In Part I of this series, we reviewed the extent and impact of the diabetes epidemic and noted that the traditional approach to diabetes was clearly not working to prevent or reverse diabetes.
In Part II, we dove into the science to show that we have had evidence that Type II Diabetes could be reversed through bariatric surgery. What was most interesting was the fact the improvements in blood sugar control and diabetes emerged well before the weight loss resulting from the surgery. The trigger theory of the twin cycle postulates a mechanism behind this dramatic and immediate improvement and suggests a path where therapeutic diet interventions could accomplish the same effects as bariatric surgery.
From this theory, the key to diabetes reversal lies in improving liver function and decreasing the liver’s role in diabetes by changing the fat flows from the liver - the key steps:
Here the evidence is mixed between evidence from diets of varying:
The DIRECT study (http://www.directclinicaltrial.org.uk) in the UK - took 298 Type II diabetics people through a randomized controlled study:
The results were dramatic:
VIRTA Health has recently (https://www.virtahealth.com) research published the 1 year results of their study of 300 Type II Diabetics
What is interesting is the difference in composition of the VIRTA diet:
The VIRTA study included longstanding diabetics and those on insulin while the DIRECT study spefically excluded these populations.
Both studies clearly show that therapeutic nutritional intervention can reverse diabetes.
In both studies, changes in blood sugars came before weight loss and correlated with changes in liver function - suggesting similar mechanisms: reducing the metabolism of carbohydrate into fat by the liver, and reversing the flow of fats from storage to utilization.
In my opinion, the biggest practical difference between these approaches is calorie restriction vs carbohydrate restriction and which is easier to sustain over time.
This is where a ketogenic approach may have advantages. It has been proposed that there is a metabolic advantage to ketosis whereby a 'calorie is not a calorie'. In other words ketogenic diets cause a greater expenditure of energy than non-ketogenic diets. Scientific evidence for this is limited, and if there really is an advantage, the effect is likely small and would not explain why people lose weight when carbohydrates are restricted to the point of ketosis. This common observation of sustainable weight loss with ketosis is more likely explained by three attributes of nutritional ketosis:
How can these findings be applied to diabetics today?
At Wellness Garage, we will soon be launching a Diabetes Remission and Reversal program that:
Dr. Brendan Byrne