The Safety and Benefits of Low Carbohydrate Nutrition
While Virta’s approach to reversing type 2 diabetes goes well beyond a nutritional intervention, one of the critical components of our care plan is limiting carbohydrate intake to within each individual’s level of tolerance. In other words, we regard type 2 diabetes as a manifestation of carbohydrate intolerance. For those unfamiliar with the science of low carbohydrate nutrition, it is fair to ask about the safety of doing this long-term.
The bottom line? Yes, living a low carbohydrate lifestyle is in fact safe.
Anecdotally, our human ancestors adapted to thriving on a low carbohydrate diet long, long before agriculture, and some notably healthy human societies have lived this way into modern times. But more importantly, multiple lines of scientific study have demonstrated the safety and benefits of low carbohydrate living.
The safety of low carbohydrate nutrition
The first line of scientific study looks at the benefits of low carbohydrate nutrition for adult metabolic health. In just the last decade or so, many trials have specifically addressed safety. Here are a few of those examples:
- Gardner et al. in their randomized controlled trial (RCT) of 311 “free-living, overweight/obese” women noted that “concerns about adverse metabolic effects of the Atkins diet were not substantiated within the 12-month study period”. Participants on the low carbohydrate arm of that trial also enjoyed the greatest weight loss and improvements in lipids, insulin, blood glucose and blood pressure (Gardner, 2007).
- The similar study of Dansinger et al. also found no adverse effects in the low carbohydrate arm (Dansinger, 2005).
- Writing in the New England Journal of Medicine (NEJM) in 2003, Foster et al. showed greater weight loss and improved lipid profiles in those randomized to the low carbohydrate group versus the low fat group (Foster, 2003).
- Also in NEJM, Shai et al. in a two-year RCT showed greater weight loss and improved lipid profiles and insulin sensitivity plus lower C-reactive protein (CRP, a biomarker of inflammation) in the low carbohydrate versus the low fat group. No adverse effects were noted (Shai, 2008).
- Yancy et al. randomized 120 volunteers to a ketogenic (a type of very low carbohydrate nutrition preferred here at Virta) or low fat diet and similarly found the ketogenic diet superior for weight loss and lipid profiles without major adverse effects (Yancy, 2004).
These studies are just a few of many examples (cf., Hays, 2003; Krebs, 2010; Chiu, 2016; Dashti, 2007; Westman, 2008; Volek, 2009; Saslow, 2014; Sacks, 2002; Nordmann, 2006; Westman, 2007; Siri-Tarino, 2010; Nielsen, 2009; Ajala, 2013; Paoli, 2014; Noakes, 2014; Hashimoto, 2016).
The safety of saturated fat intake
The second line of study examines the recent paradigm shift in the relationship between fat intake and the risk of heart attacks and strokes. When most doctors went to medical school, they learned that eating fat increased that risk. But modern studies have shown that this is in fact incorrect, and that they were led astray in part by some questionable influence from the US sugar industry (Kearns, 2016).
Even leaving the latter point aside for another article, the recent shift in our understanding of fat intake and health has been dramatic. Ramsden and colleagues have recently recovered and diligently re-analyzed data from the 1960s, initially ignored or perhaps suppressed, from two original studies that were designed to prove the link between saturated fat and its relationship to cardiovascular health. To their surprise, they have found that, if anything, diets which replaced saturated fat with polyunsaturated fat increased cardiovascular risk (Ramsden, 2016, Ramsden, 2013).
This is consistent with clinical trial evidence that blood levels of saturated fats actually correlate with carbohydrate rather than saturated fat or cholesterol intake (Forsythe, 2008, Forsythe, 2010, Volk, 2014).
Indeed, using the standard physicians’ (Framingham) equation to estimate cardiovascular risk, the average participant in a published Virta predecessor trial could expect a 40-50% reduction in her long term cardiovascular risk (Westman, 2008, Castelli, 1986).These results give us confidence in our approach. All along, it seems to have been Americans’ carbohydrate intake driving the stark rise of diabetes and heart disease, and so reducing carbohydrate intake is perhaps the greatest thing one can do to improve metabolic health (Wang, 2003, Ameer, 2014, Wang, 2015, Sanders, 2016).
Problems with Conventional Diabetes Treatments
On the flip side, it is well-proven that the typical approach to treating diabetes – an inevitable increase in medications – is very dangerous and not very effective. Perhaps the most famous such study clearly showed increased mortality with doctors’ attempts to reduce hemoglobin A1c (HbA1c) down to non-diabetic levels by conventional treatments (ACCORD, 2008; ACCORD, 2011). That study and many like it have proven what doctors and patients know all too well – conventional treatments for diabetes cause weight gain while risking an increase in dangerous side effects (Monami, 2013; Fonseca, 2013; Liu, 2012; Turner, 1999; Chiang, 2014, Duckworth, 2009; Pathak, 2016; Stoekenbroek, 2015). Insulin injections in particular may actually do more harm than good for those with type 2 diabetes (Erpeldinger, 2016).
Indeed, when the American Diabetic Association (ADA) reviewed overall conventional treatment in the United States over 2006 to 2013, they found that, while medication utilization had changed dramatically, control of blood sugar had not improved at all (Lipska, 2016).
Safety at Virta
And a final note of caution. Please do not take any of this to imply anyone with diabetes can or should “try this at home”—medical supervision matters when reversing diabetes. Adopting low carbohydrate nutrition can have many beneficial effects on diabetes control for all the reasons above. Beyond the rapid and sometimes dramatic improvements in blood glucose, there are also prompt changes in how the body processes electrolytes and minerals in important ways. These changes typically require prompt reductions in diabetes and hypertension medications in order to avoid problems with over-medication. This is why Virta is staffed by physicians who are uniquely experienced in handling these changes and de-prescribing medications. We take our professional responsibility very seriously and never compromise on safety. We do not replace anyone’s primary care doctor or endocrinologist but instead use our unique experience and monitoring tools to handle these changes safely.