Can Type 2 Diabetes Be "Reversed?"

This is a question a lot of my readers ask me. Their doctors may tell them that if they lost weight they'd reverse their diabetes and there are books on the market that claim the same thing.

Unfortunately, the concept of "reversing" diabetes doesn't hold up well to scrutiny.

The media version is that Type 2 Diabetes is caused by gluttony and sloth and can be prevented or cured by diet and exercise, but the truth is quite different. The research makes it it very clear that overeating doesn't cause diabetes. You can read the documentation for this HERE.

This should help you stop blaming yourself for your condition if you have Type 2 diabetes, but it also implies that if you have the underlying condition, which manifests clear clinical indicators when people with diabetic heritages are young and thin, you aren't going to cure the underlying condition with simple interventions.

But what about the studies where interventions "prevent" diabetes? Well, a lot of them turn out to be studies where a group of people with marginal blood sugars--for example an average fasting blood sugar of 123 mg/dl (6.8 mmol/L)-- do something that keeps their blood sugar at 123 mg/dl compared to another group who start out the same but end up with a blood sugar of 126 mg/dl (7 mmol/L). Because diabetes is diagnosed with strict cutoffs, and the fasting cutoff for diagnosing diabetes is 125 mg/dl (7 mmol/L), the first group "prevents diabetes" and the second develop it. The actual difference between the two groups is minuscule and they both have the same likelihood of developing diabetic complications.

This is what happened in the DPP trial that supposedly found metformin "prevented" people with pre-diabetes from developing diabetes. As soon as the study was over, when the people taking metformin stopped taking it their blood sugar rose the couple of points that put them into the diabetic range. Had they prevented diabetes? Of course not. They had controlled their marginal blood sugars a bit, which is something else entirely.

Weight loss can make blood sugar control easier, and there are studies of people who have pre-diabetic blood sugars that make it look like losing weight can "prevent diabetes." But it is worth remembering that the vast majority of the obese who have pre-diabetic blood sugars will never develop diabetes. So interventions where people with pre-diabetes lose weight and with it the insulin resistance caused by overweight may make it look like they "prevented diabetes" but the intervention may have only been effective in those people whose marginal blood sugars were caused by factors other than the genetic damage that leads to diabetes--people, in short, who would never have developed diabetes.

It is also possible that the diet "prevented" diabetes by cutting hundreds of grams of carbs out of the diet--this happens when you cut way down on food. So blood sugar did drop--while the diet was in force, but will come right back up once the diet is abandoned, as most diets are.

This appears to be the main reason that gastric bypass appears to "reverse diabetes." As I blogged earlier, the long term data do not support this claim and over time people whose blood sugars improved with WLS see them deteriorate again.

Indeed, over my eleven years of interacting with the diabetes community online I have met a lot of people with diabetes who have lost enough weight to make it into the normal BMI range who have maintained their weight loss. I did that myself. I have never met anyone with diabetes whose blood sugars became truly normal after losing weight.

Now before I get a load of email from those of you who have cut the carbs, lost a lot of weight, and now have A1cs of 5.0 and fasting blood sugars of 83 mg/dl I want to take a moment to discuss what I mean by "truly normal".

True normal to me means you can eat anything and end up with a blood sugar under 100 at 90 minutes past mealtime. My son can do that. My 93 year old mother can do that. They don't have diabetes genes and they can metabolize any amount of carbohydrate. That's what I consider true normal. Roughly one third of the population appears to have that kind of blood sugar control.

Normal people are the ones who can go on a low fat diet and drop weight without feeling hungry--and who insist we people with diabetes should be able to do the same thing. Because they really can eat bananas on their oatmeal and see completely normal blood sugars, normal people have no clue what we people with diabetes are up against. And sadly, many doctors and nutritionists appear to have normal blood sugars which is one reason they give such flawed advice to the rest of us.

But those of us who have damaged glucose regulation systems are never going to be normal by that definition. If we think we will, because that's what the doctors tell us, and deny our selves food, overwork ourselves at the gym, because of that belief, only to learn we still can't eat a single bagel at coffee break without seeing our blood sugars soar, we may end up very disappointed indeed.

I believe one reason so many people with diabetes give up after a few years of pursuing diet and exercise is because they don't see the promised "reverse" no matter how hard they work--especially if they use the low fat strategies that too many dietitians and doctors still promote.

But this is a shame, becuase while we can't reverse our diabetes we can control that diabetes.

"Control" means doing whatever it takes to give ourselves normal blood sugars. The people in the metformin study were controlling their blood sugars, not reversing their pre-diabetes. People who cut way back on their carbohydrate intake are controlling their diabetes. People who take a brisk walk after dinner to lower their blood sugar are controlling their blood sugar.

Control is different from reversal in that as soon as you stop using the tools and techniques of control your blood sugars will start climbing right back up.

It may take a couple weeks for the deterioration to set in. I often hear from people who report that have been eating low carb diets for months and have lost weight who say that when they eat carbs now they get much better blood sugars. They probably do, but if they keep eating carbs they will see those blood sugars start rise again and they'll also start gaining weight because the rising blood sugars will trigger the secondary insulin resistance which causes weight gain.

Once you have established good control, you can take the occasional day off without harm. But when the occasional turns into the daily, you will quickly learn the difference between control and cure.

You may have been told some drugs can "rejuvenate beta cells" and that they can reverse your diabetes. This claim has been made (and debunked) for Avandia, and is now being made, very loudly for Byetta and Januvia, though without compelling proof.

In fact, I have never yet seen a single study where the blood sugar improvements produced by a drug lasted for any significant time after the drug was discontinued. With one sole exception: people with Type 2 diabetes who are given insulin for a few weeks at diagnosis appear to have much better blood sugars years later. Details HERE. Unfortunately, very few people are given insulin at diagnosis. Instead they are given oral drugs, and none of them produce lasting effects when discontinued.

Someday science may find ways to truly reverse diabetes. But for now we have to be grateful we have learned how to achieve effective control. Because control works. If you keep your blood sugars normal you can avoid diabetic complications. The best way to do this is to follow the advice you'll find on HERE.

But when you find a method of control that works, don't expect your diabetes to go away. Because your diabetes wasn't caused by overeating or lack of exercise, it can't be cured by those tools either. Your diabetes can be managed, superbly, and we have to be grateful for that. But I'd like to see a cure and for me a cure would mean that I could stop counting carbs, stop testing blood sugar and have the same rock solid normal blood sugars a normal person would have.

The drug companies are not working on cures, because if you were cured you wouldn't need to buy $400 dollars worth of their drugs every month. Their drugs provide only control, and not very good control at that. Until we start funding research that is not undertaking to fatten someone's bottom line things are going to stay that way. Why kill the golden goose?

Drug companies sell doctors (and the public) the idea that their drugs do reverse diabetes. The media tell the public people with diabetes could prevent their condition and save the public a ton of money with a few "simple lifestyle changes."
Don't be taken in. We need cures and true reversal of diabetes and the first step to get there is for society to get out of denial.

The only way we will prevent diabetes is to eliminate the toxic pesticides and other pollutants that flow through our blood streams and modify the brains and pancreases of our fetuses. We need to stop prescribing SSRI drugs that modify blood sugar metabolism to every teenager who breaks up with their boyfriend. We need to realize that plastics are bioactive and get them out of our food supply--and our blood streams. We need to demand that fast food outlets take the MSG, transfat and high fructose corn syrup out of their offerings.

Once people have diabetes, we need to stop blaming them for it, and put some public money into looking for interventions that will really cure them, not just control them.

Will any of this happen? Not likely. Too many people make money from poisoning our environment and selling us bio-destructive products. But that is what we need.

UPDATE August 19, 2009: A day after I published this post, Scott Strumello drew my attention to this incredibly exciting piece of news:

Exsulin Corporation Announces Publication Of Phase 2 Trial Results For Novel Islet Regeneration Treatment In Type 1 & Type 2 Diabetes

I've been hearing about INGAP almost as long as I have been following diabetes. This INGAP trial (the drug has been renamed) involves a peptide that appears to actually regenerate islet cells in both Type 1 and Type 2 diabetes. Most importantly, the increased C-peptide values remained "after washout" i.e. after the drug was discontinued.

The company behind INGAP has had a lot of trouble getting funding over the years, probably because a cure would rob big pharma of its chronic disease cash cows.

Let's pray that the next stage of testing of this drug finds it is safe and that some company that cares more about your health than its profits will get behind it.