In today’s interview I get to speak with biotech entrepreneur and Head of Research for Virta Health, Dr James McCarter, about how their online type 2 diabetes program is providing clinically-proven treatment and ongoing support to patients from an entirely remote setting.
James is very passionate about the important work he is a part of at Virta Health. Currently, there are millions of people living with type 2 diabetes across the globe, with these figures continually on the rise. Virta Health have set an ambitious goal for themselves: they are on a mission to reverse type 2 diabetes in 100 million people worldwide by 2025.
In today’s interview we get a chance to talk about what the Virta program offers to their patients and the positive outcomes people are experiencing, including a reversal of their type 2 diabetes and other metabolic disorders, without the use of medications or any invasive procedures.
If you know someone who is suffering from type 2 diabetes or other metabolic diseases and is interested in learning more about how the Virta Health program can help, this interview is for them.
I enjoyed this interview and after speaking with James, I have a better understanding of how bringing together the latest peer-reviewed research, new technology and innovative ways of care delivery we can offer treatment in a safe, cost effective way to millions off people.
Special thanks to James for joining me on the show. Enjoy the episode!
Show Notes with Timestamp Links
Highlights of what we talk about during the interview:
Click on one of the timestamp links in the brackets to jump to that point in the interview audio.
[00:20] – Introducing Dr James McCarter (MD and PhD qualified) Head of Research for San Francisco based Virta Health, Adjunct Professor of Genetics at the Washington University School of Medicine, experienced biotech entrepreneur and a keen Quantified Self follower.
[00:45] – Virta Health established the first online type 2 diabetes reversal clinic providing clinically proven treatment and support from a remote setting. So, what things are included in the treatment they provide? They provide numerous beneficial support structures including: 1. Tele-medical support from an experienced, qualified physician 2. Online nutrition and behaviour change education 3. Daily access to a health coach 4. Biometric feedback. 5. Online community. James explains the vital role each play in successful outcomes for their patients.
[04:32] – The daily support provided by the health coach is normally done through an app (iOS and Android) and could include anything from advice regarding nutrition to ingredient education and menu selection to emotional support.
[05:41] – Another goal of Virta Health is to reduce the amount of unnecessary diabetes medication use. In addition to significant savings that result from weaning of the often quite costly medications, there are also many benefits to health, including the removal of the possibility of adverse effects such as hyperglycaemic events. Read the personal story of Mike Halle Virta Health review at Rock Health for a great anecdote on health care costs associated with type 2 diabetes management.
[09:05] – Virta is currently only available to people within the US, but James explains how there are plans for an eventual expansion beyond that. Virta have set an ambitious goal for themselves; they plan to reverse type 2 diabetes in one hundred million people by the year 2025.
[09:56] – While Virta’s primary focus is working with patients with type 2 diabetes; they also work with patients with prediabetes, obesity and metabolic syndrome. The Virta treatment results in great improvements in symptoms of diabetes, but it also shows improvements in cardiometabolic risk factors, markers for fatty liver disease, and cardiovascular outcomes for patients. If you are not sure if they could help you with a metabolic issue visit their website and fill out the online enquiry form. ONce you’ve done that then one of their intake specialists will call you to find out more and see if you qualify for treatment with the Virta clinic.
[11:45] – James explains how most of Virta’s patients come through employers (companies and businesses). The reason is Fortune 500 companies are responsible for half of all healthcare cost in the US and so will often self-insure. The savings benefits to the company in terms of reducing healthcare costs associated with type 2 diabetes are immense.
[12:56] – We are now seeing that type 2 diabetes, and other diseases associated with insulin resistance, are reversible. Because the reduction in refined carbohydrate intake is a key aspect in the reversal of these conditions we are starting to see a reduction in the consumption of things like, sugary beverages. It will be interesting to see how the food and beverage companies associated with these types of products will adapt going forward.
[14:37] – What is the Virta diet? The diet uses nutritional ketosis to reverse metabolic problems caused by overconsumption of carbohydrates. Over half of daily calories in a typical American diet comes from rapidly digestible carbohydrates, which causes glucose & insulin spikes, hunger and cravings.
[16:41] – James further explains what happens biochemically when we switch from using carbs to fats for our primary source of energy, which is what happens when we enter nutritional ketosis. The liver converts fatty acids into endogenous ketones, which become the alternative fuel source for the brain. (Biohackers Lab Tip: Listen to Dr Brianna Stubbs about what are exogenous ketones and the benefits of exogenous ketones)
[17:52] – Virta uses a medically approved low carb/ketogenic diet for both weight management and general metabolic health. There are benefits to other factors, as well, including dyslipidemia, blood pressure and, inflammation. James explains how numerous studies have shown that ketones are known to act as hormones reducing oxidative stress and inflammation.
[19:15] – What type of health testing does Virta do? Virta Health use different types of health measurements in a commercial setting versus the clinical trials setting. Commercially, patients will take a blood panel and an EKG to start with and also take at-home measurements of their weight, glucose and ketone blood levels daily.
[21:11] – Virta recently shared the results (published in the peer-reviewed journal “Diabetes Therapy”) of their one-year clinical trial (working with Indiana University Health), looking at remote care and nutritional ketosis for treatment of type 2 diabetes. They also have research publications coming out soon; including some looking at cardiovascular and liver outcomes. James shares some impressive results comparing the outcomes of the Virta treatment group versus the usual care group.
[25:11] – Low carb diet approaches have a long history; they date back millennia and have been promoted for weight loss since the mid 1800’s. James explains how Dr. Bruce Bistrian showed carb restriction worked in reversing diabetes back in the mid-1970’s and how, since, they have made this approach sustainable by shifting away from carbs without the caloric restriction. There are numerous other recent studies such as those done by Dr. Stephen Phinney and Dr. Jeff Volek (both co-founders at Virta), as well as, numerous others looking at people with metabolic syndrome. However, James explains what makes the latest Virta study different.
[28:14] – The remote aspect of the Virta treatment is very convenient for today’s busy lifestyles. Virta also ensured they tested the efficacy of in-person vs remote treatment and compared the results, which turned out to be indistinguishable. The health coach support, access to online education and the biometric feedback all really seem to help keep people on track and motivated.
[32:13] – Upon signing up to the Virta programme, their patients receive a starter kit with all the necessary gadgets for taking measurements. By helping people understand and demystifying what all the numbers mean, Virta is empowering them to do their own testing and take their own measurements.
[35:29] – Previously, we discussed nutritional ketosis and insulin resistance diet with Dr. Ben Bikman and, whether or not, having a ketone measurement of 0.5 mmol is absolutely necessary for achieving the benefits of nutritional ketosis. James explains how their clinical trials confirm that, even though initially, the average ketone value measured was slightly above 0.5 mmol, over a year, that average falls to 0.3 mmol. He believes there is most likely a sliding scale in the level needed to achieve benefits and patients see successful outcomes even if they don’t necessarily achieve 0.5mmol or above. (See how to test for ketones here)
[38:20] – The relationship with the health coach can often help people uncover what they could do better if they are not seeing desired results. For instance, sometimes there are hidden carbs in your meals you might not be aware of like, cashews nuts.
[40:08] – The health coach also works with people to individualise their treatment. Unsurprisingly, the one-size-fits-all approach doesn’t work here and each patient will have personal goals they need to achieve. They work to accommodate each individual’s lifestyles and backgrounds into their treatment.
[41:44] – As people get further into treatment and people have started to get a good handle on their diet and nutrition other factors also come into play; including, for example, exercise, sleep or stress levels. Life coaching and psychological support during changing life circumstances, or stressful events, is also an important component of the treatments success.
[43:33] – Virta is designed to be a continuous treatment, with a one-year minimum commitment. Beyond the first year the treatment is less intensive, and the price point reduces to reflect that. Having access to continual health and lifestyle coaching helps to keep people on track.
[45:04] – Addressing the Virta criticism. One Dr claims that low carb diets will result in early death in the long-term. However, James explains that this idea stems from dated thinking that says diets high in fat result in cardiac disease. We now know that a better marker for cardiac disease is insulin resistance.
[47:18] – Can people on vegan or vegetarian diets still achieve nutritional ketosis? There is an article on the Virta blog website that explains how to achieve ketogenesis on vegan/vegetarian diets. It is somewhat trickier and you need to make sure you are including other sources in your diet, but it is doable. A number of Virta employees and patients are vegetarians. (Biohackers Lab Tip: Listen to Dr Carrie Diulus, M.D. and Dr Will Cole who also have more in-depth info on plant based keto options.)
[48:47] – Dave Feldman has shown how a switch to a high fat diet can sometimes cause cholesterol levels to spike, often causing panic in people. His experiments are a great example of how a Quantified Self experiment can change the knowledge base of biomedical science. James explains why LDL rise in isolation is not a good marker for cardiac disease and how in combination with other positive changes it is not a concern. Having physicians who understand the diet and what the results are showing, is key; Virta offers continuous medical supervision to all their patients. (Biohackers Lab Tip: Listen to Dave Feldman explain high cholesterol levels on a keto diet)
[53:57] – Some employers provide this treatment as a fully covered benefit. James explains how, in time, they hope to see more insurers come on board. The single lump sum fee of $370 covers the whole year’s treatment and support, and consequent years have a reduced fee.
[55:38] – For more information on the company visit their website virtahealth.com where you can find multiple blog articles, with new ones coming out every week, and sign up for the mailing list. To follow Dr James McCarter find him on Twitter @JPMcCarter.