Diabetes lifestyle intervention trial fails: modest changes bring modest results

At one point, the National Institute of Health (NIH) stopped their Look AHEAD (Action for Health in Diabetes) trial, which was investigating an “intensive lifestyle intervention program” to reduce the considerable cardiovascular risk associated with type 2 diabetes, compared to traditional diabetes support and education. After 11 years, there was no difference in incidence of cardiovascular events (e.g. heart attack and stroke) between the two groups, prompting the NIH to end the trial.

Why didn’t the intensive lifestyle intervention work? The major flaw in this study was that the intensive lifestyle intervention was not “intensive” at all. The program consisted of four years of instruction and counseling, encouraging subjects to follow a conventional low-fat diet (less than 30% of calories from fat and less than 10% of calories from saturated fat) and exercise three hours per week, with the goal of losing 7% of their body weight and maintaining that weight loss throughout the trial.1 However, the suboptimal 7% goal was not even met.

The average weight loss was less than 5 percent.Of course there was no reduction in cardiovascular risk! For a diabetic starting at 200 lbs., that is a weight loss of less than 10 lbs. Why would anyone expect this tiny amount of weight loss to significantly improve someone’s health; especially someone with diabetes – a disease whose primary risk factor is excess weight?2

To meaningfully reduce the serious cardiovascular risks associated with diabetes, diabetics must achieve a healthy weight; losing a few pounds is simply not enough. Conventional recommendations to reduce fat intake or portion sizes do not bring about meaningful weight loss. Even the study’s authors  acknowledged that subjects who lost more weight fared better: Analysis of Look AHEAD after one year found that a 5-10% weight loss was associated with reductions in HbA1c, blood pressure, C-reactive protein, and improved lipid profile; 5-10% was a step in the right direction, but greater weight losses translated into greater reductions in those risk factors. In the words of the authors, “Modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year, but larger weight losses had greater benefits.” The magnitude of the weight loss correlated to the magnitude of improvement in risk factor measurements.3,4 If the subjects were coached to reach a healthy weight with a nutritarian diet, rather than just to lose a few pounds, the researchers probably would have seen a dramatic reduction in cardiovascular events. My results are unequaled in this field. Most of the type 2 diabetics who follow my nutritarian program become non-diabetic.

The goal must be set high – the goal is to reverse diabetes.

At this point in time, when obesity and diabetes have become epidemic, we cannot set suboptimal goals. The ubiquitous watered-down advice saying that losing 5-10% of one’s body weight will significantly improve health has no place here; it is misleading and dangerous. Cardiovascular disease is the most common cause of death among diabetics – having diabetes more than doubles the risk of heart attack and stroke. More than 11% of American adults have type 2 diabetes, and it is the 7th leading cause of death in the U.S.5 Lifestyle interventions must be aggressive if we want to prevent heart attacks and strokes, reverse diabetes and save lives.

It’s not that lifestyle interventions don’t work – it’s just that modest changes are not enough. A slightly lower fat version of the standard American diet cannot complete the demanding task of reversing diabetes. Only radical changes will produce radical results – a radical lifestyle change, to a natural, high-nutrient, vegetable-based (nutritarian) eating style, plus frequent exercise.  In a study, my colleagues and I investigated the efficacy of a nutritarian diet-style for treating patients with type 2 diabetes. Within just 7 months, 62% of the participants reached normal (nondiabetic) HbA1c levels, triglycerides dropped and the average number of medications dropped from four to one.  A nutritarian eating style has tremendous potential to reverse diabetes and ameliorate the associated cardiovascular risk.6

The choice to make is this: do you want to lose a few pounds, or do you want to get rid of your diabetes?

High-nutrient eating derails toxic hunger and food addictions, and has enabled my overweight clients to achieve dramatic weight loss results, in contrast to the modest results achieved by slight modifications to the disease-causing standard American diet. Hundreds of my patients and readers have reversed their diabetes, many losing 100 pounds or more:  Charlotte, Calogero, and Robert  just to name a few. They now live healthy active lives, and the cardiovascular risk that loomed over them has diminished with the disappearance of their diabetes.




1. Look AHEAD trial protocol. Available at: https://www.lookaheadtrial.org/public/LookAHEADProtocol.pdf

2. Khaodhiar, L., S. Cummings, and C.M. Apovian, Treating diabetes and prediabetes by focusing on obesity management. Curr Diab Rep, 2009. 9(5): p. 348-54.

3. Wing RR, Lang W, Wadden TA, et al. Look AHEAD Research Group. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011 Jul;34(7):1481-6.

4. Belalcazar LM, Reboussin DM, Haffner SM, et al.; Look AHEAD Research Group. A 1-year lifestyle intervention for weight loss in individuals with type 2 diabetes reduces high C-reactive protein levels and identifies metabolic predictors of change: from the Look AHEAD (Action for Health in Diabetes) study. Diabetes Care. 2010 Nov;33(11):2297-303.

5. American Diabetes Association: Diabetes statistics. Available from: http://www.diabetes.org/diabetes-basics/diabetes-statistics/.

6. Dunaief DM, Fuhrman J, Dunaief JL, Ying G. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet. Open Journal of Preventive Medicine. 2012 Aug;2(3):364-371