What is true is that everyone with type 2 diabetes is carrying more weight than their body can cope with. In other words, the problem is not the number of very, very heavy people: it’s the vast majority of us who are heavier than is ideal.
The trouble is that many regard themselves as having a normal weight because they look similar to other people of the same age.
But the key is that they weigh more than they did in their 20s (as growth has stopped by the early 20s, this weight is a rough yardstick of an ‘ideal’ weight). And where that extra fat ends up. As my team at Newcastle University and I have discovered, it’s what this fat does in the pancreas that is particularly significant.
The pancreas, which is hidden deep behind your stomach, is the most important organ in diabetes, and thanks to our groundbreaking work, we know that losing weight can transform its health.
Losing weight helps (ironically, perhaps) by getting the pancreas to fill out
The trouble is that many regard themselves as having a normal weight because they look similar to other people of the same age, writes Roy Taylor, who is Professor of Medicine and Metabolism at Newcastle University
Then I came across research that showed losing weight rapidly after weight-loss surgery can reverse high blood sugar levels, and strip the liver of that fat. I decided to replicate this effect using a very low-calorie plan to trigger rapid weight loss in a short period.
The results of our study with type 2 patients were stunning — within seven days their blood sugar levels had dropped to normal. Among those who contacted me after our results were published in 2011 were people with type 2 diabetes who had a ‘normal’ BMI — they said that after losing weight using our plan, their blood sugar levels had returned to normal, too.
This is when I hit upon the personal fat threshold (PFT) concept — basically, this means that we all have our own tolerance for weight gain. And it’s your PFT that determines if you’ll get type 2.
Let me explain using the example of a patient I’ve advised but whose story is typical of many. Harry, who was in his 40s, looked slim and his BMI was 24, in the ‘normal’ weight range, and yet he developed type 2 — why?
The clue was that 20 years or so before he was diagnosed, Harry had been slimmer and since then he’d increased his BMI by about three units. He’d become too heavy for his own body — and through no fault of his own, he was more susceptible to just a moderate amount of fat.
And when he lost weight — just under 2st (12kg), getting his BMI down to 21 — he reversed his diabetes. Some heavy people, thanks to their genes, have apparently endless storage capacity — so while they acquire more and more fat, although it may look excessive, it is stored safely, rather than spilling over into the liver and then the pancreas.
Not everyone who steadily puts on weight during their adult life will develop type 2 diabetes. Some people are much more susceptible. What is certain, though, is that if you have type 2, you’ve become too heavy for your body.
Falling into the weight gain trap
Food is used to fuel the body. And a healthy body is highly efficient at getting the most out of the food it receives.
After you finish a meal, what you have eaten is stored away to provide a supply of sugar and fat.
Energy from these stores is needed throughout the day and night. And in normal health, both of these processes — the storage of food and its later use — are tightly controlled. The secret of how this happens lies in the amazing hormone insulin.
Insulin is made in the pancreas. Quietly going about its business, it puts the right amount of insulin into the blood minute by minute.
Normally, as soon as you take your first mouthful of any food, your body starts to break it down. All the starchy food is turned into sugar and that rapidly gets into the blood.
For instance, from an ordinary helping of pasta, about 30 teaspoonfuls of sugar are released — 30 spoonfuls!
Your body will get almost the same effect from eating the pasta or the sugar, except for slight differences in the speed at which it gets into the blood.
To deal with this sudden rush of sugar, your pancreas normally makes lots of insulin, which allows the body to use the sugar or store it away.
So why do things start going wrong?
Your remarkable body can cope with any mix of foods, but there is one thing that it may struggle with: a little too much food too often over many years.
It can be difficult to imagine what an extra tiny amount each day adds up to over time, but, to give you an idea, an extra small apple every day, for instance, will add around 4 lb to your weight in a year. Which means that ten years later you will be 40lb heavier! That is 2 st 12 lb (or 18kg).
If even an apple can make me put on weight, you may ask, why should I bother making ‘healthy’ choices?
That’s because all foods are not equal. Certain types of food are more satisfying, and will keep you feeling full for longer, whereas others with the same calorie content are more rapidly absorbed by the body, after which you will quickly feel hungry again.
So the type of food you eat affects the amount you eat overall. For instance, it’s easy to see that an additional two squares of milk chocolate (similar calorie count) are far more likely to slip down than an apple every day. Similarly, if you eat a ready meal (likely to have lots of added sugar), you will probably feel hungry an hour or so after, and might eat more.
But a meal of meat and plenty of fibrous vegetables which has the same calories as that ready meal will leave you feeling satisfied for much longer and stop you snacking.
Three steps to better health
Targets
For most people it’s the same, whether you weigh 12 st or 24 st: as a rule of thumb, losing 2½ st (about 15 kg) will be sufficient to take you below your personal fat threshold, strip the fat from your organs and return your blood sugar to normal.
If you weigh less than 12½ st and have type 2, it’s better to think about losing about 10 per cent of your body weight. The approach we developed at Newcastle University to reverse type 2 is simple:
PLAN
this perhaps good for persons who are not diabetic as well. ( slanka)
1. Rapid weight loss (eight weeks)
This is very different from the standard, steady-as-you-go approach and while the effect of removing fat from the liver and pancreas is the same whether weight loss is over two months or 12, losing the weight quickly is easier. You’ll have 700 to 800 calories a day — replacing a meal with a complete nutrition drink is the easiest option (find them in supermarkets and chemists). Do discuss your plans with your doctor in advance.
2. Return to normal eating (four weeks)
WE suggest starting by replacing your evening shake with a small meal; after two weeks, replace your lunch shake with another small meal, then two weeks later add in breakfast and stop all shakes (each meal is 400 to 500 calories).
3. Keep the weight down long term
As a rough guide, you’ll need only three-quarters of the calories you used to eat. For details for the three steps, see my new book.
When you eat more than your body needs, it has to find somewhere to store the extra fat. To begin with, fat will build up under the skin. It can be stored there safely — up to a point.
Then it will start spilling over into the organs of the body, particularly the liver and the pancreas. And this is where it causes type 2 diabetes — in those people susceptible to it.
Most people can tolerate too much fat in the pancreas, and never get type 2 diabetes. But if your pancreas happens to be less able to cope with fat, then you will run into trouble. It is the luck of the draw, depending on which genes you inherited.
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