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Could rapid weight loss being healthier sometimes?
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This seems to be a UK thing, since I never hear this language used except when reading UK studies, but I have issues with their definition of “remission.” What they mean, according to the study abstract, is simply what an American would call good glucose control - a1c within acceptable range - in the case of this study, below 6.5. This isn’t hard to do, mine is currently below 5. However, I am for sure still diabetic - if I were to eat a big bowl of rice right now, my levels would skyrocket and I would wind up sick.magnusthenerd wrote: »lynn_glenmont wrote: »I'm a little confused. The article linked in the OP is from 2016 and appears to be discussing the methodology for the planned DiRECT study, whose results were expected to be available beginning in 2018. What were the results?
Also, the linked article included a plan for returning patients in the intervention cohort to the VLCD if they regained weight OR if a1c measurement returns to diabetic range (search the article for "rescue plans" to find what I'm talking about). To me that, combined with the relatively short term of the study, should invalidate those subjects -- you couldn't really draw valid conclusions on whether their diabetic was reversed because of the weight loss or because they were in a steep deficit. The somewhat ambiguous description of the previous Counterpoint study ("Results showed a mean weight loss of 15.3 kg and a rapid return of fasting blood glucose to normal, which persisted for up to 3 months after return to normal diet." - emphasis added) also leaves room for the diabetic reversal to be attributed to the state of being in a steep deficit (600 kcal/day) rather than the actual weight loss.
What's wanted is a study to see if two, three, five years after returning to a maintenance diet, the subjects still have a healthy a1c.
The two year results study:
https://www.ncbi.nlm.nih.gov/pubmed/30852132
It’s not necessary to eat a VLCD in order to get your a1c down. Any reasonably controlled intake of food will do it.
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This is a discussion of remission on a US site: https://www.uwhealth.org/health/topic/special/type-2-diabetes-can-you-cure-it/abo1541.html
"What is remission?
Of those people who don't need diabetes medicine, some find that their diabetes does "reverse" with weight control, diabetes-healthy eating, and exercise. Their bodies are still able to make and use insulin, and their blood sugar levels go back to normal. Their diabetes is in remission.
"Complete remission" is 1 year or more of normal A1c and fasting glucose levels without using diabetes medicine. When you have complete remission, you still get tested for high blood sugar, high blood pressure, high cholesterol, and kidney and eye problems. You do regular foot checks.
"Prolonged remission" is 5 years or more of normal A1c and blood sugar levels without using diabetes medicine. You might have lab tests less often. But your doctor will still check on any heart, eye, foot, or other health problems you have had from diabetes, even if they are better than before."
I've seen it used in other ways too -- usually meaning improving insulin sensitivity.
https://caloriesproper.com/high-protein-magic/ -- discussion of study regarding improving insulin sensitivity and thus putting IR/prediabetes into remission.
I know I've seen somewhere (from a US source) a discussion of weight loss/increased exercise putting IR or T2D into "remission" as meaning you could eat a potato (or whatever) without it hurting blood sugar control, vs. very low carb diets controlling the effects of the disease but not necessarily putting it into remission (since if anything IR increases), at least not until there is also weight loss, etc. But I can't find that now.
I do have a friend who lost a bunch of weight and put his diagnosed T2D into remission, and he didn't have to eat a super carb controlled diet or avoid rice. He was supposed to eat generally healthfully, but that seemed to be more about maintaining the weight loss and just because it's good for everyone to do, his IS had improved. But I understand that's anecdotal and I talked to him, not his doctor.2 -
magnusthenerd wrote: »magnusthenerd wrote: »I'm concerned with the level of confirmation bias involved as there is a clear desire for the outcome to be true rather than a careful review of the data and accepting a best course of action.
The design of experiment biases the outcome. Much of this notion of damaging metabolism is originating from the WLS industry.
Could you explain how so? In what way would you change either the experiment's procedures or measured outcomes to reduce or eliminate the biase?
The design only evaluated those under medical supervision and an extreme low calorie diet. To evaluate the impact you need a control group and an second evaluation group - such as one following the MFP plan of 1-2lb/week rate.
This design also does not take in to account the long term impact. Considering weight is an output of behavior is there a focus on changing behavior?
I imagine the immediate concern is to mitigate a greater risk, such as morbidly obese patients.
There was a control group - those kept under the normal Diabetic Care Guidelines. I don't think you're suggesting a control group removed from standard guidance as that would be medically unethical.
Why does the study need to evaluate changing behavior when the point of the study isn't "can we sustain weight loss", the study is designed to see "does rapid weight loss induce T2D remission?" It does include counseling to maintain the weight loss post low calorie diet, as maintaining the weight loss is one goal of the study - to see if the remission lasts when weight loss is maintained.
The concern of the study is evaluating is rapid weight loss a method to induce T2D remission. T2D is a rather big deal in terms of projected medical costs.
Well that's the bias - the study is conducted to promote WLS without showing alternatives. It addresses a symptom, but not the root cause.
Why rapid weight loss? Why push surgical intervention and not address the behavioral root cause?
It is known that weight loss is an effective means to induce T2D remission - it would be interesting to see if the rate of loss alters effectiveness.1 -
magnusthenerd wrote: »magnusthenerd wrote: »I'm concerned with the level of confirmation bias involved as there is a clear desire for the outcome to be true rather than a careful review of the data and accepting a best course of action.
The design of experiment biases the outcome. Much of this notion of damaging metabolism is originating from the WLS industry.
Could you explain how so? In what way would you change either the experiment's procedures or measured outcomes to reduce or eliminate the biase?
The design only evaluated those under medical supervision and an extreme low calorie diet. To evaluate the impact you need a control group and an second evaluation group - such as one following the MFP plan of 1-2lb/week rate.
This design also does not take in to account the long term impact. Considering weight is an output of behavior is there a focus on changing behavior?
I imagine the immediate concern is to mitigate a greater risk, such as morbidly obese patients.
There was a control group - those kept under the normal Diabetic Care Guidelines. I don't think you're suggesting a control group removed from standard guidance as that would be medically unethical.
Why does the study need to evaluate changing behavior when the point of the study isn't "can we sustain weight loss", the study is designed to see "does rapid weight loss induce T2D remission?" It does include counseling to maintain the weight loss post low calorie diet, as maintaining the weight loss is one goal of the study - to see if the remission lasts when weight loss is maintained.
The concern of the study is evaluating is rapid weight loss a method to induce T2D remission. T2D is a rather big deal in terms of projected medical costs.
If that's what it's supposed to find out, they shouldn't put people who regain weight or return to T2D status on another course of VCLD. They should count the ones who return to T2D status as people whose T2D remission from rapid weight loss was not sustained. They can't have it both ways.
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magnusthenerd wrote: »magnusthenerd wrote: »I'm concerned with the level of confirmation bias involved as there is a clear desire for the outcome to be true rather than a careful review of the data and accepting a best course of action.
The design of experiment biases the outcome. Much of this notion of damaging metabolism is originating from the WLS industry.
Could you explain how so? In what way would you change either the experiment's procedures or measured outcomes to reduce or eliminate the biase?
The design only evaluated those under medical supervision and an extreme low calorie diet. To evaluate the impact you need a control group and an second evaluation group - such as one following the MFP plan of 1-2lb/week rate.
This design also does not take in to account the long term impact. Considering weight is an output of behavior is there a focus on changing behavior?
I imagine the immediate concern is to mitigate a greater risk, such as morbidly obese patients.
There was a control group - those kept under the normal Diabetic Care Guidelines. I don't think you're suggesting a control group removed from standard guidance as that would be medically unethical.
Why does the study need to evaluate changing behavior when the point of the study isn't "can we sustain weight loss", the study is designed to see "does rapid weight loss induce T2D remission?" It does include counseling to maintain the weight loss post low calorie diet, as maintaining the weight loss is one goal of the study - to see if the remission lasts when weight loss is maintained.
The concern of the study is evaluating is rapid weight loss a method to induce T2D remission. T2D is a rather big deal in terms of projected medical costs.
Well that's the bias - the study is conducted to promote WLS without showing alternatives. It addresses a symptom, but not the root cause.
Why rapid weight loss? Why push surgical intervention and not address the behavioral root cause?
It is known that weight loss is an effective means to induce T2D remission - it would be interesting to see if the rate of loss alters effectiveness.
Having an experiment test the hypothesis isn't a bias. There are already studies where diabetics lose weight another way, it seems just an added expense to run a comparison group.
And most importantly, the claim of bias isn't actually demonstrating something wrong with the study. Bias itself isn't something wrong with a study, it is a reason to look for methodology errors.
Weightloss can induce remission in early T2D, it doesn't have this kind of success rate in people at the medicated level.1 -
The sobering and difficult conclusions I fear is that gaining weight damages our metabolisms. As in all of us are already there. The speed or style of weight lose doesn't matter.
I have seen nothing that suggests "slow and steady" or "keto" or "vegan" or "Mediterranean" or anything leads to better maintenance after weightloss.
Every person who is maintaining is an anecdote for whatever method they used, and we sll have our opinions, but nothing i have seen improves adherence or maintenance.
I hope the info is out there and that we all aren't damaged from the initial gain.0 -
I wonder if the VLCD (which appears to be liquid-based, though I admit I skimmed the article) essentially puts the participants into a regular fasted state. The original 5:2 diet was being used to control blood sugar, and has been successful in reversing pre-diabetes (I don't know about full diabetes) so maybe the fasting issue is a factor here. It's only because the 5:2 diet had weight loss as a side-effect that it became well known and popular.
My personal view is that some initial rapid weight loss in very obese individuals may be beneficial as a kick-starter, and I seem to recall reading a recent study which showed that those who had rapid weight loss kept more of it off long-term than those who didn't. But I can't remember how large the study group was. That said, I have done all kinds of crash diets over the years, with fast weight loss initially, and - of course - put it all back on and more as soon as I went back to my old habits. The only thing that is now working for me (and has been since 2013) is fastidious logging, a fierce control of my calorie intake, and a new-found love of exercise. Luckily for me I find the whole process interesting, but I can fully understand why people struggle.0 -
SnifterPug wrote: »The only thing that is now working for me (and has been since 2013) is fastidious logging, a fierce control of my calorie intake, and a new-found love of exercise
Congratulations, when I get to maintenance weight I hope and pray that I come up with a formula that works for me. (I may steal parts of yours too)
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How would this compare to a group that lost weight at a standard rate ~1lb/week? How does this compare to a control group losing no weight?
There is no "damaging metabolism" as metabolism is nothing more than a series of biochemical pathways.
I question the long term effect as dramatic change adopted in the short term rarely leads to long term changes in behavior. In the long term it may actually cause harm as individuals feel the need for dramatic intervention instead of forming habits which promote health.
I was in a house with someone for a few weeks who was on a ~800 calorie diet under medical supervision.
They were on a "diet break" at the time.
They ate high calorie "junk food" (either takeaway or that is easy to cook at home) for every meal and lots of high calorie snacks.
They had midnight snacks of tater tots / potato gems covered in melted cheese and bacon.
Medically supervised starvation periods can not magically or instantly educate a person or their tastebuds and cooking skills.
All things take time. Learning is a key form of nourishment.
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The big news last night was the barbaric surgery brings about many of the positive health outcomes as the more enlighten, educated, ones who have taken the slow approach to change their outlook and lifestyle.1
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I wonder if it will help the person. Typically, the thought is that diet breaks help people achieve maintenance better with a large amount of weight to lose by preparing them to eat at maintenance levels instead of always dieting. Too many people have this mindset of "this is what I eat on a diet" and "this is what I eat when I'm not on a diet", instead of "this is how much I eat when I'm on a diet", and "this is how how much I eat when I'm not on a diet".How would this compare to a group that lost weight at a standard rate ~1lb/week? How does this compare to a control group losing no weight?
There is no "damaging metabolism" as metabolism is nothing more than a series of biochemical pathways.
I question the long term effect as dramatic change adopted in the short term rarely leads to long term changes in behavior. In the long term it may actually cause harm as individuals feel the need for dramatic intervention instead of forming habits which promote health.
I was in a house with someone for a few weeks who was on a ~800 calorie diet under medical supervision.
They were on a "diet break" at the time.
They ate high calorie "junk food" (either takeaway or that is easy to cook at home) for every meal and lots of high calorie snacks.
They had midnight snacks of tater tots / potato gems covered in melted cheese and bacon.
Medically supervised starvation periods can not magically or instantly educate a person or their tastebuds and cooking skills.
All things take time. Learning is a key form of nourishment.3 -
After reading all the threads it all makes sense and Web MD gives a pretty good explanation aswell.
Yes, I am reading WebMD now and obsessively checking my January lab results against it, lol.
After I figured out the relevant abbreviations, all in normal ranges!
I guess my blurred vision and lethargy is due to the hoof beats of sleep deprivation horses rather than the hoof beats of diabetes unicorns.1 -
For the last time, before I lose my mind, it's type 1. Diagnosed when I was in my late 40's. I was on insulin for years.
Within the last year, I was tested for antibodies. It was discovered that my pancreas is now producing enough insulin. They don't know how. They don't know why. I was taken off of insulin. All of my doctors refer to me as a medical anomaly.
Just recently, my leptin resistance vanished as well. I had previously been on injections for that.
I also had my tonsils removed in fourth grade. Any questions? No? Great!
In fairness, that's a different story than "losing 30 pounds allowed me to quit taking insulin for my type 1 diabetes."3
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