Extreme low-calorie diet leading to radical weight loss can reverse diabetes: Lancet study

An extreme low-calorie diet that leads to an average weight loss of 10kg helps reverse type-2 diabetes, says a study reported in the journal, The Lancet.

The weight-loss diet plan was a formula, drank mostly as a shake, of 825–853 calories a day for three to five months, followed by a stepped reintroduction of solid food over two to eight weeks. Study participants were encouraged to be active, but were not asked to follow a structured exercise plan.

Close to 70 million adults in India have diabetes in India, with another 10.2% of the population with glucose intolerance, a precursor to diabetes.

Studies show that south Asians develop diabetes a decade earlier than Caucasians at a lower weight, and those with prediabetes progress to overt diabetes at a faster rate.

While losing weight has been linked to better management of type 2 diabetes, this is the first study to show that substantial weight loss leads to lasting remission without medication even in people who have had type-2 diabetes for six years.

The Lancet study by researchers from Newcastle and Glasgow Universities showed almost half (45.6%) of those who took part in the programme stayed in remission after a year.

This included 86% of people who lost more than 15kg, 57% of people who lost 10-15kg, and 34% who lost 5-10kg.

In the comparison group, remission was seen in four per cent people with best available diabetes care but not the low-calorie diet.

Worldwide, 425 million – one in 11 adults — have diabetes, of whom half — 212 million — are undiagnosed.

Untreated diabetes leads to irreversible complications, such as retinopathy that causes blindness, kidney damage, heart disease, slow-healing wounds and amputations.

“We are all immensely encouraged by these data and should try to achieve substantial weight loss early on after diagnosis for reversal,” said Dr Anoop Misra, chairman, Fortis centre of excellence for diabetes, metabolic diseases and endocrinology.

But, several roadblocks remained. Misra said the data didn’t apply to non-obese individuals, in ethnic group like Indians where such reversal could be inherently difficult, and in many Indians who were non-compliant to basics of diet and exercise.

Bariatric surgery that restricts stomach capacity has also been shown to reverse the disease.

“People with diabetes who lose 10-15% of their body weight show a very dramatic and significant change in their diabetes status, with some becoming diabetes free and others controlling blood glucose at lower medicinal doses,” said Dr Pradeep Chowbey, chairman, Max institute of minimal access, metabolic and bariatric surgery, New Delhi.

“The benefits are most apparent in people who are morbidly obese, with a body mass index (ratio of the weight to height) of more than 30.”

Abdominal or belly fat was a risk factor for type-2 diabetes. “Visceral fat, deep intra-abdominal fat that’s stored underneath subcutaneous belly fat, cells have an affinity for insulin, insulin gets fixed with fat cells and less is available for metabolism,” Dr Chowbey said.