am a T2 diabetic and a strong supporter of LCHF diets which I find work for me.

      I also declare an interest in that I am a volunteer for Diabetes UK *BUT* I do not always agree with their views and anything I say here is probably not in line with their current stated views.

      On the subject of artificial shakes – I can see the strong attraction of a short term programme where you are given just a row of packages and times to take them which form your complete diet. The removal of any decisions makes the short term diet much more manageable. The fixed regime is also easily manageable and quantifiable as part of a controlled experiment. It seems psychologically suitable for a short term trial.

      In my view none of this “reflects both poor reasoning and understanding by Diabetes UK and the professors behind these studies”.

      I would not support this kind of packaged diet as a long term strategy because people need to eat real food and a varied diet. Unless, of course, patients with eating disorders found this an essential way to maintain their diet goals.

      On your statement “the fast and significant weight loss is achieved because starvation diets trigger the state of ketosis. This state of ketosis can be triggered with just real food and without starvation and without all the challenges that a starvation diet gives rise to.”

      I would respectfully suggest that “correlation does not imply causation”. A starvation diet triggers rapid weight loss. A starvation diet triggers ketosis. A starvation diet is seen in these specific circumstances to reduce or reverse diabetes. These are all aspects of a starvation diet and it does not prove that the ketosis is the only aspect responsible for the reversal of diabetes nor that inducing ketosis using other methods would achieve identical results to a starvation diet.

      So my personal view is that for such a study a packaged solution for the diet is sensible, reproducible, and quantifiable.

      In this light, the study should be encouraged.

      You seem to be hung up on the choice of dietary components instead of the exciting prospects of new learning based on the study.

      Be reassured that the public is in general not as gullible as some might hope and is quite capable of working out that there are alternatives to commercial packages for a 600 Kcal per day diet.

      The increasingly popular 5:2 diet relies on two days of eating 500 Kcal for women or 600 Kcal for men and does not require commercial products. People can work out that they can create a longer term 500/600 Kcal diet from natural ingredients and many will no doubt welcome books which contain suggestions on how to do this.

      Please note that I do not disagree with your views that a LCHF diet can assist weight management and that you can maintain a LCHF diet using natural foods.

      I am only concerned that you appear to be knocking a potentially worthwhile study based on the fact that it uses a commercial weight loss product which may compete with your commercial offerings.

      • As a member of Diabetes UK and Volunteer I totally agree with you. Lowish Carb 50-100 max not into ketosis as far as I know and a return to full fat milk some cream and proper butter and I lost two stones and reduced Hba1c and medication relatively easily last year. I have kept it off and made sure I lost the odd pound gained at Christmas relatively easily. Now ready to tackle the next two which loss will satisfy me if it reduces medication etc.again. Will have to wait and see as a few more pounds after that could be even more beneficial.

  • The ketosis per se is not likely to reverse the diabetes: it is likely to be the lowered insulin levels that would allow the receptors to resume their function properly.

    The 5:2 approach is not great. I see many patients who have tried this version of IF ultimately abandon it, as it does not have consistency. The “leangains” approach is consistent and the body soon adjusts to this daily regimen.

    No matter, we must change what we are doing. Insanity… etc

  • Robin you are so right. I have specifically referred to what the Professors, involved in the trial, believed caused the improvement to the diabetes for a reason…which is to highlight their poor understanding of the operation of insulin. I certainly do not agree with their interpretation of the results of their study. I can not get excited about a study which is based on a misunderstanding of basic A level biochemistry and a slave like addiction to calorie counting be it low or very low. The only good thing about a VLCD is that your carb intake is radically reduced because you are eating less calories per se but the reduction in metabolic rate and the loss of muscle mass is very damaging.

    To make a real step forward in the management of obesity and diabetes in this country we need the health professionals to finally accept that counting calories is a red herring which has actually caused the problem in the first place and taking people towards even more calorie counting with starvation diets is actually a step away from sanity. I am all for exciting thinking and solutions but not one based on faulty biochemistry and old thinking…

    • I recall emailing Prof Taylor about 2 years ago, and he said they found no muscle loss. Strange but true?? What do others think?

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  • Before criticising any published research, it helps to get one’s facts right. To get one’s fats right, it helps to read the published research properly, rather than skim the second hand criticism written by others. One would think that an ex-lawyer of all folks would understand this.

    The Newcastle study began with a supervised postgrad student trying to test a hypothesis. The hypothesis was that if bariatric surgery seemed to reverse the diabetic symptoms in the short term of morbidly obese white North Americans who had been diagnosed with T2DM, then perhaps a similar effect might be achieved by following a Very Low Calorie (VLC) diet.

    How do you test a hypothesis? By carrying out an experiment. That’s what scientific experiments do: they try to falsify a hypothesis by recording and processing data collected inter-subjectively. Inter-subjective data collection is the collection of data that can be collected by any person at any place at any time by repeating the same steps as the original investigators.

    The results of the Newcastle study suggested that the VLC diet did indeed appear to mimic the effects of bariatric surgery. MRI imaging showed that the VLC diet stripped most deposited fat from the liver by the end of the first week, but that it took up to six weeks for deposited fat to be stripped from the pancreas. Blood sugars dropped. H1ABc dropped.

    Big deal I hear you say. Very small study. Not every participant responded the same way. What are the long-term outcomes? Yep – all these objections are valid and were pointed out by the study’s authors. It was a very small study, because it was a research project conducted by a post-grad under supervision. Does none of you noisy knockers have any idea at all how underfunded medical research is in the UK at provincial universities like the University of Sunderland, especially ones that were until 1992 mere polytechnics? Evidently not.

    What do you do if you have some interesting results from a very small study? Remember how science is supposed to work? If you can manage to persuade the bean pushers to cough up the ready, then you carry out a larger study. And that’s what happening now.

    It’s called science. Don’t like it? Think you could do better? Then forget your Mickey Mouse degrees in politics, economics and law, go back to uni and train to become a scientist! Oh but that would be, like, too much hard work and, poor diddums, it would make your brain hurt. Besides, you never were any good at maths, physics and chemistry at school. No thank you – you’d prefer to criticise without having a clue what you’re talking about, and rely on what you remember from the unnamed, poorly remembered biology textbook you skimmed the night before your AS-level when you were sixteen.

  • Task, ‘facts right’ not ‘fats right’. For the record, I ought to point out also that, to the best of my knowledge, the education boards of England and Wales have never offered an A-level in biochemistry. The closest one can come to an A-level in biochemistry is a module in biochemistry offered in some chemistry A-levels. To get an idea of what’s included see http://www.creative-chemistry.org.uk/alevel/biochemistry/

    If you download some of the worksheets for the biochemistry module of the A-level in chemistry (see above) you will see that it’s very introductory. I’ve never come across a standalone biochemistry UK textbook (written in SI units) specifically intended to cover this material at the level needed for the biochemistry module in A-level chemistry. I’d be interested to know the titles of any.

    The chemistry I studied at school at A-level was woeful. Roughly, half was inorganic chemistry with an emphasis on physical chemistry. Most students, including me, found that quite enjoyable because you could figure out the solutions from first principles. The other half that was organic chemistry, however, was a nightmare at A-level. Endless memorisation of endless organic reactions with no proper understanding of the underlying principles possible, because that required a good grasp of the quantum mechanics of molecules. In turn, this required an advanced understanding of quantum mechanics, which required a high level of skill in solving Schrodinger equations. In turn, this required high-level skills in creating mathematical models of the molecules’ energy bonds using the mathematical language of linear and non-linear algebra, and so on.

    In my view, to claim that an A-level understanding of biochemistry gleaned from a ‘A-level text book in biochemistry’ is sufficient to unravel and understand the mysteries of T2DM is so naive that only someone with no proper grounding in biochemistry or medicine, and who has a wilfully blind agenda, could make such a claim.

    • And, ‘tsk’ not ‘task’! Sigh.

      • Editorial

        Thanks very much for bothering to comment but next time be good if addressed some specific points rather than impersonating a 1950′s teacher who is close to retirement and has come to hate his pupils. Sorry to hear about your funding difficulties

        • I’m not impersonating anyone, let alone someone close to retirement who hates his pupils. It would be good if you would you cite the A-level text book you rely on to refute careful academic studies.

  • First thank you for taking the time out to share your thoughts on why you think this article is so wrong.
    I do appreciate that it can be very irritating when a non-scientist has views about science and the question then is whether it is proper or appropriate for a non-scientist to have any locus at all. Whilst I cannot speak for all I should point out that lawyers are actually trained in the evaluation of evidence as part of their professional training which is why in most disputes of any substance, lawyers are invited to pass ultimate judgement on the quality of evidence.
    The thrust of my piece is not whether the enquiry by the post graduate in Newcastle is wrong or right but I challenge how that study has been progressed and from that I am questioning how the progression of science generally is influenced by big pharma or quasi pharma. I can also confirm that I do agree with you that science is about trial and error, about ideas being tested and then taken forward or not according to results but what we need to be very alert to is the influence of pharma and the pursuit of financial gain. The example of the Newcastle mini trial being transformed into a large study is a good example of how big pharma / quasi pharma can influence health and science.
    Prior to the publication of the Newcastle trial there have been numerous peer reviewed published studies in various scientific journals (including the Lancet; New England Medical Journal and others of similar standing) that have shown that you can reverse type two diabetes with a ketogenic low carb diet. These results were achieved without starvation or specific products. Fat was lost around the liver and pancreas fast just as was declared in the Newcastle trial. These studies were larger and over a longer period of time. In other words the same results have been achieved from just eating whole food available from the local shops. So why would you ignore such studies in favour of a smaller study? It is very peculiar that these earlier studies have been ignored by Diabetes UK and not even mentioned by Newcastle or subsequent papers arising from the Newcastle study.
    So why have ketogenic low carb studies not been progressed? Could it be the lack of funding as there are no big pharma or quasi pharma companies behind the products? Do you think in all honesty it would be better to pursue a solution which is based on manufactured shakes and meal replacements rather than whole real food and that is putting aside the issues of metabolic rate and other associated issues with VLCDs?
    Indeed some years ago I wrote to Diabetes UK asking them why they did not recommend a low carb diet for the management of diabetes and listed the various studies at that time published showing excellent results. I was informed by their team of experts that low carb diets are dangerous for health due to their being
    • high in fat
    • Low in essential fibre –
    • Low in starch that is required for good health
    • High in protein which can be dangerous
    Whilst I am not a scientist but a mere lawyer I did draw their attention to the actual list of essential nutrients which are required for good health. As you probably know none of these essentials are excluded by a ketogenic low carb diet. Indeed there are no essential carbohydrates.
    So this article is not about bashing science or scientists but it is asking the difficult question about how science is funded and pushed forward. As someone who is interested in evidence I cannot ignore that for over 30 years people have been buying in bucket loads VLC Ds to manage their weight (with and without diabetes) and as yet these diets have not delivered sustainable results other than for shareholders. That is evidence too. Yes it falls below a randomised clinical trial but it is evidence that should be evaluated.
    Finally I should say that my facetious comment on A level chemistry / biochemistry was really just that. Having said that it is a basic module of first year biochemistry and first year medicine that the only food group that stimulates insulin secretion significantly is carbohydrate and that this food group is not essential for human existence.

    • Yup, contact with the evidence married with the capacity to recognise the evidence for what it is matters so much more than whether one is beholden of recognised qualifications, which can amount to the mere acceptance of the dogma of the day. You have my backing, Hannah.

  • “the only food group that stimulates insulin secretion significantly is carbohydrate and that this food group is not essential for human existence.”

    My ageing (ninth) edition of Guyton and Hall purchased in a charity shop is my source of the snippet that levels of cortisol can potentate gloconeogenesis by several orders of magnitude (6 – 10 times). In English then proteins can be converted to glucose and could conceivably potentate secretion of insulin, in addition to the need created by the supply of glucose to the blood from carbohydrates and sugars ingested as a meal or snack.

    To move on from that and hopefully to aid Richards understanding ..

    The relationship that glucose has with insulin and that gluconeogenesis has with each is worthy of consideration, especially as to how this fits in with biology in general and evolutionary advantage allied to any seasonal variation is the supply of food. To cross reference our experience with examples from the natural world seems an odd thing for us to do as we too readily consider ourselves distinct or superior beings detached from nature. The reality is we are bound by the laws of nature just as much as is the next beast.

    Richards intrinsic point is a good one, that discussion of biochemistry is rarely used to augment many a proposition it could, and the ‘experts’ are as at fault in this as are the rest of us, but the application of his point is thrust in entirely the wrong direction. through being dogmatically fat-phobic those who trialled the effects of starvation diets did so not realising the same effects could be achieved quite naturally by reintroducing sufficient amounts of aft back into the diet. This could have three beneficial effects. levels of insulin could fall, some of the drivers of insulin resistance could be redressed, and lipolysis and ketosis accompanied by improved signalling involving ghrelin would permit a natural desire not to ingest so many calories.

    The hibernating bear does not wake for a midwinter snack in the middle of his 100 day sleep because the presence of body-fat, and the ghrelin they release, suppresses his appetite and permits him to sleep through without raiding the fridge. Hormones command his behaviour and have more command over ours than we credit.

    Another point worthy of note is that the bear sleeps through and has no need to visit the bathroom. That his body does not need to excrete waste is in keeping with an observation that he is not eating, but he is nonetheless burning fuel and will emerge in the spring several kilos lighter and bereft of surplus body-fat. Body-fats make for fuel that burn cleanly and with few toxic by-products. Quite like a car the emissions can be expressed as water vapour and carbon dioxide in exhaled breath. Other metabolites result in a need to drink more water, the need to pee more frequently, and the need to pass urea and other wastes that result from detoxification of metabolic by-products.

    Despite it’s common acceptance the notion that animal fats could be toxic to animals is, frankly, infantile. Th reason energy can be stored as body-fat is in expectation that it may needed to be utilised as fuel. Lipolysis and ketosis is the reverse of the process that is lipogenesis, and lipogenesis results mainly from two co-factors, one being insulin and the other being glucose.

    The biochemistry augments a systems analysts approach — or maybe it could be the other way around, — or even a bit of both: And that makes for synergy.

    There is a lot of synergy to be witnessed in nature. Often the synergy makes for clearer sense than does the ‘science’.

    Airing and sharing ideas is how we improve them, while voicing incredulity helps cast light upon its origins. We can be as grateful for Richards contributions as he could be for ours.

  • The premise for the study is all wrong the truth is there is a lot of PR for bariatric surgery pass on like science, bariatric surgery doesn’t miraculously cure diabetes. Just after two years only 1/3 of the patient are able to keep glucose A1C under 7% and no they don’t have normal glucose metabolism by any measure. Second for diabetes or even impaired blood glucose to appear there has to be a diminish amount of functioning beta cells. No short term extreme calorie reduction diet is going to give rest to the beta cells enough for beta cells regeneration to occur and diabetes to be reversed. Diabetes is characterize by a carbohydrate intolerance the only way to improve the condition is by restricting carbs and reduce glucotoxicity so that it can give enough rest time to beta cells to recuperate or at least avoid further complications.

    • To quote Roy Taylor at length from http://www.ncl.ac.uk/magres/research/diabetes/documents/Diabetes-Reversaloftype2study.pdf

      “The particular diet used in the study was designed to mimic the sudden reduction of calorie intake that occurs after gastric bypass surgery. By using such a vigorous approach, we were testing whether we could reverse diabetes in a similar short time period to that observed after surgery.

       The essential point is that substantial weight loss must be achieved. The time course of weight loss is much less important.

       It is a simple fact that the fat stored in the wrong parts of the body (inside the liver and pancreas) is used up first when the body has to rely upon its own stores of fat to burn. Any pattern of eating which brings about substantial weight loss over a period of time will be effective. Different
      approaches suit different individuals best.

       It is also very important to emphasise that sustainability of weight loss is the most important thing to ensure that diabetes stays away after the initial weight loss. Previous research has shown that steady weight loss over a 5 – 6 month period is more likely to be successful in keeping weight down in the long term. For this reason, ordinary steady weight loss may be preferable. However, if you are not able to lose around 2½ stone over, say, six months by this approach, then the very low calorie diet may be best for you.

      So no particular approach or commercial plan or product is being mandated. The focus is on sustainable weight loss by whichever method works for you personally.

      Also very interestingly

      “Could it work for people with a normal BMI?

       Yes, most certainly, provided that the diagnosis of type 2 diabetes is correct. Some people are unable to cope with even moderate amounts of fat in their liver and pancreas. Type 2 diabetes only happens when a Personal Fat Threshold is exceeded. Losing weight within the range which is “normal” for the general population is then essential for health. ”

      The key concept for me is the Personal Fat Threshold which is not tied to BMI. I am currently within the normal BMI range but taking my weight down towards the middle of the range or lower to see what that does to my BG control.

      Oh, and Charlie, you said “The premise for the study is all wrong the truth is there is a lot of PR for bariatric surgery pass on like science, bariatric surgery doesn’t miraculously cure diabetes.”
      If you look back at the studies you should see that they began when someone noticed that the reversal of diabetes sometimes actually took place BEFORE the surgery, and the initial study was to confirm that the specific diet regime undergone by patients prior to bariatric surgery could reverse diabetes in patients who did not then have bariatric surgery. The results were positive, and further study lead to the views I have posted above.

      • You are confusing reversing diabetes with having non diabetics numbers while in a diet that matches your diminish beta function. Yes some diabetics can have non diabetics numbers without medications while in a diet that matches their functioning beta cells. The problems is a very low calorie diet is not sustainable long term and as soon as they return to eating an amount of carbohydrates they can’t handle they will return to their diabetics numbers. The only way to sustain those non diabetics numbers is with low carb diet that can be maintain as long time like a life style change. You will not cure diabetes with a short term diet change, not unless his diabetes is unique as is an outlier, but the great majority will only see a very short term benefit.

        • Charlie, have you really read what I posted above?

          In particular, the phrase “we were testing whether we could reverse diabetes”?

          Or are you saying that Professor Roy Taylor is confusing reversing diabetes with maintaining low numbers through a very low carbohydrate diet?

          If you want more detail, look at the link I posted and the associated information.

          The concept of the Personal Fat Threshold is centred around fat in the pancreas inhibiting insulin control. If this fat is removed by weight loss (not necessarily dieting) then there is a reasonable chance that the cell function will return as long as the pancreas is not too badly damaged. Diabetes reversal is shown by the return of the ability to regulate sugars in the blood.

          The whole study was based on observed diabetes REVERSAL.

          • Also there’s no reason to suppose maintenance is needed. Perhaps a shorter vlcd once a year, much easier to accomplish than permanent dietary restrictions. There could even be a national vlcd month holiday.

          • Vlcds were also VERY common in hunter gatherer times, where food sources were never 100% reliable. So periods of vlcd every year is perfectly inline with nature.

      • Hello David

        I was diagnosed four years ago with Type 2 Diabetes. I am 180 cm tall and weighed 73 kg. Most people would describe me as skinny. I have always eaten well, exercised and looked after myself. I am a vegetarian. I read the Roy Taylor research. His work at the Magnetic Resonance Centre sounds very good. I read several of the studies. I have an academic background so I found them quite easy to read. It made sense to me. In January I decided to try it. I stayed on the diet for 7 weeks. I never ate more than 650 calories. I exercised vigorously for 6 days a week. My health improved markedly. My blood glucose readings tested at home several times a day by me went down to the mid 4s and usually under 6.0 for fasting (first thing in the morning. Postprandial was also very good. I was so excited. My hard work had paid off. And then the bad news ………….. I have been off the diet for a week now. I now weigh 62 kg. I have started slowly eating protein (eggs, cheese and tofu), avocado, some good oils,a few fruits, nuts and seeds and good grains (wheatgerm, oats, psyllium fibre, wheat bran, wholemeal flour). My blood glucose readings have skyrocketed. They start off in the morning high (before I have even eaten – the opposite of when I was on the diet)and stay high all day. My postprandial reading tonight taken 3 hours after eating and two hours after doing laps at the swimming pool was 9.4. It is usually on the diet between 4,5 and 6. My understanding of Professor Taylor’s research is that by now my pancreas and liver should have emptied sufficient fat and returned to normal functioning. My blood glucose readings should also be normal now. They aren’t and they are now back to where they used to be before I started the diet. I want to believe the research that has been done by Roy Taylor and his team but it doesn’t seem to mesh with what is happening with me. And no I don’t have Type 1 diabetes. The fact that my readings were normal on the diet suggests either that I had returned to normal or that the diet I was eating did not allow my glucose readings to spike. I think it is the latter now. My readings were normal because I was not eating carbohydrates. The diet is very low in calories and carbohydrates. I ate one Optifast shake in the morning and two big plates of non-starchy veges while on the diet. My diet was very low carb. My carbs have increased quite a lot now. Despite the fact they are good carbs my blood glucose readings are not treating them as being low GI (they certainly don’t lead to a slow rise in blood sugar). And they stay high for a long period of time. My body just doesn’t seem to like carbs very much and it doesn’t seem to matter what kind they are. I think this is a possible reason why the people in Professor Taylor’s research may also see low blood glucose readings. They are consuming low carb diets. What happens when they go back to more normal but good eating patterns?

  • Hi, after reading this awesome piece of writing i
    am as well glad to share my know-how here with colleagues.

  • I saw the link know the intervention and I am telling you they have based their study on the wrong assumptions their theory has already being disproved. There is more to diabetes that fat around the pancreas. They will not reverse diabetes on the great majority of diabetics.

    • Can you please provide references to the studies which explicitly disproved the results of the Newcastle Studies.

  • I am not going to give you a class on diabetes you apparently have no clinical experience treating diabetes. But let us assume that the way most diabetes develop is not with the fasting glucose being the last to go up, so that patients are suffering damage to their beta cells for many years from postprandial hyperglycemia and ROS before their doctors notice that they have past the threshold of diabetes diagnosis and by that time most have lost more than 50% of their beta cells. Let us assume that the many genes that have found to be affected for a diagnosis to occur don’t exist. Let us assume that the many organs and their signaling like the brain, liver, gut, etc. that are required to maintain glucose homeostasis don’t exist. Let us further assume that the many common prescribed medications that are associated with causing diabetes don’t exist or that pesticides and environmental contaminants associated with causing diabetes don’t exit either.

    Let us assume that all there is to diabetes is fat in the pancreas.

    What in this crash diet few pounds lost is going to cause it to be from pancreas? Some magic ingredient in the shakes? Because you can’t control were the fat is going to be burn, obesity around the waist and intra-abdominal fat is the hardest to lose. Short term crash diet calorie restriction don’t work because they are too short and long term calorie restriction are a failure because living in constant hunger is very hard to sustain all your life. That have been proven time and time again not just in an experimental settings but also in real life. The only chance for the resilient body to recuperate from diabetes is by going into a healthy low carb diet. Is the best intervention for diabetes. Were you can control glucotoxicity and in a healthy way lose some weight, exercise to gain more muscle to help you dispose of glucose. If your diabetes is reversible that is your best chance you have. If not at least you will reduce or eliminate complications from developing.

    • Ummm…O.K.Charlie, you note my lack of clinical experience.

      Perhaps you would like to outline the depth and breadth of your clinical experience? A few medical and/or postgraduate research qualifications?

      I note that you have wriggled out of providing a single piece of evidence to back up your assertions.

      You may, of course, have missed that the Newcastle Study was undertaken at the Newcastle Magnetic Resonance Centre where they scanned the liver and pancreas to establish the levels of fat before and during the study. They claim to have observed that the fat went from the liver and pancreas during the fast weight loss.

      You, of course, from your vast (but so far unquoted) clinical experience may of course know better.

      You may even know some references to studies which disprove this.

      Don’t be shy – share with us all.

  • I see you just want to believe no matter what that diabetes has a simple explanation and a fast cure. You will just have to wait a few years they will either be receiving the Nobel Prize for finding a cure for diabetes with a treatment that has being tried since the disease was first diagnosed or you will see an abstract trying to give a positive spin on how the money was well spend and maybe asking for some more. I don’t see any point in continuing the conversation, so Good luck.

  • I must admit there is one big question I have for David who clearly is well versed in the Newcastle Study.

    If my understanding is correct and the success as noted by those involved in the study was due to significant weight loss and in particular fat around the pancreas and liver why is there no discussion around ketosis as one of the key triggers to this improved body state. My understanding from comments made by Mike Lean is that ketosis is irrelevant but if burning fat is one of the keys ot success then ketosis must be relevant.

    Ketotic diets also systematically deliver more significant and faster weight loss than diets that are non ketotic. Whilst I do acknowledge that one comment previously made is that speed is not an issue, clearly Low calorie diets have failed so far to combat the problem and so perhaps speed is part of the mix if hidden. INdeed Mike Lean has been quoted as recognising that speed of weight loss is relevant to commitment and this is a real issue for the slower options.

    I would be appreciate some insight on this.

    • Hannah, firstly I freely admit to not being an expert on ketosis.

      I do chat on line to people who are in ketosis, some more or less permanently, and it does seem to work for them. I find the whole thing very interesting and am intending to check some more stuff very soon.

      One thing I think may be causing some confusion – the difference between an eating plan or short term diet specifically for weight loss, and one for BG control in diabetics.

      As far as I can tell, as a practising diabetic, there are several different things going on.

      If you cannot easily control your blood glucose then it makes sense to reduce anything in your food which makes control more difficult.
      Reducing carbohydrates, especially simple carbohydrates, is one obvious way to do this, and seems to be working for me.
      I am on lowish carbs and losing weight and my BG is improving. However as far as I can tell I am not in ketosis; at least it wasn’t flagged up in my last set of bloods about a month ago.
      [Update: having checked by blood test results I don't see any listing for 'Ketones' as such.]
      So my preferred long term eating style is LCHF but quite possibly without going into ketosis. I may well be dipping into ketosis, especially on longer bike rides, but I am not sure how I would tell. Ketostix after the ride, perhaps?
      Anyway, to me LCHF seems sensible with ketosis as a matter of choice.
      I find I am managing to confuse myself over ketosis – as far as I can see you enter ketosis as soon as you use up all the available carbs plus dietary protein which can be converted more slowly into glucose. Everyone may do this any day – I presume that ‘in ketosis’ means spending most of a 24 hour period in ketosis, burning dietary and/or body fat.


      To me the Newcastle Study started out being about rapid weight loss, and a logical progression from an observation. I think from reading stuff on the Internet it went something like this:

      1. Some good results are being seen from bariatric surgery.
      2. Hang on, there are signs that diabetes may be reversing prior to surgery.
      3. Let’s take the pre-surgery protocol and study it in isolation.
      4. Cool! It looks as though an eight week Optifast diet can reverse diabetes in some cases.
      5. Magnetic Resonance Imaging shows that excess fat has been stripped away from the liver and pancreas, one week for the liver but another seven weeks before the pancreas is clear.

      {Cue a couple of years of mumbling at Newcastle}

      6. We think that it is significant weight loss that is key to the reversals of diabetes that we have seen. Our imaging work shows that the liver and pancreas are cleared of excess fat before the reversal is seen. This fat removal seems to take priority over other fat stores.
      We think that controlled significant weight loss over a period of six months could show very good results. How the weight loss is achieved is less important than the sustainability of weight loss. If people find themselves unable to lose weight slowly and steadily, then a very low calorie diet such as that used in the study may be appropriate to achieve the targets.


      This sort of brings me to the basis of your question.
      Why did they not use a diet which specifically induced ketosis?
      [I haven't actually seen anything to say if the Optifast diet actually pushes you into ketosis - to lose all the weight you must be burning mainly fat. As I said ketosis isn't my specialist subject. Further checking using Slimfast in the search turns up sites which say a shake only diet will push you into ketosis. They see this as a bad thing.]

      I think the answer to your question about diet choice for the study is probably in the steps above.
      There was an established clinical protocol for a crash diet immediately prior to bariatric surgery, using a known diet product which was available on prescription.
      The subsequent studies all flowed down from this initial observation of a part of an established protocol.
      I suspect that to have changed the diet plan in the initial studies would have introduced far too many unnecessary variables.
      I don’t think Newcastle have ever got to the stage of testing to see which alternative diets/eating styles are best for short and long term weight loss.
      They were focussed on investigating the results observed from a specific crash diet regime.

      The PDF I linked to further up the conversation does seem to talk a lot of sense.
      The aim is to lose significant weight and keep it off.
      This brings your approach with ketosis firmly into centre stage.
      Newcastle seem to be very wisely not espousing any particular approach to weight loss, as it is not central to their research.
      They are focussing on the benefits of significant weight loss in the control or reversal of diabetes and the use of Magnetic Resonance to identify where the fat is lost from.

      I fully agree with you that very low calorie diets on their own, especially the diet shake products, are not a long term answer for weight loss.
      If they were that good the suppliers would put themselves out of business. :-)
      However I do feel that they can have a role in a planned long term campaign for sustainable weight loss as long as there is an understanding that there is no ‘magic’ involved.
      For some people a ‘crash diet’ can fit into an eating plan.
      It can help boost morale with a speedy short term improvement, or start shifting weight again if you plateau.
      It can remove uncertainty – glass, powder, liquid, job done.
      The shake regime is also very easy to follow and as long as you do not cheat. There is no ‘well, just a little bit more won’t really hurt’ temptation you get with eating a regular non-packaged long term diet.
      So I am currently trying out a ‘shake regime’ as part of my ongoing eating plan to see if it does give me a rapid boost in my weight loss.
      I will not be doing the full eight weeks because my initial weight loss target is a stone, but it motivates me to have a short period of fasting when I know that I am on a long term eating plan which is already maintaining/reducing my weight.

      I am also very much open to alternative approaches, but the shakes will do in the short term whilst I research further.

      So, I am really very much on your side in all this with regards to the current blindness of the NHS and Diabetes UK over the importance of reducing or eliminating carbohydrate.
      I am very much in support of the LCHF approach to weight and BG management.

      I started posting here because some of your original blog post seemed to be missing certain aspects of the Newcastle Study, and also focussing too much on a commercial product you took exception to. In short, I thought your treatment of the subject was unfair.

      I note, going back to look at the top of this discussion, that you say

      “Guess what –if you starve people they will lose weight fast. I am not sure you need a study to show that but what you really want is a study that shows what happens after they have been on a starvation diet.”

      I think that this has been addressed – the more recent output talks about fat reduction in the liver and pancreas as significant outcomes, and the importance of sustaining the weight loss long term.

      You also say

      ““Substantial weight loss achieved following bariatric surgery can reverse type 2 diabetes in 70-80% of patients. However research has proved that it can also be reversed by a strict energy restricted diet with around 15 kg weight losses” So Diabetes UK’s support seems to be based on the theory that only weight loss is required and providing it is significant – diabetes will be solved. Blimey it does make you ask competency questions.”

      I would reply “Blimey, this does look interesting.”

      Within the caveats of the study, which as far as I can tell has been mainly looking at people within 4 years of diagnosis, there does seem to be at least a chance of reviving your pancreas for a while. This could be outstanding news.

      This could also, coincidentally, be a golden opportunity for the diet industry although very bad news for suppliers of high sugar and high carbohydrate food and drink.

      Anyway, I am addressing the Newcastle Study as best I can through personal action.

      I intend to reduce my weight to the middle or below of the standard BMI range, and see what that does to my BG control.
      Depending on results, if I manage to pass my Personal Fat Threshold I will be very happy indeed.
      I am aware that there are no guarantees that my condition is reversible.
      I am also aware that if I fail to reverse my diabetes it doesn’t mean the approach won’t work for someone else.
      I am also aware that if I do by some miracle succeed that doesn’t mean it will work for everyone else.
      However the cost/benefit analysis suggests that it is worth trying.

      I will try and report back in six months.

      • “I find I am managing to confuse myself over ketosis – as far as I can see you enter ketosis as soon as you use up all the available carbs plus dietary protein which can be converted more slowly into glucose.”

        There is no need to confuse yourself, David, you have a good understanding. That said:

        The body appreciates homoeostasis (a state of balance) yet could not function without certain balances swinging first one way and then the other. Example might be wakefulness vs sleepiness, satiety vs hunger, alert and guarded vs relaxed. None of these alterations that swing around the happy medium are achieved via conscious effort, they are managed by hormones. Hormones too have a notional balance, yet they work by shifting one way and the next around that supposed ‘balance’.

        I would suggest then then homoeostasis as a concept applicable to physiology that is both deserved and errant. Yes, in general sense there is rightful ‘balance’ in all affairs, yet there could be no function without constant departure from the ‘mean’ balance. In reality homoeostasis is constantly modulated. Modulation infers ‘more of’ or ‘less of’ rather more than it infers a black and white ‘on or off’.

        Without ‘knowing’ as such my adopted perception is that cell metabolism would be dual fuel, either in an absolute sense or one which aids a working understanding. To my knowledge hormones do not appear and disappear so much as they work as agonists and antagonists whose balance shifts by degree. Metabolism is commanded by hormones such as cortisol, insulin, and ghrelin, for instance. I think the dual fuel nature of cell metabolism may well be able to tolerate two states. It offends my perception to think cells switch from burning glucose in one moment and ketones in the next. It would be risky, if you think about it. I think a 60/40 state is every bit as likely a prospect as may be a 40/60 state. in other words ketosis and glucosis are metabolic states that may co-exist but with shifts in emphasis governed by shifts in hormones that respond to shifts in the balance of the cues that bring influence to bear upon hormonal balances.

        I do not know whether you have given thought to glycogen and its relative mobility as an energy source compared to fats from adipose tissues. Neither do I know if you have considered how energy supply from the digestive track can be attenuated by the presence of (soluble) fibre or fats in the last meal, and I cannot begin to guess if you have thought that the presence of fats in the digestive track may be axial in a process involving modulation of the rate of digestion according to need. If these are pertinent interests then they are things that bring control to bear upon the speed with which glucose may be passed from the digestive track and into the blood. I don’t know definitively, btw, but observations, experience, and systems analyst approach lend assurances they might be the case.

        What I am directing is that you have every right to take inspiration from the Newcastle study but I think you should preserve your right to reserve some scepticism when faced with a direction that there could be a simple fix to what is an involved problem. The notion of a personal fat threshold may be helpful, but might not actually describe cause and effect that well.

        So there is nothing ‘wrong’ with the results, and there is nothing to be disproved. The study throws up some ‘dots’ and people are at liberty to join them. But the issue remains are there other pertinent ‘dots’ that have not been flagged, and if these ‘dots’ were planted on the page would it influence how we join all the ‘dots’ for the most promising image.

        Anyway there remains a legacy.

        For the last few decades people have been encouraged to become fat phobic. We are easily convinced fats in the diet will make us fat. They do not, Sufficient fat in the diet encourages ketosis which opens the door to lipolysis (the controlled release of body fats for burning) and less compulsion to eat more calories than we need. We have been convinced fats in the diet will poison our heart through raising cholesterol. The effect upon cholesterol fats may have upon cholesterol is both true and false on account of the devil in the detail. But any supposed effect dietary fats upon cholesterol would apply to all fats and not just saturated fat. Furthermore the perceived effect cholesterol has in inducing fatty plaques is myth in entirety and stems from a confounding error rooted in work now more than one century old.

        In 1976 it was established, but long since overlooked and consigned to oblivion, that oxidised cholesterol can be atherogenic (promote growth of those troublesome plaques) whereas pure cholesterol never was an atherogen, not in 100, nor in 1 million years. Th fat/cholesterol hypothesis whose roots trace back to the 1950s is founded upon a confounding error and supposition that associates with the level of ignorance of its founder Dr Ancel Keys.

        In other words the level of mass-hysteric fat-phobia beholden of ‘experts’ and commoners alike is not deserved upon any level whatsoever by the facts that associate with affairs.

        Hence the VLC findings are not faulted as such, but they are weak in the discussion and directions that follow. They are weak because they are in accord with a mass-hysteric fat-phobia that is dogmatic in its persistence. They do not challenge dogma,m and the dogma, the easy, lazy, recommendation that is as easily adopted by consumers is actually one of the factors encouraging incidence of obesity and likely promoting incidence of T2DM too.

        Different approaches may work. An outlook that considers the effects of hormones explains why VLC, barriatric, or HFLC interventions can achieve similar benefits, but the hormonal centric outlook indicates ’cause’ better than does others, and through identification of cause (HCLF) we can seek to prevent or redress by limiting exposure to the ’cause.

        Charlie is attempting to aid your understanding and not defeat it, just as I am.

        Hannahs piece is a good one that is not necessarily more correct than the VLC recommendations, but it is more open minded, inclusive, and insightful.

        • Chris, a load of very interesting stuff.

          I may be reading you incorrectly, but you seem to be linking the Newcastle Study with a recommendation to pursue VLC diets.

          I am not currently seeing it that way – I see the current state of the Newcastle Study as diet agnostic.

          It appears, as I outlined in my numbered list, to be a study which started looking at the results of a VLC diet and reached much broader conclusions.

          Working backwards, diabetes has been reversed; what changes have we seen? MRI shows major loss of fat from the liver and pancreas.
          Tentative conclusion; lose significant weight and this will clear the fat from the liver and pancreas and this may reverse diabetes.

          Your ‘winter/summer’ example may well explain the workings behind this.

          If I understand you correctly you are saying that our bodies are designed to gain weight in the summer – and the more food that is available the more we are prompted to eat – then lose weight in the winter as we use up our fat stores. One nice aspect of this cycle is that fat burning does not stimulate appetite so you don’t feel starving in the winter half of the cycle.

          I would agree that this is a very reasonable explanation of how obesity has become so prevalent
          We have evolved technologically very swiftly compared with our very long phase of biological evolution and the challenges that we evolved biologically to deal with have mainly gone away.
          We (in the developed nations) now have surplus food, especially cheaply produced bulk staples which are carb heavy, all the year round.
          One of our major biological imperatives has just gone away.

          I am not sure, though, that this explanation invalidates the basic premise of the Newcastle Study.
          It may expand on it, or explain some of the mechanisms behind the results.

          Bottom line (including yours) seems to be to get rid of some fat and this could improve things :-)

      • Oops!
        I think I got carried away and didn’t answer one of your questions.

        If the question was “why do they think ketosis isn’t important” then I think the answer is two fold.

        Firstly, if you are going for an aggressive weight loss over a short period you can’t avoid ketosis – you are burning mainly fat – so any diet will cause ketosis under these circumstances.

        Secondly, ketosis by itself is just the burning of fats instead of glucose. You can maintain or gain weight whilst in ketosis if you want to. So someone in ketosis but maintaining weight (and therefore amount of body fat) wouldn’t fit with the parameters of the study. I am assuming that they also wouldn’t lose any fat from the liver or pancreas.

        It would certainly be fascinating to see how an obese diabetic fared on a ketogenic diet which maintained weight but I don’t think anyone has considered this as an area of study. I would suspect the result would be much better BG control at a minimum.

    • The functional and causal distinction between weight gaining (sequestering body-fat) and weight loss (releasing energy previously stashed away as body-fat) is an alteration to the balance of certain hormones. Our hormones command the process rather more than we do. If cortisol and insulin levels are high over-eating will be encouraged as preparation for a coming famine. In nature the famine typically comes in winter or in the dry season.

      If lipogenesis (the ability to synthesise fatty acids for sequestration at the typical adipose sites) confers evolutionary advantage in nature then the advantage is gained, not so much during the process of gaining weight (synthesising and sequestering fats), but more so when these fats are released (lipolysis) for burning (ketosis).

      The big hurdle to perceiving the simplicity and elegance in this nataural and evolutionary derived arrangement is that we too readily presume the fats we eat will lead to weight gain. Now suppose a person who expends 2500 calories per day ate only fats. Their body (metabolism) would be forced to burn 2500 calories from fats and this dictates insulin levels would fall and that lipogenesis (which requires cofactors of insulin and glucose) would be denied.

      This example is merely a thought experiment far more extreme than would be recommended in real life but if a person were lean they would need to eat 2500 calories to break even. Now suppose a person is 10kg overweight. They have 90,000 calories worth of energy stored as body-fat. This equates to fuel in the tank. A late discovery is that fat cells secrete a hormone called ghrelin. If you like, how much ghrelin is secreted will be a function of how much bod-fat is present. Ghrelin sits high in cascade that permits a person (with body-fats to spare) to to eat less and yet not feel hunger.

      Now I don’t know the precise ins and outs but it would appear the signal or sensitivity from ghrelin is trumped if levels of insulin are high. There are several influences but if a person insists upon eating a high-carb diet ghrelin cannot exert its influence because the signal is trounced by insulin.

      When ghrelin has its say, and if the mix of the diet diet can establish ketoisis, then ghrelin sits in a cascade that will permit a fat person to tolerate eating, say, 2000 calories per day while they expend 2500. Irrespective of whether we starve ourselves or elect to eat a low-carb high-fat diet weight loss requires fat-burning (ketosis) and ketosis can only arise if hormones alter their balance from ‘summer’ mode to ‘winter’ mode. In the wild nature takes care of the switch from summer to winter mode and does so in keeping with the seasons or the seasonal variations in the availability of food.

      But the human no longer lives ‘wild’ in the natural world and the species now inhabits a man-made environment that no longer supplies the same environmental cues to our hormones. The cues are several, and while some big ones stem from food not all of the important ones are food related.

      Artificial light, long ‘days’, short ‘nights’, and the contrasting amounts of sleep in the TV generations compared to stone-age man has cortisol levels rise in general and follow aberrant patterns. Cortisol can bear upon insulin, and in commanding gearing over gluconeogenesis cortisol has consequence for BG, which is another factor raising demand for glucose. Cortisol is ‘light sensitive’ and typically this sits at the top of the cascade that encourages summer mode. If cortisol levels fall in response to decreasing day length the gateway is opened for winter mode. But aberrant cortisol levels and rhythms can be redressed by countering ‘free-electron’ deficiency. Now …

      In the days when man walked barefoot, or wore footwear made of hide or having tanned leather soles then free-electron deficiency was not an issue. Now in the days when shoes have soles made of plastic and rubber man is insulated from ‘ground’ and man can no longer draw free-electrons from ground to the extent he once did. Work has indicated modern man assimilates a positive charge that stone-age man did not, and further work has indicated cortisol levels are ‘normalised’ if this positive charge, caused by free-electron deficiency, is addressed. Lest we forget, ….

      .. … A plentiful supply of more readily digestible carbohydrates, and to an extent over supply of protein, replicate the conditions of ‘summer’.

      Modernity presents modern man with conditions that perpetually replicate the conditions of ‘summer’ as would arise in the natural world only in the season of summer itself. If the cues that influence our hormones replicate conditions of summer all year round then our hormones and body will behave just as if it is summer all year round and metabolism is commanded to continue preparing for winter.

      If Mike Lean is directing ketosis is irrelevant then, for not having thought long enough or hard enough, he is a fat-head. Ketosis is very relevant.

      Consider Dinorwic Power Station or ‘electric mountain’. Essentially there are two ponds associating with a hill in North Wales and some gargantuan plumbing hewn form the rock that separates them. When the grid is generating electricity and yet demand is low, water is pumped from the lower pond at the bottom of the hill through the cavernous plumbing to the pond at the top of the hill. This consumes electricity but stores energy. When the grid is generating but demand for electricity peaks and exceeds generating capacity then the somebody removes the plug from the upper pond and permits flow back down to the lower (empty) pond. The mass of the water and the force of gravity acting on it has energy that can flow through turbines and thus generate electricity. Dinorwic is self financing. The difference in price that applies when electricity is bought from the grid and then sold back, is enough to cover the overheads of lost energy (inefficiency) and provide a margin of profit. Dinorwic follows a daily cycle whose precise timing is tuned to need, but the modal nature nonetheless is great analogue for the modal aspects of metabolism. Creature that gain weight do so for a purpose and advantage, but in modern man that purpose no longer rests comfortably with context or need.

      Now if Mike Lean says speed of weight-loss is important to reversing symptoms of diabetes he may have taken up with an important ‘dot’, but if he then fails to recognise weight loss and ketosis as dots that should be linked then I regret to have to say plainly his rectum has connected with his larynx.

      Weight loss or weight gain is not so much about calories, it is more about hormones. The mix of the food groups supplying these calories has bearing upon our hormones and our hormones can signal, quite naturally, ‘you need to eat more’ (to prepare for winter) or, ‘you get by eating less’ (you have successfully prepared for winter ) because you have fat reserves to spare. Obesity arises because of endocrinological imbalance.

      In the hope of putting David on the right track what the work of the VLC people indicates, but does not prove conclusively, is that T2DM is a condition that arises (often) in association with obesity (insightful, but that was already well perceived) but is also seen in association, perhaps, with the kind of hormonal balances that promote obesity (meaning hormonal imbalances may explain T2DM more insightfully than mere discussion of calories in vs calories out, starvation diets, or being overweight, and in need of losing some). The VLC work is not ‘wrong’ but is suffers from being superficial and discussion that could be far more insightful.

      The bottom line is that T2 diabetics do not tolerate carbohydrates in the diet very well, and they can cut back on these to good effect. Moreover fats can be reintroduced to good effect. They will re-establish control of BG, they will lose weight, and in time insulin resistance and hormone sensitivity may well be restored, in a more sustainable and less punishing way than severe calorie restriction HFLC diets can achieve the same ends as VLC, but the former are more in keeping with human need and physiological function. It is only dogma that prevents ‘experts’ perceiving the merit in HFLC. If the diet contains sufficient fats (sats and monos are best for this) over consumption is discouraged. The low fat regime encourages over-eating and is likely amongst the causes of T2DM.

      I’ll return with some helpful links.

  • I can’t see how very rapid weight loss is going to solve the diabetes problem in the LONG term. I agree that there are short term benefits but then what? Maybe the long duration of the proposed new study of 5 years will clarify things.

    Recently I met a 16 stone woman who had had bariatric surgery. She was 42 and had gone from 26 stone to 16 stone over three years after a gastric sleeve operation. She had only recently qualified for type two diabetes as this was a pre-requisite for surgery. Her diabetes was still in remission.

    What she told me was that she ate 1,200-1,3000 Calories a day and that she felt no hunger on this. She could only eat small amounts at a time and had to avoid certain foods eg fizzy drinks. Her life had been made so much better by the surgery and she had no regrets.

    However, she said that even though she was only on 1,250 Calories a day, she would NOT be able to reduce her weight further and that her plateau was expected to be permanent. She did regular exercise at a gym too. She said this happened to ALL bariatric patients and that once you lost 70% of the excess weight that this would be as good as it got.

    I am of slim build and average height and my usual calorie intake to maintain my weight is 2,150. I exercise for 40 minutes of various exercise a day including weight training. I eat a 35-80g of carb diet a day and feel energetic and well. I am 54. My liver fat was very low in an expensive health board body fat monitor but this was as far as it went. I’ve been eating like this for 10 years and wasn’t fat to start with. I’m just more muscular.

    I have several patients, I’m a doctor, who have been on the Cambridge Diet and similar and the usual pattern is that they lose weight to start with but then abandon the diet and quickly regain the weight and then some.

    I don’t know what happens after very low calorie diets or bariatric surgery completely but lowered muscle mass, maybe an adverse effect on T3, maybe persistent high cortisol levels but something or somethings sinister go on in the body or brain permanently and you end up with people whose metabolism is messed up.

    The people on the American Weight Registry who had kept their excess weight off, did this at some cost. The average person was female, had an age in the mid 40s, ate 1,3000 Calories a day and did an hour of exercise, mainly walking a day.

    Do people who embark on these very strict diets know what they are letting themselves in for long term? I know we are desperate to find a cure for diabesity but I certainly wouldn’t want to try it.

  • Katherine,

    very interesting stuff.

    I note that your patient is eating below what some on line calculators throw up as her BMR – although I have assumed a height of 5′ 6″ just to get an estimate. Her body seems to have adjusted to this lower level of calorie intake.

    Intriguingly the BBC posted a story this morning about diet and diabetes


    which says
    “Only eating breakfast and lunch may be more effective at managing type 2 diabetes than eating smaller, more regular meals, scientists say.

    Researchers in Prague fed two groups of 27 people the same calorie diet spread over two or six meals a day.

    They found volunteers who ate two meals a day lost more weight than those who ate six, and their blood sugar dropped.

    Experts said the study supported “existing evidence” that fewer, larger meals were the way forward.”

    This could suggest that the long term meal management, long after bariatric surgery, has a slight predisposition to retain weight. Ironic.

    Please note that I am not pushing the Slimfast/Cambridge diets, especially in the long term. However in the case you have outlined, I wonder if a short time on a more restricted diet of some sort would serve to drop some more weight which would then be maintained when she returned to her regular diet. Sixteen stone seems a high weight to plateau at. However I think I would settle for sixteen stone and diabetes in remission. Or would I? That is a very hard question to answer.

    From my very personal position I hope I am very aware of the implications of this study. If I can reduce my body weight significantly there is a CHANCE that I can improve my BG control or put by diabetes into remission.

    If I achieve this then I will have enormous motivation to do whatever I can to maintain this position. If I am not able to reverse my diabetes at lest I will have tried. I am already eating a restricted diet – as in about 80% of the supermarket shelves are irrelevant to me and most of the foods I ate for pleasure all my life are now off limits.

    The people I chat to on line who are or have been trying very low calorie diets are in general very highly motivated and very aware if the long term implications. Some have been on the shakes for three months or more, still losing weight. I am humbled by their dedication because I don’t believe I could do that. They are an inspired and inspiring minority.

    Imposed rapid weight loss is unlikely to be fruitful in the long term. If it is regarded as a “short term fix” then that is all it will be. There is generally a reason why people are overweight – probably that they lack the motivation not to over eat. No diet will fix this – they need to completely change their lifestyle. I know people who have tried the Cambridge diet with similar results to those you see – generally because there is a target of “must lose half a stone before ” instead of “must change the way I eat”.

    So studies like the Newcastle Study can point out that if you strip the fat from your liver and pancreas by significant weight loss then you may be able to reverse T2 diabetes but sadly I would be amazed if the vast majority of T2 diabetics would be able to profit from this in the long term. The risks of being over weight have been highlighted for decades but people don’t seem to realise that it means them.

    I didn’t realise what it meant to me.
    I am six foot tall.
    I was diagnosed in 2008 when my weight had crept up to 14 stone 7 lbs (I didn’t feel any different in myself from when I was 13 stone 7 lbs) and I suddenly lost about 5 pounds for no apparent reason. Also classic symptoms of continual thirst. My blood glucose was very high.
    Over time I learned improved my eating and reduced my weight to around 13 stone 5 lbs (my rough average over about 20-30 years) and I thought that I had my weight nicely managed.
    My BG control was better but not outstanding.
    I felt resentful that people such as the lady you described could (had the leeway to) trim off several stone and put their diabetes into remission.
    I am now thinking that I am still over weight around the waist and that I might be able to benefit from the loss of abdominal fat.
    I am down to 12 stone 5 pounds and determined to go lower.
    I have upped my exercise a lot by cycling, but I will struggle to get the miles in over the winter.
    Ideally I would like to weigh 11 stone 7 lbs which was my late teenage weight.

    So to answer the quote your last paragraph:

    “Do people who embark on these very strict diets know what they are letting themselves in for long term? I know we are desperate to find a cure for diabesity but I certainly wouldn’t want to try it.”

    Yes I do, and no I didn’t. It isn’t a lot of fun at times but the alternatives are even less attractive. Long term eating a lower calorie diet with very few carbohydrates isn’t that bad – there is a very wide range of attractive foods – it is just the memory of the other 80% of the supermarket shelves that can get you down. I used to love home made brown seedy bread. Sigh! Wrapped around home made chips. Groan!

  • I’m trying to understand what people have written, but as someone who didn’t even get an O’level in science, I’m finding it very hard! All I know is this: my type 2 diabetes has developed over 55 years, due to (probably) chronic intense childhood stress raising cortisol levels and a diet consisting almost solely of refined carbs leading to being 5 stone overweight. I will do anything to lose weight and reverse diabetes. Can anyone just say the healthiest way to do this? Help!

    • Hi Yvonne,

      In a nutshell:

      Eat protein at every meal, three times a day. (Eggs, fish, meat, poultry, nuts, tofu, cheese. You need to eat enough protein so you don’t feel the need to snack before the next meal.

      Eat low starch vegetables freely. These are vegetables that grow above the ground. The main ones to avoid are potatoes and parsnips. Carrots and swedes are ok.

      Add enough naturally saturated fats, extra virgin olive oil, avocado oil, coconut oil, butter, cream to make your foods tasty and to cook with.

      Limit fruit to 2 portions a day. Best are berries. Tropical fruits such as banana, pineapple and mango. You can still eat them but cut down the portion size.

      The main things to avoid are: sugar and sugar products including fruit juice. bread, pasta, rice, potatoes and potato products, breakfast cereals including oats and vegetable oils (not because they are carby but because they increase inflammation in the body.

      Be careful not to drink your calories. Cappucinos, latte’s, alcohol, milk, milk shakes, fruit juice and smoothies pack on a lot of calories. Plain or fizzy water is best.

      Make exercise part of your daily routine. Start weight training two or three times a week and walk and stretch the in-between days. Start with 10 minutes a day and when you have ingrained the habit over a few weeks or months increase the time you spend.

      Most of what we get up to are due to habits. It can be very difficult to change dietary habits. I was 40 before I could bear to leave anything on my plate thanks to a nagging mother!!!

      I feel much better avoiding wheat completely. It is amazing how much trashy food is completely avoided when you do this. I also avoid as much processed food as possible.

      Best wishes, Katharine.

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  • There seems to be a lot of argument about the content of various different diets from people with either vested interests in one approach or another or from people biased by success or failure at various diets or even other peoples failures or success.

    The Newcastle study has produced interesting science. The benefits of reducing fat around the liver and pancreas seems solid and would be achieved by any diet that results in significant weight loss for a significant number of people.

    To argue about which diet is better than another seems daft to me. Find what works for you. From my experience too much choice leads to bad food decisions and abandonmentof diets.

    I have been following the Newcastle diet for just over a week now. I am using Atkins shakes because the Optifast shakesare not generally available. I have lost around 4-5 kilos and definitely lost size around my waist. My BG has dropped massively and is withn normal range although I am still taking my oral meds. My blood pressure has also dropped to normal ranges And I feel so much healthier and energetic despite thestarvation calorie level

    If you are a GP I urge you to stop giving wishy washy dietary advice. This diet works by giving lots of focus. I am hungry and would love to eat a curry or some chips but I can’t balance it off in my mind against other good eating behaviour elsewhere. It’s not one of my shakes and it’s not veg.Simple.

    There are also people confusing long-term diet with short-term drastic action. I 100% beleive that following the Newcastle diet will rid me of T2 diabetes. Once I have succeeded the next phase is never ending up where I am again.

    Achieving weight loss through eating natural food rather than shakes makes nutritional sense but T2 sufferers mostly have a history of bad nutritional decisions. I firmly believe that limiting choice limits the scope failure.

    Rather than knocking the research or the diet we should welcome the research, learn from it and sieze the opportunities. I would rather face 8 weeks of healthy natural ketosis diet but I think I would fail. I think I will succeed via the shakes and veg only approach. Once my weight has dropped sufficiently I will endeavour to eat a healthy an balanced diet. I already appreciate food more than ever before but moderation and balance are essential long term.

    • Dear Darren thanks for sharing your positive experience of the VLCD and your success to date.
      You are so right when it comes to the science. If you are in ketosis you will lose fat and that will include the fat around the liver and waistline which is so good for one. I am also pleased that you have the benefit of ketosis because you do not feel hungry. All very good.
      Everything you are experiencing explains why literally millions of folk every year do Lighter Life or Cambridge Diet or one of the many other VLCDs that are now readily available either on the internet or elsewhere but that is not really what I was writing about. Indeed Cambridge Diet would have been out of business 50 years ago if they did not give people the immediate results which you are so enjoying. All I was writing about was how we fund science and how research and results are evaluated.
      The issue I have with the “Newcastle Study” is that it was not new science. Cambridge Diet and its many off spring have been putting obese people on the VLCD for over 50 years and the results speak for themselves. Nothing new I am sorry to say. What was so naughty was that fact that Professor Taylor and Professor Mike Lean did make out that it was somehow revolutionary and did not explain that the fast fat loss (particularly around the liver and waistline ) were side effects of ketosis. Any ketosis diet produces the same benefits and I urge you to read a larger study carried out in Southport managed by a GP called David Unwin which brought about the same results but with whole food. Unfortunately for David there is not a large corporate in the shape of the Cambridge Diet looking to flog shakes to help fund a bigger study. And this is the rub. How much science being presented to the public is actually the result of corporate millions or real breakthrough work.

      Yes you can say that I have a conflict of interest but frankly you dont need my products to follow a LCKD – just go to any food shop and buy fat and protein with a little green vegetables and you will be fine.

      I do hope you find your way to long term good health and beat the odds when it comes to the VLCD which has repeatedly, over the past 50 years, delivered extreme weight loss followed by extreme weight gain. As explained in my piece it is hard not re gain weight because on a VLCD you will lose significant amount of muscle which is not true for the other ketogenic diet known as the LCKD.

      I do genuinely hope you succeed but do remember that the “ healthy balanced diet “ ( which is based on a high carb low fat approach ) as presented by the UK government in the form of SACN is yet to be supported by any proper clinical data. So perhaps your goal post VLCD is a different diet.

      All the best

  • It’s not necessarily the case that Prof Taylor’s research is in some way opposed to the LCKD. In the first place, the mechanisms he’s elucidated are plainly supportive of the LCKD, and his research represents a “proof of concept” that can be applied to any strategy that leverages intraorgan fat, which can be shown to be the case with LCKD.
    Secondly, when Drs David and Jen Unwin published their trial of low carb diets for diabetes in Diabetes Care last year, it contained this note – “Roy Taylor, Professor of Medicine and Metabolism, Newcastle University, provided helpful discussion, statistical advice and comment in the writing of this paper”, and Prof Taylor’s “Type 2 Diabetes. Etiology and reversibility” was reference 9.

  • HI.
    Thank you so much for your comment. Prof Taylor and Prof Lean have consistently argued that ketosis is not the active element in the success of the very low calorie diet.

    It is true that the statistical results from their work into the very low calorie diet will support a LCKD and that is because both states trigger ketosis. Ketosis is, in my mind and others, the active player and whether you trigger ketosis by using starvation or using a Keto Low Carb Diet the ketosis is the same. What then starts to separate the diets is issues over metabolic rate and lifestyle issues as well as sustainability. This view is not shared by Lean and Taylor who have consistently stated that it is the radical reduction of calories that is critical . They are linking the success of the VLCD to starvation of calories and that only.

    This is naturally supported by Cambridge Diet which supports the DiRECT study via its subsidiary company.

    I am delighted that the Unwin Paper has been published and if discussion with Prof Taylor has taken David further forward .. that is just great.

  • I have taught Health and Nutrition for years. Whilst I appreciate your ideas, I think I will stick with the well researched ideas of Dr. Taylor.

    We will never be successful in winning this war as long as we use terms like starvation and bang on about fear of ketosis!!

    Unfortunately to me it sounds more like your selling a program than really trying to find solutions. Just my opinion as I am not a doctor or scientist either.

  • I belive all you are doing is selling the Atkins Diet using sudo medical terms. Ketosis features very highly in Atkins and can be dangerous.
    Marketing over substance.

    • Editorial

      This is a not uncommon idea about ketosis from a previous generation of dietitians. Don’t wish to be rude but it is rubbish. Have a look at some of the other posts on this site about it, especially ones relating to its use on the NHS for childhood epilepsy and the experimental trials going on for its use with cancer. If you are really interested in knowing about the latest thinking on ketosis, rather than rubbishing it from an armchair, take a look at Peter Attia’s website; he’s a Harvard trained physician and would be amused by your description of the terms involved as “sudo” – particularly since it is “pseudo”.

  • JimW,

    It is truly simple, really.

    There exists seasonal variation in the supply of food – in the natural world. This truism becomes increasingly the case with rising latitudes. So many warm blooded species have evolved tricks and means to overcome the food privations of winter. Smaller mammals may go underground and stash nuts in a winter larder. Larger mammals may store energy about their body’s as body fat.

    The ability to assimilate energy as added body fat is a physiological adaptation certain species have evolved to lend evolutionary advantage. They can hibernate and have no need to feed because release body fats from fat stores and their cells and tissues and they can live of that energy. The fats must be released from fat cells (lipolysis) and then converted to ketone bodies (ketosis) which can then be supplied to cells and metabolised. It is a truly natural and fairly long established natural arrangement that evolution has settled upon. Grisly bears have taken this physiological adapt ion to its most extreme. In less than eight months of the year they can assimilate enough body fat to presents a store of energy that will keep them fuelled over the four months of hibernation when they will not feed at all.

    The take away message is that the mammals that gain body fat do so because it has been a tried and tested means to lend them evolutionary advantage and they do so with the express intent that those body fats will be burned as fuel. The process is called lipolysis and ketosis.lipolysis is a tried and tested good thing.

    Unfortunately ketosis sounds too much like ketoacidosis which is not such a good thing. Hence in the days when Atkins encouraged people to take up with low-carb eating the ‘experts’ who saw Atkins recommendations as heretical in the extreme managed in their haste to confuse ketosis with ketoacidosis. Through being just a lttle too hasy, and through not looking to nature for inspiration, the experts who would rubbish Atkins recommendations suffered foot in mouth syndrome in the extreme. They simply did not know their ketosis from their ketoacidosis. I imagine it would have been an easy mistake to make back in the dark ages.

  • My understanding is the the use of shakes was to try and maintain a measurable sample with little variation between the subjects. Isn’t that what any scientist would do? It helps to reduce any possible variables. I’m doing a low calorie diet with 600-800 (aiming for 600, sometimes creeping a bit over) calories a day and vitamin mineral supplements… and so far the results are promising. Off the metformin, blood pressure under control and fasting Blood Sugars at low level


  • Hi


    I am delighted that you have made such good progress. Ketosis is brilliant even if you are achieving it through very low calorie control.

    You can trigger ketosis with very low carb diets. The use of shakes was not to control the subjects but because the original Roy Taylor study was funded by Optifast – which makes shakes – and the current study is being funded by Cambridge Diet which makes another version of the same shakes.

    Actually the issue I was presenting is really the need to investigate ketosis. Ketosis can be achieved through starvation – which effectively is about 650 to 750 calories a day ( as you know) or through very low carbohydrate diets. The brilliance of the very low carbohydrate diet over the very low calorie diet is sustainability on a number of fronts. There are many other benefits of triggering ketosis with food rather than starvation but for some reason all the money into research is being pumped into the exploration of the VLCD rather than the LCKD and for some strange reason some of the researchers do not appear to recognise ketosis as the key factor in the success of VLCD in the short term studies that have been published so far.

    Anyway I hope that ketosis continues to bring the results you are looking for. All the best.

  • It’s completely irresponsible for people without medical or scientific training or qualifications to gainsay medical research, simply because it doesn’t align with their personal theories, especially when it concerns the treatment of a life-threatening disease such as diabetes, and especially when that writer has an audience. Thankfully it’s not cancer you’re recommending treatment for.

    • Editorial

      If only it wasn’t necessary Groucho. If only those who are paid to give us advice hadn’t been getting it so wrong, if only rates of diabetes and obesity hadn’t soared on their watch,if only their dangerous and ill-informed advice had not been so damaging to diabetics for decades,if only they would fess up and confess what a disastrous mistake telling people with diabetes to push up the blood sugar with a high carb low fat diet. It’s hard and poorly paid work but someone has to do it. As for cancer the official advice is in need of an even bigger overhaul. It is so great you hand landed up here Groucho there is so much for you to learn. Good luck

  • Ancel Keys, the man behind the low fat nonsense did not interpret his Seven Countries research results correctly and appeared to be in a war with Professor John Yudkin who identified correctly the problems with high carb and high sugar diets.

    The governments believed Key’s science as the answer not the science of Professor Yudkin.

    Both scientists but with different agenda. One reticent and one loud and over-bearing. Even today scientists do not always agree and are not always right. Even a big study has its flawa…

  • It’s interesting, so many people with so many different experiences. It wouldn’t have something to do with us all being so very different, would it.

    I was diagnosed type II in ’97 and told in no uncertain terms not to reduce carbs, I asked because in my simple mind, hearing relatives with type I talking about carb counting I reckoned carbs were something to do with it.

    I lowered carbs 4 years ago to about 40gms per day, within weeks I had to throw away Gliclazide, Januvia and as an added bonus, atorvastatin because my total cholesterol dropped to 3. I had also avoided progressing onto insulin which my GP had been discussing with me. I even lost weight, about 25kgs.

    The weight loss stopped and now my body is happily converting protein into glucose and my BG is all over the place and often increases at 3am when I’m asleep (FreeStyle Libre measures BG every 15 minutes).

    I thing the important thing about The Newcastle Diet is in relation to how the liver and pancreas are or are not working and even having said that, some are getting different results to the initial research. At least this offers some hope for some of us. I’ve looked at my diet and I’m already pretty close, just have to cut out protein.

    • Hi

      Thank you for your comment.

      Actually one of the classic misunderstandings is that the only macronutrient that stimulates insulin is carbs. If you look at the diet recommended by Dr Bernstein and others the key is keeping carbs to below 20g a day and keeping protein down. The key is eating “fat to fullness”. You may be very interested in the work by Dr Trudi Deakin, a brilliant UK Dietician and recognised expert in keto diets. I actually stole these very words from her latest presentation at a Diabetes Conference in London at the end of last year.

      The first issue is ketosis and fantastic health benefits from the ketogenic state but we must always look beyond the obvious and consider sustainability. So whether ketosis can be achieved by starvation ( the Newcastle Diet) or a careful management of macro nutrients ( the LCKD) the issue is what happens months and years later and for that we need to consider not only health but also general wellbeing in terms of nutrients and social acceptability.

      We know that eating the LCKD is actually not too difficult and can be adapted from whole food without loss of nutrients etc and does ensure that the person managing thier diet can eat normally with others etc.

      However with the starvation option you do need added nutrients and this means you are not using purely whole foods. You need shakes etc. Secondly a liquid diet is not great for normal life and can lead to eating issues. Finally from the studies, I have seen, and the history of the VLCD ( the starvation diet) there appears to be long term problems with sustainability unless the patient is carefully transferred from the liquid diet to a LCKD and whole foods. So actually you are going to end up putting the patient onto the LCKD in any event.

      The Newcastle Study gave birth to a far bigger study in Scotland ( which is still on going ) and hopefully we will see whether the VLCD ( Starvation Diet ) does deliver sustainable results with the support of the LCKD and what is required to avoid the classic problem that the diet works in the short term but over time brings the weight back on and/or the return of the health issues apparently solved.

      Anyway, lets see what comes out in a couple of years.

      All the best

  • I have no problem with VLCDs, provided people are told to limit how much carbs they eat once the VLCD ends. VLCDs clearly gets good result, but the key is to keep the fat off, and we all know that the NHS eat well plate does not work for most people.

    • Point very well made. There are issues about metabolic rate and the VLCD but perhaps that requires a new topic for discussion.

  • I was diagnosed with diabetes in mid 2015. I weighed 10 stone 8 pounds (Under 5ft tall woman) and my HbA1c was 74 mmol/mol. My GP wanted to put me on Metformin, but I politely refused. Following Professor Taylor’s personal fat threshold theory I lost weight via the Twinkie diet and later via healthy eating and exercise. I gave my self a treat day once a week where I would whatever I liked. I never followed a VLCD. I came down to 8 stone 2 pounds and my HbA1c was 49 mmol/mol. 8 months later I got depressed and started eating junk food and buffets non-stop for 3 months (I must have eaten 20+ Tolberones in 2 months). My weight ballooned to 9 stone. I dreaded my next blood test – my HbA1c was still 49 mmol/mol. I think this somewhat supports Professor Taylor’s theory although I need to eat consistently healthier and get my BMI to 25 (24 because I’m Asian) to have a normal blood sugar.

  • I take the long view, that paying these Researchers millions of pounds / dollars / Zlotys etc, is a sound investment.
    Firstly, it will keep them all in ‘paid employment’ and therefore won’t be needing a Govt. handout.
    Secondly, it will provide us with a body of evidence, which, when properly collated and scrutinized will show that ‘Low Calorie’ diets do NOT work, and/or are too difficult to maintain.
    It is not in the financial interests of the Diabetes or Cardiac Industries for a clear, simple resolution of the Great Diet Debate, so the more pointless but heroic ‘studies’ undertaken, the more money for them.

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