Many experts believe Type 2 diabetes is an incurable disease that gets worse with time. But new research raises the tantalizing possibility that drastic changes in diet could reverse the disease in some people.
Recently, a small clinical trial in England studied the effects of a strict liquid diet on 30 people who had lived with Type 2 diabetes for years. Nearly half of those studied went into a remission that lasted six months after the diet was over.
"This is a radical change in our understanding of Type 2 diabetes," said Dr. Roy Taylor, a professor at Newcastle University in England and the study's senior author. "If we can get across the message that 'Yes, this is a reversible disease -- that you will have no more diabetes medications, no more sitting in doctors' rooms, no more excess health charges' -- that is enormously motivating."
It is not the first time that people have reversed Type 2 diabetes by losing a lot of weight shortly after a diagnosis. Studies have also shown that obese people who have bariatric surgery can see the condition vanish even before they lose very much weight.
But the new study, published March 21 in Diabetes Care, showed that the reversal caused by a temporary diet can persist for at least half a year as long as patients keep weight off, and can occur in people who have had the disease for many years.
The researchers followed the participants after they had completed an eight-week, low-calorie-shake diet and then returned to normal eating. Six months later, those who had gone into remission immediately after the diet were still diabetes-free. Though most of those who reversed the disease had been diabetic for less than four years, some had been diabetic for more than eight years.
When Allan Tutty, 57, learned five years ago that he had Type 2 diabetes, he asked health care providers if there was a cure. "It was a case of, 'Look, you've got it, deal with it. There's no cure,'" said Tutty, who manages a home for people with brain injuries in Newcastle.
Later, Tutty spotted a notice recruiting volunteers for a diabetes study that asked, "Would you like the opportunity to reverse your condition?"
Tutty said he jumped at the chance, becoming one of 30 men and women ages 25 to 80 to sign up. Tutty was one of 13 participants whose fasting plasma glucose dropped, and during the six-month follow-up remained below the 7 millimoles per liter (or 126 milligrams per deciliter) that define diabetes.
Although Tutty completed the study nearly three years ago, his fasting blood sugars continue to be in the healthy range, he said.
Type 2 diabetes develops when the body cannot use insulin properly or make enough insulin, so the body cannot properly use or store glucose (a form of sugar) and sugar backs up into the bloodstream, raising blood sugar levels. In the United States, 8.9 percent of adults 20 and older have been found to have diabetes, and health officials estimate that an additional 3.5 percent have undiagnosed diabetes.
Although no one knows exactly why the diet appeared to reverse diabetes, Taylor said it might be related to how the body stores fat. Excess fat in the liver can spill into the pancreas, inhibiting insulin secretion and the liver's response to insulin, resulting in insulin resistance and diabetes.
He suggested that going on a very low-calorie diet allows the body to use up fat from the liver, causing fat levels to drop in the pancreas as well. That "wakes up" the insulin-producing cells in the pancreas, normalizing blood glucose levels.
DURABLE CHANGE?
While some earlier studies have shown that blood sugars can normalize after significant weight loss, endocrinologists said they were impressed by the persistence of the lower blood sugar levels for months after the diet.
"Decreasing caloric intake for any reason brings with it a rapid improvement in glucose control," said Dr. Robert Lash, the chairman of the Endocrine Society's clinical affairs committee and a professor of internal medicine at the University of Michigan. "What's exciting here is that the improvements in glucose control persisted when the participants went back to eating a diet with a normal number of calories."
Questions remain about how long the effect will last and whether it can work for the typical patient with diabetes.
Dr. George King, the chief scientific officer at Joslin Diabetes Center and a professor at Harvard Medical School, said that even short-term remission would reduce or put off some of the serious complications associated with diabetes, such as nerve damage, kidney damage, loss of vision, heart attacks and strokes.
Rapid weight loss can be hazardous. The participants in the Newcastle trial, who ranged from overweight to extremely obese, were under supervision when they stopped their diabetes medications and started a 600- to 700-calorie-a-day regimen of three diet shakes at mealtimes and half a pound of nonstarchy vegetables a day.
Tutty, who weighed about 213 pounds before the trial, lost a little more than 30 pounds, the average weight loss in the trial. The people in the study most likely to respond to the treatment were in their early 50s on average and younger than the nonresponders, and they had had diabetes for fewer years. They had been taking fewer medications than nonresponders, had lower fasting glucose and hemoglobin A1c levels (a measure of diabetes control) before the trial, and had higher baseline serum insulin levels.
The big challenge for dieters was returning to normal eating.
"They would describe going back to the kitchen and almost having a panic attack," Taylor said. "We used that as an opportunity to instill new habits, and were very directive about how much to cook and how much to eat."
FAT THRESHOLD?
A news release from Newcastle University quoted Taylor as saying, "This supports our theory of a Personal Fat Threshold. If a person gains more weight than they personally can tolerate, then diabetes is triggered, but if they then lose that amount of weight then they go back to normal.
"Individuals vary in how much weight they can carry without it seeming to affect their metabolism -- don't forget that 70 percent of severely obese people do not have diabetes. The bottom line is that if a person really wants to get rid of their Type 2 diabetes, they can lose weight, keep it off and return to normal.
"This is good news for people who are very motivated to get rid of their diabetes. But it is too early to regard this as suitable for everyone."
A larger trial involving 280 patients is underway.
Celia Storey added information to this report.
ActiveStyle on 04/25/2016