Yes, weight loss can help reverse type 2 diabetes..
Recent research has suggested that weight loss can significantly reduce symptoms or reverse type 2 diabetes. The NHS prefers to use the term ‘remission’, meaning blood glucose levels are within the healthy non-diabetic range. [1] [2]
A recent study published in the British Medical Journal (BMJ) found that while drugs and generic lifestyle changes have improved the general health of patients, many still develop vascular complications in later life, and their life expectancy remains lower than average. [3] This study suggests greater emphasis on weight loss is required to achieve remission and better health long-term. We’ve listed tips to help you do this below.
…But it’s complicated
Increasingly, medical experts are focusing their attention on how disease works, rather than reacting to symptoms as and when they emerge. Diabetes is an immensely complicated disease and figuring out its underlying mechanisms will take time. However, medical professionals are confident that type 2 diabetes is rare without weight gain. [4]
At the moment, remission is rarely achieved and not necessarily permanent. [5]
Nevertheless, there is reason to be hopeful. The single largest clinical trial investigating type 2 remission, DiRECT, has shown positive results so far. [6] The trial monitors participants following a weight-loss programme. At year 1, 46% of these intervention participants were in remission and 24% had achieved significant weight loss (15kg). [7]
The NHS is testing a low-calorie diet inspired by this trial in select places around the UK. The diet has different stages, beginning with low-calorie substitutes like soups and shakes, and moving onto the reintroduction of solid foods. This diet is also supplemented by regular exercise. [8]
How does it work?
The relationship between weight gain and the development of type 2 diabetes is not yet fully understood. Whilst it’s early days, there are some theories as to why weight loss might trigger remission or improve blood glucose control.
One theory is that central fat hinders the function of key organs involved in the regulation of blood glucose. It has been suggested that by removing this fat, you can reduce inflammation and potentially improve your body’s ability to use insulin effectively.[9] [10] Other research has suggested that inflammation may block insulin production by activating certain proteins. [11]
The crucial thing you are aiming for when you lose weight is increased sensitivity to insulin. A high-calorie diet, particularly those involving refined carbohydrates, will force your body to produce high levels of insulin. This diet leads to weight gain and consistently high insulin levels, which in turn leads to insulin resistance in your cells and further weight gain. [12] Let’s break this cycle.
So what can I do to lose weight and help reverse type 2 diabetes?
1. Try a low-carb diet
The NHS offers no specific diet for diabetes. [13] [14]
As a person with diabetes, your conversations with NHS professionals have probably focused on managing portion sizes and substituting certain foods for less calorific options. However, if you want to increase your chances of remission, you should consider overhauling your entire diet.
Low-carbohydrate diets are a good place to start. They essentially focus on ‘real food’, ensuring that your body can make the most of the carbohydrate you consume. This means an emphasis on certain vegetables (as a source of slow-release carbohydrate), and fat as an alternative or supplementary energy source.
You can expect to gain three main things from a low-carb diet: lower HbA1C, sustained weight loss, and more stable blood glucose levels (less risk of high spikes and severe hypos). [15] Sounds good right?
A standard ‘low-carb diet’ has no fixed definition, but there are a number of trendy approaches that you may have heard of.
Some of these low-carb diets are stricter than others. For example, the ketogenic diet is very low-carbohydrate and has garnered a reputation for being a real physical and mental challenge (and risky for those with other health conditions).
Your new diet doesn’t have to be this intense. So long as you stick to the basic nutritional principles outlined above, you can select the diet best suited to your individual preferences and needs. The RYH plan tailors diet to suit both your condition and your tastes.
2. Think activity, not exercise
Whilst HIIT will make the pounds fly off, it’s hard to maintain and, let’s be honest, not always that fun. If you want to lose weight gradually and keep that weight off, you’d be better off maintaining a consistent level of physical activity, supplemented by exercise that you enjoy. Physical activity helps your body to use insulin better. [16] If you can walk to the shops, do. If you’re a slow walker, hurry up! Even standing up whilst you have your morning coffee could make a difference.
3. Snack sensibly
Food isn’t just fuel, it’s fun. Eating when bored is something many of us do, often without giving too much thought to what we’re shovelling in. To make sure you limit the negative impact of snacking, consider consuming ‘healthy’ snacks.
We’re not talking plain old celery sticks here (although that is an option!). A healthy snack can be something more tasty like granola, yoghurt, cheese and apple, or berries. You also want to avoid those options that look healthy but contain a lot of fast-release sugars, like shop-bought smoothies.
These options release sugar slowly into your bloodstream and avoid spikes in blood glucose which, as a person with diabetes, will only make you feel more lethargic.
4. Say no to processed food
There’s no shame in admitting that processed food is very tasty. In fact, thanks to our prehistoric past, we’re genetically hardwired to eat as much of it as possible when we can.
Before modern times, food high in calories and fat was hard to come by, resulting in an urge to consume as much of it as possible when the opportunity presents itself. Now that these resources aren’t naturally restricted due to the abundance of freely available processed food, we have to fight a tendency to over-consume them.
But we can fight this urge! It’s time to take control of your diet and select the foods you know will nourish it over a long period of time.
5. No crash dieting
Crash dieting is not an effective way of maintaining weight loss. It also feels gross!
There are a number of theories as to why this type of diet is so unsustainable. It has been suggested that suddenly restricting the amount of food you consume will switch on genes that increase the uptake and storage of what you’re eating. It might also encourage changes in your metabolism that prevent further weight loss — your body’s reaction to running out of food. [17]
Many people who reached a so-called ‘weight loss plateau’ give up on their unsustainable diet and regain the weight they lost. This is why it’s so important that you find a diet that suits your individual needs and preferences. Your focus should be on finding the right food, not avoiding it all together. The RYH plan can help you with this.
6. Manage your expectations
Weight loss isn’t a miracle cure, but it is a good way to take care of your body and improve your general health. There’s no denying that type 2 diabetes is incredibly inconvenient; even if you don’t achieve remission, improving your control over blood glucose levels is an empowering and positive step to take.
To summarise, we don’t know exactly what the interaction between weight and type 2 is, but we do know that weightloss can give greater control over blood glucose levels and even lead to remission. Remission means that blood glucose levels are healthy without the need for medication. Fat is not a dirty word, and you must select the correct carbohydrates. Consider the RYH plan to begin your remission journey.
References
[1] ‘‘More people need to know type 2 diabetes is reversible’ argues report’, NHS [Online], https://www.nhs.uk/news/diabetes/more-people-need-know-type-2-diabetes-reversible-argues-report/
[2] Type2 diabetes remission, Diabetes UK [Online], https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/type2-diabetes-remission
[3] BMJ 2017;358:j4030
[4] Ibid
[5] ‘‘More people need to know type 2 diabetes is reversible’ argues report’, NHS [Online], https://www.nhs.uk/news/diabetes/more-people-need-know-type-2-diabetes-reversible-argues-report/
[6] Direct Trial, https://www.directclinicaltrial.org.uk
[7] ‘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 [Online], https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30068-3/fulltext
[8] ‘NHS launch low calorie diet programme to help more people put their diabetes into remission’, Diabetes UK [Online], https://www.diabetes.org.uk/about_us/news/nhs-low-calorie-diet-remission
[9] C. Rogers, Gut Well Soon, p. 70
[10] H. Wu and C. H. Ballantyne, ‘Metabolic Inflammation and Insulin Resistance in Obesity’, ahajournals.org,
[11] C. Rogers, Gut Well Soon, p. 70
[12] ‘Reversing Type 2 Diabetes’, https://www.diabetes.co.uk/reversing-diabetes.html
[13] ‘What is a healthy, balanced diet for diabetes?’, Diabetes UK [Online], https://www.diabetes.org.uk/Guide-to-diabetes/Enjoy-food/Eating-with-diabetes/What-is-a-healthy-balanced-diet
[14] ‘Food and keeping active’, NHS [Online], https://www.nhs.uk/conditions/type-2-diabetes/food-and-keeping-active/
[15] ‘Low Carb Diet – What is Low Carb?’, https://www.diabetes.co.uk/diet/low-carb-diabetes-diet.html
[16] ‘Diabetes and exercise’, Diabetes UK [Online], https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/exercise
[17] ‘What to do about weight loss plateau’, Medical news Today, https://www.medicalnewstoday.com/articles/326415#food-journal