Reversing prediabetes: can it be done naturally (and permanently?)
**This article was originally published on Pendulum Therapeutic’s blog
Our comprehensive guide to help you understand what's possible.
Overview
Getting diagnosed with prediabetes can come as a shock.
It’s usually unexpected, and often leads people to worry about developing type 2 diabetes.
The good news is that not only can you prevent prediabetes from progressing further, you can actually reverse it—naturally and without the need for medication.
Reversing prediabetes has been a focal point in clinical research for decades. And while many different methods have been tried, exercise and dietary changes have so far proven to be the most consistent and effective means of reversing prediabetes.
In this article, we’ll help you understand how prediabetes develops and what can be done to reverse it naturally.
Table of Contents:
What is prediabetes?
Prediabetes is a condition in which a person’s average blood sugar levels have risen above the healthy limit (typically 5.7% or below on a blood A1C test) but haven’t yet crossed the threshold used for diagnosing type 2 diabetes (6.5% on an A1C test)1.
Approximately 88 million people (~1 in 4 people) in the United States have prediabetes and are considered at risk for developing type 2 diabetes2.
Fortunately, many people with prediabetes are able to prevent it from progressing and, in some cases, are even able to reverse it.
What causes prediabetes?
Prediabetes is often caused by a combination of factors—such as a diet that is high in sugar and low in fiber, or a lack of sufficient amounts of exercise—that lead to elevated blood sugar levels for a sustained period of time1,2,3,4,5,6.
The human body is equipped with a complex system for sensing and regulating blood sugar levels. When we eat foods that contain sugars, our digestive system breaks them down to their smallest unit (glucose) which is absorbed into the bloodstream (this is why you sometimes see blood sugar levels interchanged with the term blood glucose levels).
From there, the glucose is pulsed through the body to be taken up by cells in need of energy or else stored in muscles and the liver where it can be accessed if the body needs an extra boost of energy.
Prediabetes, and type 2 diabetes, develop when this sugar regulating system fails to remove sugar from the blood (either by taking it up into cells throughout the body or failing to deposit excess sugar in muscle and liver reserves). Critical to this system is the hormon insulin which signals to cells that they should uptake sugar from the blood. When cells are less sensitive to insulin—known as insulin resistance—diabetes can develop.
There are many factors that can contribute to this dysregulation.
A high sugar diet, for example, can simply cause the system to become overwhelmed by sugar which can lead to a desensitization to it—effectively making it harder for the body to respond to rising sugar levels.
Obesity, too, is known to increase the risk of developing prediabetes and type 2 diabetes. The mechanics of how obesity influences diabetes development is an ongoing area of study; however, it likely has to do with body fat’s known role in promoting the release of certain hormones that alter sugar regulation.
Other factors that are known to contribute to the development of type 2 diabetes include low levels of exercise, genetics, the gut microbiome, and stress to name a few 1,2,3,4,5,6.
What happens if prediabetes is left untreated?
If left untreated, prediabetes can develop into type 2 diabetes and may lead to further downstream health conditions, such as kidney disease, heart disease, high blood pressure, and various types of nerve damage6.
Fortunately, studies in different populations around the world have found that only about 4-20% of people with prediabetes go on to develop type 2 diabetes within the study’s timeframe (which does vary from study to study)6.
Setting aside variation between studies, it’s clear that not everyone with prediabetes will go on to develop type 2 diabetes. This is partly due to the fact that treatment of prediabetes doesn’t always include medication; many studies report that lifestyle changes can help stop the progression of prediabetes and sometimes even reverse it.
Can prediabetes be reversed?
Yes, prediabetes can be reversed in many cases.
The first step is talking with your healthcare provider about your options and forming a plan that is specific to your needs. Your environment, diet, habits, and genetics can all influence your health, so it’s important to form a plan that is tailored to your specific circumstances.
In general, however, reversing prediabetes often involves a combination of lifestyle changes that aim to lower the amount of sugars in your diet while simultaneously increasing your body’s usage of sugars and fortifying your body’s natural defenses against conditions like diabetes.
Can weight loss reverse prediabetes?
Weight loss is often associated with reversal of prediabetes. This is partly a byproduct of other reversal methods—exercise, diet, or surgery—but also may have benefits of its own.
Body fat plays an important role in keeping us healthy. It helps to protect our organs from physical and temperature related damage as well as provides a source of energy that can be used in times of need. But too much body fat can also be damaging, particularly for sugar regulation7.
Researchers have found that stores of excess body fat release hormones and other factors that cause low levels of inflammation in the body and suppress insulin signaling—an important component of sugar regulation. Loss of excess body fat may then help in conditions like prediabetes where sugar regulation is less efficient7.
This is also supported by clinical trials in which weight loss has been observed to be a predictor of successful prevention of diabetes and potential prediabetes reversal.
One study involving more than 1000 people found that the loss of just 2 pounds was enough to reduce participants’ risk of developing diabetes by 16%4,5,6.
Additionally, surgery in which part of the digestive tract is modified, also known as bariatric surgery, is known to help obese individuals with prediabetes significantly reduce their risk of developing type 2 diabetes, in some cases by as much as 87%.
Whether this benefit comes from altering the digestive tract or from the weight loss that follows is still under investigation4,5,6.
It should be noted, too, that weight loss as a treatment for prediabetes should be closely monitored to ensure that safe and effective methods are used. This is particularly important for individuals who are managing eating disorders.
Can exercise reverse prediabetes?
Exercise is an important part of most treatments aimed at reversing both prediabetes and type 2 diabetes.
All of the large prediabetes studies included exercise in their treatment group, each of which found that treatment involving exercise reduced the risk of developing type 2 diabetes and reduced some participants’ blood sugar levels down to healthy, “normal” levels3,4,5,6
While each study involves an exercise component, the nature of the exercise differs.
According to the American Diabetes Association, exercise is defined as any planned physical activity that increases your energy output, such as walking, running, swimming, weight lifting, or resistance training.
During exercise, muscles throughout the body require energy. Initially that energy comes from their own stores of sugar, but as exercise continues they start to deplete their energy stores and turn to sugars in the blood for energy. As a result, blood sugar levels may decrease following exercise.
One study, The United States Diabetes Prevention Program, had participants engage in 150 minutes of exercise per week (equivalent to 30 minutes a day for 5 days). This, in combination with a healthy diet and weight loss, resulted in almost 50% reduction in progression to type 2 diabetes when compared to participants who weren’t instructed to follow this routine8.
These results are mirrored in the Finnish Diabetes Prevention study in which some participants were given educational classes about healthy habits, had a calorie restricted diet, and were instructed to exercise at least 4 hours per week. This group was 58% less likely to develop type 2 diabetes compared to the control group9.
Taken together, this suggests that exercise is an important part of reversing prediabetes. However, it should be noted that exercise alone is unlikely to be an effective method for diabetes management—each of these studies used a combination of diet and exercise to achieve a sustained benefit for participants.
Can diet reverse prediabetes?
As with exercise, dieting is commonly incorporated in the treatment of prediabetes.
This is because many sugars in our foods can directly contribute to blood sugar levels; meaning that the more sugar we eat, the more likely we are to have higher blood sugar levels.
Beyond just limiting sugar intake, a healthy diet typically includes foods that are high in fiber.
Fiber is a type of nutrient found in many vegetables. The human body has a difficult time breaking down fibers which, on its own may be beneficial for blood sugar control—high fiber meals tend to be more filling and may slow absorption of other nutrients (such as sugars)10,11.
A large benefit that comes from fiber can be traced back to the gut microbiome—the ecosystem of bacteria, fungi, and viruses that live within our digestive tract.
Some species of bacteria in the gut microbiome are capable of using fibers as a nutrient source. In the process of breaking down fibers, these bacteria produce short chain fatty acids that can be absorbed by human cells lining the gut. Once absorbed, these fatty acids trigger a chain reaction that has many effects in the human body, including improved sugar regulation12.
For this reason, methods for countering prediabetes often involve diet restructuring to decrease sugar intake, increase fiber consumption, and cultivate a diverse and beneficial gut microbiome.
But what diet works best? Unfortunately, there is no clear answer to this question because the effectiveness of any diet hinges on several factors: how often you exercise, your current health, your environment, the resources you have available to you, and many more.
Diets shown to be effective in treating prediabetes—often in combination with exercise and weight loss—in large clinical trials include decreased saturated fat intake, reducing total calorie consumption, and increased dietary fiber intake8,9.
It is noteworthy, too, that the more successful trials involved consultation with a dietitian or frequent guidance from healthcare professionals3,4,5,6. Additionally, dieting has proven difficult to maintain over long periods of time and thus extreme diets are typically not adhered to for long periods of time. Because of this, it’s important to work with a healthcare professional when structuring and carrying out a diet.
What foods should you avoid if you have prediabetes?
If you have prediabetes, it’s important to work with a professional to determine what foods you should eat more of and which you should avoid.
General guidance from the American Diabetes Association suggests that people with prediabetes avoid foods with added sugars in them (sugary drinks, cookies, candy) as well as refined grains (white bread, white rice, high sugar breakfast cereals)13.
Paying attention to a food’s glycemic load is also important. We’ve discussed this in more detail in a previous article.
Are there supplements that can help reverse prediabetes naturally?
Reversing prediabetes, at its core, is reducing your average blood sugar levels. Supplements can help with this process, though many supplements are still poorly understood and much more research is needed to fully understand how to use supplements effectively and safely.
You can read more about supplements and their effect on lowering blood sugars here.
Can intermittent fasting reverse prediabetes?
Intermittent fasting has grown in popularity in recent years as a way to lose weight and potentially manage conditions like prediabetes.
To date, very few studies have been done to examine if intermittent fasting is beneficial for either prediabetes or type 2 diabetes14. The few studies that have been done are relatively small but provide some promising early results that suggest intermittent fasting may be beneficial.
However, there’s also reason for concern as people taking insulin while intermittent fasting may be at an increased risk of hypoglycemia (when blood sugar levels dip too low)14.
At this point, there isn’t sufficient evidence to say whether intermittent fasting is a safe and effective means to reverse prediabetes.
Are there other methods to reverse prediabetes naturally?
Above, we discussed some of the most studied methods for reversing prediabetes naturally. In recent years, there have been developments in some promising areas of study that may prove to be helpful in reversing prediabetes.
Prominent among these is research into the gut microbiome.
The gut microbiome consists of a many different species of bacteria (as well as viruses and fungi). Studies suggest that this microscopic ecosystem has a big role to play in keeping us healthy and that includes influencing blood sugar regulation.
How it does this is still being worked out, but it does seem that having certain species present decreases your odds of developing conditions like prediabetes and type 2 diabetes12.
Based on these studies, several teams of researchers have focused on finding ways to cultivate a diverse gut microbiome containing various beneficial species of bacteria—the idea here is to figure out how to alter an individual's gut microbiome in ways that improve their blood sugar levels.
Recently, a medical probiotic known as Pendulum Glucose Control was demonstrated in a clinical trial to help lower blood sugar levels (specifically a decrease in A1C levels)15. Pendulum Glucose Control is not proven to reverse prediabetes or type 2 diabetes, but these promising results suggest that medical probiotics prove to be a good tool in managing A1C and blood glucose levels.
For more information on how to lower your blood sugar levels, see this article.
Final Thoughts
Prediabetes is often seen as the road that leads to type 2 diabetes. But as we’ve stated, that doesn’t always have to be the case.
Prediabetes is a reversible condition.
And the evidence so far suggests that with the right diet and exercise routine, and maybe some help from the right probiotics, prediabetes can become just a memory, not a life-long sentence.
Additional Questions
Can prediabetes be reversed permanently?
Reversing prediabetes is not always permanent. Even the most effective means of reversing prediabetes hinge on the continued use of treatments, whether they’re medications, exercise routines, or diets.
This is because blood sugar levels are dynamic and always capable of rising in response to changing lifestyles (For example, as we age, it can be difficult to maintain certain exercise routines).
How long does it take to reverse prediabetes?
Reversing prediabetes typically takes a significant amount of work and won’t happen quickly. This is because reversing prediabetes requires you to establish new habits and new routines that change your average blood sugar over time.
An exception to this is bariatric surgery which is known to rapidly reduce blood sugar levels in some individuals4.
However, even with surgery, lifestyle changes need to be adopted to maintain this reversal.
How often should I check my blood sugar if I have prediabetes?
The American Diabetes Association suggests that people with prediabetes check their blood sugar once every 1 to 2 years1. This check should include fasting blood glucose as well as blood A1C tests.
References
“Diagnosis.” Diagnosis | ADA, www.diabetes.org/a1c/diagnosis.
“Prediabetes - Your Chance to Prevent Type 2 Diabetes.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 June 2020, www.cdc.gov/diabetes/basics/prediabetes.html.
Khan, Radia Marium Modhumi et al. “From Pre-Diabetes to Diabetes: Diagnosis, Treatments and Translational Research.” Medicina (Kaunas, Lithuania) vol. 55,9 546. 29 Aug. 2019, doi:10.3390/medicina55090546 https://pubmed.ncbi.nlm.nih.gov/31470636/
Portero McLellan, Katia Cristina et al. “Therapeutic interventions to reduce the risk of progression from prediabetes to type 2 diabetes mellitus.” Therapeutics and clinical risk management vol. 10 173-88. 20 Mar. 2014, doi:10.2147/TCRM.S39564 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964168/
Schwarz, Peter E., et al. “Nonpharmacological Interventions for the Prevention of Type 2 Diabetes Mellitus.” Nature Reviews Endocrinology, vol. 8, no. 6, 2012, pp. 363–373., doi:10.1038/nrendo.2011.232. https://www.nature.com/articles/nrendo.2011.232
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Chait, Alan, and Laura J den Hartigh. “Adipose Tissue Distribution, Inflammation and Its Metabolic Consequences, Including Diabetes and Cardiovascular Disease.” Frontiers in cardiovascular medicine vol. 7 22. 25 Feb. 2020, doi:10.3389/fcvm.2020.00022 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052117/
Knowler, William C et al. “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” The New England journal of medicine vol. 346,6 (2002): 393-403. doi:10.1056/NEJMoa012512 https://www.nejm.org/doi/full/10.1056/NEJMoa012512
Uusitupa, Matti et al. “Ten-year mortality and cardiovascular morbidity in the Finnish Diabetes Prevention Study--secondary analysis of the randomized trial.” PloS one vol. 4,5 e5656. 21 May. 2009, doi:10.1371/journal.pone.0005656 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682577/
McRae, Marc P. “Dietary Fiber Intake and Type 2 Diabetes Mellitus: An Umbrella Review of Meta-analyses.” Journal of chiropractic medicine vol. 17,1 (2018): 44-53. doi:10.1016/j.jcm.2017.11.002 https://pubmed.ncbi.nlm.nih.gov/29628808/
National Research Council (US) Committee on Diet and Health. “Dietary Fiber.” Diet and Health: Implications for Reducing Chronic Disease Risk., U.S. National Library of Medicine, 1 Jan. 1989, www.ncbi.nlm.nih.gov/books/NBK218764/.
Li, Wei-Zheng et al. “Gut microbiota and diabetes: From correlation to causality and mechanism.” World journal of diabetes vol. 11,7 (2020): 293-308. doi:10.4239/wjd.v11.i7.293 https://www.wjgnet.com/1948-9358/full/v11/i7/293.htm
“Nutrition Overview.” Nutrition Overview | ADA, www.diabetes.org/nutrition.
“Review for ‘Intermittent Fasting and ‘Metabolic Switch’: Effects on Metabolic Syndrome, Pre‐Diabetes and Type 2 Diabetes Mellitus.’” 2020, doi:10.1111/dom.14080/v1/review4. https://pubmed.ncbi.nlm.nih.gov/32372521/
Perraudeau, Fanny, et al. “Improvements to Postprandial Glucose Control in Subjects with Type 2 Diabetes: a Multicenter, Double Blind, Randomized Placebo-Controlled Trial of a Novel Probiotic Formulation.” BMJ Open Diabetes Research & Care, vol. 8, no. 1, 2020, doi:10.1136/bmjdrc-2020-001319. https://drc.bmj.com/content/8/1/e001319
