A diagnosis of type 2 diabetes can be scary, and the thought of living with the condition forever can feel like a huge weight that just cannot be released. If you or someone that you love is dealing with this, then you have probably wondered if it is possible to reverse or cure diabetes. The answer, unfortunately, is a not clear cut one. Before I explain why that is, let’s start with an overview of this common health condition. If you prefer to listen to this article, click here.
Introduction
Type 2 diabetes (which I will refer to as just diabetes moving forward) affects over 425 million people worldwide, or about 8% of the global population. Here in the United States, an estimated 30 million people are living with the condition – that’s 10% of the population. An additional 88 million US adults, about 1/3 of the adult population, have pre-diabetes. People with pre-diabetes are at a high risk of eventually developing diabetes. While the number of adults being diagnosed with diabetes has been pretty stable and even in a slight decline for the last decade, rates among children are on the rise.
While the number of adults being diagnosed with diabetes remains stable, more and more children are developing the condition every year.
Diabetes is characterized by elevated blood sugar levels and insulin resistance. When blood sugar levels remain high for an extended period of time, this can cause damage to the body in a number of ways, including kidney damage, nerve damage, vision problems, and more.
So, is a diagnosis of diabetes a life sentence of taking medications every day for the rest of your life? It’s not! It is possible for diabetes to be in remission, which means that a person can live normally without any clear signs or symptoms of the disease affecting them in their daily lives.
Feel free to not contain your excitement.
Experts use at least two criteria to determine if diabetes is in remission:
A Hemoglobin A1c (HbA1c) below 6.5% and,
The ability to forgo diabetes medications for at least a year while maintaining a fasting blood glucose of <100 mg/dl [5.6 mmol/l]
Now the big question is, how does one achieve diabetes remission?
A quick internet search suggests that there are many ways to “cure” diabetes. Everything from moringa leaves to nopal have been touted as ways to keep blood sugar permanently in check, but let’s see what the data has to say.
Research on diabetes reversal has largely focused on three areas:
Calorie-restricted diets
Low-carbohydrate diets, and
Surgical interventions
Let’s start with calorie-restricted diets.
Topic 1: Calorie-restricted diets
Low-calorie diets (LCD) have been studied as a cure for diabetes since the 1970s with positive results, including lower blood sugar levels, improved insulin resistance, and reduced medication use. The benefits of LCD are largely a result of weight loss. Sadly, a majority of the study subjects were not able to keep the weight off in the long-term - and this is not their fault.
In these studies, weight loss was achieved by reducing caloric intake to under 1000 calories a day. Imagine eating just 3 digits of calories per day for months on end! This is less than what a 4-year-old child needs to eat in a day, so it is no surprise that people found it hard to eat this way for more than a few months. In some cases, just 2-10% of study participants remained in remission after 1-4 years of following a calorie-restricted diet, while other studies have shown a 46% remission rate after one year. There is a lot of variety in the outcomes that people see while on these diets, and I will explain why later on.
Eating so few calories that your plate of food matches a child's can reduce blood sugar, but it is also really, really hard to maintain.
It is important to note that the results of these diets do not all fall into the positive category. Staying on a LCD in the short-term undeniably benefits blood sugar, but it could potentially create more long-term problems associated with not getting enough vitamins and minerals. Another potential consequence is rebound weight gain, which is always a concern after severe calorie restriction. Because there are no long-term studies looking at these outcomes specifically, it is unclear if very low-calorie diets are a remedy, or just a pathway to more problems later on down the road.
Topic 2: Low-carbohydrate diets
When most people think of diabetes, they think of sugar and carbohydrates. This makes sense, especially when you consider that reducing carbohydrate intake was the main approach to managing diabetes before insulin was discovered in the early 1900s.
Instead of severely reducing calorie intake altogether, these diets target intake of carbohydrates, limiting intake to under 130 grams per day. Such diets are now considered standard for diabetes management.
Researchers testing the possibility of achieving diabetes reversal however, not simply management, usually aim to reduce carbohydrates to the point of forcing the body into ketosis. This is a state where the body switches from glucose as its main energy source to fat, and ketones are the byproduct of this transition. In essence, research subjects are put on a very strict keto diet.
Fun fact: ketones can change the way your breath smells, giving it a fruity or metallic scent.
To achieve this, carbohydrate intake has to be really low, like about 20-30 grams per day. So, just a single bowl of cereal would send you past that limit.
While these diets can be tough to stick to, people have found positive results with this approach. Lowered HbA1c%, body weight, medication use, and insulin have all been observed after a minimum of 6 months in 55-95% of patients. However, follow up studies beyond the two-year mark are lacking. Without such studies, it is hard to know if these benefits are sustainable over time.
Topic 3: Surgical interventions
Bariatric surgery is an evidence-backed way to improve blood sugar levels very quickly, oftentimes within a matter of hours. Common options include the sleeve gastrectomy (SG) and the roux-en-Y gastric bypass (RYGB).
While these procedures are considered safe, as is the case with any type of surgery, they are not risk free, nor are they cheap. These surgeries are normally only prescribed for people with diabetes who are at a body mass index (BMI) of 40 or higher, or for those who are at a BMI between 35 and 40 with at least two conditions related to carrying excess weight on their bodies.
Bariatric surgery is incredibly effective for reducing blood sugar, but it isn't for everyone.
Short-term studies are promising, but in the long-term, after a decade or two, the effectiveness of the surgery may decline. Studies suggest that 20-80% of patients remain in a state of improved diabetes symptoms 5-10 years after surgery. Now, this wide range may seem a bit hard to interpret, and rightfully so. This is because every person who undergoes surgery comes with their own unique set of health and lifestyle factors which dictate in large part what their outcomes will be, and those will be discussed in a little bit.
Conclusion
The most up to date research suggests that calorie-restricted diets, low-carbohydrate diets, and bariatric surgery are all useful interventions for getting diabetes under control. However, even with these interventions, is it not appropriate to say that diabetes has been reversed or cured. The preferred term is remission. This jargon matters because the reality is that diabetes doesn’t exactly go away, and symptoms can crop up again if proper lifestyle and behavioral changes are not kept in place (or if something else goes wrong).
How likely someone is to achieve remission depends on a number of factors. Those who are most likely to see their diabetes go into remission are people with:
A lower BMI,
Who are relatively young,
Have never had to use insulin therapy,
Have high C-peptide levels (which is an indicator of how well your pancreas is producing insulin),
And have had diabetes for a short period of time with pretty much no complications.
If you have diabetes, be sure to follow your care team’s recommendations when it comes to taking medications, following a diabetes-friendly diet, checking your blood sugar, staying active, and getting regular eye and foot exams. It is a hard road, but it is definitely one that is worth traveling. If you have prediabetes and would like to get some help getting your blood sugar down, use this link to get in touch with me for a free discovery session. I would love to get to know you and see how we can work together to get your health to a better place!
If you learned anything new or think that someone you care about could benefit from this information, share this article, and subscribe to the blog for regular updates on commonly asked nutrition questions.
Enjoy today!
References:
Buse, J. B., Caprio, S., Cefalu, W. T., Ceriello, A., Del Prato, S., Inzucchi, S. E., . . . Kirkman, M. S. (2009). How do we define cure of diabetes? Diabetes Care, 32(11), 2133-2135. doi:10.2337/dc09-9036
Centers for Disease Control and Prevention. (2019). National Diabetes Statistics Report. Retrieved December 13, 2021, from Center for Disease Control and Prevention website: https://www.cdc.gov/diabetes/data/statistics-report/index.html
Cohen, R. V., Shikora, S., Petry, T., Caravatto, P. P., & Le Roux, C. W. (2016). The Diabetes Surgery Summit II Guidelines: a Disease-Based Clinical Recommendation. Obes Surg, 26(8), 1989-1991. doi:10.1007/s11695-016-2237-6
Hallberg, S. J., Gershuni, V. M., Hazbun, T. L., & Athinarayanan, S. J. (2019). Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients, 11(4), 766. doi:10.3390/nu11040766
Pietrangelo, A. (2021, October 20). The Effects of Diabetes on Your Body. Retrieved December 13, 2021, from Healthline website: https://www.healthline.com/health/diabetes/effects-on-body
Westman, E. C., Yancy, W. S., Jr., & Humphreys, M. (2006). Dietary treatment of diabetes mellitus in the pre-insulin era (1914-1922). Perspect Biol Med, 49(1), 77-83. doi:10.1353/pbm.2006.0017
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