VLCD of diagnosis with loss of first phase

VLCD diets (800 cal) are being advocated by Professor Roy Taylor
 as being able to achieve   significant rapid weight loss similar to that achieved
with Bariatric surgery leading to remission of T2DM.  The basis of this the fat spill over theory
that fat spills over from subcutaneous tissue into ectopic fat and he twin
cycle hypothesis that states that T2DM is the result of excess fat accumulation
in the liver and pancreas. This leads to glucotoxicity and resultant Insulin and
Lipo-toxicity leading to reduced insulin secretion in Beta cells. It postulates
that if this ectopic  fat build-up can be
  reversed as by VLCD liver and pancreatic
function can be restored.(van Wyk and Daniels, 2016)

This argues against the general belief that in T2DM Beta
cell mass gradually declines and is at 50% at time of diagnosis with loss of
first phase insulin response (10 minutes after eating) and this is irreversible.
Also traditional medical nutritional therapy has aimed been for only moderate
calorie restriction 500-1000 below maintenance and gradual weight loss.  The rapid correction of gluco and lipo-toxicity
appears to be more effective than slow resolution from more standard MNT. The major
disadvantages is  that unlike bariatric surgery
this is  not permanent and maintenance could
be an issue. (van Wyk and Daniels, 2016) 

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There seems to some be evidence for their
effectiveness of VLCD in the peer reviewed literature and in particular that
they can work in primary care.




Lim 2011 put 11 T2DM patients on 8 weeks VLCD
(600 cal diet). Beta cell function
and hepatic insulin sensitivity returned normal with associate decrease of
liver and pancreatic fat. Diabetes duration 8 years diabetes duration. Similar weight loss was achieved by both
groups (14.8% and 14.4). 87% of short duration and 50 % of long achieved remission
after 8 weeks.  In the long duration
group despite no remission in 50% there was a significant improvement in glycaemic
control without hypoglycaemic agents. .(Steven and
Taylor, 2015)

3.     Following the 8 weeks a stepped return to iso-caloric
diet and a structured individual weight maintenance program was used to
reintroduce solid food. 1 shake was changed to a solid meal every 3 days. To
look duration of  remission Steven et al followed
up 2 group after 6 months 13 of 30 achieved FBG