Guest blog-Can Diabetes Type 2 Be Reversed? Experts Answer (Part 4 of 4)


(Due to the length of this article it is being presented in 4 parts-Maureen)

It is the burning question most, if not all, people with diabetes type 2 have: can my diabetes be reversed?

There is so much information, thousands of articles, home remedies that promise readers the ultimate chance to reverse their diabetes. It sounds too good to be true.

However, as with all things on the net and with our health, we must be wary of what we read and what is fed to us as information. Most articles recommend healthy eating and exercising as a way of reversing your diabetes.

These are two lifestyle changes that are easy to do if you put your mind into it. Does it work though? If it does, how can you go about doing this or where should you start? We reached out to 28 experts in the field who spilled the beans to us about the reversal of diabetes type 2 and whether it is a myth or a reality. To find out more, please keep reading.

22. Sandra J. Arevalo, MPH, RDN, CDN, CLC, CDE

Diabetes Type 2 is a condition that cannot be cured however, it can be IMPROVED.

This could happen when there is an improvement in insulin sensitivity. Diets that are high in carbohydrates (such as sweets and starchy foods, such as rice, potatoes, pasta or bread) cause weight gain, mainly around the abdominal area.

This causes the Beta cells in your pancreas to produce more insulin. The higher your insulin, the hungrier you feel, the more you eat, and the more weight you gain. Due to the already increasing amounts of insulin your body’s cells then respond to this process refusing the insulin.

This is called insulin resistance. Insulin resistance causes your blood sugar to rise. You can reverse this process by adopting a diet that is low in carbohydrates and high in fiber, weight loss, and regular exercise. Some people who need to lose more than 100 pounds might need to get bariatric surgery to help the weight loss process.

Diabetes Type 2 might be reversible but not cured because when you gain the weight back, neglecting your diet and exercise, insulin resistance attacks again.

23. Grace Rivers, RDN, LD, CDE, CHC

Type 2 diabetes can be controlled to the point where it looks as though diabetes has gone away. This is sometimes seen when someone has lost a significant amount of weight. The blood sugar levels may be in a safe category and diabetes meds may have been decreased or discontinued.

As time goes on, however, blood sugar levels can begin to rise again. Diabetes is a progressive disease which means that what is done today to care for it, may not work as well a year or two from now. A key to keeping blood sugar levels under control is to be active, watch portions of all foods, include all food groups and visit your doctor to make sure the blood sugar levels are staying at a safe level.

24. Rachel Freeman APD CDE

The answer is no, not entirely. And it depends on the cause or contributing factors to type 2 diabetes. For an older person who has developed type 2 diabetes later in life because of their family history and/or age, where their beta cells of their pancreas have deteriorated, there is, unfortunately, no way to reverse type 2 diabetes.

If however, type 2 diabetes is a result of insulin resistance and being overweight, there is excellent evidence that exercise, decreasing added sugars and saturated fats in the diet, choosing low glycaemic index foods and losing weight – particularly around the abdominal region, can improve blood glucose levels to the extent that it seems like diabetes has been reversed.

This essentially means that the type 2 diabetes is being managed at a level that seems as if the diabetes isn’t there at all. Choosing a healthy diet, exercising regularly and maintaining a healthy weight is the key. Eventually, what will likely happen is that blood glucose levels will increase again at a later time, as the person gets older, or if the person returns to an inactive and unhealthy lifestyle and regains weight because the beta cells of the pancreas have already been stressed.

The good news though is that this can be delayed, and we can do something about preventing and managing the early stages of diabetes through simple lifestyle modifications, and the body will remember these efforts if they can be maintained early in the diagnosis and for as long as possible. This in turn will delay the progression of diabetes and development of diabetes complications.

25. Jessica Crandall RDN,CDE

Diabetes once diagnosed is always in the backdrop- typically it is a progressive disease however some clients are able to prevent progression of the disease to where it is really at a halt if you are able to lose a modest amount of weight, implement healthy eating behaviors as well as activity.

For example, the DPP results showing 150 minutes of activity per week and healthy eating habits resulting in a weight loss of 5-7 % of total body weight resulted in a 58% reduction in diabetes progression.

For every 2.2 pounds of weight loss, diabetes risk was reduced by 13%.

So to clarify I don’t ever say that it is reversed but it can be in the backdrop or in remission….

26. Jenna Kress, RD, CDE

Research is promising showing Type 2 diabetes may be put into a state of remission with intensive interventive and significant lifestyle changes such as after large weight loss and strict diet and exercise. Remission of diabetes means there are no signs or symptoms of it, and blood sugars are in non-diabetes ranges without the use of medication.

However, the alternate term “reversed” often being used, may confuse people and mistake the good control of diabetes (remission) as a complete cure. Unfortunately, there is no current long term cure yet, and if one had gained back the weight they had lost or went back to old lifestyle habits, Type 2 diabetes would come back and sign and symptoms would present.

As more research continues it would be beneficial to strive for controlled Type 2 diabetes or remission, through interventions that will work for the individual for long term quality of life.

27. Alison Massey MS, RD, LDN, CDE

During the initial stages of Type 2 diabetes weight loss (if needed), as well as lifestyle changes, can sometimes but not always help individuals reduce their A1c back into a prediabetes level, however they still technically have Type 2 diabetes.

In this case, the Type 2 diabetes is managed by lifestyle modifications. Weight loss surgery is also an effective method for managing Type 2 diabetes but this doesn’t mean that the individual won’t necessarily have issues with blood glucose levels in the future especially if weight is regained.

Type 2 diabetes is a chronic disease (meaning there isn’t a “cure”) and tends to be progressive. The longer that someone has been living with Type 2 diabetes the less insulin their beta cells may be producing. This doesn’t mean that lifestyle modification is irrelevant–but does mean that individuals should work on accepting their Type 2 diabetes diagnosis so they can focus on managing their diabetes in the best way possible.

28. Meghan Jardine, MS, MBA, RDN, LD, CDE

As a registered dietitian and certified diabetes educator, I learned through formal training that type 2 diabetes is irreversible. However, as a nutrition researcher and health care provider, I see different results—in different people.

The good news is diabetes is not a static condition and a type 2 diabetes diagnosis doesn’t mean the condition will progressively get worse. Mounting research finds plant-based eating patterns can prevent, manage, and, in some cases, eliminate diabetes symptoms, significantly reducing or eliminating the need for medication and insulin.

At the Physicians Committee for Responsible Medicine, we conducted a randomized controlled diabetes trial and found participants who ate a low-fat vegan diet lost more weight, had greater reductions in hemoglobin A1C, and had greater improvements with cholesterol than the control group (those following a conventional diabetes diet).

Some in the vegan diet group eliminated the need for medications altogether, and their blood glucose numbers and A1C fell into a healthy range. These results could be classified as reversing the disease since reverse technically means to turn in the opposite direction.

How does it work?

Here are the five dietary guidelines used in the studies:

Eliminate all animal products: Steer clear from meat, fish, dairy products, and eggs.

Limit high-fat foods: Avoid added oils, pastries, fried foods, and limit olives, avocado, nuts, and seeds.

Fill up with fiber: Fill your plate with whole grains, fruits, vegetables, and legumes (beans, peas, and lentils). Aim to consume at least 40 grams of fiber per day.

Focus on low glycemic index foods: While reducing fat and increasing fiber can significantly improve insulin sensitivity, low glycemic index (GI) foods reduce after-meal blood glucose levels. Low GI foods include pumpernickel or rye bread, oats, beans, bran cereals, most fruit, and sweet potatoes, compared to higher GI foods such as white potatoes, processed foods, and cold cereals.

Take a vitamin B12 supplement: Anyone following a plant-based diet should supplement with vitamin B12. This nutrient is readily available in fortified cereals, plant-based milks, and vitamin-enriched products.

Following these five principles can significantly influence blood glucose levels. However, not everyone responds the same. Some people with have immediate low blood glucose levels. Others may experience a slow and steady improvement of glucose control. Some may have temporary high glucose levels. Our experience is that this is transient and most people will improve.

It’s important to check your glucose more often and discuss medication adjustments with your primary care provider. The important factor to remember is that, just like weight loss, the lifestyle changes need to stick. Once the animal products and high-fat foods come back into the diet, glucose levels start to rise and diabetes symptoms reappear.

29. Jayne Lehmann BN(Ed) DipAppSc(Nsg) FRCNA RN CDE

Once you have diabetes, it is there for life. I help people to get their blood glucose levels back to or as near as possible the normal range. Firstly this will help you to feel better in the short term but it also helps to protect your blood vessels which can become very irritated and damaged by high glucose levels. Focussing on healthy eating, limiting unprocessed foods and getting a wide variety of fruits and vegetables in the diet helps.

Try to keep carbohydrate amounts stable across the day (some choose lower carbohydrate targets), stand more and sit less and include activities that increase the heart rate and also strength based activities most days across the week. Think about the amount of stress you experience to see how it is increasing your blood glucose levels. If you smoke – stop because it is speeding up the damage to your blood vessels. If you drink alcohol, limit how much you drink.

Even if you aim to lose 5% of your body weight, if overweight, you are likely to see a fall in your blood glucose levels back into the normal range but even then we can’t say diabetes has been reversed or gone away. These actions build-up the body’s ability to respond to rising levels but if you get sick, eat more carbohydrate or gain some weight, more than likely your blood glucose levels will be on the rise again into the diabetes range.

It is well worth putting in extra effort when first diagnosed with type 2 diabetes because it is likely to give you a bigger health benefit for effort ten years down the track with less damage to your small blood vessels. That’s a good return on investment because after all these things are recommended for everybody if they want to be healthy!

Conclusion

Reversing diabetes type 2 does not happen overnight.

While views on how it can be reversed are many, the idea is the same: it can be reversed but cannot be cured. It is important to understand the difference between the two terms. As experts suggest above, pre-diabetes and type 2 diabetes can be made easier to control through medication, smart lifestyle choices including exercise and diet.

Reversal of diabetes means that you are off medication, however, that you are managing your diabetes by engaging in a healthier lifestyle. If you shed the extra pound, eat healthy and are active, you may no longer need the medications but you will have to keep engaging in those lifestyle changes.

We hope that this expert round table has shed some light into the topic of diabetes reversal.

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