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).

You Can Get Your Hemoglobin A1c to Normal Range Without Medications on a VLCD

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?


The Amount of Total Weight Loss Did Not Predict Diabetes Reversal

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….

Fat-Loss not Weight-Loss

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)#

You Have 4-5 Years to Reverse your Diabetes Before it Changes Your Body.

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.


We Need A New Approach to Type II Diabetes.

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.



This article is part of our clinical studies series. Once a week Enara Health takes a deeper look at a clinical study or article. 





Posted by:Dr. Rami Bailony

Dr. Bailony completed his medical school and internal medicine training from UCSF. Thereafter, he went on to complete a fellowship in Healthcare Innovation with Medicine X at Stanford University where he focused on behavioral change, obesity and diabetes management. From there he went on to co-found Enara Health and Enara Health Group which uses online and mobile platforms to provide clinical programs for obesity and type II diabetes.

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