For reasons that are complex and beyond the scope of this article, many people do not realize that it is possible to reverse type 2 diabetes mellitus (T2DM) solely by utilizing behavioral and lifestyle modifications, such as the implementation of consistent habits around nutrition and exercise. To get my opinion on these complexities, you can glance through my Caveats and Perspectives on the Politics of Medicine and The Functional Medicine Philosophy.
All to often, in conventional medicine, the patient with T2DM is sold on the idea that they will need to rely on lifetime support with pharmaceuticals, most commonly, synthetic insulin and / or glucose-regulating drugs such as Metformin. If the patient is fortunate enough to be informed by the conventional practitioner, regarding the significant impact that nutrition and exercise may confer upon their state of health, a secondary problem arises, whereby they are not guided and coached in the art of accountability and how to reach their wellness goals. Were you aware that it is possible to reverse diabetes solely with lifestyle modifications? Let's take a look at some recent research.
The 2020 DIADEM-I randomized controlled trial [1] out of Qatar assessed 147 diabetic patients from the Middle East and north Africa region. These trial participants had a diagnosis of early T2DM, having been diagnosed within three years or less, age range between 18-50, and with a BMI of at least 27 (according to the BMI chart for adults, a BMI of 27 is classified as overweight for most individuals).
The goal of the trial was to discover if intensive lifestyle intervention (ILI) was sufficient to result in significant loss of excess weight and improved blood glucose levels. The primary outcome measured was weight loss after 12 months of receiving the treatment protocol. Secondary outcome measures included control and remission of diabetes. The control group for this trial received a treatment protocol based on clinical guidelines, which means they were given conventional diabetes medications, in the absence of specific lifestyle modifications.
Participants were randomly allocated in a 1:1 ratio to either the treatment group (intensive lifestyle intervention) or the control group (standard of care with medication). Lifestyle interventions for the treatment group consisted of:
Total diet replacement phase, in which participants were given low-energy meal replacements
Gradual food reintroduction combined with physical activity support
A weight-loss maintenance phase, involving structured lifestyle support
Here are some key metrics by the 12 month timeframe of this study:
The average body weight was reduced by 11.98 kg (26.4 pounds) in the ILI group compared with 3.98 kg (8.8 pounds) in the control group
21% of participants achieved more than 15% weight loss in the ILI group compared with 1% of participants in the control group
Diabetes remission, defined as HbA1c under 6.5% [2], occurred in 61% of ILI participants compared with 12% of those in the control group
33% of participants in the ILI achieved glucose values within the normal range compared with 4% of participants in the control group
The results for the ILI treatment group were found to be both statistically and clinically significant compared with the control group. Significant weight loss was attained in the ILI group and this weight reduction was associated with remission of diabetes in over 60% and normalized blood glucose values in over 30% of the ILI participants. Phenomenal results.
The 2018 DiRECT trial out of Scotland and England [3-4] was designed relatively similar to the previously discussed DIADEM-I trial. The treatment for the intervention group was weight management, while the control group received standard T2DM management (medications). There were 149 participants in both the treatment and control groups. Specific criteria for participant's to enter the trial included an age range of 20-65, diagnosed with T2DM within the previous 6 years, a BMI range of 27-45, and no use of insulin.
Participants were randomly allocated in a 1:1 ratio to either the treatment group (with lifestyle intervention) or the control group (standard of care with medication). The primary outcomes measured were weight loss of at least 15 kg (33 pounds) and remission of diabetes, defined as HbA1c less than 6.5%. Lifestyle interventions for the treatment group consisted of:
Withdrawal of diabetes and blood pressure medications
A total diet replacement phase for 3-5 months, in which participants were allowed 825-853 kcal (Calories) per day
Gradual food reintroduction for 2-8 weeks
Structured support for long-term weight-loss and maintenance phase
Here are some key metrics by the 12 month timeframe of this study:
24% of treatment participants showed weight reduction of 15 kg (33 pounds) or more compared with 0% of participants in the control group
46% of treatment participants achieved diabetes remission compared with 4% of participants in the control group
Remission status from both groups varied with the degree of weight loss
**0 of 76 participants (0%) that gained weight achieved remission
**6 of 89 participants (7%) that maintained up to 5 kg (11 pounds) weight reduction achieved remission
**19 of 56 participants (34%) that maintained between 5-10 kg (11-22 pounds) weight reduction achieved remission
**16 of 28 participants (57%) that maintained between 10-15 kg (22-33 pounds) weight reduction achieved remission
**31 of 36 participants (86%) that maintained more than 15 kg (33 pounds)weight reduction achieved remission
The average body weight decreased by 10 kg (22 pounds) in the intervention group and by 1 kg (2 pounds) in the control group
Quality of life indicators improved by 7.2 points in the intervention group and worsened by 2.9 points in the control group
Adverse events were increased in the intervention group, but none were serious enough to result in participant withdrawal
Although the DiRECT trial witnessed a slightly lower overall remission rate than the DIADEM-I, these were still phenomenal results. The principle investigator of the DIADEM-I clinical trial is Dr. Shahrad Taheri [5], a professor out of Weill Cornell Medicine's Qatar and New York campuses. Dr. Taheri contends that his DIADEM-I trial may have resulted in a higher remission rate because the participants were approximately a decade younger, on average, and also had the diagnosis of T2DM for a shorter period of time.
Keep in mind that I used these specific clinical trials only as examples of diets leading to diabetes remission status. The specific interventions used in these trials are by no means the only way to achieve the goal. There are many variations on lifestyle habits and interventions that may lead to similar successes. For example, implementation of low-carb Mediterranean-style diets have been shown to induce diabetes remission by lowering HbA1c levels, reducing the need for diabetes medications in patients with newly diagnosed T2DM [6]. I did not find studies that concluded with T2DM remission from Paleolithic-style (PD) and ketogenic-style diets(KD). However, studies have shown that implementation of both the PD and KD resulted in improved glucose control and lipid profile, suggesting that both dietary styles have the potential to result in diabetes remission [7-8]. More studies are warranted and required to expand upon these findings. Finally, another study concludes that weight loss of 10% or greater in participants with T2DM doubled the likelihood of diabetes remission at 5 year follow-up and this was achieved without extreme lifestyle interventions or calorie restrictions [9].
If you, a friend, or a loved-one are unsatisfied with the management of T2DM through the conventional medical system, or are interested in implementing more natural approaches with the potential to carefully wean off of medications, then search for functional medicine practitioners or integrative practitioners in your area today. When searching for a practitioner, always call and ask questions of the supporting staff first, to ensure you are finding the right clinic for you.
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Disclaimer: The information within this blog is for educational purposes only and is not meant to be interpreted as medical advice, or to diagnose, treat, or cure any disease. The articles within this blog are simply a sharing of knowledge and information based on research and / or experience. If you feel the need to see a doctor for your condition, then you should definitely follow your instincts and do just that. Please do not alter your dose of any prescribed medications without the direct supervision of your healthcare practitioner. The information contained herein is not intended to replace a one-on-one relationship with a qualified healthcare practitioner. These statements have not been evaluated by the FDA.