When Sami Inkinen was diagnosed with pre-diabetes in 2012, he wasn’t an overweight couch potato. Far from it. The founder of real estate website Trulia was an elite athlete, earning the title of Half Ironman World Champion in his age group the year before.
“I didn’t understand how it was possible,” Inkinen said about the diagnosis in a 2017 interview with Forbes. “I had thought that diabetes was a disease of uneducated, lazy people who had no willpower.”
Over the next few years, Inkinen would learn a lot more about diabetes — that it affects over 30 million people in the U.S. and that an estimated one in three adults has pre-diabetes (although 90% don’t know it).
He would learn that diabetes can kill, leading to kidney failure, loss of vision, blindness, lower limb amputation, heart attack and stroke if untreated. And he’d learn that it’s expensive. Treatment costs an average of $16,752 per person annually.
If You Cure a Disease in a Forest and No One’s Talking About It, Did It Happen?
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? Diet. Specifically, the ketogenic diet.
Keto Diet Puts Diabetics in Remission
After Inkinen’s pre-diabetes diagnosis in 2012, he spent the next few years researching the disease and treatments and ultimately teaming up with Stephen Phinney, MD, Ph.D in 2014 to form Virta Health, a research and virtual medical clinic whose mission is to reverse type 2 diabetes.
Phinney has been researching the keto diet and publishing studies on it for over 40 years. But last month, Virta published the results of what may be the most comprehensive study of the diet yet, a two-year intervention tracking 349 people who were divided into two groups. One followed a keto diet, the other followed their usual care for diabetes.
The results are impressive. At the end of two years, the keto group saw incredible improvements: 55% were able to reverse their diabetes and stop all medications except Metformin, and 18.5% were able to achieve remission. That is, they were both officially out of the diabetic range and off of all diabetes medications. Plus they maintained that state for at least one year.
The keto dieters were also able to lose weight (an average of 12% of body weight), reduce their dependence on insulin — dosages dropped 81% — and reduce triglycerides, inflammation and other markers for metabolic syndrome.
By contrast, just 10.5% of the participants in the control group were able to reverse their diabetes, and none was able to achieve full remission.
The control group also gained an average of 5% of their body weight, had a 13% increase in insulin dosages, and saw only modest improvements in triglycerides, inflammation and metabolic syndrome markers.
It’s also worth noting that this research is entirely self-funded — Virta receives its funding from venture capital investors.
Why Your Doctor Isn’t Prescribing Keto
The publication of this study should be enough for doctors and the medical associations to recommend a ketogenic diet for diabetics. Yet the response so far has been…crickets.
Ok, not entirely crickets. To be fair, earlier this year, the American Diabetes Association (ADA) did finally recommend a low carb diet as an option for treating diabetes. Previously, the ADA insisted that low carb diets are “unsafe,” since the brain “needs” 130 grams of dietary carbohydrate per day.
But most doctors have been unwilling to recommend keto to their patients, whether for diabetes, weight loss or anything other than treating epilepsy in children. This is surprising, given the wealth of studies on how low carb, high fat diets affect cardiovascular disease, weight loss and other metabolic disorders.
I think there are a number of factors at play. These include:
1. Doctors don’t know much about nutrition.
It’s ironic that most of us turn to our doctors for advice about what we eat, since they receive very little education about nutrition — often less than 10 hours on the subject in all of medical school.
Moreover, many doctors — like many people — have entrenched views on nutrition that are based on cultural and intellectual bias, not scientific data. These ideas just feel right.
The idea that vegetarian or vegan diets are healthier than other diets is an example of this. So is the idea that a low fat diet is healthier than a high fat/low carb diet, despite a mountain of evidence to the contrary.
2. Doctors don’t want to be perceived as crazy.
In some ways, the ketogenic diet is a victim of its own success. Though it has been around since the 1920s, it gained popularity recently among body builders, celebrities and the average Joe and Jane who want to lose weight.
Because of this, keto is viewed as a fad (at best) or dangerous (at worst) by many in the medical community.
For example, an article in the Harvard Health Letter from October 2018 titled, “Should you try the keto diet?” has as its subhead, “It’s advertised as a weight-loss wonder, but this eating plan is actually a medical diet that comes with serious risks.”
The article goes on to quote Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital, who says that keto can result in nutritional deficiencies.
“If you’re not eating a wide variety of vegetables, fruits, and grains, you may be at risk for deficiencies in micronutrients, including selenium, magnesium, phosphorus, and vitamins B and C,” McManus says.
I find this interesting because when I compare a ½-lb. hamburger to a ½ cup of broccoli, the hamburger has far more nutrients.
Sure, broccoli is loaded with vitamins A and C, providing 24% and 84% of daily requirements, respectively, plus folate (21% of daily requirements) and vitamin K (138% of daily requirements).
But the hamburger has 47% of niacin, 17% of riboflavin, 32% of B6, 69% of B12, 12% of B5, 24% of iron, 9% of magnesium, 17% of potassium, 35% of phosphorous, 66% of zinc, and 46% of selenium required daily.
While the Harvard Health Letter frequently recommends limiting red meat, which could actually result in significant B-vitamin deficiencies, the keto diet could include both the hamburger and the broccoli, providing quite a nutritionally complete meal.
Still, many doctors don’t want to recommend it because they don’t want to be seen as nut jobs who chase fads.
3. Doctors don’t want to get in trouble.
At the moment, keto isn’t a standard treatment for diabetes or anything really, except epilepsy in children.
That puts doctors in an awkward position. If they don’t adhere to a standard of care, they could get into legal trouble with their practices, hospitals, insurance companies, licensing boards or patients.
So if an intervention, like a diet, isn’t part of the customary practice for treating a particular malady, doctors could run into problems recommending it.
This actually happened to Dr. Tim Noakes, a South African M.D. and professor of exercise science and sports medicine at the University of Cape Town. After offering the advice that breastfed babies should be weaned onto a high fat, low carb diet, the Health Professionals council of South Africa accused him of “unprofessional conduct,” resulting in a trial in which Noakes could have lost his medical license.
He ended up being exonerated, but his trial surely gave many doctors pause.
Follow the Money
4. Powerful organizations in the agricultural and pharmaceutical industries stand to lose big bucks if people shun bread, sugar, pasta and insulin in favor of eggs and bacon.
To be sure, there are the entities with a vested interest in keeping dietary advice as it is. An admission that keto actually has the power to reverse a major disease that plagues millions worldwide is also an admission that keto is a healthy way of eating (at least for the one-third of American adults with this disease and possibly others).
Such an admission would almost necessitate changing the U.S. dietary guidelines. This doesn’t seem like a big deal, but these guidelines direct how money is spent on everything from medical research to government-funded school lunches to which products are developed and marketed by the food industry.
We didn’t get Snackwells because people demanded overly sweet cardboard-like cookies. We got Snackwells because the U.S. adopted a low-fat dietary standard.
There are billions of dollars in whole grain breads and diabetes medications at stake here, and doctors who depend on research grants from these organizations may be loath to rock the boat.
I am not suggesting that doctors would knowingly recommend dietary advice that is unsound, but simply that they may have an unconscious bias toward standard, old-fashioned dietary advice, especially if their funding depends on supporting it.
5. People have a natural bias toward consistency.
Dr. Robert Cialidini is a social psychologist and expert on the science of persuasion. One of his key principles of influence is consistency — that is, people tend to behave in ways that are consistent with things they’ve already said or done.
Make no mistake: This social psychological principle is powerful. Cialdini says that the more public, voluntary and active a statement or action is, the more likely a person is to continue behaving in ways that support that statement or action.
So if you’re a doctor and you’ve already stated your view that say, a plant-based diet is healthier than a meat-based diet, it’s going to be hard to shift gears.
But it’s going to be even harder — perhaps nearly impossible — to change course if you’re the head of a prestigious medical association, the editor of a nutrition journal or a researcher at an Ivy League university.
a) you have authority,
b) you’ve likely put your views in writing,
c) you may have given speeches in support of that view, and
d) you may have authored papers, conducted studies and/or taught classes that support that view.
In other words, it’s not that the doctors who don’t want to embrace keto are bad scientists. It’s not even about fear of looking foolish for changing their minds. Rather, I think it’s a natural human instinct to try to preserve internal consistency.
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What Makes Doctors Change Their Minds
Actually, most of the doctors who are leaders in the keto community started out as devotees of low-fat, high carbohydrate diets.
So what made them change? It’s simple: Personal experience.
Before Dr. Noakes began recommending a low carb, high fat diet, he recommended the exact opposite. An avid runner and author of over 750 scientific books and articles, he frequently wrote about the benefits of carbohydrates for athletes and even helped develop a carbohydrate gel for endurance runners.
Then he found himself 50 pounds overweight and diagnosed with type 2 diabetes. His own father had died of complications of the disease.
Suddenly, the impact of a low-fat, high carbohydrate diet became personal. That’s when Noakes, an A1-rated scientist, dove seriously into researching diet and became a leading voice in the keto/low carb community.
He’s not alone. Many low carb and keto doctors had a similar path, including:
— Dr. Georgia Ede, a Harvard-trained psychiatrist, discovered that eating low carb relieved her chronic fatique syndrome, fibromyalgia, migraines and IBS;
— Dr. Ken Berry, author of Lies My Doctor Told Me and YouTube keto vlogger, found that he simply couldn’t lose weight following the traditional low-fat diet, but keto helped him lose weight and improve his fitness;
— Dr. John Limansky, an internist an avid exerciser who was always thin discovered in his 20s that he was on the road to diabetes and high blood pressure from eating a low fat diet;
— Dr. Tro Kalajian, an internist and obesity medicine specialist, who grew up obese and ultimately lost 150 pounds and became ripped on a low carb ketogenic diet;
— Dr. Brian Lenzkes, an internist who battled weight gain for most of his life, trying to treat it by eating six small low-fat meals a day and working out six days a week to no avail until finally discovering keto and intermittent fasting.
and many more.
Perhaps the tide is turning. It needs to. There is plenty of sound research to support keto and low carb diets as methods to improve health. My hope is that others will review this research with an open mind.
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