This week I want to highlight a 2016 study in Diabetes Care looking at using a VLCD (Very Low Calorie Diet) to reverse diabetes. A VLCD is a diet that is 800 calories or below that usually consists of liquid shakes. At Enara Health, we formulated a whole food VLCD, specifically to reverse type II diabetes, so this study is of particular interest.
The study looks at why some diabetics are able to reverse their diabetes with a VLCD, while other are not. What factors predict success? Is a VLCD right for you?
`The study looked at people with type II diabetes who completed a VLCD and separated them into responders (people who successfully got their fasting glucose under 120 and maintained it without medications) versus non-responders(fasting glucose greater than 120 at 6 months).
40% of participants reversed their diabetes and 47% of the participants with high blood pressure came off their medications. Responders dropped their hemoglobin A1c by 1.4% (from 7.1 to 5.8). Under 5.7 would be normal and 5.7-6.4 is pre-diabetes so that is an impressive achievement. Unfortunately, non-responders only dropped their hemoglobin A1c by 0.4% (from 8.4 to 8.0). What were some differentiating features between responders and non-responders?
Responders and non-responders lost the same amount of weight (about 15% of their original body weight). Yes – you heard that right. So if it is not about weight, it is about….
Responders started out with lower percent body fat (36.2%) versus non-responders (42.2%). Responders also lost more parentage body fat 6% versus 5% despite similar weight loss. At Enara Health, we always focus on fat loss rather than weight loss and it was not surprising to see this.
|Responders (n = 12)||Nonresponders (n = 17)|
|Baseline||After VLCD||After 6 months||Baseline||After VLCD||After 6 months|
|Weight (kg)||99.8 ± 3.2||84.1 ± 3.1||84.4 ± 3.2||96.7 ± 3.9||83.6 ± 3.5||84.8 ± 3.7|
|BMI (kg/m2)||34.0 ± 0.8||28.6 ± 0.8*||28.7 ± 0.7#||34.4 ± 1.1||29.8 ± 1.1*||30.2 ± 1.1#|
|Waist-to-hip ratio||0.97 ± 0.02||0.93 ± 0.02*||0.93 ± 0.02#||0.96 ± 0.02||0.91 ± 0.01*||0.92 ± 0.01#|
|Fat mass (%)||36.2 ± 1.9||30.1 ± 2.0*||31.5 ± 1.9#||42.6 ± 2.2°||37.2 ± 2.0*||40.8 ± 2.5|
|Serum insulin (mU/L)||20.4 (5.7–48.1)||7.9 (3.4–16.6)*||7.6 (3.1–31.6)#||9.3 (3.9–48.9)°||5.5 (1.4–22.9)*||5.9 (1.2–14.9)#|
The largest predictor of success appeared to be diabetes duration before starting a VLCD. The responders had a shorter diabetes duration (about 4 years) than non-responders ( about 9 years). They also were on less diabetes medications to start and had higher levels of fasting insulin. Fundamentally, this means that diabetes changes the way your pancreas is able to respond to blood sugar and that process becomes irreversible after 7-9 years. The longer you have diabetes the more attenuated your first phase insulin response becomes – this means that your pancreas is not producing the right amount of insulin at the right time to properly control your blood sugar. The damage to pancreas appears to be connected directly to percent of visceral fat (triglycerides) stored in and around your pancreas.
Ultimately, what the study suggests is that type II diabetes “can now be understood to be a metabolic syndrome potentially reversible by substantial weight loss, and this is an important paradigm shift.” However, that weight loss needs to happen early (like right now early) and evolve into sustainable lifelong habits. Our current healthcare system is not equipped to do this. Long-term reversal of type II diabetes can be achieved but it requires a new kind of healthcare. One that is radical and empowering. That is why we created Enara Health.