14.06.2024

Is the NHS ‘soup and shake’ type 2 diabetes diet really the solution for we’ve been waiting for?

June Davidson was deservedly proud of her achievement after following an extreme diet that put her type 2 into remission. The groundbreaking slimming plan, developed by a team at Newcastle University, involves consuming just 800 calories a day for up to four months in order to lose between 22lb and 33lb (10kg to 15kg) – enough, experts say, for most people to reverse the condition.

Also known as the ‘soups and shakes’ diet – because meals are replaced with low-calorie liquid variants – it is being offered on the after trials found it could help curb the nation’s escalating type 2 diabetes crisis. And the need is clear. The blood sugar condition, which dramatically increases the risk of heart attacks, kidney failure, stroke, amputations and blindness, affects more than five million people and costs the NHS £10 billion a year.

Anti-diabetes drugs alone cost £746 million in 2021/22, up from £423 million in 2015/16. If trends continue, one in ten adults will suffer from diabetes by the end of the decade.

For June, from Crowthorne, Berkshire, who was diagnosed with type 2 diabetes in 2018, the results were extraordinary – at least at first.

DISHEARTENED: Lynne Lewis regained the weight she lost on the low-calorie diet after her husband’s death

The 'soups and shakes' diet ¿ where meals are replaced with low-calorie liquid variants ¿ is being offered on the NHS after trials found it could help curb the nation's escalating type 2 diabetes crisis

The ‘soups and shakes’ diet – where meals are replaced with low-calorie liquid variants – is being offered on the NHS after trials found it could help curb the nation’s escalating type 2 diabetes crisis

The 86-year-old lost 20 per cent of her bodyweight, dropping from 13st (83kg) to under ten (64kg).

Four months of 800 calories a day were far from easy. June recalled being ‘always hungry’, except for an hour after every shake, and occasionally having a lettuce leaf or small stick of celery to curb her stomach pangs.

What kept her going was focusing on what really mattered – being free of diabetes and off medication at the end of it all.

And when she managed it, she felt euphoric. Her blood sugar levels, which had been ‘very high’, fell so significantly that her GP stopped prescribing her daily dose of type 2 diabetes drug metformin.

With the weight off, she felt ‘healthier than ever,’ taking daily walks and playing golf.

But today, three years on, things are not quite so rosy.

June is now heavier than she was before she started the diet – at more than 14st (89kg). And last month, with her blood sugar creeping dangerously high again, her GP put her back on metformin.

‘I’m so cross with myself,’ said June, who worked as a personal assistant at a pharmaceutical firm before retiring. ‘I relaxed once I lost the weight, so went back to what I was doing all the time – eating out.

‘I don’t have an unhealthy diet – I have a family history of obesity, type 2 diabetes and heart disease, so I eat porridge for breakfast, lots of salads and fish. I don’t even eat cakes or biscuits. But bread is my downfall. Now I have to try to lose the weight again. It’s maddening.’

Lynne Lewis with her husband Thomas John Lewis in around 2012

Lynne Lewis with her husband Thomas John Lewis in around 2012

Lynne Lewis holding a picture of her wedding in 1976, at her house is Pentwyn near Pontypool, Wales

Lynne Lewis holding a picture of her wedding in 1976, at her house is Pentwyn near Pontypool, Wales

June’s frustration is understandable – and something she no doubt shares with many others who had hoped the pioneering diet would rid them of type 2 diabetes for good.

Today, the ‘soups and shakes’ method is being rolled out across the UK, and everyone eligible – those aged 18 to 65 who have a body mass index (BMI) of more than 27 and have been diagnosed with type 2 diabetes within the last six years – will be able to access it by March, the Government announced last month. It is currently available in 21 parts of England and more than 2,000 people have started treatment on the 12-month plan, which costs the NHS about £1,100 per patient.

IT’S A FACT

The charity Diabetes UK predicts that by 2030 the condition will cause more than 87,000 hospital admissions each year.

Those taking part are given a voucher code and log on details for a website where they can order meal replacement products including shakes, soups, porridge and meal bars – each containing 200 calories. The meals arrive to their home the following day.

Initially, the scheme involves weekly Zoom meetings with mentors and fellow participants, which become fortnightly after food is reintroduced and then monthly. The Government hopes tens of thousands of people could eventually benefit from it.

This high-level backing came after results from a groundbreaking clinical trial. It showed the rapid weight loss over the first few months with meal replacements, followed by a gradual return to a healthy diet and regular coaching sessions, could reverse the condition in ‘up to half’ of participants after a year.

The ongoing study, called Direct and funded by the charity Diabetes UK, is led by metabolic health expert Professor Roy Taylor at Newcastle University and dietician Professor Michael Lean at the University of Glasgow.

Last month it released further results which show some people remained free of diabetes even five years later – suggesting, according to Prof Taylor, that the benefits could be ‘permanent and lifelong’.

It’s an extraordinary achievement. But for all its successes, it is far from the magic bullet clinicians might have hoped for. As people such as June have found, it works only if weight loss is maintained.

That, for many, is the hardest part. But a significant number of people struggle to even get through the initial weight-loss phase.

Who is Geoff Whitington?

BACK ON YOUR BIKE: Geoff Whitington’s sons, Ian and Anthony, have twice helped him get into shape

BACK ON YOUR BIKE: Geoff Whitington's sons, Ian and Anthony, have twice helped him get into shape

Geoff Whitington, the star of the heartwarming BBC documentary Fixing Dad, transformed his health – losing seven stone and putting his type 2 diabetes into remission – after his sons, Anthony and Ian, decided to overhaul his lifestyle in 2013.

Along with regular exercise, he stuck to an ultra-low 600-calorie-a-day diet, with the support of Direct trial chief Professor Roy Taylor.

But Geoff suffered a relapse when the Covid pandemic led to a resurgence of bad habits. Geoff, now 71, from Sevenoaks, Kent, put on two stone in lockdown and had to start taking blood sugar drug metformin again – five years after he reversed the condition.

He then developed sepsis in 2021 when routine checks on his foot ulcers – a complication of diabetes – were not made.

‘It was touch-and-go for a while,’ says Anthony. ‘He was in hospital, on a ward with people having amputations and dying.

‘But it was the shock he needed. He had been eating carbs and drinking alcohol. We had to fix him all over again.’ So Anthony, 45, and Ian, 43, put him back on a healthy diet and reduced his calories by getting him on just two meals a day.

Geoff is no longer taking metformin after his blood sugar returned to normal and has lost the weight he gained. Last month, he cycled 66 miles around Loch Ness with his sons.

Anthony says: ‘Dad struggled in the pandemic. But it shows that, with a bit of motivation, you can turn it around. A relapse doesn’t mean you’ve failed.’

An NHS pilot programme, which began in September 2020, found that 41 per cent of 1,087 people did not complete the plan.

Those who stuck it out lost an average of 2st (13kg) after three months – but put weight back on after introducing food again. At the 12-month mark, the average weight lost was 1st 11lb (11.4kg) – around ten per cent of their bodyweight.

NHS England has not yet released data on how many saw their diabetes reversed but expects to do so ‘within nine to 12 months’. But it may not match the Direct trial’s success. Weight loss of at least 2st 5lb (15kg) was required ‘by most people’ in order to reverse diabetes, the research suggested.

Susan Jebb, professor of diet and population health at the University of Oxford, sits on the advisory board for the NHS rollout but is also planning a trial to investigate other options for people who don’t benefit from the extreme diet.

She said the dropout rate was similar to other weight loss programmes and acknowledged that the results so far were not as good as the Direct trial.

‘Often when you take a treatment from carefully managed trials into what you might call routine practice, the results are worse,’ Prof Jebb said. ‘These results so far aren’t quite as good as the trials – you have to be honest about that – but they are still very good.

‘There are all sorts of reasons why that might be. People who sign up for trials are a particular kind of person – very committed and determined – and they get a lot of extra care, which affects the results.

‘In the real world, it’s different. We also have to acknowledge that lots of people who are eligible for the programme won’t want to take it up – this kind of diet is not going to be suitable for everyone. So we don’t yet know what the uptake might actually be.’

Richard Wilson, 66, said his group in Solihull, West Midlands, started with 20 participants in August 2022 and is now down to six. ‘Quite a few of my fellow participants were confessing that, after the initial weight-loss phase, they were really struggling and had gone off the diet for various reasons,’ he said.

The retired management consultant lost 3st 8lb (23kg) – 20 per cent of his bodyweight – after 12 weeks of soups and shakes, putting his diabetes into remission, but had regained 19lb (9kg) by April. For the past month, he’s been back on the diet.

Geoff Whitington, 62, holding a bike wheel aloft above his head

Geoff Whitington, 62, holding a bike wheel aloft above his head

Geoff Whitington, 62, with his sons, Ian (left) and Anthony (right), in Shadoxhurst Kent

Geoff Whitington, 62, with his sons, Ian (left) and Anthony (right), in Shadoxhurst Kent

The problem, as patients are finding, is that keeping weight off in the long term is not easy.

Even in the Direct trial, the number of participants who remained in remission dropped over time. Of 149 patients enrolled at the start of the Direct trial in 2016, just over one third were still diabetes-free after two years.

Patients in the trial who put weight back on were offered a ‘reset’ option, which involved restarting the soups and shakes phase. They were also offered weight-loss drug orlistat.

During the two years of study, half of the participants needed a reset period, one in ten needed two periods and 5.6 per cent needed three. Despite this, the most recent data, announced earlier this year, showed just 11 of the 149 patients were still in remission.

Naveed Sattar, professor of metabolic medicine at the University of Glasgow, who is involved in the Direct study, acknowledged work has to be done to understand how to help more people for longer.

He said: ‘All options are on the table – drugs to curb appetite, more low-calorie diet phases, training or education – but at the moment we don’t know which might work best.

‘Anecdotally, I can tell you that those who managed to sustain their weight fundamentally changed their lifestyles, becoming more active and changing their diets completely.

‘But some people get sucked back into old habits, or their environment or family circumstances don’t allow the changes. We need to work out how we help those people too.’

Lynne Lewis, 70, from Pontypool in South Wales, regained weight – and her diabetes – after her husband’s death. She was diagnosed with type 2 diabetes in 2009 and started the diet in 2015 after experiencing diabetes-related cataracts in her eyes and poor circulation in her toes, which can be a precursor to nerve damage and amputation.

But after eight weeks on the diet, her blood sugar had dropped. ‘I was a dress size 22 and I went down to a 12,’ she said. ‘I was able to come off metformin completely.’

After Lynne’s husband John died suddenly in November 2018, the weight crept back on.

‘The grief meant everything went out the window,’ she said. ‘I’m now a dress size 16, my blood sugar is high and I’m back on metformin.

‘If my husband hadn’t died, maybe I’d have managed to stick at it. But it’s completely my fault.’

Aside from bitter disappointment and self-blame, is the diet a cost-effective use of NHS money?

Prof Sattar believes so. The Direct trial found there were fewer heart attacks, strokes and other serious issues in the group given the diet and support, regardless of whether they achieved diabetes remission. ‘We focus on remission but what we also invoke [with this diet] is a period of time where people have less excess fat,’ Prof Sattar said.

‘For some of the chronic complications of diabetes, what matters is not the weight they reach but how long they’ve been at that weight.

‘The hope is that we delay or slow the complications for these people.’

Prof Jebb added: ‘Obesity is a chronic, relapsing condition. It’s not surprising you’re going to have to have another go [at dieting]. In an ideal world we would have one treatment to help you lose weight and one to help you keep it off.

‘We’ve got good at the first bit – but rubbish at the second.

‘Maybe we have to accept that the best thing people can do is attempt that acute phase of weight loss, not beat themselves up if they put it back on – and just try again.’

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