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Is it possible to reverse Type 2 diabetes by using a specific diet? What about insulin-dependent Type 2 diabetes?

  • Is she overweight? – Ben Oct 14 '17 at 21:55
  • Yes. A low-carb, high-fat diet and/or intermittent fasting will do the job. Go to DietDoctor.com, a site dedicated to a LCHF lifestyle, and its affect on type 2 diabetes and insulin resistance. A lot of science discussed, but it is explained well for us 'non-doctors'. – Doug.McFarlane Oct 17 '17 at 18:02
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    @Doug.McFarlane Comments are not meant for answering questions. Please post your 'answer' as a real answer. (You might have to expand it, though) – LаngLаngС Oct 17 '17 at 20:59
  • Edited to remove the personal details to comply with site guidelines. You may revert if you disagree. – DoctorWhom Oct 26 '17 at 2:26
  • Related: Is there any cure for type 2 diabetes? – kenorb Nov 9 '18 at 14:33
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It depends on how long the patient has been on insulin, and whether "pancreatic exhaustion" has been reached.

If the person has been on insulin only a few years when there is still endogenous insulin production ( check by doing a C-peptide test ), then yes, it's possible.

See the work by Prof Taylor at Newcastle, England using extreme low calorie diets which rapidly reverse hepatic and pancreatic steatosis, restoring hepatic sensitivity to glucose levels.

And for pathogenesis https://link.springer.com/article/10.1007%2Fs00125-008-1116-7

https://www.ncbi.nlm.nih.gov/pubmed/21656330

Update: The 12 month results from the DiRECT study show that 50% of the patients in the intervention arm ( The intervention comprised withdrawal of antidiabetic and antihypertensive drugs, total diet replacement (825–853 kcal/day formula diet for 3–5 months), stepped food reintroduction (2–8 weeks), and structured support for long-term weight loss maintenance ) went into remission off all diabetic drugs. The greater the weight loss, the more likely remission was achieved.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext

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    Agreed, but I can't upvote because by only including that study, it seems that you're advocating a 600 kcal diet as the solution - which I don't think was your intention. The evidence is strong for certain dietary paradigm shifts, like the whole food plant based diet as discussed in the other answer, so perhaps broadening your answer would help clarify what you mean. – DoctorWhom Oct 15 '17 at 9:00
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    Neil Barnard's studies on whole foods as a whole when I read them a few years ago did not reverse diabetes but may have lead to increased diabetic control. The Newcastle diet replicates the period of near starvation following gastric bypass surgery that leads to reversal of diabetes without the unnecessary surgery. The physiological mechanism is as I explained. And yes, a 800 kcal diet does work in selected patients. A large UK trial is now testing this. – Graham Chiu Oct 16 '17 at 9:59
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    These other half hearted diets don't work generally because they don't reverse the underlying pathology which is hepatic glucose sensitivity, and steatosis. The diet doesn't fix peripheral insulin resistance. That likely needs aerobic exercise. – Graham Chiu Oct 16 '17 at 10:03
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    Maybe, when it's in beta. – Graham Chiu Oct 22 '17 at 23:21
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    @GrahamChiu Trouble is, we won’t get to beta unless we have knowledgeable supporters. You could „just follow“ the proposal and maybe read and upvote 5 questions you deem worthy. That shouldn’t take too much of your time away and would be a huge step towards beta. I‘m really looking forward to read your Q&A‘s in the beta phase! – Narusan Oct 26 '17 at 9:07
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As Neil Barnard explains in this video, a low fat whole food plant based diet has yielded positive results. But note here that you don't need to go full vegan for this to work, the most important element is to drastically increase your whole grain carb intake, drastically reduce your fat intake, and increase your physical activity levels. This is best done under medial supervision because your medication will have to be adjusted to deal with the increased carb load.

In contrast, the popular low carb, high fat ketogenic diet while having some benefits for diabetes patients, allowing people to reduce their medicine intake, is not usually not going to reverse diabetes, and this diet comes with serious adverse health risks. Anthony Lim explains in this video that he used to recommend the low carb approach to his patients with some success, but how doing the opposite led to complete cures.

An important factor that causes people to get type 2 diabetes and keep them diabetic is the indoctrination of the general public that eating large amounts of (unrefined) carbs is bad for health. I experience this almost every time when I'm ordering my diet in restaurants, particularly in North America. On one occasion a very obese waiter told me that the 1 kg of potatoes I ordered for dinner is bad for health.

  • Might be an entertaining watch. Videos are often just a waste of time. Any written stuff to back that up? Also, Barnard is an ideologue: ncahf.org/articles/o-r/pcrm.html wondering: that much talking and activism, how much time to read and research? – LаngLаngС Oct 15 '17 at 11:18
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    @LangLangC There is a LOT of solid evidence for the potential of whole food plant based diet + exercise (especially involving weight loss) to have an enormous impact on diabetes; it's not just Neil Barnard. I can't say one way or another about Neil specifically, but your article from NCAHF is 20 years old... Evidence has grown exponentially since then. – DoctorWhom Oct 15 '17 at 15:25
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    Also this is what we see in clinical practice. The ACLM and ACPM are professional organizations whose websites are great resources for references. – DoctorWhom Oct 15 '17 at 15:27
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    I want to see a prospective trial of a vegan diet that is isocaloric with the patient's previous diet to treat diabetes. I predict that there will be zero cases of reversal T2DM despite Barnard says because that's what the evidence says to date. – Graham Chiu Oct 16 '17 at 18:59
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    ncbi.nlm.nih.gov/pmc/articles/PMC2677007 74 weeks of vegan diet. All falls in HbA1c correspond to weight loss. – Graham Chiu Oct 26 '17 at 3:33
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Yes. T2D is reversible, with some caveats.

T2D is essentially a set of symptoms in a body that has ingested too much sugar, and has lost insulin sensitivity. "Type 2 diabetes primarily occurs as a result of obesity and lack of exercise." --wikipedia Diabetes_mellitus_type_2

T2D is an arbitrary diagnosis based on the easily-measurable blood glucose level: wikipedia Diabetes_mellitus_type_2#Diagnosis

Outside the arbitrary medical definition, which has a binary diagnosis, it's much more meaningful to talk about insulin sensitivity as a spectrum.

Some people are insulin-sensitive superstars, far better at efficiently digesting sugars than "normal" people, and generally speaking T2 diabetics are less insulin-sensitive than normal people.

A helpful analogy is IQ. The arbitrary definition of moron is a person with IQ between 50-69, an imbecile has an IQ from 20-49, and idiots have IQs below 20. That's pretty easy to measure, and also pretty meaningless. A much more useful application of IQ scores is to try to make ALL people improve their own individual IQ score over time through education.

We don't focus enough on the fasting blood glucose level, or response of blood glucose level to ingested sugar as a spectrum of insulin-sensitivity. Instead, we just have 1 label, T2D. Kinda like if we ignored geniuses, morons, and regular people, and just had a single "disease", called "dumb", for people with an arbitrary IQ, let's say below 73.

When you ask about reversing diabetes, what you're really asking is, can a person use diet to improve their insulin sensitivity, as measured by fasting blood glucose, and/or response of blood glucose to ingestion of sugar. The answer is yes!

Diet is the strongest factor in improving insulin sensitivity.

Carbs are just sugar chains consisting of 3 or more sugars, so it's useful to divide all nutrition into simply sugar, fat, and protein, and never use the word carbs again. Just call them long-chain or complex sugars, so you don't camouflage diabetes-inducing sugars as nutritive-sounding "carbohydrates".

Eating very low-sugar diets (ketogenic, atkins, or even many low-calorie diets) improves insulin sensitivity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313649/

Here are some caveats:

  1. Most, if not all, T2Ds are terrible eaters who consume(d) loads of sugars, so dietary changes are difficult for many T2Ds.

  2. Some damage caused by eating sugar is irreversible. If you got your legs sawed off because you were extremely insulin-resistant for a long time, they won't grow back. Somewhere around 100,000 diabetes leg amputations happen every year in the US. This is a huge problem.

  3. Reversal is slow, unless the person commits to a very drastic change, like a ketogenic diet (for most people this means <40g of sugar per day). Humans usually believe in lucky positive events, and expect to see immediate feedback from any changes, but most important achievements in life require small investments of energy and attention every day, over periods of months or years. This is why so few people are financially secure, physically fit, happily married, well-adjusted, and healthy. All of the important problems in life require consistent attention and near-daily investments of effort in PROCESSES over long investment horizons. The positive events, like winning Mr. Olympia, cover modelling on Forbes, and celebrating a happy 50th anniversary, aren't really "events", so much as results flowing naturally from slow, consistent processes. The behaviors that will reverse T2D are not comfortable, and your aunt will have to take those actions every day for months before seeing any positive results.

If you can make your aunt see that sugar caused her T2D, and that not eating sugar will reverse it, and she carries a powerful enough "WHY", such as not getting her legs sawn off, being able to hike mountains with her nieces and nephews, living a long and happy life, then she will start substituting fat for sugar in her diet, and live happily ever after.

Just be aware, it's a psychological battlefield, and the same thinking and actions that got her where she is will NOT get her out.

Other Sources:

  • Comments are not for extended discussion; this conversation has been moved to chat. – JohnP Aug 23 '18 at 20:02

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