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.

“What if we’re wrong about diabetes?”

That’s the title of this video, which came up in Lisa’s YouTube related videos feed about a year ago.

It’s a gripping TEDMED talk from 2013 by Dr. Peter Attia, who confesses the judgmental attitude he had harbored six years earlier toward an obese patient who had come into the emergency department with foot ulcerations.

She obviously must have let herself go, he thought, consuming too many calories and not moving enough.

But then three years later he found himself 40 lbs. overweight and with metabolic syndrome, and he knew that physical inactivity was not the cause in his case: he had been “exercising three to four hours every day, and following the food pyramid to the letter.”

It led him to wonder whether, in the case of obesity, insulin resistance and type 2 diabetes, the medical community might have the chain of causation backwards.

Watch this video. It’s totally worth the 16 minutes.

I have found Dr. Attia one of the most thoughtful online voices when it comes to evaluating and making sense of dietary and lifestyle research related to both longevity and healthspan.

As he says in this video, perhaps he’s been humbled by what the thought he knew that turned out to be mistaken.

I expect I will have several more posts in this series that feature (or at least mention) Dr. Attia. His website is an amazing resource, and his podcast, The Drive, is the only one for which I pay for premium access.

Like Tim Ferriss, Dr. Attia also has introduced me to many other leading researchers and thoughtful analysts. Follow him on Twitter.

See previous posts on My Health Journey, and to get future posts follow on FacebookTwitter or LinkedIn, or subscribe by email.

Diabetes is Devastating

As my blog starts its new direction, I had planned on beginning in my next few posts with some background on my health exploration journey, but a news release about a study from Mayo Clinic that came into my inbox yesterday caused me to revise my plan.

The study in the Rochester, Minn. area identified 116 patients with diabetes and 232 who didn’t have diabetes, but otherwise were matched for heart failure risk factors like age, hypertension, sex, coronary artery disease and diastolic dysfunction.

Following both groups for 10 years, researchers found that 21% of the patients with diabetes developed heart failure, while just 12% of the patients without diabetes did.

So while we’ve long known that diabetes is associated with a host of health problems, here’s fresh evidence of another: almost doubling the risk of heart failure, although in this study it didn’t increase mortality.

Still, this new study adds to what already was a grim prognosis, both for individuals with diabetes and for society as a whole. As this paper in the journal Population Health Management put it:

Diabetes and its complications, deaths, and societal costs have a huge and rapidly growing impact on the United States. Between 1990 and 2010 the number of people living with diabetes tripled and the number of new cases annually (incidence) doubled. Adults with diabetes have a 50% higher risk of death from any cause than adults without diabetes, in addition to risk for myriad complications. Reducing this burden will require efforts on many fronts—from appropriate medical care to significant public health efforts and individual behavior change across the nation, through state- and community-specific efforts.

That same paper suggests that in the next decade

  • the total number of Americans with diabetes will increase from 43 million to nearly 55 million,
  • that annual diabetes-related deaths will increase by more than 55,000 and
  • annual diabetes medical costs will go up almost $100 billion.

It all means that preventing (or even reversing) type 2 diabetes is probably the most important thing we can do.

But the statistics are clear: what we’ve been doing as a society for the last 30 years hasn’t been working.

What I’ve been learning and experiencing over the last three years through personal investigation and application suggests that we have more ability to influence this trajectory than we might think.

I’ve read about thousands of patients with prediabetes or type 2 diabetes getting their Hemoglobin A1c levels down to the point where (under medical supervision, of course) they have been able to discontinue taking insulin or diabetes medications, and are no longer considered even prediabetic.

I know some people are skeptical that type 2 diabetes can be reversed, but given the scope of the problem it sure seems worth exploring.

If type 2 diabetes is three times as prevalent as it was a generation ago, this can’t be a genetic problem. Our genes don’t change that fast.

Since changes in our environment and behavior are likely responsible for the epidemic, shouldn’t we look at reversing those changes as much as we can, at least in our personal lives, where we have the most control?

I was never diagnosed as prediabetic, but I’ve made some significant changes and have seen lots of benefits in my own health. I couldn’t have made them all at once, but I evolved them over time.

Type 2 diabetes isn’t the only disease that seems to have potential for lifestyle prevention or reversal. Some of the same interventions seem to work in other diseases, too – mainly because diabetes, as we see in this Mayo Clinic study, is a risk factor for a host of other ailments.

Curious? Follow along on Twitter, LinkedIn or Facebook and I’ll tell you how it happened.