Can weight loss reverse diabetes? 5 practical tips for healthy weight loss
In the UK, 3.5 million people are living with type 2 diabetes. This number is expected to increase to over 5 million by 2025 (1). Type 2 diabetes is a disease characterised by insulin insensitivity, leading to high blood sugar levels. Type 2 diabetes can lead to complications such as heart disease. This article will provide useful evidence-based tips on how people with diabetes can lose weight in a healthy way and explain why losing weight can reverse or improve type 2 diabetes.
Can Type 2 diabetes really be reversed or improved through weight loss?
On a positive note, Type 2 diabetes can be significantly improved or even be reversed through lifestyle changes! Weight loss can be especially beneficial for diabetic patients. The primary care-based Diabetes Remission Clinical Trial (DiRECT) found that by losing weight almost half (46%) of people with type 2 diabetes could achieve remission after 1 year and 36% after 2 years (2)! Another study found that by losing about 33 pounds people could reverse their type 2 diabetes (3).
Why does losing weight improve or reverse type 2 diabetes?
Beta cells in the pancreas secrete insulin. Insulin lowers blood sugar levels. In some individuals in the DiRECT trial weight loss improved beta cell function, leading to the reversal of their type 2 diabetes (2). Other studies have confirmed this and found that weight loss is associated with decreased levels of HbA1C, which binds to and carries sugar in the blood (4).
Liver fat levels are too high in over 70% of people with type 2 diabetes (5). This excess fat in the liver causes the liver to respond less effectively to insulin (insulin resistance). Insulin normally tells the liver to stop making sugar (glucose). The liver does not ‘hear’ insulin when there is excess liver fat, which causes the liver to make more glucose, increasing blood glucose levels. Experts propose that excess liver fat could cause more fat to be sent to different areas of the body, including into the beta cells, which could cause the beta cells to secrete less insulin (6). Excess abdominal fat may also cause inflammation, which can activate proteins that block insulin production. Inflammation can decrease the body’s ability to use insulin effectively (7,8). Fortunately, liver fat levels can be decreased through weight loss, which can improve or even reverse diabetes (6).
There is some evidence that suggests that weight loss reduces the risk of cardiovascular (heart) and other complications of diabetes, but more research is needed to fully understand this area (6).
Tips for losing weight in a healthy sustainable way:
1. Exercise
For effective weight loss it is recommended that you increase your activity levels. The World Health Organisation recommends that adults should aim for at least 150–300 minutes of moderate-intensity aerobic physical activity (for example cycling) per week (9).
2. Sleep
Good quality sleep is important for losing weight. Research has shown that losing sleep on a diet can decrease the amount of weight lost (10) and increase overeating (11).
3. Avoid sugary drinks and artificial sweeteners
There is strong evidence connecting sugary drinks to obesity, type 2 diabetes, and heart disease (12,13,14). Research shows that decreasing the consumption of sugary drinks is associated with weight loss and reduced risk of obesity (15).
Research has shown that artificial sweeteners increase appetite, and that regular use of artificial sweeteners is associated with increased vulnerability to type 2 diabetes and weight gain (16, 17).
4. Drink more water
Water has 0 calories and helps with weight loss. Research has shown that people who drank water before a meal felt more full and ate less than those who did not drink water before a meal (18). Many people confuse dehydration with hunger. Studies have shown that drinking more water increases the burning of fat (lipolysis) and increases metabolism, helping with weight loss (19).
The NHS eat well guide recommends 6-8 glasses of fluids per day (20). Our founder, Catherine Rogers recommends using a metal water bottle and filtering your water when possible. For more useful, practical advice read her book Gut Well Soon: A Practical Guide to a Healthier Body and a Happier Mind (21)!
5. Very important: Improve your gut health by eating a Mediterranean style low carb diet
Many studies have linked gut health (composition of the gut microbiome – the organisms including bacteria that live in the gut) to type 2 diabetes and obesity (22). Fortunately, gut health and microbiome composition can be improved through diet. For example, in the double blind randomised clinical trial Medina-Vera et al. found that a high-fibre, polyphenol-rich and vegetable-protein functional food diet improved participants’ microbiome diversity and increased the amount of ‘good’ anti-inflammatory bacteria (23).
For more information about gut health and diabetes, read our blog on the importance of treating the cause rather than the symptoms of diabetes.
Studies have shown that the Mediterranean diet is effective for weight loss, improves blood sugar levels and reduces cardiovascular risk factors (24). A Mediterranean diet involves eating plenty of vegetables, fruits, legumes, nuts, beans, cereals, grains, fish, and unsaturated fats such as olive oil (25).
Research has shown that a short term Very Low Calorie Diet resulted in significantly more weight loss than diets with more calories (26). For more information about the Very Low Calorie Diet you may be interested in reading the following article.
Not sure where to start?
Even with these evidence-based healthy weight loss tips, losing weight can seem daunting. Fortunately, Reset Your Health has a 4 week plan specifically designed by a team of doctors, nutritionists, chefs and scientists for people with diabetes and weight concerns. This 4 week plan includes a wide range of tasty, easy and affordable recipes for breakfast, lunch and dinner, which can help you stabilise your blood sugar levels, manage your weight and improve gut health and therefore possibly improve your diabetes.
If you would like to find out more about the science behind how to achieve a healthier lifestyle you may be interested in reading Gut Well Soon: A Practical Guide to a Healthier Body and a Happier Mind by Catherine Rogers (21). This book breaks down the evidence into simple language and provides practical tips and advice that you can immediately implement to improve your life.
References
1. UK D, possible Y. Diabetes statistics [Internet]. Diabetes UK. 2021 [cited 4 July 2021]. Available from: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics
2. 5. Lean M, Leslie W, Barnes A, Brosnahan N, Thom G, McCombie L et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. The Lancet Diabetes & Endocrinology. 2019;7(5):344-355. Available from: https://pubmed.ncbi.nlm.nih.gov/30852132/
3. McCombie L, Leslie W, Taylor R, Kennon B, Sattar N, Lean M. Beating type 2 diabetes into remission. BMJ [Internet]. 2017 [cited 4 July 2021];:j4030. Available from: https://pubmed.ncbi.nlm.nih.gov/28903916/
4. Gummesson A, Nyman E, Knutsson M, Karpefors M. Effect of weight reduction on glycated haemoglobin in weight loss trials in patients with type 2 diabetes. Diabetes, Obesity and Metabolism [Internet]. 2017 [cited 4 July 2021];19(9):1295-1305. Available from: https://pubmed.ncbi.nlm.nih.gov/28417575/
5. Targher G, Bertolini L, Rodella S, Tessari R, Zenari L, Lippi G et al. Nonalcoholic Fatty Liver Disease Is Independently Associated With an Increased Incidence of Cardiovascular Events in Type 2 Diabetic Patients. Diabetes Care. 2007;30(8):2119-2121.
6. Roden M. Mechanisms of Disease: hepatic steatosis in type 2 diabetes—pathogenesis and clinical relevance. Nature Clinical Practice Endocrinology & Metabolism. 2006;2(6):335-348.
7. Fontana L, Eagon J, Trujillo M, Scherer P, Klein S. Visceral Fat Adipokine Secretion Is Associated With Systemic Inflammation in Obese Humans. Diabetes [Internet]. 2007 [cited 4 July 2021];56(4):1010-1013. Available from: https://pubmed.ncbi.nlm.nih.gov/17287468/
8. Wellen K. Inflammation, stress, and diabetes. Journal of Clinical Investigation. 2005;115(5):1111-1119. Available from: https://pubmed.ncbi.nlm.nih.gov/15864338/
9. Physical activity [Internet]. Who.int. 2021 [cited 4 July 2021]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity
10. Nedeltcheva A, Kilkus J, Imperial J, Schoeller D, Penev P. Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity. Annals of Internal Medicine. 2010;153(7):435. Available from: https://pubmed.ncbi.nlm.nih.gov/20921542/
11. St-Onge M, McReynolds A, Trivedi Z, Roberts A, Sy M, Hirsch J. Sleep restriction leads to increased activation of brain regions sensitive to food stimuli. The American Journal of Clinical Nutrition. 2012;95(4):818-824. Available from: https://pubmed.ncbi.nlm.nih.gov/22357722/
12. Malik V, Willett W, Hu F. Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. The American Journal of Clinical Nutrition. 2009;89(1):438-439.
Available from: https://pubmed.ncbi.nlm.nih.gov/19056589/
13. de Koning L, Malik V, Kellogg M, Rimm E, Willett W, Hu F. Sweetened Beverage Consumption, Incident Coronary Heart Disease, and Biomarkers of Risk in Men. Circulation. 2012;125(14):1735-1741. Available from: https://pubmed.ncbi.nlm.nih.gov/22412070/
14. Malik V, Popkin B, Bray G, Despres J, Willett W, Hu F. Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A meta-analysis. Diabetes Care. 2010;33(11):2477-2483.
Available from: https://pubmed.ncbi.nlm.nih.gov/20693348/
15. Hu F. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity Reviews. 2013;14(8):606-619. Available from: https://pubmed.ncbi.nlm.nih.gov/23763695/
16. Imamura F, O’Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju S et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. 2015;:h3576. Available from: https://pubmed.ncbi.nlm.nih.gov/26199070/
17. Yang Q, Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings:. Neuroscience 2010 Yale J Biol Med 2010;83(2):101-108 [Internet]. 2021 [cited 4 July 2021];. Available from: https://pubmed.ncbi.nlm.nih.gov/20589192/
18. Jeong J. Effect of Pre-meal Water Consumption on Energy Intake and Satiety in Non-obese Young Adults. Clinical Nutrition Research [Internet]. 2018 [cited 4 July 2021];7(4):291. Available from: https://pubmed.ncbi.nlm.nih.gov/30406058/
19. Thornton S. Increased Hydration Can Be Associated with Weight Loss. Frontiers in Nutrition [Internet]. 2016 [cited 4 July 2021];3. Available from: https://pubmed.ncbi.nlm.nih.gov/27376070/
20. The Eatwell Guide [Internet]. nhs.uk. 2021 [cited 4 July 2021]. Available from: https://www.nhs.uk/live-well/eat-well/the-eatwell-guide/
21. Rogers C. Gut well soon: A Practical Guide to a Healthier Body and a Happier Mind. 2019. Purchase from Amazon: https://www.amazon.com/Gut-Well-Soon-Practical-Healthier-ebook/dp/B07PLMH1W8/ref=sr_1_1?dchild=1&keywords=gut+well+soon+catherine+rogers&qid=1625420946&sr=8-1
22. Muñoz-Garach A, Diaz-Perdigones C, Tinahones F. Gut microbiota and type 2 diabetes mellitus. Endocrinología y Nutrición (English Edition) [Internet]. 2016 [cited 4 July 2021];63(10):560-568. Available from: https://pubmed.ncbi.nlm.nih.gov/27633134/
23. Medina-Vera I, Sanchez-Tapia M, Noriega-López L, Granados-Portillo O, Guevara-Cruz M, Flores-López A et al. A dietary intervention with functional foods reduces metabolic endotoxaemia and attenuates biochemical abnormalities by modifying faecal microbiota in people with type 2 diabetes. Diabetes & Metabolism [Internet]. 2019 [cited 4 July 2021];45(2):122-131. Available from: https://pubmed.ncbi.nlm.nih.gov/30266575/
24. Huo R, Du T, Xu Y, Xu W, Chen X, Sun K et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. European Journal of Clinical Nutrition [Internet]. 2014 [cited 4 July 2021];69(11):1200-1208. Available from: https://pubmed.ncbi.nlm.nih.gov/25369829/
25. What is a Mediterranean diet? [Internet]. nhs.uk. 2021 [cited 4 July 2021]. Available from: https://www.nhs.uk/live-well/eat-well/what-is-a-mediterranean-diet/
26. Johansson K, Sundström J, Marcus C, Hemmingsson E, Neovius M. Risk of symptomatic gallstones and cholecystectomy after a very-low-calorie diet or low-calorie diet in a commercial weight loss program: 1-year matched cohort study. International Journal of Obesity [Internet]. 2013 [cited 4 July 2021];38(2):279-284. Available from: https://pubmed.ncbi.nlm.nih.gov/23736359/