By Marika Sboros

Prof Tim Noakes has welcomed robust new evidence showing that simple dietary change really can reverse type 2 diabetes.

In other words, evidence showing that diabetes doesn’t have to be chronic, progressive and degenerative. And that diabetics don’t have to face an increased risk of heart attack, blindness, limb loss and declining mental function.

Physicians at the Virta Health company in the US have shown just that in a peer-reviewed study just published in Diabetes Review. Led by Virta medical director Dr Sarah Hallberg, it is a one-year trial. It shows that a low-carbohydrate, ketogenic diet puts 61% of patients with type 2 diabetes into remission.

That’s big. Yet many experts have quickly attacked the study. Noakes has written a letter to a Cape newspaper (scroll down to read it below), explaining why the study really is a watershed. He looks at why it gives diabetics and their families renewed hope.

And why, in essence, type 2 diabetes is “a condition of choice”.

Dr Jeff Stanley

A common criticism is that the study is not a randomised controlled trial (RCT). (RCTS are the so-called “gold standard” of modern science.)

Ethical barriers

Co-author Dr Jeff Stanley deals a knockout blow to that one. The Virta researchers haven’t claimed that their study is an RCT, Stanley says. And ethical, funding, financial and other constraints makes RCTs notoriously difficult in nutrition research these days.

Stanley points to an RCT by University of California, San Francisco researchers published in the Journal of Medical Internet Research last year. It shows similar results.

Others have tried criticising the study because they claim that low-carb, ketogenic diets are “dangerous fads”. They do so without providing any evidence, robust or otherwise, in support of that claim.

And when all scientific health argument fails them, critics attack the study on environmental grounds. They claim that low-carb diets hurt the planet.

Why LCHF works

The Virta researchers are undeterred.

Stanley rightly says: “This approach works, and we will help millions of people reclaim their health.”

Stanley also pays tribute to visionary Virta founder, Finnish billionaire type 2 diabetic Sami Inkinen. Inkinen is also co-founder of the leading online real estate company Trulia.

In a tweet, Stanley says of Inkinen:

“He could be on a beach after selling Trulia for $3B, but instead started a company that is changing/saving the lives of people with t2 diabetes.”

A Canadian-led study, of which Noakes is a co-author, has also shown strong evidence of low-carb, high, healthy fat diets for “diabesity”. That’s doctors’  term for the twin epidemics of obesity and diabetes. That study’s message goes further than that. It also looks at obstacles to nutrition science research.

So what’s the beef?

In fact, there is a wealth of evidence showing that LCHF diets do work for diabetes. That raises the question why so many doctors and dietitians still don’t recommend it.

Here’s what Noakes had to say about the Virta study in a letter to the editor of the Cape Times on February 15.

His letter is headlined: Dangerous fad diet (low carbohydrate ketogenic) puts 61% of patients with type 2 diabetes mellitus into remission in 1-year trial.

To the Editor

In 2013, my colleagues and I published The Real Meal Revolution (RMR). The central theme of the book is that persons with insulin resistance (IR) – the underlying biological abnormality in Type 2 Diabetes Mellitus  (T2DM) – enjoy substantial health benefits when they restrict their dietary carbohydrate intakes to between 0-150 grams per day depending on the severity of their IR.

The book and the eating plan it promotes became an overnight success with the South African public. Just as rapidly influential medical colleagues and dietitians across the country dismissed it as a dangerous diet fad that causes harm.

Challenge to convention

The unrivalled success of the book and the challenge to dietary convention that it poses, soon became a unifying provocation for the subsequent 4-year, multi-million rand investigation into my professional conduct by the Health Professions Council of South Africa (HPCSA).

Click here to read: Noakes verdict: he won battle but war goes on


On Wednesday, February 7 2018, the medical journal, Diabetes Therapy, published a peer-reviewed scientific paper (1) reporting the findings from the first year of a 2-year study of the use of remote care (telemedicine) for the management of type 2 diabetes mellitus (T2DM) undertaken by the Virta Health company in San Francisco.

The key focus of the study was to ensure that patients with T2DM develop a state of continual mild ketosis by eating a severely carbohydrate-restricted diet (<30 g/day). This is the same diet prescription promoted for the management of IR and T2DM in the RMR and all my other nutrition books.  In fact, the RMR was used as a patient resource for dietary information in the Virta Health trial.

The study initially enrolled 262 persons with T2DM for the intervention trial; at the end of the first year, 218 remained in the study giving a retention rate of 83%. A further 87 T2DM patients who continued to receive conventional care (insulin and/or other anti-diabetic medications; non-ketogenic high carbohydrate diet) were also followed for 1 year.

Drop in drug use

Ninety-four percent of T2DM patients on the intervention trial had either reduced or ceased their insulin use at the end of year one. The use of other anti-diabetic medications excluding metformin fell from 57 to 30% and no patient was still using a sulfonylurea drug at the end of the trial.

In contrast, medication use increased by 9% in the group receiving conventional care.

Click here to read: ‘Cure’ for type 2 diabetes? A doctor’s journey

Despite reduced use of anti-diabetic medications, 61% of subjects on the intervention trial “reversed” their diabetic markers, especially glycated haemoglobin (HbA1c) values, to below those considered diagnostic of T2DM.

As a result, these patients are technically “in T2DM remission”.  This does not mean that they are, or ever will be “cured” of T2DM since re-introduction of a higher carbohydrate diet to persons with severe IR/T2DM will rapidly reverse these gains.

However it might logically be expected that persons “in T2DM remission” will be much less likely to develop T2DM complications in the future, provided they continue to restrict their carbohydrate intake to <30g/day.

Cost savings

Other benefits included an average 12% (14kg) weight loss, decreases in systolic and diastolic blood pressures and in all blood markers of IR and inflammation. In contrast, most of these markers deteriorated in the usual care group.

The authors conclude that a North American with T2DM who stops using insulin will save $10 000 per annum for the rest of his or her life.

The importance of this study is many fold. First, it disproves the depressing medical opinion that T2DM is a chronic progressive disease with a dismal future. Instead, it shows that T2DM can be effectively managed with a quite simple dietary change.

Second, it shows that, in essence, T2DM is a condition of choice.

Patients can choose to eat <30 g/day of carbohydrate and so minimize their risk for developing any of the disease’s myriad complications. Or they can continue to eat an unrestricted carbohydrate diet, in which case it is probable that they will develop the complications of T2DM regardless of how much medications they use.

Stopping the diabetes epidemic

Third, it confirms that the cause of the current T2DM/obesity pandemic is clear.  It was the adoption of the high carbohydrate diet mandated by governmental agencies and vigorously promoted by medical and dietetics organizations around the world since 1977.

Every month another 15 000 South Africans develop T2DM. The Virta Health study proves that this is unnecessary. This tragic epidemic can be stopped.  Persons with IR need to understand that eating a diet in which carbohydrate intake is unrestricted will likely lead to T2DM and all its tragic complications.

This is as we described it in RMR in 2013.

  • I am co-author with Prof Tim Noakes of Lore of Nutrition, Challenging Conventional Dietary Beliefs (Penguin 2017). I am contributing author to Healthy Eating, The BIG Mistake by Dr Verner Wheelock (Columbus 2018)
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