Reversing the inevitable

Dave, a 57-year-old retired para-medic, came to us for help on a hot summer day, sweating and slightly winded. He had read online that people were reversing diabetes with keto diets and was looking for help.

His Type 2 diabetes was long-standing and severe, he had been on insulin for more than 20 years and he was on an insulin pump using more than 200 units per day.

Even with this, his glycated hemoglobin was 11.9 per cent (the target is seven per cent) and his C-peptide level, a marker of his pancreas’ ability to produce insulin on its own, was very low.

Chronic, progressive disease
Conventional wisdom would tell us that there was no hope for Dave to reverse his condition on his own. Medical textbooks characterize diabetes as a chronic, progressive disease that can, at best, be slowed by a combination of lifestyle and medications. Medical treatment leads to very little remission.

The general progression of diabetes is such that by nine years after diagnosis, less than 25 per cent of diabetics remain on one medication, and after 10 to 12 years, more than 50 per cent are on insulin.

The odds were not encouraging for Dave, but there was also encouraging research about diabetes reversal. Roy Taylor from Newcastle University and his team have systematically developed the Twin Cycle Theory of metabolic dysfunction. Proven through a series of experiments, the theory demonstrates that diabetes is a disease of energy overload, a story of how the body tries and fails to accommodate increasing storage of energy and how each person’s threshold for decompensation is different.

Energy, of course, comes from food, and is essentially processed through two different pathways: glucose or fat. Both energy systems have buffers against overload. The glucose system has a small but immediate buffer through the storage of glucose as glycogen in muscle. The fat system has an immense capacity to buffer excess energy through the storage of fat in subcutaneous adipose tissue. And, of course, the fat system can buffer the glucose system.

With prolonged periods of energy overload, these buffers begin to break down. Muscle inactivity results in lower capacity to store glycogen in muscle, resulting in more energy being converted into fat. Our ability to store fat in subcutaneous tissue eventually hits a limit and fat begins to be stored in places where it was not meant to be stored.

Fat also begins to build up in other non-fat cells (ectopic fat), which results in insulin resistance. Muscle takes up less of the glucose from dietary carbohydrates, causing more of this glucose to be converted to fat in the liver.

Ectopic fat in the liver also results in insulin resistance. This, in turn, causes the pancreas to release more insulin both in response to meals but also at baseline in order to control the liver’s production of glucose and maintain normal fasting blood sugars.

Eventually, ectopic fat finds its way into the pancreas and affects insulin production. At this point, insulin production plateaus and can no longer control blood glucose levels.

Once fasting blood sugars reach seven millimoles per litre, we call this Type 2 diabetes.

Taylor describes this as a “metabolic vicious cycle” that repeats and progresses from weight gain to insulin resistance to abnormal blood sugars all the way to full-blown diabetes.

Reversing the cycle
Our individual propensity toward insulin resistance and diabetes is variable and depends on our ability to accommodate energy overload; in other words, our personal fat threshold. Some people are able to gain more weight and stay healthy, while for others, a small amount of weight gain leads to fat storage in the wrong places (muscle, liver, pancreas) and the beginning of the metabolic vicious cycle.

Age, genetics and lifestyle behaviours — especially nutrition, activity levels, sleep and stress levels — may increase or decrease our risk of developing insulin resistance.

To reverse this metabolic vicious cycle, we need to reverse the energy overload and get ectopic fat out of the pancreas and liver. The cycle can be broken when weight loss leads to the decrease and elimination of ectopic fat in the liver and pancreas.

The Wellness Garage has combined the learnings of the Twin Cycle Theory with other lifestyle medicine research to develop a systematic, evidence-based, lifestyle behaviour approach to reversing insulin resistance.

As a lifestyle medicine clinic, our mission is to help people take control of their health by improving the six pillars of lifestyle behaviours: nutrition, exercise, sleep, stress tolerance, relationships and purpose.

For Dave, this meant a shift toward whole foods, eliminating sugars and refined carbs, introducing time- restricted eating and getting active. The results were almost immediate — within the first week, his insulin dropped by 40 per cent and his blood sugars dropped to five to seven millimoles from more than 15.

By eight months, Dave was 70 pounds lighter and was off insulin completely. His diabetes remains controlled on medication and his insulin resistance continues to improve. Most importantly, he has a whole new outlook on life.

Emerging evidence shows that by better understanding and addressing the root cause of diabetes as a disease of energy overload, it can be reversed, often all the way to complete remission.

Impressive ROI
What would the return on investment look like if this was done as a standard of practice?

Let’s look at what the data shows us:

• The average age of diagnosis for Type 2 diabetes is 45 years
• The initial medication prescribed is often metformin, which is cheap
• By nine years, there is a 75-per-cent chance that another medication will be required — the choices here are not so cheap (for example, the annual cost for one drug is $1,833)
• By 10 to 12 years, there is a 50-per-cent chance that insulin will be required
• The total drug cost from age 45 to 65 can easily be greater than $50,000
• If we factor in other costs to employers (reduced productivity, missed work), the cost will be greater than $80,000• There’s the potential for short- and long-term disability
• There are potential costs around co-morbidities (such as heart disease, hypertension, kidney failure, retinopathy and neuropathy).

Compared to the cost of an intensive, year-long lifestyle medicine approach to lifestyle change (roughly $2,000 to $4,000), the potential ROI appears massive.

For benefit providers and insurers, the time has come to rethink diabetes as a preventable, reversible condition that does not have to result in high personal and financial costs and can be addressed through a systematic, evidence-based lifestyle approach.

Brendan Byrne is the medical director and co-founder of the Wellness Garage in White Rock, B.C. Anyone interested in participating in a pilot study for diabetes reversal in the workplace can contact him at [email protected].