So what does the latest science say? Do we know what causes diabetes?

it's when a susceptible person acquires too much fat inside the pancreas.

And so these insulin producing cells are struggling for quite a long period of time.

That's pre-diabetes.

And eventually they start not being able to function properly.

And that's diabetes.

So What's causing type 2 diabetes? It's carrying around more fat than the individual can cope with.

Too many carbs, too much fat, too much protein, whatever it happens to be.

So if, if someone's not familiar with the direct trial, what's the synopsis of this? What type of study was it? What was the dietary intervention? And then perhaps we can get into how the results have kind of changed from year two to year five.

The direct trial was designed to test whether we could actually have a clinically useful weight loss program run by family doctors, run in primary care, that would build upon what we already knew.

We knew type 2 diabetes was reversible by m- major weight loss, and we also knew from a second study that it would stay away provided weight loss was maintained, and we knew it affected short-term diabetes.

So we designed a randomized study, which meant that people at random were allocated either to healthy eating, just the best guidance of the time, or to rapid weight loss, followed by advice as to how to keep the weight down.

And we showed indeed in the first year that with the weight loss diet, almost fifty percent of people were in remission, forty-six percent striking finding, and the weight loss at one year was ten kilograms.

And at two years it was about eight point six kilograms and the proportion of remissions had fallen.

But what happened after that? And we now have five-year data, which is really very exciting to see what's happened to these people who are managed in these two different ways.

But in terms of their effect on the underlying disease and, and blood glucose control, how do you, how do you compare these interventions?

What is the twin cycle hypothesis?

The twin cycle hypothesis was my attempt to put together all the observations on how the body actually worked, how the body dealt with food and metabolism, and what went wrong in type 2 diabetes.

So over the years, we'd learned firstly that muscle was very resistant to insulin, and using MRI techniques, advanced MRI techniques, we could measure the glycogen in muscle and, in fact, use this to show that people who had normal, uh, insulin sensitivity in muscle stored a lot of their food as muscle glycogen within the first five hours after eating.

One third, really quite a lot.

Whereas people who had low sensitivity to insulin in muscle, so-called insulin resistance, those people stored almost none.

And from other work, we knew that the only way that that glucose would be handled, it's not being stored properly, the only way it could be handled would be for the body to turn it into fat.

Now, that sounds like magic, but that's exactly what the liver does.

And I guess given the importance of skeletal muscle in glucose homeostasis, I wondered if you'd ever considered, um, the inevitable kind of muscle loss that, that comes with losing a significant amount of body weight, particularly if you're not doing resistance training concurrently.

Sir, can you please tell the, the, our audience who and, uh, who are you, what you do?

Well, I'm Dr.

Colonel Chief Roy Taylor, Doctor of Criminal Justice, Colonel United States Army Military Police Corps, and an active chief of police, and I've been in law enforcement for the past 45 years, and a chief of police in federal, state, local, and now private law enforcement agencies for the past 31 years.

In addition, I use my knowledge and skills and training and education, uh, as a police procedure expert in federal court, and mostly, uh, testify on 1983 cases, which means a federal civil rights violation.

Oh.

What's the job of a police officer? To be a servant to the public 24 hours a day.

So the Marines look sharp in their uniform.

We like for our officers to look sharp in their uniform, but that's really where the commonality ends.