Intermittent fasting and other possible methods to make diabetes remit | Health & Wellness

In 1980, 4.7% of the world population suffered from type 2 diabetes. The figure, associated with obesity and aging, reached 8.5% in 2014 and 9.3% in 2019. And it continues to grow, mainly in low- and middle-income countries. Until not long ago, this disease, which increases the risk of cardiovascular disease or cancer, seemed like a degenerative process that always got worse and ended up requiring insulin and other drugs. However, this idea has changed in recent years. In 2017, the magazine The Lancet published the DiRECT study, a study that demonstrated that if a significant weight loss was achieved, it was possible to make the disease remit and get rid of the drugs. The obstacle to that knowledge changing the course of the disease was that the nutritionists and personal trainers who helped the patients in this study are not within the reach of the public health.

Since the publication of that study, different techniques are being tested to achieve that weight reduction that makes diabetes regress. Today, the magazine Journal of Clinical Endocrinology & Metabolism publishes a paper showing how an intermittent fasting intervention can improve the health status of people who suffer from the disease, reduce the need for medication and even eliminate it completely due to the remission of the disease. The authors, researchers from the Hunan Agricultural University (China), applied a type of diet, baptized as Chinese medical nutrition therapy, which combined five days of fasting in which 840 kilocalories were consumed daily at controlled times, followed by 10 in the which was eaten normally.

Ninety percent of the 36 volunteers with diabetes, including those taking drugs to lower blood sugar and insulin levels, were able to reduce their medication, and 55% saw their disease subside and were able to stop taking their drugs for at least a year. Among the trial participants, the average weight loss was nearly 12 pounds, compared with a 200-gram drop in the comparison group that ate a normal diet. Dongbo Liu, author of the study, affirms that “diabetes is not necessarily a lifelong disease”, but “it can remit if patients lose weight by changing their diet and exercise habits.”

Cristóbal Morales, an endocrinologist at the Vithas Hospital and the Virgen Macarena University of Seville, warns that the study “is with few volunteers and with a population such as the Chinese in which patients with diabetes are different from those that can be found in Spain”. particularly because of their lower body mass index. However, he believes that intermittent fasting can be one more tool to lose weight. “There are studies that show us that there is a great metabolic benefit in losing between 5 and 10% of body weight. Intermittent fasting can appeal to a lot of people and the important thing is to lose weight and keep it off, and it seems like it doesn’t matter how you do it,” he explains.

According to Morales, the idea of ​​making diabetes remit is something recent, but now they aspire to achieve it with different methods to lose weight. In a guideline recently published by the Diabetes Canada association, it is noted that “sustained weight loss of about 15 kilos is associated with the highest probability of remission of type 2 diabetes.” That goal would be a possibility for patients without mental illness or severe eating disorders, cardiovascular disease, heart failure or chronic kidney disease.

Surgery and drugs

As in many other ailments, even if you know what to do, it is not easy to carry it out. Andrea Azcárate, head of the Endocrinology service at the Sanitas La Moraleja University Hospital in Madrid, points out that, after losing weight, “the most difficult and necessary thing is to maintain that loss for a long time.” “It is about offering a personalized treatment that can be more useful to each patient. Fasting has been done for many years, although now it is fashionable. It can be useful for patients not to peck, to let them rest [al aparato digestivo] and to improve insulin sensitivity. But you never have to be too categorical ”, he adds. “Not all diabetic patients are the same, some are highly medicated and the medication must be adjusted or the trend towards dehydration must be monitored, which could cause kidney problems”, he continues.

The reference intervention to lose a lot of weight and against which other methods are compared is bariatric surgery. However, according to Azcárate, to meet the criteria it is necessary to have a body mass index of more than 35 (a man of 1.75 meters should weigh more than 104 kilos). The method proven in the DiRECT study, with diet and exercise and very close follow-up by professionals, achieved diabetes remission in almost 50% of the participants. However, it requires very expensive resources. Therefore, experts and patients look with hope to new drugs for obesity such as semaglutide or tirzepatide. These drugs mimic incretins, hormones our bodies produce when we eat that reduce appetite and increase resting energy expenditure. Semaglutide has shown that it can reduce, on average, 15% of the weight of those who take it, and tirzepatide up to 22.5%, figures that would be similar to those of bariatric surgery.

Despite the fact that the demonstration that weight loss can make diabetes remit offers hope for patients and that there are new methods to achieve it, the path to reduce the volume of fat and maintain it in the long term remains complicated. New drugs or strategies like intermittent fasting are tools that open a door to a solution.

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