In Categories: Practical Tips

You may have heard a lot about type 2 diabetes – but do you know what it actually does to your body?

In this video series, we’ll explore the causes of type 2 diabetes and how to reverse it.

How to reverse diabetes

  1. How food affects blood sugar
  2. Carbohydrate intolerance and insulin resistance
  3. How type 2 diabetes became an epidemic
  4. Treating type 2 diabetes—and why ‘eat less, exercise more’ doesn’t work
  5. The history and safety of ketogenic diets
  6. Research on ketogenic interventions for type 2 diabetes
  7. Ketogenic meals and food options

1: How food affects blood sugar

What happens when we eat carbohydrates, protein and fat?

Your blood insulin responds very differently to different macronutrients. Fat does not impact blood insulin levels. Carbs have a high impact, protein impacts them moderately, but fat? No impact!

Carbs and fats provide energy for the body. When carbs are limited in the diet, fat becomes the preferred and efficient fuel source. When you reduce your intake of one macronutrient, you have to increase your intake of at least one other macronutrient—otherwise you’ll feel hungry and not have enough energy. The low-fat craze started with flawed science that incorrectly stated that fat was dangerous. In a low carb, high-fat diet, fat provides you with the energy your body needs, and also helps knock out hunger and cravings.


2: Carbohydrate intolerance and insulin resistance

Type 2 diabetes is a disease of high blood sugar. It can also be thought of as carbohydrate intolerance or insulin resistance. That means when someone with type 2 diabetes eats carbohydrates, it causes their blood sugar to rise above what is healthy.

Everyone has a different carbohydrate tolerance. One person may be able to eat a carb-heavy diet with no problem, and another may get blood sugar spikes and gain weight from eating very few carbohydrates. Both people can be healthy, as long as they are eating within their personal tolerance levels.

So, what is a carbohydrate? It’s one of the main energy sources in many foods, including bread, pasta, fruit and starches. When carbohydrates are digested, they are broken down into glucose in the blood. You may know this as blood sugar.

The body allows for only 1 tsp of sugar per 5 liters of blood, but there are 9 tsp in a cup of cooked white rice.

The excess glucose in your blood is pulled out by the hormone insulin. In a person with a high carbohydrate tolerance, this process works well and excess blood sugar is promptly removed.

In a person with carbohydrate intolerance, type 2 diabetes or prediabetes, this system breaks down. The body loses its insulin sensitivity and more and more insulin is required to remove the excess blood sugar. As a result, blood sugar levels remain high and insulin levels are high as well, and these high insulin levels can make your body even less sensitive to insulin.

The result? The cycle will happen over and over again and the problem will get worse.


3: How type 2 diabetes became an epidemic

52 percent of adults in the United States have type 2 diabetes or prediabetes, which means that you are more likely than not to have diabetes or be developing it. How did we get here?

Well, in 1977, the U.S. government recommended new dietary guidelines. Remember the food pyramid?

The food pyramid recommended 6-11 servings of carbs per day, and very little fat — a low-fat, high-carb diet. As we outlined in our last video, type 2 diabetes is a disease of carbohydrate intolerance. Someone with type 2 diabetes or prediabetes has a low carbohydrate tolerance, so eating carbs will lead to exaggerated blood sugar spikes. While those with a high carb tolerance may be able to eat a carb-heavy diet and remain healthy, someone with a low carb tolerance will experience chronic high blood sugar and likely even weight gain if they eat a high-carb diet.

Soon after these guidelines were recommended in 1977, type 2 diabetes prevalence increased dramatically, and it hasn’t slowed down since.

 

These dietary recommendations have made high carb, low-fat foods a staple of the American diet. “Healthy” foods like fruit-on-the-bottom yogurt, sugary protein shakes and low-fat processed grains flooded the market. The standard American diet began to include more sugary drinks and sodas, as well as more processed grains. Since all carbohydrates (even complex carbs) are broken down into sugar in the body, these dietary recommendations meant that the average blood sugar of Americans began to rise – and the diabetes epidemic began to grow.


4: Treating type 2 diabetes—and why ‘eat less, exercise more’ doesn’t work

With the explosion of type 2 diabetes, there has also been an explosion in the treatments offered – many new drugs have been brought to market, and there are hundreds of lifestyle interventions to choose from.

The problem with the medication-based approach is that you’ll most likely have to be on these medications for the rest of your life. They are expensive and many come with a host of side effects. The medication approach focuses on management of diabetes, not reversal. Taking medications for type 2 diabetes combats the end result, which is rising blood sugar, but does not address the root causes—insulin resistance and carbohydrate intolerance.

Shifting the paradigm to diabetes reversal, however, means addressing the root causes of type 2 diabetes.

Most lifestyle interventions focus on eating less and exercising more. But many patients have tried this and have seen minimal results, while also fighting unsustainable hunger and cravings. The problem with these programs is that they tend to be high in carbs, even if they are cutting back on calories. When you eat a high-carb diet, the resulting increase in your blood sugar triggers an insulin response in your body, and insulin blocks your body’s ability to burn fat. Insulin actively blocks the breakdown of stored body fat, meaning that as long as insulin is high, it will be very difficult to lose weight—even if you are eating very little.

Plus, when you eat too few calories, you’ll be exhausted, and struggle with constant hunger and cravings. The solution? If you want to lose weight and potentially reverse your diabetes, don’t just eat fewer calories on a high carb diet. Instead, switch to a low-carb, high fat diet that won’t cause blood sugar spikes. By keeping your blood sugar down, you’ll keep your insulin levels down, and unlock your body’s natural ability to burn its stored fat. It may seem counterintuitive, but to lose fat, you have to eat fat. This type of low-carb, high-fat diet is called a ketogenic diet.

*I do not recommend making significant dietary changes without physician supervision, especially if you are on any medications.


5: The history and safety of ketogenic diets

There are cultures who have thrived for centuries on high-fat, low-carb diets, such as the Masai warriors and Inuits.

And ketogenic diets have been used as medical treatments for a long time—specifically, to treat children with epilepsy. In the past 20 years, elite athletes, especially endurance athletes looking for an edge, have started adopting low carb and ketogenic diets for improved performance.


6: Research on ketogenic interventions for type 2 diabetes

Clinical trials have proven a low-carb, high fat diet to be significantly more effective than programs that encourage you to eat less and exercise.

In our clinical trial, Virta patients lost almost 12% of their starting body weight in 6 months1that’s nearly 3x the weight loss of commercially available weight loss programs.

McKenzie et al., 2017

And contrary to what you might have been told, low-carb, high fat lifestyles have not demonstrated an increased risk in cardiovascular disease. In fact, patients in our clinical trial also had a significant reduction (22%) in triglycerides, which are associated with risk for cardiovascular disease, in just 10 weeks.1

56% of patients were able to lower their HbA1c to below the diagnostic threshold for type 2 diabetes, and 47.7% were able to reverse their diabetes—lower their HbA1c while eliminating their medications (excluding Metformin).1

McKenzie et al., 2017


7: Ketogenic meals and food options

There are plenty of delicious high-fat, low-carb options available. Let’s go through a sample day on a ketogenic diet.

Breakfast. You can enjoy breakfasts like scrambled eggs with cheese and sausage, bacon and fried eggs cooked in butter, cream cheese pancakes, full-fat yogurt with raspberries and almonds or even a breve latte from Starbucks.

Lunch. Salads are always a good option for lunch – load it up with meat or tofu, cheese, avocado, veggies and a full-fat dressing like olive oil or ranch. In a rush? Grab a lettuce-wrapped burger or bread-less sandwich from any fast food outlet. Like to cook? Try steak and brussels sprouts smothered in butter, salmon and asparagus with hollandaise sauce or a Thai curry made with tofu, coconut milk and green beans.

Snacks. For snacking, try salted nuts and olives, salami and cheese, celery and almond butter or full-fat yogurt.

Dinner.  Prefer to dine out? Try a lettuce wrapped burger from a fast food restaurant, a salad from Chipotle or surf and turf with broccoli from Applebee’s. Feel free to have a glass of wine or scotch. Want something sweet? Try some low-carb ice cream, dark chocolate, almond flour pancakes or berries with whipped cream.

32 Comments

  1. Dr. Hallberg has a way of communicating that is from the heart and also backed up by very solid science. The people I have shared this with, with type 2 diabetes, were influenced enough to reduce, dramatically, the carb intake.

    I consider her the current overall leader in our health revolution, ahead of Dr. Gundry, Dr. Bland, Dr. Bredesen, Dr Hyman, Dr. Mercola, Dr. Perlmutter, Dr. Wahls, Dr. Natasha Campbell-McBride, Dr. Tom O’Bryan.

    In her presentation on LDL she took full account of the outliers, and this impeccable approach to the scientific method should set a standard for all of our health professionals.

    She makes it seem to be so easy to make convincing presentations, with solid science, and break it down to a level that everybody can understand.

    Reply

  2. Some anecdotal data may, actually , shed some light on the LDL conundrum. After 18 months on a ketogenic diet a cardio IQ was performed by Quest. Four items were out of the reference range, and my suspicion is that these VLDL numbers are representative of what would be the reference range 75,000 years ago.
    VLDL- SMALL- 23 (57-124)
    VLDL – MEDIUM- 29 ( 42-110)
    VLDL- LARGE. – 6 ( 9-36)
    IDL- LARGE- 85 (152-319 )

    These are some details of the calcium score after 22 months for the above subject:
    Coronary Artery Score:

    Left Main Artery (LMA) Score = 0
    Left Anterior Descending Artery (LAD) Score = 11.5
    Left Circumflex Artery (LCX) Score = 0
    Right Coronary Artery (RCA) Score = 0
    Posterior Descending Artery (PDA) Score = 0
    Total Calcium Score = 11.5

    Reply

  3. Has there been any investigation of elevated homocysteine during rapid weight loss?
    Dr. Gundry posted about this in 2006 and included a somewhat dated remedy ( using folic acid ) : “Abstract 4133: Dietary Change Induced Weight Loss Produces a Dramatic Rise in Serum Homocysteine Levels: Modification by Folic Acid and B Vitamin Supplementation”
    ( http://circ.ahajournals.org/content/114/Suppl_18/II_892.2 )

    Reply

  4. QUestion … how much to eat (total calories a day) to not gain but lose weight?

    Reply

    1. Virta Health

      That depends on your body and your energy needs. Check out this video series by Steve Phinney. Video 3 will give you some insight into how your body’s needs change as you move from weight loss to weight maintenance: https://blog.virtahealth.com/dr-stephen-phinney-ketosis-ketogenic-diets/

      Reply

  5. Are potatoes in the carb catagory? Just wondering how to replace fresh pasta or rice with something else.

    Reply

    1. Virta Health

      Potatoes are carbs. You can try zucchini noodles and cauliflower rice!

      Reply

      1. Thank you

        Reply

  6. Thank you for explaining just how things work. I have just (2months ago)gone off Diabetes Type 2 medication. BGLs around 7-10 now. It looks like I replace the rolled oats for cauliflower for breakfast and the three slices of wholegrain sourdough bread for veggies. Those two items were the continued delaying function. I’ll be on my way to decreasing the BGLs to normal, now. I have lots of fat from cold pressed virgin olive oil in my home-made hummus and over the veggies. I can look forward to the soya coffee with no guilt.

    Reply

  7. Wonderful info! But I need to know more specifically how to follow keto diet. Is there a limit to fat? Can too much fat stall weight loss? Is there a range for Ketosis that I need to stay in? Husband is testing between moderate and high ketones but has actually gained weight! I am testing no ketones yet and hve lost two pounds. I need some advice.

    Reply

    1. Virta Health

      There’s a lot of advice here in our FAQ: https://blog.virtahealth.com/nutritional-ketosis-faq/

      Reply

  8. Im doin the best i can, but the one thing really stoppin me is fruit, is it ok to have an orange or an apple a day if im doing everything else right?

    Reply

    1. Virta Health

      We recommend keeping your carbs to under 30/day as you are adapting, so as long as your carbs are under your personal tolerance, you’re ok! Check out our guide to reversing diabetes here: https://www.virtahealth.com/reversediabetes

      Reply

  9. Vincent Norris April 23, 2018 at 1:25 pm

    Been diabetic for 23 years, what are chances of reversing diabetes & getting off of some of my medicines?

    Reply

    1. Virta Health

      We have many patients who have reduced their medications after having diabetes for decades. Check out our guide to reversing diabetes here: https://www.virtahealth.com/reversediabetes

      You can also apply for the treatment here: https://www.virtahealth.com/thevirtatreatment

      Reply

  10. Robert Schmidt April 25, 2018 at 2:57 pm

    I was diagnosed with Type 2 diabetes and started with a nutritionist two years ago. I was losing weight (20 lbs) and doing well on her prescribes diet. She reviewed my food log and comment that I was cutting down too low on my carbs. She said that it would damage my kidneys. I was concerned and slightly increased my carbs — which led to cravings and weight gain. Why was that the advice given? It failed.

    Reply

  11. One point most people are not commenting on is the increase in total LDL cholesterol that is evident in the high-fat diet. fluffy LDL or not, how should we interpret this increase? To what level LDL increase is safe on keto?

    Reply

    1. Virta Health
      Virta Health May 4, 2018 at 4:22 pm

      Check out this post on that very topic! It includes our 1-year results: https://blog.virtahealth.com/blood-lipid-changes-with-ketogenic-diet/

      Reply

  12. Patti DeFelicis May 12, 2018 at 12:19 am

    I’m glad you talk about personal tolerance. My doc wants me to go on a ketogenic diet, but even when on the Autoimmune Paleo Diet, my adrenals would go a bit nuts. I can’t go any longer than 6 hours without food overnight…my adrenals start pumping out the adrenalin after about 3 to 6 hours of sleep (no matter what I eat or don’t eat before bed) and I wake up with anxiety. Adding a bit of carbs (3/4 cup at dinner and 1/2 cup at lunch) has allowed me to go a full 6 hours (would love 7 or 8) but it still feels terrible when I wake up.

    Reply

  13. I’m confused because I see different doctors recommending different diets and both point at cultures with low incidence of diabetes. Dr. Hallberg points at the Masi warriors & Inuit cultures, but I’ve seen another doctor who says that a Japanese style diet (rice, fish, etc…) works well for them and should work well for us.

    Reply

  14. How does this diet affect high cholesterol?

    Reply

    1. Virta Health

      The Virta Treatment (of which this diet is a part) improved 22 of the 26 markers of cardiovascular disease risk that we followed. More on that here: https://blog.virtahealth.com/improving-cardiovascular-disease-risk-factors-virta-treatment/

      Here’s a video explaining the results of our clinical trial: https://www.youtube.com/watch?v=5UGauD22Ni8

      Reply

  15. I made a mistake in an earlier comment that I need to correct. I thought the VLDL represented the very small particles, and that is totally wrong. Here are the actual test results of the very small particles from a Quest Diagnostics after about 18 months on a ketogenic diet, with abundant use of MCT oil as caprylic acid. If the administrator deletes that comment, to avoid confusion, that would be fine with me. I can also provide much more data, as that test is pretty comprehensive.

    CardioIQ Lipoprot Subfract,IM
    LDL, Very Small-d
    102
    88-187 nmol/L

    LDL, Very Small-c
    122
    86-203 nmol/L

    LDL, Very Small-b
    98
    73-236 nmol/L

    LDL, Very Small-a
    95
    49-249 nmol/

    Reply

  16. Can somebody at Virta help us find the actual presentation at the 2017 world polyphenol conference on lectins and polyphenols and artery flexibility? I can only find the agenda where the title of the presentation and time is made. He described what he was going to say in an interview a few weeks earlier, more rigidity of arteries with re-introduction of lectins, but I cannot find the actual presentation. He had a publication in 2013 on the reversal of endothelial dysfunction, is why I think we should take this other publication seriously:
    ” 200 consecutive pts, aged 51-86, M:F ratio 3/2, with known vascular risk factors of HTN, DM, Hypercholesterolemia, hx of MI, Stent, CABG, were enrolled in a dietary program, which emphasizes large amts of leafy green vegetables, olive oil, radical reduction of grain, legumes, nightshades, and fruits; and generous amts of grassfed animal proteins, emphasizing Shellfish and avoiding commercial poultry (Diet Evolution). All pts were instructed to take 2-4,000 mg of high DHA fish oil, 200mg of Grape Seed Extract, and 50 mg of Pycnogenol per day. All pts had Endothelial Reactivity (ER) using PAT before and after a 5-minute arm occlusion using the EndoPAT 2000 (Itamar, Israel) at baseline and at 6 months.
    Baseline Endothelial Reactivity was 1.88+/-0.7 (range 1.0-3.3), with 145/200 pts (72%)having endothelial dysfunction (less than 1.60). At 6 months, ER increased to 2.25+/-0.5 (range 1.2-3.6) (p<0.01). Only 40/200 (20%) remained with ED, but all had increased ER numbers. Ten pts stopped the polyphenols after a normal PAT; all developed ED on repeat PAT "
    ( http://atvb.ahajournals.org/content/33/Suppl_1/A137 )

    The actual title of presentation at the conference: "Polyphenols and a lectin limited diet abolish elevated markers of vascular inflammation in patients with coronary artery disease"

    Here is a link to the conference agenda where his name is mentioned:
    https://polyphenols-site.com/2017/images/stories/2017/PDF/Vienna_Polyphenols_World_Congress_2017_-_Agenda_to_print.pdf

    David Feldman and Ivor Cummins are also making substantial contributions to help us decide what to do and what not to do in regards to cardio health.

    Reply

  17. Boon Song Lim June 3, 2018 at 10:47 am

    How much carb should be consider a low carb diet?
    My mum suffers from type one diabetes and is injecting 8ml of quick acting insulin in the morning, 6 in the evening
    Her blood sugar is still on 10-14 and we are very concern

    Reply

    1. Virta Health

      We have more information on low carb diets here: https://blog.virtahealth.com/nutritional-ketosis-faq/

      We recommend that you obtain medical supervision before making any dietary changes so that your physician can adjust your medications as needed.

      Reply

  18. I feel the information is partial and not based scientific research, it treats values but what is the root of insulin resistance is avoided, the theory that taking the sugar and carbohydrates and enter protein and oil will improve the situation is based on clear results of the diet in shorten period, of course that the problem root is not treated and became worst, the insulin resistance is not a genetic only or abnormal function developed by the consume of carbs, evidence shows more and more that actually refined carbs and oil and animal protein is connected. I think modestly that the for those that want to reverse the chronic disease the best way is to test what is offered and then go to a fasting-sugar-overload test and see if the resistance has been removed, I will like to read if this has been checked by the doctors, thanks

    Reply

  19. Is this diet okay for someone that has gout? I just became a vegetarian because of got, but Im also prediabetic and want to avoid all medications.

    Reply

    1. Virta Health

      Great question! We have a post and video on this topic here: https://blog.virtahealth.com/ketogenic-diet-gout/

      Reply

  20. Do you know if a doctor in the Philadelphia area that has the same beliefs as Dr. Hallberg? Id love to have a doctor that doesn’t want to push medicine first.
    Thanks!

    Reply

  21. Anita Boom Van Doorn July 4, 2018 at 8:33 pm

    Thank you for this information. I am on metformin and wonder why it’s excluded from reducing it as a medicin when on a LCHF diet.

    Thanks
    Anita

    Reply

    1. Virta Health

      We do reduce or eliminate Metformin in many patients who want to. We just don’t include it as part of our reversal criteria because it is not diabetes-specific. Many patients choose to stay on this medication for reasons other than blood sugar control.

      Reply

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