12 Weeks on a Strict Liquid Diet Program Reverses Diabetes

Written by Kathleen Doheny
Reviewed by J. Michael Gonzalez-Campoy MD, PhD, FACE, Scott Isaacs MD, FACP, FACE

 An intensive weight loss diet, totaling about 825 calories a day, can send type 2 diabetes packing,1 according to a study published in the Lancet. The diet is extremely limited—just 825 calories a day—and was overseen by primary care health care providers.

"About half of everyone [who followed the diet] were free of diabetes one year after starting," says Roy Taylor, MD, professor of medicine at the University of Newcastle, UK, and senior author of the study.1

"It didn't surprise me," Dr. Taylor says of the results, "We've been studying this [concept] for a decade," he tells EndocrineWeb.

Background on the Study

Dr. Taylor's team recruited 306 men and women with a diagnosis of type 2 diabetes from 49 clinics across Scotland and England.  The participants had an average body-mass index of 27–45 kg/m2

Patients in 23 of the clinics were assigned to follow the diet while patients in the other 26 clinics received the usual care for those with diabetes. Patients ranged in age from 20 to 65 years; all had been diagnosed within the past six years. At the start, all were overweight or obese.1

The test group received a total diet replacement consisting of 825–853 kcal/day liquid diet that was provided to participating patients who were followed closely by a designated healthcare professional, usually a nurse,1 Dr. Taylor says. Patients stayed on the 825-calorie liquid diet for three to five months.1

"It sounds like a very fierce diet," he tells Endocrine Web, "But after 36 hours or so, the sensation of hunger is no longer troublesome." Patients following the liquid diet program did not complain about energy levels, either.1

The men and women assigned to the low-calorie diet group were asked to commit to staying with the program for 12 weeks with an option to extend it another eight. “And most did,” he says. "The average duration on the program was 16 weeks."

Fewer Calories in Liquid Form Prove Effective

After the liquid phase, there was a structured reintroduction of regular food for some meals, then ongoing education and support about how to maintain the lower weight.1

Diabetes remission, defined as a hemoglobin A1C of less than 6.5%, was achieved in 46% of those who were on the diet (68 patients).1 Only 6 people (4%), of those in the control care group, had remission.

At 12 months, nearly one-fourth of those in the diet group had lost 33 pounds or more.1 None in the comparison group lost about 2 pounds

During the study, those in the diet group were able to stop taking diabetes and blood pressure medications, and just had their blood glucose and blood pressure monitored.

"This sort of diet is entirely safe," Dr. Taylor says, provided the patients continued to see their health professional regularly.

Diabetes Reversal Most Likely Early On

Why does this work to reverse diabetes in some?

"What happens is the two main abnormalities of type 2 diabetes are both sorted out when weight loss occurs," Dr. Taylor says. "These two abnormalities are brought about by too much fat inside the liver cells and too much fat inside the insulin-secreting cells in the pancreas."

"One of the jobs of the liver is to hand out fat to the rest of the body," he says, When it hands out too much, problems arise.

The liver changes are dramatic, he says. The effects in the pancreas decrease more gradually. With less fat flooding the pancreas, ''the insulin-secreting cells wake up and go back to being able to respond rapidly to produce insulin," Dr. Taylor says. "It's all due to the weight loss.''

While the study participants had all been diagnosed with type 2 diabetes within the past six years, Dr. Taylor says that those diagnosed within the past four years who go on this type of extreme diet have a very good chance of reversing diabetes.

The program has caught on in the U.K. and elsewhere, he says, and he suggests anyone wanting to try it talk to their doctor—and they don't need a specialist, he says, just someone who can monitor blood glucose levels and blood pressure.

What Do Experts in the US Say About the Approach

“The study findings make sense and reflect the value of treating obesity aggressively in patients with type 2 diabetes, especially early on, and is now the typical, accepted approach,” says J. Michael Gonzalez-Campoy, MD, PhD, FACE, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology in Eagan.

The program can be done, he says, even if you don't have access to a specialist such as an endocrinologist; and that is good news, he says.  

The vast majority of patients with overweight or obesity, and diabetes, do not have access to specialty care," he tells Endocrine Web, “yet they see their primary care doctor. The study is proof that the primary care doctor can manage this program,” he says.

The study findings echo results seen in prior research, and in many clinics around the country, according to Scott Isaacs, MD, FACP, FACE, medical director of Atlanta Endocrine Associates, in Atlanta, Georga. 

“Remission was closely related to the degree of weight loss at 12 months," Dr. Isaacs says. Dr. Isaacs has seen these results in his own clinic, as he has been providing a similar program for nearly 20 years.

"I have seen temporary diabetes remission rates similar to this study," he says.  However, he has an important caveat, noting that ''the vast majority of patients regain all the weight when they discontinue the meal replacement diet," Dr. Isaacs tells EndocrineWeb, and the diabetes returns quickly.

Keeping the weight off is crucial, Dr. Taylor agrees. In this study, when the practitioner provided education about nutrition and components of a healthy diet, patients were reminded that they would be eating about two-thirds of what they used to consume if they wanted to maintain the lost weight.1

None of the doctors have any relevant disclosures with regard to this study. The liquid diet formula was donated by a company, which had no role in the study, according to Dr. Taylor, and funding was provided by Diabetes UK.

Sources

Lean, MEJ, Leslie WS, Barnes AC,  et. al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. Ahead of print. December 5, 2017. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext?elsca1=tlpr  Accessed December 13, 2017.

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