Title: Life Without Diabetes: The definitive guide to understanding and reversing type 2 diabetes
Author: Roy Taylor
Publisher: Short Books, 2020
ISBN: 978-1-78072-409-6
The author, Roy Taylor, is Professor of Medicine and Metabolism at the University of Newcastle; Honorary Consultant Physician, Newcastle Acute Hospitals NHS Trust; and Director of Newcastle Magnetic Resonance Centre. Nevertheless, he has found time to write this interesting book which describes how to achieve remission of type 2 diabetes (T2DM) using lifestyle to reduce adiposity (success more likely if action is taken as soon as possible after diagnosis). He then explains how remission may be maintained by not becoming ‘too fat for your body’ – ie, individualisation: a diabetogenic BMI may be 24 for you but 28 for your sibling. If you want to avoid T2DM, make sure that you can still fit into the clothes you wore when you were 21 years old (assuming you were slim and healthy) – don’t cheat with the ever-expanding jogging bottoms.
At over 300 pages the book may appear long, but it is organised into reader-ready chunks and each chapter ends with a Quick Read summary box. There is even a prologue on ‘How to use this book’ so that you can rapidly access the sections of personal interest. For example, if you are ‘Escaping from type 2 diabetes’, go directly to Chapter 7 (p. 156). The writing style is engaging and accessible to a wide readership, avoiding unnecessary use of jargon and complex language. There is a novel approach to the explanation of normal energy balance, nutrient metabolism, storage and utilisation and how things go awry in T2DM – “a bad case of food poisoning”. Chapters 2 and 3 are recommended ‘stand-alone’ reading for anyone who has to teach the topic to any age or ability range.
Chapters 5 and 6 are enthralling as a memoir or novel with the triumvirate almost developing persona and the reader being taken into the detective’s confidence to solve the mystery of the disappearing beta cells – the development of the Twin Cycle Hypothesis and key investigations including COUNTERPOINT (COUNTERacting the Pancreatic inhibition Of Insulin secretioN by Triglyceride), COUNTERBALANCE (COUNTERacting BetA cell failure by Long-term Action to Normalize Calorie Intake) and finally DiRECT (Diabetes Remission Clinical Trial). Magnetic resonance imaging was the hero providing images of the culprit in action in living humans (conclusive compared to slices of stained dead tissue).
The rationale for rapid weight loss over a short period using a very low calorie diet liquid meal replacement regimen followed by a gradual re-introduction of normal eating is carefully and practically detailed (recipes for Step 1, p. 245; Step 2, p. 272; Step 3, p. 283), recognising that achieving and maintaining weight loss is not for the fainthearted and adhering to a ‘new normal’ lifestyle can be challenging but almost certainly rewarding – lose 15 kg (2st 5lb), no T2DM. If you have pre- diabetes, lose 10 kg (1st 8lb) or 10% of your weight if you are under 80 kg (12st 8lb) to return to nornoglycaemia. Removing the excess fat from the liver and pancreas allows the beta cells to recover and return to normal insulin production – but only if the beta cells have not been damaged for too long. The final chapter offers advice on interpreting health stories, for example, fallacy by association, understanding risk, study size, bandwagons, ‘evidence-free ideas’. Is it now safe to ‘go to work on an egg?’
Overall an enlightening, entertaining read suitable for anyone with an interest in diabetes or the fate of food in the body – a motivational text for anybody who finds fighting the flab a daunting prospect. Returning to a BMI of 21 is a fantasy, but following the advice in Chapter 8 would cut the risk of reaching my personal fat threshold – I’ll start working on it ..…
Author proceeds from this book are all donated to Diabetes UK – a magnanimous gesture.
Correspondence: Dr Caroline Day,
Visiting Fellow, Diabetes Group,
Aston University, Birmingham B4 7ET, UK
E-mail: cday@mededuk.com