Doctors urge caution over 800-calorie liquid diet for diabetics

Weight loss should be gradual to ensure sustainable changes to lifestyle over time, expert says

A diabetes-busting diet hailed as a landmark breakthrough in treatment of the condition would be unsustainable for many due to busy lifestyles and malnutrition concerns, doctors said.

Results of a Diabetes Remission Clinical Trial (Direct) in the UK showed some patients who stuck to an 800 calorie liquid diet of soups and shakes over a three-month period were able to reverse a diagnosis of type two diabetes.

The average recommended daily calorie intake to lead a healthy life is around 2,000 calories for women, and 2,500 for men, dependent on activity levels.

Research funded by Diabetes UK showed around a quarter of people who started a low-calorie diet then returned to a normal calorie consumption remained in remission three years later.

But doctors advised caution on replicating the calorie crunching diet, outside of a controlled setting.

“Although weight loss is crucial to reversing diabetes, I usually don’t recommend extreme diets, such as liquid only diets or those that are carb free or meat only,” said Dr Idrees Mubarak, an endocrinologist at Saudi German Health in Dubai.

“Our lifestyles need to be sustainable lifelong, not just for three months or a year.

“Whenever the person comes off the diet, there is usually a reoccurrence of diabetes.

“800 calories a day is very low — it is bordering on starvation and that can have issues in itself.”

In the study, funded by Diabetes UK, 298 people recruited from GP surgeries received standard diabetes care, while the other half were put on strict calorie controlled diets.

Supported by dieticians, the second cohort consumed nutrient-packed soups and shakes for between 12 and 20 weeks at a time.

Those who managed to maintain a healthy weight after the trial were free from symptoms and no longer required diabetes medication, five years later.

The initial study that began in 2017 showed 46 per cent of patients who stuck to the low calorie diet for three to five months were still in remission a year later, while 36 per cent remained free from diabetes after two years.

After five years, 23 per cent of the study group who had an average weight loss of about 9kg continued to be free of symptoms.

Study authors said results were significant, as the five-year milestone was common with other diseases such as cancer, where the chance of it returning also dramatically falls after five years of remission.

“We have seen weight loss be effective in diabetes treatment, even in bariatric surgery,” said Dr Mubarak.

“Weight loss is never easy and should be a long-term process, to have a liquid diet for three months is not a solution.

“A fair target is to lose 10kg in a year, it should be a gradual process — after three years they will be a different person and have a sustainable healthy lifestyle.”

Around one in five have diabetes in the UAE, with that number expected to double by 2040.

The condition is usually associated with obesity, a sedentary lifestyle and poor diet.

Scientific breakthrough

The current scientific understanding of diabetes is that insulin resistance is a body fat issue.

When people lose their visceral belly fat and gain muscle mass, it improves their biology of carbohydrate metabolism and insulin sensitivity.

“The original study showed that almost half of patients became non-diabetic and no longer required medication using this method,” said Dr Aswin Pankajakshan, an endocrinologist and diabetic specialist at NMC Royal Hospital in Dubai.

“They were checked five years later, and it showed that the three-month 800 calorie diet had been effective at them losing visceral fat and then insulin resistance.

“The study was extremely positive and shows that weight loss can be very effective.

“Whenever a patient is diabetic there is an impact on multiple organs so even if it is reversed for just five years, it means they will not have the associated complications during that time.

“In the future, we could have similar programmes in place here.”

Malnutrition risk

Consuming fewer than 1,000 calories a day can lead to protein energy malnutrition and contribute to behavioural changes such as apathy, poor attention, anxiety and irritability.

An ultra low-calorie diet outside of a controlled setting can also bring changes to the skin, temperature regulation and how protein is metabolised.

“It is not practical or feasible to consume just 800 calories a day (outside of a clinical trial) as according to Dubai Health Authority regulations, daily diets should contain at least 1,000 calories,” said Dr Ajith Kumar, consultant endocrinologist at Burjeel Hospital in Dubai.

“It is also not legal to prescribe a diet with fewer calories than that.

“In the UK, it was a government NHS supported trial, where patients were monitored and followed up on.

“After the short period of meal replacement drinks, they returned to a regular diet," Dr Kumar said.

“The problem with trying to translate the same method to other countries is that we are unable to do it safely.

“If patients try to follow the same diet on their own, it can lead to consequences.”

“It (low calorie diet) can be a good thing for a short period, but this study was a meal replacement programme to achieve short term weight loss,” said Dr Kumar.

“We should be careful with weight loss advice, particularly when it is clear a diet with fewer than 1000 calories a day can be problematic.”