Can extreme low-calorie diet cure diabetes?
June 24, 2011 6:35 AM   Subscribe

A study conducted at Newcastle University (UK) shows that type 2 diabetes can be completely reversed, not with medication, but through following a 600-calorie diet for two months.

The diet consists solely of liquid diet drinks and low starch vegetables for two months. At the end of the two months, the subjects of the study were given advice on portion control and healthy eating, and then "resumed normal eating".

Study was conducted with eleven volunteers with diabetes. Ten of the eleven returned for followup tests after three months. Of these ten, seven remained completely free of diabetes.

(There was a control group of another eleven subjects with diabetes who made no dietary changes.)

Following the diet was difficult and stressful:

“When my doctor mentioned the trial I thought I would give it a go as it might help me and other diabetics. I came off my tablets and had three diet shakes a day and some salad or vegetables but it was very, very difficult and I’m not sure I’d have done it without the support of my wife who went on a diet alongside me.

“At first the hunger was quite severe and I had to distract myself with something else – walking the dog, playing golf – or doing anything to occupy myself and take my mind off food but I lost an astounding amount of weight in a short space of time.

“At the end of the trial, I was told my insulin levels were normal and after six years, I no longer needed my diabetes tablets. Still today, 18 months on, I don’t take them. It’s astonishing really that a diet – hard as it was – could change my health so drastically. After six years of having diabetes I can tell the difference - I feel better, even walking round the golf course is easier.”
posted by marsha56 (134 comments total) 36 users marked this as a favorite

 
If somebody would clarify what "diet drinks" means, this would constitute a plan for the next two months.
posted by penduluum at 6:44 AM on June 24, 2011


600 calories?
posted by clavdivs at 6:45 AM on June 24, 2011 [2 favorites]


These things often seem to turn out to not be quite so miraculous, but the optimist in me definitely wants this to be true.
posted by Forktine at 6:46 AM on June 24, 2011 [4 favorites]


I'd assume that 'diet drinks' means those meal replacement drinks. I'd be very wary of trying this without consulting a doctor and dietician. At 600 calories a day it would be very difficult to get all the nutrients, you're basically going eat like an someone suffering anorexia.
posted by papercrane at 6:47 AM on June 24, 2011 [9 favorites]


Obviously needs more data but this could be the beginning of some amazing news for a lot of people.
posted by jeffmik at 6:47 AM on June 24, 2011 [1 favorite]


This is pretty extraordinary. Going to go read up. (assuming Type 2).
posted by bystander at 6:47 AM on June 24, 2011


A 3 month follow-up seems very short.
posted by muddgirl at 6:48 AM on June 24, 2011 [11 favorites]


Type II diabetes, natch. This obviously isn't a restoration project for my islets of Langerhans.
posted by stevis23 at 6:48 AM on June 24, 2011 [12 favorites]


Just want to point out that this is talking about Type 2 diabetes rather than Type 1 diabetes.
posted by hydropsyche at 6:48 AM on June 24, 2011 [2 favorites]


Whoa. If this works...
posted by Jahaza at 6:52 AM on June 24, 2011


Emphasis mine:
The research, presented today at the American Diabetes Association conference, shows that an extremely low-calorie diet, consisting of diet drinks and non-starchy vegetables, prompts the body to remove the fat clogging the pancreas and preventing it from making insulin.

The volunteers were closely supervised by a medical team and matched with the same number of volunteers with diabetes who did not get the special diet. After just one week into the study, the pre-breakfast blood sugar levels of the study group had returned to normal. And MRI scans showed that the fat levels in the pancreas had returned to normal. The pancreas regained its ability to make insulin.

After the eight-week diet the volunteers returned to normal eating but had advice on healthy foods and portion size. Ten of the group were retested and seven had stayed free of diabetes.
Wow. Holy crap. They rebooted the pancreas. I wonder whether the change lasts longer than 3 months.
posted by zarq at 6:52 AM on June 24, 2011 [20 favorites]


Oh for god's sake. w/o reading this, only adult-onset diabetes could even conceptually be affected in this manner. People are gonna die attempting to emulate this.

My wife has been an insulin-dependent diabetic since she was a toddler, and about once a month we get a thoughtless email or predatory telemarketing call promising a no-injection "cure" based, nearly always, on ignorance of the difference between the two types of diabetes. The ignorance comes in two types, too: well-meaning, or murderous.

The failure of this post to distinguish between the two varieties is absolutely par for the course and will surely be replicated in the avalanche of bogus diabetes reversal books, videos, diet plans and spas which will hurriedly follow the announcement of this news.
posted by mwhybark at 6:52 AM on June 24, 2011 [6 favorites]


mwhybark: " The failure of this post to distinguish between the two varieties is absolutely par for the course."

Which is easily fixable. The mods can edit the post with marsha56's permission.
posted by zarq at 6:55 AM on June 24, 2011 [2 favorites]


So, on first skim read - fasting can, I like zarq's term 'reboot' the pancreas. For type 2 only, tested on a handful of people only. Still good news, but I suspect there will be conditionals.
posted by bystander at 6:57 AM on June 24, 2011 [1 favorite]


The pdf is available. Off to read it.
posted by gaspode at 6:57 AM on June 24, 2011 [6 favorites]


Of course, it might help to mention that somewhere around 90% of diabetes cases are type 2, rather than type 1. So while this won't do a thing to help those with type 1 diabetes, it might be a boon for the great majority of diabetes patients nonetheless.
posted by 1adam12 at 6:58 AM on June 24, 2011 [8 favorites]


The press release specifies that it's Type 2 diabetes.
posted by gaspode at 6:59 AM on June 24, 2011


oh, no argument this is amazing news if it is repeatable/reproducible/enduring.
posted by bystander at 6:59 AM on June 24, 2011


Can extreme low-calorie diet cure diabetes?

Speaking as a Type II diabetic , the answer is no. You're not going to get people to eat like that long term, especially after they leave the study. Hell, the article noted only 5%-10% of people would be able to continue such an extreme diet. Most people can eat just fine when they're under medical supervision and getting special food. It's a bit harder when you're back in the real world.

Diabetics were kept alive in the early part of the 20th century via basically starving them (i.e. extremely restricted diet), at least until insulin was discovered. I'm not sure what this study is offering. It's already well known that diet and exercise helps immensely in controlling the disease.
posted by Brandon Blatcher at 7:00 AM on June 24, 2011 [2 favorites]


I recall reading or hearing of other studies showing that early(ish) onset Type II diabetes can be reversed with diet and lifestyle changes.

From what I remember though, it has to be fairly early. If one has had Type II for a long time, the damage to the pancreas has been done and can no longer produce insulin. At this point diet won't help.
posted by device55 at 7:01 AM on June 24, 2011


gaspode: "The pdf is available. Off to read it."

Excellent. Thank you!
posted by zarq at 7:02 AM on June 24, 2011


Also, you're never cured of diabetes is the current teaching. You can control it and get your blood levels down, but for medical purposes you're still diabetic, because you're still not as insulin sensitive as regular folks.
posted by Brandon Blatcher at 7:03 AM on June 24, 2011 [1 favorite]


From what I remember though, it has to be fairly early. If one has had Type II for a long time, the damage to the pancreas has been done and can no longer produce insulin. At this point diet won't help.

Yes, and the paper states that all of the study subjects were reasonably early-onset diabetics (<4 years)
posted by gaspode at 7:03 AM on June 24, 2011 [1 favorite]


Speaking as a Type II diabetic , the answer is no. You're not going to get people to eat like that long term, especially after they leave the study.

The study didn't suggest that people eat like this forever. In the study, subjects followed the extremely restricted diet for 2 months, then "resumed normal eating." 7 of 10 were still free of diabetes at a 3-month follow up.

This is one of those tiny, highly suggestive studies that gets a lot of press but may turn out not to be replicable or in some other way not lead to a great breakthrough. And 3 months is a short follow-up time, as someone up-thread mentioned.

But nobody suggested people go on an extremely low-cal diet permanently.
posted by not that girl at 7:03 AM on June 24, 2011 [12 favorites]


The study is 11 people only. It suggests extreme calorie restriction (600 kc, versus a normal diet of 2000+) for 8-12 weeks has an effect that reinvigorates the pancreas.
There is no evidence whether this will be more broadly applicable, or whether it will be long lasting, but it is still quite positive news.
posted by bystander at 7:03 AM on June 24, 2011 [2 favorites]


Also, you're never cured of diabetes is the current teaching. You can control it and get your blood levels down, but for medical purposes you're still diabetic, because you're still not as insulin sensitive as regular folks.

And they measured insulin resistance in the paper, and crucially, it didn't change. That seems to me like it would indicate a temporary fix rather than a long-term cure.
posted by gaspode at 7:04 AM on June 24, 2011 [2 favorites]


At 600 calories a day it would be very difficult to get all the nutrients...

No, it should be easy to get all the nutrients. You just won't get all the calories. Which is the point.

You're not going to get people to eat like that long term, especially after they leave the study.
At the end of the two months, the subjects of the study were given advice on portion control and healthy eating, and then "resumed normal eating".
"Normal" meaning what, though?

People are gonna die attempting to emulate this. My wife has been an insulin-dependent diabetic since she was a toddler...

And has she died from any of that thoughtless/murderous advice? If you are actually diabetic and currently treating it, surely you know enough to be able to filter out most of the bad advice.
posted by DU at 7:04 AM on June 24, 2011 [4 favorites]


penduluum: "If somebody would clarify what "diet drinks" means...

From the pdf:
After the baseline measurements, individuals with type 2 diabetes started the diet, which consisted of a liquid diet formula (46.4% carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace elements; 2.1 MJ/day [510 kcal/day]; Optifast; Nestlé Nutrition, Croydon, UK). This was supplemented with three portions of non-starchy vegetables such that total energy intake was about 2.5 MJ (600 kcal)/day. Participants were provided with sugges- tions of vegetable recipes to enhance compliance by varying daily eating. They were also encouraged to drink at least 2 l of water or other energy-free beverages each day, and asked to maintain their habitual level of physical activity. Ongoing support and encouragement was provided by means of regular telephone contact. At the end of the 8 week intervention participants returned to normal eating but were provided with information about portion size and healthy eating.
...this would constitute a plan for the next two months."

I'm not a doctor or a nutritionist, but I would suggest against it without medical supervision and a support system of friends to rely on.
posted by zarq at 7:05 AM on June 24, 2011 [1 favorite]


This thread is a great example of the importance of RTFA.
posted by Marisa Stole the Precious Thing at 7:06 AM on June 24, 2011 [47 favorites]


gaspode: " And they measured insulin resistance in the paper, and crucially, it didn't change. That seems to me like it would indicate a temporary fix rather than a long-term cure."

Is it possible that a nutritious, restricted calorie diet could maintain the effect over time, though? Hypothetically, I mean.
posted by zarq at 7:07 AM on June 24, 2011


The study didn't suggest that people eat like this forever. In the study, subjects followed the extremely restricted diet for 2 months, then "resumed normal eating." 7 of 10 were still free of diabetes at a 3-month follow up.

From the article:
He warned that only a minority of people, perhaps 5% or 10%, would be able to stick to the harsh diet necessary to get rid of diabetes.
Also, they did not resume normal eating: "After the eight-week diet the volunteers returned to normal eating but had advice on healthy foods and portion size." i.e. they got education on how to eat, what to eat and how much to eat, which suggests they could have gone back to being diabetic if they continued previous methods of eating.
posted by Brandon Blatcher at 7:07 AM on June 24, 2011 [3 favorites]


I mean, a less restrictive diet, but perhaps not one with normal caloric intake.
posted by zarq at 7:07 AM on June 24, 2011


So...starving reverses diabetes? I suppose that makes sense biologically. I can't imagine trying to live on that, though. And by "live" I mean go to work, take care of the kids, etc, etc. I do not mean walk the dog and golf.
posted by maryr at 7:08 AM on June 24, 2011 [1 favorite]


Is it possible that a nutritious, restricted calorie diet could maintain the effect over time, though? Hypothetically, I mean.

I think it's possible, but I don't think the diet that they were on is behaviorally sustainable. I wonder, if they were looking for long-term fixes, if a gradual ramp up to a still-controlled diet of 1200-1400 kcal or so would work as a long-term thing. I feel like the absolute key would be lots of support, both social and physican.
posted by gaspode at 7:09 AM on June 24, 2011 [1 favorite]


People are gonna die attempting to emulate this.

This isn't like a skateboard stunt you see on youtube where you can just go out and try it and get yourself killed three minutes later. This is a difficult program undertaken under professional supervision. It's pretty damn unlikely someone who's survived under Type I diabetes is going to execute it by accident.
posted by George_Spiggott at 7:09 AM on June 24, 2011 [7 favorites]


Ah, on my posting I see you clarified. But yeah, maybe slowly increasing caloric intake would not freak out the pancreas (that's the technical term.)
posted by gaspode at 7:10 AM on June 24, 2011 [1 favorite]


If type 2 diabetes is frequently caused by overweight, and the vast majority of people who are successful at losing weight wind up gaining it back, I think the odds are very long that advice on portion sizing and healthy food choices is going to keep these people from winding with up with Type 2 diabetes again. Note: my premise may be faulty, I don't know much about Type 2 diabetes.
posted by stupidsexyFlanders at 7:11 AM on June 24, 2011 [3 favorites]


Is it possible that a nutritious, restricted calorie diet could maintain the effect over time, though?

Totally. That's exactly what I've been taught. I have a daily caloric and carb goal, and a App on my iPod to track calories, fat, carbs and blood glucose levels.

So...starving reverses diabetes? I suppose that makes sense biologically. I can't imagine trying to live on that, though. And by "live" I mean go to work, take care of the kids, etc, etc

This is the EXACT problem that comes up repeatedly in the diabetes testing program I've been a part of in Savannah, GA for the past couple of years. Everyone knows what they have to do, but in the process of raising kids, having a job, marriage, etc, keeping track of all that and doing a good job of it takes a lot of effort.
posted by Brandon Blatcher at 7:12 AM on June 24, 2011 [1 favorite]


It's pretty damn unlikely someone who's survived under Type I diabetes is going to execute it by accident.

Also reasonably sure that someone who tried a really low calorie diet could just go have a sandwich if it wasn't working out.
posted by device55 at 7:12 AM on June 24, 2011


gaspode: " I think it's possible, but I don't think the diet that they were on is behaviorally sustainable. I wonder, if they were looking for long-term fixes, if a gradual ramp up to a still-controlled diet of 1200-1400 kcal or so would work as a long-term thing. I feel like the absolute key would be lots of support, both social and physican."

That makes sense.

These findings aren't that surprising. IIRC, there were a handful of studies performed on small groups of men a number of years ago which found that metabolic syndrome was positively affected by a long-term low-calorie diet. If I remember correctly, the average caloric intake was around 1000-1200 calories. One study restricted the men to a 500 calorie intake. (This is all from memory, so the numbers may be off.)

The diets required careful supervision by physicians. But they did create a lasting change.
posted by zarq at 7:15 AM on June 24, 2011


Quick google search turned up this study from 2005. 500 calories, and all the subjects were non-diabetic.
posted by zarq at 7:16 AM on June 24, 2011


So sorry! Of course it should say "type-2 diabetes". I've e-mailed mods asking them to fix this. My bad!!
posted by marsha56 at 7:19 AM on June 24, 2011 [2 favorites]


[hanged the FPP to say "type 2 diabetes" on poster's request. carry on]
posted by jessamyn at 7:19 AM on June 24, 2011 [4 favorites]


Murder averted.
posted by (Arsenio) Hall and (Warren) Oates at 7:21 AM on June 24, 2011 [6 favorites]


It's widely reported that a large percentage of Type 2 diabetics who have gastric band surgery become free of diabetes within a short period of time. They will, of course, be on a very restricted diet following the GB surgery. This new study strikes me as a similar fix, but without the gastric band.
posted by essexjan at 7:23 AM on June 24, 2011 [3 favorites]


Also, as I understand it from the news reports, the very low-calorie intake in the Newcastle study was not intended to be a lifelong diet, but was for a few months only, under medical supervision.
posted by essexjan at 7:25 AM on June 24, 2011


It's widely reported that a large percentage of Type 2 diabetics who have gastric band surgery become free of diabetes within a short period of time. They will, of course, be on a very restricted diet following the GB surgery. This new study strikes me as a similar fix, but without the gastric band.

From the Guardian link:
Taylor, the director of the Newcastle Magnetic Resonance Centre, had the idea for the study after it was shown that diabetes was reversed in people who had undergone stomach stapling or other forms of bariatric surgery because of obesity. "What was remarkable was that the diabetes went away over the course of one week. It was widely believed the operation itself had done something, [that] the hormones in the gut were thought to be the cause. That is almost universally believed."

Taylor thought the massive drop in calorie intake after surgery could be responsible and to test this hypothesis set up the study, which included MRI scans of the pancreas to look at any changes in the fatty deposits.

posted by EndsOfInvention at 7:28 AM on June 24, 2011 [2 favorites]


DU: No, it should be easy to get all the nutrients. You just won't get all the calories. Which is the point.

You're right. I should have said it would be difficult to get all the nutrients you need without supplements. It's not something anyone should attempt without careful consideration and research.
posted by papercrane at 7:28 AM on June 24, 2011 [1 favorite]


My wife has been an insulin-dependent diabetic since she was a toddler, and about once a month we get a thoughtless email or predatory telemarketing call promising a no-injection "cure" based, nearly always, on ignorance of the difference between the two types of diabetes. The ignorance comes in two types, too: well-meaning, or murderous.

The failure of this post to distinguish between the two varieties is absolutely par for the course and will surely be replicated in the avalanche of bogus diabetes reversal books, videos, diet plans and spas which will hurriedly follow the announcement of this news.


Mwhybark, my sincerest apologies.
posted by marsha56 at 7:29 AM on June 24, 2011 [2 favorites]


We discussed this last night at our house. It's an amazing feat if it can be replicated and even moreso if it lasts, but a 600-calorie liquid diet for two months is hell on wheels even with medical supervision. I wouldn't think less of any diabetic who couldn't manage it because I almost certainly couldn't.
posted by immlass at 7:32 AM on June 24, 2011 [4 favorites]


I have a slight vested interest in this because my wife works as a diet counsellor using similar kinds of very low calorie diet to help people struggling with obesity.

The diet being used here is remarkably similar to the Cambridge Diet (and the more recent but very similar 'Lighter Life' plan) that's currently seeing a moderate resurgence in the UK and elsewhere. People have been using diets like these since the 1970s, and they work pretty well for a lot of people, and are generally considered to be nutritionally complete and medically safe for the majority of adults in reasonable health. The key is the follow-up work towards balanced, healthy eating. The diet not only gives a fairly quick weight loss, but also gives people a few weeks or months of 'time out' from food to reassess their relationship with eating. The intention is that clients fix their weight problem once and for all, and don't just go back to gaining weight again. Yo-yo dieting is worse for you than being overweight but stable in a lot of ways.

A person on 500 calories today tends to feel pretty crappy for the first three days, and then ketosis kicks in, and the body starts burning fat for fuel. At this stage most people report that they feel like they've got more energy than normal and don't really feel hungry. The failure rate of this sort of diet is pretty much entirely due to people not being able to cope with feeling hungry for three days at the start.

So far, the medical vetting process has precluded putting people with diabetes on these diets, or indeed people suffering from any of a number of conditions. But perhaps in the future my wife will find herself working alongside the physicians of clients with type 2 diabetes.
posted by le morte de bea arthur at 7:37 AM on June 24, 2011 [5 favorites]


I feel like nobody is noticing this part (emphasis mine) -- From the original post:

"I no longer needed my diabetes tablets. Still today, 18 months on, I don’t take them."

Everyone talking about a 3-month follow up being too short, I agree, but at least this one guy has had 1.5yrs of positive results so far.
posted by mbatch at 7:38 AM on June 24, 2011 [3 favorites]


Forget reading the articles, does anyone read the post?

The post clearly says the diet is temporary: "for two months."

The post clearly says this study is only for type-2 diabetes.

And yet half the comments in this thread are about along the lines of 'the diet is unsustainable in the long term' and reminders that this is only for type 2 diabetes.

I know its Friday, but Jesus Christ people....
posted by Pastabagel at 7:42 AM on June 24, 2011 [6 favorites]


reminders that this is only for type 2 diabetes.

I added that part recently [see my previous comment] at the poster's request, fyi.
posted by jessamyn at 7:44 AM on June 24, 2011 [3 favorites]


but at least this one guy has had 1.5yrs of positive results so far

Unfortunately, this is just an anecdote. I'm not skeptical of the claim that a short-term low-calorie diet can help patients with diabetes. But the majority of research shows that extreme weight loss will not be maintained by most patients in the long term. If the researchers want to show that these beneficial effects last even while weight is regained, I'd like to see followups over the next 5-10 years.
posted by muddgirl at 7:44 AM on June 24, 2011


The post clearly says this study is only for type-2 diabetes.

That's because the mods changed it at the OP's request.
posted by headnsouth at 7:44 AM on June 24, 2011 [1 favorite]


Pastabagel: The post clearly says this study is only for type-2 diabetes.

The post was edit to make it clear that it was only for type-2 diabetes. If you read the comments you can see zarq suggested it.
posted by papercrane at 7:45 AM on June 24, 2011 [1 favorite]


The rumor that this is true has been going around for ages. I'm glad someone did a study on it and saw that there is some merit to dietary diabetes control.

I am insulin resistant, but I do not have diabetes. The concerns I have follow my understanding of dietary control of insulin resistance, so let me try to explain them to the best of my ability.

On a 600 calorie, controlled diet which I am assuming severely restricts carbohydrates and bread items, this is naturally going to reverse all of your symptoms of insulin resistance/diabetes. You, essentially, will 'no longer have it'.

The problem lies when you begin to eat normally again. Unless you keep those diabetic triggering foods out of your diet (any bread, sugars, etc.) you're going to get diabetes or insulin resistance again.

So the question is... does this 'cure' diabetes or is it more like "I am allergic to cats so I stay away from cats and I no longer have symptoms so I'm no longer allergic to cats, as long as I stay away from them."?
posted by Malice at 7:48 AM on June 24, 2011 [1 favorite]


600 calories per day is pretty extreme, but a longer-term, less-radical calorie reduction in conjunction with a reduction in poor-quality carbohydrates can also achieve a reversal in type-2 Diabetes symptoms for some people.

Getting rid of processed carb products and sugars in favour of more protein and carbs from fruits and vegetables is achievable and less likely to make you super cranky and feel as though you are starving.

It means a wholesale change in eating habits, and those can be very hard to break.
posted by bwg at 7:49 AM on June 24, 2011 [1 favorite]


Pastabagel: " And yet half the comments in this thread are about along the lines of 'the diet is unsustainable in the long term' and reminders that this is only for type 2 diabetes."

One of the questions being raised by people in this thread is whether the diet will need to be continued in order to maintain its long-term effects. One of the causes of Type 2 diabetes is a decrease in insulin production. This study indicates that one possible reason for that decrease is most likely due to an overabundance of fat, clogging the pancreas. The assumption being made is that when pancreatic fat was reduced, insulin production in some of the subjects of the study increased and caused a cessation of diabetes symptoms.

Since the diet is draconian and unsustainable, a next step would be to determine what dietary: (nutritional and caloric) balance would be required for long-term maintenance.
posted by zarq at 7:50 AM on June 24, 2011


Adding to that: As someone with insulin resistance, if I consume a no carbohydrate, low-sugar diet (aside from going crazy from the lack of carbs) all of my symptoms of insulin resistance will go away. If I begin to consume breads or sugars again, or even high carb vegetables, the symptoms will return. So from experience, I'm wondering if this is just the case here.
posted by Malice at 7:51 AM on June 24, 2011


Now we just need a 600 calorie pill, and we can advertise it as a 1-a-day cure for diabetes!
posted by blue_beetle at 7:52 AM on June 24, 2011


Study was conducted with eleven volunteers with diabetes. Ten of the eleven returned for followup tests after three months. Of these ten, seven remained completely free of diabete

I'd be curious how these people did on a diabetes diagnosis test after that three months, before people start trotting out the word cure.

I feel like nobody is noticing this part (emphasis mine) -- From the original post:

"I no longer needed my diabetes tablets. Still today, 18 months on, I don’t take them."


That's referring to this gentleman:
Gordon Parmley, 67, of Stocksfield, Newcastle upon Tyne, a trial participant, said he first noticed something was wrong when his vision went "fuzzy" and he had trouble focusing while playing golf. He had been on medication since being diagnosed with type 2 diabetes six years ago.
My first thought is that his diabetes seems more the natural progress of age and I'd like to know what medication he was on. From the sound of it ("diabetes tablets") he was taking something something like Glucophage XR, which is just a pill. Was he taking 500mg once day or 1500mg twice a day? One is a lot easier to deal with and control with diet and exercise than the other. Frankly he doesn't sound like he was severely out of control if symptoms only cropped up when he turned 65.

Look, I have Google alert for diabetes and usually there's an article other day about some wonderful new treatment that could potentially reverse Type 2. It's been that way for 3 or 4 years since i've had the alert, so I'm a little skeptical of any article that trots out a cure.
posted by Brandon Blatcher at 7:52 AM on June 24, 2011


Forget reading the articles, does anyone read the post?

I read both, and I'm tired of people posting the results of tiny, short term, preliminary medical studies with the usual dumb-ass media "it's cured!" headlines intact. It is not that difficult to be a little circumspect and frame a post like this to include some of the essential facts, and I think it would cut down significantly on the backlash in some of the responses.

The claim clearly laid out in the (corrected) post that this study "shows that type 2 diabetes can be completely reversed" is clearly unjustified. The study is obviously promising and interesting and I don't mind preliminary stuff being presented for discussion but we can and should do better with accuracy in framing.
posted by nanojath at 7:53 AM on June 24, 2011


Malice, can you explain the difference between being insulin resistant and a type 2 diabetic, please? I'm not sure I understand where the line between the two conditions is drawn? Is it simply that your symptoms are similar to a diabetic, but are not so severe that they require doses of insulin?
posted by zarq at 7:53 AM on June 24, 2011


Is it simply that your symptoms are similar to a diabetic, but are not so severe that they require doses of insulin?

Not all Type II's require insulin. Often oral meds, combined with diet and exercise is enough.
posted by Brandon Blatcher at 7:57 AM on June 24, 2011


Metafilter: well-meaning, or murderous.
posted by AzraelBrown at 7:57 AM on June 24, 2011


And has she died from any of that thoughtless/murderous advice? If you are actually diabetic and currently treating it, surely you know enough to be able to filter out most of the bad advice.

Sure, if you’re a reasonable person, you’re going to do your research and not grasp at straws. I imagine no Type Is on this website (myself included) would try to follow a Type II cure, even if not specified as such; we do know ourselves well enough not to try to replace our insulin pumps with herb X or diet Y or ionized water or colour therapy (yes, I’ve been told both ionized water and the colour yellow could cure my recalcitrant pancreas). I’m just worried about the less reasonable people, especially unreasonable parents with Type 1 small children. A diet is certainly better than relying on the colour yellow, but there have definitely been way too many cases of people dying, particularly children because mom was suckered into an ionized water-type deal, because hope is a powerful thing.

In any case I think this is an interesting study that’s certainly worth talking about, and now that it’s changed to reference Type II, no harm, no foul (and sorry for the derail). I think Type Is just reacted poorly because we see the non-distinction all the freakin’ time. And also we know that when the Dullsville Daily News picks this up, it’s not going to make the distinction as usual and a relative from Dullsville will helpfully forward the article to us, as always.
posted by ilana at 7:59 AM on June 24, 2011 [3 favorites]


Quick google search turned up this study from 2005. 500 calories, and all the subjects were non-diabetic.

No, actually the study lists a 500-calorie deficit, that is, a diet 500 calories below what average "appropriate" intake would be. I read the whole thing because I was pretty darn eating-disordered for a couple of years in my teens and the few weeks where I managed to stay at or below 600 calories a day were horrible, so I wondered how people could possibly survive for two years on 500 calories a day. Answer - that's not what was being tested!

Most of the subjects lost weight though many stayed technically obese.

You can survive just fine on say 1200-1500 calories a day - there's enough play available there to allow for variety and feeling fairly full.
posted by Frowner at 8:01 AM on June 24, 2011


I was diagnosed with Type II diabetes three months ago, and the analogy my doctor used was a plane on autopilot - when the autopilot is enagaged there are a lot of things the pilot doesn't have to worry about, and the flight will go just fine. But now my autopilot is broken, so I need to manage things closely if I don't want to crash.

I won't have a chance to read the PDF until later (gotta go to work), but unless this restores that autopilot function I think it is misleading to call it a cure. There was a man in my diabetes education class who had been off medication for six years and considered himself cured, but once he stopped monitoring his glucose levels and controlling his diet his diabetes came back. If these new patients are in the same position I can't see how they can be called cured.

I'm also curious to find out if there were problems with low blood sugar for the participants on such a low calorie diet, which can be just as dangerous as high blood sugar.
posted by InfidelZombie at 8:04 AM on June 24, 2011 [1 favorite]


To be honest, zarq, I'm not sure why I'm considered Insulin Resistant and not Diabetic. I don't know where the line is myself, but that is what all of the doctors I have been to say. I have a problem absorbing insulin and overproduce it when I consume carbohydrates. This makes me 'like' diabetic, but not. I also have PCOS, which is related to the Insulin Resistance.

However, despite not being diabetic, I still have to follow a diabetic diet if I want to keep my symptoms to a minimum. I've heard Metformin helps with my condition, but if I were to inject insulin into my system it would just cause more problems.
posted by Malice at 8:04 AM on June 24, 2011


Type II is caused by lifestyle (in those with a genetic predisposition) and can be cured with lifestyle, but 600 calories is far too extreme, not sustainable and does not teach good eating habits. Better to make reasonable changes -- no whites (no white bread, white rice, white pasta, etc.), eliminate added sugar, no sweetened beverages, no juice. Consume whole foods with their fiber, ie. brown rice, wheat berries, quinoa, barley and oat groats, etc., and lots and lots of fruits and veg (not juice). Sub beans and nuts for meats as often as possible. And most importantly, get exercise because it helps your regulate blood sugar. These changes must be permanent, so you should not try to change everything all at once because you will overwhelm yourself or burn out. Wean yourself off of the sugar, and gradually increase exercise. Make one change this week, add another change next week, just be sure you are always moving forward. You don't have to make yourself miserable.
posted by antinomia at 8:04 AM on June 24, 2011 [1 favorite]


Frowner: " No, actually the study lists a 500-calorie deficit, that is, a diet 500 calories below what average "appropriate" intake would be. I read the whole thing because I was pretty darn eating-disordered for a couple of years in my teens and the few weeks where I managed to stay at or below 600 calories a day were horrible, so I wondered how people could possibly survive for two years on 500 calories a day. Answer - that's not what was being tested!"

Ah ha! You're right. I misread it. Thanks for the clarification. 500 calories per day did seem pretty low. :)
posted by zarq at 8:05 AM on June 24, 2011


but 600 calories is far too extreme, not sustainable and does not teach good eating habits.

It isn't meant to be sustained! It's a short term approach that then changes to include "regular" eating with the kind of education you advocate.
posted by OmieWise at 8:08 AM on June 24, 2011 [2 favorites]


To be honest, zarq, I'm not sure why I'm considered Insulin Resistant and not Diabetic.

There's specific numbers for being classified as a Type II diabetic. Your BG was probably between 100-125 in the first test, as an example.

I was diagnosed with Type II diabetes three months ago, and the analogy my doctor used was a plane on autopilo

I use the manual vs automatic shifting in a car. Normals have automatic, Type II's have to manually shift. And we often seem to be stuck on a damn hill, hee.
posted by Brandon Blatcher at 8:08 AM on June 24, 2011 [2 favorites]


This may not be a miracle cure or anything, but at the very least it probably lowers your A1C score quite a bit.
posted by Halloween Jack at 8:09 AM on June 24, 2011


My wife has been an insulin-dependent diabetic since she was a toddler, and about once a month we get a thoughtless email or predatory telemarketing call promising a no-injection "cure" based, nearly always, on ignorance of the difference between the two types of diabetes.

This is such a common and frustrating problem; there have been so many times when I have desperately wished they would have decided on a completely different name for Type II diabetes. My daughter has been an insulin-dependent diabetic (Type I) since age four, and the comments from ignorant and/or confused people throughout her life have been maddening. Ranging from "Did you feed her too much candy when she was a baby?" to "Oh, that's terrible, I heard diabetics don't live past age 20." One of the most bizarre came from a woman at a junior high track meet: Upon overhearing me asking my daughter whether she had checked her blood sugar, this woman helpfully interjected (to my lean, athletic daughter who was standing right there in her track uniform!), "Did you know you can lower your blood sugar by losing weight and exercising?"

But, back on topic, isn't it possible to achieve the same kinds of results as were achieved in the study without the dangerously low calorie count? One of my neighbors lost a significant amount of weight two years ago and essentially "reversed" his Type II diabetes, inasmuch as he was able to stop taking medication for it (he still checks his blood sugar regularly, though, just to make sure things are going okay).
posted by amyms at 8:12 AM on June 24, 2011 [1 favorite]


I use the manual vs automatic shifting in a car. Normals have automatic, Type II's have to manually shift. And we often seem to be stuck on a damn hill, hee.

Hmm..trying to extend that to type I's. Maybe it's that I have to pull over add and fluid constantly to keep the thing running?
posted by stevis23 at 8:13 AM on June 24, 2011


Some people here are asking what people's diet would return to after the 8 week 600 calorie/day regimen. The article states clearly:

After the eight-week diet the volunteers returned to normal eating but had advice on healthy foods and portion size. Ten of the group were retested and seven had stayed free of diabetes.

I don't know what constitutes 'normal eating' but it's clearly not 'highly restricted calories'. That's not to say that there wouldn't be challenge for some people, but the article claims that the calorie restriction is just for 8 weeks.

Of course, the question is whether it holds up in larger studies.
posted by adrianhon at 8:13 AM on June 24, 2011 [2 favorites]


As a type 2 diabetic, I'm always leery of the word "cure" in articles about the 'beetus. Looking at this actual report, the word "cure" appears just twice -- once saying there is no cure, and secondly in a footnote about an paper with the word cure in the title. This isn't a cure. This is a "reboot" treatment. The average BMI for the participants was 33 which, tied to their belly circumference and fat kg puts them into the obese category. They lost a lot of weight. If, after the severely restricted calories they return to eat healthy and exercise, I have no doubt they will have stopped the disease in its tracks. But if people do this "reboot" and then go back to what made them obese in the first place, the disease comes back. Theses people are not cured; they're in remission.

I am presently on a calorie/carb restricted diet (a gluttonous 1500 cal compared to the 600 in the study) and exercise regimen that burns about 1300 cal above my basal metabolic rate each day. I'm losing weight but I'm also no longer needing my diabetes meds to have the blood glucose levels of a non-diabetic. I have a threshold of weight/bf% + carbs/day that makes this happen. When I told my mother about this, she asked if I'd been cured. No, I said because if I go back to eating like I did and not exercising, I'll be right back in 'beetus land. I know this because it happened before. Changing my diet and exercise makes the disease "go away" but when I fall off the wagon and eat like the fatty I used to be, the disease will come back.
posted by birdherder at 8:13 AM on June 24, 2011 [4 favorites]


Oh, great. The cure for diabetes is anorexia.

Next week: AIDS cures cancer!
posted by schmod at 8:17 AM on June 24, 2011 [1 favorite]


Malice: "To be honest, zarq, I'm not sure why I'm considered Insulin Resistant and not Diabetic. I don't know where the line is myself, but that is what all of the doctors I have been to say. I have a problem absorbing insulin and overproduce it when I consume carbohydrates. This makes me 'like' diabetic, but not. I also have PCOS, which is related to the Insulin Resistance."

No worries. I can look it up.

My wife also has PCOS, so I'm familiar with its symptoms.
posted by zarq at 8:21 AM on June 24, 2011


You know, it's interesting—this is more or less what my dad managed to do a year or so after being diagnosed with Type 2 diabetes. Doctors had said he'd need to take insulin for the rest of his life, but he curtailed his diet significantly and began walking 6 to 10 miles a day and pretty soon, he no longer needed the insulin. He's been off of it for at least five years, I think. 'Course, he's retired and lives alone, so that helps in terms of having the time to walk that much and plan his own meals.
posted by limeonaire at 8:23 AM on June 24, 2011 [1 favorite]


But, back on topic, isn't it possible to achieve the same kinds of results as were achieved in the study without the dangerously low calorie count?

YES, totally, that's why I'm really skeptical here, especially when the doctors think only 5%-10% of diabetics will be able to do this. Ok, what's happens to the other 90%? You've just given a bunch of diabetics a test that most of them will fail. How is that progress? Wouldn't it better to go with the more established procedures that have a record of giving more long terms results?

My favorite book for learning and dealing with being a Type II was "The First Year Type 2 Diabetes: An Essential Guide for the Newly Diagnosed". That felt like a better time frame from learning, coping and educating one's self. It's not an easy process, based on what I went through and want I saw others going through.
posted by Brandon Blatcher at 8:23 AM on June 24, 2011 [2 favorites]


Hmm..trying to extend that to type I's. Maybe it's that I have to pull over add and fluid constantly to keep the thing running?

You change up manually but changing down involves stopping the car and physically adjusting the gearbox with a spanner?
posted by EndsOfInvention at 8:23 AM on June 24, 2011


Oh, great. The cure for diabetes is anorexia.

...what is it you think anorexia is, exactly?
posted by griphus at 8:24 AM on June 24, 2011 [6 favorites]


At 600 calories a day it would be very difficult to get all the nutrients...

The FPP says 10 calories a day.

[600 calories per two-months]
posted by uncanny hengeman at 8:33 AM on June 24, 2011


I'm not entirely sure why this is so surprising. Type II diabetes can often be "cured" or controlled with diet, but the problem is that like many of us, many diabetics have trouble maintaining strict diets in the long term. I don't doubt that this produces short-term results, but suspect they are just that, short-term, without any lifelong changes to diet.

The other thing to consider is that after two months at 600 calories and a mostly liquid diet, you are naturally going to eat a lot less for quite a while afterwards. So this is actually a much longer period of restricted calorie eating until you gradually stretch your stomach out and get used to more and more calories, so I'd expect the return of diabetic problems to be extended, rather than immediate.

And a final warning. I had a friend who had gastric band surgery and had a bad reaction to it that kept her processing very low calorie amounts for several months. She eventually lost muscle definition in her legs to the point she was in a wheelchair. Severe calorie restriction isn't something to mess with on your own.
posted by threeturtles at 8:34 AM on June 24, 2011 [1 favorite]


... that's why I'm really skeptical here, especially when the doctors think only 5%-10% of diabetics will be able to do this. Ok, what's happens to the other 90%?

I'm wondering if perhaps this could be an in-patient treatment for the first week or two, with intensive daily outpatient followup for rest of the eight weeks and for the first 30 days of "normal eating". Definitely not a hospital, but something like a spa light. I suppose that sounds pretty extreme, but maybe not more extreme than bariatric surgery.
posted by marsha56 at 8:39 AM on June 24, 2011


A person on 500 calories today tends to feel pretty crappy for the first three days, and then ketosis kicks in, and the body starts burning fat for fuel. At this stage most people report that they feel like they've got more energy than normal and don't really feel hungry.
Oh gosh. Former anorexic, and at the outset I was eating about five hundred calories a day. It's true that I stopped feeling hungry, but boy is it not true that I had a lot of energy. I had no energy. Also, I was cold all the time. I can't even explain what that cold felt like: it was like being cold from the inside out, so that even putting on clothes or cranking up the heat didn't make me feel warm.

It's probably worth it if it cures Type 2 diabetes for the long term, but I wouldn't pretend that this is going to be anything but really miserable for a lot of people. And I would worry a little bit that it will morph into an eating disorder for some people, because starving is a hard habit to quit.
posted by craichead at 8:40 AM on June 24, 2011 [1 favorite]


Um ... how many calories in one beer? I'm asking for a friend of mine.
posted by ZenMasterThis at 8:41 AM on June 24, 2011


I was under the impression that type II diabetes was a result of the cell culling insulin receptors (there's a fancy name for this I'm forgetting) from the cell's surface after prolonged over-stimulation. Not sure if the transcription pathways have been worked out yet.

This sounds like something that could shock the body into changing back to the normal insulin receptor levels but it could also be having a different effect, one that compensates for insulin receptor loss and has some unforeseen consequence in the future.

TL;DR I want this to be true, people's bad eating habits needn't be an irreversible death sentence.
posted by Slackermagee at 8:41 AM on June 24, 2011


Oh, great. The cure for diabetes is anorexia.

Next week: AIDS cures cancer!


You laugh, but.
posted by en forme de poire at 8:43 AM on June 24, 2011 [1 favorite]


Fresh Air had a great segment on addictions yesterday that addressed why overeating is such a cultural problem leading to the large number of overweight individuals despite the fact that only 10% of obesity is linked to metabolic dysfunction. Link here. It seems like this research just supports that addressing this naturally occurring eating addiction would be a key approach to managing type II diabetes. And that our brain is capable of rewiring pleasure centers to foster healthier living, but it isn't trivial, easy, or helpful to just admonish people to "be healthier".
posted by meinvt at 8:45 AM on June 24, 2011 [2 favorites]


ZenMasterThis: "Um ... how many calories in one beer? I'm asking for a friend of mine."

That depends on what he or she is drinking.
posted by zarq at 8:45 AM on June 24, 2011


boy is it not true that I had a lot of energy

Diets that use this kind of extreme low calorie approach (actually most of them don't go lower than about 700-800 calories) are generally only appropriate for people who have a pretty high BMI at the start of the diet. They've got fat reserves to keep them going. An anorexic doing the same thing is bound to feel pretty terrible; in the absence of much fat, the body will start to break down muscle and other tissue, which is a really bad thing.

I've been on one of these diets; seven or eight weeks on about 700 calories a day. I felt absolutely fine, and had enough energy to build a patio and redecorate my house while doing so.
posted by le morte de bea arthur at 8:49 AM on June 24, 2011 [2 favorites]


I'm wondering if perhaps this could be an in-patient treatment for the first week or two, with intensive daily outpatient followup for rest of the eight weeks and for the first 30 days of "normal eating".

Then the issue becomes who is going to pay for it and having people get the time off, while getting the support of their family and friends in changing their habits. It's not an insurmountable challenge, but it is a challenge.
posted by Brandon Blatcher at 8:53 AM on June 24, 2011


It is a challenge, agreed. But I know a LOT of people who've undergone the extreme versions of stomach stapling. I guess I was hoping this could be a replacement for that.
posted by marsha56 at 8:58 AM on June 24, 2011


But I know a LOT of people who've undergone the extreme versions of stomach stapling. I guess I was hoping this could be a replacement for that.

Curious, how does the stomach stapling generally work out for them?
posted by Brandon Blatcher at 9:00 AM on June 24, 2011


A clarification -- the FPP says "There was a control group of another eleven subjects with diabetes who made no dietary changes." This is incorrect.

Per both the press release and the actual article, the control group consisted of nine individuals without diabetes who were matched on weight, age, and sex, were not treated, and were not followed up. That is, they served as a reference for baseline normal HbA, plasma glucose, ... (cf Table 2) in a non-diabetic group.

A question that the authors are attempting to answer is whether those markers of diabetes differed less significantly from control baseline as the intervention went on and more significantly from case baseline as the intervention went on. That is, fewer daggers and more asterisks as you go across time in table 2.
posted by Westringia F. at 9:02 AM on June 24, 2011 [1 favorite]


I'd like to remind you infidels and kaffirs that this is perfect timing: Ramadan is just around the corner! Just don't uh, pig out at iftar!
posted by orthogonality at 9:05 AM on June 24, 2011 [1 favorite]


Malice, can you explain the difference between being insulin resistant and a type 2 diabetic, please? I'm not sure I understand where the line between the two conditions is drawn?

It's a somewhat-arbitrary point, and one that's been moved recently. As your insulin resistance increases, your pancreas overproduces insulin to compensate, and at a certain point it can't really make enough to overcome the resistance. That's when you start getting bad blood sugar levels that have real and terrible health consequences, and that's traditionally about where the T2D diagnostic point has been set. However, as explained to me by my nutritionist, it turns out that just chronically having high blood levels of insulin can ALSO have health consequences, and so they've moved the diagnostic point lower to help reflect that fact.

According to gaspode, this VLCD doesn't reverse insulin resistance, it just makes it possible for your body to make more insulin. It's like if you have a door that's getting stickier and stickier over time so you have to push harder and harder on it; this diet doesn't make the door not stick, it just gives you a battering ram. The biggest thing we know about so far that DOES make the door less sticky is frequent, vigorous, high-intensity exercise.

I'm neither a dietician nor a nutritionist. This is what my nutritionist told me.
posted by KathrynT at 9:10 AM on June 24, 2011


And to follow up on my own pedantry...

It should be noted that while the diabetes markers at the end of the intervention did not differ significantly from the baseline controls -- ie, they had similar HbA, plasma glucose, ... to non-diabetic individuals -- it should be noted that the end-of-study cases were VERY different in BMI, &c from the non-diabetic controls. It would be interesting to know if their HbA, plasma glucose, ... were in line with those of non-diabetic individuals of their new weight, or whether "pound for pound" their markers were still higher.

If it's the latter case, it might indicate that some folks are genetically predisposed to diabetes & have elevated marker values at any weight, and being overweight pushes them over the edge.
posted by Westringia F. at 9:13 AM on June 24, 2011 [1 favorite]


Curious, how does the stomach stapling generally work out for them?

If you want an "I know a guy" story, I know a guy -- college student -- who had his stomach stapled and went from morbidly obese to just obese. It doesn't sound like much, but the change was drastic. I'm bad at eyeballing weight, but it took off two hundred pounds, at least. He went from a man beleagured by his own body to, well, a comfortable-looking/seeming fat guy. Like I said, this is an "I know a guy" story, so I don't know how well it applies to the general case, but it worked.
posted by griphus at 9:15 AM on June 24, 2011


Curious, how does the stomach stapling generally work out for them?

The first person I knew who had this done had a lot of complications. She was sick a lot afterwards, although she did lose a lot of weight and kept most of it off. The others I knew had fewer complications, but struggled more with keeping it off. I also knew someone who switched from having an eating addiction to a problem with alcohol. It happens.

I knew one guy who had the surgery and pretty much announced that he had no intention of changing his eating habits. He expected the surgery to do all the work. He gained all the weight back. He also said he had an allergy to all fruit and vegetables. I guess that would have made it harder. His foods of choice were always pretty high-fat, high-carb stuff.

The last place I worked, stomach stapling became a thing that lots of people went thru. It always worked in the beginning, but not everybody was successful long term. Lost touch when my last contract ended a few years ago, so I can't give you more current info.
posted by marsha56 at 9:18 AM on June 24, 2011


This whole thing seems like bullshit, at least based on anything I've learned in 20 years as a type 1.

Type 2 diabetes isn't about your pancreas being "clogged with fat". People with type 2 diabetes produce a normal amount of insulin, but their cells have trouble using it to process sugars in their blood. Its not even a pancreas problem as far as I've ever heard from doctors or read. Cells become more insulin resistant as someone gets more fat, which is frequently the trigger for type 2.

The most common treatment for type 2 patients is diet modification / calorie restriction. Lots of people stop showing symptoms (and go off meds) if they lose weight and keep it off. This study doesn't seem like anything new at all.
posted by pkingdesign at 9:21 AM on June 24, 2011


I am not diabetic, but I know that if I wanted to do a 600 calorie/day diet for 2 months I think I would need to take short-term medical leave and have a decent support network and regular doctors visits helping me through it.
posted by Theta States at 9:39 AM on June 24, 2011 [2 favorites]


People with type 2 diabetes produce a normal amount of insulin

This is not true for all people with type 2, especially as the disease progresses. As the study points out (linked above and here, too), beta cell function may decline over time in a person with type 2. This extreme calorie restriction appeared to restore beta cell function that had been lost, as well as restoring insulin sensitivity.
posted by chinston at 9:43 AM on June 24, 2011 [2 favorites]


Interesting. They say that gastric bypass surgery essentially "cures" Type 2 diabetes and I wonder if the extreme caloric deficit is the mechanism by which that happens.
posted by elsietheeel at 9:53 AM on June 24, 2011


People with type 2 diabetes produce a normal amount of insulin

Yeah, quick refresher on Type I and Type II diabetes, care of the American Diabetes Association:
Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin.

Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Only 5% of people with diabetes have this form of the disease. With the help of insulin therapy and other treatments, even young children with type 1 diabetes can learn to manage their condition and live long, healthy, happy lives.

Type 2 diabetes is the most common form of diabetes. Millions of Americans have been diagnosed with type 2 diabetes, and many more are unaware they are at high risk. Some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans, Native Hawaiians and other Pacific Islanders, as well as the aged population.

In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin (emphasis mine). Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead to diabetes complications.
As a Type II, I like to think I'm marinating in a sugar glaze for the worms.
posted by Brandon Blatcher at 9:57 AM on June 24, 2011


My wife also has PCOS, so I'm familiar with its symptoms.

This is entirely off topic and I'll not mention it anymore here, but I thought I'd let you know that I recently was recommended by a doctor to drink whey protein every morning. It's supposed to help regulate insulin levels. I thought if she didn't know, your wife might want to try it. (It is recommended for those with PCOS.)
posted by Malice at 10:00 AM on June 24, 2011 [2 favorites]


Malice: "This is entirely off topic and I'll not mention it anymore here, but I thought I'd let you know that I recently was recommended by a doctor to drink whey protein every morning. It's supposed to help regulate insulin levels. I thought if she didn't know, your wife might want to try it. (It is recommended for those with PCOS.)"

Thanks for that! I'll mention it to her.
posted by zarq at 10:06 AM on June 24, 2011


I use the manual vs automatic shifting in a car. Normals have automatic, Type II's have to manually shift.

I dislike this analogy because most automatic transmissions are garbage, and manual shifting is normal and superior.
posted by exogenous at 10:18 AM on June 24, 2011 [1 favorite]


I stand corrected / more informed that type 2 can include reduced insulin production. I guess I actually knew this: my elderly uncle had type 2 for years and eventually started taking a small amount of insulin. I've heard of some very obese type 2's needing insulin as well, I've assumed because of advanced resistance rather than reduced insulin production. This article from 2004 says that ~27% of type 2's require insulin. The study (and this post, frankly) would do well to point out in all caps that this would apply to a subset of patients who have likely had type 2 for quite a while. Something like "maybe a cure*!"

* kind of, for some.
posted by pkingdesign at 10:19 AM on June 24, 2011


the few weeks where I managed to stay at or below 600 calories a day were horrible

I did this for a while, and I was about twenty pounds overweight so it wasn't a question of no fat reserves. It was indeed horrible. I couldn't focus, had no energy, was FREEZING all the time. It's true after the first couple of days you're not hungry, but it's probably because of the misery.

I say this not to disparage the article, but just so people who might think to try this know that it really is something that you should be doing with a nutritional counselor and your doctor and a whole lot of personal support.
posted by winna at 10:34 AM on June 24, 2011 [1 favorite]


I did this for a while, and I was about twenty pounds overweight so it wasn't a question of no fat reserves. It was indeed horrible. I couldn't focus, had no energy, was FREEZING all the time. It's true after the first couple of days you're not hungry, but it's probably because of the misery.

I say this not to disparage the article, but just so people who might think to try this know that it really is something that you should be doing with a nutritional counselor and your doctor and a whole lot of personal support.


Anything 900-1100 calories a day does this to me as well, plus some. It's horrible, I even get panic attacks if I am low/no carb for too long while cutting calories.

Calorie restriction is a tricky thing and you're right to advise doing it with a nutritional counselor. Unfortunately a lot of people don't have access to them.

For me, if I don't seriously restrict calories, despite exercise, I just won't lose weight.

Getting healthy is a mess!
posted by Malice at 11:09 AM on June 24, 2011 [1 favorite]


There are some theories that type II has an autoimmune component as well
http://www.ncbi.nlm.nih.gov/pubmed/12059095
I wonder if restricting the food intake also restricts types of foods that cause inflammation as well
posted by melissam at 11:43 AM on June 24, 2011


Everyone gains back some of the weight after bariatric surgery as your stomach stretches to accomodate more food. On average those who have the surgery ultimately lose 30% of their weight. (This is a statistic from memory from a slide from a class in advanced nutrition from my masters program.) And yes, the risks of complications are real -- my aunt died during bariatric surgery. That being said, it is a life changer for some people, for those who can successfully use it to ease their way into healthier eating and exercise patterns and are lucky enough to avoid the complications.

PCOS, insulin resistance, type 2 diabetes, all should be on the same no-simple-carb diet, they're all different manifestations of the same root problem. I've heard (annectdotaly) of women losing their PCOS symptoms after cutting sugar and simple carbs from their diet.. it's worth a try, I guess. Protein in the morning is good advice, it's more filling than carbs. I've never understood people who can eat a muffin or bagel for breakfast, I crash around 10 am if I haven't eaten an egg or an equivalent amount of protein.

Extremely calorie restriction causes muscle wasting. Since muscles burn more calories than fat, as you lose muscle it gets harder and harder to keep it off, which is how yo-yo dieting works. This is why it is better to make small changes and include exercise. You want to spare and/or grow your muscles as you lose, and you have to get used to a lower level of intake because you'll have to maintain that level for the rest of your life because you body's caloric needs decrease.

The kind of person to see for accurate medical advice and/or monitoring for these kinds of changes is a Registered Dietitian. Anyone can call themself a "Nutritionist", but an RD is licensed and has a medical education. Doctors, btw, have varying amount of nutrition expertise -- most medical schools do not cover it at all, and those that do often have only a nutrition 101-level class. But they can refer you to an RD.
posted by antinomia at 12:22 PM on June 24, 2011


I love the fact that the NHS has a blog evaluating news coverage of medical research.

Here's their report on this story: 'Crash diets' studied for type 2 diabetes.

Personally, I'm rather more optimistic than the NHS.

Thanks for posting this!
posted by kristi at 12:28 PM on June 24, 2011 [2 favorites]


For me, if I don't seriously restrict calories, despite exercise, I just won't lose weight.

That isn't just you. Weight loss is generally accomplished through calorie restriction, not exercise. The amount of exercise you need to do every day to provide significant weight loss is impractical for most people.
posted by Justinian at 12:38 PM on June 24, 2011


that's a good blog, kristi. thanks for the link.
posted by gaspode at 12:43 PM on June 24, 2011


From kristi's link:
Conclusion

This was a very small preliminary, non-randomised, uncontrolled study. Only 11 people with diabetes received the dietary intervention. Although the researchers took one-off measures in eight people without diabetes for comparison, these people did not follow the diet. There was also no comparison group of people with diabetes who did not receive the diet intervention.
As such, very limited conclusions can be made from this study. Contrary to some news reports, it provides no evidence of a cure for diabetes.
Importantly, the study only examined the effects of eight weeks of an extreme energy-restriction diet, where the daily intake was only 600 calories. The longer-term health implications and risks of such a diet are not known.
Carefully conducted randomised controlled dietary studies in a much larger number of people with type 2 diabetes, and with longer follow-up, are needed. This research will need to carry out a more detailed assessment of the possible effects of such an intervention on diabetic control and on health in general. It will also need to ascertain whether the positive effects seen in this study are sustained when a person returns to a normal diet.
People with type 2 diabetes should continue to follow the dietary advice given to them by their doctor. The participants in this study were all given medical supervision throughout, and it is advised that people with the condition do not attempt this diet on their own.
Well, so much that summer project.
posted by Brandon Blatcher at 1:02 PM on June 24, 2011 [1 favorite]


craichead: And I would worry a little bit that it will morph into an eating disorder for some people, because starving is a hard habit to quit.

See also: diabulimia.
posted by shannonm at 1:24 PM on June 24, 2011


Well, so much that summer project.

Eh, all of the quoted material is pretty much bog-standard disclaimer one could make about any small, preliminary trial.
posted by Justinian at 1:50 PM on June 24, 2011


...yes, as it is true for every small, preliminary trial. Not really dismissible for that reason.
posted by muddgirl at 2:00 PM on June 24, 2011


I'm not dismissing the dismissal, I'm dismissing the idea that the dismissal dismisses something particularly dismissal worthy about this particular study.
posted by Justinian at 2:11 PM on June 24, 2011 [1 favorite]


So you're dismissing a strawman?
posted by muddgirl at 2:18 PM on June 24, 2011


The comment was an attempt at humor ("Hey, it's summer, time to cure my diabetes!").
posted by Brandon Blatcher at 2:20 PM on June 24, 2011


I do not understand your human's "humor".
posted by Justinian at 2:59 PM on June 24, 2011


I think insulin resistance arises in the course of type 2 diabetes because it allows the body to make the most of the limited amount of insulin it can produce by forcing cells which can use other fuels (fat and protein) away from glucose, thereby reserving that insulin for cells that can only burn glucose, which includes the brain along with the spinal cord and presumably, though I haven't seen this made absolutely explicit, the rest of the nervous system as well.

I feel that strong evidence for this comes from recent studies showing that Rituxin (which is a monoclonal antibody to B cells, the source of all endogenous antibodies) limits or eliminates insulin resistance:

The researchers believe that insulin resistance, the hallmark of type 2 diabetes (unlike type 1 diabetes where it is the insulin-producing cells that are destroyed), is the result of B cells and other immune cells attacking the body's own tissues.

PCOS is strongly associated with type 2 diabetes and with high levels of circulating testosterone in women:

PCOS is characterized by a complex set of symptoms, and the cause cannot be determined for all patients. In many cases it is characterised by a complex positive feedback loop of insulin resistance and hyperandrogenism. In most cases it can not be determined which (if any) of those two should be regarded causative.


However, I think there is a very good case to be made that insulin resistance does cause PCOS.

It does so by shifting the metabolism of cells from burning glucose to burning fat, which causes fat cells to become much more active, and the active fat cells convert adrenal hormones into testosterone in a process known as peripheral conversion.

In light of this, it's interesting that Malice's doctor recommends whey protein for PCOS. I wonder whether that could work because it would have the effect of allowing some cells which would otherwise burn fat to burn protein instead, reducing the amount of peripheral conversion.
posted by jamjam at 3:58 PM on June 24, 2011


Research shows promise in reversing Type 1 diabetes.
posted by ZenMasterThis at 6:26 PM on June 24, 2011 [2 favorites]


"resumed normal eating."

The people in this study didn't "resume normal eating"; you don't get a BMI of 33 from "normal eating". They started normal eating, probably for the first time in their lives for some of them. I think it's really sad there are so many (not all!) people suffering from a horrible disease that can significantly shorten lives and reduce their quality, because as a society we're so fucked up about food.
posted by smoke at 6:52 PM on June 24, 2011 [2 favorites]


you don't get a BMI of 33 from "normal eating"

I think this depends on what you mean by "normal eating." If you mean the absolute amount of calories eaten, then yeah, there probably have to be general differences. But if you mean normal eating habits I don't really think obese people are likely to be all that exceptional. I know I personally can eat to satiety essentially whenever I want without gaining any weight at all -- in fact if I want to gain weight I really have to force-feed myself. I don't have particularly awesome self-control in a lot of other aspects of my life, so I know that's not the reason. And while I try to make an effort to eat healthier now, I definitely couldn't claim that, for example, in college -- and I was thin then as well. We're only really starting to identify the factors that control appetite and energy processing (e.g. gut flora, epigenetic modification, leptin signaling...) and a lot of these don't come from society, at least not in the sense that people usually think.

It may be possible that a really low calorie diet like the one in the study has lasting changes on some of these factors, incidentally. I'd love to see a study comparing gut microbiota before and after, as well as circulating leptin levels and gene expression.

Not that we're not fucked up about food as a society, because I definitely agree with that!
posted by en forme de poire at 11:12 AM on June 25, 2011 [4 favorites]


There's a degree of leptin resistance tied up with the whole metabolic syndrome/type 2 diabetes/obesity thing. Of course untangling cause and effect is a fucker.
posted by gaspode at 2:54 PM on June 25, 2011


« Older "I can tell you right now there is no I in A.I., a...  |  Root Hog or Die... Newer »


This thread has been archived and is closed to new comments