Reversing the Tide: Why Medicine Still Ignores the Cure for Type 2 Diabetes

By Joyce Kurisko

When TIME recently released a special issue on diabetes, it echoed the familiar refrain: monitor your glucose, manage your medications, count your carbs. Buried inside was a brief nod to the idea of type 2 diabetes “remission,” but the publication never seriously explored the decades of research showing that insulin resistance can be reversed—and that, for many people, type 2 diabetes itself can go into remission—with a low-fat, whole-food, plant-based diet that targets saturated-fat-driven insulin resistance at its source.¹⁵ Instead, like most mainstream coverage, it focused on newer drugs, high-tech devices, and incremental improvements in blood sugar control.

This isn’t just an academic oversight. It’s a practical tragedy. The American College of Lifestyle Medicine (ACLM) now openly states that type 2 diabetes is largely a diet- and lifestyle-driven disease that can be prevented, arrested, and often reversed with a predominantly whole-food, plant-based diet and other lifestyle interventions.² Yet “most people with type 2 diabetes report never being told their disease may be prevented, arrested, and even reversed” with such an approach.² That means millions are being managed—but not told that a genuine path to reversal even exists.

What Insulin Resistance Really Is

In healthy metabolism, insulin is the hormone that allows glucose to move from the bloodstream into cells. Think of it as a key that fits into a lock on the cell membrane. When insulin binds to its receptor on the surface of muscle or liver cells, the receptor activates a series of proteins inside the cell called Insulin Receptor Substrates (IRS)—primarily IRS-1 and IRS-2.³

Here’s the simplified sequence:

1. Insulin binds to the insulin receptor.

2. The receptor activates and attaches phosphate groups to itself (auto-phosphorylation).

3. It then phosphorylates IRS proteins on specific tyrosine sites.

4. Activated IRS recruits downstream enzymes (like PI3K and Akt).

5. This cascade moves glucose transporters (GLUT4) to the cell surface, increases glucose uptake, and suppresses liver glucose output.

   
   

When all of that works, blood sugar stays in a normal range with modest amounts of insulin.

In insulin resistance, the problem is not an absence of insulin (at least early on). The problem is that this IRS-mediated signaling pathway is blunted. The “lock” is gummed up. The insulin receptor still binds insulin, but the message to IRS-1 and IRS-2 gets scrambled.

Saturated Fat and the IRS “Short-Circuit”

What scrambles that message? A vast body of research now points to excess fatty acids—especially saturated fat—accumulating inside muscle and liver cells as a key driver.⁴

When there is more fat circulating than your fat cells can comfortably store, it spills into tissues that were never meant to hold much fat at all. This ectopic fat builds up as tiny droplets inside muscle fibers and liver cells. These fats are converted into toxic lipid intermediates—most notably diacylglycerols (DAGs) and ceramides.⁴

Those intermediates flip on stress enzymes (like JNK, IKKβ, and novel protein kinase C isoforms).⁴ Instead of letting the insulin receptor phosphorylate IRS-1 on helpful tyrosine sites, these enzymes phosphorylate IRS-1 on serine sites—essentially “tagging” IRS-1 in the wrong place.³ Once that happens:

• IRS-1 can’t do its job.

• PI3K and Akt don’t activate properly.

• GLUT4 transporters don’t move to the cell surface.

• Muscle cells don’t take up glucose.

• The liver doesn’t properly shut off glucose production.

  
  

Blood sugar rises, even though insulin is present in large amounts. The pancreas responds by pumping out even more insulin, leading to chronic hyperinsulinemia, which can further stress tissues and, over time, exhaust the insulin-producing beta cells.

This is insulin resistance at the molecular level—not too many carbs floating around, but too much fat in the wrong place, corrupting the IRS signaling system.

Ectopic Fat: The True Villain

This intramuscular and intrahepatic fat—“ectopic fat”—has been extensively documented. In one classic study, young, lean people who were genetically predisposed to type 2 diabetes were found to have increased intramyocellular fat, defective insulin signaling, and reduced insulin-stimulated glucose uptake, even before any rise in blood sugar.⁵ When they lost weight and reduced that muscle fat, insulin sensitivity improved dramatically.⁵

This intracellular fat is the true villain. Studies show that reducing liver and muscle fat restores insulin sensitivity within days or weeks, long before major weight loss occurs.⁵ Roy Taylor of Newcastle University proposed the now well-known “twin-cycle” hypothesis:

• Chronic calorie excess—typically from high-fat, energy-dense foods—causes fat buildup in the liver.

• Fatty liver overproduces glucose and very-low-density lipoprotein (VLDL) triglycerides, sending more fat to the pancreas.

• As pancreatic fat accumulates, the beta cells become impaired and blood sugar rises into the diabetic range.⁶

  
  

Taylor’s work showed something profoundly hopeful: if you remove that excess fat from the liver and pancreas—through substantial weight loss and/or dramatic reductions in dietary fat—normal glucose control can return. In the DiRECT and related trials, 46% of people with type 2 diabetes achieved remission at one year with intensive weight-loss interventions; those who lost the most weight had the highest remission rates.⁶ In follow-ups, a meaningful proportion maintained remission at two years.⁶ The mechanism tracked perfectly with imaging—liver and pancreatic fat fell, beta-cell function improved, and diabetes retreated.

A Low-Fat, Whole-Food, Plant-Based Diet in Action

Years before these imaging studies, clinicians were already seeing that when patients adopted a low-fat, high-fiber, plant-based diet, insulin resistance often melted away.

In a landmark randomized trial, Neal Barnard, MD, and colleagues assigned people with type 2 diabetes either to:

• A conventional American Diabetes Association (ADA) diet, or

• A low-fat vegan diet with about 10% of calories from fat, focused on whole grains, legumes, vegetables, and fruit.⁷

  
  

The low-fat vegan group:

• Lowered HbA1c more than the ADA group.⁷

• Lost more weight.⁷

• Reduced or discontinued diabetes medications more often.⁷

  
  

Later work using MRI and spectroscopy confirmed that plant-based diets lower liver fat and intramyocellular fat, increasing insulin sensitivity in just 16 weeks—even without calorie counting.⁸ A whole-food, plant-based (WFPB) diet naturally:

• Minimizes saturated fat

• Maximizes fiber

• Lowers calorie density

• Promotes spontaneous weight loss and fat “off-loading” from liver and muscle

  
  

In other words, it directly reverses the ectopic fat problem that breaks IRS signaling.

Fuhrman, McDougall, and Kempner: Clinical Experience Meets Mechanism

Joel Fuhrman, MD, author of The End of Diabetes, has used a nutrient-dense, plant-rich “Nutritarian” approach for decades. His approach emphasizes vegetables, beans, intact grains, nuts, seeds, and fruit, while avoiding processed foods and animal products.⁹ In an interview with Dr. Lee Kurisko, Fuhrman stated that, in his experience, about 90% of motivated type 2 diabetics who fully follow his program can normalize blood sugar and reverse insulin resistance—often within weeks or months, with the longest taking up to nine months.⁹ Medications are tapered and frequently discontinued under medical supervision.

John McDougall, MD, working from a similar starch-centered philosophy, observed that patients with type 2 diabetes often improved so rapidly on his Starch Solution (based on potatoes, rice, beans, and other complex carbohydrates) that metformin and other oral agents had to be stopped at the start of the program to avoid hypoglycemia.¹⁰ This is the opposite of what most people expect when they hear “high-carb” diet—yet it is exactly what you’d predict if saturated fat and ectopic fat, not carbohydrate, are the main drivers of insulin resistance.

Going back even further, Walter Kempner, MD, at Duke University used an extremely austere “rice diet”—white rice, fruit, fruit juice, and table sugar—with virtually no added fat or animal protein. He documented dramatic improvements and often near-normalization of blood sugar, blood pressure, and kidney function in patients with severe hypertension and diabetes.¹¹ The diet was nutritionally incomplete and not a long-term solution, but it proved the principle: radically lowering dietary fat and animal products can reverse insulin resistance and diabetes complications, even when the diet is very high in carbohydrate, including simple sugars.

Taken together, Fuhrman, McDougall, and Kempner all saw in practice what modern mechanistic science confirms: cut the fat, especially saturated fat; flood the body with whole, unrefined plant foods; and insulin resistance can reverse quickly.

Mastering Diabetes: Clarifying Type 1 and 1.5

Cyrus Khambatta, PhD, and Robby Barbaro, MPH—co-founders of the Mastering Diabetes program and both living with type 1 diabetes—have helped popularize this message. Their system promotes a low-fat, whole-food, plant-based diet rich in fruits, vegetables, legumes, and intact whole grains, with total fat typically around 10–15% of calories.¹²

Crucially, they are very clear about what can and cannot be reversed:

• Type 1 and type 1.5 diabetes involve autoimmune destruction of beta cells. A WFPB diet does not “cure” or reverse these autoimmune diseases.

• What can be reversed in type 1 and 1.5 is insulin resistance—the same ectopic-fat-driven problem that affects everyone else. When people with type 1 adopt this diet, they often see:

  • Much better glucose control

  • Dramatically lower insulin requirements

  • Improved weight, lipids, and cardiovascular risk

• Type 2 diabetes, pre-diabetes, and gestational diabetes, on the other hand, are often fully reversible, because in many cases the beta cells are still present but “poisoned” by fat and chronic overload.¹²

  
  

So when we say “reversal” in this article, we are referring to reversal of insulin resistance and remission of type 2 diabetes, not a cure of autoimmune type 1.

Weight Loss Helps—but Diet Quality Matters, Too

The weight-loss/remission trials like DiRECT show that losing about 10–15 kg (roughly 22–33 pounds) can push type 2 diabetes into remission in about half of participants, especially if the disease is of short duration.⁶ Rapid weight loss drains fat out of the liver and pancreas, restoring insulin sensitivity and beta-cell function.¹³

However, many people with type 2 diabetes are not severely overweight. Some have BMIs in the “normal” or only mildly elevated range and still have significant insulin resistance. Fuhrman, McDougall, and others have long pointed out that these “normal-weight diabetics” often only reverse their insulin resistance when they dramatically change the quality of their diet—specifically:

• Eliminating or minimizing animal products and added oils

• Centering meals on whole plant starches (beans, lentils, intact grains, potatoes)

• Eating large volumes of vegetables and fruit

  
  

In these individuals, it’s not just the quantity of fat stored that matters, but the type and location: saturated fat within liver and muscle cells, driving IRS dysfunction. For them, a WFPB approach doesn’t just reduce calories; it reprograms the metabolic environment that determines how insulin signaling behaves.

The ACLM Diabetes Bill of Rights

The American College of Lifestyle Medicine has gone so far as to issue an official Diabetes Bill of Rights.² Among its declarations:

• You have the right to be fully informed about all treatment options for type 2 diabetes, including the benefits of treatment with a predominantly whole-food, plant-based diet.²

• You have the right to know that type 2 diabetes may be prevented, arrested, and even reversed with appropriate lifestyle changes.²

• You have the right to work with health professionals who understand the links between lifestyle choices and type 2 diabetes and who are equipped to treat and reverse disease through therapeutic lifestyle change.²

  
  

Yet most patients never hear these words in a clinic exam room. The default narrative—that type 2 diabetes is “chronic and progressive”—remains deeply embedded in medical culture.

Why Most Doctors Still Don’t Tell Patients About Reversal

This disconnect isn’t because physicians don’t care. It’s because:

• Medical training includes very little nutrition or lifestyle medicine. Most physicians receive only a few hours of formal nutrition education, often focused on biochemistry rather than practical dietary patterns.

• Clinical guidelines have historically emphasized glucose control, not reversal. Remission has only recently been formally defined by major diabetes organizations, and is still often presented as rare or exceptional.

• Pharmaceutical and device solutions are heavily marketed and easier to bill for, while intensive lifestyle counseling is poorly reimbursed and logistically challenging.

  
  

As a result, patients are routinely told they will “need medication for life,” even though high-quality trials now show that substantial proportions of patients can achieve remission with diet and lifestyle—and even higher proportions when bariatric surgery is added to the mix.⁶ From a patient’s perspective, that is a profound failure of informed consent.

The Carbohydrate–Insulin Model Has Been Debunked

Many people have heard a different story: that carbohydrates raise insulin, insulin drives fat storage, and that in turn causes obesity and diabetes. In this “carbohydrate–insulin model,” the solution is to cut carbs (especially starches) and eat more fat, often including saturated fat, to reduce insulin levels.

But controlled metabolic ward studies have tested this model and found it wanting. When calories and protein are matched:

• Low-fat, higher-carb diets sometimes produce more body-fat loss than low-carb, high-fat diets, even though insulin levels are higher.¹⁴

• The expected large, sustained boost in energy expenditure from ketogenic or very low-carb diets has not materialized; any differences tend to be small and transient.¹⁴

  
  

These results, combined with the twin-cycle data and WFPB trials, point to a different reality:

• Energy balance and calorie density matter for body weight.

• Saturated fat and ectopic fat matter profoundly for insulin resistance.

• Whole-food carbohydrates—especially from fruits, vegetables, legumes, and intact grains—are not the enemy. In the context of a very low-fat, unprocessed diet, they are often the primary tool for restoring metabolic health.

  
  

In other words, insulin certainly promotes fat storage in the short term, but insulin spikes from healthy carbohydrates are not the root cause of the diabetes epidemic. Chronic overload of saturated fat and calories, combined with low fiber and highly processed foods, is.

What This Means for People With Type 2 Diabetes

Putting all of this together:

• Insulin resistance in type 2 diabetes is largely driven by saturated-fat-induced ectopic fat in liver and muscle, which damages IRS signaling and blunts insulin’s actions.³⁴

• Many people—particularly those early in the course of disease—can reverse insulin resistance and achieve remission of type 2 diabetes by:

  
  

  • Adopting a low-fat, whole-food, plant-based diet

  • Losing enough weight to reduce liver and pancreatic fat

  • Increasing daily physical activity

• For others with longer-standing diabetes, significant beta-cell loss, or other complicating factors, these changes can still greatly reduce medication needs, improve glucose control, and lower cardiovascular risk.

  
  

Outside of autoimmune type 1 and fully burned-out beta cells, type 2 diabetes is best understood not as an inevitable downhill slide, but as a reversible metabolic state.

Mainstream medicine’s fixation on blood sugar numbers—rather than the underlying insulin resistance—has blinded it to this reality. The cure for many is not hidden in a syringe, pump, or pill, but on a plate: less saturated fat, more whole plants.

As Dr. Fuhrman often says, “The body is designed to heal when we stop injuring it.” And as the ACLM’s Diabetes Bill of Rights affirms, patients have the right to know that type 2 diabetes is not necessarily a life sentence, but often a diet-driven condition that they can help reverse.²

References (for your magazine layout)

You can keep these as numbered endnotes or adapt to your house style:

1. Himsworth HP. The relation of carbohydrate metabolism to diabetes. Clin Sci. 1935;2:67–94.

2. American College of Lifestyle Medicine. Diabetes Bill of Rights. 2024.

3. DeFronzo RA, Ferrannini E. Insulin resistance: a multifaceted syndrome responsible for NIDDM. Diabetes Care. 1991;14(3):173–194.

4. Samuel VT, Shulman GI. Mechanisms for insulin resistance: common threads and missing links. Cell. 2012;148(5):852–871.

5. Petersen KF, et al. Reversal of muscle insulin resistance by weight reduction in young, lean, insulin-resistant offspring of parents with type 2 diabetes. Proc Natl Acad Sci USA. 2003;100(12):7029–7034.

6. Taylor R, et al. Primary care–led weight management for remission of type 2 diabetes (DiRECT). Lancet. 2018;391:541–551.

7. Barnard ND, et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care. 2006;29(8):1777–1783.

8. Kahleova H, et al. Effect of a plant-based diet on insulin resistance and intramyocellular fat in overweight adults. J Nutr. 2020;150(11):3110–3117.

9. Fuhrman J. The End of Diabetes. New York: HarperOne; 2012.

10. McDougall J. The Starch Solution. New York: Rodale; 2012.

11. Kempner W. Treatment of kidney disease and hypertension with rice diet. Am J Med. 1948;4:545–577.

12. Khambatta C, Barbaro R. Mastering Diabetes. New York: Avery; 2020.

13. Lean MEJ, et al. Counterpoint Study: Reversal of type 2 diabetes after weight loss. Diabetologia. 2011;54:2506–2514.

14. Hall KD, et al. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016;104(2):324–333.

15. TIME. From Diagnosis to Empowerment. TIME Special Edition: Diabetes 2025.

16. TIME. Type 2 Diabetes Remission Is Possible. Here’s How to Do It. 2022.

If you’d like, I can now re-generate a clean Word file using this exact text (no ellipses, no missing sentences), but you can also just copy–paste this directly into your e-magazine layout.