Just Read: Reversing Type 2 Diabetes (It’s Possible and a Choice for Patients) – A Narrative Review of the Evidence

2018.05 Low Carb and Low Carbon - Ted Eytan MD-1001 660
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001 660 (View on Flickr.com)

(A) Mean changes of hemoglobin A1c (HbA1c) from baseline to last published date for each study retrieved to represent the three methods of reversal; (B) mean changes of weight from baseline to last published date for each studies retrieved to represent the three methods of reversal. Note: We chose these three studies to represent the three methods of reversal based on publication date and relevance to diabetes reversal. Note that baseline characteristics differ. Surgery trial examined by sleeve gastrectomy and Roux-en-Y gastric bypass separately and were represented as sleeve and bypass in the graph. Surgery: STAMPEDE [34,35]. Low-calorie diets (LCD): DIRECT [65,66]; carbohydrate restriction (LC): IUH [99,107].Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ, Hallberg SJ, Gershuni VM, et al. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients [Internet]. 2019 Apr 1 [cited 2019 Apr 2];11(4):766.

When I went to medical school, I was taught that diabetes is an incurable, chronic disease, a part of human existence that we could only prevent from getting worse.

The percentage of people with diabetes when I was taught with was also a fraction of what it is today:

2018.10.24 Low Carb and Low Carbon 571
2018.10.24 Low Carb and Low Carbon 571 (View on Flickr.com)

Now, in this century, we realize we can’t cure diabetes, but we can reverse it and put it into remission.

This is an excellent review paper with the state of the science and the point made that there are three ways to reverse diabetes today:

  • Bariatric Surgery
  • Low Calorie Diets
  • Low Carbohydrate Diets

In medical practice, surgery and low calorie diets have the attention in conventional practice (for now, that’s changing)

The current body of evidence suggests that bariatric surgery is the most effective method for overall efficacy and prolonged remission, even though concerns associated with surgical complications, treatment cost and complete lifestyle modification after surgery remain challenges for wide adoption of this approach. While both the LCD and LC dietary approaches are convincing for reversing diabetes in the short term (up to two years), long term maintenance of diabetes remission is still unproven. There are limited available data supporting long term maintenance of weight loss and its associated glycemic improvements in response to LCD; similarly, long-term adherence to a low carbohydrate diet will likely remain an obstacle without the development of proper patient education and optimal support for long-term behavioral change. Moreover, research in understanding the mechanism of diabetes reversibility in all three approaches and its overlapping mechanistic pathways are lacking; this is an area for future research emphasis.Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ, Hallberg SJ, Gershuni VM, et al. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients [Internet]. 2019 Apr 1 [cited 2019 Apr 2];11(4):766.

We’re speaking of Type 2 Diabetes

Reminder that we’re speaking of type 2 diabetes here, which accounts for 90-95% of people with diabetes, and is usually the data that’s cited. We cannot reverse type 1 diabetes; however, patients, families, and their doctors are doing amazing work to make living with type 1 diabetes much more manageable with diet. (see: Just Read and Just Visited: Duke Diet and Fitness Center and Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet – More reasons I love this century

Reference

Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ, Hallberg SJ, Gershuni VM, et al. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients [Internet]. 2019 Apr 1 [cited 2019 Apr 2];11(4):766.

Image used under a CC BY 4.0 license.

Potential Conflicts of the Authors

S.J.H. is an employee and shareholder of Virta Health, a for-profit company that provides remote diabetes care using a low-carbohydrate nutrition intervention, and serves as an advisor for Atkins Corp. V.M.G. has no conflicts of interest to declare. T.L.H. is an employee of Virta Health. S.J.A. is an employee and shareholder of Virta Health.

Images and text used under CC-BY-SA license

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