Treating type 2 diabetes effectively has never been as simple as merely taking the right pills. Lifestyle modifications and a holistic management strategy have long been known to play a significant part in outcomes for diabetics, and diet is certainly no exception. But, until recently, it was assumed by experts that the role of diet in diabetes management was, at best, to simply improve outcomes of lifelong treatment.

However, recent research may suggest a changing tide in how experts think of the potential that dietary changes may play in treating type 2 diabetes. To be more specific, certain dietary adjustments may have the power to permanently negate the need for diabetes treatments, which is known to doctors as “remission”.

We would like to stress that we are not advocating that anyone discontinue or alter their treatment regimen in favor of the techniques discussed in this article. This is meant only to explore interesting trends in research. Always follow the advice of your doctor in treating your diabetes.

Intermittent Fasting

If you spend time on health-related forums online, you may have seen the term “intermittent fasting”, or “IF” for short, floating around. This dietary protocol explained further below, has been popular in health and fitness-conscious communities for a while now, as it has been touted for its supposed weight loss-assisting, cognitive-boosting, and general health-promoting effects.

However, experts had not yet determined whether the apparent health benefits of intermittent fasting might extend beyond weight management into improving diabetes-specific biomarkers like HbA1C – a blood marker often used as a proxy for a person’s average blood sugar over an extended period. They were even less aware of whether IF might have the potential to entirely remove some patients’ dependence on antidiabetic medications in a process known medically as “remission”. As it turns out, though, recent research may be flipping the current understanding of IF on its head.

But before we get too far ahead in discussing emerging trends in the research around IF and diabetes, let’s first take a closer look at IF for context.

What is Intermittent Fasting?

Intermittent fasting certainly has a sophisticated ring to it, but in reality, this term simply describes a straightforward protocol for timing one’s meals throughout a given time frame.  In fact, it’s even less specific than that; to be precise, IF describes any meal timing plan which prescribes periods of time during which no calories are consumed.

Importantly, IF is not a diet in the same way as the ketogenic diet or the Atkins diet, for example. Unlike these and other examples of pre-planned diets, IF does not require its followers to eat, or not eat, any foods in particular. IF doesn’t even specify the amount of food that may be eaten. The only restrictions involved in IF are concerned with the timing of one’s eating; everything else is beyond the purview of IF.

The misconception of IF as a diet is a common one, and it’s an important distinction to make. Another common misconception is that IF refers to a specific pattern of eating and fasting. In reality, anyone who regularly goes for any amount of time without eating (i.e., anyone who sleeps through the night without a midnight snack) can technically say that they are following an IF protocol. Thus, when reading about the potential benefits of IF, it’s also important to note the specific timing protocols to which those benefits are ascribed, as not all IF protocols are created equal.

Remember that an infinite amount of variation can exist under the heading of “intermittent fasting”. Typical plans might consist of an eight-hour eating window and a sixteen-hour fasting window each day, or a twelve-hour eating window and a twelve-hour fasting window each day, or – well, you get the picture. Some IF plans might also make use of different time periods for their fasting intervals; for instance, a plan might prescribe a day of fasting each week, or some other non-daily variation.

Making Anti-Diabetic Meds Redundant: The Theory

Unlike type 1, type 2 diabetes (T2D) is often acquired, meaning that it results from bodily trends that exhaust the body’s ability to appropriately respond to the presence of insulin. For example, a sustained diet that is high in sugar and other carbohydrates can leave an individual in a high-insulin state throughout most of the day to digest all those carbs. In some individuals, the body can become accustomed to high concentrations of insulin in the blood and may begin to experience progressively weaker cellular responses in turn. While this is a simplified explanation, the upshot is that maladaptive changes in insulin sensitivity can often occur as the result of sub-optimal lifestyle conditions.

What researchers have hypothesized, and what recent research seems to indicate as a possibility, is that the same processes by which T2D develops may also alleviate T2D symptoms enduringly when reversed. In other words, just as a person might acquire insulin insensitivity through sub-optimal conditions, they might also bolster insulin sensitivity by changing those conditions.

So, how does IF change bodily conditions in a way that’s favorable to reversing T2D? Well, eating and digesting food involves a series of complex processes that implicate multiple bodily systems, including the digestive tract, the endocrine system, and the circulatory system. Spending time in a fasted state induces changes in how these systems operate, some of which are ideal.

Recall that insulin insensitivity may be developed through desensitization that occurs from a persistently high baseline due to constant grazing and a high-carb diet. As it turns out, insulin levels correspond roughly with meals, spiking when you eat and dropping off thereafter. Spending time in a fasted state allows your insulin levels to return to baseline, allowing your body to re-sensitize to the contrasting high and low concentrations.

Another potentially positive facet of IF is its tendency to induce weight loss. Fasting requires your body to dig into its energy stores, mobilizing stored energy to power your bodily processes until the next meal provides a new supply of energy. IF switches the body into an environment that is well-suited for mobilizing fat stores, and increases metabolic and mitochondrial function. Together, greater availability of energy and an improved tendency for the body to turn to fat stores for fuel mean that followers of IF are more likely to experience weight loss than their counterparts who spend less time in a fasted state regularly. Because obesity is positively correlated with type 2 diabetes incidence and morbidity, IF-associated weight loss may play an important role in diabetic health and even remission.

The Data on Intermittent Fasting and T2D

Prior to the study in question, quite a bit was known about IF’s potential to bring about positive changes to weight, metabolic health, and cardiovascular health, all of which are known to be positive factors for beneficial outcomes in type 2 diabetes patients. Researchers eventually hypothesized that IF could therefore have a particularly potent impact on the health of T2D patients, and before long, a group of researchers sought to evaluate that hypothesis in a controlled study.

In a Chinese study on 72 patients, nearly half of the IF group achieved remission from their T2D (plus significant weight loss), while virtually zero remission (and limited weight loss) were achieved by the control group. The implications of these findings are potentially staggering. While the results of any one study should be approached with skepticism until they have been more rigorously evaluated and replicated, the study certainly seems to suggest that T2D may not be the lifelong disease it is generally considered as being.

Unfortunately, for the moment, there is relatively little data on this specific question. Given how significant a discovery this would be for the treatment of diabetes, it is likely that future researchers will seek to further investigate this matter, and a more definitive answer could certainly be on the horizon.

Downsides and Complications of Intermittent Fasting

Even if the research turns out to be misleading and IF does not have the potential to bring T2D patients closer to remission, IF is generally well tolerated and can be adapted to an individual’s needs in many cases, and the health benefits outside of diabetes can still make it an attractive proposition.

As always, no medical treatment or diet is ever appropriate for every individual, and we do not recommend making any changes to your diabetes treatment or diet without consulting a healthcare professional, including your doctor or a registered dietitian. However, there are also some general caveats to mention to present a balanced picture of what IF might have to offer (though this is by no means an exhaustive list of the possible drawbacks to IF; speak to a healthcare professional if you’re considering IF).

First of all, IF may generally be discouraged for individuals with a history of disordered eating. This general policy is grounded in a concern that adopting a habit of depriving oneself of food for extended periods of time may trigger or exacerbate existing dysfunctional psychological relationships with food avoidance. This may be particularly true for individuals who have suffered, or who presently suffer, from anorexia or bulimia.

Secondly, despite its simplicity, IF takes significant attention and consideration to get right. Many IF novices often choose an over-zealous timing pattern to begin with, only to find that the sudden and drastic change leaves them balanced precariously between fatigue and low energy, and feeling bloated from leaving themselves too little time to consume sufficient calories. They may also fail to realize that IF does not mean skipping a meal; simply dropping breakfast or dinner without accounting for those calories and nutrients elsewhere throughout the day is a recipe for potentially unwanted weight loss and even a nutrient deficiency, as well as hunger pangs and an increased likelihood of falling off the IF wagon.

Finally, even when done thoughtfully, IF can have medical implications that make it unsuitable for some. For instance, some medications must be taken with food, meaning that individuals with conditions that require multiple medications throughout the day may have little flexibility in when they eat. Certain conditions, like low blood pressure or atypical nutrient requirements, may also preclude IFG as being an advisable or healthy option to consider.

Other Potentially Helpful Lifestyle Adjustments

There’s a saying that goes, “Don’t let perfect be the enemy of good”. The same applies to this discussion; regardless of whether IF can effectively achieve remission, there are nevertheless many possible health benefits for diabetics to realize through this and other dietary interventions, as well as other lifestyle modifications. We’ve included a short list of lifestyle changes for diabetics to consider incorporating into their treatment plan with the approval of their doctor.

Exercise and weight management

Excessive weight can decrease insulin sensitivity and blood sugar regulation while shedding excess pounds can have the opposite effect. Weight loss can be achieved through dietary intervention or additional physical activity, or both, but a doctor should be consulted before embarking on a weight loss journey to ensure your approach is safe.

Physical exercise of all kinds can also improve insulin sensitivity, which has cascading benefits on circulatory health, cognitive health, and nerve damage. People can have daunting ideas of the sorts of activities required to achieve a benefit from exercise, but the reality is that even gentle exercise can be beneficial. Again, some people may have medical conditions to consider when becoming active, but generally speaking, the more active you can safely be, the better for your overall health and diabetes management.

Stress reduction

Reading about the impacts of stress on diabetes can be, well, stressful. It turns out that stress, whether it be about work, money, or interpersonal matters, can affect our physical health. Specifically, it can trigger harmful hormonal effects which can be especially significant in diabetics’ bodies. Chronic stress can even lead to an increase in insulin resistance, contributing to the progression and worsening of type 2 diabetes.

Thankfully, managing stress effectively can also help counter these same processes. Learning to cope effectively with stress can be as simple as identifying sources of stress in your life and mitigating them, developing a mindfulness practice, or seeking professional help to work through how you respond to stressors in your life.