Diabetes Reversal: Is It the Calories or the Food?

Diabetes reversal, not just treatment, should be a goal in the management of type 2 diabetes. Type 2 diabetes can be reversed with an extremely low calorie diet. Type 2 diabetes can also be reversed with an extremely healthy diet, but is that because it’s also low in calories? The study subjects lost as much weight on the green leafy vegetable-packed plant-based diet as the semi-starvation diet based on liquid meal replacements. So, does it matter what we’re eating as long as we’re eating few enough calories to lose 15 pounds a month?

Even if diabetes reversal is just about calorie restriction, instead of subsisting off largely sugar, powdered milk, corn syrup, and oil, on the plant-based diet at least one can eat food, in fact, pounds of food a day, as many low-cal veggies as we can stuff in our face. So, even if it only worked because it’s just another type of calorie restricted diet, it’s certainly a healthier version. But even participants who did not lose weight, or even gained weight eating enormous quantities of whole healthy plant foods, appeared to improve their diabetes. Thus, the beneficial effects of this kind of diet appear to extend beyond weight loss.

 The successful treatment of type 2 diabetes with a plant-based diet goes back to the 1930’s, providing incontestable evidence that a diet centered around vegetables, fruits, grains, and beans was more effective in controlling diabetes than any other dietary treatment. Randomized controlled trial: insulin needs were cut in half. A quarter ended up off insulin altogether, but again this was a low-calorie diet. Kempner reported similar results 20 years later with his rice and fruit diet, for the first time showing documented reversal of diabetic retinopathy in a quarter of his patients, something never even thought possible. An example was a 60-year-old diabetic woman already blind in one eye and could only see contours of large objects with the other. Five years later, on the diet, instead of it getting worse, it got better. She could make out faces, see signs, and read large newspaper print, in addition to being off insulin, with normal blood sugars and a 100 point drop in her cholesterol. Another patient went from just being able to read the big headlines to being able to read newsprint four months later. What was behind these remarkable reversals? Was it because the diet was extremely low-fat, no animal protein, no animal fat—or, was it because the diet was so restrictive and monotonous that the patients lost weight and improved their diabetes that way?

To tease that out, what we need is a study where they switch people to a healthy diet, but force them to eat so much that they don’t lose any weight. Then, we can see if a plant-based diet has benefits independent of all the weight loss. For that, we had to wait another 20 years, but here it is. Diets were designed to be weight-maintaining. Participants were weighed every day, and if they started losing weight, the researchers made them eat more food. In fact, so much food some of the participants had trouble eating it all, but they eventually adapted; so, there was no significant alterations in body weight despite restrictions of meat, dairy, and eggs, and enough whole plant foods—whole grains, beans, vegetables, and fruit—to provide 65 grams of fiber a day, four times what the Standard American Diet provides.

The control diet they used was the conventional diabetic diet, which actually had nearly twice the fiber content of the Standard American Diet; so, it was probably healthier than what they were used to eating. So, how did they do? With zero weight loss, did the dietary intervention still help? Here’s the before and after insulin requirements of the 20 people they put on the diet. This is the number of units of insulin they had to inject themselves with before and after going on the plant-based diet. Overall, insulin requirements were cut about 60%; half were able to get off insulin altogether, despite no change in weight. So, was this after five years, or seven months, like in the other studies I showed? No, 16 days.

So, we’re talking diabetics who’ve had diabetes as long as 20 years, injecting 20 units of insulin a day, and then, as few as 13 days later, they’re off insulin altogether, thanks to less than two weeks on a plant-based diet. Patient 15: 32 units of insulin on the control diet, and then, 18 days later, none. Lower blood sugars on 32 units less insulin. That’s the power of plants.

 And as a bonus, their cholesterol dropped like a rock, in 16 days. Just like moderate changes in diet usually result in only modest reductions in cholesterol,  asking people with diabetes to make moderate changes often achieves equally moderate results, which is one possible reason why most end up on drugs, injections, or both. Everything in moderation may be a truer statement than people realize. Moderate changes in diet can leave one with moderate blindness, moderate kidney failure, and moderate amputations. Moderation in all things is not necessarily a good thing.

 The more we, as physicians, ask for from our patients, the more we, and they, get.  The old adage “Shoot for the moon” seems to apply. It may be more effective than limiting patients to small steps that may sound more manageable but are not sufficient to actually stop the disease.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

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• D R Young, W M Vollmer, A C King, A J Brown, V J Stevens, P J Elmer, S Craddick, D L Sturtevant, D W Harsha, L J Appel. Can individuals meet multiple physical activity and dietary behavior goals? Am J Health Behav. 2009 May-Jun;33(3):277-86.

Images thanks to Gerd Altmann via Pixabay and Daniellehelm, S, and Alan Cleaver via Flickr.

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