A breakthrough for type 2 diabetes?

By Tracy Kelly

Can we put type 2 diabetes into long-term remission? It’s a question that’s asked often and to date we don’t have the answer – but that could all change within a few years. 

That’s because Diabetes UK has recently awarded a £2.4 million research grant to look into whether losing weight – and keeping it off – through a low-calorie liquid diet is a feasible long-term treatment for putting type 2 diabetes into remission.  

As part of the Diabetes Remission Clinical Trial (DiRECT) study, researchers will recruit 280 overweight people with type 2 diabetes and put them on two separate diets. This new trial follows a 2011 study that found that 11 overweight people with type 2 diabetes saw their insulin production return to normal and their type 2 diabetes put into remission after eight weeks on a low-calorie liquid diet. 

Following the huge media interest in this study, many people with type 2 diabetes were interested in this approach. But as exciting as these findings were, the study did not focus on the effects of the diet in the long term and there is still much about low-calorie diets that we are yet to understand.

As part of the new trial, one group of 140 people will spend between eight and 20 weeks on a low-calorie diet of 800 calories a day – mainly nutritionally complete diet soups or shakes, plus ample fluids. Then, as normal food is reintroduced, they will learn how to change their lifestyles permanently. 

The results of this group will be compared with an equal number in the second group, who will follow what is currently accepted as the best advice for weight loss and weight maintenance. 

Both groups will be monitored for two years to study the long-term effects of their diets on weight. MRI scans will look at what’s happening inside their bodies during the diet.

The aim is to see whether the stress and effort of following a restrictive diet for several months is beneficial in the long run. After all, 800 calories is not a lot – people following such a diet are likely to feel hungry quite a lot of the time. Also, will they be able to stick to it for long enough for it to be successful? Even more fundamentally, this kind of diet is not an easy option or a ‘quick fix’ and people will still have to follow a healthy lifestyle afterwards to stop their type 2 diabetes coming back. It’s a fact that weight regain after liquid diets is common.

Type 2 diabetes will always be a serious condition, but perhaps it won’t always be seen as a condition that people have to manage for the rest of their lives – and that inevitably gets worse. If this study shows that low-calorie liquid diets can be used safely, on a bigger scale and as part of routine care, it could completely change what we know about type 2 diabetes and how it is treated by the NHS. It could also provide an accessible way to help people with this condition live longer, with a better quality of life and a reduced risk of serious health complications.  

For more information about the trial visit www.diabetes.org.uk/DiRECT

Tina tries... facing her running demons

I can’t express how much I hate running (and rain). As far as I’m concerned it’s the devil’s exercise – I’m still haunted by the schoolgirl memory of running 400m, then throwing up at my PE teacher’s feet.

But the time came to face my fear. Lloyd, my personal trainer, suggested I try a form of exercise that’s easy to do outside of our gym sessions. And even after telling him of (yet another) class of ‘86 drama, he seemed willing to take on the challenge of getting me running again.

Lloyd explained that for a newbie it’s not all about pounding the tarmac for minutes on end. He wanted to set an initial pace that wouldn't scare me, so I can build on it in time. We began with a 10-minute warm-up of fast walking, then set to work on 40 minutes of walking and running at a 2:1 ratio – two minutes of fast walking, then one minute of running. He explained how important it is not to fly off too fast at the beginning as you’ve got to keep going for the 40 minutes. ‘Easy!’ I hear you cry, but those 60-second bursts of running felt longer and longer. I did make it through, though, with a small sense of achievement and a very fetching pair of rosy cheeks – thankfully there was no vomiting.

Go on, then, I'll admit it wasn’t that bad, even in the rain. (Did I just say that out loud?) I can only think this was down to Lloyd keeping my spirits up. He also pointed out that varying the terrain and running on softer ground is a lot less stressful on your joints. It was a great way to get into running and I’ll be intrigued to see if I'm ever able to complete a parkrun (parkrun.org.uk) without stopping… 

So, the big question: would Tina try it again? Yes, I already have! With the help of my very patient, marathon-running boyfriend, I upped the ratio so I can now run for longer and walk for shorter periods. And after a particularly frustrating train journey out of London at the weekend to visit my folks in Suffolk, there was nothing for it – I had my trainers and the countryside on my doorstep: I was going for a run.

I even stopped the obsessive 60-second-clock watching. Not that this particular run didn't come with its share of danger moments: farmers with guns, dog walkers, a fallen tree in my path and, worst of all, forgetting to put a bra on! But all my train traumas were soon a distant memory. How satisfying.

I now have to clean my trainers for all the right reasons (NOT because I've been doing the gardening in them). I may need a second pair – I may even have to venture into a sports shop. Note to self: pick up a sports bra while I’m there.

NEXT TIME: Tina tries those big scary machines at the gym

Tina tries… an aqua class

By Tina Betts

Tina risks getting her face wet in the hope it will do something spectacular to her body…

I'm no mermaid. At the school swimming gala I was always the one having to start in the pool because I couldn't dive in. An underwater wardrobe malfunction aged 14 (in front of the boys – of course!) didn’t help my confidence, but I’ve moved on. And since a friend taught me how to swim the breast stroke correctly, I'm not averse to getting my face wet, just so long as I can still touch the bottom!

I must admit lane swimming sounds as dull to me as running on a treadmill, though, so I'm quite excited by my first aqua class with Cheryl. I've even got the perfect cossie - the websites call it a legsuit, but I prefer to call it my Victoriana. It’s basically an all-in-one with shorts and it’s perfect for holding all the right bits in and making you feel secure when stepping out of the changing rooms (take that, class of ’86!).

So I'm raring to go. I’ve been warned this is not about fancy footwork – it’s a proper workout, but your body and joints are completely supported, ‘like gloves around a hand’, as Cheryl explains. 

The pool is the perfect temperature and once I've got the hang of facing the right direction and minimising my splashing (I did notice the other members of the class giving me a wide berth!), I'm smiling and having fun. The challenge of getting an ‘eddy flow’ is particularly good – that’s where the whole group runs in one direction for a few strides, then abruptly changes direction. A great mix of different exercises means you get a good workout without the pain of not being able to walk the next day.

And I've been back. Unlike my Spanish class, I haven’t had to force myself to join in Cheryl’s aqua class after a rubbish day because the old endorphins kick into action and I always feel loads better afterwards. I’m conscious I need to keep my new exercise regime varied, so I guess that's where Lloyd steps in again. I wonder what he has lined up for me next? Oh, my lord, I do believe I'm getting excited!

Cheryl Stafford is a personal trainer at Nuffield Health (nuffieldhealth.com). For anyone interested in what’s actually happening to your body underwater, here’s what Cheryl told me…

·       Water provides hydrostatic pressure, which basically means pressure all around the body (rather like a glove around a hand). This aids blood circulation and has a massaging effect on the muscles.

·       Water protects the joints from impact, so you’re able to replicate high-impact land moves more safely and for longer periods of time. The cooling effect of water also allows for a quicker recovery.

·       Water provides frontal resistance – basically, the harder you push, the harder the water pushes back! The same movement on land will be approximately 12 times harder in the water, so you use far more energy.

·       Water provides a dual concentric contraction, which means both your front and back muscles have to work concentrically as water exerts force all around the body. In land-based exercises you work against gravity, so one muscle is working eccentrically (ie lengthening), while the other is contracting or shortening. The eccentric contractions are related to DOMS (Delayed Onset Muscle Soreness, ie not being able to walk downstairs the day after a workout!). This is less likely in an aqua class as it’s difficult to work a muscle eccentrically.  

·       The water turbulence requires you to be more balanced and so results in greater postural gains.

·       Working against the eddy flow or turbulence is very difficult and so increases intensity – for example, when you’re running in a circle and are then required to change direction. This principle can be used a lot in aqua exercises. The turbulence is increased when there are more people in the pool, working in opposite directions, and when the pool wall is higher than the water level, as the water rebounds back off the wall.

·       It’s an ideal complement to a weight-based routine as you’re using muscles differently. The body adapts to exercise, so there are diminishing returns if you’re constantly doing the same thing. In addition to a varied exercise regime, you should change your routine every 6–8 weeks to prevent de-training.

Break the diet cycle

Diet is a four-letter word that often spells failure. In the November issue of Healthy Food Guide, our experts explain how you can lose weight for good by breaking free of the vicious cycle of deprivation and disappointment caused by fad diets.

Successful weight loss is all about creating healthy relationships with food and your body. We asked nutritionist Zoe Wilson for her top tips for healthy eating…

1 It’s OK to have an ‘imperfect’ meal or snack

You eat three meals a day, seven days a week – so if one or two of these meals aren’t great, it’s no big deal!

2 Before you eat ask yourself, ‘Am I actually hungry?’

That’s the grumbling, empty tummy hungry — not the ‘I don’t want to sit at my desk anymore’ hungry. If you’re not really hungry, is there something else you could do? Maybe you could step outside for some fresh air or make that phone call you’ve been putting off for a while.

3 Turn off the TV, computer or phone to enjoy food
By eating with distractions such as these you won’t register you’ve had your meal or snack, leaving you wanting more when you don’t need it. Take time out and sit at a table so you can concentrate on what you’re eating.

4 Have what you really want

There’s no point in choosing a yogurt or piece of fruit if you really want a piece of chocolate — you’ll feel cheated! Have that piece of chocolate (but not the whole bar) and savour every moment of it.

5 Take note of the ‘sigh moment’
There comes a point, when eating a meal, when our stomach says it’s full – we will often pause and take a deep breath. But many of us miss this cue because there’s still food on our plate. Be mindful of this cue, then put down your knife and fork.

6 Eat slowly!

Try to take at least 20 minutes to eat your meal. This gives your stomach enough time to tell your brain it’s full. Put your knife and fork down between mouthfuls, cut your food into smaller pieces and focus on tasting your food.

7 Don’t deprive yourself in social settings

Food is at the centre of many social occasions, and it’s fine to join in. But if you’re not hungry, don’t feel pressured to go to the buffet table or to take that canapé. And in restaurants, order a starter instead of a main or share something with a friend.

8 Leave the table satisfied but not full

There’s a difference between not feeling hungry anymore and feeling stuffed to the brim. Listen to your stomach as you eat and try to finish on a hunger scale of about 7/10 — with 0/10 being starving and 10/10 being full-to-bursting.

9 Pretend you’re a critic

Think about the flavour and texture of each mouthful, and assess how appealing the meal is to your eye. By appreciating the elements of your food you will feel more satisfied.

10 Use smaller crockery and glassware

This makes a smaller portion look bigger, helping you eat less but still feel satisfied. Replace dinner plates with starter-sized plates, and swap 500ml wine glasses with 250ml glasses. 

For more advice on breaking the diet cycle, check out the November issue of Healthy Food Guide magazine.

Comforting crumbles

At HFG we love finding ways to make our favourite dishes healthier. From satisfying pies to decadent desserts, we believe that with a bit of nutritional tinkering most culinary treats can be enjoyed as part of a balanced diet.

In our November issue, we put the spotlight on fruit crumbles and our chefs surpassed themselves when experimenting with healthier fillings and toppings. In fact, they managed to concoct so many delicious variations there wasn’t enough room for all of them in the magazine. But we didn’t want you to miss out, so we thought we’d share the leftovers with you here. A serving of either crumble contains one of your 5-a-day and is low in saturates and salt.

Apple and raspberry

Serves: 6

Prep: 5 min

Cook: 20 min

400g tin sliced apples

200g frozen raspberries

60g caster sugar, plus 1tbsp extra

60g self-raising flour

40g rolled oats

30g low-fat spread

1tsp vanilla extract

6 small scoops low-fat ice cream, to serve

1 Preheat the oven to 190°C/fan 170°C/gas 5. Combine the tinned apples, frozen raspberries and the 1tbsp caster sugar in a 1.25 litre baking dish.

2 Put the flour and oats into a mixing bowl, then rub in the spread with your fingertips until the mixture resembles breadcrumbs. Stir in the remaining 60g sugar.

3 Sprinkle the vanilla extract over the fruit, then add the crumble topping. Bake for 20 min or until golden. Serve with the ice cream.       

Per serving: 238kcal, 3.7g protein, 4.9g fat, 2.4g saturates, 35.1g sugar, 3.9g fibre

Strawberry and almond

Serves 6

Prep: 10 min

Cook: 25 min

125g reduced-calorie strawberry jam

500g strawberries, halved

25g toasted flaked almonds

60g caster sugar, plus 1tbsp extra

60g self-raising flour

40g rolled oats

30g low-fat spread

1tsp vanilla extract

6 small scoops low-fat ice cream, to serve

1Preheat the oven to 190°C/fan 170°C/gas 5. Warm the jam in a saucepan, then add the strawberries and stir to combine. Transfer to a 1.25 litre baking dish.

2Put the flour and oats into a mixing bowl. Rub in the spread until the mixture resembles breadcrumbs, then stir in the sugar and almonds. Sprinkle over the strawberry mixture, then bake for 20 min or until golden. Serve with the low-fat ice-cream.

Per serving: 258kcal, 4.8g protein, 7.2g fat, 2.6g saturates, 34g sugar, 3.1g fibre

Pick up the November issue of Healthy Food Guide magazine for eight more variations including a classic apple and sultana and an exotic pineapple, rum and raisin.