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Can You Reverse Type 2 Diabetes?

A closer look at the Type 2 Diabetes Newcastle studies

In 2008, researchers at Newcastle University, let by Professor Roy Taylor, asked a question no one had really asked before: Can we reverse type 2 diabetes? Three years later, they had the answer.

The groundbreaking Counterpoint study (2011) found that yes, type 2 diabetes can indeed be reversed. By the end of the first week of the eight-week trial, the study participants all had normal fasting glucose levels. And by the end of the eight weeks all had reversed their diabetes. Months later seven of the 11 remained diabetes-free.

Such dramatic results might be expected to shake the medical world to its foundations. At the time, Professor Taylor said:

This is a radical change in understanding Type 2 diabetes. It will change how we can explain it to people newly diagnosed with the condition. While it has long been believed that someone with Type 2 diabetes will always have the disease, and that it will steadily get worse, we have shown that we can reverse the condition.”

Criticism of the study, however, was sharp. The trial was too small, critics claimed (it only included 11 people). The participants hadn’t had diabetes for very long (four years or less). Few doctors even heard about the study, and fewer still recommended the treatment—8 weeks on an extremely low-calorie diet—to their patients in spite of its startling success.

The study wasn’t widely reported in the U.S., but the initial news coverage was strong in the U.K. (home of Newcastle University) and the possibility of reversing their own diabetes fired the public’s imagination. People began trying what came to be called the Newcastle Diet on their own, with and without their doctors’ support, and with equally dramatic results.

In 2013, the Newcastle researchers followed up with a group of these people and published the results as a report in the journal Diabetic Medicine. This was followed by the CounterBALANCE study (designed to address criticisms of the original Counterpoint study) in 2015 and the DirECT study published in December 2017. In all four instances, the findings were the same: it is entirely possible to reverse type 2 diabetes in 50-80 percent of those who have the disease. The key? Reducing fat in the liver and pancreas. How do you do that? Let’s take a look at the actual studies.

Counterpoint: You CAN reverse type 2 diabetes

The Counterpoint study (2011) was set up after researchers noticed that type 2 diabetes patients often became non-diabetic after weight-loss surgery. While we’ve long known that weight loss can help control or even normalize blood sugar, the puzzling issue was that patients were getting normal glucose readings within 7 days after surgery—far too soon for any significant weight loss to occur.

Professor Taylor speculated that this was due not to the surgery itself but to the extreme calorie restriction that results from weight-loss surgery. The liver and pancreas are two of the first places to lose fat when calories are severely restricted, and he believed the reduction of fat in these two areas might be the deciding factor in diabetes reversal. The Counterpoint study was designed with this in mind and used the same type of calorie-restricted diet that post-surgery patients experience.

The study included 11 volunteers who’d had type 2 diabetes for no more than four years. They were put on a very low calorie diet consisting of meal-replacement shakes plus small amounts of non-starchy vegetables for a diet of 600-700 calories per day. Participants followed the diet for eight weeks, then transitioned back to normal eating. MRI scans were used to measure the amount of fat in their livers and pancreases before and after weeks 1, 4, and 8.

Within the first seven days of the diet, liver fat decreased by 30%. As the fat in the liver decreased, the liver’s insulin sensitivity increased, and by day seven the participants had normal fasting glucose levels. Over the course of the study, pancreatic fat slowly decreased, while insulin sensitivity and secretion increased. By the end of the study, all 11 volunteers had reversed their type 2 diabetes.

At a 3-month followup seven of the 11 remained-diabetes free and those who did not had regained weight. And although there was no official followup beyond the 3-month point, some of the original participants still reported being diabetes-free as recently as 2016.

CounterBALANCE: You CAN stay diabetes-free

The Counterbalance study (2015) was a follow-up to the Counterpoint study, and addressed some of the loudest criticisms of the original. It was larger (29 people) and included both long-term (more than 8 years) and short-term (less than 4 years) diabetic patients. Participants followed the same diet used in the Counterpoint study.  

By week eight, 87% of the short-term group and 50% of the long-term group had reversed their diabetes. Both groups also saw significant improvement in their blood pressure and cholesterol, on a par with the effect of medication. Both groups lost roughly the same amount of weight during the study, leading researchers to conclude that the longer a person has diabetes, the less likely they are to respond to dietary therapy. However, the fact that 50% were still able to reverse the condition means that dietary therapy is a promising option even for long-term diabetics.

After transitioning back to normal eating, the study volunteers were given individualized dietary advice and followed for six months. Those who had reversed their diabetes sustained their weight loss and remained diabetes-free at 6 months post-diet.

As a result of this study’s findings, DiabetesUK—the British counterpart to the American Diabetes Association—agreed to fund a third, much larger study.

DiRECT: More gradual weight loss can have the same effect

This most recent study, funded by DiabetesUK, is still underway but has published its initial results. The goal was to see whether an intensive weight-loss program administered through primary-care doctors’ offices could have the same effect as the stringently-controlled earlier studies. It consisted of 306 people divided into the treatment group, who followed the weight-loss program, and a control group who received standard diabetes care. All of the volunteers had been diagnosed within the past six years.

For the DiRECT study, volunteers followed a higher-calorie diet (825-853 calories per day, rather than 700) for a longer period of time (3-5 months). As with the Counterpoint and Counterbalance studies, the diet consisted of meal replacement shakes. The participants then spent 2-8 weeks transitioning back to everyday eating, with structured weight-loss education throughout. They were once again assessed at the 12-month mark.

At 12 months, 46% of those in the treatment group had reversed their type 2 diabetes and remained diabetes-free. And in real-world terms, the number is likely higher.

Only 86% of those in the treatment group showed up for their 12-month followup. The researchers used the medical records of the no-shows where available, but 4% had no records. In addition, 17% of participants stopped treatment before 12 months was up and another 4% agreed to treatment but never actually began the diet. The 46% statistic includes all of these—those who never began treatment, those who dropped out midway, and those for whom there was no followup—in the 54% who did not achieve a reversal. When we include only those who actually completed the program, the results are even more dramatic. 

In addition, the study of people attempting to reverse their diabetes on their own (2013) found that some 68% achieved their goal, while others were able to reduce their blood glucose levels even though they fell short of actual reversal.

Can we reverse type 2 diabetes? The Newcastle studies say we can, and that dietary intervention should be the first-line treatment.

Can we reverse type 2 diabetes?
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Can we reverse type 2 diabetes?
In 2008, researchers at Newcastle University, let by Professor Roy Taylor, asked a question no one had really asked before: Can we reverse type 2 diabetes? Three years later, they had the answer.
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