Type 2 diabetes in newly diagnosed 'can be reversed'
An extreme eight-week diet of 600 calories a day can reverse Type 2 diabetes in people newly diagnosed with the disease, says a Diabetologia study.
Newcastle University researchers found the low-calorie diet reduced fat levels in the pancreas and liver, which helped insulin production return to normal.
Seven out of 11 people studied were free of diabetes three months later, say findings published in the journal.
More research is needed to see whether the reversal is permanent, say experts.
Type 2 diabetes affects 2.5m people in the UK. It develops when not enough insulin is produced in the body or the insulin that is made by the body doesn't work properly.
When this happens, glucose - a type of sugar - builds up in the blood instead of being broken down into energy or fuel which the body needs.
The 11 participants in the study were all diagnosed with Type 2 diabetes within the previous four years.
They cut their food intake drastically for two months, eating only liquid diet drinks and non-starchy vegetables.
Fat loss
After one week of the diet, researchers found that the pre-breakfast blood sugar levels of all participants had returned to normal.
MRI scans of their pancreases also revealed that the fat levels in the organ had decreased from around 8% - an elevated level - to a more normal 6%.
Three months after the end of the diet, when participants had returned to eating normally and received advice on healthy eating and portion size, most no longer suffered from the condition.
Professor Roy Taylor, director of Newcastle Magnetic Resonance Centre at Newcastle University and lead study author, said he was not suggesting that people should follow the diet.
"This diet was only used to test the hypothesis that if people lose substantial weight they will lose their diabetes.
"Although this study involved people diagnosed with diabetes within the last four years, there is potential for people with longer-standing diabetes to turn things around too."
Susceptibility question
Dr Ee Lin Lim, also from Newcastle University's research team, said that although dietary factors were already known to have an impact on Type 2 diabetes, the research showed that the disease did not have to be a life sentence.
"It's easy to take a pill, but harder to change lifestyle for good. Asking people to shift weight does actually work," she said.
However, not everyone in the study managed to stay free of diabetes.
"It all depends on how much individuals are susceptible to diabetes. We need to find out why some people are more susceptible than others, then target these obese people. We can't know the reasons for that in this study," Dr Lim said.
Professor Edwin Gale, a diabetes expert from the University of Bristol, said the study did not reveal anything new.
"We have known that starvation is a good cure for diabetes. If we introduced rationing tomorrow, then we could get rid of diabetes in this country.
"If you can catch people with diabetes in the early stages while beta cells are still functioning, then you can delay its onset for years, but you will get it sooner or later because it's in the system."
But Keith Frayn, professor of human metabolism at the University of Oxford, said the Newcastle study was important.
"People who lose large amounts of weight following surgery to alter their stomach size or the plumbing of their intestines often lose their diabetes and no longer need treatment.
"This study shows that a period of marked weight loss can produce the same reversal of Type 2 diabetes.
"It offers great hope for many people with diabetes, although it must be said that not everyone will find it possible to stick to the extremely low-calorie diet used in this study."
Dr Iain Frame, director of research at Diabetes UK, which funded the study, said the diet was not an easy fix.
"Such a drastic diet should only be undertaken under medical supervision. Despite being a very small trial, we look forward to future results particularly to see whether the reversal would remain in the long term."
source: https://www.bbc.com/news/health-13887909
2.
White rice 'raises diabetes risk', say US experts
Replacing white rice with brown rice and wholemeal bread could cut the risk of diabetes by a third, US experts say.
White rice poses a diabetes threat because it causes steep rises in blood sugar, say Harvard researchers in Archives of Internal Medicine.
Brown rice and other wholegrain foods are a healthier option as they release glucose more gradually, they say.
The study is based on questionnaires; some say the data is not robust enough to base firm conclusions on.
It may be that people who eat less white rice tend to live healthier lifestyles, for example.
'Brown is better'
In the study of nearly 200,000 US people, white rice consumption was linked to type 2 diabetes.
After adjusting for age and other diabetes risk factors, those who ate five or more 150g servings of white rice per week had a 17% increased risk of diabetes compared with people who consumed less than one serving - about a cup of rice - per month.
Although few people - only 2% - in the study ate this much white rice, the finding was significant.
Yet eating brown rice appeared to have the opposite effect, cutting the risk of type 2 diabetes.
People who ate two or more servings of brown rice per week had an 11% reduced risk of developing the condition compared with those who ate less than one serving a month.
Based on the results, the researchers estimate that replacing 50g or one-third of a typical serving of white rice with the same amount of brown rice would lead to a 16% lower risk of type 2 diabetes.
And replacing the white rice with wholegrains, including brown rice and pasta, wholemeal bread and rolled oats, could cut the risk by more than a third.
Food composition
Dr Qi Sun and other researchers say the explanation lies in the composition of the food.
Like other wholegrain foods, brown rice is high in fibre and releases its energy slowly.
In contrast, white rice has had all the bran and some of the germ removed during milling.
This gives white rice a higher glycaemic index (GI) - a measure of how much a food raises blood sugar levels compared with the same amount of glucose or white bread.
"From a public health point of view, replacing refined grains such as white rice by whole grains, including brown rice, should be recommended to facilitate the prevention of type 2 diabetes," according to the researchers.
Experts generally recommend that at least half of carbohydrate intake should come from whole grains like brown rice.
More than 70% of the rice consumed in developed countries such as the US and UK is white.
Dr Victoria King of Diabetes UK said that, since the results were from self-reported food diaries and questionnaires, it was not possible to make conclusive recommendations on how much of certain foods, such as brown rice, might protect against type 2 diabetes at this stage.
"The best way to prevent type 2 diabetes is by keeping active and eating a healthy balanced diet that is low in fat, salt and sugar with plenty of fruit and vegetables," she said.
3.
Dieting 'keeps diabetes at bay'
29 October 09 00:09 GMT
A period of careful eating and regular exercise can stave off diabetes for a decade, a study suggests.
US researchers followed up nearly 3,000 overweight people who had taken part in a three year diabetes prevention programme.
The group had initially been divided into three - assigned either to a diet and exercise programme, the diabetes drug metformin or a placebo.
The Lancet report notes it was the dieters who reaped the most benefit.
All three groups were given access to ongoing lifestyle coaching once the initial three year trial had ended.
That trial, carried out by the US-based Diabetes Prevention Program Research Group, had shown a diet aimed at achieving 7% weight loss, combined with half an hour of exercise five days a week, reduced the risk of developing Type 2 diabetes by 58% compared with the placebo group.
The group on metformin, a drug which has been used to treat the condition since the 1950s, saw their risk decline by nearly a third.
In the seven years after the trial ended, both the drug and placebo groups - now also eating more carefully and exercising - saw the rate of diabetes fall.
But the most significant drop was among those who had started out on a diet and exercise regime - their risk was over a third lower than the placebo group.
In an accompanying editorial, Dr Anoop Misra, a specialist in diabetes in New Delhi, described the prevention of the disease as "a long and winding road".
'No short cut'
Dr Misra said: "There seems to be no short cut, and a persistent and prolonged intensive lifestyle intervention seems to be the most effective way to travel on it."
But he warned it could not be the only measure: "We need more effective drugs for those who cannot follow intensive lifestyle therapy because of infirmity."
Type 2 diabetes usually appears in people over the age of 40, however increasing numbers of children are being diagnosed with the condition, some as young as seven.
Although obesity is a risk factor, not all people with type 2 diabetes are overweight.
Dr Iain Frame, head of research at Diabetes UK, said: "It is fascinating to read about the 10-year follow up studies and of the importance of lifestyle interventions, with or without metformin, in the prevention of Type 2 diabetes even after 10 years.
"There is clearly no easy route to take to prevent Type 2 diabetes but indications are that with further research into the long-term benefits of good dietary advice, physical activity and, where necessary drug therapies, we may be a step closer into helping people at high risk of developing Type 2 diabetes modify their lifestyle choices that are sustainable in the longer term."
4.
No quick drug fix for high diabetes risk
15 March 10 00:01 GMT
Two key treatments do not halt diabetes in people with early signs of the disease, a large study has found.
Researchers said the results showed the only way to ensure future health in people at high risk of diabetes was exercise and a healthy diet.
Trials in more than 9,000 people also found no reduction in future heart problems in people prescribed two drug treatments compared with dummy pills.
Diabetes UK said 7m people in the UK were at risk of developing diabetes.
Everyone taking part in the study, published in the New England Journal of Medicine, had been diagnosed with what doctors call "impaired glucose tolerance".
It effectively means that people have high blood sugar and their bodies are starting to not respond to insulin as well as they should.
Sometimes called pre-diabetes, it is thought that the condition is a stage in the development of full-blown type 2 diabetes, and can be associated with obesity.
It is thought that in the UK, around 17% of 35-65 year olds have impaired glucose tolerance.
Medical intervention
In the trial, researchers in the US and UK looked at whether using a drug that lowers blood pressure or a drug which lowers blood sugar could be used to stop diabetes developing in these high-risk patients.
But the results, from patients in 40 countries, found no great difference in how many people went on to get diabetes when prescribed either drug compared with a dummy pill.
Neither did the drugs prevent future heart attacks and strokes, which are dangerous complications of the condition.
In the blood-sugar lowering drug part of the study around a third of people went on to develop diabetes within five years whether they were taking the real medicine or dummy medicine.
Professor Rury Holman, director of the Diabetes Trials Unit at the University of Oxford, said the treatments were proven to be effective once someone had diabetes but there was an "urgent need" for drugs to prevent the disease and its complications developing in the first place in those at high risk.
He said: "The most successful treatment for someone at high risk of diabetes is diet and exercise."
'Dramatic difference'
Co-author Professor John McMurray from the University of Glasgow agreed that the results reinforced the importance of lifestyle changes in preventing diabetes.
"Losing as little as 5% of body weight has been shown to make a dramatic difference in other studies."
Dr Victoria King, research manager at Diabetes UK, said: "Unfortunately there is unlikely to be a quick and easy route to prevent type 2 diabetes and a healthy balanced lifestyle with a good diet and physical activity levels are the best preventative methods."
But she added some drugs may be of benefit in these patients and the latest study would help doctors prescribe the most appropriate option.
Professor Alan Maryon-Davis, president, UK Faculty of Public Health, said: "A huge number of people are in this 'nearly diabetes' category without realising it.
"We need to rapidly expand the national healthcheck programme, with many more community dietitians and exercise advisors ready to offer help."
5.
'High GI' carbohydrates increase women's heart risk
12 April 10 23:40 GMT
Women who eat diets heavy in certain carbohydrates may be at greater risk of coronary heart disease, according to researchers.
A study of over 47,000 Italian adults found that women alone whose diets contained a lot of bread, pizza and rice doubled their heart disease risk.
These foods have a high glycaemic index (GI), meaning they release energy and raise blood sugar quickly.
The findings are published in Archives of Internal Medicine.
The experts say much more research is needed to understand why these high GI foods, rather than carbohydrates per se, appear to pose a risk - and why the risk applies to women and not men.
Low GI carbohydrates, such as pasta, which release energy and raise blood sugar far slower, showed no such link with heart disease.
Glycaemic index
The doctors who produced the report studied 15,171 men and 32,578 women who completed dietary questionnaires over many years.
This allowed the researchers to calculate overall carbohydrate intakes as well as the average glycaemic index of the foods eaten and the glycaemic loads of the diets.
The glycaemic index (GI) is a measure of how much a food raises blood glucose levels compared with the same amount of glucose or white bread.
The glycaemic load is calculated based on the glycaemic index of a given food and also on the total amount of carbohydrates it contains.
After seven years, 463 participants had developed coronary heart disease.
The researchers found that the women whose diet had the highest glycaemic load had more than double the risk of heart disease compared with those women with the lowest glycaemic load.
The authors concluded: "Thus, a high consumption of carbohydrates from high-glycaemic index foods, rather than the overall quantity of carbohydrates consumed, appears to influence the risk of developing coronary heart disease."
The researchers believe that a high-glycaemic diet may dampen 'good' cholesterol levels in women more than in men.
But further research is needed to verify the absence of a link between high-glucose foods and cardiovascular disease in men, says the study.
Victoria Taylor, senior heart health dietician at the The British Heart Foundation, said that for women, choosing lower GI foods could be useful in helping them to reduce their risk of coronary heart disease.
She said: "They could try broadening the types of bread and cereals they eat to include granary, rye or oat; including more beans, pulses; and accompanying meals with a good helping of fruit and vegetables."
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