We used to believe that type 2 diabetes was a problem of obesity: eat too much sugar and junk food and you’ll gain weight and get diabetes. Simple.
But through using sophisticated scanning technology, my team has been able to show that diabetes can strike whatever your girth.
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 gain sufficient weight to push you through what we call your ‘personal fat threshold’.
Whatever your size, if you have type 2 diabetes, your fat stores 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 tipping point based on your genetic make-up and is individual to you.
Key to this is the discovery, by my team in Newcastle, of the precise mechanisms that prompt type 2 diabetes to take 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 make sure that glucose is taken out of 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 instead transformed into fat to be stored elsewhere.
Then, when you’re not eating (such as at night when you’re asleep) your body will tap into these glycogen stores to keep blood glucose levels topped up.
However, if, as many people do these days, you get into the habit of grazing constantly throughout the day, your blood sugar levels never drop low enough to require topping up from your glycogen stores.
It becomes a perpetual one-way process: excess blood glucose converted to fat.
If this continues, at some point you will reach your own ‘personal fat threshold’ and the safe stores of fat under the skin become overfilled and start to spill over to build up in the liver and pancreas where — crucially — fat impedes the ability 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 seeks to redress the balance by pumping out extra glucose into the bloodstream and passing excess fat to the pancreas.
Ultimately, this fat will consume the pancreas’s insulin-producing cells, causing them to malfunction.
When my team discovered this connection, it was pretty revolutionary.
Our studies have been able to show that type 2 diabetes strikes when the liver and pancreas become engorged with fat — but you don’t have to be particularly overweight for this to happen. That depends on your ‘personal fat threshold’.
It also explains how some morbidly obese people can remain free from diabetes, but some apparently skinny people can get it.
Through using sophisticated scanning technology, my team has been able to show that diabetes can strike whatever your girth, writes Professor Roy Taylor
Whatever your size, the problems occur because you’re eating too much — for you personally.
In the developed world, where enticing, quick-fix, calorie-dense food is everywhere, you have to be unusually disciplined to avoid putting on weight.
In Western society we gain half a kilogram a year (1lb) through most of our adult life, and we gain an average of 5kg (or three-quarters of a stone) with each decade.
Because such a significant proportion of the worldwide population is overweight there’s a statistically greater chance that the numbers of those busting their personal fat threshold will have increased (and will continue to do so).
That’s one reason why the incidence of type 2 diabetes is rising.
But what is surprising is the fact that the majority of very heavy people do not have type 2 diabetes, and only half of all people developing the condition are obese.
SLIM ARE AT RISK TOO
We are now very clear: you do not have to be obese to develop the condition. You simply have to be susceptible to excess fat — in the wrong place.
Some people have an endless storage capacity for fat under the skin (and can seemingly escape type 2 diabetes). They might carry more fat than they need, but it doesn’t clog up the liver and pancreas.
But if a naturally slim person has a low ‘personal fat threshold’, they can be at equal risk of type 2 diabetes as someone twice their size.
Whatever your size, if you have type 2 diabetes, your fat stores are full to the brim and you have a good chance of reversing your diagnosis with dramatic weight loss.
Work on your will power
Write down why you want to escape from diabetes and read it when you face temptation:
1. I don’t want to suffer like my father
2. I can’t stand the gut problems the diabetes tablets cause
3. I don’t want to have to worry about going blind
4. I want to be able to keep both my feet
5. I really don’t want to increase my risk of a heart attack
6. I hate feeling unhealthy
Our research has shown that the build-up of fat in your liver triggers type 2 diabetes, and a sudden drop of liver fat can reverse it. Once the liver and pancreas are stripped of this excess fat, in most cases they will start working normally again — as long as the fat doesn’t return.
Most people need to lose 15kg to get back below their ‘personal fat threshold’, but if you were slim when diagnosed with diabetes, you probably need to lose less.
If you weigh less than 80kg when you start, you might find losing 15 per cent of your weight is enough.
As part of the super-easy three-stage diabetes busting plan I have been outlining on these pages all this week, I encourage everyone who wants to beat diabetes — regardless of how slim you are — to embark on a liquid meal replacement diet for a few weeks to get your blood sugar levels back under control.
Then you will be ready for stage two — healthy, calorie-controlled meals. Try the recipes here for inspiration. Tomorrow I’ll explain stage three — how to keep your diabetes away for life.
Turkey and quinoa meatball soup with peas and basil
This turkey and quinoa meatball soup with peas and basil takes 10-15 minutes to prepare
Prep time: 10–15 mins
Cook time: 15–20 mins
Cals: 425 (per portion)
- 30g basil, leaves picked and finely chopped
- 65g cooked quinoa
- 250g turkey breast mince
- 2 sprigs of thyme, leaves picked
- 1 sprig of marjoram, leaves picked and finely chopped
- 1 spring onion, trimmed and finely chopped
- 1 tbsp tomato purée
- 1½ tbsp olive oil
- 1 litre chicken or vegetable stock
- 200g frozen peas
- Salt and pepper
Finely chop 5g of the basil leaves and place in a large bowl with the cooked quinoa, turkey mince, thyme, marjoram, spring onion and tomato purée.
Season with a generous pinch of salt and pepper and mix until everything is well combined. Shape into 10 meatballs, roughly 40g each, or the size of a golf ball. Refrigerate for 10 minutes to firm.
Place a large, heavy-based frying pan or casserole dish over a medium heat. Add the olive oil and fry the meatballs on all sides for 10–12 minutes, until lightly browned, taking care not to burn them.
Add the stock, bring to the boil and simmer for 15 minutes. Add the peas and cook for a further 3 minutes. Season to taste.
Roughly tear the remaining basil leaves and stir into the soup just before serving.
Tomato, harissa and fennel broth with cod and butterbeans
This tomato, harissa and fennel broth with cod and butterbeans can serve two people
- ½ onion, peeled and thinly sliced (about 80g)
- 1 small carrot, finely chopped
- 1 red pepper, deseeded and finely chopped
- 2 medium tomatoes (around 150g), roughly chopped
- 1 tsp olive oil
- ½ tsp fennel seeds, finely ground to a powder
- 2 tbsp harissa paste
- 800ml vegetable stock
- 1 × 400g can butterbeans, drained
- 300g cod, cut into 5cm (2in) chunks
- 60g organic spelt grain
- 5g fresh coriander, finely chopped
- 5g fresh dill, finely chopped
- 2 slices wholegrain toast, to serve
- Lime wedges, to serve (optional)
Place the onion, carrot, pepper and tomatoes in a saucepan with the olive oil and sauté over a medium heat for 10 minutes, until everything is soft.
Stir in the ground fennel seeds, spelt and harissa and cook for 1 minute.
Pour in the vegetable stock, bring to the boil, then reduce the heat and simmer for 20 minutes.
Remove from the heat, blitz with a hand blender until completely smooth, then season to taste.
Return to a low heat and bring to a very gentle rolling simmer.
Add the butterbeans and cod and poach for 5-7 minutes.
Stir through the coriander and dill, then divide between two bowls. Serve with the toast and a wedge of lime, if using.
Note: The base of this soup can be made up to two days ahead. Simply poach the fish and butterbeans when you are ready to eat and add the herbs to serve.
The base is brilliantly versatile. Try it with salmon, prawns or even shellfish
Caramelised onion, kale and pearl barley soup
The caramelised onion, kale and pearl barley soup takes one hour to cook and is 250 calories
Prep time: 15 mins
Cook time: 1 hour
- 1kg onions (unpeeled weight), peeled and thinly sliced
- ½ tbsp olive oil
- 2 tbsp Worcestershire sauce
- 2 sprigs each of rosemary and thyme, leaves picked and chopped
- 800ml beef or vegetable stock
- 100g pearl barley
- 70g kale, thinly sliced
- 300ml unsweetened soya milk
- Salt and pepper
Place the onions in a large, heavy-based casserole dish or frying pan.
Stir in the oil, Worcestershire sauce and a few tablespoons of water.
Cover with a lid and place over a medium-low heat to sauté gently for about 50 minutes, adding the herbs halfway through, until the onions are caramelised and a deep brown colour.
Check regularly and stir from time to time to make sure the onions don’t catch and burn.
Add a splash more water if necessary.
Meanwhile, cook the pearl barley in 300ml water over a medium heat for 25-30 minutes. It should be soft, but with a bit of bite.
If the water is absorbed before it has fully cooked, simply add some more. Drain and set aside.
Add the stock, pearl barley and kale to the onions and simmer for a further 10 minutes.
Stir in the soya milk and bring to boiling point. Ladle into bowls, season to taste and serve.
Aubergine, chickpea and harissa stew
The aubergine, chickpea and harissa stew can serve four people and takes 25 minutes to cook
Prep time: 10 mins
Cook time: 25 mins
- 3 medium aubergines (around 300g each), sliced into generous chunks
- 1½ tbsp olive oil
- 1 medium onion, peeled and finely chopped
- 2 garlic cloves, peeled and finely chopped
- 1 red chilli, finely chopped (deseeded for a milder heat)
- 3 sprigs of thyme, leaves picked
- 1 tbsp harissa
- ½ tsp ground cinnamon
- 1 tsp ground ginger
- 1 tsp turmeric
- 2 × 400g cans chopped tomatoes
- 800ml vegetable stock
- 1 × 400g can chickpeas, drained
- 15g fresh coriander, roughly chopped, to garnish
- 1 x medium head of broccoli, broken into florets
Preheat the oven to 240c/fan 220c/gas 9.
Coat the aubergine chunks with 1 tbsp of the oil and season with salt and pepper. Spread out evenly on a baking tray (use two if necessary) and roast for 20-25 minutes until the edges are crispy and the flesh is a deep golden brown.
Meanwhile, place the remaining ½ tbsp of olive oil in a large saucepan and sauté the onion, garlic, chilli and thyme over a medium heat for about 7 minutes, stirring regularly, until softened.
Be careful not to let the garlic burn. Stir in the harissa and spices and cook for another minute. Pour in the tinned tomatoes, vegetable stock and chickpeas, bring to the boil, then reduce the heat and simmer for 15 minutes.
Stir in the roasted aubergines and simmer gently over a very low heat for 5 minutes.
Remove from the heat and leave to cool for about 5 minutes before adding the coriander.
Meanwhile, steam the broccoli. Season both stew and veg to taste and serve.
Roasting the aubergines maintains a lovely texture and adds a layer of flavour
The hearty soup made with leeks, carrots, celery, butterbeans, barley, kale, bay leaves and herbs takes 15 minutes to prepare and is only 165 calories
Prep time: 15 mins
Cook time: 30 mins
Cals: 165 (using 25g barley)
- 1 tbsp extra-virgin olive oil
- 1 medium leek (100g), cut into 1cm slices
- 3 large carrots, peeled and cut into 1cm slices
- 1 litre chicken or vegetable stock (made with a stock cube or stock pot)
- 4 celery stalks, cut into 1cm pieces
- 400g tin of butterbeans
- 25g of pearl barley
- 6 leaves of spring cabbage, kale or cavolo nero
- 1 bay leaf (sliced)
- Dried herbs such as thyme or mixed herbs
- Salt and black pepper
Heat the oil in a large saucepan. Add the leek and carrots and sauté for 10 minutes until they start to soften. Then pour in the stock.
Add the celery, drained tin of butterbeans and pearl barley, along with the sliced cabbage leaves, bay leaf and herbs.
Season with a little salt and black pepper.
Bring the soup to the boil, then reduce the heat and let it simmer for 20 minutes, part covered with a lid.
Add an extra grind of black pepper just before serving and enjoy the juicy chunks of veg.
Butterbean stew with spiced aubergines and soft-boiled egg
The butterbean stew with spiced aubergines and soft-boiled egg takes 25 minutes to cook
Prep time: 15 mins
Cook time: 25 mins
- 1 × 400g can chickpeas, drained and rinsed
- 1 × 400g can butterbeans, drained and rinsed
- 500g cherry tomatoes
- 3 tbsp tomato purée
- 1 heaped tsp chilli flakes
- 2 tsp ground coriander
- 2 tsp ground cumin
- 3½ tbsp olive oil
- 1 large aubergine (around 400–450g), sliced into 8 long wedges
- 4 medium free-range eggs
- 28g fresh coriander, roughly chopped
- 200g green beans
Preheat the oven to 220c/fan 200c/gas 7.
Place the pulses, tomatoes, tomato purée, chilli flakes, 1 tsp each of the ground coriander and cumin and 2 tbsp of the olive oil into an ovenproof casserole dish and stir to coat.
Mix the remaining olive oil with the remaining ground spices in a small bowl, then spoon over the aubergine wedges, tossing to coat.
The base – pulses with tomatoes and spices – is also good with bacon and eggs for breakfast
Place the wedges on a baking tray. Roast the wedges and the tomatoes in the oven for 20 minutes, stirring the casserole halfway through. Remove from the oven and stir in the fresh coriander.
Bring a large saucepan of water to a rolling boil and, using a dessert spoon, lower the eggs into the pan.
Cook for 6 minutes, remove and run under cold water, until cool enough to handle.
Peel the eggs and discard the shells. Using the same pan, boil the green beans for 2 minutes, then drain. To serve, place spoonfuls of the stew on to each plate. Top with the aubergine, green beans and a halved soft-boiled egg.
I never thought I’d be free of diabetes
Shivali Modha, 38, is an accountant. She lives in Barnet, North London, with her in-laws, her husband and their two daughters aged ten and eight. She says:
My dad had type 2 diabetes, so I knew what was in store for me. I was diagnosed aged just 26 and it was a huge shock.
In my culture, there is this idea that if you are sick, disabled or impaired in some way, then it is your fault.
Shivali Modha (pictured), 38, from Barnet, North London, went down to 9st and saw her blood sugar control started to improve. In 2018 she was told her diabetes was in remission
You are under pressure to deal with it yourself, quietly, behind closed doors.
Diabetes impacted my marriage, too. I completely lost my self-esteem and any feelings of attractiveness. Everything became so medicinal — the injecting, the hypos.
My husband became my carer and it did not feel like a sexual or romantic relationship.
It was almost as if diabetes became the third person in our relationship.
When I heard that it might be possible to put your diabetes into remission through diet I could not believe I would ever be able to get rid of it after 11 years of tablets and injections.
Ms Modha (pictured in 2007) was diagnosed with type 2 diabetes when she was just 26-years-old
But I threw myself into a strict diet and took up running.
My weight went down to 9 st and my blood sugar control started to improve and I was able to reduce my diabetes medication.
With a few ups and downs along the way, by 2018 I was told my diabetes was in remission.
Now, I know that you can be proactive about it and can do something to reverse the impact of type 2 diabetes.
I continue to watch what I eat and stay active to maintain both my weight loss and keep my diabetes in control.
I think it is important to understand that I will always be diabetic.
But by sustaining my lifestyle, I will be able to have control over it and improve the long-term prognosis.