While doctors have known for years that weight loss can not only prevent diabetes but sometimes reverse it, recently Taylor has found new clues as to why.
Type 2 diabetes, he says, “is simply due to too much fat inside the liver and pancreas of people who happen to be susceptible to the fat-induced damage.” Losing a substantial amount of weight can kill off that fat, often allowing the organs to work again, including a return to normal insulin production by the pancreas.
Behind the Weight Loss Advice
In an earlier study, Taylor’s team assigned 149 patients to the strict weight loss program and another 149 to usual care such as treatment with medications. Most were diagnosed within the previous 6 years before the start of the study.
After a year, only 4% of the usual care patients had remission of the diabetes, but 46% of those on the weight loss program did. The more they lost, the higher the chances of reversal. While 7% of patients who lost less than 11 pounds went into remission, 86% of those who lost 33 pounds or more did, Taylor found.
In general, “remission” in diabetes means a person’s blood sugar levels remain normal. While some refer to this as a “cure,” diabetes is not a “one and done,” disease. That is, it could always return if the patient regains the weight or returns to unhealthy habits. In 2009, a group of diabetes experts wrote that “remission” is a term used when a person has normal blood sugar levels for one year without therapy or surgery.
The new research ties in with recent thinking among experts about what happens when type 2 diabetes develops, says Domenico Accili, MD, chief of endocrinology at Columbia University Vagelos College of Physicians and Surgeons. “We have been talking for some time, that in diabetes, primarily type 2, the insulin-producing [beta] cell is not dead but simply inactive,” he says. “If you put patients with diabetes on a diet, you can do marvels with their beta cells.”
Taylor’s research, and that of others, suggest that lifestyle modification, such as weight loss and exercise, may have a larger impact on diabetes than experts had thought, Accili says.Prompt weight loss as soon as possible after the diagnosis can definitely turn people around, agrees Matthew Freeby, MD, an endocrinologist and director of the Gonda Diabetes Centers at UCLA Medical Center, Santa Monica and Westwood, CA. He agrees with Taylor’s advice.He emphasizes lifestyle changes and weight loss as a first step. “We give them a 3-month trial of diet and lifestyle [modification] before starting medications,” he says. “A lot of times, for many patients newly diagnosed, we will see the sugars melt back into the normal range” after the weight loss and other changes. He has seen it happen after a weight loss of 7% to 10% of their starting weight.While that’s great news, Freeby warns that the effort is never done: “Once someone rises that high, they are always at risk for their sugars rising again.” Weight maintenance becomes critically important, he says.Maher says the effort to maintain the weight loss is constant and tremendous, but worth it. “I keep to a very, very low-carb diet,” he says. “No pasta, bread, rice or potatoes.” But he did indulge a bit to have ”a few glasses of bubbly” at his 70th birthday bash, he says.