Chris Smyth Health Editor
The Times
Gerry Gajadharsingh writes:
“Finally, the NHS is waking up to the possibility that for many people Type 2 diabetes need not be the irreversible condition it was once thought to be.
However, they are focusing on “dramatic weight loss” as the main strategy. The trial of 298 diabetic patients in 2017, showed that 46% of those patients on an “ultra-low-calorie food replacement diet” for 3 to 5 months were in remission with no need for medication a year later. 2 years later this had reduced to 32%, showing that for over two thirds of the patients, the diet had not worked long term.
I think there are better ways to achieve better long-term compliance with dietary change. Weight reduction is often a positive side effect of better metabolism. Whilst you can lose weight by significant reduction in food intake (note that I did not just say calorie reduction), I think this is very difficult for the majority of patients to keep up and I wonder whether it may cause more long-term problems. Eating is an important part of life, enjoyment and socialising and eating well is critical for our metabolism and health.
Metabolic Balance was designed by a German Internal medicine doctor to optimise metabolism, it works for a variety of health problems including Type 2 diabetes management. One of my recent patients with Type 2 diabetes (and a number of other medical problems), lost 16kg in 3 months following her individualised Metabolic Balance programme, without starving herself. In fact, her diet in terms of calorific intake was not much different to what she was eating before. What was different was an increase in her intake of dietary protein and dietary fat (fat has more calories that carbohydrate by the way), reduction in high glycaemic load carbohydrates and eating 3 meals a day and not snacking, a key principle in Metabolic Balance.
More importantly she enjoys what she eats, and I suspect that she will follow these principles for the rest of her life. Her blood glucose is now normalised, and her other health problems are also much better after only 3 months.
The NHS say that their programme is “just” over £1,000 per patient, which is not that much lower compared to the cost of a full bespoke Metabolic Balance programme carried out in the private sector, with a comprehensive blood screen before and after the programme.
We’ll wait to see if the NHS want to do a comparison trial of their “ultra-low calorific diet” with Metabolic Balance programmes for Type 2 diabetes, but don’t hold your breath.”
A soup and shake diet can reverse diabetes for at least two years, according to the latest results from a trial that offers hope to millions of overweight people.
Those who kept the pounds off after dramatic weight loss on an 800-calorie regimen were more likely to continue in remission, suggesting that type 2 diabetes should no longer be seen as permanent. The NHS is about to test using the method in routine treatment, saying that it “has the potential to transform the lives” of diabetics.
The study suggests that dramatic weight loss reduces levels of fat in the pancreas, allowing it to recover the ability to produce insulin. People with type 2 diabetes do not produce enough insulin or become resistant to it, leading to dangerously high blood sugar levels if not controlled. Complications can include blindness and amputations.
In 2017 results from a trial in 298 diabetics showed that 46 per cent of those on an ultra-low-calorie food replacement diet for three to five months were in remission with no need for medication a year later, with help from an NHS dietician on reintroducing normal meals. Today updated results showed that after an extra year 70 per cent of these patients are still in remission.
Professor Roy Taylor of Newcastle University, who led the study, said: “These results are a significant development, and finally pull down the curtain on the era of type 2 diabetes as an inevitably progressive disease. We now understand the biological nature of this reversible condition.
“However, everyone in remission needs to know that evidence to date tells us that your type 2 diabetes will return if you regain weight.”
Those who stayed in remission after two years lost an average of 15.5kg (two and a half stone) initially and put 4.3kg back on after the first year, while those who relapsed after a year lost an average of 12kg (just under two stone) initially and then regained 7.1kg, according to results presented at the Diabetes UK Professional Conference yesterday.
Over the full two-year period, those who failed to reverse diabetes at all lost an average of 3.2kg, those who relapsed after a year lost 3.7kg and those still in remission lost an average of 10.4kg.
Almost five million people in Britain have diabetes, 90 per cent of them type 2, after a doubling of cases in two decades fuelled by obesity. The NHS spends billions of pounds a year treating the disease.
Professor Mike Lean, a co-author at Glasgow University, said that reversing type 2 diabetes was “incredibly exciting”. He added: “Achieving that entirely in NHS primary care is vital. People with type 2 diabetes and healthcare professionals have told us their top research priority is, ‘Can the condition be reversed or cured?’ We can now say, with respect to reversal, that yes it can.”
The diet programme costs little more than £1,000 per patient. Professor Jonathan Valabhji, NHS England’s clinical director of diabetes and obesity, said: “Our own pilot of low-calorie diets for 5,000 people has the potential to transform the lives of those already diagnosed with the condition.”
The study found that, overall, 36 per cent of those put on the diet were still in remission after two years. However, this rose to 64 per cent of those who lost more than 10kg and 70 per cent of those who lost more than 15kg, according to results also published in The Lancet Diabetes & Endocrinology.
Elizabeth Robertson, director of research at Diabetes UK, said: “These results further challenge the perception that type 2 diabetes needs to be a lifelong condition for everyone diagnosed with it. Remission of type 2 diabetes can be life changing; [the trial] offers one potential solution, we are committed to working with the researchers and the NHS to ensure these exciting findings reach people with type 2 diabetes as soon as possible.”