A claim you hear on longevity podcasts
Leaning for. Of 9 studies that test it, 8 partly agree and 1 agrees.
The claim checked: People with type 2 diabetes on insulin for years can be off it within three days, and normal in three months Hear it at 0:03
Only one of nine studies agrees, and it followed 3 men: they stopped insulin after 5 to 18 days of fasting. Eight are mixed. In larger trials, people came off insulin over weeks or months, not days: 39.4% at 12 months in one trial, and 31 of 78 in another. Others cut their dose rather than stopping.
Computed from 9 studies that test this point, each judged by two readers, in full. 10 more studies are waiting for a full read and do not count yet.
“I I've taken people who are type two diabetics, who are on insulin for ten years, who are so sick and massively overweight. And within three days, they're off the insulin.”
other primary study · 2018
“The minimum number of days to discontinuation of insulin was 5 and the maximum was 18.”
Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. BMJ Case Rep
Who: 3 men aged 40-67 with type 2 diabetes for 10-25 years, each on at least 70 units of insulin daily
PMID 30301822
controlled trial · 2021
“Furthermore, exploratory subgroup analyses suggested that the mean effect of the intervention was not substantially different between men and women, or insulin users versus non-users.”
A randomized controlled trial of pharmacist-led therapeutic carbohydrate and energy restriction in type 2 diabetes. Nat Commun
Who: 188 adults aged 30-75 with type 2 diabetes (mean duration 8.8-11.8 years), BMI >=30, on at least one glucose-lowering medication (some on insulin), recruited at 12 community pharmacies in British Columbia
PMID 34508090
controlled trial · 2020
“At 12 months, 13 of 33 (39.4%) participants in the intervention group had discontinued insulin compared with 2 of 36 (5.6%) in the control group (p<0.001).”
Low-energy total diet replacement intervention in patients with type 2 diabetes mellitus and obesity treated with insulin: a randomized trial. BMJ Open Diabetes Res Care
Who: 90 adults aged 18-70 with insulin-treated type 2 diabetes (median diabetes duration 12-13 years, median insulin duration 4 years) and BMI >=30, at two London hospitals
PMID 32049634
other primary study · 2018 · landmark
“Forty percent (31/78) of CCI participants who began the study with insulin prescriptions (average dose of 64.2 units) eliminated the medication, while the remaining 60% (47/78) of insulin users reduced daily dosage from 105.2 to 53.8 units ( P < 0.0001).”
Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther
Who: Adults with type 2 diabetes (mean ~8.4 years since diagnosis, ~30% of intervention group on insulin) in Lafayette, Indiana, self-selected into a continuous remote care ketogenic intervention or usual care
PMID 29417495
controlled trial · 2023 · landmark
“At 12 weeks, the IF group had an insulin dose of 45 ± 19 IU while the control group had an insulin dose of 63 ± 35 IU, resulting in a total daily insulin dose reduction in the IF group over 12 weeks by 9 ± 10 IU as opposed to the control group with an increase by 4 ± 10 IU ( P = 0.008).”
Efficacy and Safety of Intermittent Fasting in People With Insulin-Treated Type 2 Diabetes (INTERFAST-2)-A Randomized Controlled Trial. Diabetes Care
Who: 46 adults aged 18-75 (mean 63) with insulin-treated type 2 diabetes, mean diabetes duration 21 years, HbA1c >=7.0%, insulin >=0.3 IU/kg, in Graz, Austria
PMID 36508320
other primary study · 2005
“More importantly, this improvement was observed while diabetes medications were reduced or discontinued in 17 of the 21 participants, and were not changed in the remaining 4 participants.”
A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond)
Who: 21 completers (20 men) aged 35-75 with type 2 diabetes and BMI >25 (mean 42.2) at Durham VA outpatient clinics; 8 on insulin at baseline
PMID 16318637
trial or observed group · 2008
“These effects occurred despite the fact that patients had been taken off all blood glucose-lowering medication (including insulin) during the VLED and were still obese at the end of the VLED (BMI = 32.3 kg/m2).”
Loss of 50% of excess weight using a very low energy diet improves insulin-stimulated glucose disposal and skeletal muscle insulin signalling in obese insulin-treated type 2 diabetic patients. Diabetologia
Who: 10 obese (BMI >30) insulin-treated type 2 diabetes patients (8 women, 2 men), diabetes duration 8 +/- 3 years, insulin >=30 U/day (mean 94 U/day), with residual C-peptide, at Leiden University Medical Centre
PMID 18080107
systematic review · 2021
“Finally, Webster et al. reported a decrease in glucose-lowering medications, including discontinuation of insulin in 8 of 11 participants, after 15 months [ 19 ].”
Efficacy of Ketogenic Diets on Type 2 Diabetes: a Systematic Review. Curr Diab Rep
Who: adults with type 2 diabetes in clinical trials and observational studies of ketogenic diets
PMID 34448957
other primary study · 2020
“All patients in the LCHF group either had insulin discontinued (36.8%) or insulin dose reduced (63.2%) by the end of follow-up.”
Effects of the low carbohydrate, high fat diet on glycemic control and body weight in patients with type 2 diabetes: experience from a community-based cohort. BMJ Open Diabetes Res Care
Who: overweight adults (BMI >=25) with type 2 diabetes at Johns Hopkins Community Physicians endocrinology practices; 21 LCHF and 36 usual-care patients on insulin at baseline
PMID 32193200
Two of nine studies agree. In 11 people who had had diabetes for under 4 years, fasting blood sugar fell to normal after 1 week of a very low-calorie diet. In a small trial, more people on a low-carb diet got their A1C below 6.5% by 16 weeks. Seven are mixed: A1C fell, but most people stayed in the diabetes range or kept taking diabetes drugs.
Computed from 9 studies that test this point, each judged by two readers, in full. 9 more studies are waiting for a full read and do not count yet.
trial or observed group · 2011 · landmark
“After 1 week of dietary intervention, fasting plasma glucose decreased from 9.2 ± 0.4 to 5.9 ± 0.4 mmol/l ( p = 0.003; Fig. 1 ) and was not significantly different from that of the non-diabetic control group (5.3 ± 0.1 mmol/l; p = 0.18).”
Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia
Who: 11 completers (9 men, 2 women, mean age 49.5) with type 2 diabetes of <4 years duration, HbA1c 6.5-9.0%, BMI 25-45, not on insulin, plus 9 matched non-diabetic controls, Newcastle UK
PMID 21656330
controlled trial · 2017
“At both 16 and 32 weeks, a greater percentage of participants in the intervention group lowered their HbA 1c to less than 6.5%, the cutoff for type 2 diabetes, compared to the percentage of participants in the control group (intervention group: 9/12, 75% at 16 weeks and 6/11, 55% at 32 weeks; control group: 1/8, 13% at 16 weeks and 0/8, 0% at 32 weeks; Table 3 ).”
An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial. J Med Internet Res
Who: 25 overweight adults (BMI >=25) across the US with type 2 diabetes (mean duration ~5 years, HbA1c 6.5-9%, mean ~7.1%), taking no diabetes drug or metformin only
PMID 28193599
other primary study · 2008 · landmark
“From baseline to 24 weeks, the reduction of mean ± SD hemoglobin A 1c was greater for the LCKD group (8.8 ± 1.8% to 7.3 ± 1.5%, p = 0.009, within group change, n = 21) than for the LGID group (8.3 ± 1.9% to 7.8 ± 2.1% p = NS, within group change, n = 29; between groups comparison p = 0.03) (Table 2 ).”
The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond)
Who: 84 obese/overweight adults aged 18-65 with type 2 diabetes >1 year (BMI 27-50, ~80% women), community volunteers; most on glucose-lowering drugs including some on insulin
PMID 19099589
trial or observed group · 2016 · landmark
“After return to isocaloric eating, 40% (12/30) achieved a fasting glucose of <7.0mmol/l (responders).”
Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders. Diabetes Care
Who: 30 adults aged 25-80 with type 2 diabetes of short (<4 years) or long (>8 years) duration, BMI 27-45, in North East England
PMID 27002059
other primary study · 2018 · landmark
“The NMA also revealed that all dietary approaches significantly reduce HbA1c (− 0.47 to − 0.82% reduction) and fasting glucose (− 1.00 to − 1.61 mmol/l reduction) compared to a control diet.”
A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus. Eur J Epidemiol
Who: Network meta-analysis of randomized trials in adults with type 2 diabetes (mean age 44-67, BMI 25-43) comparing 9 dietary approaches
PMID 29302846
controlled trial · 2022 · landmark
“As shown in Figure 3 , HbA1c levels decreased for both diets, but we did not observe a significant difference between diets [mean percentage changes: WFKD, −9% (95% CI: −11% to −7%) and Med-Plus, −7% (95% CI: −9% to −5%); P = 0.11].”
Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin in individuals with prediabetes and type 2 diabetes mellitus: The interventional Keto-Med randomized crossover trial. Am J Clin Nutr
Who: 33 adults aged 41-77 (median 60.5) with prediabetes (61%) or type 2 diabetes (39%), BMI 22.7-39.7, San Francisco Bay area; T2DM participants on metformin with or without sulfonylurea, insulin users excluded
PMID 35641199
controlled trial · 2016
“However, it is worth emphasizing that the likelihood of achieving HbA1c<7% was twofold in those allocated to the VLCK diet group.”
Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus. Nutr Diabetes
Who: 89 adults aged 30-65 with type 2 diabetes of <=10 years, BMI 30-35, HbA1c <9%, not on insulin, at seven endocrinology centres in Spain
PMID 27643725
controlled trial · 2009
“Participants in the low-carbohydrate arm achieved an initial mean reduction of A1C 0.6% in the first 3 months, but this was not sustained.”
Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care
Who: 105 overweight adults (BMI >=25, mean ~35-37) with type 2 diabetes >=6 months and A1C 6-11% (mean 7.4-7.5%), mostly Black or Hispanic women, Bronx, New York; many on metformin, sulfonylurea or insulin
PMID 19366978
controlled trial · 2020
“Over 3 months, our study found that both a-LCD ( p < 0.01) and LFD ( p < 0.05) improved HbA1c level, while better HbA1c level was seen in the a-LCD group( p < 0.01), which is consistent with our previous research [ 15 ].”
An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial. Nutrients
Who: 45 analysed adults with type 2 diabetes (mean duration 14-16 years, mostly retired) at Soochow University hospitals, China; nearly all on oral glucose-lowering drugs and/or insulin
PMID 33022991
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