Virta Health: Reversing Type 2 Diabetes with Low-Carb Diets & Coaching

By Ben Pallant, Abigail Dove, and Adam Brown

Study shows a 1% A1c reduction in ten weeks with reduced or eliminated medications in most participants. Is it the real deal? Read on for the details!

A brand new company called Virta Health launched this week with a bold vision to "reverse" type 2 diabetes without medications or surgery. The Virta model relies on extremely low-carb diets – less than 30 grams of carbs per day – paired with a diet high in fat and moderate in protein (learn more below). Virta calls itself an “online specialty medical clinic” because participants get access to a health coach and physician, online peer support, and ongoing information and feedback on their health.

Along with the launch, Virta published a 10-week study showing that its approach drives strong outcomes: 1% improvement in A1c (from 7.6% to 6.6%), significant medication reductions (especially in insulin users), and an average 7% body weight loss. Is this the real deal? Read on below for more details on the study, the program, and a Q&A with Virta.

Virta is currently available to people with type 2 diabetes and prediabetes as a covered benefit through some employers/health plans, as well as to people able to pay out of pocket (cash pay). Financial assistance is available, as the typical cost is roughly $400 per month for the first year. Those interested in Virta can get more info here and apply for a free consultation here.

What kind of outcomes has Virta demonstrated?

Virta just published the results of its first 10-week study. The trial involved 262 people with type 2 diabetes, and the results are very encouraging so far:

• In ten weeks, the average participant’s A1c dropped by 1% from an average starting A1c of 7.6%. By the end of the study, over half of the participants had an A1c less than 6.5%, the cutoff generally used to define type 2 diabetes.

• 75% of participants lost at least 5% of their body weight, and the average weight loss was about 7% – for example, a 200-pound person losing 14 pounds. In preliminary six-month data posted on the company’s website, average weight loss has increased to 12%.

• More than half of participants in the study reduced or eliminated their use of at least one diabetes medication.

• An impressive 87% of those using insulin either decreased their dose or eliminated their use of insulin altogether.

• 91% of those enrolled in the study completed it, and participants reported the same level of hunger at the study start and after 10 weeks. That indicates the low-carb, high-fat approach was sustainable for most participants and didn’t require starvation. Virta personalizes the food plan and is not focused on counting calories.

• Some participants in the study were newly diagnosed, while others had longstanding diabetes. The 262 study participants had an average age of 54 years.

• Virta may be best for those who have flexibility on what they will eat – not everyone will want to eat less than 30 grams of carbs per day, though many Virta users have been surprised at how filling the low-carb approach is.

It is important to note that these are short-term results, the study had no control group, and the participants may not be typical of people with type 2 diabetes as a whole, so it is hard to draw strong conclusions at this point.

However, it is known that sustained and significant weight loss – achieved by any method – can improve A1c and even cause remission of diabetes, usually in those who have had type 2 diabetes for a duration of less than 10 years. But it's hard to maintain weight loss for a long period of time, so it will be interesting to see the results of Virta's approach as the study continues over the next two years.

It is great to see Virta committed to sound research, even though it's challenging to do well in nutrition. The company’s Chief Medical Officer, Dr. Stephen Phinney, and Chief Science Officer, Dr. Jeff Volek, are respected researchers in this area. This study builds on many low-carb trials in diabetes; see a list from Virta here and a recent review article here.

What is nutritional ketosis?

When carbohydrates aren’t available as a sufficient source of energy, the body starts using fat as an alternative form of fuel. It does so by converting fat into ketones, which cells are then able to use as fuel. This process is called "nutritional ketosis". Virta relies on extremely low carbohydrate diets with less than 30 grams of carb intake per day to induce a controlled state of ketosis. Interestingly, Virta doesn’t set any limits on how many calories participants can consume overall (this is similar to the well-publicized Atkins diet). All that matters is that the calories come from mostly fat (over 70%) and moderate protein, with virtually no carbohydrates.

Ketogenic diets like Virta’s should be approached with caution, since eating less than 30 grams of carbs per day is far lower than most people typically eat. Virta relies on individualized coaching and planning, medical expertise, and careful monitoring to make sure that participants taking diabetes medications undergo ketosis safely – read more details on safety here. For example, if insulin is dropped too significantly, diabetic ketoacidosis (DKA) is possible, which occurs when ketones reach dangerously high levels. As always, it’s important to talk to a medical professional before making any extreme changes in what you eat. diaTribe is glad to see that Virta has a team of physicians and coaches focused on safe carbohydrate restriction.

What do people with diabetes think?

It will be interesting to see how long people stay on Virta’s program in the long run – that will be the measure of the success. But for now, there are certainly some happy participants – on Virta’s website, see testimonials from Wilma, Jerry, Robin, Tim, and nearly a dozen other people with diabetes, as well as from several doctors, including Dr. Mark Savant from San Francisco, CA, and Dr. Denise Bilbau, an internist in Portland, OR, who works with Kaiser. All the interviews are very interesting, and diaTribe highly recommends them to anyone hoping to hear more views about Virta.

diaTribe’s own Adam Brown has shared many of the benefits of eating fewer carbs in his column, Adam’s Corner: more time-in-range, less hypoglycemia, less medication, less diabetes hassle and math, and much higher quality of life. As an insulin user, Adam has likened eating fewer carbs to putting diabetes on cruise control, rather than a rollercoaster.

Q&A with Virta

diaTribe (dT): How will the individual version of Virta Health be priced? 

Virta Health (VH): Most of Virta's patients come through employer-sponsored health plans, and Virta is covered for those people. For patients who come to Virta directly, we offer an out-of-pocket (cash-pay) option that costs roughly $400 per month for the first year. Virta has both monthly and yearly payment options, and also offers a patient assistance program based on the ability to pay. After you apply online, you’ll receive more information about Virta that includes pricing details, which you can review before scheduling a consultation.

dT: What does the free consultation entail?

VH: After you apply, you’ll receive an email with directions to schedule a consultation phone call where one of our specialists will tell you more about our program, and overview of our approach and the science behind it, and more detail on what you’ll experience.

dT: What employers and payers are now offering Virta?

VH: Virta is available to employers, health insurers, and health systems, and we’ll be announcing some of our customers soon. In the meantime, people with type 2 diabetes should check with their employers to see if the Virta Clinic is part of their covered health benefits. [Editor’s note: Our guess is that to date, most employers will not have heard of the Virta Clinic, but we encourage those to ask who are interested in this service.]

dT: Can physicians refer anyone to Virta now? We see a physician can request more info, but then what?

VH: Yes, physicians can refer patients now to Virta. If you’re a physician, you can schedule a call with our specialists to discuss a patient referral here. During the call, physicians can learn more about the referral process, as well as background on our clinical trial and how Virta can be a partner for physicians looking for specialty care for their patients with type 2.

dT: Can Virta be used for people with prediabetes or people with type 1?

VH: Virta is available for people with type 2 diabetes and prediabetes, but not for those with type 1 diabetes.

dT: Virta’s stated goal is to reverse type 2 diabetes in 100 million people by 2025. Can you say more about that? A lot of the 415 million with diabetes haven’t even been diagnosed. Is the assumption that most people who try this won’t have a problem with the diet?

VH: To reverse type 2 diabetes safely and sustainably in millions of people, we needed to change the care delivery model from a periodic physician visit to continuous and highly personalized care in an outpatient setting. And so, we formed Virta with a mission to reverse type 2 diabetes in 100 million people by 2025, and empowered our physician-led care team with a technology platform that enables remote care and ongoing personalization. We have a lot of work ahead of us, and that’s why we’re deeply committed to research and evidence in all that we do.

dT: What has building Virta meant to you, Sami (Virta’s CEO and Founder)?

Sami: Besides my own family, starting and building Virta has been the most purposeful and meaningful thing I’ve done in my life so far. There is no better reward for our hard work than hearing things like ‘you saved my life’ and ‘you gave my life back’ from our patients. I hope more and more entrepreneurs will focus on big, meaningful problems like diabetes.

[Editor's Note: diaTribe is no longer accepting submissions to do a Test Drive of Virta involving our readers. If you have already reached out about trying a free, 12-month trial, you will be hearing from us soon!]

[Photo Credit: Virta Health]