Wednesday, February 11, 2015

The Nutrition Debate #287: Can Type 2 Diabetes Be Reversed?

The Nutrition Debate #88: “Reversal of Type 2 Diabetes,” has proved, to my surprise, to be a very popular post on this blog; it has had over 6,000 page views. Let me be clear: I do not believe that type 2 diabetes can be “reversed,” and so I can understand that someone reading that post (#88) might have felt misled by me. That was not my intention. Nor was I consciously intending to glom readers by attracting them to an appealing prospect through a headline. I was simple reporting on a paper in a peer-reviewed British medical journal that had precisely that title; that’s why my blog title was in quotes.
The paper was interesting. Its “AIMS/HYPOTHESIS is that “Type 2 diabetes is regarded as inevitably progressive, with irreversible beta cell failure. The hypothesis was tested that both beta cell failure and insulin resistance can be reversed by dietary restriction of energy intake.” Okay, it’s a hypothesis. Its aim is to challenge an assumed truth – one that virtually all medical practitioners espouse – that type 2 diabetes is “inevitably progressive.” And they propose to do it by “dietary restriction of energy intake” alone. To be clear, they mean fewer calories, not fewer carbohydrates. Interesting, huh?
The hypothesis apparently sprang from the observation that “normal glucose metabolism is restored within days after bariatric surgery in the majority of people with type 2 diabetes.”  “There is now no doubt,” they concluded and report in their Counterpoint Study, “that this reversal of diabetes depends upon the sudden and profound decrease in food intake, and does not relate to any direct surgical effect.” To be clear: That’s food (total energy) intake, not carbohydrates.
The CONCLUSION/INTERPRETATION of this study was only a little less assertive than their hypothesis: “Normalization of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone. This was associated with decreased pancreatic and liver triacylglycerol stores. The abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake.” Okay, they hedge a bit. They say “the abnormalities underlying type 2 diabetes are reversible…” But they still use the word “reversible.” That’s pretty strong, but they are scientists and provide the quantitative data to support their findings: pancreatic and liver fat cells (triglycerides).
My inveterate editor discovered a follow-up study that was done by the same researchers, and I reported on in The Nutrition Debate #89, “‘Reversal of Type 2 Diabetes' Revisited.” Unfortunately, it glommed only 367 page views, but in it the authors reported on “individuals (who) began to feed back their personal experiences of attempting to reverse their diabetes.”  CONCLUSION: “These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal should be a goal in the management of Type 2 diabetes.”
This and other work by these intrepid researchers earned them the high privilege of presenting “The 2012 Banting Memorial Lecture: Reversing the twin cycles of Type 2 diabetes” (full text link here). So, they are clearly not crackpots. They are scientists looking for answers to why and how the “underlying abnormalities” of type 2 diabetes are “reversed.” From my perspective, they have demonstrated to their medical peers that their work was at the very least “interesting.”
The paper based on the Banting Lecture that was published in Diabetes, the organ of the American Diabetes Association. The abstract concludes: It is now clear that Type 2 diabetes is a reversible condition of intra-organ fat excess to which some people are more susceptible than others.” But they’re talking about “pancreatic and liver triglycerides.” My readers are not particularly interested in their pancreatic and liver triglycerides. They don’t even care that much about their serum triglycerides (although The Nutrition Debate #197: “Triglycerides and Alcohol Consumption,” logs over 1,500 hits). People with Type 2 Diabetes want to know how to “eradicate” the damn disease. Ideally with just a pill!!!
My readers are also interested in what they can do, if anything, to avoid being “more susceptible.” And if they were “more susceptible,” if there is anything they can then do to “reverse” the “condition” to which they have succumbed. My conclusion is that if you are among those who are susceptible, and have succumbed to the condition in the sense that you are diagnosed diabetic or pre-diabetic, and you are sincere about mitigating the risk of diabetic complications (both micro and macro vascular), there is a course of action you can take, and it is stated in the CONCLUSION of the overlooked post #89, to wit:
 “These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal should be a goal in the management of Type 2 diabetes.” And in my book the best way to lose weight is to eat Low Carb, not cans of Optifast, the 47% carb liquid diet formula used in this study.


  1. I consider Roy Taylor's work to be basically weak science and unethically reported by the author. There have been lots of criticism of his work, but primarily I claim his severe calorie restricted diet is in fact a VLCD, so which did he show that calorie restriction or carb restriction works? We don't know. Second, I consider him irresponsible for suggesting that diabetes is reverse. He didn't show anything about reversal. I think it was a poor choice for a Banting award. No wonder we have totally stupid stuff like the US Diabetes Prevention Program which claims that people get diabetes because they are fat and lazy and that the solution is to eat a low fat calorie restricted diet.

    1. Good morning, Brian. I was afraid a perceptive reader like yourself would catch the fact that a low calorie diet is also by definition a low carb diet, all things being equal (with the same macronutrient proportions). And that someone might quibble about the word "reversal."

      I agree, of course, with the quibble, which is why I wrote this piece. And while I don't like -- In fact, vehemently disagree with use of the word in this context -- it is fair to say that Type 2 diabetes can be put into remission, again for the vast majority of people (yourself, as we know, excepted).

      I have just written #293, to be published in a few weeks, about a new venture that Eric Westman is involved in. In it he says, "However, it is certain that following HEAL's Low-Carb Protocol will put almost every person with Type 2 diabetes into remission." Would you agree that that is a fair statement?

  2. It would be a big help if doctors just understood the benefits that a patient can gain with a low carb diet, and give their patients something tangible to work for. But most are given the "progressively worse" lecture and told they can be happy if they keep their A1Cs in the 6s. So that's what they try for, and true to the prediction, they get progressively worse.

  3. It's depressing, I agree. And it's hard to explain. I try again in #292 coming up in a couple of weeks, and provide a hopeful alternative in #293, but we're swimming against the tide and the wind and the current. Of course, the news that the 2015 Guidelines will probably drop the limitation on dietary cholesterol, which I write about in #295 to be published a week later, is good news. I do think the Titanic is turning, and there's a fleet of smaller ships (and dinghies like this blog) plying a different course, so...hang in there..