“Can you get type 2 diabetes again once you’ve reversed it?”

Ask Dr. Jason Fung

Can high levels of B12 be a sign of kidney failure? What effect can fasting have on autoimmune disease? What is the best way to break a fast? And, is it possible to ever really cure type 2 diabetes?

It’s time for this week’s Q&A about intermittent fasting and low carb with Dr. Jason Fung:

Could you talk about high vitamin B12?

Can abnormally high B12 levels be a sign of kidney failure if diabetic and doing intermittent fasting?

Eileen

B12 levels are not a sign of kidney failure. Mostly we worry about low vitamin B12, especially in vegans.

Dr. Jason Fung

Impact of fasting on autoimmune disease

I read your response about autoimmune disease and fasting and you stated autoimmune disease has little to do with diet.

Are you familiar with Dr. V. Longo’s studies regarding fasting? He is doing research that is starting to show that fasting and autophagy can be very effective in improving various autoimmune disease.

Charmaine

We don’t know what causes most autoimmune diseases. However, fasting may potentially improve them by regeneration of the immune system. Dr. Longo’s studies suggest this is possible, but there are several caveats. This research is done in animals, and it may or may not apply to humans. Second, autoimmune diseases are all different and we don’t know if some of them are more responsive or not. Third, you generally need longer fasts going out to about 7 days. Fourth, we don’t know how often you would need to repeat these fasts.

In medicine, it is all about risk versus reward. The reward is theoretical but potentially important. The risk is minimal, although 7 days of fasting is generally not fun. My own advice is that everybody should give it a try, under proper supervision, since there is little risk. I would repeat a 7 day fast in about a month or 6 weeks as it may not respond to immediately. If you notice a significant improvement, then I would consider using it on a regular basis. If you notice no change, then I would not continue.

Dr. Jason Fung

Breaking a fast

Good day Dr. Fung,

Firstly I want to thank you for writing your book, The Obesity Code. I received it for a Christmas present and I will be reading it in 2019.

I have two questions:

  1. What is the correct way to break a 16-8 fast while on a ketogenic diet? A normal LCHF meal or drink a bullet proof coffee?
  2. Can I IF on a 16-8 window every day or must is it better to fast one day and eat normally the next day?

Look forward to hearing from you.

Regards
Ben de Swardt

  1. There is no ‘correct’ way. General principles would be that longer fasts need to be broken more gently. 16:8 is fairly short so it likely doesn’t matter much. Also, a second general principle is to eat natural foods. I would prefer an LCHF meal rather than a bulletproof coffee for that reason.
  2. Yes, many people (myself included) use a 16:8 schedule daily. Skipping breakfast becomes quite easy after a while, so I fall into a 16:8 rhythm quite naturally. For other reasons, I think that eating earlier in the day is better than late, so skipping dinner is probably better than skipping breakfast, but for social/work reasons, skipping dinner regularly is difficult for many people.

Dr. Jason Fung

What does reversing type 2 diabetes mean to you?

When doing LCHF and IF with awesome results (A1C around 5.6, down from a high of 9.0) it looks like reversion of diabetes. If symptoms (ie high glucose) are all normal, does it mean one has to maintain this lifestyle forever? People without diabetes can have all the pizza and beer they want with little effect on blood sugars. While one who has reversed diabetes can never be truly cured. Is this correct?

John

If you had type 2 diabetes (T2D) and then you get your A1C under 6.0 without medications, then you are defined (in Canada) as non-diabetic. In other words, your T2D reversed. But if you return to the diet that gave you T2D, you will get it again. Think of your body like a sugar bowl. If you eat lots of sugar and glucose, the bowl fills up. If you eat more glucose, then it overflows and spills into the blood. That’s T2D. If you empty the sugar bowl, then you won’t have T2D, but it doesn’t mean that you will never get it again.

Dr. Jason Fung

 

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Dr. Fung has his own blog at idmprogram.com. He is also active on Twitter.

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Dr. Fung’s books The Obesity Code, The Complete Guide to Fasting and The Diabetes Code are available on Amazon.

2 comments

  1. Ronald Kurtz
    Was working to reduce my diabetes and per a 14-16 hour daily fasting regimen and eating real unprocessed foods including pastured raised meat/eggs and wild caught fish. Am on Metformin 500 mg X 2 daily, and T2D since 2014.
    A1C went from 7.8% down to 7.1% this past August measurement
    Also: ALT=22 Unit/L, fasting glucose=154 mg/dl, fasting insulin 4.8 mcunit/mL, B12= 693 pg/ml. Homocysteine = 12 mcmol/L

    Had a serious poison ivy infection treated last week with my doctor prescribed a shot of cortisone and course of prednisone steroid which it healed the infection on my arm. I stopped the steroid 4 days ago because unfortunately, my blood sugar was elevated 200-220 levels and stays high most of the day. I plan to see my doctor and get an insulin shot.

    I am guessing my liver has a signal that keeps pumping glucose into my blood. Has my liver become insulin resistant? Will my liver come back to normal function? Is there a doctor in New Hampshire you can recommend to manage myT2D until I get rid of this disease. Thank you

    Reply: #2
  2. Kerry Merritt Team Diet Doctor

    Was working to reduce my diabetes and per a 14-16 hour daily fasting regimen and eating real unprocessed foods including pastured raised meat/eggs and wild caught fish. Am on Metformin 500 mg X 2 daily, and T2D since 2014.
    A1C went from 7.8% down to 7.1% this past August measurement
    Also: ALT=22 Unit/L, fasting glucose=154 mg/dl, fasting insulin 4.8 mcunit/mL, B12= 693 pg/ml. Homocysteine = 12 mcmol/L
    Had a serious poison ivy infection treated last week with my doctor prescribed a shot of cortisone and course of prednisone steroid which it healed the infection on my arm. I stopped the steroid 4 days ago because unfortunately, my blood sugar was elevated 200-220 levels and stays high most of the day. I plan to see my doctor and get an insulin shot.
    I am guessing my liver has a signal that keeps pumping glucose into my blood. Has my liver become insulin resistant? Will my liver come back to normal function? Is there a doctor in New Hampshire you can recommend to manage myT2D until I get rid of this disease. Thank you

    Hi, Ronald! We are unable to provide medical advice here, but you may want to check out our doctor locator to find a low-carb doctor in your area! https://www.dietdoctor.com/low-carb/doctors
    (I removed your personal information from your comment to protect your privacy.)

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