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Could rapid weight loss being healthier sometimes?
magnusthenerd
Posts: 1,207 Member
So this thought has started to fester after listening to Diabetes Researcher Nicola Guess discuss the The Diabetes Remission Clinical Trial (DiRECT) study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/
In it, roughly half of people that lost 15kg or more in a few months put their Type 2 Diabetes into remission, meaning they no longer needed to use any of their medications. That's pretty incredible.
Of note, Dr. Guess pointed out that this result is not seen merely by losing 15kg, but only seems to show up when the weight loss is rather quick. It seems that the protocols necessary to cause it involve very low calorie diets - 900 calories a day. Obviously these are levels that should only be done with some kind of medical support. Yet it also seems concerning if the general tendency in the public's mind is to shun rapid weight loss and have stories out their about damaging metabolism if, in fact, it the way to treat diabetes, a disease that threatens to topple the health system at the rate it is growing globally.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/
In it, roughly half of people that lost 15kg or more in a few months put their Type 2 Diabetes into remission, meaning they no longer needed to use any of their medications. That's pretty incredible.
Of note, Dr. Guess pointed out that this result is not seen merely by losing 15kg, but only seems to show up when the weight loss is rather quick. It seems that the protocols necessary to cause it involve very low calorie diets - 900 calories a day. Obviously these are levels that should only be done with some kind of medical support. Yet it also seems concerning if the general tendency in the public's mind is to shun rapid weight loss and have stories out their about damaging metabolism if, in fact, it the way to treat diabetes, a disease that threatens to topple the health system at the rate it is growing globally.
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I'm calling bs on it needing to be fast weight loss.
I've lost just shy of 30 pounds, 10 lbs between September and June and 20 lbs since I started mfp in June.
I am a type 1 adult onset diabetic. I've gotten off insulin since I started a pescatarian diet which is plant based with seafood, eggs and some dairy.
I do not consider my weight loss fast. I've been very sensible about it and know that slow weight loss is sustainable.
Any doctor who suggests a quick loss diet on 900 calories per day is a doctor that I wouldn't trust.14 -
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.5 -
Damaging metabolism
It bounces back once starting to refeed, unless there is long-term severe calorie restriction like in the case of eating disorders.
Losing weight quickly for obese or morbidly obese people is important. It's literally a matter of life and death, regardless of their insulin issues.
I would think that 900 calories per day plan is monitored by a doctor? I didn't read the link but if it's published on the NIH label, then it was a strictly monitored plan with a focus on electrolytes and basic nutrition. I'm sure the subjects were on supplements and guided nutrition.
900 calories for you and I out there on our own? Not a good idea at all.5 -
I'm not entirely sure where you see that in the results? The article is not very clear at all on anything. It seems like this experiment is still ongoing?
I don't think that anyone denies that in certain cases, the benefits of rapid weight loss can outweigh the risks. For very obese people with health complications from it. Perhaps with T2D as well, although I am not sure if the research is there yet.
However for most people just trying to lose some weight, slow and steady is still by the best way to do it.5 -
I'm calling bs on it needing to be fast weight loss.
I've lost just shy of 30 pounds, 10 lbs between September and June and 20 lbs since I started mfp in June.
I am a type 1 adult onset diabetic. I've gotten off insulin since I started a pescatarian diet which is plant based with seafood, eggs and some dairy.
I do not consider my weight loss fast. I've been very sensible about it and know that slow weight loss is sustainable.
Any doctor who suggests a quick loss diet on 900 calories per day is a doctor that I wouldn't trust.
I've never heard of any type 1 diabetes being treatable by anything besides using insulin. I've never heard of there being type 1 adult onset. Type 2 is called adult onset.
Type 2 is treatable early on with weight loss.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.
Not sure the exact comparison, but the prognosis for anyone once they're on a medication to treated T2D is not good for recovery. Dr. Guess said something like a 5% loss in weight doesn't seem to do anything.
I'm not saying one can damage metabolism - I'm saying it is a common lore put out there to discourage people from rapid weight loss.
It doesn't matter if it causes long term changes in behavior. If doing it causes remission and that remission has a lasting protective effect, that's all that matters in terms of it being a treatment for T2D. And honestly, no, that's also a misnomer - I think people overstate the idea that the diet that induces weight loss has to be the one to maintain it. In a certain sense, it can't even be correct because any diet that causes weight loss is going at least need to be less food than the one that maintains it unless you accept maintenance as an asymptote.cmriverside wrote: »Damaging metabolism
It bounces back once starting to refeed, unless there is long-term severe calorie restriction like in the case of eating disorders.
Losing weight quickly for obese or morbidly obese people is important. It's literally a matter of life and death, regardless of their insulin issues.
I would think that 900 calories per day plan is monitored by a doctor? I didn't read the link but if it's published on the NIH label, then it was a strictly monitored plan with a focus on electrolytes and basic nutrition. I'm sure the subjects were on supplements and guided nutrition.
900 calories for you and I out there on our own? Not a good idea at all.
Again, I'm not saying metabolic damage will happen, I'm talking about what gets bandied about. It could be doubly harmful for both being a false notion and for it being a mental barrier to people doing what could treat T2D.
I listened to Dr. Guess on a podcast about the results (https://sigmanutrition.com/episode294/). The study is ongoing to see how long the remission lasts while the subjects are at maintenance, no longer losing weight. There is a 1 year follow up data that I think Guess said came out in December 2018.I'm not entirely sure where you see that in the results? The article is not very clear at all on anything. It seems like this experiment is still ongoing?
I don't think that anyone denies that in certain cases, the benefits of rapid weight loss can outweigh the risks. For very obese people with health complications from it. Perhaps with T2D as well, although I am not sure if the research is there yet.
However for most people just trying to lose some weight, slow and steady is still by the best way to do it.
I'm not sure there is research to show slow and study is better for most people. There certainly is research that for people with a fair amount to lose, people who lose rapidly initially have the best results in terms of keeping off at least part of the loss.8 -
Did you really mean to imply that I don't know what type of diabetes I've had for the last 12 years?14
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magnusthenerd wrote: »Of note, Dr. Guess pointed out that this result is not seen merely by losing 15kg, but only seems to show up when the weight loss is rather quick. It seems that the protocols necessary to cause it involve very low calorie diets - 900 calories a day. Obviously these are levels that should only be done with some kind of medical support. Yet it also seems concerning if the general tendency in the public's mind is to shun rapid weight loss and have stories out their about damaging metabolism if, in fact, it the way to treat diabetes, a disease that threatens to topple the health system at the rate it is growing globally.
This is interesting, and I wonder what the mechanism is. (I noticed that she's on SigmaNutrition as I subscribe to that podcast but am always behind, so will have to listen to it.)
It does seem consistent with the fact that WLS seems to address T2D very effectively and quickly.
I'm not as down on rapid weight loss as some here. I think there's something to be said for slow and steady allowing more time for changing habits (but if you have a lot to lose you can start with a fast loss and then transition to slower).
I do think unsupervised 900 cal would be a dangerous thing for people to assume they should aspire to, as it's so easy to not get adequate nutrition, and unfortunately there's so often a tendency that if something is good for specific purposes people decide it might be a good choice for others (like vanity weight loss). See the various posts from people asking about following the pre WLS diet unsupervised and without intending to get WLS, because it must be safe if those other people do it.3 -
Did you really mean to imply that I don't know what type of diabetes I've had for the last 12 years?
No, I'm flat out stating you are using odd terminology for it. Given a 1 is right next to a two on a keyboard, the most common explanation would be that you had a typo over a lack of awareness of your disease. You can develop Type 1 as an adult, but it it would not be adult onset type 1. Adult onset is the term used for type 2. It would be liking saying you have type 2 type 1 diabetes. The most clarifying thing would be to call it LADA.
It also isn't terribly relevant to remission of T2D as it still has the autoimmune pathology of Type 1.
What it does have in common with T2 is that it has been viewed as an inevitably progressive decline disease. Partial remissions happen spontaneously. I would be surprised and interested that there exists any protocol with any known success rate at inducing total remission.9 -
This is interesting, and I wonder what the mechanism is. (I noticed that she's on SigmaNutrition as I subscribe to that podcast but am always behind, so will have to listen to it.)
It does seem consistent with the fact that WLS seems to address T2D very effectively and quickly.
I'm not as down on rapid weight loss as some here. I think there's something to be said for slow and steady allowing more time for changing habits (but if you have a lot to lose you can start with a fast loss and then transition to slower).
I do think unsupervised 900 cal would be a dangerous thing for people to assume they should aspire to, as it's so easy to not get adequate nutrition, and unfortunately there's so often a tendency that if something is good for specific purposes people decide it might be a good choice for others (like vanity weight loss). See the various posts from people asking about following the pre WLS diet unsupervised and without intending to get WLS, because it must be safe if those other people do it.
WLS is actually the impetus behind the study. The pre WLS involves a liver reducing diet to make the surgery safer, and it was wondered if the diet prep for WLS and immediately following it induce the changes, rather than the surgery itself.3 -
magnusthenerd wrote: »
No, I'm flat out stating you are using odd terminology for it. Given a 1 is right next to a two on a keyboard, the most common explanation would be that you had a typo over a lack of awareness of your disease. You can develop Type 1 as an adult, but it it would not be adult onset type 1. Adult onset is the term used for type 2. It would be liking saying you have type 2 type 1 diabetes.
I don't know who you think you are. One thing you are not is my endocrinologist.
I have TYPE 1 ADULT ONSET DIABETES .
No typos. No mistakes. No lack of awareness.
Shame on you!14 -
I'm calling bs on it needing to be fast weight loss.
I've lost just shy of 30 pounds, 10 lbs between September and June and 20 lbs since I started mfp in June.
I am a type 1 adult onset diabetic. I've gotten off insulin since I started a pescatarian diet which is plant based with seafood, eggs and some dairy.
I do not consider my weight loss fast. I've been very sensible about it and know that slow weight loss is sustainable.
Any doctor who suggests a quick loss diet on 900 calories per day is a doctor that I wouldn't trust.
Type 1 diabetes is the result of autoimmune attack on the insulin-secreting ("islet") cells of the pancreas, it does not go into remission as a result of a change in diet. It can occur at any age. Once those cells are lost you cannot produce insulin; and you maintain the auto-immune response against those cells so even if you had some new ones transplanted or created new islet cells via some sort of stem-cell therapy, the immune system would just kill them off again. Unless someone comes up with a way to fix the primary immune system fault, you can't 'cure' this form of diabetes, only treat it with insulin.
Insulin is not only a thing to lower blood sugar, it is a permission slip for muscles to uptake sugar (basically, a lunch slip)--without it they cannot get nourished. It seems likely the insulin-governed system for controlling blood sugar evolved so that nerve cells would always eat first and muscles would wait in line for their turn.
It doesn't matter what you do with type 1 diabetes in terms of diet--if you go off insulin you will have no insulin in your system at all because you have no cells capable of producing it. You will develop ketoacidosis and go into a coma, because with no insulin present your muscles don't have permission to 'eat' glucose.
You may want to have a sit-down with your doc to get clear on exactly what is going on with you; what you claim to be doing sounds dangerous to me.
By contrast Type 2 diabetes results from peripheral insulin resistance in the muscles. The muscles have been told to eat so much because of excess insulin (that was released in response to a calorie-overload diet relative to exercise amount) that they down-regulate the insulin receptors, to 'silence the noise' of insulin constantly telling them to 'eat'. Since they no longer respond to normal levels of insulin, the pancreas has to secrete more insulin for the muscles to 'get fed'. You can see how this quickly becomes a bad feed-forward loop. Unchecked over months to years, eventually the insulin secreting cells in the pancreas 'burn out' and the end-stage type 2 diabetic becomes insulin-dependent. Before the pancreas burns out this form of diabetes is potentially reversible with diet and exercise--diet to keep the insulin secretion low and exercise to urge the muscles to up-regulate their insulin receptors back to normal levels.20 -
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!13 -
I'm calling bs on it needing to be fast weight loss.
I've lost just shy of 30 pounds, 10 lbs between September and June and 20 lbs since I started mfp in June.
I am a type 1 adult onset diabetic. I've gotten off insulin since I started a pescatarian diet which is plant based with seafood, eggs and some dairy.
I do not consider my weight loss fast. I've been very sensible about it and know that slow weight loss is sustainable.
Any doctor who suggests a quick loss diet on 900 calories per day is a doctor that I wouldn't trust.
Hi, this is the second post in which I’ve seen you claim that you are a type 1 adult onset diabetic who has gotten off insulin. Since the definition of type 1 is that the body completely loses the ability to make insulin due to destruction of the pancreatic cells which make insulin, and the way adult onset type 1 is diagnosed and distinguished from type 2 is that all the usual tricks for helping with type 2 such as weight loss and reducing carbs DON’T WORK, your claim doesn’t make any sense. Can you explain?11 -
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!
If your pancreas is producing enough insulin, then by definition you don’t have type 1. The actual meaning of “type 1” is “doesn’t produce insulin.” Plenty of type 2 diabetics with severe disease are on insulin and have leptin resistance.11 -
Just because you were on insulin doesn't mean you had type 1 diabetes.
I suppose it's possible your autoimmune-system derangement went into remission before all the islet cells were destroyed, but if so that should be published as a letter in a medical journal. To my knowledge it would be a medical first.
If you *had* antibodies once and do not have them now, you also need an immunologist to figure out why and make sure the loss of those antibodies, which at first glance would seem fortunate, doesn't mean some other serious problem such as an onset of leukemia or lymphoma that would affect all antibodies indiscriminately and leave you immunosuppressed (plus, you know--cancer...)10 -
Quick note to other type 1 diabetics: if this person's story is accurate, it's a rare anomoly. Do Not Try This At Home. Stay on your insulin.18
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There is indeed such a thing as adult onset type 1. It’s sometimes called LADA. It’s not nearly as common as adult onset type 2, but it does happen, in a similar way to child onset type 1, through an autoimmune attack. However, it is distinguished from type 2 by weight loss, metformin and similar meds, and dietary changes having no effect on it. The usual course of lada is for it to be misdiagnosed as type 2 initially, then later when the person does not respond to the usual type 2 protocol and gets very ill, they are correctly diagnosed and put on insulin.magnusthenerd wrote: »
I've never heard of any type 1 diabetes being treatable by anything besides using insulin. I've never heard of there being type 1 adult onset. Type 2 is called adult onset.
Type 2 is treatable early on with weight loss.
Not sure the exact comparison, but the prognosis for anyone once they're on a medication to treated T2D is not good for recovery. Dr. Guess said something like a 5% loss in weight doesn't seem to do anything.
I'm not saying one can damage metabolism - I'm saying it is a common lore put out there to discourage people from rapid weight loss.
It doesn't matter if it causes long term changes in behavior. If doing it causes remission and that remission has a lasting protective effect, that's all that matters in terms of it being a treatment for T2D. And honestly, no, that's also a misnomer - I think people overstate the idea that the diet that induces weight loss has to be the one to maintain it. In a certain sense, it can't even be correct because any diet that causes weight loss is going at least need to be less food than the one that maintains it unless you accept maintenance as an asymptote.
Again, I'm not saying metabolic damage will happen, I'm talking about what gets bandied about. It could be doubly harmful for both being a false notion and for it being a mental barrier to people doing what could treat T2D.
I listened to Dr. Guess on a podcast about the results (https://sigmanutrition.com/episode294/). The study is ongoing to see how long the remission lasts while the subjects are at maintenance, no longer losing weight. There is a 1 year follow up data that I think Guess said came out in December 2018.
I'm not sure there is research to show slow and study is better for most people. There certainly is research that for people with a fair amount to lose, people who lose rapidly initially have the best results in terms of keeping off at least part of the loss.
There is no form of type 1 which can be helped by losing weight and eating better.
10 -
rheddmobile wrote: »There is indeed such a thing as adult onset type 1. It’s sometimes called LADA. It’s not nearly as common as adult onset type 2, but it does happen, in a similar way to child onset type 1, through an autoimmune attack. However, it is distinguished from type 2 by weight loss, metformin and similar meds, and dietary changes having no effect on it. The usual course of lada is for it to be misdiagnosed as type 2 initially, then later when the person does not respond to the usual type 2 protocol and gets very ill, they are correctly diagnosed and put on insulin.
There is no form of type 1 which can be helped by losing weight and eating better.
I will argue semantics as important here and say no. There is type 1 diabetes that can happen when an adult - or could onset when an adult, but calling it Type 1 adult onset is bad terminology because it sounds like it is referencing type 2. That's why it is typically called LADA, also Type 1 in Adults, Adult-Onset Atypical Type 1 Diabetes, or Late Onset Type 1.
As for the rest, yeah type 1 is a very different pathology from type 2. Frankly, I'm not sure type 2 is a monolithic disease itself - there's some differences in people having the insulin insensitivity in their liver versus in the muscle cells.
Also agreed about the things unlikely to alter the course of T1D as an autoimmune disease. I suppose technically some people do follow diets to alleviate autoimmune symptoms, but I don't think that could truly halt the process going on in T1D.3 -
Please explain what adult onset type I diabetes is ?0
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After reading all the threads it all makes sense and Web MD gives a pretty good explanation aswell.0
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Low carb diets can help type 1 diabetics control their illness. It will not cure it.1
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Did they mention how long the remission lasted after transitioning to maintenance or is it still not determined?0
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amusedmonkey wrote: »Did they mention how long the remission lasted after transitioning to maintenance or is it still not determined?
It is ongoing. They're releasing follow up data annually. While not in the particular study, I would suppose the longest lasting remission would be someone who had WLS that induced it.0 -
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.1 -
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?0 -
magnusthenerd wrote: »
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.1 -
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.0 -
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.0 -
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
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magnusthenerd wrote: »
Thanks. Too late to read it now, but I'll try to remember tomorrow.0
This discussion has been closed.
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