Hello and welcome to PREKURE’s weekly snippet of science, where on a weekly basis we share emergent research related to extending the human healthspan.
Three easy, cost-effective things you can do right now to work towards reversing T2D.
What is Diabetes?
Everyone has sugar in their blood, this sugar is called glucose and it helps us to carry out the functions we need to on a daily basis. The normal amount of glucose that should be present in your blood at any given time is about 5 mmol/L. This is the equivalent of a teaspoon of sugar. This homeostatic optimal level of sugar in the blood is tightly controlled by the pancreas and two key hormones. Insulin is the first of these hormones, it signals the body to store glucose in the muscles and liver as glycogen. When your body runs out of space in these two areas, glucose is then stored in fat cells. The second hormone is glucagon. Glucagon is signalled when blood glucose levels drop and sends a message to convert glycogen back to glucose and release it into the bloodstream [1].
So what exactly is Diabetes? Diabetes is the umbrella term that essentially refers to three presentations of the same disease. Type 1 Diabetes occurs when the beta cells in the pancreas stop producing insulin, this results in an inability to control blood glucose levels. Type 1 Diabetes is an autoimmune disease that usually presents in childhood. Recent advances in gut microbiome research suggests that there may be a link between the gut microbiome and the development of T1D [2]. Type 2 Diabetes stems from a condition called insulin resistance. Insulin resistance occurs when the body is forced to hypersecrete insulin for a long time to control constantly high blood glucose levels. This is what happens when people spend a lifetime eating diets consisting predominantly of carbohydrates. While historically T2D has been regarded as a disease of older adults, recent studies illustrate that pre-diabetes (the warning sign before full blown T2D occurs) is becoming increasingly common in children and adolescents in developed countries [3, 4]. The third presentation of diabetes is gestational diabetes which occurs during pregnancy and is usually diagnosed during the 24th and 28th week of pregnancy. Given our growing understanding of the link between metabolic health and brain health, there is evidence that neurodegenerative diseases like vascular dementia may be classified as a new category of Diabetes, essentially Type 3 Diabetes [5, 6].
What does the research tell us about reversing T2D?
There is hope on the horizon and a growing body of research shows that T2D can be reversed and sent into remission. The key to achieving this hefty feat? Diet and exercise. The Diabetes Remission Clinical Trial (DIRECT), ‘ReverseDiabetes2’ (Netherlands), Virta Health (USA), and Hope for T2D (UK) all illustrate the impact that reducing dietary carbohydrate can have on T2D. This makes sense though, doesn’t it? If your body has trouble processing and regulating sugar then it seems only reasonable that you would reduce the amount of sugar you eat. It is important to include your regular prescriber in the loop as you make lifestyle changes as the medication doses you take will need to change as your body does.
The Virta Health trial in the United States was overseen by the late Dr Sarah Hallberg and continues to run after her passing. The group recently released their 5 year findings which fly in the face of everything that was previously thought to be true about T2D. Below are some of the key findings [7]:
- Sustained blood sugar control. Virta patients experienced persistent improvements in blood sugar on average, while requiring significantly fewer medications.
- Medication de-prescription. Half of patients prescribed insulin at the start of the trial no longer needed it at five years. Across all diabetes drugs, prescriptions were reduced by nearly 50%.
- Weight loss. Average weight among Virta participants decreased by 7.6%, exceeding the 5% benchmark for clinically significant weight loss by more than 50%.
- Broad improvement in cardiometabolic health. In addition to improvements in triglycerides, HDL cholesterol, and markers of inflammation, patients even showed encouraging signs in reversing the progression of chronic kidney disease.
These results show that it is possible to get your life back and reverse your T2D. Not easy, but possible. So, what three things can you do right now to start your journey towards reversing your T2D?
Remember, before you follow the steps below you need to make an appointment with your usual prescribing doctor to ensure that you have the support you need to change any medications you are taking as you need to.
3 Ways to improve your Health right NOW
1. Reduce the amount of carbohydrates in your diet
Research shows that there is a dose-response relationship between T2D metabolic markers and the degree of carbohydrate restriction [8]. Essentially, the less carbohydrates you consume the more pronounced the changes will be, especially for HbA1c. There are a few ways you might want to tackle reducing your carbohydrate intake. You might want to track what you are currently eating and then aim to reduce the amount of carbohydrates a little each week. Think of this as the slow and steady approach. Alternatively, you could look at a specific threshold like a low-carbohydrate diet which is less than 120g per day, or a keto diet which is less than 50g of carbohydrate per day and start aiming to eat that many carbohydrates.
A quick and easy swap to get you started with lowering your carbohydrate intake is to swap your pasta with spiralised zucchini, beetroot, pumpkin or butternut. With it being winter this is a great option to still enjoy a warm and cosy bolognese with far fewer carbohydrates.
2. Move your body for at least 30 minutes a day
Exercise is a great way to increase your body’s insulin sensitivity and teach it to start using glucose more efficiently again [9]. Ideally, a good exercise program will include some zone 2 or easy cardio (think walking, biking, swimming at a leisurely pace), some resistance training or strength training (think squats, push ups, lunges) and some balance and mobility exercises. But, if it’s been a while since you’ve dusted off your trainers, start small. Start by going for a short walk a few times a week and aim to be on your feet for 20 – 30 minutes. You could rope in a few friends and start a walking group or pop some headphones in and listen to your favourite music or podcast.
3. Get a good night’s sleep
How well we sleep affects how effectively our body works the following day. Research shows that a poor night’s sleep can worsen insulin resistance and lead to increased blood sugar levels during the day [10]. How can you set yourself up for a good night’s sleep? Put devices away about 1-hour before bedtime, sleep in a cool and dark room, and try to go to bed at the same time every night.
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