Reversing Type II Diabetes

Type 2 diabetes: Focusing on fat loss not carbohydrates per se

This article aims to give you the knowledge behind the cause of type 2 diabetes (T2D) and possibly change the way you think about treatment.

I’m sure the first thing you think of when I ask you to visualise a diet for a type 2 diabetic is a low carb diet. Most people believe T2D is a caused by excessive sugar consumption and thus to fix this problem the best option is to cut sugar out. I want to explain why it isn’t quite as simple as this and why low carbohydrate diets aren’t the only solution. To do this I am going to explain what causes T2D and what happens when T2D is reversed.

And if you’re not convinced that diabetics don’t have to cut carbs here are a few examples of studies showing you can treat type 2 diabetes with a high carbohydrate diet: example 1, example 2, example 3.

Notably a review of current evidence concluded:

‘Recent studies suggest that low carbohydrate diets appear to be safe and effective over the short term, but show no statistical differences from control diets with higher carbohydrate content and cannot be recommended as the default treatment for people with type 2 diabetes.’

What I want you to take home from this is that although low carbohydrates do work (if they can be adhered to) they are not the only option for T2D. If you want to read more on the pros and cons of low carb diets I’ve written on this previously here.

What causes type 2 diabetes?

I know you have covered this in previous learning outcomes and what you’ve been taught is not wrong! There is just a bigger picture.. by the end of this I hope you will see how what you’ve already been taught about insulin resistance and beta cell dysfunction fits into this bigger picture of how the body handles nutrients and what drives dysfunction of this in type 2 diabetes.

The personal threshold theory:

This theory has been proposed, tested and developed by Professor Roy Taylor and his research team. You can find his publications here.

The personal threshold theory states that type 2 diabetes develops when we reach a point at which we can no longer safely store fat and we begin to build up fat stores around our organs. For diabetes specifically it is the fat build up in our liver and pancreas that we will focus on.

The notion that we have a personal fat threshold explains why some people develop diabetes at lower body fat levels than others.
Prominent examples of this are :

1) Ethnicity: South Asians have a higher risk of developing T2D than Caucasians. This is because of where they are genetically predisposed to store their fat. South Asians tend to store fat around their organs at a lower BMI than Caucasians. When we look at the relative risk it is quite alarming. A Caucasian man with a BMI of 30 is equal to a South Asian man with a BMI of 25 in terms of risk of developing T2D.

2) Gender: Women have a lower risk of developing cardiovascular disease and T2D as they store their fat more peripherally i.e. around their legs, bum and under arms as opposed to men who tend to store fat more centrally – close to their organs. Women store fat in a safer way than men reducing their comparable risk.

So, to recap: we can all store a certain amount of fat safely before fat starts accumulating in places like our liver and pancreas and causing problems.

The point at which you are unable to store fat safely is termed your personal fat threshold. This is individual and is largely influenced by genetics. Fat storage above this point contributes to the progression of type 2 diabetes.

The twin cycle theory

The twin cycle theory proposes that it is this fat accumulation in the liver and pancreas that is key to the development of type 2 diabetes.

Let’s look at what happens when we start to store fat in the pancreas:

Cells called beta cells which are within the islets of langerhans within the pancreas produce insulin.I realise this sounds like a Lord of the rings quote but it is as simple as there are some cells in the pancreas that produce insulin..I only mention it here so that if you read anything that refers to islets or beta cells you know what the context is.

Fat accumulation in the pancreas impairs insulin response to ingested food. This happens because fat storage reduces insulin sensitivity causing tissues to become resistant to insulin. When this occurs more insulin is required to clear the same amount of blood glucose. This puts a large strain on the cells which produce insulin and after a while they often can’t keep up with the amount of insulin required and become fatigued. At this point we see blood glucose levels rise as the body can’t supply the insulin needed to maintain glucose levels in a healthy range.

And now let’s look at what happens when fat stores in the liver increase:

Fat accumulation in the liver increases resistance to insulin mediated suppression of glucose production. Normally when insulin is present this is a sign that there is enough glucose already and our body’s own insulin production is turned off. However, if the liver becomes insulin resistant it can’t sense the presence of insulin as well and thus continues to produce glucose. Adding to already elevated blood glucose levels.

What happens when we restrict calories and promote fat loss:

A very interesting set of studies by Professor Taylor explored what happens when overweight T2D are put on very low calorie diets. It was observed that individuals following these diets quickly improved their blood glucose scores (after just 7 days) and were able to reverse their diabetes.

The researchers then looked at what happened in the liver and pancreas during this period. They found that liver fat was very quickly reduced resulting in normalized glucose production in response to insulin. The drastic drop in fasting blood glucose levels seen after just 1 week of very low calorie dieting was attributed to this reduction of fat in the liver.

The fat in the pancreas took longer to reduce. Here insulin production was at least partially restored after 8 weeks of very low calorie dieting.

For further reading on this see this LINK and in particular HERE

So, given this.. Have we been thinking about type 2 Diabetes the wrong way?

Most treatments aim to reduce blood glucose but this is a case of treating the symptom not the cause of the problem.

We know that the cause of chronically high blood glucose levels is excess fat accumulation around the pancreas and liver yet continue to focus on foods that acutely reduce blood glucose levels rather than body fat- which is the root cause of the problem.

On the treatment of type 2 diabetes with a focus on reducing blood glucose (symptom) and not fat loss (cause).

“One of the great tragedies is that we’ve known this for about a hundred years and all the treatments have ever done is reduce the blood sugar – this is the consequence, but what drives it is the weight.” – Prof Mike Lean, Professor of nutrition at Glasgow University.

Recap:

• Eating too much results in excess energy which is stored as fat.

• After a certain level of fat (this level differs between individuals and is termed personal fat threshold) fat accumulates around organs such as the liver and pancreas

• This is when type 2 diabetes starts to develop

• Insulin resistance results in the liver continuing to produce glucose despite already high blood glucose levels

• Fat accumulation in the pancreas results in beta cell dysfunction (the cells which produce insulin)

• This leads to chronically high levels of blood glucose otherwise known as type 2 diabetes.

Type 2 diabetes is reversible!

• Losing fat through dieting can re-start the normal production of insulin at the pancreas and re-sensitise the liver to the presence of insulin resulting in normalised glucose production.

• These effects can reverse type 2 diabetes
(At least in patients who have had the disease less than 10 years – it is thought that after this beta cells are permanently damaged )

Take home:

As personal trainers working with clients who have or are at risk of developing T2D it is important to focus on fat loss. As I am sure you already know this can be achieved via many methods with one important factor in common- an energy deficit over time.

As we have discussed in here it is excess fat which causes diabetes and thus it is the removal of this fat that can reverse diabetes.

Written by ACA Contributor Emma Storey-Gordon BSc Hons

Emma Storey-Gordon is an online personal trainer with a research science back ground in cardiovascular disease and diabetes. Her key interests revolve around the benefits of diet and exercise to health and disease prevention. As well as how a change in life style can help reverse the ill effects of obesity.