Research into diet and stopping the symptoms of type 2 diabetes are still in their infancy, but there are some interesting developments, writes Clair Naughton.

‘Reversing’ type 2 diabetes is something that is discussed regularly in magazines and on television with stories of people being ‘cured’ of diabetes. On closer inspection, all these stories have a common thread; the people who have reversed their diabetes have done so by losing large amounts of body weight, often the equivalent of 10-15% of their total body weight.

It is generally accepted as true that with massive weight loss, a person can potentially reduce the demands on their body so much that they now acquire sufficient working insulin to control their glucose levels.

Visceral fat and type 2 diabetes
When fat stores build up in the liver the fat eventually extends over into the pancreas (the organ in the body that makes insulin). The build up of fat in the pancreas over time prevents the pancreas releasing insulin after meals, thereby causing high blood glucose levels and type 2 diabetes.

Professor Roy Taylor of Newcastle University in England has been carrying out research in the area of reversing type 2 diabetes for the past few years. He suggests that too much fat in the liver, the pancreas and around the abdomen preventing normal insulin release and normal insulin action are defects that can be reversed by substantial weight loss.

Professor Taylor’s research focused on radical weight loss by means of a very low calorie diet (<800 calories) in a bid to reverse type 2 diabetes. The idea being that when the body isn’t taking in enough calories in food, fat that is stored in the wrong part of the body (in the pancreas and liver) is used up first for energy. Removal of fat from the pancreas can potentially allow insulin release to return to normal.

We all individually have a “personal fat threshold”

Professor Taylor suggests that individuals can tolerate different levels of fat in their liver and pancreas. He calls this their personal fat threshold. When a person has more fat than they can cope with (they exceed their personal fat threshold), he says they develop type 2 diabetes.

Not all obese people get type 2

One person can be obese and not develop type 2 diabetes while another can be considered normal weight for their height and have type 2 diabetes. One of the reasons for this may be because they may have different personal fat thresholds. This is particularly the case in people of Asian ethnicity who have a higher incidence of type 2 diabetes.

The results of the latest of Professor Taylor’s research study into the reversal of type 2 diabetes were published on 6th November :

Diabetes UK has announced a breakthrough today, in using a low-calorie diet to put Type 2 diabetes into remission in some people. The DIRECT trial (Diabetes Remission Clinical Trial) has reached the end of its first year and 45.6% of those who followed a low-calorie diet, under the supervision of a GP, have put their Type 2 diabetes into remission.

Weight loss was a key factor. 86% of people who lost more than 15kg on the programme were in remission after a year, as were 57% of people who lost 10 to 15kg, and 34% who lost 5 to 10kg. The low-calorie diet of 800 calories a day for 8 to 20 weeks, is made up of four soups or shakes. These have all the essential vitamins and minerals. This period is followed by a long-term programme of weight loss maintenance. Read the full Diabetes UK announcement here http://bit.ly/2fiDdy5.

Remission is defined as blood glucose (or blood sugar) levels returning to the normal range. Diabetes UK added “This doesn’t mean diabetes has gone for good. It’s still really important for people in remission to get regular healthcare checks, so any complications can be monitored and any signs of Type 2 diabetes coming back can be caught early”.

Background

Diabetes UK awarded £2.5 million to Newcastle University (Professor Roy Taylor) and University of Glasgow (Professor Mike Lean) to find out if an intensive low-calorie, diet-based, weight management programme can put Type 2 diabetes into remission, and keep it there. And to test if this can be delivered entirely within the NHS. Read more here http://bit.ly/2fiDdy5.

More work yet to do

These are the initial results of the trial, work is ongoing. Participants of the study will need to be followed up long term to determine how long the remission of Type 2 diabetes lasts for and to gain a deeper understanding of the long-term implications of the study. Not everyone with Type 2 diabetes will benefit as not everyone with Type 2 diabetes is overweight, other factors are how long someone has diabetes, and a person’s ethnicity.

Don’t go it alone

Following a low-calorie diet to put Type 2 Diabetes into remission is not a quick fix, it is very challenging and it is not recommended to try this alone. Anyone with Type 2 diabetes considering losing weight in this way needs to discuss it with their GP and dietitian to get tailored advice and support. If a person is taking medications that has a risk of low blood glucose levels (hypos), sulphonylureas or insulin they will need to consult with their GP as their medications will need to be adjusted as the weight loss continues. It would also be necessary to monitor the blood glucose levels more closely at home and keep a watchful eye for hypos.

Participants of the study needed the ongoing support and advice of experts to gradually re-introduce normal food into their diet and get support to help them maintain their weight loss long term.

The possibility of reversing diabetes relates specifically to type 2 diabetes. One should not embark on a very low calorie diet without medical supervision. With any weight loss programme, diabetes medication may need to be reviewed especially if the medication puts the person at risk of low blood glucose levels (hypos).

Diet and exercise advice
Meanwhile, if you have type 2 diabetes, your nutritional needs are the same as everyone else – no special foods or complicated diets are needed. The key to eating well with diabetes is eating regular meals, watching your serving size and following a healthy eating plan that is low in refined sugars and fat. This means:
• Choosing lower fat options when eating meat, poultry, dairy products and spreads
• Enjoying a good variety of fresh fruit and vegetables
• Getting most of your energy from unrefined and whole grain starches, for example, potatoes and wholegrain bread and cereals
• Keeping high sugar and high fat foods as treats only.
You need more than 40 different nutrients for good health and no single food supplies them all. Eating a wide variety of foods is the key to ensuring that you get all the nutrients you need.

Exercise is also important to help maintain a healthy weight and for weight loss. The recommendation for everyone if you have diabetes or not is to do 30 minutes of moderate activity five days a week, but if you need to lose weight this should be increased to 60-90 minutes a day. When exercising moderately, we should:
• Be a little short of breath but not gasping
• Sweat a little, but not profusely
• Have an increased heart rate, with it beating faster than normal.
Pick enjoyable activities, for example, walking or dancing. If you currently don’t exercise, start slowly and build up your level of activity slowly. If you are concerned about any potential health problems prior to exercising discuss it with your GP.

Plan exercise and encourage a friend or family member to exercise with you. Planning your exercise ahead of time works well. Think of your exercise as an important appointment that cannot be missed.

Clair Naughton is a Diabetes Nurse Specialist and Diabetes Ireland, Regional Development Officer, North West