Dr C: “The NHS ‘Soup & Shake’ diet will be harder than you think”

The National Health Service is giving 5,000 Type 2 diabetes patients a meal replacement diet, after studies revealed it saw people lose weight and some cured altogether – but Dr C says there’s more to it than that DR CHRISTIAN GIVES HIS TAKE ON THE HOT H

It’s all very well handing out shakes and soups, and if this diet is as successful as the NHS hopes it will be, it’s great news. But I wonder how 5,000 people will stick to such a restrictive plan. Even those who know Type 2 diabetes can lead to blindness and limb loss, and who desperately want to reverse it, will find it hard to avoid all normal food for 12 weeks.

YES, TYPE 2 DIABETES CAN BE REVERSED!

Type 2 diabetes is a metabolic disease so, if you eat excessively, your body’s response to try to control things like your blood sugar levels also has to be excessive – but when you eat less excessively, those responses calm down, putting the condition in remission. Two big studies where they trialled this type of diet saw people lose weight, and some went into remission from diabetes. We know that when you admit people to hospital and provide all their meals, that can work, but this new trial by the NHS will rely on people sticking to it at home. They will be offered diet replacement products of 900 calories a day for 12 weeks. Alongside that, they’ll receive support, including advice about how to reintroduce food after the meal replacement phase. In the studies, this support was face-to-face and in groups, but it’s likely to be online in the ongoing NHS plan. We know from things like gastric bands that if you’re given proper before, during and aftercare, it can be really effective. But it’s human nature to look for shortcuts, so people get the gastric band, then often don’t bother with the therapy and it doesn’t work.

BE REALISTIC

We shouldn’t underestimate hunger. It’s a horrible feeling that stops you doing anything else; you can’t concentrate, you can’t sleep, you’re light-headed and you may get headaches, so I worry people won’t be able to stick to the plan. Patients will be tempted beyond anything they’ve ever experienced before, because that’s the nature of hunger. If you’re the one who buys the food and other people in your house are eating normally, that’s very hard to ignore, too. We know it works, done properly – and that’s great – but there’s more to food than calories. How, when and what we eat is very behavioural, and changing behaviour takes a lot of effort. That’s why gastric band surgery often fails.

GET PAST WEEK ONE

The research compared this diet to normal NHS weight-loss advice and, after 12 months, a quarter of those on the meal replacement diet had lost 15kg or more, but nobody following the NHS diet advice did. Perhaps the reason this works is because it takes the guesswork out of dieting. All the meals are provided for three months, but the bit I worry about is when the hunger pangs kick in – which they will. If you can get through the first week or so, you will probably get used to it, so I hope the support during that really hungry period is strong. Perhaps even if you cheat a tiny bit, you’ll still lose weight because the diet is so low in calories. Even with the odd slip-up you will definitely be eating less than before.

USE THE SUPPORT

One of the first patients to be enrolled on the diet has lost over 10kg, her Type 2 diabetes is in remission and she says she has learned how to eat in moderation. That implies they’re working hard on the support, in which case it’s more than a “shake and soup” diet. If there is really extensive support, supervision and advice, it could be a really useful option – but adjusting to life on just 900 calories a day could leave you weak, lethargic, badtempered and unproductive. Also, it’s important to remember that anyone who has Type 2 diabetes and reverses it on this diet will still be prone to it. As humans, we copy the behaviour of

those around us, and as many people overeat, it’s easy to fall back into bad habits.

This needs to be a change in eating for life.

AVOID DODGY DIETS ON SOCIAL MEDIA

People may read this and think meal replacement diets in general have been given the green light by the NHS, but that’s not the case. This one will provide all the nutrition you need, but similar sounding diets that you see advertised on social media may not. If you really want it to work, it can, but you need to put in lots of work, and stay on your guard. Good luck!