The US government is testing the keto diet to treat veterans' diabetes. Critics say it could have long-term health risks.
- The Department of Veteran Affairs is experimenting with the keto diet to treat diabetic patients, partnering with a company called Virta Health to provide free treatments to 400 veterans.
- The treatment is based on research showing that low-carb diets can prevent spikes in blood sugar, effectively "reversing" the symptoms of diabetes.
- Critics are concerned the high fat content of the keto diet could have potential health risks in the long-term for veterans, including raising cholesterol levels and reducing other nutrients.
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Diabetes is one of the largest, most expensive problems facing America's veterans, and the US government is staking its hopes for a solution on an unconventional treatment: the popular keto diet.
The Department of Veterans' Affairs (VA) has launched a partnership with a digital therapeutics startup Virta Health to treat diabetic veterans using the low-carb, high-fat keto diet, at no cost to the vets or the VA.
The partnership, first announced in May 2019, has enrolled 400 veterans into Virta's program, which includes personalized nutrition plans and online access to health coaches and physicians.
So far, the results have been promising, according to the company's data. A pilot program with the VA found that half of the participating veterans achieved blood sugar levels below the threshold for diabetes after three months on Virta's program. And the treatment successfully reduced medications, including insulin, by 53% across the entire group.
But some experts have raised concerns that there may be unforeseen health consequences following this kind of treatment, and that the VA's buy-in will lend legitimacy to what is still an experimental treatment.
Keto could reduce symptoms of diabetes by managing blood glucose, but it isn't a cure
Prior to working with the VA, Virta had been studying keto as a treatment for diabetes for over two years.
Diabetes is an inability to balance blood sugar. Reducing carbs manages the problem at the source by preventing blood sugar from rising in the first place, according to Dr. Mark Cucuzzella, a professor at West Virginia University School of Medicine, a US Air Force Reservist, and a marathon runner who has published several studies on keto and diabetes.
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"The most impactful thing on your blood glucose is the amount of carbs in your diet. The low-carb diet is effective because it lowers the insulin load," Cucuzzella, who is not affiliated with Virta, told Insider in an interview. "Insulin is the master switch."
Medications like insulin can mitigate diabetes symptoms by managing blood sugar levels. But keto can help patients reduce medications, said Dr. Sarah Hallberg, medical director for Virta.
Eating carbohydrates causes blood sugar to rise, but eating fats does not. It means diabetic patients can get their daily calories without needing to use insulin to balance out spiking blood sugar levels.
"Standard treatment puts people on a one-way street of progression for diabetes, with temporary pharmaceutical treatment that will have to be added on to," Hallberg told Insider. "We're able to give people another lane going the other way by bringing blood sugar into non-diabetic range while reducing and eliminating medication."
That doesn't mean keto can cure diabetes.
Virta refers to its treatment as a "reversal" of diabetes. In layman's terms, this means the disease is in remission. The treatment only works as long as the low-carb diet is maintained. As soon as carbs are re-introduced, the same problems with blood sugar and insulin emerge.
What makes a good keto meal plan
A keto diet is any eating plan that pushes the body into a state of ketosis — when it begins producing substances called ketones, explained Dr. Ethan Weiss, a cardiologist and founder of a ketone-detecting device. (Weiss previously served as a medical advisor for Virta.)
"Keto" typically refers to eating plans in which a majority of daily calories come from fat, along with some protein and minimal carbs. People with diabetes could cut their carb intake to as low as 30 grams a day and still be healthy.
But the key to medical keto is going beyond counting macronutrients. Instead, it's important to focus on whole-food sources of fats, cutting carbs without completely eliminating nutrient-rich foods like veggies.
Critics say 'enthusiasm outpaces evidence' when it comes to keto, and the trial may put vets at risk
It's not clear what long-term health effects the keto diet might have.
The Physicians Committee for Responsible Medicine, a group of medical experts who advocate a plant-based diet, sent a letter to VA officials asking them to reconsider the partnership, and keto treatment, based on evidence that a high-fat, low-carb diet could potentially increase risks of diabetes, particularly diets high in saturated fat.
Skeptics have also noted that most of the data showing keto can treat diabetes is based on studies led and funded by Virta itself. There is barely any hard data on keto's health effects beyond two years on the diet.
Hallberg acknowledged the lack of long-term evidence, but said the same problem has plagued nearly every other type of therapeutic diet (with the exception of the Mediterranean diet).
"There's needs to be a hard outcome, long-term trial looking at a variety of eating patterns, no question," she said.
But in the meantime, diabetes continues to be diagnosed in record numbers, particularly among military veterans.
"Do we have 10-20 years to wait for that? We're in the midst of an unprecedented diabetes and obesity epidemic," she said. "We have to do something now."
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