New research shows that rapid weight loss is key to beating diabetes. It worked for Dr Michael Mosley — this is how
Most of us believe that if you lose weight fast you will put it back on even faster. It is part of dieting folklore. I recently heard a leading nutritionist claiming with complete confidence, “Low-calorie diets are really bad for you and they don’t work. There’s absolutely no benefit to doing them or fasting. It’s just wishful thinking.”
So was she right? According to a review article by some of America’s leading obesity experts published in the New England Journal of Medicine (“Myths, Presumptions, and Facts about Obesity”), almost certainly not.
As the authors point out, numerous trials have shown that “more rapid and greater initial weight loss is associated with lower body weight at the end of long-term follow-up”. In other words, it can be better to lose weight quickly than slowly.
A recent multinational study, the largest of its kind, backs up this claim. The Preview study (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World) was set up to find the best ways to stem the apparently inexorable rise of type 2 diabetes, the greatest health problem of our time.
When it began in 2013, those volunteers taking part in the trial — 2,326 overweight men and women from eight countries (Britain, Denmark, Finland, Holland, Bulgaria, Spain, New Zealand and Australia) — all had pre-diabetes. This is a condition where you have raised blood sugar levels, but they are not yet in the diabetic range. There are no symptoms and pre-diabetes is normally only picked up by random blood tests. It is becoming increasingly common and the risk of getting it rises rapidly with age.
According to the British Medical Journal rates of pre-diabetes in the UK have tripled in the past ten years, up from 11 per cent to 35 per cent of the adult population. Having pre-diabetes doubles your risk of heart disease and unless you do something about it you will almost certainly develop type 2 diabetes. The best way to stop this is to lose weight, particularly around your middle.
What is the best way to do that? The Preview study is testing the claim that rapid weight loss may be the way to go and its initial findings, revealed yesterday at the European Obesity Summit in Sweden, are promising. Those taking part in the trial were asked to go on an 800-calorie diet for eight weeks, with the aim of losing 8 per cent of their body weight. In fact most of them did far better than expected, losing an average of 11kg (24lb), 11 per cent of their initial body weight.
Professor Jennie Brand-Miller of the University of Sydney, one of the lead researchers, was particularly pleased by the effect this had on their blood sugar levels. “In many cases,” she said, “their blood glucose is back to healthy levels and their pre-diabetes has disappeared.”
She told me that although living on 800 calories can be tough to start with, most people soon adapt and stop feeling hungry. It is important, however, to drink plenty of fluid to reduce the risk of headaches and constipation. It was encouraging, she said, that when the volunteers lost weight, they became more active, which added to the benefits.
The myth that rapid weight loss is associated with rapid weight regain is no more true than Aesop’s fables
Dr Katrina Purcell from the University of Melbourne recently led a study of 200 obese subjects who were randomly allocated to either a rapid weight loss diet or to a standard low-fat, slow and steady diet, and asked to lose 12.5 per cent of their body weight. The volunteers were tracked for three years and the rapid weight loss group were the clear winners. As she pointed out: “Across the world, guidelines recommend gradual weight loss for the treatment of obesity, reflecting the widely held belief that fast weight loss is more quickly regained. However, our results show that achieving a weight loss target of 12.5 per cent is more likely, and drop-out is lower, if losing weight is done quickly.”
Commenting on this study, Dr Corby Martin and Professor Kishore Gadde from Pennington Biomedical Research Center, Baton Rouge, wrote: “This study . . . indicates that for weight loss, a slow and steady approach does not win the race, and the myth that rapid weight loss is associated with rapid weight regain is no more true than Aesop’s fables.”
It is obviously essential, if you go on a low calorie diet, that you get adequate levels of protein and other nutrients. Those taking part in the trials I’ve mentioned were given low calorie soups and shakes, but it can be done with real food.
I’ve recently written a book, The 8-week Blood Sugar Diet, which goes into the science of rapid weight loss, but which also includes daily 800-calorie recipes, balanced to ensure they are low calorie but nutrient rich. Studies done by Professor Roy Taylor of Newcastle University have shown that type 2 diabetics who stick to an 800-calorie daily diet typically lose about 14kg in eight weeks and most are able to come off their medication.
The critical thing, once you’ve lost the weight, is to keep it off. Four years ago I discovered I was a type 2 diabetic. I lost 10kg and reversed my diabetes. Since then I’ve kept my weight down and my blood sugar levels normal by cutting back on sugary and starchy carbs and instead eating a Mediterranean diet, rich in vegetables, fruit, fish, nuts and olive oil. With the occasional glass of red wine.
Exercise, or at least increased activity, is also an important way to keep weight off and diabetes at bay. In the Preview study they have randomly allocated their volunteers to either 150 minutes a week of moderate exercise or a far shorter but more intense regimen. We will find out which is more effective in 2018.
Strawberries are not the only fruit — which foods to eat and which to avoid
This is a bold and radical diet, one that involves eating 800 calories a day for up to eight weeks. It will help you to get rid of your tummy (visceral) fat fast. Once your visceral fat levels start to drop (and this happens within days), the fat clogging up your liver will also begin to melt away like snow under a hot sun. Within weeks prediabetics and type 2 diabetics should see their blood-sugar levels falling back towards normal. This will set you on course for a leaner, healthier future.
What to eat to control your weight and your blood sugar
First, cut right down on sugar, sugary treats, drinks and desserts — no more than once or twice a week and preferably less. You can use sugar substitutes such as stevia and xylitol, but try to wean yourself off your sweet tooth.
Minimise or avoid the starchy “white stuff”: bread, pasta, potatoes, rice. Be wary of “brown” alternatives; the extra fibre can be negligible. Brown rice is OK, but some wholemeal breads have added sugar. Switch instead to quinoa, bulgur (cracked wheat), whole rye, whole-grain barley, wild rice and buckwheat. Legumes, such as lentils and kidney beans, are healthy and filling.
Avoid most breakfast cereals; they are usually full of sugar, even the ones that contain bran. Oats are good, as long as they are not the instant sort.
Full-fat yoghurt is also good. Add berries, such as blackberries, strawberries or blueberries, for flavour. Or a sprinkling of nuts.
Start the day with eggs — boiled, poached, scrambled or as an omelette. They’ll keep you fuller for longer than cereal or toast. Delicious with smoked salmon, mushrooms and a sprinkle of chilli.
Snack on nuts; they are a great source of protein and fibre. Try to avoid salted or sweetened nuts, which can be moreish.
Eat more healthy fats and oils. Along with oily fish (salmon, tuna, mackerel), consume more olive oil. A splash makes vegetables taste better and improves the absorption of vitamins. Use olive, rapeseed or coconut oil for cooking. Avoid margarine and use butter instead. Cheese in moderation is fine.
High-quality proteins to wolf down include oily fish, prawns, chicken, turkey, pork, beef and, of course, eggs. Other protein-rich foods: soya, edamame beans, Quorn, hummus. Processed meats (bacon, salami, sausages) should be eaten only a few times a week.
Eat plenty of different-coloured veg (from dark leafy greens to bright-red and yellow peppers). Add sauces and flavouring — lemon, butter or olive oil, salt, pepper, garlic, chilli, gravy.
Avoid too many sweet fruits; berries, apples or pears are fine, but sweet tropical fruits, such as mango, pineapple, melon and bananas, are full of sugar.
Have a drink, but not too many. Try to average no more than one to two units a day (a small glass of wine or shot of spirits is one and a half units) and cut back on beer — it’s rich in carbs, which is why it’s known as “liquid toast”.
Recipes
Day 1
Blueberry and green tea shake, pepper with jewelled feta and aubergine with lamb and pomegranate
Breakfast
Blueberry and green-tea shake (100 calories)
Serves 1
200ml water
1 green teabag
50g blueberries
2 tbsp greek yoghurt
1 tbsp almonds
1 tbsp flaxseeds
Method
Bring the water to the boil, add the teabag and allow it to steep for 4 min. Remove the teabag and chill the tea in the fridge (preferably overnight). Pour into a blender with the other ingredients and whizz together.
Lunch
Pepper with jewelled feta (220 calories)
Serves 1
1 red pepper
25g feta, diced
1 tbsp mint, roughly chopped
1 tbsp coriander, roughly chopped
1 spring onion, finely chopped
1 tbsp pistachio nuts, roughly chopped
4 cherry tomatoes, halved
5cm piece of cucumber, diced
Seeds from a pomegranate
Juice of half a lemon
Method
Cut the pepper in half and remove the seeds. Brush the skin with olive oil and place the pieces skin side up on a baking tray. Heat the grill to high and place the pepper under it for 5 min. Place all the other ingredients in a bowl or tub and toss together. Remove the pepper halves from the grill and stuff with the feta mixture.
Dinner
Aubergine with lamb and pomegranate (490 calories)
Serves 2
2 aubergines, halved lengthways
1 tbsp olive oil
1 onion, finely chopped
½ tsp ground cumin
½ tsp paprika
½ tsp ground cinnamon
200g lean minced lamb
1 tbsp pine nuts
1 tbsp tomato puree
2 tbsp pomegranate seeds
Handful of flat-leaf parsley, chopped
Method
Preheat oven to 220C/gas 7. Place the aubergines in a roasting dish skin side down. Lightly smear with some of the olive oil, season with a pinch of salt and plenty of black pepper, and bake in the oven for 20 min. Meanwhile, heat the remaining oil in a pan, add the onion and spices and cook over a medium heat for 8 min. Add the meat, pine nuts and tomato puree and cook for another 8 min. Just before the end, stir in the pomegranate seeds. Remove the aubergines from the oven and divide the lamb mixture evenly between each half. Return to the oven for a further 10 min. Serve topped with parsley leaves.
Day 2
No-carb bircher muesli, beetroot falafels and veg frittata
Breakfast
No-carb bircher muesli (180 calories)
Serves 1
1 tbsp raisins
50ml apple juice
2 tbsp ground flaxseed
2 tbsp plain yoghurt
Pinch of ground cinnamon
1 tbsp walnut pieces
Method
Place the raisins in a bowl and pour over the apple juice. Leave to chill in the fridge for at least 1 hour or overnight. When ready to eat, mix with the ground flaxseed and the yoghurt and sprinkle over the cinnamon and walnut pieces.
Lunch
Beetroot falafels (290 calories)
Serves 2
½ tbsp olive oil
1 red onion, chopped
1 tsp cumin seeds
Pinch of cayenne pepper
4 mushrooms, finely chopped
1 × 400g tin chickpeas, drained and rinsed
250g raw beetroot, peeled and coarsely grated
1 egg
1 tbsp tahini paste
Squeeze of lemon juice
Vegetable oil, for brushing
To serve:
2 tbsp greek yoghurt
1 bag of rocket leaves
Preheat the oven to 200C/gas 6.
Method
Heat the oil in a frying pan and fry the onions for 5 min or until softened. Add the cumin, cayenne and mushrooms and cook for a further 2 min, then transfer the mixture to a food processor with the chickpeas, two thirds of the grated beetroot, egg, tahini and lemon juice. Whizz to a rough paste, transfer to a bowl and stir in the remaining grated beetroot. Season with a pinch of salt and plenty of black pepper.With damp hands, shape the mixture into 8 balls and space on a baking sheet lined with parchment. Brush the falafels with oil and bake for 25 min. Serve with a dollop of greek yoghurt and a handful of rocket.
Dinner
Veg frittata (320 calories)
Serves 2
2 red peppers
Drizzle of olive oil
3 spring onions, chopped
2 garlic cloves, crushed
200g tinned chickpeas, drained and rinsed
1 tsp smoked paprika
100g baby spinach leaves
4 large eggs, beaten
Pinch of salt and freshly ground black pepper
Method
Cut the peppers into halves or quarters and remove the seeds. Brush lightly with oil, then place the pieces skin side up on a baking sheet and grill on high, until the skin blackens and blisters. Place the hot peppers in a heatproof bag and seal tightly. Leave to cool. Peel the charred skin from the peppers and roughly chop. Heat the olive oil in a large frying pan over a medium heat and sauté the spring onions and garlic until soft. Add the pepper to the pan, with the chickpeas and paprika. Sauté everything together for about 5 min. Add the spinach and keep stirring until it wilts. Add the eggs and seasoning and stir gently to incorporate them into the whole mixture, then allow to set over a medium heat — this should take 2 min. Preheat the grill to high, then slide the whole pan underneath to set the top of the frittata. It will take only 1 min to become light golden and puffed up.
