Reducing calories intake to just 500 kcal per day may eliminate the need for insulin and improve heart function in some patients with type 2 diabetes, according to a new study.

Researchers at Leiden University Medical Center (LUMC; The Netherlands) studied 27 obese, insulin-dependent patients (14 men and 13 women, average age 55 years) with type 2 diabetes mellitus to investigate the effects of prolonged caloric restriction. The patients received a 16-week very low calorie diet (VLCD). Plasma lipids, lipoproteins, and plasma cholesteryl ester transfer protein (CETP) were measured at baseline and after 16 weeks. Functionality of high-density lipoprotein (HDL) with respect to inducing cholesterol efflux from human monocyte cells (THP-1) was also determined.

The results showed that a 16-week VLCD markedly decreased plasma CETP concentration and increased plasma apolipoprotein (apo)AI levels, without significantly affecting HDL-cholesterol and HDL-phospholipids. The results suggest that the VLCD diet may eliminate the need for insulin and improve heart function in some type 2 diabetics. The patients on the extreme diet also had significant improvement in diastolic function that was durable over 18 months, which correlated with the persistent reductions in pericardial fat. The study was published in the December 2011 issue of Diabetes Care.

“Lifestyle interventions may have greater cardiac benefits than medication. It's striking to see how a simple intervention like reducing caloric intake can diminish the need for insulin,” said study coauthor Sebastiaan Hammer, MD, PhD. “For the first days, coming off insulin is an effect of the diet itself; but afterward, it is an effect of losing weight.”

VLCDs are based on a formulated, nutritionally complete, liquid meal containing 800 kcal or less per day, but contain the recommended daily requirements for vitamins, minerals, trace elements, fatty acids, and protein. Carbohydrate may be entirely absent, or substituted for a portion of the protein; this choice has important metabolic effects. The VLCD is prescribed on a case-by-case basis for rapid weight loss (about 1.5-2.5 kilograms per week) in patients with a body mass index (BMI) of 30 and above.
 

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