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The Soups and Shakes Diet for Diabetes Remission: Does It Work?

The NHS soups and shakes programme put about a third of completers into diabetes remission. How total diet replacement works, who qualifies in the UK, and options in the US.

TYPE 2 DIABETES REMISSION

Dr. Sayantan Banerjee

10/31/20268 min read

The NHS calls it the Type 2 Diabetes Path to Remission Programme. Almost everyone else calls it the soups and shakes diet. For about three months you replace every meal with nutritionally complete soups, shakes and bars. Then you bring normal food back step by step, with support to keep the weight off.

It sounds extreme, and in some ways it is. It is also the most carefully studied route to type 2 diabetes remission that we have. If you are thinking about it, or your GP has mentioned it, this guide covers how it works, what the results show, who qualifies, what it feels like, and what you can do in the US, where there is no national equivalent.

Where the idea came from

The approach grew out of work at Newcastle University led by Professor Roy Taylor. In 2011, his team published a small study in which 11 people with type 2 diabetes followed a diet of about 600 calories a day for eight weeks. Using MRI scans, they showed that fat in the liver fell sharply within the first week, and fasting glucose returned to normal. Over the eight weeks, fat in the pancreas fell too, and insulin production after meals recovered.

The study was tiny, but it gave a clear mechanism. Remove the excess fat from the liver and pancreas, and glucose control can recover. The next step was to see whether this could work in ordinary GP practices. That became the DiRECT trial, which used a slightly higher calorie level that was easier to sustain.

How the programme is structured

The NHS programme is based on DiRECT and runs for about 12 months in three phases.

Total diet replacement, around 12 weeks. You have around 800 to 900 calories a day, entirely from specially formulated soups, shakes and bars. These provide the protein, vitamins and minerals you need. You drink plenty of water, and some programmes allow tea, black coffee and low-calorie drinks. No other food is eaten.
Food reintroduction, around 6 weeks. Normal meals come back one at a time, usually starting with one simple, measured meal a day while the other meals remain formula products.
Weight maintenance, for the rest of the year. You eat normal food, with regular support sessions from a coach or dietitian, either in groups or online.

Before you start, your GP or practice nurse reviews your medication. In DiRECT, diabetes tablets and blood pressure medicines were stopped on day one, then restarted only if readings rose. This is safe only with medical supervision, because glucose and blood pressure can fall quickly once calories drop. Never stop medicines on your own.

What the results show

In DiRECT, which recruited 306 people from 49 GP practices, 46% of the intervention group were in remission at one year, against 4% of the control group. At two years, 36% were still in remission. Average weight loss at one year was 10 kg.

The five-year follow-up, reported in 2024, found 13% of people with data were in remission at five years. Among those in remission at two years, about a quarter were still in remission at five years. Weight regain was the main reason remission ended. Even so, the intervention group had about half as many serious illnesses needing hospital admission over five years.

The first real-world NHS results were published in The Lancet Diabetes & Endocrinology in 2024. In the early phase, 7,540 people were referred. Among people who completed the programme and had two HbA1c results, 32% were in remission at one year. Among everyone who started before 2022 with enough data, the figure was 27%. Completers lost about 10 kg on average, roughly 22 pounds. Those in remission had lost about 16 kg.

So the programme works for about one in three people who complete it. It doesn't work for everyone, and about 45% of people who started didn't complete the full year. That dropout rate is the honest weak spot, and it is worth thinking about before you begin.

Who qualifies in England

The criteria change from time to time, so check with your GP surgery. At the time of writing, the programme is broadly for people who:

are aged 18 to 65
were diagnosed with type 2 diabetes within the last 6 years
have a BMI of 27 or more, or 25 or more if they are from a Black, Asian or other minority ethnic background
have a recent HbA1c within the range set by the programme
are not using insulin
are not pregnant or breastfeeding, and don't have certain other conditions such as a recent heart attack or an active eating disorder

The programme isn't available in every area of England, so ask your practice whether it is offered locally. Scotland and Wales have their own weight-management and remission services, so check with your local health board.

What about the US?

There is no national soups and shakes programme in the US. The closest options are:

medically supervised total meal replacement programmes, often run by hospital weight-management services or obesity medicine clinics
very low calorie diet programmes run by a physician, sometimes covered by insurance for people with type 2 diabetes
structured low-calorie programmes with a registered dietitian, which may be covered as medical nutrition therapy

Call your health plan and ask specifically about "medically supervised total meal replacement" or "very low calorie diet for type 2 diabetes". Ask your doctor whether they can refer you.

Trying this on your own with supermarket shakes is a different matter. Many store products are not designed to replace all your food for 12 weeks and may not provide enough protein, vitamins or minerals. More importantly, nobody is adjusting your medication. If you take insulin, a sulfonylurea or an SGLT2 inhibitor, please don't start a very low calorie diet without your doctor.

What it feels like, week by week

People describe a fairly consistent pattern.

Days 1 to 4 are usually the hardest. Hunger, headaches, tiredness and irritability are common. Many people feel cold. It helps to start on a quiet week, drink plenty of water, and plan distractions for the times you would normally eat.

From about day 5, hunger often settles. Many people are surprised by this. Part of the reason is that the body begins using more fat for fuel and produces ketones, which seem to dampen appetite. Part of it is that there are no food decisions to make, so there is less temptation.

Weeks 2 to 12 are mainly about routine and boredom. Weight usually falls quickly at first, partly from water, then more steadily, often 1 to 2 kg (2 to 4 lb) a week. Glucose readings often improve within the first one or two weeks.

Social situations are the main challenge. Birthdays, work lunches and family meals take planning. Many people find it helps to tell close friends and family what they are doing and why.

Side effects and risks

Most side effects are mild and temporary. The common ones are:

constipation, which is helped by water and sometimes a fibre supplement or mild laxative, as advised by the programme
feeling cold
dizziness when standing up quickly, often because blood pressure has fallen
tiredness in the first week
hair thinning, usually two to four months in, which normally recovers once eating returns to normal

Rapid weight loss raises the risk of gallstones. In DiRECT, two serious events in one person, biliary colic and abdominal pain, were judged possibly related to the diet. Contact your doctor if you have severe pain in the upper right side of the abdomen.

Who should think twice

The programme is not right for everyone. It generally excludes people who are pregnant or breastfeeding, have a current or past eating disorder, have advanced kidney disease, have had a recent heart attack or stroke, or need insulin. Long-standing diabetes, over about six years, lowers the chance of remission, although some people still benefit.

It is also worth being honest with yourself about whether you can manage 12 weeks without normal meals. Many people can, and find it easier than they expected. Others know from experience that it would be miserable for them. That is fine.

Alternatives if total diet replacement isn't for you

If you can't face soups and shakes, other approaches can also reduce liver fat and lead to remission:

a structured low-calorie diet of normal food, often around 1,200 to 1,500 calories a day
a lower-carbohydrate diet, which many people with diabetes find helps both glucose and appetite
intermittent fasting or time-restricted eating, with medical advice if you take glucose-lowering medicines
partial meal replacement, for example one or two shakes a day with one normal meal
GLP-1 medicines, which help many people lose weight, although a normal HbA1c on these counts as good control rather than remission

The trials suggest the total weight you lose and keep off matters more than the method you use to lose it.

Getting food reintroduction right

The weeks after the shakes are a vulnerable time. Your appetite returns, and old habits are waiting. A few things help:

Plan your first meals before you finish the formula phase. Simple, measured meals work best, such as grilled fish or chicken with vegetables, eggs with salad, or a lentil soup.
Bring meals back one at a time. Start with one meal a day for a week or two.
Build every meal around protein and vegetables. Add starchy carbohydrates in small, measured portions.
Keep weighing yourself weekly. A small rise as glycogen and water return is normal, usually about 1 to 2 kg. A continued rise is a signal to adjust.
Keep moving. Physical activity becomes more important in maintenance than it is during weight loss.

The real work starts at week 18

The maintenance phase is where people succeed or fail. DiRECT showed that remission tracked almost exactly with weight kept off. People who kept off 10 kg or more at two years had a remission rate of 64%.

Your body will push back. After weight loss, hunger hormones change and stay changed for at least a year. Plan for that, rather than hoping it won't happen. Set a regain limit, for example 2 kg, and decide in advance what you will do if you reach it. Some programmes offer a short "rescue" period with formula products. Ask whether yours does.

How my book can help

Long-term habits are the core of The Type II Diabetes Remission Strategy. Its 16-week programme uses ordinary food rather than shakes, with everyday nutrition, strategic intermittent fasting, progressive exercise and daily habits. It includes a diet plan and a tracker journal you can keep using after any structured programme ends. See the book page.

Frequently asked questions

How many calories is the soups and shakes diet? Around 800 to 900 a day in the NHS programme, and 825 to 853 in the DiRECT trial.

How long do you stay on the shakes? About 12 weeks in the NHS programme, and 12 to 20 weeks in DiRECT.

Can I do the soup and shake diet if I take insulin? Only under close medical supervision. Most programmes exclude people on insulin.

Is the NHS programme free? Yes, for eligible people in areas where it is offered.

Can I buy the products and do it myself? It isn't recommended without medical supervision, especially if you take diabetes or blood pressure medicines.

What happens if I regain the weight? Glucose often rises again. Acting early, with a return to stricter eating or support from your team, gives you the best chance of staying in remission.

Can I exercise during the shakes phase? Yes, gentle activity such as walking is encouraged. Avoid very hard exercise in the first week or two while your body adjusts, and stop if you feel dizzy.

Will I feel hungry all the time? Most people find hunger is worst in the first three or four days and then settles. Drinking plenty of water and keeping busy at usual mealtimes helps.

Can I do it if I'm vegetarian or vegan? Plant-based formula products exist. Ask the programme team which products they use and whether they suit your diet.