Despite the growing evidence from different studies like Counterpoint (2011), Counterbalance (2016) and the Diabetes Remission Clinical Trial (DiRECT 2018) demonstrated that reversal of Type 2 Diabetes is possible, achieving reversal is not commonly encouraged by our healthcare system. In fact, reversal is not a goal in diabetes guidelines.
The traditional thinking of type 2 diabetes is as follows. Once you have it, you have it. You cannot cure it. You cannot reverse it. You can only manage it. Patients are often told that, you will have Type 2 Diabetes for life. It will get worse and then you’ll go blind or leg amputated. You will soon be on insulin, get used to it! The best you can hope for is to slow its progression through your diet, exercise, and oral medicine or insulin.
If you have to get worse, if you can’t avoid complications and premature death, then why struggle with your diet and managing your diabetes?
Actually, it is simply a BIG lie. Contrary to popular belief, the pancreas is not burnt out beyond repair. Perhaps the most widely accepted mechanism of remission is based upon Taylor’s ‘Twin Cycle’ hypothesis, which postulates that both hepatic insulin resistance and dysfunction rather than death of beta (β) cell determine diabetes onset. Several studies were carried out to test this hypothesis, and all demonstrated that chronic excess calorie intake and ectopic fat accumulation within the liver and pancreas are fundamental to the development of this disease. Once you unclog the fat, the pancreas starts to work again and insulin is secreted normally. Type 2 diabetes is both preventable and reversible, not chronic and progressive. It is not a life sentence. However, taking medications will not cure the disease. Rather than addressing the root cause, management guidelines for type 2 diabetes focus on reducing blood sugar levels through drug treatments. Diet and lifestyle are touched upon, but diabetes remission by cutting calories is rarely discussed.
In June 2019 DiRECT study data announced at the 79th annual Scientific Sessions of the ADA shows restoration of beta cell function is possible. The study proves that type 2 diabetes is a reversible disease and patients who once suffered may be able to regain their previous quality of life. In Jan 2021 the DiRECT study in the UK has demonstrated total remission of type 2 diabetes, including the withdrawal of glucose lowering medications, for periods of up to 3 years. The intervention involved an initial period of marked weight loss (typically around 15kg) induced by using very low-calorie formula diets.
Importantly, the primary care-based Diabetes Remission Clinical Trial (DiRECT) showed that 46% of people with type 2 diabetes could achieve remission at 12 months, and 36% at 24 months, mediated by weight loss. Provided weight regain is minimized, remission of type 2 diabetes is durable over 2 years, with a gradual increase to normal beta cell functional mass. This major change in our understanding of the underlying mechanisms of disease permits a reassessment of advice for people with type 2 diabetes.
A 2021 scotish study found that 7,710 of the study participants, or around 5%, were in remission from type 2 diabetes even without things like scientific interventions and invasive procedures such as bariatric surgery.
Diabetes reversal, not just treatment, should be a goal in the management of type 2 diabetes. In 2021 a large-scale review of clinical evidence led by researchers at UCL and Aston University concluded that, achieving ‘remission’ for people with type 2 diabetes through dietary approaches and weight loss should be the primary treatment goal of GPs and healthcare practitioners. Unfortunately, most of the actors in the health care system do not have financial incentives to get you healthy and keep you healthy. Profits are made through visits, prescriptions, and tests.
At least five approaches have claimed to reverse Type 2 diabetes in many people.
Bariatric surgery such as gastric bypass and gastric banding frequently puts Type 2 diabetes into remission. This means that the signs of diabetes disappear – often within days, before any significant weight is lost. Actually, this fact had been known since 1982. The 10 year follow up of a group of surgical patients had shown that many patients maintained normal blood sugars even off medications. The exact mechanisms by which bariatric surgery elicits these improvements to glycaemia are not completely understood, although energy restriction, vagal tone, gut hormones, bile acid metabolism and reprogramming intestinal glucose metabolism have all been implicated.
According to a new study presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2023 Annual Scientific Meeting, more than half of patients with diabetes and a history of metabolic surgery (51%) experienced remission of their diabetes even if they did not achieve significant weight loss after surgery. This study shows that diabetes remission is not fully contingent on weight loss after gastric bypass surgery.
Type 2 diabetes is a curable disease
Researchers from King’s College London say metabolic surgery can essentially “cure” patients with severe cases of type 2 diabetes. They found that 37.5 percent of patients having gastric bypass or biliopancreatic diversion surgery remained diabetes-free throughout a 10-year follow-up period. In 2009, the American Diabetes Association defined a “cure” as any treatment which causes diabetes remission for over five years. The findings from this study provide the most robust scientific evidence yet that full-blown type 2 diabetes is a curable disease, not inevitably progressive and irreversible
Extreme caloric restriction
A new study from Newcastle and Glasgow Universities shows that low-calorie diet caused remission in 90% of trial patients who lost 15kg or more, even those who had been diabetic for six years.
Remarkably, during the first 12 months of remission, the maximum functional beta‐cell mass returns completely to normal and remains so for at least 24 months, consistent with regain of insulin secretory function of beta cells which had dedifferentiated in the face of chronic nutrient oversupply. Remission is independent of BMI, underscoring the personal fat threshold concept that type 2 diabetes develops when an individual acquires more fat than can be individually tolerated even at a BMI which in the nonobese range.
Low Carb High Fat diet
The new study conducted by Virta Health shows dramatic improvements in type 2 diabetes with a model which relies on extremely low-carb diet – less than 30 grams of carbs per day – paired with a diet high in fat and moderate in protein. Many patients were even able to completely quit diabetes medications, suggesting that type 2 diabetes is highly reversible. Virta Health’s Treatment for Sustained Type 2 Diabetes Reversal Provides New Hope for Chronic Disease Patients. San Francisco-based Virta Health, the first company with a clinically proven treatment to safely and sustainably reverse type 2 diabetes (T2D) and other chronic metabolic diseases without the use of medications or surgery, has raised a $45 million series B funding round, bringing the total equity funding to $75 million to date.
One Duke University study followed 82 obese people with Type 2 diabetes who were assigned to either a very-low-carb or a low-calorie diet. After six months, the low-carb group had a lower average HbA1c level and had lost more weight than the low-calorie group, and 95% were able to reduce or totally eliminate their diabetes medicines.
Whole food plant-based diet
The Physicians Committee for Responsible Medicine [PCRM], has long contended a whole food plant-based diet can prevent, manage – and even reverse – type 2 diabetes. The American Diabetes Association has maintained that a plant-based eating pattern is an effective option for type 2 diabetes management in its 2018 Standards of Medical Care in Diabetes.
Raw Food Diet
A really interesting watch is the Raw for 30 documentary in which 6 people with a combination of type 1 and type 2 diabetes each joined a program to go raw for 30 days. Some members of the group were able to completely come off all diabetic medications and were effectively reversed diabetes.
According to Dietary strategies for remission of type 2 diabetes: A narrative review (July 2021), which looked at over 90 papers describing the effects of various diets on type 2 diabetes until 21 December 2020 found that, Meal-replacement diets ‘soup and shakes’ helped around one in three people successfully achieve remission, while low carbohydrate diets were able to help around one in five people achieve remission. Sustained remission was linked to the extent of sustained weight loss. Low calorie and Mediterranean diets were also able to help people achieve remission – but at much lower rates. Only around 5% of people on low-calorie diets stayed in remission after one year, while only 15% of people on a Mediterranean diet stayed in remission after a year.
In 2012, data from the Look AHEAD trial, which used a combination of meal replacements and an energy restricted, low-fat diet, showed in a post-hoc analysis that remission occurred in 11.5% of people at 12 months in the intensive lifestyle group (ILI), despite an impressive weight loss of 8.6%.
In 2014, participants following a low-carbohydrate Mediterranean diet resulted in a greater reduction of HbA1c levels, higher rate of diabetes remission, and delayed need for diabetes medication compared with a low-fat diet.
In 2020, data from Qatar (DIADEM-1) has demonstrated that a Total Diet Replacement (TDR) approach can be highly effective in achieving remission in a cohort of patients with a Middle Eastern and North African origin. 61% of participants achieved remission, whereas 33% achieved normoglycaemia [Hba1c < 5.7%].
Too good to be true?
The idea of reversing Type 2 diabetes is still considered somewhat extreme. Opposing voices raise several objections, such as there aren’t any large, well-controlled for an extended period studies on dietary approaches like those that exist for drugs. Type 2 diabetes it is not a death sentence. It starts with changing your belief about what’s possible. Whether you are on medication or insulin or just ignoring it hoping it will go away, you can make changes to improve your health.
The American College of Lifestyle Medicine has released an expert consensus statement in May 2022 to assist clinicians in achieving remission of type 2 diabetes in adults using diet as a primary intervention. The expert consensus statement is endorsed by the American Association of Clinical Endocrinology (AACE), supported by the Academy of Nutrition and Dietetics (AND) and co-sponsored by the Endocrine Society.
This unique publication in the American Journal of Lifestyle Medicine is the first to focus on diet as primary means of achieving lasting remission of diabetes – without medications or procedures – in contrast with the usual role of diet as an adjunctive therapy. Knowing that diet alone can achieve remission is an empowering message for many adults with type 2 diabetes, especially when supported by consensus among internists, cardiologists, family physicians, endocrinologists, nutritionists, dieticians and lifestyle medicine specialists.
The current standard of care may be suitable for some, but others would surely choose reversal if they understood there was a choice. The choice can only be offered if providers are not only aware that reversal is possible but have the education needed to review these options in a patient-centric discussion.
Zen Healthcare is just one example of a health care provider that believes type 2 diabetes is reversible and has data to back that up. It was born out of the passionate desire and commitment to make Nepal a Diabetes Free Zone.
We have a unique opportunity to define the standard of care for chronic disease treatment and go from ‘care’ to ‘cure.
Would you like to be a part of our Diabetes Free Nepal campaign and contribute to make Nepal a proud nation?