Thursday, June 30, 2011

Amazing, shocking, unbelievable news about type 2 diabetes and diet!

Have you caught the amazing, shocking, unbelievable news that type 2 diabetes can be managed through weight loss and lifestyle change?

I sure did.

Um, I first caught it in medical school nearly 20 years ago and see it virtually daily in my office.

I'm guessing if you've got type 2 diabetes, you caught that news from your doctor. In fact I'd be shocked to learn if there were a single type 2 diabetic on the planet who wasn't told at diagnosis that weight loss and/or lifestyle change could reverse the course of their disease, and while they'd need to maintain their losses/changes to maintain the reversal, that lifestyle can have at least as great an impact on disease course as drugs.

So how is it possible that suddenly it's making headline news?

Well you see there was this study that got published in the journal Diabetologia. In it, the authors report that when 11 recently diagnosed, non-insulin dependent, type 2 diabetics were put on a low-carb, 600 calorie diet for 2 months, their diabetes magically disappeared, and that in 7 of them, by adhering to lifestyle/dietary changes, it stayed gone for an additional 3 whole months.

Wanna know what else disappeared for the participants?

Weight. In the first week they lost nearly 10lbs, or 5% of their presenting body weights. By the end of 8 weeks, they lost nearly 30lbs or 13% of their presenting body weights.

So is it surprising that a recently diagnosed type 2 diabetic who loses 30lbs living off an extremely low calorie, low carb diet, can come off of their oral hypoglycemics?

About as surprising as a lemon tasting sour.

What's perhaps more surprising than the fact that this study was published (small sample size, not even remotely surprising results, and an incredibly extreme and potentially dangerous intervention) was the authors' first line assertion,

"Type 2 diabetes is regarded as inevitably progressive, with irreversible beta cell failure"
Really? Who regards it that way? Certainly not any doctors I know. Every doctor I know counsels their patients that lifestyle management (weight and/or fitness) can mitigate risk, and in many cases, even reverse the condition.

But here's the biggest bee in my bonnet.

Studies on extremely low-calorie dieting very clearly state that the vast, vast majority of dieters regain all of the weight they so rapidly lose. We also know that ultra-rapid weight loss leads to disproportionate muscle loss, which in turn may help to explain why folks who lose weight extremely rapidly, when they inevitably head back to their old lifestyles, gain back more weight than they lost. What this means for these study participants, is that there's an extremely real likelihood that they'll not only gain back the 30lbs they lost as participants of this study, but that they'll gain back more. What they'll also almost certainly gain back is their type 2 diabetes, and this time, consequent to their disproportionately lost muscle mass, and their greater than before regain, may well require more, not less, medication to manage their resurgent disease.

Ethics should have stopped this study dead in its tracks.

Finally, the authors' enthusiastic conclusion about their work?
"It carries major implications for information to be given to newly diagnosed patients, who should know that they have a potentially reversible condition and not one that is inevitably progressive"
To me anyhow, that demonstrates an incredible lack of perspective, as not only have physicians been counseling their newly diagnosed, type 2 diabetic patients that their condition is potentially reversible with lifestyle change for decades, but the intervention recommended by the authors in this paper is in fact likely to lead to a regain of both weight and type 2 diabetes. Taking this one step further, I'd argue folks who follow these authors' amazing, shocking, unbelievable, major-implications approach, their diabetes will in fact be "inevitably progressive".

Where's a good peer reviewer when you need one?

Lim, E., Hollingsworth, K., Aribisala, B., Chen, M., Mathers, J., & Taylor, R. (2011). Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol Diabetologia DOI: 10.1007/s00125-011-2204-7