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The starvation diet that can REVERSE type two diabetes: How dramatic weight-loss could lower blood-sugar levels
Drastic, short-term dieting may lower blood-sugar levels, research shows
Participants in 2011 study lost an average of 2st 5lbs over eight weeks
Scan three months later revealed they still had normal blood-sugar levels
Intermittent fasting - such as the 5:2 diet - has also shown success
Cutting-edge: One of the most effective ways to tackle type 2 diabetes is to lose weight.
One of the most effective ways to tackle type 2 diabetes is to lose weight, and it seems that dramatic weight loss may be particularly beneficial for blood-sugar levels.
This surprising effect was first seen in patients who had undergone weight-loss (bariatric) surgery. As well as losing weight, many also reversed their diabetes.
We will look at surgery on the next page, but there may be ways to replicate these benefits without major surgery — the answer may be as simple as a drastic, short-term diet.
This is very much cutting-edge thinking and is the brainchild of Professor Roy Taylor, director of Newcastle Magnetic Resonance Centre at Newcastle University. Inspired by the diabetes-reversing effects of bariatric surgery, he decided to investigate the impact of a short-term, low-calorie diet on type 2 diabetes, using regular MRI scans to record exactly what was going on in the body.
What he found could help to transform the health of many people with type 2 diabetes, even those who have had it for years. In a study published in 2011, he took 11 people with newly diagnosed type 2 (defined as being diagnosed in the previous four years) and gave them liquid diet formula.
This provided 600 calories and was formulated so they received the right amount of nutrients. They also had around 200 calories of non-starchy vegetables such as broccoli and spinach — these provided fibre usually obtained from carbs, which were excluded from the diet.
After a week, MRI scans showed the fat around their livers had dropped by 30 per cent; furthermore, their blood-sugar levels were normal. At the end of the eight-week trial, fat levels in the pancreas had also plummeted and they were producing insulin again.
Participants also lost an average of 2st 5lb (15kg). At a follow-up scan three months later, they had all regained about half a stone but most still had normal blood-sugar levels despite eating normal food again (although they'd been advised to eat two-thirds the amount they used to eat).
Three of the 11 had normal blood-sugar levels, four were borderline and three had blood-sugar levels indicating diabetes (but only just, and all were no longer taking the tablets they used to have to take).
What was going on? Type 2 diabetes can be linked to a gradual build-up of fat in the pancreas and liver, which prevents them working properly. The very low-calorie diet meant the body was starved of energy, so it turned to its fat stores. When the fat disappeared, the organs resumed normal functioning.
In a second study, with 29 patients with recently diagnosed and long-term diabetes (more than eight years), the diet reversed diabetes in 84 per cent of the short-term patients and 50 per cent of the long-term. ('Reversing' was defined as a blood-sugar reading under 7 after fasting; 7 is the official level for a diabetes diagnosis).
HALVING MY WEIGHT PROBABLY SAVED MY LIFE, SAYS MOTHER OF THREE
Lifestyle changes: Tracey Albert has lost nearly 8st since she was diagnosed with type 2 diabetes
Tracey Albert, 47, a former sales and marketing manager, is divorced and lives in Medway, Kent. She has three grown-up children.
I'd always been a healthy size 10, but after being made redundant in 2009, depression hit and I was diagnosed with bipolar disorder. The medication and depression triggered rapid weight gain and I ballooned to size 26; I weighed just over 19 st (I'm 5 ft 1in). I was constantly exhausted and needed sleeping tablets. My GP put me on the list for gastric band surgery.
In autumn 2013 I started getting thirsty and going to the loo a lot and was diagnosed with type 2 diabetes. It was a real shock. But the diagnosis gave me a kick up the bottom as I'd been in denial.
My GP prescribed metformin, a drug that reduces blood-sugar levels, and enrolled me on a six-week NHS nutrition course. I was advised to stick to 1,200 calories a day — quite a change from my old diet of toast, sandwiches, pasta, biscuits and chocolate.
I also started walking twice a day, 45 minutes a time. Within six months I'd lost 5st and my blood sugar levels were normal.
I've lost just under 8st since my diagnosis. My GP's taken me off the gastric band list and while I'm still taking metformin, I'm sure that I'll be able to come off it soon.
Professor Taylor concluded that, for those with longer-term diabetes, a bigger weight loss was needed to reverse the condition.
'However, the study also showed that everybody responds to a restricted diet,' he says. 'The blood glucose might not drop below the diabetes threshold, but it still drops considerably.'
Professor Taylor has now embarked upon a five-year study, called DiRECT, exploring the long-term effects of a very low-calorie diet versus conventional NHS dietary advice. 'This study could lead to a quantum leap forward in our understanding of how best to manage type 2 diabetes,' he says.
The charity Diabetes UK, which is backing the research, agrees. Dr Alasdair Rankin, its director of research, says: 'If this study shows that a low-calorie diet can be used safely and effectively to bring about and maintain type 2 diabetes remission for significant periods, it could change the way the condition is viewed and managed.
Effective: Intermittent fasting — eating normally for five days, and cutting calories (to 500 for women, 600 for men) for two days — has also shown success in reducing blood-glucose levels.
'But until we have the results from this research, it is important that people with type 2 diabetes who are trying to lose weight follow guidance from their GP.'
Intermittent fasting — eating normally for five days, and cutting calories (to 500 for women, 600 for men) for two days — has also shown success in reducing blood-glucose levels.
Professor Taylor's studies have triggered much interest among those with type 2 diabetes, with some keen to try the theory for themselves. However, he warns: 'An extremely low-calorie diet isn't suitable for all. If you have ongoing problems, it would be unwise.'
Consult your doctor before embarking on drastic changes to your diet or exercise regimen
FIVE FOODS TO REDUCE YOUR RISK OF DEVELOPING TYPE 2 DIABETES
Diet and lifestyle changes can prevent pre-diabetes developing into type 2. Here are five foods that can help.
Green leafy vegetables
Just one serving of green leafy vegetables could reduce your risk of type 2 diabetes by 14 per cent
Just one serving (around 2 tbsp) of green leafy vegetables such as spinach, kale, broccoli and cabbage a day could reduce your risk of type 2 diabetes by 14 per cent. Make that 1½ servings and the risk is cut by 30 per cent, according to a University of Leicester review. Green veg is rich in magnesium, which appears to protect against diabetes. If you have pre-diabetes, aim for 7-10 portions of veg and fruit (with the focus on veg), suggests Paul McArdle, a specialist dietitian who helped write the latest nutrition guidelines for diabetes.
Yoghurt
Dairy products — even full-fat — can reduce the risk of diabetes. A U.S. study last year found that just two tablespoons of yoghurt a day cuts your odds of developing diabetes by a fifth. The calcium is thought to improve your ability to metabolise insulin. Avoid added sugar.
Walnuts
Adding a handful of mixed nuts to your diet can improve the way glucose and insulin are processed if you have pre-diabetes. Walnuts appear to be particularly protective: a large U.S. study in 2013 found that those who ate a 28g packet — 10-15 nuts — twice a week for eight weeks were 24 per cent less likely to develop type 2 diabetes than those who rarely or never ate them.
Adding a handful of mixed nuts to your diet can improve the way glucose and insulin are processed.
Wholegrains
Studies suggest three servings of wholegrains a day (one is a slice of wholemeal bread, a bowl of cereal, two heaped tablespoons of brown rice or pasta) cuts the risk of diabetes by 31 per cent. The fibre helps reduce blood-sugar spikes, while plant compounds (isoflavones) in some wholegrains lower blood sugar. White bread, white rice, pastry, cakes and processed foods can increase your risk by 40 per cent. Also watch your potato intake, says Paul McArdle, as the starch quickly breaks down into sugar.
Coffee
Compounds in coffee appear to help insulin work better. A U.S. study in 2006 suggested people who had four or more cups a day had a 47 per cent lower risk of diabetes. But caffeine can raise blood sugar in people who already have diabetes.
Are you getting the right tablets?
Many patients with type 2 diabetes can keep it under control with diet and exercise — but if these don't work, here we look at the medication you're likely to be offered.
First-line treatment
Metformin: This is the most common drug taken for type 2. It reduces the amount of glycogen — or stored sugar — your liver releases into the bloodstream and increases the cells' sensitivity to insulin.
'It's inexpensive and has the lowest risk of side-effects such as weight gain and hypoglycaemia (where blood-sugar falls too low),' says Professor Anthony Barnett, a leading diabetes researcher based at Birmingham Heartlands Hospital and the University of Birmingham.
WATCH OUT FOR THESE DANGER SIGNS OF RISING BLOOD SUGAR
If you're passing more urine than usual, suffer from persistent thirst and your blood-sugar levels are high, you could have hyperglycaemia — excessively high blood-sugar.
It can occur as a result of an infection or stress. Talk to your GP about how to get your levels down.
Severe hyperglycaemia, or Hyperosmolar Hyperglycaemic State (HHS), which is more common in older people, is characterised by a sudden, very high rise in blood sugar (with readings over 40). It is linked to dehydration or illnesses such as heart attack of even a mild dental or urinary infection — illness can stop people taking medication or alter the way the body responds to insulin and glucose.
First symptoms include weakness, leg cramps or visual disturbance — these should never be ignored, as it can become serious very quickly. Contact your GP for advice. You may need hospital treatment with fluids and insulin and the earlier this is given the better.
Passing large amounts of urine, feeling thirsty, vomiting and abdominal pain are signs of ketoacidosis. If you have these symptoms and high blood-sugar levels, seek medical assistance.
Ketoacidosis occurs when not enough insulin is produced so the body can't use sugar and breaks down fat for fuel. This produces ketones which, in high quantities, poison the body.
Common in type 1 diabetes, new research suggests ketoacidosis is more common than thought in type 2 diabetes, too — especially in Afro-Caribbean and South Asian patients, possibly due to genetic differences in the way pancreatic cells respond to blood-sugar levels. This is being called type 1b diabetes. Ketoacidosis is treated with insulin injections until sugar levels are normal again.
There's also emerging evidence that it helps lower the risk of heart disease, and the damage to small blood vessels that can cause eye problems, he says.
Cons: Metformin causes stomach problems such as diarrhoea in an estimated 10-15 per cent of cases.
Second-line treatment
Daonil, Diamicron, Amaryl, Actos: These drugs are prescribed to be taken in conjunction with metformin or on their own.
The first three are a type of drug known as sulphonylureas; Actos is a glitazone drug. They work by increasing the amount of insulin your pancreas produces, or increase sensitivity to insulin, respectively. Glitazones also lower blood pressure, increase levels of the healthy HDL form of cholesterol and reduce blood fats.
Specialists say the earlier you are offered a second drug (on top of metformin), the more effectively your diabetes (and any associated complications) can be controlled.
'We tend to be very cautious in our treatment of diabetes in the UK and GPs often wait too long to put a patient on that second drug,' says Professor Barnett.
Under NICE guidelines, back-up drugs should be considered when you have a blood-sugar reading of 6.5 using an HbA1c test. Yet research from the University of Leicester in 2013 showed most UK doctors don't take action until the reading is closer to 9.
'In Holland, 70 per cent of patients with diabetes have good glucose control, but in the UK it is only 30-40 per cent, and one reason for that is that we don't prescribe the second drug early enough,' says Professor Barnett.
'The longer we wait, the harder it is for patients to get good control and, ultimately, this increases the risk of complications.'
Cons: These drugs can cause weight gain as they raise insulin levels — and insulin promotes fat storage.
Sulphonylureas have an increased risk of hypoglycaemia. 'Fifty per cent of people stop taking this type of diabetic medication within a year — in many cases because of these effects,' says Professor Barnett. 'Glitazones, particularly, can cause weight gain of anything up to 10kg-12kg in one to two years.'
Third-line treatment
Byetta jabs: The third line in treatment are newer drugs known as DPP-4 inhibitors and incretin mimetics, which effectively raise insulin levels.
You'd be offered these if your blood sugar is not being properly controlled by metformin and a sulphonylurea or glitazone.
Lifestyle: Many patients with type 2 diabetes can keep it under control with diet and exercise.
Examples of DPP-4 inhibitors include Januvia and Galvus. Incretin mimetics, which are given as injections, are prescribed under brand names such as Byetta or Bydureon.
A third, even newer, type of tablet SGLT-2 inhibitors (eg, dapagliflozin) was launched in 2013 and works on the kidneys to increase the amount of glucose you excrete in the urine.
These can be offered as a second-line treatment to work alongside metformin if other drugs are contraindicated. Or they can be used as a third daily drug alongside metformin and one of the options above.
TOP TIPS TO REMEMBER
Take a short walk after eating. A 15-minute stroll after each meal reduces blood sugar better than a single 45-minute stroll
The advantage of the jabs is they increase people's sensation of fullness, which helps with weight, says Professor Nicholas Finer, a specialist in diabetes and obesity at University College London and spokesperson for the Society of Endocrinologists.
Cons: Because they're expensive, many GPs won't/can't give these drugs early enough for them to have their true benefits say experts.
'Fifty per cent of people don't take their diabetes medication properly because of side-effects like weight gain and hypos — yet we have drugs less likely to cause these side-effects that offer a huge advantage, but NICE want us to give older, less expensive drugs,' says Professor Barnett.
Depending on the drug, side-effects can include dizziness and pancreatitis.
Could weight loss surgery be a solution?
Weight-loss surgery — also known as bariatric surgery — has been the last resort for the obese for a number of years.
But extraordinary findings suggest that it can also reverse type 2 diabetes — sometimes even within days and before the patient has lost a significant amount of weight. A major U.S. review of more than 600 studies involving more than 135,000 patients found that surgery completely reversed type 2 diabetes in 78 per cent of patients.
This is because surgery can alter where or how quickly food reaches the bowel (some procedures bypass much of the small intestine). This, in turn, can influence the hormones in the gut that control blood-sugar levels.
Reversing diabetes: Weight-loss surgery — also known as bariatric surgery — has been the last resort for the obese for a number of years. Extraordinary findings suggest that it can also reverse type 2 diabetes
'We can't quite call bariatric surgery a cure, as some patients may redevelop diabetes again in the future, but we can certainly say it puts patients into remission,' says Pritak Sufi, a bariatric surgeon at the Whittington Hospital in North London, and the Spire Hospital, Bushey.
'Surgery has a much better success rate the closer to diagnosis it's given,' says Professor David Kerrigan, a bariatric surgeon at Phoenix Health, which provides surgery privately and for the NHS.
Under NICE guidelines, surgery can be considered if your Body Mass Index (BMI) is over 35 and you've recently been diagnosed with type 2 diabetes (people of South Asian descent may be referred with a BMI of 28, as it often starts at a lower weight in this group).
While around 250,000 people in England could qualify for bariatric surgery, only 9,000 procedures were carried out in 2010-2011. This may be partly because some GPs see surgery as a last resort.
MAKE SURE YOU HAVE THESE IMPORTANT CHECK-UPS
If you have type 2 diabetes, it is important to be regularly monitored with specific checks to reduce the risk of complications.
EYES: Diabetics are offered free annual eye checks, which include photography of the retina (now available at most High Street opticians) to check for diabetic retinopathy.
BLOOD PRESSURE/CHOLESTEROL: Annual checks are important. You will most likely be offered statins. 'You do need them,' says Professor Anthony Barnett, a leading diabetes researcher based at Heartlands Hospital, Birmingham. 'There is no doubt that they save the lives of diabetics.'
URINE: This should be checked annually for protein, which indicates kidney damage. If any is found, ACE inhibitor drugs can boost the kidneys' performance and prevent further damage.
FEET: Vigilance is key. Do a weekly foot check and see a chiropodist annually. The gold standard treatment is given by new integrated foot departments in local hospitals (involving a podiatrist, vascular surgeon, orthopaedic surgeon and footwear expert).
TESTOSTERONE: Diabetes is linked to lower testosterone, which can cause problems with erections and low libido. Dr Parijat De, an endocrinologist at Sandwell and West Birmingham Hospitals, recommends men have a testosterone test (early morning when levels are highest) and possibly testosterone treatment.
There are four types of bariatric surgery commonly performed in the UK, and some are more effective at reversing diabetes than others.
Like any operation, bariatric surgery carries risks — including infection and a risk of dying (although, a report by the University of Birmingham found just 70 people out of 29,285 patients died within 30 days of surgery). Ten to 15 per cent of patients develop gallstones through losing weight so quickly, and 7 to 8 per cent need repeat surgery because of complications, or not getting the desired results. You can also regain weight and the diabetes can return.
Gastric band
Here a saline-filled silicone band is placed around the top of the stomach, reducing its size by about a 12th. 'It's thought the band also stimulates nerves which tell your brain that you are full,' says Mr Sufi.
Pros: Safe, uncomplicated keyhole procedure, it takes less than an hour and requires a night in hospital, with a week off work. Cheapest technique, easily reversible.
Cons: This doesn't affect hormones associated with type 2 diabetes, so benefits are limited to those created by subsequent weight loss. On average, 50 per cent of excess weight is lost in 18 months. Half of patients will come off medication completely. A fifth need further surgery within five years for problems such as infection or band slippage. It's also easy to 'cheat' by liquidising foods.
Cost privately: £5,000 (includes two-years' follow-up).
Gastric Sleeve
Here the largest part of the stomach is removed, leaving a small tube-shaped section. 'The stomach goes from being shaped rather like a bag to more like a banana,' says Mr Sufi. 'This reduces capacity and removes the part that produces the appetite-stimulating hormone ghrelin, so patients feel less hungry.'
Pros: The surgery takes an hour, so is better for high-risk patients such as the extremely obese. Patients lose 60 to 70 per cent of their excess weight over two years and 70 to 75 per cent of patients are 'cured' of diabetes.
Cons: The 'new' stomach can stretch if patients overeat. 'About 10 per cent come back with regained weight within three years,' says Mr Sufi. The operation requires two to three nights in hospital and up to three weeks off work. Irreversible, and relatively new, so long-term data is lacking.
Cost privately: Around £9,000.
Gastric Bypass
The stomach is reduced to a small pouch and connected to the bowel about 3 to 4ft lower down the intestine than normal. This triggers the release of GLP-1, a hormone that stimulates the release of insulin and makes it more effective.
TOP TIPS TO REMEMBER
Wash hands with soap and warm water before a finger-prick blood test. Warm water boosts blood flow to the fingers and residue on hands can affect results
Pros: The average patient loses 80 per cent of their excess weight within 18 months and up to 80 per cent of patients will be 'cured' of diabetes. The other 20 per cent will need less medication. Long-term safety is well established.
Cons: A higher risk of complications, such as internal bleeding, in the first few days. Patients need daily vitamin and mineral supplements for life to avoid deficiency, and a quarter also need injections of vitamin B12. While a bypass can be reversed, it's not advisable. The pouch can stretch and about ten per cent of patients regain weight.
Cost privately: £10,400.
Duodenal Switch
This combines a gastric sleeve and bypass. But it retains the duodenum, the top of the intestine.
Pros: This causes large weight loss (90 per cent of the excess) and also alters hormonal balance, meaning a 90 per cent 'cure' rate for diabetes.
Cons: This surgery is only offered to around 2 per cent of patients because of side-effects, notably protein deficiency (because the part of the intestine through which we normally absorb most protein is bypassed) which can lead to loss of muscle mass and weakened immunity. Bowel function can also be problematic and some patients suffer wind and leakage.
Cost privately: Around £11,500.
Gardening is the perfect medicine
Exercise is vital for preventing type 2 diabetes — but even simply just moving more can help control and even reverse the condition.
This is because whenever we exercise, our bodies use sugar to make energy. This sugar comes from the bloodstream and from the muscles and liver (where it's stored as glycogen).
The benefits aren't just physical. Canadian research suggests that inactive adults with type 2 diabetes are almost twice as likely to be depressed as those who are physically active.
Stay active: Heavy gardening strengthens muscles
'The people starting out with the lowest levels of fitness have the biggest gains to make from just being less inactive,' says Dr Sheri Colberg, professor of exercise science at Old Dominion University in the U.S. She argues that exercise 'is a forgotten tool' for treating diabetes.
The exercise solution
Instead of thinking about 'exercise', which can be daunting, think in terms of increasing your 'physical activity', which means everything you do counts — for example, walking to the shops.
'Think about just standing up more during the day,' says Dr Colberg. 'Don't sit for longer than an hour at a time.' Prolonged sitting is thought to slow the metabolism, affecting the body's ability to regulate blood sugar.
'Walking is ideal. And once you start walking more, add in faster intervals — for example, walking a little faster between two driveways, intermittently.'
The Department of Health advises at least 150 minutes of moderate-intensity aerobic activity every week — such as cycling, fast walking, water aerobics, pushing a manual lawnmower — as well as muscle-strengthening activities (weights, working out with resistance bands, heavy gardening, yoga or exercises that use body weight for resistance, such as sit-ups) on two or more days a week.
For information on getting active go to diabetes.co.uk. Dr Colberg's website, diabetesmotion.com offers advice for exercising with diabetes. Check with your doctor if planning an extreme change or a new regimen (such as running) for the first time, says Dr Colberg.
Compiled by Louise Atkinson, Helen Foster and Fiona Duffy
Source: Daily Mail