UK Doc: Type 2 Often Curable

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According to Dr. Roy Taylor of the United Kingdom’s University of Newcastle, we need to change our understanding of what causes Type 2 diabetes. Then we can treat it and reverse it. What is this new understanding?

Dr. Taylor made headlines in 2011 when his team “reversed” Type 2 diabetes in 11 people by putting them on a 600-calorie-a-day diet. His subjects achieved normal glucose levels within a week. That’s not so amazing. If you don’t eat, your glucose numbers will of course come down. But by the end of the eight-week study, most of them achieved normal numbers on a glucose tolerance test, which is much harder to do. It shows their insulin response had returned.

“Their first phase insulin response increased gradually over 8 weeks of a very-low-calorie diet,” Dr. Taylor reports. It became “indistinguishable from that of age- and weight-matched nondiabetic control subjects.”

In his new paper, called “Type 2 Diabetes: Etiology and Reversibility,” Dr. Taylor describes how that recovery happened. He used new kinds of MRIs to look at what was actually happening to people’s liver and pancreas. By seeing how liver and pancreas change as they get better, he says we can understand how diabetes develops in the first place.

What he found is that fat in the liver and pancreas seems to cause all the problems. High fat levels cause the liver to become insulin resistant. So it starts pumping out unneeded glucose (the process the drug metformin tries to stop).

As a fatty liver makes glucose levels rise, bad cholesterol levels also rise, which leads to a fatty pancreas. Fat in the pancreas blocks insulin signaling and production. Voilá! You have diabetes.
This story is a change from our old understanding. The classic story of Type 2 is that insulin resistance (IR) in the muscles forces the pancreas to work harder. Over time, the pancreas “wears out” and diabetes starts.

But Dr. Taylor says insulin resistance in the muscles, by itself, will never cause diabetes. Instead, high insulin levels, partly caused by insulin resistance, promote fat production and deposition.

When that fat gets into the liver, it blocks insulin action there. The liver starts to produce and leak glucose. That’s when blood glucose levels start to go up. You probably have prediabetes at that point. When the pancreas also gets fatty, diabetes is in full effect.

This could actually be good news. If you can reduce fat in the liver and pancreas, their normal function returns rapidly in most cases. First, reduced liver fat leads to normal fasting glucose levels: the liver isn’t leaking at night. Then reduced fat allows the pancreas to produce insulin normally. As a result, blood glucose after meals steadily improves.

And it turns out that reducing liver and pancreas fat happens quickly, before more general weight loss is seen. According to Dr. Taylor, the liver’s rapid fat loss explains why bariatric (weight-loss) surgery often seems to reverse diabetes in a matter of days, before any significant weight loss occurs. Liver and pancreas fat goes down before body fat does, and normal insulin function can return very quickly.

Is this a cure?
Unfortunately, fat loss would only be a cure for diabetes if it can be maintained. It’s no surprise people eating 600 calories a day will have low glucose numbers. We already knew that Type 2 almost disappears in times of famine. With less food (especially less carbohydrate) the body needs less insulin, so the pancreas can keep up and start to heal.

But people can’t maintain a diet like that for long. What happens when they stop? Normally, any weight loss diet is followed by a weight regain. Do the liver and pancreas also regain their fat and restart the diabetes?
It seems that most people do, but that doesn’t mean they have to. Diabetes Self-Management commenter Jim Snell wrote:

I heard from Dr. Taylor’s groups that people who did this diet had to maintain tight calorie control, exercise, and discipline, or the bad numbers returned. That does not mean one stays at 600 calories but means one does not jump to 2000 calories either.

Jim says 1200 calories a day and regular exercise are working for him. Dr. Taylor says physical exercise is crucial to keeping unwanted fat out of the organs, but says exercise alone cannot do it.

Unfortunately, the very-low-calorie approach doesn’t work for everyone, even temporarily. As a reader named Margaret commented,

If a liver is damaged through means other than fat deposits, e.g. hepatitis, HSV-2 [herpes virus], etc. a diet won’t cut it… Depending on the degree of damage or the progression of such viral liver attacks, it may be that regardless of what a diabetic eats they may progress, even from oral medications such as metformin to insulin.

In other people, the pancreas may be too damaged to keep up a basal level, even if the fat doesn’t return. They will still benefit from insulin injections. These two groups seem to make up about 20% of people with Type 2 according to Dr. Mark Hyman, author of The Blood Sugar Solution.

Remember that Dr. Taylor’s theory still needs to be confirmed by other research. Still, from what we know, it seems to me that going very low calorie for some weeks might be a good jump-start to your program. Getting the fat out of the liver and pancreas, even temporarily, can’t hurt.

It might be best to do this with a doctor’s supervision. If you’re on insulin or a sulfonylurea, those might need to be reduced or stopped.

But there’s no sense doing that, in my opinion, if you don’t have a follow-up plan you can live with, most likely one that’s low carb and low calorie and includes some exercise. Is that possible for you? What do you think?

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