By Dr Attia Anwar

In a few recent studies in newly diagnosed type 2 diabetic patients, it is shown that remission is possible through intensive lifestyle modification and if weight gain is avoided remission can be sustained.
The main interventions for this purpose are a whole plant-based diet and moderate exercise. There are five components of lifestyle medicine increased physical activity, healthy eating consisting mainly of a plant-based diet, adequate sleep, stress management, and avoidance of harmful substances like alcohol and tobacco. If we carefully examine all five components of lifestyle medicine, we will see that they play a necessary role in the prevention and management of diabetes and other non-communicable diseases. Lifestyle medicine is relatively new to many physicians and patients but it is the fastest growing field of medicine. It does not replace conventional medicine rather it makes it work better by focusing more on scientifically and medically proven non-pharmacological approaches towards the treatment of disease. There are proven strategies that can produce remission of diabetes without drugs.
Lifestyle modification not only plays a role in the management of blood sugar but also prevents the complications of diabetes such as diabetic retinopathy, neuropathy, and foot ulcers. This is very important for overall well-being, especially in developing countries where amputees have to face stigma, poor general well-being, and loss of economic power.

Type 2 diabetes can be reversed by healthy living on a whole plant-based diet, weight control, having good sleep hygiene, and avoiding stress as much as possible. These strategies should be added to the optimal treatment of diabetes. Every newly diagnosed diabetic should be given a trial of healthy living before starting pharmacological management. It is also important for the pre-diabetic or people with borderline glucose levels so that they should not progress to full-fledged diabetes.

Modification of lifestyle is the first line of treatment for diabetes mellitus. Weight loss is necessary for type 2 diabetes mellitus and hypertension related to obesity. Exercise and healthy eating are needed to lose weight and both of them are pillars of lifestyle medicine. When we do physical activity and exercise there is physical stress on the body which results in the transportation of glucose to the increased demand of the body. It causes improvement in blood sugar by increased intake of glucose, increased utilization of glucose, improved insulin sensitivity, and protection of the function of insulin-producing cells of the pancreas. Exercise recommended for all adults is at least 150 minutes of moderate physical activity per week.
Remission of diabetes means that the patient does not need medications for a certain period till their blood glucose stays normal. Maybe he never needs them if he sticks to a healthy lifestyle. This is very important and proved by research studies. Although it has long been proven that lifestyle modification is the first line of treatment for diabetes and pre-diabetes. However, most clinicians fail to stick to lifestyle modification. Patients especially in our region expect doctors that he should write a prescription for medicine, simple advice is not enough for them. They think that the doctor’s job is to give them medicine rest of the things they can do on their own. That is the reason, even sometimes doctor who is totally convinced that this patient does not need medications writes some harmless multivitamins that are also not required.

This remission of diabetes is going to give us hope. If we can reverse a major disease by bringing some changes in life, patients will be off medicine. This will be a breakthrough in convincing the whole population. Every medicine has its side effects. However, the lifestyle changes that are recommended for the reversal of diabetes are very useful changes. They will improve your general health and will also prevent many other diseases. The main stress is on diet and physical activity to lose some weight and maintain a healthy weight. But if we combine the other three pillars of lifestyle medicine like adequate sleep, avoidance of stress, and abstaining from harmful substances like alcohol and tobacco. It is like the cherry on the cake that it is going to improve your blood glucose further and reduce the risk of heart attacks and stroke.
It is very important that we counsel our patients and tell them about all options of treatment along with side effects, that are available, and help them to make informed choices. That means we should use the approach “skills before pills” for everything. If it is possible to avoid pills we should avoid them and help our patients to adapt to a change in living by scientific methods. In this way, they can benefit from recent research, and the burden of diseases and medicines is reduced. Then we should monitor and help them to maintain that change. This will be beneficial for individuals and then overall for society.

The author Dr. Attia Anwar is a consultant family physician with a postgraduate degree from the Royal College of GP UK. She is a strong advocate of health and well-being and wants patient participation in decision-making regarding health.