We used to believe that type 2 diabetes was a problem of obesity: eat too much sugar and junk food and you will arrive and get diabetes. Easy.
But using advanced scanning technology, my team has been able to demonstrate that diabetes can strike regardless of your circumference.
Interestingly, this is never a random attack – problems only occur if you accumulate more fat than your body can safely store.
Anyone can get type 2 diabetes, regardless of your body size, but only if you have enough weight to push you through what we call your ‘personal fat threshold’.
Regardless of your size, if you have type 2 diabetes, your fat reserves are full to the brim and you have a good chance of reversing your diagnosis with dramatic weight loss. (File photo)
This is the metabolic turning point based on your genetic make-up and is individual for you.
The key for this is the discovery, by my team in Newcastle, of the precise mechanisms that cause type 2 diabetes to hold.
When you eat a meal, the levels of glucose (sugar) in your blood will rise and insulin (produced in the pancreas) is released to ensure that glucose is removed from the blood and stored as glycogen in temporary storage depots in the liver and in muscles around your body.
When those glycogen stores are full, excess blood sugar is converted to fat instead to be stored elsewhere.
Then, when you don’t eat (such as at night when you sleep), your body will tap into these glycogen stores to raise blood sugar levels.
However, if, like many people nowadays, you get into the habit of constantly grazing throughout the day, your blood sugar levels will never drop low enough to require topping up your glycogen stores.
It becomes a permanent one-way process: excess blood glucose converted to fat.
If this persists, you will at some point reach your own ‘personal fat threshold’ and the safe accumulations of fat under the skin will become too full and begin to skip to accumulate in the liver and pancreas where – crucial – fat the power of these vital organs to function effectively.
Problems only occur if you accumulate more fat than your body can safely store. (File photo)
When your liver is clogged with fat, it tries to restore balance by pumping extra glucose into the bloodstream and directing excess fat to the pancreas.
Ultimately, this fat consumes the insulin-producing cells of the pancreas, causing them to malfunction.
When my team discovered this connection, it was quite revolutionary.
Our studies have shown that type 2 diabetes strikes when the liver and pancreas become drenched in fat – but you don’t have to be overweight for this to happen. That depends on your ‘personal fat threshold’.
It also explains how some people with morbid obesity can stay free of diabetes, but some apparently skinny people can get it.
Using advanced scanning technology, my team has been able to demonstrate that diabetes can strike, regardless of your circumference, writes Professor Roy Taylor.
Regardless of your size, the problems arise because you eat too much – for you personally.
In the developed world, where tempting, quick-to-fix, high-calorie food is everywhere, you have to be unusually disciplined to prevent you from arriving.
In Western society, we gain half a kilo a year (1 pound) for most of our adult lives, and we get an average of 5kg (or three-quarters of a stone) every decade.
Because such a significant portion of the world’s population is overweight, there is a statistically greater chance that the number of people who exceed their personal fat threshold has increased (and will continue to do).
That is one reason why the incidence of type 2 diabetes is increasing.
But what is surprising is that most very heavy people do not have type 2 diabetes and that only half of all people who develop the condition are obese.
SLIM IS ALSO A RISK
We are now very clear: you do not have to be obese to develop the condition. You just have to be sensitive to excess fat – in the wrong place.
Some people have an endless storage capacity for fat under the skin (and may seem to escape type 2 diabetes). They may contain more fat than they need, but it does not block the liver and pancreas.
But if a naturally slim person has a low ‘personal fat threshold’, he can run the risk of type 2 diabetes as much as someone twice the size.
Regardless of your size, if you have type 2 diabetes, your fat reserves are full to the brim and you have a good chance of reversing your diagnosis with dramatic weight loss.
Work on your willpower
Write down why you want to escape from diabetes and read it if you get tempted:
1. I don’t want to suffer like my father
2. I can’t stand the intestinal problems caused by the diabetes tablets
3. I don’t want to worry about becoming blind
4. I want to be able to keep both my legs
5. I really don’t want to increase my risk of having a heart attack
6. I hate to feel unhealthy
Our research has shown that the build-up of fat in your liver causes type 2 diabetes, and a sudden drop in liver fat can reverse this. Once the liver and pancreas have been stripped of this excess fat, they will return to normal in most cases – as long as the fat does not return.
Most people have to lose 15 kg to get below their ‘personal fat threshold’, but if you are slim in diagnosing diabetes, you probably have to lose less.
If you weigh less than 80 kg when you start, it might be enough to lose 15 percent of your weight.
As part of the super-simple three-stage diabetes plan I have set out on these pages throughout the week, I encourage everyone who wants to beat diabetes – no matter how slim you are – to follow a liquid meal-replacement diet for a few weeks to control your blood sugar levels regain control.
Then you are ready for phase two – healthy, calorie-controlled meals. Try the recipes here for inspiration. Tomorrow I’ll explain phase three – how to keep diabetes away from life.
Turkey soup with turkey and quinoa with peas and basil
This turkey and quinoa meatball soup with peas and basil takes 10-15 minutes to prepare
Preparation time: 10-15 minutes
Preparation time: 15-20 minutes
Cals: 425 (per serving)
- 30 g basil, leaves picked and chopped
- 250 g turkey breast minced
- 2 sprigs of thyme, leaves picked
- 1 sprig of marjoram, leaves picked and chopped
- 1 spring onion, chopped and finely chopped
- 1 liter of chicken or vegetable broth
Finely chop 5 g of the basil leaves and put in a large bowl with the cooked quinoa, minced turkey, thyme, marjoram, spring onion and tomato puree.
Season with a pinch of salt and pepper and mix until well combined. Form into 10 meatballs, about 40 g each, or the size of a golf ball. Cool for 10 minutes to solidify.
Place a large, heavy pan or oven dish over medium heat. Add the olive oil and fry the meatballs on all sides for 10-12 minutes, until light brown, making sure you do not burn them.
Add the stock, bring to the boil and simmer for 15 minutes. Add the peas and cook for another 3 minutes. Season.
Tear the remaining basil leaves and stir the soup just before serving.
Tomato, harissa and fennel broth with cod and butter beans
This tomato, harissa and fennel broth with cod and butter beans is suitable for two people
- ½ onion, peeled and cut into thin slices (about 80 g)
- 1 small carrot, finely chopped
- 1 red pepper, seedless and finely chopped
- 2 medium-sized tomatoes (approximately 150 g), roughly chopped
- ½ teaspoon fennel seeds, finely ground to a powder
- 1 × 400g can butter beans, drained
- 300 g of cod, cut into 5 cm pieces
- 5 g fresh coriander, finely chopped
- 5 g fresh dill, finely chopped
- 2 slices of whole wheat toast, to serve
- Lime wedges, to serve (optional)
Place the onion, carrot, pepper and tomatoes in a pan with the olive oil and cook over a medium heat for 10 minutes, until everything is soft.
Stir the ground fennel seeds, spelled and harissa and cook for 1 minute.
Pour in the vegetable stock, bring to the boil, reduce the heat and simmer for 20 minutes.
Remove from heat, blitz with a hand blender until completely smooth and season to taste.
Return to a low heat and bring to a very soft rolling simmer.
Add the butter beans and cod and poach for 5-7 minutes.
Stir through the coriander and dill, then divide into two bowls. Serve with toast and a slice of lime, if used.
Note: the basis of this soup can be made up to two days in advance. Poach the fish and butter beans when you are ready to eat and add the herbs to serve.
The basis is brilliantly versatile. Try it with salmon, shrimp or even shellfish
Caramelized onion, kale and Alkmaar barley soup
The caramelized onion, kale and Alkmaar barley soup takes an hour to cook and is 250 calories
Preparation time: 15 minutes
Preparation time: 1 hour
For 4 persons
- 1 kg onions (unpeeled weight), peeled and cut into thin slices
- 2 tbsp Worcestershire sauce
- 2 sprigs of rosemary and thyme, leaves picked and minced
- 800 ml beef or vegetable broth
- 70 g kale, thinly sliced
- 300 ml unsweetened soy milk
Place the onions in a large oven dish or heavy frying pan.
Stir in the oil, Worcestershire sauce and a few tablespoons of water.
Cover with a lid and place on a medium heat to gently sauté for about 50 minutes, add the herbs halfway through, until the onions are caramelized and have a deep brown color.
Check regularly and stir occasionally to make sure that the onions do not catch and burn.
Add a splash of water if necessary.
Meanwhile, boil the Alkmaar barley in 300 ml of water over a medium heat for 25-30 minutes. It must be soft, but with a bit of biting.
If the water is absorbed before it is fully boiled, simply add more. Drain and set aside.
Add the broth, pearl barley and kale to the onions and simmer for 10 minutes.
Stir in the soy milk and bring to the boil. Spoon into bowls, season and serve.
Eggplant, chickpeas and harissa stew
The eggplant, chickpea and harissa stew seats four people and takes 25 minutes to cook
Preparation time: 10 minutes
Preparation time: 25 minutes
For 4 persons
- 3 medium-sized aubergines (approximately 300 g each), cut into large pieces
- 1 medium-sized onion, peeled and finely chopped
- 2 cloves of garlic, peeled and chopped
- 1 red chili, finely chopped (pitted for a milder heat)
- 3 sprigs of thyme, leaves picked
- 2 x 400 g cans of chopped tomatoes
- 1 × 400g can chickpeas, drained
- 15 g fresh coriander, roughly chopped, to garnish
- 1 x medium-sized broccoli, broken into florets
Preheat the oven to 240c / 220c / gas 9 fan.
Brush the eggplant chunks with 1 tbsp of the oil and season with salt and pepper. Spread evenly on a baking sheet (use two if necessary) and cook for 20-25 minutes until the edges are crispy and the meat is deep golden brown.
Meanwhile, put the remaining ½ tbsp of olive oil in a large saucepan and fry the onion, garlic, chili and thyme over a medium heat for about 7 minutes, stirring frequently, until soft.
Make sure the garlic does not burn. Stir in the harissa and spices and cook for another minute. Pour in the tomato preserves, vegetable broth and chickpeas, bring to the boil, reduce the heat and simmer for 15 minutes.
Stir in the roasted aubergines and cook gently on a very low heat for 5 minutes.
Remove from heat and allow to cool for about 5 minutes before adding coriander.
Meanwhile, steam the broccoli. Season and serve both stew and vegetables.
Roasting the aubergines retains a nice texture and adds a layer of flavor
The hearty soup made with leeks, carrots, celery, butter beans, barley, kale, bay leaves and spices takes 15 minutes to prepare and is only 165 calories
Preparation time: 15 minutes
Preparation time: 30 minutes
Cals: 165 (using 25 g of barley)
For 4 persons
- 1 tbsp extra virgin olive oil
- 1 medium leek (100 g), cut into 1 cm slices
- 3 large carrots, peeled and cut into 1 cm slices
- 1 liter chicken or vegetable broth (made with a stock cube or pot)
- 4 celery stalks, cut into 1 cm pieces
- 400 g can of butter beans
- 6 leaves of spring cabbage, kale or cavolo nero
- Dried herbs such as thyme or mixed herbs
Heat the oil in a large pan. Add the leek and carrots and cook for 10 minutes until softened. Then add the stock.
Add the celery, drained can of butter beans and Alkmaar barley, along with the sliced cabbage leaves, bay leaves and spices.
Season with some salt and black pepper.
Bring the soup to the boil, reduce the heat and let it simmer for 20 minutes, partially covered with a lid.
Add an extra grind of black pepper just before serving and enjoy the juicy pieces of vegetables.
Butter-like stew with spiced aubergines and soft-boiled egg
The stew with boiled aubergines and soft-boiled egg takes 25 minutes to cook
Preparation time: 15 minutes
Preparation time: 25 minutes
For 4 persons
- 1 × 400g can chickpeas, drained and rinsed
- 1 × 400g can butter beans, drained and rinsed
- 1 full teaspoon of chili flakes
- 1 large eggplant (approximately 400–450 g), cut into 8 long segments
- 28 g fresh coriander, roughly chopped
Preheat the oven to 220c / fan 200c / gas 7.
Place the legumes, tomatoes, tomato puree, chili flakes, 1 teaspoon each of the ground coriander and cumin and 2 tbsp olive oil in a baking dish and stir to a layer.
Mix the remaining olive oil with the remaining crushed herbs in a small bowl, then scoop the eggplant wedges and knock them over.
The base – legumes with tomatoes and herbs – is also good with bacon and eggs for breakfast
Place the segments on a baking sheet. Roast the wedges and tomatoes in the oven for 20 minutes and stir in the oven dish halfway. Remove from the oven and stir in the fresh coriander.
Bring a large saucepan of water to the boil and let the eggs sink into the pan with a dessert spoon.
Cook for 6 minutes, remove them and let them run under cold water until they are sufficiently cool to handle.
Peel the eggs and throw away the shells. Cook the green beans in the same pan for 2 minutes and drain. Place spoons of the stew on each plate. Top with the eggplant, green beans and a halved soft-boiled egg.
I never thought I’d be diabetic
Shivali Modha, 38, is an accountant. She lives in Barnet, North London, with her parents-in-law, her husband and their two daughters of ten and eight years. She says:
My father had type 2 diabetes, so I knew what to expect. I was only diagnosed for 26 years and it was a huge shock.
In my culture there is the idea that if you are sick, disabled or disabled, it is your fault.
Shivali Modha (photo), 38, from Barnet, North London, went to the 9th and saw her blood sugar control begin to improve. In 2018 she was told that her diabetes was in remission
You are under pressure to handle it yourself, behind closed doors.
Diabetes also affected my marriage. I completely lost my self-respect and all sense of attractiveness. Everything became so medicinal – the injection, the hypos.
My husband became my caretaker and it didn’t feel like a sexual or romantic relationship.
It was almost as if diabetes became the third person in our relationship.
When I heard it might be possible to remedy your diabetes through diet, I couldn’t believe I would ever get rid of it after 11 years of tablets and injections.
Mrs. Modha (photo in 2007) was diagnosed with type 2 diabetes when she was only 26 years old
But I threw myself into a strict diet and started running.
My weight dropped to 9 th and my blood sugar levels started to improve and I was able to reduce my diabetes medication.
With a few ups and downs en route, I was told in 2018 that my diabetes was in remission.
Now I know that you can be proactive and do something to reverse the impact of type 2 diabetes.
I keep watching what I eat and stay active to both maintain my weight loss and control my diabetes.
I think it’s important to understand that I will always have diabetes.
But by maintaining my lifestyle, I can control it and improve the long-term prognosis.