Dr. Sarah Hallberg made several career pivots—all fueled by her anger at unscientific and harmful practices perpetuated by the medical community—before becoming Medical Director at Virta Health. In this talk, delivered on Dec. 15, 2018, at a CrossFit Health event at CrossFit Headquarters, Hallberg speaks about some of those unscientific and harmful practices, specifically those pertaining to the management of obesity and Type 2 diabetes (T2D). She outlines the physiological problems inherent in treating T2D with insulin, the benefits of treating the disease with a carb-restrictive diet, and the data from a recent Virta Health study that demonstrates the positive effects of carb restriction.
Hallberg began her career as an exercise physiologist but decided to go to medical school when she discovered the misguided exercise advice a cardiologist with whom she worked was doling out to his patients. After medical school, she became a primary care physician, but she knew her career path would involve another pivot when she realized, “I am part of the problem. I am doing nothing helpful here. I am a drug dealer.” That pivot occurred when Indiana University Health asked her to develop an obesity program.
Hallberg delved deeply into the scientific literature on obesity. Her reading was fueled by a curiosity about why, when she was a physician, none of her patients were losing weight with the recommended low-fat diet. She soon discovered there was no scientific basis for this recommendation. There was, however, a considerable amount of data supporting carb restriction, so this is the treatment they recommended through the Indiana University program.
After Hallberg performed a TED Talk at Purdue University, 500 people enrolled in the program. Not only did those who followed the low-carb recommendation lose weight; many were cured of T2D as well. Hallberg notes that after one year, “60% of the patients with Type 2 diabetes had reversed their diabetes,” and 83% of participants were able to adhere to the diet.
With more than 50% of adults in the United States suffering from diabetes or prediabetes and health-care costs on the rise, Hallberg claims we are collectively experiencing a “slow suicide under the direction of bad advice.” She concedes that solving the problem of health care is a “David and Goliath situation” and says, “The Goliath is the status quo.” To make the necessary changes, she insists, we have to band together and remember that we have science on our side.
Read a transcription of the presentation here.
Comments on Dr. Sarah Hallberg on Carb Restriction as a Sustainable Diabetes Treatment
Just watched this again, and even better the second time around. Also kind of ominous how she made the hypothetical scenario about 50% of people catching an infectious disease.
The world has lost a brilliant, probing mind. It's up to all of us to continue her mission and identify how we are part of the problem and what we can do to improve the situation.
This was great to watch, delivered with great energy and passion and with a message so straight forward and non-complex that there will be continued success in Dr Hallberg's work. The world has lost a true gem in her passing. Long live her legacy.
Great simple explanation. Especially like the fact she wants to educate the patients so they can make the best choice to reverse (or improve) their condition.
As recently as 2009 Vivian Fonseca, the editor-in-chief of the American Diabetes Association’s journal Diabetes Care, could open an article in his journal with the words “Type 2 diabetes is a progressive disease …” Dr Sarah Hallberg, of the Indiana University Weight Loss Program, believes that ain’t necessary so.
Before 1977–before the Federal government first advised the people of America to eat more carbohydrate and less fat–patients with diabetes were given sane and sensible dietary advice: type 2 diabetes is a disease of carbohydrate intolerance, so patients were advised to avoid carbohydrates. Those were the days of special diabetic foods such as low-sugar jams, but such foods are no longer much marketed, because type 2 diabetics have in recent decades been told to treat fat, not sugar or carbohydrate, as the enemy.
The war on fat was declared by Ancel Keys (1904-2004), a physiologist from Minnesota, who argued that because atherosclerotic plaques are full of cholesterol and other fats, people should avoid fatty and cholesterol-rich foods. And his argument was urgent because the US suffered, after the war, from an epidemic of heart attacks. And since diabetics, too, are prone to cardiovascular disease, they too were steered away from low-carbohydrate foods to low-fat foods.
Which Sarah Hallberg finds ridiculous. As she protests, type 2 diabetes is a disease of carbohydrate intolerance, and if patients suffer from an increase in heart attacks and strokes, perhaps their high levels of glucose and insulin are driving the synthesis of abnormal fats by the liver. And perhaps, in turn, the abnormal fats are then deposited within the arterial walls.
She’s of course right, and in her recent work she’s shown that putting type 2 diabetics on low-carbohydrate diets not only lowers their blood sugar and HbA1c levels, it also helps restore their blood lipid patterns to near-normality. Type 2 diabetes, it transpires, is not a progressive disease: it can be reversed.
Dr Hallberg is not the only person to have made this discovery, and perhaps the best book on the subject is Dr David Cavan’s 2014 book Reverse Your Diabetes, which shows how low-carbohydrate diets can indeed reverse your diabetes. But though Sarah Hallberg is not alone, she may be the best advocate for the new story. She’s a great communicator.
Unexpectedly, we now have not one but two competing techniques for reversing type 2 diabetes, Sarah Hallberg’s low-carbohydrate diet and Roy Taylor’s low-calorie diet: Dr Taylor has shown that the insulin-secreting cells of the pancreas are disabled by abdominal fat, and when he puts his patients on diets of only 800 or so calories a day, they eventually lose enough abdominal fat to rescue their insulin secretion.
Interestingly, Roy Taylor’s clinical findings are similar to Sarah Hallberg’s, in that he can reverse diabetes in about two thirds of patients, with the best results being found amongst the more recently-diagnosed folk. Future research will probably integrate Hallberg’s and Taylor’s work into one combined pathophysiological narrative, but for now let us rejoice that, in a single decade, at least two separate approaches have confounded the depressing fatalism that ruled the field as recently as 2009.
Dr Hallberg is now extending her studies beyond a year or two, to discover for how long patients can maintain low-carbohydrate diets and to discover for how long diabetes can be maintained in remission. My guess is that they can both be maintained indefinitely, because we don’t need to eat carbohydrates. They are not essential foods.
During the 19th century, Ignaz Semmelweis in Vienna was driven literally mad by his failure to persuade his obstetric colleagues to wash their hands before, rather than after, they internally examined women during the delivery of their babies–even though such examinations with unwashed hands led, on a horrific and easily-measurable number of occasions, to the deaths of women from puerperal fever or infection. But on failing to persuade his colleagues, Semmelweis was, infamously, reduced to prowling their wards, denouncing them to their faces as murderers.
Dr Hallberg has, however, avoided this trap. Even though she is bewildered by the survival of Ancel Keys’s low-fat idea, she recognizes her carbohydrate-endorsing colleagues as good people, anxious to do good, who have simply been misled by a flawed hypothesis, and she approaches them courteously and with respect. Moreover, she is clearly winning them over, because she has one insuperable force on her side, namely the empirical observations of good science.
Sarah Hallberg is a rare person who saw through the failings of the low-fat high-carbohydrate story: she recognizes diabetes as a disease of carbohydrate intolerance. But she also possesses the diplomatic skills to convert the opposition. She will prevail in ways poor Semmelweis did not.
It is interesting that crossfit has had recent blogs vilifying modern medical research, yet has linked this study (and private company). As a fellow physician, I urge readers to take what they read/hear on the internet as opinion. Do your own research, present this study to your doctor, and have a conversation with him or her about your care.
Great presentation/Q&A
Sounds like CrossFit can be not only the swim coach, but the lifeguard too.
Great talk! So much great information but especially like where she makes the analogy about how the diabetes epidemic would be approached/attacked much differently if the epidemic was an infections disease one. What would happen if 52% of the population had an infections disease? Powerful statement
Love the focus and efforts to help 'every day' people!!
There are also some evidence that suggests a Carb restricted dieet combined with Creatine supplementation may extend the life span of cancer patients.
Mars, the addition of Creatine is interesting here. Do you have any resources you can share? Carbohydrate restriction, given the high glucose utilization of cancer cells, makes mechanistic sense and I've seen studies on this. I've not heard of adding creatine supplementation, and am wondering what the mechanism might be. Are the possible benefits of creatine supplementation dependent on and/or additive to those of carbohydrate restriction alone? Would love to hear your thoughts, or see any evidence you're aware of.
Great talk, but if Dr. Hallberg is waiting for NIH to come around, she might have to wait forever.
NIH is fully invested in old carbs plus drugs paradigm, in the intellectual and financial sense:
https://www.sciencemag.org/news/2018/06/us-lawmakers-want-nih-and-cdc-foundations-say-more-about-donors
*in the, not "old.
They seemed to have now latched onto the DASH diet. Very sad.
Dr. Sarah Hallberg on Carb Restriction as a Sustainable Diabetes Treatment
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