The concept of reversal or remission of type 2 diabetes is increasingly gaining strength within the scientific community. (10) It was first noted in the 1980s, due to the outcomes of bariatric surgery, which found that obese individuals with type 2 diabetes frequently achieved normalized blood glucose levels shortly following their procedure. (6) The major determinant of achieving normal blood glucose regulation was correlated with the degree of achieved weight loss. Researchers also noted that a greater degree of weight loss was required for longer duration type 2 diabetes, than was for shorter duration diabetes. (13)
This led researchers to consider how different diets may impact type 2 diabetes. What became clear in the few larger scale studies was the correlation between weight-loss and blood sugar normalization. We’ll go over a few of these studies, but first a little background information on type 2 diabetes.
Type 2 diabetes
In the U.S., 10.5% of the population has diabetes – roughly 95% of which is type 2 diabetes. An additional 34.5% of adults have prediabetes, 90% of which is undiagnosed. (1) Thus, nearly half of the U.S. population is dealing with blood sugar imbalances related to type 2 diabetes.
Type 2 diabetes symptoms
Since almost all who are prediabetic are undiagnosed, it’s important to know the signs and symptoms so you can be proactive. (2) These include:
- blurred vision
- dry skin
- fatigue
- frequent infections
- increased hunger
- increased thirst
- increased urination
- numbness or tingling of hands or feet
- slow healing sores
- unexplained weight loss
Why high blood sugar is bad
Type 2 diabetes can lead to many health problems such as: (3)
- eye disease
- foot problems
- gum disease
- heart disease
- incontinence
- kidney disease
- nerve damage
- sexual problems
- stroke
Type 2 diabetes tests (2)
- A1C – measures your average blood sugar over 2 – 3 months. Normal = less than 5.7%.
- Fasting blood sugar – measures your blood sugar after an overnight fast. Normal = less than 100 mg/dL.
- Glucose tolerance test – measures your blood sugar after an overnight fast, then 1, 2 and possibly 3 hours after drinking a glucose liquid. Normal = less than 140 mg/dL at 2 hours.
Can I reverse type 2 diabetes with diet?
The terms ‘reversal’ and ‘remission’ of type 2 diabetes are found in the scientific literature. However, recent consensus supports the use of ‘remission’ in reference to type 2 diabetes (11) and the term ‘cure’ is not used as there is the potential for a re-occurrence. (4)
Remission is generally acknowledged as an A1C below 6.5% for an extended period of time, without the use of anti-diabetes medications. (12)
- A review of the scientific and medical literature found that weight loss of 15+ % of body weight had a disease-modifying affect on type 2 diabetes – “…an outcome that is not attainable by any other glucose-lowering intervention.” (7) The authors of the review concluded that “… many patients with type 2 diabetes would benefit from having a primary weight-centric approach to diabetes treatment.”
- Another literature search involving 99 scientific articles found that diabetes remission is achievable by two different diets, in addition to the aforementioned bariatric surgery. The two diets are either low-calorie or low carbohydrate diets. Bariatric surgery had the greatest impact on blood sugar, with the low-carbohydrate diet coming in next, followed closely by a low-calorie diet. (4)
- A clinical study involving 306 individuals found that a primary-care led weight management program led to remission of type 2 diabetes. All of the participants had been diagnosed with type 2 diabetes in the past 6 years and had a BMI of 24 – 45. The intervention consisted of a total diet replacement formula for 12 – 20 weeks (825 – 853 kcal/day), followed by a gradual food reintroduction (2 – 8 weeks), and then structured support for weight-loss maintenance. One year in, 46% of the intervention participants had achieved remission of diabetes. Two years in, 36% remained in remission. In an analysis of all participants, out of those who maintained at least a 10 kg weight loss, 64% achieved remission. (5, 8)
- In a prospective cohort study involving 867 people with newly diagnosed type 2 diabetes, remission was achieved in 30% at the 5-year period. Again, weight loss played a big part in their blood glucose normalization. Those who lost ≥ 10% of their weight in the first year after diagnosis had a significantly higher likelihood of remission. In fact, weight loss of ≥10% early on in their diagnosis was associated with a doubling of the likelihood of remission at 5 years. The researchers found that a very low‐calorie diet (624 – 700 kcal/day) for 8 weeks was associated with remission in 87% for those recently diagnosed with diabetes (<4 years) and in 50% of people with long-standing disease (>8 years). (9)
With nearly half of the U.S population dealing with diabetes and it’s negative impacts – both financially and on their quality of life – it’s essential to continue to study the longer-term feasibility of specific diets that achieve remission of type 2 diabetes. Current research shows a correlation with remission and weight-loss from a low-carbohydrate diet or a low-calorie diet. Though exercise was not covered in this piece, certainly it assists with weight-loss and maintenance and thus is an important part of the solution. Hopefully this information helps individuals dealing with type 2 diabetes to feel more in control of their health and offers some doable dietary solutions.
References
1. Diabetes Research Institute. “Diabetes Statistics.” Diabetesresearch.org, 2017, http://www.diabetesresearch.org/diabetes-statistics.
2. Centers for Disease Control and Prevention. “Type 2 Diabetes.” CDC, 30 May 2019, http://www.cdc.gov/diabetes/basics/type2.html.
3. Basu, Rita. “Type 2 Diabetes | NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases, 19 Apr. 2019, http://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes.
4. Hallberg, Sarah J, et al. “Reversing Type 2 Diabetes: A Narrative Review of the Evidence.” Nutrients, vol. 11, no. 4, 1 Apr. 2019, p. 766, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/, 10.3390/nu11040766.
5. Taylor, Roy, et al. “Understanding the Mechanisms of Reversal of Type 2 Diabetes.” The Lancet Diabetes & Endocrinology, vol. 7, no. 9, Sept. 2019, pp. 726–736, http://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30076-2/fulltext, 10.1016/s2213-8587(19)30076-2.
6. W J Pories, K G MacDonald, Jr, E J Morgan, M K Sinha, G L Dohm, M S Swanson, H A Barakat, P G Khazanie, N Leggett-Frazier, S D Long, Kevin F O’Brien, Jose F Caro, Surgical treatment of obesity and its effect on diabetes: 10-y follow-up, The American Journal of Clinical Nutrition, Volume 55, Issue 2, February 1992, Pages 582S–585S, https://doi.org/10.1093/ajcn/55.2.582s
7. Lingvay, Ildiko, et al. “Obesity Management as a Primary Treatment Goal for Type 2 Diabetes: Time to Reframe the Conversation.” The Lancet, 30 Sept. 2021, http://www.sciencedirect.com/science/article/pii/S014067362101919X#bib11, 10.1016/S0140-6736(21)01919-X. Accessed 30 Dec. 2021.
8. Lean, Michael E J, et al. “Durability of a Primary Care-Led Weight-Management Intervention for Remission of Type 2 Diabetes: 2-Year Results of the DiRECT Open-Label, Cluster-Randomised Trial.” The Lancet Diabetes & Endocrinology, vol. 7, no. 5, May 2019, pp. 344–355, http://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30068-3/fulltext, 10.1016/s2213-8587(19)30068-3.
9. Dambha‐Miller, H., et al. “Behaviour Change, Weight Loss and Remission of Type 2 Diabetes: A Community‐Based Prospective Cohort Study.” Diabetic Medicine, vol. 37, no. 4, 26 Sept. 2019, onlinelibrary.wiley.com/doi/full/10.1111/dme.14122, 10.1111/dme.14122.
10. Kalra, Sanjay, et al. “Quantifying Remission Probability in Type 2 Diabetes Mellitus.” Clinics and Practice, vol. 11, no. 4, 9 Nov. 2021, pp. 850–859, 10.3390/clinpract11040100. Accessed 25 Nov. 2021.
11. Kalra, Sanjay, et al. “What’s in a Name? Redefining Type 2 Diabetes Remission.” Diabetes Therapy, 24 Jan. 2021, 10.1007/s13300-020-00990-z.
12. Hallberg, Sarah J, et al. “Reversing Type 2 Diabetes: A Narrative Review of the Evidence.” Nutrients, vol. 11, no. 4, 1 Apr. 2019, p. 766, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/, 10.3390/nu11040766.
13. Steven, S., et al. “Reversal of Type 2 Diabetes after Bariatric Surgery Is Determined by the Degree of Achieved Weight Loss in Both Short- and Long-Duration Diabetes.” Diabetic Medicine, vol. 32, no. 1, 12 Sept. 2014, pp. 47–53, 10.1111/dme.12567.
Jessica Mollet, RDN, LDN 