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Reversing Type 2 Diabetes

by Christopher Case, M.D.

It is that time of the year again to set New Year’s resolutions. These often include losing weight, eating healthy, and exercising. If you are an individual with type 2 diabetes, improving blood glucose levels may be one of your resolutions.

First, and foremost, talk with your health care provider, licensed dietitian, or certified diabetes educator to make sure that any diet or exercise regimen is safe for your medical conditions. The internet can be a good resource, but it is important to remember that quality information comes from peer-reviewed scientific journals rather than opinion articles.

Can you really reverse Type 2 Diabetes?

Yes, reversing type 2 diabetes is possible and may be defined as “being able to stop all medications and keeping glucose levels in a normal range.” Recent published studies confirm what we have observed here in practice: people with type 2 diabetes enrolled in a medically supervised weight loss protocol can reverse diabetes and decrease the need for medications. It has been shown that the pancreas and liver—two organs central to blood glucose control—improve in function after weight loss. Other studies show that weight loss via a medically supervised very-low-calorie regimen have similar results as bariatric surgery, but without the risk of surgery.

Not only do patients see improvement in type 2 diabetes, but also other conditions such as high cholesterol, high blood pressure and sleep apnea. Fortunately, an individual may also save money with discontinuation of oral medications and perhaps insulin. Weight loss may lower the risk of heart and kidney problems along with a reduced risk of early death.

So, what should you eat?

Scientists at the NIH have convincingly shown that weight loss is achieved by a reduction in calorie intake, whether a low fat or a reduced carbohydrate diet. It is adherence to caloric reduction and consistency of the selected dietary pattern that is most important rather than percentages of macronutrients in fats or carbohydrates. These studies also show that even with long-term commitment to behavior changes, risk of weight regain exists.

Discuss healthy eating habits with a licensed medical professional and consider a target number of calories per day that would enable weight loss. Check out NIDDK’s The Body Weight Planner to get an estimate of caloric intake for weight loss. Also, discuss with your provider any vitamin or mineral supplements—most of the time these are not necessary with a balanced dietary pattern. Finally, even with weight loss of 3-5% of body weight, glucose and cholesterol levels may improve, and often quality of life improves.

The American Diabetes Association suggests eating a wide variety of non-starchy vegetables, at least half your plate for lunch and dinner, plus a quarter plate size portion of lean protein and whole grains or beans. It is recommended to minimize sodium intake and try to obtain as few calories as possible from beverages. Snacks are often not necessary, but could include berries, light cheese or yogurt, or a small portion of almonds. Another goal is to consider higher-fiber intake: aim for 25-30 grams of fiber daily from whole foods. Try to minimize ultra-processed foods and reduce portion size. Any food may be enjoyed in moderation, but all calories count.

What about exercise?

Unfortunately, exercise alone has not been shown to consistently cause weight loss, however it is essential for heart and mental health, reducing blood glucose levels, and weight loss maintenance. If your health care provider agrees, then you could exercise at home or the gym, inside or outside, aiming for 150 minutes per week of moderate intensity exercise such as walking. These minutes may be divided into 30 minutes 5 days a week or even smaller, more frequent intervals. Adding muscle strengthening exercise is also beneficial to avoid muscle loss associated with aging. For people with diabetes who experience high blood sugar levels after a meal, exercise afterward can help lower glucose spikes.

Let us turn the calendar to 2021—hopefully a better year—keep these important resolutions to put diabetes into remission.