A Critical Look at the UK’s Soup and Shake Diet for Type 2 Diabetes

This summer, the UK government announced an initiative aimed at addressing the rising prevalence of type 2 diabetes (T2D) by rolling out an 800-calorie meal replacement plan, consisting of soups and shakes. This plan, officially called the Path to Remission Programme, will be available to 5,000 individuals among the nearly 4 million people diagnosed with T2D in the UK.

T2D is a condition that keeps your body from properly processing glucose, leading to a build up of glucose in the blood.

While the objective of the new plan is to help manage diabetes by promoting weight loss, critical questions need to be raised about its long-term effectiveness, sustainability, implications for health and relationship with food. So, if you have read the headlines and are wondering if you should try replicate this type of plan on your own, please read on.

Understanding the 800-Calorie Plan

The 800-calorie diet, classified as a ‘Very Low-Calorie Diet’ (VLCD), is designed to induce rapid weight loss, that may lead to improved glycemic control and potential remission of T2D symptoms in some people.

The eligibility criteria includes individuals must be aged 18 – 65 years; have a diagnosis of type 2 diabetes within the last 6 years; and have a BMI over 27 kg/m2 (where individuals are from White ethnic groups) or over 25 kg/m2 (where individuals are from Black, Asian and other ethnic groups).

In the initial 3-month phase, a diet of just soups and shakes totalling around 800 calories a day are consumed. In the second phase, participants begin to reintroduce solid foods as part of a maintenance diet, supported by coaches for 12-months.

The Diabetes Remission Clinical Trial (DiRECT) found that 46% of participants who lost more than 10 kg were in remission from Type 2 diabetes one year after beginning a low-calorie formula diet intervention, with remission defined as maintaining normal blood glucose levels without diabetes medication.

At the five-year mark, approximately 26% of those who initially achieved remission were still in remission. Additionally, those in the intervention group experienced fewer serious health complications requiring hospitalisation compared to those receiving standard diabetes care.

The Case for Caution

Whilst the media headlines emphasise positive outcomes of this trial, it is apparent from the longer-term results that maintaining remission is very challenging.

Whilst very low calorie diets like this have been used by dieticians for a long time and clearly can work for some people, in my view these diets are ultimately that - diets - or short clinical interventions that require strict protocols and support systems that may not be replicable in the general population.

So, while there may be some potential benefits to the extreme Soup and Shake diet when used appropriately in a clinical setting, a closer examination reveals several significant concerns - and why it is not advised this approach is adopted by the general public on their own:

1. Potential oversimplification of diabetes causes: By emphasising weight loss as the main solution, the approach may oversimplify T2D, leading to the misconception that excess weight is the sole or primary cause of the disease, when in fact this notion is scientifically outmoded.
   The latest thinking on T2D indicates it works the other way round - weight gain is a symptom of metabolic dysfunction, not the cause, although inflamed fat may end up accentuating metabolic issues in the long-run. T2D is in fact a multifactorial metabolic condition characterised by insulin resistance, and each individual’s experience is unique, influenced heavily by genetics, family history, emotional factors, inflammation, and other metabolic factors. Not all individuals with T2D have excess weight, and not all individuals with excess weight have T2D.

2. Risk of weight stigma: The emphasis on weight loss may also perpetuate weight stigma, potentially placing blame on individuals for their diagnosis. This can lead to feelings of shame, guilt, and self-blame, which are harmful to mental health and can increase stress—a factor that can itself worsen insulin resistance and blood sugar control.

3. Semi-starvation: 800 calories a day is suitable for a 1-year old, and would be deemed a semi-starvation diet for a 12 year old. Therefore, it would be completely inadequate for an adult requiring the energy to function in their normal daily life. VLCDs can also lead to a reduction in lean muscle mass along with fat loss, especially when not combined with exercise. Muscle mass plays a vital role in insulin sensitivity and overall metabolism, so losing it can potentially worsen insulin resistance over time and make maintaining weight loss more difficult.

4. Potential for nutritional deficiencies: Although the NHS meal replacements are fortified, they may lack the complete range of nutrients found in a balanced diet of whole foods. Whilst the Soup and Shake diet is very much short-term intervention, it is important that anyone considering replicating the VLCD approach and using meal replacements recognises that long-term adherence to a similarly restrictive diet could result in deficiencies in nutrients such as fibre, antioxidants, and essential fatty acids.

5. Mental wellbeing: The principles of my approach to eating behaviour change and nutrition at Gut Reaction emphasise self-compassion and a healthy relationship with food. Conversely, research has indicated that restrictive diets can lead to increased anxiety around food and a negative body image. A study published in Eating Disorders found that individuals who frequently dieted reported higher levels of binge eating and feelings of loss of control. This can create a toxic cycle that undermines long-term health.

6. Potential for weight cycling: Whilst the NHS Soup and Shake diet is still in relative infancy, the general research into extreme caloric restriction reveals that this type of approach often leads to rapid weight regain once the diet is discontinued. According to a study published in the American Journal of Clinical Nutrition, individuals on VLCDs can experience up to a 50% weight regain within one year. This cycling of weight loss and gain can be harmful, both physically and psychologically, leading to disordered eating patterns.

THE CASE FOR A Balanced Approach to Diabetes Management

As a Behavioural Eating Specialist with a background in nutrition and Intuitive Eating Counselling, it is apparent to me that a one-size-fits-all approach can not adequately address the complexities of managing diabetes. Personalisation in dietary and lifestyle interventions has been shown to improve adherence and outcomes in chronic disease management.

Whilst personalised support may not be able available to everyone with T2D, generally I would still encourage those with T2D looking to proactively support their health, with or without medications, to consider more balanced, sustainable approaches that promote overall health, rather than to adopt or try to replicate more radical, restrictive interventions.

T2D is fundamentally characterised by insulin resistance. So, with my T2D clients, rather than make body weight the focus, we shift attention to directly to supporting insulin sensitivity and metabolic function through nutrition and lifestyle, in ways that feel practical, manageable, and with the least food restriction as possible.

I help individuals learn what impacts their blood sugar - including dietary choices, movement, sleep, stress and other health and lifestyle factors. Client education and self-understanding are both key in my view. This includes working through problematic eating patterns, beliefs and habits including emotional eating.

Whilst this approach requires a person to be willing to learn to listen to their body and to be compassionate, curious and patient with their self whilst going through their own learning curve, it may be more beneficial and conducive to long-term behaviour change and health promotion than simply restricting calories.

MY CONCLUSIONS

While the UK government’s 800-calorie diet plan for managing type 2 diabetes may offer a short-term solution for some, and I like to remain open-minded to all emerging approaches to managing the condition, I would urge anyone, particularly those considering replicating this particular programme, to approach with caution and a critical eye.

In my experience, a holistic approach to nutrition that prioritises sustainable habits and mental wellbeing is key to lasting health improvements. By embracing a balanced approach and considering individual needs and relationship with food, we may support effective diabetes management that extends beyond any temporary diet.

Please note: If you have diabetes, any dietary change should be discussed with your doctor..

References

1. https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/

2. https://www.thelancet.com/action/showPdf?pii=S2213-8587%2823%2900385-6

3. Lean, M.E.J., et al. (2018). "Durability of a Primary Care Diabetes Remission Strategy Following a Very Low Energy Diet." Diabetes Care, 41(5), 971-978.

4. Drenjančević, I., et al. (2015). "Weight regain after very low-calorie diets: A systematic review and meta-analysis." American Journal of Clinical Nutrition, 101(5), 1144-1152.

5. The British Dietetic Association (BDA). (2020). "Guidelines on Dietary Fiber."

6. Tribole, E., & Resch, E. (2012). "Intuitive Eating: A Revolutionary Program that Works." St. Martin's Press.

7. Wilfley, D.E., et al. (2013). "The impact of dieting on the psychosocial adjustment of adolescents." Eating Disorders, 21(5), 405-421.

8. Hagger, M.S., & Chatzisarantis, N.L.D. (2007). "Self-determination theory and the psychology of health behavior." Health Psychology Review, 1(1), 195-207.

9. Public Health England. (2016). "The Eatwell Guide."

10. Tylka, T.L., & Kroon Van Diest, A.M. (2015). "The intuitive eating scale-2: item refinement and psychometric evaluation." Journal of Counseling Psychology, 62(1), 67-78.

11. Diabetes Prevention Program Research Group. (2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin." New England Journal of Medicine, 346(6), 393-403.

12. American Diabetes Association. (2020). "Standards of Medical Care in Diabetes—2020." Diabetes Care, 43(Supplement 1), S1-S232.

13. van der Velden, L., et al. (2017). "The effectiveness of a diabetes self-management education program for people with type 2 diabetes: A systematic review." Patient Education and Counseling, 100(2), 225-239.

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