Paleo, Type 2 Diabetes, and "Getting off meds" with Diet and Lifestyle

According to the CDC, almost half of Americans are on at least one prescription drug. 20% are taking at least three, and 10% are taking at least five.

Since so many of these drugs are prescribed for diet and lifestyle-related diseases, it’s no surprise that “getting off meds” has become the ultimate Paleo success story. “I reversed my diabetes and got off insulin or good!” It’s the ultimate triumph of healthy food over “diseases of civilization.”

There’s a lot of truth to that. Paleo has helped a lot of people get off medication, and it is inspiring read about. If that’s you, kudos! But those success stories often come packaged with a totally unhelpful narrative that demonizes the “evil” medications as something you shouldn’t need if your diet is good. And for a lot of people, that’s just not true.

It’s true that diet can help people reduce or even get off meds, but it doesn’t actually have to be an either/or choice. Medication and lifestyle changes can complement each other – “I got off meds” is not the only success story that counts. Chronic diseases are complicated, and there’s no reason why Paleo and metformin can’t coexist.

Diet vs. Medication for Diabetes

If you look only at drug-based treatments, diabetes looks like a chronic, progressive disease that only ever gets worse. The best-case scenario is to slow down the course of the disease.

This study tracked the progression of typical care for Type 2 diabetes in the UK. Patients typically started with one medication after their HbA1c (a long-term measurement of blood sugar control) got too high. But eventually one medication wasn’t good enough and HbA1c went back up, higher than it was before. Then they went on a second medication. That brought HbA1c down temporarily, but it went back up again. Then they went on a third medication…you get the idea.

The medications only worked temporarily, and patients had to keep adding more and more. Adding more drugs didn’t help control blood pressure or weight – in fact, some of the drugs made patients gain weight. It’s a really depressing picture of what patients can expect from diabetes management.

But what if there was an alternative to adding more medications that didn’t work? This study didn’t mention diet and lifestyle approaches at all. (That might be because one of the authors is an employee of AstraZeneca, a pharmaceutical company that makes a bunch of diabetes drugs.)

This study didn’t have any such conflict of interest. The researchers looked at patients with Type 2 diabetes who didn’t want to increase their medication use when their HbA1c went up. Instead of giving their study subjects any different or additional medication, the authors suggested some basic diet and lifestyle changes (basically “don’t overeat” and “work out for a few hours every week”). Patients followed their diet and exercise recommendations were much more likely to see their blood glucose control improve and their HbA1c go down – without adding any more meds. For a lot of their patients, diet and lifestyle changes worked as an alternative to endlessly adding medications that only help in the short term.

So is diabetes really such an inevitably progressive disease? Or does it only look that way from the perspective of drug-based treatment? Can diet and exercise actually turn it around?

Diet for Preventing and Treating Diabetes

Diet interventions and a few hours of exercise a week significantly reduce or even eliminate the need for diabetes medication – especially if the diet restricts refined carbs and you provide social and behavioral support to make it easier to stick with.

This study showed that diet and exercise was almost twice as effective as metformin in preventing diabetes among a high-risk population. The study looked at subjects who had problems with glucose tolerance – their blood sugar regulation wasn’t working very well. Diet and lifestyle interventions (7% weight loss and at least 2.5 hours of exercise a week) reduced diabetes incidence by 58% compared to a control group. That was much more effective than metformin (31% reduction). The benefits of lifestyle over metformin were still visible 10 years later.

A bunch of studies also show that diet and exercise interventions help people who already have diabetes reduce or discontinue medication, especially if the diet is reasonably intelligent about carbohydrates.

• In this study, women with gestational diabetes (diabetes during pregnancy) got either a control diet or a diet low in refined carbohydrates. At the end of the study, half the women in the low-refined-carb group got off insulin.
• In this study, a low-carbohydrate diet (14% calories from carbs) was twice as effective for lowering medication use in people with type 2 diabetes than a high-carbohydrate (53%) diet. In the low-carb group, at least 31% of subjects achieved a significant reduction in blood sugar medication, compared to 13% in the high-carb group.

Sustainability Matters.

This study also emphasized the importance of a sustainable diet. The study compared a “group lifestyle intervention” to a one-time referral to a dietician. The group lifestyle intervention included a once-a-week meeting where a dietician went over skills like setting goals, forming habits, and addressing cravings.

The program was based on a pretty typical low-calorie diet and about 3 hours/week of moderate physical activity. The diet was kind of gross (full of processed meal-replacement junk food and way too low in energy to be sustainable), but the important point here is that the group intervention taught people behavioral skills and social support, like what to do when you’re craving, or how to make good habits so healthy eating is easy.

In the group intervention, 82% of subjects improved so much that they stopped or reduced non-insulin diabetes medications, and 86% got off insulin. Compare that to 38% and 44% of patients who were simply referred to a dietitian. Diets for reversing diabetes work better when they’re psychologically easier to stick to and there’s a high level of social support – in other words, when the diet is actually sustainable in the long run.

All of that adds up to pretty substantial evidence that the most basic of diet and lifestyle interventions can give insulin and metformin a run for their money when it comes to diabetes control. And that happened even in the studies using high-carb, low-fat diets (which is exactly the opposite of what most Paleo eaters find helpful for diabetes).

Now imagine if you replaced all the low-fat, low-calorie, meal-replacement-bar junk in these studies with Paleo foods. Imagine if your diet addressed aspects of type 2 diabetes like inflammation, the health of your gut biome, and potential autoimmune components. Imagine if you made an effort to include anti-diabetic foods like non-starchy vegetables and antioxidant-rich spices. Is it really any surprise that if you take an effective intervention for getting people off diabetes medication and make it even better, it helps people get off diabetes medication?

It’s Not Just About Getting off Meds.

But even though it’s cool to imagine people righteously burning up their prescriptions, the reality is that some people won’t be able to get off medication just by eating Paleo, and that’s OK. “Paleo got me off meds” isn’t the only success story worth telling. “Paleo helped reduce my insulin use” is just as worthy, and for that matter, so is “Paleo got my meds to actually work.”

There’s plenty of evidence for this happening. For example, adding lifestyle intervention to metformin is better than just providing the drug alone. This study found that probiotic and prebiotic supplements made antidiabetic drugs (metformin, in this case) more effective in mice. Paleo gut-biome nerds, take note!

Remember how antidiabetic drugs slowly became ineffective over time? What if diet and lifestyle could stop that? Wouldn’t that be a victory even if it didn’t completely get the person off medication?

Summing it Up

Personal anecdotes aren’t the only evidence for diet and exercise as a way to help reverse diabetes. There’s actually a lot of evidence that lifestyle changes can reduce dependence on medications or even get people off drugs completely. But on the other hand, nothing is a miracle cure, not even Paleo. It’s great if Paleo helps someone get off insulin or metformin or some other drug, but eating Paleo and taking medication aren’t mutually exclusive, and getting off medication isn’t the only success story worth telling.