Diabetes Self-Management Blog

According to Dr. Roy Taylor of the United Kingdom’s University of Newcastle, we need to change our understanding of what causes Type 2 diabetes. Then we can treat it and reverse it. What is this new understanding?

Dr. Taylor made headlines in 2011 when his team “reversed” Type 2 diabetes in 11 people by putting them on a 600-calorie-a-day diet. His subjects achieved normal glucose levels within a week. That’s not so amazing. If you don’t eat, your glucose numbers will of course come down. But by the end of the eight-week study, most of them achieved normal numbers on a glucose tolerance test, which is much harder to do. It shows their insulin response had returned.

“Their first phase insulin response increased gradually over 8 weeks of a very-low-calorie diet,” Dr. Taylor reports. It became “indistinguishable from that of age- and weight-matched nondiabetic control subjects.”

In his new paper, called “Type 2 Diabetes: Etiology and Reversibility,” Dr. Taylor describes how that recovery happened. He used new kinds of MRIs to look at what was actually happening to people’s liver and pancreas. By seeing how liver and pancreas change as they get better, he says we can understand how diabetes develops in the first place.

What he found is that fat in the liver and pancreas seems to cause all the problems. High fat levels cause the liver to become insulin resistant. So it starts pumping out unneeded glucose (the process the drug metformin tries to stop).

As a fatty liver makes glucose levels rise, bad cholesterol levels also rise, which leads to a fatty pancreas. Fat in the pancreas blocks insulin signaling and production. Voilá! You have diabetes.
This story is a change from our old understanding. The classic story of Type 2 is that insulin resistance (IR) in the muscles forces the pancreas to work harder. Over time, the pancreas “wears out” and diabetes starts.

But Dr. Taylor says insulin resistance in the muscles, by itself, will never cause diabetes. Instead, high insulin levels, partly caused by insulin resistance, promote fat production and deposition.

When that fat gets into the liver, it blocks insulin action there. The liver starts to produce and leak glucose. That’s when blood glucose levels start to go up. You probably have prediabetes at that point. When the pancreas also gets fatty, diabetes is in full effect.

This could actually be good news. If you can reduce fat in the liver and pancreas, their normal function returns rapidly in most cases. First, reduced liver fat leads to normal fasting glucose levels: the liver isn’t leaking at night. Then reduced fat allows the pancreas to produce insulin normally. As a result, blood glucose after meals steadily improves.

And it turns out that reducing liver and pancreas fat happens quickly, before more general weight loss is seen. According to Dr. Taylor, the liver’s rapid fat loss explains why bariatric (weight-loss) surgery often seems to reverse diabetes in a matter of days, before any significant weight loss occurs. Liver and pancreas fat goes down before body fat does, and normal insulin function can return very quickly.

Is this a cure?
Unfortunately, fat loss would only be a cure for diabetes if it can be maintained. It’s no surprise people eating 600 calories a day will have low glucose numbers. We already knew that Type 2 almost disappears in times of famine. With less food (especially less carbohydrate) the body needs less insulin, so the pancreas can keep up and start to heal.

But people can’t maintain a diet like that for long. What happens when they stop? Normally, any weight loss diet is followed by a weight regain. Do the liver and pancreas also regain their fat and restart the diabetes?
It seems that most people do, but that doesn’t mean they have to. Diabetes Self-Management commenter Jim Snell wrote:

I heard from Dr. Taylor’s groups that people who did this diet had to maintain tight calorie control, exercise, and discipline, or the bad numbers returned. That does not mean one stays at 600 calories but means one does not jump to 2000 calories either.

Jim says 1200 calories a day and regular exercise are working for him. Dr. Taylor says physical exercise is crucial to keeping unwanted fat out of the organs, but says exercise alone cannot do it.

Unfortunately, the very-low-calorie approach doesn’t work for everyone, even temporarily. As a reader named Margaret commented,

If a liver is damaged through means other than fat deposits, e.g. hepatitis, HSV-2 [herpes virus], etc. a diet won’t cut it… Depending on the degree of damage or the progression of such viral liver attacks, it may be that regardless of what a diabetic eats they may progress, even from oral medications such as metformin to insulin.

In other people, the pancreas may be too damaged to keep up a basal level, even if the fat doesn’t return. They will still benefit from insulin injections. These two groups seem to make up about 20% of people with Type 2 according to Dr. Mark Hyman, author of The Blood Sugar Solution.

Remember that Dr. Taylor’s theory still needs to be confirmed by other research. Still, from what we know, it seems to me that going very low calorie for some weeks might be a good jump-start to your program. Getting the fat out of the liver and pancreas, even temporarily, can’t hurt.

It might be best to do this with a doctor’s supervision. If you’re on insulin or a sulfonylurea, those might need to be reduced or stopped.

But there’s no sense doing that, in my opinion, if you don’t have a follow-up plan you can live with, most likely one that’s low carb and low calorie and includes some exercise. Is that possible for you? What do you think?

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Comments
  1. In matters of behavior & habit, when the pain of staying the same is strong enough, people will change. That is, of course, an oversimplification, but points to the importance of behavioral health research on this finding, to maximize the potential for success of those who are strongly motivated and are fortunate enough to have no co-morbid conditions, that the liver and pancreas can actually recover. Gives real meaning to LIFE + LONG lifestyle change & people are going to need lifelong support to maintain it.

    Posted by Robin C |
  2. Readers, modern rates of sugar consumption - especially via sugary drinks - are a key driver of global obesity and type 2 diabetes, together the greatest public-health challenge of our times:http://www.ncbi.nlm.nih.gov/pubmed/20693348

    In an effort to counter these disturbing trends - especially amongst young people and Indigenous peoples - I am calling for a ban on all sugary drinks in all schools in all nations:http://www.australianparadox.com/pdf/Sugary-Drinks-Ban.pdf

    If after assessing the facts you think this proposal has merit, please forward it to parents, students, teachers, principals and heads of schools, nurses, doctors, dentists and others involved in public health and education.

    Posted by rory robertson (former fattie) |
  3. very informative - Thanks

    Posted by M. S. Shaikh |
  4. I agree with Rory about the sugary drinks! People just don’t GET IT!!! It would be great to support a ban of these drinks in schools, but then the kids will get them at home anyway…along with cookies, candy, chips,etc. There has to be better education and awareness regarding the hazards of all this sugar we consume. I remember seeing a film clip “Joe’s Lung” in grade school, showing the bad side effects of smoking…Get the PTA involved…the schools need to produce a similar expose’ for sugar–then show both the kids and the parents!!! We all know that food companies will continue to produce what we consume…it’s all about profits! So, let’s send these food companies a new message by not buying sugary drinks and snacks for our own families.

    Since there are people out there now that are just being diagnosed Type 2 diabetic, it may be a good idea to use this 600 calorie method as a first line approach to try to reverse the diabetes early in the game…before being exposed to all the drugs that can damage the liver and pancreas. Of, course, tests need to be run to make sure there is nothing else going on that would make this approach dangerous. At the very least it should be discussed and offered as an option for the patient.

    Posted by Mary G |
  5. Listen all this sounds do-able for the overweight person.But I

    Know folks who do not have a weight problem at all. what about them? Are they dealing with the same issues? If so we know that the low caloric intake may not impact the situation at all, right?

    Exactly what is the best advise for people who are diagnosed as D-2, and weight is normal or below normal?

    Could it be that something else is going on?

    I have wanted to inquire into this for a while. Dave I have read your articles before and appreciate your expertise and resourcefulness in communicating with real studies,etc. Keep up the great job!

    Posted by Liz Singletary |
  6. Liz asks some important questions. I as one do not see body weight and its fat as the real issue.

    What I believe in my opinion is that the pancreas and possibly the liver get off track when those organs - especially the islets constantly sit/bathed in excess blood glucose and oxidation products. Studies have been done both on cadavers and others whereby islets from t2 diabetics that seem to be dead/shutdown/burned out return to making insulin when put back in normal glucose oxidation products levels.

    Dr. Taylor’s work is extremely important in that he has some 23rd century tools to watch real time on pancreas islets and liver using mri spectography to see what is changing as the islets come back alive non invasively.

    My opinion is that for type 2’s who have had elevated blood glucose in their blood system too long cause the islets to literally go to sleep and stop working. My read is that the skeletal muscles and their glucose temporary storage fill up to the limit with no more room to store glucose. Hence it backs up in the blood system.

    Along with Dr. Taylor’s excellent work; I also believe that the tight diets/bariatric surgery also help to remove excess glucose trapped in the skeletal muscles and make possible regular regulation. No room in muscles and glucose has no where else to go. Does that mean tight/starvation diet is constantly needed. My read is no but that this regimen is needed to flush out excess glucose and then return to a diet that does not constantly overload the muscles with glucose. In the past, we probably burned much more energy like the folks working on the pharaoh’s tomb stone projects moving 2 ton stone blocks by hand.

    Posted by jim snell |
  7. Hi Liz,

    If someone is diagnosed Type 2 with normal or below normal body weight, something else often is going on. You could beTtype 2, or you might have LADA or (a kind of slow-acting type 1) MODY (also called monogenic diabetes). You might benefit from insulin.

    Or you might not. There are thin Type 2s. But I would like you to be tested for these other possibilities before you tried starving yourself, if you’re already thin.

    Posted by David Spero RN |

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