Lifestyle change - cut your type 2 diabetes risk with Lipotrim

The official dogma is that lifestyle change is required if we are to reduce the risk of type 2 diabetes in the UK population. A sedentary lifestyle leading to excess weight, increases the risk of many of the long term health conditions that type 2 diabetes brings.

Quoting the Meerkats “Simples”

If Only!

Type 2 diabetes is a terrible illness and should be taken very seriously indeed. The effect of living with type 2 diabetes is profound. This debilitating "lifestyle disease" causes many health issues, ranging from problems with your eyes and feet, erectile dysfunction and thrush, to heart problems and possible lower limb amputation. At the time of diagnosing type 2 diabetes, the individual may have already placed their body under pressure for many years.   Less well known, however is that type 2 diabetes is usually preventable and often reversible.

Once diagnosed with type 2 diabetes, the individual will likely be prescribed increasing amounts of medication, over time, to help the struggling body regulate the blood glucose levels. Eventual reliance on injecting insulin or using newer, more powerful drugs persists until the body finally gives up.

Type 2 diabetes levels in the UK are increasing and show no sign of slowing. With around 3 million type 2 diabetics in the UK, and over half a million people thought to be type 2 diabetic yet undiagnosed, controlling excess weight should therefore be top of everyone's list.

 

Type 2 diabetes - what is being done?

This article on the BBC News channel describes type 2 diabetes, the effects it has on the body, and what a Doctor recommended for one patient. The NHS is currently rolling out the National Diabetes Prevention Programme and so it is important to look at what the lifestyle changes proposed by health professionals could do:

The lifestyle changes that can cut type 2 diabetes risk

By Dr Rangan Chatterjee

Doctor in the House

The recommendations made to this patient were based around 4 lifestyle changes: food, movement, stress and sleep.

Food

It is very good to see food at the top of the list. Consumption of food and drink is the first, and most important, lifestyle change to be made if you are trying to prevent or treat type 2 diabetes.

Food, or really the contribution excess food makes to an individual's weight, causes the emergence of insulin resistance. It is insulin resistance, and the body's subsequent lack of ability to adequately regulate blood glucose levels, that inevitably leads to a diagnosis of type 2 diabetes and the inevitable downward health spiral.

Tackling excess weight is the lifestyle change that truly matters to type 2 diabetics.

Lowering weight from obese levels away from a BMI >35 and ideally into a healthy range (BMI 20 to <25) has a massive impact on the treatment and reduction of type 2 diabetes. Susceptibility to type 2 diabetes is increased at much lower rates, but becomes more and more probable as BMI increases.  Some populations, such as south Asians become susceptible even at weights considered normal for white Europeans.

The food advice given to type 2 diabetics is often as is described by the Doctor:

I advised her to eliminate refined carbohydrates in her diet such as sugary breakfast cereals, white rice and bread.I encouraged her to increase her intake of healthy, natural fats such as avocados, nuts, and olives as well as healthy protein sources such as salmon and anchovies.

The food lifestyle changes described are important for nutritional health and will likely have a small benefit to her circulating glucose levels. It is highly important that any excess weight is lost to truly gain blood glucose control and so this advice must also promote a reduced intake of calories below that required each day. It is quite possible these lifestyle changes may even lead to a worsening of blood glucose control and diabetes, if body weight increases as a result of an increased, albeit "healthier calorie" intake.

Movement

It is evident that for an individual to be type 2 diabetic, they are highly likely to be carrying excess weight (as discussed above). Eating less and moving more is the mantra for losing weight and making a positive lifestyle change.

What if the diabetic is confined to a wheelchair? What if the excess weight is such that exercise is painful, even dangerous?

The Doctor advised his patient to stop her intense gym sessions and replace them with yoga and the result was that:

At the end of her yoga session, La-Vern not only felt as though she had worked out but also felt rejuvenated and energised. Plus, it was the only "switch off" time she had all week.

Some Questions

This raises an important question. What is the role of exercise? Is it adequate to just "feel" like you are exercising or should we all be following the exercise guidelines of approximately 30 mins moderate exercise 5 days a week? For extremely overweight people, 30 minutes moderate exercise could mean just getting dressed each morning. Is this an acceptable method of exercise?

The effect exercise alone has on diabetes is likely to be small since excess weight itself can lead to difficulty for meaningful activity. For an overweight individual to gain the most from exercise, we must initially tackle the excess weight. Effective and significant weight loss opens the door to more meaningful and potentially less painful, increased activity levels.

Stress and Sleep

The blue light emitted from smart phones and their use late at night can have an effect on sleep pattern. The knock-on effect can be increased susceptibility for putting on excess weight and stress. 

It is important to reduce the amount of "screen-time" before bed and to keep to good sleep routine, with reduced caffeine and alcohol levels especially in the evenings.

We must not ignore the effect sleep apnoea has on sleep deprivation and stress levels. Weight loss can often be the most effective treatment method to reduce Obstructive Sleep Apnoea symptoms and is possibly even curative.

Lipotrim has an answer.

The prevention or treatment of type 2 diabetes often revolves around making small lifestyle changes that need to be maintained for a long period of time. By looking at these recommendations we have seen that these small changes may have an effect, but it is the necessity to reduce the excess body weight that in turn reduces the insulin resistance that will have the strongest effect. The diabetes needs to be stopped quickly. The longer it takes the more difficult it may be to stop.

Losing weight is not easy. It is easy to say, but decades of history prove that despite the massive attempts at weight control, the battle is being lost. Calorie restriction and increased exercise takes too much time, produces scant results and so will have little effect on weight. Type 2 diabetes will not be effectively contained.

Lipotrim however uses nutrient complete formula foods for weight loss.  Taking care of the advice given above to make healthier food and lifestyle changes will assist with weight maintenance after the loss. The very low calorie nature of Lipotrim leads to rapid weight loss at the maximum safe rate. 

A significant reduction in weight often allows for increased exercise levels, reduced sleep disturbance and stress levels and, if you are already type 2 diabetic, reversal or prevention of type 2 diabetes if you are at risk.

If you would like to learn more about taking a major step towards a better and healthier life change contact Lipotrim today:

Lipotrim UK      0800 413 735            
Lipotrim ROI     00353 (0) 1525 5636

To find your nearest Lipotrim pharmacy click on either UK or ROI

Counting Calories? Pharmacy has the answer.

Fitness trackers and food labels, have they stepped out of line?

Whether people are trying to lose excess weight or maintain their weight, they need to know the number of calories they are eating and the number of calories being used through exercise. Only then can they truly calculate their expected weight gain, weight loss or weight maintenance.

How can you count the calories you are eating and work out how many calories you are using? 

Food composition tables, used in food labelling, is the mainstream method of calculating calorie intake, and fitness tracking devices for calories used. They both use simple maths, but will almost certainly give a very wrong result. Research demonstrates that both methods, relied on by the public and healthcare professionals, could be almost worthless.

Food Composition tables

The composition of almost any food item can be looked up in official books or searched online. These charts will detail what calories, vitamins, minerals and macronutrients the food consists of.

But how about the specific food sample you are planning to eat? Not just whether it is a beef burger but this particular beef burger on your plate. 

All foods, previously living plants or animals, vary in their composition in the same way that people differ in their composition. For example we do not all have exactly the same level of muscle mass even though we share the same general physiology.

For food composition tables to exist, hundreds of samples of the same food, from avocados to beef burgers, have to be analysed and the results averaged. If you eat 100 beef burgers, you might get close to the amount of calories listed per 100 consumed, but a single beef burger is likely to have a different value to that listed in the food composition table or on the food label. 

A wonderful study by Professor Jackie Stordy at Surrey University requested dieticians to plan a 1000 Calorie diet menu. Her graduate students purchased the foods and analysed them under laboratory conditions. They found an enormous variation between the samples, ranging from 1050 Calories up to 1600 Calories. Remember the menu was meant to be 1000 Calories, and so the poor soul attempting a 1000 Calorie a day programme, actually eating 1600 Calories per day would be very disappointed indeed.

It is essential that next time you study food labels, look at food composition tables, or rely on literature produced from commercial diets and books, you understand that you cannot be sure the calories stated is accurate. Use the food labels as a guide rather than as gospel.

Fitness trackers

Recent research from Stanford University in California has shown fitness trackers, such as the FitBit Surge and the Apple Watch, to be so inaccurate they are potentially worthless. 

The fitness tracker devices studied by Stanford University included 45 wrist-worn devices such as:
Apple Watch, Fitbit Surge, Basic Peak, Alpha 2
Microsoft Band, PulseOnMio, and the Samsung Gear S2.

The researchers measured the heart rate (HR) and energy expenditure (EE) in a diverse group of 60 people. The group was subjected to a range of activities including walking, sitting and cycling. The effect on their heart rate and energy expenditure, the number of calories burnt, were then measured using various fitness devices and compared to that measured using detailed laboratory tests, including continuous telemetry and indirect calorimetry.

Why measure heart rate (HR) and energy expenditure (EE)?

Physical health is the topic of our time. The NHS is making lifestyle advice and obesity intervention centre stage through the roll out of the new National Diabetes Prevention programme (DPP). We are being constantly reminded on how the NHS is running out of money through our inability to be healthy; our smoking and drinking habits, and most notably our increasing waistlines.
Fitness trackers, in the form of wrist-worn devices, are currently perched at the top of many people's wish list, and worn for all to see. The fitness market is currently worth £4.7 billion  and technology is playing a big part in our attempts to improve our health.

Heart rate

Measuring heart rate gives a quick measure of the amount of work the heart is under. A person can have a "normal" resting heart rate within quite a range, generally between 60 and 100 beats per minute. If the heart rate is outside of these values for any prolonged time medical advice should be sought. A trained athlete may well have a heart rate of below 60 and someone with tachycardia will likely have a regular resting heart rate above 100.

On taking exercise the heart rate gives a measure of fitness level and also a measure of training intensity.
Heart rate is therefore a useful basic measure of health and fitness.

Energy expenditure

Measuring energy expenditure, the number of calories lost over time, is widely used to estimate the effectiveness of a persons weight management regime. Combining the HR and EE, using a fitness device, theoretically should allow for a tighter and more accurate assessment of any health improvement progress. Counting calories consumed or used up through exercise, is essential in all weight loss programmes.
The majority of weight loss programmes, designed for you or self imposed, will include a method of counting calories consumed (Food composition tables and food labels discussed above). Measuring the calories burnt is even more difficult and therefore many people are turning to fitness trackers that claim to provide this data.

What did the research on fitness trackers find?

Firstly the good news. The fitness trackers measured heart rate generally within the 5% leeway the researchers felt acceptable (walking showed the highest error in HR at just 5.5%). 

The comparison of the results for HR between the fitness tracker and laboratory measurements means that, if you do use one of the wrist-worn devices you can be quite sure the readings are accurate whether you are an athlete or just managing your health or weight.

The bad news is that the measurements of energy expenditure, made by fitness trackers, overall was poor. None of the devices measured the energy expenditure within the target range of less than 5% error. Shockingly the error rates for measuring energy expenditure ranged from an error margin of 27.4% up to an embarrassing 92.6%.

It is also important to note that the results from the research into fitness trackers was under laboratory conditions. Real life use would predictably produce much worse results through changeable conditions and potential for the user of the device to not follow the manufacturers instructions fully.

What can we take away from this study on fitness trackers?

The results demonstrate the need for users, and more importantly healthcare providers, to proceed with caution when relying on, or recommending the use of, these wrist-worn devices for weight management purposes.

These devices should not be trusted as an accurate guide on the amount of calories burnt over a period of time. Using these devices for measuring heart rate however could be recommendable.

Exercising to lose weight

Travelling a mile, either by running or walking (remember work done = force x distance) uses about 100 extra Calories (without consuming a sports drink). The number of calories to use up a single pound of body fat is 3500 Calories. It is important to remember that the calories taken from stored fat are only those necessary to make up the difference from the calories actually eaten. So if you are eating 1000 Calories and burning 2000 Calories a day, only 1000 Calories will be taken from storage. To lose a pound of fat weight, at that rate, will take 3.5 days.

It takes approximately 35 miles of exercise (3500 Calories divided by 100 Calories per mile moved) to burn off 1 pound of body fat. Wearing a dysfunctional fitness tracker may not help your assessment of your calorie burn, or in real terms, towards losing weight or maintaining your weight after weight loss.

Increased exercise levels in the UK are being encouraged as part of an overall strategy to prevent and treat the rising levels of excess weight. The NHS Diabetes Prevention Programme is one such measure with exercise being employed to tackle obesity and type 2 diabetes in the UK. Hopefully it will be recognised that overweight people with disabilities, elderly people, or even seriously overweight and obese people, will not usually be able to do sufficient exercise to even make a dent in their excess weight.

Lipotrim has the solution

Lipotrim uses a bespoke computer programme to help pharmacies accurately measure the calories expended under real life conditions by a dieter. This method could be also be used to validate the performance and accuracy of fitness trackers. It is one of the outstanding features of dieting with Lipotrim. In addition to rapid, reliable and safe weight loss, sufficient to put type 2 diabetes into remission, it is possible to learn the actual daily calorie usage over a prolonged period of time. The Lipotrim results, predicting calorie usage, comes at no extra cost to the patient, and the whole programme at zero cost to the NHS.  

This is a typical weight loss pattern of a compliant Lipotrim dieter. It is a plot of weight change over time, showing the drop in weight is continuous over each period of time. An accurate reading of kg weight loss per day can be read from the graph, and easily converted to Calories used up per day (conversion is 7700 Calories per kg).

The Lipotrim formula foods contain a fixed calorie intake per day. Any deviation from the diet and the resulting weight loss would no longer follow the straight line, as seen in this model example. If the person were to do more exercise, above that taken on an average day, the slope of the weight loss line will become steeper since more calories are used up. 

Since the calories lost per day can be easily and accurately taken from the graph, by adding this output value to the calories consumed, which is fixed in the case of the Lipotrim dieter, the total maintenance calorie value can be calculated. The total maintenance calorie value is the number of calories that, if you strictly consumed just that amount per unit of time (no more, no less), body weight would be maintained. Eat more and weight will be gained, eat less and weight will be lost.

Pharmacies offering the Lipotrim weight management programme have a powerful tool that saves the NHS enormous amounts of money, and offers reliable and substantial weight loss, sufficient to prevent and treat most cases of type 2 diabetes. We have also demonstrated Lipotrim could also provide evidence of the impact of exercise on the utilisation of calories.

Hopefully the DPP will take note of the impact pharmacies are already having on this critical aspect of healthy living, despite the NHS having to deploy billions of pounds each year to achieve much poorer results. 

There are times when pharmacies should not be invisible to the health authorities.

Lipotrim UK      0800 413 735
Lipotrim ROI     00353 (0) 1525 5636

NHS diabetes prevention programme expanded but what about pharmacists!

NHS National Diabetes Prevention Programme expanded in Lancashire and South Cumbria 

Type 2 diabetes remains as one of the major serious diseases, resulting in many long term medical issues such as blindness and amputation. Type 2 diabetes causes extreme suffering to its victims and is an ever increasing burden on the NHS, even though it is largely a preventable disease. The most effective prevention and treatment of this "lifestyle disease" is weight loss. Pharmacy is in an ideal position to deliver significant weight losses, resulting in the reduction of type 2 diabetes prevalence and severity, all with no expense to the NHS. Pharmacy is undervalued.

Using QOF figures with estimates from the Diabetes Prevalence Model 2016 (Public Health England) and 2012 APHO Diabetes Prevalence Model, there are an estimated 4.5 million people with diabetes in the UK. This includes 1 million people not aware they have type 2 diabetes and are yet to be diagnosed.

Five million people in England are at high risk of developing Type 2 diabetes. More than 90% of people with type 2 diabetes are obese. Forecasts predict that there will be a large increase in the prevalence of diabetes with one in three people likely to be obese by 2034. Since one in ten people are likely to develop type 2 diabetes in this time period, the NHS must find a better preventative method than currently employed.

The current programme is designed to aid people take control of their health by giving them the tools, information and support needed to make significant lifestyle changes. Ultimately the work done through the NHS Diabetes Prevention Programme aims to reduce the risk of diabetes and the burden of diabetes on the NHS.

This Lancashire Telegraph article looks into the expansion of the national NHS Diabetes Programme

Lancashire Telegraph Article - National Diabetes Programme

In this news article Russ McClean, 56, Chair for patients across East Lancashire said:

"As a diabetic, I am really pleased that the commissioners have decided to roll out the programme and give people the tools to look after themselves." 

"We all know the NHS is falling down, it will take prevention to save money when it comes to diabetes."

The Telegraph's health expert Dr Tom Smith said:

"If something doesn't change, diabetes is going to be the biggest health issue for our country in the future, not alzheimers, not cancer, Type 2 diabetes".

Lipotrim welcomes any move to address the rising levels of type 2 diabetes in the population but feel there is an important opportunity being missed by both the NHS and type 2 diabetic patients.

Firstly what is Type 2  diabetes?

Type 2 diabetes is one of a group of metabolic diseases in which the person suffers from prolonged high blood glucose levels (blood sugar). The  most common cause of high blood sugar is due to insulin resistance where the body's cells do not respond properly to insulin. To compensate for the reduced effectiveness, excess insulin is carried in the blood. Ultimately the system is overwhelmed by prolonged elevated sugars with serious long term health consequences.

The primary risk factor for type 2 diabetes appears to be related to carrying excess weight. Having a family history of diabetes may also increase the person's diabetic risk.

What is the NHS Diabetes Prevention Programme missing?

The NHS Diabetes Programme, although commendable in its attempt to reign in the levels of type 2 diabetes, misses the two key issues surrounding diabetes that it is aiming to solve:

1    Decreasing the risk of diabetes

Significant weight loss for a majority of existing type 2 diabetics will usually send the diabetes into remission (it is important to note that current medication cannot cure diabetes). For those patients at high risk of developing type 2 diabetes, namely those overweight but not yet obese, a reversal of their excess weight to a more healthy level (ideally BMI <25) will greatly reduce the likelihood of developing type 2 diabetes. In some ethnic populations, notably those from South Asia, the increased risk from weight starts at an even lower BMI.

So the NHS programme should work? 

Yes and no. The issue surrounding losing significant weight is time. The patients that are most likely to require such lifestyle interventions will often need to lose a greater  amount of weight and at a faster rate than is traditionally lost on lifestyle intervention programmes. A patient losing weight through lifestyle intervention will be lucky to sustain  weight losses of 1lb a week.

Many diets fail to produce significant weight loss because it takes too long, and daily life events can often negatively intervene. When there is an element of food addiction the problem is magnified. If the patient cannot exercise, the problem is enhanced.

The diabetes prevention programme entails the patient being actively recruited by the NHS healthcare provider. If the patient accepts their place on the programme they will be attending monthly sessions for around 12 weeks each lasting in the region of 1 to 2 hours:

7.1   Individuals with a Body Mass Index (BMI) > 25 are eligible for Tier 2 WMS.iiTier 2 WMS are commissioned by local authorities, they tend to be deliveredin person through group sessions in the community, should be multicomponentlifestyle services (including physical activity, behaviour changeand nutrition elements) and typically last for 12 weeks. 

Data used to construct the programme, taken from randomised trials in countries such as USA and Japan, has claimed a 30% to 60% reduction in type 2 diabetes. Real world studies however have suggested this type of programme might reduce type 2 diabetes incidence by 26%, with a measly 1.57% reduction of weight at 12 to 18 months compared with "usual care".

A patient with a starting BMI of 35 would finish with a BMI of 34.5 with this predicted reduction in weight, way short of even reaching a non-obese BMI at <30. A 26% reduction in type 2 diabetes is an unlikely result.

2    Decreasing the burden on the NHS by diabetes

The cost to the NHS in delivering the diabetes prevention programme is not insignificant, especially since the desired uptake number is 100,000 interventions in the first year alone. The expected costs are:

• £2.70 to invite and recruit each patient
• £270 per patient on average per year to deliver the interventions
• initial implementation payments per area of between £30,000 and £60,000

The NHS is therefore going to be spending a vast amount of money and resources to simply educate and motivate people to be healthier.

Is Bariatric surgery the face behind the programme?

The diabetes prevention programme Tier 3 and Tier 4 involves the recommendation and use of bariatric surgery. Weight loss surgery is a serious proposition for both the patient and NHS because bariatric surgery;

• is not always a single operation for the patient. Follow-up operations may be required and results are not guaranteed. In a study of 209 type 2 diabetics who underwent surgery, only 34.4% had complete diabetic remission. The conclusion of the study was that "Focusing on improved glycaemic control rather than remission may better reflect the benefit of this type of surgery". 
• can cost around £10,000 per operation. Does the NHS have this money going spare to not achieve high remission rates?
• requires surgeons, and plenty of them, if the lifestyle interventions fail to deliver the significant weight loss as we expect. We do not have the numbers of qualified surgeons available nor the extra money in the NHS. 

The detail behind the recommendation for surgery is also interesting:

7.4Surgical intervention is only an option if all appropriate non-surgical measuresto achieve or maintain an adequate, clinically beneficial weight loss s havebeen tried and the person has been receiving or will receive intensivemanagement in a Tier 3 WMS.iii

There is no mention of using a Very Low Calorie Diet (VLCD), in the NHS diabetes prevention programme Tier guidance, such as Lipotrim.

VLCDs have a pivotal role to play in the prevention and treatment of type 2 diabetes, especially in the modern climate of rising prevalence of the disease and prolonged austerity. A private, patient funded weight management programme would have a zero running cost for the NHS. Lipotrim would therefore deliver cost savings this prevention programme is aiming to achieve without the implementation and running costs the NHS is having to fund.

What about pharmacists?

It is scandalous to see the undervalued network of pharmacies, with their highly trained pharmacists, have not been used to deliver this programme. The extended opening hours of pharmacies and the expertise of their pharmacists could have been utilised to enhance the availability and effectiveness of any national weight management programme. The recruiting and educating of new DPP trainers, coupled with the need for premises is unnecessary and frivolous. 



Pharmacy is already contributing to the tackling of type 2 diabetes through their every-day, opportunistic lifestyle interventions. The network of Lipotrim pharmacies are adding their own success stories with significant weight losses contributing to medication cessation.

Current successful evidence based pharmacy weight management programmes, such as Lipotrim, save the NHS money now and in the future, and should be harnessed, not ignored.

Contact Lipotrim today
UK        0800 413 735
lipotrim@lipotrim.co.uk  

The NHS National Diabetes Prevention Programme