Once a diabetic, always a diabetic—this has been the presumption of most patients and even the common man. One of the main reasons for this is because not more than 2% of those with type 2 diabetes (T2D) enter spontaneous remission. When the numbers are not so encouraging, the clinical paradigm still remains that T2D is non-reversible. Maintaining a standardized blood glucose level and adhering strictly to sugar-free and starch-free diets is the current recommendation. Such practices are helpful in maintaining normal glycemic levels but don’t aid in curbing T2D advancement nor promote its remission.
There have been a couple of long-term studies and researches that have focused primarily on diet management and lifestyle changes to put diabetes into remission. One of those prominent studies is the DiRECT study (Diabetes Remission Clinical Trial) which clearly shows that weight loss is a very effective way to halt diabetes progression and stalk its effects. The study also showed that following a low-calorie or a very-low calorie diet (LCD or VLCD) is a sure shot way to lose weight efficiently and also sustain the lost weight in the long run by following certain eating habits and dietary interventions. LCD Interventions Offer Beneficial Diabetes Remission Effects Before going into any of the details, let’s start by understanding what is meant by a low calorie diet. An LCD is nothing but consuming between 800 and 1200 calories per day. It is a short-term approach to weight management which should not be followed as a lifestyle change forever. During this tenure, the individual following the LCD is given meal replacements such as shakes and soups, or very small portions of the normal foods that we eat everyday. The diet is usually followed for around 12 weeks after which normal food is reintroduced slowly in small proportions until the normal routine is reached. Such a plan seems easy and doable but practically, following it diligently needs much will power and not all individuals can pursue one. It is always better to consult your doctor and get a green signal for the LCD before venturing into one. If approved, once again it is smart to get the advice of a dietitian/nutritionist to plan the LCD according to your body type, requirements, and health conditions. Recommendations by ADA and EASD for LCD The DiRECT study result showed that almost 50% participants entered diabetes remission and almost a third of them maintained the remission state after 24 months. The effect of remission was directly proportional to their ability to sustain weight loss. Impressed with such results, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have suggested the use of low-calorie diets for patients suffering from type 2 diabetes for achieving remission and diabetes control. Not all individuals can enter diabetes remission and there are a couple of factors that must be fulfilled for being eligible for it. For instance, the individual should maintain HbA1c levels below 6.5 for at least six months continuously and should not be using medications to control diabetes. Until now, the standard care of treatment has not focused mainly on reversal which makes us wonder whether this type of treatment is the best one. But of late, we have a number of studies repetitively emphasizing on the success of LCDs, VLCDs, and carbohydrate restriction (LC). But, most of these have shown that remission is possible for short-term (for 2-5 years) beyond which we do not have clear results on sustaining the remission successfully. The DiRECT study is still in process to understand whether or not long-term remission could be successful and we hope that the picture becomes clearer after this. Still, presently our hope is that LCDs and VLCDs do offer a remedy for diabetes and with sustained weight management efforts and we can keep diabetes under remission—there have been individuals who have maintained the remission for more than 10-15 years. Knowing More about LCDs When we have been eating a specific number of calories until now, suddenly reducing the intake by more than 50% or more has a greater impact on the body. For instance, there are a couple of side effects due to a low-calorie diet including headache, constipation, and dizziness. Continuing an LCD might sometimes lead some people into hypos and hence, keeping tab on blood glucose levels regularly and changing medications might become necessary. Before starting to follow any diet plan, it is better to speak to your doctor and understand whether or not the diet plan satisfies all the nutrient requirements, take glucose tests often, and get in touch with a dietitian to get a custom-made diet plan. Such a plan not only helps people lose weight, which in turn helps manage diabetes, but also assists in maintaining normalized HbA1c levels and blood glucose levels. Conclusion Until now, individuals involved in the DiRECT study and those administered with LCD by ADA and EASD do think that the LCD meal plan is really hard to follow and keep up with, needs ample motivation, and the meal replacements might be quite expensive to many. A total-diet replacement offers better results for T2D remission for a couple of years. We are at a threshold where diabetes could become the greatest health threat if we don’t exert much effort to curb its rise. Given a choice, many individuals would surely opt for reversal and hence, educating people about the availability of diabetes remission is necessary. When reputed organizations such as the ADA and the EASD advise individuals to follow an LCD for diabetes remission and control, what’s the use of CGM, accu-chek, precision nutrition, and other stuff that complicate things without providing the necessary solution? Let’s stick to the basics—a well-balanced diet plan, lifestyle modifications, good sleep, reduced stress, and a daily dose of meditation/yoga to keep diabetes under control.
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