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When Cliff Dominy set off for a bike ride in the fall of 2017, he felt good about doing something to change his health trajectory. It was a longer journey than expected – not long after starting out, he felt chest pain. When he saw his doctor about it, “it felt like they threw the whole medical encyclopedia at me,” he says. “It turned out I had a partially blocked coronary artery. I also had fatty liver disease, the non-alcoholic version, and type 2 diabetes.”
Mr. Dominy and his wife, a physician, had been on many diets together over the years, all with limited, short-term success, and, as a currency trader, he’d spent most of his forties at a computer desk. Yet, at 51, he didn’t consider himself “an unhealthy person,” so his first reaction to the diagnosis was shock. His second was to go back to skills he’d last used years earlier as a molecular research scientist investigating diabetes: “I started fishing around for behavioural changes that might bring my markers of diabetes back into the healthy range.”
Cliff Dominy" The goal is to lose weight, specifically from your [liver and pancreas] so you need to choose a nutrition program you can stick to. You have to choose food you enjoy eating and activity you enjoy doing. It’s an exhausting process, but you have to persevere.
Type 2 diabetes has long been described as a progressive, permanent illness. Mr. Dominy learned that, while that is still true, newer evidence shows that remission is also possible – through behavioural changes, a growing number of people have experienced long periods of healthy blood glucose levels without medications, essentially returning to a non-diabetic state for years at a time.
This year, the Diabetes Canada Clinical Practice Guidelines will be the first in the world to provide evidence-based insight into what this means for people with diabetes and their health-care providers.
Endocrinologist Harpreet Bajaj, the Chair of Diabetes Canada Guidelines and an author of the new chapter and an accompanying user’s guide on remission, is quick to point out that remission may not be an appropriate goal for everyone with the disease. The behaviour changes required can be considered extreme and prolonged, and remission is, by definition, temporary. At the same time, he points out that the major studies done on the subject offer hope for many. For example, in the DiRECT study, conducted in the UK, about 25 per cent of people living with type 2 diabetes contacted were willing to undertake a severely calorically restricted meal-replacement plan with shakes and soups. Of the 298 people who did, 46 per cent met the criteria for diabetes remission at the end of one year and about a quarter after two years. Nine out of 10 who lost 15 kilos or more put their diabetes into remission.
Much is not yet known, and research is ongoing. About 15 per cent of people who have type 2 diabetes are not overweight, and almost 15 per cent of people in the DiRECT study who lost 15 kilos or more didn’t experience remission. “We don’t want people to think, ‘Oh, I can cure my diabetes forever,’” says Dr. Bajaj. “Remission is not attainable for everyone, and we don’t know why yet. Yet with discipline and support from a health-care team, it is possible for many.”
Cliff Dominy is among the fortunate.
A dietitian suggested the Mediterranean diet, which didn’t work for him, so he and his wife decided they’d try a low-carb diet instead. A year later, he’d lost 50 pounds and his blood glucose was in normal range, which he’s now maintained for almost five years.
“The goal is to lose weight, specifically from your [liver and pancreas] so you need to choose a nutrition program you can stick to,” he says today. “You have to choose food you enjoy eating and activity you enjoy doing. It’s an exhausting process, but you have to persevere.”
Advertising feature produced by Randall Anthony Communications with Diabetes Canada. The Globe’s editorial department was not involved.