Until recently, type 2 diabetes was mainly treated by controlling risk factors such as high blood pressure, cholesterol, and blood sugar (glucose) levels, usually through prescription medication. But this approach doesn’t address the underlying causes of type 2 diabetes, such as problems with the hormone insulin, which is no longer effectively controlling blood sugar.
Taking medication can help control blood sugar levels, but it does not help explain the biological causes of type 2 diabetes. A growing body of research shows that weight loss, either through surgery or diet, can help combat some of the underlying causes of type 2 diabetes. It does this by helping the body control blood sugar levels. This is important because controlling blood sugar by improving insulin production and function is key to remission from type 2 diabetes.
Most of this research so far has focused on the use of meal replacement shakes to help people with type 2 diabetes, which is why this approach may be prescribed by a doctor. More recently, however, researchers have begun studying other diets, such as low-carb diets, to help achieve remission. Although research in this area is still ongoing, study results so far have shown that a low-carb diet holds promise. To better understand which diets best help people achieve type 2 diabetes remission, in our most recent review we examined over 90 publications describing the effects of different diets on type 2 diabetes. We found that while higher quality research has focused more on shakes than meal replacements used in clinical trials, other approaches (such as low-carb diets) have also proven to work well.
Our review found that a meal-replacement diet helped about one in three people achieve successful remission, while a low-carb diet helped about one in five people achieve remission. People who lost weight on both diets could remain in remission for up to two years if they maintained their weight loss. Low-calorie and Mediterranean diets could also help people achieve remission, but at much lower rates. Only about 5% of people on the low-calorie diet remained in remission after one year, while only 15% of people on the Mediterranean diet remained in remission after one year.
Defining Remission One of the major challenges in writing our review was defining what remission is. Knowing how to define it was important so we could understand which diets would best help achieve remission. This was difficult because the definition varies between different groups of experts and research studies. Most define remission as a decrease in blood sugar levels below the range to diagnose diabetes, but some definitions say it must be done without the use of medication while others do not. Other definitions state that weight (especially mid-range fat) must be lost in order to achieve remission.
Another challenge in defining remission was that some reports suggest that a low-carb diet can normalize blood sugar levels even without weight loss. This happens because the carbohydrates we eat are broken down into sugars, causing our blood sugar levels to rise. A low-carbohydrate diet means that less blood sugar appears in the bloodstream, which leads to improved blood sugar control. For this reason, we initially defined remission based on the definition used in each study. Then we compared the number of people whose blood sugar levels had normalized without medication for at least six months, which is considered by most to be true remission.
Decrease vs. Remission While a low-carb diet helps people achieve remission, there is concern that blood sugar levels may rise again as more carbohydrates are consumed. For this reason, in our review, we suggest calling this not remission, but perhaps amelioration of diabetes, since type 2 diabetes is still present but the negative effects are well managed. We believe that remission can only be achieved when fat is lost from around the organs. This allows insulin to be restored and used effectively. However, since carbohydrates are also an important source of energy in our diet, consuming less of them often results in lower caloric intake, which typically leads to weight loss. So if someone can stick to a low-carb diet over the long term, not only will they lower blood sugar levels and the risk of complications for their diabetes, but they can also achieve remission.
Regardless, the evidence we examined in our review made it clear that there are many ways that a person can significantly improve their blood sugar levels through diet, and that in many cases this can lead to remission. The most important thing that we have found with any diet is that at least 10-15 kg of body weight must be lost in order to achieve remission. Although weight loss appears to be the best predictor of success, it does assume fat loss from the pancreas and liver. For future studies, it will be important to compare how these diets work for different races, as type 2 diabetes can occur with lower body weights in different races who may have less weight to lose.
Not everyone can achieve remission, but people who are younger (under 50), male, have had type 2 diabetes for less than six years, and are losing more weight are more likely to be successful. This could be because these people are able to reverse the causes of their diabetes by restoring more of the pancreas’ ability to make insulin and the ability of the liver to use it. However, this does not mean that others will not succeed in improving their diet, lifestyle, and losing weight. Whether or not a person achieves remission, lowering blood sugar levels is important in managing the negative effects of type 2 diabetes and reducing the risk of complications. But when it comes to choosing a diet, the most important thing is to choose one that suits you and that you are likely to stick with for the long term
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