How Weight Loss puts Type 2 Diabetes into Remission
For some time now, we have known that in those with Type 2 Diabetes, insulin producing beta cells in the pancreas aren’t functioning properly. It was previously believed that these cells were simply dying off.
New research has shown that rather than dying, these beta cells are merely going dormant - and they can be revived and restored to normal operation.
The key was understanding why they were failing to begin with.
To put it simply, excess fat chokes off the ability of the liver and pancreas to maintain glucose and insulin production, respectively.
In a healthy system, the liver processes carbohydrates to produce glucose – the raw energy source your body needs to function. It also converts excess energy into fat, for storage. Insulin produced by the pancreas acts as a restraining agent – helping to normalize how much glucose the liver produces, and regulate the glucose to fat ratio. The result of this balance is a steady, reliable level of glucose in the bloodstream, with any excess being stored for future use.
The problem starts when an excess amount of subcutaneous fat has already been stored up in the body, and caloric intake continues to exceed demand.
Initially, the body prefers to store excess fat in locations just beneath the skin. Your belly, hips, thighs - just about everywhere. Once a signficant amount of fat has been stored in these areas however, the body will start to let fat circulate in the bloodstream - and put it anywhere it can. This includes the major internal organs.
When your body begins storing excess fat in the liver, it becomes insulin resistant. As insulin fails to fully regulate glucose production, blood sugar levels gradually begin to increase beyond desired levels. This triggers the body over time to increase insulin production. The increased insulin actually accelerates the liver's fat production rate. This results in higher blood glucose levels and fat production.
As excess fat continues to clog up the system and circulate in the bloodstream, the fat that reaches the pancreas stresses the beta cells which are responsible for insulin production. These cells react defensively by ceasing insulin production and going into a dormant state.
As more and more beta cells shut down, insulin production slows. When these self-feeding cycles reach a trigger level, diabetes begins to present itself. This entire process is called the twin cycle hypothesis of the aetiology of type 2 diabetes, and was first presented as a possible explanation in 2007.
Reactivating beta cell function is as simple as reducing the fat that causes it to go dormant. [3]
In order to test this theory, researchers performed a series of studies. The first study confirmed a much higher level of fat than was expected in the livers of Type 2 Diabetics. They found fat percentages averaging between 13-16% - much higher than the normal 5% in a healthy liver.
The next step was to cut off all of the excess fat production, reduce weight significantly, and observe the results. To acheive this, a test group was placed on a crash diet of 700 calories per day for a period of 8 weeks.
Within just 7 days, the immediate reduction in liver fat caused insulin to act normally once again, and blood glucose levels began to normalize. [4]
By the end of the first 8 weeks, fat inside the pancreas had decreased, the insulin-producting beta cells were begining to re-awaken and produce insulin again. Within 12 months, many of the test subjects had reached 100% normal insulin production.
Total remission rates (restoration to 100% beta cell function producing insulin) varied, but were significantly tied to the length of time the individual had been living in a diabetic state.
Test subjects who had been only recently diagnosed with Type 2 Diabetes were the most likely to achieve complete recovery. In those who had been diabetic for 10 years or longer, the dormant beta cells weren't nearly as resilient, and fewer were able to successfully reactivate in response to treatment.
Additionally, as the research team continued to monitor study participants, those who failed to reduce their excess body fat sufficiently also failed to achieve or maintain full remission of diabetic symptoms.
The take-away here, is that if you can achieve and maintain a healthy weight, and do so quickly enough after diagnosis, Type 2 Diabetes can be fully reversed and prevented from re-surfacing. But if you regain the weight, it will also return.
The speed at which individuals lost weight is not a prerequisite to success, but ultimately losing a minimum of 10% body weight proved necessary for significant recovery.
Some time after the results of this research were published, a second research team set out to better understand the long-term outcome for study participants. They determined that roughly 30% of those in the study had achieved remission 5 years after the initial study commenced. Those who lost at least 10% body weight and maintained their results were twice as likely to be among that group.
In all of the study results, it was found that the amount of excess weight lost directly correlated with the sucess rate in Type 2 Diabetes remission.
In other words, long-term crash dieting is not as necessary as simply achieving the end goal - and even a modest 10% weight loss goal can dramatically increase your chances of full remission.
A few additional notes - remission is not a cure, and Type 2 Diabetes is not purely tied to obesity.
Remission is not exactly the same as "a cure" - individuals have varying levels of predisposition to developing Type 2 Diabetes that tie to a number of factors including lifestyle and genetic markers. Remission simply means that the body no longer shows any signs of the disease.
Additionally, different people have different fat thresholds. [5] Only 50% of people diagnosed with Type 2 Diabetes have a BMI over 30 when their condition is identified. Our bodies have different points at which beta cells will begin to shut down due to damage from excess fat. This is why many morbidly obese people do not express diabetes, while other individuals find themselves pushed over the edge at a BMI in the mid 20's.
Being diagnosed with Type 2 Diabetes essentially means that because of your unique Personal Fat Threshold, your weight has simply exceeded what your body is capable of handling.
By this logic, if you regain the weight you lost your diabetic condition is virtually guaranteed to re-surface.
Staying within your personal fat threshold will keep Type 2 Diabetes at bay - but exceed that level and it will return.
While this may sound discouraging, keep in mind that it also means you can prevent diabetes from effecting your health simply by maintaining a weight your body can handle.
Indefinitely.
