Once diagnosed with diabetes, we are disheartened by the fear of being stuck with a deadly disease for lifetime. Diabetes is a serious disease since it is the stepping stone to coronary heart disease (number one killer) and it is a final broadcast of the metabolic errors silently perpetuating in the body over a period of time.
However, those with type 2 diabetes can find some respite in the evidence suggesting role of substantial fat loss in normalizing blood sugar levels.
One of the main derangements in Type 2 diabetes is compromised insulin action and recognition. Unlike type 1 diabetes where insulin production is absent/insufficient, among type 2 patients the existing insulin is not being able to do its job well due to fat acting as a barrier. SO, technically if the fat barrier is removed, it opens the gates for insulin to enter and start its work. “Type 2 diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intra-organ fat” (Taylor 2013)
Evidence across different population groups show remission (temporary reversal) of diabetes with intensive and committed dietary changes. The common thread between all interventions has been loss of body weight to the tune of 10-15% of the total body weight achieved by means of severe calorie restriction.
For e.g. Assuming you weigh 110 kgs and have been detected with diabetes, losing just about 11-16.5 kgs can bring you closer to normalcy .
Keep a tab on that fat
Fatty tissue is like fast spreading fungus that begins with stomach and extends to the liver impairing its function. Gradually, the fat from liver spills onto the pancreas which are the main insulin producing glands. The fat forms a layer on the pancreas like a fuzzy coat the prevents it from releasing insulin freely into the body. The constant expanding barrier of fat means that insulin function will be impaired leading to higher sugar levels in blood! We do know that insulin has to sit at the gate ( cell surface) to open them for entry of glucose.
How does weight loss help!
Weight reduction corresponds with a reduction in the fat mass, especially that sitting at your waistline. Lower weight means reduced demands on existing insulin and improved efficiency of work with only optimal fat tissues.
Creating an energy deficit by consuming lesser calories will force the body to use the stored fat as a fuel (ketosis). Utilization of this fat means gradual clearing up of the fatty layer from all vital organs allowing them to function adequately.
The American Diabetes Association divide remission into three levels:
- Partial remission: blood sugar levels are elevated, but remain below diabetic levels for at least a year without medication.
- Complete remission: blood sugar levels remain at a normal range for at least a year without medication.
- Prolonged remission: when someone has been in complete remission for 5 or more years.
Evidence from Research!
30 Individuals with type 2 diabetes for 6 months to 23 years were put on a very low calorie diet (700-800 calories per day) for 8 weeks.
During the first eight weeks of the study, the volunteers consumed three diet shakes per day, along with about 240 grams of non-starchy vegetables, for a total of about 600 to 700 calories daily. After eight weeks, regular solid food was introduced at weight-maintaining levels of roughly 1,600 to 2,000 calories per day, or roughly one-third less than the participants had been eating before the study. The volunteers were also seen once a month for six months and provided with an individualized weight maintenance program.
On average, the participants lost 14 kilograms, and did not regain any weight during the 6 month study period. Achieving this levels of weight loss may not put the individual into normal weight category but despite being overweight or obese, 12 of the participants who had been diagnosed with Type 2 diabetes within the last 10 years reversed their condition and remained diabetes-free six months later. At the end of the study, 87% of the people with diabetes less than four years successfully reversed their diabetes as did 50% of the people with type 2 diabetes for more than eight years.
Take home message
- Retaining normal blood glucose requires sustained commitment to weight maintenance. Regaining weight means regaining the troublesome fat tissue.
- Long standing diabetes with poor control makes reversal difficult but not impossible
- Claim prolonged remission of diabetes if blood glucose has been normal for 5 years or more!