Type 2 Diabetes Reversal: Low Fat, High Fiber, or Low Calorie required?Published 3.7.2016
Type 2 diabetes (T2D) can be reversed with diet, that much is eminently clear. I have written about the research of Roy Taylor of Newcastle University previously. Earlier this week, I wrote about fiber in the diet and pondered whether fiber content was more important than fat content. This piece is a continuation of that beginning.
It's not the fiber, it's the low fat.I was wrong. It's the fat content of the diet that seems to matter for diabetics, not the fiber content. Fiber conveys all sorts of health benefits as I listed in the previous post, but to reverse insulin resistance, it appears that a low fat diet is required. Compare these various means to reverse T2D— but before we do that, let me define some terms.
When I say T2D is reversed, I mean that no drug of any kind is needed to control blood glucose level and an oral glucose tolerance test (OGTT) can be passed WITH NO ALTERATIONS IN DIET BEFOREHAND. To put it another way, T2D is reversed if no drugs are required AND potatoes and pasta can be eaten without causing a diabetic reaction. Meaning that not only is blood glucose under control, insulin sensitivity has been restored.
Proponents of low carb high fat diet to manage T2D often claim that they need no insulin to control their blood glucose levels. However, prior to taking an OGTT, they have to "carb up" for a few days or they fail the test. Likewise, they can't eat a potato or a plate of pasta without having a diabetic reaction. Their T2D might be managed, but it's not reversed. They are still insulin resistant.
So with those definitions established, let's list the diets that have reversed T2D— and have the study results to prove it.
Diets that have reversed T2D
- As already noted, Dr Roy Taylor has shown that returning pancreatic and liver function to normal in a T2D sufferer requires removal of the ectopic fat from those organs. He doesn't really claim that his diet restores insulin sensitivity, but it may well. Taylor's plan is a low calorie plan based on a liquid meal replacement product that is 20% fat, 16% protein with the remainder carbohydrates. In addition, he tells patients to eat 200 calories of cabbage (or similar) for fiber. Yes, calories are low, but so is the fat in the plan. Taylor ascribes the effects to the low calorie aspect of the plan—saying that if you can eat 800 calories of food and stick with it it will work too. In other words, he's not saying it's the low fat content of the diet. Any diet will work if you keep calories low. The Newcastle protocol has worked for patients with T2D of 11.5 years. Taylor has only begun to test the protocol on people with longer term T2D, and whether or not the reversal is permanent.
- Dr Joel Fuhrman's Eat to Live Diet reversed T2D in adherent patients. Eat to Live is very low fat, although Fuhrman doesn't specify a particular percentage. Dairy and red meat are off the menu, as are egg yolks. Lean animal products are limited to 10% of calories, meaning only very small portions are allowed. Vegetables can be eaten without limit, so it can't be called a calorie restricted plan— though the effect for anyone following it will be to consume fewer calories than they had been. Fuhrman also says that once the T2D is reversed and any other health issues are resolved, then additional fats from whole plant sources (seeds, nuts, avocados) can be added.
- The vegan Macrobiotic Ma-Pi diet can reverse T2D. The diet is not a very low calorie intervention, intake is about 1800 calories, though that level will cause weight loss in most people. It's a high carb intervention, and the fat content of the diet is slightly lower than the shakes used in the Newcastle protocol at 18%. The fact that is vegan will be off-putting to some. This post at the Carb-Sane Asylum details the diet. Weight loss was one of the goals in this study.
- Vegan doctor Neil Barnard has also shown that a low fat, and thus by definition high carb, diet can reverse T2D. His diet is low fat and vegan.
- In the 1950's Dr Walter Kempner used a diet based on white rice, fruit, and sugar but next to no fat to cure a host of diseases, including T2D. The diet was bland and monotonous, Kempner apparently whipped patients who weren't adherent. Yet is reversed T2D and cured the ancillary diseases T2D can manifest.
- Vegan doctor Michael Greger presents evidence that it's not the weight loss, it's the type of food eaten. This article is the primary source for the video and was supposedly free to access, but in reality could not be accessed without academic credentials. So, I asked in the comment section about the macronutrients, and the fat content was very low at 9%. The point was to see if T2D could be reversed without weight loss. The subjects were lean men who were still using insulin to control their blood glucose levels. The subjects included long term T2D sufferers, who were very quickly able to get off all medications. Carbohydrates constituted 70% of the diet, leaving 21% to be protein.
The Common FactorWhat do all of the above diets have in common? They are high carb low fat (HCLF), even the Newcastle shake based diet. Now to be clear, Newcastle's Roy Taylor seems to be agnostic regarding macronutrient ratios, and has said the problem can be summarized in two words: "too much." As in the problem is prople eat too much food, period. I've never heard him address the extremely high fat diet option, but he is definitely not anti-low carb, nor is he a proponent of veganism. The diet he helped Michael Moseley design to show people how the Newcastle diet could be done with real food is not vegan, nor does it seem particularly low fat— at least based on the example meal plan I saw.
But what about a plant based low carb diet, such as Eco-Atkins? In fact, Eco-Atkins is a vegan low carb diet, though certainly it's not as low carb as other low carb high fat (LCHF) diet variants. There is evidence that Eco-Atkins for non-diabetics, has the same good effect as a high carb vegan diet. Adherence was better for the HCLF vegan diet. Half the subjects assigned to Eco-Atkins dropped out, while less than a third of the HCLF subjects dropped out. As adherence is the essential factor in any type of treatment, this is not a small point. Both diets were designed to result in calorie restriction; subjects at at 60% of maintenance level. This evidence does not show that T2D can be reversed with Eco-Atkins. Markers related to blood sugar improved on both diets, but the subjects were not diabetics. To my knowledge, no one has studied Eco-Atkins as a means to reverse insulin resistance.
One more thing about Eco-Atkins though. It is difficult to eat a LCHF vegan diet. The only way Eco-Atkins achieves a high fat percentage is by incorporating large amounts of refined fats (oils). This does not seem to me to be the best way to eat. Notably, Eco-Atkins is not as low carb and the traditional Atkins diet. At Greger's NutritionFacts.org site I asked a question about Eco-Atkins. Greger's view is that all that matters is that the diet be a vegan diet, which (absent a lot of refined oil) is going to tend to be lower fat. If all that matters is eating plants, not animals, then Eco-Atkins should work. I'm not convinced, however. Elevated levels of free fatty acids (FFA) seems to be the cause of insulin resistance. If that's the case, eating a diet that raises blood FFA content (in other words a LCHF diet) would seem to be the exact wrong thing to do.
However, insulin resistance and free fatty acids is a topic for another day.
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