With considerable fanfare, and very long overdue, there is currently a NHS pilot for type 2 diabetes. It is intended to promote the remission of type 2 diabetes, without the need for medication, and through diet alone. It is a considerable step forward for the NHS in the fight against obesity but ignores many years of evidence that goes much further towards reaching the remission goal.
The NHS is seemingly oblivious to the well-established weight management programmes being provided by pharmacies with NHS contracts throughout the UK. Pharmacies have published their evidence of diet success, including diabetes remission, and are even offering their expertise at no cost to the health service. It is terrible that pharmacy has been ignored.
Worse still, the NHS has chosen to provide, as a total diet replacement, a low calorie diet instead of a very low calorie diet.
Low calorie diet or a very low calorie diet?
You need to know the difference between a low calorie diet and a very low calorie diet!
The NHS pilot uses a total diet replacement low calorie diet.
Would the addition of “very” to “low calorie” make that much of a difference?
It is likely some people may think these dieting descriptions are interchangeable, but this is far from semantics. There is some critical diet and nutrition science that says otherwise.
Choosing the wrong diet for the job in hand and you risk a much higher chance of diet failure. If you are looking for more than just weight loss, namely medical benefit, missing the target could be much worse than a less than satisfactory weight loss.
Take this recent announcement regarding weight loss with the NHS pilot for type 2 diabetes:
As they correctly say, weight loss can bring huge benefits to type 2 diabetics,
“people living with type 2 diabetes who were overweight could improve their diabetes control, reduce diabetes-related medication and, in some cases, put their type 2 diabetes into remission (no longer have diabetes).”
This sounds encouraging diet news for type 2 diabetics but it isn’t as good as it seems. It is almost certainly not as good as it could be, as we will discuss below.
Let’s take the NHS pilot’s low calorie diet details to assess its potential for diet and clinical success:
- Total diet replacement
- Around 900 calories per day intake
- For up to 12 weeks
- Must be aged 18 – 65 years
- Must have a diagnosis of type 2 diabetes within the last 6 years
- Must have a BMI over 27 kg/m2 (where individuals are from White ethnic groups) or over 25 kg/m2 (where individuals are from Black, Asian and other ethnic groups)
- Live within the areas where the low calorie diet pilot is taking place*
But first, as we alluded to earlier, it is critical to understand the various diet definitions:
Total diet replacements –
include very low calorie diets (VLCDs) and low calorie diets (LCDs), are specifically formulated programmes that are based around formula foods that aim to replace the whole of the daily diet. These formula foods are nutritionally balanced with key vitamins, minerals, high quality protein, essential fats, fibre and other nutrients, and are designed to replace conventional foods for a period to facilitate optimal weight loss. They provide controlled energy intake lower than can be achieved with a reduced intake of normal foods.
Low calorie diet –
Diabetes.co.uk state “The NHS defines a low calorie ( kcal ) diet of between 1,000 and 1,500 calories per day for women, and between 1,500 and 2,000 calories per day for men” whereas Diabetes.org define it as follows: “A low-calorie diet is made up of around 800 to 1,200 calories a day.”
By its broad definition, low calorie diets may range from the total diet replacement offered by the NHS type 2 diabetes pilot (as mentioned earlier) to the varied, available meal replacement diets, ie those supplementing a normal food intake with fortified formula foods.
Very low calorie diet -
VLCDs are defined as hypocaloric diets which provide between 450 to 800 kcal per day and are relatively enriched in protein of high biological value. They must contain the full complement of vitamins, minerals, electrolytes and fatty acids
Back to the NHS pilot for type 2 diabetes, low calorie diet details…
NHS pilot: Total diet replacement
Just eating less has been the NHS edict for as long as anyone can remember. Completely replacing all conventional foods with a nutritious formulation makes much more diet sense. Bravo NHS!
Effectively this is tackling weight loss as we would with any addictive behaviour. We have said this many times, “the drive to eat is a powerful innate human instinct”. Just cutting back is no better an option for those suffering from obesity, as it is for those suffering from alcoholism.
Abstinence creates the platform to gain control over existing, often ingrained food and drink habits.
The only issue is that not all total diet replacements are the same, as we’ll discuss in this article.
JUDGEMENT: Good diet method choice
NHS pilot: Around 900 calories per day intake
Calories are the units of energy we humans require to survive. A car cannot differentiate new petrol via the pump from that stored in the fuel-tank. The human body is the same. The human body carries thousands of calories within excess fat, meaning a dieter can rely on its body fat for energy (so long as essential nutrition is forthcoming).
There is therefore no requirement for a calorie intake above that provided by the essential nutrients.
The NHS pilot for type 2 diabetes has chosen a low calorie diet, presumably without emphasizing the benefits of a predictable and stable ketosis. Their dieters are likely to be unnecessarily hungry.
Even if a state of ketosis was established, the unnecessarily small calorie gap would mean a slower than needed rate of weight loss.
Full essential nutrition can be delivered, to women or men, at a cost of around 400 to 500 calories per day. The maths dictates the NHS diet is likely to result in a 1lb per week slower weight loss than is possible.
Why? Is there any benefit to paying a credit card off more slowly? No. Delay becomes more costly. Similarly, there is no merit in slowing the rate of weight loss, unless it is to appease those ignorant of the science, or to attempt to satisfy prejudices of the public.
Note – desires and needs when it comes to dieting are completely different things.
Utilising the same total replacement principle, but instead using a very low calorie diet, such as Lipotrim, has proven to allow for a more stable ketosis and ensuing sense of comfort, but also a more rapid weight loss without detriment to nutrition intake or health.
JUDGEMENT: Prohibitive choice of unnecessarily high calorie intake
NHS pilot: For up to 12 weeks
Following on from the rate of weight loss, we come to diet duration.
With an optimal intake of only around 400 calories per day (Lipotrim), the rate of weight loss equates to about a stone a month of predictable weight loss. So, even if a very low calorie diet alternative were employed, those suffering from obesity (carrying many extra stone of excess weight) will not reach a healthy weight in the specified 12 weeks.
We have already discussed the potential for a kind of food addiction, so don’t think starting and stopping the diet periodically will help. It is much more difficult to periodically start and stop any diet than most people think.
So long as ALL the essential nutrition is provided, the dieter can safely remain on a medically monitored very low calorie total diet replacement for the duration of time necessary to reach a healthy weight. Lipotrim, given under the supervision of the pharmacist or doctor, has proven this for over 30 years.
JUDGEMENT: Terrible choice to unnecessarily restrict beneficial medical outcomes
NHS pilot: Must be aged 18 – 65 years
The necessity to ensure clinical safety is applauded, so having a restriction of 18 years plus is understandable. In fact, and sorry to generalise, the peer pressure those under 18 years would endure makes dieting using total food replacement potentially very difficult.
Prevention of childhood obesity is a key part of the NHS Long Term Plan, but calorie and nutrient restriction during puberty causes many problems in experimental animals. Treating childhood overweight should not be treated casually.
However, what of the 16 or 17 year old, already suffering from weight-related type 2 diabetes? In the right circumstances why would this potentially critical treatment be withheld? They are highly likely past puberty and essentially, physically an adult.
So, what of those type 2 diabetics over 65 years old?
Type 2 diabetes is not a disease to dismiss. Approximately 6,000 diabetes-related amputations are carried out per year according to Diabetes.co.uk. Worse still, when considering age is that:
Therefore, those who are potentially most at risk of diabetic complications are excluded from the assistance the NHS is claiming to be acting on.
Our hope is that, since the NHS diet is only a pilot and is properly supervised, availability for others under the care of the healthcare professional can be increased.
Thankfully Lipotrim utilises a standard SOP for 18 to 70 year olds, but also supports those people outside of those limits, with adequate health criteria, on a patient-by-patient basis
JUDGEMENT: Understandable age restriction but neither absolutely necessary, nor medically helpful to those most in need.
NHS Pilot: Must have a diagnosis of type 2 diabetes within the last 6 years
Type 2 diabetes is a progressive disease with terrible long-term consequences such as kidney disease, eyes disease, nerve damage, heart disease and stroke.
The term, lifestyle disease tells us everything we need to know. It is predominantly associated with excess weight. Lose the weight and we see better glucose control, but better still, with enough weight loss (around 15kg+) we can remove the diabetes.
Lipotrim’s experience is that the mandatory reduction in blood sugar during the first week of dieting to establish ketosis provides a remission of the diabetes symptoms long before a 15 kg weight loss. With continued dieting there seems to be no recurrence of elevated sugars.
It is important to understand, medication to normalise blood glucose does not nullify the eventual outcomes of type 2 diabetes. Historically type 2 diabetes has required an escalation of the potency of medication with no remission of the disease.
Those who have suffered this disease for many years have become a medicated yet overweight patient. It could be argued this cohort, standing outside of the pilot’s inclusion criteria and on the precipice of some serious, irreversible medical issues, could be the most in need.
JUDGEMENT: Good start, by why alienate a good proportion of the millions of type 2 diabetes sufferers potentially most in need or remission?
NHS pilot: Must have a BMI over 27 kg/m2 (where individuals are from White ethnic groups) or over 25 kg/m2 (where individuals are from Black, Asian and other ethnic groups)
The understanding of the difference excess weight brings to various ethnic groups is necessary and welcomed.
This graph demonstrates how ethnicity affects the incidence of diabetes. Having a lower threshold of acceptance onto the NHS pilot for Black, Asian and other ethnic groups makes absolute sense.
But prevention is better than cure wouldn’t you agree?
So, let’s go back to our food addicted type 2 diabetic.
They access the NHS pilot and manage to lose all their excess weight, say 3 stone with an end-point BMI of 22. They are fully in diabetic remission and firmly in the healthy BMI zone.
Then, say 6 months later, they re-present with a 2 stone weight gain. Their diabetes may be back. One issue, their BMI is 26.
The benefit of the diet has already been proven yet should they be turned away purely down to BMI? Is it acceptable to withdraw the offer of effective treatment, and allow an embedding of habits and increase of weight before we intervene again?
Along the addiction analogy, do we wait until a reformed alcoholic is drinking bottles of vodka, or do we intervene sooner if possible?
Lipotrim offers a more patient-centric approach, allowing for interventions appropriate to the circumstances (and backed up by our expert team available via the Lipotrim helpline).
JUDGEMENT: On the face of it, the understanding of and acceptance of BMI is good, however more can be done to help those battling obesity.
NHS Pilot: Live within the areas where the low calorie diet pilot is taking place*
As a pilot it is understandable that there will be a gradual coverage and a slow increase in availability. Unfortunately this will take considerable time.
Luckily, Lipotrim offers coverage across the entire UK, including the Channel Islands, Gibraltar and Bermuda NOW, via its network of pharmacies.
JUDGEMENT: A case of waiting for the expansion of the NHS pilot for type 2 diabetes for many, but help is available now!
To summarise the NHS type 2 diabetes pilot:
- there is a real difference between a low calorie diet and a very low calorie diet, even if they are both total diet replacements
- the NHS low calorie diet is a big step forward but there seems to be some questionable choices that are likely to negatively affect its level of comfort and results, both for weight loss and medical outcomes
- Lipotrim has the evidence already to satisfy the requirements of the NHS low calorie diet
- Lipotrim is available from pharmacies across the UK and offers everything the NHS is trying to do but much BETTER!
*Where is the NHS type 2 diabetes pilot taking place?
Bedfordshire, Luton and Milton Keynes, Birmingham and Solihull, Derbyshire, Frimley, Gloucestershire, Greater Manchester, Humber Coast and Vale, North Central London, North East London, South Yorkshire and Bassetlaw
The programme will also become available in the following areas from early 2022:
Black Country and West Birmingham, Bristol, North Somerset and South Gloucestershire, Kent and Medway, Lancashire and South Cumbria, Mid and South Essex, North East and North Cumbria, Nottingham and Nottinghamshire, Somerset, South West London, Sussex, West Yorkshire