For years, type 2 diabetes has been considered a lifelong, progressive condition. However, groundbreaking research led by Professor Roy Taylor from Newcastle University has challenged this notion, demonstrating that type 2 diabetes can be reversed through significant weight loss. Professor Taylor's work, particularly his research on low-calorie diets and "Newcastle" weight loss programme, has revolutionized the treatment of type 2 diabetes, offering hope to millions diagnosed with the condition.
The Groundbreaking Research: Reversing Type 2 Diabetes
Professor Roy Taylor's journey to revolutionize type 2 diabetes treatment began with a groundbreaking study that revealed the disease could be reversed through rapid weight loss. This study challenged the long-held belief that type 2 diabetes was an incurable, lifelong condition. Now, for many people, we know it is not.
The DIRECT Study: A Turning Point
The Diabetes Remission Clinical Trial (DiRECT), presented at the annual scientific sessions of the American Diabetes Association, provided compelling evidence that type 2 diabetes could be reversed through weight loss. The study, rooted in previous work by Dr. Taylor and his colleagues, found that very low-calorie diets normalized fasting plasma glucose in just 7 days in patients with type 2 diabetes due to a rapid fall in liver fat content and subsequent restoration of insulin sensitivity. This and other findings suggested that fast weight loss - instead of the traditional gradual approach - might help.
The DiRECT study involved 300 people with type 2 diabetes and a body mass index between 27 and 45 Kg/ m2 from 49 GP practices across Scotland and Tyneside. Participants on a low-calorie diet were guided back to a normal diet by a nurse or a diet advisor after the study period. The intervention group followed a program consisting of three Optifast meal replacement shakes or soups per day - Optifast is one of many commercially available options - for a daily intake of 825-853 kcal. There was no other food, and alcohol was not permitted. The weight loss goal was 33 pounds or more over 3-5 months; almost 90% of the intervention group made it. The protocol did not include exercise.
The results of the DIRECT study were remarkable. At the end of the first year, 46 percent of the participants on the low-calorie diet reversed their type 2 diabetes. After two years from the start of the study, 36 percent were in remission from their type 2 diabetes. The odds of remission - meaning a hemoglobin A1c below 6.5% on repeat testing, off all medications - were directly related to the amount of weight patients lost; 60% of subjects who lost 22-33 pounds were free of type 2 disease at 2 years, versus 29% who lost 11-21 pounds, and 5% who lost less than 11 pounds. As Dr. Taylor stated, "If people lose around 30 pounds and keep it off for 2 years, there’s a two-thirds chance of them escaping type 2 [diabetes]. People want to understand their options, and this is an option. This is very good news for people with diabetes."
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A subgroup analysis also presented found that beta cell function rebounds rapidly after weight loss and is pretty much normal at 2 years, so long as people keep the weight off. Among those who went into remission, the rapid initial response to a glucose bolus came back to near normal soon after food reintroduction, and “was sufficient to get nondiabetic blood glucose control,” with a mean hemoglobin A1c of 6% at 2 years. “We [also] saw, quite remarkably, was a slow steady return to almost completely normal” maximum beta cell capacity over the first 12 months. The most likely explanation is that beta cells are overwhelmed and shut down in a milieu of too much fat and glucose, but are able to reconstitute their specialist function and come back online once it’s addressed.
Long-Term Effects and the Personal Fat Threshold
A new study from Newcastle University has shown that people who reverse their diabetes and then keep their weight down remain free of diabetes. In addition, the team found that even patients who have had Type 2 diabetes for up to 10 years can reverse their condition.
In a previous study led by Professor Taylor, published in 2011, showed that diabetes could be reversed by a very low calorie diet. In this new study, 30 volunteers with Type 2 diabetes embarked on the same diet of 600 to 700 calories a day. Participants lost on average 14 kilograms - just over 2 stone. Over the next 6 months they did not regain any weight. Overall, 12 patients who had had diabetes for less than 10 years reversed their condition. 6 months later they remained diabetes free. In fact, after 6 months a thirteenth patient had reversed their diabetes. Though the volunteers lost weight they remained overweight or obese but they had lost enough weight to remove the fat out of the pancreas and allow normal insulin production.
One of Taylor’s most important new discoveries is that everyone has their own fat threshold: an individual level of tolerance for levels of fat in the body. "It’s a personal thing. It’s nothing to do with the sort of information that’s often provided about obesity, which is about average BMI and what the population is doing. The bottom line is, a person will develop type 2 diabetes when they’ve become too heavy for their own body. It doesn’t matter if their BMI is within the ‘normal’ range. They’ve crossed their personal threshold and become unhealthy." Our bodies start to have trouble controlling blood sugar when fat can no longer be stored safely under the skin and it spills over into the liver and then the pancreas. If these organs get clogged with fat, they stop functioning properly and that is when you develop type 2 diabetes.
It is particularly important to note that if you have a family history of type 2 diabetes, you are more susceptible genetically. People in these circumstances need to be “very careful” about weight, especially in adult life, Taylor says. If you’ve increased weight quite a lot above what you were at the age of 21, you’re in the danger zone - and you should get out of it. If you’ve got a family tendency for diabetes, then you really want to avoid weight gain in adult life. As Taylor explains in his book, if you have increased your BMI by three units or more since you were in your early 20s, you are at risk. It doesn’t matter how slim you look to other people.
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The "Newcastle" Weight Loss Programme
Taylor’s “Newcastle” weight loss programme is a clinically proven method of reversing early type 2 diabetes and his approach is currently being rolled out to people with the condition by the NHS. The people in his programme managed to do this - typically by consuming only slimming meal shakes and non-starchy vegetables, plus one cup of tea or coffee each day with skimmed milk - lost a life-changing amount of weight in just eight weeks.
Key Components of the Programme
The diet includes 3 diet shakes per day and 240 grams of non-starchy vegetables taking in between 600 and 700kcal a day for 8 weeks. Volunteers then gradually returned to eating normal food over the next two weeks with very careful instruction on how much to eat. Volunteers were seen once a month and supported with an individualized weight maintenance programme over the next 6 months. To keep weight steady after the weight loss, they were eating around one third less than before the study.
Professor Taylor's Book: "Your Simple Guide to Reversing Type 2 Diabetes"
Professor Taylor has compiled everything he has learned directly with the public, in a new book, Your Simple Guide to Reversing Type 2 Diabetes. It’s a 153-page paperback that takes you through the latest research on how the disease develops and explains why rapid weight loss can be so effective at reversing the condition in the early stages - which usually means during the first six years of a diagnosis.
In one study, he found that nine out of 10 people with “early” type 2 diabetes were cured after losing more than 2½st (15kg). The book also explains who is at greatest risk and why some people who have a “normal” Body Mass Index (BMI) develop the disease, when many people who are more overweight - or even obese - do not.
Taylor decided to write the book because, even though most diabetes experts in the UK have now accepted that his rapid weight loss programme works, many doctors in Europe and the USA remain unconvinced. He feels it is his job - his “duty” even - to make people aware of the discoveries he and others have made in recent years and feels a responsibility for passing on this knowledge.
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Taylor hopes that by writing a paperback in simple, accessible language, he will reach people who are heading towards or have already received a diagnosis and want to learn more about his research. He also wants to explain to as many people as possible what causes type 2 diabetes so individuals feel empowered to make healthy decisions about their body and the food they eat. The book is for anyone who wants to understand what happens to food after they swallow it and how that’s handled by their body. And also, critically, how that affects their health. For example, he has found most people don’t realise that if you eat more carbohydrates or protein than your body needs, the excess is converted into fat and then stored.
Perspectives on Professor Taylor's Work
Dr. Alvin Powers, MD, director of the diabetes center and a professor of medicine at Vanderbilt University, Nashville, commented on the DiRECT study, stating, "This study really proposes a new approach to people who have recent-onset type 2 diabetes. Our current approach is to recommend reduced caloric intake, exercise, and medication. It’s usually viewed as a progressive disease, with some individuals eventually requiring insulin. These remarkable results were obtained in the real world of clinical practice, not in a research study."
Cautions and Considerations
While the NHS England is planning on following NHS Scotland that has started schemes of calorie restriction for type 2 diabetics, experts have warned that more studies are needed to ensure safety of such interventions. They have warned that calorie restriction is not suitable for all individuals and should be done only under medical supervision and with adequate support.