Is Keto the Cure for Type II Diabetes?

A drug-free approach might be the best treatment we have for America's most ubiquitous lifestyle disease.


A keto-compliant salad featuring collard greens and bacon crumbles. Photo courtesy of Brian Ambrozy/Flickr

Type II diabetes is one of America's most ubiquitous—and expensive—chronic diseases. Patients often require a suite of pharmaceutical products to manage high blood glucose levels, and the complications that arise over the long term, ranging from loss of vision and limbs to kidney failure and coronary artery disease, strain the resources of patients, their families, and the health care system.

The financial strain on insurance companies, employers, and Medicaid and Medicare is even more enormous. A 2013 study in the American Journal of Preventive Medicine put the lifetime direct medical costs for type II diabetes treatment at $124,000 for patients diagnosed in middle age. With nearly 30 million Americans affected by the disease, the American Diabetes Association estimates the national cost of direct diabetes care to be roughly $176 billion per year.

But unlike type I diabetes, which is an autoimmune disorder that destroys insulin-producing cells in the pancreas, type II diabetes is a lifestyle disease, and thus reversible. Over time, people with type-II diabetes can be made more receptive to their own insulin, which in turn allows their bodies to effectively clear glucose from the blood without insulin medication. The trick for the vast majority of type II patients is as simple as losing weight. ("The relationship between obesity and diabetes is of such interdependence that the term 'diabesity' has been coined," two diabetes researchers wrote in 2005.)

But that "trick" is actually pretty hard. Permanent weight loss without bariatric surgery is practically impossible at the population level. A 2014 study by Kaiser Permanente that looked at incidents of non-surgical diabetes remission in 122,781 patients found that it basically doesn't happen. The most commonly cited number among obesity researchers, meanwhile, is five percent—only five percent of people who lose weight without surgery will succeed in keeping it off over the long term.

Now Virta Health, a Silicon Valley startup, has developed a lifestyle modification system that can reverse the markers of type II diabetes. In a study published this month, Virta researchers found that over the course of a year, they were able to achieve remission of symptoms and a cessation of several pharmaceutical products in nearly two hundred patients using a "novel metabolic and continuous remote care model."

Virta uses a combination of the ketogenic diet—which involves moderate fat and protein intake combined with very low carbohydrate intake—and frequent remote contact with a physician and a health coach to help patients change their lifestyle and lower their body weight, their blood glucose, and their HbA1c (a biomarker for diabetes). In its February study, 94 percent of patients in the intervention arm of the trial were able either to cease using insulin or to radically lower their insulin dose, and all of the patients in the intervention arm were able to stop using a class of antidiabetic drugs called sulfonylureas, which increase the amount of insulin released by the pancreas. The control group meanwhile, increased its insulin use over the course of that same year.

At $370 a month, Virta's model isn't cheap, but it's cheaper over the course of a year than the suite of drug therapies many type II patients require. And if Virta's model is scalable, the long-term savings on dialysis, hospital stays, and management of diabetic foot ulcers could be massive. Already, the company has partnered with Purdue University and Nielsen to offer the Virta system as a covered health benefit to employees with type II diabetes. The company's stated goal is to reverse diabetes in 100 million people by 2025.

I recently spoke to James McCarter, Virta's head of research, about the company's treatment model and the broader landscape of type II diabetes care. McCarter received his A.B. in biology from Princeton, and he got his M.D. and a PhD in genetics from Washington University in St. Louis, where he's an adjunct professor at the medical school. Our conversation has been edited for length and clarity.

Reason: Every doctor recommends lifestyle modification as the first course of treatment for patients with type-II diabetes and pre-diabetes. Yet most patients end up on metformin and eventually insulin and some other pharmaceutical products. Physicians seem jaded about lifestyle modification as a viable treatment. Do they have good reasons to be jaded?

James McCarter: I think endocrinologists and primary care doctors have reason to be jaded, in that they've seen lifestyle modification fail so many times. The conventional advice of "eat less and exercise more" has been shown to not work. People can do caloric restriction for a while, but you know what happens when you calorically restrict without any overall strategy other than just eating less? You get hungry. Exercise, and you get hungry. You can battle that hunger and craving for a while, but eventually it's going to come back. What's generally seen with most lifestyle interventions is that people will lose five pounds and gain it back over the course of a year.

Exercise is great for overall fitness and something that I believe in strongly in terms of maintenance of overall health. But it's not a good strategy for weight loss.

Reason: So instead, type II diabetes patients and their doctors end up treating symptoms instead of trying to reverse the disease itself.

McCarter: I think that's right, and I think to your point about physicians being jaded, they've seen that lifestyle modification only works in a minority of people. They're not surprised when a patient comes back three months, six months, or a year later and the disease has progressed.

Reason: If one of the problems with lifestyle modification is that only a tiny fraction of patients can self-motivate or self-direct an effective change, what does the Virta model do differently? How do you help the patient who can't pull off lifestyle modification?

McCarter: If you look at a large study that was done by Kaiser a number of years ago, they saw that their remission rate of type II diabetes was well under 1 percent. We're seeing well over 50 percent. So what's causing that 50-times improvement in our results? It really comes down to two things. Let's talk first about the physiology and then we'll talk about the behavior change.

First of all, using nutritional ketosis as an underlying part of the physiology approach has a tremendous impact on people's ability to succeed in getting glycemic control, which is reduction in medications, improvement in metabolic health, and reduction in weight.

The reason for that is that unlike a willpower approach, where you're just trying to force yourself to eat less, using nutritional ketosis allows you to tap into body fat for fuel. That means you have incoming energy from your body fat storage and from dietary fat. As a result, people will naturally tend to eat fewer calories because they are satiated.

We ask people everyday, "Tell us on a four-point scale how you feel about your hunger, cravings, mood, and energy. What we see is that as people achieve nutritional ketosis, energy and mood go up, hunger and cravings go down.

In effect, the physiology of ketosis is providing you with a tail wind. It's making the whole process much easier.

Reason: Various kinds of diets can work for almost everyone for at least a little while. How do you make those new eating habits stick?

McCarter: The other part of our model is the coaching. The number of people who can just read a diet book and implement its recommendations without any monitoring or coaching is small. What we're doing with Virta is we're providing five things: We're providing a physician with telemedicine for medication management; a health coach with an ongoing, one-on-one daily relationship who consults on nutrition and behavior change; education that's provided online; biometric feedback; and an online community.

Essentially, we're providing a whole support environment that allows people to understand what they're doing and why.

Reason: Is there a calorie deficit? It seems like there would have to be for weight loss, but I'm also guessing that it would be a small one because you seem to be very skeptical of crash diets or excessive calorie restriction. Or does keto somehow defy the claim that calories out need to exceed calories in?

McCarter: Rather than measuring calories, what we're doing is having people monitor their approximate macronutrients. Roughly how many carbohydrates am I having on a daily basis? How much protein am I having on a daily basis? It's a low-carbohydrate, moderate-protein diet.

What we have people do instead of an elaborate food diary is measure daily blood beta hydroxybutyrate. That's one of the ketone bodies, and by seeing an elevation in beta hydroxybutyrate, we're able to say, "Oh, you're actually in nutritional ketosis which means you're burning fat for fuel which is what we want to achieve."

It doesn't mean you have a caloric deficit necessarily, but at least you're getting your diet and other aspects of your lifestyle correct in a way that supports nutritional ketosis. And we're looking at glucose as well. That way we can say on a daily basis, are you on track or off track?

Now, calories still do matter. What generally happens, even though we are not asking people to count calories, is that because they are feeling satiety in their meals at an earlier point, they're creating a deficit. Rather than having a second or third helping, they're saying after one helping, "Gosh, I feel you know, adequately full." They are generally eating less, especially in the first six months.

Reason: So instead of having the goal be "I will eat 500 fewer calories today than my body needs," patients are focused on getting the macro ratio roughly right and checking their efforts against the ketone blood test?

McCarter: Right, and it's going to be a different journey for everyone. Some people just get it right out of the gate. Other people will take quite a few weeks or even months before they really figure out exactly how to do this. One of the key things we've found is a need for individualization. We want this to work not just for the quantified self-optimizer, but for somebody who has had diabetes for 10 or 20 years, who is on insulin or other potent diabetes drugs they want to stop taking. It has to work for somebody who is a stay-at-home parent, for a business traveler, for somebody working the night shift. It has to work for different ethnic cuisines; it has to work for different dietary restrictions.

That's what both our software and our health coaches aim to do. Make changes that work for specific individuals.

Reason: Where do you think the rest of the medical community is on the utility of a low carbohydrate diet for weight loss? In the realm of nutrition science, the debate over dietary fat still seems pretty contentious.

McCarter: Conventional wisdom has shifted somewhat. Many physicians would describe it as effective for weight loss, but most would say that it is a short-term measure that is not sustainable. Many do worry about dietary fat. There is a growing movement that counters the status-quo. While the number of physicians that recommend a sustained low carb approach for weight loss and metabolic health is still limited, it is growing rapidly. For instance, the international petition [Dr. Sarah Hallberg of Virta and Indiana University Health] started for Dr. Tim Noakes last week has garnered nearly 35,000 signatures, including many physicians and medical professionals. [Editor: Tim Noakes is a South African physician who pioneered early research into the low-carb, high-fat diet as a treatment for type II diabetes. The Health Professions Council of South Africa is attempting to revoke Noakes' medical license because he told a woman on Twitter that she could feed her baby such a diet when the child finished breastfeeding.]

We find that when we start taking care of a patient, their primary care doctor, who often begins as a skeptic, quickly converts to a supporter based on the results we obtain and the supporting scientific literature we provide.

Reason: It seems like the ability to do a lot of this coaching and guidance remotely is what's going to make this model scalable for Virta and anybody else that wants to help large numbers of people make lifestyle modifications. Because if everybody needed to check in with someone who lived where they lived, this seems like a thing that could maybe only go so far.

Jim: You're exactly right. It doesn't work without technology and it doesn't work without the ability to provide what we call continuous remote care. We actually tested that in our clinical trial. Of the 262 people with type II diabetes that were in the intervention arm, half received everything remotely—the physician, the health coach, the education, all of it.

The other half received all the remote stuff but also came to an in-person classroom setting with 10 to 20 other people and a health coach at our clinic. Initially, it was once a week, and then less frequently over time. The outcomes between the in-person group and the remote-only group were statistically indistinguishable.

Reason: Most of my own weight loss was self-directed, but I recently signed up for a remote coaching service with daily lessons as a way to get better about my eating habits, and I noticed that the combination of check-ins with a real person and daily lessons on a website is strangely compelling for reasons that aren't entirely related to the content. I feel watched, but not in a bad way.

Jim: That's part of the reason we structured Virta the way we did, with an actual one-on-one relationship with a coach. There are prior clinical studies that have shown that when you have this coaching relationship, as opposed to entirely automated or entirely self-directed program, people will do better.

Reason: What do you make of the fact that some patients in your trial couldn't come off of metformin? Does that mean some aspects of type II diabetes are not actually reversible? That it could take longer to reverse the symptom that metformin treats?

Jim: Let me talk you through the medications a little bit and address Metformin as part of that. The first thing I should say is that medication reduction is symptomatic of an overall improvement in metabolic health.

Of all the medications for type II diabetes, there are things that can be done right away and there are things that take more time. First off, we want to avoid hypoglycemic events, which is low blood sugar. If you're on potent hypoglycemic medications, which are medications like sulfonylureas and insulin that lower your blood sugar, and then you go on a carbohydrate-restricted diet, that's going to drive you toward low blood sugar levels. So what we try to do early on is very aggressively remove sulfonylurea. Fully everyone in our trial were off that within the first three months.

After that, we're aggressively titrating the insulin downwards, so that about half of the insulin was gone by three months and another nearly half of patients had it reduced. Ninety-four percent of people in the intervention group were able to either reduce or eliminate their insulin use.

But the one that we generally will leave alone and not aggressively reduce is metformin. The reasons for that are that it is generally well-tolerated, it's generally inexpensive, and there's a growing body of evidence that it's effective in prediabetes. The American Diabetes Association now recommends metformin for people with prediabetes to prevent progression to diabetes, and there is also emerging evidence that it may have some other benefits, including longevity benefits.

That's the rationale to leave metformin in place if it's well-tolerated. Our definition for having reversed diabetes is that patients have glycemic control, which means they've lowered their hemoglobin A1C lower than 6.5, which is the diabetes threshold, without diabetes medications other than metformin.

Reason: Chronic diseases require decades of expensive treatment, which means effective lifestyle modification could save payers—be they insurance companies, patients, or employers—thousands of dollars a year per person. Can you talk a little about Virta's disruption potential and what kind of blowback that might attract?

McCarter: There's plenty of work to be done, so I'm not worried about what's going to happen to many of the incumbent players. For instance, there are not enough endocrinologists to take care of all the people with type II diabetes in the United States. If Virta is successful over time, maybe this allows endocrinologists, who are incredibly well-trained, to concentrate on more challenging diseases, like type I diabetes and other extremely challenging endocrine disorders.

As for the pharmaceutical industry, there's plenty of disease out there to be handled. There are also people for whom the types of behavior change we're advocating are not a fit for them. It's not as if we're going to get 100 percent adoption. The industry is going to be disrupted over time, but it will adjust.

Reason: So it's overly dramatic to say that one thing will work for everyone, or that an effective new treatment option will crater incumbents overnight?

McCarter: To get a sense of how industries adapt, it helps to look back at the late 1970s, which is when the dietary recommendations for low-fat foods came out. You can see that within about five years, the food industry rolled out thousands of products where they just removed fat and put in sugar and starch. That probably didn't do consumers any favors, but it showed the speed with which industry can respond.

Reason: The food industry seems to be changing again right now. I've noticed with delight that a ton of products now advertise their protein content on the package, the same way they used to advertise their low-fat content.

McCarter: Yeah, people are focusing on protein. In the coming five years, I think you're going to see a return to the idea that fats can be beneficial. As opposed to saying something is low-fat, I think you're going to see things that advertise as being high-fat.

Reason: That still feels far away to me, but maybe not that far. The number of products and recipes that incorporate chia and coconut and almonds has increased quite a bit. Those are all very fatty, delicious, and thus satiating things. It seems like the next logical step for manufacturers is being more explicit about why they think these products are good for us.

McCarter: There was actually a report from Credit Suisse a couple of years ago, maybe two years ago now, where they basically predicted all of this. It was kind of an industry direction report suggesting that fat was a marketing tool.

Reason: A health care tool potentially being scalable and scaling a health care tool are two different issues. How does Virta scale?

McCarter: On the commercial side of things, our goal is to make this available and affordable to everyone over time. To begin to break through, we've been concentrating on employers. Self-insured employers are on the hook for the costs. What we can do is we can go to that employer and say, "Hey, work with us to have your folks with type II diabetes join the Virta Clinic and turn that around." We put a fair amount of the fee structure at risk. It's outcomes-based, so if we don't succeed in reversing type II diabetes, we don't get paid.

Reason: Does Virta currently have a way to follow study participants past the 12-month mark? The Kaiser study you mentioned covers a pretty long time horizon, and I know obesity researchers like to point out that weight regain gets likelier with each passing year.

McCarter: Absolutely. The Virta-IUH trial (see listing) was originally designed for two years and has recently been extended to five years. You can read the description on our blog. We will be publishing two-year and five-year outcomes. We are also following our commercial patients long-term, with more to come on that in a few months. The longterm view is super important.

NEXT: School Forbids Students from Touching Snow

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  1. But unlike type I diabetes, which is an autoimmune disorder that destroys insulin-producing cells in the pancreas, type II diabetes is a lifestyle disease, and thus reversible.

    Victim blaming.

    1. There is a genetic element to A1c, but the keto diet nicely supresses that (inaccurate) measure of insulin response - in other words, if you measure type 2 by A1c, keto works.

      If you measure by finger stick, LOTS more of those "cured" folks are still diabetics.

    2. There is a genetic element to A1c, but the keto diet nicely supresses that (inaccurate) measure of insulin response - in other words, if you measure type 2 by A1c, keto works.

      If you measure by finger stick, LOTS more of those "cured" folks are still diabetics.

      1. Nope, You are wrong. Since they measure the BG by finger stick at least once a day. (and the results are dramatically down) The biomarkers are recorded in an app and the health coach and endocrinologist see the numbers daily.

        1. Jim - once a day finger stick is only slightly more accurate than A1c, especially when the subject knows a low number is "good" and learns quickly which time of day measurement makes his life easier. These study are about manipulating definitions,not insulin response or body function.

    3. Start earning $90/hourly for working online from your home for few hours each day... Get regular payment on a weekly basis... All you need is a computer, internet connection and a litte free time...

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  2. Get your bulletproof coffee.

    1. that is such a waste of money. Just make your own with regular generic store ground coffee and MCT oil

  3. Keto diet saved my life. Lost over 100 pounds.

    1. Congratulations. You've done an amazingly hard thing, and you deserve a huge pat on the back!

    2. I've lost over 50 myself. It works. My blood pressure dropped too. I was on the high end of "normal" but now it's goo again. Dr Atkins was right over 40 years ago. Keto is just a rebranding of the strictest level of his diet. Everyone says it's "new" *eye rolls*

  4. Hey! Who knew? Dr. Berg was right all along.

  5. No, but Kelo has proved promising. Knock down your poverty house, get your fat ass out walking around instead of sitting on the couch eating Breyer's.

  6. The answer is yes.

  7. Good interview but for Zod's sake pick either the surname (McCarter) or his given name (Jim) but not both!

  8. I've had very good results with low carb/keto. Never been diabetic, but it's never too early to start prevention. Not to mention the risk of cognitive decline/Alzheimer's down the road.

  9. How would you measure ketowhatever at home? Does it show up on a home blood test?

    1. It's not that difficult to tell without any testing at all, but usually, urine. Ketostix are pretty definitive. However, as a former HS wrestler, I can say again the average teen is usually in tune enough with their body after the first box of ketostix to know whether they're in ketosis or not.

      1. Nah, get a Precision Xtra blood meter. The ketone strips are kinda expensive at around a buck apiece, but much more accurate. For the first two weeks, I measured every day. Once I got to around 1 mmol/liter. I started monitoring once a week. Now I tend to stay at around 2 mmol/liter. My insulin resistance has gone from high to below the 50% line. I want to eventually get to levels around the 25 percentile. LP-IR is the test that I use.

        1. Also, I've pretty much stopped measuring except for maybe 2 times a month just to check. You are correct in saying that once you do it for a while, you know when you are in.

    2. Ketones can be measured via urine, breath, or blood with accuracy improvement in same order.
      While measuring for ketosis is fun, it's virtually unnecessary for for most people. You can smell ketones in urine. For most people, if they are in ketosis they can easily go many hours without hunger.
      Virtually everyone can enter ketosis just by not eating for 24-hours. In fact, nearly everyone has some small amount of ketones in their blood after waking from daily sleep.

    3. You just track food for a while and learn which foods are very low in carbs and then you get a feel for it and you don't have to track any longer. I recommend My Fitness Pal or Carb Manager for phone apps. Also stop eating those tubs of Cherry Garcia.

  10. This isn't particularly surprising. We've known for decades that keeping your body in ketosis is an effective strategy for dealing with diabetes. There have also been plenty of studies that show that people on very low sugar diets burn more calories than people getting that "recommended" 300g of sugar a day. Bonus: diets that induce ketosis also tend to be better for people looking to gain muscle mass. The fearmongering about food cholesterol affecting blood cholesterol has been long disproven. Ancel Keys intentionally omitted data that disproved his hypothesis when he performed his study that has been the basis for all recommended diets since.

    1. On the topic of weight loss, it is IMO worth everyone's time to look at the Kaiser Permanente / CDC cooperative studies that are colloquially called the ACEs studies. Kaiser's work at looking for effective weight loss strategies found that the only effective long term plan was to get people who are obese to go to counseling, not for their weight, but for underlying issues, particularly for childhood trauma and neglect.

  11. I bet if people had to pay out of pocket for type II diabetes treatment they'd find a way to fix their lifestyle

    1. Honestly, this is unlikely to affect the issue in any meaningful way. It sounds good, but the data does not agree.

    2. You'd be wrong. What generally happens is that folks with diabetes but no insurance quit taking their medication entirely. (This response is not limited to those with diabetes--same is true for hypertension and other ailments). Next, they buy cheap food (beans and rice are standards) that are sky-high on the glycemic index (making blood sugar high). Then they have a bunch of diabetic complications and have limbs chopped off, suffer chronic renal insufficiency, end up on dialysis (paid for by federal government), live miserably for a year or two and then die.

      Given the contempt you show for people suffering with Type 2 diabetes, I think it's a fair guess that you think people can be punished into being thin if the punishment is harsh enough (and you are unaware that there are folks with Type 2 who are, indeed, thin already). Fat shaming is one of the last generally acceptable prejudices, where jokes and cruel statements and lower wages are all okey-dokey with most folks. Further, being fat is uncomfortable. Very. A casual look around at the (growing) percentage of the population subjected to those slings and arrows (external and internal) is some indication that perhaps the situation is not as simple as "punish them until they do what I want" and that adding more punishment will not be effective unless death is your desired outcome.

      1. Who said anything about punishing people?

      2. "...Fat shaming is one of the last generally acceptable prejudices,.."

        Care to define and justify that claim?
        I'm 'triggered'!

      3. I don't hate fat people, but I hate people who whine about how fat people are such helpless victims.

        1. I see susancol is a troll, tossing bullshit and unwilling to support it.
          Hey, susancol, fuck off.

        2. Do you blame cancer patients for getting cancer too?

      4. Given the contempt you show for people suffering with Type 2 diabetes, I think it's a fair guess that you think people can be punished into being thin if the punishment is harsh enough

        Your obesity, your insurance, and your prescription compliance are your business. I simply object to being forced to pay for it.

        A casual look around at the (growing) percentage of the population subjected to those slings and arrows (external and internal) is some indication that perhaps the situation is not as simple as "punish them until they do what I want" and that adding more punishment will not be effective unless death is your desired outcome.

        I have no doubt that some obese 50 year old cannot easily change their ways; it probably takes a couple of generations for cultural norms rejecting gluttony to become reestablished. But so what? How does that justify to force me to pay for the consequences of other people's bad choices?

      5. Fat shaming is one of the last generally acceptable prejudices, where jokes and cruel statements and lower wages are all okey-dokey with most folks

        Choosing to overeat is the same kind of choice as choosing to sexually harass or rape someone: you have urges and you either control them or not. And people judge you according to whether you are capable to control your urges or not. So, it's not a "prejudice", it's an actual judgment and a well-founded one.

        And I don't want to "punish them until they do what I want", I simply don't want to associate with people who can't control their urges, and I don't want to be forced to pay for the consequences of their bad choices.

    3. It is not as easy as you think. The ADA give life style guidelines that make type 2 diabetes worse. If you are type 2 and are not in ketosis then you get very hungry because of lack of carbs. So people get very hungry. They eat food with carbs and they are satiated for awhile (a couple of hours) Then the hunger strikes again. Will power isn't enough. THese people cannot access their fat stores. However, if you can get into ketosis (the proper range) you can go run for 20 or 30 miles without fueling. (water of course) It is harder than you think.

  12. I've never known a skinny person who does a low carb diet.

    1. Why would they? Why give up toast, cereal, bread, pasta, fruit, potatoes, winter squash and many other yummy foods if you don't have to. Their bodies and microbiome can handle carbs. Others' bodies can't. It's not shocking--anyone raising animals will have observed the same thing. I have two horses, mother and son. They are the same size. I have to feed one more than three times what I feed the other to keep them at the same weight and level of fitness.

      Sadly, it does appear to be becoming more and more obvious that diabetics can't just "eat carbs in controlled amounts", but must eschew them. Let me say that "kale and bacon" for breakfast doesn't make my heart go pitta-pat, but it is better than death. Marginally.

      1. Bacon and eggs is pretty doable though.

    2. There are meany who are insulin resistant and skinny. Look up Peter Attia and Ivor Cummins.

    3. I know several, some were fat before, some never were and just think keto keeps them in better shape. You should go to the gym sometime and make friends.

  13. I've been eating keto for 5 yrs without any special coaching; however, there is A LOT to learn about what constitutes both real and low carbohydrate food. I'm healthier than I've ever been. The big picture is surprisingly simple. It boils down to eating what humans have always eaten, what humans are designed to eat, what humans ate prior to industrialization or even the agricultural revolution: animals and above ground vegetables, possibly occasional seasonal fruits. You just cut out all the high carb, nutrient poor foods like beans and grains (which are inedible anyway unless soaked, sprouted, fermented, or cooked), and also the overly processed, toxic, industrial "foodstuffs" like margarine, sugar, vegetable oils, etc. The keto diet is not just the "diabetes reversal" diet. It is the human, species-appropriate diet. If truth can win out: Today it's for diabetes reversal, but tomorrow it's for the prevention of all chronic diseases of "modern lifestyle."

    1. You are correct. Also, I eat a metric ton of greens everyday. I say that because the backers of SAD and other carb heavy diets try and categorize keto as just a bunch of fat, bacon, etc. when there is really a lot more too it. I've even given up most fruits. I have about 2 cups of blackberries with sugar free heavy whipping cream over a weekend once a month or so...about the worst thing I eat.

      Keto also forces people to cook more and they tend to eat cleaner.

      1. Yeah, of course you *can* eat a bunch of greens on keto, but at this point, I don't make a point of requiring myself to eat vegetables. I do like to ferment cabbage for some homemade probiotics. The veggies are there for some flavor, variety, or a "side," but meat, fish, and eggs are where it's at, if you want bioavailable nutrients. You can live optimally 100% on animals if you want to--it's called zero carb. I'm not fully zero carb, but after more research, I have stopped stressing the vegetables for the last year or so, and I'm leaner than ever. I don't know my body fat percentage, but my waist is 26 in and my hips are 36 in, and I feel exactly where I need to be. I'm in my mid 30s, back to the size I was as a teenager (and after having 3 kids). I just eat as much as I want, whenever I want, which usually turns out to be about twice a day, but I don't stress any particular fasting regimen. I do try to eat raw egg yolk or liver every day for my "vitamin." I wish I hadn't been afraid of red meat and cholesterol during my 20s--what a waste! Back then, I was 20 lbs heavier, hungry all the time, and exercising constantly.

        1. Eating greens (actual greens, cruciferous, etc.) helps your liver cope with the added stress of dealing with the fat transport, add fiber, and the phyto nutrients are helpful. No, you do not have to eat them, but they are definitely beneficial. The Inuits did not eat much, if any, plant material. They were fine. For me, the greens are an optimization step. I think the heavy weights in the field like Dr. Phinney, Volek, etc. would agree.

  14. Yes. It likely is a key component in reducing all the metabolic diseases in the US...arteriosclerosis, memory disorders, arthritis, etc. About 2/3's of the people in the US are insulin resistant, so when they follow that stupid food pyramid diet they are either pre-diabetic or diabetic. The Gov is helping its citizens get fat and sick by pushing The Food Pyramid and the myth that a high carb diet is healthy. Healthy whole grains? They are just little poison pills for people that are predisposed to being insulin resistant.

    Keto is incredibly easy to follow as well. Eat meat and greens (lots of greens) with a few nuts, some good oils, grain fed butter, eggs, etc. You are naturally satiated. I've gone from 230lbs to 185lbs since September of 17. Will stop at about 175 or whatever equates to 15% body fat. I also do IF (16/8) 4 days a week and dinner-to-dinner (24hrs) 3 days a week. In fact, when I have an important event I fast that day cause it increases my mental function substantially. Will eventually, start carb cycling a bit when I hit equilibrium weight for 15% body fat.

    One thing I've noticed is that many Progs seem to hate this diet. Probably because the Gov is also aligned against it?

    1. It's not the food pyramid that is creating the problem even if it is useless/cronyist. The problem is food manufacturers and restaurants. They are the ones adding a shitton of sugar and carbs to everything they make/serve because it is cheap and profitable. And they resist straightforward labelling (not that that would help much since the problem is the food not the label) like the plague.

      1. Since the food pyramid was published, the rise in obesity starts. The low fat products that were produced because of the high carb /low fat bullshit have high carbs + lots of sugar because of the dietary advice the American public was getting. The products mimicked the official line. Now there was a fair amount of collusion between various agricultural factions to produce the "scientific" rationale for Americans indulge in low fat foods full of sugar and refined flour with little idea what they were doing to their bodies. This is what the food pyramid wrought.

        1. I am a low carb adherent but can you show me on the food pyramid it says to have sugar frosted flakes for breakfast every morning and totino's part pizzas for dinner every night?

      2. The problem is food manufacturers and restaurants. They are the ones adding a shitton of sugar and carbs to everything they make/serve because it is cheap and profitable

        Fortunately, there is still a "vegetables", "fruit", "meat", and "fish" section in most major supermarkets, where you can purchase foods that have no sugar or carbs added to them.

        And they resist straightforward labelling (not that that would help much since the problem is the food not the label)

        Foods clearly list the grams of carbs and grams of sugar. How much more straightforward do you want it?

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  16. I am surprised that the underlying goal here isn't mentioned. The goal is for your pancreas to produce glucagon for more hours of the day instead of insulin. That is either/or hormone. Glucagon for when blood sugar is low to tell the body to move fatty acids and glycogen into the bloodstream. Ketogenesis is the outcome - not created by diet. Insulin for when blood sugar is high to tell the body to burn glucose and store excess.

    The way to get into glucagon mode is:
    1. eat only within an 8 hour window each day - in effect fasting for 16 hours each day. Small snack/meals throughout the day undermines a 'keto diet' for all sorts of reasons. This is really a lot easier than a 'diet'.

    2. For the meals you do have, it's ok to fill up. As long as what you are filling up on is bulkier low-glycemic foods that digest slowly. Think of fiber/water as important as fats/protein/carbs. Ketogenesis requires more water and fiber allows slower digestion. Once you stop eating, stop thinking about eating. Easier said than done prob but if that is the problem then address THAT problem via a doctor.

    3. The only exception is during heavy exercise/work. The more you sweat, the more quick carbs you need. But most today aren't sweating by default. We just eat like our ancestors who DID sweat.

    1. If you eat under 20 grams of carbs a day you'll go into ketosis mode for most human beings. You don't have to follow whatever weird ass diet you are promoting here.

  17. The trick for the vast majority of type II patients is as simple as losing weight. But that "trick" is actually pretty hard.

    Under socialized medicine: "You have a choice. Either you deprive yourself of the foods you love and make yourself miserable, or you can take this free pill."

    Under free market medicine: "You have a choice. Either you deprive yourself of the foods you love and make yourself miserable, or you end up spending tens of thousands of dollars per year on medical treatments for your obesity and diabetes."

    Losing weight isn't hard if you are sufficiently motivated.

  18. I'm a little surprised no one has brought up the cost component to eating a diet with little carbs or processed foods. I cringe every time I see the cost of quality protein in the grocery store. This diet is great, if you can afford it. What about all the folks who can't?

    1. It shouldn't be about the protein. Even in ketosis, the additional amount of protein required beyond normal requirements is minimal - and Americans already eat more protein than is needed (bodybuilders excepted). The fat is what satiates hunger (assuming one eats reasonably slowly) - and fat is pretty cheap. People on those diets eat way more protein that they need or is helpful - because they can't think of another way to get bulk/volume into that meal. What people should be doing is using veggies/fruit/beans/squashes/roots for that bulk component (like 50-75% of the plate) rather than grains or anything processed. Any additional beans will provide the additional protein - so no additional meat is necessary at all.

      There is no such thing as a 'diet' that reduces weight. You can't reduce weight by ingesting food. The only way to reduce weight is to burn existing body fat - and that is only done between meals. The only purpose of the food on a diet is to satiate hunger for as long as reasonable and avoid the crash-burn of carb-heavy meals.

      That sort of meal SHOULD be cheaper. But it does tend to require more cooking and more at-home eating.

      1. Just as an example - the toughest meal for me is breakfast. Don't have much time but I'm always hungry in the morning and know I need to eat then. You'd be amazed what can go into a smoothie - cottage cheese, peanut butter, plain yogurt/kefir, precooked beans/squash, greens/veggies, seeds, etc - yes even 1/4 tub of soft tofu. Whey protein powder if fridge is short of real proteins (rel cheap by the scoop). Add fruits (not bananas though) and spices for the main taste.

    2. You can do low carb on the cheap. Count carbs, keep them under 20-30 a day and you're golden. You can do that with cheap food or with expensive food.

  19. $370 per month for the Virta model seems a bit steep. If you know where to look you can find good cost effective programs like this one>> Diabetes runs deep in my family. Ive started early to research and find ways to keep a healthy lifestyle.

    1. Just do Atkins or Keto and you'll be fine, you don't have to do tons of research, just look up the guidelines, get a calorie counting app for your phone and quit making excuses about "doing research" . You can learn the fundamentals in 5 minutes, after that track everything you eat until you get a feeling for what you can and what you can't eat.

  20. Herro.

  21. For some people it is the cure. Probably not everyone but spiking your blood sugar constantly is what destroys your pancreas and on keto you consume almost not sugar or carbs (under 20grams a day), so it's a no brainer that it can put the disease in check if it hasn't progressed to the point that the pancreas is toast.

  22. In 6 months I have lost 60 lbs and dropped 6 clothing sizes. I am no longer considered obese. My vision is improved, the tingling in my feet is gone, and my fibromyalgia nonexistent, and I am no longer considered a diabetic. I take no medications. Under 20 carbs a day is quite sustainable, diabetes is not. You don't need constant monitoring, you just need to be consistent about checking your glucose levels after every meal until you hit that sweet spot of a under 20 point rise after a meal. Keto on 🙂

  23. "Virta uses a combination of the ketogenic diet?which involves moderate fat and protein intake combined with very low carbohydrate intake"

    Keto diets are usually high fat, moderate protein, low carb. Does Virta say moderate fat so that they won't be the victims of a Branch Davidian style raid?

    1. No, moderate fat (or highER fat) is correct. When compared to the current standard, keto *is* a high-fat diet. But Virta is going for caloric deficit with its patients. That means the right amount of protein, enough fat to make them feel satisfied, and skipping the carbs so that their bodies use the fat (the stored body fat, especially) as fuel.

      It's a smart no-hunger weight loss strategy.

  24. Most dietitians recommend gradual weight loss because it's typically more sustainable in the long term, but the keto diet approach could be a good option for fast weight loss for type II diabetes if done under the care of a dietitian and with clearance from your healthcare provider. According to Everyday Health Take vegetables, which are important on keto and have carbs. Figuring out which nonstarchy (low-carb) vegetables are best can be one of the many carb-counting challenges of adhering to this restrictive approach.

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