Diabetes

Updated 03 December 2015

Breakthrough: how type 2 diabetes can be reversed

A team from Newcastle University, UK, has shown that type 2 diabetes is caused by fat accumulating in the pancreas – and that losing less than one gram of that fat reverses the diabetes.

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Diabetes affects about three-and-a-half million South Africans  (about 6% of the population), and it's on the increase.

Type 2 diabetes affects 9% of the global population and was once known as adult-onset diabetes, but is now also found in young adults and children.

Type 2 diabetes is a long-term condition and the most common variety of diabetes. Patients with type 2 diabetes become resistant to insulin, a hormone that helps turn glucose from food into energy. To overcome this resistance, the pancreas makes more insulin, but eventually, it just can't make enough.

Research led by Professor Roy Taylor of Newcastle University in the UK and published online in Diabetes Care has shown that type 2 diabetes can be reversed in patients if they lose weight on a calorie-restricted diet.

How the study was done

Read: Discovery may lead to new diabetes treatment 

In the small trial, 18 people with type 2 diabetes (who had had the disease for seven to 15 years) and 9 people who didn't  have diabetes were measured for weight, fat levels in the pancreas and insulin response before and after bariatric surgery.

Taylor found that people with type 2 diabetes had increased levels of fat in the pancreas.

After the bariatric surgery, those with type 2 diabetes were immediately taken off their medication and all participants were measured again eight weeks later.

Both groups lost the same amount of weight, around 13% of their initial body weight.

Critically, the pool of fat in the pancreas did not change in the non-diabetics but decreased to a normal level in those with Type 2 diabetes.

This shows that the excess fat in the diabetic pancreas is specific to type 2 diabetes and is what prevents insulin being produced in a normal way.

Professor Taylor said: "For people with type 2 diabetes, losing weight allows them to drain excess fat out of the pancreas and allows function to return to normal. In other words, they no longer have diabetes type 2.

"So if you ask how much weight you need to lose to make your diabetes go away, the answer is one gram! But that gram needs to be fat from the pancreas.

At present the only way we have to achieve this is by calorie restriction by any means – whether by diet or an operation."

Read: Dr Taylor on why diabetics should eat breakfast

In patients who had started the trial with type 2 diabetes, fat levels in the pancreas (pancreatic triglyceride) decreased by 1.2% over the 8 weeks.

With an average pancreas for a person with type 2 diabetes having a volume of 50 ml, this is the equivalent of around 0.6 grams of fat.

However, the patients who had never had diabetes saw no change in the level of fat in their pancreas. This demonstrates that the increase in fat in the pancreas is specific to people who develop type 2 diabetes.

Importantly, individuals vary in how much fat they can tolerate in the pancreas before type 2 diabetes occurs.

Read: Dr Fung on why prescribing insulin is wrong for type 2 diabetics

Transforming thinking on type 2 diabetes treatment

Traditionally, type 2 diabetes has been thought of as a progressive condition, controlled by diet initially, then medication, but which may eventually require insulin injections. Read up on the current treatment for type 2 diabetes.

In an interview with the BBC regarding how he helped the Hairy Bikers duo lose weight, Professor Taylor described how, as far back as 2008, he asked people in a trail to stick to a very low calorie diet. 

Over 8 weeks they lost 15.3kg and their diabetes went away.

He said that they were able to show that as the fat level in the pancreas went down, the insulin producing cells gradually woke up and started behaving absolutely normally.

In the 12 May 2013 issue of the British Newspaper The Guardian Britain Richard Doughty detailed how he reversed his type 2 diabetes through following Professor Taylor's recommended 800 calorie diet for eight weeks.

Doughty, who was never overweight and followed a healthy lifestyle, decided to follow Taylor's diet advice – or end up being dependent on insulin and having to cope with all the complications of type 2 diabetes such as heart disease, kidney and nerve disease as well as blindness and erectile dysfunction, to name a few.

His diet consisted of 3 litres of water a day, three 200-calorie food supplements such as shakes or soups and 200 calories of green vegetables. He also ran three times a week and did all of this under medical supervision. After 11 weeks his "diabetes had resolved itself".

Another point in case: Carlos Cervantes, 53 and from the US, weighed 120kg, suffered a heart attack in spring 2011, his eyesight and kidneys were failing and he faced having an infected toe amputated. He even had fungus growing out of his ears, feeding on his ultra-high blood sugar levels. He read about Taylor's research and embarked on a 600 calorie diet. He replaced the supplements with vegetables, fruit, lean chicken, turkey, occasional bread and a daily milkshake. Two months later he had lost 40kg and 18 months later he is still free of his type 2 diabetes. (Source: The Guardian/Youtube)


Read: Could high insulin make you fat?

Professor Taylor adds: "This new research demonstrates that the change in level of fat in the pancreas is related to the presence of type 2 diabetes in a patient. The decrease in pancreas fat is not simply related to the weight loss itself.

It is not something that might happen to anyone whether or not they had diabetes. It is specific to type 2 diabetes.

"What is interesting is that regardless of your present body weight and how you lose weight, the critical factor in reversing your type 2 diabetes is losing that 1 gram of fat from the pancreas."

Health24's Diabetes expert weighs in

Dr Wayne May, endocrinologist and Health24's Expert on diabetes agrees that type 2 diabetes is reversible.

He says this has been shown in patients who have markedly altered their diets and  lost weight.

"Reversing diabetes is more likely in patients whose diabetes is controlled on tablets, although there are patients who have achieved this on insulin as well," he says.

"This U.K study showed that patients who followed a very low calorie diet, were able to reverse their diabetes and after a few months (it was a short term trial) still had normal glucose levels."

Dr May, who is also a consultant at Chrysalis Clinic Bariatric surgical unit says there is now also a lot of evidence that weight loss through bariatric surgery can reverse diabetes in about 30% of patients over 5 years.

"The trick in both cases though," he maintains, "is that in the long term you  needto maintain the lifestyle changes and weight loss, otherwise all you will have done is to temporarily push down the glucose levels into the normal range and then with time they will go up again."

With type 2 diabetes reaching epidemic proportions in South Africa, it's encouraging to know that our health is in our own hands and we do not always have to resort to expensive medication to regain our health.

If you would like to follow a low-calorie diet to reverse diabetes, always do it under medical supervision. A good starting point would be to ask our DietDoc or Dr May your questions in our Expert Forums.

Read more: 

Weight-loss surgery is more successful than lifestyle changes for type 2 diabetics

Weight loss surgery can benefit overweight patients with type 2 diabetes for up to nine years

The difference between a bypass and gastric band

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