How diet alone can achieve diabetes remission

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Cate Collings, MD

Each year, approximately 1.4 million American adults are diagnosed with type 2 diabetes. But when doctors discuss treatment options with newly diagnosed patients, they often fail to include intensive, whole-food, primarily plant-based dietary intervention as a potential strategy for achieving remission without drugs or procedures.

It’s a shame because remission should be the primary clinical goal of type 2 diabetes treatmentand evidence shows that a person’s diet is an important factor in morbidity and mortality linked to type 2 diabetes worldwide. But a lack of physician training, false assumptions that patients are unwilling to engage in intensive interventions, and flawed quality measures that ultimately penalize positive outcomes through on-the-fly nutritional interventions. of life often result in treatment plans that approach Type 2 diabetes looks more like an irreversible chronic disease.

Fortunately, the medical community recognizes the need for change. In May, the American College of Lifestyle Medicine released an expert consensus statement Dietary interventions for treating type 2 diabetes in adults with a goal of remission which has been endorsed by the American Association of Clinical Endocrinology, supported by the Academy of Nutrition and Dietetics, and co-sponsored by the Endocrine Society.

Dietary recommendations as a treatment for diabetes generally focus on disease prevention and management. The expert group behind the consensus statement focused on diet – without drugs or procedures – as the primary means of achieving lasting remission from diabetes rather than its more common role as therapy extra.

This multidisciplinary panel of experts (including representatives from seven other medical organizations) agreed on the effectiveness of a whole plant-based diet and reduced calorie intake through volume reduction food, portion size, energy density or a combination of the approaches over time. standard American diet for promoting remission in type 2 diabetes. A high level of consensus has also been reached on the risk of significant adverse effects associated with a very low carbohydrate diet.

The panel agreed that remission should be defined as normal blood glucose measurements (normal A1c

The publication delivers a stimulating message. It can be argued that failure to present a food-as-medication treatment option to people with type 2 diabetes is a failure of informed consent and shared decision-making. Many studies show that sufficiently intensive lifestyle interventions can lead to type 2 diabetes remissionwith a success rate similar to bariatric surgery but without the excessive costs of surgery or potential complications. Nevertheless, patients are often referred to riskier and more invasive treatments before considering an intensive lifestyle change.

The critical element of the dose

The expert consensus statement can help guide shared decision-making, but it is essential that clinicians who prescribe food as medicine develop the knowledge and skills to do so. Just as medications must be dosed correctly to achieve the desired result, intensive lifestyle interventions must be sufficiently dosed to obtain remission. For example, these interventions should be more intensive than those aimed at prevention type 2 diabetes. Many lifestyle medicine treatment plan failures are the result of incorrect dosing.



Example of a therapeutically dosed diet to achieve remission in type 2 diabetes.

The success of a whole, primarily plant-based diet in achieving remission is, of course, largely dependent on the patient’s ability to adapt to intensive changes and joinwhich has been difficult for adults with type 2 diabetes.

Poor communication and lack of support clinicians are common obstacles. This is why it is important to receive treatment from a clinician trained in lifestyle medicine who can clearly support and prescribe the proper dosage. The clinician must consider cultural differences and the social determinants of health and the influence they have on a patient’s treatment plan.

Remission will not happen for everyone. Some studies suggest that the longer a person has had diabetes, the more less likely they have to get a remission. Further research is needed to determine the extent to which dietary treatment as medication can maintain remission over the long term. But through shared, patient-by-patient decision-making, it is possible to alter the growing trajectory of type 2 diabetes and be part of the solution to making lifestyle interventions the foundation of health and well-being. all health care.


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