Why don’t I like the phrase “reversing diabetes”
Why don’t I like the phrase “reversing diabetes”
The phrase “reversing diabetes” is an increasingly common one, and a regular source of concern and occasional irritation to me. When I write about diabetes, and particularly my experience living with Type 2 Diabetes (T2D), I generally write about the benefits of exercise and diet, so why a more negative blog? Well,there are a number of things, starting with not specifying the type of diabetes being discussed.
Type, type, type
Diabetes is a complex and serious health condition that occurs when the amount of glucose (sugar) in the blood is too high. The reasons for this can vary dramatically, and are used to divide the condition into different types. Most commonly these are Type 1 and Type 2, and you can find more detail about the differences between these here.
There are other less commonly occurring types of diabetes, including Gestational diabetes, MODY, Neonatal diabetes, Wolfram Syndrome and Alström Syndrome and you can read more about them here.
What is common to all types of diabetes is that prolonged high blood glucose levels can cause serious complications. What is NOT common to all types is the treatment; this varies from simple lifestyle changes through a wide range of oral and injectable medications including insulin. It is extremely important that anyone writing about diabetes or proffering a public opinion understands that these differences exist, and and is specific about they type of diabetes they are talking about. Unfortunately many do not, or choose widely generalise without thought for the consequences or the feelings those living with the condition. To be clear, at present there is no cure for Type 1 diabetes or many of the other types, and what most commentators are talking about when they reference “reversing diabetes” is T2D.
Whilst not exclusively the case, the reason for this lack of specificity is often quackery, the second reason I am writing this blog.
Public awareness of diabetes has grown in parallel to the increase in numbers of people diagnosed with all types of diabetes. This has driven a thirst for knowledge in those newly diagnosed as well as their friends and families. Unfortunately, the number of people and companies seeking easy financial gain from the misfortune of those living with diabetes has grown in lock-step with this thirst for knowledge.
The collage of shame here show a few example of the many things that fall directly into the quackery category. These “cures” and treatments that claim to “reverse diabetes” include okra water, cinnamon, Indian gooseberries, turmeric, chocolate, coffee, coconut water, yoghurt, basil and several variations of the scam that is homoeopathy (it’s just water, get over it). A number of these come with a strong side-order of conspiracy theory, usually along the lines of “They don’t want you to know this”, where “they” are big-phama, your doctor, and/or the NHS. I thought I had come across all possible variations of quackery in the last few years but whilst assembling this collage I discovered a new one; a the simple leg exercise that, repeated 3 times a day, can reverse your diabetes. I may be doing them a bit of a disservice as clicking on the link shows that you also need to part with your credit card details, home address mother's maiden name and a substantial amount of money to be a beneficiary of this knowledge; perhaps handing over a lot of money is part of the cure....
The spectrum of these examples run from outright fraud, through journalism that deliberately misrepresents science for sensationalist benefit to well intentioned but incorrect advice. Most significantly they are all similar in that none of them cure or reverse diabetes.
In addition to the ethical problems of promising benefits that can not reasonably be expected to occur, this nonsense also brings the risk that a person with diabetes may choose to forego lifestyle changes and treatments that could help them in favour of ineffective and fictional benefits being promoted. There is further damage done by these rackets is in the propagation of the stereotypes that already surround diabetes. Many People Living with Diabetes (PWD), especially those diagnosed with T2D later in life and without a medical emergency, do not fully appreciate and are not educated to understand the serious of the condition if left untreated. The quackery also exaggerates the stigma surrounding diabetes, already a considerable source of distress to those living with the condition, and a further reason that some PWD do not seek out the treatment they need.
So, throwing out those who don’t specify the type of diabetes in their claims, and putting aside the abundant quackery, what is left? By and large a lot of generalisation.
The reasons for T2D are ultimately likely to prove very complex as complex early results from the ANDIS project (All New Diabetics in Scania) http://andis.ludc.med.lu.se are showing. Commentators on this emerging data contend that the current diagnosis and classification of diabetes are inaccurate and are not useful in predicting disease outcome or guiding therapy, something that is already well-understood by those living with the condition and many who treat them; our individual experience of living with T2D varies enormously.
If one PWD has genuinely “reversed” their T2D, what possible evidence is that this would hold true for others? Most claims being made are related to diet, and taking into account cultural, religious and personal preferences (yes, just like everyone else, PWD have strong preferences about what they eat!) no one diet is going to be something that everyone is prepared to accept, or be able to make a long-term part part their lives.
I have a personal example of this; many PWD have made great improvements in their health by following the plans set out in “Dr. Bernstein’s Diabetes Solution”. It is an excellently book from a very inspirational doctor, and well worth a read (not a quick read mind you, my copy runs to over 500 pages and weighs nearly a kilogram). Unfortunately the extremely low carbohydrate diet he recommends is one I can’t live with in the medium or long-term; I have tried on a number of occasions, and this uncompromising diet isn’t something I have the strength of mind to follow every day. I have every respect for those to do manage to adopt this approach to eating, but it’s not for me.
Interestingly, Dr. Bernstein is very cautions when asked in this interview about whether you can reverse diabetes, stressing that if it is possible, it would only be the case if caught at a very early stage and treated intensively.
Being a bit more DIRECT
One approach that is worth mentioning at this point is the DIRECT (DIabetes REmission Clinical Trial), currently being undertaken at the University of Glasgow and Newcastle University. This very exciting work, funded by Diabetes UK has been showing great success in using very low calorie diets to bring about and maintain remission in those people with T2D. The initial 2011 trial showed that this had promise. A follow up trial in 2016 validated this approach and looked at a longer time horizon of six months. This is exciting work which has the potential to transform both the way T2D is treated, but also viewed by the general public. However, the work to date has been based on very small numbers of patients, all of them extremely obese and all of whom are treated at an early stage in their journey with the condition.
However compelling these results, and noting that not all patients were successfully treated, this is by no means universal. Professor Taylor's Personal Fat Threshold theory about this (which I will discuss in more detail at another time), is explained by him in a lecture shown here.
This involves a very low-calorie (e.g. below 800 Kcal per day) diet for up to 20 weeks, followed by a gradual re-introduction to normal (but healthy) food over a period of two to eight weeks with expert support.
So whilst there are some interesting approaches to successful management of diabetes, It should be abundantly clear that there isn’t a silver bullet approach to “reversing” diabetes. Promoting a universal solution to the problem is a slap in the face to all who struggle with their diabetes, and does nothing other than promote stereotypes and perpetuate myths.
What has gone before
All of the approaches discussed, from outright quackery to some of the solutions that may ultimately provide remission for some PWD, deal with reducing future blood glucose levels and reducing or ameliorating the risk of complications that this brings.
None of them address the damage done to the body from high blood glucose levels in the past. Many people with T2D live with the condition for months or years before diagnosis and first treatment, and many are only diagnosed when the complications arising from their diabetes manifest. To say that someone's diabetes has been reversed implies that this damage is somehow rectified, and nothing is further from the truth. The implications of this is to undermine the
So what should we do?
My view, and it is a very personal one, is that we (the community of PWD, Healthcare Professionals and those involved in public health) should;
- Stamp down on quackery wherever it raises it’s head and call to account those who promote it
- Correct those, especially anyone in the media, who use the phrase “reverse diabetes”
- Always be clear that diabetes (of whatever type) is an extremely serious condition that must not be taken lightly
- Promote self management, a healthy diet and exercise for anyone with, or at risk of, diabetes
- Continue to invest in research about diabetes