Reversing Diabetes- The Beginning of Virta Health and West Virginia Connection
In Spring of 2016 two pioneers Sami Inkinen and Dr. Stephen Phinney visited Jefferson Medical Center and our community with a bold idea of reversing diabetes 100 million patients worldwide. Their company was to be called Virta Health. They choose our community to share the idea as we had already implemented much of what they envisioned at a large scale- an “all in” approach to teach patients to understand their diabetes, the effects of food (especially the carbohydrates), and how to give support to those willing to believe and heal. We had already taken sugar drinks out of our small hospital and offered low carb meals allowing us to reduce medications for hospital patients. We hosted many free community meetings on the topic, and set the foundation for the clinic where I work now- the WVU Center for Diabetes and Metabolic Health.
Dr. Stephen Phinney is a pioneering physician, researcher, and endurance athlete who challenged the low fat lifestyle and “carbo loading” over 30 years ago. The academic elite’s attempt to suppress him and the resistance of medical journals to publish his science is another sad chapter in the ongoing food fight and public health disaster of obesity. Dr. Phinney is now vindicated by almost everything we know now on the science of obesity and sports nutrition and has authored over 300 research papers. Together with scientific partner and Virta Co-founder Dr. Jeff Volek they have over 1000 publications.
Finnish Entrepreneur Sami Inkinen is a World Amateur Ironman Champion with 8:24 Personal Best achieved on a combination of diet (70% fat) and limited training time (10-12 hours/wk). Sami and his wife Meredith Loring rowed from San Francisco to Hawaii unsupported in an incredible 45 day record breaking ultra endurance achievement called the “Fat Chance Row”. Achieving this feat without any measurable breakdown in the body speaks volumes for the protective capacity of a well formulated, low carb diet. Sami and Meredith raised over $200,000 for Dr. Robert Lustig’s foundation studying the harmful effects of junk food and sugar.
The movie “Cereal Killers 2- Run on Fat” charts world class triathlete Sami transition from pre-diabetic sugar burner to a faster, healthier, fat fueled endurance athlete under the guidance of Dr. Stephen Phinney. Sami, who used to follow flawed conventional wisdom and eat lots of carbs to fuel his sport, was diagnosed as a pre-diabetic. When he switched to a low carb diet he was able to reverse his diabetes without suffering any drop off in his athletic performance. In fact, he even got faster and “bonk proof”. In an anti-sugar crusade Sami and Meredith rowed 4,000 kms unsupported from California to Hawaii and in the process give us a window into the astonishing capacity of how the body burns fat . Together these two pioneers would form Virta Health.
[For my story of Fat Adaptation and incorporating the work of Drs Phinney and Volek go here]
As a person with a type of diabetes called MODY (maturity onset diabetes of youth) ,which is low insulin state, I was invited to be an early participant in the Virta program and technology. (Note: Most with Type 2 Diabetes have insulin resistance and a high insulin state– leading to fat accumulation and obesity also). A kit showed up at my house with a scale that connected to the cloud and a glucose and ketone meter and the Virta App where I uploaded my data daily. The meters now are Bluetooth with auto upload to a cloud dashboard. A highly trained health care professional would see my readings daily and communicate. Already having knowledge and experience in low carb my needs were minimal, but most new patients have 3 to 4 brief text interactions daily as they are learning and adjusting medications.
For a deeper dive into Virta I had the privilege in 2017 to visit their lead researcher Dr Sarah Hallberg of Indiana University and witness her busy clinic of prescribing hope. The Virta research trials were taking place there with Dr. Hallberg the lead clinical investigator. For most diabetes is a disease of despair with constant warnings of progression, complications, and a lifetime of escalating medication. Prescribing hope is when we share with patients there is a way out and it is a healthy sustainable path. Dr. Hallberg’s 2015 Ted Talk Reversing Type 2 diabetes starts with ignoring the guidelines has over 8 million views and she has been the lead author on multiple scientific publications over the last 5 years even while battling Stage 4 Lung Cancer. I dedicated a recent talk at Low Carb Boca to her as she has been my inspiration for courage in the field of medicine and in life.
The American Diabetes Association (ADA) slow acceptance of Low Carb Diets
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. The lead statement in the 2017 ADA Standards of Medical Care in Diabetes stated this “Diabetes is a complex, chronic illness requiring continuous medical care….”. Not a very hopeful message for those suffering with the condition.
Virta’s work and results 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 has sustained the results out to year two in an ongoing 5 year trial , 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. The progression of fatty liver also retreats on this way of eating and the only treatment for this condition is “weight loss”. Three quarters of patients stayed with the program after 2 years.
Virta’s results are in agreement with 100s of analysis and 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. Virta’s 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.
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]
According to the evidence, therefore, WVU’s partnership with Virta, is a highly rational decision. WVU’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 most gain weight and get sicker. Some of us got 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. Out of this global clinical work we built The Society of Metabolic Health Practitioners and we published clinical guidelines to assist other clinicians in the methods .
Back to the Future- the Collision of 2 Pandemics and Taking Action!
The colliding pandemics of Covid 19 and Type 2 Diabetes has inspired WVU Medicine to take tangible and bold action in 2022. More than 16 percent of West Virginia’s population has been diagnosed with diabetes, equating to more than 232,000 residents, according to the American Diabetes Association, and the highest proportion of any U.S. state, according to America’s Health Rankings. West Virginia also leads the nation in deaths from diabetes and in adult obesity rates. The economic burden of diabetes is huge. Data gathered by the American Diabetes Foundation shows West Virginia spends approximately $2.5 billion on health costs related to diabetes and prediabetes each year. Evidence and the ongoing experience shows a major contributor to the severity of COVID-19 and its complications is the presence or emergence of diabetes in the affected individuals. More than a third of people with COVID-19 who require hospitalization suffer from diabetes, with a case fatality rate far greater than well people.
“Managing” Type 2 diabetes in the traditional way is not the solution. Making diabetes go away is. Helping the large volume of patients achieve diabetes remission cannot be done with traditional “management” which does not result in diabetes remission. Now after several months of discussion, sharing the science, and sharing stores of some of our local amazing patients, the West Virginia University Health System (WVU Medicine) is partnering with type 2 diabetes reversal leader Virta Health to offer its virtual diabetes reversal treatment to eligible employees in West Virginia and across the country. As the state’s largest private employer, WVU Medicine’s collaboration with Virta provides hope for significant improvement in metabolic health in the Mountain State.
“Type 2 diabetes is one of the biggest health issues facing West Virginians — and our employees are no exception,” Michael Edmond, M.D., WVU Medicine chief medical officer, said. “Our partnership with Virta is a key stepping stone toward ending this epidemic and one that we hope creates a ripple effect to spread diabetes reversal across the state.”
In Virta’s peer-reviewed clinical outcomes, the majority of completing patients achieve blood sugar below the diabetes threshold, while removing or reducing the need for medications such as insulin. Over two years patients also saw over 10 percent weight loss and improved over 20 markers of cardiovascular health, including blood pressure.
The magic touch is what is termed a “continuous care model”. Most of disease management is done in “episodic care”- when you come in for visits at set interval but there is little to no interaction between visits, and no coaching or support. The Virta model is a fully virtual, high-touch care model. Via the Virta app, patients interact — often multiple times per day — with clinicians and health coaches, who provide personalized dietary recommendations, monitor biomarkers, and de-prescribe medications as needed. This continuous remote care drives adherence and retention, even with rural and other hard-to-reach populations. In the 2 year study 75% of the patients stayed on the program. This adherence is far superior to standard care where many diabetes patients do not follow up and are often labeled “non-compliant”. Maybe we just need to give more support and care? A recent published Virta study even supports the positive outcome with depression and poor mental health, another pandemic in our region.
“Partnering with WVU Medicine provides an opportunity to reverse the unsustainable trajectory of diabetes in West Virginia,” Sami Inkinen, Virta Health co-founder and CEO, said. “We look forward to establishing our footprint here to help residents reverse their disease and take back control of their health.”
In summary diabetes is still undefeated and deaths and disability are rising annually. A recent expert panel urged Congress to overhaul diabetes care and prevention, including recommendations to move beyond a reliance on medical interventions alone. From the report:
“Diabetes in the U.S. cannot simply be viewed as a medical or health care problem, but also must be addressed as a societal problem that cuts across many sectors, including food, housing, commerce, transportation and the environment,” the commission wrote in its Jan. 5 report to Congress and the U.S. Department of Health and Human Services (HHS).
“We aren’t going to cure the problem of diabetes in the United States with medical interventions….”
Hmmmmm….maybe the scientifically proven Virta approach if scaled up can be the answer.
Under the arrangement, WVU Medicine only pays for successful health outcomes tied to diabetes reversal metrics. Virta is available to eligible WVU Medicine employees and dependents at no additional cost.
To learn more on Virta go here: www.virtahealth.com/join/wvum or reach out to support@virtahealth.com .
For a webinar on the Virta program go here
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Dr Mark Cucuzzella is Professor at WVU School of Medicine and practices at WVU Center for Diabetes and Metabolic Health and Shepherdstown Primary Care.
He is also the lead author of a recent paper from the International Working Group on Remission of Type 2 Diabetes on safe medication reduction in Type 2 Diabetes
Mark is a founding member and Board member of The Society of Metabolic Health Practitioners.
Mark has a similar mission as Virta Health https://wvliving.com/a-man-on-a-mission/
And from the Benedum Foundation Annual Report p 14-19
March 2016- Sami Inkinen and Dr Stephen Phinney address a local audience at Mellow Moods Café Shepherdstown
Dr. Mark Cucuzzella introduces Sami and Dr Phinney and discusses low carbohydrate diets in 2016
A Fork in the Road- Which Do You Take? A lifetime of medication or lifestyle medicine to restore health?
Patients now have the option with Virta Health
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Here is a flyer for WVU Medicine Employees and family members with Type 2 Diabetes. Contact them if you feel this may help you!
