The assertion is at the heart of an ongoing debate about the keto diet’s effect on diabetes. Some diabetes experts are skeptical of Virta’s promise and are expressing concerns that the company’s partnership with the federal government is giving the diet too much credence.
Despite its strict requirements, the keto diet has gained popularity in recent years with consumers and studies noting it helps shed pounds and can lead to improved health. But the company’s claim about reversing diabetes is unusual. Type 2 diabetes is often linked to excess weight, and the company said its studies suggest that significant weight loss through keto can lower patients’ blood sugar and their need for diabetic medications.
The diet has won support among some diabetes researchers and patient groups. But other public health advocates are concerned that the science of treating diabetes with a keto diet is not well studied. They worry about keto’s effect on the heart and the scarcity of vegetables and fruits generally in the diet.
Under the accord, Virta is providing its services free to about 400 VA patients for a year while federal officials evaluate the service and their health.
But Virta declined to provide KHN with underlying data, citing the need to protect patient information. It did arrange an interview with its then-chief counsel and vice president of finance, Anand Parikh. He said he expected the partnership with the VA to soon expand. Parikh, who left the company in December, said that future government collaboration will likely involve payment to Virta but that it was too early to estimate a price. The treatment currently costs other patients $370 per month, plus a one-time $500 initiation fee.
A VA spokesperson did not respond to detailed written questions concerning the partnership.
Virta offers diet coaching, monitoring, and support through a smartphone application. Patients can use the services around the clock and regularly upload their blood sugar readings and other medical details, such as weight and blood pressure.
“One of the most important things about our approach is that we individualize for each person,” Parikh said.
The VA’s work with Virta has raised alarm bells, including on Capitol Hill.
In October, Rep. Josh Gottheimer (D-N.J.) sent a letter to Wilkie saying that the “partnership between the VA and Virta Health Corporation provides tacit approval of the ketogenic diet as a means to reverse the impacts of type 2 diabetes.” His letter also added, “Promoting a ketogenic diet for patients with diabetes may put them at increased health risk.”
Virta’s Studies Find Benefits of Keto
Virta officials first floated the idea of a partnership during President Barack Obama’s administration. A deal was finalized last year after former Rep. Jeff Miller (R-Fla.), who is now a Washington lobbyist, signed up to work for the company. Miller retired from his seat in January 2017 after serving as the powerful chairman of the House Veterans’ Affairs Committee for six years.The day after registering as a lobbyist for Virta, Miller sent a note to Darin Selnick, then a senior VA political appointee, with proposed language for an agreement between Virta and the VA, according to emails obtained through the Freedom of Information Act. Selnick reviewed it, then passed it along to an official in the VA’s research department.
Parikh said the VA thoroughly evaluated Virta’s research before the deal was done. The partnership was announced in May.
Virta was founded in 2014 by venture capitalist Sami Inkinen after doctors told him he had signs of a prediabetes condition. Joining him were Dr. Stephen Phinney and Jeff Volek, who researches low-carb diets. The two had written a book about the Atkins diet, which also emphasizes severely limiting carbohydrates and turning to some high-fat foods.
Still, many health experts said there is little evidence the diet can produce long-term results that ameliorate diabetes.
Proponents of the keto diet note that a vegetarian option is also available.
The papers were peer-reviewed, yet they are all based on a single, non-randomized clinical trial of 262 patients, which was funded by Virta. Among the authors of these papers are Volek and Phinney.
Concerns About Missing Nutrients in the Diet
Dr. Randall Stafford, who directs Stanford University’s Program on Prevention Outcomes and Practices, reviewed Virta’s research and called the results “encouraging.” Yet he said the control group was “fairly useless, given that it was composed of people who did not want to change their diets.”Stafford said results don’t suggest that Virta’s treatment alters diabetes.
“My interpretation is that the keto diet is a temporizing measure, not a cure,” he said.
In April, the Physicians Committee for Responsible Medicine, a nonprofit research and advocacy organization that advocates for plant-based diets, urged Wilkie in a letter to cancel the Virta partnership.
“The company’s approach is to place patients with diabetes on a low-carb ketogenic diet,” the letter reads. “At best, this type of diet may act as a ‘Band-Aid’ for diabetes, yet it carries serious health risks,” including higher cholesterol levels and nutrient deficiencies.
“Any diet can be effective when bundled with intense lifestyle interventions,” Joshi said in an interview. “The real question needs to be over the long-term benefits of the diet itself.”