In Categories: Science & Research

Dr. Stephen Phinney put together a three-part video series on ketogenic diets and nutritional ketosis. You’ll learn the nutrition science behind ketosis, what the research shows regarding its safety and benefits (including if and when you should obtain medical supervision), and how to troubleshoot your eating plan to optimize your ketogenic diet.

Dr. Stephen Phinney on Nutritional Ketosis and Ketogenic Diets

Stephen Phinney, MD, Ph.D, explains the science of nutritional ketosis, a natural metabolic state in which your body is fueled mainly by fats and ketones, instead of carbohydrates (glucose).

Dr. Stephen Phinney on the Safety and Benefits of a Ketogenic Diet

Stephen Phinney, MD, Ph.D, explains the benefits of a ketogenic diet and the research on the safety of this dietary approach.

Dr. Stephen Phinney on Problem Solving a Ketogenic Diet

Are your ketones consistently low? Have a headache? Having trouble figuring out your macros? Stephen Phinney, MD, Ph.D, explains 5 common mistakes people make on a ketogenic diet—and how to fix them.

Dr. Stephen Phinney is the Chief Medical Officer and Co-Founder of Virta Health, the first clinically-proven treatment to safely and sustainably reverse type 2 diabetes without medications or surgery.

Dr. Phinney is a physician-scientist with 40 years of experience divided between academic internal medicine and industry. He has studied nutritional biochemistry as well as low carbohydrate research and its benefits for physical performance and insulin sensitivity. His career has emphasized the interaction between diet and exercise and their effects on obesity, body composition, physical performance, and cellular membrane structure.

His extensive experience in the design of clinical nutrition trials in both academic and industrial settings has led to more than 87 peer-reviewed papers and book chapters on clinical nutrition and biochemistry. He is the author of four books, including The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance, two foundational books on low carb nutrition science and nutritional ketosis that he co-authored with Jeff Volek, Ph.D, RD. Dr. Phinney also previously served on the editorial board of the American Journal of Clinical Nutrition.

Dr. Phinney received his medical degree from Stanford University, holds a Doctorate in nutritional biochemistry and metabolism from the Massachusetts Institute of Technology and completed post-doctoral research at Harvard University.

45 Comments

  1. Awsome information! Thank you so much.

    Reply

  2. Excellent. In trying to maximise fat consumption, what is your view on eating large amounts of animal fat on beef or pork? Can I eat too much animal fat?

    I am 3 yrs on low carb and lost 32kg. need to lose another 20kg but have plateaued a bit I think because of higher protein than I need.

    thanks for your efforts.

    Reply

    1. Virta Health

      Sources of saturated and monounsaturated fats should provide the majority of your dietary fat intake with a limited amount from polyunsaturates. Many animal fats are great sources of fat. More on saturated fat here: https://blog.virtahealth.com/the-sad-saga-of-saturated-fat/

      Reply

  3. Very good and clear information. I like this way of eating and it makes me feel good and energetic. I have lost a lot of edema. My problem is the term “satiety”. I have had a problem with binge eating and probably have destroyed my feelings of satiety so it’s hard for me to judge. Often, I feel full but eat more, so even though my fasting blood sugars and HbA1c have improved, my weight has not. I am on the Virta program.

    Reply

    1. Virta Health

      Congrats on your improved blood sugars! We talk a bit about mindful eating in this post on weight loss plateaus. The section on eating out of emotions, habits and hunger might help you: https://blog.virtahealth.com/break-weight-loss-plateau-low-carb/

      Reply

  4. Please let me know Where your physicians in chicago

    Reply

    1. Virta Health

      We are open nationally! Our physicians are licensed in every state, and you’ll meet with your physician through telemedicine (video). You can learn more and apply here: https://www.virtahealth.com/thevirtatreatment

      Reply

  5. Hi there
    I have a question I wondered if someone could answer regarding Lipids, Particularly TGs and HDL.
    Why when doing Keto and in Ketosis would your TGs go up, when they were going down and HDL go down when it was going up. we have about 25-30g carbs a day, about 70 – 100g of protein and the rest is made up of fats.
    TC and LDL have both gone up slightly, there is a problem with inflammation of the gums awaiting dentist work.

    Reply

    1. Virta Health

      Follow Virta on Facebok to ask Dr. Phinney specific questions during on of our Facebook live Q&As!

      Reply

  6. So much sensible information! Excellent videos Dr. Phinney!

    Reply

  7. Hi,

    I am Type 2 and living in the UK. I am doing my Keto diet on my own, my DR say I have to stop sometime and hoping to find someone in my city to help me stay on this diet. Lost a lot of weight, off my insulin and still on my tablets. The DR is ok with this but no guidance from them at all. On the National Health Service you really can’t get any dietary counselling that would endorse this. Enjoy these blogs.

    Reply

    1. Virta Health

      Thank you for reading!

      Reply

  8. I’v been low carb for 2 yrs and lost 35 lbs and moved my HbA1c from 6.4 to 5.7.
    I saw you had canola oil on the slide with good fats. You also mentioned safflower oil for cooking.
    I though veg oils were toxic for cooking so what makes those 2 oils healthy?
    Thanks, I appreciate what you and Verta are doing!

    Reply

    1. Virta Health

      Thanks for your comment! Here’s an answer Dr. Phinney wrote up on canola oil: https://blog.virtahealth.com/canola-oil-keto/

      As for safflower oil, Dr. Phinney was referring to high monounsaturated versions (also called ‘high oleic’) of safflower and sunflower oils.

      Reply

  9. Iam so happy to hear again about the keto diet. I have a book about it written by Dr. Don Colbert,and i was afraid of started because of the believe i had on fat. I have faced a lot health challenges and after been found with diabetes 2 8 years ago i manged to heal it without medicine through eating right foods,just two weeks ago i went for test and my sugar is normal. I now eat once a day and i think i eat a lot of protein,i like beans a lot and groundnuts. I have observed that some times my body itches at night and iam constipated most of the time and my sight also is not good because i can not see from a far. Sometimes i feel tired but i exerice twice a day. I really need your guide on being on a keto diet because here in africa,zambia were iam even doctors do not know how to advice,i know that i need to eat about 70% fat,15% carbs and 15% but i really do not know how to really go about it,please help me on how i can improve my health and feel great again,do you thing the itchin and the hotness i feel sometimes can be luck of salt because i do not take a lot of salt. Thanks.

    Reply

    1. Virta Health

      We can’t give personal medical advice in this forum, but Dr. Phinney has written a FAQ on ketosis here that can answer a lot of your questions: https://blog.virtahealth.com/nutritional-ketosis-faq/

      Reply

  10. Thank you so much! I’ve been planning on going on Ketogenic Diet for some time now but was skeptical about the safety of it because there is definitely a lot of misinformation on the internet. Watching these videos made me much more confident.

    I was hoping you would comment on kidney stones because I’ve seen some comments about Keto Diets increasing the chance of getting kidney stones, and it seems to be quite prevalent in my family. I have read some information defending against this point but would like to hear your scientific opinion on it, if at all possible! Thank you again!

    Marcus

    Reply

    1. Virta Health

      Dr. Phinney said,

      “Kidney stones have many causes. The most common chemicals found in kidney stones are calcium, oxylate, and uric acid. Significant promotors of kidney stone formation are genetic (aka inherited) factors, dehydration, and low dietary magnesium. Although serum uric acid levels go up in the early adaptation phase of a well-formulated ketogenic diet, this is caused by decreased excretion, not increased production. And after a month or two, the kidneys adapt to maintaining normal uric acid excretion. At Virta, we devote considerable attention to hydration, adequate but not excessive dietary sodium and calcium, and despite plenty of green vegetables, nut, and seeds (dietary sources of magnesium), we supplement magnesium when there are early clinical signs of depletion. Our clinical experience is that kidney stones are rare during a well-formulated ketogenic diet.”

      Reply

      1. Thank you for your fast reply.

        Reply

  11. Looks like the 2nd movie is not available (at least in Canada):
    https://youtu.be/aA0v9-PAeBo

    Reply

    1. Now it is working.

      Reply

  12. Thank you for the great tutorial.
    I have been in ketosis diet for about four weeks or so . My total cholesterol shot up from 6.6 mmol/L (above the desired <5.2) three years ago to 11.1 mmol/L today! and my calculated LDL went up from 3.62 to 7.74 mmol/L. I am quite lean, and not doing this for weight loss, but for other health benefits. My HDL is about the same, and my triglycerides went up from o0.85 to 1.44. I understand that for a few people total cholestrol and LDL can go up quite a bit. My question is are these elevated levels okay, will they normalise. I have no idea how to explain this to my traditional doctor. Thanks for any clarification

    Reply

    1. Virta Health

      We can’t give personal medical advice in this forum and recommend that you give your physician some information on LCHF and its effect on diabetes. You can point them to our clinical trial here (https://www.virtahealth.com/research), and we’ll have some more information on heart health and the Virta Treatment coming out soon.

      Reply

  13. I tried ketogenic in 2014 and successfully saw weight reduction and I was training for my 3 rd marathon. However, I began to have palpitations and an overwhelming feeling of fear, to the point of going to an emergency room while on a business travel with what appeared to be “heart attack” symptoms. The drs said that I was fine, but had my tryglicerydes at 35 and a significant loss of important minerals, leading what they diagnosed as a “metabolic collapse” so recommended I stop that WOE and gave me an anti depressant among mineable supplementation. I canceled the marathon and returned to a “normal” eating. 50 lbs later, I am still having a hard time “getting back” your thoughts ?

    Reply

    1. Virta Health

      We can’t give out medical advice in this forum. We’d recommend that you talk with your physician!

      Reply

  14. Thanks for this clear and informative set of videos.

    You address mostly medication for T2D. Is there any science about the impact of SSRIs on insulin levels and control? For example, many people taking sertraline experience intense cravings for carbohydrates – not the “normal” kind, but very very intense. Is it even possible to get into ketosis without significant hunger on drugs of this kind?

    Reply

    1. Virta Health
      Virta Health May 3, 2018 at 5:28 pm

      Thanks for your question! We asked Dr. Phinney, and he said: “There is no simple answer to this question due to the greatly variable responses between individuals taking SSRI medications. We know of many people taking SSRIs who successfully follow a well-formulated ketogenic diet, but to our knowledge there are no randomized controlled studies to assess their effects on appetite and cravings during nutritional ketosis.”

      Reply

  15. Regarding fasting, is Dr Phinney recommending that we shouldn’t do fasts longer than 1 day (24 hours)? Along with a ketogenic diet, I frequently do 18 hour fasts (basically just skip breakfast) and twice a week I try to do a 23 hour fast (skip breakfast and lunch). I always have two coffees with coconut milk in the morning which I know technically isn’t “proper” fasting.

    Is this type of fasting okay to do on a ketogenic diet or am I putting my body into starvation mode and slowing down my metabolism? I’m trying to lose some weight so I hope I’m not doing myself more harm than good!

    Reply

    1. Virta Health
      Virta Health May 4, 2018 at 4:22 pm

      As long as it’s under 24 hours, Dr. Phinney says it’s fine!

      Reply

  16. I watched all of your videos and it all makes sense. I have tried to follow a Keto diet in the past. I recently lost my gallbladder. Can I still follow.a Keto diet? Also, I’m so confused with the information out there. I’ve studied Dr. Esselstyn’s information on eating a plant based diet. It appears contrary to your information. How do I figure out who is right??

    Reply

    1. Virta Health

      Dr. Phinney wrote about what to do if you have no gallbladder and want to do keto: https://blog.virtahealth.com/ketogenic-diet-no-gallbladder/

      We recommend that you look at the research and data to determine your eating plan. Keto and plant-based aren’t mutually exclusive – check out our guide to a low carb vegetarian or vegan diet: https://blog.virtahealth.com/vegan-vegetarian-low-carb-keto/

      Reply

  17. More resources or training for Providers? Thank you for the information!

    Reply

    1. Virta Health

      Hello! We have a forum for healthcare providers here where you can ask questions and share information: https://www.facebook.com/groups/101052947207366/

      Reply

  18. Thank you for this information. Is diet soda ok on a ketogenic diet. I have battled addiction to regular cola for decades and really struggle without something “cold and fizzy” to drink.

    Reply

    1. Virta Health

      Yes, many of our patients drink diet soda, but everyone’s body reacts differently. If you find that diet soda is stalling your progress, you may want to decrease the amount you consume.

      We have some articles and videos on artificial sweeteners and sugar alcohols here:
      https://blog.virtahealth.com/keto-diet-artificial-sweeteners-sugar-substitutes/

      Reply

  19. Sheila Mikulin July 20, 2018 at 7:49 pm

    With respect to fasting: If the goal is to induce autophagy, why is fasting not good? When looking at a GKI of 1 or below, fasting is almost always required ???

    Considering Dr. Seyfried’s work?

    Sheila

    Reply

    1. Virta Health

      Dr. Phinney said fasting under 24 hours is fine, but beyond 24 hours comes with some risks. He wrote more on this here: https://blog.virtahealth.com/science-of-intermittent-fasting/

      Reply

  20. Dear Doctor, please help me out! I have gastritis and I have a hard time consuming enough sodium because it upsets my stomach. Is there a way to get around this problem?

    Reply

    1. Virta Health

      Sorry for the delay! We asked Dr. Phinney and this was his answer:

      Two quick points: First, esophageal reflux and gastritis typically get better when one is following a well-formulated ketogenic diet. Persistent symptoms of pain on swallowing or stomach upset should be discussed with a physician. Second, the most soothing way to consume sodium is as a non-spicy broth with little if any added fat and a sodium concentration similar to the fluid that surrounds our cells –i.e., plasma. That’s 140 mEq per liter, which translates to one gram of sodium in 10 ounces of broth. This is the amount of sodium in one standard bouillon cube of in one half level teaspoon of table salt.

      Reply

  21. Carol Crevier, RN MPH August 12, 2018 at 6:47 pm

    We counsel patients regularly along the same lines of the Virta clinic within our primary care setting, but would appreciate interacting with you or your team on a professional level.

    Are you planning to address the professional community in any of the national association meetings in the near future?

    Reply

    1. Virta Health

      We just completed a 2-day continuing medical education course, “The Emerging Science of Low Carbohydrate and Nutritional Ketosis,” at the Ohio State University in Columbus. The full event was video recorded, and we will be posting it for free online access in the near future! Check our website for more information in the coming weeks. Also, given the very positive feedback from our audience and speakers, we hope to make this an annual event focused on the needs of the professional healthcare community!

      I’ll also send an email putting you in touch with one of our scientists for further discussion.

      Reply

  22. Very filling words of wisdom…thank you!
    I didn’t start Keto for weight loss ( although I’m overweight for my height/age etc … the weight loss is a bonus ) more that, I was refusing to take high BP pills the doctor kept pushing me to take every visit… I’d researched enough to know change of diet and lifestyle could help… I was also in a spiralling whirlwind of constant eating, never feeling full… all that stopped as soon as I started Keto ( I’m still gobsmacked I’m not hungry and I crave no sugar etc).
    Also my joint inflammation is way down these days 🙌🏼
    My initial internet search was ..’why am I always hungry?’ …

    I have been horrified at a few Facebook Keto groups, where everyone is the expert, they just sling out incorrect information and others take it as gospel…a lot of damage is being done… and the fact people just want to replace their old habits with quick fixes is crazy .. that’s not eating real foods. Totally unsustainable lifestyle. What’s the rush..it’s a tasty journey.

    Thanks again for these videos… it all makes valuable sense.

    Reply

  23. Thank you for these videos.
    I’m following a high fat, moderate protein and low carb way of eating for about two weeks now.

    My ketones are constantly very high from the beginning, above 4… Today at fasted state I measured 7.2 and my glucose was 85. My glucose has been in the low 80’s in fasted and fed state.

    I’m intrigued, why are my ketones so high?

    Thank you,

    Reply

    1. Virta Health

      Thanks for your note, and we are glad you like the videos. For specific medical questions, we recommend that you speak directly with your healthcare provider. (We can’t answer individual medical questions in this forum).

      Reply

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