Stating the Obvious

With today’s 24/7 barrage of news and information, it’s hard to decipher what’s really important, what is actually true & factual, and what pieces of “news” are so obvious that we have to stop and question whether those are actually newsworthy at all.

A few days ago I came across a news article with the following headline: “A Low-Carb Diet Could Help Stave Off Diabetes.” Having to pause for a “captain obvious” moment, I clicked on the article to investigate what new level of brilliant insight might be included in the article.

Low-Carb as Possible Prevention

Researchers from Tulane University conducted a study where they compared two groups of subjects. One group ate a low-carb diet, the other group ate a standard diet. In a period of 6 months, the low-carb group had lower A1C levels, had lost more weight, and exhibited lower fasting blood glucose levels compared to the standard diet group. This is hardly shocking news as millions of people worldwide are approaching low-carb lifestyles with similar, if not much more measurable results than found in this study.

Within the study, two elements about the low-carb subject group stand out:

  1. The researchers had the low-carb group begin the test (first 3 months) with 40g of net carbs/day, then in the second 3 months, increase their carbs to 60g of net carbs/day. Knowing that it takes time for a body to shift from being fueled by an over-abundance of sugar/glycogen to being fueled by ketones, increasing the carbohydrate level after 3 months seems like an odd variable to introduce into the study.
  2. Additionally, the study explicitly states the subjects who ate low-carb were directed to focus on “net carbs”, which we know can be suspect in terms of enabling ketosis. The market is littered with foods that claim to be “keto” or “keto friendly” that offer undesirable ingredients like soluble corn fiber, tapioca starch, chicory root fiber and other bulking agents or fillers. Sure, these products can contain fiber that, on paper, lower the gross-to-net carb ratio, but do nothing to help the body move into ketosis, not to mention cause undesirable GI distress. So, is it possible a low-carb respondent in this study was actually eating 100g of carbs, but 40g came from a mix of these types of products? It’s possible…we just don’t know.

Pre-Diabetes: The Precursor

We know there is ample evidence applying a ketogenic diet to people who have Type 2 Diabetes (T2D) can dramatically improve their condition, even completely removing their need to use exogenous insulin. But importantly, the researchers sought to understand whether it would be possible to use a low-carb diet to help change the spiraling metabolic health of those who are pre-diabetic. Most estimates in the U.S. peg the number of adults considered pre-diabetic at around 90M, which would be over 40% of the adult population. So, changing the trajectory for these adults would help them reverse their metabolic condition, lead a healthier life, and reduce the enormous pressure on our medical system and economy having to treat chronic disease.

If we know T2D is a disease of insulin resistance, and we know an overconsumption of carbohydrates is a major driver of that insulin resistance, then changing the dietary pathway to a low-carb or even ketogenic lifestyle to reverse the T2D would make logical sense. That is exactly the pathway Virta Health is taking as well as leading thought leaders in this area such as Dr. Eric Westman at Duke University. What makes treating insulin resistance, or pre-diabetes, more difficult is it takes time to develop, so the damaging effects are not immediate, thus the urgency to change course happens when it’s too late. Here’s an analogy. Think about pre-diabetes as an earthen dam on a river. At first, the dam is effective at stopping the water. But over time, the water begins to find its way through cracks and crevices within the dam, and as that happens more often and with greater force, the dam weakens, and eventually begins to crumble. There will come a point where the dam breaks, but it takes time & pressure to cause that breakage. The development of pre-diabetes happens in a similar fashion.

How to Assess Pre-Diabetes

The first step we need to take is to embrace the science and admit that T2D is a disease of insulin resistance, which is exacerbated by a carbohydrate-heavy diet. We’ve discussed the failure of the U.S. Dietary Guidelines at length at

Secondly, we need to instill a metabolic health assessment as part of early-life health assessments. Given we are seeing younger people become insulin resistant and suffer from T2D at earlier ages, these metabolic assessments need to start in the teen years.

Thirdly, if an adult has not had a metabolic assessment, a situation assessment is mandatory with some important tests as described by Mayo Clinic: A1C, Fasting Blood Sugar, & Blood Glucose.

Finally, at the risk of stating the obvious, drop the carb levels significantly. Start with eliminating sweets, breads/starches, soft drinks, snacks (ie, potato chips, pretzels) and all the empty calories that contribute to this condition. Moving to a low-carb diet is a good first step (< 140g total carbs/day), but becomes even more powerful when combined with a solid exercise plan and intermittent fasting.

An Inconvenient Truth

We’re metabolically sicker as a human population than we’ve ever been, and the truth is staring us right in the face. Too much processed food, WAY too many carbohydrates and sugars, an over-abundance of seed/vegetable oils, an obsession with snacking, loosing sight of food as medicine and relying on pharmaceuticals, and an unwillingness to admit the inconvenient truth that our dietary habits are driving metabolic disease. It’s imperative we open our eyes and use our critical thinking skills to observe what is happening. Once we do, we have to drive change, and it starts with each of us trying to share evidence about a better way. We can’t rely on captain obvious…it’s on us.