Monday, March 2, 2020

Retrospective #380: Newcastle Diet (“Counterpoint Study”)

The “Newcastle Diet,” as presently practiced, is not the same as the original diet developed at Newcastle University for their 2011 “Counterpoint Study.” I wrote about the original study in 2013 in "Reversal of Type 2 Diabetes" (Retrospective #88) and "'Reversal of Type 2 Diabetes' Revisited" (Retrospective #89). Due to the appealing but highly misleading title, Retrospective #88 was my most popular column ever. Note: The authors used quotes in the title.
The author’s use of quotes in the title is misleading in part because of their definition of “reversal”: “Reversal of diabetes” was defined by them as “achieving fasting capillary blood glucose < 6.1mmol/l [110mg/dl] and/or, if available, HbA1c less than 43 mmol/mol (6.1%) off treatment.” In my book, that is not a “reversal” and certainly not a “cure,” as some would claim. A FBG of 110 is smack in the middle of “pre-diabetic” in the U.S. (which begins at 100mg/dl (5.6mmol/L). By way of reference, many doctors consider an A1c of 5.7% (39 mmol/mol) – the threshold for “pre-diabetes” – to be incipient, frank Type 2 diabetes. That’s because it is manifest evidence of Insulin Resistance (IR), the cause of Type 2 diabetes. “Pre-diabetes” is simply an arbitrary point on the Insulin Resistance continuum.
But why is the Newcastle Diet named the “600 kcal diet”? Quoting from the original Newcastle University 2011 paper, the dietary protocol of the Counterpoint Study “consisted of a liquid diet formula (46.4% carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace elements; 2.1 MJ/day [510 kcal/day]; Optifast; Nestlé Nutrition, Croydon, UK). This was supplemented with three portions of non-starchy vegetables such that total energy intake was about 2.5 MJ (600 kcal)/day.” That is why the Newcastle Diet is called the “600 calorie diet.”
However, Diabetes.co.uk, which funded the study and has the only official description of it on the web, now says it is an 800kcal diet, comprised of “Optifast meal replacement sachets, which provided 75% of the calories (600 calories). The other 200 calories came from non-starchy vegetables.” Then, “Note: The diet is referred to as the 600 calorie diet (rather than 800) due to the meal replacement aspect of the diet totaling 600 calories.” Wrong! The Optifast portion is 510 kcal, and the other 90 calories come from “three portions of non-starchy vegetables.” Maybe NHS doesn’t want Brits trying such a “drastic” (600kcal total) diet, and certainly not one approved and supervised by an RD or doctor.”
Note also the macronutrient composition of the Optifast part of the original Newcastle Diet: 46.4% carbs, 32.5% protein, and 20.1% fat. That’s high carb, very high protein and low fat. And that’s not counting the 3 servings of “non-starchy vegetables,” which if you ate them would boost the carb content higher, to perhaps 55% of the 600kcal diet and 66% carbs in the 800kcal diet. Folks: eating that high carb is how you developed diabetes in the first place!
In addition, the 32.5% protein is much too high. Virtually no one recommends more than 30%, and hardly anyone eats more than 20%. Americans eat 15% on average, and the Nutrition Facts panel on packaged and processed foods is based on 10% protein So, basically, Newcastle is a low-fat diet, the way government Dictocrats want us to eat.
Okay, so why does this diet work? The answer is that it is fundamentally a very low-CALORIE diet. On this the authors agree. They stipulate, “Normalization of both beta cell function and hepatic insulin sensitivity in Type 2 diabetes was achieved by dietary energy restriction alone” (my emphasis). Makes sense. You eat less, you lose weight. In this respect the Newcastle diet is similar, both in mode and outcomes, to bariatric surgery…but tremendously safer. And in lieu of the 300g of carbs that the typical Western 2,000 kcal diet includes, the original Counterpoint Study (600kcal) version would have 59g of carbs from Optifast and 23.5g added for “non-starchy vegetables” = 82.5g total. So, in addition to being very low in DIETARY fat, the original Newcastle is (moderately) low carb, at least by comparison! In the higher-fiber 800kcal version recommended by Diabetes.co.uk, the carb count climbs to 132 grams, no longer considered “low-carb,” but it’s still pretty low compared to 300g for women or 375 carb grams for men (on 2,500kcal)!
In the U. S., 300g of carbs is the RDA in a 2,000kcal diet; 375g in 2,500kcal for men. Surely everyone knows, even if the NHS and the ADA and the public health establishment won’t admit it, TYPE 2 DIABETES IS A DIETARY DISEASE. Why not just admit: The best treatment for Type 2 diabetes is a high fat, moderate protein, LOW CARB diet.

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