Magnetic Resonance (MR) Centre

Newcastle University
Campus for Ageing and Vitality
Newcastle upon Tyne, NE4 5PL
Telephone: 0191 208 1250, Fax: 0191 208 1151
www.ncl.ac.uk/magres

Reply from Professor Taylor on frequent questions asked

Further information on the research on Reversing Type 2 Diabetes

Thank you for contacting me about the studies on reversing type 2 diabetes. These have
caused great interest amongst people with diabetes, and as of 2018, I have received w e l l
over 3,000 enquiries and messages. Although I have replied to most of these personally, I am
sorry to say that it is no longer feasible to do this. The research continues. I hope the
following items will provide some useful information, but bear in mind that this is only factual
information and only your doctor can provide personal medical advice.

What are the main research findings?

1. The initial study was in people who had type 2 diabetes of up to 4 years. Type 2 diabetes
of several years duration can be reversed to normal. Weight loss of around 15kg is
usually needed. After more than 10 years of diabetes a return to normal glucose control,
even with major weight loss, is much less likely.

2. It is certainly possible to wake up the insulin producing cells of the pancreas by losing a
substantial amount of weight.

3. This happens because the fat content in the pancreas decreases. Previous studies have
shown that fat stops insulin release. The insulin producing cells recover their special
function, and this continues providing fat is not allowed to accumulate.

4. If weight is then kept steady, diabetes does not come back at leave over several years.

Could it work for me?

 This research is in “type 2 diabetes”, the usual common form of diabetes. There are some
rare forms of diabetes which may be mistaken for type 2 diabetes:

a) Diabetes occurring after several attacks of pancreatitis is likely to be due to direct

damage to the pancreas (known as “pancreatic diabetes”)
b) Secondly, people who are slim and are diagnosed with diabetes in their teens and
twenties, with a very strong family history of diabetes, may have a genetic form
(known as “monogenic diabetes”)
c) Thirdly, type 1 diabetes sometimes comes on slowly in adults, and these people
usually require insulin therapy within a few years of diagnosis (“slow onset type 1”)

None of these rare conditions will respond in the same way as the common, true type 2 diabetes.

 So, if you have the common form of type 2 diabetes, this could work for you. However, you
should not underestimate just how much change in your day-to-day life will be necessary
to bring this about. It requires motivation and persistence.

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 Magnetic Resonance (MR) Centre
Newcastle University
Campus for Ageing and Vitality
Newcastle upon Tyne, NE4 5PL
Telephone: 0191 208 1250, Fax: 0191 208 1151
www.ncl.ac.uk/magres

Reply from Professor Taylor on frequent questions asked

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
from a level, which is “normal” for the general population, is then essential for health. See
the online article by Richard Doughty.

Practical advice

 The particular diet used in the 2011 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. That allowed us to discover the underlying mechanisms.

 A surprising observation was that people found this dietary approach to be easier than
they has expected.

 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. Ordinary
steady weight loss, by cutting back on the amount eaten each day, 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. We now know that the very
low calorie approach can be followed by very steady weight control.

A. The slower standard approach would involve:

a) Decreasing total food (and alcohol) intake by about one half

b) Using smaller plates
c) Eating more slowly
d) Recognising that the sensation of hunger is sign of success, not a signal to eat
e) Enjoy that hunger. Celebrate with a glass of water; maybe fizzy water

However, if a person finds this difficult, the liquid meal approach may be more successful.

More details about steady, avoidance of weight gain are available on the Diabetes UK website.

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 Magnetic Resonance (MR) Centre
Newcastle University
Campus for Ageing and Vitality
Newcastle upon Tyne, NE4 5PL
Telephone: 0191 208 1250, Fax: 0191 208 1151
www.ncl.ac.uk/magres

Reply from Professor Taylor on frequent questions asked

B. The research diet

To carry out the Newcastle research study, the following diet was used:

 One sachet of a liquid formula diet (~ 200 calories) three times per day. The study used
Optifast, but there are many other brands available from supermarkets or online (see
below).

 Three portions of non-starchy vegetables per day. Lack of variety was a problem of the
diet, so we devised a few recipes to make the vegetables more interesting. The range of
possibilities is infinite, but you can find the recipes we used on the website -
http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm.

 No alcohol during the 2 month period of weight loss. This is merely because alcohol itself
is so calorific – 7 calories in every gram.

 You should consult your doctor before embarking upon any very low calorie diet. In
particular, any medication you are taking may need to be adjusted. Some general
information about this is also on the website (refer to Information for your doctor:
https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation). None of this
information is a substitute for proper, individual medical advice.

 Our research subjects found the diet challenging to stick to especially in the first 36 hours.
Motivated people were selected to take part in the research and support from the team
was given frequently. Support from the families of the research volunteers was very
important in helping them comply with the diet. Hunger was not a particular problem after
the first few days, but the complete change in social activities (not going to the pub, not
joining in the family meals etc.) was a challenge over the eight weeks. Careful planning in
advance is essential.

 DO NOT INCREASE EXERCISE DURING THE WEIGHT LOSS PERIOD. See below.

Optifast
Although Optifast was used in the study, this is not readily available in the UK. An alternative
liquid food supplement of similar calorific content is equally suitable. These are available from
most local supermarkets; you should try several brands to find one most suited to your taste. One
brand available on the internet is Exante. Do not be concerned by the high sugar content, as after
the first day of very low calorie diet your body is able to handle this reasonably well. The product
may need to be made up in water or skimmed milk. Always read the advice upon the particular
product.

After achieving your target weight - how do you keep your weight down in the long
term?

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 Magnetic Resonance (MR) Centre
Newcastle University
Campus for Ageing and Vitality
Newcastle upon Tyne, NE4 5PL
Telephone: 0191 208 1250, Fax: 0191 208 1151
www.ncl.ac.uk/magres

Reply from Professor Taylor on frequent questions asked

Once you are at your personal target weight, the critical thing now is to become accustomed to
eating approximately 2/3 of the total amount you used to eat. Plan a gradual transition to normal
eating over 2-4 weeks. There need be no restriction upon any particular foodstuffs, although
naturally foods that are very calorie-dense are best avoided. The goal is keeping the weight down
[you may find your weight increases 1 – 2 kg over a few days on returning to a higher calorie
intake; this is because your glycogen stores return to normal and glycogen is stored in the water
inside your body].

If you are increasing your exercise, do not eat more. It is so easy to over- compensate for
exercise.

Most people maintain a consistent healthy weight in the long term; most successfully by:

a) Weigh weekly - write it down

b) Watch portion size carefully and don’t eat between meals
c) Walk, cycle, stairs. Maintain a high level of everyday physical activity
d) Party but payback. Enjoy life and especially occasions to celebrate, but there is a price.
You must eat only about half your current intake for a few days

How about exercise?

 Do not increase your usual daily activity whilst losing weight. This is because sub -
conscious compensatory eating will make weight loss very difficult.
 However, a sustainable increase in daily physical activity during long term weight
maintenance is essential, along with keeping food portion size under control.
 DUK is also funding research into reversing type 2 diabetes in non-obese people
https://www.ncl.ac.uk/magres/research/diabetes/newstudy-retune/.

What research is going on?

 Diabetes UK is funding the major 5 year study (DiRECT) to find out how many people can
reverse or improve their diabetes by a low calorie liquid diet. This is being carried out
entirely in Primary Care. Further details are available on the Diabetes UK website.

Future volunteers?

Thanks to all who offered to help with future studies.

We are looking for volunteers who have normal or very slightly raised body weight (a BMI of less
than 27) and who have developed type 2 diabetes.

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Magnetic Resonance (MR) Centre
Newcastle University
Campus for Ageing and Vitality
Newcastle upon Tyne, NE4 5PL
Telephone: 0191 208 1250, Fax: 0191 208 1151
www.ncl.ac.uk/magres

Reply from Professor Taylor on frequent questions asked

Any other information?

 Further information will be posted on the website

https://www.ncl.ac.uk/magres/research/diabetes/#research

 Already available are the links to the full scientific papers describing the reversibility of
diabetes and also the scientific review of the existing knowledge in 2008, which described
the “twin cycle hypothesis” which we have now tested.

 An up-to-date review of how weight loss works was added in 2013. In 2016, a review of
what is happening to the insulin producing cells (beta cells) provides further explanation.
In 2017, a further review described practical dietary management after weight loss. The
first year results of DiRECT are published in The Lancet.

 Also available is a paper, which describes what happened to diabetes when weight loss
was achieved at home. This information was provided by many people around the world
using email.

 In the Information for Doctors, other research papers are available. Where possible, the
full paper is provided as a printable file and if copyright permits this, the link to the paper
is provided.

 Also, all information will be added to the website, which is updated from time to time.

 Please remember that this website and its links provide information and not personal
medical advice. Do consult your Doctor for personal advice.

Thank you for your interest in this work.

With best wishes for your personal recovery

Roy Taylor July 2018

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