Written by Diana Licalzi, MS, RD, CDE
Recent studies have shown that people with type 2 diabetes can reach non-diabetic blood sugar levels after adopting dietary interventions that lead to weight loss. The terms “reversal,” “resolution,” and even “cure” have all been used to describe this phenomenon. This spurred experts from the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK to come together to establish an official definition for this development. They concluded that people with type 2 diabetes are considered in “diabetes remission” after reaching an A1c of less than 6.5% for three months or more after stopping medications.
Why “remission”? Because terms like “cure” give the impression that diabetes may never return. People who achieve diabetes remission still have a greater risk of developing diabetes again, especially if they revert to their previous lifestyle habits.
Nonetheless, the term “reversing diabetes” is commonly used in the current scientific literature, generally referring to when someone has reached normal glucose levels without the need to continue glucose-lowering medications. Here at Reversing T2D, we also choose to use the term “reverse” as our goal is to help our members attain life-long, non-diabetic levels. However, we understand that “reverse” doesn't imply permanence; as stated before, if an individual returns to their old lifestyle, type 2 diabetes can return.
What does the science show about reversing type 2 diabetes naturally?
The majority of research published to date shows that many individuals with type 2 diabetes can reach normal glucose levels with weight loss [1-3]. The Counterpoint, Counterbalance, and DiRECT trials are among the major studies that show how low-calorie diets, accompanied by weight loss, can lead to diabetes reversal.
In this small but highly controlled 2011 study, researchers examined the effects of calorie restriction on reversing type 2 diabetes, specifically its effects on beta-cell function and insulin sensitivity. Healthy beta cells, the pancreatic cells responsible for producing insulin, are essential for diabetes reversal.
After eight weeks on a low-calorie diet, participants lost an average of 33 lbs. In the first week, fasting blood sugar levels dropped to normal (from 165 mg/dL to 99 mg/dL), liver fat decreased by 30%, and liver insulin sensitivity improved significantly. By the end of the eight weeks, blood sugar continued to drop to 88 mg/dL, pancreatic fat decreased, and beta cell function trended towards normal levels. This data indicates lowering fat in the liver and pancreas can lead to improved insulin sensitivity and a return of beta cell function.
The DiRECT trial published in 2018 found that nearly half (46%) of 149 participants placed on a structured weight-loss program were able to achieve diabetes remission. Those who lost 33 lbs or more were most likely to achieve remission. In this study, participants—diagnosed with type 2 diabetes within six years and who weren’t on insulin—were randomized into a control or a dietary intervention group. The intervention group received a very low-calorie diet for 12 weeks, followed by an ongoing structured program. At the two-year mark, follow-up research found that one-third of participants remained in remission. This data shows that remission is closely linked to the degree and duration of weight loss.
Lastly, the Counterbalance study dove deeper into the characteristics of people who could achieve diabetes remission (responders) compared to those who could not (non-responders). People with type 2 diabetes followed a very low-calorie diet for eight weeks, followed by a six-month weight maintenance program. On average, those who responded best to a low-calorie diet, lost an average of 33 lbs while 40% of them achieved a fasting blood sugar of less than 126mg/dL for at least six months.
These three trials indicate that: (1) weight loss is a very effective way to reverse type 2 diabetes, especially when visceral fat (fat around the organs) decreases. In all three trials, a 33 lb weight loss was established as a potential threshold for diabetes reversal. (2) The longer someone maintains an optimum weight, the better chances they have of staying diabetes-free. (3) Certain characteristics make some people respond better to dietary changes and achieve diabetes remission.
Can everyone reverse type 2 diabetes with weight loss?
In all three trials, almost half of the individuals achieved remission, which was sustained for at least one year. Those who had a better chance of reversing type 2 diabetes included individuals who :
- Were younger (50 years vs. 59 years)
- Had a shorter duration of diabetes (<6 years)
- Required fewer medications (~2 or less)
- Had lower fasting blood sugar and HbA1c, higher levels of circulating insulin, and lower total body fat.
Remember, these are just a few characteristics based on three studies and should not discourage you from trying to reverse diabetes if you do not share these attributes. It's also important to note that while weight may play a role in the development of type 2 diabetes, it's not the only contributor to this condition. Genetics and other lifestyle factors can play a role as well. More research is needed to examine diabetes reversal beyond just weight loss.
In our Reversing T2D 10-Week Program, we have witnessed a diverse range of people reverse type 2 diabetes through a combination of both diet and exercise modifications, with and without weight loss.
To read real stories, check out our testimonials page.
Weight loss isn't easy. So what diet is best for reversing type 2 diabetes?
Evidently, achieving weight loss through a very low-calorie diet can lead to diabetes remission but this approach is challenging, especially without a structured program and medical supervision. So, what is the best and safest way to reverse type 2 diabetes naturally?
The American Diabetes Association says that a variety of eating plans can safely and efficiently help people with diabetes achieve weight loss. They cite that the Mediterranean-style, low-carbohydrate, and vegetarian or plant-based eating patterns are all examples of healthful eating patterns that have shown positive results in research for individuals with type 2 diabetes. However, they state that low-carbohydrate eating plans tend to be more difficult to stick to in the long term. Because type 2 diabetes reversal depends on sustained weight loss, we don’t recommend low-carb diets.
Earlier this year, the American College of Lifestyle Medicine came to a consensus that for long-term remission of type 2 diabetes, individuals should focus on changing their style of diet (e.g., the Mediterranean, DASH, or whole-food plant-based diets) instead of simply restricting specific nutrients (e.g., low carbohydrate, low fat, and high protein).
The Mediterranean, DASH, and plant-based diets all focus primarily on whole, plant foods (whole grains, vegetables, legumes, fruits, nuts, and seeds) while avoiding or minimizing meat (and other animal products), refined foods, ultra-processed foods, and foods with added fats.
If you feel ready to achieve long-term diabetes remission by following this approach and a structured program, then learn more about our 10-Week Reversing T2D Program.
Seven small changes to start reversing type 2 diabetes
- Set a realistic weight loss goal. Focus on a body percentage (losing 5-10% of your initial body weight) instead of a number.
- Swap high fatty proteins like red meat for leaner, more nutrient-dense ones like beans, lentils, and tofu. Doing so will reduce the saturated fat in your diet (a high-calorie food) and increase your fiber intake (a key nutrient that helps with weight management).
- Try Meatless Mondays as a way to start incorporating more plant-based meals into your diet.
- Treat animal proteins as a side dish instead of the main entrée.
- Think before you drink. Avoid sugar-sweetened beverages like soda, Gatorade, sweet teas, etc.
- Make fruits and/or veggies the foundation of every plate.
- Get moving! Not only does exercise help us maintain a healthy body weight but it also stimulates our muscles to take up glucose in the bloodstream helping to improve blood sugar control.