Can I reverse type 2 diabetes with food?

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.

Inflammation and the foods that fuel or squelch it

We hear so much about inflammation in the news today, from anti-inflammatory diets to diseases of inflammation, that the term can seem too broad to grasp. For most of us, we want practical solutions on how our diet and lifestyle can best impact the inflammation in our bodies. Here is an easy review to give you some ideas about how you can modify your meals to lower chronic inflammation and improve your health and wellbeing.

What is inflammation?

Inflammation is the body’s first line of defense of the innate immune system. (3) It is a normal and beneficial reaction by our bodies to clear threatening pathogens and begin the healing process from blunt trauma, foreign microbes, and toxic chemicals. (1, 2) There are two forms of inflammation – acute and chronic – and they each have very different purposes and outcomes.

Acute inflammation

Acute inflammation is short-term and it protects and heals the body following injury or infection. Symptoms include heat, redness, pain and swelling. This is due to the immune system’s response at the site of injury to widen blood vessels, increase blood flow, release antibodies and flood the area with white blood cells to fight invaders and infection. (4)

Neutrophils are the first white blood cells to arrive and they release reactive oxygen species (ROS) which kill the invading microorganisms, but also kill healthy human cells. (4) In addition, they release antimicrobial amino acids and pro-inflammatory cytokines, such as interleukin 1, interleukin 6 (IL-1, IL-6), tumor necrosis factor (TNF-α), and interferon. (5, 6) These cytokines cause the liver to produce C-reactive protein (CRP) and other proteins which start the systemic inflammatory response, leading to a fever and an increase in white blood cells. (6) This cascade of events continues until the invaders are removed and the injury is healed.

However, when acute inflammation continues for prolonged periods of time it becomes chronic. Chronic inflammation can be dangerous as it is associated with many diseases.

Chronic inflammation

In chronic inflammation, the primary white blood cells that are involved are monocytes and macrophages. Monocytes help to fight infection and macrophages absorb foreign invaders and wastes. (7) They also release chemicals, including IL-1, TNF-α, and prostaglandins, that continue the pro-inflammatory response. Later T and B cells arrive. T cells kill the body’s own cells that have been infected and B cells produce antibodies targeting the foreign invaders. (5) Macrophages and other white blood cells release ROS and proteases which kill the invaders but also damage the body’s own cells. (10)

Chronic inflammation symptoms

Symptoms of chronic inflammation can be more difficult to notice. They include:

  • abdominal pain
  • chest pain
  • fatigue
  • fever
  • joint pain
  • mouth sores
  • skin rash

Causes of chronic inflammation

The most common causes of chronic inflammation include:

  • autoimmune disorders
  • chronic stress
  • excessive alcohol consumption
  • excessive/insufficient exercise
  • obesity
  • smoking
  • toxins
  • untreated acute inflammation (8)

Inflammatory diseases

Chronic inflammation is involved in the disease processes of many conditions, including:

  • Alzheimer’s disease
  • arthritis
  • asthma
  • atherosclerosis
  • bursitis
  • cancer
  • celiac disease
  • crohn’s disease
  • depression
  • diverticulitis
  • gingivitis
  • heart disease
  • inflammatory bowel disease
  • obesity
  • type 2 diabetes

Labs that indicate inflammation

Common clinical indicators for inflammation include elevated blood CRP and homocysteine. Other indicators include a high erythrocyte sedimentation rate, a high white blood cell count, and a low albumin level, though these tests are not as accurate as they can indicate other non-inflammatory conditions. (4)

Inflammatory foods

Foods that are high-glycemic, meaning that they rapidly cause our blood sugar to rise, are inflammatory. (4, 11) Typical high-glycemic foods include sugar-sweetened drinks, sweets, and pasta/cereal/bread made with refined flours as opposed to whole grains. (Pro Tip: always look for the first word in the ingredients list of these products to be “whole”)

Anti-inflammatory foods

Polyphenols are anti-inflammatory and they are found in plant-based foods. They are broken down into four groups:

  • lignans – flaxseeds, cashews, etc.
  • stilbenes – grapes, berries, peanuts, etc.
  • phenolic acids – orange, lemon, thyme, pepper, cocoa, basil, etc.
  • flavonoids – parsley, oregano, turmeric, green/black tea, elderberry, chickpeas, etc. The more well-known flavonoids are anthocyanins and isoflavonoids. Anthocyanins are found in fruits and vegetables with red, blue and purple pigments. Isoflavonoids are found in soybeans.

Omega-3 & Omega-6 fatty acids. Several different omega-3s exist, but the majority of scientific research focuses on alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). (4) Sources for ALA include flaxseeds and walnuts. EPA and DHA are found in oily fish such as salmon and sardines.

The reason it’s important to lower inflammation by boosting one’s omega-3s, is to lower the ratio of omega-6 to omega-3 fatty acids, which is roughly 15:1 in the U.S. It is estimated that humans evolved on a diet with an omega-6 to omega-3 fatty acid ratio of 1:1. (4) Therefore, we would benefit by lowering consumption of omega-6 fatty acids, which are found in vegetable oils used in processed snacks such as chips, desserts and fast foods.

Fruits and Vegetables have been inversely associated with CRP levels and other biomarkers of inflammation. (4) Specifically choose those with vibrant, bright colors – focus on eating the rainbow.

Carotenoid levels of α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein, and zeaxanthin have been inversely associated with circulating levels of CRP, thus they are anti-inflammatory. (4) Sources of carotenoids include carrots, sweet potatoes, winter squash, tomatoes, watermelon, citrus, dark green leafy vegetables, cruciferous vegetables, salmon and eggs.

Arginine. Higher intakes of arginine are also associated with lower levels of CRP. (4) Common sources of arginine are nuts, seeds, beans, peas, turkey and beef.

Alpha-lipoic acid. Supplementation with 300 mg/day of alpha-lipoic acid was found to result in a decline in blood levels of interleukin-6 which is an inflammatory biomarker. (4) Food sources of alpha-lipoic acid include spinach and organ meats, such as cow liver, heart and kidney.

Exercise. Physical activity decreases inflammation, as measured by reductions in CRP and pro-inflammatory cytokines. (4) However, too much of a good thing can cause problems as excessive exercise can increase systemic inflammation, therefore, moderate exercise is best.

Conclusion

With an abundance of options to lower your chronic inflammation – from colorful fruits and vegetables like berries and spinach to tasty spices like basil and pepper and drinks that include green and black tea, as well as dark chocolate and salmon – it should be easy to incorporate more anti-inflammatory goodness into your life so you can improve how you feel.

Consider adding more colorful foods into your meals, and your mealtimes will not only be healthier, but they’ll also be tastier and more pleasing to the eye. After all, we consume a meal not only through our mouths, but also with our sight.

To your heath!

Jessica Mollet, RDN, LDN

References

  1. Nair, A., Thankachen, R., Raj, J. and Gopi, S., 2022. Inflammation, symptoms, benefits, reaction, and biochemistry.
  2. Cause of inflammation in diabetes identified. (n.d.). ScienceDaily. Retrieved February 8, 2022, from https://www.sciencedaily.com/releases/2016/11/161102080309.htm‌
  3. Aristizábal, B., & González, Á. (2013). Innate immune system. In http://www.ncbi.nlm.nih.gov. El Rosario University Press. https://www.ncbi.nlm.nih.gov/books/NBK459455/‌
  4. Inflammation. (2016, November 7). Inflammation. Linus Pauling Institute. https://lpi.oregonstate.edu/mic/health-disease/inflammation‌
  5. Scott A, Khan KM, Roberts CR, Cook JL, Duronio V: What do we mean by the term “inflammation”? A contemporary basic science update for sports medicine. Br J Sports Med 2004; 38(3): 372-80.
  6. Feghali CA, Wright TM: Cytokines in acute and chronic inflammation. Front Biosci 1997; 2: d12-26.
  7. Differentiated cells and the maintenance of tissues. In: Alberts B, Bray D, Lewis J, et al., eds. Molecular biology of the cell, 3rd ed. New York: Garland Publishing, Inc.; 1139-1193.
  8. Inflammation: What Is It, Causes, Symptoms & Treatment. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/21660-inflammation‌
  9. Cory, H., Passarelli, S., Szeto, J., Tamez, M., & Mattei, J. (2018). The Role of Polyphenols in Human Health and Food Systems: A Mini-Review. Frontiers in Nutrition, 5(87). https://doi.org/10.3389/fnut.2018.00087
  10. Bian XW, Chen JH, Jiang XF, Bai JS, Wang QL, Zhang X: Angiogenesis as an immunopharmacologic target in inflammation and cancer. Int Immunopharmacol 2004; 4(12): 1537-47.
  11. Esposito K, Nappo F, Marfella R, et al.: Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation 2002; 106(16): 2067-72.

Feed Your Microbiome

You’ve undoubtedly heard of the microbiome – whether from ads selling particular products to information surrounding the dangers of over-prescribing antibiotics. But maybe what you don’t know is how essential the microbiome is to our overall health and wellbeing and why we should be considering it as we select what’s best for us to consume.

For starters, the microbiome is made up of 50 TRILLION microbes and is essentially a large ecosystem that lives in your gut – the 33 foot long tube that goes from your mouth to your anus. (1) In fact, we are outnumbered 10-to-1 by the cells of the microbes in our gut! It’s no wonder the microbiome plays such a central role in our lives.

We evolved for millions of years in a reciprocal relationship with these bacteria. Who we are to-date is the best example of what evolution has created to withstand our current environment and circumstances. It’s that important. So it should be no surprise that our microbiome affects our:

  • digestion
  • hormone balance
  • immune function
  • insulin resistance
  • metabolism
  • mood, and
  • our genes! (2)

Consider your microbiome as a ecosystem, and we can either support a healthy ecosystem that looks like a lush green garden, or one that looks like a battlefield, wrecking inflammation within our whole system.

What creates the microbiome as battlefield? For starters – junk food, some medications like PPIs (Nexium, Prilosec), NSAIDS (Ibuprofen, Aspirin) and antibiotics. And non-organic animal products that come from animals that have been treated with antibiotics. (2)

On the other hand, a healthy lush microbiome is diverse and this is cultivated through a varied consumption of fiber and omega-3s. Studies show the importance of eating 30+ different plants per week to sustain this diverse microbiome. (1)

Some of the best sources of foods that we can eat to feed, populate and diversify our good bacteria are:

  • fermented foods
  • fruit
  • greens
  • legumes (most powerful for gut-healing)
  • mushrooms
  • omega-3s (flaxseed, chia, salmon, sardines) (4)
  • onions/garlic
  • sulforaphane (most concentrated form is in broccoli sprouts) (2)
  • whole grains

When eating these foods, we are not only feeding our good bacteria within our microbiome with the fiber they require, but we are also repopulating them with the good bacteria living on these foods. More recent research shows that eating these foods are even more effective in repopulating a diverse microbiome than is the ingestion of a singular probiotic. (3)

In case you needed inspiration for you and your family to incorporate more plants into your meals, here you go. You’re welcome :-).

Feed your microbiome.

References

  1. “American Gut Overview.” Americangut.Org, americangut.org/american-gut-overview/. Accessed 5 Aug. 2020.
  2. Bulsiewicz, B., 2020. Fiber Fueled. 1st ed. Avery.
  3. Suez J, Zmora N, Zilberman-Schapira G, et al. Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT. Cell. 2018;174(6):1406-1423.e16. doi:10.1016/j.cell.2018.08.047
  4. Menni C, Zierer J, Pallister T, et al. Omega-3 fatty acids correlate with gut microbiome diversity and production of N-carbamylglutamate in middle aged and elderly women. Sci Rep. 2017;7(1):11079. Published 2017 Sep 11. doi:10.1038/s41598-017-10382-2

Introduction and fasting

Welcome to my blog where I will explore the intersection of nutrition and health – both physical and mental. I am fascinated by how this living organism we inhabit is impacted by all that we digest – and not just dietary, mind you (which is why I have enjoyed teaching Yoga and exploring various spiritual traditions). But for this blog I’ll be dealing mostly with nutrition. In my quest to explore all aspects of human nutrition, I am constantly reading research and listening to podcasts from the greatest minds dedicated to nutrition research. I’ll be sharing this with you and parsing the differing views around nutrition as the science is young and ever – evolving.

With science in general, it’s best to always acknowledge that the data is “based on what we know right now” because thankfully science is ongoing and ever-expanding. This acknowledgement allows for, and even expects, changes in our understanding as new data is discoverered and published.

So can I jump right in with a favorite topic?

Time-restricted feeding, a.k.a, fasting

Time-restricted feeding (some may call it fasting) means narrowing the window in which you eat. For instance, within a 24-hour period, it’s choosing 8 hours within that window to consume your calories.

Say you begin your first meal at 10 am. That would mean that you would need to finish your last meal by 6.

Just so you know, this gets easier to do over time. Some people start out with a 12-hour window. Then slowly taper to a 10 or 8-hour window.

If you are dealing with obesity or diabetes (and there’s even some research on the merits of fasting for cancer), you will want to shorten the feeding time period to 6 or 8 hours. But don’t start there. Start with 12 hours and slowly bring yourself down.

Please also be aware that many do better with a dietary feeding window that ends by 5 or 6 pm. This is especially true for those with diabetes and obesity.

There’s so much on this exciting topic so please see the links below on recent research on time-restricted eating. It is certainly exciting that we can greatly impact our health just by the timing of our meals.