If we’ve learned anything about type 2 diabetes from mainstream media, it’s that weight loss and exercise ought to be the perfect cure — unfortunately, it’s not that simple.
A recent clinical trial, referred to as the United-Kingdom-based Diabetes Remission Clinical Trial (DiRECT), placed patients with type 2 diabetes on a yearlong calorie-restrictive diet and found that close to half of the participants achieved nondiabetic blood sugars, qualifying them as “in remission.”
All of these patients had been diagnosed within six years prior to the study.
A secondary study confirms that the reason these patients achieved remission is not because of “reversing insulin resistance” like many diabetes articles and diets would have you believe, but instead because the weight loss resulted in improved function of their pancreatic beta cells.
How are beta cells involved?
Beta cells are housed by the islet cells of the pancreas and are solely responsible for the production of insulin. In patients with type 2 diabetes, the actual root of the condition can vary. For some, it is overall insulin resistance, and for others, it is impaired beta cell function.
“This observation carries potentially important implications for the initial clinical approach to management,” explains senior study author Dr. Roy Taylor, professor of medicine and metabolism at Newcastle University. “At present, the early management of type 2 diabetes tends to involve a period of adjusting to the diagnosis, plus pharmacotherapy with lifestyle changes, which in practice are modest. Our data suggest that substantial weight loss at the time of diagnosis is appropriate to rescue the beta cells.”
Approximately 46 percent of the participants following the weight-loss protocol were able to achieve nondiabetic blood sugar levels and maintain that control.
In the 54 percent who didn’t achieve remission, the study reports that while some simply didn’t lose enough weight, others didn’t respond to the weight loss like the other participants.
When testing each group’s overall beta-cell function, the study did find that only those in the 46-percentile group showed an improvement.
“Undoubtedly, intervening in the progression of type 2 diabetes as early as possible before advanced end-organ damage occurs is the optimal approach,” Dr. Eric Sodicoff, author of The Phoenixville Nutrition Guide, told Healthline. “Identifying such patients early is ideal, and this study clearly established that the longer a patient has lived with type 2 diabetes, the less likely they are going to respond to a calorie-restriction method.”
Balanced better than boomerang diets
Sodicoff cautions against severe calorie-restrictive dieting, however, because while it may lead to results initially, the rebound most people experience is severe.
“I see patients all the time, unfortunately, who do just that,” explained Sodicoff. “They dip their A1C into nondiabetic range and rebound right back up. They put their diabetes into remission via low-carb, high-fat, ketogenic diets, and then rebound disturbingly fast.”
The rebound Sodicoff is describing is a rapid weight gain that brings with it the return to high blood glucose levels.
“I clearly and frequently remind people that returning to their old pattern of eating is not an option. Dieting is capable of normalizing blood glucose levels but returning to the carbohydrate tolerance they may have once enjoyed is gone forever.”
Sodicoff also points out that lifelong calorie restriction is essentially impossible.
“Just look at what happened to Ancel Keys subjects in his starvation studies,” suggests Sodicoff.
Keys was an American physiologist in the early 1900s who became well-known for his starvation studies.
“His patients suffered depression, anxiety, thinning hair, loss of sex drive, and incessant food cravings,” explains Sodicoff.
How crash dieting can hurt in the long run
“They found that losing dramatic amounts of weight in a short amount of time had devastating impact on a person’s basal metabolic rate (BMR),” Oerum told Healthline.
Your BMR is the amount of calories your body burns simply to keep itself alive and function.
Anything additional, like the calories you burn when you go for a jog, is not part of your BMR. A significant decrease in your BMR, explains Oerum, is not a good thing, because it means your body is now burning fewer calories — sometimes even 600 fewer calories per day — which means the amount of food you can eat without gaining weight is 600 calories fewer, too.
“Diet is at least 80 percent of the equation when it comes to weight loss,” explained Oerum, “but this most recent study didn’t seem to acknowledge exercise at all.”
Referencing the American Diabetes Association, Oerum explained that losing 7 percent of your bodyweight (which is 15 pounds if you weigh 200 pounds) and exercising merely 20 minutes per day can reduce your risk of developing type 2 diabetes by nearly 60 percent.
“I do believe that extreme deprivation and extreme restriction and rules around food will lead to other issues and rebounding later on,” said Oerum. “When you go extreme in one direction, you’ll eventually have an extreme response in the other direction.”
The rebound of the participants in this most recent study is unknown since they were only observed for one year.
Instead of severe calorie restriction and too many “food rules,” Oerum recommends putting the protein on your plate first, then a good serving (or three) of vegetables, and then a small serving of carbohydrates.
Most of all, Oerum says to look beyond the calories and the macronutrients like fat and carbohydrates.
“Cut out the processed junk, and aim for real food.”