Reversing Diabetes

It is a Proven fact that Type 2 Diabetes (T2D) is Reversible.

If you have had T2D for four years or less there is a very good chance, up to 10 years an even chance but beyond 10 years it is very difficult to get rid of T2D.

Anyone that has had diabetes for six months is almost certain to get rid of their diabetes if they lose 15 kg of weight. On the other hand if you have had diabetes for 15 years you will certainly feel a lot better and probably dramatically improve control of blood sugars but not get rid of T2D completely. If you are on insulin you will almost certainly be able to stop insulin.

Here is how the liver and pancreas normally work to control your blood sugars;
1. The pancreatic hormone, Insulin [produced by Beta cells], lowers glucose (blood sugar) levels in your blood and increases stores of sugar as glycogen and fat in the liver.
2. The pancreatic hormone, Glucagon [produced by alpha cells], raises blood sugar by converting the livers glycogon and fat stores into glucose to give to fuel the bodies cells.

When levels of blood sugar rise, either from the result of eating food or the release of glucose from the liver, Beta cells release insulin which cause the liver to store more glucose into glycogen and increase the uptake of sugar from the blood into the muscles cells and fat tissue.

When levels of blood sugar fall Alpha cells in the pancreas releases glucagon which go to the liver to stimulate the liver to break down glycogen into glucose which is released into the blood.

T2D is primarily due to decreased levels and decreased sensitivity to insulin (Insulin Resistance or IR) so less sugar is stored in the liver and muscle cells and therefore more has to be stored as fat.

Common symptoms of T2D include;
increased thirst, frequent urination and unexplained weight loss. Symptoms may also include increased hunger, tiredness and sores that do not heal.

Everything that you eat goes to the liver to be processed and converted into fat and glycogen (glucose) stores which it then releases into the blood. A tiny amount of sugar comes directly from food (which is higher after meals) but the liver is pumping sugar into the blood all the time as needed.

The liver does not care if you are eating a high carbohydrate, high fat or a high protein diet. It can deal with any of these macronutrients but there is one thing your liver can not deal with and that is excess calories over a long period of time. If you are eating excess food, just an extra mouthful a day over many years, then the amount of fat inside liver cells will gradually build up although at different rates in different people.

If that happens the level of sugar in the blood is going to rise very slightly within the normal range and you’ll make more insulin to try and control that. But insulin will actually stimulate the liver to turn any food into fat and the fat tends to be stored inside the liver cell. This excess of calorie intake results in higher blood sugar [although still in the normal range] which stimulate the beta cells to produce insulin. Normally this will switch off glucose production by the liver but of course that depends upon the liver being sensitive to the insulin. If fat levels inside the liver are already a little high this will lower the liver insulin responsiveness so that more glucose will be released for longer and again stimulating more insulin production. Fasting sugar levels are then going to tend to rise. 

T2D is the most common metabolic disease in humans. If something is this common then the cause has to be simple. It is simply the amount of fat in the liver which determines what your fasting blood sugar level is. If the fat in your liver is too high you can then develop T2D whether your body is fat or not. You do not have to be obese or have a high BMI level to have T2D. Some people are more susceptible to calorie excess than others.

The liver makes fat and passes it out to the rest of the body as a very low density lipoprotein. This triglyceride will be delivered to all tissues in the right amount and excess will get stored in fat cells under the skin which is where the majority of your body fat is stored. The problem arises when at some point these subcutaneous tissue stores become full. This varies widely between people and the lucky ones can store vast amounts. Other people have to store any excess as abdominal fat and fat inside the organs such as the liver and pancreas. This will cause the insulin producing Beta cells to stop responding to sugar so you have no acute insulin response after a meal. Glucose levels will rise after meals and will be turned into fat within the liver in susceptible people. This means more fat arrives at the pancreas damaging the insulin producing beta cells. The liver spinning first then the pancreas switches on and they interact and grind miserably on for probably decades until you get T2D. 

For a while it was assumed that abdominal fat provided fat directly to the liver that was producing more triglyceride by the liver. Detailed studies of abdominal fat compared with fat inside the organs, especially liver fat, shows very clearly that the liver fat is the problem, not abdominal fat. The vast majority of fatty acids produced by the liver are actually coming from the fat stores under the skin and not the abdomen. 

So abdominal fat is not the main problem but the waist circumference measurement and BMI readings are still enormously useful as it is a way of measuring excess fat in the body. It is not important what your BMI or waist size is compared to other people. It is what your waist size is, compared to what it was, when you were young and had not yet accumulated fat. To get rid of T2D you must reduce BMI by 3 points whether you have a high or low BMI as different people have genetically different BMI’s even when they were young.

Muscle insulin resistance (IR)
IR is the earliest metabolic feature of T2D. If people have a genetically low sensitivity to insulin in the muscle they are likely to develop diabetes in the future. Exercise can only slightly improve insulin sensitivity. However, you can improve IR drastically if you lose substantial weight because that is how to reduce liver fat. You must find the easiest way for you to restrict your total food/calorie intake to lose 15kg to get rid of T2D. This will improve liver insulin sensitivity in 7 days but muscle insulin sensitivity is not changed even 8 weeks after the start of the diet because it is more determined by genetics. In the general population insulin sensitivity in muscle is quite wide and also in diabetic patients the range is wide and entirely within the normal range. Most people with low IR are not diabetic. If you happen to have genetically low muscle insulin sensitivity you will have a tendency to turning food into fat in your liver after every meal. If your weight stays constant your liver is dealing with this. But if you give your liver excess calories your liver has to convert it to fat.

So if you are a person that does not have a large fat storage layer under the skin you will get T2D even though you have a normal BMI. We need to know the BMI of when an individual is healthy and what it is now. No one has the same BMI as they had at 21. “Why have I got diabetes? All my friends are fatter than me and they don’t have it.” It is Genetic luck. You are susceptible at a lower level of fat than most people. The only way for them to get rid of their T2D is to lower the level of fat in their body towards the level when they were 21 years old. If you have T2D you have exceeded your personal threshold.

Beta Cell Plasticity;
Some people have resilience to the attack by fat and glucose on their beta cells. If you lose sufficient weight and still have not got rid of diabetes then sadly your beta cells were relatively non-resilient and more susceptible to being permanently damaged by the fat attack.

Studies show Beta cells will respond badly to excess fat but will show some recovery afterwards. Beta cells can lose their capacity to produce insulin. Some of the beta cells turn into alpha cells and therefor they produce glucagon. This is why glucagon levels are raised in T2D. Some cells go back to producing no hormones at all. If you take away this metabolic stress, cells can return to being beta cells provided they have not been suppressed for too long. Beta cells are excellent detectors of glucose levels in the blood and can be overwhelmed by high glucose levels, more with some people than in others.

Diet;
Losing weight slowly with calorie restriction does not generally work. What is needed is severe calorie restriction of 1800 calories per day or less and a diet that is nutritionally complete, including protein. 1800 calories a day is a reasonable level to aim for and a way to produce rapid weight loss. You can use a liquid calorie diet over a short period of time. This can reduce the stress of trying to decide what to eat and how much to eat as can happen with slow weight loss diets where eventually you will just go back to what everyone else is eating around you. This liquid diet needs to be combined with low starch vegetables to help the digestion and give you something to chew and prevent constipation. 

To lose weight you must severely restrict calorie intake then gradually increase calories to have a soft landing. Your friends and family may have a higher threshold  of tolerance to calories so when you go back to a non weight loss diet you need to eat for your threshold and not eat the same as everyone around you.

Normal diet ideas after losing weight;
1. Some people go well on a Mediterranean style low carbohydrate diet.
2. Others may just cut back on carbohydrates. Avoid potato, rice, pasta and bread. For example you can reduce carbohydrate food sizes to one medium sized potato [not 3] or only one palm full of rice or pasta instead of a whole plate.
3. If you are not hungry in the morning you can avoid eating before midday if that suits you.
4. Some people have low calorie days once or twice a week.

Physical activity;
Do not start a new exercise programme while trying to lose weight. People who have already eaten themselves into 15kg of excess weight over the years and are middle aged are particularly prone to compensatory eating. That’s why you join a gym but find that your weight does not change.

The best way to maintain weight and prevent the regain of weight over the following years is to make sure you have an increase in daily activity built into every day life. Something that will use calories so it needs a descent amount of exercise time. A long duration activity like walking.