A new health startup boldly claims to reverse diabetes without drugs, and Silicon Valley's favorite diet is a big part of it

Melia Robinson/Business Insider

• Sami Inkinen, who founded the Silicon Valley real-estate startup Trulia, recently moved into healthcare with a startup called Virta Health.
• Virta makes a bold claim that its medication-free approach can reverse Type 2 diabetes.
• Patients enrolled in the Virta Health system get access to specialists via smartphone and are prompted to follow a ketogenic diet.
• Inkinen hopes to eventually expand Virta to tackle other conditions beyond diabetes.

Sami Inkinen, the founder of real-estate startup Trulia, recently took an approach to his health that's increasingly common in the Silicon Valley startup world: he got sick, got better, then made it his mission to help other people follow in his footsteps.

The 5-foot-11-inch, 183-pound athlete had just finished his seventh Ironman when a physician diagnosed him with pre-diabetes, a common precursor to the full-blown disease.

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While regular exercise may help reduce your risk of developing prediabetes and diabetes, which together affect more than 100 million Americans, it can't prevent the conditions - and everything from what you eat to your genetics play a role as well. Inkinen set out to find out what else he could change to reduce his risk. Diet emerged as vital.

"You can't out-run or out-exercise poor nutrition choices," Inkinen told Business Insider. "It is not going to work."

Inkinen founded a company, Virta Health, that aims to give people with Type 2 diabetes access to the tools he used when he learned he was prediabetic - an approach Inkinen claims can reverse the disease.

"We take chronic disease from care to cure, and we've proven that," he said.

Chief among those tools - which can all be accessed via a smartphone or laptop - is a team of trained medical professionals who manage patient care remotely via text and video chat.

The other key component of the Virta Health toolkit is a new way of eating: a plan known as the ketogenic (or "keto") diet. The low-carb, high-fat regimen centers on rich foods like eggs, salmon, meat, and avocados while severely restricting fast-fuel items like rice, potatoes, bread, fruit, and sweets.

While some call the diet extreme, Inkinen uses a different word: freedom.

"It's been liberating to not have cravings, to not think about food all the time," he said. "When I look back I think, 'How did I suffer for so long?'"

'The Virta Treatment'

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In a nutshell, the Virta Health system is a specialty medical clinic that patients can access any time of day by logging into the platform on their laptop or smartphone.

Virta isn't cheap - without insurance, it costs $500 to start and $199 each month after that. But the company says most of its users get free access via their employer's health plan.

To help patients enrolled in Virta transition to a ketogenic eating plan and stick with it, they get partnered with a physician and a health coach who coordinate and monitor their diet, exercise, and medications. Patients talk with providers over video chat and text message about what they're eating, how well they're sleeping, and what medications they're taking.

Specialists, in turn, give patients pointers on lifestyle changes designed to help them regain control of their blood-sugar levels. In the diabetes universe, stable blood sugar - often measured using a tool called A1C - is the holy grail of wellness. More energy, weight loss, and improved sleep tend to emerge as side effects of that objective.

Inkinen points to several peer-reviewed studies that appear to back up Virta's approach to treating diabetes.

For a clinical trial published last month in the journal Diabetes Therapy, researchers from Virta and three US universities followed 349 adults with Type 2 diabetes for a year. Half of them were enrolled in the Virta system; half chose to follow their typical treatment protocol (such as a low-fat or low-carb diet and regular insulin injections). After a year, the overall improvements in the Virta group were significant: on average, participants lost 12% of their body weight, reduced their use of medications like insulin, and saw their A1C levels decline roughly 1.4%. The other group saw no change on average in any of those measures.

Still, because the study was funded by Virta and written by people with a financial stake in the company, its findings must be taken with a grain of salt. (Similarly, most Weight Watchers research is funded internally, though it gets published in peer-reviewed journals.)

But the idea for using the ketogenic diet as part of what Inkinen calls "the Virta Treatment" didn't come from nowhere. Several short-term, non Virta-sponsored studies of the eating plan (some of them in people with diabetes) suggest the diet is linked with significant improvements in health. Those benefits include weight loss in non-diabetics, better blood-sugar control, improved A1C measures, and reductions in medications for people with the disease.

How the keto diet turns your body into a fat-burning machine

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The ketogenic diet is designed to flip your body's source of energy so that rather than drawing from carb-heavy foods like rice and potatoes, it pulls its fuel from fat.

Followers are encouraged to eat large amounts of fat and protein from things like meat, salmon, and eggs. Keto bloggers who share tips online frequently boast about their favorite "fat bombs" - rich concoctions of low-carb veggies like cauliflower loaded with butter, cheese, and bacon - which help them power through the day.

The meal plan essentially turns the traditional Western diet - with its emphasis on grains - on its head.

To understand how the keto diet works, you should know that most of our food contains carbs. They're an easy fuel source, and one our bodies are accustomed to using. The carbs in fruit come from naturally occurring sugars; those in potatoes, veggies, and pasta come from starches. They're all ultimately broken down into sugar, or glucose, for energy.

When robbed of carbs, the body is tricked into believing it is starving and turns to fat as an alternate source of fuel. In the process of digging into its fat stores, the body releases molecules called ketones; hence the name "ketogenic" or "ketone-producing" diet. This state is known as nutritional ketosis.

This is why, as long as you're not eating carbs, you can ramp up your intake of fatty foods like butter, steak, and cheese and still lose weight. The body becomes a fat-melting machine, churning out ketones to keep running.

Getting into nutritional ketosis requires fully adopting the keto diet, which is not easy for everyone. It can take the body several days of fully keto eating just to start transitioning. In the meantime, some early adopters of the plan have described a range of unpleasant side effects, like cravings and fluctuations in energy. That's where Virta's 24/7 approach to remote care comes in.

"This is not a one size fits all approach," Inkinen said. "This is highly individualized and managed by full-time physicians. That part of the treatment is not optional."

Recent studies on keto and diabetes are promising

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Some researchers who support the keto approach point to a growing body of research that suggests a ketogenic diet works better than other leading diets for people with Type 2 diabetes.

In a small six-month study published in the journal Nutrition and Metabolism, 84 people were randomly split up and placed on a ketogenic diet or a low-carb diet. The ones on the keto plan saw better improvements in blood-sugar control and eased their use of medications like insulin more than people on the low-carb diet.

A pilot study published in the Journal of Medical Internet Research stacked the keto diet against a low-fat diet and concluded that people on the keto diet lost more weight, had better A1C measures after eight months, and were also significantly more likely to stick to the keto plan.

Laura Saslow, an assistant professor of nursing at the University of Michigan, has studied the use of low-carb and ketogenic diets for several years. She told Business Insider that she fully supports Virta's approach to treating Type 2 diabetes and said it can be "quite effective."

For these reasons, Virta's chief medical officer and co-founder Stephen Phinney, a practicing internal medicine physician in Sacramento, has called the ketogenic diet "life-saving." But Phinney also serves on the advisory board for Atkins, a diet program whose claims of fast, easy weight loss are not heavily backed by scientific studies.

The jury is still out on the keto diet - but Virta is plowing ahead

But despite promising results from short studies, there are still no long-term human studies of the keto eating plan - which is enough to give some researchers pause.

Edward Weiss, a kinesiologist at St. Louis University and the lead author of a recent study on the diet, previously told Business Insider that the keto diet was a scary "experiment that the population is doing on itself."

Inkinen likes to counter that kind of sentiment by pointing out that the current American diet is also kind of an experiment - and it "hasn't turned out well."

Inkinen hopes Virta can help address the lack of long-term studies on keto with its own research. A current clinical trial that they had slated to run for two years has been extended to run for five, he said.

Inkinen also sees the potential to expand the company's unconventional remote approach, which gives patients access to a team of specialists who can be reached on their smartphone or computer, to treat more than just Type 2 diabetes. The company is currently studying whether the Virta treatment can work for a range of other conditions in the metabolic family, including chronic inflammation, non-alcoholic fatty liver disease, sleep apnea, prediabetes, and cardiovascular health.

This month, the company published another internally funded peer-reviewed paper, which suggested that people with Type 2 diabetes using the Virta intervention saw improvements in a number of factors related to cardiovascular health, including blood pressure.

"There are all these places where we have multibillion dollar drugs to treat the symptoms but nothing to address the underlying cause. If we can do this with Type 2 diabetes, what if we could have impact in all of these areas?" Inkinen said. "That would be amazing."