Headlines vs Science: Calorie Restriction and Diabetes

The PR for a new analysis of dietary strategies for weight management in diabetes certainly is an attention grabber. The only trouble is that the headlines don’t line up with the science and real world outcomes in diabetes. The press release says:

Low energy diets and meal replacements appear best for kicking diabetes

But in fact, the analysis showed modest results compared to the press release. The press release talks about “almost 80 percent of people with T2D” on such a diet having a remission that lasts for two years.

But to come up with such a high number required caveats. That big number pops up only if people lose sufficient weight, and if they have not had type 2 diabetes for a long time – and only in some studies.

Facts Are Stubborn

Stepping back from the puffery, the facts are more daunting. Long-term remissions of diabetes through dietary interventions alone are not common. In the current paper, researchers found one-year remission rates as low as 11 percent. The best they found was 54 percent for patients receiving a low calorie total diet replacement.

A new study in PLOS Medicine tells us that 4.8 percent of patients in Scotland have a remission after a diagnosis of type 2 diabetes.

So really, science tells us the outcomes for persons with high body weight and type 2 diabetes are more modest than the headlines suggest. Simply stated, if you take away a person’s food and give them only limited portions with few enough calories, they are more likely to lose weight than they will with other diets. Then, if they lose enough weight (more than ten kilos or ten percent of initial weight), they might have a short-term remission in their diabetes.

In reality, diet can certainly help with diabetes, but “kicking diabetes” is not the average outcome for dietary approaches.

Serious Pursuit of Remission

Going for a remission in type 2 diabetes is certainly a good ambition. This is a disease that will slowly destroy a person’s health in many ways. Achieving and maintaining a lower weight can help, because the adipose tissue that accumulates in a person with both obesity and type 2 diabetes is promoting systemic inflammation that causes much of the harm to health.

Different approaches work for different people and no one approach is right for everyone. But for the moment, the most effective single treatment for a person with both obesity and type 2 diabetes is bariatric surgery. We have good outcome data for up to a decade that tells us it is more effective than typical medical and dietary approaches.

Yes, some people will benefit from very low calorie diets and meal replacements. When they do, that’s great. But over the long term, most will not. So the PR spin to say that those approaches are “best for kicking diabetes” seems misleading and inappropriate.

Click here for the study and here for the press release. For data on how uncommon remissions of typ2 two diabetes are in the current environment for medical care, click here.

The Revolt, painting by Luigi Russolo / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

November 22, 2021