Book a consult A first-principles approach to remission
The first target is not a perfect diet label. It is losing enough excess weight to reduce fat in the liver and pancreas—and move below your personal fat threshold.
A visual metaphor: these conditions often cluster, but not every condition is caused by diabetes.
Look below the glucose
Glucose is measurable, but it is only one expression of a much larger metabolic story.
Fatty liver, hypertension, dyslipidemia, PCOS, sleep apnea, gout and vascular risk frequently travel with insulin resistance. Thyroid disease can coexist and deserves proper assessment, but should not automatically be blamed on diabetes.
Dr. Thapa’s framework
01 / First principles
The remission engine
In typical type 2 diabetes, sustained weight loss can reduce excess liver and pancreatic fat, improve insulin sensitivity and allow insulin-producing cells to recover function. The amount required is personal—not dictated by an “ideal” BMI.
The route is flexible. Crossing the threshold is the target.The glucose lever
Carbohydrate reduction often lowers glucose quickly and can reduce hunger for some people. The therapeutic dose varies: stricter at first for some, more liberal in maintenance for others.
Use glucose response, A1C, appetite and sustainability—not ideology.Remission: A1C below 6.5% for at least three months without usual glucose-lowering medication. It is not a cure, and eye, kidney, foot and cardiovascular follow-up continues.
See the Canadian guidelineResearcher spotlight
Professor of Medicine & Metabolism, Newcastle University
“Personal fat threshold” explains why type 2 diabetes is not reserved for people at a high BMI.
Each person has a different capacity to store energy safely in subcutaneous fat. Once that capacity is exceeded, fat is more likely to spill into organs such as the liver and pancreas. Genetics and fat-cell biology help set that capacity.
Taylor’s twin-cycle hypothesis and the DiRECT and ReTUNE studies changed the conversation: substantial weight loss can normalize organ fat and glucose even in some people with a BMI below the conventional obesity range.
Below your threshold
Energy is stored predominantly under the skin, with less spillover into organs.
Above your threshold
Liver and pancreatic fat can rise, driving excess liver glucose and beta-cell stress.
Waist, weight trajectory, ethnicity, family history, metabolic markers and response to weight loss often reveal more than BMI alone. A lean or atypical presentation also deserves assessment for LADA, MODY, pancreatic disease, medication effects or another diagnosis.
The twin-cycle hypothesis
A simplified map of a complex physiology—not a claim that every person follows an identical path.
More energy enters storage than leaves it.
Insulin becomes less able to restrain liver glucose output.
The liver sends more triglyceride-rich VLDL into circulation.
Susceptible beta cells lose normal meal-time insulin response.
Liver fat can fall quickly; pancreatic recovery may follow over time.
Routes to the same physiology
Choose the least intensive tool likely to work, then escalate when needed. Every route should protect muscle, nutrition and long-term follow-through.
Vegan, Mediterranean, lower-carbohydrate, animal-forward and other whole-food patterns can all work if they create a sustainable energy deficit and preserve lean mass.
Best diet: the effective one you can maintainThe DiRECT and NHS remission programmes use a time-limited, nutritionally formulated low-energy phase, followed by food reintroduction and long-term support.
Strong randomized and real-world evidenceShorter eating windows or intermittent fasting can make energy restriction simpler for some people. They are tools—not magic independent of energy balance.
Medication review comes firstGLP-1–based therapies and other medications can produce clinically meaningful weight loss and improve glucose while they are used, when medically appropriate.
Pair medication with a maintenance planBariatric and metabolic procedures are powerful options for selected people and can lead to durable remission, but require lifelong nutritional and medical follow-up.
An evidence-based treatment, not a failureThe carbohydrate spectrum
Most digestible carbohydrate contributes to blood glucose, but foods, portions and individual responses differ. Lowering the dose can improve post-meal glucose immediately—before major weight loss occurs.
A useful reference point—not a biological law
That range can be a practical starting experiment for some adults. Your effective maintenance ceiling may be lower or higher, and depends on medication, activity, food quality, kidney health, lipid response and what you can sustain.
Read the CSIRO explanationDr. Thapa’s preference
For patients who prefer it, Dr. Thapa often starts with protein-rich whole foods—meat, fish, seafood, eggs and dairy as appropriate—plus non-starchy plants according to preference and tolerance. This can simplify carbohydrate reduction, support satiety and help preserve muscle during weight loss.
It is a clinical preference, not a claim that vegan, Mediterranean or other patterns cannot work. Very restrictive carnivore approaches have limited long-term remission-trial evidence; nutritional adequacy, LDL response, kidney function and individual risk should be monitored.
Find your own ceiling
The dawn phenomenon
Because glucose does not come only from food. Your liver stores it—and releases it.
In the early morning, circadian hormones signal the liver to increase glucose production so the body can wake and move. In type 2 diabetes, liver insulin resistance and an insufficient insulin response can let that rise run higher than intended.
A typical clue is a stable overnight glucose followed by a pre-dawn rise, without a preceding low. CGM—or selected overnight checks interpreted with your care team—can help separate dawn physiology from late food, poor sleep, medication timing or nocturnal hypoglycemia.
Morning glucose ↑
Fasting as a tool
Fasting can reduce eating opportunities and help some people access stored energy. It is not required for remission, and longer is not automatically better.
Finish dinner, remove late snacks and eat breakfast when genuinely hungry.
Concentrate meals in a consistent daytime window, often earlier rather than later.
A higher-risk medical tool, not a casual challenge. Use only with individualized supervision.
Maintenance is treatment
Weight regain can rebuild liver and pancreatic fat, and glucose can rise again. The maintenance plan begins before the weight-loss phase ends.
Set a personal weight range that triggers early action—not shame.
Prioritize adequate protein and progressive resistance training.
Repeat A1C and cardio-kidney risk assessment; continue eye and foot care.
Use a pre-agreed food, fasting, medication or support “rescue” plan early.
Read deeper
Books can make the science practical. They do not replace individualized medical advice.
The clearest public-facing account of the personal fat threshold and weight-loss-first model.
An evidence-based 50–70 g/day low-carbohydrate framework with food and exercise guidance.
A balanced scientific review comparing energy restriction, low carbohydrate approaches and surgery.
Family Physician
Metabolic Health
About the physician
Family Physician in Airdrie, Alberta, with a focused clinical interest in metabolic health, obesity, insulin resistance and sustainable chronic disease care.
Dr. Thapa helps people understand why rising blood sugar, fatty liver, high blood pressure, sleep disruption, gout, PCOS and other cardiometabolic concerns so often cluster. His approach begins with the major physiological target—enough weight loss to reduce ectopic fat—then uses carbohydrate reduction, meal timing, movement, sleep and medication according to the individual.
Before medicine, Dr. Thapa completed a PhD in behavioural neuroscience at the University of Lethbridge. That training shapes his practical approach to behaviour change: improvement lasts when the environment and routine make the desired action easier to repeat.
He lives in Airdrie with his family and is the founder of CentaurMD.ca, reflecting an ongoing interest in building tools that support better care and decisions.
“The diet name is not the treatment. The treatment is reaching and maintaining the physiology of remission safely.”
Evidence around the world
Remission is most likely when enough weight is lost, medication is adjusted safely, and long-term support prevents regain.
Roy Taylor’s twin-cycle work places excess liver and pancreatic fat at the centre of typical type 2 diabetes—and explains why meaningful weight loss can restore normal glucose control in many people.
2025 reviewA structured low-energy programme showed that remission can be delivered in routine primary care and at health-system scale. The long-term lesson is equally clear: continued support matters.
NHS Path to RemissionThe international consensus definition is A1C below 6.5% for at least three months without usual glucose-lowering medication. Remission is not a cure; monitoring continues.
Consensus reportDiabetes Canada supports remission as a possible treatment goal for some people while emphasizing individualized care, medication safety and ongoing complication screening.
Diabetes CanadaCommon questions
Yes, for some people—especially when it produces enough sustained weight loss. The same is true of Mediterranean, lower-fat, lower-carbohydrate and animal-forward patterns. Food quality, protein adequacy, lean-mass preservation and maintenance matter whichever route you choose.
No universal BMI guarantees remission. The key concept is meaningful loss from your personal starting point and reduction of ectopic fat. People at a lower BMI can still exceed their personal fat threshold; people at a higher BMI may remain metabolically well for longer.
No. Late food may contribute, but the dawn phenomenon comes from increased liver glucose output before waking. Look at the full overnight pattern and review sleep, stress, illness and medication timing with your clinician.
No. Remission can relapse, and prior glucose exposure may still carry risk. Continue A1C, blood pressure, lipids, kidney, eye and foot monitoring on a schedule agreed with your care team.
Start with your physiology
Book an in-person visit for a comprehensive metabolic and type 2 diabetes assessment at One Health Associate Medical in Airdrie.
Call (403) 948-6422One Health Associate Medical
836 1 Ave NW #201
Airdrie, AB T4B 0V2