More than 25 years ago Dr. Roy Taylor began working to better understand the physiology behind type 2 diabetes. It became clear to him that the real genesis of the problem began with the amount of fat in the liver because if you reduced the amount of liver fat you reduced the amount of insulin resistance, and that was what was causing the high blood sugar.
You see, it is not obesity that causes type 2 diabetes, since about 16% of type 2 diabetics are normal weight. It is where your particular body stores fat that is critically important.
Fat basics 101
The body has three main areas for fat storage:
— Subcutaneous fat, which is fat storage under the skin. In some areas, like the hips or buttocks, it can dimple and is called cellulite but it is generally metabolically safe and not a problem for health, though many of us want to get rid of it.
— Visceral fat, which lies deep in the abdomen and between organs.
— Ectopic fat, which is fat stored within organs like the liver and pancreas.
Fat stored in and around the organs is considered the most dangerous and contributes to what is called an “apple” shape of fat distribution (as opposed to a “pear” shape around the hips and thighs). The problem, as Taylor recognized, is that fat stored in this area contributes to insulin resistance which is the precursor to almost all metabolic disease.
The personal fat threshold
What is interesting is that different people can have vastly different storage patterns for fat, with some people able to store extra calories eaten in subcutaneous fat very well and others having a much smaller threshold for storing fat under the skin before they start depositing it in and around the organs.
That’s why for a minority of type 2 diabetics, though they have a normal bodyweight they nevertheless have stored extra fat in their liver, creating insulin resistance there and then getting a “spillover effect” that also affects the pancreas. The effect of this fat storage pattern on the liver and pancreas was originally called the “twin-cycle hypothesis” and like all good hypotheses in science can be tested…
The twin-cycle hypothesis
To test the twin-cycle hypothesis, Taylor and colleagues launched an eight-week study known as Counterpoint that put 11 diabetics on a very low–calorie diet (about 700 calories). After just one week of such a restricted energy intake, the fasting blood sugar level normalized from about 166 mg/dl (milligrams per deciliter) down to 106 mg/dl, while the fat content in the pancreas fell from 8% to 1.1%, and the liver fat level fell from 12.8% to 2.9%. Within just seven days insulin resistance in the liver disappeared and insulin responses during the eight-week period became similar to the normal control group.
Taylor created a website devoted to providing information for clinicians and patients about the low-calorie diet and other tips on how to reverse type 2 diabetes: www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation. Soon afterward, he started to receive emails from people telling him about their experiences with the diet.
“In the comfort of their own kitchens these people had lost the same amount of weight as in our trial subjects — about 33 pounds,” Taylor said. “Most of them had gotten rid of their type 2 diabetes … This was something that real people would do if the motivation was strong enough.”
The DiRECT Trial
Then, to investigate if a very low–calorie diet could be used as a routine treatment for type 2 diabetes Taylor collaborated with his colleague, Dr. Mike Lean, to launch the randomized, controlled Diabetes Remission Clinical Trial (DiRECT) at 49 primary care practices in the United Kingdom. In all, 298 patients diagnosed with type 2 diabetes within the past six years were randomized to a very low-calorie diet or control group. The intervention group used mostly low-calorie meal replacement shakes and a meal of mostly vegetables or soup each day to reach 825-850 calories a day for three to five months, followed by a food reintroduction and weight loss maintenance phase.
Remission varied with weight loss in the whole study population, with zero achieving any results who gained weight, but 7% were normalized who maintained weight losses of up to only 11 pounds. Some 34% of the participants who lost between 11 and 22 pounds went into remission, 57% of the participants had 22-33 pound weight losses and 86% of those who achieved weight losses of 33 pounds or more were now free of diabetes.
The bottom line
In general, it is now understood from the research that type 2 diabetes is caused by a small amount of excess fat inside the liver and then inside the pancreas. And this is a potentially reversible condition if you drop the fat out of those regions.
If a person has type 2 diabetes they have become too heavy for their body (exceeding their personal fat threshold). Some people can handle much more excess weight without problems than others.
A “normal” weight person sensitive to small increases in fat and who genetically stores that fat in the liver and pancreas can get blood sugar problems and very likely elevated blood fats or triglycerides as well. Weight loss of around 15% of starting bodyweight (or 33-plus pounds) is necessary for most people to reverse the condition, but if you have diabetes at normal weight it may only need to be a 6-7% weight loss. For more information I strongly recommend checking out Taylor’s book “Life Without Diabetes.”
Thomas Morrison is a fitness coordinator at the Bradley Wellness Center.