ISLAMABAD, Oct 17 (Online): Type 2 diabetes has become one of the most widespread health conditions worldwide. While medications can help people manage their symptoms, some medical experts suggest that lifestyle changes, such as following a low-calorie diet, can reverse this chronic condition. But are such changes always sustainable?
Is it always safe to follow a low-calorie diet to send type 2 diabetes into remission? We investigate. Image credit: Anna Tabakova/Stocksy.
Around 96%Trusted Source of the estimated 537 million people around the world who have diabetes are living with type 2 diabetes. The number of people with diabetes is expected to riseTrusted Source to about 783 million by 2045.
While there is currently no cure for type 2 diabetes, its symptoms can be managed — and even reversed — through weight lossTrusted Source and lifestyle changes, such as exercisingTrusted Source more and following a healthy dietTrusted Source.
Recently, some scientists have focused on the use of a low-calorie diet as the answer to type 2 diabetes remissions. However, some say following a low-calorie diet for the long term may not be feasible in the real world.
What exactly is a low-calorie diet? How could it help reverse type 2 diabetes? And is this type of diet appropriate for everyone with type 2 diabetes?
Medical News Today spoke with five medical experts on this subject to find out whether or not a low-calorie diet is the right move for people with type 2 diabetes.
How are diet and type 2 diabetes related?
Type 2 diabetes is a condition where the body can no longer use or produce insulin correctly. One of the main causes of type 2 diabetes is having overweight or obesity.
“Type 2 diabetes is a weight-related disorder in which people are not able to make enough insulin for their [bodies],” Dr. Jennifer Cheng, chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center explained to MNT. “They develop insulin resistance when gaining weight. The insulin goes into the fat tissue instead of their bloodstream.
The improvement of glycemic control is related to weight loss.”
Because of type 2 diabetes’ ties to weight, most treatment options revolve around healthy lifestyle changes, including dietary changes.
In general, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommendsTrusted Source that people with type 2 diabetes follow a diet focusing on vegetables, fruit, protein, whole grains, dairy, and heart-healthy fats.
Additionally, past research suggests that specific diets — such as the DASH dietTrusted Source, Mediterranean dietTrusted Source, and paleo dietTrusted Source — could also have a positive impact on type 2 diabetes
What is considered a low-calorie diet?
A person on a low-calorie diet will consume between 1,000 and 1,500 caloriesTrusted Source a day, depending on their specific needs.
The purpose of a low-calorie diet is to create a calorie deficit that can ultimately lead to weight loss. A consistent 500 to 1,000 calorie deficit can help a person lose 1 to 2 pounds (0.4–0.9 kilograms) per week.
The Dietary Guidelines for AmericansTrusted Source suggest a healthy diet consists of:
• focusing on fruits and vegetables for half of each meal
• choosing whole grains and protein
• selecting low-fat or fat-free dairy, lactose-free dairy, or fortified soy versions
• limiting sodium, saturated fat, and sugar.
Because the amount of calories needed varies between each person, they should talk to their doctor or registered dietitian before starting a low-calorie diet.
How could a low-calorie diet help reverse diabetes?
Dr. Kathleen Axen, department chairperson and deputy chair graduate nutrition for Health and Nutrition Sciences at Brooklyn College, is the co-author of a studyTrusted Source on low-calorie diets and type 2 diabetes published in June 2021.
According to her, because insulin resistance is a major feature of type 2 diabetes and weight loss reduces insulin resistance, that would be a way for a low-calorie diet to have put diabetes in remission.
“Decreases in adipose tissue mass lower blood levels of free fatty acids, which would mitigate their effects on liver metabolism, allowing liver pathways to be more responsive to insulin,” she added. “Lower insulin resistance results in better control of blood glucose and blood lipids.”
Monique Richard, a registered dietitian nutritionist, owner of Nutrition-In-Sight, and national media spokesperson for the Academy of Nutrition Dietetics, said if a person is decreasing their caloric intake, they are also decreasing the amount of carbohydrates they consume, which affects blood glucose levels.
“Lower blood glucose spikes will in turn decrease insulin needs from the pancreas preserving the function of the beta cells that make insulin. The process of the body storing additional energy (calories) as fat will likely be greatly diminished. Depending on the calorie deficit, pathways to burn the excess glucose and fat stores will also become active in order to meet the body’s needs.”
– Monique Richard
“The entire cascade of metabolic functions within the body will be affected, likely allowing cells to become more sensitive to the glucose-insulin process since it is not overwhelmed by excess,” Richard added.
Can a low-calorie diet place type 2 diabetes in remission?
Previous studies have provided evidence that following a low-calorie diet can help place type 2 diabetes into remission for the long term.
The American Diabetes Association defines diabetes remission as sustaining normal blood sugar levels — an HbA1c level of less than 6.5% — for 3 months or longer.
A studyTrusted Source published in June 2021 found people who followed an intermittent very-low calorie diet were able to achieve optimal glycemic control.
And other researchTrusted Source published in September 2022 reported one-third of its study participants were able to place their diabetes into remission for at least 8 years after following a very low-calorie diet.
The Twin Cycle Hypothesis
At the Annual Meeting of the European Association for the Study of Diabetes 2023, Dr. Roy Taylor, professor of medicine and metabolism at Newcastle University in Newcastle, United Kingdom, spoke in support of a low-calorie diet leading to lasting remission of type 2 diabetes in a real-world setting.
He told MNT that the proof for this can be found in a series of five major studies conducted in Newcastle that confirm the Twin Cycle HypothesisTrusted Source.
“The latter used our study data from studies on people with and without type 2 diabetes and predicted in 2008 that a period of low-calorie diet would sharply decrease the fat content of the liver,” Dr. Taylor explained.
“That would bring benefits in two ways. It would improve the response to insulin and allow the body to return to normal the output of glucose from the liver. Crucially, it would return to normal the raised output of fat from the liver which was soaking all tissues of the body in excess fat, but the insulin-producing cells in particular would be suppressed by this.”
– Dr. Roy Taylor
“So the Twin Cycle Hypothesis predicted a waking up of the insulin-producing cells once this metabolic stress was removed,” he continued.
“To my surprise, the critical study published in 2011 showed this is exactly what happens providing the low-calorie diet is sufficient to decrease body weight [by] 10–15kg. Our subsequent studies sorted out details, and especially showed that remission lasted as long as the weight regain was avoided,” said Dr. Taylor.
Is a low-calorie diet right for everyone with diabetes?
While evidence seems to support a low-calorie diet as an option for placing diabetes into remission, it is important to note that this type of dietary intervention may not be for everyone.
“There are people with diabetes who are not overweight to start with, as it is not a uniform disease,” Dr. Axen said. “They should not lose more weight, as they will lose lean body mass. Those with high blood glucose levels or who have other complications can’t rely only on diet. They risk exacerbation of retinopathyTrusted Source, nephropathyTrusted Source, neuropathyTrusted Source, and cardiovascular diseaseTrusted Source.”
“A low-calorie diet is not appropriate for everyone,” Dr. Cheng also cautioned. “It can be dangerous for those who are on this type of diet and have a high risk for low sugars, without enough calories, especially in older adults. If they are not obese, then there is not as much benefit for a low-calorie diet.”
Starting a low-calorie diet is one thing — staying on it for the long-term is another.
“Our culture makes it difficult to avoid some of the more nuanced changes that may be associated with a low-calorie diet,” Richard explained.
“For example, many restaurant meals and convenience foods offered tend to have more calories than making the meal yourself. If the person is not invested in learning about healthier recipes or products to make meals, it may not be ‘real-life’ or practical for them. Eating is also a very important social connection to restrict for a long duration and could affect mental and physical health,” she added.
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