How to Reverse Type 2 Diabetes

 

Diabetes reversal, not just treatment, should be a goal in the management of type 2 diabetes. Type 2 diabetes can be reversed not only with an extremely low calorie diet, but it can  also be reversed with an extremely healthy diet. Could it be because an extremely healthy diet is also low in calories? This is the topic of my video Diabetes Reversal: Is It the Calories or the Food 

Study subjects lost as much weight on a green, leafy vegetable-packed plant-based diet as those who were on a semi-starvation diet based on liquid meal replacements. So, does it matter what we’re eating as long as we’re eating few enough calories to lose 15 pounds a month?

Even if diabetes reversal is just about calorie restriction, instead of subsisting off largely sugar, powdered milk, corn syrup, and oil (common ingredients in some liquid diet drinks) on the plant-based diet at least one can real food—in fact, as many low-cal veggies as desired. So, even if it only works because it’s just another type of calorie-restricted diet, it’s certainly a healthier version. But, even participants in the study who did not lose weight—or even gained weight eating enormous quantities of whole healthy plant foods—appeared to improve their diabetes. Thus, the beneficial effects of this kind of diet appear to extend beyond weight loss.

The successful treatment of type 2 diabetes with a plant-based diet goes back to the 1930s, providing “incontestable evidence” that a diet centered around vegetables, fruits, grains, and beans was more effective in controlling diabetes than any other dietary treatment. In a randomized controlled trial, insulin needs were cut in half and a quarter of the subjects ended up off insulin altogether. But, again, this was a low-calorie diet. Walter Kempner at Duke University School of Medicine reported similar results 20 years later with his rice and fruit diet studies, showing for the first time documented reversal of diabetic retinopathy in a quarter of his patients, something never even thought possible. One patient, for example, was a 60-year-old diabetic woman already blind in one eye and who could only see contours of large objects with the other. Five years later, while on the diet, instead of her vision getting worse, it got better. She “could make out faces and read signs and large newspaper print,” and got off insulin, had normal blood sugars, and had a 100-point drop in her cholesterol. Another patient went from only being able to read big headlines to being able to read newsprint four months later. What was behind these remarkable reversals? Was it because the diet was extremely low-fat or because there was no animal protein or animal fat? Or, was it because the diet was so restrictive and monotonous that the patients lost weight and improved their diabetes that way?

To tease this out, we needed a study where researchers switched people to a healthy diet, but forced them to eat so much they didn’t lose any weight. Then, we could see if a plant-based diet has unique benefits independent of all the weight loss. For that, we had to wait another 20 years until a study in the 1970s. In it, diets were designed to be weight-maintaining. Participants were weighed every day, and, if they started losing weight, the researchers made them eat more food—in fact, so much food that some of the participants had trouble eating it all, but they eventually adapted. Thus, there were no significant alterations in body weight despite restrictions of meat, dairy, eggs and processed junk, and there were enough whole plant foods—whole grains, beans, vegetables, and fruit—to provide 65 grams of fiber a day, four times what the Standard American Diet provides.

The control diet they used was the conventional diabetic diet, which actually had nearly twice the fiber content of the Standard American Diet, so it was probably healthier than what they had been used to eating. So, how did the even healthier diet group do? With zero weight loss, did the dietary intervention still help? The study compared the number of units of insulin with which subjects had to inject themselves daily before and after going on the plant-based diet. Overall, despite no change in weight, insulin requirements were cut about 60 percent, and half of the diabetics  were able to get off insulin altogether. Was this after five years, or after seven months, as had been the case in the other studies discussed above? No.

It was after 16 days.

To be clear, we’re talking about diabetics who had had diabetes as long as 20 years, injecting 20 units of insulin a day, getting off insulin altogether in as few as 13 days, thanks to less than two weeks on a plant-based diet. Patient 15, for example, had injected 32 units of insulin while on the control diet, and then, 18 days later, none. Lower blood sugars on 32 units less insulin.

That’s the power of plants.

As a bonus, their cholesterol dropped like a rock to under 150 on average in 16 days, making them nearly heart attack proof as well. Just as “moderate changes in diet usually result in only modest reductions” in cholesterol, asking people with diabetes to make moderate changes often achieves equally moderate results, which is one possible reason why most end up on oral drugs, injections, or both. Everything in moderation may be a truer statement than people realize. Moderate changes in diet can leave one with moderate blindness, moderate kidney failure, moderate amputations. Moderation in all things is not necessarily a good thing.

The more we, as physicians, ask from our patients, the more we—and they—get. The old adage, “shoot for the moon,” seems to apply. It “may be more effective than limiting patients to small steps that may sound more manageable but are not sufficient to actually prevent disease progression.”


Although I have dozens of videos about diabetes, I think Diabetes Reversal: Is It the Calories or the Food may be the single most powerful one I‘ve made. Please share this life-changing, life-saving video with anyone you know who has type 2 diabetes or is at risk for the dreaded disease. As far as I’m concerned, it should be required viewing for every healthcare practitioner. I wish I had seen it when I was a medical student!

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This is the final installment of a three-part series. If you missed the first two, check out Reversing Diabetes with Surgery and Reversing Diabetes with Food.

For more on the remarkable work of Dr. Kempner, see:

For more related videos, give one of these a try!

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Why Drugs and Diet Can Sometimes Fail in Diabetes

“People with type 2 diabetes are at elevated risk for a number of serious health problems, including cardiovascular disease, premature death, blindness, kidney failure, amputations, fractures, frailty, depression, and cognitive decline.” In other words, the higher people’s chronic blood sugars are, the more heart attacks and strokes they have, the shorter their lifespans, and the higher their risk of complications such as blindness and kidney failure, which I discuss this in my video When Drugs and Diets Don’t Lower Diabetes Deaths.

A study was designed in which 10,000 diabetics were randomized into an intensive blood sugar-lowering intervention, where they put people on one, two, three, four, or five different classes of drugs, with or without insulin, to drive blood sugars into the normal range. Of course, this is not treating the underlying cause—that is, the actual disease—but by lowering one of the effects of the disease by any means necessary, these high blood sugars, the hope was to prevent some of the devastating complications. How did they do?

The intensive blood sugar lowering with drugs increased mortality. After reviewing mortality trends, they concluded that the harm associated with the increased risk of death outweighed any potential benefits, and they stopped the study prematurely for safety reasons. They were successful in bringing down people’s blood sugar, but in trying to push people’s hemoglobin A1c under six, they ended up pushing people six feet under. They speculated that this may have been due to the adverse effects of the very drugs used to treat the disease.

Even just injected insulin itself may promote cancer, obesity, and atherosclerosis, worsen diabetic eye disease, and accelerate aging. Insulin therapy may promote inflammation in the lining of our arteries, which may help explain the results of that drug trial and other trials like it that showed the same thing: no reduction in so-called “macrovascular” complications—heart attacks and strokes—with intensive blood sugar lowering. However, intensive therapy was associated with a 21 percent reduction in the development of microvascular complications like kidney dysfunction.

Any such benefits should be weighed against the increased risk of dying, increased weight gain, and increased risk of severe hypoglycemia in intensively treated patients. So, trying to normalize people’s blood sugar with medications alone may not be the best  idea. “It also should be noted that these trials relied virtually exclusively on [drugs] and did not include any serious effort at [diet and other] lifestyle change…”.

A study published in the New England Journal of Medicine found that an intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events such as heart attacks in overweight or obese adults with type 2 diabetes. It did not increase their risk of death, but it didn’t seem to decrease it either. In fact, the trial was stopped after about 10 years on the basis of futility—participants lost weight, but they weren’t dying any less. That’s what we see across the board with these types of lifestyle interventions. It’s good that the dietary intervention wasn’t killing anyone, but why wasn’t it actually helping people live longer?

Because they didn’t actually put them on a healthier diet.

They just put them on a smaller diet––a calorie-restricted diet––meaning essentially the same lousy diet, but just in smaller portions. If we eat less and exercise more, we can lose weight, get more physically fit, get slimmer, and have better blood sugar control, but if our diets continue to be so un-heart-healthy that our bad LDL cholesterol doesn’t improve, we’re not going to be unclogging our arteries. Whereas individuals following healthier diets may experience not only improved reductions in blood sugar and body weight, but cardiovascular risk as well. Yes, by eating a smaller quantity of food, without changing quality, we can lose weight, but the point of a lifestyle intervention is not to just fit people into skinnier caskets.


What kind of diet does help diabetics? See How Not to Die from Diabetes and Plant-Based Diets & Diabetes. You’ve probably heard that Diabetics Should Take Their Pulses. Why is that the case? See Why Is Meat a Risk Factor for Diabetes? and How May Plants Protect Against Diabetes?.

Healthier diets can even reverse some of the complications of diabetes once thought irreversible. See Can Diabetic Retinopathy Be Reversed? and the part of my annual review From Table to Able: Combating Disabling Diseases with Food that discusses the remarkable reversal of painful diabetic neuropathy.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How to Treat Dry Eye Disease Naturally with Diet

One of the most common eye disorders, dry eye disease, causes irritation or discomfort, and can decrease functional vision, sometimes causing a dramatic deterioration in the quality of life. About five million Americans over age 50 suffer from moderate-to-severe dry eyes, and tens of millions more have mild or episodic manifestations of the disease, at a cost of more than $50 billion.

In terms of treatment, there are several drops and drugs that can help. We spend hundreds of millions of dollars on things like artificial tears, but currently there is no therapy available to actually fix the problem. If drugs don’t work, doctors can try plugging up the outflow tear ducts, but that can cause complications, such as plugs migrating and eroding into the face, requiring surgical removal. Alternatively, surgeons can just cauterize or stitch up the ducts in the first place.

There has to be a better way.

What about prevention? Dry eyes can be caused by LASIK surgery, affecting about 20-40% of patients six months after the operation. With a million LASIK procedures performed annually, that’s a lot of people, and sometimes the long-term symptoms can be severe and disabling.

There’s a long list of drugs that can cause it, including antihistamines, decongestants, nearly all the antidepressants, anticonvulsants, antipsychotics, anti-Parkinson’s drugs, beta-blockers, and hormone replacement therapy, as well as a few herbal preparations.

In the developing world, vitamin A deficiency can start out as dry eyes and then progress to becoming the leading cause of preventable childhood blindness. Vitamin A deficiency is almost never seen in the developed world, unless you do it intentionally. There was a report in the 1960s of a guy who deliberately ate a vitamin A-deficient diet, living off of bread and lime juice for five years, and his eyes developed vascularization and ulceration of the cornea, which you can see (if you dare) in my Treating Dry Eye Disease with Diet: Just Add Water? video. That was better than what happened to an unfortunate woman who was the member of a cult and tried to live off of brown rice and herbal tea: Her eyes literally melted and collapsed.

There are also a couple case reports of autistic children who refused to eat anything but French fries or menus exclusively comprised of bacon, blueberry muffins, and Kool-Aid, and became vitamin A deficient. A case in the Bronx was written up as vegan diet and vitamin A deficiency, but it had nothing to do with his vegan diet—the kid refused to eat vegetables, consuming only potato chips, puffed rice cereal with non-fortified soymilk, and juice drinks. “His parents lacked particular skill in overcoming the child’s tendency to avoid fruits and vegetables.”

A plant-based diet may actually be the best thing for patients with dry eye disease, those who wear contact lenses, and those who wish to maximize their tear secretions. People with dry eyes should be advised to lower protein, total fat, and cholesterol intake, and do the following:

  • increase complex carbohydrates;
  • increase vitamin A content (by eating red, orange, yellow, and dark green leafy vegetables);
  • increase zinc and folate intake (by eating whole grains, beans, and raw vegetables, especially spinach);
  • ensure sufficient vitamin B6 and potassium intake (by eating nuts, bananas, and beans);
  • ensure sufficient vitamin C intake (by eating citrus);
  • eliminate alcohol and caffeine;
  • reduce sugar and salt intake; and
  • consume six to eight glasses of water per day.

We know dehydration can cause a dry mouth, but could dehydration cause dry eyes? It may seem kind of obvious, but evidently it was never studied until recently. Is the answer to just drink more water? We know that those suffering from dry eye are comparatively dehydrated, so researchers figured that tear secretion decreases with progressive dehydration just like saliva secretion decreases and gives us a dry mouth. And indeed, as one gets more and more dehydrated, their urine concentrates and so does the tear fluid. But one can reverse that with rehydration, raising the exciting prospect that improving whole-body hydration by getting people to drink more water might bring relief for those with dry eyes. The researchers recommend eight cups of water a day for women and ten cups a day for men.


Find more on the importance of proper hydration in my How Many Glasses of Water Should We Drink a Day?, Does a Drink Of Water Make Children Smarter?, and Can Dehydration Affect Our Mood? videos.

To learn more on other topics related to eye health, check out:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: