Dr. Stephen Phinney: How do keto and Virta affect heart health and cardiovascular risk?

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This is a very relevant
question because we just had
a new publication come out today
in Cardiovascular Diabetology
that really focused on this.
So we had published
maybe two months ago now,
we had published the one year
Type II diabetes outcomes.
We showed that A1c improved.
We showed that glycemic
control was better,
insulin resistance was
better, weight improved.
And in this paper we really focused on
all the different risk factors
around cardiovascular disease.
– And that’s important
because in the diabetes paper
published two months
ago in Diabetes Therapy,
we noted that although a whole
group of diabetes-associated
risk factors got better, one
of the more controversial
changes is that the LDL
cholesterol level in our
patient group as a whole rose slightly
but statistically significantly.
We felt it was important
to take a much closer look
at the full range of heart
disease risk factors.
And that is what’s encompassed
in the peer-reviewed paper
that we had published just today
and can be accessed through our website.
– Yeah, so to give kind
of a brief overview
of what we’ve showed in that paper,
Steve mentioned the rise in LDL
and LDLc in the group on average,
but there are a few markers
that some researchers believe
might be a better predictor
of cardiovascular risk
or at least equal to LDLc.
So those are LDL particle
number and apo B.
Those two markers
statistically were unchanged
at one year in our cohort of patients.
And then, we also looked
at the particle size.
Some believe that small,
dense LDL particles
might be more atherogenic
than the larger particles.
And our small dense LDL particle number
actually significantly
decreased at one year.
And the whole, the particle size of all
the LDL particles increased at one year.
So in terms of looking at
the whole picture of risk,
we certainly saw that increase in LDL
that a lot of people get concerned about.
But when you put all
of the markers together
and consider the whole risk profile,
we’re definitely getting an improvement
in a lot of different risk factors.
And we still are concerned about LDL,
but we see a lot of
improvements in other ways.
– Understand that the test
that we use to measure
LDL particle size and
number is a new test,
it’s not universally available.
It’s a predominantly
a research-based test.
And there are a couple of
different ways that these
can be analyzed, and the
medical practice community
has not arrived at a, kind of a uniform
recommendation for these values.
So this is a research test that we did.
And it may not be available
to the average person
through their primary care physician.
For instance, I saw my
physician a few weeks ago
and asked, and I get my health care
through Kaiser Permanente
here in California,
and I asked if they could
run a LDL particle size
and number for me and they
said “no, we don’t do that.”
But, it’s important that other factors
that we did look at,
such as HDL cholesterol,
which is so-called good cholesterol
and triglyceride values,
then those are part of
a standard lipid panel.
When the ratio of HDL to
triglycerides goes up,
that is, you have more HDL
relative, proportionately
to triglyceride, that is
correlated with an improvement
in LDL particle size and number.
So, again, we’ve looked at,
I think we had 18 different
cardiovascular risk factors
in this current paper,
and those were included in that.
So the point is, this
is a very complex area,
it’s an area of active research.
But what we want to provide
is a broader perspective
of all the parameters,
rather than focusing in on what we have
with the cholesterol-diet-heart hypothesis
where the focus for a couple of decades
has been just on the LDL.
The true picture is much
more complex than that
and we want to get into
some of those details.
– Sure. And there’s evidence even to say
that the picture is
more complex from that,
from the Imbarac trial,
because they put people on STLT2s.
They saw LDL go up but they saw
cardiovascular mortality decrease.
– Dramatically, yes.
– 38% I think, maybe.
So, there’s definitely
something to say where
there are other factors at play,
and it’s not all about one lipid marker
in terms of cardiovascular risk.
So we’ll find out someday.
– So before we get into
specific questions,
do we wanna talk about
the range of risk factors?
– Sure.
– That we looked at, responses
such as hypertension, inflammation.
– Yeah. I think also when
we’re talking about different
risk factors and looking
at the whole risk profile,
inflammation is also an
independent risk factor
for cardiovascular disease.
Many consider it or
hypothesize it be an under,
potentially an underlying cause.
So we looked at a few broad
markers of inflammation
in this study, we looked
at high-sensitivity
C-reactive protein and
white blood cell count.
And both of those dramatically improved.
The CRP response especially was pretty
astonishing at one year.
And then blood pressure as well,
blood pressure significantly increased,
and the really cool thing–
– No, it actually decreased.
– Sorry thanks, improved, decreased.
So blood pressure
decreased, so it improved.
And because of this we
actually had to de-prescribe
medications for the
patients because they didn’t
need the medication anymore.
So that’s a really unique finding too.
– So a lot of patients
moved from the hypertension,
borderline hypertension area
to normal blood pressure with a reduced
total medication use in the population.
Which is a very unusual finding,
’cause usually the way
with standard medication
treatment for hypertension
you have to give
more medications to get better control.
– Sure.
– We got better control
because nutritional ketosis
and the Virta treatment that
embraces and supports that
is such a powerful metabolic tool.
– So, that’s a little
bit of a recap on our
cardiovascular risk factor
paper that just came out
today in Cardiovascular Diabetology.
You can go to our website
and you’ll find a link
to that paper there.
And then we’ll have
certainly more information
coming out from Virta tomorrow about that.


  1. Hi,
    why not advise to put a bit more focus on fat sources richer in MUFA and less in SFA like olive oil? Still fine keto, but less ldl-c. Maybe people start liking it.

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