Reversing Type 2 Diabetes

Reversing Type 2 Diabetes

Is it possible to reverse Type 2 diabetes? We tell you all the factors involved, and give you an answer.

There are more than 450 million patients with Type 2 Diabetes (now T2D) worldwide, and it’s estimated that by 2045 there will be more than 700 million.

Think about what a single diagnosis of T2D means in terms of medical treatments, quality of life, time in hospitals, risk of other pathologies, etc.

  • Now multiply that by 700 million
  • This is the pandemic we’re facing.
  • Along with obesity, it’s become a number one public health problem.
Let’s say that, without exaggerating, if I were asked about what the 5 great global threats in the next 50 years are, without blinking I would say that at least one of them is T2D. We already discussed this in this link, that Diabetes was the Disease of the 21st century.

Type 2 diabetes

But the question we’re going to look at today is the following:

Can Type 2 Diabetes be reversed?

  • Yes.
  • Wait, surely it’s not that simple.
  • Well, no, there’s a lot to clarify.
It turns out that this is something we’ve known for quite some time: T2D is reversible, but little or nothing is said about it within the media or the medical field in general.

We want to stress that type 2 diabetes is a chronic and progressive disease, but (fortunately) this is not always the case.

Losing weight, an obligation

Weight loss (of fat) helps T2D remission in a DEPENDENT DOSE.

What does that mean?

That the more weight lost, the greater the chances of success, this being understood as a way to stop being type 2 diabetic.

A loss of 15kg leads to remission in 80% of patients with obesity and T2D. This isn’t just me saying that, it’s in a wonderful review from the Nature Reviews Endocrinology, published very recently (Magkos et al., 2020).

Lose weight

That is, out of 100 obese and type 2 diabetic patients, 80 will stop being obese if they lose 15 kg and maintain that loss.

The first part is difficult, but the second part is even more difficult: it’s where most health professionals fail, and if we don’t recognise this point, the failure will be even greater.

Can it be reversed forever?

This is another question we must ask ourselves, the answer to which is no.

Perhaps this is why most professionals remain on the side of caution when generalising about the ‘reversibility’ of type 2 diabetes.

Sadly, not all patients get the desired remission. In fact, the vast majority do not.

Factors

There are factors that make such a reversal more likely, and others that make it unlikely.

Some factors that keep you from being a type 2 diabetic

The duration of T2D

The more years you’ve been a diabetic, the harder it is to stop.

The pathophysiological alterations in diabetes accumulate over the years and there comes a time when reversing them is practically impossible.

Basal glycemia and control of T2D at diagnosis

There are degrees and degrees of control of diabetes. A more uncontrolled diabetes will be more difficult to reverse.

The degree of overweight, obesity and insulin resistance

In line with the previous point, an obese person with a BMI of 46, who is also diabetic, will have a much more difficult time with remission than an obese person with a BMI of 33, for example.

Foods

Looking after the diet is essential.

What does it mean to reverse T2D?

What do we call diabetes reversal?

We doctors like to agree when we talk about something, so that we’re all talking about the same thing.

We consider a type 2 diabetes to be reversed when the patient in question no longer meets diagnostic criteria for T2D.

In this case, for simplicity, we’ll look at the A1C.

This is a reductionism, because T2D causes many physiopathological alterations on top of an elevation of the Hb A1C (Glycosylated Hemoglobin).

I’m talking about lipotoxicity, increased ROS, increased chronic inflammation, insulin resistance, etc.

In this way:

  • If your Hb A1C is greater than 6.5: you meet the diagnostic criteria for T2D
  • If your Hb A1C is between 5.7-6.5: you meet the diagnostic criteria for PREDIABETES
  • If your Hb A1C is <5.7: all OK

Following this premise, imagine a patient who starts out with an Hb A1C of 8% and through treatment (several oral antidiabetics), a correct diet and physical exercise, ends up with an Hb A1C of 5.3% and many kilos less.

We could say, that at least at that given time, that the patient does not meet diagnostic criteria for T2D and therefore has reversed their diabetes.

In other words (although we find it hard to say): They are metabolically healthy!

Physical activity

Physical exercise is one factor in reversing type 2 diabetes.

How to reverse Type 2 Diabetes?

I wish we had a universal recipe, but that’s not the case.

If we had to sum it up in two words, it would be: FATloss.

So what should be done then? An energy deficit.

How to create an energy deficit

With some of the following ways:

Reducing total calorie intake

The traditional “diet”: always eat less

Strenght training

Strength training is essential.

Reducing energy absorption

Over the years, drugs such as the famous Orlistat have come to light, which reduces the absorption of fat in the digestive tract.

The side effects of these drugs usually smell pretty bad.

Reducing appetite

There are many strategies to achieve this: perform intermittent fasts, increase protein intake, use some GLP-1 analogues (Saxenda, Ozempic, Trulicity).

Energy loss

There are drugs recommended for diabetic patients, called Glyphozines, which cause a urinary loss of glucose.

Diabetic athlete

That energy, wasted, helps to generate the desired calorie deficit.

Increasing total daily energy expenditure and Improving Metabolism

  • Exercise, in general.
  • Strength training, in particular.

Is Losing Weight enough to reverse T2D?

Good question.

In the intervention study LOOK AHEAD, the participants, although they maintained over 10 years an important weight loss with respect to the basal weight, had an increase of the A1C and therefore many became T2D.

This tells us that there are other weight-independent lifestyle factors that condition the recurrence of T2D once it has subsided:

Figure

The moral would be this: weight is not the only condition at play in the group without diabetes.

So, what other factors are at play?

Reducing Carbs to Stay Free of Type 2 Diabetes?

A carbohydrate-restricted diet (whether moderate, low or ketogenic) is an alternative for those who

  • Are T2D and want to stop being so;
  • Want to minimise their risk of T2D while healthy;
  • Have been able to reverse T2D and they want to prevent a recurrence.

Benefits of reducing carbohydrates

Exchanging carbohydrates for protein and fat, even when we talk about isocaloric exchanges, produces

  • Lower postprandial (after meal) blood glucose.
  • Less insulinemia.
  • Lower blood sugar on fasts.
  • Less A1C.
  • Smaller appetite.

What happens with hunger?

Now let’s stop briefly at the last point: smaller appetite.

Obesity and T2D are related to lower intracerebral response to hyperglycaemia, that is, when we elevate blood glucose, there is no proportional elevation in the CNS level due to, probably, insulin resistance at that level

This is problematic because this intracerebral increase in glucose signals satiety to the carbohydrates.

This means that a T2D is much less satiated by carbohydrates.

Increasing Proteins and Fats

But we don’t live on carbohydrates alone.

Low carb

A window of opportunity is opened to other hormonal satiety signals derived from PROTEIN and FAT, such as Cholecystokinin, GLP1 and YY peptide.

This is why when you switch to a low carb diet many of you feel less hungry. In I tell you everything you need to know about this kind of diet.

Support: Intermittent Fasting

IF, by improving insulin resistance, also improves this situation and decreases long-term hunger.

You get your fill with less food.

This results in easier maintenance of weight loss and initial metabolic improvements.

Therefore, effectively, a (higher or lower) carbohydrate restriction could be a useful strategy to maintain sufficient metabolic health to avoid becoming a type 2 diabetic again once you are no longer a diabetic.

Conclusions

  1. T2D is a serious issue.
  2. But it’s possible to reverse, though not forever.
  3. To reverse it, lose fat. 15 kg will get a remission of 80%.
  4. To maintain the remission, keep the weight lost and opt for a low-carb diet, individualised and adapted to each to your situation.
  5. Training in general and strength training in particular is essential to maintain that remission.

Bibliography

  1. Magkos, F., Hjorth, M. F., & Astrup, A. (2020). Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nature Reviews Endocrinology.

Related Entries

  • We’ve talked about Intermittent Fasting, but if you want to find out more about it I recommend you read this article.
  • Turmeric is a natural remedy for Diabetes. Get to know it by clicking here.
  • Amongst others Herbs can provide Natural Remedies for Diabetes. You’ll find a list of them here.
Review of Type 2 Diabetes

How to reverse Type 2 Diabetes - 100%

Losing weight - 100%

Maintaining good habits - 100%

Conclusions - 100%

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About Borja Bandera
Borja Bandera
Borja Bandera is a young doctor who focuses on nutrition, exercise and metabolism, he combines his professional activity with his vocational dissemination and research.
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