It’s been a while since we checked in on Virta Health. The type 2 diabetes management program was founded by some of the most influential names in the ketogenic diet movement, and its customers serve as one of the best sources for real-world data on the effectiveness of low-carb diabetes management.
Virta is founded on the belief that a low-carbohydrate diet works wonders for people with diabetes. Kevin Kumler, Virta Health’s president, told Diabetes Daily that “Virta works. It’s sustainable; it’s durable; and people can maintain blood sugar control, weight loss, and stay off the medications.”
“This isn’t a 12-week crash diet. This is a permanent change. We’re going to work with you day by day to change your relationship with food in a way that you like and in a way that your body responds to.”
How Virta Works
Virta is a virtual health clinic. Participants interact with Virta clinicians and coaches using their smartphones. Most messages are sent by text, though you can set up live calls and chats. The average patient is communicating with Virta “two to four times per day” when they start, says Kumler. “And that’s the level of support you may need if you’re going to make a real lifestyle change.”
Virta doctors officially take over your type 2 diabetes management care, including your prescriptions, which makes sense, because a stated goal of the program is to reduce participants’ reliance on diabetes drugs.
“It’s a coach in your pocket helping you eat differently so that you can be healthier. If you have type 2 diabetes, it can help you get your blood sugar under control without drugs. If you’re using drugs to control your blood sugar, we’re gonna try to work with you to get you off those drugs.”
Kumler says that the status quo just isn’t working for most people with type 2 diabetes:
“They see their doctor twice a year for six minutes. They’re given some cursory coaching on lifestyle and a retitrated drug regimen,” and sent home. “Many times patients are told to do the impossible. They’re put on insulin and told to lose weight, which is a really hard thing to do.”
Kumler has personal experience with poor diabetes outcomes, which helped lead him to Virta. His father died from complications of type 2 diabetes: “He got the usual care. He was a physician; he got medication and more medication. He was told it was a progressive disease, that he would have it for the rest of his life.” It led to amputations and, eventually, death.
But when Kumler learned about low-carb, he says, “I realized there was a better way.”
‘Reversing’ Diabetes
Virta has a potentially controversial marketing message: The business loudly proclaims that it can reverse type 2 diabetes. The word reverse conflicts with the public health consensus on diabetes treatment.
In 2021, a consortium of major international diabetes organizations coauthored a consensus statement on the definition of type 2 diabetes remission. In considering the issue, a panel of experts rejected the broad use of the term reversal because it carries an implication that the disease has been cured or resolved. It is widely believed that even in the most emphatic cases of diabetes remission, the disease will easily reoccur if the changes that prompted remission (including lifestyle shifts or new medications) are undone.
Virta doesn’t disagree with the consensus at all: “We agree with that. That’s absolutely true.” But Kumler believes that reversal is an apt term for people who can stick with the program for good.
“Our approach to reversal is that reversal is the process. … I don’t care what you call it. It’s getting a person off their drugs, getting their blood sugar under control, helping them lose weight.
“The word remission makes it sound like it’s in hibernation, just waiting to pounce on you at any given moment. But with a lifestyle change, that’s not the case.”
The Virta Diet
A ketogenic diet is the very heart of the program. Kumler describes it as “low-carb, high-fat for satiety, and moderate protein.”
If you have diabetes, you probably already understand why it makes sense to eat fewer carbs, the part of our diet that most obviously leads to high blood sugar levels. The American Diabetes Association has agreed that “Reducing overall carbohydrate … has demonstrated the most evidence for improving glycemia.”
The long-term safety of low-carb and ketogenic diets remains a matter of dispute and conjecture. Many low-carb eaters find themselves eating plenty of red meat and saturated fat, ingredients that are highly associated with cardiovascular disease and other long-term health issues.
There’s more than one way to do low-carb, of course, and Virta doesn’t mandate that its participants eat any red meat at all. Virta was co-founded by the two scientists who advanced the theory of a “well-formulated ketogenic diet” replete with “valuable micro-nutrients and minerals from vegetables, nuts/seeds, and berry fruit.” Virta coaches “help each individual match this lifestyle to their own personal preferences and what their body tolerates and what they’re excited to eat for the rest of their lives,” says Kumler.
Though Virta also offers advice and support on topics like exercise, sleep, and stress management, they’re not the emphasis of the program. Carbohydrate restriction is the foundation for everything, and Virta’s experts believe that the diet alone can yield secondary benefits. The data backs up this claim, suggesting that Virta participants enjoy improvements in sleep quality and depressive symptoms.
“At the core, it’s really about helping people eat in a way that their body is going to respond well to,” says Kumler.
And there is some wiggle room. “People can add some carbohydrates back into their diet over time to make it more sustainable … this isn’t built on willpower; it’s based on you eating foods that you like.”
The Results
The signature validation of the Virta Health method was published in June 2022: the results of a five-year study of the outcomes of 200 Virta patients.
Participants enjoyed:
Weight loss (an average of 19 pounds)
Improved A1C (a drop of 0.3 percent)
Lower fasting insulin levels
Improved insulin sensitivity
Better triglycerides and HDL (“good”) cholesterol results
Reduced inflammatory markers
Fewer diabetes medications (total diabetes medications reduced 46.6 percent)
While the A1C improvements weren’t enormous, and only a minority of participants met the clinical definition of diabetes “remission,” most people with diabetes would probably be elated with these results. Study participants were able to improve their blood sugar control and other metabolic risk factors despite aging five years, even while dropping so much medication. (The expectation, of course, is the opposite: that as type 2 diabetes progresses, patients will experience rising blood sugar levels despite using more medication.) Of note, about half of the participants who had previously been prescribed insulin were no longer using the drug at the end of the five years.
The results certainly require a large grain of salt. This wasn’t a rigorous study with controls; it was entirely undertaken by Virta Health employees, and it seems extremely subject to selection bias. Dozens of patients dropped out of the program, and their results, which were presumably not quite so successful, are not included in the above numbers.
Nevertheless, it seems clear that some Virta members are thriving on the program. Kumler even shared that a growing number of Virta participants have gotten tattoos of the company logo.
Other smaller studies have shown that the Virta protocol improves metabolic health across the board: “improved liver health, improved kidney health, improved cardiovascular health, improved mental health,” according to Kumler.
Keto in the Age of Ozempic
I asked Kumler if blockbuster diabetes drugs like semaglutide (Ozempic) and tirzepatide (Mounjaro) are a threat to Virta’s business model. He’s emphatic that they are not, for several reasons.
“The idea of these drugs as a quick fix is a bit of a fallacy. They haven’t shown to be a fix without fundamentally addressing lifestyle,” says Kumler. “In many cases, people are using them intermittently or discontinuing them without changing their underlying lifestyle. That means the weight’s going to come back.”
Experts believe that drugs like Ozempic need to be taken indefinitely to sustain weight loss, glycemic control, and other benefits, according to Everyday Health. Virta’s program, therefore, could offer patients a way to supplement their Ozempic weight loss. It could also help people maintain weight loss after transitioning off the drugs, which can be extraordinarily expensive.
Kumler also believes that Virta’s results are impressive enough that the program should be considered at least as beneficial as, and perhaps superior to, the new generation of weight loss drugs. More broadly, Kumler says that the drugs are more likely to help more people find Virta Health, because they have helped show that sustainable weight loss isn’t impossible.
Virta also boasts that its program benefits everyone across the socioeconomic spectrum, helping to address some of the persistent inequities that have led to disproportionate rates of poor diabetes outcomes in minority communities.
Most Virta Health users have the program reimbursed by insurers or employers. Virta has inked deals with several large insurers, including Blue Shield of California, which has reported that its members using Virta have responded with lower A1C, weight loss, and elimination of more than half of their diabetes medications (not including metformin).
A smaller number of patients pay for Virta Health out of their own pockets, and the business is currently expanding its offerings for people with obesity and prediabetes.