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

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
virtahealth.com/research 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..

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