Dietary strategies for remission of type 2 diabetes: A narrative review

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Eddy Edson

Eddy Edson

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Relationship to Diabetes
Type 2
Just published: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jhn.12938

From a group of UK academics and medical practitioners.

Practice points

• Type 2 diabetes (T2DM) remission should be considered as a treatment goal for people living with T2DM (especially for those within 6 years from being diagnosed). The ability to achieve this may be influenced by duration of diabetes, weight loss and gender. Therefore, it should be positively discussed with this in mind.
• Based on the evidence from clinical trials weight loss (typically 15 kg or greater) is the main driver and predictor of remission. However, more data are needed so that it is more reflective of an ethnically diverse population.
• Based on evidence from clinical trials, maintenance of weight loss appears to be the main driver of continued remission, and this therefore needs to be a key focus of the planning and delivery of all services designed to achieve remission.
If a diet low in carbohydrate is sustainable to the individual, normoglycaemia may be maintained in the absence of weight loss, although evidence is limited and loss of remission is likely to occur if carbohydrate restriction ceases.
• Total dietary replacements (TDR) and low carbohydrate diets have been demonstrated as being effective in facilitating weight loss and remission of T2DM. Evidence of effectiveness beyond 2 years is limited. The dietary approach should be one which the individual can maintain for the long term.
• TDR and low carbohydrate diets, if appropriately supported, are considered safe and should not be avoided in suitable individuals who find these approaches acceptable. Clinicians should therefore aim to support their use within clinical practice as part of person-centred diabetes care.
• Programmes supporting people toward achieving remission need to be structured and offer continued, regular support, including the involvement of dietitians (mandated by the National Health Service England).
 
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They still think that we caused our type 2 by gaining weight rather than the relentless pressure to eat low fat and lots of 'healthy' carbs - they still think it's the patients fault for getting fat rather than eating 'all the wrong things'.
I wonder if I will live long enough - mind you - it will still be them who are the clever ones and worked it out for themselves, rather than the poor people they have spent decades accusing of doing it wrong eventually hearing that they were right all the time.
 
Well, I ate a lot, got fat, got diabetes.
Ate less, got thin, got rid of diabetes.

I totally ate my way into being fat and diabetic.
Now I'm thin and eat 'all the wrong things' I'm still good.
 
The NHS is an odd beast. Often seems to blame its own customers, the patients, for their ailments. Then, rather that looking holistically at the whole patient, often just prescribes medication to combat this or that symptom. And then more medication to combat new symptoms brought on by the previous meds, etc etc. It seems very reluctant to believe that a good healthy life style can, in many cases, cure or bring into remission ailments for many. Of course, this will not be the case for many too or for many ailments either. But T2 diabetes seems to be different in that it may, in many cases, be treatable or avoided by the patient by changing the lifestyle.

A caring profession that has no time to care (through no fault of their own), given just minutes to assess and help a patient, often over the phone.

In my zillion years on this planet I have come across just one doctor who was brilliant. Listened, understood, reasoned, communicative. And I have come across many who were rushed, tired, not listening, good with prescription pads, poor advice, etc etc.

My 'diabetes' was my own fault through a rubbish, stressed, lifestyle. No advice from the doctors that could have helped avoid the problems. I was not even told that I was pre diabetic....ever!

Wierdly, after all that, I have to say it, it is the NHS that has saved my life, twice, mainly through brute force though. So they do a good job but could do so much better if they had better resources and time..

I have to say it, the reverse has been true of nurses. Most are great, caring, dilligent. I have come across one (agency staff) that was just plain horrible. Bad attitude, rough, seemed uncaring, etc

Things are changing, slowly, and more and more doctors seem to be listening to their patients and prescribing better, so there is hope for the future.

And of course, there is the other side of the coin. Sometimes, often times, the patient does not know or understand what they have done or are doing to themselves and how to reverse it. Sometimes patients are confused, angry, fed up, tired, desperate, in pain, worried, and what they need more than anything is someone with time to explain things and help them understand and to help them change their life style if that is the better way to go.

Nah!!! Here, take these Vallium tablets.... next!
 
travellor said:
Well, I ate a lot, got fat, got diabetes.
Ate less, got thin, got rid of diabetes.

I totally ate my way into being fat and diabetic.
Now I'm thin and eat 'all the wrong things' I'm still good.
Click to expand...
You had to make a poor choice of grandparents first to get T2.;-)
 
Eddy Edson said:
The dietary approach should be one which the individual can maintain for the long term.
Click to expand...
This part cannot be forgotten as it's absolute key to longer term success...
 
The explanation given by Dr Jason Fung in the book The Diabetes Code makes perfect sense and is very convincing in the support of it being perfectly possible to reverse Type 2 diabetes by dietary changes. And that meds and even insulin are counterproductive in achieving that goal and exacerbate the problem.
 
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