I am specifically asking about high-fat, low-carb regimens (as opposed to low-fat or high-protein versions). Has the scientific community reached a consensus on this? If it does happen, is the condition reversible?
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During ketosis, the body undergoes glucose sparing, where it stops utilizing glucose to save it for brain function (though the brain can also use ketones, so energy supply isn’t an issue).
The primary proven driver of insulin resistance is having high body fat. It doesn’t seem to matter if those excess calories came from fats or carbohydrates.
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The most significant factor is your total caloric intake and your weight; any eating plan can lead to insulin resistance if it results in obesity. Pick whatever diet helps you manage calories if you’re concerned about this.
Diets high in fat can trigger insulin resistance even if you don’t gain weight A high-fat, high-saturated fat diet decreases insulin sensitivity without changing intra-abdominal fat in weight-stable overweight and obese adults - PubMed It might be reversible by stopping the diet in the short term, but there’s evidence suggesting long-term use damages beta cells permanently. Look at the VIRTA data: they saw initial A1c improvements from weight loss and carb restriction, but then A1c steadily climbed back up, indicating worsening insulin sensitivity. They’ve become less transparent with their data recently. From VIRTA HbA1c Baseline: 7.6% 1 year: 6.2% 2 year: 6.3% 3.5 year: 6.8% 5 year: 7.2% Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial - PubMed Virta Health clinical trial patients showed lasting type 2 diabetes reversal and remission at 5 years.
The answer hinges on your definition of “low carb.” Many studies label anything under 35-40% carbs as “low carb,” and while those might not be ideal, the link to insulin resistance is unclear. However, strong evidence suggests very low carb (keto) diets can actually resolve insulin resistance, often performing better for type 2 diabetics than other approaches.
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When you follow a very low-carb diet, your tissues adapt by using less glucose. This is an evolutionary mechanism to save glucose for specific needs like red blood cells or the brain. Making tissues more resistant to insulin is just a way to ensure glucose goes where it’s needed most. There’s no proof this physiological insulin resistance is harmful. Most data linking insulin resistance to health problems comes from people eating high-carb diets who need insulin sensitivity to clear blood sugar and prevent vessel damage. This isn’t the same situation as someone on low carb who isn’t constantly spiking their blood sugar.
Over 50% of the US population is diabetic or prediabetic (National Diabetes Statistics Report | Diabetes | CDC), and the vast majority of them have never tried a ketogenic diet.
According to this source (http://ajcn.nutrition.org/content/84/3/475.full.pdf), a lack of muscle mass might be the actual cause, rather than body fat itself.
I find Professor Roy Taylor’s Twin Cycle Hypothesis to be the most persuasive explanation for why both zero-carb and ultra-low-fat diets can reverse type 2 diabetes: it’s about exceeding a personal fat threshold, which causes fat to accumulate in the liver and pancreas, eventually leading to insulin resistance.
I personally know three individuals who switched to a high-fat, low-carb lifestyle and ended up with severe diabetes. It’s been known for some time that saturated fat can cause diabetes. Even thin people can be diabetic, so it’s not just about body fat; the fat intake itself is the culprit.
That’s incorrect. Insulin resistance stems from hyperinsulinemia, or excessive insulin levels. Since insulin reacts to carbs and protein rather than fat, a thin person eating high-carb/high-protein could eventually become insulin resistant. Conversely, a heavier person eating low-carb/high-fat would likely have a lower risk of insulin resistance than that thin person.