Study: Curing Type 2 Diabetes With Weight Loss and Without Diet

Geschatte leestijd: 8 minuten Diabetes type 2 can be cured within 2 to 10 years after onset by means of weight loss. In the Netherlands, diabetes is the 11th leading cause of death, directly behind breast cancer [1]. In 2015, there were 1.1 million Dutch people diagnosed with diabetes. This accounted for approximately 1.7 billion euros in healthcare costs in 2011. These figures concern all forms of diabetes, with type 2 being the most common.

Diabetes type 2

In type 2 diabetes, the body no longer responds well to insulin. As a result, it is no longer able to regulate blood sugar properly. Professor Roy Taylor of Newcastle University in Great Britain has devoted almost 40 years of his life to studying this condition and its underlying causes. He presented his findings last week at the European Association For The Study Of Diabetes (EASD 2017) in Lisbon. Taylor’s main conclusions are:

• Excessive calories lead to excessive fat in the liver
• As a result, the liver responds inadequately to insulin and produces too much glucose
• The excess fat in the liver is passed on to the pancreas, causing the cells that produce insulin to begin to fail
• Reducing the amount of fat in the pancreas by less than 1 gram can restart normal insulin production, reversing type 2 diabetes
• Restoring the function of the pancreas and reversing type 2 diabetes is possible at least ten years after the onset of the condition

Curing Type 2 Diabetes Through Weight Loss

‘Could it be that it was all so simple?’ Taylor’s work now confirms his Twin Cycle Hypothesis; Type 2 diabetes is caused by fat accumulation in both the liver and the pancreas. As mentioned, his work is based on the hypothesis that the liver poorly responds to insulin due to this, producing too much glucose. At the same time, the large amount of fat in the liver also increases the process of transporting fat to all other tissues. Including the pancreas, making it unable to produce sufficient insulin. So, too little insulin and inadequate response to the insulin that is present. In the Counterpoint study of 2011, it was confirmed that if an excess of nutrition was drastically reduced through a low-calorie diet, all this damage could be reversed [3]. In this research, Taylor and colleagues demonstrated a significant reduction in the amount of fat in the liver, restoring insulin sensitivity. This occurred within 7 days of starting a low-calorie diet. The pancreas takes a little longer. In 8 weeks, the amount of fat in the pancreas was reduced and insulin production was restored, thereby normalizing blood sugar.

“I think the real importance of this work is for the patients themselves,” Professor Taylor says. “Many have described to me how embarking on the low calorie diet has been the only option to prevent what they thought — or had been told — was an inevitable decline into further medication and further ill health because of their diabetes. By studying the underlying mechanisms we have been able to demonstrate the simplicity of type 2 diabetes.” Roy Taylor, Newcastle University

Type 2 Diabetes Is Not a Death Sentence

Diabetes (type 2) does not have to be a death sentence. Even after ten years, you can reverse these conditions by reducing the relatively high amount of fat in the pancreas. Currently, this can only be achieved by significant weight loss. In the Counterbalance study of 2016, Taylor and colleagues demonstrated that these effects can be reversed in most people after 10 years [4]. This restored metabolism also applies to the long term as long as the lost weight is not regained. Professor Taylor explains: Our lab studies have shown that excessive fat causes the loss of function of specialized cells. These cells go into survival mode, merely surviving while no longer contributing to the overall health of the body. Removing the excess fat enables the cells to resume this specialized function of producing insulin, providing an explanation for effects already observed in clinical studies.

Curing Type 2 Diabetes: No Extreme Diet Needed

Okay, the word “extreme” is relative. If you’re used to eating 6000 calories a day, then a normal diet will quickly feel extreme. However, what was remarkable in Taylor’s studies was that the diet used for weight loss was actually liked by the participants. The diet did not cause hunger and fatigue in the participants, while they quickly felt much better. The researchers used a two-pronged plan. First, lose weight through a diet without exercise. Then, a carefully planned transition period to phase two, focusing on maintaining the lower weight through moderate calorie restriction and daily physical activity. On average, this resulted in a weight loss of 15 kilos. So, we’re not talking about people weighing 150 kilos who need to lose 80 kilos. This method has been clinically applied since the research data appeared on the website of Newcastle University, and people who were highly motivated to start with it have reported having no symptoms of diabetes. In a British follow-up study, the Diabetes Remission Clinical Trial (DiRECT), it had to be determined to what extent this method should become a standard treatment. The findings from this are now known. One third of people with type 2 diabetes remained ‘diabetes-free’ for two years. The degree of remission was associated with the weight loss that was successfully maintained.

Curing Type 2 Diabetes Without Dieting

Curing diabetes without losing weight? So, overweight can cause health problems like type 2 diabetes. To get rid of these problems, you have to lose weight, as confirmed in the above studies and trials. Or do you? Losing weight is of course easier said than done. Don’t get me wrong, we would jump for joy if we were to hear that cancer can be cured by a certain diet or exercise. But that wouldn’t mean cancer would be eradicated. Knowing and doing are two different things.

Curing Diabetes Through Biological Tweets

More research has been done on the role of fat mass in type 2 diabetes. In 2015, researchers at George Washington University showed that the fat cells of overweight people send messages to other cells [1]. Messages that can lead to type 2 diabetes. “Biological tweets,” as Dr. Robert Freishtat calls them. Short messages that can travel long distances in the body and can cause the metabolic functions of other cells to deteriorate. Functions such as insulin processing. These messages are sent in the form of exosomes. Molecules that previous research in animals had already shown can affect insulin sensitivity [2]. The message itself is mainly determined by the microRNA in the exosomes [3,4].

Reprogramming Fat Cells

“What happens to this message when the overweight is lost?”: the researchers at George Washington University wondered. So, they conducted a follow-up study looking at the microRNA in the exosomes of people who had lost weight through gastric bypass surgery [5]. Last month, they published the results in Obesity. Six African American men with an average BMI of 51.2 underwent surgery for gastric bypass. For perspective: A BMI higher than 40 falls under morbid obesity. Above 50 is not even indicated on most tables. Blood was taken before the procedure to analyze the exosomes in the blood. This was done again a year after the procedure when the average BMI had decreased to 32.6. They found 168 microRNA molecules that had changed after the procedure. Further analysis showed that many of these microRNA molecules were responsible for regulating blood sugar. The outgoing messages had changed in such a way that they led to higher insulin sensitivity in other cells and thus protected against type 2 diabetes. Each patient had increased insulin sensitivity and other features of improved metabolic functions. They were effectively cured of their diabetes, according to Dr. Freishtat.

Reprogramming Without Losing Weight

Such gastric bypass surgery was necessary in this case to achieve the desired weight loss. If you have a BMI of 50, you can’t rely solely on a behavioral change. In the future, researchers hope to rewrite these ‘tweets’. In follow-up research, the researchers expect to see the same changes in exosomes with slower methods of weight loss, such as diet and exercise. If a test can be developed that warns of diabetes earlier with this knowledge, it could prompt people to work on their weight sooner. They ultimately hope to block the (unpleasant) outgoing mail from the fat cells to prevent the metabolic problems associated with overweight.

Curing Type 2 Diabetes and Then?

Two studies above have once again shown that in many cases, people can be cured of type 2 diabetes. Will this insight help to view diabetes differently?

Weight and Diabetes

In a recent clinical trial, the effect of weight loss on type 2 diabetes was once again demonstrated. Nearly half of the people with type 2 diabetes achieved remission or a ‘non-diabetic state’. In the study, weight loss was achieved within 6 years after the diagnosis of diabetes. New research has now shown that this positive effect of weight loss is associated with improvements in the functioning of beta cells in the pancreas. These are the cells responsible for insulin production. These findings contradict the previous assumption that the function of these cells permanently deteriorates in people with type 2 diabetes.

Lose Weight as Soon as Possible after a Diagnosis of Type 2 Diabetes

According to the researchers, normally after the diagnosis, there follows a period of getting used to the diagnosis itself, medical treatment, and modest lifestyle adjustments. Their research now makes it clear that sustainable weight loss after the diagnosis can save the beta cells. For the study, people who had been diagnosed with type 2 diabetes in the past year were sought. Half were assigned to a control group that followed the normal treatment for diabetes. The other half received an intensive protocol and guidance for weight loss (intervention group). A year later, 46% of the people in the intervention group had regained control of blood sugar regulation. Some in the intervention group who did not see these results simply had not lost enough weight. Among those who had lost enough weight but did not see results, it was unclear why this was the case. Next, the researchers looked at potentially relevant metabolic characteristics. Think of the amount of liver fat, fat in the pancreas, triglycerides in the blood, and the function of beta cells. They found that the people who lost weight and saw results in diabetes (responders) were similar to those who did not see this effect (non-responders). Both saw improvements in liver and pancreatic fat and triglycerides in the blood. However, the responders had lost weight faster after the diagnosis, an average of 2.7 years compared to 3.8 years in the non-responders. This seemed to ensure that one important characteristic differed between the responders and non-responders. Beta cell function improved only in the responders.

First-Phase Insulin Secretion Restored by Weight Loss

The biggest difference was in the so-called first-phase insulin secretion. Beta cells in the pancreas release insulin in two phases. In the first phase, this happens with a brief peak that lasts about 10 minutes. In people with type 2 diabetes, this first-phase insulin secretion is normally absent. However, in the study, it increased in the responders.

‘Don’t Play the Victim’

For clarity: Much follow-up research still needs to be done on the effect of weight loss on type 2 diabetes. But these insights can lead to a new awareness. A diagnosis of type 2 diabetes does not have to be a final verdict in many cases. Even if you were previously unable to change your lifestyle resulting in diabetes, that doesn’t mean it’s too late now. At least, if you act reasonably quickly. So, it’s not happening to you, you’re letting it happen to you. That sounds harsh. Moreover, losing weight will not help everyone (as far as type 2 diabetes is concerned). Still, I would always prefer to hear that a big challenge awaits me than that the race is already over.

1. volksgezondheidenzorg.info/ranglijst/ranglijst-ziekten-op-basis-van-sterfte
2. Newcastle University. “Type 2 diabetes is a reversible condition.” ScienceDaily. ScienceDaily, 13 September 2017.
3. Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011 Oct;54(10):2506-14. doi: 10.1007/s00125-011-2204-7. Epub 2011 Jun 9. PubMed PMID: 21656330; PubMed Central PMCID: PMC3168743.
4. Very low calorie diet and 6 months of weight stability in Type 2 diabetes: Pathophysiologic changes in responders and non-responders. Sarah Steven, Keiren G Hollingsworth, Ahmad Al-Mrabeh, Leah Avery, Benjamin Aribisala, Muriel Caslake, Roy Taylor. Diabetes Care. Doi: 10.2337/dc15-9422
5. Ferrante SC, Nadler EP, Pillai DK, et al. Adipocyte-derived exosomal miRNAs: a novel mechanism for obesity-related disease. Pediatr Res 2015;77:447-454.
6. Deng ZB, Poliakov A, Hardy RW, et al. Adipose tissue exosome-like vesicles mediate activation of macrophage-induced insulin resistance. Diabetes2009;58:2498-2505.
7. Bartel DP. MicroRNAs: target recognition and regulatory functions. Cell 2009;136:215-233.
8. Karelis AD, St-Pierre DH, Conus F, Rabasa-Lhoret R, Poehlman ET. Metabolic and body composition factors in subgroups of obesity: what do we know? J Clin Endocrinol Metab 2004;89:2569-2575
9. Monica J. Hubal, Evan P. Nadler, Sarah C. Ferrante, Matthew D. Barberio, Jung-Hyuk Suh, Justin Wang, G. Lynis Dohm, Walter J. Pories, Michelle Mietus-Snyder, Robert J. Freishtat. Circulating adipocyte-derived exosomal MicroRNAs associated with decreased insulin resistance after gastric bypass. Obesity, 2017; 25 (1): 102 DOI:
10. Roy Taylor, Ahmad Al-Mrabeh, Sviatlana Zhyzhneuskaya, Carl Peters, Alison C. Barnes, Benjamin S. Aribisala, Kieren G. Hollingsworth, Rachel L. Curtis, Alexey K. Sokhi, M. Loredana Marciniak, Angela M. Sargent, Ashley A. Lomas, George Thomaides-Brears, Lucia Johnstone, Emma Evans, Naveed Sattar, Michael E. Lean. Remission of Human Type 2 Diabetes Requires Decrease in Liver and Pancreas Fat Content but Is Dependent upon Capacity for β Cell Recovery. Cell Metabolism, 2018; DOI: 10.1016/j.cmet.2018.08.003
11. Ketema Paul, Guillaume Bidault, Stephen T. O’Rahilly, Nicholas J. Wareham, Federico Innocenti. Weight loss restores early response and insulin secretion dynamics in recently diagnosed type 2 diabetes. American Journal of Physiology-Endocrinology and Metabolism, 2019; DOI: 10.1152/ajpendo.00539.2019