Dr. Jeff Volek: Human Responses to Nutritional Ketosis

well thank you for that warm introduction certainly a pleasure to be here this is my first uh biohacker conference so it's it's great to be here so i can talk slow i can talk medium i can talk fast i think to get through all the slides i have today i'm going to talk fast because there's a lot of really provocative evidence and really fascinating work being done in the area of ketosis so uh the title of my talk the human response to nutritional ketosis really sums up the obsession i've had the last two decades of my life as a scientist and really wanting to understand how how do people respond to an intervention that elevates their ketones and it's been a fascinating journey so i'm gonna take you uh take you with me um and share with you some of the highlights um and where the emerging research is going in regards to ketosis so i'm a professor at osu now and we are performing studies primarily dietary intervention studies that induce ketosis and our primary method of inducing ketosis is to actually feed people so we have a metabolic kitchen we prepare food and and feed various clinical populations healthy populations military populations and study a wide variety of outcomes and just to give you a sense of the interest in this area now well actually let me let me just take a quick poll how many people are in ketosis now are trying to be in ketosis now can you just raise your hand a few okay good so we're going to test your ketones in a minute and see if you're lying no the the interest has just exploded the last couple years has seen a resurgence in the interest in ketones like never before and i was fortunate and honored to host a conference at ohio state university back in august mid-august where we had uh over 20 of the top scientists all over the world uh studying various aspects of ketogenic diets and exogenous ketones present their work and it was just a really energizing and enlightening two days and what i can share with you is that these talks were all recorded and they will be available free very very soon both on the ohio state website as well as virta health is going to uh be providing all those videos they it should be within the week actually so some great content there so my approach today uh was to first for those that are maybe not familiar with ketones is to really provide some basics on ketone metabolism and definitions around ketosis and nutritional ketosis and then talk about some of the targets which include diabetes and pre-diabetes and some of the more emerging areas such as cancer various neurological conditions and disorders and then on the other end of the spectrum there's even applications here for athletes and specifically um we're very interested in how we can enhance warfighter performance and and the health of our military personnel so just quick uh history on ketones so uh you know if if you studied uh physiology in in college you were likely taught that ketones were toxic byproducts of fat metabolism and the reason for that is ketones were first discovered this going back over a century ago in the urine of uncontrolled type 1 diabetics and that negative connotation has been really hard to shake and it's only recently that we we're now understanding that ketones are not toxic in fact based on the current research we're describing ketones as super fuel and longevity metabolites but the obsession with you know maligning fat and and demonizing ketones um has really uh been part of the fabric of the dietary guidelines and what we promote in this country but and thankfully that the dark ages of ketones is coming to an end and in many ways i would describe the condition now as the golden age of ketones where we are now making discoveries around diabetes reversal around new mechanisms of ketones they're not just an alternative fuel for the brain they're actually signaling molecules they have hormone-like effects we were seeing keto adapted athletes not just finishing races but setting records and we now have various methods of inducing ketosis through exogenous ketones and ways to promote longevity so let me just give you a real uh basic primer uh here on ketones so ketosis is really a highly evolved highly conserved process and fundamentally it's a way for humans to fuel their brains and the problem is you know we store our our majority of our fuel in adipose tissue and the problem is the brain can't use fat in that form so we had to evolve an alternative pathway which is really what ketosis is so when we're breaking down adipose tissue releasing fatty acids at a high rate and that those fatty acids are taken up by the liver and essentially exceeding the liver's capacity to oxidize those fatty acids we have this pathway by which they can be converted into ketones and this occurs primarily in the liver so we're converting those fatty acids partially breaking them down into smaller molecules called ketones and our two primary ketones are beta-hydroxybutyrate and acetyl acetoacetate there are four carbons and unlike fatty acids long chain fatty acids these ketones can in fact be taken up by the brain and used as fuel so that's how we use fat for fuel in order to ensure a stable fuel source for the brain and once they're taken up they're they're oxidized and converted back to acetyl coa and generate atp and we actually knew all this metabolism 50 years ago george cahill at harvard performed cutting edge research studying starvation uh ketosis and it's true uh if you're if you're consuming carbohydrate as a primary nutrient your brain depends on glucose as an energy source it needs about 150 grams of glucose per day just to function normally but if you're in ketosis and cahill showed this with very uh invasive arterial venous different studies across the brain looking at healthy adults who had been starved for up to four weeks and showed that the brain can extract up to two-thirds of its energy from ketones dramatically reducing its glucose requirements so uh you know that that metabolic knowledge has been available we just really haven't taught healthcare professionals this so uh when we're distinguishing different states of ketosis concentrations really matter a lot so it's important to understand you're all producing ketones right now no matter if you just ate a bagel or a muffin your liver is still producing ketones albeit at a very low rate now when you restrict carbohydrates for most people to say under 50 grams per day that metabolic machinery starts to kick into gear and you will see ketone levels increase by an order of magnitude from say 0.1 millimolar all the way up to one perhaps up to three or four millimolar so that's a ten-fold increase and that's the range we call nutritional ketosis and while that is an order of magnitude higher than what you would see in the carb fed state it's actually an order of magnitude lower than what you see in ketoacidosis and that is a dangerous life-threatening situation so it's really understanding the magnitude here when we get into nutritional ketosis we consider that an optimal range of ketosis and when you stay in that range for several weeks and months the body fundamentally goes through adaptations to maintain near-perfect inter-organ fuel exchange and this is a process we're continuing to unravel and understand on a deeper level but we know fundamentally what happens when you're keto adapted is you become very proficient at burning fat your rates of fat oxidation double and that's true if you're a type 2 diabetic or if you're an elite ultra endurance athlete you will essentially double your rate of fat burning so again we knew all that um we knew most of all that for for decades what's newer in the science of ketosis over the last six seven years is the understanding now that beta-hydroxybutyrate in particular is a potent signaling molecule we worked out a lot of the mechanisms here for one it's a potent histone diacetylase inhibitor that is a primary way in which we upregulate expression of genes it also inhibits other pathways in cells that are related to inflammation and oxidative stress so we now understand ketones in the range of nutritional ketosis not only provide fuel but provide a signaling stimulus and for example we now have ligands four ketones that inhibit the nlrp3 inflammasome and this provides a mechanism as to the anti-inflammatory effects that are quite commonly observed with ketogenic diets and there were actually two separate groups working independently on longevity experiments uh that started about three years ago and both published their results simultaneously in cell metabolism about six months ago and interestingly both studies found more or less the same thing that mice fed ketogenic diets not only lived longer but had expanded health span so they lived healthy longer they functioned physically better and cognitively had higher levels of neurocognitive performance than mice not in ketosis and they worked out a lot of the mechanisms and it turns out in terms of anti-aging anyway a lot of the same underlying mechanisms that we've uncovered with caloric restriction are mimicked by ketones and ketogenic diets without the caloric restriction and now we have various methods of inducing ketosis so traditionally the ketogenic diet was the primary method of promoting endogenous ketone production and when you restrict carbohydrates and follow a well-formulated ketogenic diet your liver puts out about somewhere between 50 and 100 grams of ketones per day and now we have um exogenous ketones or ketone supplements in different forms and this has really just been a new area that's been discovered in the last couple years so we're really just scratching the surface in terms of what we know about exogenous versus endogenous ketones and how they may work additively or synergistically and so i won't get any further into this today in my talk but this is a really exciting area to understand how various methods of inducing ketosis affects organ health and various aspects of well-being so i would be remiss if i didn't at least have one slide on the practical aspects of a ketogenic diet so there's a lot of misconceptions and and misunderstanding around a ketogenic diet it's uh what it constitutes and and really how easy or how difficult it is um and what i would describe it as a highly pleasurable diet as opposed to one that's very restrictive and and barbaric and impossible to sustain over the long term as you can tell by the delicious food pictured here it's actually quite a a pleasurable way of eating and it's more than just restricting carbohydrate that's certainly a big part or a big principle of the diet but it's uh it's important to get protein in the right range it's not a high protein diet it's not a high meat diet in fact protein at high levels is anti-ketogenic it's important to understand that the quality of fat is very important if not more important than the quantity of fat so embracing saturated fat is very important it's a preferred fuel on a ketogenic diet so um there's a lot of nuance to in a lot of art to actually formulating and implementing ketogenic diet in people but once you understand those it's actually a very uh sustainable way of eating and we've proven people can stay on these diets over months and years and decades so let's talk about some of the clinical targets and most amendable applications of ketogenic diets so first of all now hopefully canada is doing better than the us but the situation's pretty dismal right now two out of five adults in the united states are classified as obese and almost three out of four are obese or overweight so that's the new normal in the united states we have a really serious out-of-control situation and when you look at the prevalence of diabetes and pre-diabetes over half adults either have diabetes or on the fast track to developing it so again staggering uh figures here and unfortunately they're not getting better things are continuing to deteriorate yet we have really good evidence around ketogenic diets for weight loss and this is probably the most well studied one of the most well studied aspects of ketogenic diets to the point now we have systematic reviews and meta-analyses and this is one of the more recent meta-analysis that shows ketogenic diets are superior to low-fat diets for weight loss so this is not you know my opinion or this is now an area where we have a critical mass of evidence to support the use of ketogenic diets i'll just show one example of a randomized clinical trial we've published we've done dozens of these types of trials these are in people with metabolic syndrome or pre-diabetes and you see greater weight loss in fact if you look at the individual responses the average weight loss is greater than any of the individual weight loss trajectories in the low-fat group and i'll just point out because many experiments they don't explicitly ask participants to restrict calories it's ad libitum or two satiety and yet people naturally restrict calories when they are focused on inducing ketosis so this is really an important attribute of the ketogenic diet and this is just an example of various biomarkers that how they respond to a ketogenic diet so especially those markers related to insulin resistance syndrome and metabolic syndrome clearly respond in a more favorable way than low-fat diets so the dyslipidemia the insulin resistance the glucose the insulin levels all respond better to a ketogenic diet and i'll just point you to the last set of bars there actually saturated fat levels in the blood go down on a ketogenic diet which really seems paradoxical because people are consuming two three times more saturated fat in their diet and of course we've been told you have to reduce saturated fat in your diet because it contributes to heart disease right but really it's what's important is if you're accumulating saturated fat and when you're on a low carbohydrate ketogenic diet you may be taking more in but your body's promptly oxidizing it converting it to co2 and water and if you're not accumulating it there's no harm i mentioned earlier there's consistently anti-inflammatory effects observed with ketogenic diets so here's actual data showing a panel of pro-inflammatory cytokines and inflammatory markers all improve more on a ketogenic diet and perhaps most striking i've been involved with long-term study in type 2 diabetics and this is now we've published one-year data we've actually collected data now out past two years but i'll just show you the published data here this was in a trial of 262 type 2 diabetics that were put on essentially a ketogenic diet combined with a novel remote care model this is through a company that i've founded called virta health and the results are nothing short of extraordinary we're told that type 2 diabetes is a chronic progressive irreversible disease yet we show here we can normalize hemoglobin a1c levels while we're getting people off medications not adding medications and they're losing significant amounts of weight and people can stay on these diets we had an 83 percent of our participants active in our program at one year and we haven't lost too many more at two years either so with the right care model and the right information people can stay on these diets and actually uh become not diabetic they are they do not have uh the diabetic condition now i won't say we've cured them per se but as long as they're in ketosis they don't have elevated blood sugars in a1c levels and they're off all diabetic medications with the exception we tend to keep them on metformin so really the data we have now it's pretty clear if you kind of think about the insulin resistant phenotype and all these various biomarkers that associate with insulin resistance they all tend to go in a worse direction the more carbs we eat in our diet and the more we restrict carbohydrates especially when we get down to a ketogenic diet the more robust all these markers improve now where this carb at what carb level do does any given person start to exhibit diabetic symptoms that varies a lot because we all vary in our level and degree of insulin resistance and carb tolerance but i think this this continuum exists within each person and it makes a lot of sense to find what level of carb tolerance works for you where you don't have elevations in a lot of these biomarkers so i think that you know diabetes is where we have the strongest evidence right now we have a lot of published clinical trial data and it just makes an enormous amount of sense from a pathophysiological state where carbs diabetics are carb tolerant so why do we recommend they consume half their energy from carbs it's really insanity uh but i want to talk to you a little bit about some other targets uh where we don't quite have the same level of evidence but there's certainly a lot of excitement and a lot of footprints in the sand that are leading us to uh to think that we will at some point in the near future have the evidence so one is cancer you know a lot of cancers a lot of tumors rely on glucose as a fuel tumors often don't have fully functioning mitochondria so they rely on glucose and glycolysis as a way to metastasize and grow and there are other reasons why restricting carbohydrate and ketosis may benefit certain types of cancer which is part of the reason that we're very interested in studying this at ohio state so here are just some of those reasons some of it's purely metabolic which which is what i just described if you can decrease glucose flux which is exactly what a ketogenic diet does more potently than any other intervention i can think of including drugs you could essentially starve the tumor and nourish the rest of the body but there's also a lot of evidence tumors are are flourish in a inflammatory type environment and the anti-inflammatory effects of a ketogenic diet would deter growth and there's a lot of evidence that we're improving just a lot of markers of patient well-being so i want to share with you an ongoing trial that we have at ohio state because most of the data we have right now in cancer i mean there's tremendous interest all over the country and the world really but the data to date are primarily pre-clinical so we have primarily animal data as well as some small human studies and case studies but a lot of it's shaping up very nicely so what we're doing at ohio state is we're starting with breast cancer in particular stage four metastatic breast cancer enrolling these women who are in pretty bad shape the median life's medium survival for a newly diagnosed patient with metastatic breast cancer is about five years um i'm sorry the five year survival of these patients is about 20 percent so uh at that point the care is primarily palliative so we're enrolling women with newly diagnosed metastatic breast cancer who are on their traditional chemotherapy is generally the standard treatment approach and and putting them on a ketogenic diet over a six-month period and i will say we're um it's a slow recruiting study but the patients we have are highly motivated they're able to induce ketosis it's just showing you a quote from one of our patients here who says i'm so glad i participated in this trial the study team have taught me a new way of eating that is healthier for me in many ways aside from any effects it may have on my cancer treatment my most recent scan showed that my liver metastases have regressed and are almost undetectable and we actually have the proof behind that to support that so we're measuring the actual tumors using the standard floral deoxyglucose uptake method and we happen to have the most sophisticated pet ct scanner in the world at osu it's a fully digital photon counting machine and we're doing some very advanced dynamic type imaging but for those of you not familiar with this you're essentially infusing a sub physiologic dose of glucose tracer that is detectable by the pet scanner and any organ that takes up glucose at a high rate such as a glucose avid tumor would show up on these scans now you can also see the heart or the myocardium and the brain also take up glucose and show up dark on on these scans so um i don't have a lot of data to share with you at this at this point in time but we have finished multiple patients and i can tell you that all patients right now that our past three months in this trial have shown at least a small to moderate too large in some cases regression of their tumors which is highly unusual and this is an example of a baseline and three-month scan and you can see here this woman had a lot of metastases in her liver on the top and you can see pretty dramatic just visual reduction in the intensity of those liver metastases and you can actually see the numbers there the suv is the standardized unit uh go from 11 to just under seven which is quite a remarkable reduction other just an interesting note here uh i don't know if i have a pointer but uh you can see where the heart is uh on the baseline scan and notice that images of the dark heart is not there on the bottom scans so that tells you the heart actually loves ketones and adapts to using ketones when you're in ketosis and and this uh we think is really important in terms of cardiac function there's at least animal data now um suggesting when the heart is fueled by ketones that it's more efficient and this has really important potential implications for cardiac failure and other conditions associated with hypoxia in the heart so the the um the evidence is looking very promising and encouraging for cancer i would say the most work going on right now there's probably at least a dozen trials going on with brain cancers and gliomas across the country if you just look up studies in clinicaltrial.gov so it's definitely an area to stay tuned uh on and i suspect in a few years we're going to have a lot more data human data to be looking at so um neurological conditions again a lot of interest here we have really solid evidence in epilepsy and seizures in fact we've known that ketosis is very effective at minimizing or eliminating intractable seizures in kids we've been we've known that for almost 100 years and it's in fact now more or less considered a standard treatment for many kids and adults with seizures and part of it um really goes back to our understanding of brain metabolism the brain actually prefers ketones over glucose if your ketones are elevated in the blood the brain will take them up in direct proportion to the concentration and that's why you see this nice linear relationship between blood levels of ketones and brain uptake and and this is regardless of glucose levels in your blood so if ketones are there the brain will preferentially take them up now you you know to get a significant contribution of ketones you do have to get them up to pretty high levels um higher than probably what you can get on a ketogenic diet if you want to get half your brain energy requirements you need to have ketones up in the four to five millimolar range uh but but if you think about the exogenous ketones here here's a potential application where you can see ketones up in the four to five millimolar range where you're providing the majority of energy in the brain from ketones so this is you know one area where you may think well what if i combine the diet with exogenous ketenes and would that allow the brain to be functioning better on ketones and this really is you know the big question if the metabolism science is is pretty well worked out if you have elevated ketones the brain will take it up the bigger question is so what if the if the brain's running on ketones is it more efficient less efficient are do you have better cognitive functioning well here's what we do know if your brain's running on ketones you're very likely protected from seizures uh if you have epilepsy or there's ongoing work in navy divers that also experience seizures because of the high oxygen levels under water we also know that you're profoundly protected from low blood sugar or hypoglycemia and this is really important um for now if your type 1 diabetic hypoglycemic episodes are one of the major risk of of being a type one diabetic but also if you're an athlete hitting the wall that's hypoglycemia in the brain or an energy crisis in the brain and time after time we hear keto adapted athletes talk about being bonk proof they don't hit the wall hypothalamic inflammation and inflammation in the brain is fundamental to a lot of neurodegenerative diseases and we're increasingly seeing evidence that various neurological conditions benefit from ketosis similar to the story with cancer it's a lot of pre-clinical data now we don't have large clinical trial data yet but we do have quite a bit of evidence suggesting that neurocognitive performance is enhanced when individuals are in ketosis and i won't go through all these studies but if you're interested in this area of research there's about a dozen references that show in various animal studies and and even human studies that ketosis improves various aspects of neurocognitive function and performance we're seeing some really provocative work uh in alzheimer's so it turns out you know alzheimer's disease is actually a metabolic disease much like diabetes in that it's associated with impaired glucose uptake in the brain and and that you know for for that matter that's true for most neurodegenerative diseases there's a hypo metabolism in the brain now what's interesting is there's some recent evidence showing that although glucose uptake is impaired in alzheimer's and it's even impaired in mild cognitive impairments so decades before clinical signs of alzheimer's but ketone uptake is normal and stephen kunan from canada is actually doing the cutting edge work in that area showing that alzheimer's patients who are just in moderate ketosis are showing you can essentially make up for that energy gap with ketones and in turn that's associated with improvements in clinical uh signs of the disease and alzheimer's is a huge problem it's not just a debilitating disease for the person and family members and caregivers but it's an incredibly costly disease in terms of health care expenses and we have a big interest in traumatic brain injury as well and there's a lot of similarities in in terms of the hypometabolism and impaired glucose uptake in tbi uh and and this ties into our interest with the military where a lot of our soldiers are coming back up to a quarter of soldiers deployed to afghanistan and iraq come back and have signs and symptoms of tbi and that increases their risk of depression and psychiatric disorders so there's a lot of interest in how ketosis might minimize or attenuate some of the secondary damage associated with tbi and in fact we have some proposals out of funded that would study parachute jumpers because it turns out these during training these jumpers when they land in the impact about 15 to 20 percent of them develop signs of mild traumatic brain injury and we think that if we can provide them ketones um before they jump that it'll offer some neural protection for them so let me talk a little bit about the uh the sports and athlete implications especially how it relates to military applications so you know this is really the world turned upside down for for athletes because we've been told you have to eat carbs before during after exercise you got a carb load that carbs are an obligate nutrient and it turns out that's totally not true that you really can think of carbs more as optional not obligate and and you've got a lot of really pioneering athletes out there especially in the ultra endurance world who are proving that um that concept so here's three really um top athletes um two on the left ultra distance athletes and in a more traditional sport the uh the tour de france you have chris froome and all these athletes are attributing their success to a low carbohydrate approach and these are some athletes we've studied in the lab both with military background and you can kind of read through their quotes there but it's essentially they described this as a transformative uh experience for them in terms of enhancing their readiness and resiliency and performance uh in the military and that's a big reason why we we think we should study this and it's it's trickling into team sports i would say soccer and rugby is are two of the sports that have embraced this the most and right in my own backyard the columbus crew i've been working with for the last four years and they've really changed the culture slowly there to a point now where they are really getting good buy-in and compliance with the low-carb diet they're convinced their athletes are healthier perform better they recover faster so we were interested in studying athletes who were you know at the cutting edge here of adopting low-carb ketogenic diets and performing well so we we conducted this study about five years ago now and we've published a couple papers on this it was a rather simple straightforward study we just wanted to recruit a group of high-level athletes to come to our lab and go through a pretty comprehensive battery of test invasive tests they included muscle biopsies and infusing tracers and collecting urine and feces and stool samples i mean we were like hunters trying to maximize the everything we could uh and and learn as much as we could from these really um elite athletes and we're still sorting through all the data we did all types of transcriptomic and metabolomic analysis but i'll just share with you you know arguably the most striking result here was their extraordinary ability to burn fat as i said at this onset um one of the basic adaptations to ketogenic diet is you double your rates of fat burning and and here's the data and so these the high carb control athletes their level of fat oxidation that's a really high level they're really good fat burners at .7 grams per minute but the fat burning in these keto adapted athletes is literally twofold higher and it's 50 percent higher than the highest rates ever reported in the literature so they literally shattered the fat burning ceiling and when they run for three hours and we measure their contribution of fat and carbohydrate to energy expenditure they're burning almost 90 percent fat so there's just a very low level of glucose oxidation happening and what perhaps is one of the more striking and surprising results for me was that when we measured their glycogen levels despite the fact they're eating very little carbohydrate they're almost exactly the same as their high carb counterparts so you really have to scratch your head how in the heck could you have normal glycogen levels and re-synthesize glycogen during recovery when you're not eating a lot of carbohydrate and the short answer is well you become very efficient at processing and conserving any glucose that your body has it may be broken down into lactate lactate can be converted back to glucose and glycogen so your body is highly conserving those glucose molecules and preserving glycogen and the reason i had the picture of the sled dogs there is because there's actually data the iditarod sled dogs they've done some really nice studies metabolic studies on these dogs and they're the most impressive athletes on the planet they also conserve their glycogen while thriving on a very low carbohydrate high fat diet and they're running 100 miles a day for 9 or 10 days during that race it's pretty extraordinary metabolically so just like the population the military has a real obesity and diabetes problem in fact recent statistics are showing it's a crisis a national security threat in fact where two-thirds of soldiers are considered overweight or obese uh they also have a lot of sleep disorders um so they're as described in that article fat and tired but this was a a white paper on uh military-eligible uh young people aged uh 17-24 and almost three out of four of those people were ineligible to join the military if they wanted to because primarily of their fitness lack of fitness which is primarily uh related to obesity so we're we're in the process of studying um military populations in our first prospective study of this was in our a group of army rotc cadets at ohio state where we put them on a ketogenic diet for 12 weeks and basically just asked the question can we improve any outcomes that would be relevant to the soldier in terms of enhancing their readiness so this is unpublished but we randomized 15 people to a ketogenic arm and we had 15 people in a control high carbohydrate iron we had a couple women and we were successful in getting them into ketosis which is not trivial because a lot of people would argue well you can't get mostly college-age kids into ketosis they're drinking too much beer and eating too much junk food but we were able to do that with a high degree of of uh of compliance and what was really extraordinary here this was not a weight loss study we did not prescribe calories but yet every single person lost weight not not a small amount of weight either this is almost 16 17 pounds across the 15 people and they lost fat they lost visceral fat by mri and they did all that you know they improved their body composition while they're adapting to this training program and improving their strength and power and military-specific type tests as well and we took biopsies their mitochondria were more efficient and just like i showed you with those athletes they did a pretty good job at conserving their glycogen despite being in ketosis and so i'm showing you really i think these are the only three studies ever published that in humans that studied glycogen levels in people on ketogenic diets the first was finney and he only had these elite cyclists on a ketogenic diet for four weeks showed glycogen levels were cut in half this tank study that i just showed you we had it 10 to 12 weeks it's 14 the faster athletes that we i showed you were completely conserved glycogen they were on a ketogenic diet for almost two years it was 20 months on average so some adaptations uh to ketosis take several months maybe even years to fully come to fruition and this is a quote from one of the participants in the tank study who had quite a favorable response uh and who was also a master sergeant uh in the military and he really wants to take the message out to all the military and he lost 23 pounds and this was a person that was pretty lean actually to begin with but still lost all fat actually gained a little lean tissue so this is my last slide um that i'll leave you with uh you know if you're not excited about ketones in ketosis and all the various ways they can improve health and performance i'm not sure how to get you excited because there's just so much emerging research and encouraging research being done in so many areas right now that this is a really promising area that we need to make more people familiar with in the health care uh arena and just general consumers uh because there's still a lot of misinformation a lot of uh defensiveness by people in the healthcare industry against ketones and yet this is probably one of the most powerful tools we have to promote health so thank you i will be happy to answer any questions you have whether it be now or afterward thank you very much cool thank you thank you jeff amazing there's already a few questions on the on the app and one of them is that if you don't consume animal products uh what way can you you know get the benefits of ketosis without destroying your gut and everything else that goes on with having a lot of protein fats from plant sources yeah i mean it's first of all it's not a high animal meat diet because again protein is anti-ketogenic but if you really are a vegetarian want to eat no animal products it it's a little tricky it's a little bit of threading the needle because it does eliminate several food sources and trying to get all your protein requirements from just simply plant sources and vegetables usually you carry a little bit of pro of carbs with those uh foods which makes it hard to induce ketosis uh if you can at least eat some eggs or fish uh it's much more doable but again you know there's so many people that think it's a high animal meat diet and that's not the case it's minimal animal products what would a typical keto meal look like i mean there's a lot of like discussion you know about having a ketogenic meal but i think there is many different ideas about it is it avocados in the steak or is it something more well it's it's uh usually a small protein source whether that be beef chicken fish eggs but you want the fat so you want to leave the skin on the chicken you want the fattier cuts of meat you want the marbling or you want to add high-fat sauces butter cream sauces to the meats and then a vegetable or a non-starchy vegetable so not corn or peas or potatoes but pretty much cauliflower salad vegetables broccoli asparagus brussels sprouts and again adding fatty sauces and butter to that would be fine to make it taste better and uh nuts and seeds um even some berry fruits can be incorporated because of the high water content in in you know in very small amounts something like bilberries blueberries raspberries but think of it more as a garnish not a you know not a two cups of of berries right but avocados olives tomatoes they're all botanically fruits can usually be incorporated in small amounts there's actually a tremendous amount of variety you can incorporate in where you're not feeling deprived and like you're sacrificing gotcha so what is the maximum amount of protein to consume in one meal to avoid affecting your ketogenic performance well we usually prescribe protein based on reference body weight so it's somewhere between around 1.2 up to a high of 2 grams per kilogram reference body weight uh so you know not if you're overweight if you did it on your current weight you'd over prescribe uh protein so it's based on reference weight and for most people you know that that's going to fall somewhere around 70 maybe up to 120 or 30 grams of protein per day and if you're eating a couple meals a day it would you'd break that up evenly i see there is i mean i know that you've been quite successful as a company at least from getting investment and you've done great studies that really show already uh that we can use dietary interventions when are you planning to expand berta internationally well so i i alluded to the fact we've published our year-long diabetes study and that was through a company i founded called virta health with steve finney and sami inkanan and our primary focus is reversing type 2 diabetes in a hundred million people by 2025. so we're really focused on the type 2 diabetes market now and we've we have the clinical evidence and we're now proving that with actual customers which are primarily large self-insured companies however the company is considering other targets because of the evidence that i shared with you today um and we've developed the platform to be able to scale what we do uh in in unique ways with a sort of telemedicine continuous remote care model so we do think maybe five years from now we will maybe treating other disorders and diseases but we do have some science to work out and as as far as the foreseeable next year or two we're going to be focused on the diabetes market and that's just you know it's a it's a massive problem worldwide yeah so i'm from finland i'm very proud that you have something on board i mean he's a finn this is super human can you tell like in a short way like uh he's his um little canoe trip oh well sami incan is our ceo and he is from finland uh and uh he's a tremendous uh entrepreneur and and uh and ceo for us uh but he's also a highly accomplished athlete and the reason we crossed paths was despite being a champion triathlete uh and and and uh i would think it's accurate to say a uh you know a biohacker absolutely thought he was doing all the right things developed pre-diabetes uh and and that really brought him to the science the low-carb science and we crossed paths about the time that he was planning to row from california to hawaii unassisted with his wife open ocean road open ocean road weeks and uh he wanted to prove he could do that without a lot of carbohydrate and sugar and so forth and so he run pretty much on fat and he managed to do it and break some guinness world records yes he not only did it he he set a record with his wife uh and he we we helped him sort of plan all the food because you had to carry all your food uh with you there were no stops or shipments that could be provided so he's not only an extraordinary entrepreneur but uh quite an extraordinary athlete to uh to to accomplish that that that level of uh physical exertion certainly and you're also extremely amazing character and i'm happy that you guys are together you know solving this problem for once and for all so thank you very much dr wallach for coming along pleasure

Channel: Biohacker Summit

Views: 30,399

Keywords: keto

Id: mht3mFFOkHQ

Length: 52min 40sec (3160 seconds)

Published: Thu Nov 12 2020