Is a 600 calorie diet the only way to crack type II diabetes?Written by Elspeth Stewart
There has been some great new research into a 600 calorie diet reversing markers of type II diabetes in a matter of days. This study was carried out in conjunction with Newcastle University and published in Diabetologica1. Participants were given shakes which consisted of a balance of protein, carbohydrates and fat and on top of this they were allowed to consume 3 portions of non-starchy vegetable each day. I think it is great that more research is being done into non-pharmaceutical approaches to turning back type II diabetes - this is important information that can really change lives in a cost-effective way and without any side effects.
However, its important to also make people aware that severe calorie restriction is not the only way to tackle type II diabetes - at least, if action is taken early.
It all started with bariatric surgery
The researchers discussed how previous research on the metabolic effect of bariatric surgery2 had got them thinking. Bariatric surgery is a technique used for weight loss which involves limiting food and calorie intake by restricting stomach size through various techniques. The research demonstrated that within days of bariatric surgery, metabolic markers for diabetes have largely normalised, well before any weight loss has taken place.
Now bariatric surgery is a serious intervention and generally this procedure is not reversible. It is usually only carried out on morbidly obese people with a BMI over 40 but more recently it has started to be recommended for individuals with BMIs over 30 or 35, if they also have conditions such as diabetes or cardiovascular disease. As a nutritionist, I am very conscious that the body needs nutrients to work well and those nutrients come through food. An overweight individual may not need more calories for energy while they still have fat reserves but they still need the same amount of nutrients such as zinc, magnesium and vitamin B6. Nutrients act as co-factors - supporting the thousands of enzymes which carry out biochemical processes in the body. Bariatric surgery is a very effective way to reduce calorie intake but an individual will never be able to eat normally again and will certainly not be able to eat enough food in a single day to supply all the vitamins and minerals required for good health.
Similar results without surgery
The idea of being able to achieve a similar result through following a calorie controlled programme for 8 weeks sounds like a much less drastic way of achieving the same results. The body gets an opportunity to 'reset' and (hopefully) the patient gets appropriate education into what dietary and lifestyle changes are required to maintain good metabolic health.
So what would that dietary education consist of? If you asked me, I would suggest something like our In2shape programme which is a low glycaemic diet based around 3 meals and 2 snacks every day, plenty of non-starchy vegetables, moderate carbohydrate and grain intake. Consistent protein through the day and healthy fats from seafood, nuts, seeds and foods like avocados. Why would I recommend a diet like this? Quite simply because there is published scientific research3 that demonstrates that this diet also has a positive effect on metabolic markers assocaited with metabolic syndrome and diabetes including glycosylated haemoglobin (HbA1c ), fasting insulin levels, triglycerides, cholesterol and high blood pressure. Which leads me to ask the question:
Is a 600 calorie diet the only way to reverse markers of type II diabetes?
No, it definitely is not. This very low calorie diet (VLCD) approach is possibly a good option for those individuals whose diabetes have advanced to a stage where the pancreas is no longer producing sufficient insulin. For anyone in the early stages of this condition, VLCD might still be an ideal way to give the body a 'reset' before commencing a new approach to living. However, for this group, making less drastic dietary and lifestyle changes can also make a difference and may be easier from a compliance perspective. From my experience working with people who've come to me after following VLCD diets for weight loss, it doesn't always result in healthier food relationships. Which means that there is initial success but things may not stay that way for long. And anyone with adrenal dysfunction may find that VLCDs exacerbate this issue and lead to outright adrenal fatigue.
So what can be done?
The most important thing is to take action as soon as possible. Food is the primary trigger to the metabolic shift towards type II diabetes because high-glycaemic (high sugar) foods trigger an increased insulin response. Over time, this style of eating leads to the development of insulin resistance and more and more insulin is required for the cells to get the same effect, and eventially insulin 'burn-out'. A sedentary lifestyle will also increase the likelihood of developing diabetes.
The good news is that cutting sugars and simple carbohydrates from the diet can make a difference (so long as changes are made before diabetic complications have started to appear). As blood glucose levels normalise, so will insulin levels and with time, the body re-sensitises to this hormone. Exercise stimulates insulin sensitivity so commencing regular moderate exercise is essential. It may also be helpful to identify and address any nutrient deficiencies, as some play a role in metabolic syndrome, such as chromium and vitamin D. Reducing stress (and therefore cortisol) will also be helpful as cortisol disrupts blood sugar levels.
Some people have an increased tendency towards developing diabetes. This may be genetic (e.g. south Asian or African ethnicity) or it may be linked to other factors such as vitamin D deficiency or what their mother was eating during pregnancy. Give that dark skin makes it harder to produce vitamin D, this puts the UK's Asian and African populations at a very high risk of developing diabetes. Some of these things make diabetes appear to be 'inevitable' or 'irreversible' - "My parents both have diabetes so I will too." But this is simply not the case. Vitamin D deficiency can be corrected and diet and lifestyle can be changed.
It is important to note that both emotional and physical stress trigger cortisol release so it's not only about the way we think or the job we have - addressing physical issues such as pain, food allergies, digestive complaints will all help reduce cortisol levels too. Each piece of the puzzle on its own might not be quite as effective but bring it all together and the body is in a much better place to shift back towards a more normal metabolic state. To be truly effective, it is important for these lifestyle changes take place as soon as possible and certainly before any organ damage associated with diabetes has taken place (e.g. to the kidneys, eye, liver or pancreas).
Eating is to be enjoyed
For many people, food is an important part of life - family gatherings are often focused around meals. We celebrate a birthday, an anniversary or a reunion with a night out to a restaurant. Adopting healthy eating patterns does not have to get in the way of these important moments - once these dietary principles have been followed for a while, treats such as cakes or desserts are fine, so long as they really are treats and don't happen too often. Many people worry that healthy eating will be bland or tasteless but this is usually because their palate has become used to high sugar, high salt foods. Once sugar has been removed from the diet, the taste buds quickly adjust and it then becomes possible to appreciate the flavour of a much wider variety of foods. Addressing zinc deficiency may also improve taste sensation.
We eat like those around us
The best part about this type of health intervention is that it doesn't just influence the wellbeing of that individual. Usually, it also benefits those around them, as the new style of eating is adopted by all. A parent who adopts healthy changes to the way they eat will influence the health of their children for years to come - thereby helping the next generation to grow up making better food choices.
1 Lim, E. L., Hollingsworth, K. G. & Aribisala, B. S. (2011). Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia, ePrint June .
2 Pories WJ, Caro JF, Flickinger EG, Meelheim HD, Swanson MS (1987) The control of diabetes mellitus (NIDDM) in the morbidly obese with the Greenville Gastric Bypass. Ann Surg 206:316–323
3 Schiltz B et al. A science-based, clinically tested dietary approach for the metabolic syndrome. Metab Syndr Relat Disord. 2009 Jun;7(3):187-9