We all know that there's no cure for type 2 diabetes, but we know if we diagnose diabetes early, we can still do something about it and reverse the process to go back to normal blood sugar. Once we reverse the diabetes, it does not mean you're completely cured.
So today, we're going to talk about some of the proven tips to reverse diabetes. This will be a series of posts for everyone to follow. We all know that data from longitudinal epidemiological studies showed that patients with early stage diabetes and prediabetes can be reversed.
This longitudinal study published in Sweden involved around 2,500 individuals without diabetes and a group with pre-diabetes or early stage diabetes and then they were followed up for 12 years. It was noted that a significant 22% of those patients who had early stage diabetes were able to revert to normal blood sugar within eight years.
So what happened? What factors involved that made these patients go back to normals? What they found out was if you compare those individuals with pre-diabetes compared to those who have stable weight or they did not lose weight, the individuals with pre-diabetes or early stage diabetes have blood sugar between 100 to 125 but when they lost weight had an increased likelihood of reverting to normal blood sugar.
So it means that, it's mostly the fat that triggered the problem of type 2 diabetes and if you lose that fat, then you could reverse the process. Furthermore, the individuals with early stage diabetes who were obese meaning overweight, we based it on your weight according to your height, a BMI of more than 30 kg per meter squared had a higher risk of progressing to diabetes compared to those with normal weight.
Again, showing that one of the major factors that progress your diabetes is increased fatness in the body. Weight loss resulted in normal glycemia but being overweight and obese, risk of progression to full-blown diabetes.
So what do these data tell us? Its telling us that in this longitudinal study lifestyle modifications that will promote weight loss can help restore your glucose into normal level. Therefore, lifestyle modification that will lead to weight loss can help.
Second, that weight management is indeed an effective strategy that we should try in preventing pre-diabetes and its progression to diabetes. How? Possibly because the fat cells make the tissues insulin resistant.
Remember, our pancreas produces insulin. Insulin will then drive sugar into the cell but if the tissue is filled with fat and adipose tissue because of increasing weight, then insulin cannot function properly. So by making the patient lose weight, you improve insulin sensitivity meaning insulin can work very well in bringing sugar inside the cell.
Obviously, one of the major reasons why we have increasing weight is because we're taking too much calories from too much food. Excess calories coming from carbohydrates and fat has three possible fates meaning if you overeat, this is what happens.
So this illustration tells you that the fat coming from the food we eat can either be first oxidized for energy, the excess glucose is converted into fat and this is then used for energy by the muscle or by the tissues. Or secondly, if you're not utilizing it because you don't move, you don't exercise, then excess calories will be converted into fat and stored in a rather full liver. This is where fatty liver comes in. But most importantly, it is also exported in the form of triglycerides.
So if you look at the blood test, if you have high triglycerides, high triglycerides therefore means you're overeating carbohydrates. It's converted into fat and then delivered to other tissues aside from the liver but also to the pancreas. Now, what happens to the fat that is delivered to the pancreas? What is the pancreas? The pancreas is the organ that produces insulin.
You have to take care of it because if the pancreas is damaged, you don't have insulin, that's where you become full-blown diabetic. So I don't like fats in the pancreas. Why? So this is the cycle. Too much calories converted into fat in the liver. High fat in the liver will export these triglycerides somewhere else. Where does it go? To the islet cells of the pancreas.
So if you want to reverse the process, you know where to start, the culprit is the positive caloric balance or too much food. This hypothesis has been proven to be true in studies. If we reduce the pancreatic fat, removing the fat because we remove extra calories from the food, studies have shown that we can reverse the function of the pancreas in terms of producing insulin.
So in this counterpoint study where the patient was given set number of calories, the purpose was to put the patients in a state of weight loss. The individuals lost approximately 15 to 16 kilos. They found out a significant reduction in pancreatic fat and even the pancreatic triglyceride content significantly reduced after eight weeks of low-caloric diet.
In response to the removal of fat from the pancreas, you can clearly see that there's restoration of the insulin response to a meal. This is what we like. First, we are able to restore the damage of the fat on the pancreatic islet and this is where reversal of the disease can happen.
Those who had effective weight loss, unfortunately, all of them did not have durability of effect. Meaning, there were those who responded wherein the liver fat cell, nawala yung fat sa liver, nawala yung fat sa pancreas, and pancreas was able to resume producing insulin. But, meron ding non-responders.
And who are these people? Their liver fat fell, narimove din ang fat sa pancreas but the glucose stimulated insulin secretion did not return. Meaning, yung pancreas still was not able to produce insulin. And then those non-responders were found out to have longer duration of the disease.
Meaning, the longer they've been diabetic, the more fat there has been in the pancreas and in the liver. So in the pancreatic islet cells, the more destruction there is to the islet cells so that the islets can no longer rebound and produce insulin back. So this has clinical implications.
That's why we want to diagnose patients early. We want to treat them early so that we can hopefully revert you back to normal, hopefully still without medications. And we can do this as long as you screen early for those patients with a family history of diabetes, for those patients who has gestational diabetes, especially for those patients who are overweight and obese.
After those two studies, then there's a study to determine if a primary care physician leading the weight loss program, can this data translate into outcomes that we've seen in practice. So this is called the direct data wherein primary clinical doctors were given recommendations of a hypocaloric diet around 800 calories for their patients and all their patients were then followed up for two years and see what happened.
This is the weight loss and remission study called the direct trial. This direct weight management program actually is in a primary care setting wherein patients were told to consume a liquid 800 calorie diet of processed soups and shakes, including non-starchy vegetables for the next three to five months before they were then progressively reintroduced solid food over a period of further two months. So this research was then continued for approximately two years.
But what they found out was that patients who lost more than 15 kilograms result in an 86 percent remission within 12 months. And this is a staggering result showing that significant weight loss does result in reversal of diabetes. Clearly therefore, my point of this post is that the direct study after 24 months clearly showed that diabetes is not really a lifelong disease.
Yes, it's a chronic disease, but you don't have to burden yourself with medication because we can reverse the process through lifestyle modification. If only there's a way that you can be motivated and the physician can actually motivate you to lose weight, you can make a plan. Diabetes can be reversed by weight loss.
In this trial, 36 percent remission at 24 months, 64 percent chance of remission if you lose more than 10 kilos, but 70 percent chance of remission if you lose more than 15 kilos. What I'm saying here is we can do this. I've seen my patients revert to normal.
In every lectures I do, I always tell my audience, my goal when I treat diabetes is to diagnose early. Second, if I diagnose them early, it's not only to prevent them from progressing to full-blown diabetes or to develop complications, but I'm very ambitious. I want them to go back to normal, if possible reverse diabetes.
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