059: Dr. Jeff Volek - 10+ Years of Keto Research, Cholesterol on Keto, Exogenous Ketones, and How Keto is Reshaping Outdated Nutritional Guidelines
So. Hello. And thank you for tuning into Bikita answers podcast. I'm your host. Dr Anthony guests in this week. Join me is Dr Jeff bullets if you don't know of this guy's name. You do much research. He has been the author on over three hundred articles two hundred lecturers five plus books. He's just one of the first people in the space, and Dr Stephen Finney or the ones who kind of have pioneered they'll a movement ten years ago or so they started with the signs of low carbohydrate living book in and also the art insci- of low carbohydrate performance in with that. I mean, they were just years and years, and you're the head of the game and have pushed all the research forward. They're not doing a lot of crazed f so whether that's research in fighting outweigh the benefits are to move forward and drank diet or using verte health, which is the company trying to get reversal of one hundred million people from diabetes, and the work is just non stop. So it was great. Conversation with Dr Volk about everything that he's learned last ten twenty thirty years. I mean this. One of the most knowledgeable blanquita diet. So couldn't think him enough for being on the show and taking his time on his busy schedule. So without further ado, here's my conversation with Dr Jeff of elect. But before we get started. I wanna let you guys in a little secret that is we have some brand new key Avar flavors in. So the same thing that we had with brownie that you guys loved and went crazy about we sold out in five days when we release that one. We have lemon poppy seed in salted caramel. So these are just ridiculous lemon poppy seed, tastes exactly like a frosted lemon, poppy seed, Muffin or cake, or whatever you buy at Starbucks that delicious, but kills you don't buy those things, and then also salted caramel, which tastes pretty much. Like it says so care mouth. So these things are great on the go as a treat whatever same standards, we have the other bar. So we tested bludgeoned with this noble, spike, no Kitone levels, actually increased couple team members heat levels. And yeah. Otherwise, the exact same call Jin from ten to eleven just because you know, ten grams was enough that we go eleven otherwise these things are amazing. So if you wanna try up before they got a stock, which me happen, very very soon. We just launched them perfectly dot com and use the code new Kita bars at twenty percents off your order this whole month. So go suck up. Now. If you already have bingo favorite flavor nine is the lemon poppy seed on route that little sucker in enjoy it for this show. Jeff folic. Thank you for me on the show today. My pleasure. Great to be here. Anthony, you are a busy, man. I think and so really appreciate you taking time to concert. So for the few people who may not know of you, you give me a quick background of the year extensive work history. Think that when I was looking through in preparing to me like three hundred scientific research journals two hundred lectures, five bucks, many many decades of work in this field. So if you just maybe give people a short background. Yeah. I stumbled into this area. Boy, it's it's going on twenty five years ago or so early nineties as a budding graduate student who wasn't convinced what I was being taught by professors was exactly correct in an S bene-. Interesting rabbit hole to go down published. My first studies in in the early two thousand but I started doing experiments in the mid nineties, and and it's been quite a journey. So it's been really to, you know, two decades of research in this area and seen some highs and lows in terms of the. Acceptance in general attention on a diet, but I have to say the last couple of years in particular have been quite refreshing just in terms of the volume of science in overall interesting Kita genyk diets. Have a Google Scholar alert sat and it seems like every single day. Now, I'm getting some new stuff come across the my Email inbox a couple years ago as maybe once a week, I was getting something. So yet the pace has just been astronomical as of lately when user to going is you were just interested in the physical performance. What were those things that your professors were telling you that you maybe weren't on board with needed to solve yourself? Well, I was I started out in dietetic and became a registered dietitian. And so I had to classic training which unfortunately, really hasn't changed much today. So you know, everything was about low fat. Hi, car, lots of grains, and etc. But then I went onto graduate school in exercise physiology because I was interested in sport nutrition exercise metabolism. And you know, but it was it was right at the time of entering into graduate schools master's student when it really started to challenge some of the ideas of especially managing diabetics. I mean, we were taught as dietitians that we needed to feed, you know, anyone with type two diabetes over half their calories from carbs and wasn't quite smart enough to understand why that didn't make sense. I thought I just didn't quite get it. But it just didn't make sense to me the more studied it the more. I was right. It doesn't make any sense. But really inspired me to wanna study metabolism on a deeper level and understand this in the more got into it. A lot of it was self teaching and reading a lot of articles the more realized a lot of what we think we know is is actually incorrect in you know, in professors who were were not really advocating low car. So they were confirming the status quo, which is athletes need carbs was that just few strategies that the feelings register incorrect or was that what was the main problem that you have with it at that point status quo. Well, there's no doubt DEA both in general nutrition as well. As for nutrition, there's an emphasis on high carbohydrate diets is being healthy, especially in in for athletes where you have coming out of the sixties with a lot of the work in Scandinavia with. Glycogen being discovered in the relationship between high carb diets and glycogen is being obligated for. High performance, and and that really led to carbohydrate loading. So you have this carb supremacy paradigm that's been going on now for forty or fifty years, and it's more or less, you know, the more carbs better fuel before during after exercise in. We're seeing now that that doesn't work well for a lot of people, and we can get into this more. But you have a lot of athletes really struggling with this type of approach when they really abandoned their car bloating, folk this moron protein fat and limit to carbs. It's nothing short of transformative for a lot of these folks. So. Nutrition's very complicated. There's no silver bullets. But I think this mindset of. As pump as much carbs as possible is not correct. I would I would argue. It's consumers few carbs as possible while maintaining optimal performance is a better strategy Annette doesn't necessarily mean Kita genyk or even very low carb for some athletes, but it's a it's a mind shift. It's a different paradigm of instead of maximizing carbohydrate intake, you're really focused on minimizing it while trying to optimize performance in that could be different for different athletes. It can even be different within a person ending on their goals in life sore status. If the as you age, you tend to get more carbon dollar in in so your needs can change over time in in response to different events in your life. So this this is something that, unfortunately, is is very complicated. There's no simple answer. Here. But I think we've over emphasized carbs in general in Iraq. Nord low carb is an option for athletes in anonymously in. So was the first vertically dove into his performance in regards Kara hydro consumption. Well, actually, I always I would say that what you really started my interest in wanting to even go to graduate school and become was always leaving after a masters, but I really felt in lovers cert- with search in the decision was pretty easy to stick around another four or five years and get a PHD, but I became quite interested in fat metabolism in cholesterol, like protein metabolism. Because a lot of the current dietary guidelines are based primarily on the diet heart high popped assists, which was Ansel keys in the really primarily the sixties and seventies. It really disdain. This theory was promoted in his still in many ways promoted today, but that was all based on the idea that over consumption of fat, specifically saturated fat, raise cholesterol, and that intern increased risk for heart disease. So, you know, I really initially gonna get focused on studying how nutrition low carb diets affected cholesterol metabolism. And that's that's been a continuous interest of mine were still doing studies in that area. Because it's just fascinating end. If we're actually positive for a second. I mean, I think that I have heard on the Keita space this term of lean mass, hyper responder, how'd you break that down a digestible format for people who've who haven't really understood a lot of the science. Yeah. Well, the I think just to take a step back. If you look at how Kita genyk diets affect cholesterol metabolism in generally have very uniform response in terms of triglycerides down consistently. And that's good HDL cholesterol. Good cholesterol goes up in most people and LDL cholesterol. However, which is the one physicians focused on on prescribe statin, if that goes up that is quite variable in terms of colest- LDL cholesterol concentration we've done dozens of studies including highly controlled beating studies with precision controlled meals, and you know, you take hundred people feed them the exact same food for a month measure their cholesterol under the most well-controlled conditions in what you'll find is have the people their LDL cholesterol goes up the other half. They go down. Some people goes up quite remarkably might may be fifty points in another person that goes down fifty points. And and so if you dig a little deeper, you know, now, we have really good evidence that LDL cholesterol is not just a singer. Oil type of particle. It's small particles large particles have different composition in. There's very good evidence. Now, although I will admit this is controversial. But if you look at the evidence now, it's pretty clear, it's the small dense LDL particles that are most after Janik in confer the most risk for cardiovascular disease, and it's tied to triggers red levels. So it's no surprise on Akita genyk diet. You see consistently the small atherogenic particles go down in that's independent of whether or not you are a, hyper responder in terms of your LDL cholesterol. So that's just kind of the so you get into this paradigm of do believe, it's the total cholesterol, that matters LDL cholesterol concentration. Believe more on the HDL small LBL particles are the ones that. Our most important into you know, simple answers. Nobody knows for sure. But Kito a ketogenic diets definitely improve one in loaf. Head diets are definitely better lowering LDL cholesterol. So you have a sort of conflicting paradigms here, but you know, the idea of hyper bonders, so there seems to be in this kind of, you know, new area. There's only a few studies a lot of anecdotal testimonial. Data out there. But it seems that if you add exercise, especially high volume endurance, exercise to Akito genyk diet, a greater percentage of people manifest in hyper cholesterol mic response. So in other words, share in Durance athle- gonna care Jack died there's a much better chance you end up being one of these hyper respond IRS. And so we don't know exactly what accounts for that. Whether there's just. Some inherent genetic up propensity successful, endurance athletes, have whether there's trillion interaction between exercise I suspect it could be a little bit of both. But probably the latter simply because especially in these alternate Durance athletes that are very successful and well trained that they are prodigious fat burners function of cholesterol is to transport fat around the body through the bloodstream, and if you need to move fat around at a greater rate in more efficiently. It makes sense that you would expand your cholesterol pool. It's not that. It's Athar genyk. You just need more lipid carrying vehicles to move fat to the muscle and other tissues organs that are using a lot of fat than we know keyed after the athlete really anybody who's key to adapted devils their rate of fat-burning, but. Especially in these endurance athletes where you see extremely high rates fat oxidation. So we think it's a functional adaptation that's actually serves a purpose. More that it's a state of flux things moving around more. And I think that we can confuse that with a lot of clinical assumptions, which is at higher of whatever cholesterol that means bad in you need to go down because you're unhealthy. Whereas if someone's sedentary lifestyle, not moving the union bunch of terrible food that that maybe that correlation does make a little bit more sense. But if you know every other marker, we see inflammations low oxidative stress is low oxidized LDL's Lau, small park is low things like that. I think we can just come up with the with the updated model on this year's doing not exactly right. All the other biomarkers pretty much anything you can think of measuring improves so into it's very isolated increase in LDL. And you know, the skin. To the whole controversy around cholesterol is a risk factor, which you know, that's a highly beloved belief, by physicians in most healthcare professionals. But the reality is, and I don't wanna totally dismiss. But it's I think it's fair and accurate to say that it's been overstated how important cholesterol levels are in a lot of that's been driven by drug companies for as we have very effective drugs that can decrease cholesterol. So I think they've. That's just say influenced the narrative a bit on that. If you really look deep into the evidence relationship between cholesterol levels, heart attack, heart disease, are not Diculeng, strong and. You know, cholesterol is fine. If it's circulating in the blood. It's only when it penetrates the arteries contributes to atherosclerosis, which is really more of an inflammatory mechanism than a cholesterol mechanism. So we you push one of the first bucks on. I would say key die that the modern form of Arden signs of low carbohydrate living in kind of immediately after the hour, very soon. After that the same thing aren't signs of low carbohydrate performance in other me what eight eight tennis years ago now. Yeah, it's hard to believe. But I believe the ad were pro ching decades. So it's time to update what was so that's things. I wanted to touch with you on what are the things that you would update if you go back in really second versions of each of these generalize Kita outs or low carbohydrate leaving in as well as performance quarter. The things that we know now that we didn't back then. Well, a couple of things that probably the most obvious new. New newer area of Kitone research is the now recognition that beta hydroxybutyrate, the principal circuiting tone is a is a potent signalling molecule, so it's acting like a hormone in. This is in addition to its well documented a role isn't alternative fuel. So now, it's it's it's it's even more plead trope in terms of how we look at Kia genyk diets in how they're functioning, it's. It's it's it's really hard to pin down a specific mechanism because it works a lot of different pathways in. Now, we have a whole bunch more. You know, for example. We know that made hydroxybutyrate is potent h deck inhibitor Histon de assimilation hitter, which affects gene expression and up regulates antioxidant defense. It also decreases inflammation through the P three and flam. And so these are direct signaling effects of Keat zones. You know that happened to explain a lot of the clinical outcomes, you know, we had documented in many previous studies. But now we actually understand mechanism bit more. So this is really interested. A lot of the basic scientists now wanting to now look at various ways of inducing ketosis in for example, looking at longevity. You've got a lot of interest now in that area because of these signaling affects of key tones, so that's one we really didn't touch on that much at all in the books, and that's really because that work kinda started seven or eight years ago in their spent a lot of a lot of. Subsequent publications supporting that. So with that maybe lend a hand to people who supplement with key tones either with Saul to esters removes your viewpoint on the ceiling molecule aspect, obviously. Yes, it can. Allow yourself to have an alternate fuel or addition to fuel especially when you're becoming Kito adapted. But with a role catering supplements, I mean is there possibly that? They are providing a lot of signaling benefits, or what is your view on that? Yeah. Well, it's possible. But this is a whole new area too. And we're really in an embryonic stage and understanding how these Kitone and different forms of factors Yala Judy and whether or not they mimic recapitulate, the human response to a ketogenic diet, a big area of interest for me. But again, we don't there's so many more questions than answers and we've been trying to move this field forward. But what you have to realize is there's there's gonna be differences for sure almost guaranteed. But the question more is are there some similarities because a kid genyk diet? Some of the benefits are attributed to keep downs. But many of the benefits are more related to the restriction in carbohydrate, lower, insulin stimulation in signaling and some of the downstream responses to that. And you're not going to get most of those benefits such as enhanced fat oxidation just by taking his key tones consuming carbs along with. So I have an open mind. I think these these new supplements need to be investigated. But it'd be premature to say you could just replace the Keita genyk diet with exaggerates towns, keep eating all the carbs you want. But I do think there's probably going to turn out to be some important locations of exaggerate ski tens maybe even as an adjunct to the Keita genyk diet, or as a sort of lead into a. Jack died for people that may struggle with getting into ketosis. There's many many questions in potential applications. Just a lot of sort out. The yet likely difference is between the different types of executives key tones, whether it's Esther salt in what minerals are attached to the salts and so forth. So mechanism is one of the main things guys would have included. What about second third big big things that you know, now that we didn't know before. Well, just just the volume of research out there. I mean in almost every area. I mean, we had good evidence that diabetes was highly mental decay jank diets, but we have even stronger evidence. So we would just update some of the literature basis. You know, when we wrote the books there was not a lot of interest in cancer and some of the different neurological conditions outside of epilepsy. Alzheimer's, for example, there's some really. Strong preclinical data now for those targets that I think are worth writing about. Now, we still have a lot of questions because we don't have large randomized clinical trials, but I I allow that work is underway and the preclinical data animal studies in smaller human studies, case studies all very promising and just mechanistically metabolic ly- the theories of pretty strong. So it's really exciting times while we wait for some of this work to get done. So this there would be areas date around sort of other clinical targets beyond obesity, diabetes metabolic syndrome, which are pretty tightly linked to the insulin resistant FINA type. In his far as a performance edgy goes. I mean was one year I still a huge driving factor of researchy do. But I mean, what are the big things that we now is that tation periods. It electrolyte needs. Like, what are what are the big things that may be like, oh now that it's eight hundred nineteen we know this I should put that in before well that that that area of performance, which is kind of a broad term. But in terms of enhancing, physical performance and even meant mental cognitive abilities. It's moved forward. Slowly. So we could certainly update what we wrote. I think we were pretty right on with what we wrote there's been a few studies published that confirm a lot of what we wrote. But but that area moves really slow in part because it's really hard to get funding in general to study Jack diets in any area. But it's especially difficult in the area of sport performance red lettuce performance, just because it's not something the mainstream sponsors again, I h would would even consider. So it's it's really hard area to move forward because of limitations in funding. But, but there have been, you know, a few studies here their published over the last few years that that show positive effects of Kita genyk diets. If you had limited money to study, some of these things like what are the top few pressing issues that you think would unlock the next wave of research. Well, you know, we're really focused here at OSU in two main areas are thrust one is the performance side of it in that is really more on the military applications. So how can we enhance soldier health readiness resilience? So we think that very broadly in terms of just enhancing the human condition or optimizing human abilities, and for the soldier that can take on a lot of different aspects. But that crosses over into athletes as well at the end of the day these soldiers are need to perform just like athletes to in also because funding wise, we have opportunities to go to department of defense or darva until fourth them if we take that route. So that's one big vote. But it's pretty broad because we're looking at everything from you know, how ketosis might enhance physical performance to cognitive abilities to protection from concussions in enhancing, recovery, etc. The other big areas that were focused on here. No, she was cantor. And I think that's one of the next frontiers. As I said, the the data very promising now, but we really need better human studies. And so we have one ongoing trial. Now, it's still relatively small study. But compared to what's been published it's the largest human trial right now. And that's in women with stage for metastatic breast cancer in a can't talk too much about that. But it will say him. It's feasible in women except the diet. No problem in they they get into nutritional. Joses and the really results look very promising. And these are women in a really sick. They prognosis is is pretty poor with this kind of diagnosis and treatments more or less palliative that point so so we're very excited about that project. But we're we've got a lot of other projects in pipeline to to look at everything from combining gauging diet with different drugs that could be synergistic with Kita genyk diet in also looking in different types of cancer. So the think that's going to be a really exciting area over the next several years decades, really because there's a lot of work that needs to be done in that replacing some sort of stairs of care or is it as agile therapy. How do you imagine a best case scenario checking out is a great question. In most cases, I think most people are feeling ki ki genetic diets. As an adjunct to other therapies, so if you're getting radiation therapy or chemotherapy or even immunotherapy the hypothesized must cases the Decatur genyk diet would enhance synergies with those other treatment Paradyne's. As far as bringing it back to your your focus on military personnel. You said a study published last month immune group, people you want to maybe walked through findings there and me highlight highlight you guys got to refresh. Sure. Well, this is kind of a. Pilot study in many ways because we wanted this dash with military that we could even recruit a group of military personnel in get them to accept the diet in in get them into ketosis because that one of their biggest concerns to be quite Frank. They they don't think that they don't wanna change too much work to change the diet of soldiers. So so we recruited a group of of people into the study that are part of the Ohio State. Our army ROTC were most of them were from our we had a few others. So these were. Relatively young. I mean age about twenty five though the few up in the thirties early forties. And the idea was just to see if they would accept the diet. But we also did a lot of measurements too. So it was a twelve week intervention. We created fifteen now. People into the Keita genyk group in another fifteen into a low fat sauce standard American diet group and trapped them for twelve weeks train them into through a whole battery of tests, including everything from muscle biopsies resting metabolic rate in cognitive test in body composition, so forth. And we promise the first paper. We have other papers were working on now with the first paper was really focused on the body composition while it's focused on the these Billy park, which it was feasible was very. Was very well received just due to compliance. What was a measurement that you're looking at for feasability? Actually, measuring Keith Jones every day. We'd have them into a finger stick in measure beta hydroxybutyrate and have them report that back to us every day, and that really served two purposes wanted to measure compliance, but it also is a way for us to individualize the diet because everyone's a little different than needs to restrict carbs in moderate protein. To a different extent to be ketosis. So we got everybody above one million molar, which is quite impressive in these sort of outpatient studies. So everyone was in ketosis, and it was not a weight loss study. So we did not prescribe calories. We wanted that to be one of the outcomes it was dependent variable. But the it was quite a robust effect on weight loss every single person lost weight lean way loss was on the low over fifteen pounds, and it was almost all fat loss. And it was really the first day to measure visual fat. So the fact it's round your organs, which is much more highly sushi with cardio metabolic disease in we did that with the preferred advanced imaging meth. Using marai? And and so the Cuba genyk diet significantly reduced this real fat as well. And did not negatively impact or positively impact in relative to the high carb group adaptations to training. So they got stronger adapted to the training in the same way that the high court group did which is positive in our mind in a lot of that was focused on strengthen power less on endurance. So that was kind of another novel aspect because that's kind of a question out there. Whether not being key to adapt. It would negatively impact strengthened power in this case it did not Zo. We had wide range of performance parameters that we looked at. Did you see the initial dip off than can rebalancing twelve weeks? Actually, we did look at that in we expected, but it wasn't as profound as we thought. I'm not sure why. Because they're usually as a is a drop off. But maybe that's more specific to the endurance community where you really need to give it a good three to four weeks before you start feeling that normal, and that really wasn't the case too much, but we were very careful implemented well-formulated diet. So that adequate sodium in people weren't volume depleted, which can happen. If you're not aware of the natural ketosis and so forth. So that may have contributed some. But it was there wasn't a. No real drop office as we thought there might be. So the physical adaptation was the exact same pretty much or or similar the physical health markers were all positive outcome. So we had higher facts addition a lot of Israel, fat loss premiums and body composition. And did you guys truck? I mean, I feel like this would be a very important thing to look out for military application, but any sort of subjective or objective mental markers. As far as mental health goes, focus concentration energy levels. Anything like that? Yeah. We get a whole battery cognitive cash that we haven't presented that yet. Having to be honest having analysed yet either I can't speak to that right now. And we did a lot of surveys and things in overall. I mean there were few subjects struggled a little bit. But overall there were there were some amazing transformations in terms of. Decomposition few subjects, and they provided some very powerful testimonials for us. So it had overall very positive effect. But lease for that. I doubt in in arguably the primary goal of the study was. Really dress the obesity problem in the military because you know, it's it's it's frightening. But in three fourths of soldiers right now are either overweight or obese and close to around seventy percent of youth of seventeen to twenty three are ineligible for the military, primarily because of obesity Ennis's been described as a national security crisis because we may have trouble filling a military not because people don't want join. But because they don't meet the criteria. So so we really kinda played that angle more than anything in this. Initial paper. We have some other data to it was a little more of mechanistic from muscle biopsies, looking at glycogen might Kondracke functioning and so forth, the pretty provocative all very positive. So there are a lot of other questions. We were trying to address in the study to will likely get out them the later this year. What's interesting to me is I wonder if that I mean has there been any look as if that's before they're entering the military. Or if it's after the end of the military, either high stress or poor nutrition is leading to these things. I mean, have you looked into that at all? Well, I think you know. It's not been well documented, but but you see definite transit kinda mimic the general population. And if you look on these basis in what food is provided. It's it's very much modeled after the doctor guideline so's lot high carbohydrate and electrolyte of sugar available to these soldiers and. It's not surprising at go army dot com. The literal army website is says an Emory Marie which is a meal ready to eat. So like a winning combat what what soldiers can have access to eat. And it says contains phone Andre spaghetti side. Dish rice corn fruit or mashed potatoes. Cracker bread spread peanut butter. Jelly cheese. Bread desert cookies or pound cakes candy, Eminem skittles zeros beverages. Gatorade like mixes cocoa dairy shakes and hot sauce. It's yeah. I mean, this is what we're feeling are top soldiers with. I mean, it's it's sad. That almost like you said, this is potentially a pilot's additional deeper in feel figure out where we can go. But have to imagine that Kito friendly Marie would would only reverse though, VC problem. But but also just thinking about me personally being able to eat one meal a day really easily dia versus I'm always hungry three four five meals a day, if I'm not I mean, just that if you're in combat and in super stressed, and then you looking at things like it'd be b b also act as a signal to decreasing Zayed to improve recovering and things like that. I think that obviously we have love why that would make sense actually, I mean, you just named off a whole bunch of things were trying to study because you know, Kito adapting person profoundly changes every cell in the body. I mean in terms of the feels that using the, gene expression. And in that regard. I mean, it it can affect just about every performance parameter in health marker. We think in in a positive way based on a lot of the work done in clinical populations. But there's a lot of work to do to translate this to the soldier also kind of bus through the bureaucracy in the in the military in the department of defense. It's it's hard to move fast there. So this has been a long sort of effort to get them comfortable with key tones in Kita genyk diets. They are very interested in exile Gysky tones, I think it's more palatable for them to think about providing that versus changing diet. So they are funding quite a bit of research in that area of which is I think positive because it's like a foot in the door to maybe a convincing them than the diet would have even more applicants but having said that. I have gotten a lot of grants rejected, but I'm not quitting. So, you know, there is a lot of grass roots support for if you talk to a lot of soldiers at basis, they're they're doing this. But it's you know, it's gotta be met with some top down support as well. And we're not quite area. Will thanks between the work. Do all everybody is far as before you would have added more data Iran type two diabetes. And so if you'll know about verte health and what you're doing there. Maybe just a quick overview of the work. That's on there. Yes. So Verna health is a company that I co-founded with Stephanie might co author on the books as well. And in good friend and collaborator researches to. And then some Incan our currency owes the other co founder, so it what we've founded was a company that's really focused on reversing type two diabetes at scale our mission is to reverse diabetes. One hundred million people by twenty twenty five I think that might have been extended to twenty twenty seven now, but we are making very good progress. Our our initial focus which is to prove we could do this. And so we started a clinical trial couple years ago. And we've published one year data now and our two year data was just accepted. So it'll be published soon four hundred or so patients with type two diabetes prediabetes that we. Enrolled into our program, which at its core is Kita genyk diet, but we've combined that with virtual care model, which essentially means we educate people on Akita jank diet through nap and provide them with a hell access to health coach pretty much twenty four hours a day as well as the physician that is really key to all this because of the need to adjust medications from safety standpoint. And so we've basically built the infrastructure to practice telemedicine. From scratch. So that's the San Francisco based company, and we've published data now, we're working with several contractors to temple our program their in their companies, and even now talking with insurance plans and the results are quite extraordinary of in our clinical trial. We are able to reverse diabetes approximately half of the patients that were enrolled in that is while we're getting them off medications. So that we're getting most patients either off insulin or significantly reducing the dosage off so finery is in other diabetes in blood pressure medications, and they're losing significant amounts of weight, even though that's not a focus of our program. But they they lose -nificant amounts away. They've been able to. To maintain that out two years now. So the. Companies driving really in many ways, and in very much focused on scaling in being able to deliver this to many people's possible. And unfortunately, there are hundreds of millions of people cross the planet that need help than the early. Not getting it. So Huzzah workers far is a protocol is concerned you have a blanket recommendation. You say, okay, this amount of macro 's in whatever food you won the personalized to the person you give him food choices. What is well. So you know, we have the app and the health conscious basically, individualize the curriculum that we've developed fridge patient in. We also collect biomarkers to help personalize it and that is all being integrated then and and so there's a lot of machine learning. Artificial intelligence built into everything that we do. So the more people retreated better, we get in more automated, we can become which is really necessary to scale the numbers that we want to. So the. A custom on boring flows. They take a quiz. They work with somebody in generally. Yes. Like, you did with the study tracking more serum concentration of HP or mean, how are the ways that you ensuring that they are complying? Yeah. That's that's part of it is is measuring Jones. So we provide him buddy with a meter and strips and record their values in one way to individualize it and kinda monitor them we monitor their weight as well. So right now, those are really kind of the two primary biomarkers were tracking. And you know, as far as the education, they're getting it's it's variety of different some modalities of information from everything from, you know, video recordings to of online support group that the the one thing you sort of miss him when you doing this through an app, you can individualize the intensity in the content to great ext. Which lose the group support. So we have developed support groups that people can engage with other people going through some of the same challenges and so forth. I mean, so it's a very sophisticated program. That loops always things together in a pretty innovative way. And the results are quite quite striking. When you consider a Cording to Kaiser Permanente the spontaneous remission rate for diabetes less than one percent in you said around fifty percent, currently what you're getting his forest people who are either off of their medication entirely or those were retreating or reversing. Yeah. We define reversal as hemoglobin. Anyone see under six point five got and and off all diabetes medications, except the metformin. So that is about one half in. We have very good engagement with the program to as you know, most dietary interventions lifestyle intervention programs there's high attrition rate. But I believe we're just under a correction may be around eighty percent. One year is rob just a little bit from there two years. So we've had excellent adherence in. And that's really a big issue because, you know, at least in my experience others a lot of people that are convinced. The science is strong in it is in diabetes, especially, but they still believe no one can stay on this diet that it's it's too difficult and too much of a sacrifice in a burden. So that's the bigger issue. A lot of people have been a at least with our program the data. Would suggest otherwise. And I think that one of the things that you mentioned earlier that it's very important for someone to work with Dr Patrick back. Their medication can you speak a little bit more than that's somebody is joining trank key for the first time the feeling better, and they just trying to play around their medication. Whether it's cute idea EM in generally, the you guys very safe for most people. But if you're. If you're a diabetic on insulin. You really do need to be very careful because I mean, the main risk is if you're if you start a genetic diet and continue on your same dosage of insulin. You will very likely experience a precipitator hypoglycemia, which can be very dangerous in life threatening land you in the emergency room. And so that's the real risk that people need to understand if you're taking insulin or safari as or any drug that stimulating insulin. There is a need to adjust those medications quickly. This is not something that takes weeks months. It's it's pretty much right away. A that has to be managed by knowledgeable of physician who's has experienced with this of the Why's it can be very danger. So if someone's listening to this podcast, you know, they have diabetes, they know and they want to work with someone like this. Do you guys have opened enrollment or how does that work if not you have Hannah's doctors resources? Primate business miles to work with large self insured companies and insurance plans, so a. The ideas, you have a contract with company, and and then we get access to these employees and in in in enrollment into our program, but we also do a direct to consumer sort of pathways. Well, so that is available on the website. There's a site there where you can request more information. And we you know, we will accept them, you know, pocket payments to work with verdicts. Well, so you had to kind of go through a series of questions in in be screened. But that that's also a possibility is that you're looking to do to scale this two hundred million people by twenty twenty seven is hit make it direct access or is it more working with large companies in just killing little think working with the insurance plans is is the most efficient way to scale. Interesting. So what was necessary as far as the big mile since you guys are trying to reach in the next one to three years from from research standpoint. Just deciding we're contracts and and really continuing to build the foundation. So that you know, we can scale the results are nothing else out it really compares with this. So MRs matter of the floodgates open. We need to be able to to meet the need, and that's not trivial because you don't wanna lose the quality of the outcomes were giving now when you go ten x one hundred x which is what we're talking about here. So there's a lot of attention on on just tightening up everything we can in and making improvements to what we're doing. And in building a very strong foundation, where we can you know, we can really scale affectively keep great outcomes one of the things also as meaning to ask you is is four as individual aspect to hump Shiga focus on food. Polity or is it more so start with macro to get them, drip win, and then have an econ moral whole food real food. Dieter? What is the emphasis you guys have? There is one of the things that to to with research that sort of keeps diet is one that people just say it's quote, unquote, low carb, therefore, it's Kito or they feed them really awful quality foods vegetable oils that on occasion, diet and try to infer health outcomes about and so I mean was yours is approached ameliorate that or on rent people to getting high quality, healthy foods. Yeah. That's a really important question. And this is what's great about it. In a we emphasize whole foods were not really peddling a lot of supplements or fake foods were not a food company. Really? This is just teaching people how to clean out their cupboards in refrigerators, go to the store and buy different foods than they were before. And in teaching them how to prepare those into really highly palatable implausible meals. So there's a lot of principals to what we're doing because you're exactly right. It's more than just restricting carbs in elevating key tones, you can induce ketosis variety different ways. But it's not going to be effective in completely side effect, free and most important sustainable, unless you understand all the components of a well-formulated Kita genyk diet in. In that gets into you know, issues around getting protein in the right range, the quality of fat understanding mineral balance excetera, and this is what we teach people, and it doesn't take long time to the teach this. But what you have to understand is almost all of the components to well-formulated conflict with consensus. Consensus. Should mainstream ideas now of what's healthy? So there are lotteries in people despite their knowledge in really motivation to wanna stay on this diet still fail. And that's where the ongoing support in. You know, access to health coaches is really important to make this stick long-term. There's not a lot of people that really are. Promoting this idea of a will formulate Akita jank diet. And so that's if you wanna call it our secret sauce, so to speak, none of his priority. Really? I mean, we've written about it in books in doubt there. But there's a lot of people practicing gate genyk diets in a casual way might get your term success. But a lot of people really really don't make it stick long-term lease others. Just it's it's tough to against the grain for so long people may be ostracized by their friends or family from a different choices or someone's cousin her that exit still gonna kill you in. So then the another can have eggs in women in red meat is also terrible the main it's a lot of education. I think when people especially when the coming from a standard American diet in following Flaminio following what the government told us to do entering. I mean, a lot of family, friends, and even physicians in other healthcare professionals can sabotage the best. Efforts in the most motivated person. Those are things we help people. Navigate through all those challenges. Well, yeah. Love what you doing over there. Anyway, people can support verte. Let's say they're not direct comes customers or anything like that just to spread the word. Yeah. Great question. I mean, we're. This is out of my scope with company, but you know, we're we're we're think we're okay for now in terms of venture capital. So I won't you know, pledge money here media research instead, but yeah, preciado you just give me the opportunity to talk about Berta were or certainly, you know, wanna get the name up there in make people aware of it in in promoted in positive way. So that that I think alone is is very valuable to us as far as what's next on your plate like for research impersonal. Well, like, I said it in terms of research, I spent most of my day just on the hunt for money and a writing grants and trying to to keep the lab open funded because the type of work, we do it's not cheap. I mean, you know, he you can't do you'd be surprised, you know, with a million dollars sounds like a lot of money, and you can do some definitely some good work. But even that is a pretty relatively small moderate study. So that's the challenge is getting the standard of sort of federal sponsors out there to invest more money into this area. 'cause that's the challenge. But, you know, I'm working hard in the areas of cancer in in military applications in so pumping out a lot of grants. I will say hi states been great in terms of building multidisciplinary teams in. So we're working in cancer in have grades. Support from the colleges here in the religious love the patients come in and ask about it. And so it's very much on their radar one other area that I think is very promising is in congestive heart failure. So there's also a lot of new evidence that the heart really prefers key tones over other substrates and that when it's fueled by key tones, it's functioning better. And so it's would be naturally. A logical think patient with congestive heart failure would benefit from a ketogenic diet or potentially dodges key tones another area were were really getting some proposals out trying to advance jarmin concussions as well traumatic brain injuries, huge different areas of so excited about the next five ten years. One of my biggest fears is that. That was kinda fall off of it in the view as a as a fad. And then we just kind of have a movement away from that to something else. That's gonna biggest fear that we're trying to prevent days did day-to-day. I think it's so effective. Great tool for so many different things, especially with the state of the state of our side in we're from hell come right now. So think I agree. I worry a little bit about that too. But I I think the genie's out now. And yes, you're right. People still describe it critic described as a fad it's gonna go away. But. You know, I don't know. I think there's just too much science out there. Now, the massive data is is too much to ignore. Other people are still trying to nor it. So I highly doubt it's going to go away might might vigor concern is the scientists just been a trickle forward rather than accelerate forward because they're still challenges in getting funding and just the sort of way research is done sciences slow process. So I'm kinda really motivated to figure out new ways to celebrate the pace of science in translation of that science. So we can take advantage of of the benefits of this diet, different disease states or just for. Better functioning for everyone while you're doing your part. So thanks Jeff for being on show. Besides people going to PubMed in and Amazon is searching your name getting materials there or anywhere. You wanna point them for for more information? Yeah. I mean on the verte website. We have a blog that we try to get new content up every week or two. And so there's some really excellent information that is being posted there. Of some kind of people to that as a way to keep up on some of the relevant topics around key tones. Nutritional ketosis. Thanks again. Appreciate okay. Thank you anti. All. Right. Everyone thinks listening to another episode of Akita lenses podcast enjoyed it. But even if you didn't I would love review score itunes wherever you listen to your podcast and a review. So we can get about more people you'd better guess how the information that you need to please go to wherever you listen to your podcast review. If you to go over to perfect dot com slash podcast and enter Email for all top tips and guides getting started Qizheng diet. Thanks next time.