For decades we’ve heard that diabetes prevention is simple—lose weight, eat less, and exercise more. But something is wrong with the conventional wisdom. Nearly 115 million people live with either diabetes or prediabetes in the United States, and that number is growing. It is time to reverse this trend.

Virta was founded in 2014 with the goal of reversing diabetes in 100 million people by 2025. They have made this possible through advancements in the science of nutritional biochemistry and technology that is changing the diabetes care model.

James McCarter, MD, PhD, is Head of Research at Virta, and in this interview, Dr McCarter explains how Virta is using a combination of a very low carb, ketogenic diet together with 1-on-1 health coaches and some sophisticated machine learning techniques to predict sentiment in natural language and spot anomalies in blood biomarkers.

After the recording was made, Dr McCarter realised that he was off by about a decade on Joslin. Rather than 1920s, Dr. Elliott Joslin actually began keeping a diabetes registry early in the 20th century and published The Treatment of Diabetes Mellitus in 1917.  “Joslin carried out extensive metabolic balance studies examining fasting and feeding in patients with varying severities of diabetes. His findings would help to validate the observations of Frederick Madison Allen regarding the benefit of carbohydrate- and calorie-restricted diets.”

Here’s the outline of this interview with James McCarter, MD, PhD:

[00:01:00] Divergence, Inc.

[00:01:43] Presentation: The Effects of a Year in Ketosis with James McCarter, MD, PhD at the Quantified Self Conference and Exposition.

[00:02:44] Books by Gary Taubes.

[00:03:13] Omega 3:6 ratios.

[00:05:54] Rapeseed and Canola.

[00:06:44] Wild Planet sardines.

[00:07:11] The Virta story.

[00:07:18] Sami Inkinen.

[00:07:38] Study: SD. Phinney, BR. Bistrian, WJ. Evans, E. Gervino, GL. Blackburn, The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation., Metabolism, volume 32, issue 8, pages 769-76, Aug 1983, PMID 6865776.

[00:08:48] Jeff Volek, PhD, RD on PubMed.

[00:09:51] Fear of fat.

[00:10:13] USDA dietary guidelines.

[00:12:59] The goal is to reverse T2D in 100M people.

[00:14:09] Study: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet (London, England). 2016;387(10027):1513-1530. doi:10.1016/S0140-6736(16)00618-8.

[00:14:29] Joslin Diabetes Center.

[00:16:37] The causes of T2D.

[00:17:35] Calories are now more accessible.

[00:18:22] Sugar and refined carbohydrate intake.

[00:20:26] Prerequisites for the Virta program.

[00:22:19] Telemedicine, health coaches, online nutrition and behaviour education, biometric feedback, peer community.

[00:23:53] Getting off meds.

[00:24:50] HbA1C > 6 or glucose > 120 mg/dL

[00:25:32] Purdue University.

[00:26:28] Podcast: Econtalk: Mark Warshawsky on Compensation, Health Care Costs, and Inequality.

[00:29:02] Study: American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033-1046. doi:10.2337/dc12-2625.

[00:29:27] Study: McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, Glon RM, McCarter JP, Volek JS, Phinney SD. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes. 2017;2(1):e5.

[00:30:45] Discontinuing 2/3 of the meds.

[00:32:54] Health coaching.

[00:34:18] Behaviour change.

[00:35:30] Biometrics, blood BHB.

[00:38:10] Reducing blood pressure and CRP.

[00:38:30] Study: Youm, Yun-Hee, et al. "The ketone metabolite [beta]-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease." Nature medicine 21.3 (2015): 263-269.

[00:39:49] Blood levels of BHB and weight loss.

[00:41:36] STEM-Talk #43: Jeff Volek Explains the Power of Ketogenic Diets to Reverse Type 2 Diabetes.

[00:43:33] Machine learning.

[00:45:57] The Team at Virta including Nasir Bhanpuri, Catalin Voss and Jackie Lee. See article Will robots inherit the world of healthcare? For links to their talks.

[00:46:49] Random Forest.

[00:47:06] Nourish Balance Thrive 7-Minute Analysis.

[00:48:05] Natural Language Processing.

[00:48:57] Nourish Balance Thrive Highlights email series.

[00:50:26] Finding purpose in your work.

[00:51:59] Using machine learning to change behaviour.

[00:53:25] Book: Hooked: How to Build Habit-Forming Products by Nir Eyal.

[00:54:11] Podcast: How to Avoid the Cognitive Middle Gear with James Hewitt.

[00:55:37] $400 per month for one year.

[00:57:58] Blog Post: Does Your Thyroid Need Dietary Carbohydrates? By Stephen Phinney, MD, PhD.

[01:00:21] Article: Understanding Local Control of Thyroid Hormones:(Deiodinases Function and Activity) and Podcast: The Most Reliable Way to Lose Weight with Dr. Tommy Wood.

[01:02:12] Podcast: How Busy Realtors Can Avoid Anxiety and Depression Without Prescriptions or the Help of a Doctor with Douglas Hilbert.