Diabetes goes into remission in many patients who undergo bariatric weight-loss surgery, which significantly restricts caloric intake prior to clinically significant weight loss.The research team investigated the effects of a very low calorie diet VLCD, consisting of one-quarter the normal intake, on a rodent model of type 2 diabetes.
Using a novel stable (naturally occurring) isotope approach, which they developed, the researchers tracked and calculated a number of metabolic processes that contribute to the increased glucose production by the liver. The method, known as PINTA, allowed the investigators to perform a comprehensive set of analyses of key metabolic fluxes within the liver that might contribute to insulin resistance and increased rates of glucose production by the liver-two key processes that cause increased blood-sugar concentrations in diabetes.
Using this approach, the researchers pinpointed three major mechanisms responsible for the VLCD's dramatic effect of rapidly lowering blood glucose concentrations in the diabetic animals. In the liver, the VLCD lowers glucose production by: decreasing the conversion of lactate and amino acids into glucose; decreasing the rate of liver glycogen conversion to glucose; and decreasing fat content, which in turn improves the liver's response to insulin.
These positive effects of the VLCD were observed in three days. Using this approach to comprehensively interrogate liver carbohydrate and fat metabolism, we showed that it is a combination of three mechanisms that is responsible for the rapid reversal of hyperglycemia following a very low calorie diet.
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