Stress-Free Longevity

Episode 18: Understanding Type 2 Diabetes with Professor Mike Lean

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Episode Overview

In this groundbreaking conversation, Professor Mike Lean, the only doctor in the UK on the GMC Specialist Register for Human Nutrition, reveals how type 2 diabetes can be reversed through targeted weight loss. With over 40 years of medical experience and as lead investigator of the landmark DiRECT trial, Prof. Lean explains why diabetes isn’t the permanent condition we were taught it was, how fat in vital organs drives the disease, and the practical steps people can take to achieve remission. This interview challenges decades of conventional medical advice and offers genuine hope for millions living with type 2 diabetes.

Key ‘Type 2 Diabetes’ Insights:
  • Type 2 Diabetes Is Reversible: The disease is no longer considered permanent. The DiRECT trial demonstrated that 86% of people who lost 15kg achieved remission, fundamentally changing how we understand and treat type 2 diabetes.
  • Ectopic Fat Is the Real Problem: It’s not total body weight that matters—it’s fat accumulating inside vital organs (liver, pancreas, heart) that causes diabetes. Subcutaneous “cuddly” fat is metabolically safe.
  • Personal Fat Threshold Varies: Everyone has a different genetic threshold determining when fat enters organs. Asian and Indigenous populations develop diabetes at BMI 22-23, whilst Europeans typically need higher BMIs before experiencing problems.
  • The “Big Bang” Approach Works Best: Intensive weight loss (800-850 calories daily for 8-12 weeks) proves more effective than slow, gradual changes because dramatic results create motivation to maintain the effort.
  • Snacking Is a Manufactured Habit: Fifty years ago, snacking culture didn’t exist. We’re now consuming 300-400 calories more daily than previous generations, driven by food industry marketing rather than biological need.
  • Exercise Won’t Reverse Diabetes: Whilst excellent for overall health and wellbeing, exercise alone cannot reverse type 2 diabetes or achieve the weight loss needed for remission. Diet is the primary tool.
    • Expert ‘Type 2 Diabetes’ Takeaways
    1. If diagnosed with type 2 diabetes within the first six years, losing 10-15kg can potentially put the disease into remission and allow you to stop medications
    2. Focus on dietary intervention rather than exercise as your primary strategy for diabetes reversalConsider an intensive short-term approach (with proper nutritional support) rather than attempting gradual weight loss over many months
    3. Return to three structured meals per day without snacking between them—recognise that hunger between meals is normal and manageable
    4. If you have diabetes risk factors (family history, Asian/Indigenous background, gestational diabetes history), focus on weight management even if you’re not visibly “overweight”
    5. Test for prediabetes and intervene early—losing just one stone at the prediabetes stage can prevent progression for up to 30 years
    6. Use person-first language: “people living with diabetes” rather than “diabetics” to reduce stigma
    7. Seek online support from trained dietitians if intensive weight loss is needed—it’s often more effective than in-clinic consultations
      8. About Our Guest

      Professor Mike Lean is a General Physician and specialist on the GMC Specialist Register for Diabetes, Endocrinology, and Human Nutrition—the only doctor in the UK with this specific registration for Human Nutrition. With over 40 years of medical experience, he was the lead investigator of the landmark DiRECT (Diabetes Remission Clinical Trial) study, which demonstrated that type 2 diabetes can be reversed through substantial weight loss. His research has fundamentally changed NHS policy across the United Kingdom, with all four national health services now offering diabetes remission programmes. Professor Lean’s work has shifted the paradigm from managing type 2 diabetes as a chronic condition to treating it as a reversible disease.

      Visit Professor Lean’s Academic Profile

      Watch the ‘Type 2 Diabetes’ interview
      https://www.youtube.com/watch?v=tod8DJdASjs
      ‘Type 2 Diabetes’ Resources

      Key Research Discussed:

      • The DiRECT Trial – Diabetes Remission Clinical Trial demonstrating type 2 diabetes reversal through weight loss
      • Counterweight Plus Programme – The evidence-based weight loss programme developed in Scotland and used in the DiRECT trial

        • Relevant Organisations:

        NHS Diabetes Remission Programmes – Information on accessing diabetes remission support through the NHS

        Diabetes UK – Patient-led research priorities and diabetes remission information

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        • The post Episode 18: Understanding Type 2 Diabetes with Professor Mike Lean first appeared on Stress-Free Longevity.

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        Stress-Free LongevityBy Dr Eoghan Colgan