Prof. Peter Brukner, Prof. Stephen Phinney & Prof. Grant Schofield - 'Q&A with Dr. Stephen Phinney'

Overview of Fasting

Dr. Steve Phinney and Dr. Richard Bernstein discuss fasting and its effects on the body.

The Fini View of Fasting

• Dr. Phinney agrees with up to two days of total fasting, but beyond that, there is conflicting information about the effects on resting metabolic rate and preservation of lean body mass.

• After two or three days of total fasting, there is no loss of lean mass based on measuring the body excretion of protein breakdown products.

• With a ketogenic diet, 1.5 grams per kilo of protein is needed to maintain or improve lean body mass.

• When you feed no protein and no calories by the fourth or fifth day, the average healthy person loses three-fourths of a pound of lean body mass per day.

Long-Term Total Fasting

• Long-term total fasting can lead to loss of strength and function as well as decreased resting metabolism.

• For someone with terminal brain cancer whose life expectancy is measured in a matter of months, total fasting may extend their lives if carefully assessed for risk-benefit ratio.

Malnutrition and Lean Body Mass Recovery

• Severely malnourished patients who are plugged into feeding tubes recover at a rate of two to four ounces per day.

• Recovery time from long-term fasting is always longer than the maximum rate of loss.

Overall, while short-term fasting can have benefits, long-term total fasting should be approached with caution due to potential negative effects on lean body mass and metabolism. Careful assessment should be done for those considering it for medical reasons.

Importance of Adequate Mineral Nutrature

Dr. Phinney discusses the importance of adequate mineral nutrature in order to optimally use protein.

Minerals are Important for Optimal Protein Use

• Intracellular minerals like potassium, magnesium, and phosphorus are extremely important to be contained in a well-formulated ketogenic diet.

• Examples of ketogenic diets where people have given particularly protein isolates show that if they don't contain enough potassium, phosphorus, and magnesium, people can eat everything right and lose lean body mass.

• Salt is also important as sodium restriction causes the body to waste potassium.

Virta Health's Future

Dr. Phinney talks about Virta Health's future plans.

Virta Health's Future Plans

• Virta Health is poised to become a publicly traded company with many tens of thousands of patients enrolled in treatment.

• They are building a data registry that will be an amazing compilation of data from which they can increasingly make their treatments patient-specific.

• They tracked all their patients who developed COVID and found that most did not require any form of acute medical care.

Getting Involved in Medical Practice

In this section, the speaker talks about how he got involved in medical practice and his experience before meeting Sir Hope.

Starting a Medical Practice

• The speaker and Jeff Bullock were kidnapped by Sami incident who asked them to write a book on medical practice.

• They planned to franchise their treatment manual to medical practices and train physicians and staff.

• Their experience before meeting Sir Hope convinced them that they had to start their own medical practice group.

Learning Virtual Medical Care

• The speaker and Jeff Bullock learned how to do virtual medical care.

• They had three years of practice at Metro Virtual Medical Care before it became necessary with COVID.

Benefits of Prepared Minds

• The speaker believes that chance benefits prepared minds.

• He was not prepared for the pandemic but is thrilled to be here.

Leaving Virta Behind

In this section, the speaker talks about leaving Virta behind and what he plans to do next.

Building Fences and Roads

• The speaker compares pioneers who define new territory with settlers who build fences, roads, and laws.

• He is more of the mindset of "don't ask permission; ask forgiveness."

Expanding Research

• The speaker has outside funding now to expand research into depression, congestive heart failure, diabetic kidney disease, and potentially non-diabetic kidney disease.

• Having Virta in the rearview mirror allows him the freedom to do that.

Long COVID & Nutritional Ketosis

In this section, the speaker discusses long COVID and its relation with nutritional ketosis.

Lower Incidence of Long COVID

• Anecdotes from patients suggest that they have a much lower incidence of long COVID.

• A study in Norway and Sweden showed that 50% of people still had symptoms at six months, but the speaker's experience seems to be less than that.

Role of Inflammation

• The speaker thinks inflammation is a key driver of long COVID.

• However, what's driving that inflammation is unclear.

Brain Fog

• Brain fog may be membrane damage to DHA in the brain from reactive oxygen species.

Exogenous Ketones & Metabolic Health

In this section, the speaker talks about exogenous ketones and their practical use in metabolic health.

No Practical Use Yet

• At this point, there is no practical use for exogenous ketones in metabolic health.

• Jeff Bullock and some interesting people are studying head trauma in people who are training to do parachute jumps.

Potential Intervention for Trauma

• One could do a randomized trial of giving somebody something to chug before they jump out of an airplane door.

• A ketogenic diet might be a good intervention for contact sports like football players, hockey players, rugby players, etc.

Changing Diet vs. Gene Transcription

• People who have no chance of changing their diet should just go ahead and change their diet.

• It's unclear what the time course is for taking it before somebody sees results.

The Future of Ketogenic Diet in Acute Care Medicine

In this section, the speakers discuss the potential future of ketogenic diet in acute care medicine.

Potential for Ketogenic Diet in Acute Care Medicine

• There is a significant future for ketogenic diet in acute care medicine.

• CRP does not go down in the first three months, but other keys on the keyboard are markedly reduced very promptly.

• To validate intravenous ketones as an intervention tool, one would have to get an investigational new drug number and go through a whole process that costs more than 100 million dollars.

Role of Ketogenic Diet in Elite Performance

In this section, the speakers discuss the role of ketogenic diet in elite performance and different types of sports.

Use of Ketogenic Diet in Sports

• The use of ketogenic diet is becoming quite popular in ultra-endurance sports.

• However, there is still skepticism about its use in more intense sports and team sports such as ball sports.

• Some individuals respond differently to ketogenic diets than others, so it may not be universally beneficial or effective.

• Professional athletes who have figured out something that works uniquely well for them may not share their secrets with others.

Adapted Approach to Ketogenic Diet

• A slightly adapted approach involves being metabolically flexible and using the right fuel at the right time.

• Ultra marathoners train low and may eat some low glycemic carbs before events lasting longer than three hours. They typically use strategic carbs during the event, with about 10% of their total energy expenditures coming from carbs.

Carbohydrate and Ketogenic Diets

In this section, the speakers discuss the individual variation in response to ketogenic diets. They also mention their experience with elite athletes who follow a ketogenic or low-carb diet.

Individual Variation in Response to Ketogenic Diets

• There is a huge individual variation in response to ketogenic diets.

• Elite athletes may be completely ketogenic or low carb during the week and top up on heavy training days.

• Trial and error is necessary to determine what works for each individual.

Experience with Elite Athletes

• The Melbourne football club won their first Premiership in 57 years due to a perfectly balanced forward line that included both a vegan and a carnivore player.

Recommendations for Keto with ApoE4 Gene

In this section, Dr. Vinnie asks for recommendations on how someone with the ApoE4 gene should approach keto. Dr. Peter Attia discusses lean metabolic hyper responders and ongoing research into their response to keto.

Lean Metabolic Hyper Responders

• Lean metabolic hyper responders have dramatic elevations in LDL cholesterol when following a ketogenic diet.

• A grassroots scientific project led by David Feldman is recruiting 100 hyper responders for careful testing, including coronary artery calcium score and angiographic CT angiography.

• Initial results show remarkably low coronary calcium scores despite long-term dislipidemia.

• Full data set will be presented at a meeting after one year of further testing.

Approach to Prescribing Keto for ApoE4 Gene

• Dr. Vinnie asks if Dr. Attia would prescribe a ketogenic diet to someone with the ApoE4 gene.

• Dr. Attia is cautious and concerned about anything bad that happens to someone on a ketogenic diet, but acknowledges that people vote with their mouths.

• Prospective studies are needed to collect data and determine the best approach.

Type 2 Diabetes Epidemic

In this section, Charlie Bloomer discusses the epidemic of type 2 diabetes and its impact on economies around the world.

Type 2 Diabetes Epidemic

• The epidemic of type 2 diabetes is bankrupting economies around the world.

• The Virta studies are associated with venture capitalism.

Virta Health's Business Model

In this section, the speaker explains how Virta Health sells its services to self-insured employers and insurance companies. They focus on treating type 2 diabetes patients who are already on multiple medications.

Virta Health's Promise

• Virta Health enrolls patients in their treatment with the promise of getting paid when they achieve therapeutic success markers.

• They get paid for success if they lower hemoglobin A1c, reduce weight, and de-prescribe expensive medicines.

• Insurance companies are attracted to this model because it saves them money.

Going Public vs. Getting Acquired

• The company wants to go public instead of getting acquired.

• The current business model seems unfair since they only get paid if they succeed in treating patients.

• However, their higher success rate compared to other providers makes them attractive to insurance companies.

How Virta Health Started

In this section, the speaker talks about how Sami Inkinen came up with the idea for Virta Health and how it got started.

Sami Inkinen's Background

• Sami Inkinen is a Finnish-trained nuclear engineer who worked as a safety officer at a Finnish nuclear power station.

• He was bored with his job because nothing exciting happened.

Starting Virta Health

• Sami Inkinen came up with the idea for Virta Health.

• The company's business model was his idea.

• It got them in the door with insurance companies and helped them expand their access.

Side Effects of Ketogenic Diets

In this section, the speaker talks about the side effects of Virta Health's ketogenic diet.

Side Benefits

• The ketogenic diet has some side effects, but it also has potency efficacies.

• It can improve asthma, joint pain swelling, polycystic ovary syndrome, and more.

• Women of childbearing years are urged not to get pregnant while on the diet because its effects on fetuses are unknown.

Virta Health's Future Plans

In this section, the speaker talks about Virta Health's plans for the future.

Depression and Bipolar Disorder

• A foundation funded by wealthy families is committed to studying the relationship between well-formed ketogenic diets and depression and bipolar disorder.

• This could be a massive cost-saving measure for economies.

Expansion to Australia

• Sami Inkinen came out to Australia to look at setting up Virta Health there.

• He ultimately decided that the insurance structure was too different from that in the US.