1/9 Shakeshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🧃" title="Getränkepackung" aria-label="Emoji: Getränkepackung">and soups https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥣" title="Schüssel mit Löffel" aria-label="Emoji: Schüssel mit Löffel">prescribed on the NHS to reverse diabetes https://abs.twimg.com/emoji/v2/... draggable="false" alt="😵" title="Benommenes Gesicht" aria-label="Emoji: Benommenes Gesicht">

From 1 Sept, 5,000 people with #T2DM in 10 areas of https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flagge des Vereinigten Königreiches" aria-label="Emoji: Flagge des Vereinigten Königreiches"> are going to be offered them

What& #39;s all the fuss about? https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">Do they work? https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">Are they the best option available?https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">

A short Twitter thread.... #MedTwitter
1/9 Shakeshttps://abs.twimg.com/emoji/v2/... draggable=and soups https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥣" title="Schüssel mit Löffel" aria-label="Emoji: Schüssel mit Löffel">prescribed on the NHS to reverse diabetes https://abs.twimg.com/emoji/v2/... draggable="false" alt="😵" title="Benommenes Gesicht" aria-label="Emoji: Benommenes Gesicht">From 1 Sept, 5,000 people with #T2DM in 10 areas of https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flagge des Vereinigten Königreiches" aria-label="Emoji: Flagge des Vereinigten Königreiches"> are going to be offered themWhat& #39;s all the fuss about? https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">Do they work? https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">Are they the best option available?https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">A short Twitter thread.... #MedTwitter" title="1/9 Shakeshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🧃" title="Getränkepackung" aria-label="Emoji: Getränkepackung">and soups https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥣" title="Schüssel mit Löffel" aria-label="Emoji: Schüssel mit Löffel">prescribed on the NHS to reverse diabetes https://abs.twimg.com/emoji/v2/... draggable="false" alt="😵" title="Benommenes Gesicht" aria-label="Emoji: Benommenes Gesicht">From 1 Sept, 5,000 people with #T2DM in 10 areas of https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flagge des Vereinigten Königreiches" aria-label="Emoji: Flagge des Vereinigten Königreiches"> are going to be offered themWhat& #39;s all the fuss about? https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">Do they work? https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">Are they the best option available?https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Denkendes Gesicht" aria-label="Emoji: Denkendes Gesicht">A short Twitter thread.... #MedTwitter" class="img-responsive" style="max-width:100%;"/>
2/9 The evidence to support this comes from the work of Prof Roy Taylor& #39;s DiRECT Trial, published in @TheLancet (refs at end)

306 ppl age 20-65 with #T2DM diagnosed in last 6 yrs, were randomly allocated to either:

Diet OR
"Current best practice"

Ppl on insulin were excluded
3/9 The DiRECT Trial

1. Removal of meds for #T2DM + BP on day 1
2. TOTAL diet replacement with a 825-853 cal/day liquid formula (soup or shake) for 3-5 months, then:
3. Stepped food reintroduction for 2-8 weeks, then:
4. Structured support for long-term weight loss maintenance
4/9 The DiRECT diet is a VERY LOW CALORIE diet

Interestingly (this is important) it contains between 122-126g of carbohydrate/day which ALSO makes it a LOW CARBOHYDRATE DIET #LCHF (but NOT a VERY low carb diet)

Participants were given 4 x 200cal sachets of soup or shake a day
6/9 Costs:

A review (see link) calculated the cost as £1,907 per remission achieved

When you consider that diabetes costs the NHS and estimated £10bn/year this seems good value

https://link.springer.com/content/pdf/10.1007/s00125-020-05224-2.pdf">https://link.springer.com/content/p...
7/9 Low Calorie v Low Carb

Disappointingly, DiRECT doesn& #39;t look at this. From the research with @lowcarbGP at my practice we have found that #LCHF diets achieve a remission rate in #T2DM of 49% and that #LCHF diets are sustainable over many years
8/9 My reflections

Great to be using dietary interventions in #T2DM rather than meds https://abs.twimg.com/emoji/v2/... draggable="false" alt="👍" title="Thumbs up" aria-label="Emoji: Thumbs up">

I& #39;m not convinced v low calorie diets are sustainable long term, #LCHF is

These soups + shakes are ULTRA-PROCESSED foods

Aren& #39;t we meant to avoid them?

Where& #39;s the real food? https://abs.twimg.com/emoji/v2/... draggable="false" alt="☹️" title="Stirnrunzelndes Gesicht" aria-label="Emoji: Stirnrunzelndes Gesicht">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤢" title="Angewidertes Gesicht" aria-label="Emoji: Angewidertes Gesicht">
8/9 My reflectionsGreat to be using dietary interventions in   #T2DM rather than meds https://abs.twimg.com/emoji/v2/... draggable=I& #39;m not convinced v low calorie diets are sustainable long term, #LCHF isThese soups + shakes are ULTRA-PROCESSED foodsAren& #39;t we meant to avoid them?Where& #39;s the real food? https://abs.twimg.com/emoji/v2/... draggable="false" alt="☹️" title="Stirnrunzelndes Gesicht" aria-label="Emoji: Stirnrunzelndes Gesicht">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤢" title="Angewidertes Gesicht" aria-label="Emoji: Angewidertes Gesicht">" title="8/9 My reflectionsGreat to be using dietary interventions in #T2DM rather than meds https://abs.twimg.com/emoji/v2/... draggable="false" alt="👍" title="Thumbs up" aria-label="Emoji: Thumbs up">I& #39;m not convinced v low calorie diets are sustainable long term, #LCHF isThese soups + shakes are ULTRA-PROCESSED foodsAren& #39;t we meant to avoid them?Where& #39;s the real food? https://abs.twimg.com/emoji/v2/... draggable="false" alt="☹️" title="Stirnrunzelndes Gesicht" aria-label="Emoji: Stirnrunzelndes Gesicht">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤢" title="Angewidertes Gesicht" aria-label="Emoji: Angewidertes Gesicht">" class="img-responsive" style="max-width:100%;"/>
You can follow @DocRunner1.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled: