Intermittent fasting may help bring diabetes into remission

In 1980, 4.7% of the global population suffered from type 2 diabetes, a condition associated with obesity and aging. The figure reached 8.5% in 2014 and 9.3% by 2019. In mostly low and middle-income countries, the prevalence of the disease continues to grow.

Until very recently, it was thought that type 2 diabetes – which increases the risk of cardiovascular disease and cancer – initiated a degenerative process that always got worse and ended up requiring insulin and other drugs to manage it.

In 2017, The Lancet medical journal published the DiRECT study. Researchers noted that, if significant weight loss could be achieved, it was possible to put the disease in remission and end dependency on pharmaceutical drugs. The study had included not only the participants living with diabetes, but also the nutritionists and personal trainers who helped them – sources who are not often consulted by public health policymakers. Since the publication of that study, different techniques have been tested to assist individuals lose weight.

The Journal of Clinical Endocrinology & Metabolism recently published a paper showing how intermittent fasting can improve the health status of people who suffer from the disease, reduce their need for medication, and even eliminate type 2 diabetes entirely. The authors – researchers from Hunan Agricultural University – also applied a special diet to participants, dubbed “Chinese medical nutrition therapy.” This combined five days of fasting – in which only 840 calories were consumed daily at controlled times – followed by 10 days in which subjects ate their regular diet at usual times.

Of the 36 volunteers with type 2 diabetes, around 90% of them – including those taking drugs to lower blood sugar levels – were able to reduce their medication consumption. About 55% saw the disease subside and were able to stop taking drugs entirely,

Among the trial participants, the average weight loss was nearly 12 pounds, compared with a 200-gram drop in the control group that followed a normal diet. Dr. Dongbo Liu – one of the study’s authors – affirms that “diabetes is not necessarily a lifelong disease… it can go into remission if patients lose weight by changing their diet and exercise habits.”

But Dr. Cristobal Morales – an endocrinologist with the Vithas Hospital at Spain’s University of Seville – warns that the study “used very few volunteers.” He also explains that the diabetes patients among the Chinese population are very different from diabetes patients in Western Europe, due to their lower body mass index (BMI). Yet, he concedes that intermittent fasting can be one more tool to lose excess weight: “There are studies that show a great metabolic benefit to losing between 5 and 10% of body weight. Intermittent fasting can be attractive to a lot of people… the important thing is to lose weight and keep it off. It doesn’t seem to matter how you do it.”

According to Morales, making diabetes go into remission is a recent idea, but now there is hope to achieve it via different weight-loss methods. A guideline recently published by Diabetes Canada states that “sustained weight loss of about [30 pounds] is associated with the highest probability of remission of type 2 diabetes.” That goal would be feasible for patients, so long as they are not suffering from mental illness, severe eating disorders, cardiovascular disease, or chronic kidney disease.

As with many other ailments, even if you know what to do to treat it, carrying out the solution isn’t always easy. Dr. Andrea Azcárate – head of Endocrinology at the Sanitas La Moraleja University Hospital in Madrid – points out that, after losing weight, “the most difficult and necessary thing is to maintain that weight loss for a long time.”

“It’s key to offer personalized treatment that can be more useful to each patient. Fasting has been done for many years, although it has suddenly become fashionable. It can help patients avoid snacking, to rest [the digestive system] and improve insulin sensitivity. But not all diabetic patients are the same,” she adds. “Some are heavily medicated and the medication must be adjusted constantly. The trend towards dehydration [as a result of the meds] must be monitored, as it can cause kidney problems.”

Various forms of weight-loss surgeries can also help patients reduce body mass. But these are riskier and, according to Dr. Azcárate, to meet the criteria for such a surgery, a patient needs to have a BMI of more than 35. As an example, a man measuring 5ft7 would need to weigh at least 230 pounds to qualify for such a procedure. Only in very severe cases is this usually considered to be a viable option.

The method proven in the DiRECT study – which includes diet, exercise and very close follow-up by professionals – achieved a diabetes remission rate of almost 50% among the participants. However, such a program requires a lot of time and monetary resources. Therefore, experts and patients of more modest means are hopeful that recently-approved drugs that treat obesity – such as semaglutide or tirzepatide – can help. These drugs mimic incretins – hormones our bodies produce when we eat – which can reduce appetite and increase resting energy expenditure. Test studies of the aforementioned drugs show that those who take them can lose between 15 and 22.5% of their total body weight.

Sign up for our weekly newsletter to get more English-language news coverage from EL PAÍS USA Edition