The protocol about to be described is extreme. We share it in the spirit of helping people make proper choices through science and education. Please do not begin this program or encourage anyone to do so without proper medical attention.
Lim et al 2011 set out to demonstrate that mild cases of type 2 diabetes are completely reversible if an extreme but medically surprised intervention is set out upon early on after diagnosis. Individuals with a BMI that was stable for more than 4yrs, and were type 2 diabetics for less than that but only being treated with metformin or sulfonylurea were recruited. Of the 16 recruited, 11 finished the study. One left for an unrelated medical reason and 4 quit being unable to adhere to the protocol. They were matched with 9 control non-diabetics.
The participants were told to eat habitually until the beginning of the study. Diabetic medication was discontinued and shortly thereafter, the intervention begun. They were put on a liquid diet of 46.4% carbohydrate, 32.5% protein and 20.1% fat accounting for 510kcal. They then ate 90kcal of non-starchy vegetables and had an average energy intake of 600kcal/day! Doing this for a day or 2 to kick start ketosis is one thing but maintain this for 8 weeks is very difficult.
On the first day of the study, fasting blood glucose was 9.2 mmol/l, the normal range is 2-6 mmol/l. After 1 week on the diet, fasting blood glucose was at 5.9mmol/l and stabilized for the rest of the intervention time at 5.7mmol/l. While in the higher range of normal, it falls within safe parameters. Triacylglycerol dropped from 2.4mmol/l to 1.2mmol/ in the first week and remained stable at 1.3mmol/l (normal is below 1.7mmol/l). Plasma insulin was recorded at 151 pmol/l, dropped to 73 pmol/l after 1 week and finished at 65 pmol/l (normal being 57-79pmol/l). Total cholesterol dropped from 5.1 to 3.2 mmol/l over the same time period. With the normalization of blood glucose levels, the beta cells of the pancreas began to heal and the condition itself was reversed. Peripheral insulin sensitivity improved. Clearly this was a difficult protocol that required regular medical follow-ups but on those with the tenacity to complete it, it worked!
12 weeks after the protocol was completed, a follow-up was done. All participants noted a mild weight gain (avg. of 3.1 kg) which is not surprising given the weight loss they had experienced. Fasting glucose rose from 5.7mmol/l to 6.1mmol/l. 3 participants who completed the protocol had become diabetic again based on 2h post-load plasma glucose of > 11.1mmol/l. Fasting insulin remained unchanged.
This study demonstrates that if an extreme protocol is put into place and subjects follow it, mild diabetes can be completely reversed in a few short weeks.
In the event that one wants to start taking control of their diabetes, beginning an exercise program of aerobic and strength work with dietary intervention approaching ketosis, while difficult would likely be easier and require less medical intervention (though would clearly still require follow-up).
While reading this study, I was struck by the average change in BMI dropped from 33.4kg/m^2 to 28.7 kg/m^2. We reported here that a loss of 5 BMI units should reverse type 2 diabetes based on all the available evidence- here we have direct measurable evidence.