Reversing Type 2 Diabetes with a Low-Carb Diet

Dr. Sarah Hallberg, one of my Health Sherpas, says patients who want to reverse type 2 diabetes have three medically proven options, backed by multiple published studies:

  • Bariatric Surgery
  • Very Low Calorie Diet
  • Low Carbohydrate Diet

Bariatric Surgery works for many people, with 30% or more able to achieve long-term remission. It also has the obvious downsides of surgical risk and expense. But it should be presented as an option, and some people will find it right for them.

A Very Low Calorie Diet, depending on the study, ranges from 300 to 1,800 calories per day. While these work really well in the short term, there is an issue with weight gain after the period of calorie restriction ends. It’s difficult to maintain the weight loss: the faster you lose weight, the faster you tend to regain it, and progress on diabetes can be lost too.

Low Carbohydrate Diets – Dr. Hallberg points to 22 randomized controlled trials (RCTs), 10 meta-analyses and 10 non-randomized trials, including six studies of two years or longer, including the Virta Health/Indiana University Health study she leads.

I think it’s worth watching the video below in its entirety for context, but if you want to skip ahead, she starts describing her results at about the 16:00 mark:

These results are phenomenal: Half of patients maintaining diabetes reversal at two years.

As she says, can you imagine if a drug had that kind of sustained effectiveness?

Here’s how the methods compare in blood sugar control:

Comparison of sleeve gastrectomy, gastric bypass, very low calorie diet and low-carbohydrate diet.

In HbA1c, low carbohydrate is better than sleeve or very low calorie at two years, and equal to bypass.

And here’s how they compare from a weight loss perspective:

As Dr. Hallberg pointed out, the patients in her study (the purple line) started at a higher weight, and the average time with diabetes before the study was 8 years. Shifting the purple line’s starting point down 10 kg would make it pretty similar to either of the surgical options.

I greatly admire Dr. Hallberg and her collaborators, and I think the work Virta Health is doing is outstanding. Their results are great, and I think their intensive coaching intervention is valuable for people adopting this new way of eating.

I would add a fourth approach that I think will be the most effective, however: a combination of a low carbohydrate diet with intermittent fasting.

It conceptually combines the effects of the purple and orange lines in the graphs above.

Dr. Jason Fung calls fasting “medical bariatrics.” It has the benefits of bariatric surgery without the surgical expense and risk. It’s a lot easier to undo, too: You simply resume eating.

In fact, you have unlimited flexibility in adjusting the dosage of fasting. You can start with a 12-hour eating window each day, or you can fast for 16 or 18 hours and only eat from noon to 6 p.m. or noon to 8 p.m.

You can even consider alternate-day fasting, as in the #July4Challenge.

Low carbohydrate eating makes those fasting periods much less difficult, because fat and protein are more satiating than carbohydrates.

It’s kind of magical how these two strategies work together.

One final observation: At about the 23-minute mark of the video, Dr. Hallberg makes a really important point about the misplaced emphasis on randomized controlled trials in gauging efficacy.

RCTs are important when you have a drug intervention, because you’re typically testing a drug vs. a placebo, and the only thing you’re asking of the patients in the study is to just be sure they take whichever pill is assigned.

Diet is different. Motivation matters.

So does belief. If you’re randomly assigned to a diet for purposes of a study, even if you’re really motivated to change, you may not have really bought into the rationale behind the diet.

More on belief in a bit.

Dr. Hallberg in the U.S. and Dr. David Unwin in the U.K. have each demonstrated that a significant portion of patients under their care (as many as half) are able to reverse type 2 diabetes, going off diabetes medications, through a truly low-carb diet.

They’re not alone. Dr. Eric Westman at Duke, Dr. Tro and Dr. Brian Lenzkes, Dr. Ken Berry and scores or even hundreds of others are doing the same, although perhaps not quite at the same scale or with rigorous comparative studies.

They’re just helping patients who are motivated to get healthy and lose weight, and who are willing to try a low-carb approach.

For type 2 diabetes reversal (and prevention) and for weight loss, low-carb works.

I believe low carb + periodic fasting works even better.

I can’t “prove” it by the RCT standard, and the people I’ve mentioned above may not all agree with the combination.

They each have their own emphases: Dr. Fung’s is mainly on fasting, while I think some of the others who promote low-carb think it’s most important to eat healthy fat and moderate protein meals to satiety. They say the key is avoiding hunger, which makes compliance easier.

My experience has been that combining both perspectives has led to the best result for Lisa and me.

Now back to what I said about belief.

There’s plenty of evidence that if you will adopt a low-carb eating pattern you can eat until you’re full, rarely feel hungry, improve your metabolic health and lose weight.

But as long as you toy with the idea instead of taking the plunge, you’ll never really know. As one of the great Christian theologians put it in a different context:

“Understanding is the reward of faith. Therefore, seek not to understand that you may believe, but believe that you may understand.”

St. Augustine of Hippo

Give low carb with periodic fasting a try.

Embrace the journey. Take the plunge.

If it doesn’t work for you, you can always have bariatric surgery later.

In the next few days I’ll have a post describing a new free community we’re setting up to support people in making these changes and swimming against the societal dietary currents. I look forward to telling you about it.

It will be another installment in the series about my health journey. You can follow along on FacebookTwitter and LinkedIn or subscribe by email

If you’re ready to get started yourself, use my #BodyBabySteps.

If you’ve found this helpful, I hope you’ll share with your friends using the buttons below.

Rebecca Williams: Then and Now

I began telling the story of my health journey about 13 months ago on this blog to share what my wife Lisa and I had learned over the previous three years about getting metabolically healthy and losing weight.

We told Lisa’s story of losing at least 40 pounds in July, and followed up in November with her amazing achievement of fitting into her wedding dress for the first time in 36 years. We’re now both down 50 pounds or more from our respective peaks.

Along the way several readers have told us how we had helped to inspire them to try low-carb eating and intermittent fasting. That’s been really gratifying for us, because it’s exactly why we shared our stories in the first place.

So we were particularly happy John Bishop agreed to share his story in August, and that now Rebecca Williams, a colleague at Mayo Clinic, is doing likewise.

Below is Rebecca’s story in her own words. She’s living proof that the standard “eat less, move more” advice is simplistic and ineffective for weight loss in the real world.

And that there is a better way. Here’s what she sent me:

10 years ago, at the age of 41, I ran my first mile with the goal of finishing a marathon. Like many, I really thought that I would lose a tremendous amount of weight by running.

I was wrong. I lost a little, but I was still 60 pounds overweight when I crossed the marathon finish line a year and a half after I ran that first mile. Why was that? I thought I did everything I was supposed to do when running long distance. I carb loaded, I fueled with gels every 30-60 minutes, and since I was burning a tremendous number of calories, I rewarded myself afterwards with pancakes and ice cream.

However, when I step back and objectively assess what I did, I see where I went wrong. 

Rebecca at mile 25 of her 2012 marathon (left), and in a workout earlier this month.

On average, runners burn 100 calories per mile. So, let’s say I’m out for a 15-mile-long run. That means I’m burning 1,500 calories. However, carrying 60 extra pounds meant that 15 miles took me 3-4 hours, and if I was ingesting a 100 calorie gel every 30 minutes, I was taking in at least 600 calories. Then if I rewarded myself with pancakes and ice cream afterwards, that would quickly surpass the additional 900 calories I burned while running. No wonder I didn’t lose weight!

Over the past 10 years I continued running and finished a 200-mile relay, nine half marathons, and countless 5K’s. The weight hung on.

In March of 2020, my husband, Bruce, discovered Dr. Annette Bosworth (a.k.a. Dr. Boz), an internal medicine physician from South Dakota. He purchased her book Anyway You Can, and after reading it he was inspired. The book tells the story of how she saved her mother’s life. Her mother was battling stage IV Chronic Lymphocytic Leukemia (CLL). Facing another round of chemo, her mother decided that she would rather die. Dr. Boz had been studying the science behind the ketogenic diet and was convinced that it would help her mother. The book is the full story of how the ketogenic diet helped her mother achieve optimal health while still battling this chronic cancer. Throughout the book she also explains the benefits of the ketogenic diet.

At the time I was reading this book, Lee Aase started posting stories about his and his wife, Lisa’s, health journey, and I was inspired by them. When I finished Dr. Boz’ book, I was convinced that this is what I needed to do. 

Bruce and I took Dr. Boz’ online course, Consistently Keto, and on September 7, 2020 we started our ketogenic journey.

  • We reduced our total (TOTAL not net) carbs to <20g per day.
  • We measure our urine ketones each morning and use the Chronometer app to track our food and activity.
  • I began my day with a bulletproof coffee using a tablespoon of salted ghee and a tablespoon of Brain Octane Oil (MCT). This would keep me satiated until Noon when I at two eggs and 3-4 strips of bacon. I had a half cup of mixed nuts and cheese for an afternoon snack, and dinner was a ribeye steak with creamed spinach.
  • As the weeks progressed, I started to incorporate 18:6 intermittent fasting. I dropped the bulletproof coffee and now drink it plain and black. My eating window is from Noon to 6pm. 

Since beginning this keto journey, I am rarely hungry, and the sugar/carb cravings are gone. I lost 25 pounds, and I am continuing to run. However, I now run in a fasted state as my body is using my fat for fuel.

I still have 35 pounds to lose in order to reach my goal weight, but I have to say that the ketogenic diet is by far the easiest thing I have ever done and the only thing that has ever worked to help me drop the weight. 

I feel amazing! So amazing, in fact, that I am training for my second marathon. In January 2021 I started a couch to marathon training program. The first 12 weeks is training for a 5K, the next 12 weeks are training for a 10K, the next 12 weeks are training for a half marathon, and then the final 12 weeks are training for the Walt Disney World marathon in January 2022. I’m looking forward to this experience allowing my body to burn fat for fuel rather than depend on carbs.

The hardest part of this was making the decision to do it. The easiest part is doing it.

If you have been considering trying low-carb living with intermittent fasting, I hope Rebecca’s story will be that extra nudge that gets you started.

If you have questions about keto or fasting, feel free to ask in the comments below or in my social feeds on Twitter, Facebook or LinkedIn.

If like John and Rebecca you have a story you’re willing to share to help inspire others, send me an email.

I hope you’ll pass along Rebecca’s story with your friends using the sharing buttons below.

Who’s right about dietary fat and carbohydrates?

Professor Tim Noakes had a long career in sports medicine and exercise science at the University of Capetown in South Africa, and for several decades was aligned with the orthodoxy that athletes depend on carbohydrates for peak performance.

He even was an inventor of a commercial glucose goo used by marathon runners, and was an advocate for carbohydrate loading. He invested 30 years of his research career on the pro-carbohydrate side.

Then he dug into the research on low-carb, high fat diets and came to the conclusion he had been wrong.

It’s difficult to admit publicly that you have been wrong for three decades.

It’s even harder when you face withering public rebukes from colleagues and former allies, and even professional license revocation.

Professor Noakes is a giant figure with immense courage to have done so. This documentary tells the story of his trial in South Africa when he was accused of giving irresponsible and harmful medical advice via Twitter.

We all should feel indebted to him for his fortitude. He is of course one of my Health Sherpas.

Conventional and government-backed wisdom have said for more than 50 years that dietary fats, and especially saturated fats, are dangerous and increase the risk of heart disease.

Professor Noakes and other low-carb proponents have argued that evidence is lacking in the case against dietary fat, and that consumption of carbohydrates that exceeds our tolerance is instead responsible for increased prevalence of the metabolic syndrome and a host of associated diseases, including type 2 diabetes and heart disease.

As he says in the video below, “We can’t both be right.”

If you have any doubts as to whether a low-carb, high healthy fat diet is better supported by science than the current low-fat dogma, you owe it to yourself to watch this video.

Here’s just one slide from his talk, in which he describes a study that showed that a high-fat diet reduced all coronary disease risk factors across the board as compared with a high-carbohydrate diet.

When you see a study showing 14 of 14 risk factors changing for the better with a high-fat diet, you should at least consider whether the science really justifies the current low-fat government guidance.

If you think your friends might find this post helpful, I hope you’ll share by email or on your social networks using the buttons below.

To get these updates on a regular basis you can subscribe by email, or follow me on FacebookTwitter and LinkedIn, where I’ll also be posting links.

Check out My Health Journey for our full story, and my #BodyBabySteps for tips on getting started on your own health-improvement journey.

Dr. David Unwin on Cutting Carbs

Most people readily agree, whatever their dietary predispositions or convictions, that reducing sugar intake is an important first step toward sustainable weight loss.

What many fail to appreciate is that carbohydrates — especially starches — are essentially long strings of sugars joined together. And when your body digests them, chopping them apart, that can raise your blood glucose level as much as a sugar-sweetened beverage.

That’s one of the points Dr. David Unwin, one of my Health Sherpas, makes in this tweet:

In the video below he is addressing the Royal College of General Practitioners in London at their 2018 Public Health Collaboration Conference.

He describes:

  • how he had seen the number of patients with diabetes in his practice increase by more than 1,000% since the 1980s,
  • how through a low-carb diet about 50% of his patients with diabetes were able to get it into remission without the use of drugs,
  • how Norwood Surgery went from the poorest quality ratings for diabetes management in his region of the NHS to the best in just five years,
  • how Norwood spends the least on diabetes medications of any practice in his region, and
  • Why bananas are so terrible.

That last point comes from this innovative infographic Dr. Unwin has developed to represent various types of carbohydrates in terms of teaspoons of sugar equivalents.

See all of the carb categories converted to sugar teaspoon equivalents.

Dr. Unwin also describes how his patients’ diets, which because they are low-carb are necessarily higher in fat, also have led to

  • lower blood pressure and triglycerides,
  • higher HDL (good) cholesterol
  • improved liver function
  • average weight loss of 9.7 kg (21.3 lbs.) over an average of 26 months.

And according to a heart disease risk calculator from the Joint British Societies for the prevention of Cardiovascular Disease, they also saw a reduction of 12 years of “heart age.”

One of the main fears many have related to a low-carb, high-fat diet is that they will raise their “cardiovascular risk.” If that’s a concern for you, I hope you’ll make time to watch this video.

Dr. Unwin says that in 25 years of practice he had never seen a patient with type 2 diabetes go into remission.

Not even once.

In the last five years, using a low-carb diet, about half have achieved remission.

These are truly remarkable results, but Dr. Unwin is not alone in achieving them. In future posts I’ll introduce you to some of his low-carb co-belligerents.

If you think your friends might find this post helpful, I hope you’ll share by email or on your social networks using the buttons below.

To get these updates on a regular basis you can subscribe by email, or follow me on FacebookTwitter and LinkedIn, where I’ll also be posting links.

Check out My Health Journey and my #BodyBabySteps.

Here Comes the Bride!

I married Lisa 36 years ago next month, and since then we’ve been blessed with six children, and as of 2 a.m. yesterday, 13 grandchildren.

It was just after our daughter Rebekah (the mother of grandchild #13) was married four years ago that we decided we needed to seriously explore some changes in our diet and lifestyle.

I weighed over 260 lbs. then, and Lisa thinks she was 185. She isn’t sure because she wasn’t exactly going out of her way to find a scale.

I told her weight loss story (to that point at least) in July, and how much progress she had made between Rebekah’s wedding and our youngest son, John’s. The first year or so had been really frustrating, until we got on the low-carb, high-fat diet combined with intermittent fasting.

In May she had gotten down to 145 lbs., and so on her birthday she decided to try on her wedding dress for the first time since Dec. 22, 1984.

We couldn’t get the back zipped up then, but we thought if she kept going she might eventually close the gap, so to speak.

Having become a 13-time grandma earlier in the morning, she decided to try on her wedding dress again yesterday afternoon.

Lo, and behold…

Lisa was down to 135.8 yesterday, the lowest she’s been since the Reagan administration.

I’m so happy for her, especially because she had previously felt so frustrated and defeated, and now she feels healthy and in control of her eating habits.

Sometimes she fasts, and sometimes she feasts. Generally she’s avoiding extra sugar and carbs, but that doesn’t mean she can never have these things as a treat.

In fact, her dinner Tuesday night was a Papa Murphy’s Herb Chicken Mediterranean Pizza.

With zero guilt on the side.

See the whole series about my health journey. Follow along on FacebookTwitter and LinkedIn.