Saturday, November 30, 2019

Retrospective #287: “Can Type 2 Diabetes Be Reversed?”

The Nutrition Debate #88,” Reversal of Type 2 Diabetes,” proved to be a very popular post; it has had over 8,200 page- views. But let me be clear: I do not believe that Type 2 diabetes can be “cured,” and so I can understand if someone reading that post (#88) might have felt misled. That was not my intention. Nor was I consciously intending to glom readers by attracting them with “click bait” to an appealing prospect through a headline. I was simply 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 very interesting. Its AIMS/HYPOTHESIS was 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 believe – that Type 2 diabetes is “inevitably progressive.” And they tested it by “dietary restriction of energy intake” alone. To be clear, they did it with fewer calories, NOT fewer carbohydrates.
The hypothesis 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.” Again, 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 data to support their findings: normalization of pancreatic and liver fat cells (triglycerides).
My inveterate editor discovered a follow-up study done by the same researchers, and I reported on in The Nutrition Debate #89, “’Reversal of Type 2 Diabetes’ Revisited.” Unfortunately, it glommed only 725-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 researchers earned them the high privilege of presenting the ADA’s “The 2012 Banting Memorial Lecture: Reversing the twin cycles of Type 2 diabetes.”  So, they are clearly not fringe researchers. They are scientists looking for answers to why and how the “underlying abnormalities” of Type 2 diabetes are “reversed.” From my perspective, they have certainly demonstrated to their medical peers that their work deserves a much closer look.
A paper based on the Banting Lecture was published in Diabetes, the American Diabetes Association’s magazine. 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. People with Type 2 Diabetes want to know how to “eradicate” the damn disease. Ideally with just a pill, and definitely without bariatric surgery!
My readers are also interested in what they can do, if anything, to avoid being “more susceptible.” Well, there is a course of action you can take, and it is stated in the CONCLUSION of the overlooked post, Retrospective #89:
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.”
In my book the best way to lose weight is to eat Low Carb, not 3 cans of Optifast (510kcal), the 46.4% carb liquid diet formula used in this study. Very Low Carb is 5% carb, Low Carb 15% carb and even Moderate Low Carb is 25% carb.

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