A smart attentive viewer just pointed out that the total number of participants considered in the analysis (169) is not truly the entire set of people who started the program (262) and that the latter may be more reflective of true efficacy. If this number is used, rate of remission at 5 years boils down to 9% (rather than 14%) and rate of complete remission to 3% (rather than 5%). Same general ballpark but a meaningful difference in the grand scheme
I simply want to thank you and your team, Dr. Gil, for all of the lifesaving information that you bring us in a digestible form. An open-minded and non-biased approach is what we need more of in every single science-based field, which is sad to say because you would think that it would naturally be that way given that it's science and nutrition, but it isn't. We truly appreciate you and are very grateful. Thank you.
Keto and Diabetes: Drastically reducing carbs induces ketosis, where the body uses ketones as fuel. VIRTA Study Results: After 1 year: 25% of participants achieved remission, 12.5% completely normal without medication. After 5 years: 20% remained in remission, but glucose levels slightly rebounded. Limitations: Difficult to sustain long-term; many participants relapsed. Not suitable for everyone. Solution: Combine various diets like Keto, Mediterranean, etc., tailored to individual needs.
@@jlarson1040The fundamental problem is low-carb for too long. Keto can be a good short term solution, however it needs to be cycled. This is the best way to utilize the keto diet I’ve found. Plant based keto is better, but it still isn’t meant for long term usage.
Most keto diets are high saturated fat diets due to all the meat. What I'd love to see a study done on is plant-based keto with healthier fats like olive oil, flax oil, avocados, chia seeds. This way you eliminate both the carbs and the saturated fat, both of which I believe play a role in the disease process.
Hope you have found the studies showing the perils of eating saturated fats and particularly beef and butter, by now. In addition to saturated fats contributing to insulin resistance and high blood pressure, they can end up in cells that aren't supposed to hold fats. I couldn't imagine fatty pancreas or fatty liver (outside of the typical causes of obesity and alcoholism) would improve people's blood sugar. It's that thought that excessive iron intake makes your pancreas inflamed.
Great video as always and I really appreciate how you keep harping on the problem with anecdotes. I think one of the major issues is, that it's easy blame yourself if you're doing something that isn't working for you, when you keep getting the false impression that it works for everyone else.
Welp. We can't agree on everything. Virta says in their extended notes that they recommend all patients stay on Metformin for life. Their patients with all the coaching did experience significant weight loss on average, which is a big factor in diabetes. Their recipes are high in processed meat, so the concerns are not just about diabetes. And the Adventist 2 study, 20 years in duration, 96,000 participants, not ~200, and funded by NIH, not Virta, without all the coaching & software, which had the advantage of a cohort without the confounders of alcohol and tobacco, do show a dramatic difference in incidence of diabetes between diet types: 4x.
Great video. One thing that I am not clear is what % of participants followed keto after the first year? This can shed light on why the significant rebound after 5 years.
It's a difficult diet to follow, I hear. I wonder if that is why people are such evangelists, they have to hype it up to themselves in order to follow it. Nothing but good things to say about. It gives motivation needed to follow. Also no mention of calorie reduction or did I miss it? If it makes people eat less, then that alone would have an effect on diabetes. This is often where the low fat diets work (for some) on diabetes. As if you eat 100% wholefoods - you get lots of fibre - which fills you up.
@@andrewnorris5415 As someone who has been on keto since 2018 it's not for everyone. All the temptations out there with snacks and bread and pasta, fruit, sweets, and all the processed foods, etc. takes a lot of willpower to resist.
@@rherteux 100%. I'm wholefoods vegan and I also still get the occasional temptation for those junk carbs. But I manage to avoid them thankfully. Simple things like brown rice and lots of veg with beans, nice blend of spices, or curry with chickpeas or a green smoothie, or plain porridge, fill me up lots. I realise it may not work for everyone. While temptations for sweets and processed carbs are not too bad for me, I do have a little IBS which I cannot seems to shake :( But I live with it as I personally feel good on this diet and I know it is proven in the blue zones etc. My bloodwork comes up good too.
As a VIRTA participant, i can say that the education is great. Their program is also flexible for the individual. The coaches are looking to help you find a way to make things work for you. The impressive part is the number of people that quickly have their medications reduced.
In the short term, as Gil overviews, the results appear to be strong, but over time the results lose robustness, because the science is clear: fat impairs glucose metabolism, as shown by Cyrus Khambata of ‘Mastering Diabetes’ Over the 5 yrs of the Verta Health study, 90% of participants fail to return to normal. Says it all.
Yeah, wow, 25% at one year and 14% at five years. Super impressive 🤔🙄 And if you compare that to 43% on a vegan diet, it looks even less impressive - nearly double the rate of remission. Excuse me while I avoid the heart attack-inducing, planet-killing keto nonsense for a diet with a better record.
I did keto for 5 years until my heart attack with no family history of heart disease. My HbA1c was exactly like those in the study, with initial good result and later elevated level during heart heart attack. Now I am on Dr. Esselstyn diet for heart disease. WFPB diet also lowers my HbA1c and weight (losing 40 lbs). So far so good, no more chest pain.
I did STRICT keto for 2 years. First year everything looked pretty good as for my fasting glucose and A1c. Then year 2 everything started to creep back up! I was very strict with less than 20 grams of carbs a day. Also developed muscle cramps in my abdomen which I never experienced in my life. Tried to stay hydrated but nothing helped until I went back to more carbs!
What I'd really be interested in knowing is what happens when the successful keto participants ate fruit or grains. Would they react as a diabetic or as a non diabetic person? This is the main argument against Ketogenic diets and I'm curious to know.
I thought I read in those old Atkins books that when you have lost the weight you want, you are to gradually add more fruit, grains, and starch back into your diet. When you start gaining weight again, that is your carb threshold. Atkins was never meant to be a super low carb diet to follow your whole life, just til you lost all the fat.
On keto I just avoid most fruits and grains. Especially the high carb ones. But limited berries and /or an apple of the not so sweet variety seem to be okay with me. The newer varieties that are developed for high fructose content, not so much. Most all grains have too high of a carb content. I.E. oatmeal. I am trying hi protein millet but the results are still pending on that one. (Vario)
Likely, at least initially as low-carb eating would result in not keeping preformed insulin around. It would also depend on the individual as far as how long they've had diabetes, much weight loss, how much beta cell activity do they still have.
They would react as a diabetic because too much fat is what causes insulin resistance. I eat super high carb very low fat, at least 500 grams of carbs a day, and my a1c is perfect. 5.0 when I last tested. I would easily pass a GTT.
Diet is generally 30g carbs max / 105g protein target. Add fat to meals to be satisfied. They give educational material and coaches. How healthy beyond that is up to participants.
Look up Dr. Roy Taylor, he has done extensive research on this. He says x percent of bodyweight and diabetes goes into remission about 80% of the time.
@@sweet-taters I think that people often stay on an unhealthy ketogenic diet because they noticed improvement i their HbA1c, when in reality it was just the fact that they lost weight that improved things. And how do we know if even a "healthy" keto diet is healthy long term?
weight changed similarly to the glucose parameters (down after 1 year, partial rebound at 5 y) and likely mediates at least some of the changes based on everything we know
Nice! I am another anecdotal success story along with others who have posted. Prediabetic in February of '20 (61 y. o.). Did keto for about 18 months. Fixed the prediabetes. Dropped 50 pounds. Moderated the extreme low carb to add a few back in. Also do 16 - 8 IF. Blood work 2 weeks ago was PERFECT! Also maintained most of the weight loss. Feel great! I think my body is working the way it was designed to work. IMO keto is a tool, not a life style FOR ME. I still pay attention to carbs but I'm not the keto knot-zee I was 4+ years ago. But I will say - I will never eat sugar again!
@@rabbout I suspect it was/is. But the extreme low carb diet really kick-started the weight loss. It was so encouraging to try something and actually see positive results is relatively short time. I have added carbs back in to my diet but I'll never eat pasta or sugar again and I limit my breads. As I mentioned in my original comment, IMO keto is a tool, not a life style. It worked for me. Other's results may vary.
Great video, Gil. I think the obvious question is whether the study was controlled for exercise and weight-loss. If the study chose participants who were motivated to stick to a certain diet, they would likely have been motivated in other areas such as exercise which would then be a confounding variable. The result may mean 'do exercise and whatever diet that helps you lose weight' if these factors weren't controlled. With the rebound also having the implication of a healthy diet *that you can stick to* being key. So perhaps the lesson of all these studies is that there are various diets - keto, low-carb etc. which have been shown to put people into remission, and the real message is: chose the one you can stick to (and do exercise).
Thanks for this discussion. As a runner I think it should be pointed out that the Keto diet (in endurance athletes) can cause RED-S (Relative Energy Deficiency in Sports). I know of a 22-year-old with osteoporosis because of this. Women need to be careful that they don't mess up their hormones going on a strict Keto diet to lose weight.
I’m a cyclist who does a lot of rides of more than 90 minutes, sometimes 3+ hours. When I tried a keto diet it was a complete disaster. I was fine for about 50 - 60 minutes into a ride but then I would feel worse and worse until I struggled to get home. Keto enthusiasts kept telling me to give it more time and that my body would adjust and I kept the diet up for almost 2 months before abandoning it. I felt terrible and I was getting slower and slower on the bike. I don’t have type 2 diabetes or pre diabetes, I was just trying keto because of some enthusiastic people who told me that they felt fantastic on a keto diet.
Osteoporosis is not caused by a ketogenic diet or any diet with sufficient nutritional mix and volume. It can be caused by simply eating too little of any healthy diet. Karen Carpenter died of heart failure from anorexia (eating too little). She no doubt also had early osteoporosis. Elite cycling climbers have this problem because they wish to keep weight too low. Keto is not calorie restriction.
Yeah, probably the biggest reason I can't do low carb is that I do a lot of high intensity cardio. I tried just a low carb diet, not even keto, and it was unbearable. Felt like garbage all the time and could barely get my workouts done. If you're doing a lot of low-intensity cardio, and/or weight lifting primarily, I can see how you could sustain it, for me low carb anything is just a non-starter.
You are correct, what works is different per person... Unfortunately a lot of nutritionists only have one tune... Eat less and move more... They don't go over all the options and try to find the one that works for you as an individual... And that just sad! Good that you are here to show all the options available. And to everyone who's looking for their matching diet, ENJOY the adventure ;)
@@BartBVanBockstaele unfortunately it's not! Before delivering any line at all they should look at the patient in front of them. When i was diagnosed with T2D (which turned out the be LADA) I was told the same crap. I was 36 with a BMI of 24 and 15% fat, hitting the gym 3 days a week... As educated professionals they SHOULD personalise the treatment and make sure you get additional tests...
hands down. I´d go as far as saying it's the ONLY nutrition channel. there's lots of diet channels (vegan channels, keto channels etc) married to a specific diet that will butcher the science to argue for their favorite foods but there's no other channel dedicated to actually going over nutrition science seriously
I trust him more than any other RUclips guru I've come across. For no other reason than that it is mainstream. So many people addicted to social media need to be talked off of the ledge they are standing on. He does a good job of it.
I liked your unbias presentation on keto diet. The reason why it didnt work for a lot of people is because people cheat on diets or do not have the discipline. If you want good health it is not easy. NOthing good comes easy. I think the keto diet is a gr8 place to start and then you could add a little more carbs. I have been on a low carb diet (Not keto low but about 50-70 grams most days for the first 6 months) for almost one year and within the last 3 months I have added a little more carbs ( not refined carbs). It is working well for me. I also do intermittent fasting 17:7 and dry fast twice per week. I have no metabolic issues at 63. Just wanted to lose some weight and lower LDL a bit. I am now a bit below normal bmi at 102 lbs from 136 at 5 3". It should be noted that LDL skyrockets on low carb diets for some people, like me. You have to find that balance in the amount of carbs/protein/fats that works best for your body. It's a constant monitoring and tweaking but you will feel GREAT at the end. Make sure your diet is supervised if you are unsure of what to do.many keto .doctor out there. I don't add fats to my diet also, what is natural within meat tissue suffice for me. I do not use seed oils but if I have to use oil it a good avocado oil /coconut oil/ghee, and i use sparingly. less than a teaspoon. It goes a long way just to add flavour to food.
It's really really difficult to stay in ketogenisis long term. Being in true ketogenisis requires a very restrictive diet. I maintained a relative low carb, about 15%-20%, for a couple years, but even that required me to carefully monitor what I ate. After lowering my A1c from 5.8 to 5.2, I started adding in more carbs in the form of legumes and fruit. I enjoy my diet much more now.
I completely agree about successful, diets are diets are what we can do well with. It isn’t one size fits all. We can morph and change, and it is ok. After Covid, my pancreas was highly affected and I had glucose insulin instability no matter how I ate. It took about three years to restabilize no matter how I ate. I loved eating Keto and what it did for me. If you plan your keto intake, it gives you enough fiber and proteins. I used whole foods ingredients and primarily focused on proteins first. I ate low carb keto for over two decades and would continue to if I didn’t have major mast cell issues and also have to eat a low histamine diet. I still eat fairly low carb. It is a preference and feel better. Virta does a great job.
I would recommend that any of these reviews on diabetes diets include the weight loss correlation info. It seems to me that we are seeing more and more info indicating that obesity may be one of the greatest culprits regarding diabetes and any diet that helps address that obesity may be helpful for a significant proportion of patients.
Thanks for covering this study, doctor. Low carb has worked for me for years. I just wish I had an answer for why I’ve been able to sustain it for so long while others haven’t. I’m sure it has something to do with discipline and the variety of controls I’ve put in place for myself. Maybe our focus needs to be more on behavior management than specific diets.
And also the education to get the mindset that there is no option other than this, once we come to terms with this option less way we will be comfortable
As a vegan , i consume a moderate fat, moderate carb , high protein diet.. keeps me happy and healthy and satiated... Diabetes and cvd runs in our family..so we have to be extra careful.. my parents are lactovegetarians but they stick to a very Mediterranean style diet. We eat local and also buy from the local organic farmers.. My diet was amazing but i didn't excercise becuz I'm restricted to my desk and the bed for i have to study for 14+ hours.. don't get the time to workout.. and this took a toll on my body and mind and neck (don't see how i can combat cervial problems while studying) but I'm working oht again.. stretching is a huge part of my routine with right cardio and body weight weight excercises like squats .. I was extremely lean about an year ago becuz i worked out a lot and also lifted weights. I'm not fat but i think I'm gonna have to workout probably becuz we're supposed to move our body and we never evolved to not workout..
Sustained improvements were noted in body mass (−7.6%). I'm assuming the improvements were due to fat loss. This is consistent with virtually all of the literature, and that's no slight on keto or anything. There are definitely a lot of anecdotes where people swear that keto helps them feel more satiated. While this idea cannot be generalized to everyone, some people strongly claim it, and I’m not one to argue with their experiences. I think it’s an interesting question that does not yet have a definitive answer: why do certain diets work for certain people? As you mentioned, the participants in this trial were motivated, and that is hugely important. A lot of people start keto or other diets after already being sold on the idea of the diet being highly effective. If this psychological effect could somehow be harnessed for good, it could be incredibly powerful. I also think that for many overweight or obese individuals embarking on these diets with motivation, it’s often the first time they truly pay attention to what they eat - learning about foods, what keeps them satiated, what to avoid, and so on. It also likely removes a lot of the mindless eating, which I believe to be a big factor in people getting overweight - maybe less so in more severe obesity, which requires a bit more troubles with eating. I’d bet the resources these participants had at their disposal played a significant role as well. There’s a lot to learn here that could be applied in the future.
Gil, I have done a good bit of reading and thinking about diabetes after my brief experience with prediabetes related to a brief period of being debilitated. Based on that, I think that keto is a great acute intervention to get someone's glucose lower (maybe for 3-9 months), but that it causes problems that only appear in the long term. The issue is fat, mostly saturated fat. Saturated fat, especially in the long term exerts its own effects on metabolic health and blood sugar, and long term keto (which almost always includes high saturated fat, can create its own issues that hurt people already vulnerable to diabetes. I'm less sure about a "healthy fat" keto (with low saturated fat). You can comb the research for what I'm saying and I'm pretty sure you'll see evidence corroborating each of my claims. But you are a better, more patient analyst that I am. If you want to look into it, by all means, do! Great videol
I follow a low carb diet and find that keeping saturated fat low is totally doable--you just can't emulate the people who are eating a rib-eye steak every day and putting butter and cheese on everything. It might be worth watching the video Gil has linked at the end of the video on how to do a keto diet healthily.
This is why authentic therapeutic keto should be meditettenan style keto. Since fats are the main source they should be monitored to their fatty acid content. Fats should be Fatty fish . Olive oil. A little bit of canola oil. MCT oil. And a minority should be saturated fat. Ideally the rest should be on clean cuts of meat. Low fat milk. And outside of that it should be mostly plant based.
Worth mentioning that for most of diabetes patients their markers would go worse over that 5 year period, even after increasing on medications, so achieving any reduction with KETO\LC is significant.
Any diet which leads to weight loss can improve diabetes. But unlike keto - not all of them leads to increase cardiovascular and some types of cancer risk.
There is evidence the same can be achieved without using idiotic diets 😁. The secret is in the weight loss amount, a higher protein consumption seems to help as well. But there is nothing magical about a Keto diet.
@@pedrobarros2000 Many people try to lose weight on low fat low carb diet (calorie restricted diet) and they fail miserably ( feeling hu(a)ngry), worse, eat healthy (?) no fat sugary snacks to assuage the hunger pain, etc etc... and then counter intuitively, they load up on bacon and eggs and lose weight. Then they go WTF... A Keto zealot is born.
As always, great explanations! Could we get a video about nutrition for menopause and perimenopause? My mother used to drink some morning shakes (grape juice, soy milk and golden flaxseed powder) that were supposed to help with hormone balance, and I want to know if that is evidence based advice or not. Any tips about women aging would be great content!
I did low carb keto for a couple of years & lost 30 lbs. I then started IF 18/6 & lost 15 lbs more. My a1c went to 5.9 (off all meds) from 6.4. I exercise daily with cardio & do resistance 2-3 x per week, bmi 20.4. Unfortunately, while it helped in many areas, my cholesterol & apo-b went dangerously high. I have been doing the Mediterranean Metabolic Balance for 5 months now & my cholesterol & apo-b are now completely normal, but my last a1c was 6.2. My weight is stable at 111lbs @ 5'2", still not on any meds & I am hoping my body will eventually adjust to healthy carbs over time. Personally, I had to make a choice between diabetes (many family members have it-even the skinny ones) & my heart. I wish I could have continued as I loved the diet, but all of my body wasn't loving it. I wish everyone success at finding what works best for them! Thanks again for the great content!
The McDougall Starch diet claims the same type of results. Although I lost 15% of my weight on this diet, it was too hard to maintain. I have settled on the Mediterranean diet for the last 5 years.
I think there was a study where they found that someone who had been long term medicated for years on diabetes could get no effect of changing diet and/or exercise regiments but someone who just had begun like within a few years could get an effect. I think the conclusion here is that the doctors should try and have the patients change their way of living not just giving up and feeding medicine the rest of their life
I often think that the initial approach to dealing with a diagnosis of T2D doesn’t help. Rather than immediately prescribing a set of medications, why not get people to go lower carb. Doesn’t need to be keto or anything like that but being strict (as we would with a smoker or alcoholic) and saying ‘your days of ice cream and sodas are over if you want to avoid an early death’. I suspect people don’t realize just how deadly the disease is! If we first get sugars lower naturally and then think about drug therapy people can make the trade off more clearly - eg if you want to eat pasta, then we’ll need to put you on this medication to help you. This to me is a much more informed choice. Many people instinctively don’t want life long medication and so letting them see FIRST that it isn’t needed might change the mindset. Afterwards, if they feel that the restriction is too hard to sustain, work on dietary pattern plus medication.
Gil, the problem I have with the video is that it is only looking at this Keto study. It needs to be compared in context to a low-carb diet and a plant-based diet (China study diet). Also, only looking at H1Ac is only one data point. Using the same sample of people, you need to check how their other metabolic numbers performed.
Any whole food diet, with good variety of fibers, tasty enough (can develop over time) so that people can adhere to, works. I said ANY whole food diet, but that's close to meditarranean still, because a diet without fibers and colors aren't working long term (immune cells require fibers).
I do fairly low carb (under 100 g/day), carbs mostly from vegetables, berries, seeded bread, occasional dark chocolate. 80-100g of protein which is lean turkey, chicken, tofu, nuts, LF yogurt. Low saturated fat (only 15-20 g/day). I am 55 and resolved my elevated blood glucose and A1C, lowered high cholesterol that had for several years. My fasting insulin is 4, A1C is 5.3, fasting glucose 85. My total cholesterol is 175. My BP is 110-115/75. It went down when I lowered my saturated fat intake and switched to potassium salt. You need to find a perfect balance for yourself and do blood tests to measure results and what works for you. I would log everything in a nutrition app and get calculated the carbs, the saturated fat and protein. I have no problem eating as many calories as I want. No problem with weight.
It would be very useful if the study had shown the ketone values for the people who achieved lower A1c vs the ones who failed to improve their A1c. Essentially is the outcome dependent on how well the participants maintained ketosis, or just different body types.
What I'm curious about in this Keto study....Do the participants have a lower caloric intake with the keto diet than before going on the keto diet? What were their other health markers showing? How did they feel?
Yes. People don't stay on diets. What I was interested in was for the people who never got positive results. Did they adhere to the diet or did Keto just not help?
Very interesting and very promising. Many questions: did the app keep track of meals, macros, portions? Did the long term results for those who "stayed with the program" change with adherence to actual low carb? Any report on level of activity? And is full on keto fat heavy in the meals vs just low carb? Love that you conclude by discussing variations and options with healthy carbs. For everyone it starts by not eating highly processed foods, sugar,
Excellent review of a solid study. Is this, however, a low carb diet? Were participants shown to be in ketosis? Do you need to be in ketosis for a diet to be ketogenic anymore?
So how many of those who went back to being a clear diabetic person, did so because they failed to keep on track with their diet, Ketosis should irradicate the need for substancial insulin production, and if the participants kept to a level of max 10% carbs a day, these carbs are nessecary for certain functions in the body, however the little production of insulin that is beng made from the pancreas should suffice for the relatively small amounts of carbs being consumed. I have myself used the ketogenic diet and experienced a good weightloss of both fat and excess water retainment in the body relating to the fat storage, however I never realy preped myself on maintaining a good and varying menu, this as lead me to leave the diet after a short while, I think that this is consistent with other people trying keto, it is hard to maintain focus and diligens in doing this diet. But on the other hand we tend to react somewhat differently to what we ingest, but the chemical processes in our bodies do more or less function similary to eachother.
I have seen people put type 2 into remission with both HCLF and LCHF. What seemed to be common in most cases is the elimination of hyper palatable ultra process foods, which translated to weight loss via a calorie deficit and improvement of all markers including remission of type 2. Also endurance athletes have the lowest risk of all cause mortality and type 2 diabetes and they literally drink sugar water all day. What is the difference between endurance athletes and the general population…utilisation. If you eat in a calorie deficit it is most likely you are eating carbohydrates at a level below utilisation, hence why people doing high carbohydrate diets still lose just as much body fat as any other diet.
I don't know if you read the comments but I would love to know your take on nutrigenomics, which is to say, genotype tailored nutrition. I unfortunately have a copy of the APOE4 allele, which I am sure you know, is just bad luck for everything you can imagine but I am still puzzled as to what is optimal for someone afflicted as I am. Do you think that large studies in the future will increasingly take into account genotype when it comes to nutrition or is this too difficult to control for at this stage? Thanks for your videos, really appreciate the level-headedness and content!
Gil, please do a program about Lp(a) when you can. Most are unaware of this lipid anomaly, as I was. I learned I had it when on a keto diet and my total cholesterol went through the roof. Most docs still don’t test for it. A lipidologist tested me.
The common simplification that ketones replace the glucose is a bit misleading. Fat (fatty acids) enter the energy (ATP) production metabolic (Crebs) cycle in the form of the Acetyl-CoA. This then binds with oxaloacetate to produce citrate (the first reaction of the cycle). Without the presence of the oxaloacetate this can't happen and thus fatty acids can't be used as an energy source. Importantly, in humans glucose (via pyruvate) is the only source for the production of oxaloacetate ("fats burn in the fire of carbohydrates"). When there is a relative lack of glucose in the system (after depleting the liver glycogen stores), gluconeogenesis kicks in and oxaloacetate (among other sources) is used for its production. The acetyl CoA starts to cumulate as it can't be now used for citrate production. This excessive acetyl CoA is then converted by the liver into the ketone bodies. However, these ketone bodies are no miracle remedy for the lack of glucose. The only pathway for using them to produce ATP is through converting them back to the same old acetyl CoA which consequently has to bind with oxaloacetate. Oxaloacetate (yet again) has to come from glucose, which can come only from food or from gluconeogenesis. With the chronic lack of glucose in food (keto diet), amino acids (i.e. breakdown of proteins) are the only significant source for it. No, glycerol spines of the triglyceride fats don't cut it. The only REAL advantage of the ketone bodies then is that, unlike fatty acids, they can pass through the blood-brain barrier into the brain and be used as an energy source there. But again, only when there is enough glucose present there to form the oxaloacetate. So the first additional question in this study (beyond the obvious control of glycemia) should have been the concern with muscle mass loss from the protein breakdown. Also, high fat diets generally lead to the increase in LDL and it would be interesting to see if this had any effect on arterial plaque formation, especially after the 5 year period. And I understand that there was no control group but in such a case the control is the general population (same as with the effects on glycemia). And finally, high fat diets are reported to be associated with at least some types of cancer (colorectal). Five years may not be sufficient to see an effect here but it would be nice to see that the question has been raised too.
I agree about the need for science in nutrition. I believe that it's really a low calorie diet, not necessarily a low carb diet that can improve health markers. (See Twinkie diet.) Interestingly, aside from restrictive or fad diets, the GLP1 drugs have helped to lower A1c considerably. There is also a GLP1 gene therapy that might provide a "cure" for diabetic patients in the future (in trials now). The next 5 years are going to be exciting for diabetic patients, not to mention those suffering from an obesity addiction. BTW, we're not down on keto or low carb or carnivore. We're just tired of the fanaticism and know-it-all behavior of those advocating these diets. Good discussion.
I have been low carb for 4 years. I find there additional benefits to lower carb intake and lower blood sugar. My appetite is much lower resulting in 65lb weight loss. Low carb requires much less willpower to keep the pounds off.
Everyone has to find something that works for them . Would be best for younger generation start on good eating practices , so they can keep most flexible , enjoyable diet. For myself I was never pre-diabetic , hip to waist 1 to 1 at my worse. So I just modify the Med to my liking - no white rice , but small amount of brown , not much bread , so high fibre german/swiss style or sourdough . But lots of other carbs, beans, lentils, berries, fruit ( less banana ,unless post gym session ) , sweet potato , squash etc . Huge amounts of non-starchy veggies, salads, nuts, EVOL , some eggs, chicken, fish , yoghurt/kefir and hard cheese., few pieces of very dark chocolate . Think I could take my diet anywhere in world to some degree. Yeah in India , Asian or some other countries will need to eat more simple carbs, more sodium , but I will be active 8 hours plus a day walking, hiking, swimming as a tourist , enjoying life. Most people could just benefit from cutting out sugar , soda , junk etc , increasing veggies, fruit, water, nuts/carrots/fruit as snacks Other "junk" I miss very rarely is french fries . Or a very very dark chocolate ice cream , low sugar no one makes in my country. A pint would last me a month anyway - 1 small spoonful and some raspberries , with some no added sugar greek yoghurt to bulk it up . Ie for treats , like dark chocolate I just need a small piece , to savour Though I don't have a sweet tooth , I will accept a small piece of birthday cake to be gracious and celebrate a person's life . Will eat mammal if host took effort to show love and care , Not against meat , just the factory , brutal uncaring farming practices . But if donet respectfully , circle of life . happy for my body to feed the soil
@@matthewcreelman1347 Even if you're not Keto you shouldn't be eating that crap! The longer you don't eat refined carbs the less your body craves them.
Guess i belong to the lucky group. It was 14% when disgnosed back in 2022. Cut sugar, high carbs and procesed food. Chose active and stress free lifestyle. a1c continues to stay under 5.4%. lipid readings are normal too. Early intervention and age factor might have helped.
Gil, Thank you for covering the work of Phinney, Volek and others involved with the Health trial. As a follow-up, how about an “Optimizing Keto for Apo B” discussion with yourself and Dr Ethan Weiss?
The answer for me is YES, low carb/keto did reverse diabetes into remission. I was also able to get off of 3 Medicare hypertension and stop taking Prilosec for acid reflux, off all diabetic meds in the first 3 months. Rosacea cleared up and joint pain disappeared. I am 57 years old and now on no medications. Also, lost 35 lbs. Total win for me and never going back to SAD. Low carb for life.
I have been in “remission” from type 2 diabetes for 8 years, keeping my carb ultra low (60lbs. I am 63. Is the diet for everyone, probably not. Food issues probably got them in trouble in the first place (which was my problem, being a former carb junky), not surprised lots of folks cannot stick to any “diet” long term.
I was a 59 year old "fat but fit" mostly WFPB (vegan) cyclist who was declared "diabetic" after an hba1c and a fasting test in 2019 following a bad bout of flu and given a patronising talk about healthy eating. (though to be honest I had been somewhat clueless and had bonked on a few long cycle rides in the days when I thought fruit smoothies were "fuel" - clearly I had been sailing a bit close to the wind ...) I lost 10 kilos over a few months and the new practice retested and took me off the metformin.. 5 years later I'm down to a BMI of 25 on the WFPB "high carb" diet I've thrived on for over 40 years - albeit free from "extras" - and they STILL insist on calling it "remission under dietary control". I now avoid juice, jam, cake and cookies not because I'm terrified of hyperglycemia or a hypo crash, but because I don’t want to get heavy again. The one positive apart from losing the weight is that I got 3 years of free covid and flu shots, but I turn 65 next year anyway.... This year I relented and had the eye test and the hba1c - all clear of course along with a BP and lipid score that would ordinarily make it "come back in 5 years" (QRISK 7.7 % plus 1% for my "deprived" postcode ). I'm one of the healthiest adults on their books at any age and they still treat me like an invalid. I'm simply a person who gets insulin resistant over 30-odd BMI if kept off the bike by illness... I have an in-law 5 years younger whose BMI is over 40 and who has every chronic condition EXCEPT diabetes.... If I emigrate to France as hoped, perhaps they'll do a glucose stress test and finally end this nonsense... A very large positive is I have taken ownership of my own health and am wary of the population-based health profession mincing machine.
It’s interesting that both a low carb diet AND a plant based diet which is high carb both improve diabetes. Some experts say weight loss is responsible for plant based diets effect on diabetes. You didn’t mention weight loss here.
It is entirely possible that what cures, or at the very least, improves diabetes, among other diseases, isn't simply what one eats, but what one doesn't eat. By simply cutting all the junk, salt and sugar from our diets will most likely yield positive results.
Diabetic since 2013, 26 finger readings and well above 10 hba1c, very sick. Lost 40kg by daily exercise, eating only small serves natural foods, no liquor and insulin twice daily. After two years hba1c 5.x, insulin x 1 and eat only medium serves natural non processed foods including fatty meats and fish and fruit, all green vegetables, no rice or potatoes. Exercise mostly daily 1+ hours. Don't feel deprived, just natural to stay healthy. Would never want to return to the 2013 sickness. I suppose my point is do what works for you.
@@kieunchang7656 It often is, but really, there is not need to makes this any more complicated than simply looking at your body. If there are fat rolls/love handles, you're too fat. You can then use a scale to track weight loss with some degree of accuracy, but a tape measure or even pant size would not be bad. Reality is that people who are too fat know they are too fat. They just don't want to know it.
Knowing whether follow-up patients continued to adhere to the same low carb diet would be an important consideration. Also I don’t see “fix” as in the title being the same as remission. If a low carb diet provides continued improvement in blood markers after being relaxed or removed, that could be considered a “fix” or a “cure” which this study apparently does not address
I do strict intermittent fast with lots of fruits and starchy veggies. Along with non starch veggies, rice, flax quinoa, beans, meat, cheese, tofu eggs milk very sparing refined sugar. I am 66 145lb, BMI is 23.5. Fasting sugar around 90. Diabetes runs in my family I suspect mostly because of poor food choices. I suspect it will come back to haunt those who eat ridiculously high fat & extremely low carb. I strive to keep both in moderation. No refined flour, or ultra processed foods like cereal, noodles, I mostly eat brown rice as opposed to white rice. Intermittent fast, wise food choices is hard but very much obtainable. I doubt I could do keto for 6 months certainly not for the rest of my life!
I was very obese, went on keto and lost 100 pounds in a year. I know people who have rebounded and others who will exhale acetone with every breath for the rest of their life. This is an anthropological problem. For more centuries than we can conceive of, we fought for every calorie. Now that calories are basically free, most of us can't overcome the urge to gorge ourselves and for most of us that means glucose issues and obesity. Once you figure out how to control it and maintain your health you have to do that for the rest of your life, or your symptoms return. It really is that simple. I long for burger buns, but lettuce wraps keep me healthy, and that will never change.
I think the problem with keto/low carb is it’s hard to keep doing it year after year. That’s my experience. If you cut down on sugar and starch your hb1ac will drop probably to normal. Then you relax a bit and begin to eat carbs as usual and bingo. Your prediabetes/ diabetes raises its ugly head again. Of course this is an anecdote. The upshot is it’s probably for the best that we cut back on carbs if we can and burn up a bit of blood sugar through exercise. It’s not easy as most people are not really consistent in exercise and diet including me.
Did they track other metrics to get the complete health picture instead of focusing only on A1c? At the end you mentioned safe and healthy keto, but I wonder how many keto diet followers actually practice that, instead of doing "bad keto"?
Does this intervention reduce BMI? I failed low carb as likely could not regulate the high fat and protein just stalling any weight loss and A1C increased. You should do a video on the high starch diet for those that work for.
Hi Dr Gil, I’m one of your fan of what you do, I just one to know if eating brown rice is healthy, and how many cups is acceptable to consume daily? Thanks
Any long-term health implications? If I'm sucessful in overcoming my carb addiction, and follow a well-formulated therapeutic nutritional ketogenic diet for life, should I worry because I'm not on a mixed diet anymore?
It just shows how difficult it is to get people to eat healthy . These people had access to a large amount of support and monitoring and just could not maintain. Now exercise is known to reduce blood sugar so that could be supplemented with some added carbs . Total elimination is probably not possible for the majority but can you empty some carbs that are healthy versions
Carbohydrates improve insulin sensitivity. The key is to cut out the fat. Ketogenic diets are for sedentary people who want to lose weight without cutting out bacon, butter and brie. Walter kempner reversed patients type 2 diabetes with rice, fruit, juice and pure white table sugar. 95% carbohydrates, 5% protein, zero fat.
As a type 1 diabetic, I ignore almost all news or advice about breakthroughs in diabetes treatments, because I find that 99% of them are exclusive to type 2 diabetes. Sometimes it feels like Type 2 is such an epidemic that researchers don't even bother with Type 1 anymore. I understand that probably isn't true, but it does sometimes seem that way.
@@SpikeFastingRacing It 'works' just fine, like all diets that lead to an energy deficit. The problem is that few people actually follow it. Treatments only work when they are followed. That is true for ALL treatments.
If you've got diabetes, and it keeps getting worse, despite your meds .. are there any other options? Even if it might not work for you - if you have no other options, isn't worth a *try* at least? It doesn't seem to have much in the way of negative side effects.
One thing I didn't hear was whether those people tested after five years remained on the keto diet. It shouldn't be surprising that people who go back to the same behaviors get them into the same trouble that their behaviors got them into the first place. Also, did they factor for weight loss?
While I do support Dr. Cavalho's temperate, scientific attitude on a number of subjects, but this study clearly shows what the ketogenic diet is capable of and I consider this an absolute failure. Ketogenic diets are popularised as a fix for ill carbohydrate metabolism, even if it worsens other key health parameters (like nonHDL cholesterol). With funding, experts, apps and whatnot they achieved a 3% remission in 5 years and even from this population I expect that some patients are in remission due to weight loss and not the diet type. This is a huge nail into the coffin of ketogenic diets for me.
I'd be interested in knowing whether there was an impact on lipid profiles as well as gut microbiome. Seems intermittent fasting is more effective (and maybe a keto diet is kind of a cheat for intermittent fasting)
The latest figures from 2022 is 1 inn 4 health care dollars (from all sources) are spent on diabetes; 412.9 billion on direct and indirect causes (lost wages). Included in that number is 32% of medicare dollars go for diabetic care. The cost of illness accelerated by diabetes like cancer, hypertension, and heart disease are not in those calculations. When you look at those numbers, it's not to difficult to figure out what is ballooning US healthcare.
11:00 what you are describing is survivorship bias, people tend to hyper-focus on successful cases and ignore the unsuccessful cases, which tends to overestimate our chances of success. This is the same reason why people plat the lottery despite overwhelming odds.
This reinforces for me that we have individual needs. We all have to find a way of eating that works for us. I would be miserable if I had to eat a high fat, low carb diet.
Vast majority believe they're on a keto diet when they don't understand how they need to eat to make it happen. People who stay on it, doing it right are a very small minority.
For those who weren't diabetic anymore after a year, I wonder how many of them achieve that status simply by weight loss. Was weight loss measured and accounted for? Weight loss alone can put diabetes into remission. So for those of the 25% who were no longer diabetic, how many of them experienced significant enough weight loss that the weight loss would have done the remission regardless of diet?
You can "cure" type 2 diabetes on ANY DIET. All you got to do is lose weight. There is nothing magic about Keto. Everything Keto diet advocates say is completely bogus.
Do we know why the VIRTA approach rebounded? Or why any intervention sees HBANC1 rise again? I mean if it was initially able to reduce Hb, then something must be going right. Is it that the body adapts to the new diet and so hb 'normalises'?
While effective for diabetes, what about other health impacts at five years and dependence upon the type of low carb diet, high red meat vs plant based for example?
I eat a low carb diet but not keto - and I can tell you I don't eat a lot of red meat at all (once or twice a week, and it's always lean sirloin) - in fact, I eat a lot of chicken & fish and most of my fat comes from olive oil and avocados - you don't have to eat a high saturated fat diet to be keto or low carb.
Good video, but looks like study definitely needed a control group -- Where would people be after 1, 2, 5 years, etc., absent the intervention. Also would like to see results broken down by where people were at (say) one year -- How much (for example) did their A1C go up relative to those people who never had much change in blood sugar. The overall averages could be driven by people who were never helped much by the diet and whose sugars went up massively, driving the overall average up vs. others who did pretty well with the diet, even if they were were (after 5 years) pre-diabetic or were on the low end of the diabetic scale.
Are the remissions inherently the result of the diet being ketogenic, or could they be the consequence of fat loss that can come with a globally more healthy, satiating diet, with far less heavily transformed foods ?
The problem I see is that "keto diet" is a large umbrella-term. People who eat a carnivore diet, and people who eat a lot of vegetables, and some meat and fish and cheese and nuts, are all making a "keto" diet, but they are also making two completely different diets, the results of which should not be compared. If I get this study right, the "keto" diet was not uniform, but adapted to the preferences of the participant. This increases compliance but decreases meaningfulness. Also, whereas people on a varied diet, based on vegetables (excluding carrots, onions, beetroots, etc.) and cheese, nuts, meat and fish can "comply" for many years, I do believe people who choose the "carnivore" diet, or the "Palaeolithic" diet, or any diet which in fact greatly reduces variety and fibres, end up getting tired of that "keto" diet. I think an analysis of which participants stayed, which left, which rebounded and which did not rebound, crossed with the specific "keto" diet they were following, could give indications about what "keto" diets work and what do not work.
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A smart attentive viewer just pointed out that the total number of participants considered in the analysis (169) is not truly the entire set of people who started the program (262) and that the latter may be more reflective of true efficacy. If this number is used, rate of remission at 5 years boils down to 9% (rather than 14%) and rate of complete remission to 3% (rather than 5%). Same general ballpark but a meaningful difference in the grand scheme
I simply want to thank you and your team, Dr. Gil, for all of the lifesaving information that you bring us in a digestible form. An open-minded and non-biased approach is what we need more of in every single science-based field, which is sad to say because you would think that it would naturally be that way given that it's science and nutrition, but it isn't. We truly appreciate you and are very grateful. Thank you.
Keto and Diabetes:
Drastically reducing carbs induces ketosis, where the body uses ketones as fuel.
VIRTA Study Results:
After 1 year: 25% of participants achieved remission, 12.5% completely normal without medication.
After 5 years: 20% remained in remission, but glucose levels slightly rebounded.
Limitations:
Difficult to sustain long-term; many participants relapsed.
Not suitable for everyone.
Solution:
Combine various diets like Keto, Mediterranean, etc., tailored to individual needs.
Blueprint diet too
well said!
Why no mention of low-fat, plant-based diet?
ChatGPT gives better answers than diet gurus
@@jlarson1040The fundamental problem is low-carb for too long. Keto can be a good short term solution, however it needs to be cycled. This is the best way to utilize the keto diet I’ve found. Plant based keto is better, but it still isn’t meant for long term usage.
Most keto diets are high saturated fat diets due to all the meat. What I'd love to see a study done on is plant-based keto with healthier fats like olive oil, flax oil, avocados, chia seeds. This way you eliminate both the carbs and the saturated fat, both of which I believe play a role in the disease process.
No they are not. Who says you have to eat meat.
Hope you have found the studies showing the perils of eating saturated fats and particularly beef and butter, by now. In addition to saturated fats contributing to insulin resistance and high blood pressure, they can end up in cells that aren't supposed to hold fats. I couldn't imagine fatty pancreas or fatty liver (outside of the typical causes of obesity and alcoholism) would improve people's blood sugar. It's that thought that excessive iron intake makes your pancreas inflamed.
Great video as always and I really appreciate how you keep harping on the problem with anecdotes. I think one of the major issues is, that it's easy blame yourself if you're doing something that isn't working for you, when you keep getting the false impression that it works for everyone else.
Welp. We can't agree on everything. Virta says in their extended notes that they recommend all patients stay on Metformin for life. Their patients with all the coaching did experience significant weight loss on average, which is a big factor in diabetes. Their recipes are high in processed meat, so the concerns are not just about diabetes. And the Adventist 2 study, 20 years in duration, 96,000 participants, not ~200, and funded by NIH, not Virta, without all the coaching & software, which had the advantage of a cohort without the confounders of alcohol and tobacco, do show a dramatic difference in incidence of diabetes between diet types: 4x.
Great video. One thing that I am not clear is what % of participants followed keto after the first year? This can shed light on why the significant rebound after 5 years.
It's a difficult diet to follow, I hear. I wonder if that is why people are such evangelists, they have to hype it up to themselves in order to follow it. Nothing but good things to say about. It gives motivation needed to follow. Also no mention of calorie reduction or did I miss it? If it makes people eat less, then that alone would have an effect on diabetes. This is often where the low fat diets work (for some) on diabetes. As if you eat 100% wholefoods - you get lots of fibre - which fills you up.
Could possibly be a bit of carb creep. And also what people call keto; ie did they start of very strict and then addeds in keto products.
@@andrewnorris5415 As someone who has been on keto since 2018 it's not for everyone. All the temptations out there with snacks and bread and pasta, fruit, sweets, and all the processed foods, etc. takes a lot of willpower to resist.
@@rherteux 100%. I'm wholefoods vegan and I also still get the occasional temptation for those junk carbs. But I manage to avoid them thankfully. Simple things like brown rice and lots of veg with beans, nice blend of spices, or curry with chickpeas or a green smoothie, or plain porridge, fill me up lots. I realise it may not work for everyone. While temptations for sweets and processed carbs are not too bad for me, I do have a little IBS which I cannot seems to shake :( But I live with it as I personally feel good on this diet and I know it is proven in the blue zones etc. My bloodwork comes up good too.
Excellent way to start my Monday (thank you for great data!)
As a VIRTA participant, i can say that the education is great. Their program is also flexible for the individual. The coaches are looking to help you find a way to make things work for you.
The impressive part is the number of people that quickly have their medications reduced.
Sadly, not for very long. I hope for you that you will be among the lucky few.
You are still on a strict keto diet?
In the short term, as Gil overviews, the results appear to be strong, but over time the results lose robustness, because the science is clear: fat impairs glucose metabolism, as shown by Cyrus Khambata of ‘Mastering Diabetes’
Over the 5 yrs of the Verta Health study, 90% of participants fail to return to normal. Says it all.
Yeah, wow, 25% at one year and 14% at five years. Super impressive 🤔🙄 And if you compare that to 43% on a vegan diet, it looks even less impressive - nearly double the rate of remission. Excuse me while I avoid the heart attack-inducing, planet-killing keto nonsense for a diet with a better record.
I did keto for 5 years until my heart attack with no family history of heart disease. My HbA1c was exactly like those in the study, with initial good result and later elevated level during heart heart attack. Now I am on Dr. Esselstyn diet for heart disease. WFPB diet also lowers my HbA1c and weight (losing 40 lbs). So far so good, no more chest pain.
Thanks for the wonderful video. I hope all the diabetic patients watch this video.
I did STRICT keto for 2 years. First year everything looked pretty good as for my fasting glucose and A1c. Then year 2 everything started to creep back up! I was very strict with less than 20 grams of carbs a day. Also developed muscle cramps in my abdomen which I never experienced in my life. Tried to stay hydrated but nothing helped until I went back to more carbs!
What I'd really be interested in knowing is what happens when the successful keto participants ate fruit or grains. Would they react as a diabetic or as a non diabetic person? This is the main argument against Ketogenic diets and I'm curious to know.
Same thought exactly. Add a GTT, see what the results are.
I thought I read in those old Atkins books that when you have lost the weight you want, you are to gradually add more fruit, grains, and starch back into your diet. When you start gaining weight again, that is your carb threshold. Atkins was never meant to be a super low carb diet to follow your whole life, just til you lost all the fat.
On keto I just avoid most fruits and grains. Especially the high carb ones. But limited berries and /or an apple of the not so sweet variety seem to be okay with me. The newer varieties that are developed for high fructose content, not so much. Most all grains have too high of a carb content. I.E. oatmeal. I am trying hi protein millet but the results are still pending on that one. (Vario)
Likely, at least initially as low-carb eating would result in not keeping preformed insulin around. It would also depend on the individual as far as how long they've had diabetes, much weight loss, how much beta cell activity do they still have.
They would react as a diabetic because too much fat is what causes insulin resistance. I eat super high carb very low fat, at least 500 grams of carbs a day, and my a1c is perfect. 5.0 when I last tested. I would easily pass a GTT.
So what was the weight loss situation in the VIRTA study? Also, how healthy was their keto diet overall?
Diet is generally 30g carbs max / 105g protein target. Add fat to meals to be satisfied. They give educational material and coaches. How healthy beyond that is up to participants.
Look up Dr. Roy Taylor, he has done extensive research on this. He says x percent of bodyweight and diabetes goes into remission about 80% of the time.
yes, I'd love to know that too, plus what were their lipids? How much fat did they eat? how much protein? how were their kidneys doing this diet?
@@sweet-taters I think that people often stay on an unhealthy ketogenic diet because they noticed improvement i their HbA1c, when in reality it was just the fact that they lost weight that improved things. And how do we know if even a "healthy" keto diet is healthy long term?
weight changed similarly to the glucose parameters (down after 1 year, partial rebound at 5 y) and likely mediates at least some of the changes based on everything we know
Nice! I am another anecdotal success story along with others who have posted. Prediabetic in February of '20 (61 y. o.). Did keto for about 18 months. Fixed the prediabetes. Dropped 50 pounds. Moderated the extreme low carb to add a few back in. Also do 16 - 8 IF. Blood work 2 weeks ago was PERFECT! Also maintained most of the weight loss. Feel great! I think my body is working the way it was designed to work. IMO keto is a tool, not a life style FOR ME. I still pay attention to carbs but I'm not the keto knot-zee I was 4+ years ago. But I will say - I will never eat sugar again!
Hi, wasn't the weight loss the main contributor to the health improvement?
@@rabbout I suspect it was/is. But the extreme low carb diet really kick-started the weight loss. It was so encouraging to try something and actually see positive results is relatively short time. I have added carbs back in to my diet but I'll never eat pasta or sugar again and I limit my breads. As I mentioned in my original comment, IMO keto is a tool, not a life style. It worked for me. Other's results may vary.
Great video, Gil. I think the obvious question is whether the study was controlled for exercise and weight-loss. If the study chose participants who were motivated to stick to a certain diet, they would likely have been motivated in other areas such as exercise which would then be a confounding variable. The result may mean 'do exercise and whatever diet that helps you lose weight' if these factors weren't controlled. With the rebound also having the implication of a healthy diet *that you can stick to* being key. So perhaps the lesson of all these studies is that there are various diets - keto, low-carb etc. which have been shown to put people into remission, and the real message is: chose the one you can stick to (and do exercise).
what a nice message you always give and what a nice scientific analysis as always, love the channel. Keep it up
Thanks for this discussion. As a runner I think it should be pointed out that the Keto diet (in endurance athletes) can cause RED-S (Relative Energy Deficiency in Sports). I know of a 22-year-old with osteoporosis because of this. Women need to be careful that they don't mess up their hormones going on a strict Keto diet to lose weight.
I’m a cyclist who does a lot of rides of more than 90 minutes, sometimes 3+ hours. When I tried a keto diet it was a complete disaster. I was fine for about 50 - 60 minutes into a ride but then I would feel worse and worse until I struggled to get home. Keto enthusiasts kept telling me to give it more time and that my body would adjust and I kept the diet up for almost 2 months before abandoning it. I felt terrible and I was getting slower and slower on the bike. I don’t have type 2 diabetes or pre diabetes, I was just trying keto because of some enthusiastic people who told me that they felt fantastic on a keto diet.
Yeah, when I was running and cycling a lot I ate a high carb diet. It worked, plenty of energy and good health.
Must be anecdotal - pmc.ncbi.nlm.nih.gov/articles/PMC9932495/
Osteoporosis is not caused by a ketogenic diet or any diet with sufficient nutritional mix and volume. It can be caused by simply eating too little of any healthy diet. Karen Carpenter died of heart failure from anorexia (eating too little). She no doubt also had early osteoporosis. Elite cycling climbers have this problem because they wish to keep weight too low. Keto is not calorie restriction.
Yeah, probably the biggest reason I can't do low carb is that I do a lot of high intensity cardio. I tried just a low carb diet, not even keto, and it was unbearable. Felt like garbage all the time and could barely get my workouts done. If you're doing a lot of low-intensity cardio, and/or weight lifting primarily, I can see how you could sustain it, for me low carb anything is just a non-starter.
You are correct, what works is different per person... Unfortunately a lot of nutritionists only have one tune... Eat less and move more... They don't go over all the options and try to find the one that works for you as an individual... And that just sad! Good that you are here to show all the options available. And to everyone who's looking for their matching diet, ENJOY the adventure ;)
Eat less and move more IS the very best 1-liner they can deliver. The problems start with achieving it and that needs to be personalised.
@@BartBVanBockstaele unfortunately it's not! Before delivering any line at all they should look at the patient in front of them. When i was diagnosed with T2D (which turned out the be LADA) I was told the same crap. I was 36 with a BMI of 24 and 15% fat, hitting the gym 3 days a week... As educated professionals they SHOULD personalise the treatment and make sure you get additional tests...
Roy Taylor Newcastle University. Worked for me.
Oh wow, what a study. Thanks for talking about it.
Always waiting for excellent information!
Gil has the best nutrition channel on RUclips. Change my mind.
hands down. I´d go as far as saying it's the ONLY nutrition channel. there's lots of diet channels (vegan channels, keto channels etc) married to a specific diet that will butcher the science to argue for their favorite foods but there's no other channel dedicated to actually going over nutrition science seriously
I trust him more than any other RUclips guru I've come across. For no other reason than that it is mainstream. So many people addicted to social media need to be talked off of the ledge they are standing on. He does a good job of it.
I liked your unbias presentation on keto diet. The reason why it didnt work for a lot of people is because people cheat on diets or do not have the discipline. If you want good health it is not easy. NOthing good comes easy. I think the keto diet is a gr8 place to start and then you could add a little more carbs. I have been on a low carb diet (Not keto low but about 50-70 grams most days for the first 6 months) for almost one year and within the last 3 months I have added a little more carbs ( not refined carbs). It is working well for me. I also do intermittent fasting 17:7 and dry fast twice per week. I have no metabolic issues at 63. Just wanted to lose some weight and lower LDL a bit. I am now a bit below normal bmi at 102 lbs from 136 at 5 3". It should be noted that LDL skyrockets on low carb diets for some people, like me. You have to find that balance in the amount of carbs/protein/fats that works best for your body. It's a constant monitoring and tweaking but you will feel GREAT at the end. Make sure your diet is supervised if you are unsure of what to do.many keto .doctor out there. I don't add fats to my diet also, what is natural within meat tissue suffice for me. I do not use seed oils but if I have to use oil it a good avocado oil /coconut oil/ghee, and i use sparingly. less than a teaspoon. It goes a long way just to add flavour to food.
It's really really difficult to stay in ketogenisis long term. Being in true ketogenisis requires a very restrictive diet. I maintained a relative low carb, about 15%-20%, for a couple years, but even that required me to carefully monitor what I ate. After lowering my A1c from 5.8 to 5.2, I started adding in more carbs in the form of legumes and fruit. I enjoy my diet much more now.
I completely agree about successful, diets are diets are what we can do well with. It isn’t one size fits all. We can morph and change, and it is ok. After Covid, my pancreas was highly affected and I had glucose insulin instability no matter how I ate. It took about three years to restabilize no matter how I ate.
I loved eating Keto and what it did for me. If you plan your keto intake, it gives you enough fiber and proteins. I used whole foods ingredients and primarily focused on proteins first.
I ate low carb keto for over two decades and would continue to if I didn’t have major mast cell issues and also have to eat a low histamine diet.
I still eat fairly low carb. It is a preference and feel better.
Virta does a great job.
Really appreciate the amazing reviews that you do, and explain clearly for us laypeople. Thank you.
I would recommend that any of these reviews on diabetes diets include the weight loss correlation info. It seems to me that we are seeing more and more info indicating that obesity may be one of the greatest culprits regarding diabetes and any diet that helps address that obesity may be helpful for a significant proportion of patients.
Thanks for covering this study, doctor. Low carb has worked for me for years. I just wish I had an answer for why I’ve been able to sustain it for so long while others haven’t. I’m sure it has something to do with discipline and the variety of controls I’ve put in place for myself. Maybe our focus needs to be more on behavior management than specific diets.
Has it worked for your LDL/ApoB levels?
And also the education to get the mindset that there is no option other than this, once we come to terms with this option less way we will be comfortable
As a vegan , i consume a moderate fat, moderate carb , high protein diet.. keeps me happy and healthy and satiated... Diabetes and cvd runs in our family..so we have to be extra careful.. my parents are lactovegetarians but they stick to a very Mediterranean style diet.
We eat local and also buy from the local organic farmers..
My diet was amazing but i didn't excercise becuz I'm restricted to my desk and the bed for i have to study for 14+ hours.. don't get the time to workout.. and this took a toll on my body and mind and neck (don't see how i can combat cervial problems while studying) but I'm working oht again.. stretching is a huge part of my routine with right cardio and body weight weight excercises like squats ..
I was extremely lean about an year ago becuz i worked out a lot and also lifted weights. I'm not fat but i think I'm gonna have to workout probably becuz we're supposed to move our body and we never evolved to not workout..
Sustained improvements were noted in body mass (−7.6%). I'm assuming the improvements were due to fat loss. This is consistent with virtually all of the literature, and that's no slight on keto or anything. There are definitely a lot of anecdotes where people swear that keto helps them feel more satiated. While this idea cannot be generalized to everyone, some people strongly claim it, and I’m not one to argue with their experiences.
I think it’s an interesting question that does not yet have a definitive answer: why do certain diets work for certain people? As you mentioned, the participants in this trial were motivated, and that is hugely important. A lot of people start keto or other diets after already being sold on the idea of the diet being highly effective. If this psychological effect could somehow be harnessed for good, it could be incredibly powerful.
I also think that for many overweight or obese individuals embarking on these diets with motivation, it’s often the first time they truly pay attention to what they eat - learning about foods, what keeps them satiated, what to avoid, and so on. It also likely removes a lot of the mindless eating, which I believe to be a big factor in people getting overweight - maybe less so in more severe obesity, which requires a bit more troubles with eating. I’d bet the resources these participants had at their disposal played a significant role as well. There’s a lot to learn here that could be applied in the future.
Gil, I have done a good bit of reading and thinking about diabetes after my brief experience with prediabetes related to a brief period of being debilitated. Based on that, I think that keto is a great acute intervention to get someone's glucose lower (maybe for 3-9 months), but that it causes problems that only appear in the long term. The issue is fat, mostly saturated fat. Saturated fat, especially in the long term exerts its own effects on metabolic health and blood sugar, and long term keto (which almost always includes high saturated fat, can create its own issues that hurt people already vulnerable to diabetes. I'm less sure about a "healthy fat" keto (with low saturated fat). You can comb the research for what I'm saying and I'm pretty sure you'll see evidence corroborating each of my claims. But you are a better, more patient analyst that I am. If you want to look into it, by all means, do! Great videol
Basically I'm saying long term saturated fat gets you in the ass, eventually, but at first it may not hurt as much as reducing carbs helps.
Also red meat/tma/tmao is one factor in many keto diets that might only start to cause problems in the long term.
I follow a low carb diet and find that keeping saturated fat low is totally doable--you just can't emulate the people who are eating a rib-eye steak every day and putting butter and cheese on everything. It might be worth watching the video Gil has linked at the end of the video on how to do a keto diet healthily.
I don't think the Inuits would agree.
This is why authentic therapeutic keto should be meditettenan style keto. Since fats are the main source they should be monitored to their fatty acid content. Fats should be Fatty fish . Olive oil. A little bit of canola oil. MCT oil. And a minority should be saturated fat. Ideally the rest should be on clean cuts of meat. Low fat milk. And outside of that it should be mostly plant based.
Worth mentioning that for most of diabetes patients their markers would go worse over that 5 year period, even after increasing on medications, so achieving any reduction with KETO\LC is significant.
Any diet which leads to weight loss can improve diabetes. But unlike keto - not all of them leads to increase cardiovascular and some types of cancer risk.
There is evidence the same can be achieved without using idiotic diets 😁. The secret is in the weight loss amount, a higher protein consumption seems to help as well. But there is nothing magical about a Keto diet.
@@pedrobarros2000 Many people try to lose weight on low fat low carb diet (calorie restricted diet) and they fail miserably ( feeling hu(a)ngry), worse, eat healthy (?) no fat sugary snacks to assuage the hunger pain, etc etc... and then counter intuitively, they load up on bacon and eggs and lose weight. Then they go WTF... A Keto zealot is born.
Always useful information.
As always, great explanations! Could we get a video about nutrition for menopause and perimenopause? My mother used to drink some morning shakes (grape juice, soy milk and golden flaxseed powder) that were supposed to help with hormone balance, and I want to know if that is evidence based advice or not. Any tips about women aging would be great content!
I did low carb keto for a couple of years & lost 30 lbs. I then started IF 18/6 & lost 15 lbs more. My a1c went to 5.9 (off all meds) from 6.4. I exercise daily with cardio & do resistance 2-3 x per week, bmi 20.4. Unfortunately, while it helped in many areas, my cholesterol & apo-b went dangerously high. I have been doing the Mediterranean Metabolic Balance for 5 months now & my cholesterol & apo-b are now completely normal, but my last a1c was 6.2. My weight is stable at 111lbs @ 5'2", still not on any meds & I am hoping my body will eventually adjust to healthy carbs over time. Personally, I had to make a choice between diabetes (many family members have it-even the skinny ones) & my heart. I wish I could have continued as I loved the diet, but all of my body wasn't loving it. I wish everyone success at finding what works best for them! Thanks again for the great content!
The McDougall Starch diet claims the same type of results. Although I lost 15% of my weight on this diet, it was too hard to maintain. I have settled on the Mediterranean diet for the last 5 years.
I think there was a study where they found that someone who had been long term medicated for years on diabetes could get no effect of changing diet and/or exercise regiments but someone who just had begun like within a few years could get an effect. I think the conclusion here is that the doctors should try and have the patients change their way of living not just giving up and feeding medicine the rest of their life
I often think that the initial approach to dealing with a diagnosis of T2D doesn’t help. Rather than immediately prescribing a set of medications, why not get people to go lower carb. Doesn’t need to be keto or anything like that but being strict (as we would with a smoker or alcoholic) and saying ‘your days of ice cream and sodas are over if you want to avoid an early death’. I suspect people don’t realize just how deadly the disease is! If we first get sugars lower naturally and then think about drug therapy people can make the trade off more clearly - eg if you want to eat pasta, then we’ll need to put you on this medication to help you. This to me is a much more informed choice. Many people instinctively don’t want life long medication and so letting them see FIRST that it isn’t needed might change the mindset. Afterwards, if they feel that the restriction is too hard to sustain, work on dietary pattern plus medication.
Gil, the problem I have with the video is that it is only looking at this Keto study. It needs to be compared in context to a low-carb diet and a plant-based diet (China study diet). Also, only looking at H1Ac is only one data point. Using the same sample of people, you need to check how their other metabolic numbers performed.
Any whole food diet, with good variety of fibers, tasty enough (can develop over time) so that people can adhere to, works.
I said ANY whole food diet, but that's close to meditarranean still, because a diet without fibers and colors aren't working long term (immune cells require fibers).
I do fairly low carb (under 100 g/day), carbs mostly from vegetables, berries, seeded bread, occasional dark chocolate. 80-100g of protein which is lean turkey, chicken, tofu, nuts, LF yogurt. Low saturated fat (only 15-20 g/day). I am 55 and resolved my elevated blood glucose and A1C, lowered high cholesterol that had for several years. My fasting insulin is 4, A1C is 5.3, fasting glucose 85. My total cholesterol is 175. My BP is 110-115/75. It went down when I lowered my saturated fat intake and switched to potassium salt. You need to find a perfect balance for yourself and do blood tests to measure results and what works for you. I would log everything in a nutrition app and get calculated the carbs, the saturated fat and protein. I have no problem eating as many calories as I want. No problem with weight.
It would be very useful if the study had shown the ketone values for the people who achieved lower A1c vs the ones who failed to improve their A1c. Essentially is the outcome dependent on how well the participants maintained ketosis, or just different body types.
What I'm curious about in this Keto study....Do the participants have a lower caloric intake with the keto diet than before going on the keto diet? What were their other health markers showing? How did they feel?
Yes. People don't stay on diets. What I was interested in was for the people who never got positive results. Did they adhere to the diet or did Keto just not help?
Very interesting and very promising. Many questions: did the app keep track of meals, macros, portions? Did the long term results for those who "stayed with the program" change with adherence to actual low carb? Any report on level of activity? And is full on keto fat heavy in the meals vs just low carb? Love that you conclude by discussing variations and options with healthy carbs. For everyone it starts by not eating highly processed foods, sugar,
Excellent review of a solid study. Is this, however, a low carb diet? Were participants shown to be in ketosis? Do you need to be in ketosis for a diet to be ketogenic anymore?
Based on what I could find, it does seem that most patients were indeed in ketosis, and their ketone levels are measured throughout
So how many of those who went back to being a clear diabetic person, did so because they failed to keep on track with their diet, Ketosis should irradicate the need for substancial insulin production, and if the participants kept to a level of max 10% carbs a day, these carbs are nessecary for certain functions in the body, however the little production of insulin that is beng made from the pancreas should suffice for the relatively small amounts of carbs being consumed.
I have myself used the ketogenic diet and experienced a good weightloss of both fat and excess water retainment in the body relating to the fat storage, however I never realy preped myself on maintaining a good and varying menu, this as lead me to leave the diet after a short while, I think that this is consistent with other people trying keto, it is hard to maintain focus and diligens in doing this diet. But on the other hand we tend to react somewhat differently to what we ingest, but the chemical processes in our bodies do more or less function similary to eachother.
I have seen people put type 2 into remission with both HCLF and LCHF. What seemed to be common in most cases is the elimination of hyper palatable ultra process foods, which translated to weight loss via a calorie deficit and improvement of all markers including remission of type 2.
Also endurance athletes have the lowest risk of all cause mortality and type 2 diabetes and they literally drink sugar water all day. What is the difference between endurance athletes and the general population…utilisation. If you eat in a calorie deficit it is most likely you are eating carbohydrates at a level below utilisation, hence why people doing high carbohydrate diets still lose just as much body fat as any other diet.
Inb4 „in my particular case this random diet solved all my problems“ anecdotes (it’s good though, happy for you!) for algorithm
Did all the participants that improved their HbA1 levels also lost body fat?
I don't know if you read the comments but I would love to know your take on nutrigenomics, which is to say, genotype tailored nutrition. I unfortunately have a copy of the APOE4 allele, which I am sure you know, is just bad luck for everything you can imagine but I am still puzzled as to what is optimal for someone afflicted as I am. Do you think that large studies in the future will increasingly take into account genotype when it comes to nutrition or is this too difficult to control for at this stage? Thanks for your videos, really appreciate the level-headedness and content!
Gil, please do a program about Lp(a) when you can. Most are unaware of this lipid anomaly, as I was. I learned I had it when on a keto diet and my total cholesterol went through the roof. Most docs still don’t test for it. A lipidologist tested me.
The common simplification that ketones replace the glucose is a bit misleading. Fat (fatty acids) enter the energy (ATP) production metabolic (Crebs) cycle in the form of the Acetyl-CoA. This then binds with oxaloacetate to produce citrate (the first reaction of the cycle). Without the presence of the oxaloacetate this can't happen and thus fatty acids can't be used as an energy source. Importantly, in humans glucose (via pyruvate) is the only source for the production of oxaloacetate ("fats burn in the fire of carbohydrates"). When there is a relative lack of glucose in the system (after depleting the liver glycogen stores), gluconeogenesis kicks in and oxaloacetate (among other sources) is used for its production. The acetyl CoA starts to cumulate as it can't be now used for citrate production. This excessive acetyl CoA is then converted by the liver into the ketone bodies. However, these ketone bodies are no miracle remedy for the lack of glucose. The only pathway for using them to produce ATP is through converting them back to the same old acetyl CoA which consequently has to bind with oxaloacetate. Oxaloacetate (yet again) has to come from glucose, which can come only from food or from gluconeogenesis. With the chronic lack of glucose in food (keto diet), amino acids (i.e. breakdown of proteins) are the only significant source for it. No, glycerol spines of the triglyceride fats don't cut it. The only REAL advantage of the ketone bodies then is that, unlike fatty acids, they can pass through the blood-brain barrier into the brain and be used as an energy source there. But again, only when there is enough glucose present there to form the oxaloacetate.
So the first additional question in this study (beyond the obvious control of glycemia) should have been the concern with muscle mass loss from the protein breakdown. Also, high fat diets generally lead to the increase in LDL and it would be interesting to see if this had any effect on arterial plaque formation, especially after the 5 year period. And I understand that there was no control group but in such a case the control is the general population (same as with the effects on glycemia). And finally, high fat diets are reported to be associated with at least some types of cancer (colorectal). Five years may not be sufficient to see an effect here but it would be nice to see that the question has been raised too.
With so many "Google Drs" out there you are the voice of sanity.
I agree about the need for science in nutrition. I believe that it's really a low calorie diet, not necessarily a low carb diet that can improve health markers. (See Twinkie diet.) Interestingly, aside from restrictive or fad diets, the GLP1 drugs have helped to lower A1c considerably. There is also a GLP1 gene therapy that might provide a "cure" for diabetic patients in the future (in trials now). The next 5 years are going to be exciting for diabetic patients, not to mention those suffering from an obesity addiction. BTW, we're not down on keto or low carb or carnivore. We're just tired of the fanaticism and know-it-all behavior of those advocating these diets. Good discussion.
I have been low carb for 4 years. I find there additional benefits to lower carb intake and lower blood sugar. My appetite is much lower resulting in 65lb weight loss. Low carb requires much less willpower to keep the pounds off.
I'm happy for you! What's type of the low-carbohydrate diet do you eat? (Mostly saturated of mostly unsaturated fats? do you eat much fiber?
Everyone has to find something that works for them . Would be best for younger generation start on good eating practices , so they can keep most flexible , enjoyable diet. For myself I was never pre-diabetic , hip to waist 1 to 1 at my worse. So I just modify the Med to my liking - no white rice , but small amount of brown , not much bread , so high fibre german/swiss style or sourdough . But lots of other carbs, beans, lentils, berries, fruit ( less banana ,unless post gym session ) , sweet potato , squash etc . Huge amounts of non-starchy veggies, salads, nuts, EVOL , some eggs, chicken, fish , yoghurt/kefir and hard cheese., few pieces of very dark chocolate . Think I could take my diet anywhere in world to some degree. Yeah in India , Asian or some other countries will need to eat more simple carbs, more sodium , but I will be active 8 hours plus a day walking, hiking, swimming as a tourist , enjoying life.
Most people could just benefit from cutting out sugar , soda , junk etc , increasing veggies, fruit, water, nuts/carrots/fruit as snacks
Other "junk" I miss very rarely is french fries . Or a very very dark chocolate ice cream , low sugar no one makes in my country. A pint would last me a month anyway - 1 small spoonful and some raspberries , with some no added sugar greek yoghurt to bulk it up .
Ie for treats , like dark chocolate I just need a small piece , to savour
Though I don't have a sweet tooth , I will accept a small piece of birthday cake to be gracious and celebrate a person's life .
Will eat mammal if host took effort to show love and care , Not against meat , just the factory , brutal uncaring farming practices . But if donet respectfully , circle of life . happy for my body to feed the soil
that's exactly what I found. 70 pounds down going on 5 years:)
Well, for some people it’s easier. For others, basically not being able to have cookies, cake, chips, etc, ever again makes it pretty hard.
@@matthewcreelman1347 Even if you're not Keto you shouldn't be eating that crap! The longer you don't eat refined carbs the less your body craves them.
Guess i belong to the lucky group. It was 14% when disgnosed back in 2022. Cut sugar, high carbs and procesed food. Chose active and stress free lifestyle. a1c continues to stay under 5.4%. lipid readings are normal too. Early intervention and age factor might have helped.
Gil, Thank you for covering the work of Phinney, Volek and others involved with the Health trial. As a follow-up, how about an “Optimizing Keto for Apo B” discussion with yourself and Dr Ethan Weiss?
we did it a couple years ago, it's linked in the end of this video
The answer for me is YES, low carb/keto did reverse diabetes into remission. I was also able to get off of 3 Medicare hypertension and stop taking Prilosec for acid reflux, off all diabetic meds in the first 3 months. Rosacea cleared up and joint pain disappeared. I am 57 years old and now on no medications. Also, lost 35 lbs. Total win for me and never going back to SAD. Low carb for life.
I have been in “remission” from type 2 diabetes for 8 years, keeping my carb ultra low (60lbs. I am 63. Is the diet for everyone, probably not. Food issues probably got them in trouble in the first place (which was my problem, being a former carb junky), not surprised lots of folks cannot stick to any “diet” long term.
I was a 59 year old "fat but fit" mostly WFPB (vegan) cyclist who was declared "diabetic" after an hba1c and a fasting test in 2019 following a bad bout of flu and given a patronising talk about healthy eating. (though to be honest I had been somewhat clueless and had bonked on a few long cycle rides in the days when I thought fruit smoothies were "fuel" - clearly I had been sailing a bit close to the wind ...)
I lost 10 kilos over a few months and the new practice retested and took me off the metformin.. 5 years later I'm down to a BMI of 25 on the WFPB "high carb" diet I've thrived on for over 40 years - albeit free from "extras" - and they STILL insist on calling it "remission under dietary control".
I now avoid juice, jam, cake and cookies not because I'm terrified of hyperglycemia or a hypo crash, but because I don’t want to get heavy again.
The one positive apart from losing the weight is that I got 3 years of free covid and flu shots, but I turn 65 next year anyway....
This year I relented and had the eye test and the hba1c - all clear of course along with a BP and lipid score that would ordinarily make it "come back in 5 years" (QRISK 7.7 % plus 1% for my "deprived" postcode ).
I'm one of the healthiest adults on their books at any age and they still treat me like an invalid.
I'm simply a person who gets insulin resistant over 30-odd BMI if kept off the bike by illness...
I have an in-law 5 years younger whose BMI is over 40 and who has every chronic condition EXCEPT diabetes....
If I emigrate to France as hoped, perhaps they'll do a glucose stress test and finally end this nonsense...
A very large positive is I have taken ownership of my own health and am wary of the population-based health profession mincing machine.
It’s interesting that both a low carb diet AND a plant based diet which is high carb both improve diabetes. Some experts say weight loss is responsible for plant based diets effect on diabetes. You didn’t mention weight loss here.
It is entirely possible that what cures, or at the very least, improves diabetes, among other diseases, isn't simply what one eats, but what one doesn't eat. By simply cutting all the junk, salt and sugar from our diets will most likely yield positive results.
I agree, its all about balance and I think we are slowly coming back around to that!
Diabetic since 2013, 26 finger readings and well above 10 hba1c, very sick. Lost 40kg by daily exercise, eating only small serves natural foods, no liquor and insulin twice daily. After two years hba1c 5.x, insulin x 1 and eat only medium serves natural non processed foods including fatty meats and fish and fruit, all green vegetables, no rice or potatoes. Exercise mostly daily 1+ hours. Don't feel deprived, just natural to stay healthy.
Would never want to return to the 2013 sickness.
I suppose my point is do what works for you.
Salt is important :)
thank you for another great video !
Lower BMI? The common denominator across all these extreme diets?
BMI is only meaningful on a population level. As an individual, just look at your weight. While BMI is not complicated, weight is even simpler.
@@BartBVanBockstaele Waist circumference is "alleged" to be the better measure.
@@kieunchang7656 It often is, but really, there is not need to makes this any more complicated than simply looking at your body. If there are fat rolls/love handles, you're too fat. You can then use a scale to track weight loss with some degree of accuracy, but a tape measure or even pant size would not be bad. Reality is that people who are too fat know they are too fat. They just don't want to know it.
Knowing whether follow-up patients continued to adhere to the same low carb diet would be an important consideration. Also I don’t see “fix” as in the title being the same as remission. If a low carb diet provides continued improvement in blood markers after being relaxed or removed, that could be considered a “fix” or a “cure” which this study apparently does not address
Did they check at all whether they were still insulin resistant?
they didn't run a OGTT but their HOMA-IR improved at 1 year and partly (though not entirely) rebounded at 5 year
@@NutritionMadeSimple thank you, and great video as always.
I do strict intermittent fast with lots of fruits and starchy veggies. Along with non starch veggies, rice, flax quinoa, beans, meat, cheese, tofu eggs milk very sparing refined sugar. I am 66 145lb, BMI is 23.5. Fasting sugar around 90. Diabetes runs in my family I suspect mostly because of poor food choices. I suspect it will come back to haunt those who eat ridiculously high fat & extremely low carb. I strive to keep both in moderation. No refined flour, or ultra processed foods like cereal, noodles, I mostly eat brown rice as opposed to white rice. Intermittent fast, wise food choices is hard but very much obtainable. I doubt I could do keto for 6 months certainly not for the rest of my life!
I was very obese, went on keto and lost 100 pounds in a year. I know people who have rebounded and others who will exhale acetone with every breath for the rest of their life.
This is an anthropological problem. For more centuries than we can conceive of, we fought for every calorie. Now that calories are basically free, most of us can't overcome the urge to gorge ourselves and for most of us that means glucose issues and obesity. Once you figure out how to control it and maintain your health you have to do that for the rest of your life, or your symptoms return. It really is that simple.
I long for burger buns, but lettuce wraps keep me healthy, and that will never change.
You make this Portuguese person so proud! Your information is so important for people to hear. Thank you!
I think the problem with keto/low carb is it’s hard to keep doing it year after year. That’s my experience. If you cut down on sugar and starch your hb1ac will drop probably to normal. Then you relax a bit and begin to eat carbs as usual and bingo. Your prediabetes/ diabetes raises its ugly head again. Of course this is an anecdote. The upshot is it’s probably for the best that we cut back on carbs if we can and burn up a bit of blood sugar through exercise. It’s not easy as most people are not really consistent in exercise and diet including me.
Did they track other metrics to get the complete health picture instead of focusing only on A1c? At the end you mentioned safe and healthy keto, but I wonder how many keto diet followers actually practice that, instead of doing "bad keto"?
Does this intervention reduce BMI? I failed low carb as likely could not regulate the high fat and protein just stalling any weight loss and A1C increased. You should do a video on the high starch diet for those that work for.
Hi Dr Gil, I’m one of your fan of what you do, I just one to know if eating brown rice is healthy, and how many cups is acceptable to consume daily? Thanks
Any long-term health implications? If I'm sucessful in overcoming my carb addiction, and follow a well-formulated therapeutic nutritional ketogenic diet for life, should I worry because I'm not on a mixed diet anymore?
It just shows how difficult it is to get people to eat healthy . These people had access to a large amount of support and monitoring and just could not maintain. Now exercise is known to reduce blood sugar so that could be supplemented with some added carbs . Total elimination is probably not possible for the majority but can you empty some carbs that are healthy versions
Carbohydrates improve insulin sensitivity. The key is to cut out the fat. Ketogenic diets are for sedentary people who want to lose weight without cutting out bacon, butter and brie. Walter kempner reversed patients type 2 diabetes with rice, fruit, juice and pure white table sugar. 95% carbohydrates, 5% protein, zero fat.
As a type 1 diabetic, I ignore almost all news or advice about breakthroughs in diabetes treatments, because I find that 99% of them are exclusive to type 2 diabetes. Sometimes it feels like Type 2 is such an epidemic that researchers don't even bother with Type 1 anymore. I understand that probably isn't true, but it does sometimes seem that way.
A video about ketogenic diet with no bitter comments or trolls. Congratulations, Gil!
Keto doesn’t work for anything
@@SpikeFastingRacing That is just not true. It was first used to help epilepsy. Many have benefitted for many reasons since.
@@SpikeFastingRacing Don't start flaming, please.
_(BTW you cannot convince me to stop keto dieting however hard you try, I guarantee to you.)_
@ Ketosis diets waste the body away. It will shorten your life.
@@SpikeFastingRacing It 'works' just fine, like all diets that lead to an energy deficit. The problem is that few people actually follow it. Treatments only work when they are followed. That is true for ALL treatments.
Please, please, please! Audio podcast 🙏
it’s much easier to listen while doing whatever someone is doing.
I routinely run videos while working. Just bc the picture is there doesn't obligate me to watch it, especially talking head content!
If you've got diabetes, and it keeps getting worse, despite your meds .. are there any other options? Even if it might not work for you - if you have no other options, isn't worth a *try* at least? It doesn't seem to have much in the way of negative side effects.
One thing I didn't hear was whether those people tested after five years remained on the keto diet. It shouldn't be surprising that people who go back to the same behaviors get them into the same trouble that their behaviors got them into the first place. Also, did they factor for weight loss?
While I do support Dr. Cavalho's temperate, scientific attitude on a number of subjects, but this study clearly shows what the ketogenic diet is capable of and I consider this an absolute failure. Ketogenic diets are popularised as a fix for ill carbohydrate metabolism, even if it worsens other key health parameters (like nonHDL cholesterol). With funding, experts, apps and whatnot they achieved a 3% remission in 5 years and even from this population I expect that some patients are in remission due to weight loss and not the diet type. This is a huge nail into the coffin of ketogenic diets for me.
I'd be interested in knowing whether there was an impact on lipid profiles as well as gut microbiome. Seems intermittent fasting is more effective (and maybe a keto diet is kind of a cheat for intermittent fasting)
-clicked on this vid so fast it makes my head spin -
It appears they were eating a lot of whole plant foods even while low carb. Eating whole plant foods will be beneficial whatever diet your on.
The latest figures from 2022 is 1 inn 4 health care dollars (from all sources) are spent on diabetes; 412.9 billion on direct and indirect causes (lost wages). Included in that number is 32% of medicare dollars go for diabetic care. The cost of illness accelerated by diabetes like cancer, hypertension, and heart disease are not in those calculations. When you look at those numbers, it's not to difficult to figure out what is ballooning US healthcare.
What about other risks of keto? High cholesterol, damage to kidneys from high protein consumption, overall weightgain from high fat intake.
11:00 what you are describing is survivorship bias, people tend to hyper-focus on successful cases and ignore the unsuccessful cases, which tends to overestimate our chances of success. This is the same reason why people plat the lottery despite overwhelming odds.
It is even better and faster when combined with intermittent fasting
This reinforces for me that we have individual needs. We all have to find a way of eating that works for us. I would be miserable if I had to eat a high fat, low carb diet.
You don't have to eat a high fat diet. You only need to eat a lower carb diet to keep your A1C levels within acceptable ranges.
Yes. For 1 billion dollars, I would not eat high fat low carb.
Vast majority believe they're on a keto diet when they don't understand how they need to eat to make it happen. People who stay on it, doing it right are a very small minority.
For those who weren't diabetic anymore after a year, I wonder how many of them achieve that status simply by weight loss. Was weight loss measured and accounted for? Weight loss alone can put diabetes into remission. So for those of the 25% who were no longer diabetic, how many of them experienced significant enough weight loss that the weight loss would have done the remission regardless of diet?
You can "cure" type 2 diabetes on ANY DIET. All you got to do is lose weight. There is nothing magic about Keto. Everything Keto diet advocates say is completely bogus.
6:45 "probably" is generous. You could almost substitute the words "certainly" or "entirely" here.😅
Curious about their lipid levels… Ironic, if they’re just trading one problem for an even worse one…
Do we know why the VIRTA approach rebounded? Or why any intervention sees HBANC1 rise again? I mean if it was initially able to reduce Hb, then something must be going right. Is it that the body adapts to the new diet and so hb 'normalises'?
While effective for diabetes, what about other health impacts at five years and dependence upon the type of low carb diet, high red meat vs plant based for example?
I eat a low carb diet but not keto - and I can tell you I don't eat a lot of red meat at all (once or twice a week, and it's always lean sirloin) - in fact, I eat a lot of chicken & fish and most of my fat comes from olive oil and avocados - you don't have to eat a high saturated fat diet to be keto or low carb.
Good video, but looks like study definitely needed a control group -- Where would people be after 1, 2, 5 years, etc., absent the intervention. Also would like to see results broken down by where people were at (say) one year -- How much (for example) did their A1C go up relative to those people who never had much change in blood sugar. The overall averages could be driven by people who were never helped much by the diet and whose sugars went up massively, driving the overall average up vs. others who did pretty well with the diet, even if they were were (after 5 years) pre-diabetic or were on the low end of the diabetic scale.
Are the remissions inherently the result of the diet being ketogenic, or could they be the consequence of fat loss that can come with a globally more healthy, satiating diet, with far less heavily transformed foods ?
Well analyzed
It works for those who adhere to the diet.
The problem I see is that "keto diet" is a large umbrella-term. People who eat a carnivore diet, and people who eat a lot of vegetables, and some meat and fish and cheese and nuts, are all making a "keto" diet, but they are also making two completely different diets, the results of which should not be compared. If I get this study right, the "keto" diet was not uniform, but adapted to the preferences of the participant. This increases compliance but decreases meaningfulness. Also, whereas people on a varied diet, based on vegetables (excluding carrots, onions, beetroots, etc.) and cheese, nuts, meat and fish can "comply" for many years, I do believe people who choose the "carnivore" diet, or the "Palaeolithic" diet, or any diet which in fact greatly reduces variety and fibres, end up getting tired of that "keto" diet. I think an analysis of which participants stayed, which left, which rebounded and which did not rebound, crossed with the specific "keto" diet they were following, could give indications about what "keto" diets work and what do not work.