To: Editors, US News & World Report
Your Publication is Misinforming its Readers on Low-Carb Diets
U.S. News & World Report recently published an article criticizing the Department of Veteran Affairs (VA) for testing a new program to treat its population with diabetes in partnership with Virta Health, a private company. U.S. News quoted a number of skeptics of Virta’s novel approach, which includes the use of a ketogenic diet combined with a mobile app, to treat type 2 diabetes. We, as doctors, welcome skepticism, yet we wonder why U.S. News has been so excessively critical of a new, evidence-based approach that in our view, offers the first truly promising solution to a tragic epidemic. We further question the decision by the magazine to publish the complaints of a group that is motivated by an animal-rights agenda rather than science and human health.
For decades, pre-diabetes and type 2 diabetes, which afflict more than half the populations of the U.S. and Canada, has been considered a progressive, unstoppable disease that leads to painful decline and early death.
Virta’s findings should therefore be welcomed as a breakthrough. In a large trial undertaken at the University of Indiana, Virta has managed to demonstrate that a type 2 diabetes diagnosis can, in fact, be reversed. This controlled clinical trial, now in its third year, has sustained the results it obtained at year one, with more than half of its population reversing its diabetes diagnosis and more than 90% reducing or eliminating the need for insulin and other medications. Moreover, these patients have also seen the vast majority of their heart-disease risk factors (23 of 26 measured) improve.
Virta’s results are in agreement with nearly 100 additional trials on carbohydrate restriction, including some six experiments lasting at least two years, a period of time generally thought to be long enough to reveal potentially negative side effects; So far, there are none. This type of science —a controlled clinical trial—is considered to be the gold standard of science: a rigorous test that can yield reliable cause-and-effect data.
U.S. News erroneously attempts to contradict this data by citing a study employing observational, or epidemiological data. Yet epidemiology is a weak type of science that can ultimately only show associations, not cause-and-effect evidence. It is therefore a type of science best–if not effectively only–used for hypothesis generation. Once a hypothesis has been tested, in clinical trials, there is no longer a need to go back to this far weaker evidence.
Low-carb diets have now been tested, in numerous clinical trials, on thousands of people. These tests show that the diet is safe and effective in combating diet-related diseases. The evidence is especially strong for type 2 diabetes.
For these reasons, the American Diabetes Association (ADA) included low carbohydrate and very low carbohydrate diets as “Medical Nutrition Therapy” in their 2020 Standards of Medical Care in Diabetes and 2019 Consensus Report.
In fact, the ADA, in its 2019 consensus report, stated that “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.” [emphasis added]
Other concerns raised by U.S. News have also been already proven false: the low-carb diet is not nutrient deficient, and its tendency to raise LDL-cholesterol is usually transient (Read here, here, here, and here). Moreover, the type of cholesterol that inevitably goes up with carbohydrate-restriction is the “good,” HDL cholesterol that is linked with lower heart-disease risk.
According to the evidence, therefore, VA’s partnership with Virta, was a highly rational decision. The VA’s decision also seems highly rationale to us.
As physicians, we are successfully employing low-carb and ketogenic diets in our practices. Nearly all of us once recommended the official, traditional high-carb diet to our patients, only to see them gain weight and get sicker. Some of us got fat and sick ourselves. Switching to carbohydrate restriction has brought back hope into our practices: We now see people lower their blood pressure, lose weight effortlessly, and reverse their type 2 diabetes within weeks. We have seen these benefits endure in our patients and ourselves for years. Patients have been able to get off their medications and save money. Further, we know from the medical literature that our decisions and recommendations are based in sound science.
We ask: why does U.S. News appear to be pursuing a campaign to denigrate low-carb and ketogenic diets? We note that the “Best Diets” annual cover story routinely puts these diets at the bottom of the list, without any explanation or citation of the evidence. We have observed that the panel of experts assigned to rank diets includes many vegetarian/vegan advocates but not a single authority experienced with the practice and perhaps even the literature of low-carb or ketogenic diets. This is not balanced reporting for your readers and yields results that do not reflect the current science.
We also note that the recent article on Virta cites criticism by the Physicians Committee for Responsible Medicine,” which is an animal-rights group with physicians representing fewer than 10% of its members. Animal-rights groups tend to be opposed to low-carb diets based on the faulty assumption that these diets are based entirely on animal foods.
We don’t understand why U.S. News would promote ideological agendas and weak science. We urge you to develop a more balanced and evidence- based approach to your reporting on the science.
If you could meet one of our patients, with obesity and diabetes, facing limb amputation—as we have—we feel you would be more responsive to the science that would help your many thousands of readers. They deserve to know the best and most current science on how to get healthier.