Can following a low-carb diet reverse type 2 diabetes long term by improving blood sugar control while reducing or eliminating diabetes medication?
The recent publication of Virta Health's two-year clinical trial data answers that question with a resounding "yes":
Frontiers in Endocrinology: Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: A 2-Year non-randomized clinical trialThis study is a continuation of Virta's trial previously published at 10 weeks in 2017 and one year in 2018, which compared a low-carb dietary intervention to usual care in people with type 2 diabetes.
Adults who enrolled in this study were given the choice of following a low-carb intervention or receiving standard diabetes care. The 262 participants who selected the intervention group were provided with a very-low-carb diet (initially 30 grams of total carbs per day, then increased based on individual tolerance), frequent nutrition coaching and education sessions with a registered dietitian, and supervision by a medical care provider. Those who chose to receive usual care (87 people) were provided with standard diabetes management from their doctor and referred to a registered dietitian for nutrition counseling or classes consistent with American Diabetes Association guidelines.
At two years, the low-carb intervention group experienced several impressive changes:
- Retention: 74% of the original participants (194 people) remained in the study
- Diabetes outcomes:
- Nearly half (53%) of participants were considered to have reversed their diabetes, meaning their blood sugar control improved, yet medication was reduced or eliminated
- As a group, average hemoglobin A1c (HbA1c) was reduced by 0.9% (similar to results in diabetes drug trials)
- 67% of insulin and oral diabetes medications (other than metformin) were eliminated altogether. For participants who still used insulin or oral drugs after two years, dosages were greatly reduced
- Weight: Average weight loss was 26 pounds (11.9 kg), and three-quarters of the participants lost at least 5% of their body weight, including abdominal fat
- Cardiovascular risk markers: Triglycerides decreased and HDL cholesterol increased, whereas LDL cholesterol increased only slightly, on average
- Liver health: Liver function markers, fatty liver scores, and liver damage scores improved
- No adverse changes in bone health or thyroid or kidney function were seen
By contrast, the group that received usual diabetes care and nutrition recommendations didn't experience diabetes reversal or improvement. In fact, some of the usual-care participants needed more diabetes medication after two years. Additionally, very few of them lost any weight or experienced other health improvements.
Although this wasn't a randomized, controlled study - considered the "gold standard" for scientific evidence - it may actually provide more important "real-world" information about how effective and sustainable low-carb diets can be. It clearly demonstrates that for people who want to follow a carb-restricted approach and work as a team with supportive and knowledgeable professionals, long-term diabetes reversal and overall health improvement is entirely possible.
