How to Reverse Type 2 Diabetes

In recent years, diabetes — both types 1 and 2 — has become a runaway epidemic, says nephrologist Jason Fung, MD, author of The Diabetes Code. “Since type 2 diabetes constituted about 90 to 95 percent of all diabetes, this was a pretty serious problem,” Fung says. But the American Diabetes Association (ADA) no longer considers type 2 diabetes as an inevitably chronic and progressive disease. Indeed, type 2 diabetes can be reversed, he explains. We spoke to him about the disease and his treatment approach.

Experience Life | We used to fear that type 2 diabetes was a life sentence. But new evidence says this is not the case?

Jason Fung | Type 2 diabetes is largely a dietary and lifestyle disease, and reversing it does not require drugs, but a change in the diet and lifestyle. If people lose weight, their diabetes would either get much better or go away. Many, many scientific studies showed this exact same thing.

I published The Diabetes Code in 2018, which said in plain English that the idea that type 2 diabetes is irreversible is a lie and a particularly dangerous one, because it would lead people to give up hope for remission. Several years after that (2021), the ADA published criteria for remission, tacitly admitting that this indeed was reversible disease.

EL | Do conventional treatments that rely on insulin or other blood-glucose-lowering drugs help, or can they exacerbate the problem, leading to other concerns, such as weight gain and even heart disease?

JF | There are many types of drug treatment for lowering blood glucose — some good, some bad, and some downright ugly. Dietary treatment is always best because that is the root problem. However, drugs certainly have their place in treatment.

We know that obesity and type 2 diabetes are closely related. The newest medications — GLP1 [agonists] and SGLT2 inhibitors — lower blood glucose but also tend to cause weight loss, so they’re good. Metformin and other DPP4 inhibitors are usually weight neutral, so they’re also neutral.

The older medications, which include insulin and sulphonylureas, are downright ugly because they cause weight gain.

Consider this scenario, which is all too common, even now: An overweight patient was diagnosed with type 2 diabetes and eventually put on insulin, which was considered first-line treatment only a few years ago. This insulin causes them to gain weight — some 20 or 30 pounds. As they gained weight, their type 2 diabetes got worse. This meant they needed more insulin. Which caused more weight gain. Which made them need more insulin. And so on.

This patient’s blood glucose was getting better, but their type 2 diabetes was getting worse. Does this seem to be a good treatment? It’s rather like treating alcohol withdrawal with more alcohol. Yes, the shakes get better, but the alcoholism, the actual disease, was getting worse.

EL | What is your recommendation for treating type 2 diabetes effectively?

JF | Dietary treatment is the most important since this is a dietary disease. The ADA says reducing carbohydrates can aid blood-sugar management. In published, real-world studies you can put about 50 percent of type 2 diabetics into remission with such a diet.

It’s not hard to understand: Carbohydrates are sugar molecules. If you eat carbs, which your body breaks down into glucose, your blood glucose (blood sugar) goes up. If you eat proteins and fats (you are eating amino acids and fatty acids), then you are not eating sugar and your blood sugar does not go up. That is, some foods — especially carbs — raise blood glucose and other foods don’t raise blood glucose. Obviously, it makes sense to eat more foods that don’t raise blood glucose and less of those that do. In sum, reduce carbohydrates.

This effect is clear in a food’s glycemic index (GI), which measures how much blood sugar goes up with certain foods. Some foods raise blood sugar a lot; others not at all. It only applies to carbohydrate-containing foods because the glycemic index of an egg is zero. GI for beef is zero, etc.

The other significant way to treat type 2 diabetes is intermittent fasting. Again, not hard to understand: If you don’t eat, your body will start burning the excess glucose in your body. If your blood glucose goes down, you don’t need medications to do it. Eventually, you can stop all medications, which means remission.

EL | Is it possible to reverse type 2 diabetes even if you’ve had it for a number of years, or is this mostly if you catch it in an early stage?

JF | It is reversible in most cases but not all. It depends upon how long you’ve had diabetes and how severe it is. It’s best to catch it early, but I’ve seen people reverse their disease even with a 20-year history of the disease.

EL | What do you recommend for type 2 diabetes prevention in the first place?

JF | I recommend the same things: reduce refined carbohydrates, practice intermittent fasting.

Fasting is a part of everyday life. If you don’t eat after dinner (say, 7 p.m.) until breakfast the next day (say, 8 a.m.), that is a 13-hour period of fasting that you should have every single day without thinking about it. It’s normal. The very word “breakfast” suggests that you must fast, and then break your fast, meaning it’s just a part of a normal cycle — there is a time to eat (feed) and a time to not eat (fast). If you keep those cycles balanced, you should be OK.