In today’s interview I get to speak with senior entrepreneur and former Head of Research for Virta Health, Dr James McCarter .
James is back on the show today to debunk some commonly held misconceptions about the keto diet, using peer-reviewed clinical trial data from type 2 diabetics patients.
With keto’s increasing popularity, naturally there is going to be some skepticism about the validity of all the positive praise it has received. Critics of the diet raise some reasonable questions.
However, increasing number of research studies have come back debunking many concerns, often with results quite to the contrary.
We also get a chance to talk about the effects of the ketogenic diet on hundreds of Virta Health patients with type 2 diabetes.
- What are 12 common keto myths and why they are wrong
- What was the Virta Health trial design like
- What benefits did the keto diet have for type 2 diabetes patients
- What are effects of the diet on the cardiovascular health and the health other organs
- Is keto a sustainable diet or just therapeutic
Then this interview is for them.
I really enjoyed this interview with James who is back again to help us make sense of some of the misinformation that keeps popping up when it comes to the keto diet.
Enjoy the episode!
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Show Notes with Timestamp Links
Find summarised highlights of what we talk about during the interview.
Use the clickable timestamp links to jump direct to those points in the audio file below:
[00:19] – Introducing Dr James McCarter (MD and PhD qualified) is currently an Adjunct Professor of Genetics at the Washington University School of Medicine and the Senior Entrepreneur in Residence at BioGenerator. He is also the former Head of Research for Virta Health.
[01:10] – After looking at evidence from Virta Health as well as the results of other random clinical trials and meta analysis, the American Diabetic Association (ADA) changed its guidelines that came out in Jan 2019. James explains how for the first time low/very low carb recommendations were made by the ADA.
[05:07] – Myth 1: The keto diet is unsustainable long-term. Not True. There is now evidence of 74% retention with all individuals demonstrating nutritional ketosis for a time.
[07:54] – Myth 2: Ketogenic diet could cause diabetic ketoacidosis. Not True. Diabetic ketoacidosis is different from nutritional ketosis; they are very distinct metabolic states. The latter does not predispose the patients to transition into the former.
[09:37] – SGLT2 inhibitors (a diabetes medication such as Invokana, Jardiance or Forxiga for eg. ) predisposes patients to transition to ketoacidosis and euglycemic ketoacidosis. At Virta, patients are generally taken off this medication.
[11:00] – Myth 3: Being on a ketogenic diet will cause low blood-sugar (hypoglycemia). Not true. However, it is important to remove the medications that can cause this, i.e, sulfonylureas such as glipizide and glyburide.
[13:13] – James explains there is an exception with about 1% of patients that have atypical diabetes and respond quite well to sulfonylurea.
[13:35] – Myth 4: Being on a ketogenic diet will deprive your brain of glucose. This is a common falsehood. The body is very capable of regulating blood-glucose levels. Both through the process of gluconeogenesis and using ketones as fuel for the brain.
[15:42] – Myth 5: The ketogenic diet will cause cardiovascular damage. Also untrue; in fact there were improvements in risk factors and biomarkers. James explains how Virta Health and Indiana University conducted a clinical trial to address concerns around this.
[18:25] – Myth 6: Ketogenic diet will cause a bad cholesterol profile. Not True. James explains what we see with the LDL profile and how one of the things that occurs is a resolution of atherogenic dyslipidemia, which is a state that puts people at risk of cardiovascular disease.
[21:11] – James explains why he would like to see National Institute of Health impartial body with large funding to conduct a large scale trial to see a morbidity/mortality improvement and why nutritional trials are hard to conduct.
[23:47] – Myth 7: Ketogenic diet will cause inflammation. Not true. Part of the ketogenic diet can include eating meat and dairy which some people claim causes inflammation. James explains what is actually seen is a reduction in inflammation bio-markers.
[25:40] – Myth 8: Going on a ketogenic diet will disrupt the thyroid hormone causing hypothyroidism. There is no evidence in the published literature that the thyroid requires dietary carbohydrates.
[26:07] Thyroid hormones levels change but the level of TSH, which is expected to rise in hypothyroidism, decreases on average. Could this be linked to underrating? James explains why low sodium levels are important to consider to avoid a variety of keto flu symptoms.
[29:29] – Myth 9: The ketogenic diet harms your kidneys. Not true. Clinical trial outcomes do not indicate this; there were no cases of worsening kidney function and while the uric acid levels rise initially, they return to normal quickly.
[30:30] – Do gout symptoms increase initially with the ketogenic diet? James recommends monitoring this with your physician and not going off the gout medication.
[31:19] – Myth 10: The ketogenic diet will harm your liver. Not true. In humans it has been shown to actually decrease the amount of fat in the liver and can be very effective way for treating non-alcoholic liver disease.
[32:56] – Myths 11&12: Eating a ketogenic diet will cause muscle loss and decrease bone mineral density. Not true. In fact, scans looking at muscle mass and bone mass showed favourable changes and bone mineral density was excellent.
[34:15] – In most of these trials we are talking about Virta Health diet patients. James describes the Virta Health trial design.
[38:29] – Is the benefit people are seeing down to the reduction in calories and is extra weight the problem? James discuses the reversal of cause and effect. He explains that a low carbohydrate diet can reverse metabolic syndrome even with the absence of weight loss.
[42:49] – James recently purchased the Oura ring to look at his sleep metrics. He shares what he found while wearing the Dexcom G6 continuous glucose monitor for a week. How did glucose and REM sleep correlate?