Can Type 2 Diabetes Be Reversed?

Did you know that 10.5% of the world’s population has diabetes? That means 537 million people! Inside the United States, 37.3 million people have diabetes (11.3% of the US population). Type 2 diabetes constitutes approximately 95% of all cases of diabetes. Another 541 million are at serious risk for developing diabetes. Let’s look at proven ways to manage, prevent, and even reverse (when possible) diabetes with a healthful lifestyle.

What Is Diabetes Type 2 Reversal?

Reversing diabetes is a term that usually refers to a significant long-term improvement in insulin sensitivity in people with diabetes. The A1c or the fasting plasma glucose level returns either to a prediabetic or normal level without medication. Reversing diabetes usually includes a reduction of abdomen visceral fat and the fat content in the liver. By reversal, we mean remission and not an absolute cure. The remission of type two diabetes does not imply that all organ damage that resulted from diabetes has disappeared. Reversing type 2 diabetes is easier within the first ten years from diagnosis.

Precisely, diabetes remission occurs when the HbA1c is less than 6.5% (48 mmol/mol) or the fasting plasma glucose level is lower than 125. It is measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. Annual lab checks are essential to be sure the person stays in remission.¹

Lifestyle Factors and Type 2 Diabetes

Sustained Weight Loss

Obesity increases insulin resistance causing the pancreas to make more insulin to counter the inefficiency of insulin’s action. With insulin not functioning properly, blood glucose levels remain higher than normal (hyperglycemia). Even before type 2 diabetes occurs (or even if it doesn’t occur), high levels of insulin injure the body by encouraging the development of atherosclerosis, high blood pressure, elevated triglycerides, abnormal activation of the sympathetic nervous system, and increased inflammation throughout the body. Excess abdominal fat, rather than lower body fat, increases the risk of diabetes. Even a 5 to 7 % weight loss helps improve blood sugar in individuals who have prediabetes and a 15% or moreweight loss is recommended for obese individuals with type 2 diabetes.

Some studies show that a reduced calorie but nutrient-dense diet, weight loss, and increased physical activity are linked to type 2 diabetes remission.²³ 

One study contrasted the effectiveness of lifestyle interventions (reduced calorie diet, regular exercise and physical activity, and structured lifestyle support). The average one-year weight loss for patients receiving the lifestyle intervention was about 26 pounds. Patients in a comparison group who received standard, medication-centered diabetes care lost only 9 pounds on average. About 61 percent of the patients receiving the lifestyle intervention no longer had diabetes after the one-year trial compared to just 12 percent of the standard care group.⁴

Win While You Lose

Both excessive fat around the abdomen organs (visceral fat) suggests that extra fat is accumulated in the liver and the pancreas. Bad news as visceral fat (VAT) increases the risk for cardiovascular diseases. A 7% weight loss resulting from a lifestyle-based strategy of balanced nutrition and exercise is likely to result in a 25% reduction in VAT.  This improves one’s chances of reversing diabetes and lowers the risk of heart and blood vessel diseases.⁵

Exercise!

Physical activity and exercise physiologically lower blood glucose, using and bypassing the insulin requiring pathway, so physical activity is a MUST for conquering this condition. A single bout of exercise increases the rate of glucose uptake into the contracting skeletal muscles.⁶ A 15-minute stroll after meals effectively lowers blood sugar and promotes reversal of type-2 diabetes and cardiovascular disease.⁷

When to Exercise

Exercise before a meal can reduce blood sugar levels in individuals who have type 2 diabetes but exercise immediately following a meal reduces both blood sugar and fat levels in the blood for that day.⁸

Moderate exercise is safer and more effective for those with prediabetes and diabetes. High-intensity exercise tends to burn glucose more than fat, while moderate-intensity exercise tends to burn fat more than glucose.⁹

Relish a Whole Plant-Based Diet!

The proteins and fats in red meat and poultry may increase a person’s risk of diabetes.¹⁰ The EPIC cohort study found a 22% greater incidence of type 2 diabetes over 12 years in the highest versus lowest quintile of animal protein consumption and a 5% higher incidence per 10 g increment of animal protein intake.((van Nielen M. Dietary protein intake and incidence of type 2 diabetes in Europe: the EPIC-InterAct Case-Cohort Study. Diabetes Care. 2014 Jul;37(7):1854-62.)  In contrast,  well-balanced vegetarian diets significantly lower fasting blood sugar levels,  reduce A1C, and diabetic medications. Moreover, adoption of a vegetarian diet has been shown to be more beneficial in improving diabetes symptoms than traditional medication in some studies.¹¹

Both observational and interventional studies demonstrate the benefits of plant-based diets in treating type 2 diabetes and reducing the damage to large and small blood vessels. Note that the type and source of carbohydrate (unrefined versus refined), fats (monounsaturated and polyunsaturated versus saturated and trans), and protein (plant versus animal) play important roles in the prevention and management of type 2 diabetes.¹²

Fiber is also very important. Bulky, fiber-rich meals can increase feelings of fullness and delay hunger, enabling one to lose weight. Soluble fiber can also improve glucose tolerance and insulin responses to carbohydrate intake. Many lean diabetics who don’t take insulin experience improved glucose control and a reduction in blood lipid levels with greatly reduced insulin requirements after consuming a high-fiber (at least 50g of fiber a day),  high complex-carbohydrate diet for only a few weeks.

Super Grains for Diabetes

All in all, it is more prudent to eat smaller amounts of nutritious, low-fat foods that are naturally high in fiber (like vegetables, whole fruits, whole grains, beans, nuts, and seeds) than an abundant amount of highly processed carbs, high-protein, and high-fat, sweet “goodies.” Use intact grains and whole fruits that have a low or medium glycemic index scores (berries, plums, pears, peaches, oranges, grapes, and apples).. Barley, steel-cut oats, brown rice, quinoa, cracked wheat, wheat berries, rye berries, amaranth, and millet are considered intact grains. Whole-grain bread made with more intact and coarsely ground whole grains reduced postprandial glucose in adults with type 2 diabetes compared to whole-grain bread made with finely milled whole grains.¹³

Enjoy Legumes

The resistant starch, soluble fiber, and low glycemic load in beans, all help to stabilize blood sugar, reduce risk of diabetes, and combat diabesity. Even in overweight, type 2 diabetic patients, substituting legumes for red meat improves blood sugar control and lipids (cholesterol, LDL and HDL cholesterol). ¹⁴  Eating lentils, navy beans, and chickpeas reduces the consumption of food, improves satiety, and even lowers blood glucose after a second meal!¹⁵

Animal Products, Inflammation, and Diabetic Complications

Chronic inflammation fuels diabetic complications and increases comorbidities such as cardiovascular diseases, neuropathy, and cancer. Studies show that individuals following Western or ‘meat-based’ diets tend to have higher biomarkers of inflammation.¹⁶ In contrast, those following ‘vegetable-and-fruit’ based patterns tend to have lower levels of these biomarkers. A recent systematic review and meta-analysis found that those adopting a fully or mostly plant-based diet had significant reductions in C-reactive protein and other obesity-related inflammatory biomarkers compared to those following control, non-plant-based diets.¹⁷

Animal Protein and Kidney Disease

Diabetes markedly increases the risk for chronic kidney disease. Red meat consumption has been strongly linked to kidney failure.¹⁸One large study found that patients with chronic kidney disease who consumed diets high in animal protein were three times more likely to develop kidney failure than patients who consumed diets high in fruits and vegetables.¹⁹ A dietary regimen that is plant-based has real, proven benefits.

Why Does a Whole Food Plant-Based Diet Work?

Plant-based diets are high in fiber, antioxidants, and magnesium, promoting insulin sensitivity. Antioxidants such as polyphenols may inhibit glucose absorption, stimulate insulin secretion, reduce glucose release from the liver, and enhance glucose uptake by the cells.²⁰ Fiber, which is found only in plant foods, is fermented by intestinal bacteria to produce short-chain fatty acids that allow cells to respond better to insulin. Additionally, soluble fiber protects from inflammation. Diets high in plant foods decrease the production of trimethylamine N-oxide, a compound that has been linked to insulin resistance and cardiovascular disease.

Caveats: Vegetarians should be sure that their B-12 and vitamin D levels are within good range. Deficiencies in these vitamins are common. So it is wise to get a dietician to review your menu to be sure that you are getting the best nutrition. Avoid refined carbohydrates.

How to Eat

Snacking between meals, eating junk food, and overeating overload our system and increase the requirements for handling glucose and fats in the blood – not a winning strategy in an already impaired system. Chew your food. Don’t drink it. Why? Chewing food improves metabolism and decreases hormones that promote hunger. This makes appetite control easier!

Mind Your Minerals!

Chromium, an essential nutrient found largely in whole grains, is vital for the normal functioning of insulin. A high-sugar diet aggravates chromium deficiency since it increases urinary losses of chromium. When chromium supplements are given to a person with diabetes, there is observed an improvement in their fasting blood-sugar levels and insulin responses.

Magnesium deficiency also plays a role in insulin resistance and carbohydrate intolerance. Good sources of magnesium include green leafy vegetables, whole grains, nuts, legumes, berries, and other fruits.

Vanadium helps insulin do its job. It is found in whole grains, mushrooms, parsley, and dill.

Leverage Your Beverage

Some promote the “eat, drink, and be merry, for tomorrow we die” approach to life. But the evidence to date is that most people prolong their death and suffer for years with chronic diseases before they die. Above, we presented the eating aspect. Now, how about the drinking? Mother’s milk for babies, and for everyone else, water–pure, cool, refreshing water! Of course, small quantities of natural juices of fruits and vegetables as part of your “feasting” will not generally be an issue but the habitual indulgence of juices, sweetened and caffeinated drinks, and alcoholic beverages is a plan for long-term distress, not success. Alcohol damages the brain, liver, pancreas, and heart muscle, as well as elevates triglycerides. It depletes the body of magnesium and B vitamins needed to combat the metabolic syndrome and diabetes. The net effect of sugary drinks, zealous juice drinking, and sheik alcohol imbibing is more weight, more fat, more demand on the pancreas and heart with potentially devastating pathological consequences. So, “leverage your beverage.” Drink at least 8 glasses of water per day for most people and use prudently natural fruit and vegetable juices.

Let the Sunshine In!

Adequate but not undue exposure to sunlight is essential for optimal health. Some of the beneficial effects are mediated through hormones like serotonin, melatonin, and vitamin D. Vitamin D inadequacy predisposes individuals to glucose intolerance in type 1 and type 2 diabetes. This inadequacy has been shown to impair insulin synthesis and secretion in humans and in animal models of diabetes.²¹ Indeed, individuals who are deficient in this vitamin are more likely to develop diabetes than those who are not—regardless of their weight.²² Furthermore, population studies link vitamin D insufficiency in early life with later-life onset of type 1 diabetes. Getting enough vitamin D during infancy and childhood is associated with a reduced risk of islet autoimmunity among children at increased genetic risk for type 1 diabetes.²³

Approximately 1 billion people worldwide may have deficient or insufficient levels of vitamin D due to chronic disease and inadequate sun exposure related to sunscreen use.²⁴ One in seven teenagers in the United States is vitamin D deficient.²⁵ Living in northern latitudes, obesity, and having dark skin increases one’s risk for this deficiency. The elderly also do not obtain enough vitamin D from exposing their skin to the sunlight.

Get Adequate Sleep

Be active but get good sleep. Adequate sleep is an important way to markedly reduce insulin resistance and regulate blood glucose in the young and not-so-young. Sleep improves the ability of the body to burn glucose and fat. In fact, repetitive sleep loss can increase weight and reduce the cells’ ability to dispose of glucose properly by 30 to 40 percent.That’s like driving a loaded car with one-third less power!²⁶

Accumulative sleep loss worsens type 2 diabetes. One study compared diabetic individuals who were poor sleepers to those who were good sleepers. They discovered that those who were poor sleepers had 23 per cent higher levels of blood glucose in the morning and 48 per cent higher levels of blood insulin. These figures meant that poor sleepers with diabetes had 82 per cent higher insulin resistance than normal sleepers with diabetes.²⁷

So, turn off the lights (including the computer and television) and have a good night’s rest!

Be Faithful With Your Follow Up Visits

Weight gain, infections, stress, another illness, or certain medications can lead to a recurrence of type 2 diabetes. Be sure to check your A1C and/or fasting plasma glucose at least once a year and more often if you experience weight gain, unusual stresses, infections or a new diagnosis.

Even after remission of T2D, damage to the kidneys, nerves, heart, blood vessels, hypertension, and eyes may occur.²⁸ Annual screening for the kidneys, heart, and eyes are essential assessment tools to help prevent or slow down these complications.

Rest, Don’t Stress

For people with diabetes, both physical and emotional stresses take a toll on their health. Stress can play real havoc with their blood sugar. Both physical and emotional stress can prompt an increase in the stress hormones epinephrine and cortisol resulting in an increase in blood sugar levels. Cultivating and expressing gratitude helps to reduce stress levels! Spending time in a green environment–a park, a forest, a garden– recharges one’s energies.

The serenity prayer should become a way of life. Give it a try: God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and wisdom to know the difference.

Work Cited:

IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022 Jan;183:109119. doi: 10.1016/j.diabres.2021.109119.

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