11/06/2019 by Dr Philip Bazire 0 Comments
Type 2 Diabetes
Is remission of Type 2 Diabetes possible? Is bariatric surgery the only way, or can it be achieved with diet?
This week is Diabetes Week, an initiative of Diabetes UK to increase awareness about diabetes and to raise funds for their continued to support diabetic patients, both medically and socially.
Type 2 diabetes is closely associated with obesity. In overweight and obesity, the normal fat stores are overloaded, and fat starts to accumulate at other sites, such as in the abdomen, in the abdominal organs, around the heart, and in the muscles. This so-called ectopic fat causes the functional disturbances that can lead to the onset of type 2 diabetes, with decreased insulin secretion from the pancreas and the onset of insulin resistance in the liver, muscles, and other tissues.
It has long been known that weight loss improves diabetes, but it is only recently that it has been shown that significant weight loss can actually lead to remission of the disease. This was initially seen with bariatric surgery, which was the first treatment for obesity to produce such rapid and effective weight loss. We still do not understand all the mechanisms that lead to remission, but certain factors have been identified that are more closely associated with success: duration of diabetes <4 years, a lower glycated haemoglobin (HbA1c) and fasting blood glucose, and no need for insulin therapy.
To achieve this effect and maintain it in the long term (in those patients in whom it is possible), it would appear that a considerable amount of body weight needs to be lost – it will vary between individuals, but is probably over 20% of body weight for persons with obesity.
Other factors that are very relevant in the remission of diabetes are the elimination of fat from other sites of ectopic fat storage, particularly the liver and muscle, and the resolution of lipoinflammation. These actions will restore a healthy metabolic environment to these tissues, with improved insulin sensitivity and correction of how the body uses fats and sugars.
PronoKal’s PnK Method is an ideal diet to lose weight and to eliminate ectopic fat both from the abdomen and from muscle. The PnK Method is a very low calorie diet that reduces carbohydrate intake to induce a ketogenic state that provokes rapid and significant weight loss. The Method includes a specific exercise programme designed to promote the elimination of fat from muscle, with reactivation of normal energy metabolism. The diet targets the abdominal fat in and around the abdominal organs, particularly in the liver and pancreas.
Additionally, the PnK Method includes a treatment for lipoinflammation, considered to be a very important factor not only in the onset of chronic obesity-related diseases (diabetes, heart disease, stroke, cancer…), but also in weight control after completing the diet. This treatment will reduce the risk of weight regain and of the complications of obesity.
Average weight loss with the PnK Method is around 9 kg (about 1½ stone) in the first month of ketosis. After a rapid weight-loss phase, there is a dietary re-education phase, in which normal foods are reintroduced and patients are guided towards a healthy, balanced diet that they will be able to maintain in the long term. Long-term weight stability is favoured by the correction of the body’s metabolism and by the reduction in lipoinflammation. To ensure our patients have the best possible chance of long-term success, we perform follow-up for 2 years to detect any deviations early on.
The PronoKal diet methods are suitable for overweight or obese type 2 diabetic patients controlled on diet or on oral antidiabetic medication. Clinical trials comparing the PronoKal methods with a low-calorie diet in type 2 diabetic patients have shown a significantly greater reduction in HbA1c (glycated haemoglobin) within 4 months with PronoKal.