With so many people facing the challenges of managing Type 2 Diabetes, our clinical advisory board member Michael Dansinger, MD, a nationally recognized authority on dietary and lifestyle counseling for weight loss and disease prevention provides insights into the opportunity of Type 2 diabetes reversal.
Do you know someone who has “reversed” their type 2 diabetes? It’s one of the world’s most common and serious chronic diseases, so knowing how to reverse it is important. Although there’s no cure, many people have been able to achieve “remission” of type 2 diabetes, meaning their blood sugar levels become normal or nearly normal without diabetes medication. Diabetes reversal is simply the process of getting as close to diabetes remission as possible. Below are 5 steps toward diabetes reversal.
Step 1. Understand what causes type 2 diabetes
Currently, about 12% of the adult population in the United States has diabetes, including about one-fourth of people over age 65 years. The vast majority (around 95%) is type 2 diabetes, which is caused by a series of gradual changes in the body. It often starts with unhealthy dietary habits that take root in childhood and extend into adulthood. Physical activity can’t entirely offset the health consequences of too much unhealthy food, which eventually results in excess body fat inside the abdomen, organs and muscle tissue. This leads to “insulin resistance”, meaning the hormone insulin is less effective than it should be. Insulin is a hormone made by the pancreas organ, which is necessary for cells and tissues to get sugar from the blood for energy.
In people with insulin resistance, the pancreas often has to make double, triple, or quadruple the amount of insulin that would otherwise be needed by the body! After many years of excess insulin production, the insulin-producing cells of the pancreas appear to gradually wear out, stop working properly, and slowly die off. If the pancreas cannot make enough insulin, the sugar levels in the blood get too high. High blood sugar levels cause even more damage to the insulin-producing cells, leading to a vicious cycle of progressive worsening of type 2 diabetes. This can lead to complications of diabetes including premature death from heart disease and other causes. Pills and/or insulin shots are often used to improve the blood sugar levels and reduce the risk of complications, but medications do not reverse the underlying problems that cause type 2 diabetes.
2. Understand what reverses type 2 diabetes
Diabetes reversal always involves making favorable dietary changes. Doing so means the body requires less insulin, which takes some of the strain off the overworked pancreas cells. Favorable dietary changes that produce weight loss can reduce insulin resistance, so the body doesn’t require quite so much insulin production. Weight loss often leads to feeling better physically and emotionally, which fuels a favorable cycle toward better health. Feeling better leads to more physical activity and better eating and more weight loss, and so on. Over time, if healthy habits and weight loss are sustained, the damaged pancreas cells may partially heal.
Weight losses in the 15% range are often enough to achieve remission or near-remission of type 2 diabetes. For example, individuals with type 2 diabetes who weigh 200 to 250 pounds may be around 30 to 40 pounds away from their “remission weight”. A 20% reduction in calorie intake (for example eating an average of 2000 calories instead of 2500 daily) may be sufficient to achieve this.
3. Decide to “Go For It” and get support
Many people with type 2 diabetes aren’t aware that the right eating strategy and lifestyle program may produce enough weight loss to achieve remission or near-remission. Bariatric surgery (such as gastric bypass or gastric sleeve surgery) is an alternative diabetes reversal method to achieve the necessary dietary changes and weight loss. Either way, diabetes remission typically requires working with a team of medical professionals and others who can provide a structured approach with guidance, accountability, and feedback.
There’s a big difference between knowing what to do, versus actually following through on a solid plan. Knowing what to do may be as simple as reading this article. However the next step may be the most challenging—deciding wholeheartedly to make it a top priority and taking steps to work with the right team.
4. Define a strategy and follow through
A solid diabetes reversal strategy includes a medical professional plus additional support. Primary care providers can often provide a good strategy, or make some recommendations. There are many healthy eating strategies that produce good results. The key is to follow the plan closely. A good eating strategy finds the right balance—strict enough to work, but flexible enough to actually follow adequately. It’s important to work with a dietitian or with a coaching program that provides dietary guidance, structure, and accountability. It helps to have external encouragement from others—for example when couples follow the same healthy eating strategy together. Programs may include individual encounters and/or group meetings that may take place either in person or remotely by phone or video. Keeping a food and activity log to review with a dietitian is almost always necessary for good results—doing so provides the structure, accountability, and feedback needed to make ongoing progress. The degree of adherence to the program is the key determinant of the degree of progress.
5. Maintain progress and inspire others
Everybody who has successfully reversed their type 2 diabetes has had times when they fell off track. The difference between those who maintain the progress versus those who don’t comes down to getting back on track after every slip. Having someone in place to assist with such episodes can dramatically increase the odds of long-term success. It’s hard to lose weight and keep it off, but it can be done by putting one’s self in the position of being encouraged and accountable. Maintaining progress is a skill set that’s acquired gradually by getting up every time after getting knocked down.
Successful individuals inspire others by serving as a role model. They help themselves by attracting and assisting people who want to learn from their example. Doing so results in a growing network of like-minded people who become stronger together by learning from each other and encouraging one another.