January 26th, 2017 was an exciting day for the IPTN. In collaboration with the UBC Department of Cellular and Physiological Sciences and the Life Sciences Diabetes Research Group, the IPTN hosted its first “official” event. Over 200 people, including UBC diabetes researchers, community dieticians, family physicians, pharmacists, and the interested general public were packed into the Life Science 3 auditorium on the UBC campus to learn from two world leaders in nutrition research. Engaging a multi-disciplinary audience is exactly what the IPTN is designed to do so you can expect more of these types of events in the future!
The first speaker was Dr. Stephen Phinney, MD, PhD who provided an excellent overview of “Nutritional Ketosis”. A link to Dr. Phinney’s talk is here (https://www.youtube.com/watch?v=U8ak28B2E3Y ). Dr. Phinney has been studying ketogenic diets for over 30 years and has conducted some of the pioneering studies in the field (e.g., https://www.ncbi.nlm.nih.gov/pubmed/6865776 ), along with publishing three books on the topic. His talk was excellent and provided a mix of the history, biochemistry, integrative physiology, philosophy, and real-life application of ketogenic diets. Some key take-home points were that: a) there are large differences between “nutritional ketosis” (a term that Dr. Phinney has popularized) and “ketoacidosis” (the pathophysiological state that can be encountered in individuals with type 1 diabetes), and (b) that it takes expert guidance along with some trial and error to find the individual macronutrient distribution “sweet spot” for a properly formulated ketogenic diet. Dr. Phinney used the figure below (originally published in one of his books) to demonstrate that nutritional ketosis occurs at a blood ketone concentration of ~0.5-3.0 mM, which is an order of magnitude higher than typical levels seen in the carbohydrate-fed state (<0.1 mM) yet an order of magnitude lower than dangerous ketoacidosis (>10 mM). He also showed some data on mouse lifespan in the context of ketogenic diets that was very exciting.
Dr. Sarah Hallberg followed Dr. Phinney with an engaging and provocative talk on the use of ketogenic diets for treating type 2 diabetes (watch online here: https://www.youtube.com/watch?v=RBJp8T7SqBs). Dr. Hallberg is the Medical Director of the Indiana University Health Medically Supervised Weight Loss Program and has a popular Ted talk on this topic which has garnered more than 1.3 million views (https://www.youtube.com/watch?v=da1vvigy5tQ). A ketogenic diet is an example of a therapeutic nutrition approach for people with type 2 diabetes. The diet used by Dr. Hallberg and her group involves whole foods (meats, eggs, olive oil, leafy green vegetables, nuts) that are low in carbohydrate and high in fat (a so-called low-carb high-fat [LCHF] approach). An overview of the literature and evidence from her own work as an obesity doctor demonstrated the powerful effect this nutritional approach can have on not only weight loss but glycemic control and overall cardiovascular risk. A key take-home point from Dr. Hallberg’s talk was that “you are not what you eat” – this was in reference to an overwhelming amount of data she presented showing that consuming a “ketogenic” diet that is high in fat (but low in carbohydrate) does not make you fat and actually has positive effects on your blood lipid profile. Dr. Hallberg emphasized that a small proportion of people see an increase in LDL cholesterol while following her ketogenic diet program but that this may not represent increased cardiovascular risk (related to the size of the LDL particles that are elevated on a ketogenic diet) and that overall she is confident as an internal medicine specialist that their overall health and cardiovascular risk is still much reduced. This highlighted the potential for individualized approaches and the need to take an integrative multi-disciplinary approach to nutrition therapy.
Dr. Hallberg’s talk ended with her presenting some preliminary data from a large (N=400) clinical study that she is leading examining how ketogenic diets might be used in the clinical management of type 2 diabetes. I am not sure if there is such a thing as a “definitive trial” but Dr. Hallberg and her colleagues from Virta Health (a private corporation with the goal of delivering tools to healthcare providers to help implement ketogenic diets in clinical care) are tackling a pretty big research question with this study. They will follow patients for five years after initiation of personalized ketogenic diets that are led through in-person or virtual group-based counselling programs. Outcomes include diabetes remission, haemoglobin A1C, weight loss, and cardiovascular disease risk. We hope to have Dr. Hallberg back in 5 years to tell us about the results!
The IPTN leadership team also met with Drs. Phinney and Hallberg during the day to discuss scientific, education, and policy issues surrounding a food first approach to managing and preventing chronic disease. Overall it was a highly successful day and we thank Drs. Phinney and Hallberg for visiting and all of the attendees for their support. Stay tuned for more IPTN seminars and events in the near future.