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For doctorsVirta Health publishes two-year data on low-carb diet for type 2 diabetes
, medical review by Dr. Bret Scher, MD
in Diabetes, Low carb & high fat, New study, Virta Health 
Can following a low-carb diet reverse type 2 diabetes long term by improving blood sugar control while reducing or eliminating diabetes medication?
The recent publication of Virta Health’s two-year clinical trial data answers that question with a resounding “yes”:
This study is a continuation of Virta’s trial previously published at 10 weeks in 2017 and one year in 2018, which compared a low-carb dietary intervention to usual care in people with type 2 diabetes.
Adults who enrolled in this study were given the choice of following a low-carb intervention or receiving standard diabetes care. The 262 participants who selected the intervention group were provided with a very-low-carb diet (initially 30 grams of total carbs per day, then increased based on individual tolerance), frequent nutrition coaching and education sessions with a registered dietitian, and supervision by a medical care provider. Those who chose to receive usual care (87 people) were provided with standard diabetes management from their doctor and referred to a registered dietitian for nutrition counseling or classes consistent with American Diabetes Association guidelines.
At two years, the low-carb intervention group experienced several impressive changes:
- Retention: 74% of the original participants (194 people) remained in the study
- Diabetes outcomes:
- Roughly half (53%) of participants were considered to have reversed their diabetes, meaning their blood sugar control improved, yet medication was reduced or eliminated
- As a group, average hemoglobin A1c (HbA1c) was reduced by 0.9% (similar to results in diabetes drug trials)
- 67% of insulin and oral diabetes medications (other than metformin) were eliminated altogether. For participants who still used insulin or oral drugs after two years, dosages were greatly reduced
- Weight: Average weight loss was 26 pounds (11.9 kg), and three-quarters of the participants lost at least 5% of their body weight, including abdominal fat
- Cardiovascular risk markers: Triglycerides decreased and HDL cholesterol increased, whereas LDL cholesterol increased only slightly, on average
- Liver health: Liver function markers, fatty liver scores, and liver damage scores improved
- No adverse changes in bone health or thyroid or kidney function were seen
By contrast, the group that received usual diabetes care and nutrition recommendations didn’t experience diabetes reversal or improvement. In fact, some of the usual-care participants needed more diabetes medication after two years. Additionally, very few of them lost any weight or experienced other health improvements.
Although this wasn’t a randomized, controlled study — considered the “gold standard” for scientific evidence — it may actually provide more important “real-world” information about how effective and sustainable low-carb diets can be. It clearly demonstrates that for people who want to follow a carb-restricted approach and work as a team with supportive and knowledgeable professionals, long-term diabetes reversal and overall health improvement is entirely possible.
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It may not be an RCT, but it's still a CT, and thus should still rank higher than much of the epidemiological evidence currently being used by those people, to dictate nutrition policy.
"Comment: All authors are employed by or consult for a company that uses low-carb dietary approaches in its for-profit business. As I explain in Unsavory Truth, the influence of industry funding is often unconscious, unintentional, and unrecognized. Nevertheless, the opinions of the authors can be predicted from their financial connections to Virta Health."
I'm not saying that I agree with her conclusion, but it does have some good points.
I do think in this study, it's hard to separate the value of the "continuous care intervention" from the low carb diet. I've seen a lot of criticism of Virta because the intensity of the intervention is difficult and expensive to replicate. I hope the involvement with the VA can address that question. I would like to see a study that gives the "usual care group" the same level of "continuous care intervention" as the low carb group.
I have never heard of a sugar and grain deficiency. In fact both are nutritionally devoid.... that's why grain products are typically fortified.
11 years eating low carb, on insulin still, but a1c always close to 5.0.
For the rest of the world to be willing to recognize the efficacy of this way of eating on diabetes intervention, the studies have to meet the same scientific criteria we accuse the other studies of not meeting. I think this study left the door open to criticism that there was no control for the intensity of intervention. Therefore it can be argued that the intensity of intervention was the reason for greater benefit in the "continuous care intervention" group, not the diet itself.
Personally I don't believe that, but it leaves the door open for others to disregard this study because of that issue--and I have seen that criticism of the first year intervention study specifically mentioned in some other reviews of the literature.
Doctors and nurses need to just stop believing in pharma and get back to real health and nutrition.
Although her field of study is nutrition, she constantly ignores the science about lowcarb and ketogenic diets.
I think her opinion is to be taken with a grain of salt.
I am so happy that mainstream is finally keeping up with how much what we eat effects our bodies.
Lean and mean!
LCHF, Keto is having a transformative effect on my health since January. After having two stents put in last August I was researching the effects of statin drugs and stumbled upon the raging controversy over the low carb diet. Since January I've lost 30 lbs and all of my blood work and markers have improved except oh my total cholesterol is a teeny bit high. The toll in human suffering caused by Ancel Keys and his fraudulent science and those who have perpetuated it to this day is beyond reckoning. Hopefully the tide is turning and this Insanity with it.
Big Pharma publishers the successful results of a study , that they paid for, about compound XKE 1963. Now after FDA approval they are selling it to make a profit. But we really can't believe
the data because the study was paid for by the drug company.
But Virta publishes the successful results of a study, that they paid for, about their program that they have developed and are now selling for a profit despite no regulatory oversight by anybody. But we have to accept their data because why?
The best I can determine from being involved with sites like this is that they ain't Big Pharma. They have the same goal as Big Pharma , that is, to help people get better while making some money. But since they are not Big Pharma we can believe them and the results of their studies that they have funded.
And the worst part is that anybody raising question about their data are treated as some sort of heretic which makes me beginning to think that sites like this are becoming more of a cult then a rational discussion of the science.
But again as the old saying goes no one is ever lost money under estimating the scientific literacy of Americans
So as a preface to the questions I have which I hope someone here will be able to answer, here is my backstory.
70 year old former neurologist who struggled with weight all of his life with a family history of obesity, diabetes and coronary artery disease. Years on pritikin . Up and down and almost ready to quit when heard Gary taubes on the Canadian show quirks & quarks in 2007 I've been low carb since and actually ketogenic since January 2018. So I'm not the sort of some crazy infiltrator here . Actually I was responsible for a Vet vetpto get enrolled in the Verta VA connection they have.
So my questions. And please before responding to this actually go read the whole article and not just the abstract so you don't embarrass yourself.
1- how applicable is this program to the general population? I assume this was a well motivated group that got involved in the first place and yet there was a 1 out 4 dropout rate. Yet in the article there are only a couple of lines then explain this. The best one is family emergencies. I'm sorry but what family emergency makes one eat carbs? Did the local pizza guy come up with a gun and hold it to the patient's head?
2 - why is the Virta approach better than a GP just telling his patient to get a keto Mojo? Now I know patients that are starting this program are on diabetic medicines and when dropping carbs need to adjust their meds but as they say this ain't rocket science. Hey, I'm a neurologist and even I can figure this out. 😃
3 - why are they letting people continue metformin even if labs are normal?
4 - the biggest question is why is a ketogenic diet better than just a low-carb diet? My mom did well for many years is it type 2 the old low carb diet for diabetics. She never had difficulties until the late seventies when her doctors switched over to a low-fat diet and started to you for more meds as your blood sugars increased.
But like big Pharma I don't think we'll ever know. Because if we could show that just cutting carbs they are all the difference then a company like virta wouldn't need to exist.
Unfortunately coming to this site I feel like I'm King made that drink the Kool-Aid
I would be interested from hearing from any of the doc gurus that are here to comment.
But not to be cynical who wants to risk with 9 bucks a month. How about you Bret?
joe doro
doing research in the WFPD movement. The researchers tend to be affiliated with the same groups, such as the Physician Committee for Responsible Medicine, Forks over Knives, Mastering Diabetes, McDougall, etc and a vested interest in the outcomes. What’s compelling about the Virta trial is the data are dependent on biomarkers and the outcomes are greater than any research I’ve read regarding WFPB effects on diabetes. Ultimately, both keto and WFPB work, and I don’t think it is an us vs them thing (which both sides make it out to be. It’s great to have multiple options that can improve health outcomes.
Wondering if I too should limit my carbs (though trying to put on more weight and bulding muscle) and go back to the gym and get back to where I was with muscle training. Though now I am more suseptable to having a hypo after exercise if not checked.
Generally I am fine though, just want to try and reverse what I can and get better energy levels.
Once the shock passed, I decided I wasn't going down that pharma slippery slope unless I absolutely had to, and definitely not until I did some research of my own. Fortunately, that started with Dr. Jason Fung, and then Dr. Sten Eckberg, Dr. Berg and a few others on YouTube (Actually a lot of others..).
For starters, if I was going on drugs for something, I needed to be sure something was actually wrong. High blood sugar - Got it! Need to cut carbs. Done.
But I'd never had any heart, liver or kidney issues, so I asked for some tests to show how bad these conditions really were. Three heart tests, one liver test, and one test for kidneys. Every one of them was normal. Actually, above normal and pretty much perfect. I also checked on the side effects and long term risks vs. potential benefits of every medication recommended starting with the medical PDR's on each one. I found that nothing prescribed actually did anything to address the root cause, offering only symptomatic treatment, and with a very negative long term consequences. Plus tons of side-effects. Not for me!
So, three 1/2 months ago I jumped on low carb dieting (actually Keto only I didn't know it at the time). I've kept a detailed log of everything I've eaten, corresponding blood glucose readings for same, my exercise regimen, my blood pressure, and my dramatically declining weight. Detailed! It's what you have to do..
I identified every food I needed to avoid by trial and error, along with some help from the Glycemic Load/Glycemic index I found online. I'm now 102 days in and have been in ketosis since the start. I'm happy to say that all my numbers are way, way down - and continuing to move in that direction.
My daily intake of carbs is between 10-20, and I'm personally not having any difficulty with that level.
My weight has dropped rather quickly from 204 to 178 (-26 lbs.). My wife is following my diet and has lost 14 during the same period.
I do periodic fasting 2x week but only 24hr fasts. I just skip dinner, go to bed. Skip breakfast, then enjoy lunch. Easy if you're in ketosis.
My 2nd A1c test was at 6.2, down from 6.5 only a month in. Not great but definitely in the right direction. My last A1c was at 5.9 three months later, and I'm anticipating < 5.7 this time around.
My current Avg. Fasting Glucose is 98.1, down from 137 at the time of my diagnosis.
My Avg Random Glucose (2 hrs after meals) is 106.1, which is actually up a bit over the past 2 weeks but all it needs to be is less than 140 which it easily is every time now.
My Avg Random Glucose just before meals 98.6 and steadily declining like my fasting glucose is.
My 2nd Triglyceride test came in at 87, way down from 188. I attribute a lot of this improvement to simply walking and to some degree also having less red meats.
I need another lipid panel soon, but I suspect my LDL and HDL ratio is much improved by diet and exercise.
That "high blood pressure" I have averages between 110/73 to 120/78, and it's rarely more than 124/80. I test it 4 x day.
I'm still 70 though so can't really do much about that one. It is what it is...
I do try to walk twice a day, but only1 mile each time. I was doing one 3-5 mile walks per day but found that my body starts releasing cortisol on longer jaunts, and that results in a release of cortisol which in turn results in higher blood glucose, so it's way better to keep it slow and short so it stays aerobic and doesn't get anerobic.
I also work out 3-4 times a week, but I keep it down to few reps with max weight (HIIT).
So that's where I've gotten to. Assuming my A1c comes in below 5.7, I'm thinking I'm not actually in the "diabetic" range and I plan on keeping it that way. If there's anything at all that concerns me at all now it's my weight. It continues to slip lower although it does seem to have leveled off lately. I'm reluctant to add more carbs for fear of increasing my blood glucose numbers while I'm doing my best to reduce insulin resistance.