Whilst the first discovery of diabetes was thought to have occurred as early as 1500BC, it wasn’t until much later in history, in the 11th century, that the disease started to take on some of the characteristics which define it today.
Physicians used to taste the urine of those with the condition, and in around 1776, scientist Matthew Dobson discovered that the sweet-tasting urine was due to its increased concentration of glucose (1,2).
In 1812 diabetes was recognised as a clinical condition. Yet, little was still known about its causes, prevalence, or treatment (2).
The function of Insulin was not identified until 1909, when scientists Edward Albert Sharpey-Schafer and Jean de Meyer discovered that it was responsible for bringing down your blood glucose levels, also known as hyperglycaemia (2,3). With this rich history, it is no surprise that curing the disease, reversing it or slowing its progression has been extensively studied.
Within this, the question of how to reverse type 2 diabetes (previously called adult-onset diabetes) continues to be a hot topic. In this article, we will provide an overview of the disease.
We will then look at how it progresses, with an overview of the evidence surrounding the natural reversal of type 2, from diet and lifestyle changes.
What is type 2 diabetes?
Type 2 diabetes is the commonest type of diabetes, thought to affect around 90% of people with the condition (4). Figures from the World Health Organisation (WHO) in 2014 showed that overall; diabetes affects an estimated 422 million people worldwide (5).
The WHO also reports that diabetes was the seventh leading cause of death in 2016. It is safe to say, therefore, that diabetes is a serious condition.
Understandably, those with prediabetes or already living with diabetes will want to know how best to treat it and manage the associated risks. What’s more, we are also hearing more about how to reverse type 2 diabetes. You may have also heard this being called ‘remission’. This article aims to provide a round-up of the available evidence for how to achieve diabetes remission.
Type 2 diabetes is a condition whereby your body does not produce enough of the crucial hormone insulin, or the insulin it does produce is not effective. Your pancreas is the organ that is responsible for producing insulin. #
When you consume food or drink containing carbohydrates, your body converts it into glucose (a sugar), which is sent into your bloodstream to be used for energy. Glucose is the bodies, and particularly the brains, preferred energy source.
However, having too much in the bloodstream can lead to problems. Excess glucose in the blood reduces the ability of your cells to absorb and use this glucose for energy – this is called insulin resistance. Over time, in a state of insulin resistance, the pancreas becomes overworked as it is constantly trying to battle with a raised blood sugar level (also called blood glucose level).
It attempts to overcome this producing more insulin. Eventually, the overworked beta cells of the pancreas stop producing enough insulin, or the insulin they do produce does not work properly. This leads to the development of prediabetes and then commonly, on to type 2 diabetes (6,7).
It is widely agreed by organisations such as the American Diabetes Association, that weight is a key risk factor for the development of type 2 diabetes. In this recent review of 86 meta-analyses, a higher body mass index was consistently identified as a significant risk factor for the development of the condition. You can read some more about the symptoms of diabetes, and the risk factors, here.
When you have been diagnosed with type 2 diabetes, you will be advised on the best form of treatment for you. This may include dietary and lifestyle changes and possibly diabetes medication and/or insulin therapy. If you have type 2 diabetes that is not effectively managed, your blood glucose levels can be too high. This is called hyperglycaemia and is a common, yet serious, complication of diabetes.
Now we have briefly covered what type 2 diabetes is, it is important to know that there are several things that set it apart from type 1 diabetes. Type 1 diabetes occurs due to autoimmunity, and is usually diagnosed in childhood. Read on for an overview of type 1 diabetes in the next section of this article.
Type 1 diabetes:
In type 1 diabetes, insulin-producing beta cells in the pancreas eventually become worn out and stop producing insulin. This occurs because type 1 diabetes is an auto-immune condition, meaning that it is caused by a person’s immune system ‘attacking’ their own body. It is not known what causes type 1 diabetes, and research is ongoing. According to Diabetes UK, type 1 diabetes affects around 8% of those with diabetes.
In type 1 diabetes, the way in which the body attacks your insulin-producing beta cells leads them to no longer produce any more insulin. This is when symptoms of diabetes begin to show, which, in type 1 diabetes, typically happens in childhood. You can read more about type 1 diabetes in here.
Understanding how type 2 diabetes progresses
We have previously mentioned hyperglycaemia, which is a consequence of type 2 diabetes. Some of the main risk factors for type 2 diabetes, such as heart attack, stroke and the microvascular complications such as diabetic retinopathy, are strongly associated with hyperglycaemia.
Hopefully now we have established that blood glucose levels are heavily impacted by what you eat, thus giving you a mechanism by which to improve your control of your blood glucose levels.
Yet, there are also many other variables that can affect blood glucose levels, which you can read about in this article.
When we focus on hyperglycaemia as a key factor within the progression of diabetes, it is also important to remember that it is not a static measure. Even if your diabetes management is tightly controlled, you may still require increases in or changes to your diabetes medication (8).
For example, NICE clinical guidance recommends that blood glucose levels be monitored with HbA1c at 3-6 month intervals initially, and then only reducing to 6 monthly if targets are met. Drug treatments should be modified in a step-wise process, which will be dependent on blood results and other clinical parameters.
Diabetes is a progressive disease, and within this progression, hyperglycaemia can continue to worsen even with treatment (8). If we think back to the explanation of what diabetes is and what happens to the pancreas in type 2 diabetes, this is a good place to start.
Type 2 diabetes progression is mainly characterised by decline in the function of the beta cells of the pancreas. Worsening of insulin resistance also plays a key role in the progression of type 2 diabetes. The following are markers for how the progression of type 2 diabetes may be measured:
- Worsening HbA1c levels
- Increased fasting plasma glucose levels
- Worsening hyperglycaemia, whether fasting or after a meal
If you are concerned that you may need an adjusted treatment plan for your diabetes, it is essential that you speak with your specialist team. Based on your blood results, they may recommend you increase or change your course of diabetes medication. They may also recommend dietary or lifestyle changes, such as how to effectively lose weight (and maintain it), or increased physical exercise.
Can type 2 diabetes be reversed by diet and exercise?
Before we look into the mechanisms by which you might be able to achieve diabetes reversal, we must explain what this means. When your diabetes has been put into remission, you will have blood glucose levels in the normal range and will no longer need medication to manage your blood glucose levels.
The change this can bring to the lives of people who have been used to regular healthcare appointments and taking daily medication is significant. There are thought to be various ways in which this can be achieved, although achievement of remission status does not mean it is permanent – ongoing monitoring of blood glucose levels, weight and other clinical parameters remains essential.
The evidence suggests that weight loss for those who are overweight or obese is the strongest predictor of successful diabetes remission (9,10,11). Whilst it has been shown through various studies that achievement of remission status through diet and lifestyle changes is possible, weight loss surgery (bariatric surgery) has been shown to be the most effective way to achieve this.
Yet, bariatric surgery is a significant commitment and is not a decision taken lightly. If you are interested in finding out more about your suitability for bariatric surgery, speak with your healthcare team.
How to reverse type 2 diabetes:
Low carb diets
Low carb diets continue to be a popular approach to losing weight, commonly chosen over the more traditional low-fat diet. Official definitions are lacking, and various sources will state the maximum level of carbs per day differently.
One common definition, however, is that of a diet <130g of carbs per day. In this review and meta-analyses of randomised controlled trials (RCT’s), this level of carbohydrates per day was thought to be achievable.
There’s generally no need to go the whole hog and start following a ketogenic diet or the paleo diet. There is evidence that the ketogenic diet is effective for weight loss and good diabetes control in the short term, although there is not much evidence on the sustainability, as found in this recent study.
As with many things in the world of nutrition, one size does not fit all, and whilst low carbohydrate diets are popular and appear safe in the short term, more evidence is needed to determine the longevity of this approach to changing your diet. In a further review of RCT’s carried out in 2015, low carb diets showed no statistical differences from diets with higher carbohydrate content.
It concluded that they cannot be recommended as the only treatment for people with type 2 diabetes. Remember, that one size does not fit all! Many people will be successful on a low carb diet and may adapt to the changes easily, whereas some may not.
Seek professional help and remember that dietary changes are only a small piece of the puzzle – exercise, behaviour change strategies and support are crucial too.
See the next section of this article for some ideas of foods to eat on a low carb diet.
Low calorie and very low calorie diets
A very low calorie diet is typically defined as containing no more than 600-800 calories per day, with a low calorie diet containing somewhere between 800 and 1200 calories per day.
A study conducted in Newcastle, England, which was funded by Diabetes UK, showed promising results. The study was only small, although the results showed that after eight weeks on a low calorie diet showed that participants had reduced the amount of fat in their liver and pancreas.
They produced more insulin as a result of this, and achieved remission status – this was maintained in some participants six months later. Diabetes UK consequently funded another study, the DiRECT study, which is showing more promising results with the use of a very low calorie diet.
Despite the success for remission with this diet, it is important to remember that it is not for everyone. The calories typically come largely from shakes and meal replacements, which many may find hard to maintain. Always speak with a healthcare professional before making any significant calorie reductions, or embarking on this kind of diet.
When we think of the principles of a healthy lifestyle, exercise usually goes hand in hand with a nutritious diet. For those who are able, regular exercise is a cornerstone of the various lifestyle changes that can have a positive impact on diabetes management. This includes the ability to reverse diabetes, or put it into remission.
Several of the studies demonstrating cases of successful diabetes remission were focused not only on encouraging a healthy diet, but also on increasing exercise levels among participants.
Exercise improves your sensitivity to insulin, meaning the insulin your pancreas does produce in type 2 diabetes is more effective to the body’s needs, thus reducing or eliminating the need for medication. In combination with a healthy diet, exercise can reduce the demand for insulin in the body.
In this small scale study 67% of participants newly diagnosed with type 2 diabetes achieved at least partial remission after 6 months intensive dietary counselling and supervised exercise.
One recent, larger RCT also found an association between greater rates of remission with intensive lifestyle intervention (including exercise), than with the more traditional method of diabetes education and support. The level of remission achieved was modest, although cannot be ignored.
The adoption of positive dietary changes and exercise are not new phenomena’s when it comes to efforts to improve our health. Yet, there is certainly building evidence in support of certain approaches when it comes to aiming for diabetes remission. Always remember to speak with your healthcare professional if you are interested in making lifestyle changes, to see what support they can offer you.
What foods can help to reverse type 2 diabetes?
The key to enhancing your health with the food that you eat is to get a balance of foods so you can achieve a wide nutrient intake.
Of course, there are foods that are more nutritious than others, and will help you on the road to enhancing your health with diet far more than some will. Yet, it is also healthy to adopt the mentality that ‘all foods fit’, as even the less nutritious foods we have mentioned can be enjoyed in moderation.
Depending on your management plan for trying to place your diabetes into remission using diet and lifestyle changes, there are some foods that can help you with this process.
The following foods are useful to include in a low carbohydrate diet:
- Plenty of non-starchy vegetables such as cauliflower, broccoli, peppers, courgette, onions, carrots and green leafy vegetables. This particular dietary change is key for those wishing to follow a more plant-based diet. A plant-based diet is an approach that is becoming more popular as a means to explore prevention of diabetes, as explained in this American Diabetes Association Diabetes Spectrum article.
- Nuts and seeds (choose unsalted where possible)
- Lentils, beans and other pulses
- Milk, yoghurt and cheese. Dairy can be a nutritious and filling addition to your diet. If you can’t eat dairy or choose not to, ensure any alternatives are calcium-fortified and ideally, unsweetened. Soya milk a nutritional profile most similar to cow’s milk, so can be a great substitution for dairy foods.
- Lean protein sources. This may include meat (choose processed meats less frequently), fish, eggs, tofu or other plant-based protein sources such as tempeh.
- Healthy fat sources. These include olive, rapeseed and sunflower oils for cooking and avocado and olives for snacking or adding to your meals. Oily fish such as salmon and mackerel is also great for increasing your omega-3 (heart-healthy) fat intake. Try and aim for 1 portion per week.
- Wholegrains. Following a low carb diet does not mean you need to follow a ‘carb-free’ diet. You can still enjoy grains, ideally wholegrain, in moderation, and keep your total carbohydrate intake below 130g per day.
Diabetes UK and the American Diabetes Association both have some fantastic meal plans for people on a low carb diet, with more information about portion sizes.
Low GI diet
Another approach that many people choose to take to manage their diabetes naturally is to eat a low-GI diet. There is a large body of evidence supporting the efficacy of a low GI diet for improving blood sugar levels and achieving and maintaining weight loss.
In this large European study, over 1200 adults were screened from 8 countries within Europe. After the initial low-calorie phase of the diet, 773 people progressed to the maintenance diet stage. The participants were assigned to varying different diets, including a low protein and high GI diet, and a low GI, high protein diet. Of these participants, 548 completed the intervention (71%), strengthening the results of the study.
The study concluded that it was the latter type of dietary pattern which led to the best rate of weight maintenance, as well as completion rate of the study. Interestingly, only the low protein, high GI diet was associated with significant weight regain. This helps to support the evidence around the satiating effect of dietary protein, as well as the impact low GI can have on maintaining weight loss.
In addition, this review study also supports the positive impacts of following a low GI diet on both weight loss and improving insulin resistance. Among its conclusions were that studies that focused on low GI diets, based on high quality carbohydrates, consistently led to health benefits for patients.
The GI, or glycaemic index, of a food is a way to rate foods that contain carbohydrates. The GI of such foods is determined based on how quickly, or slowly, they are absorbed into the bloodstream.
GI is represented by a number, somewhere between 0 and 100. Pure glucose has a GI of 100 and is frequently used as a reference to help rate other foods. The number indicates whether your blood glucose levels are likely to be impacted slowly, moderately, or quickly (like for pure glucose) by a particular food.
Foods that are rich in carbohydrates and are broken down and absorbed quickly by your body, are called high GI foods. These foods can cause your blood glucose levels to increase rapidly.
If you are following a low GI diet, you should aim to have these following high GI foods and drinks less frequently:
- Sugary drinks
- Sugary foods such as very sweet desserts, jam and marmalade
- Sweetened hot drinks and cereals
- White bread, pasta and rice
Low GI foods are generally classified as having a GI of below 55. Foods that are classified as low GI include:
- Most fruits and vegetables
- Unsweetened milks
- Some wholegrain breads and cereals.
Whilst there are some basic principles to follow when you are eating a low GI diet, it is important to know that other things can affect GI too. How you cook the food, the fat content and the overall mix of foods on your plate can all impact the GI of your meal. In this article, the potential pitfalls are explored in a bit more detail.
Natural remedies for diabetes
Whilst it is not recommended to control your diabetes solely with supplementation, many people choose to use supplements to help control their blood glucose levels. These supplements may include vitamins, herbal supplements or probiotics.
Always consult a doctor or registered nutrition professional before taking a supplement, and ensure you disclose any use of them to your specialist team.
One supplement that receives a lot of attention is magnesium. Magnesium deficiency is common among people with diabetes (12). This is thought to be due to the losses from urine as a result of frequent urination, caused by high glucose levels.
Low levels of magnesium in the blood can also affect your insulin sensitivity (13), so you may want to keep an eye on your levels when you have diabetes.
Supplementation may not be recommended routinely, although studies have shown that if you are magnesium deficient, topping up your levels can lead to better blood sugar control.
You can also increase the magnesium in your diet by including more magnesium rich foods.
Vitamin C has also been in the spotlight recently when it comes to diabetes management. In this study conducted in Australia, significant improvements to glycaemic control were seen alongside vitamin C supplementation. The mechanism for these improvements is not fully known, meaning we should interpret with caution, although nevertheless, the study did have a number of strengths.
Another exciting area of research in the diabetes world is probiotics. In 2019, a study protocol for a systematic review was launched, which will seek to clarify the evidence for probiotics as part of the treatment for hyperglycaemia in diabetes. Whilst the authors highlight some existing research supporting the use of probiotics in diabetes, there are also areas of confliction.
In this review of the literature on curcumin and type 2 diabetes, it was recognized that there is a body of evidence showing the benefit of this supplement on glycaemic control in animals. Whilst the authors recognized that more research was needed, and that animal studies cannot be translated to benefit in humans, curcumin is one to watch.
Challenges for diabetes remission
Evidence shows us that reversing diabetes, although it can also be challenging to achieve. Sustaining dietary and lifestyle changes to achieve significant weight loss is difficult for the majority of us, due to the strength of our habits, a lack of support networks, knowledge gaps and the mass of conflicting information out there.
For those who have developed type 2 diabetes, a calorie-restrictive diet and regular physical activity are usually not part of their daily habits.
A significant diet and lifestyle changes need to be made. In order to make these changes, you need to be motivated, and you will have to work hard.
In order to return to normal liver insulin sensitivity levels, you will need to reduce liver fat content. Type 2 diabetes can be frustrating because it can continue to progress despite treatment with medications to lower blood glucose levels.
There are many obstacles to overcome, including:
- insulin signaling defects, glucose transporter defects
- lipotoxicity (toxicity of fat within the body)
- beta-cell dysfunction (which is dysfunction of the insulin-producing cells of the pancreas due to amyloid protein being deposited in pancreatic cells called islets)
- oxidative stress
- excess fatty acids
- lack of incretin effect
These changes do not happen overnight, so you will need to be patient as well. Results may not show up right away, but that does not mean that positive changes are not occurring within your body. The reward is not immediate, but it is worth it.
The advice to consult your specialist team remains, as they are likely to have a wealth of information that could help you. They will be able to support you with your decision making and maybe even direct you toward more support networks.
In the modern age we live in, much of this support is going online, making it easier than ever to connect with people in the same situation as one another. If you’re interested in making some health-promoting changes to your lifestyle, perhaps some of the areas covered in this article may be a good place to start?