- The Washington Times - Wednesday, December 6, 2017

Losing weight — without exercise — and maintaining a healthy diet can cause Type 2 diabetes to go into remission and allow patients to stop taking medications, according to a study that challenges the long-held medical belief that the acquired disease is a lifelong illness.

Published Wednesday in the medical journal Lancet, the study shows that patients who committed to a strict diet and then managed their new weight were able to stay off medication to manage their diabetes.

“Especially in the United States, there’s a widespread belief that diabetes can only be managed by drugs,” Roy Taylor, one of the study’s co-authors, told the Washington Times. “We’ve got quite an uphill battle of getting a buy-in from [doctors] that this is possible, but I think the results of the Lancet trial should overcome that.”

According to the Centers for Disease Control and Prevention, about 30 million people in the U.S. have diabetes, with up to 95 percent of them suffering from the Type 2 form of the disease. Diabetes occurs when the body can’t produce enough insulin to manage glucose levels. Nearly 80,000 people died from diabetes-related complications in the U.S. this year.

A Type 2 diabetes diagnosis usually occurs in adults over the age of 45 who are overweight and inactive, but numbers are rising among young people and even children, a result of the ongoing obesity epidemic in the U.S.

Recommended treatment options include healthy eating and exercise, medication and in some cases insulin replacement.

For the study, participants were between 20 and 65 years old, overweight or extremely obese, diagnosed with Type 2 diabetes in the past six years and on anti-diabetes and antihypertensive medications but not insulin replacement.

The intervention group received a strict, all-liquid diet of 830 calories a day for 12-16 weeks and stopped their anti-diabetes medications immediately.

The participants also were discouraged from increasing their physical activity and were told to maintain their normal routine or include simple changes such as walking more or taking the stairs instead of the elevator.

Solid food was slowly reintroduced at the end of the weight-loss phase, usually one meal of about 500 calories, and participants were given coaching on portion control to manage their new weight.

Of the participants who lost more than 30 pounds, 86 percent were free of diabetes after one year. Of those who lost more than 20 pounds but fewer than 30 pounds, 73 percent were diabetes-free after 12 months.

“Many weight loss programs, including a lot of them in the States, use a combination of exercise and diet to try and lose weight and … that’s just the wrong thing to do because exercise causes compensated eating and makes any diet enormously difficult,” Dr. Taylor said, professor of medicine and metabolism at Newcastle University in Great Britain.

While the results of the Lancet study are promising, the level at which the British researchers defined remission is more permissive than guidelines of the American Diabetes Association, said Dr. William Cefalu, the ADA’s chief scientific, medical and mission officer.

In an email to The Times, Dr. Cefalu, who was not involved in the study, said that diabetes management has to take place on an individual basis to succeed and that the dietary guidelines in the study are too strict for widespread application.

Dr. Taylor acknowledged the difficulty of the three-months, all-liquid diet, noting the study’s and said the dropout rate was about 17 percent for the 309 participants. But what surprised him the most was the overwhelming response from people who wanted to participate in the study.

“We learned that there’s a hunger out there amongst people who have Type 2 diabetes to be able to escape from it,” he said.

Dr. Taylor said his research team demonstrated that reducing calorie intake allows the body to better manage its glucose levels.

“This is really important insight into how the body works,” he said. Dr. Mladen Gobulic of the Cleveland Clinic Wellness Institute told The Times that lifestyle changes like diet and exercise have long been accepted as a first response to a pre-diabetes or a Type 2 diagnosis.

Though the study was well done and focused on the reversal of diabetes, it doesn’t offer too much insight on achieving long-term success, Dr. Gobulic said.

“No. 1, we know from other studies of weight loss that after four or five years, the majority of people revert back to the way they already were,” he said.

“This was [a] really low-calorie diet for the first couple of months, it’s very hard to do so, they probably found some really motivated patients,” said Dr. Gobulic, who wasn’t involved in the study.

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