Study Shows Low Carb, High Fat Eating Reverses Diabetes
dgroulx
Posts: 159 Member
Study reports use of nutritional ketosis with mobile app intervention could reverse Type 2 diabetes
A newly published study has shown that an individualized approach to nutritional ketosis (utilizing fat rather than glucose to fuel the body), combined with remote monitoring via a mobile application, could sustainably and safely reverse Type 2 diabetes.
The study, compiled by San Francisco-based Virta Health, reports that the treatment could also improve other chronic metabolic diseases without medication or surgery intervention.
Purdue University in West Lafayette, Indiana, IU Health Arnett in Lafayette, Indiana, and others collaborated with Virta Health to publish one-year outcomes from the ongoing 5-year trial Feb. 7 in Diabetes Therapy. Other collaborators include the University of Southern California, Keck School of Medicine, Los Angeles; Washington University School of Medicine, Department of Genetics, St. Louis, Missouri; and Ohio State University, Department of Human Sciences, Columbus, Ohio.
The study, “Effectiveness and Safety of a Novel Care Model for Management of Type 2 Diabetes at One Year: An Open Label, Non-Randomized, Controlled Study,” oversaw 349 Type 2 diabetes patients. A control of 87 patients elected to receive “usual care” provided by their own physicians and dieticians following the American Diabetes Association recommendations. The other 262 patients elected to adopt individualized, low carbohydrate, high fat nutrition while being connected to a health coach and physician via a mobile application, which also contained educational resources.
The intervention studied focused on five points: Access to a health coach, a physician for medication management, biomarker feedback, nutrition and behavior change education, and an online community.
The dietary intervention promoted non-starchy carbohydrate sources with a moderate protein intake. This model enabled patients to sustain nutritional ketosis, where the body uses fat as its primary fuel source instead of glucose. Additionally, patients interacted with their health coach or physician via the mobile application, sometimes multiple times per day.
Virta Health and colleagues reported the results of the first year of the trial. Of the study’s 262 intervention patients, 83% remained in the program. The patients also exhibited an average decrease of 1.3% in hemoglobin A1C (a marker that represents a person’s average blood glucose over the last 3 months). Additionally, patients saw 12% weight loss during the year.
The findings demonstrated a reversal in diabetes progression. For example, of those receiving the Virta Treatment, 94% of patients on insulin decreased or eliminated their dosage by year’s end, and 60% of patients showed hemoglobin A1C levels below the diabetes threshold without medication or only metformin (metformin has indications outside of T2D). In contrast, usual care participants experienced no significant changes in A1C or diabetes medication use.
A newly published study has shown that an individualized approach to nutritional ketosis (utilizing fat rather than glucose to fuel the body), combined with remote monitoring via a mobile application, could sustainably and safely reverse Type 2 diabetes.
The study, compiled by San Francisco-based Virta Health, reports that the treatment could also improve other chronic metabolic diseases without medication or surgery intervention.
Purdue University in West Lafayette, Indiana, IU Health Arnett in Lafayette, Indiana, and others collaborated with Virta Health to publish one-year outcomes from the ongoing 5-year trial Feb. 7 in Diabetes Therapy. Other collaborators include the University of Southern California, Keck School of Medicine, Los Angeles; Washington University School of Medicine, Department of Genetics, St. Louis, Missouri; and Ohio State University, Department of Human Sciences, Columbus, Ohio.
The study, “Effectiveness and Safety of a Novel Care Model for Management of Type 2 Diabetes at One Year: An Open Label, Non-Randomized, Controlled Study,” oversaw 349 Type 2 diabetes patients. A control of 87 patients elected to receive “usual care” provided by their own physicians and dieticians following the American Diabetes Association recommendations. The other 262 patients elected to adopt individualized, low carbohydrate, high fat nutrition while being connected to a health coach and physician via a mobile application, which also contained educational resources.
The intervention studied focused on five points: Access to a health coach, a physician for medication management, biomarker feedback, nutrition and behavior change education, and an online community.
The dietary intervention promoted non-starchy carbohydrate sources with a moderate protein intake. This model enabled patients to sustain nutritional ketosis, where the body uses fat as its primary fuel source instead of glucose. Additionally, patients interacted with their health coach or physician via the mobile application, sometimes multiple times per day.
Virta Health and colleagues reported the results of the first year of the trial. Of the study’s 262 intervention patients, 83% remained in the program. The patients also exhibited an average decrease of 1.3% in hemoglobin A1C (a marker that represents a person’s average blood glucose over the last 3 months). Additionally, patients saw 12% weight loss during the year.
The findings demonstrated a reversal in diabetes progression. For example, of those receiving the Virta Treatment, 94% of patients on insulin decreased or eliminated their dosage by year’s end, and 60% of patients showed hemoglobin A1C levels below the diabetes threshold without medication or only metformin (metformin has indications outside of T2D). In contrast, usual care participants experienced no significant changes in A1C or diabetes medication use.
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Replies
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Who the kitten is "Virta Health"?5
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Where was the study published?
Who paid for it?
"Non-randomized" may not necessarily mean that it's a bad study, but it certainly raises concerns.
ETA:
Plus, the additional self-selection of drop-out patients raises more questions. Did they drop out because they weren't seeing results (so, really, they should be included as intervention patients who did not have A1C improvements -- or maybe their A1C was actually going up and the people running the study "encouraged" them to quit)?
You gloss over the results of the non-intervention control group. Results of the intervention group without the results of the control group for comparison is meaningless in judging the effectiveness of the intervention. Maybe intentionally having a control group one-quarter the size of intervention group guaranteed that equivalent or even better results would not be "significant" (in statistics, the size of the sample can affect whether a particular result is "significant," which has a quantifiable threshold in statistics).13 -
How many calories were they eating? Was it a deficit? Did they lose weight? Would these patients be able to have the same results without a health coach available 24/7?5
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I think this is the actual study link (have not read thru it so don't know all the variables on the study):
https://link.springer.com/article/10.1007/s13300-018-0373-9
eta: cause spelling...2 -
Study reports use of nutritional ketosis with mobile app intervention could reverse ***snip***
It's poor form to copy and paste something without attribution, FYI. Someone else wrote that, you should give them credit
http://www.purdue.edu/newsroom/releases/2018/Q1/published-study-reports-use-of-nutritional-ketosis-with-mobile-app-intervention-could-reverse-type-2-diabetes.html
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LOL Vitra Health, a company founded by Atkins funded "researchers" Volek and Phinney to "sell" keto. Fact of the matter is the LCHFraud diet is a band aid. High carb, low fat traditional cultures never develop diabetes until they start getting their fat intake too high see Japan, China etc20
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If they lost ~12% BW, I'm not surprised.9
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The control ought to be a different type of diet with the same degree of caloric restriction, exercise, and ongoing support.
A lot of people reverse (or put in remission) actual or incipient type 2 with weight loss and exercise.
In fact I would be more interested in finding out whether exercise, or weight loss, or the combination is what does the trick.
Hey, I *know* that a 44% (282g) carb (with about 128g being sugar) diet in the context of a 21.35% caloric deficit is also perfect for reversing type 2 when applied appropriately
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That keto is magic.cheryldumais wrote: »
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I think the point is that LCHF diet can be a good tool for T2D's to use to treat their disease. Nothing more, nothing less.7
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I think the point is that LCHF diet can be a good tool for T2D's to use to treat their disease. Nothing more, nothing less.
Except that it does not single out the fact that weight loss is most likely the primary driver of this effect, not the keto per se. (Although obviously, lowering carbs is a basic part of the dietary approach to a metabolic disorder such as diabetes).
So, yes, we are back to where we always end up on the subject of keto: it’s primary benefit is as a behavioral tool that allows some people to maintain a higher adherence to an eating plan that sustains a calorie deficit. Which is perfectly fine.
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Low carb has been known for ages as a successful way to manage blood glucose. No news there. To actually reverse diabetes would mean to go into remission and have normal or semi normal blood glucose even when consuming a moderate amount of carbs, which has been shown to happen with weight loss for some people (note how it says " patients saw 12% weight loss during the year"). Being in the normal range while on low carb but not on moderate carb is what I call pseudo reversal, not true remissions. It results from successful management, which is a good thing, and low carb can greatly help with that.7
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The control ought to be a different type of diet with the same degree of caloric restriction, exercise, and ongoing support.
A lot of people reverse (or put in remission) actual or incipient type 2 with weight loss and exercise.
In fact I would be more interested in finding out whether exercise, or weight loss, or the combination is what does the trick.
Hey, I *know* that a 44% (282g) carb (with about 128g being sugar) diet in the context of a 21.35% caloric deficit is also perfect for reversing type 2 when applied appropriately
I can give you a single data point. I went from "technically diabetic" (very very close to diabetic range but not passing the threshold for a diagnosis at 6.2-6.4 A1C) to normal after losing about 18% of my body weight on moderate carb intake (an A1C of 5.4, last one was 4.9 up from 4.6 after some weight regain). The amount of exercise I did back then was minimal, mostly consisting of 5-20 minute walks. After introducing exercise and losing even more weight it went down even further and the lowest value was 4.6. Right now I have a lower A1C after weight regain than I did back when I was at this weight but less active. So, I think it's both with weight loss having the larger effect.3 -
Woohoo! We're up to n=almost 2 (I don't think we can quote call my own aproach moderate carbs, though it was lower than before!)0
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Woohoo! We're up to n=almost 2 (I don't think we can quote call my own aproach moderate carbs, though it was lower than before!)
My carbs were around 200-250 when I was prediabetic, which is considered moderate by most definitions I think.
ETA and to augment the conversation: I had the most drastic decrease in waist size (so I must have carried a lot of visceral fat). So my fat distribution pattern at lower weights may also be a significant factor.1 -
Weight loss, no matter how it occurs, is by far the most significant factor in improving glucose control and A1c. (Type 2) I suspect that exercise-esp gains in lean mass-plays a more important role long term.6
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I think the point is that LCHF diet can be a good tool for T2D's to use to treat their disease. Nothing more, nothing less.
Except the OP title claims that LCHF REVERSES diabetes, that’s a little more than being a good tool for treating/managing the disease, and as many have pointed out - the driver of the health benefits may be more directly related to the weight loss itself, and LCHF was the means to that end for some people but not the sole requirement or even advantageous over a diets that yield the same weight loss results.7 -
WinoGelato wrote: »I think the point is that LCHF diet can be a good tool for T2D's to use to treat their disease. Nothing more, nothing less.
Except the OP title claims that LCHF REVERSES diabetes, that’s a little more than being a good tool for treating/managing the disease, and as many have pointed out - the driver of the health benefits may be more directly related to the weight loss itself, and LCHF was the means to that end for some people but not the sole requirement or even advantageous over a diets that yield the same weight loss results.
I assume reversal means better A1c and BG control without disease progression - with some improvement, as lowered A1c would indicate.
It is possible that the bg control was due to weight loss. But most people notice better BG control within days of switching to low carb without any weight loss, just like most people will have better BG control after weight loss even if the still eat moderate carb, or if one exercises after meals.
LCHF is not the only tool that can be used to reverse diabetes, but it is an effective one. If one eats fewer carbs then BG will not rise as much. It is pretty basic physiology. I find it amazing that it is not recommended to T2Ds more often.
For many, the diabetes reversal will only last as long as the weight loss does, or as long as the patient eats LCHF. It is a reversal but not a cure.12 -
WinoGelato wrote: »I think the point is that LCHF diet can be a good tool for T2D's to use to treat their disease. Nothing more, nothing less.
Except the OP title claims that LCHF REVERSES diabetes, that’s a little more than being a good tool for treating/managing the disease, and as many have pointed out - the driver of the health benefits may be more directly related to the weight loss itself, and LCHF was the means to that end for some people but not the sole requirement or even advantageous over a diets that yield the same weight loss results.
I assume reversal means better A1c and BG control without disease progression - with some improvement, as lowered A1c would indicate.
It is possible that the bg control was due to weight loss. But most people notice better BG control within days of switching to low carb without any weight loss, just like most people will have better BG control after weight loss even if the still eat moderate carb, or if one exercises after meals.
LCHF is not the only tool that can be used to reverse diabetes, but it is an effective one. If one eats fewer carbs then BG will not rise as much. It is pretty basic physiology. I find it amazing that it is not recommended to T2Ds more often.
For many, the diabetes reversal will only last as long as the weight loss does, or as long as the patient eats LCHF. It is a reversal but not a cure.
I find this bit a bit problematic. Low carb helps manage blood glucose. The underlying mechanisms are still impaired, evidenced by inability to handle carbs if re-introduced. It's a pseudo reversal and you can go back to a full blown diabetic within an hour. Weight loss, on the other hand, improves insulin sensitivity as a whole for most people. For some it's significant enough to achieve true reversal, or what I like to call remission because it can return when weight is regained.
Low carb is a tool for management, weight loss is a tool for management and treatment with a potential for remission. Saying low carb reverses diabetes is like saying blood pressure medications reverse hypertension.11 -
amusedmonkey wrote: »WinoGelato wrote: »I think the point is that LCHF diet can be a good tool for T2D's to use to treat their disease. Nothing more, nothing less.
Except the OP title claims that LCHF REVERSES diabetes, that’s a little more than being a good tool for treating/managing the disease, and as many have pointed out - the driver of the health benefits may be more directly related to the weight loss itself, and LCHF was the means to that end for some people but not the sole requirement or even advantageous over a diets that yield the same weight loss results.
I assume reversal means better A1c and BG control without disease progression - with some improvement, as lowered A1c would indicate.
It is possible that the bg control was due to weight loss. But most people notice better BG control within days of switching to low carb without any weight loss, just like most people will have better BG control after weight loss even if the still eat moderate carb, or if one exercises after meals.
LCHF is not the only tool that can be used to reverse diabetes, but it is an effective one. If one eats fewer carbs then BG will not rise as much. It is pretty basic physiology. I find it amazing that it is not recommended to T2Ds more often.
For many, the diabetes reversal will only last as long as the weight loss does, or as long as the patient eats LCHF. It is a reversal but not a cure.
I find this bit a bit problematic. Low carb helps manage blood glucose. The underlying mechanisms are still impaired, evidenced by inability to handle carbs if re-introduced. It's a pseudo reversal and you can go back to a full blown diabetic within an hour. Weight loss, on the other hand, improves insulin sensitivity as a whole for most people. For some it's significant enough to achieve true reversal, or what I like to call remission because it can return when weight is regained.
Low carb is a tool for management, weight loss is a tool for management and treatment with a potential for remission. Saying low carb reverses diabetes is like saying blood pressure medications reverse hypertension.
I just think this is true for all things that can reverse diabetes:
If you regain the weight, you lose insulin sensitivity.
If you eat more carbs, your BG rises.
If you stop exercise, you lose insulin sensitivity.
If you stop taking diabetes meds, and sometimes even if you continue with the same dose of meds, your BG rises... IMO, needs don't reverse diabetes because the disease still tends to progress.
If LCHF diets lead to weight loss and some exercise fromthe increased energy, then even better- you have lower BG while you improve your insulin sensitivity from weight loss and exercise.
I think this comes down to whether you believe that people who develop T2D do so completely independently of their level of carb intake. Will people who get fat on keto develop T2D at the same rate as those who got fat on higher carb diets? I believe that if your BG never rises too high, it is pretty hard to develop insulin resistance since a low carb diet will keep insulin low. Now I just need to wait for some multi year studies of patients doing low carb to see if their insulin sensitivity improved. From the n=1 reports from low carvers, insulin sensitivity appears to improve..... Then again, people eating keto for T2D tend to lose weight eating that way.
Who knows. It appears to improve the health of diabetics. It should be offered as a tool for those people to use, along with other lifestyle changes. JMO5 -
Here is my experience.
I was diagnosed T2 diabetic with a fasting glucose of 348 and an A1C of 12.8. The doctor gave me metformin and the Diabetes Association diet. My glucose levels were terrible. I decided to try reducing carbs to 50 g a day, and the results were immediate with the glucose checks. I decided to try the keto diet with 20 carb grams and found I was well suited to it. Glucose checks fell into a predictable and good pattern. I was happy and satisfied with what I was eating. I set calorie targets at 500 below the calculated maintenance I computed somewhere online (probably ketogains).
I lost weight at about a pound a week. Glucose readings stayed good. After 6 months, my A1C was 5.5 on metformin. My doctor reduced my dose. Glucose readings stayed good. I stayed with the keto diet. In 6 more months, my A1C was 5.3, and the doctor stopped the metformin.
An interesting thing is that my liver enzymes have always been high. By always I mean for 20+ years and when my weight was low the liver enzymes were high. I don't drink, and my doctor told me I had NAFLD. After 6 months of the keto diet, the levels were on the low end of the normal range.
I don't do any intentional exercise. I am fairly active. I had a step counter for a while but I was doing 8000 steps a day just doing my job. I decided that was reasonable activity. That level of activity was there before the diagnosis and before the weight loss.
Now - I have lost weight. Officially it is 107 pounds so far. 40 of those pounds were CICO, and I was miserable but determined. The last 67 have been with keto and a calorie limit. The total weight loss has to be a factor in all this, but as close as I could tell, the lower glucose numbers were reacting to the low carbs.
So - that is my experience. It sounds a little like the study, except I did not have any coaching besides some encouragement from people on MFP. I still consider myself a diabetic. I just control my glucose with diet and not meds. I would not say I reversed anything.
Keto helped me lose weight. I am happy with what I am eating and find it easy to follow. I credit the keto diet with the liver enzyme numbers and the low glucose numbers. I am quite happy to continue eating this way if it lets me dodge the "T2 = progressive disease" thing.
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“Keto and a calorie limit” = CICO
I totally understand the CICO concept. I lost weight because I was eating fewer calories than I was burning.
I will say that for me it was easier to do with the keto diet, but that might not be true for everyone. You have to figure out what works for you.
In terms of the glucose numbers and the liver enzymes, the last time I lost weight I still had the high liver enzymes. When I reduced calories but kept carbs at about 50% of my total calories, the glucose numbers were still high. The keto + reduced calories has been what I have done to lose weight, improve my numbers, and get off my diabetes med. It has worked quite well for me, but I am a small sample.
If I wanted to lose weight, some version of CICO is the way. Since the original post involved the diabetes study, and my experience seemed to be similar to the study results, the keto + calorie limit seemed to be a critical distinction to make.
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I'll be glad when the whole low carb/keto thing goes the way of low fat. I'm so over it.13
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Keto helps with type 2 diabetes by helping with blood glucose numbers. Without weight loss, the person with diabetes still has impaired glucose tolerance. They just have better glucose numbers which lowers their risk for certain complications of diabetes. If they eat carbs, their numbers will spike again. However, the lower glucose numbers can improve diet adherence for many people.
As an added benefit, ketogenic diets, for some people, result in a natural calorie reduction due to increased satiety. This results in weight loss, which can increase insulin sensitivity. The weight loss itself will also improve diet adherence for some people, resulting in more weight loss. With the weight loss and improved insulin sensitivity, individuals with diabetes may essentially enter 'remission'. This is true if they lose weight following a higher carb reduced calorie diet, of course, but without the immediate blood glucose improvement. I would think the highest benefit would be for those with poor glucose control (i.e. the medications don't work well for whatever reason) who are also unable to exercise to improve insulin sensitivity.3 -
Lol, I can tell just about anyone that if one is very overweight/obese with type II diabetes, just losing a significant amount of weight on ANY DIET will likely reduce/reverse it.
A.C.E. Certified Personal and Group Fitness Trainer
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Been in fitness for 30 years and have studied kinesiology and nutrition
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ladyhusker39 wrote: »I'll be glad when the whole low carb/keto thing goes the way of low fat. I'm so over it.
Maybe you shouldn't be clicking on low carb/keto threads for now
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ladyhusker39 wrote: »I'll be glad when the whole low carb/keto thing goes the way of low fat. I'm so over it.
As a tool for weight loss, especially when diabetes, insulin sensitivity and related issues are involved -- as someone who benefits greatly from lower carb, I hope it stays to help more of us.
But yeah, the "low carb/keto as magic" can fade out soon.2
This discussion has been closed.
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