"And He feeds me and quenches my thirst and when I fall sick then He (Allah) cures me" [Soorah Shu'araa: 80]


11.12.17

Type 2 diabetes is not for life

Newcastle University Press Office
Published on: 5 December 2017

Almost half of the patients with Type 2 diabetes supported by their GPs on a weight loss programme were able to reverse their diabetes in a year, a study has found.
Professor Roy Taylor
The first year results, which are published today in The Lancet, also revealed that almost nine out of 10 people (86%) who lost 15kg or more put their Type 2 diabetes into remission.
The study led by Professor Roy Taylor, from Newcastle University, and Professor Mike lean from Glasgow University, found that 45.6% of those who were put on a low calorie diet for three to five months and were able to stop their Type 2 diabetes medications.
Importantly, long-term support by routine General Practice staff was given to help the paticipants maintain their weight loss.
The trial, called DiRECT (Diabetes Remission Clinical Trial) and funded by Diabetes UK, recruited 298 people between the Newcastle and Glasgow University and builds on Professor Taylor’s earlier pilot work.
Professor Taylor, lead researcher of the DiRECT trial, said: “These findings are very exciting. They could revolutionise the way Type 2 diabetes is treated.
“The study builds on the work into the underlying cause of the condition, so that we can target management effectively.
“Substantial weight loss results in reduced fat inside the liver and pancreas, allowing these organs to return to normal function.
“What we’re seeing from DiRECT is that losing weight isn’t just linked to better management of Type 2 diabetes: significant weight loss could actually result in lasting remission."

Remission achieved

Remission was defined as having blood glucose levels (HbA1c) of less than 6.5% (48mmol/mol) at 12 months, with at least two months without any Type 2 diabetes medications.
Of the 298 people recruited to take part in DiRECT, half received standard diabetes care from their GP, whilst the other half received a structured weight management programme within primary care.
The programme included a low calorie, nutrient-complete diet for three to five months, food reintroduction and long-term support to maintain weight loss. 
Type 2 diabetes remission was found to be closely related to weight loss. Over half (57%) of those who lost 10 to 15kg achieved remission, along with a third (34%) of those who lost five to 10kg. Only 4% of the control group achieved remission.
The findings have been presented at the International Diabetes Federation Congress in Abu Dhabi today by the lead researchers, Professor Taylor and Professor Mike Lean.
Professor Lean said: “Putting Type 2 diabetes into remission as early as possible after diagnosis could have extraordinary benefits, both for the individual and the NHS. DiRECT is telling us it could be possible for as many as half of patients to achieve this in routine primary care, and without drugs.
“We’ve found that people were really interested in this approach – almost a third of those who were asked to take part in the study agreed. This is much higher than usual acceptance rates for diabetes clinical trials."

Two-year trial

Man measuring his waist
DiRECT is a two-year trial which aims to find an effective and accessible way to put Type 2 diabetes into remission for the long-term.
The trial is delivered through GP practices across Tyneside and Scotland to find out if the benefits of a structured weight management programme can be felt in a real-life primary care setting.
DiRECT also aims to understand why significant weight loss results in remission, to understand which groups might benefit in the future.
Type 2 diabetes is a life-changing condition that progresses over time, which can have devastating consequences. Finding ways to put it into lasting remission could significantly reduce the cost of delivering diabetes care and treating serious complications such as cardiovascular disease, kidney disease or stroke.
Remission could transform the lives of millions of people living with or at risk of Type 2 diabetes.
Isobel Murray, 65, from North Ayrshire, took part in DiRECT from 2014 to 2016. She was on the low calorie diet programme for 17 weeks and put her Type 2 diabetes into remission after the first four months.
Over the two year trial, Isobel lost more than three and a half stone and no longer needs to take any diabetes medication. 
Isobel said: “It has transformed my life, I had Type 2 diabetes for two to three years before the study.
“I was on various medications which were constantly increasing and I was becoming more and more ill every day. When the opportunity came to go on the DiRECT study, I had absolutely no hesitation.
“When the doctors told me that my pancreas was working again, it felt fantastic, absolutely amazing.
“I don’t think of myself as a diabetic anymore, I get all my diabetes checks done, but I don’t feel like a diabetic. I am one of the lucky ones to have gone into remission.”
Diabetes UK has committed more than £2.8 million to the DiRECT study. Recently, £300,000 has been committed so participants who wish to continue can be followed for up to three years and the full cost-effectiveness of this programme can be evaluated. 
The funding will provide further understanding around the longer term benefits, to see if a treatment of this kind could be offered to people with Type 2 diabetes in the future.

Helping millions

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “These first year findings of DiRECT demonstrate the potential to transform the lives of millions of people.
“We’re very encouraged by these initial results, and the building robust evidence that remission could be achievable for some people.
“The trial is ongoing, so that we can understand the long-term effects of an approach like this. It’s very important that anyone living with Type 2 diabetes considering losing weight in this way seeks support and advice from a healthcare professional.”
Whether putting Type 2 diabetes into remission can protect against diabetes-related complications later in life is not yet known, which is why it is important that those who achieve remission continue to receive health checks.
More research is also needed to find out who could benefit most from treatments like this in the future, taking into account factors like ethnicity and duration of Type 2 diabetes.

Reference

Roy Taylor and Michael EJ Lean et al.
The Lancet. DOI: 10.1016/S0140-6736(17)33102-1

23.9.17

PURE Study - Time To Change The Guideline to Low Carb Diet!



↑ Lecture by Prof Salim Yusuf, world renowned cardiologist at a recent cardiology meeting.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/abstract

The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3–9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering


Carbohydrates, Fats, and CVD in the PURE Study

Carbohydrate intake was divided into quintiles. Those in Q5 consumed most, and those in Q1 consumed least. As can be seen from the slide below, presented by Dr. Yusuf, using the lowest carbohydrate intake (Q1) as a reference, there is an increased risk of CVD with increasing carbohydrate consumption.


Dr. Yusuf pointed out that earlier dietary guidelines “said reduce fats and compensate for it by carbohydrates. So essentially we’ve increased carbohydrate intake in most Western countries, and this is likely damaging.”
Furthermore, Yusuf said: “We were in for a big surprise. We actually found that increasing fats was protective. Now, these are all fats. So this very first slide challenges the WHO and the AHA guidelines on diet.”
With regards to carbohydrates as a percentage of daily energy consumption, he also said: once you get past about 40% or about 55% of carbohydrate intake as percent energy, there is a steep increase in the risk of CVD. The WHO guidelines say that up to about 75% of carbohydrates is ok. But that is wrong.”
Then he adds:
Again, total fats, if anything, is protective. And the reasons for this are twofold. Too low fat is inadequate, too high fat is probably bad. And the original studies from Finland was at extremely high fat levels, not the usual fat levels that populations consume.

Does the Type of Fat Matter?


Current dietary guidelines recommend that we limit the intake of saturated fats and replace them by mono- and polyunsaturated fats. Low-fat dairy products are recommended for the purpose of avoiding saturated fats. Vegetable oils should be used instead of butter.
As Dr. Yusuf points out, these recommendations are not supported by data from the PURE study:
“Then if you look at the types of fats, saturated fats, you will see there is not really a clear pattern of anything. Within the normal range, saturated fats are not harmful. May even be slightly beneficial. But there is no harm.
With monounsaturated fatty acids which are in olive oil, canola oil, and are part of the key to the Mediterranean diet, you get a clear benefit. Polyunsaturated fatty acids which are largely from vegetable oils, and remember that is processed oil, is largely neutral.

So, fundamentally, our fat story is: some fats are good, some fats may be neutral but it is carbohydrates that are the worst thing.”



“The other thing is; in the US there is this big swing to reduce milk consumption, and even if you consume milk, they want you to consume 2% or 1% of fat. What is the evidence? A big zero. Absolutely no evidence that low-fat milk is better for you. If anything, if you look at dairy sources of saturated fats, it is protective.
If you look at meat sources of fat, saturated fats, it’s neutral. And if you look at white meat such as chicken and fish, there is a trend towards benefit. So, red meat in moderate quantities is not bad and white meat may be moderately beneficial. But dairy fats such as cheese are probably good for you, and milk, there is really no data at all to reduce the fat content of milk.”

Saturated Fats, LDL-Cholesterol, and CVD


Dr. Yusuf says:
“Now, why did we go wrong. We went wrong because of surrogate end-points.
The story on saturated fats vs. LDL is consistent. Our data shows that as you increase the amount of saturated fats, your LDL goes up. But first, look at how much LDL goes up. This is a 150 thousand people in the analysis – from about 2.85 (108 mg/dL) to just under 3 (116 mg/dL). About 0.1 mmol/L (3.9 mg/dL) increase over a huge range of percentage of saturated fat (consumption).
But CVD shows exactly the opposite end-point.


Macronutrients and the ApoA/ApoB Ratio

Dr. Yusuf also addresses the effects of carbohydrate intake on more advanced lipoprotein measurements:


Now, what about carbohydrate intake? If you look at LDL, there will be an inverse relationship. But if you look at ApoB/ApoA ratio, which today we know is the most sensitive marker for risk prediction there is a steep increase – from about 0.72 to nearly 0.85 with increasing carbohydrate intake. But with saturated fats, if anything, it is neutral or tending to go down.”


Final Remarks



Dr. Yusuf’s final remarks include these words:
“Contrary to common beliefs, the current recommendations to reduce saturated fats have no scientific basis. I’m not the only one saying this. You must have heard of the book called ‘The Big Fat Surprise’ by Nina Teicholz. She shook up the nutrition world, but she got it right.
Did you know that the seven countries studies that actually had a straight line between fat intake and CVD is fudged. I’m using the word fudged because 23 countries participated in that study and they took the seven best that fitted that line, and that’s what’s there. If you go through the literature, you will find that they chose the seven that fitted the line. The nutrition field has been distorted.”
So, is there a time for a reappraisal of public recommendations regarding the relationship between diet and heart disease following the presentation of the PURE date on macronutrients. 
Obviously, this is a rhetorical question. Let’s get to work.
Time to change. period

14.9.17

Low Carbohydrate Approach: A Paradigm (for a healthy lifestyle)

Kuliah dari Prof. Dr. Nafeeza Ismail dari UITM mengenai kepentingan diet rendah karbohidrat dalam menangani masalah diabetis dan obesiti..




9.8.17

Panduan Puasa Berkala dan Cara Pemakanan untuk Pesakit Diabetis/Obesiti

Assalamualaikum,

Hand out di bawah ini saya berikan kepada pesakit-pesakit yang mempunyai diabetis atau yang ingin mengurangkan berat badan..alhamdulillah ramai yang telah berjaya menurunkan paras gula, menurunkan berat badan serta tekanan darah..

____________________________________________________________________

Panduan untuk pesakit diabetis/obesiti

(Dengan pengawasan doktor bertauliah, terutama jika anda sedang mengambil ubat/insulin untuk diabetis)

1   1)      Puasa berkala (intermittent fasting)


a)      Formula 16:8 iaitu puasa selama 16 jam dan sela masa makan selama 8 jam
Cth: last makan malam pukul 8.00 malam dan keesokan harinya anda ‘skip’ breakfast dan makan tengahari pukul 12.00 tengahari.
Maksudnya ‘puasa separuh hari’ dan anda hanya makan 2 kali sehari (lunch, dinner)
Dibolehkan minum air kosong @ kopi @ the tanpa gula(blh dicampur stevia jika perlu) semasa tempoh puasa. Tidak digalakkan ‘snacking’
b)      Puasa penuh 2x seminggu (cth isnin & khamis)
c)      Puasa penuh selang sehari

Nota: Tujuan puasa adalah supaya tubuh membakar simpanan gula (glikogen) dan seterusnya lemak  yang  tersimpan dalam tubuh akan dibakar sebagai sumber tenaga . Proses ini akan berterusan selagi anda tidak mengambil minuman @ makanan manis/berkarbohidrat tinggi



2    2)      Diet  Rendah Karbo &  Lemak Sihat (RKLS)

Apa  yang  boleh dimakan?

Contoh diet RKLS


Contoh diet RKLS





Asasnya makanan yang mengandungi karbo rendah, kandungan protein sederhana tinggi serta lemak yang sihat.Ambillah makanan yang semulajadi, segar dan bukan yang diproses @ makanan segera. Elakkan MSG (terutama makan di luar) kerana MSG boleh meningkatkan paras insulin

·         Karbo: < 50 gm sehari. Kurangkan pengambilan karbo berkanji (ingat: ianya hanya rantaian gula!) seperti nasi, roti dan pasta. Gula makan- elakkan sama sekali!
Biskut dan kek-adalah kombinasi gula dan karbo yang perlu dielakkan sama sekali kerana ia menyebabkan anda lebih ketagih kepada gula dan menyebabkan anda lebih cepat lapar!

Contoh karbo 50 gm


Semua sayuran hijau/salad adalah ok. Makan seberapa banyak yang anda mahu.Biar anda kenyang dengan sayur/ulam dan lauk.Jika ingin juga mengambil nasi, pastikan sangat minimum (kira-kira ¼ pinggan). Digalakkan mencuba beras perang atau barli menggantikan beras putih biasa. Tip: Bagi yang bekerja, boleh mencuba sup yang dimasak di rumah dan dibawa ke tempat kerja. Lebihkan cendawan, tomato dan bawang di dalam sup.

Buah-buahan?

Buah-buahan hanya dimakan secara‘raw’ dan tidak dibuat jus.Buah-buahan yang boleh dimakan adalah seperti strawberi, epal dan pear tetapi buah-buahan tempatan seperti pisang, tembikai, mangga dan nenas TIDAK digalakkan kerana mengandungi gula yang tinggi

·         Protein – contoh ikan, ayam, daging dan telur perlu diambil dengan agak banyak. Panduan: sekitar 4 saiz tapak tangan sehari( wanitasekitar 80 gm, lelaki sekitar 120  gm sehari). Daging yang diproses seperti dalam burger, nuggets atau sosej adalah tidak berapa menyihatkan dan perlu diambil sekali sekala sahaja

·         Lemak (Jangan takut kepada lemak!) perlu diambil dalam kuantiti yang sederhana (dilebihkan). Lemak yang baik adalah seperti yang terdapat dalam minyak kelapa, minyak sawit atau minyak zaitun. Minyak kelapa adalah yang terbaik untuk menggoreng kerana ia paling stabil. Gantikan marjerin dengan mentega yang lebih menyihatkan. Juga boleh mengambil yoghurt tinggi lemak. Vitamin A, D, E dan K hanya boleh didapati dalam makanan  berlemak dan berminyak. Elakkan marjerin, minyak jagung dan minyak sayuran.

      Hati-hati makanan ‘rendah lemak’ kerana biasanya ia mengandungi gula yang tinggi atau pemanis tiruan!

#SukuSukuSeparuh . (Jika anda rasa diet di atas sangat extreme)

Ini portion mudah untuk diikuti seperti yang disarankan Kementerian Kesihatan Malaysia:
-Suku pinggan: lauk (protein, lemak)
-Suku pinggan : karbo (nasi)
-Separuh pinggan : sayur-sayuran/ulam



MAKAN BANYAK SAYURAN DENGAN PROTEIN DAN LEMAK YANG BAIK MENYEBABKAN ANDA LAMBAT LAPAR DAN INI MENSTABILKAN PARAS GULA DAN ANDA AKAN MEMBAKAR LEBIH BANYAK LEMAK



Disediakan oleh:
~Dr Hapizi
WA: 0179351516
Email : dr_hapizi@yahoo.com


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