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How to succeed on total diet replacement to reverse type 2 diabetes

Total diet replacement is a clinically-proven way to achieve significant weight loss—enough to reverse type 2 diabetes! Switching onto low-calorie shakes, soups, and porridges can feel like a big lifestyle adjustment but there are plenty of things you can do to prepare for the journey and successfully reach your health goal.
Annabel Nicholson
3/23/2022
15
min read
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Quick summary

  • Total diet replacement is a nutritional tool used to achieve significant weight loss
  • During total diet replacement, you switch onto low-calorie, nutritionally-complete shakes, soups, and porridges
  • Total diet replacement may help you safely lose up to 15% body weight, which in turn can put type 2 diabetes into remission
  • Preparation is key—remove temptations, plan how to tackle cravings, and take the time to explain what you’re doing (and why!) to your support network

If you’ve been diagnosed with type 2 diabetes or need to lose a significant amount of weight, a total diet replacement (TDR) programme could help you achieve a number of health benefits—including type 2 diabetes reversal. 

During a TDR programme, you switch onto specially formulated shakes, soups, and porridges that, in the case of the Habitual programme, provide 800 calories per day. Scientific studies have shown that in some people, it's possible to achieve significant weight loss—up to 15% of body weight— with TDR all the while staying healthy and well, making it safe and effective.[1,2]

It’s the same nutritional tool used in the breakthrough diabetes reversal trials, which showed that a combination of TDR with habit change guidance and support can help up to 60% of people reverse type 2 diabetes without needing medical intervention or medication.[1,2]

The decision to start TDR can understandably be a big one but we’ve helped enough patients through it to know that it really is a life-changing experience with rapid and motivating results. Of course, changing your daily routine isn’t without its challenges but the good news is, there are plenty of things you can do to set yourself up for success on TDR—both while you prepare to get started and once you’re well underway.

How does TDR lead to type 2 diabetes reversal?

The idea of using TDR to reverse type 2 diabetes comes from the incredible discovery that, with an appropriate level of weight loss, the disease process underlying the condition can be reversed to put type 2 diabetes into remission.[1]

By significant weight loss, we don’t just mean visible weight but more specifically, the internal fat around the pancreas and liver—the two organs involved in blood sugar regulation. An internal build-up of fat deposits reduces the pancreas' ability to produce insulin and causes the liver to become insulin resistant, resulting in elevated blood sugar levels.

Type 2 diabetes reversal is possible in 45-60% of people following a total diet replacement programme

Taheri et al., Lancet and Lean et al., Lancet

Significant weight loss has been found to remove these fat deposits from both the liver and the pancreas, at which point they regain their ability to control blood sugar naturally. Rather than surgical intervention, such as bariatric surgery, scientists have found that a low-calorie TDR programme is enough to help people achieve the weight loss required to stabilise blood sugar levels and reach remission. A small study in 2011 found that after just 1 week on TDR, the patients’ blood sugar levels had dropped to the normal range without the need for medication.[3]

This paved the way to the now well-known DiRECT trial, which was the first major study to show that type 2 diabetes reversal was possible in a real-life setting. Over the course of a year, study participants followed a programme combining TDR and behaviour change. Nearly half (45.6%) lost enough weight to reach remission and it was found that the more weight was lost, the more likely it was to reverse type 2 diabetes.[1] Another trial, the DIADEM-I trial, found the same combination of TDR and behaviour change to be successful, with 60% of study participants (all with type 2 diabetes) reaching remission.[2]

Be realistic about your expectations of TDR

Before you get started on TDR, it's important to (realistically) set your expectations—both in terms of your commitment and weight loss.

First, let’s talk about commitment. TDR programmes are able to run for an extended period of time because of their nutritional value. Despite being low in calories, TDR meals contain all the essential nutrients your body needs to stay healthy while losing weight. This is actually a legal requirement for TDR meals, unlike meal replacements, which don’t meet all your nutritional needs and therefore can’t be used in place of a whole diet. 

While the Habitual programme uses full TDR for 3 months, we want to be very clear that absolutely no one does TDR 100% of the time and this absolutely isn’t the expectation from us—and nor should it be from you. Just because you’re on TDR doesn’t mean that you should press pause on life. So, if you need time off for any reason, such as a holiday, a celebratory occasion, an illness, or maybe you just want a break, that’s absolutely fine. Taking time off doesn’t mean you’ve failed—in fact, it means you’re well on your way to success because you’re being honest with yourself by making realistic plans. Rather than worry about days off, it’s far more important to get back on track afterwards… that’s where the real behaviour change lies!

Total diet replacement may help you lose up to 15% of body weight

Taheri et al., Lancet and Lean et al., Lancet

In terms of weight loss, the average on our programme is half a stone (about 7lbs or 3kg) at 2 weeks and 2.6 stone (about 37lbs or 17kg) at 6 months. Both the DiRECT and DIADEM-I trials found similar results, confirming that losing approximately 15% of body weight is possible in a real-life setting.[1,2] But, it's important to remember that absolutely everyone is different. How quickly you lose weight or how much you lose depends on lots of different factors. Your body is going through its own journey, so try not to get disheartened if it seems like you’re experiencing stalled or plateauing weight loss—your body is doing what’s best for you.

Make sure TDR is right for you

As well as a nutritional tool, it's important to remember that TDR is a medical weight loss tool. Before starting a TDR programme, always make sure you liaise with your GP to make sure it's the right direction for you—not just in terms of actually eating the meals but also your health and wellbeing. The significant weight loss associated with TDR means it is best suited to people needing to lose a substantial amount—10-15kg. At Habitual, we don’t recommend it to anyone with a BMI of less than 25. If you take medication to manage your blood sugar levels, you'll also need to chat to your GP. TDR stabilises blood sugar levels quickly, so it's important your medication is adjusted accordingly.

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Set yourself up for success on total diet replacement

Preparation is key!

Before you start TDR, there are a few things you can do in preparation to instantly set yourself up for success:

Remove temptation 🧁

Where possible, remove temptation from your home and have a spring clean of your kitchen. If you share a kitchen with friends or family, consider asking if you can have a whole cupboard just for your TDR meals (and extra flavourings), moving any temptations somewhere else for the time being. If you’ll continue to buy food for the family, consider shopping online for the duration of TDR to avoid supermarket temptations.

Learn the rules 🤓

The general rule is that beyond the TDR meals, you shouldn’t eat anything that contains calories. However, this isn’t as simple as it sounds and there are in fact things you can eat and drink while on TDR, such as spices and herbs to add extra flavour, hot drinks such as tea, coffee, and herbal teas, and sugar-free gum. Familiarise yourself with what you can and can’t have, and make sure to stock up on different flavourings before you get started.

Know what to expect 🧠

TDR can come with a few side effects, especially in the early days and knowing what to expect can be a helpful way to prepare for the journey ahead. You may feel tired, find it hard to concentrate, and experience cravings—these feelings are all completely normal and they will pass. Your body is undergoing a huge change and it will take a few days to adjust to your new routine. Keep your mind on your goal and reasons for starting TDR, stay hydrated, and make time for yourself to do things that make you happy.

Plan for cravings 📝

We all experience cravings and the time on TDR is no different. The important thing to remember is that they’re transitory, typically lasting 3-5 minutes. If a craving hits, it’s best to keep yourself busy until the feeling passes. Make a list of different things you can do to distract yourself so you can just pick one the moment your craving arrives— go for a short walk (even just around the house!), listen to your favourite song, read a few pages of a book, do some gentle stretches, start the crossword, list anything that will keep you busy. Tiredness can also make our cravings worse, so think about how you can prioritise your sleep during TDR.

Gather support 🤝

Who you tell about TDR is completely up to you—you don’t have to tell anyone at all or you can discuss it with a few select people. There will be highs and lows on the journey, and it can be a great help to have support on harder days to keep you motivated, as well as someone to celebrate your success with! Don’t be afraid to educate the people you tell—not everyone will understand what TDR is or why you’re doing it—and make practical suggestions of ways they can help you, such as going for a walk during lunchtime or making weekend plans that don’t involve eating and drinking. 

Make every day on TDR a success

Once you start TDR, there are plenty of things you can do to feel successful each and every day:

Make note of your progress 📈

Track some of your key health indicators such as weight, sleep, activity, and mood so that you can visualise your progress. As well as a document of your journey to type 2 diabetes reversal, seeing how far you’ve come can be a great motivator and reminder of why you started TDR on a bad day.

Stay hydrated 💧

It’s important to drink plenty of water while you’re on TDR. Try to drink little and often, keeping water nearby as much as possible. General guidance is to drink 3 litres of water throughout the day to make up for the water you’re not getting from food. Staying hydrated will also keep some side effects at bay, such as lethargy and difficulty concentrating, as well as help curb feelings of hunger. Remember, if you’re thirsty then you’re already dehydrated!

Fill your time 😌

Eating adds structure to our day and you might be surprised at how much free time you have without needing to shop, prepare, cook, or eat a big meal. Relish this time and put it to good use rather than wishing you were eating—take a bath, go for a walk, read, catch up with a friend, do something creative, or if you have a family, stick to the routine of joining them at the table with your TDR meal and enjoying the relaxed family time.

Spread out your meals ⏰

Tempting though it may be to skip breakfast (especially if you’re not usually a breakfast person!) and double up on lunch, try to stick to the routine of regular mealtimes to avoid urgent hunger pangs and cravings. 

Do it with a friend 👋

While digital support is all well and good, there’s nothing like sharing a life-changing experience with someone you love. We offer a generous referral scheme (50% off two programme payments, for you and your referral), providing an opportunity for you and a friend to experience the Habitual journey together, often making the days ahead easier to navigate. If you have a friend you’d like to get started with, do reach out and we’ll sort out your promo codes.

Be kind to yourself 🥰

The path to a healthier life isn’t always an easy one, so it's important to take care of yourself and give your body what it needs. And don’t forget to celebrate each and every win… there are going to be plenty! 

It's easy to underestimate just how powerful it can feel to be prepared. Follow these tips to feel positive, prepared, and empowered to start your journey towards a healthier life—and don’t feel like this advice is just for total diet replacement! They’re applicable to any eating approach you may be trying to help you lose weight, gain control of your blood sugar levels, and live a healthier life.

References

[1] Lean, M.E.J., Leslie, W.S., Barnes, A.C., et al. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 391(10120):541-551. Accessible here.

[2] Taheri, S., Zaghloul, H., Chagoury, O., et al. (2020). Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes and Endocrinology, 8, 477–489. Accessible here.

[3] Lim, E.L., Hollingsworth, K.G., Aribisala, B.S., et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. (2011). Diabetologia 54(10):2506-14. Accessible here.

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