Google the phrase "reverse diabetes," and you get millions of results — along with endless books, articles, and products that all promise something that may sound too good to be true.
But there is one seeming bit of health hype that is indeed true — for some people, with some limits.
Reversing type 2 diabetes — or at least putting it into remission for years — is possible, according to George King, research director and chief scientific officer at the Joslin Diabetes Center in Boston. Note, however, that reversal does not mean cure. The underlying condition is still there, and symptoms will come roaring back if the careful steps taken to manage them aren't continued. And eventually, even very careful patients may again need to resume diabetes medications. But any time spent in remission, doctors say, can have long-term health benefits.
Strict diet and exercise are the remission remedies at the heart of King's book, Reverse Your Diabetes in 12 Weeks. It's no wonder there's a huge market for his book and others on the theme: In the United States, 9.6 percent of adults 20 years or older have been found to have diabetes, and health officials estimate that 3 percent more have undiagnosed diabetes.
Still, he said: "The strongest support comes from bariatric surgery. Of people who undergo bariatric surgery and who have been on diabetes medications for years, fully 50 to 60 percent of these people can go off all medications in five years." But again, weight loss surgery is no panacea: After a few years, symptoms can require at least some medicines.
Even without surgery, it had long been known that at least 10 percent of people who go on a very strict diet, lose weight, and increase their activity can get off all medications for type 2 diabetes and stay off them for 10 to 20 years, King said.
"What that tells me is that it's definitely possible to reverse type 2 diabetes; you just need to find the correct path," King said.
One caveat, he says, is how long you've had the disease. Diabetes is a condition in which the pancreas cannot properly produce insulin to regulate levels of glucose in your body. Over time, this can cause the pancreas' beta cells to burn out, making it more difficult to compensate for the body's inability to use insulin effectively. (Type 1 diabetes cannot be reversed because in this condition, the pancreas stops producing insulin altogether.)
"But most people with type 2 diabetes have enough residual beta cells that if they take the pressure off their beta cells with diet and exercise, their health will improve," King said.
Elina Veksler, 41, is living proof. At 5 feet, 2 inches and 250 pounds, the Philadelphia mother took medication for type 2 diabetes, high blood pressure, and high cholesterol. She's had diabetes since 2005, when she was admitted to the hospital with a blood sugar reading of 475 — nearly five times the level considered normal. Diabetes ran in her family: Both parents and her grandmother had the disease and her father and grandmother had died from complications of type 2.
"I wanted to be around for my children," Veksler said. "After I had my youngest child my knees and ankles hurt from the weight I was carrying around and my C-section wasn't healing right. All I could think about was how will I play with my baby? How am I going to walk with a stroller? I didn't want my child to be obese or diabetic."
After her father's death in December 2016, Veksler became a vegetarian. "I went cold turkey," she says. "No grains, no carbs, no sweets, no eating at night, no meat." Eventually, she gave up dairy and in March 2017, switched to a vegan diet. Now, she limits herself to raw fruits – mainly berries and apples – raw vegetables, nuts, homemade nut butters, seeds, and a single low-sugar chocolate bar a day.
Two or three times daily she heads to the gym for a workout and has also started to run.
The result? A 102-pound loss, and remission of her type 2 diabetes. Her blood sugars have dropped to readings in the 80s and 90s.
"Diabetes is definitely reversible," she said.
Losing weight and increasing energy expenditure are key to that kind of success. So is timing: Patients who get to work on reversal soon after they are diagnosed have the best chance of putting the disease into remission.
And starting the regimen even earlier – when you're in the prediabetes stage – is an opportunity to avoid entirely the disease and its life-altering complications.
"It's not clear that the damage done by diabetes can be reversed," said Ajay Rao, assistant professor of medicine at the Lewis Katz School of Medicine at Temple. Nor are all patients able to manage what may be a dramatic lifestyle change.
Still, Rao said: "It's a wonderful idea and goal for patients to have. Particularly when they are first diagnosed."
It doesn't necessarily take getting down to some imagined "ideal" weight to enjoy the benefits of reversing diabetes, or even just being able to reduce the amount of medication needed.
Losing weight can be especially difficult in people who are insulin resistant and can't make enough insulin to keep up, said Mark Schutta of the Rodebaugh Diabetes Center at Penn.
"But if these patients lose a certain percentage of their body weight, and we start tapering off the drugs once their A1C – a three month average of their daily blood sugars – is in normal range, they can be said to be in remission," he said.
Staying there is even more challenging. "If they regain their weight, if they decrease their activity, if they need to go on steroids, or get pregnant, however, they can once again have gestational diabetes or type 2," he said.
Schutta notes that his patients have lost significant amounts of weight with vegan, vegetarian, and diets that allow animal protein. Diet is a personal topic, both emotionally and physically. That's why it's useful to see a nutrition professional who can help you understand how what you eat and how you move affect glucose levels. Schutta warns against faddish diet information online, because there are "lots of trendy diets and diets that aren't scientifically backed that don't help patients."
Today, Veksler takes no medications. She no longer has high cholesterol or high blood pressure and, lately, she's been clearing her closet of her size 18 clothes and replacing them with size small.
Even her shoes no longer fit.
"I decided I wanted to be around for my children," Veksler said. "All doctors can do is help you control doses of medication. A person needs to choose to lead a healthier lifestyle."
"It's not only the diet," she says. "It's a commitment to life."