The UK’s burden

Type II diabetes is fast becoming a pandemic in the western world, with around 366 million people contracting the disease. 3.4 million of these are in the UK and these number is set to increase to nearly 6 million by the year 2035. With the number of people affected rapidly rising you would think that this should be public health’s number one priority, but it seems that society is just accepting that we are moving in this direction. With people that are diagnosed , simply resigned and accepting it as part of their life journey. A familiar statement over heard in the pub is “I have to be careful with what I eat now because I have diabetes.” No one seems to be addressing the rumbling pandemic sufficiently. The secondary consequences of diabetes can be as serious as losing a limp or the loss of sight in one eye, or both! That’s the cost to the individual but the NHS is also feeling the cost of this burden, which currently stands at £25,000 per minute.

The bodies burden

Diabetes is a condition where cells become unable to up take glucose (blood sugar) from the blood. Cells are the building blocks of the body, kind of like bricks to a house. In a healthy human a hormone called insulin is used by the cells to allow glucose in. Insulin is kind of like a key that opens a door in the cells to allow glucose inside. The problem with diabetic type II sufferers is either; a problem with your bodies ability to produce insulin or a problem with some of your cells reacting to insulin. Too much glucose in the blood can cause damage to the blood vessels and lead to the drastic conditions mentioned earlier.

The measure used for the diagnosis of diabetes is a person’s blood glucose levels, known as blood sugars. If this reaches a certain amount for a period of time, then that person is said to have the disease. If left untreated for a long period of time, then the problem known as insulin resistance can occur and the pancreas can stop producing insulin. However, a new study has shown that if caught at an early stage diabetes can be forced into remission.

The latest research

The Diabetes Remission Clinical Trial (DiRECT for short) took newly diagnosed diabetic patients and put them on a very low-calorie diet (800kcal per day in a liquid smoothie) to make them lose weight very quickly. The idea behind it is that obesity is one of the largest risk factors for people with type II diabetes so losing weight in the early stages can slow the progress or even reverse the disease. Before a patient becomes diabetic, they are in the pre-diabetes stages of the disease, often referred to as ‘borderline diabetes’. Meaning that their fasting blood glucose or their blood glucose levels after eating are higher than normal blood glucose levels. If untreated they are likely to develop the full disease. However, if the patient makes some lifestyle changes including losing some weight at either this stage or at the very early stages, then the disease can go into remission. During the study some of the participants almost half (45.6 per cent) of those who took part in the programme were in remission after a year. using the liquid low-calorie diet. The study found there was a close link between Type 2 diabetes remission and total weight loss. 86 per cent of people who lost more than 15kg on the programme were in remission after a year, as were 57 per cent of people who lost 10–15kg, and 34 per cent who lost 5–10kg. The 12-week course is followed up with a reintroduction phase of solid food and then a continuing weight management program to try and keep the weight off.

The implications of this study could be huge, both reducing the burden on the NHS and improving the quality of life for so many people. The NHS are currently spending £800 million a year on diabetic related drug treatment. The study has shown that by losing some weight at the early stages of diabetes the individual can regain control of their blood glucose levels without the need for drugs. For newly diagnosed sufferers, the thought of having to start popping pills everyday for the rest of their lives can be terrifying.

This method of reducing someone’s daily calories to 800kcal may seem a bit extreme but is not as extreme as the NHS’s other approach to make people lose weight very quickly – bariatric surgery. This is basically a form of internal replumbing, where the surgeon reduces the size of your stomach  which ensures you  eat far less and therefore lose weight. To offer this treatment is now relatively common practice for newly diagnosed diabetic patients who are very overweight. The problem is that with the exception of gastric banding, it is irreversible, so you need to maintain quite drastic changes to your diet for life even after you lose the weight, You are likely to need regular medication to ensure you have an adequate vitamin and mineral in your diet and  regular blood tests to monitor potential deficiencies. With the DiRECT method once you’re off the program and reintroduced solid foods you only have to keep the weight of through a positive change to your diet and physical activity.

We are off course talking about the extremes here. If you are newly diagnosed and feel that you are happy and confident that you can lose some weight without these treatments, then that would of course be the preferred action to take. By cutting out sugary, processed  fast foods, reducing alcohol and making some changes to become more active, some people can reverse diabetes. The recommendation is to try and lose 10-15% of your initial weight within 6 months. Some people will be able to do this without any help, some will require the support of a Registered Dietitian or Nutritionist and some will need the more extreme methods, but the point is that diabetes can be put into remission by diet at the early stages.

Remission??

But what does remission actually mean? It’s when blood glucose (or blood sugar) levels are in a normal range again. This doesn’t mean diabetes has gone for good. It’s still really important for people in remission to get regular healthcare checks, so any complications can be monitored and any signs of Type 2 diabetes coming back can be caught early.

The BeGoodToYourGut approach

Sian dietitian on The BeGoodToYourGut team will help you lose weight safely and sensibly if you have been diagnosed with pre-diabetes using a low calorie (800kcalorie) diet 2 days a week. She will provide you with dedicated meal plans and recipes to help you undertake this over a 6 – 8 week period and will also help you plan your portion sizes and menus for the other days of the week on a higher calorie intake, We recommend a supportive app to help you monitor your dietary intake and physical activity on a daily basis to ensure you keep to your agreed targets and address how to achieve an increase in physical activity in an enjoyable and consistent way.

This blog was written by a student dietitian Frankie Ebdon and edited by Sian Shepherd (Specialist Gastroenterology Dietitian) and Dr Andrew Millar (Consultant Gastroenterologist).