Nutritional Ketosis and Guided Behavior Change to Reverse Type 2 Diabetes

Aug. 12, 2019

James McCarter, MD, PhD. is a researcher and author of over 60 scientific publications and patents. He recently led research and clinical operations for San Francisco-based Virta Health, a nationwide medical provider that delivers the first clinically-proven treatment to safely and sustainably reverse type 2 diabetes without medications or surgery. Dr. McCarter recently directed the Virta - Indiana University Health clinical trial demonstrating reversal of diabetes using nutritional ketosis and guided behavior change. This trial has resulted in changes to the American Diabetes Association Standards of Care and consensus statement on nutrition in 2019, reflecting the benefit of low-carbohydrate diets. 

In this podcast, James discusses the results that have emerged from this research and the incredible outcomes Virta is demonstrating in helping people reverse their type-2 diabetes and improve cardiac risk markers. He also talks about the five facets of treatment behind Virta’s success, and the business model they employ to make treatment more widely available. 

Dr McCarter recently spoke at the AACE (American Association of Clinical Endocrinology) meeting in Kansas City on ketosis for T2D. These slides provide nice visuals for all of the Virta-IUH trial outcomes as well as background information.

Here’s the outline of this interview with Jim McCarter:

[00:00:19] Two-year clinical trial: Athinarayanan, Shaminie J., et al. "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." Frontiers in endocrinology 10 (2019): 348.

[00:00:23] Virta Health.

[00:01:09] Type 2 Diabetes (T2D) affects 30 million people in the US, 400 million worldwide.

[00:02:24] Long term complications of T2D.

[00:04:16] Ketogenic diet: Getting people off the glucose rollercoaster.

[00:08:47] Setting up the clinical trial; Sarah Hallberg, DO, MS, Virta Medical Director.

[00:10:13] Nine papers published by Virta so far: 7 on the trial and 2 reviews: 1, 2, 3, 4, 5, 6, 7, 8, 9, plus whitepaper on cardiovascular benefits of Virta treatment.

[00:10:46] 5 facets to treatment: In-house medication management, health coaching, nutrition behavior change education, biometric feedback, online community.

[00:16:05] Podcasts with Doug Hilbert: How Busy Realtors Can Avoid Anxiety and Depression Without Prescriptions or the Help of a Doctor, and Ancestral Health Symposium ‘18 Recap.

[00:16:54] Doug Hilbert’s AHS talk 2018: AHS18 Douglas Hilbert - Virta 1 Year Clinical Trial Results/Patient Outcomes.

[00:18:13] Adherence to the program: 74% of patients completed 2 years of the trial.

[00:18:26] Blog post: Top 10 Keto Myths Debunked After 150,000 Days of Patient Care.

[00:20:30] Jeff Volek, PhD, RD & Stephen Phinney, MD, PhD.

[00:21:20] Ketone metabolism: beta-hydroxybutyrate, acetoacetate and acetone.

[00:23:05] Beta-hydroxybutyrate as an histone deacetylase (HDAC) inhibitor; Study: Shimazu, Tadahiro, et al. "Suppression of oxidative stress by β-hydroxybutyrate, an endogenous histone deacetylase inhibitor." Science 339.6116 (2013): 211-214.

[00:24:10] Higher levels of ketones correlate with greater reductions of hemoglobin A1c and greater weight loss.

[00:24:29] Ken Ford, Podcast: Optimal Diet and Movement for Healthspan, Amplified Intelligence and More with Ken Ford (ketone signaling is discussed at minute 54:20).

[00:25:58] Kaiser study on diabetes remission rates: Karter, Andrew J., et al. "Incidence of remission in adults with type 2 diabetes: the diabetes & aging study." Diabetes Care 37.12 (2014): 3188-3195.

[00:29:09] Readout: creating less invasive ways for measuring metabolic markers.

[00:29:28] Dan Ariely; Shapa scale and app.

[00:31:55] Non-scale victories (NSV).

[00:32:56] Ashley Mason podcasts: Paleo Psychology with Ashley Mason PhD and Mindfulness and Cognitive Behavioral Strategies for Diabetes and Sleep Problems.

[00:33:22] Elimination of drugs that cause hypoglycemia (e.g., sulphonylureas).

[00:34:13] Common pitfalls: Electrolytes.

[00:37:46] Myth: Keto causes diabetic ketoacidosis.

[00:38:50] Improvements in cardio risk markers; Study: Bhanpuri, Nasir H., et al. "Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study." Cardiovascular diabetology 17.1 (2018): 56.

[00:44:25] Dave Feldman on The Fat Emperor Podcast with Ivor Cummins: LDL and All-Cause Mortality  - Does Cholestesterol Kill You?; Related NBT podcasts: How to Drop Your Cholesterol, with Dave Feldman, and How Not to Die of Cardiovascular Disease, with Ivor Cummins.

[00:49:15] American Diabetes Association (ADA) changed their Standards of Care and consensus statement on nutrition in 2019.

[00:51:04] Virta's value-based business model.

[00:54:13] Navigating difficult food environments.

[00:55:52] Robb Wolf; Chickasaw Nation.

[01:01:43] Cardiovascular effects of GLP-1 agonist and SGLT2 inhibitor drugs; Studies: Busch, Robert S., and Michael P. Kane. "Combination SGLT2 inhibitor and GLP-1 receptor agonist therapy: a complementary approach to the treatment of type 2 diabetes." Postgraduate medicine 129.7 (2017): 686-697, and DeFronzo, Ralph A. "Combination therapy with GLP‐1 receptor agonist and SGLT2 inhibitor." Diabetes, Obesity and Metabolism 19.10 (2017): 1353-1362.

[01:02:13] Podcast: Nudge Tactics for Performance and Health, with Simon Marshall, PhD.

[01:04:50] Find James on Twitter, Medium and LinkedIn.