Note: this is both a Science Made Simple article and an editorial, where I express my own opinion. A ketogenic diet and the weight loss that can accompany it is well documented to be both safe and effective as medical nutrition therapy in the treatment of type 2 diabetes. While it can enable individuals to put symptoms of the disease into remission, it is not a ‘cure’. An article widely circulated on social media earlier this week announced “What If They Cured Diabetes and No One Noticed? “So you’d think that if someone figured out a way to reverse this horrible disease, there would be big bold headlines in 72-point type. You’d think the medical community, politicians and popular press would be shouting it from the rooftops. Guess what? Someone did. Yet it appears no one noticed. The cure was simple - so simple, in fact, that it involved no medication, no expensive surgery and no weird alternative supplements or treatments. What was this miracle intervention?
Of course, the author is entitled to hold this opinion and to express it, however in my opinion, a ketogenic diet does not “reverse diabetes” - it does not “cure” it. Furthermore, I believe the distinction between “reversing diabetes” and “reversing the symptoms of diabetes” is very important, and more than a matter of semantics. “Reversal” of a disease implies that whatever was causing it is now gone and is synonymous with using the term “cured”. In the case of someone with Type 2 Diabetes, reversal would mean that the person can now eat a standard diet and still maintain normal blood sugar levels. But does that actually occur? Or are blood sugar levels normal only while eating a diet that is appropriate for someone who is Diabetic, such as a low carbohydrate or ketogenic diet, or while taking medications such as Metformin? Addendum (July 18 2019): Type 2 diabetes is the result of beta cell failure resulting from over-taxing them with a highly refined, carb-laden diet over extended periods of time (you can read more about that here).
For something to ‘cure’ type 2 diabetes, there would need to evidence of a restoration of beta-cell function. If someone was indeed ‘cured’ they would have a normal glucose and insulin response on a 3 hour glucose-insulin test (OGTT will added insulin assay at 0 hr, 1 hr and 2 hrs.). Anything short of that is ‘remission’. Firstly, it implies that there is simple, free ‘cure’ that will work for everybody. As I outline below; some people are able to achieve partial or complete remission of their symptoms following a keto diet, and others are not. Secondly, it implies that there is a simple, free ‘cure’ available, but that it is being ‘withheld’ for some reason - either because doctors don’t know about or are afraid what colleagues might think, or because the agricultural and pharmaceutical industries have ‘big bucks to lose’ by people limiting their intake of bread, pasta and insulin.
There is no question that physicians (and all clinicians) need to be selective about recommending a keto diet for their patients / clients and to be able to document from the literature that it is safe, effective and best clinical practice for the condition for which it is recommended, and appropriate for the individual. While falling markets for specific types of food products and drugs certainly have an impact on the economics of both the agricultural industry and pharmaceutic industry, it comes across like a ‘conspiracy theory’ to imply there is a ‘cure’ available out there, but that the public is being ‘denied’ access to it by “big food” and “big pharma”. Finally, it implies that if people are unable to ‘reverse their diabetes’ and get ‘cured’ following a keto diet, that it is their fault; they mustn’t have done it properly. Even if we substitute the terms and say instead “put their diabetes into remission” or “reverse the symptoms of diabetes”, it is unreasonable and unfair to assume that everyone will be successful in doing so, and if they aren’t, the responsibility falls on them.
The on-going study from the Virta Health had over 200 adults ranging in age from 46-62 years of age in the intervention group following a ketogenic diet at the end of two years. 6.5% (American Diabetes Association and Diabetes Canada guidelines). HbA1C rose slightly to 6.7% at two years. Data so far from this study demonstrates that a well-designed keto diet can be very effective in reversing the symptoms of type 2 diabetes, and that it is more effective than what was ‘standard care’ (prior to the new ADA guidelines), but it is not a ‘cure’. That is, the Virta researchers say that a well-designed keto diet can resolve the signs and symptoms of the disease in many people, which “in effect” (i.e. ‘is like’) reversing the disease - as long as the carbohydrate restriction is maintained. They don’t promote the diet as a ‘cure’, but as an effective treatment.
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