In these days of instant internet connection, when access to the vast array of human knowledge is available with the click of a mouse, it can be easy to forget how valuable it is to meet face-to-face.
On November 2nd and 3rd, close to 300 members of the growing, global low-carb community met in San Francisco for the "Weight of the Nation" conference, sponsored by Low Carb USA and Jumpstart MD, a medically-supervised weight loss program in Northern California that recommends the low-carb, ketogenic diet to its patients.
The 15 speakers over just two days represented some of the bright lights in the low-carb field, covering a gamut of topics from the complex and emerging physiologic science of ketone bodies and insulin resistance to current practical applications and outcomes. Speakers included Gary Taubes, Nina Teicholz, Dr. Steve Phinney, Dr. Jeff Volek, Dr. Sarah Hallberg, Dr. Robert Lustig, Dr. David Ludwig, Dominic D'Agostino, PhD, and more.
What follows is a short synopsis of each of the 15 speakers' key points from the packed schedule, with links for more information.
Yet, the true value of the conference is not just in the presentation of cutting-edge information. It is the unique combination of the people presenting with the people listening, scribbling down salient points, asking questions, sharing stories, making contacts, making friends.
In short, it is the content, plus community and connection that is the special, energizing elixir of these events.
In the audience were family doctors from rural Mississippi, small-town Canada, Northern Ireland and suburban California who were there to learn more so they could help their patients. There were nurse practitioners, physician assistants, dentists, chiropractors, naturopaths and fitness coaches. There were academic researchers and curious retirees. There were those whose own lives, or lives of their loved ones, have been dramatically improved for the better by adopting a low-carb, ketogenic way of eating.
To a person, all attendees had enthusiasm to learn as much as they can so they in turn can help others. Each one, in his or her own way, is a front-line agent in the global revolution to solve the obesity epidemic and reverse diabetes using an evidenced-based approach, centered around a diet low in carbohydrates.
"All the presentations were wonderful. And meeting people from all over the world was very inspiring," said Dr. Robert Malonso, a dentist from San Jose, who over the last year has lost weight and reversed his type 2 diabetes with low-carb eating. "To me, the best part was how accessible the presenters were, but what I take away most is the reinforcement of the health benefits of the low carbohydrate lifestyle. I am so passionate about this that I'm wanting to help spread the word. This conference inspired me to do that."
Day 1:
Gary Taubes
"The Quality of Calories"
Taubes, the author of influential books like Good Calories, Bad Calories, Why We Get Fat, and The Case Against Sugar, opened the conference with a fascinating look back at the history of obesity research - dating back into the 1860s. He documented how biases, egos, blinders, and socio-political undercurrents over the last 150 years have influenced how we view the cause of obesity and the people who suffer from it and how the misinformed "calories-in, calories out" model became the dominant explanation starting in the 1940s and persists to this day. Those who can't lose weight, in the words of an influential US researcher Dr. Louis Newburgh, whose views have held sway for decades "suffer from various human weaknesses of over-indulgence and ignorance." Taubes showed, however, that German and Austrian researchers by the 1930s had already posed an alternative hormonal/regulatory hypothesis of obesity that starts with individuals suffering from a disorder of excessive fat accumulation, which then drives a relentless cycle of hunger and fatigue. However, post-World War II socio-political biases ignored all the research that had occurred in pre-war Germany and continues to largely blame individuals' "gluttony and sloth" for getting fat.
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Dr. Robert Lustig
"What is Metabolic Syndrome Anyway?"
The author of The Hacking of the American Mind, Lustig is with the Division of Endocrinology in the Department of Pediatrics at the University of California, San Francisco. His 2009 lecture, Sugar, the Bitter Truth, has been seen by more than 10 million people. Lustig's talk focused primarily on the damage that table sugar (sucrose: one glucose molecule linked to one fructose molecule) does to our livers, driving liver fat accumulation, non-alcoholic liver disease and metabolic syndrome. Fructose is the molecule that does the most damage, going straight to the liver and creating liver insulin resistance and the accumulation of liver fat. In a complex talk that went into the various metabolic pathways in the liver, Lustig noted that like alcohol, arsenic and tobacco smoke, fructose is a "chronic, dose-dependent toxin." The higher one's consumption of fructose, the more the liver becomes insulin resistant. The quintessential problem of metabolic syndrome is not obesity - obesity is simply one of the markers, or symptoms, of the disorder. It is hepatic insulin resistance. And it is sugar - specifically chronic fructose consumption - that drives the liver fat accumulation and the ultimate hepatic insulin resistance that promotes metabolic syndrome.
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Eran Segal, PhD
"Personalized Nutrition for Treatment of Diabetes Based on Gut Microbiota and Clinical Data"
Segal is a computational biologist who has been working on big data analysis of the human microbiome with the Weizmann Institute, a leading microbiome research institute in Israel. Segal's talk delved into the burgeoning understanding of the 100 trillion bacteria that live in our guts and all over our bodies, and that hold 150 times more genetic material than our own 25,000 human genes. The Weizmann Institute has been leading many studies to understand the gut microbiota, the enormous effect they have on our physiology and health, and how they can be altered by numerous factors such as what we eat. Microbiome research in recent years is showing that gut bacteria play a role in obesity, mental illness, cancer, depression, autoimmune disease, allergies, asthma, drug metabolism, cardiovascular disease, hypertension, and diabetes. Segal's presentation focused primarily on the work that he and his team have been doing to personalize nutrition in relation to the microbiome. They have been collecting data from more than 1,000 human subjects, analyzing biological markers, sequencing their unique microbiome, and comparing individuals' post meal blood glucose responses from specific foods with continuous glucose monitoring. They have created an algorithm that can predict how individuals' blood glucose will respond to specific food items, based on their personal microbiome, specific body measures and blood tests. Their findings show that the same food will have very different effects on blood glucose between different people, creating an emerging way to personalize diets for various individuals based on their individual biological characteristics and the various strains of their personal microbiome.
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Dominic D'Agostino, PhD
"Ketonutrition: From Science to Emerging Applications"
D'Agostino is an associate professor in the department of molecular pharmacology and physiology at the University of South Florida, who works with NASA as well as the US military, and holds a number of patents around ketone supplements and other methods to produce and sustain ketosis. His highly scientific talk started with his initial work, some 20 years ago, as a neuroscientist to study how to protect the human brain from extreme environmental stresses, such as protecting US Navy SEAL divers from the risk of seizures in deep sea dives. His work found that a brain that is using ketones for energy, rather than glucose, is much more resilient to and protected from environmental stresses. Ketones provide not only an alternative fuel to glucose for the brain, but also are very potent as signaling molecules in the brain between cells, with impacts on inflammation pathways, immune system, oxidative stress, and neurotransmitters. Evidence is emerging that therapeutic ketosis not only helps for weight loss and type 2 diabetes, but can have applications in a number of conditions such as type 1 diabetes, polycystic ovarian disease, wound healing, brain tumors and cancer. D'Agostino said research evidence is showing ketones "fundamentally change the neuropharmacology of the brain" leading to a number of neurologic applications, not only in well proven areas such as epilepsy, but other areas such as Alzheimer's, Parkinson's Disease, autism, traumatic brain injury, anxiety and much more.
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Jeff Volek, PhD, RD
"Ketoadaptation: Implications for Human Performance"
The co-author, with Dr. Steve Phinney, of the highly popular book The Art and Science of Low Carbohydrate Performance, Volek's presentation focused on how elite athletes - as well as regular athletes - are using ketosis to achieve improved athletic performance. Some top-level ultra-endurance athletes have switched from carb-loading to using ketones for energy, such as marathoner Zach Bitters and cyclist Chris Froome. An increasing number of professional soccer and rugby teams are also adopting low-carb, ketogenic eating for better team performance. Volek went through, in physiologic detail, ten reasons why ketones are great for human performance. The ten reasons included the fact that even athletes with very low body fat (10-12%) will be able to access at least 25,000 calories of energy in their fat stores; fat is a much more efficient and clean-burning fuel; ketones are anti-inflammatory and reduce oxidative stress; athletes burning ketones for energy recover from work outs faster; and during long endurance activities they do not risk "bonking" (having the brain run out of fuel). Also included in the top ten list is that weight management, especially for sports that are weight sensitive, is much easier on a ketogenic diet and the health response to exercise is increased. Finally, athletes running on ketones can have longer athletic careers. In all, a ketogenic diet "has a profound impact on athletic performance."
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John Newman, MD, PhD
"Signaling Activities of Ketone Bodies in Health and Disease"
A geriatrician who is an assistant professor at the Buck Institute for Research on Aging and in the Division of Geriatrics at University of California, San Francisco, Newman said that while other researchers like D'Agostino and Volek were researching ketosis to help "Navy SEALs and elite athletes, I am trying to help treat your grandmother." His presentation focused not so much on ketones as alternative energy fuel to glucose, but rather their potent effect as signaling molecules in key biologic processes. "All ketone bodies have signaling activity, acting naturally like a drug" on a wide array of body tissues and physiologic pathways. Ketone bodies have a role in gene expression, inflammation responses, metabolism and cell aging (senescence.) His research in mice has found a ketogenic diet extends longevity, reduces mortality and improves memory. The applications of ketones through diet or supplements could have a role in the control of many diseases of aging such as gout, dementia, coronary disease, osteoporosis, diabetes and more. The biology is complex, however, and Newman noted there is a huge component of individual variation. The science is still in its infancy and while many clinical trials are now ongoing - such as studies of the ketogenic diet with or without ketone supplements as a treatment for Alzheimer's disease - the science is not yet at the stage where one can widely recommend putting elderly loved ones on ketogenic diets because of the risk of adverse effects, such as excessive weight loss in already frail individuals.
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Day 2:
The second day of the Weight of the Nation Conference in San Francisco featured nine notable researchers and experts.
Nina Teicholz
"Red Meat and Health"
Bestselling author and journalist, Nina Teicholz explored the weak epidemiological studies that have wrongly blamed red meat for causing diabetes, heart disease and cancer. A former vegetarian for 25 years, Teicholz said during her intensive 10-year investigation of the science for her book, The Big Fat Surprise, she had no preconceived notions or beliefs and was simply "driven by where the data led me." She discovered the research around red meat's impact on health is deeply flawed. In her presentation, she dissected each of the major studies, their methodology, and analyzed the biases of key reports of the last few decades, such as the influential 2016 WHO report that condemned red meat. She showed how the findings are not supported by the evidence. Meat is not harmful; moreover, it is a healthy, nutritious food, with micronutrients such as vitamin B12 that cannot be obtained by other food sources.
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Dr. Sarah Hallberg
"Type 2 diabetes treatment: How did we get here?"
Where do we go from here? Dr. Hallberg, the medical director at Virta Health and the founder of Indiana University Arnett's Medically Supervised Weight Loss Program, said every day in the US, 200 people have amputations and 1,795 are diagnosed with eye problems relating to their diabetes. With 50% of all Americans now with pre-diabetes or Type 2 diabetes, costing $327 billion each year, Dr. Hallberg said if diabetes were an infectious disease, it would be a national emergency with everything possible being done to halt it. However, the solution is right in front of us: carbohydrate restriction. Dr. Hallberg presented the inspiring findings of Virta Health's first year of providing extensive medical support, coaching, and training of 262 patients with diabetes. Of the 83% who stayed with the program for a year, 60% had a complete reversal of their diabetes as well as significant weight loss and improved blood lipid results. Patients' bills for prescription medications dropped almost immediately and most came off all drugs. What if we could reach all people with diabetes with information about the low carbohydrate lifestyle? We could stop this epidemic, said Hallberg.
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Dr. David Ludwig
"Which comes first, overeating or obesity?"
Ludwig, MD, Phd, the author of Always Hungry, is a professor in the Department of Nutrition at Harvard T.H. Chan School of Public Health, and director of the New Balance Foundation Obesity Prevention Center at Boston Children's Hospital. He said for too long doctors treating obesity have blamed those who are obese as having a lack of control. The philosophy that "a calorie is a calorie" gave license to the food industry to promote junk food, and the belief obese children and adults simply need to eat less and move more. Dr. Ludwig delved into the complex biological processes that control body weight, how body weight set points are vigorously defended and how continually high levels of insulin prevent fat calories from being used. Obesity comes first - the dysregulation of fat storage comes first and the body fights back against any calorie restriction. The key is to get the insulin levels down, through a low-carb, high-fat diet, so that fat can come out of storage.
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Andrew Mente, PhD
"Carbohydrates, fat consumption, and cardiovascular disease: A more complete picture"
An investigator with the ground-breaking Prospective Urban and Rural Epidemiological (PURE) study, Dr. Mente described how more than 200,000 people in 18 countries on five continents are being followed on key indicators for health. The extensive individual data collection includes medical history, diet, exercise, lab tests and physical exams. The first data analyzed in PURE was a study of dietary patterns. The findings, although observational (weak evidence), are highly supportive of low-carb, high-fat diets as a healthy way of eating. The study found that across all 18 countries, higher carbohydrate intake increased total mortality, while high fat intake is associated with a lower risk of total mortality and has no association with the risk of myocardial infarction (heart attack) or cardiovascular disease-related mortality. Furthermore, a higher saturated fat intake appeared to be associated with a 21% lower risk of stroke. The PURE findings are at complete odds with current wide-spread dietary recommendations in all the countries, Mente noted.
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Jean-Marc Schwarz, PhD
"Non-Alcoholic Fatty Liver Disease (NAFLD)"
Does dietary sugar or carbohydrate trigger a traffic jam of fat in the liver?" One of the leading world researchers in the mechanisms for fat build-up in the liver, Schwarz detailed how NAFLD has become a huge and concerning trend over the last two decades. Schwarz went into detail about the complex, highly regulated biochemical pathway of de novo lipogenesis (literally "new fat making" which is also known as DNL). The biochemical process has sugar and carbohydrate convert to fat. Fructose in particular goes straight to the liver and is made into fat. "When sugar is being converted to fat you cannot burn fat at the same time." Fructose is a "big tsunami" for the liver that rapidly creates hepatic insulin resistance and jams fat into the liver. However, that fat can rapidly go down with removal of fructose from the diet.
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Lewis Cantley, PhD
"Obesity, diabetes and cancer: The insulin connection"
Named one of the "Giants of Cancer Care" in 2017, Cantley discovered in the 1980s a family of related enzymes called Phosphoinositide 3-kinases (PI3K) which are involved in key cellular activities of cell growth and differentiation - and thus the growth of cancer cells. These enzymes are particularly involved in cancers that correlate with obesity and insulin resistance (conditions where serum insulin levels are high), such as endometrial, breast, and ovarian cancers. Cantley and his team have created drugs that inhibit P13K but have found that the continuing presence of high insulin still drives further cancer growth, rather than killing the cancer cells. How to get the insulin levels down? Drugs like metformin and other insulin lowering methods did not work. However, the ketogenic diet did. His work, published in July 2018 in Nature, showed how the combination of a ketogenic diet with the PI3K inhibitor drug strongly improves the performance of the anti-cancer drug in mouse models. He found that the ketogenic diet is more effective than other therapies at lowering serum insulin levels during PI3K inhibitor treatment. Importantly, combining a ketogenic diet with a PI3K inhibitor can stop the cancer growth. It is not the ketone bodies, per se, that are having the effect, but the ketogenic diets' impact on lowering insulin levels.
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Dr. Steve Phinney, PhD
"Inflammation, nutritional ketosis, and metabolic disease"
The Chief Medical Officer for Virta Health as well as a leading researcher in nutritional ketosis for more than 35 years, Dr. Phinney's talk focused on the role of inflammation in diabetes, cardiovascular and metabolic disease. Inflammation is "an extremely complex topic" he noted, but "nutritional ketosis is an extremely powerful and safe tool to alter a number of inflammatory pathways." There many biological markers for inflammation including white blood cell counts (WBC), C-reactive proteins, adipokines, cytokines, inflammatory enzymes (i.e.COX-2 enzymes) and more. Phinney shared evidence that both type 2 diabetes and cardiovascular disease are inflammatory diseases, and that markers of inflammation, such as elevated WBC can predict future heart disease. While a number of drugs have been investigated for lowering inflammatory markers, some have had very serious side effects. Nutritional ketosis is safe and not only provides a superior energy supply but has hormonal activity that regulates oxidative stress and inflammation. Dr. Phinney explored the new science of the ketone beta-hydroxybutyrate (BOHB) and its powerful impact on various inflammatory pathways. He also reviewed how Virta Health has been using a well formulated ketogenic diet to reverse type 2 diabetes and improve health, sharing its very promising results of its first year as also shared by Dr. Hallberg.
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Dr. Ronald Krauss
"Human lipoprotein responses and cardiovascular risk"
Dr. Krauss is a senior lipid scientist and the Director of Atherosclerosis Research at Children's Hospital Oakland Research, and an adjunct professor of medicine at UC San Francisco and in the department of Nutritional Sciences UC Berkley. He studies genetic, dietary, and hormonal effects on plasma lipoproteins and coronary disease risk. He and his research team also patented the process to analyze the particle size of Low Density Lipoproteins (LDL). Dr. Krauss's presentation surveyed what is currently known about the most prevalent blood lipid traits associated with heart disease, obesity and insulin resistance: high triglyceride levels, low levels of HDL- C, and increased number of LDL particles of the small dense kind. In his very complex talk he focused mostly on the controversial area of LDL particles and their various subclasses, particularly the difference between large, fluffy, buoyant LDL particles, which are generally not a health concern, and small dense LDL particles, which are more associated with cardiovascular disease. Small dense LDL particle size is also related to obesity, insulin resistance and metabolic syndrome and their numbers are increased by a higher carbohydrate intake. A low-carbohydrate diet decreases LDL particle size while a high saturated fat diet increases large fluffy LDL particles. He concluded that a low-carbohydrate approach likely confers cardiovascular benefit by reducing the number of small LDL particles. He noted, however, there may be a variation in responses based on individual genetics and the full impact on future cardiovascular risks is not yet known.
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Dr. Sean Bourke
"Inspiring an epidemic of health and well-being: JumpstartMD Outcomes"
The conference's final speaker was Dr. Bourke, an ER doctor who became very concerned about the alarming growth of the diabetes and obesity epidemics. In 2007 he co-founded JumpStartMD, which now has 13 locations in California, as a medically-supervised weight loss program that uses the low-carb, high-fat diet, as well as other supportive techniques, to help patients lose weight and reverse diabetes. "Half of Americans believe it's easier to figure out how to do their taxes than to eat more healthily," said Dr. Bourke who presented for the first time the aggregate results of their 22,407 patients between 2007 and 2017. Their patients were 83% women and 17% men. The mean weight loss by six months was 26 lbs; BMI was lowered by an average 4.3 points; waist size reduced by five inches, and patients' HbA1Cs improved significantly. He compared JumpStart MD's superior results to programs like Weight Watchers, Jenny Craig, and Nutrisystems. "If JumpStart was a pill or a medical procedure, it would be making headlines." Dr. Bourke says every day the team is seeing people experience much improved health and quality of life with no side-effects by returning to eating healthy fats, real food that is dense in nutrients and a low-carbohydrate diet."
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