#13 What if "Nothing Works"?

Let’s Talk About Failure

I would be lying if I told you that everyone can reverse their diabetes, no matter what. That’s internet-guru stuff. Not real life.

But here are the questions that really matter:

• what if you are one of the unlucky ones?

• What if reversal turns out to be harder than you hoped?

• What if you make progress, but don’t quite get over the line?

Was it all wasted effort?

No! Human physiology simply does not work like that.

There are extremely good reasons to work on reversing your diabetes even if you later hit a plateau. Real, noticeable, measurable health benefits come from even modest improvements in glucose control. These benefits are not hypothetical, and they are not all-or-nothing.

And there is more good news. Many of the factors that cause people to stall in scientific studies are not necessarily fixed barriers. They can often be worked around or gradually overcome if you know what you are doing. For a large number of people, remission is not lost; it is delayed.

So let’s look at this with sober heads on.

The Label Trap

In terms consistent with those widely in scientific research, remission is best thought of as follows (Lancet, 2025).

These are clear, pragmatic thresholds - excellent for researchers comparing studies and for doctors making categorical decisions.

But they also obscure a critical biological truth.

Blood-glucose control is not a good/bad binary. It is a sliding scale. The thresholds above are not cut-off points your body recognises or responds to. They are lines we draw for convenience. Your tissues respond proportionally to exposure: how high glucose runs, how long it stays there, and how stable it is over time.

In other words, remission is a label, while risk reduction is a continuum.

What Are The Odds?

In a moment, I’m going to show you why relying on headline research outcomes to estimate your chances of success is too limited - and why the reality is far more hopeful. But first, let’s be clear about where the numbers actually stand.

Karter et al. examined a large U.S. cohort of more than 122,000 people followed for seven years who were receiving usual clinical care and were not actively enrolled in a diabetes reversal programme (Karter et al., 2014). In that setting, the cumulative incidence of any remission was just 1.6%, with complete remission at 0.14% and prolonged remission at 0.007%. Those figures are frequently quoted - and they do sound bleak. They are also the reality most doctors see, which helps explain the scepticism you may encounter when you talk about reversal. The scepticism is understandable. Bear with me, though.

Now contrast that usual-care study with what happens when people do actively pursue reversal.

In Professor Roy Taylor’s DiRECT study, the subgroup who were most adherent - those who lost 15 kg or more - achieved remission rates of around 86% (Lean et al., 2019). Other intervention studies, using less intensive but still structured programmes, routinely report remission rates in the 40–70% range. So, it’s obvious that deliberate, sustained effort makes an enormous difference.

But there is a common mistake people make lookng at these result: to conclude that the remaining 14% who “didn’t make it” are simply stuck - that their diabetes is fundamentally irreversible - and then to worry that this group might include you.

That interpretation is, thankfully, unjustified.

These results come from studies with standardised protocols: a specific dietary approach, applied for a fixed duration. The choices involve compromise. The diet must be effective enough to induce remission, but also practical enough to maintain compliance across a large group. The duration must be long enough to demonstrate an effect, but short enough to fit funding cycles and minimise dropout.

For these reasons, the observed “failure rate” in such trials almost certainly overestimates the number of people who cannot reverse their diabetes at all. In a motivated individual, working with an optimised approach and an open-ended timeframe, the true chances of failure are likely far lower.

Which brings us to the next, and arguably more important, question.

What happens to the health of people who don’t achieve remission - or who simply haven’t achieved it yet?