Can a Very Low Calorie Diet Reverse Diabetes?
There is no magical way to reverse type 2 diabetes. But, a commitment to significant lifestyle changes that result in the shedding of excess weight can certainly work for some individuals, especially when obesity is the main driver of the diabetes. There has been a great deal of discussion about what is the “best dietary approach,” or “exercise approach” to reversing diabetes. A new small study** confirms that people who reverse their diabetes with significant weight loss using a very low calorie diet, and then commit to keeping the weight off, can reverse diabetes and keep it at bay indefinitely.** The research team also found that this approach works even in the face of entrenched Type 2 diabetes, in patients with a ten year history of the disease.
The study, published in the journal Diabetes Care, was helmed by Roy Taylor, Professor of Medicine and Metabolism at Newcastle University. The crux of the small study was that adequate weight loss can help to eliminate fat specifically from the pancreas, which is responsible for producing insulin. That seems to allow the pancreas to return to its normal function so that it produces and releases more normal levels of insulin. Professor Taylor published a previous study showing that a very low calorie diet could result in diabetes reversal. The study garnered interest but at the core of the discussion there still remained an important question – based on that study, would the diabetes remain in remission, long term? The investigation of this question formed the basis of this new study.
Revisiting a study with a new follow up component
Professor Taylor and his research team recruited 30 volunteers with Type 2 diabetes (duration six months to 23 years) and put them on the same very low calorie diet (VLCD) used by the previous study group. The diet allowed for 600-700 calories daily in the form of 3 shakes and they were also allowed measured portions of non-starchy vegetables. The patients lost, on average, 14 kilograms or about 30 pounds. Over the next six months the subjects maintained their weight loss by slowly introducing portion controlled amounts of regular food over two weeks and then an individualized diet for six months. The new maintenance plan contained a third less calories than the diets they had been following before the study. They were also seen once a month by the researchers. At the six month mark, 40 percent of the subjects remained diabetes free. Among the subjects, twelve of them had diabetes for less than ten years and they successfully reversed the diabetes. After the six months passed, one more subject had reversed his diabetes.
To be clear, despite the weight loss, the subjects still remained overweight or obese. But the amount of weight loss was sufficient to impact pancreatic function allowing for a reversal of the diabetes. It also appears that fat did not migrate back and deposit around or in the pancreas.
Specific study findings
Twelve subjects scored an HbA1c below 7 after the diet.
Those twelve subjects maintained the A1c scores after six months.
All the subjects lost similar amounts of weight on the very low calorie diets (VLCD).
The subjects with the best glucose levels post diet tended to be younger and had diabetes for shorter durations.
These “responders” as they were identified, seemed to have more viable beta cells (insulin producing cells).
Fatty content in both the liver and pancreas decreased in responders and non-responders (those who continued to have diabetes).
The study’s messageEven though the study was small and non-randomized, and yielded optimal results in only 40 percent of the subjects, it suggests that “under ideal conditions, if an individual loses sufficient weight, they can reverse diabetes (a metabolic disease) and maintain that reversal long term, even if they’ve been living with diabetes for many years. Findings also suggest that beta cells can be reinvigorated by weight loss in certain individuals**.** Certain subjects were eliminated before the study began after being identified as having almost completely absent insulin production. It was clear that function in those individuals would not be restored by weight loss. It’s also important to note that the study subjects were highly motivated and the study did not compare a VLCD to another dietary approach.
A follow up larger trial involving 280 subjects, funded by Diabetes UK, will determine if patients can reverse their Type 2 diabetes through weight loss efforts guided by their doctor and/or nurse health care providers.
Is a very low calorie diet (VLCD) right for you?
Very low calorie diets typically offer 600 – 1000 calories per day. Quite often the three meals are actually three shakes with very specific protein/fat/carbohydrate components. These diets are typically medically supervised ones used to help patients with morbid obesity or obesity (BMI greater than 30) to lose weight. There have been commercial or so-called trendy diets directed to consumers for the purpose of rapid weight loss. Unless medically supervised, these VLCD diets can be dangerous. Side effects of a VLCD can include bowel disturbances (constipation or diarrhea), fatigue, headaches, and gallstones.
How much weight loss is necessary to reverse Type 2 diabetes?
In this study, about thirty pounds of weight loss seemed to be the “tipping point” for the subjects, in terms of reversing diabetes. The weight loss amount needed to reverse Type 2 diabetes may vary from person to person.
Losing weight is often “the easy part,” but how do you keep it off?Not to be lost in the findings is the objective of weight maintenance, once there has been disease reversal, and weight maintenance is one of the hardest aspects to a successful lifestyle change program. Here are some tips to help prevent weight gain, once you have achieved significant weight loss and diabetes reversal:
Continue to weight yourself most days of the week
Continue to measure portions.
Continue to choose high quality foods and limit highly refined, processed foods.
Keep a food and exercise diary which can help to keep you on track.
Stay in touch with your doctor and any other healthcare professionals that can provide support.
Stick with your exercise program and make sure to sustain your levels of exercise.
Commit to a support group, exercise buddy group or any other team of supportive individuals.
Keep reviewing and validating the new habits that helped you to lose weight.
If you begin to slip, reach out to your health professional or support group immediately