The “19% Reality”: What the 5-Year Keto Study Really Shows — And Why It Confirms What I Tell My Clients About Type 2 Diabetes
- Joyce Kurisko
- Dec 23, 2025
- 5 min read
As a health coach who works closely with individuals living with Type 2 Diabetes, I often witness something remarkable: the moment when a client realizes their condition may be reversible. Most have spent years believing diabetes (type 2) is chronic, progressive, and permanent. But the truth is far more hopeful—if you follow the right approach.
This is why the five-year data from Virta Health’s ketogenic diabetes program—released over a year ago but still widely cited today—is so important. When it was first published, headlines proclaimed success. But when you look beyond the press release and examine the actual results, a very different story emerges—one that aligns with the real-world outcomes I see all too often: Strict carbohydrate restriction creates dramatic short-term improvements, but those improvements rarely hold.
Keto suppresses symptoms; it does not repair insulin resistance.
The Adherence Collapse
The study originally enrolled 262 participants into a very low-carbohydrate ketogenic diet supported by continuous remote monitoring. But by the fifth year, the intervention had largely fallen apart.
Only 122 participants remained nominally engaged—a dropout rate of roughly 53%. Of those who stayed, data collection was sparse. Critics analyzing the full dataset have noted that by year five, only a fraction of participants had complete biomarker results, and very few showed objective physiological evidence of nutritional ketosis (the metabolic state that defines the diet).
In practical terms, this means the intervention was not actually maintained for five years. For most people, "Keto" was followed for roughly one year, followed by four years of dietary drift. Despite this, the authors concluded that the intervention demonstrated "excellent retention." But in the real world, 53% attrition is not excellent. It mirrors nearly a century of clinical experience with ketogenic diets. When the medical literature first introduced keto in the 1920s as a specialized therapy for childhood epilepsy, researchers noted the same struggle. The diet was socially isolating and physically restrictive. The difficulty of sustaining keto has been known for 100 years; the latest data simply confirms it in a modern context.
The Metabolic "U-Turn"
Yet adherence is only part of the story. The metabolic patterns in the study reveal something even more important.
During the first year—when participants were strictly following the diet—the results were impressive. Weight dropped by about 11–12 percent. Fasting insulin levels dropped and blood sugar stabilized.
But these improvements were achieved through avoidance, not restoration. Keto lowers glucose by removing carbohydrates from the diet—not by enhancing the body’s ability to metabolize them. It masks the underlying problem without resolving it.
In fact, while the calculated markers of resistance (like HOMA-IR) looked better on paper, this was largely a result of removing the challenge. If these participants had been tested with an OGTT after consuming a banana rather than a fasting blood draw, the results would likely have shown severe carbohydrate intolerance.
Once carbohydrates began returning to the diet—as they inevitably do—the metabolic picture shifted. By year five, average weight loss had shrunk to 7.6 percent. HbA1c drifted upward. The illusion of control evaporated.
If keto had truly healed the metabolic machinery, a modest reintroduction of carbohydrates would not have triggered such a regression. The speed of the rebound shows that the underlying metabolic dysfunction was never repaired. Keto had been holding the symptoms underwater; once the grip loosened, they resurfaced.
The Heart of the Matter
Perhaps most concerning were the cardiovascular findings. In a population already at high risk for heart disease, we would expect significant weight loss to drastically improve cholesterol. It didn't.
The study reported no significant improvement in LDL cholesterol over the five years. While triglycerides dropped (a standard effect of cutting carbs), the "bad" cholesterol that drives plaque buildup remained stubbornly stagnant. In the world of diabetes management, trading blood sugar control for continued cardiovascular risk is a dangerous bargain.
The "Remission" Mirage
Finally, let's look at the "cure." Out of the original 262 participants, the study claims that 19 participants achieved sustained remission. That is roughly 7% of the starting group.
But we have to ask: Is this even a real remission?
The study defined remission based on HbA1c levels (average blood sugar) and the absence of medication. But HbA1c only measures the presence of glucose in the blood; it does not measure your body’s ability to process it.
If you have a peanut allergy but you simply never eat peanuts, you haven't "cured" your allergy—you are just avoiding the trigger. Similarly, if you have type 2 diabetes and you simply never eat carbohydrates, you haven't cured the disease—you are just hiding the symptoms.
True remission means metabolic flexibility. It means you can eat a banana, a bowl of oats, or a potato, and your body can metabolize that glucose properly.
If we had given those 19 "remission" patients a standard Oral Glucose Tolerance Test (drinking a glucose solution), it is highly likely they would have failed. Why? Because their underlying intolerance to carbohydrates hasn't been fixed.
So, that 7% success rate isn't just a "lottery ticket"—it’s a mirage. It represents 19 people who have successfully managed their symptoms through extreme restriction, not 19 people who have reclaimed their health and insulin sensitivity.
The Path to True Reversal
So what does reverse diabetes? Not the elimination of carbohydrates, but the restoration of the body’s ability to process them.
A Whole Food Plant-Based (WFPB) diet reduces intramyocellular fat, improves hepatic insulin sensitivity, and allows the mitochondria to handle carbohydrate normally again. Instead of bypassing the metabolic machinery, WFPB nutrition repairs it.
And unlike keto, it is sustainable. People can eat fruit, beans, potatoes, grains, vegetables, and legumes—foods of abundance, not restriction.
The five-year keto data does not demonstrate that high-fat diets reverse diabetes. It demonstrates that they temporarily suppress symptoms while leaving the underlying disease—and the patient's long-term health—vulnerable.
The solution to diabetes is not to eliminate carbohydrates. It is to eliminate the metabolic interference that prevents your body from using them. Diabetes is not caused by the banana. It's caused by the endless consumption of Chick-fil-A, McDonald's, hot dogs, and that "juicy" steak and bacon. All that saturated fat signals to your cells that they are bloated with energy and don't need more fuel, so they essentially pull their insulin receptors in and lock the doors. Stop the onslaught of saturated fats, allow the body to burn through those reserves, and you will more than likely find yourself no longer diabetic.
Clear the blockage, and you cure the disease.
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