By Richard Doughty
'Why me, I’m so thin?’ was the question I asked myself when diagnosed with type 2 diabetes three years ago, at 59.
Surely it only happened to overweight people.
A thin, healthy, ‘eat as much as you like’ guy like me should be fine.
Yet an annual test at my GP surgery revealed I had high blood sugar — 9millimoles per litre, while a normal level is 4-6mmol/l. Tests confirmed I was type 2 diabetic.
In type 2, the pancreas does not produce enough insulin to keep glucose levels normal (in type 1, it stops producing insulin altogether), and if I didn’t take action I could suffer bad sight, poor kidneys, heart failure and strokes.
I could eventually be on medication, and, most alarmingly, would be 36 per cent more likely to die early.
The condition affects more than two million people in the UK, with numbers expected to soar in the next decade.
The increase is blamed on rising obesity levels, as diabetes is thought to be triggered by excess weight.
But I have always been a healthy weight (I am 5ft 7in and weighed just 10st 7lb at the time), had no family history, ate a fairly healthy diet, never smoked, and did not have a sweet tooth.
However, new research may provide an answer.
Although doctors have thought the overweight are at more risk of type 2 diabetes, a ground-breaking study from Newcastle University produces evidence that thinner people may be just as prone.
This suggests that body mass index, or BMI — a measure of weight compared with height — is an inaccurate predictor of diabetes risk. Instead, your risk depends on how well your body can store fat.
And this fat may not be visible on our hips or tummy — but would be inside our organs.
Crucially, seemingly healthy-weight people can have a high amount of fat in their internal organs.
The theory is that diabetes is triggered by fat clogging the liver and pancreas, which are crucial for producing insulin and controlling blood sugar.
But it seems some people are more likely to store fat around these organs — and the likelihood of doing this is independent of weight.
In the medical breakthrough, scientists, led by Roy Taylor, professor of medicine and metabolism, have found evidence suggesting anyone — even if they are normal or low weight — can become diabetic despite thinking they eat healthily and do enough exercise.
The research, published in a paper on the website of the scientific journal Clinical Science, refutes the view held by many doctors that type 2 is solely a result of obesity or being very overweight.
‘We all have a personal fat threshold,’ says Professor Taylor.
‘If your body fat levels rise above that, you are likely to develop type 2 diabetes.’
Once someone rises above this threshold, their body’s ability to control blood sugar starts to slowly wear down, until it malfunctions, he explains.
‘Excess fat accumulates very slowly in the liver, and then in the pancreas.
'This triggers slowly progressive changes which eventually reach a breaking point, when the insulin-producing cells of the pancreas can no longer respond to the meal-time rise in blood glucose.
‘All the information we have suggests when people get fatter than they can tolerate, it can take ten years for all the glucose control systems in the body to be broken down and for diabetes to appear.’
Contrary to the almost universal view of doctors that type 2 in non-obese people has a different cause from common obesity-related diabetes, the professor says it is simply a disease of too much fat for the individual.
His latest research also suggests we should no longer rely on BMI as a key risk indicator.
A BMI reading, while still a good guide to general health and weight, cannot be relied on as an individual reassurance or a warning about type 2 because the research shows the likely onset of the condition depends on individual susceptibility.
The research reveals that one in every two people diagnosed with type 2 are not obese (with a BMI over 30) but simply overweight (between 25 and 29.9) or healthy (between 18.5 and 24.9).
The research team used data from the giant United Kingdom Prospective Diabetes Study of 5,102 people with newly diagnosed type 2 enrolled between 1977 and 1991, which is the basis of much current understanding of diabetes.
Around 10 per cent of those with type 2 diabetes — 200,000 people — are of a healthy weight.
Professor Taylor’s team are still unclear what determines a person’s individual fat threshold, but they are planning further studies.
Closer analysis of the data published also showed that, regardless if participants were obese, overweight or normal, a modest number reversed their diabetes by losing a specified 5 kilos.
This was proof each had their own fat thresholds.
This supported later work from Professor Taylor’s team, which suggested that if diabetics lost just a sixth of their body weight they had every chance of reversing their condition.
It’s thought that losing weight rapidly somehow helps clear fat in the liver and pancreas, helping return blood sugar control to normal.
After coming across Professor Taylor’s research shortly after my diagnosis, I managed to reverse my diabetes — in just 11 days.
The diet was just 800 calories a day made up of three food replacement supplements — a soup or a milkshake — at 200 cals each, 200 cals of green vegetables, and 2-3 litres of water or herbal teas.
I had already lost a stone under advice from my GP, but the Newcastle diet proved challenging — I sometimes felt very cold, tired, and detached, but was delighted to see my glucose levels plummet and weight drop off.
After 11 days I’d lost another 9lb to reach my target weight of 8st 12lb, and glucose level of 5.3mmol/l.
Once people have lost the weight required to reverse their diabetes, Professor Taylor recommends following a healthy balanced diet.
His research suggests the diet can reverse even long-standing diabetes, diagnosed up to eight years before.
How long does the reversal last?
‘We don’t know, but it’s three years since a large number of people successfully completed the diet and some say their glucose levels remain normal,’ says Professor Taylor.
55% The proportion of British adults who don’t view diabetes as a health risk
He first trialled the diet four years ago after he became intrigued by the observation that type 2 diabetes is reversed following gastric bypass surgery.
He realised that suddenly and drastically reducing food intake could prove beneficial.
‘If people are over-nourished and food is easily available, numbers with diabetes go up quite sharply,’ he says.
‘But we know now that if a population is starved through, say, natural disaster, the incidence reverses sharply.’
But if you starve your body of energy on a carefully worked-out diet of just 800 calories a day (for up to eight weeks, depending how much weight you need to lose) and force it to use up its reserves of fat, your organs can return to full function.
Dr Richard Elliott of Diabetes UK, which is funding trials of the diet, stresses that weight is still a significant factor in diabetes risk.
‘We know around 90 per cent of people who develop type 2 diabetes nowadays are either overweight or obese.
'However, this study helps to explain why some people do not need to gain much extra weight to develop type 2.
‘This in turn could be important in helping us understand the dramatic rise in cases of diabetes, which is predicted to grow from more than three million people now to five million by 2025.’
Professor Taylor, meanwhile, advises curbing calories over the festive period to help reduce our risk of diabetes.
‘It’s important to celebrate, and if you eat 5,000 calories on Christmas Day and have a wonderful time, great, but you must then cut back to around, say, 1,500 a day for the next week.
‘Party, but pay-back!’
Lorna Norman was considered to be a healthy weight.
The 5ft 4in 76-year-old weighed 10st 4lb, meaning she had a BMI of 24, within the ‘healthy’ range.
So the grandmother, a part-time administrator at an accountancy practice, was surprised to be diagnosed as borderline type 2 diabetic in 2007.
However, despite following a vegetarian diet and a healthy lifestyle of walking, swimming three times a week and yoga twice a week, her blood sugar levels remained high.
Last year, her GP told her she would need to take medication to control her diabetes — something she was ‘just not ready for’.
Then that summer she read about the Newcastle low-calorie diet in the Press, took a suitable food replacement product of shakes and soups, and within a month had lost a stone to reach her target weight of 8st 7lb (she had already lost some weight), and her glucose levels dropped to a healthy non-diabetic 5.5mmol/L.
‘The longer I did it, the less hungry I was,’ she says.
In September last year, two months after she came off the four-week diet, she was told her blood sugar readings were normal, and she was no longer diabetic.
She now adjusts a normal healthy diet to keep between 8st 9lb and 8st 12lb and watches her carbohydrate intake.