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 virtahealthcom/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