Diabetes has been considered for a long time an irreversible, long-life condition. Still, it is believed that it can not be cured, although can be managed with lifestyle changes and diabetes drugs.
On the other hand, some healthcare professionals claim that diabetes type 2 can be reversed and their work helped patients regain their health. Plenty of books supports this concept as well. Who is right and what are the research studies saying?
Can diabetes type 2 be reversed?
Diabetes type 2 can be managed with lifestyle changes and diabetes drugs. According to the Merck Manual- the version for healthcare professionals-, some individuals with this condition “ may be able to avoid or cease drug treatment if they are able to maintain plasma glucose levels with diet and exercise alone”.
In the scientific world, a 2019 review of 99 research papers published in the journal “Nutrients” concluded that “ evidence exists that type 2 diabetes reversal is achievable” through three approaches: bariatric surgery, low-calorie diets, or carbohydrate restriction. Although more research is needed to fully confirm these findings- including long-term evaluations, there is growing evidence that reversal is possible.
Low-calorie diets focus on counting the calories, and the typical recommendation is to consume 1200-1500 calories daily. Nutrient-rich, low/moderate calorie foods like vegetables, fruits, herbs and spices, and whole grains are encouraged, along with lean meats from poultry and fish. Processed foods, excess fatty foods, and sweetened beverages are discouraged.
Low-calorie diets help achieve weight loss and keep the blood sugar levels under control- two key factors leading to remission of diabetes. Studies found that the benefits of a low-calorie diet can be seen in as little as three to six months, as diabetes went into remission or partial remission in a number of the participants. Roughly 11 % of the individuals who followed a low-calorie diet and exercise program for one year experienced reversal of diabetes, in a large study.
Long-term remission with a low-calorie diet still remains a challenge, as many people who start the diet and other lifestyle changes do not continue to follow the plan.
Carbohydrate restricted diet
Carbohydrate restricted diets are some of the safest and most effective diets to manage weight, blood sugar levels and reduce the risk of heart diseases in individuals with diabetes. The typical low-carb diet involves counting net carbohydrates and maintaining them below 130 grams daily, although a very low carbohydrate diet can go to less than 20 grams of carbs daily. This diet emphasizes low and zero-carb foods such as green leafy vegetables, lettuce, meat, and fish. Very low are even more effective to reduce in HbA1c, weight, and insulin levels compared with low/moderate -carbohydrate or low-fat diet plans Scientists noted further improvement in glycemic control when mindful eating, and a regular exercise program was added to the diabetes protocol. Long-term benefits are still under research, and of course, will depend if the diet is maintained over time.
Both low-calorie diets and carbohydrate restricting diets can be paired with intermittent fasting, which also shows improvement in glycemic control. Intermittent fasting can be done easily but all involve choosing regular periods to eat alternating with fasting (ie eat during an 8-12 hour period, and fast the remaining time or eat one meal a day two days a week.)
If dietary and other lifestyle changes don’t help bring diabetes in remission, bariatric surgery may be able to reverse it- at least short-term. Bariatric surgery is currently approved in the US for adults with a body mass index (BMI) over 40, or BMI over 35 plus obesity-related conditions. Researchers note that the blood sugar levels quickly improve after surgery, many times within hours to days, and are followed by weight loss. Furthermore, bariatric surgery is associated with a decreased need for oral diabetes drugs and insulin and helps” reverse diabetes in up to 80% of the patients, however, long-term remission is not durable.
Furthermore, this surgery comes with several potential risks. How successful that surgery depends on the health status of the person – like other comorbid conditions, whether or not a diet and lifestyle changes are going to be followed and the type of surgery. Depending on the type of surgery, complication rates are between 9 and 21% and include bleeding, the need to re-admission of the hospital and have another surgery, hypoglycemia, dumping syndrome ( a condition that causes bloating, vomiting, abdominal cramps, dizziness, and other symptoms after a meal) aggravation of the acid reflux, and multiple nutrient deficiencies.
For best results, diets should be medically supervised by healthcare professionals. As some food groups are restricted, supplements are often necessary. While the reversal of diabetes is still under research, it seems that low-calorie diets and low carbohydrate diets, and bariatric surgery are the top three therapies to consider.