Here at Diabetes NZ we get a lot of questions about whether T2D is reversible. Dietitian Helen Gibbs looks at the latest evidence.
When Prof Roy Taylor’s team at Newcastle University published its groundbreaking low-calorie diet study in 2011 and said it could reverse type 2 diabetes in some people, most experienced dietitian practitioners like myself pretty much said “Yep, tell us something we don’t know.”
Across years of practice, I have had a few patients who make a commitment to major lifestyle change immediately after or within a few years of their being diagnosed with type 2 diabetes. They lost weight, their blood glucose values came down and they could stop their medication.
The Newcastle University study, which put participants on an extreme low-calorie diet, was carried out in its Magnetic Resonance Imaging (MRI) Centre. Researchers wanted to see what happened to overweight people’s bodies when they lost weight. In particular they wanted to measure changes to the liver and pancreas.
The test subjects went on a meal replacement programme and shed weight. As well as being able to see fat loss on the MRI, it was also evident that diabetes was reversed in some patients – their HBA1c was less than 40 mmol/mol without taking any medications.
Like all good clinicians, the Newcastle researchers were careful about how they presented the results. But the study’s findings went viral and hundreds of people with diabetes contacted them to ask how they could follow the diet themselves. There is excellent information available about the diet and study for PWD on the Newcastle University website here.
Subsequent research across the world has confirmed the Newcastle study’s findings. So should clinicians, friends and family be encouraging people who are newly diagnosed with type 2 diabetes to try and make lifestyle changes that will result in weight loss of approximately 15kg?
This kind of weight loss will not cure everyone with type 2 diabetes and it is very important that people who have an unusual presentation of their diabetes discuss it with their GP or specialist before trying any kind of low-calorie diet, as weight loss will not reverse diabetes for late-onset type 1 diabetes, post-surgical or trauma diabetes or monogenic diabetes.
But for some people it does work, people’s blood sugar levels return to normal levels and they can come ff their diabetes medication. Experts are split over whether their diabetes is “reversed”, in “remission” or “cured”. Time and more research will answer this question.
Since the Newcastle University study was published, many low-calorie diet plans, books, blogs and diet programs have sprung up. One of the best known is Dr Michael Mosley’s 5:2 diet, which recommends intermittent fasting to lose weight.
This diet reversed the UK doctor’s own type 2 diabetes (for information about his new book, see p26 Diabetes Wellness Autumn 2019).
All low-calorie diet plans have one thing in common. The programmes aim for a weight loss of around 15kg. Good programmes then work with individuals on maintaining a better lifestyle to either continue with further weight loss or to maintain the new lower weight.
The data collected from the public after the initial Newcastle study showed something very important. It didn’t matter how you lost the weight, what mattered was that you did it. And those who could sustain the diet and exercise changes within their lifestyle kept the weight off and their T2D at bay.
The research also shows that the sooner you lose weight after your diagnosis the more likely you are to succeed. However even people making lifestyle changes 10-15 years post-diagnosis may get a reversal if the beta cells in their pancreas are still producing enough insulin.
Is it worth trying it? I believe so and offer this as one of my services in my private practice. However, I also advise people who eat for emotional reasons that they need to address that first before the weight loss, to avoid setting themselves up to fail on yet another programme.
Binge eating and emotional eating can be made worse by the restrictions placed on someone trying to attempt a diabetes reversal, so unpicking that problem first will help you manage your diabetes in the longer term.
Already slim people may not need to lose 15kg of weight – in some cases this would make them unhealthily underweight. However some adults with near normal body weight have significant amounts of fat in and around their liver and pancreas (apple-shaped body types). They may see an improvement in their blood glucose levels if they lose some weight. If you are in this category and want to try losing weight, ask your GP or diabetes nurse to set you an individual goal so your BMI doesn’t go below 21.
Anyone wanting to try diabetes reversal should consult with their diabetes team before starting. Not everyone will be successful but even if you don’t put your diabetes in remission, eating more healthily and being more active will improve your wellbeing, so making changes will have benefits for everyone who tries it.
I DID IT!
Fraser, 46, a freelance digital animator from Foxton Beach, north of Wellington, was diagnosed with type 2 diabetes a year ago and immediately jumped into a self-managed health improvement programme using diet and exercise (under his GP’s supervision). Fraser, who works from home, has lost an amazing 40kg over the past year.
At diagnosis Fraser was taking the diabetes medication metformin twice daily (his HbA1c was 61 mmol/mol), then as he lost weight, his GP reduced his medication to once a day. At 12 months Fraser’s HbA1c was 38 mmol/mol, which is in the normal range for blood sugar, and his doctor took him off metformin altogether.
“I wanted to share my story to show it’s possible to ‘beat’ diabetes. I’ve come to see getting diabetes as the most positive thing to ever happen to me and those around me.
“People ask if I still have diabetes. My take on it is that I am diabetic and always will be. I just get to manage my diabetes via diet and exercise. If I started eating and living like I used to, I would definitely get sick again.