According to Roy Taylor, “type 2 diabetes is a potentially reversible metabolic state precipitated by the single cause of chronic excess intraorgan fat.” The organs accumulating fat are the liver and pancreas. He is certain “…that the disease process can be halted with restoration of normal carbohydrate and fat metabolism.” I read Taylor’s article published earlier this year in Diabetes Care.
[Do you remember that report in 2011 touting cure of T2 diabetes with a very low calorie diet? Taylor was the leader. The study involved only 11 patients, eating 600 calories a day for eight weeks.]
Dr. Taylor (M.D.) says that severe calorie restriction is similar to the effect of bariatric surgery in curing or controlling diabetes. Within a week of either intervention, liver fat content is greatly reduced, liver insulin sensitivity returns, and fasting blood sugar levels can return to normal. During the first eight weeks after intervention, pancreatic fat content falls, with associated steadily increasing rates of insulin secretion by the pancreas beta cells.
Taylor’s ideas, by the way, dovetail with Roger Unger’s 2008 lipocentric theory of diabetes. Click for more ideas on the cause of T2 diabetes.
Here are some scattered points from Taylors article. He backs up most of them with references:
- In T2 diabetes, improvement in fasting blood sugar reflects improved liver insulin sensitivity more than muscle insulin sensitivity.
- The more fat accumulation in the liver, the less it is sensitive to insulin. If a T2 is treated with insulin, the insulin dose is positively linked to how much fat is in the liver.
- In a T2 who starts insulin injections, liver fat stores tend to decrease. That’s because of suppression of the body’s own insulin delivery from the pancreas to the liver via the portal vein.
- Whether obese or not, those with higher circulating insulin levels “…have markedly increased rates of hepatic de novo lipogenesis.” That means their livers are making fat. That fat (triglycerides or triacylglycerol) will be either burned in the liver for energy (oxidized), pushed into the blood stream for use elsewhere, or stored in the liver. Fatty acids are components of triglycerides. Excessive fatty acid intermediaries in liver cells—diglycerides and ceramide—are thought to interfere with insulin’s action, i.e., contribute to insulin resistance in the liver.
- “Fasting plasma glucose concentration depends entirely on the fasting rate of hepatic [liver] glucose production and, hence, on its sensitivity to suppression by insulin.”
- Physical activity, low-calorie diets, and thiazolidinediones reduce the pancreas’ insulin output and reduce liver fat levels.
- Most T2 diabetics have above-average liver fat content. MRI scans are more accurate than ultrasound for finding it.
- T2 diabetics have on average only half of the pancreas beta cell mass of non-diabetics. As the years pass, more beta cells are lost. Is the a way to preserve these insulin-producing cells, or to increase their numbers? “…it is conceivable that removal of adverse factors could result in restoration of normal beta cell number, even late in the disease.”
- “Chronic exposure of [pancreatic] beta cells to triacylglycerol [triglycerides] or fatty acids…decreases beta cell capacity to respond to an acute increase in glucose levels.” In test tubes, fatty acids inhibit formation of new beta cells, an effect enhanced by increased glucose concentration.
- There’s a fair amount of overlap in pancreas fat content comparing T2 diabetics and non-diabetics. It may be that people with T2 diabetes are somehow more susceptible to adverse effects of the fat via genetic and epigenetic factors.
- “If a person has type 2 diabetes, there is more fat in the liver and pancreas than he or she an cope with.”
- Here’s Dr. Taylor’s Twin Cycle Hypothesis of Etiology of Type 2 Diabetes: “The accumulation of fat in liver and secondarily in the pancreas will lead to self-reinforcing cycles that interact to bring about type 2 diabetes. Fatty liver leads to impaired fasting glucose metabolism and increases export of VLDL triacylglcerol [triglycerides], which increases fat delivery to all tissues, including the [pancreas] islets. The liver and pancreas cycles drive onward after diagnosis with steadily decreasing beta cell function. However, of note, observations of the reversal of type 2 diabetes confirm that if the primary influence of positive calorie balance is removed, the the processes are reversible.”
- The caption with Figure 6 states: “During long-term intake of more calories than are expended each day, any excess carbohydrate must undergo de novo lipogenesis [creation of fat], which particularly promotes fat accumulation in the liver.”
- “The extent of weight gloss required to reverse type 2 diabetes is much greater than conventionally advised.” We’re looking at around 15 kg (33 lb) or 20% of body weight, assuming the patient is obese to start. “The initial major loss of body weight demands a substantial reduction in energy intake. After weight loss, steady weight is most effectively achieved by a combination of dietary restriction and physical activity.”
Dr. Taylor doesn’t specify how much calorie restriction he recommends, but reading between the lines, I think he likes his 600 cals/day for eight weeks program. That will have a have a high drop-out rate. I suspect a variety of existing ketogenic diets may be just as successful and more realistic, even if it takes more than eight weeks. I wonder how many of the 11 “cures” from the 2011 study have persisted.
Reference: Taylor, Roy. Type 2 diabetes: Etiology and reversibility. Diabetes Care, April 2013, vol. 36, no. 4, pp:1047-1055.
Update December 16, 2013:
Some wild and crazy guys tried this method at home. Click for results.
h/t commenter PhilT.
7 responses to “What Causes Type 2 Diabetes?”
our blessings and thanks to university of Newcastle upon Tyne and Dr. Roy Taylor and his mri spectography work findinf this detail.
from the cheap seats, my read is the need to stop chronic over supply of glucose from diet and liver excess release to arrest rhe excess fat loading of pancreas and liver. The other issue from this person from peanut galley is to remove excess glucose and oxidation products constantly bathing the pancreas islets to allow them to return to more normal conditions and provide insulin.
I did 1200 calorie diet and saw with longer delay; the return of islet insulin production.
my read is Dr. Taylor are on target using 23rd century tools to investigate this mess. My deepest blessings and thanks!
My pleasure, Jim. Thanks for your comments. I look forward to reading the scientific report of the 600 calorie/day diet. That is extreme, and would likely need professional medical oversight. High risk for nutrient deficiencies, etc.
In other words, his protocol works via carbohydrate restriction.
On a 600kcal per day diet – even if a T2D subject continued to eat the mainstream recommended 55% of total daily calories as dietary carbohydrate – this would equate to 330kcals or 82.5g of carbohydrate per day.
Even the most ‘liberal’ of advocates say that getting daily carb intakes to 100g or less constitutes a carbohydrate-restricted or ‘low carb’ diet.
Alex, it’s probably more accurate to say that it works via calorie restriction. At 600 cal/day, all the macronutrients (protein, fat, carb) are greatly restricted. You could tinker with the macro ratios in many ways it would still work, although some ratios will be safer than others. I haven’t see the study diet yet, but bet it had a relatively high ratio of protein.
I personally still think the reduction in dietary carbohydrate is the key factor rather than the restriction of overall calories. If it was just a case of caloric restriction and attendant fat loss being the key factors then how do you explain the number of studies showing similarly remarkable results for low carb diets that are not restrictive of calories and where any attendant weight loss has been corrected for?
You may find http://www.ncbi.nlm.nih.gov/pubmed/23320491 interesting, where the public response to the original work is documented.
Thanks for that link, PhilT. I recommend everybody click on it. Diabetes reversal was linked to degree of weight loss. The linked abstract talks about glucose in mmol/l; to convert to mg/dl (standard U.S. units), multiply by 18.)