Research spotlight low-calorie liquid diet

In 2013 Diabetes UK awarded the largest ever research grant in the charitys 79year history to support a new five-year study.
Professor Roy Taylor at Newcastle University and Professor Mike Lean at the
University of Glasgow will draw on over 2.4 million and work in partnership to
compare the long-term effects of a new approach to weight management with
the best diabetes care that is currently available.
The aim is to find out if this intensive weight management plan is the best way
to help people with Type 2 diabetes become non-diabetic and remain that way.
The new research
What is the background to this research?
Weight gain and obesity are the most important risk factors for Type 2 diabetes
and the reason why Type 2 has become a global epidemic that affects
overweight people of all ages.

Surgical operations, such as gastric banding and gastric bypass, are potential
solutions because they lead to dramatic weight loss, which can put Type 2 into
remission for up to 80% of patients. Such treatments; however, are expensive,
invasive and carry a risk of surgical complications, all of which mean they can
only be offered as a last resort to people who are dangerously obese.

A scan showing high levels of fat in the liver

What do we know already about low-calorie diets?

In 2011, a Diabetes UK research trial at Newcastle University tested a low-calorie

liquid diet in 11 people, as an alternative to weight loss surgery and helped
improve our understanding of how Type 2 diabetes can be put into remission.
Eight weeks using the diet helped those who took part to lose weight and
reduced the amount of fat in their liver and pancreas. Doing so helped to restore
their insulin production and put their Type 2 diabetes into remission. Three
months later, some had put weight back on, but most still had normal blood
glucose control. However, this study was only a first step it was designed to
better understand the biological processes in the body and only followed its
participants for a relatively short period of time. It was also carried out in a
research setting. We do not yet understand the long-term effect of these diets
or how a low-calorie diet might be used to bring about and maintain Type 2
diabetes remission as part of routine GP care.
What is the aim of the new study?
The new DiRECT (Diabetes REmission Clinical Trial) study will compare the longterm health effects of the current best-available Type 2 diabetes care with those
of a low-calorie liquid diet followed by long-term weight control. The aim is to
make a difference for people with Type 2 by finding out if the health benefits of
intensive weight control can be maintained in the long term as part of routine
NHS care.
What will the new study involve?
GP practices across Scotland and Tyneside will recruit people aged 20-65 who are
overweight and have been diagnosed with Type 2 diabetes in the last six years.
Participants at half the practices will be allocated to receive the current bestavailable Type 2 diabetes care, while those at the remaining practices will receive
a low-calorie liquid diet for between 8 and 20 weeks. Those who complete the
diet will then be gradually re-introduced to normal food over the next two to
eight weeks and will receive expert support to help them maintain their weight
loss in the long-term.

Prof Roy Taylor, Newcastle University

Participants on the current best-available Type 2 care will receive weight loss
support according to the latest clinical guidelines, but will not use a low-calorie
liquid diet.
Metabolic studies and MRI scans will also be used to reveal the exact
mechanisms by which significant weight loss can lead to Type 2 remission.
Lastly, psychological assessments of the healthcare professionals and people
with Type 2 diabetes who take part will be used to identify challenges and work
out how this approach to weight control might be used in routine GP care.
Where is the research taking place?
The trial will take place at GP practices across Scotland and Tyneside. The
research will be led and the data analysed by researchers at the University of
Glasgow and Newcastle University.
Who can take part in this study?
Only those who are invited by their GP practice can take part. Recruitment is only
taking place at selected GP practices in Scotland and Tyneside. Individual
patients are not being recruited.
How will this research benefit people with Type 2 diabetes?
If this study shows that low-calorie liquid diets can be used safely and effectively
to bring about and maintain Type 2 remission for significant periods of time, it
will inform and optimise future research and practice and could completely
change the way this condition is viewed.
A practical and effective approach that uses a low-calorie liquid diet to bring
about and maintain Type 2 diabetes remission could lead to significant changes
in the way that Type 2 diabetes is managed by the NHS. It could also provide an
accessible way to help people with this condition live for longer with an improved
quality of life and a reduced risk of serious health complications, without the
need for invasive weight loss surgery.

Prof Mike Lean,

University of Glasgow
If a low-calorie liquid diet can be used within routine GP care to bring about and
maintain weight loss and Type 2 diabetes remission for two years or more, it
could ultimately be of enormous benefit to millions of people living with this
condition in the UK.
When will results be available?
This study will last until October 2018. Overall findings on the long-term health
effects of intensive weight control versus the current best-available Type 2
diabetes will be released once the data obtained has been analysed. Results will
be reported in Diabetes UK publications and on the Diabetes UK website.
The low-calorie liquid diet
What will the diet used in this study consist of?
The diet used in this study will last for between 8 and 20 weeks and consist of
approximately 800 calories a day. This will be comprised of four diet soups or
shakes per day providing all essential vitamins and minerals, plus ample fluids.
Will the diet used in this study cure Type 2 diabetes?
The diet being evaluated is not a quick fix for Type 2 diabetes. It should help
people diagnosed with Type 2 in the last six years who take part in this study to
lose weight specifically the fat in and around their liver and pancreas. This
should, in turn, help to put their Type 2 diabetes into remission. It is likely that
some people who take part in this study will find the diet challenging and all of
them will have to work hard to lose weight and keep weight off in the long-term
to maintain Type 2 remission.
Is the diet used in this study available now?

Low-calorie diet foods are not available on prescription from the NHS. They are
marketed by a range of private companies, but can be expensive and come with
limited evidence of long-term benefit. This research is the only way to tell if
weight management using a low-calorie liquid diet is practical and more effective
than the current best-available treatment for Type 2 diabetes.
Should people with Type 2 diabetes follow the diet used in this study?
Until we have evidence that low-calorie liquid diets are more effective at putting
Type 2 diabetes into remission than the current best-available treatment,
Diabetes UK does not yet recommend that people with Type 2 diabetes attempt
to lose weight in this way. The charity is confident that the new study will answer
our questions and so give the NHS enough evidence to make a decision on
whether low-calorie diets should be offered as a routine treatment option. People
with diabetes should always consult their GP before making changes to the way
that they manage their condition.
What diet does Diabetes UK recommend for people with Type 2?
Diabetes UK recommends that people with Type 2 diabetes eat a healthy
balanced diet that is low in sugar, salt and fat and high in fruit and vegetables.
For information on living a healthy lifestyle and eating well with Type 2 diabetes
please see our guide to diabetes.

See our guide to diabetes for tips on healthy eating

I reversed my diabetes in just 11 days - by going

on a starvation diet
By RICHARD DOUGHTY
PUBLISHED: 01:10, 6 August 2013 | UPDATED: 11:07, 6 August 2013

Strict regime: Richard Doughty followed a drastic diet

A family bereavement, high blood pressure, an unavoidable job change.
I thought everything came in threes but I was wrong. There was more
bad news around the corner.
I was a fit 59-year-old and had just had an annual health check at my
GP surgery. This revealed I had high blood sugar 9millimoles per litre,
whereas a normal level is 4-6mmol/l and my doctor suggested I could
have diabetes.
Further tests confirmed that, yes, I was type 2 diabetic. I was stunned. I
have always been a healthy weight (I am 5ft 7in and just 10st 7lb), had
no family history of diabetes, ate a healthy diet, never smoked, and I
definitely did not have a sweet tooth.
Determined to find a solution, I began researching the condition and
how to beat it.
In type 2 diabetes, the pancreas does not produce enough insulin to
keep glucose levels normal (in type 1, the pancreas stops producing
insulin altogether), and if I didnt take action, I would be 36 per cent
more likely to die early and could suffer bad sight, poor kidneys, heart
failure and strokes. Id also eventually be on medication.

My GP said that my diabetes was mild enough to be controlled through

diet alone, and gave me a wad of leaflets on nutrition for diabetics. I
took up salads, cut down on carbohydrates and ate my five-a-day but
progress was slow. Over seven months I shed a stone but my blood
sugar was still too high around 7mmol/l.
Not satisfied with this, further internet research threw up a more
drastic approach. Scientists at Newcastle University had devised a
radical low-calorie diet that studies suggested could reverse diabetes in
under eight weeks.

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This involved eating just 800 calories a day (a mans recommended

intake is 2,500) 600 calories from meal replacement shakes and
soups and 200 calories from green vegetables. You also drink three
litres of water a day.
The theory behind the diet, which is the brainchild of Roy Taylor,
professor of medicine and metabolism at Newcastle University, is based
on the fact that type 2 diabetes is often caused by fat clogging up the
liver and pancreas, which are crucial in producing insulin and
controlling blood sugar.
This is why weight gain is such a risk factor for the condition,
particularly if that weight is carried around the belly and abdomen.
However, there are some unfortunate people like myself who seem to
be disposed to accumulating fat in the liver and pancreas, despite
being a healthy weight.
Professor Taylors studies have shown that drastic dieting causes the
body to go into starvation mode and burn fat stores for energy and
the fat around the organs seems to be targeted first.
This leads to the liver and pancreas becoming unclogged, and insulin
and blood sugar levels returning to normal.
One study by Taylors team, published in 2011 in the journal
Diabetologia, found that out of 11 type-2 diabetics following the diet,
all reversed their diabetes in under eight weeks.

Further studies revealed that type 2 diabetics needed to lose one-sixth

of their pre-diagnosis body weight to remove enough fat from the
pancreas to allow normal insulin production to resume.
After contacting Professor Taylor, and getting the nod from my GP, I
decided to follow the diet (experts warn never to start such a drastic
regimen without first checking with your doctor). My target weight was
8st 12lb.
But surviving on a soup, two shakes and green veg (necessary to
provide some fibre and keep the bowels healthy) wasnt easy.

The diet involved eating just 800 calories a day compared to a man's
recommended intake is 2,500
The first full day, a Sunday, I woke with no decent breakfast to look
forward to just some watery shake. (The meal-replacement shakes
from the shops work fine I used The Biggest Loser brand, but there
are many available.)
After just one day my glucose levels had dropped from 6mmol/l to
5.9mmol/l. Hunger was never far away. But Professor Taylor said that
the hunger pangs were something to celebrate, as it meant that the
diet was working.
Toast yourself with water, he said, and the hunger will disappear. And it
worked: I downed a pint of water and the hunger went.
The weight came off fast. By day three I had already lost 2lb.
Day four saw my glucose level plummet from 5.9mmol/l on the Sunday
to 4.6mmol/l. I even started to get used to the idea of a shake for

breakfast: thoughts of fresh crusty bread went out of the window. I was
training my mind to reduce my choices and yet value the options
remaining.
Lunch was my own delicious, thick mushroom soup (I blended
mushrooms, onions, veg stock and herbs together), washed down with
a cherry-flavoured shake. I gulped down a chicken soup supplement
before leaving the office to see a play in the evening. Concentration
levels were fine, but climbing up my local Tube station stairs afterwards
was a real slog. I felt tired and lethargic.
The pattern continued each day. I experimented with more soups such
as carrot, tomato and pea, baked veg, stir-fried veg, boiled veg and
casseroles, liberally seasoned with herbs Id never used before, such as
cumin and paprika.
Some mornings I walked to work fine, others I was in a bit of a daze,
and on certain days walking round the office was an effort. My family
were concerned about me getting thinner and somewhat shorttempered.
Day six was a bad day. Despite it being mid July, I wore four layers of
clothing to keep warm and even then my fingers grew numb. I felt
tired in the evening, and then constipation set in. Perhaps it was
because I was not drinking enough water. Laxatives saved the day and
the following morning I recorded my lowest overnight fasting glucose
reading 4.3mmol/l a real boost.
On day eight I played cricket and it was hard watching teammates
stuffing themselves with doughnuts. I had to toast a century-scoring
colleague with water.
Three days on, I was down to 8st 13lb with my glucose level down to 4.1
mmol/l.
But I could not ignore concerned comments at work about my
shrinking. Some of my clothes no longer fit me, and even I was slightly
alarmed about how thin I had got in the face.
I was known as the disappearing man by colleagues. It was time to
stop the diet. (I then returned to a healthy wholegrain diet comprising
lots of fruit and veg, chicken, fish and non-fatty foods).
Two months later, I got myself tested at the surgery to register a
healthy, non-diabetic 5.1mmol/l and was elated when my GP told me:
Your diabetes has resolved itself.
I had stuck to the diet for just 11 days, and reduced my blood sugar to a
healthy non-diabetic level. It has remained that way for the past year

my latest reading was 4.9mmol/l. I have kept to just under 9st, joined a
gym and gone running three times a week.
On Professor Taylors advice, I have also started building up my upper
body muscle: bigger muscles soak up more glucose as energy, and thus
prevent the body from storing more than it needs.
Professor Taylor started investigating the diet after he became
intrigued by the observation that type 2 diabetes is reversed almost
overnight in obese patients following gastric bypass surgery for weight
loss.
The surgeons explanation was that it was something clever to do with
gut hormones, which help control our appetite, but this was clearly
unsatisfactory.
Professor Taylor instead focused on the fact that patients were unable
to eat much in the days following the surgery, and wondered if this
could in fact be responsible for reversing diabetes.
I realised that this led to a sudden shift of fat away from the liver and
pancreas. I thought we could test this by taking people with type 2
diabetes and mimicking the very sharp reduction in food intake after
surgery.
I predicted this could strip fat out of the liver and pancreas and both
organs would return to normal and our subsequent work has
confirmed this.
And the work continues. Alan Tutty, 54, from Seaburn Dene,
Sunderland, is one of 34 volunteers in Newcastle Universitys second
trial looking at longer term effects of the diet. In eight weeks between
last November and January, he, too, successfully reversed his type 2
diabetes, shedding 26lb to reach his target weight of 13st 3lb.
Since coming off the diet, my weight has occasionally risen to 13st 9lb,
but its always crept back down to 13st 5lb, he says.
The approach has been met with excitement by other experts in the
field. James Walker, consultant diabetologist at Livingston hospital,
West Lothian, believes the research challenged conventional thinking.
A lot of people have perhaps too simplistically thought that once the
pancreas starts to fail, and stop producing insulin, it is an inevitable
decline. But this diet challenges that.
And what is brilliant is that it works so quickly. Weve even produced a
little diet booklet in West Lothian for patients mainly nicking Roys
ideas.

Professor Taylors team is now looking at whether it works for those

who have had type 2 for many years, and also whether the pancreas
stays free of fat following the diet.
The findings are due to be published next year. In the meantime, Ill
stick to my healthy diet to keep myself diabetes-free. I dont fancy
tackling those shakes again.
For more information, visit ncl.ac.uk and search for type 2 diabetes.

Ex-diabetic, Milton Keynes, United Kingdom, 5 months ago

I reversed my Type 2 diabetes in 2001, and have recently been removed
from the diabetic register. Like Saviour Pirotta, I lost six stone - mine
was slow and steady and took well over a year to achieve. At no point
did I starve myself. There were three pillars to my long-term success. 1
- Set myself up mentally with a long-term perspective, chose the habits
I wanted to support a long-term easily-maintainable lifestyle and
deliberately cultivated them. 2 - Gradual migration from fast junk food
to healthier options, also ramping down the carb content rather than
just reducing amounts. 3 - Put more activity into my life to increase the
insulin sensitivity of my muscles. Yes - genetics and many other factors
play a role. But so much sugar and refined carbs are being stuffed into
our foods that it fuels the diabetes epidemic. It is only when we really
start to eat healthily that we stand a chance of reversing the global
Type 2 diabetes statistics.

Saviour Pirotta, Shipley, United Kingdom, 5 months ago

I suffered from Type II diabetes for twenty years, using metformin and
insulin daily to control. Six years ago I went on a strict diet, lost six
stones and the diabetes went away. Although i have put some weight
on again, mostly muscle as I go to the gym and lift weights four times a
week, the diabetes never came back. I eat healthily most of time
although I do treat myself. When I tell people I am not diabetic anymore
they assume I mean I am controlling it through diet. It's not the case,
even when I do have sugary stuff my readings stay normal. It can be
done!

LaughingGravy, Wirral, 5 months ago

I love the way people claim they don't know how they got diabetes
because they ate 'healthily'. I'm sorry but our genes are not
programmed to eat a diet high in 'healthy' carbohydrates. They convert
to sugar/glucose in your system and the body produces insulin to help
store the excess glucose. We evolved eating animals, fat and a bit of
veg, fruit and nuts. Essentially 'low' carb in comparison to current
healthy guidelines. Returning to this sort of natural eating is the only
way the western world will beat diabetes, cancer and heart disease.

Excalibur, UK, United Kingdom, 5 months ago

I think near starving yourself occasionally and for short periods could
have very good long term health benefits. People living to a ripe old
age have often been through extremely lean times (e.g. wartime
rations, imprisonment etc) and pulled through. A bit difficult with all
the food and drink temptations around us and may not be beneficial for
everyone.

cornish mum, cornwall, 5 months ago

Francisca if you didn't go to the drs with symptoms of type 1 diabetes
you would eventually die from ketoacidisis my son had this before
diagnosis and lost all his body fat within a week and almost died, we
hardly took him to the hospital through anything other than necessity
and to Save his life!

cornish mum, cornwall, 5 months ago

What rubbish primalist! Without my sons insulin injections he would die
simple as that! It really drives me mad that as he gets older he will
have to deal with the ignorance of people such as yourself. The fact
that anyone has green arrowed you is to me even more disgusting and
shows how ignorant people are about type 1 diabetes. Do you really
believe that if there was any alternative to pushing a needle into my
sons skin 4+ times a day I wouldn't take it?!!!

Erinski, Barrow, United Kingdom, 5 months ago

@Primalist clearly it is you that knows nothing about diabetes, I do 7+
injections a day and 15 bloodtests, low carb / high fat does help lower
the numbers, but you absolutely cannot live without insulin injections
as a type 1, you'll be dead in a few days!

Francisca, Gers, France, 5 months ago

The reason why I don't go to the doctor is because I am sure that he will
find something badly wrong with me while I feel and look perfectly
healthy! Have you people ever thought about the fact that they lower
the max. of everything in order to convince you that you are ill? Well,
that is true and goes for cholesterol and high blood pressure as well, in
fact it goes for everything! I look well after myself in my own way, get
informed and live my life to the full! What will happen will happen and
hopefully I will live to be a very old lady still working in my garden and
fighting to keep up with all the fruit and vegetables! No pills, no check
ups, no measuring anything, just living my life!

David77, London, 5 months ago

TOP MAN! Thanks for sharing.

Primalist, York, United Kingdom, 5 months ago

It seems the ones with the least knowledge of diabetes are the
'sufferers' themselves. Please, get out from under the thrallof Diabetes
UK and their ilk and educate yourselves, they are a BUSINESS, they
make money off your illness. Your doctor makes money off you.They
don't want you to get better. Type 2 diabetes is TOTALLY curable, type 1
can be very well controlled with a low carb/high fat diet (Bernstein - 90
years old, type 1 diabetic, no insulin). You don't have to be fat to be
diabetic, but chances are you think you are eating a 'healthy' carb laden

diet - wheat, rice, fruit, soya, pasta. Do yourselves a favour, look

elsewhere. First port of call - Gary Taubes. Not a doctor, but he puts
their words into a form you can understand....unless you prefer to be
sick.
Read more: http://www.dailymail.co.uk/health/article-2385179/Ireversed-diabetes-just-11-days--going-starvationdiet.html#ixzz2qPwGQimg

Low-calorie diets for Type 2 diabetes assessed

Share:
Research which could provide a definitive judgement on whether lowcalorie diets should be offered as a treatment option to put Type 2
diabetes into remission is to start.
The 2.4 million research project funded by Diabetes UK will be carried
out by researchers at Newcastle University and the University of
Glasgow. It aims to answer the question of whether losing weight on a
low calorie liquid diet and keeping it off using a structured,
personalised support programme is a viable treatment for putting Type
2 diabetes into remission in the long-term.
Professor Roy Taylor, the lead researcher at Newcastle University, said:
We know that changes in calorie intake can produce changes in body
composition that, at least in some people, can put Type 2 diabetes into
remission. But this new study will evaluate how well people do using
this approach and uncover problems that might be faced.
We are exploring uncharted territory and along the way there will be
challenges, details to unravel, and other questions to ask. But I believe
this study will lead to a quantum leap forward in our understanding of
how best to manage Type 2 diabetes.
The trial
In the trial, GP practices across Scotland and Tyneside will recruit
people aged 20-65 who are overweight and have been diagnosed with
Type 2 diabetes in the last six years. Participants at half the practices
will be allocated to receive the current best-available Type 2 diabetes
care, while those at the remaining practices will receive a low-calorie
liquid diet of just 800 calories a day, for between 8 and 20 weeks. Those
who complete the diet will then be gradually re-introduced to normal
food over the next two to eight weeks and will receive expert support
to help them maintain their weight loss in the long-term.

As well as monitoring the long-term effects of the diet, some of the

participants will have MRI scans, which will show researchers what is
happening inside the body during the diet.
This will be the largest single research project Diabetes UK has ever
funded in its 79-year history. It follows a study from 2011 that found
that 11 people with Type 2 diabetes who spent eight weeks on a lowcalorie liquid diet all saw their insulin production return to normal and
their Type 2 diabetes put into remission. These findings backed up
anecdotal reports and results from bariatric surgery to raise the
prospect of transforming the way Type 2 diabetes is treated.
But because the 2011 study was designed to better understand the
biological processes in the body and only followed its participants for a
relatively short period of time, scientists do not yet fully understand
the long-term effect of these diets. This is why a longer and larger
study is needed to find out whether the benefits of following such a
restrictive diet outweigh any adverse effects. Also, the 2011 study was
carried out in a research setting and so it is unclear whether such diets
can be transferred to a larger scale as part of routine GP care, where
large numbers of overweight people with Type 2 diabetes are managed
in the UK.
Because of these unanswered questions, Diabetes UK does not yet
recommend low-calorie liquid diets to people with Type 2 diabetes. But
the charity is confident that the new study will answer these questions
and so give the NHS enough evidence to make a decision on whether
low-calorie diets should be offered as a routine treatment option.
Dr Matthew Hobbs, Head of Research for Diabetes UK, said: Type 2
diabetes will always be a serious health condition but perhaps it wont
always be seen as a condition that people have to manage for the rest
of their lives and that worsens inevitably over time. The 2011 study and
evidence from bariatric surgery has shown us that it can be put into
remission. If we can do this safely, on a bigger scale and as part of
routine care, then following a low-calorie liquid diet would be a real
game changer in terms of reducing peoples risk of devastating health
complications such as amputation and blindness.
Click here to read about the trial where diet reversed Type 2
diabetes from 2011
(Adapted from Diabetes UK press release)

published on: 10th October 2013