Can we Cure Type II Diabetes?

I've received a number of emails since my article, Diabetics Must Demand Accountability from the ADA on Monday - with the vast majority thanking me for taking a strong stand on the issue.

All of the emails were not, however, singing my praises. In fact, about 30% were critical of the article or me personally and ran the gamut from 'if you don't have diabetes, you simply can not understand how important the ADA is to those of us who do' to 'you're an idiot of you think the ADA is withholding a cure' to 'a high fat diet is deadly to those with diabetes, you obviously don't know the research even though you claim you do.'

First, let me say that I do think the American Diabetes Association (ADA) should be important to those with diabetes, and even those with pre-diabetes or metabolic syndrome. Because of their prominent and trusted role in the lives of those with diabetes, they should be held accountable for the progress, or lack thereof, made in finding a cure. And that was the point of my article - hold the organization, that is the leading health authority for the disease, to a high standard and expect progressive improvements in your health not simply better medical management techniques.

That isn't to say those medical interventions are not important - they are and they save lives. What they do not do is stop the progressive damage within the body - they only slow it down. Such treatments should not be viewed as the best we can do or the best we can hope for when the research data shows that there are natural, dietary interventions that may hold the key to finding a cure for Type II Diabetes!

Dare I say we may already have that key?

But, before we can consider the idea that a cure for Type II Diabetes is possible, we must first have a working definition of of "cure."

Some will argue that there is no cure because diabetes is a lifelong, progressive, chronic disease and even if you can somehow manage it, even without medication, it does not change the fact you still have diabetes.

There are others though, with definition of "cure" from other diseases and conditions where the term "cure" is applied who hold that, if by definition you're considered diabetic when you are placed on medications to manage the condition, then you are no longer a diabetic if you are able to eliminate the need for medication through whatever means - diet, exercise, etc. - and do not present symptoms that meet the definition of diabetes.

For the purpose of this article, let's start to consider "cure" as you no longer meet the strict definitions established for a diagnosis of diabetes and no longer require medication to control blood sugars and/or insulin.

I think it is also important to have a good definition, one that cannot be considered too "loose," so let's also consider the multitude of complications associated with diabetes that increase risk for other problems like cardiovascular disease - so, let's make our definition of "cure" five-fold:

improvement in fasting blood sugars to a level that indicates one is no longer meeting the criteria to be diagnoised as "diabetic"
AND
improvement in post-prandia glycemia & insulin secretion so that medication is no longer necessary and one is no longer meeting the critera to be diagnoised as "diabetic"
AND
normalized HBA1C levels so one is no longer meeting the criteria to be diagnoised as "diabetic"
AND
improvement in dyslipidemia
AND
elimination of oral medication and/or insulin injections

So, then - can we cure type-II diabetes?

If various research studies investigating dietary interventions are correct, and we even use the strict definition we have above, than yes, we can cure diabetes.

First, the problem - a low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes.

Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption. This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes with the potential to reverse the condition and perhaps cure type II diabetes.

A study published in 2004 - Glycemic optimization may reduce lipid peroxidation independent of weight and blood lipid changes in Type 2 diabetes mellitus - in the journal, Diabetes Nutrition & Metabolism, showed great promise for the standard ADA recommendations. The data showed some improvements in those following the diet for 8-weeks and is often cited as "proof" the recommendation for a low-fat, high-carbohydrate diet works.

But, if we use our definition of "cure" above, does the data support the idea that this type of dietary approach will lead to one being "cured" of their diabetic condition?

Let's see...did this dietary approach result in:

Fasting Blood Sugar improvement? Yes
Improvement in post-prandia glycemia & insulin secretion? Not measured
Improvement in HBA1C? Yes
Improvement in dyslipidemia? No
Elimination of Medications? No

By our strict definition for "cure" bove, this dietary approach will not lead to one being cured of diabetes. The improvements above will most certainly slow the progress of the complications, and may even require less medication, but the individual with diabetes following this diet will not see a cure and will be left to continue with "medical management" of their disease and hope the worst long-term complications can be delayed as long as possible.

What about other studies? Surely the literature has something within that gives us hope.

Well, back in 1992, a study published - Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM - in the journal Diabetes, provided some very intriguing data. Researchers confined subjects to a metabolic ward for 3-weeks during each diet to ensure compliance with the dietary interventions to compare the standard ADA diet with a diet much lower in carbohydrate. Each subject was crossed-over to the other diet for three-weeks to compare effects. The two diets provided the same calories and fiber, but had significant differences in their effect.

This study did not look at all parameters we've used in our definition for cure, but something very alarming did happen to those following the high-carbohydrate diet - their cholesterol was significantly impacted by the high-carb diet! The high-carb diet resulted in a 27.5% increase in triglycerides and a similar increase in VLDL cholesterol and an 11% decrease in HDL. For cholesterol levels the high-carb diet was a disaster!

Are there other studies that might show improvements that meet the strict definition of cure we've established?

In 1994 a study - Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus - was published in JAMA. In this 8-week study, researchers investigated the difference between a high-carbohydrate diet compared with a lower carbohydrate, high-monounsaturated fat diet. Again, the high-carbohydrate diet was disasterous as it resulted in increased fasting plasma triglyceride levels and very low-density lipoprotein cholesterol levels by 24% and 23% respectively, and increased daylong plasma triglyceride, glucose, and insulin values by 10%, 12%, and 9%, respectively. Plasma total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels remained unchanged. The effects on plasma glucose, insulin, and triglyceride levels persisted for 14 weeks after the diet was abandon.

These last two studies were done 12-years ago and during the time since, the ADA has remained staunch in it's high-carbohydrate, low-fat recommendation. Twelve years ago, we had the start of some very compelling data that suggested we continue to study a dietary approach that was lower in carbohydrate as a dietary intervention for those with Type II Diabetes.

So what happened?

Well, if we look through the literature, we find that researchers often adjusted their study design and rarely compared the high-carbohydrate diet to a lower carbohydrate diet again until 1998, when a study - Utility of a Short-Term 25% Carbohydrate Diet on Improving Glycemic Control in Type 2 Diabetes Mellitus - was published in the Journal of the American College of Nutrition. While this was another short-term study, this one did look at a number of items from our definition above.

The data from the study provides some insight into what effect a lower carbohydrate diet had with regard to:

Fasting Blood Sugar improvement? Yes
Improvement in post-prandia glycemia & insulin secretion? Yes
Improvement in HBA1C? Yes
Improvement in dyslipidemia? Not measured
Elimination of Medications? Yes

The researchers noted that "In those subjects on sulfonylurea therapy, the improved glycemia was achieved despite discontinuation of the oral hypoglycemic agent. "

This is our first glimmer of hope in the literature that diet alone may indeed hold the key to cure. One would think the above results would have sparked a renewed interest in researching comparitive studies of high-carbohydrate versus low-carbohydrate diets for diabetics?

Well, it didn't happen.

But in 2004, we do find a study - Effect of a High-Protein, Low-Carbohydrate Diet on Blood Glucose Control in People With Type 2 Diabetes - published in the journal, Diabetes, that again does compare the high-carbohydrate diet with a low-carbohydrate diet. Again, the results are compelling for the low carbohydrate diet:

Fasting Blood Sugar Improvement? Yes
Improvement in post-prandia glycemia & insulin secretion? Yes
Improvement in HBA1C? Yes
Improvement in dyslipidemia? Yes
Elimination of Medications? Not stated

Unfortunately this study did not tell us if those within the study were able to eliminate their medication or not with the dietary intervention.

A study last year gave us data from a Swedish research team - Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes--a brief report - published in the journal, Upsala Journal of Medical Sciences. In this study, researchers found that in their type II diabetic subjects following a low-carbohydrate diet for six months resulted in:

Fasting Blood Sugar improvement? Yes
Improvement in post-prandia glycemia & insulin secretion? Yes
Improvement in HBA1C? Yes
Improvement in dyslipidemia? Not Measured
Elimination of Medications? Yes

And, get this - while this study was just six months, the researchers noted that the improvements persisted in the six months following the end of the study! That's ONE YEAR of measurable, real metabolic improvement in study participants who had diabetes and through diet alone were able to eliminate their medications!

Then we have, from the Annals of Medicine a study published last year, Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. This study was short-term, included a very limited number of participants but was conducted within a metabolic ward to specifically measure food intake accurately. The researchers findings included:

Fasting Blood Sugar improvement? Yes
Improvement in post-prandia glycemia & insulin secretion? Yes
Improvement in HBA1C? Not Measured
Improvement in dyslipidemia? Yes
Elimination of Medications? Yes

The researchers again noted that the low-carb diet affected "markedly improved glycemic control and insulin sensitivity."

Here we have three studies since 1994 - a period of twelve years - that show elimination of medications of those with Type II Diabetes. Yet, in tweleve years we still have NO long-term study data because we have no longer term studies done specifically using this dietary intervetion to actually see if reducing carbohydrate has a lasting effect in those previously diagnoised with diabetes who, by participating in a study, were able to eliminate their medications because of a low-carb diet!

The above studies are publically available, so the ADA is well aware of them. Even if, in the last twelve years they wanted to remain cautious in their recommendations - totally understandable - why in the world have they not committed funding to a large, well-controlled, long-term study to investigate the long term effect of a carbohydrate restricted diet?

The last twelve years has been lost to us for data collection - it's gone, time we cannot get back. The ADA knows the data about a low-fat, high-carbohydrate diet does not hold promise for a cure. They have no idea what a low-carbohydrate diet can do because they simply will not commit to investigating the dietary approach for long-term data.

They are supposed to be the leading healthcare organization for those with diabetes! Why are they dismissing this potential key to the cure?