Friday, June 24, 2011

Type 2 Diabetes "Reversible"

I don't know what kind of press this study will get. It was small, just 11 people, and it was published in a non-US journal. The research was conducted in the UK (although the findings are being presented at the ADA conference in San Diego this weekend). I hope it gets media attention, because it drives home a useful point, that a life with diabetes after a diagnosis isn't a foregone conclusion:

Reversal Of Type 2 Diabetes: Normalisation Of Beta Cell Function In Association With Decreased Pancreas And Liver Triacylglycerol, Diabetologia, June 9, 2011

Studies have been showing that people with type 2 diabetes who undergo gastric bypass surgeries can - within a matter of days - stop being diabetic. Was it some hormone? Some change in concentration of branched-chain amino acids? Maybe it was just the weight loss, because it is known that weight loss - no matter how it's achieved - can reduce markers of diabetes and can reduce or eliminate need for diabetes meds.

This study supports a weight loss hypothesis, or more specifically, a fat-loss hypothesis. After one week of consuming about 600 calories a day, all 11 participants (7 men, 2 women) essentially reversed their diabetes. (Participants didn't get gastric bypass. They changed only their diet.)

After 1 week, fasting blood glucose decreased from 166 to 106 mg/dl (and stayed there, so most of the benefit was from 1 week of dieting).

After 8 weeks:
  • Average weight loss was 34 lbs (229 to 195 lbs).
  • Average loss around the waist was 5.2 inches (42.3 to 37.1 inches).
  • HbA1c dropped from 7.4% to 6.0%
  • Triglycerides in the pancreas dropped from 8% to 6%
  • Triglycerides in the liver dropped from 13% to 3%.
Conclusion: "The abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake."

Curiously, insulin sensitivity throughout the body did not improve, just the liver became less insulin resistant.

The authors say their study shows that "excess lipid accumulation in the liver and pancreas" is responsible for type 2 diabetes, that is, for abnormal insulin secretion and insulin resistance.

Participants consumed a 510-calorie liquid diet (Optifast: 46.4% carb, 32.5% protein, 20.1% fat) with an additional 90 calories from non-starchy vegetables. They drank 2 liters of water a day. They weren't any more active than before the study.

Note: This was a proof-of-concept study, not dietary advice. Any very low calorie diet (or low-carb ketogenic diet) really ought to be monitored by a professional. These diets result in higher levels of blood ketones which are acidic and require buffering or else blood pH drops ... a dangerous scenario.


Unknown said...

I'd like to see a study with over-weight diabetics that didn't get gastric bypass following the same diet. Would they reverse their type 2 diabetes within days too?

Laurie Endicott Thomas said...

The fact that type 2 diabetes is reversible if people eat less and exercise more has been obvious since at least the 1870s. By the 1930s, researchers knew that they could induce a significant degree of insulin resistance in healthy volunteers by feeding them a high-fat diet for only a week.

Bix said...

Shreela, my fault, these folks didn't get gastric bypass. I'll make that more clear.

Bix said...

This is interesting...

From Laurie's link:

Insulin Deficiency And Insulin Inefficiency, British Medical Journal, 1940

"The sole dietetic factor influencing glucose tolerance in healthy people is the absolute amount of carbohydrate in the diet. Increase of dietary carbohydrate improves the glucose tolerance, decrease of carbohydrate impairs it (Himsworth, 1935)."

"..and it was similarly found that the sole dietetic factor influencing insulin sensitivity is the absolute amount of carbohydrate in the diet (Himsworth, 1935)."

Himsworth says the absolute amount, not the relative amount.

Claudia said...

I know someone with diabetes I'd like to send this to but he'd say life isn't worth living without his donuts and Micky D's.

Sara said...

I wonder if they would still spike after a bunch of donuts or a soda.