Part 31 - Dr. Jeff Volek on Carb Intolerance, Reversing Type 2 Diabetes, and Personalized Nutrition

I talk to a lot of great people on this podcast but this may be the man who really knows this stuff at the deepest level and most qualified to talk about fat adaptation and ketogenic diets & therapies. He has been doing amazing work in this field for such a long time.

Dr. Jeff Volek is a professor, researcher, registered dietitian, and co-founder and Chief Science Officer of Virta Health. For the last two decades, Dr. Volek has performed cutting edge research on how humans adapt to diets restricted in carbohydrates with a dual focus on clinical and performance applications of nutritional ketosis. His scholarly work includes more than 300 peer-reviewed scientific manuscripts and five books, including a New York Times Best Seller, and he has provided more than 200 lectures at scientific and industry conferences around the world. He's an all around great guy and someone I admire.

He very rarely does interviews so I was honored to spend some time with him. He is busy running his lab at OSU while also being a co-founder of a major health company I mention a lot called Virta. My company SAPIEN which you can find out more about at SAPIEN.org is producing technology similar to them. They use an app as well as devices like a smart scale to help monitor patients and keep them accountable as well as communicate with a health coach as they reverse type 2 diabetes with diet and lifestyle. We're doing the same thing at SAPIEN so if you are a healthcare provider or a health coach and are interested in our platform please reach out to us via our site SAPIEN.org

Before we start the interview I want to ask people who have gotten any value out of this podcast to support me by contributing to the Food Lies film Indiegogo campaign. Go to FoodLies.org and pre-order the film or check out the great perks we're offering like the EAT MEAT shirt, movie poster, and Real Foods coin. We rely on the community to make this podcast and film a reality. I'm seriously on my last dollar here and the post production of the film is slowing down due to budget constraints. I really appreciate the support. You can also click through the show notes in your podcast app to support the film. Thanks, and here's Dr. Jeff Volek.

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SHOW NOTES

• He presented some of his research at the Metabolic Health Summit in Long Beach at the beginning of February
• Keto is very popular these days but it's a double-edged sword
• His interests in ketogenic research are broad including metabolic disease, type 2 diabetes, athletes, military personnel, etc.
• He's studying tons of military applications to help them deal with energy, fatigue, recovery, cognitive function, etc.
• He and Dr. Steve Phinney wrote the great book The Art & Science of Low Carb Living which should be perfect for the savvy nutrition folks listening to this podcast https://www.amazon.com/Art-Science-Low-Carbohydrate-Living/dp/0983490708
• The concept of carb intolerance
• What percentage of the population might be carb intolerant?
• Before the agricultural revolution humans had very little access to carbohydrate
• Low carb or ketogenic diets are what our bodies were made to run on
• There's probably only a small percentage of the population that is tolerant to these refined and abundant carbs in the modern food environment
• Carb tolerance also goes down with age
• What's great is that basically everyone can adapt to a low carb diet and this makes sense from an evolutionary perspective
• We all have the ability to run on fat but eating a ton of carbs suppresses that
• It's helping to treat diabetes (reverse it or put it in remission), cancer, neurological diseases
• The preponderance of trials shows low carb diets are superior to low fat diets in a free living setting
• There was interest and studies in ketogenic diets for weight loss in the 50s and 60s but then we hit the "dark ages" of this research with the USDA guidelines and it was basically toxic to study low carb in the 70s, 80s, and 90s
• There's been a huge amount of research done in the last 20 years that supports low carb diets
• There's so much entrenched beliefs and momentum behind low fat paradigm it just takes a while to get past it - we're doing really well actually
• The dietary guidelines don't reflect the current body of science
• They dietary guidelines actually matter - affect what kids eat at school, military eat, what's taught to dietitians
• I think we should have two dietary strategies offered as the official guidelines instead of ending up high fat AND high carb like most americans artoday
• Dr. Volek believes low carb should be the preferred option for those with any sort of metabolic syndrome
• Personalized nutrition is the future but we're just scratching the surface
• Mapping the genome and genetic testing aren't really panning out
• He's looking at some biomarkers to help tell if people are mismanaging carbs
• What about eating more protein?
• It's pretty straightforward to implement a ketogenic diet but it's also pretty challenging in modern society
• His company Virta http://virtahealth.com is working on tools for this
• I'm doing something similar with SAPIEN http://sapien.org
• They use technology to efficiently scale the program to thousands and potentially millions of patients
• Dr. Sarah Hallberg ran the clinical trials and showed amazing efficacy of the program and keto diet in reversing type 2 diabetes
• Their blood sugar and hemoglobin A1c values were normalized which is pretty unheard of in the standard treatment of T2D
• They recommend eating fat to satiety but limit carbs and protein to achieve ketosis
• They recommend 1.2 to 2 grams of protein per pound of reference bodyweight
• Ketones have an anti-catabolic effect so they decrease protein breakdown - so no need to overeat protein
• Some people report less than ideal body composition on a ketogenic diet - may be because not getting enough minerals and electrolytes
• You can get a stress response as a result from this - sympathetic nervous system response and aldosterone causes potassium to be wasted as it tries to absorb more sodium
• If you have low sodium that has a negative effect on your protein status
• He has another book called The Art and Science of Low Carb Performance focused on athletics
• He had a great presentation at the conference I missed
• In the 60s and 70s Scandinavian researchers found out about the importance of muscle glycogen which led to the concept of carb loading
• A coach out of Florida invented Gatorade a bit later and then the Gatorade Sports Science Institute formed which really influenced our view sports and exercise science
• Since the 1960s it's been unanimous that all athletes should eat as much carbohydrate as possible before, during, and after exercise. It's pretty insane. And there's multi-billion dollar industries behind it to keep it this way
• He thinks athletes should be consuming as few carbs as possible while maintaining peak performance
• Consuming all these carbs are like absorbing punches to your body - you can get away with it for a while but the damage builds up
• It also prevents them from being able to burn their own fat
• He rewrote the textbooks and what was possible with VO2 max and fat oxidation in his FASTER study
• Ultra distance runners are winning races fat-adapted
• Burning basically 100% fat for 3 hours during tests
• They're recovering better, not relying on tons of sugar and refined carbs packs, better GI function, and have greater enjoyment exercising
• He also studies military applications which overlap with these athletic advantages
• He says more importantly even are the cognitive benefits of the ketogenic diet
• They are also studying the effects of ketones on inflammatory pathways, an association with less oxidative stress, perhaps better immune functioning
• So far being in ketosis has been found to help people recover faster, cope with stress better, improved mental clarity and cognitive function
• Also helpful for traumatic brain injuries
• There's so much more that needs to be studied and there's so much promise for new applications of ketosis
• We need to support federal and private funding of research on ketogenic diets and therapies

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