A groundbreaking international study shows how to clear fat from the pancreas and improve blood-sugar control

BEER-SHEVA, Israel, November 12, 2026 – Fat that builds up in the pancreas is one of the lesser-known risk factors for diabetes and metabolic syndrome, but it turns out it can be targeted directly through what's on the plate.

A new international study led by Ben-Gurion University of the Negev, published in The American Journal of Clinical Nutrition (https://doi.org/10.1016/j.ajcnut.2026.101513), shows how a precise dietary change can draw fat out of the pancreas, the organ that regulates blood sugar and insulin secretion. The study was carried out during the DIRECT-PLUS trial and followed about 300 participants who underwent advanced abdominal MRI scans over 18 months. A green Mediterranean (Green-MED) diet produced a 14% reduction in the fat stored inside the pancreas, compared with just 0.8% in the group following standard dietary guidelines. Specifically, a direct association was observed between the amount consumed and the magnitude of pancreatic fat reduction: participants who consumed more than 3 servings of Mankai per week or more than 5.5 servings of walnuts per week had significantly greater reductions in pancreatic fat than those with lower intakes.

Unlike liver fat or abdominal (visceral) fat, pancreatic fat has no agreed clinical threshold yet, but its buildup causes local lipotoxicity. One of the study's key advances was using MRI to separate the clearance of pancreatic fat from the preservation of functional pancreatic volume. This distinction matters clinically: obesity enlarges the pancreas through fat infiltration, while diabetes and aging shrink it through beta-cell death. The study found that the green diet, together with regular exercise, cleared the toxic fat without shrinking the functional tissue, which points to preservation of the organ's healthy structure. Clearing fat from the pancreas also improved glycemic measures and insulin resistance, even after statistically adjusting for the drop in intra-abdominal fat and for weight loss. This shows that pancreatic fat affects blood-sugar control directly and in its own right, not just as a byproduct of losing weight or trimming the waistline.

The study also sheds new light on the role of the aquatic plant Mankai and points to a clear anatomical mechanism. Earlier research showed that Mankai helps balance blood sugar after meals, and this study adds another mechanism behind that effect. Refined carbohydrates worked the other way. Eating bread, cereal and pasta slowed and blocked the clearance of fat from the organ.

The study was conducted during the DIRECT-PLUS trial, one of the longest and most detailed controlled clinical trials ever run in nutrition. The isolated setting of the Nuclear Research Center in Dimona allowed close monitoring and supervised lunches, which helped produce a high retention rate of 89% after 18 months. All participants received a free gym membership and began exercising regularly. DIRECT-PLUS had already shown that a green Mediterranean diet reduces liver fat and abdominal fat. These findings extend that work to the pancreas, showing how diet quality can reach the organ, protect it, and reverse metabolic damage.

Prof. Iris Shai, the study's principal investigator from Ben-Gurion University of the Negev, Dean of Sustainability at Reichman University and adjunct professor at Harvard, “The pancreas is the main engine of blood-sugar regulation in the body. When it fills with ectopic fat (fat that collects inside organs and tissues not meant to store it), lipotoxicity develops and disrupts beta-cell function, opening the way to type 2 diabetes. The clinical novelty is the evidence that pancreatic fat is a dynamic and fully reversible store. Unlike diseases in which the pancreas loses volume to cell death, the study showed that the toxic fat can be drawn out while the functional tissue stays intact.”

She adds, “Therefore, the pancreas is a target organ whose recovery helps blood-sugar balance well beyond the general loss of abdominal fat.”

PhD candidate Liav Alufer, the paper's lead author, “The study shows how specific dietary components shape our internal anatomy. More polyphenols from foods such as Mankai and walnuts mean a larger drop in pancreatic fat, while refined carbohydrates block the fat from clearing. Alongside regular exercise, a diet built on polyphenols and low in empty carbohydrates is the most precise way to change what our internal organs are made of, beyond counting calories.”

The research group comprised Liav Alufer, Dr. Gal Ben-Arie, Dr. Hila Zelicha, Dr. Gal Tsaban, Dr. Ehud Rinott, Dr. Alon Kaplan, Dr. Anat Yaskolka Meir, Prof. Ilan Shelef, Omer Kamer, Dr. Dafna Pachter, Dana Tamar Goldberg, Dr. Hadar Klein and Noa Ebstein Karmani, of Ben-Gurion University of the Negev; Prof. Uta Ceglarek, Prof. Berend Isermann, Prof. Matthias Blüher and Prof. Michael Stumvoll, of the University of Leipzig; Prof. Meir J. Stampfer and Prof. Frank B. Hu, of Harvard University; and Prof. Iris Shai.

Funding: The study was funded by the German Research Foundation (DFG), under grant numbers 209933838 and 20160181004 (SFB 1052; B11), awarded to Prof. Iris Shai and Prof. Matthias Blüher. Additional support came from the DFG Excellence Strategy (EXC-3105/1, grant number 533765739), awarded to Prof. Shai, Prof. Blüher and Prof. Stumvoll.