Blood Sugar

#231: Sarah Hallberg, MD- Ketogenic Diet & Heart Health: New Research Updates

by Mike Mutzel



Get Early Access to Interviews and Additional Bonus Content? Become a High Intensity Health Insider and Access Bonus Content


Listen to the Audio Interview



Listen to the recording

Sound Cloud


Sponsored Message

This episode is sponsored by Health IQ, an insurance company that helps health conscious people like you get lower rates on life insurance. Get a free quote:


About Sarah Hallberg, MD

Dr. Hallberg is board certified in both obesity medicine and internal medicine and has a Master’s Degree in Exercise Physiology. She's the Medical Director of the Medically Supervised Weight Loss Program at IU Health Arnett, a program she created.

Connect with Sarah

Podcast Show Notes


03:50 When Dr. Hallberg opened a low carbohydrate clinic, they quickly saw weight loss and reversal of diabetes. She found that there was no scientific evidence that a low fat diet helped treat obesity.

05:51 Dr. Hallberg is part of the largest and longest trial of nutritional ketosis as a treatment to reverse type 2 diabetes.

07:40 Exercise, low carb and keto are now considered as treatment options for obesity.

08:42 Medications for diabetes treated symptoms, but not the progression of the disease. If you are not making dietary changes, medications contribute to hunger and over eating. Each step up in medication speeds the cycle.

11:25 We have to eliminate carbohydrates. Diabetes is a problem of elevated blood sugar. Carbohydrates, even complex carbohydrates, cause blood sugar to go up.

12:26 If you have type 2 diabetes, you should have professional care. Hypoglycemia did not occur at all in their 500 person nutritional ketosis study.

13:29 Continuous glucose monitors allow you and your doctor to see what blood sugars are doing between finger sticks. The Libre from Abbot will bring continuous glucose monitors to type 2 diabetics.

14:18 Non-dietary factors affect blood sugar. Physical health and emotional health are intertwined. Emotional health is impacted by stress and sleep.

16:28 Remote Care/Telemedicine gives better care remotely then brick-and-mortar practices by personalizing an individual’s care.  It brings care to the patient.

19:35 Virtahealth is available in all 50 states. It is available to individuals. Most of their patients come from large self-insured companies.

20:35 Most Americans have some sort of metabolic issue. Metabolically obese people are not overweight, but suffer from type 2 diabetes, fatty liver and cholesterol issues. Over 50% of adults in the US have diabetes or pre-diabetes.

21:57 Technology is coming to make tracking of ketones, blood sugar and insulin easier and more accessible. On average, our ketones tend to be lower in the morning.

24:12 Phobia of fat is a big barrier for people. There was no evidence to support a link between saturated fat and heart disease. With nutritional ketosis, you can reverse diabetes AND improve cardiovascular risk factors, such as significant decreases in blood pressure, significant increases in good cholesterol/HDL, and a significant decrease in triglycerides.

26:41 A better cardiovascular risk marker than LDL is LDL-P for type 2 diabetics or those with insulin resistance. It measures the number of LDL particles or ApoB particles. There was no change in these after a year with nutritional keto.

27:18 Inflammation markers, especially C-reactive protein (CRP), decreased by 40% over the study year.

29:38 Increase good fats: olive oil, whole food sources of saturated fat, fat from meats, coconut oil, and dairy. Stay away from highly processed vegetable, seed and soy oils. Central to any low carb/high fat diet is a whole food diet.

33:06 It is best to consume 3 to 5 grams of sodium a day, if you are on a ketogenic style diet. There are problems at the very low end and problems at the very high end of consumption.

34:25 Patients in the study with high blood pressure had reduced blood pressure while reducing blood pressure medications and at the same time, consuming more salt. Work with a physician.

35:48 Biomarkers most commonly used at Virtahealth are blood pressure, weight, blood sugar and serum ketones.

36:10 Serum ketone goals are above 0.5 mml of beta hydroxybutyrate. There may be a role in ketosis even at lower levels.

36:34 Diabetes medications lower blood sugar acutely, but cardiovascular outcomes were not improved. With SGLT-2 inhibitors, there was improvement with cardiovascular mortality improvements. This is because this class of medications elevated (but still at low levels) of ketones. SGLT-2 inhibitors without dietary intervention, increase the risk for diabetic ketoacidosis.

38:44 SGLT-2 inhibitors block the SGLT-2 path in the kidney, not allowing reabsorption of glucose, releasing glucose in the urine. They also increase the risk of UTI and yeast infection.

39:55 Metformin affects gut hormones and the microbiome, and has few side effects. On the study, persons who were able to reverse their type 2 diabetes were encouraged to stay on it prophylactically.

41:09 The American Diabetes Association guidelines are not evidence based.

42:00 DASH diet, recommended by the American Diabetes Association, was studied for a short duration once of 31 people, with a high dropout rate in one cultural population. There is evidence that this diet can make diabetes worse.

45:46 Nutrition is science. We have to be open to ideas and evidence. We need to push to get the scientific way of thinking ingrained in the nutrition space.

47:58 We need to change the dietary guidelines to ensure that they are evidence based upon a rigorous systematic scientific process.

50:51 For proper meta-analysis, you need to pay attention of the inclusion criteria. You need to go back to each study included to insure that they met the study’s criteria. Sometimes studies that do not meet criteria are included and others that do meet criteria are omitted.

55:56 Dr. Hallberg’s optimal morning routine includes black coffee and an early email check. Get something off your list first thing in the morning. She feeds her kids fat and protein in the morning (bacon and eggs). Their lunches are packed so they avoid school lunches. Fatty liver disease is being diagnosed in kids as young as 2.

59:55 Dr. Hallberg’s favorite low carb/high fat food is pizza with cheese/almond flour crust.

60:45 Dr. Hallberg’s elevator pitch is that our dietary guidelines need to be reformed, as they impact all of us.


Leave a Reply