How To Reverse Diabetes.
For most people with type 2 diabetes, reversal to normal blood glucose levels is possible.
In the US, over 45% of the population has either diabetes or pre-diabetes1.
The absolute majority of those with diabetes have type 2 diabetes, which is usually associated with excess visceral fat and poor cardiometabolic health.
This is not good.
Why?
Because a diagnosis of diabetes is very likely to shorten your life.
A diagnosis of type 2 diabetes at age 30 can result in a 14 to 16-year shorter lifespan2.
Many of these cases of diabetes are both avoidable and reversible if they do occur.
Type 1 diabetes is not reversible or avoidable.
However, reversal of type 2 diabetes is possible but most likely to occur within a few years of diagnosis.
This is why if you have been diagnosed with diabetes or prediabetes, acting early is crucial.
Type 2 diabetes is typically the terminus of years of pre-existing insulin resistance.
Insulin resistance generally progresses to metabolic syndrome, pre-diabetes and then diabetes.
Everyone is somewhere on the continuum of insulin sensitivity from very insulin sensitive to very insulin resistant, i.e. Type 2 diabetes.
The goal is to stay in the insulin-sensitive range for as long as possible throughout life, and if you do move up the scale of insulin resistance, you need to do what is necessary to move back down.
But how do you reverse diabetes?
Let’s look at the data.
Pre-Diabetes.
Of the 45% of the US population with diabetes or pre-diabetes, two-thirds of this figure is made up of those with pre-diabetes.
There are several programs designed to reverse pre-diabetes, but the most well-known is the DPP or Diabetes Prevention Program3.
The DPP is a year-long program involving multiple group coaching sessions that focuses primarily on improving:
Nutrition
Exercise
Stress Management.
This program has been rolled out worldwide and is free in many countries.
At three years, there was a 60% reduction in the probability of developing diabetes4.
Even a 5% weight reduction can reverse pre-diabetes in many patients.
But weight reduction alone may not be enough.
In those who reversed their pre-diabetes using nutrition strategies alone, there was no significant change in the risk of death at three years.
However, for those who used both nutrition AND exercise as their strategy, the risk of death from any cause fell by 28%5.
As the line goes:
“You can’t outrun a bad diet, and you can’t out diet not exercising.”
Diabetes.
The greatest risk for a shortened life expectancy and early onset of diseases arises when you move from pre-diabetes to diabetes.
A diagnosis of diabetes pulls forward the time you are likely to develop cardiovascular disease by a whopping ten years6.
If our goal is to delay the time of onset of cardiovascular disease as late as possible in life, avoiding or reversing diabetes has to be a primary goal.
How To Reverse Diabetes.
Several trials have evaluated different approaches to reversing diabetes, but they all focus on reducing excess fat, particularly excess visceral fat that resides in the major organs such as the liver and pancreas.
The DiRECT Trial used a calorie-restricted diet over 3-5 months and also withdrew diabetic and blood pressure control medications.
Importantly, the people in this trial had diabetes for less than six years and were not already on injectable insulin. All of these patients had a BMI >27.
At one year, 46% of the intervention group had reversed their diabetes7.
The more weight people lost, the greater the likelihood of diabetes reversal.
Losing 5% of body weight reversed diabetes in only 7% of patients, but for those able to lose more than 15% of their body weight, diabetes was reversed in 86% of cases.
But what about those with a relatively normal weight?
Type 2 diabetes is much more common in those with a BMI in the overweight or obese category but is not uncommon in those who are relatively normal weight.
Does weight loss work in these cases?
The ReTune Study used the same approach as the DiRECT trial with a calorie-restricted diet over 3 to 5 months and a 10% reduction in bodyweight reversed diabetes in 66% of patients8.
But why did this work if patients were not ‘overweight’?
The answer is they were, but just not by conventional BMI standards.
These patients likely had higher amounts of visceral fat but less additional subcutaneous fat.
This is known as the ‘Personal Fat Threshold’, where a person has limited subcutaneous fat stores, and when this is full, the majority of excess fat is stored as visceral fat, which drives up the risk of insulin resistance and diabetes.
This also means some individuals are ‘obese’ as per BMI criteria but currently carry little excess risk of diabetes because most of their fat stores are in subcutaneous and not visceral fat.
But What Diet Should I Use To Lose The Weight?
Low Carb? Keto? Paleo? Vegan? Low Fat? Carnivore?
Answer: Low Calorie.
The above dietary patterns are just different ways to achieve a caloric deficit.
You just have to choose the pattern that works best for you and also does not cause other adverse cardiovascular risks, i.e. a significant increase in LDL-C on a ketogenic diet (This happens to some people, but not all).
Bariatric Surgery
The most effective intervention for reversing diabetes is bariatric surgery.
At one-year post-surgery, up to 90% of cases of type 2 diabetes have reversed9.
This is a mind-blowing figure.
I believe that most patients with recently diagnosed type two diabetes can reverse their diabetes using nutritional and exercise strategies.
For some, additional assistance will be required using recent weight loss therapies such as GLP-1 agonists.
But for some patients, bariatric surgery is an amazing tool.
Summary
Everyone exists on the continuum of insulin-sensitive to severely insulin-resistant.
Increasingly, we are seeing huge percentages of the population move up that scale to pre-diabetes and diabetes with serious long-term consequences.
Reversal of diabetes is possible even in those of ‘normal weight’.
The key is to act early.
We have the tools and the methods; I just hope that more and more people get to use them.
PS: Access to the Heart Health Formula and the Heart Health Formula Express closes tomorrow night at midnight.
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
Emerging Risk Factors Collaboration. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol. 2023 Oct;11(10):731-742.
https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp
https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp
Risk of Death Associated With Reversion From Prediabetes to Normoglycemia and the Role of Modifiable Risk Factors. JAMA Netw Open. 2023 Mar 1;6(3):e234989.
10-Year Cardiovascular Risk in Patients With Newly Diagnosed Type 2 Diabetes Mellitus. J Am Coll Cardiol. 2023 Oct, 82 (16) 1583–1594.
Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018 Feb 10;391(10120):541-551.
Return to Normal Glucose Control by Weight Loss in Nonobese People with Type 2 Diabetes: The ReTUNE Study. Diabetes 1 June 2021; 70 (Supplement_1): 1184–P.
Bariatric Surgery in the Treatment of Type 2 Diabetes. Curr Diab Rep. 2019 Dec 4;19(12):156.
Very valuable advice. I’ve known people diagnosed with diabetes or pre diabetes who have been told by their doctors that the goal is now to keep A1C around 6.5 to 7 and anything in that general range is “doing great”. It’s as if the medical community at large is resigned to diabetes not being reversible which, of course, is flat out false. Thanks for bringing attention to this lifesaving information.
The diet recommended here is a mistake. The problem is that you are always hungry because carbs are digested quickly. A low carb diet, high in protein and fat is satisfying for a longer time and there fore you are not tempted to snack. Read Gary Taubes