Type 2 diabetes: Can it really be reversed?

The continuing rise in obesity is linked to the rise of Type 2 diabetes. Whilst not every case is caused by being overweight, if you’re carrying some extra weight, losing weight is the single biggest thing you can do to reduce your risk of diabetes. Many cases could be delayed or even prevented if the underlying causes were addressed in good time.  

If you have already been diagnosed with Type 2 diabetes, it’s important to talk to your GP or healthcare professional for advice. You may need medication or specialist dietary advice. The NHS also offer courses to help you manage your diabetes.  

Pre–diabetes is defined as having higher than normal blood sugar levels, but not high enough to be diagnosed with Type 2 diabetes. However, it’s a sign the disease may develop in due course. Diabetes UK recommends that everyone over the age of 40 gets a free NHS health check to check for signs they may develop the condition and discuss prevention.  

If lifestyle factors are contributing towards your likelihood of developing Type 2 diabetes, then this is the time to make important changes to improve your health and wellbeing. It can be overwhelming to think about. Overhauling a way of living that has become the norm is no easy task, but it doesn’t have to be difficult.  

Small changes add up and can really make a difference, and not just in terms of the onset of diabetes, either. Losing weight and being more active brings a wealth of benefits including better heart health, lower blood pressure, stronger bones and joints, and better mental health.  

With the help of science journalist and former medic Dr Michael Mosley, we’ve rounded up our top tips for helping to prevent Type 2 diabetes.  

Maintaining a healthy body weight helps protect against the onset of Type 2 diabetes. If you’ve been told you’re at risk, act now to prevent it taking hold.  

When we lose weight, the visible results are a great motivator, whether that’s photos, body measurements or looser clothing, but there’s a lot happening internally as well.  

Losing fat from our bodies causes blood sugar levels to come down. Speaking to Exceptional, Mosley explained that the liver and pancreas – organs that are key in controlling glucose levels – benefit from our dieting efforts. “With Type 2 diabetes it’s increasingly clear that in the majority of cases it’s caused by a build-up of too much fat in your liver and your pancreas,” he said.  

“Professor Roy Taylor at Newcastle University has demonstrated that the build-up of fat clogs up those organs and stops them working properly, leading to Type 2 diabetes.” 

Mosley first met Taylor in 2014, after he had successfully put his own Type 2 diabetes into remission by losing 10kg (1 stone 8 lbs).  

“I went to see him because I wanted to know why (it had reversed). And he said in order to reverse Type 2 diabetes you just need to lose about 1 g (0.04oz) of fat from your pancreas, but to do that you’re going to need to lose about 10% of your body weight.” 

Weight loss, dieting, mindful eating – whatever you want to call it, there are a million different ways to drop fat, and no one-size-fits-all approach. It is always important to talk to a healthcare professional before embarking on any kind of weight loss programme.  

There is mounting evidence that a rapid weight loss programme can be beneficial for halting prediabetes or putting Type 2 diabetes into remission. 

Obesity is medically defined as having a body mass index (BMI) of over 30 for most people and over 27.5 for those with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean heritage. A BMI of 40 or above is classified as severely obese.  

If you have Type 2 diabetes or are bordering on it, losing just 5% of your body weight can have a real effect on your health. If you’re obese, you have a higher chance of putting your diabetes into remission if you lose 15kg (2 stone 5lbs) quickly and safely.  

Mosley is the creator of The Fast 800 diet, a rapid weight loss approach using the Mediterranean diet, eating foods rich in protein and healthy fats such as fish, olive oil, nuts, vegetables and wholegrains.  

It involves eating around 8-900 calories (kcal) a day, for up to 12 weeks. Whilst this is undoubtedly restrictive and takes real commitment, the benefits, such as being able to stop diabetes medication, are potentially life changing. A similar level of calories is also used by the NHS for its low-calorie diet and by Diabetes UK in trials.  

Mosley recommends talking to your doctor first and looking online for more information.  

“The evidence is very clear that rapid weight loss is effective (for Type 2 diabetes). A lot of doctors are really well-informed about it, so if you have Type 2 diabetes it is worth talking to them. Essentially the sooner you can get on with it the better. If you have pre–diabetes that’s a particularly good time to act, before it goes on to develop.” 

“The NHS is now rolling out a programme called the NHS Low-calorie diet and that may be available in your area. They published results from a trial showing almost half of the participants managed to put their diabetes into remission.”  

Rapid weight loss can be beneficial for Type 2 diabetes, but it’s important to adopt healthy eating habits that are sustainable long-term. Some approaches (such as the NHS option) use meal replacement shakes before gradually reintroducing food. Mosley’s Fast 800 uses food with the option of shakes throughout, and he stresses that learning to cook healthy, nutritious meals is what’s needed to build a habit that lasts.  

“One thing I would say, is if you learn how to cook and prepare these sorts of meals while you’re on 8-900 kcal, it translates over. When you stop the rapid weight loss phase, you already have those skills. The danger otherwise is you just go back to your old habits.” 

Rapid weight loss may not be an option for you. As Mosley stresses: “With diabetes, people can be vulnerable (medically). So, it’s ok if you’re on metformin, for example, but not if you’re on insulin. You need to do it carefully.” 

If it’s not for you, it’s still possible to lose weight with a slower, more steady approach.  

It seems wrong to call this a diet, since it’s more a way of eating that can easily be adopted for life. But if your current way of eating involves lots of fast food, or processed, sugary snacks, the Mediterranean diet could bring about weight loss and its added benefits.  

Mediterranean diets are associated with lower blood pressure and cholesterol levels and better blood glucose. It is mainly plant-based, focusing on lots of green vegetables, adding in wholegrains, pulses, nuts and seeds. Protein is also important, and white meat, fish and eggs all contribute to this. There is very little red meat, processed foods or alcohol, though wine is allowed in moderation.  

If aiming to lose weight by this method initially (either through rapid weight loss or a slower more sustained approach), Mosley suggests a low carb approach might help.  

“A low-carb approach can be beneficial initially. I don’t think it’s necessarily useful long-term, but one of the advantages going lower carb in the beginning is it lowers your blood sugar levels pretty fast, and it supresses a hunger hormone called ghrelin, so you stop feeling hungry. It doesn’t work for everyone, but a low-ish carb approach has quite a lot of evidence that it can be helpful for Type 2 diabetes.”  

An important factor in creating sustainable habits is ease. If a diet requires multiple calculations, is expensive or time-consuming, you’re less likely to stick to it, but it’s easy to create meals from the wide variety of foods included in the diet. 

“It’s terrific for anxiety, depression, heart disease, you name it. It’s regularly voted as the healthiest way of eating on the planet. It’s sustainable too, easy to make meals, and super tasty.  

“It’s also not costly. People assume diets are expensive, but the Mediterranean diet doesn’t have to be. My wife (GP Dr Clare Bailey) makes recipes that are affordable. You can use frozen food, canned food. Things like lentils and legumes are really cheap. You just have to know how to prepare them, and a lot of people have forgotten that.” 

Another possible approach you might like to try is intermittent fasting. This is broadly split into two different ways of eating.  

“There’s intermittent fasting where you restrict your calories for, say, five days and then relax them for two, and then there’s time-restricted eating, where you try and restrict the hours within which you eat,” Mosley says.  

When it comes to weight loss, it’s all about what works for you. If you find restricting your calories seven days a week is too much, try relaxing it a little.  

“If you’re eating say 800 to 1,000 calories a day, after a time it’s going to mess with your social life. So, you can slow it down. Maybe do it just during the week, then at the weekend you’re more generous with your calories. Or maybe you do four days low– calorie, or even three.” 

Time-restricted eating is a complimentary approach that can benefit gut health by giving your body a rest from having to digest food.  

“You try and restrict the hours within which you eat,” Mosley says. “For example, 16:8 (8 hours eating, 16 hours fasting) or 14:10. I think 14:10 is a more sustainable approach. So, you finish eating at 8pm, and you don’t eat again until 10am. 

“Weight loss might be a by-product as you reduce the eating window, but it can also help with many other things such as better sleep, lower blood pressure, better insulin levels.” 

Eating better makes us feel better, and in turn that makes us inclined to be more active. Being more active then inspires us to want to eat better – the two go hand in hand.  

The NHS offers a nine–month programme to help those at risk of developing Type 2 diabetes. This can take the form of group sessions (if available in your area) or remote sessions. As well as advice about nutrition, the course covers physical activity and the many forms it can take.  

Walking is an amazing way to boost health. It’s also free and has the added benefit of being an outdoor activity – something that’s proven to help mental health. Walking with a friend (four-legged or otherwise) is a great social activity and there are plenty of walking groups out there to join.   

You can even step it up a gear and get into running – the couch to 5K programme is a great place to start  

Alternatively, you might like to join a gym to try a range of activities such as swimming, indoor cycling, group fitness classes or more. If you do, make sure to disclose any health issues, so you can receive the correct exercise advice.  

Whatever you try, think of exercise as a complement to better nutrition. Doing a workout isn’t a licence to eat whatever you want, and neither is it a punishment for what you ate. It’s merely an activity you enjoy, and a great way of improving overall health.