Empowered Health Course · Lesson 13 · 3:26
Thinking about type 2 diabetes as a sick-fat disease also shows that treating the sick fat can really help. The main way to do that is to reduce body weight. That's been a big shift in medical management. Before, the primary focus was fixing blood sugar, and often the medicines we had were weight-promoting — good for sugar, but with the downside of promoting weight gain.
Now we have different options. One is bariatric surgery for people with a BMI over 35 and type 2 diabetes. It's been eye-opening: when patients have surgery — especially if they've had diabetes for less than five or six years — diabetes typically goes into remission. We didn't know that was possible. The old thinking was that, by the time of diagnosis, about half the insulin-producing cells in the pancreas had died and wouldn't come back, so diabetes would be chronic and progressive. But when people lose 15, 20, or 25% of their body weight with surgery, the pancreas can come back online, those cells wake up, insulin production picks up, and the ability to store energy improves.
We also have newer drugs — GLP-1 agonists such as semaglutide and liraglutide — hormones that speak to the deep brain to lower body weight. With these, diabetes can be prevented and effectively treated. We don't call it "remission" with these drugs, because part of the definition of remission is being off all blood-sugar-lowering therapy.
There are also dietary interventions that lead to weight loss. One is a meal-replacement system — a very low-energy diet that produces substantial weight loss; losing more than 15 kilograms, for those who've had diabetes less than seven years, gives a very high chance of remission. Another option is a ketogenic diet — though you'll certainly need to talk with your clinicians first, because medication changes need to be made. I'll post a separate talk called "The Scoop on Diabetes Remission" elsewhere. Thanks for listening.
This transcript has been lightly edited from the video for readability. For the complete experience, please watch the video above.