Type 2 diabetes, metabolic syndrome and high blood sugar are caused by a lack of muscular glycogen storage capacity resulting from insulin resistance and excessive glucagon mediated hepatic gluconeogenesis. Diabetes progresses when HbA1c is above 6% and regresses when HbA1c is below 5.5%. Diabetes goes into regression (desugarization) the minute you take your blood sugar below 6.0 mmol/L or 108 mg/dl and it goes into progression (resugarization) the minute you sugar rises to 7.0 mmol/L or 126 mg/dl. Type 2 diabetes cure and reversal can be achieved through Ketosis resulting from a carb negative diet and exercise regime. Any sufficiently carb negative diet and exercise regime will significantly outperform all the following drugs: Metformin, Victoza, Januvia, Glipizide, Lantus, Janumet, Glimepiride, Humalog, Actos, Invokana, Diamicron, Amaryl, Pioglitazone, Onglyza, Gliclazide, Lucentis, Byetta, Galvus, Acarbose, Forxiga, NovoRapid, Exenatide, Apidra, Liraglutide, Repaglinide, Actrapid, Eucreas, Glucobay, Saxagliptin, Vildagliptin, Dapagliflozin, Canagliflozin, Prandin. These drugs can get your HbA1c down to 6.5% at best (which is well managed but still diabetic). A Carb negative diet and exercise regime can get it down to 5% which is non diabetic. With an HbA1c of 5% your diabetes is in full regression. With an HbA1c of 6.5% it is in slow progression.
Most Orthodox Medicine practitioners both in the UK and in the US will tell you that Diabetes is a chronic progressive disease that has no cure. What is meant by that statement is that if you are not prepared to change your eating habits or your exercise habits then you will remain diabetic for the rest of your life and even if you are prepared to change them you may alleviate the symptoms to some extent but you will still be diabetic. Incidentally your life expectancy will also be decreased by 10 years (recent data from UK insurance companies). The Mayo Clinic in the US (their pre-eminent medical facility) says the following at http://www.mayoclinic.com/health/type-2-diabetes/DS00585
"Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's main source of fuel. With type 2 diabetes, your body either resists the effects of insulin - a hormone that regulates the movement of sugar into your cells - or doesn't produce enough insulin to maintain a normal glucose level. Untreated, type 2 diabetes can be life-threatening.
There's no cure for diabetes, but you can manage - or even prevent - the condition. Start by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to control your diabetes, you may need diabetes medications or insulin therapy to manage your blood sugar."
The out of date medical position is that you can control it for 5-15 years by diet and exercise and medications such as Metformin which decreases your liver glucose overproduction and supposedly decreases your muscle cell insulin resistance and Sulphonylureas which increase your pancreatic insulin production. Then another 5-15 years with insulin. Then you will probably die of a diabetic complication. This prognosis although largely true for the last 20 years, is now out of date, false and misleading for the following reasons...
1. There are people who have successfully controlled diabetes for 20 years
with diet and exercise and periodic Metformin alone.
2. There are plenty of people who were on various medications for Type 2, but after reducing their carbohydrate intake and working out in the gym for few months, normalized their blood sugar and so were able to come off those medications.
3. There are people who have put Diabetes into regression to the point where they are clinically no longer diabetic, i.e. their blood sugar is normal and they can pass any clinical diabetic test with a non diabetic result (I am one of these)
4. There are people who have put Diabetes into regression to the point where they are clinically non diabetic and remain so doing less than one hour of exercise per day on a 100 carb gram per day diet (Sami is one of these).
5. There are plenty of people on diabetic forums who have managed to come off their meds and have reduced their HbA1c to the point where they are clinically non diabetic by going on an ultra low carb (50 carb grams per day max) diet and in addition by either losing a significant amount of their excess weight or by adding in some carb burning exercise to their regime.
6. We have testimonials from several people who following the advice on this site, have put Type 2 into regression and become clinically non diabetic.
7. A whole slew of Diabetic experts (Dr Feinman, Dr Bernstein, Dr Westman and 20 other doctors!) now (as of January 1, 2015) recommend dietary carbohydrate restriction as the first approach in diabetes management.
It is absolutely true to say that modern medical science has no drug therapy or surgical procedure that cures Type 2 diabetes except in the case where the disease is mild and caused by the patient being obese. Obese patients who are mildly diabetic can be cured with gastric bypass surgery. Likewise an extremely low calorie diet can cure them - but only temporarily - because you cannot eat an extremely low calorie diet for longer than 8 weeks - see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168743/. Better still a low carb diet can cure them (its the carbs that are the problem not the calories). Low calorie diets work on fat people who are only mildly diabetic because a fat person is eating for two essentially just as a pregnant woman is. We know that gestational diabetes is often cured when the baby is delivered. This is because the mother no longer has to eat for two - although lactating puts some extra pressure upon her metabolism. Likewise if a fat person loses his fat then he is back to eating for one normal sized person.
So the Mayo Clinic is correct for non obese people as regards a surgical or a drug therapy cure. But they are totally incorrect as regards a diet and exercise cure which regrettably is not recommended by very many people in the medical community with the notable exceptions of the 23 doctors involved in the carbohydrate restriction paper and of Dr Mercola. His type 2 diabetes page is a must read...
If you have type 2 and your pancreas has not yet burnt out then there is a combination of diet and exercise and if necessary medication which will stop diabetes progressing, and which will put it into regression rather than progression (by which I mean it will get better and better slowly each day) and which will reverse any neuralgia and will return all of your clinical symptoms to normal, providing you keep up the diet and the exercise. If you do this for long enough then you can get to the point where you remain clinically non diabetic on no medication, on less than one hour per day of exercise, with a 100 carb gram per day diet. The length of time you need to keep diabetes in regression for before you are permanently 'cured' depends upon the length of time that it spent in progression before diagnosis and effective treatment.
All you have to do is return your muscles back to the condition that they were in before you became diabetic, get your brain off its subconscious sugar addiction so that it stops telling your liver to overproduce glucose, reduce your carb intake to around 50 carb grams per day and then burn those carb grams off with exercise, and reduce your insulin resistance significantly by desugarizing your body and descaling your capillaries from their microvascular sclerosis which causes the slow healing of wounds in diabetics, and by fixing any essential vitamin or mineral deficiencies.
Drugs can reduce your HbA1c (Glycosylated Haemoglobin level - 1-2 month blood sugar average) by around 1% (according to their clinical trial results). But that is not enough to put diabetes into regression. All the drugs will do is slow down the rate of progression of the disease. To put the disease into regression you need to get your HbA1c down to 5.5%. Generally Diabetics have an HbA1c of anything from 7% to 12%. So you need to reduce your HbA1c not by 1% but by at least 1.5% and normally by 2%-5%. No drug combination can yet do that without lifestyle change as well. So drugs will buy you a bit of time. But they will not cure you unless you are prepared to help them and cure yourself with some lifestyle improvement.
The only way to achieve a type 2 diabetes cure, a full reversal, generally, is by going on a carb negative diet and exercise regime. You must burn off more carbohydrate than you eat - with carb burning exercise. So the cure is to go on a very low carb diet (we recommend 40-50 carb grams per day maximum) - see http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext and see http://www.diabetes.co.uk/news/2014/jul/researchers-recommend-carb-restriction-as-primary-method-of-diabetes-control-91152031.html and to go on a brisk walk after every meal (preferably upon a treadmill) to burn off the carbs you have just eaten and the new glucose that your liver has made from the protein you have just eaten by hepatic gluconeogenesis.
The fastest way to fix your sugar is to stay on the drugs initially and change your lifestyle by going Carb Zero or Carb Negative. Then, once your fasting sugar and your HbA1c is fixed, you can start reducing the drugs down to zero in consultation with your doctor. If you stay on any drugs for too long without getting your sugar low enough to put diabetes into regression, they will start to be less and less effective and you have to take more and more of them until your become insulin dependent as your pancreatic beta cells progressively fail. Please do not let that happen. Change your lifestyle. You will feel better, you will be better and you will live much longer.
Here is the golden rule...
Diabetes Progresses when your spot sugar is above 7.0 mmol/L (126 mg/dl),
(HbA1c above 6%)
Diabetes Regresses when your spot sugar is below 6.0 mmol/L (108 mg/dl), (HbA1c below 5.4%)
And here is the philosophy for a diabetic...
Carbs are poison. Exercise is the antidote!
Take the antidote every time you take the poison, and take it as soon as you can after poisoning yourself. Carbohydrate is 100% poison. Fat is not poisonous at all. Protein is perhaps 50% poisonous due to hepatic gluconeogenesis (the liver will turn around half of it into carbs on a very low carb diet). Do not worry about eating a high fat low carb eskimo diet. Excess carbs cause weight gain and cardio vascular trouble not excess fat - however counter intuitive that may seem or feel. Low fat foods have resulted in an epidemic of fatness. What we need is low carb foods!
This is all is easy to say (although it was not so easy to deduce) - but extremely difficult to do (until you know how). However the writer has done it and he was badly diabetic and not obese at diagnosis on 2012November26 (spot sugar was 23.0 mmol/L 414 mg/dl and HbA1c was 11.4% with a BMI of 26.7). Also a friend of his has now done it completely in just one month following our latest techniques. He was diagnosed on 2014June10 with spot blood sugar of 13.9 mmol/l (250 mg/dl) and HbA1c of 10.6%, and had been extra thirsty for 2 months prior to that - so we assume he had been fully diabetic for 2 months. And many readers of this site have done it and written in with their results - see testimonials.
We must make one thing clear. It does not matter how your reduce your HbA1c down to 5.4%. You can take every drug in the book and eat no carbs and sit on your butt all day long. You can eat a half a chocolate cake every day, take no drugs at all, and go jogging for 2 hours after the cake. You can combine any mixture of drugs exercise and diet you like.
But you MUST get your 2 hour post
prandial sugar down to 6.0 mmol/L, 108 mg/dl (without post prandial exercise)
Then you MUST get your fasting sugar down to 5.2 mmol/L, 94 mg/dl every morning
Then you MUST get your HbA1c down to 5.4% and keep it there.
Do not become a spectator at you own personal sugargeddon. Take some action!
The writer is not against diabetic drugs. He is just pointing out that they will not, by themselves, stop diabetes killing you. They will not, by themselves, stop you developing painful and debilitating diabetic complications. Do whatever combination of drugs and exercise and low carb dieting works for you. Drug assisted diet and exercise is fine (although certain drugs carry the risk of hypos with high intensity exercise). However for those of you who, like the writer, are wary of the profit driven offerings from the modern pharmaceutical industry, the good news is that diet and exercise are more powerful and more effective than drugs in the case of type 2 diabetes and further that a sufficiently carb negative diet and exercise regime will in our experience immediately put diabetes into regression without the need for any drugs at all.
The writer cannot over emphasize that it is not in general the case that merely by losing weight you can reverse type 2. A Low Carb Ketogenic diet is for a fact more beneficial than a Low Calorie Diet even if you were obese upon diagnosis - see http://www.nutritionandmetabolism.com/content/5/1/36 and see http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext . If you were clinically obese and only slightly diabetic at diagnosis, then losing weight should do it. But type 2 is caused by your body having insulin resistance and insufficient glycogen storage capacity in its skeletal muscles for your typical carbohydrate consumption and some kind of endocrine system fault/cerebral sugar addiction which causes the liver to make too much sugar or not store enough of it as glycogen. It is not caused by being fat. Being fat just increases your metabolic load and so requires your body to have a larger glycogen battery.
If you diet below a BMI of 24 for a man or below a BMI of 22.5 for a woman then you are just eating up your own muscles. But these are critical in storing sugar as glycogen and preventing diabetes from progressing. Sami, a fried of the writer, was fixed in 30 days with no weight loss whatsoever. The writer himself made the mistake of following the Newcastle Reversal concept that if you lose 15% of you body weight you cease to be diabetic. He lost more than that and destroyed his muscles and locked myself in a weak and sick and diabetic state for months. It was a DISASTER. The Newcastle Reversal Technique (low calorie weight loss diet alone) only works on obese people who were mildly diabetic on diagnosis. Prof Taylor chose people with an average BMI on 33.6 and a fasting sugar of 9.2 mmol/L (166 mg/dl). My BMI was 26.7 on diagnosis and my fasting sugar was 18.0 mmol/L (324 mg/dl) and I dieted down to a BMI of 21.0. I mistakenly thought that there was a weight at which I would become non diabetic. Nothing could be further from the truth. Weight loss only helps if you were very overweight upon diagnosis.
Around 100 grams or 1/6th of your glycogen is stored in the liver and around 500 grams or 5/6th of it is stored in your muscle cells - see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248697/. So eliminating all the fat around your liver by losing weight is unlikely to fix the problem as Prof Taylor of Newcastle University suggests. I tried it. I went from 176 lbs to 138 lbs in 14 weeks. This improved my diabetes to the point where I could almost pass a 50% OGTT. But it did not fully reverse my diabetes. In fact it damaged me and increased my neuralgia, by eating away some of my muscle tissue. Also diabetic who have liver transplants from non diabetic donors remain just as diabetic with their new liver. So the liver is not the cause of diabetes. In general to fix type 2 you need to fix not only your diet and your weight but also your muscles and your insulin resistance and your cerebral sugar addiction. In my case I had to reverse 30 years of muscular degeneration caused by a high carb sedentary lifestyle! That does not happen overnight and there is no pill which gives you fitness. Neither can it be achieved by diet alone. As of August 2014 my BMI is now 23.5, which is still a little low given the amount of muscle I have put on from brisk treadmill walking and pull ups.
For mankind's latest understanding of "The Role of Skeletal Muscle Glycogen Breakdown for Regulation of Insulin Sensitivity by Exercise" published in Frontiers in Physiology in December 2011 - see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248697/
Here is what happened in Sami's and Joe's and Vikas' and my cases...
Prior to diagnosis. 2/3 bottles of lucozade per day, 3 cans of coca cola per day, 4/5 pieces of coffee shop cake, and a snickers bar every day!!
Diagnosis Day1 (2014June10): Spot sugar 13.9 mmol/l, HbA1c 10.6% (92 mmol/mol). He had been fully diabetic for 2 months, normal weight, sedentary high stress fast food high carb lifestyle (London minicab company owner and driver 32 years old). His doctor told him he must go on Metformin immediately. He declined. Height 5ft 8½ inches, 70 Kg. BMI 23.
Day2: He called me and I said walk for 20 minutes after every meal and stop eating sugar and carbs.
Day5 (2014June15): He came to see me after having partially followed my instructions - his spot sugar was now 10.3 mmol/l (185 mg/dl). I told him to get on the treadmill. He walked for 30 minutes at 5.6 kph. Then his sugar was 7.1 mmol/l (128mg/dl). This astonished me because if I walk for 30 mins at 5.6 kph my sugar will go down by 1.5 mmol/l not 3.2. So then I said to hell with it, let's finish this, and he walked another 30 minutes at 5.6 kph for the first half and at 5.8 kph for the second half. This took his sugar down to 4.9 mmol/l (88 mg/dl). That astonished both of us. We had got his sugar to normal in one day. I then told him he must walk for 30 minutes after every meal on the treadmill at his local gym and he must eat a very low carb diet, nothing with more than 10% carbs in it.
Day11: He followed some of my instructions and walked for 30 minutes after every meal on the pavement not on the treadmill. He was still eating porridge for breakfast. His sugar was normally around 6.2 when he got up and around 6.2 after each walk. I told him he must walk upon the treadmill not upon the pavement.
Day18: Having walked upon the treadmill as instructed although still eating some porridge and drinking fully caffeinated coffee and having the odd wholemeal bread starbucks sandwich his sugar was now around 5.5 mmol/l (99 mg/dl) in the morning and after every walk. So now his diabetic symptoms have gone and he is clinically non diabetic as of June29. We will carry on with this program for another week and see what happens next.
Day 30 (2014July15): Walking 30 minutes on the treadmill each day and a further 20 mins after dinner outside, for a total of 50 minutes per day, and eating a 100 carb gram per day diet (still eating porridge for breakfast - bad idea!) he now has a morning sugar of 5.2-5.5 mmol/L (94-99). So that is it. He is clinically cured and can maintain the cure on less than an hour's exercise per day with a 100 carb gram per day diet. He got there in 30 days.
Day 36 (2014July21): Starting a new regime for 4 weeks of walking 45 minutes on the treadmill once per day. Breakfast is porridge + milk in morning with a quarter of a grapefruit, and vegetable juice. Lunch Salmon or Sardines or Cod or Sea Bass + Salad, Green Tea or Mint Tea. Dinner: Peanut butter on low carb bread and salad and soup, or lamb chops and salad (kidney beans, cheese, cucumber, avocado, lettuce, cabbage, tomato, olive oil, vinegar), glass of semi skimmed milk. This is a weight maintaining diet.
Day 40 (2014July25): Regime is going fine. His morning sugar is still between 5.2 and 5.5 mmol/L (94-99 mg/dl) walking once for 45 minutes each day on the treadmill and taking a 100 carb gram per day diet.
Day 122 (2014October16). Sami had trouble with his feet ( I think the treadmill at his health club did not have good enough suspension). So his diet was OK but he has been unable for the last month to do much walking. Anyway his HbA1c results came in today and he was 40 mmol/mol or 5.8%. That is non diabetic. He is clinically cured. 5.8% is at the high end of the non diabetic range. 5.5% or below is the target in the writer's opinion. But anything at or below 6.0% is a clinical cure. So he is cured. He managed this by restricting carbs to 100 grams per day and by walking for 45 minutes per day on a treadmill for 3 months and could not manage any walking in the 4th month. He stopped exercising in the last 30 days due to pain in his feet. So there you are, a second type2 cure in 4 months with a limited amount of carb burning exercise and a low carb but not an ultra low carb diet. So it can be done relatively effortlessly if you catch type2 early enough.
His doctor (having recommended drugs and even insulin) was amazed and asked him how he did it. He said low carb diet and exercise.
Joe had a fasting sugar of 9.0 in January 2014 and an HbA1c of 7.4%. He was mildly diabetic on diagnosis. He weighed 82 kg at the time. He made a decision to adopt the 5:2 intermittent fasting diet of Doctor Moseley, rather than a full Newcastle reversal scheme of Prof Taylor. He combined the diet with low carb and with HIT training every day. The results are a text book example of how to reverse diabetes.
Low Carb (50-60 grams per day)
4 days of 12-15 min HIT per week
3 days of 40 minute weight lifting sessions per week
5:2 Intermittent fasting diet.
Plenty of Low Carb Australian Beer!
|Date||Fasting Sugar mmol/L||Weight Kg||Blood Pressure mm hg|
|Week5||5.6||76||131 (sick - no HIT)|
WOW! - Gordon. Joe only had mild diabetes. But he killed it completely with HIT, Low Carb and 5:2 fasting and Australian low carb beer in 9 weeks! (I have seen copies of his lab results). He used a Low Carb HIT 5:2 Newcastle reversal. Or putting it another way, he used a Carb Zero 5:2 Newcastle reversal. Very effective - so long as you are 18% above normal BMI to begin with.
There is absolutely no drug that can do that!
I recommend moderate intensity exercise (brisk walking upon a treadmill). But Joe's results indicate that high intensity works just as well (as do the results of Mark Quade - see Testimonials). So at the end of the day you just have to burn off the carb grams that you eat it appears - one way or another (with moderate or high intensity exercise).
Vikas has the most astonishing story that I could hardly believe before I saw his lab results.
Vikas was diagnosed on 15th Jan 2015. He was continuously so tired that he
could not even walk 100 meters. His fasting sugar was 200 mg/dl and his post
prandial sugar was typically 265 mg/dl. His HbA1c was 10.4%. His Vitamin D was
only 12 (should be between 50 and 90). His doctor instructed him to start taking
insulin immediately and he refused. Instead he took 3 diabetes tablets daily (Voglibose,
Metformin and Gemer P1 - which is a combination of Pioglitazone, Glimepiride and
Then he read this website and decided to go for it. His regime was 1 hour of brisk walking every day in hard sunlight after lunch and a 1 hour intensive workout in the gym along with the 3 tablets and a hell of a lot of Vitamin D (around 9,000 IU per day!) Then after a mere 10 days on this regime his HbA1c came down to 8.7%. He continued this regime for a further 20 days and on 15th Feb his HbA1c was 5.1%, his fasting sugar was 96 mg/dl and his post prandial sugar was 103 mg/dl. His doctor then reduced his diabetic medication to one tablet. So if this is to be believed then he reduced his HbA1c from 10.4% to 5.1% in 30 days. The reason that I have included Vikas' figures on the home page of this site is that first of all he sent me all 3 of his blood test results for Jan15, Jan26 and Feb15, and secondly I have now realised that HbA1c is not a 3 month blood sugar average, but is actually a 4 week blood sugar average weighted toward the most recent 2 weeks. This is very well explained on the American Diabetes Association website at...
"Hb = hemoglobin, the compound in the red blood cells that transports oxygen. Hemoglobin occurs in several variants; the one which composes about 90% of the total is known as hemoglobin A. A1c is a specific subtype of hemoglobin A. The 1 is actually a subscript to the A, and the c is a subscript to the 1. "Hemoglobin" is also spelled "haemoglobin", depending on your geographic allegiance.
Glucose binds slowly to hemoglobin A, forming the A1c subtype. The reverse reaction, or decomposition, proceeds relatively slowly, so any buildup persists for roughly 4 weeks. Because of the reverse reaction, the actual HbA1c level is strongly weighted toward the present. Some of the HbA1c is also removed when erythrocytes (red blood cells) are recycled after their normal lifetime of about 90-120 days. These factors combine so that the HbA1c level represents the average blood glucose level of approximately the past 4 weeks, strongly weighted toward the most recent 2 weeks. It is almost entirely insensitive to blood glucose levels more than 4 weeks previous.
In non-diabetic persons, the formation, decomposition and destruction of HbA1c reach a steady state with about 3.0% to 6.5% of the hemoglobin being the A1c subtype. Most diabetic individuals have a higher average bG level than non-diabetics, resulting in a higher HbA1c level. The actual HbA1c level can be used as an indicator of the average recent blood glucose level. This in turn indicates the possible level of glycation damage to tissues, and thus of diabetic complications, if continued for years."
With this new understanding of the true meaning of HbA1c, Vikas' figures are completely credible. So if you throw the kitchen sink at type 2. If you take the medication and if you go zero or negative carb by walking off all the carb grams you ingest and if you add some high intensity training 3x a week, then you may, like Vikas, be able to kill it dead in 30 days!
Do not do High Intensity Training on the same muscle group every day. Do it every other day at most or it becomes counter productive. The muscles need to recover and rebuild themselves during the day after each session.
I was diagnosed on November28, 2012, with a spot sugar of at 23 mmol/l (414 mg/dl), a fasting sugar of 18.0 mmol/L (324 mg/dl) and an HbA1c of 11.4% and BMI of 26.7. I had been extra thirsty for two years and had had neuralgia in the 4th toe of my right foot for 12 months - which I mistook for an in growing toenail. So I was very badly diabetic type 2. I had plenty of insulin but no glycogen storage space in my muscles and I had significant insulin resistance (internal sugarization - microvascular capillary atherosclerosis caused by AGEs - Advanced Glycation End products).
Here is a letter from my Doctor confirming my journey...
19 December 2013
Mr Gordon Ritchie
By Email: firstname.lastname@example.org
was a pleasure to catch up with you again the other day.
I thought the research you have performed in relation to diabetes and
muscle mass was very interesting. You
have successfully cured the diabetes which was identified in November 2012 by
a combination of diet and exercise. Originally
the random blood glucose was 18 with a haemoglobin A1c of 11.4% (101 mmol/mol).
You told me that you had also been found to be deficient in vitamin D
and had been taking a supplement, although at a relatively low dose by the
sounds of things.
am pleased to inform you that your haemoglobin A1c is now 5.3% (35 mmol/mol).
This is well within the normal limits.
Your lipid profile is favourable with regards to future risks of heart
disease with a total cholesterol of 3.9, 31% healthy HDL (absolute value 1.2),
leaving an LDL of 2.2. The only
fly in the ointment is the vitamin D level is still low at 36.
You know that you need to keep it up.
I think you need a significantly increased dose of vitamin D and would
suggest for a month that you take 2000 international units daily (available
over the counter) before reducing the dose back to 1000 international units
Christmas and happy New Year.
Nick Sawyer MBBS MRCP (UK) DFOM
reference number 2709985