The Ketogenic Bible The Authoritative Guide To Ketosis Pdf Where To Buy

– Hello.
Welcome to our Facebook Live
question and answer session.
I am Dr. Sarah Hallberg,
and I am one of the medical
directors here at Virta Health,
and I’m also the primary
investigator of our large
clinical trial looking at
a remote supported
continuous care intervention
utilizing nutritional
ketosis as a treatment for
type II diabetes and pre-diabetes.
And I am thrilled to be here
with Dr. Catherine Metzgar.
– Thanks, Dr. Hallberg.
As Dr. Hallberg said,
I’m Catherine Metzgar,
and I am a member of our
clinical team here at Virta,
and I work directly with
patients during their time
in the Virta treatment.
So please list your questions
today in the comments
below the video, and we’ll
try to get to as many
as we can in the next hour.
– It’s really important too
to note that this is not
intended to be individual medical advice.
The thoughts that we share
today do not replace any advice
from your primary care
or specialty physicians.
– So our first question to get started,
– So our first question to get started,
how does ketosis and
Virta’s treatment affect
heart health and cardiovascular risk?
– Well, Catherine, that
is a really great question
and one we get all the time.
And the exciting news that I
have to share is we recently
published a paper on this exact topic.
So our paper looking at
our one-year results and
cardiovascular outcomes
again was recently published,
and I encourage everyone
to follow the link and
read it for themselves, but
let’s talk about some of the
really important highlights in the trial.
So Catherine, of all the risk
factors that we looked at,
and there were 26 altogether,
the Virta treatment improved 22 of those.
So from a big overview standpoint,
that’s pretty remarkable.
But now let’s look a little
bit more at some of the
granular details here about
things that patients are
asking about.
So one of the really important
things is that patients
who have insulin
resistance, pre-diabetes or
type II diabetes very often
struggle with something
called atherogenic dyslipidemia,
and let’s pause for a minute
and break that question down
or break that term down.
Atherogenic dyslipidemia means
essentially atherosclerosis
causing cholesterol.
And so what is this
atherogenic dyslipidemia?
What it is is increased
triglyceride levels,
decreased HDL or good
cholesterol and LDL particles
that are very small and dense.
This is really the hallmark
of atherogenic dyslipidemia,
and once again important to
stress how very common it is
in the insulin resistant
patient population.
So what happened with atherogenic
dyslipidemia in our trial?
Catherine, the results
were really remarkable.
Triglycerides decreased by almost 25%,
HDL or good cholesterol
went up by almost 20%,
and those small dense
particles, what they did is
they became large buoyant LDL particles.
So it’s really important
also to note that there’s
no medication that can do this.
– Pretty awesome.
– This is just by changing what?
Your eating, can drastically
improve something that is
a big cardiovascular risk
for this patient population.
But one of the other
important things that we get
questions about all the time is,
I know that my diabetes may be reversed,
and all these other
improvements may occur,
but what’s gonna happen
to my LDL cholesterol?
Well again, we looked at
this very specific question
in our one-year cardiovascular
risk outcomes paper.
And what happened?
Well, LDLC or LCL cholesterol
did increase slightly.
However, and this is really
important, when we look at
cardiovascular risk factors
in a insulin resistant
patient population, what
becomes a much better marker
of risk when it comes to
LDL is LDL particle number.
So how many LDL particles are there?
Another term for this is the apoB.
This is really looking at
how many particles there are
that potentially could cause
problems with heart disease.
And what we saw is that
these were unchanged
through the year, and
that is really important.
So the question that we
get asked all the time,
I mean the really root question is,
I can make all these other
things better like my diabetes,
like my liver function numbers,
but am I making some of
my cholesterol worse?
And the answer from the paper is no.
Again, the LDLP or apoB did
not change over the year,
so that is a really
important take home point
from the study.
So that’s specifically
looking at cholesterol.
So what we see is dramatic improvements in
atherogenic dislipidemia,
no change in those really
important LDLP or apoB
numbers, and we see a really
big improvement in blood
pressure, a key risk factor
for cardiovascular disease.
And here’s the important point.
Not only did we get to see
patients blood pressure
significantly decrease,
but they were taking less
medication for it.
So we were making it
better while being able to
remove medication, so again
a critical risk factor.
The other one that is really
important to make note of
is inflammation because it
is important for everyone
to understand that at every
phase of the development
of cardiovascular disease,
inflammation plays a key role.
So what happens to the
inflammatory markers with any
intervention is really important.
And the best one to look at
specifically cardiovascular
risk is one called C-reactive protein.
And Catherine, in this
study our patients decreased
their C-reactive protein by 40%.
So again, another really
important cardiovascular
risk factor made better
by the Virta treatment.
– Awesome, thank you, Dr. Hallberg.
So our next question, can
you point to any clinical
So our next question, can
you point to any clinical
evidence of ketogenic diet’s
anti-inflammatory benefits?
– Yeah, so let’s go back to
what I was just talking about
before, the C-reactive protein,
and the dramatic decrease.
We know that that is an
improvement in a cardiovascular
risk factor, and then that’s
an improvement in systemic
inflammation overall.
And we actually have this
number supported by a decrease
in our study in patients’
white blood cell counts
because that actually, people
think of white blood cells,
and they think of elevation in sickness,
but the other thing is
there can be an elevation in
chronic inflammation as well.
So not only did we see
the C-reactive protein
decreasing by 40%, but we
saw out patients’ white
blood cell count drop as well.
– For our next question, if
I’m following a low carb diet,
– For our next question, if
I’m following a low carb diet,
and I start eating carbs
again, does that make the fat
I’ve been eating have
a negative impact on my
cholesterol and heart?
– Okay, so what we’re talking
about really there is,
the question is geared towards
the past fat that someone
has consumed when they’re
eating a low carb diet,
and the answer to that is no,
that’s not gonna negatively
impact their cardiovascular disease risk.
But what they’re talking about
doing then is going back to
our standard American diet, right?
Eating fat and eating carbohydrates,
and what we have plenty
of evidence for is that that
combination is a problem.
So I would really
reframe this a say, okay,
I was eating low carb and high
fat, and I was doing better.
Maybe now I wanna add a
little bit more carbs into
my diet again, but we have
to really be cautious about
ensuring that those carbs that
are added are not exceeding
any individual’s carbohydrate tolerance,
because if you increase
carbs over your carbohydrate
tolerance and add fat in,
what you’ve done is gone
right back to the standard
American diet that has
failed us for decades.
– I think that’s a really
great point, Dr. Hallberg,
because it talks about, or
it speaks to a little bit
how we really try to
personalize the Virta treatment
to each patient’s
carbohydrate tolerance levels.
Thank you for that.
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So with that, our next
question, can you provide any
So with that, our next
question, can you provide any
clinical that the ketogenic
diet is helpful in
preventing cancer?
– So there are a lot of trials
ongoing here as a potential
adjunct cancer treatment.
So by adjunct I mean in
addition to traditional
cancer treatment.
So in order to answer that
question and as a prevention
for cancer, there would
have to be a really long
what we call the hard outcomes trial.
And I think that honestly
we’re probably pretty far
away from that, but we’re not
that far away of finding out
how a ketogenic die may play
a role in cancer treatment,
because as I said right
now, over the next few years
we’re expecting many of
the ongoing trials in this
very area to get published
and really help with some
insights into this question.
insights into this question.
– For our next question, what
are the possible side effects
of coming off of insulin
when your body does not
produce enough C peptide?
– Well, let’s go back and
first talk about C peptide
and exactly what is C peptide,
because many patients who are
getting the Virta treatment
may have their C peptide levels checked,
and why do we do that?
We do that because it gives
us a really good idea of
how much insulin their
pancreas is able to produce.
So when a patient is
first early diagnosed with
type II diabetes, on average
50% of the cells in their
pancreas that produce insulin
have actually died already
at the very beginning of the
diagnosis because they’ve been
over used for so long.
They essentially tucker out.
And so people would
initially think okay, look,
if I wanna take a look at
insulin levels and how much
insulin my pancreas is able to produce,
we’ll just draw a insulin
level, and that actually
is really problematic in giving
us answer to the question
of how much insulin is
my body able to produce
because our insulin levels are
very dynamic through the day.
They’re up and down and up
and down, so if you’re just
checking an insulin level,
you’re not really sure
if you’re catching a
high one or a low one.
But they’re also metabolized differently.
So insulin is metabolized
in the liver very quickly,
but insulin is released
along with something called
C peptide, and it doesn’t
have these peaks, troughs
and quick metabolism issues
that come with insulin.
So when we’re looking at
someone’s insulin producing
ability, what we usually
check is a C peptide.
It tells us how much insulin
they’re able to produce.
So how that we understand C
peptide a little bit more,
let’s go back to that
question and say how is that
going to influence my
ability to get off insulin?
Well, if your C peptide is
zero, meaning your body is not
able to produce any insulin any longer,
you will not be able to get
off of insulin completely.
That is a condition called insulin apenia,
and it’s very similar to type
I diabetes where patients
aren’t producing any insulin.
It’s just that the cause is different.
In type I diabetes this
is an autoimmune process,
and in type II diabetes
where someone develops low
or zero C peptide, meaning
they can’t produce insulin
any longer, it’s essentially
from pancreas burnout.
Now people who follow
a strict low carb diet
who are still producing some
insulin, meaning they have
maybe a lower but still present C peptide,
possibly still have the
ability to get off insulin
or maybe all but a very
small basal insulin.
Again and that’s something
that would be very personalized
and needs the assistance of a physician.
And that is one of the reasons
why we have a physician,
a Virta physician, assigned
to each patient in the
Virta treatment, so that we
can help patients not only
remove medication safely,
because that is critical,
but also at the beginning take
a look in patients who are
taking insulin, at the C
peptide to give them some
realistic expectations about
what can be accomplished
and potentially at what rate.
So this is a really important
question because C peptide
for anyone who has type
II diabetes over a long
period of time, and has
needed exogenous or insulin
that’s injected, a C peptide
can be really helpful in
predicting how they will be
able to get off insulin, of if.
– Thank you.
So our next question, how
often is it okay to eat keto
So our next question, how
often is it okay to eat keto
approved fruits and foods
containing erythritol or
other sugar alcohols?
Would you say daily or less than daily?
– I would say that it really
depends on each individual,
and I know that that can
sometimes be a frustrating
answer, right?
Meaning that there’s not
one simple answer for this,
but you know, the fact
of the matter is we are
all different, and what one
person can do does not mean
another person is able to
do and have the same effect.
So this is one of the areas
where a Virta health coach
comes in as a critical
piece of the puzzle,
because your Virta health
coach can help work with you
to develop your own
carbohydrate tolerance level,
and also that can lead
over to sweeteners as well
because some people, it
seems that sweeteners can
stall weight loss some, and
in other people it seems like
they can have quite a bit of
sweeteners and not ever have
an issue at all.
And so it’s something that
we need to experiment with,
and you need to have
someone to work with you and
support you through trying
to figure out what your
tolerance is.
What we can find is that
most people, most people
can consume at least
on occasion sweeteners.
Other people though, the
answer may be that they can
have them every day.
So again, individualized, personalized.
It’s such an important key
part of keeping people in
good metabolic health and
making the lifestyle changes
to do this sustainable.
– And one of the cases that
Dr. Hallberg mentioned is
the sugar alcohols or
erythritol or other sweeteners
can stall weight loss.
So we would be looking at how
often are is when including
these foods, and how does that
impact their other metrics
like blood glucose and ketones as well.
– Absolutely, thanks for saying that.
That’s a really important point.
– So the next question
comes from an individual.
So they say I’ve been
following a keto eating plan,
but my weight loss has
slowed even though I have
more to lose.
I struggle with increasing my
calories, and I still believe
it’s necessary to keep
calories on the low end
between 1200 and 1500 calories daily.
Would increasing my daily
calorie goal speed up
my weight loss?
– Increasing daily calorie
goals, no, probably not.
I would say the most important
thing is to make sure
that you’re not hungry because
that’s that sustainability
piece that is key.
And if you’re not hungry,
pushing yourself to eat beyond
that would not be a good
plan for the long run.
So a couple of things
that I would say to that.
Number one, a weight stall
for a while is very normal.
So first you have to say,
is this truly a plateau
or is this just my body’s
pause period for a little bit?
And bodies seem to
adjust to a lower weight.
So we see this in most everyone.
So my first recommendation
is to be patient on this,
and it may take a while for
your body to essentially reset.
So a pause in the weight loss
sometimes can be very normal.
And if you’re not regaining
weight, I like to tell people
think about this.
What you’re doing right
now is you’re practicing
maintenance, and it can be
very hard in the long term
for people to maintain the
weight that they’ve lost
ever more so than to get
down to a specific weight.
So practicing is something
that is a really important
part of the process for everyone.
Now if your stall in
weight loss continues on,
one of the other things I
would do is to go and spend
a week really specifically
weighing and calculating
everything because, and you
know I’m guilty of this too,
all of us here at Virta who
follow the Virta treatment
sometimes can fall into
these traps where we say oh,
that looks like a cup of tomatoes.
And even people who have been
doing this for a long time,
I encourage everyone to
pause at least every couple
of months and spend just a
few days literally weighing
and counting everything
to make sure some things
haven’t snuck back in.
And the other thinkg that I would say is
has exercise changed?
Have you started exercise?
Or have you stopped exercise,
because sometimes that
can impact it.
Believe it or not, especially
in women, what we see often
is when they begin exercise,
which why wouldn’t they?
They’re feeling better, they’ve
lost that initial weight,
they’re ready to start moving.
What happens is that can
actually cause a prolonged
weight plateau.
Now that initially sounds
like it could be a problem,
but in reality what’s
happening is they tend to be
building muscle.
And so their body composition is changing,
but they’re just not
seeing it on the scale.
So believe me, if that’s
occurring, continue on and
embrace that longer plateau,
and start to pay attention
to things like, wait a minute,
my pants fit a little bit
And you may get cues here
that you’re doing just fine
from things other than the scale.
– I think those are some
excellent tips for getting
through that weight plateau
and thinking about the
perspective from that.
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Can a ketogenic diet help
fight yeast infections?
Can a ketogenic diet help
fight yeast infections?
– There is not any data on that.
We do not have any
clinical trials on this.
You know, yeast infections
usually are caused by
they can be in warmth, so
warm places in the body,
you know, people can get
them anywhere from underneath
their breasts to underneath
(mumbling) to vaginally.
And again, sugar does
feed yeast infections.
So I think that the basic
science is there that
this may truly be a help,
but we cannot promote that
because we just don’t have
rigorous clinical trial
evidence for this.
So what I say is try it if
you’re battling yeast infections,
and see if this is something that helps.
– For our next question, how
concerned should I be about
– For our next question, how
concerned should I be about
high LDLP numbers if my HDL
numbers are in a normal range
while I’m in nutritional ketosis?
– So LDLP is again going
back to what we talked about
a little while ago, a
much better assessment of
cardiovascular risk than LDLC.
And so if someone has got
really great improvements
decreasing triglycerides,
increasing good cholesterol,
but struggled with an elevated
LDLP, what do they do?
And this is not a solidly
certain answer yet.
We don’t, there has
been no evidence one way
or the other 100%.
So this is one of those
places that you really need to
work with your physician on.
So again, the Virta physicians
may ask other questions.
What are other risk
factors that you may have,
and how are those controlled?
Or this is another place where
we may say let’s go ahead
and get something called
a coronary calcium score
to assess is there really
any burden of cardiovascular
disease already present.
But once again, this
is an individual call,
and this needs to be worked
out one on one between
patients and their physicians.
And Virta physicians are all
very, very expert in this area
to be able to ensure that
they are doing whatever
we need to do to promote
cardiovascular risk factor
reduction for each and
every patient individually.
– So do you say it’s fair
that it’s not just one number
that’s driving that you’re in
bad health or great health?
It’s really a big picture of everything.
– Absolutely, it is, Catherine.
There’s not one biomarker when
it comes to cardiovascular
health that we can point
to and say if this is good
or if this is bad, you’re in
the clear or you’re doomed.
It’s not like that.
You know, what we have is we
have a whole bunch of things
that we know are associated
with increased cardiovascular
risks, and we have to look
at the larger picture.
You can’t get lost in
the forest for the trees.
So each one of those and
taking a look at the whole
in each individual patient
is really important,
and that take personalization.
– I think that’s an excellent
reminder because it’s very
easy to get caught up on that one number.
Would you say there are any
specific drawbacks or benefits
to following a ketogenic diet
for post-menopausal women?
– So I would say there’s a
lot of advantages to following
a ketogenic diet for
post-menopausal women.
And you know, what we know
is that post-menopausal women
do tend to struggle
more with their weight,
and it tends to be central weight.
And so again, a ketogenic
diet can improve things for
post-menopausal women just
as it can for pre-menopausal
women and men of all ages.
So if someone is struggling
with those post-menopausal
weight gain, especially
in those specific areas,
I would really encourage
people to consider a
ketogenic diet.
And as far as drawbacks
goes, no, there’s no specific
drawbacks there.
I mean this is a great
patient population for this
to be implemented with.
– What could be the cause
of a strong heartbeat when
someone’s in ketosis?
Are there any suggestions
of supplements that might
help with that?
– A strong heartbeat.
So I would presume that
that just means something
that one can feel more,
that it’s not necessarily a
racing heartbeat or a feeling
of a skipped heartbeat.
So if I’m taking that question
literally, that it’s just
something you can feel more,
here is the likely cause.
Someone has lost weight,
and literally they can
feel it easier.
So when people lose weight,
and there is actually is
truly less there, right,
they can be more sensitive
to feeling their hear beat.
So a strong heartbeat per se
is probably not a problem.
Maybe a sign of your success.
Now if that goes into a racing heartbeat,
a skipped heartbeat, again
that’s something that I would
see their physician for.
– Thank you.
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So jumping to our next
question, do you have any plans
So jumping to our next
question, do you have any plans
or timelines on publishing
the two-year results of
the Virta Health Clinical Trial?
– Ooh, that is a great
question, and I’m super excited
to answer that because
well, let me say something
before I answer it, which is
we have just had an amazing
group of truly pioneering
patients who have participated in
our large clinical trial.
I mean we all, all of
us, not just at Virta,
but people around the
country should really pause
for a moment, and let’s
just tip our hats to this
group of people who have
participated in this trial that I
really think is going to be
part of a nationwide change.
So if any of our clinical
trial patients are watching,
you know a big thumbs up to you.
True pioneers.
And we are just wrapping up
now the two-year results.
So we’re having the, by the
end of this month we will have
gathered all of our data for two years,
and so it just becomes
actually analyzing that data
and writing the paper.
And that seems like okay,
we can do that in a couple
of weeks, but let me tell
you, it’s a process because
there is a lot of statistical
analysis that needs to
take place, and a lot of
writing and rewriting,
and it actually takes a really
long time to get a paper
published because they go
through a peer review process.
So what is a realistic timeline?
Well, we are very hopeful that
this paper can get out before
the end of 2018, but don’t
hold me to a promise on that
because again, it’s dependent
on many variables there
that all have to fall into line.
But we are really excited
to get those results out,
so we’re gonna be doing
everything we can to keep
that process moving forward.
I actually can’t wait for that day.
– Me either.
– It’s going to be fantastic,
and I am really excited to
share with the world again
what’s possible when it comes
to treating this epidemic.
– This next question is
a very common question
– This next question is
a very common question
I get from patients.
How should I approach fat bombs?
Are they a snack, or are
they an addition to a meal?
– So again, I’m gonna go
back to that frustrating
answer first, which is, it depends.
It can be very individual.
And so for some people it’s a great snack.
For other people they
can have it as part of
a sweet treat right at the end of a meal,
but you have to be really
cautious, and remember this.
Fat is fantastic.
We know that we need to
have a larger percentage
of fat in our diet, but
fat is not a free food.
So just because something is
containing even exclusively fat
does not mean more is better.
So we have to police things
even like a fat bomb.
So I’d say work with your
health coach on this to find out
what’s going to be the
right amount or cadence,
like every day, or do I
do this every other day?
Is this a once a week treat
for me, depending on how your
body is reacting.
And then really, you know,
how is it best for you?
Is it one fat bomb in the
afternoon, and I’m great until
I can get home and have
time to prepare dinner?
Because for some people that
may be the perfect place
to put a fat bomb.
For other people,
they’re done with dinner,
but they just want that small
bite of something sweet,
and they make a small fat bomb.
For that person, that
may also be perfect, too.
So again, individualized
on this, but remember,
fat is not a free food.
– I think that’s an important
point as well because
it’s very easy to overdo those fat bombs,
and then while you may have
amazing ketones, your weight is
probably going to stall as
well, so they can definitely go
a little too far if you’re not careful,
so that personalization
piece is very important.
Thanks for those tips, Dr. Hallberg.
– Absolutely.
And the artificial
sweeteners are what’s causing
diabetes in the first place.
What would your elevator pitch
be to answer these critics?
– Okay, so let’s go back to
the sweetener part first,
and then let’s talk about
the long term aspect of this.
We’ve got two questions here,
and I think they’re both
excellent questions, and I
wanna make sure that we treat
each of them individually.
So my feeling about sweeteners
are honestly we don’t know
how much sweeteners or the
very long impact of sweeteners.
So I take this in, this
is my view on sweeteners.
We want to be able to use
them as little as possible,
and we use them really as a
tool to make this intervention
sustainable because you
know, when it comes to sugar,
sugar for anyone with
diabetes is going to lead to
long term problems.
And so we want to be able
to keep people away from
utilizing sugar to make foods palatable.
But to tell someone who
really enjoys sweets that,
well this lifestyle
intervention, you can never have
anything sweet for the rest of your life,
that’s not going very far, okay?
But I’ll say a couple of
things, which is number one,
if when people are early on
beginning the intervention,
and they spend even a few
weeks early on without eating
anything sweet, you know,
meaning even staying away from
those sweeteners for a
short period of time at
the beginning, their taste
for sweet things will change.
And you know, you have to
try it to truly believe that
because I get that comment
from people all the time.
I can’t believe I couldn’t
eat X, Y or Z any longer
because the sweetness
was overwhelming to me.
So right there that’s gonna
enable you to be able to
decrease any sweetener use significantly.
And then I just say
use sweetener sparingly
to make things sustainable, okay?
The long term answers to
sweeteners we don’t know,
but we have pretty good
evidence that processed
carbohydrates, including
sugar and their impact on
metabolic health for patients
with type II diabetes,
pre-diabetes or insulin
resistance is negative,
so we have to keep both
of those things in mind.
Now long term impact of
this, what we know is that
long term impact of our
typical dietary guideline
associated dietary recommendations
has been a failure,
has made people sicker.
So we have great evidence
on this in ketogenic diet
in studies out to 56 weeks already.
And again, with the improvements
in metabolic health,
including the huge risk
factor for so many diseases,
cardiovascular disease, cancer,
that is type II diabetes,
long term if we are able to
reverse people out of that
disease pattern, we can
say with confidence that
they’re getting healthier.
– Are some artificial
sweeteners better than others?
– Are some artificial
sweeteners better than others?
Specifically what are the
benefits or the effects of
saccharine or glycerine or
other artificial sweeteners
like that?
– So artificial sweeteners,
there are many different
categories, if you will.
There’s sugar alcohols, and
then there’s what we call
the saccharine.
These are the chemically created,
non-nutritive sweeteners.
And so let’s talk about
sugar alcohols first.
So sugar alcohols end in o-hol.
You can always kind of pick
them up on a food label.
xylitol, erythritol, neanotol, sorbitol,
those are all examples of sugar alcohols,
and they can all actually
impact blood sugar
a little bit differently.
And so it’s important if
you’re trying out a new
sugar alcohol that you check
your blood sugar to see
what the reaction is for you.
But the ones that tend
to have the least impact
by far on blood sugar, which is key here,
are going to be xylitol
and potentially erythritol.
Now with sugar alcohols,
especially in higher doses,
people can tend to have some GI issues,
so that’s another thing
to keep in mind as well.
So experiment with them when
it comes to your blood sugar
and your individual tolerance of them.
But we tend to recommend a
lot of the sugar alcohols
overall because of that,
and actually xylitol,
let’s take a quick look at xylitol itself.
And that is one of the
interesting things that people
don’t realize is right now
everybody who’s watching this,
Catherine and I, we’re
making xylitol right now.
Our bodies make xylitol.
So again, what we’re doing
is we’re ingesting something
that we’re also making, and
so that’s one of the reasons
that we recommend that.
Our bodies are used to that.
xylitol is found, erythritol
too, a lesser degree,
naturally in fruits and even vegetables.
So again, that’s high on
our recommendation list,
but everybody needs to
check out their individual
tolerance of them.
Now the non-nutritive
sweeteners, those are ones that
have no calories, and they
don’t by themselves have
an impact on blood sugar.
And that’s been shown in multiple studies.
So let’s take a look at
Splenda, for example.
Splenda doesn’t, over
a patient population,
increase blood sugar.
Once again I’ll always say
check your own individual
blood sugar, but it tends
to not have an impact.
That being said, it’s a
chemically created compound.
So if you’re using something like Splenda,
I would use it sparingly.
And what you’ll notice with
these non-nutritive sweeteners
is that in their liquid form
it’ll say no carbohydrates,
no calories.
But when you get them
in their powdered form,
that’s a different story.
Because they had to add
something called bulking agents,
which are carbohydrates, to
make them powdery so that
you can use them for
example in baking recipes.
So there’s a big difference
between the liquid forms
of these and the powdered forms.
And one other sweetener that
I’d like to draw attention to
that is a non-nutritive
sweetener, but is little bit
different is stevia.
So stevia is just from a stevia plant.
In other words, it’s
not chemically created.
Now that being said, stevia
is available under many
different names, and some
of these the stevia leaves
are highly processed and some aren’t.
So a good idea is if
you’re choosing stevia,
you wanna take a look and
research what brand that you’re
buying so that you can get
the least processed stevia.
Or if you wanna be
completely natural about it,
grow some stevia.
Now stevia and utilized
straight from the plant
can have a little bit
of licorice taste to it.
Some people really enjoy
it, and for some people
it makes it a little less tolerable.
So those are my comments about sweeteners.
Sugar alcohols, put them into
non-nutritive sweeteners,
but the non-nutritive
sweeteners are different in
a liquid form than they
are in a powdered form.
And always when introducing
any kind of sweetener,
check your blood sugar.
– If you’re just joining us,
welcome to our Facebook Live
with Dr. Sarah Hallberg.
Please put any questions
that you have in the comments
below the video, and we’ll
address those during our
last 20 minutes or so.
And to get notified of
future Facebook Live events
and other Virta events,
make sure to follow Virta
on Facebook.
All right, here’s a really good one,
All right, here’s a really good one,
and I think the answer’s
gonna be it depends,
but maybe you can shed a
little more light for us,
is how do you know what
your personal carbohydrate
tolerance level is?
– So that’s a great
question, and it depends.
No no, but let’s answer
that with a little bit
more detail here, okay?
So what I like to say is that
people can develop different
metabolic flexibilities, okay?
So let’s just take
someone who does not have
type II diabetes, pre-diabetes,
never had an issue
with blood sugar, no family history of it,
they obviously have a higher
carbohydrate tolerance.
And now that may not last
forever because if they utilize
that high carbohydrate
and eat lots of sugar and
refined carbohydrates, they
very well may develop a
lower carbohydrate tolerance
for insulin resistance.
But that is at one end of the spectrum of
carbohydrate tolerance.
At the other end of the spectrum
of carbohydrate tolerance
when it comes to type II
diabetes is someone who has had
very longstanding diabetes,
and as we talked about earlier
has overworked their beta
cells in their pancreas
and truly is unable to
produce enough insulin.
Those people are at the
other extreme end of
carbohydrate tolerance, so
there’s a big spectrum here.
And where, most people fall in
the middle of this spectrum,
and where exactly in
the middle do you fall?
And the first thing I’ll say
is that may change, okay?
So in other words we may
find someone who’s at the
lower end of carbohydrate
tolerance, and as they implement
a Virta treatment, they improve
their insulin resistance,
which is very nicely
documented in our one-year
clinical trial.
Insulin resistance scores
dropped dramatically.
They may actually shift
themselves to having a higher
carbohydrate tolerance.
Now I’ll tell you right now
anyone who improves their
insulin resistance, if they
go back to eating a high
carbohydrate tolerance, they
will develop problems again.
So this is helping back
people out, but it’s not
curing them, and that’s a
really important point to make.
If we implement the Virta
treatment, someone does it
just for a while, goes
back to a high carbohydrate
lifestyle, they will have
recurring problems at some point.
So important to remember
that as we think about
that sustainability piece.
But in figuring out exactly
where in the carbohydrate
tolerance spectrum you
are at any given time,
keeping in mind that that could change,
it’s really going to be
following your blood sugar.
And if you have a Virta
health coach, they’re gonna be
key in helping you with that
because they’re gonna be
watching your blood sugar.
And say you try a new food.
What’s your body’s reaction to it?
Are you doing really good,
and your blood sugars have
been in the 90s, and then
all of a sudden you went out
to a new restaurant and
had a sauce on something,
on your dinner plate that
night, and all of a sudden
the next morning your blood sugar was 180?
That was over your carbohydrate tolerance.
And even though maybe the
food choices looked good,
it was probably something in
the sauce that you weren’t
aware was put in there, and
most of the time unfortunately
that winds up being sugar.
So it’s just going to be
following those blood sugars.
And you know, I’d like to
take an opportunity with
this question to point out
something that I think is
going to be key in the
type II diabetes community,
and that’s going to be
the advent of continuous
glucose monitors that are
now available to the type II
diabetes population.
So continuous glucose
monitoring is exactly that,
what it sounds like.
It’s monitoring your blood
sugar not when you prick
your finger and you check
it one, two, even more like
four or six times a day, which is helpful,
but we’ve got big parts of
the day, including overnight
where we are not sure
what’s happening with
your blood sugar.
We’re just checking it at
specific points in time
during the day.
And continuous glucose
monitors have that available,
but they have been so
expensive that they’ve really
only been implemented for type I diabetes.
But now there’s a new continuous
glucose monitor available
called the Libre, and
these are very inexpensive.
And I’ve been utilizing
them in some of our patients
who have found them to be
incredibly helpful at just this,
determining their
carbohydrates tolerance because
they can watch the line
through the day instead of just
points on that line to see
exactly how they’re reacting
to certain food.
So I think finding everyone’s
individual carbohydrate
tolerance is very important.
Working with your Virta health
coach and following your
blood sugars when you eat
anything new is going to be
a wonderful way to make sure
that you are personalizing
your carbohydrate tolerance
threshold for where
you’re at right now.
– Great answer to a great question.
– Great answer to a great question.
What amount of dairy or lactose is allowed
on a ketogenic diet?
– Well, for most people
that is a great source of
additional fat and often protein, okay?
Sometimes we will have
patients who have issues
with dairy, and maybe the lactose in it.
It may be other aspects of the
specific proteins in dairy,
and so it’s one of those things.
If people are really
struggling, if they’re having
some sort of side effect,
which oftentimes is GI,
they could try removing
dairy for a few days to see
if that could be the issue,
but I would say that’s the
exception for most patients
instead of the rule.
So for most patients the
answer to how much dairy
can you have in a day is
how much is it taking to
get you full, as long as
you’re making sure that you’re
meeting your protein
requirements for the day.
– Our next question, what
are your thoughts about
upping your carbs to 50
to 100 grams a day after
achieving type II diabetes
reversal or your goal weight?
– So it all depends on what
your individual carbohydrate
tolerance is, right?
– Nice follow up question there.
– Yes, yes, it’s a perfect,
thank you very much
for this question.
So again, let’s go back to
that spectrum idea, right?
So someone started out at the
very carbohydrate intolerant
end of the spectrum, and they’ve
done a great job with this
and they’ve worked their way up.
They very well may be
at the 50 to 100 range.
That’s totally possible.
For other people, they’re not.
They’re gonna fall maybe at
the very low end of that,
and they can do 50, but
if they go above that,
they’re gonna run into issues.
So you’re gonna have to
just check your blood sugar,
but that is not like unfathomable
range for some people.
Some people can regain what
we like to call metabolic
flexibility, or they can
tolerate higher carbohydrates,
potentially even in the 50 to 100 range.
But the other important
thing is if you are one of
those people who can get
into that 50 or 100 range,
you always wanna be asking
about the quality of the
carbohydrates that you’re adding in,
because if you’re at 30 and doing great,
then you moved up to 50,
and you’re still doing good
and we’re gonna experiment
with going higher,
if you’re adding those
in with refined flours,
I mean you’re gonna get
into trouble quickly.
If you’re choosing to add
more carbohydrates by choosing
berry fruit or choosing to eat more nuts,
those are gonna be foods
that are gonna allow you
again more flexibility.
So be cautious not only
of what your specific gram
number is, but exactly what
are the foods that you’re
choosing to increase the
carbohydrates if you’re able
in your diet.
– Do you have any evidence
of neuropathy improving
– Do you have any evidence
of neuropathy improving
with diabetes reversal?
– Well, we see this anecdotally
often in the clinic,
and patients will report an
improvement, but can I claim
that this is absolutely
a treatment for this?
No, because once again we don’t
have rigorous data on this.
So it’s one of those other
situations where I say look,
this is probably good for
a lot of things in each
individual case that we have good data on.
Try it out, and if the
neuropathy is improving for you,
You don’t have to wait for
the rigorous clinical data,
but to be able to say to the
masses you should do this
for that specific treatment,
we have to wait for the data.
It’s really important to
say that we as a company,
the Virta treatment is
being driven by data.
So we are continuously getting
more data, but what we are
doing we are only gonna be
promoting things that we know
are truly evidence based.
And like I said, there may
be plenty of good evidence
based reasons to try the Virta treatment,
and for some people that may
also improve their neuropathy,
which is fantastic.
– If you’re just joining us,
welcome to our Facebook Live
with Dr. Sarah Hallberg.
Please put you questions in
the comments below the video,
and we’ll try to get to as
many of those as we can today.
And to get notified of future
Facebook events and other
Virta events, make sure to
follow Virta on Facebook.
And we have just about 10
minutes, so we’ll try to get to
as many questions as we can
because I know there are
a lot of good ones out there.
All right, here’s another
common one that I get
All right, here’s another
common one that I get
from a lot of patients.
So I’ve noticed I’m losing hair on keto.
Is this normal, and
what can I do about it?
– So I can be, and it’s very
important to say what we should
really turn this into because
what is much more true is
I’m losing hair with rapid
weight loss because it probably
has nothing to do with the diet itself.
It’s the fact that the diet
is causing weight loss.
And we do get this question a
lot, and here’s how I like to
explain it to my patients
in a way that they can
really understand.
And that is when women have
babies, they don’t go home
from the hospital with hair loss, right?
But what they will find is
that when that baby is four,
maybe six months old, all
of a sudden they’re starting
to lose hair, and that’s
because giving birth is a big
shock to the system, right?
I mean it’s obviously a
good one, we all love it,
but it is a big shock to the system.
Weight loss is the same way.
It’s a big shock to the system.
We love it, we wanna have
it, but again weight loss
is likely to occur four to
six months after the beginning
of a period of rapid weight loss,
and that’s because the
hair grows in phases.
So what I tell patients
here is be patient.
Let the phase pass, and then
the hair will come back.
If people are really
worried about it I’ll say,
start taking some B-complex vitamins.
I mean I don’t think
there’s gonna be any problem
with patients doing that.
Whether or not that’s
gonna help, hmm, it might,
but the bigger thing is
you just gotta give it time
and let that phase pass.
– Next question, what
effect can a well formulated
ketogenic diet have on osteoporosis?
– So I’m gonna say table
the answer to this question
because we have data on this
that we have not analyzed,
but we will and intend on
publishing, looking at dexa scans
in our patients in our
large clinical trial.
So right now the evidence on
this is scant to non-existent
essentially, and so we have
the ability analyze some data
right now and put these results out.
So I’m gonna have to say hold
on this because I wanna share,
one again ensure that all my
answers are evidenced based
answers, and we will have
the answer to this soon.
– What does the research
tell us about ketogenic diets
– What does the research
tell us about ketogenic diets
for thin people with type II diabetes?
Specifically would a ketogenic
diet be a good option for
diabetes reversal for people
of southeast Asian descent?
– So the answer to that is yes.
And so patients of southeast
Asian descent do tend to
develop diabetes at a much
lower weight than in many
other parts of the world,
and so they may not have
100 pounds to lose, but it
doesn’t mean that changing
the content of the diet won’t
lead to successful diabetes
reversal just as it would with
any other patient population.
So I would really encourage
people of south Asian descent
to consider this as a
treatment for type II diabetes,
really important.
– Is a ketogenic diet an
option for a patient with
– Is a ketogenic diet an
option for a patient with
a family history of hypercholesteremia?
– Absolutely, and like I
said again let’s go back to
the cardiovascular risk
paper that we just published,
looking at improvement in
22 out of 26 risk factors.
And so having a family history
of hypercholesterolemia
does not preclude anyone from
participating in a lifestyle
change that includes nutritional ketosis.
But once again, I’m gonna
go back to say everyone
is different, and this is
one of those things that you
need to have a physician
who is following with you
to help make sure that you’re
able to make personalized
choices and treatment
plans as you move forward.
We at Virta want everyone
to have their cardiovascular
risks as reduced in all
aspects as possible.
– How often if at all
would you repeat a CAC?
And can you tell us what a CAC is?
– Yes, CAC is a coronary calcium score.
And so coronary calcium
scores are a really great way
to help people make decisions,
giving them another point
essentially, remember we
don’t wanna miss the forest
for the trees, and sometimes
that can happen when it
comes to cardiovascular risk reduction.
We wanna be able to have as
many data points as we can,
and somebody’s coronary
calcium score can be a very
helpful point here.
So in other words, if
someone’s had high cholesterol
all their life, they go on
a lifestyle intervention
like the diverted treatment,
and their cholesterol
stays elevated instead of
going down like it does with
many of our patients, or
potentially even goes up,
and they have a coronary
calcium score of zero,
that’s a really different
place than someone who has had
a lifetime of high cholesterol
and has a very, very
high coronary calcium score.
So a coronary calcium score is a CT scan.
People go in, they can usually
be had for very low prices.
I know in our area
Indiana University Health
offers them for $49.
It’s a very quick test,
in, out, and what the CT is
looking for is calcium,
calcium in the arteries that
supply the heart with blood.
And so what a coronary calcium
score should be is zero.
In other words, no evidence
that heart disease that
has developed into
coronary plaque or calcium.
Now anyone who has a positive
coronary calcium score,
even if it’s low positive,
using and checking this
over time, one of the big
things that’s going to be
a factor there is statin
medication use because anyone
with high cholesterol who
then has a positive coronary
calcium score, if they
get started on a statin,
their coronary calcium score
actually has the potential
to increase, but that
doesn’t necessarily mean that
that’s a bad thing because
calcium in that plaque
shows us that it’s stable.
And I’m gonna go here and
digress just a little bit into
coronary artery disease physiology.
Many people think of a heart attack as a
clogged tube, right?
So you develop disease in your arteries,
and they get smaller and
smaller in diameter until
one day they close,
and that’s actually now what
happens with heart attacks
and coronary artery disease
progression to an actual event.
What happens is there’s a
degree of disease in an artery,
and for whatever reason
there becomes a piece of this
plaque that’s unstable.
It gets kicked off, floats
downstream, blocks the flow
of blood, and that
causes the heart disease,
excuse me, the heart attack.
So what we wanna do is someone
has any degree of disease
is we wanna stabilize it,
and when you stabilize it
that can actually be seen as
an increase in the coronary
artery calcium score, but that
can be mean in many people
stabilization of disease,
so that’s really important.
But I love the coronary
artery calcium score in people
as again an additional data point.
And we can have a really
good discussion together
at what that person’s
individual risk factors are,
and what is our next logical step.
And it’s a decision
that should always be a
shared decision.
I think this is so important.
I will never say here’s a
prescription, you need to take it
because taking a new
prescription, that’s a really big
decision to be made, and it
should be made as a team.
It shouldn’t be one person
dictating what another
person does.
It should be to say let’s
put your, let’s put all the
ducks on the table, if you will.
Let’s talk about your risk
factor, and let’s come up
together with what our
treatment path is going forward.
– Do you need to be in
ketosis for the low carb,
– Do you need to be in
ketosis for the low carb,
high fat diet to be effective?
Or can eating keto-ish be
acceptable or successful?
– Well, that’s a great question,
and honestly the jury is out.
I think that what we know
about ketones are they can be
incredibly important in helping
people know that they’re
doing it right, right?
Because if they have
ketones, what does that mean?
It means that they’re
using fat for energy,
and they’ve got it.
They’re implementing the
lifestyle intervention well.
If they’re doing keto-ish,
and they don’t have that
to judge, I mean it’s really
a little bit more difficult
to say how am I doing today?
Was this food choice a good one for me?
Or did I just make a choice
that’s negative on my
metabolic health?
So I think they can be
really important there.
And we’re just beginning
to understand the benefits
of ketones, so I think more
and more data is coming
out on this, and I would
not be surprised within
the next few years if we
really get a much more
firm stance saying ketones
are critical in health.
There have been studies
recently that came out that show
ketones very specifically
decrease inflammation.
Once again, going back to
remind everyone, key component
of all stages of cardiovascular
disease formation,
Some really nice studies
showing that ketosis
specifically with elevated
ketone levels lead to
decrease in inflammation.
In the other one there
was even longevity studies
that came out, and yes,
it was a mouse study,
but I think it really opens up questions.
I mean where is the
possibility for ketones to play
in so many aspects of disease?
And we mentioned it briefly before.
Right now there are ongoing
a lot of trials with ketones
specifically in cancer and
in many neurologic diseases.
For over 100 years in
fact, ketogenic diets very
specifically needing
those ketones present,
treats epilepsy.
So I think that we’re
gonna find out much more on
exactly what else besides
metabolic health improvements
we may get as a benefit by
following a true ketogenic diet
and implementing that as a lifestyle.
– So stay tuned.
More info to come on ketones
over the next couple of years.
– Yes, absolutely, absolutely.
– So we have time for just
a couple more questions.
So with that we’ll go to the next one.
So is it dangerous for
someone that’s living with
So is it dangerous for
someone that’s living with
type II diabetes to do
ketogenic diet without measuring
all of those biomarkers and
just following the basic rules?
– It can be.
That’s the really quick down
and dirty answer, it can be.
It can be very dangerous
if you are not working
with a physician.
Because medications that
patients take for diabetes
are intended to lower their glucose.
And if you’re making lifestyle
interventions aimed at
lowering your glucose, you
can enter into a potentially
really dangerous double whammy.
That’s why everyone entering
into the Virta treatment plan
not only gets their health
coach who can help personalize
their food choices, but
they also have their own
Virta physician who is ensuring
that they are adjusting
those medications appropriately,
safely, but also getting
them down so that people
can successfully reverse
their diabetes and get rid
of some of their medications.
So it is so important to
have a partner in a physician
who’s working with you on this.
And I can’t stress that
enough because if we get those
blood sugars to drop too
quickly because no one is
helping with medication
adjustment, that can be
incredibly dangerous.
– So thanks everybody
for joining us today.
To get more information, follow
Virta Health on Facebook,
and check out our research,
much of which Dr. Hallberg
referenced today at
So thanks, Dr. Hallberg,
for joining us today.
I learned a lot, I hope
everyone else learned a lot,
and we’ll see you back here next time.
– Thank you so much for joining us.
I really appreciate it, and
I’ll be excited we’ll be doing
more of these in the future.

9 thoughts to The Ketogenic Bible The Authoritative Guide To Ketosis Pdf Where To Buy At 0:52

  1. I love this video, and I am looking for a doctor in my area who would essentially do what it is that you do for your patients. Do you have any suggestions on how I can narrow my search? I think I am doing well on my own as I was pretty close to being a diabetic when I started doing keto a year ago. I have made so much progress in this time but wonder how much easier and cost effective it would have been if I had a real clinic/doctor helping along the way.

  2. This needs to be pointed out as Dr. Gundry mentioned in a recent interview that he would see the actual calcification on the outside of the artery, and then, often see the plaque on the inside of the artery a few inches away. This needs to be corrected sooner rather than later. He has done over 10,000 heart surgeries so this is his specialty. He says that he is recommending a medicare approved procedure called a CT coronary angiogram, a relatively new procedure. A lot of people are getting these two things confused and I pointed this out on a Ivor Cummins recent post.
    You both are making enormous contributions to our health, but these kind of mishaps need to be addressed. Here is a link to the AHA web page with links to 13 of his publications in that journal.

    Here is a link to his twelve year followup of the 978 patients with previous heart problems:

  3. Checking out “Vαnοjο Fivu” (Google it) will allow you to cure diabetes and achieve a healthy way of life. For a time frame of 1 ½ months, my partner has been a keen follower of the program. It`s been five years since he has been taking insulin shots. He has been a type 2 diabetes patient for 6 years. His eating routine have positively changed since he has been a passionate reader and follower of this program..

  4. I guess the next step is teaching our youth good dietary habits. Its a shame our Food and Drug Administration has married the pharmaceutical corporations, and corporations like General Mills.