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.
But the question we’re going to look at today is the following:
Can Type 2 Diabetes be reversed?
- Wait, surely it’s not that simple.
- Well, no, there’s a lot to clarify.
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?
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).
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.
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.
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.
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.
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).
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.
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: FAT–loss.
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
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.
There are many strategies to achieve this: perform intermittent fasts, increase protein intake, use some GLP-1 analogues (Saxenda, Ozempic, Trulicity).
There are drugs recommended for diabetic patients, called Glyphozines, which cause a urinary loss of glucose.
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?
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:
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.
Increasing Proteins and Fats
But we don’t live on carbohydrates alone.
A window of opportunity is opened to other hormonal satiety signals derived from PROTEIN and FAT, such as Cholecystokinin, GLP1 and YY peptide.
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.
- T2D is a serious issue.
- But it’s possible to reverse, though not forever.
- To reverse it, lose fat. 15 kg will get a remission of 80%.
- To maintain the remission, keep the weight lost and opt for a low-carb diet, individualised and adapted to each to your situation.
- Training in general and strength training in particular is essential to maintain that remission.
- Magkos, F., Hjorth, M. F., & Astrup, A. (2020). Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nature Reviews Endocrinology.
- 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.