[Transcript] – How To Reverse Type II Diabetes, Create Billion Dollar Companies, Win Triathlons With A Fraction Of The Normal Training Time & Much More: The Sami Inkinen Podcast

Affiliate Disclosure


Podcast from:  https://bengreenfieldfitness.com/podcast/the-sami-inkinen-virta-health-podcast/

[00:00] Introduction/Blue Apron/Kion

[06:02] Sami Inkinen

[08:44] Sami's Trip from California to Hawaii

[13:15] How Sami Prepared for the Row

[18:25] Virta Health

[31:57] GainsWave and FemiWave

[33:10] HealthIQ

[33:59] Continuation/Measurements Sami Takes Note Of

[36:22] Exogenous Ketones

[42:50] A Typical Day of Eating for Sami

[47:22] Fasting

[54:17] Sami's Present Fitness Routine

[59:46] End of Podcast

Ben:  Hey.  What's up?  It's Ben Greenfield.  Any alcohol fanatic, or cocktail connoisseur, or wine sommelier would flip if they saw the type of drinks that I drinky drink at night.  I just flew in from Boise where I was racing the Spartan Race down at Boise, and I'm here my in office this evening recording commercials.  And as I'm prone to do when I'm working in my office at night, vape a little bit of organic tobacco and sometimes I'll blend some herbs in with that and some essential oils, I got this fantastic little vaporizer called a Buddha, the Buddha.  And I'd drink a little cocktail before dinner.

Right now, I'm drinking a sauvignon blanc that is poured over ice blended with, well, not blended with, but just topped with a little bit of sea salt, bee propolis, half a can of FitAID, and an electrolyte tablet.  I also like to take my FitVine wine, the organic biodynamic wine that I drink, and I'll like to cut that half and half and I'll put some ice in there, some elderberry extract, some Kona black salt, another electrolyte tablet.  I do weird things to my drinks, I'll admit.  I have this weird, weird kind of infatuation with bastardizing alcohol.  Anyways though, my guest on today's show is way more intelligent than I am when it comes to nutrition and he's also just a freak of an athlete.  You're going to dig him.  Sami Inkinen.  I've known the dude for years and he's brilliant and he's fast, freaking fast.  Amazing athlete, talented guy.

Also, today's podcast is brought to you by some fabulous folks like Blue Apron.  Blue Apron, it's the leading meal kit delivery in the US and they send me stuff like short rib burgers with a hoppy cheddar sauce on a pretzel bun.  It's not gluten free, but I take my, you know how you can kind of have your cake and eat it too?  You take gluten polypeptidase enzymes.  Did you know that?  You can take those and they knock out gluten.  I got seared steaks and thyme pan sauce with mashed potatoes, green beans, and crispy shallots.  I can make that all in under 45 minutes without any trip to the grocery store.  Blue Apron is actually the number one fresh ingredient and recipe delivery service in the US of A.  They have two person meal plans, they have family meal plans, they even have a wine plan. [0:02:39] ______ be careful sending that stuff.  Six bottles of wine from renowned wine makers delivered monthly.  All sorts of really really great stuff that they send over to me.  And what they're going to do is they're going to treat every single listener of my show to $30 off your first order from Blue Apron.  Very simple.  You go to blueapron.com/Ben, that's blueapron.com/Ben.  That automatically gets you $30 off.  Blue Apron, a better way to cook.  I'm supposed to say that.  I didn't make that up.  A better way to cook.  It is kind of catchy, I have to admit

This podcast is also brought to you by something that I'm taking right now.  Not the wine.  I have this shotgun mix of, get this, it's chicken collagen, cherry juice, ginger, turmeric, white willow bark, which is basically the same stuff that you find in, for example, aspirin, the salicylic acid, hyaluronic acid, boswellia, which just knocks out joint pain, and then a mineral whey concentrate with all these bioorganic minerals.  And then finally, I don't know if you've heard of these before, proteolytic enzymes, which going in your bloodstream and just break down any of the fibers and the soreness inducing compounds that you tend to get after you, say, do a race like I did yesterday, or a very hard workout, or you're beat up, or you got a surgery, or your joints are bugging you.  It's called Kion Flex.  I consider this to just be like a shotgun formula.  Everything you need for your joints, why not just throw it all into one bottle.  That's the way I think. So it's called Kion Flex.  It's a supplement that I personally make, and you can get it at Kion, getkion.com, getkion.com.  And I've got a 10% discount code for you.  You ready?  Okay.  Here it is: BenFlex10.  BenFlex10 gets you 10% off your first bottle of Kion Flex.  How do you have like them apples?  Except they're not apples.  They're amazing anti-inflammatory things.  Alright.  Let's go chat with Sami Inkinen.

In this episode of the Ben Greenfield Fitness Show:

 “…once it became clear to me that there’s an alternative, evidence-based and very effective way to treating, not just treating but reverse Type-2 Diabetes, I just got so mad, I was like, I have to start this company.” “This type of seven day or even I’ve seen this day to day water fast, and I’m not kidding what I’m gonna say.  This is serious.  It’s very dangerous.  It can be extremely very dangerous so we are very careful with our patients.  Most of them are very sick when they come in but they should not be playing around with water fasting.”

Ben:  Hey, folks.  It's Ben Greenfield, and I've got a pretty crazy cat on the show today.  I actually ran into this guy for the first time back in my triathlon days, back in Ironman days.  He used to kick my butt, he used to kick everybody's butt.  He's show up to the races on a minimal training, eating macadamia nuts in full ketosis, back when nobody was really doing this, and he would dominate.  I actually interviewed him on a podcast several years back, back in the day when I was doing triathlons more, and we did a whole podcast on how to maximize fitness with minimal training time.  And we talked about how to train for Ironman triathlon with about 10 to 12 hours per week, he revealed some of his top swim sessions, and run sessions, and cycling sessions that could save you tons of time, he talked about his self-quantification methods, what he eats, and it's been several years since I've had him on the show and he's been up to quite a bit since the time.

His name is Sami Inkinen.  You may have heard of him.  He's the CEO and the founder of a relatively new San Francisco based company called Virta Health, which is a company that is attempting to reverse type 2 diabetes.  And he's also an active investor in a whole bunch of different human health and human performance companies.  He also was a co-founder, and the COO, and the president of Trulia, which he eventually sold for about 3.6 billion.  So, the dude knows how to make money as well, he's a good businessman.  He also rode across the Pacific Ocean.  Yes, the entire Pacific Ocean.  From California all the way to Hawaii, unsupported, with his wife.  I believe also doing the whole like low carb, no carb thing.  He's got a great website that I'll link to in the show notes along with everything else that we talk about, and you can access today's show notes over at bengreenfieldfitness.com/Sami2.  As in bengreenfieldfitness.com/Sami2.  So, Sami, welcome back, dude.

Sami:  Hey, Ben!  And thanks for inviting me back.  Obviously, I didn't embarrass you too much last time.

Ben:  Yeah!  You actually, you interested a lot of people with your crazy training methods.  And actually, I know we'll kind of delve into your current minimalist fitness routine later on in today's show, but I got to ask you first, man, what was up with that crazy rowing adventure that you did from California to Hawaii?

Sami:  Ha!  I wanted to test if my marriage was built to last.

Ben:  I was going to say.

Sami:  And I'm happy to report, we are still married.  And after the row, we've also managed to produce two little girls, two little children.  So, it was built to last.

Ben:  Wait.  So, sitting down and rowing for copious periods of time does not actually affect sperm quality then, is that what you're saying?

Sami:  Well, correlation doesn't rule causality.  But we got pretty lucky, and here we are. But, yeah, joking aside, it was definitely a hard adventure.  But what I also wanted to prove and show to the world, so this was 2014, and we started planning very late in 2013, that you really don't need to be sipping sugar, or sugary drinks, or sports products to do 30 minutes or a one-hour jog or workout.  And I kind of got angry how much of this crap is being marketed to kids and juniors who start doing some sports.  It's like if you walk out of your door, you better be drinking, I'm not going to say a brand, but some sort of a sports drink.

Ben:  Oh, you can totally say a brand.  We talk about Gatorade, we talk about PowerBar, we talk about Clif Bar.  I'm sure they all love us.  And we've actually talked about this a lot on the show before, that it is a myth that you need completely topped off glycogen stores to go out and freaking run up a hill with your dog.

Sami:  Exactly.  And from all the popular science and surrounding anecdotal evidence, it was clear to me that sugar and related, or sugar-filled products is sort of a public enemy number one, now that we've gotten rid of tobacco mostly.  And so, what we wanted to prove with the row was you really don't need all that crap to exercise an hour or exercise for 18 hours a day, or in our case, exercise 18 hours a day and 45 days in a row.  So, that's what we wanted to show.  We wanted to show that you can exercise basically as much as running two marathons a day.  That's how much the total workload, or if you measured how many calories you burn today, you would need.  And we want to show you you can do that with no sports products, no sports drinks, no sugar, and in fact, practically very few carbohydrates even.

Ben:  That's actually what I was going to ask you, Sami, is when you say no sugar, do you actually mean like no starch or do you mean fructose, and maltodextrin, and glucose, and sports drinks, and things like that?

Sami:  None of that.  So, practically speaking, we were only eating real food, and then it was zero starches.  I'd say the only carbohydrates we got during the row were from dehydrated vegetables.  We had some trail mix, which was mostly nuts.  But most of the food was dehydrated beef, olives, olive oil, macadamia nuts, lots of nuts.  So yeah, there were no sports products, no maltodextrin, no gels, no bars, no drinks.  And we kept going for up to 18 hours a day, probably an average of 16 hours of work, rowing per day per person.  Went from California to Hawaii, it took 45 days, three hours.  Broke the speed world record for two-person boats.  Apparently, we weren't slowed down by the fact that we didn't have any Gatorade.

Ben:  Wow.  That's crazy.  I mean I could see, and I know some people will probably jump into the comments section and mention this, the body can take, for example, some of the odd chain fatty acids from what you'd find in animal meat and convert some of that into pyruvate, and that could potentially used to form glucose, like via gluconeogenesis.  Or some of the backbones from fats, like the glycerols, could potentially be used for glucose to give you that little bit of carbohydrate that would allow for fat to burn in the flame of the tiny amounts of glucose that it does need.  But regardless, that's a pretty hefty adventure to do on dehydrated vegetables and nuts, and a little bit of animal meat.  And in terms of your actual volume, like your training leading up to that, what were you doing to get ready to do the equivalent of a couple of marathons a day?

Sami:  Well, first of all, I have no rowing background.  My wife doesn't have a rowing background.  We don't even have a sailing background.  So, it wasn't like we were ocean experts either.  The preparation and the physical preparation was just about six months.  Little on I'd say five to six months.  So, we started in January and pushed off in June.  So, about six months, and I did not train more than I think 10 hours a week.  And what might be surprising is we did not row three hours a day, six days a week.  So, the training was primarily two things.  I'd say three, three different types of things.  One, weight lifting.  So, I did a fair amount of pullups, front squats, and deadlifts.  So, that was one.  And the purpose of that was to strengthen all the shoulders, and joints, and muscles, and things that you need in rowing and rowing motion.  And by the way, ocean rowing is pretty different from flat water rowing and expected waves and things.  It's not smooth sailing.  It's kind of like a boxing match.  So, that was one.  So, a fair amount of weight lifting.  Maybe two or up to three sessions a week.  And then, two, I did a fair amount of high intensity rowing on an Erg.  So, Concept2, which I bought, not very expensive, from Amazon.  Two to three sessions a week.  And then thirdly, we did one outside row per week, and that was anywhere between two to four hours.  So, that was kind of long, slow on the water.  Just for a few more hours.  And then I had aerobic cross training.  Running here and there, a little bit swimming there, a little bit biking there, but the core training was really weights, intensity rowing, and then one slightly longer rowing session per week.

Ben:  Yeah.  It sounds actually kind of similar to your triathlon training when I talked to you about your triathlon training back in the day.  You were doing really short, highly intense sessions on the Computrainer.  You were doing some hill sprints, and then I think you were mostly doing 50's and 100's in the pool for something long, like a 10-hour day, or in your case, like an eight-and-a-half-hour day for Ironman.  And it sounds like you did something similar to this.  So, like a Concept2 rowing workout for you, like a high intensity rowing workout to get ready for a long row from California to Hawaii, what would that look like?  Like a high intensity Concept2 workout?

Sami:  I did two types of things.  So, one was a sort of VO2max plus.  So, it was 10 times, one minute pretty much max and then one to two minutes very easy in between, and a little warm up, a little cooldown.  You can do that in well under 40 minutes.  And then another one would be more tempo.  So, sort of just below threshold, six times, five minutes, or something like that.  So those were the two typical workouts that I did during the week as an intensity workout.

Ben:  So, basically one short high intensity, like minute-long efforts, and then the other one was more like four to six-minute long efforts?

Sami:  Yes, yes.

Ben:  Nice.  I like it.  So, you're kind of targeting lactic acid tolerance with a short effort and more VO2max for those longer tempos.

Sami:  The intensity is pretty low obviously, when you're exercising 18 or 16 hours a day.  The most important thing is that your body is strong, that you don't have injuries and overuse injuries.  And we went in fresh, 'cause we didn't grind three, four hours a day for seven hours a week, and then we did a fair amount of lifting.  And I think that lifting is quiet important, that your joints, your muscles, your soft tissues are very strong.  So, when something unexpected happens, you don't lose your arm or your shoulder in the first wave.

Ben:  Yeah.  Absolutely.  And people always ask how that's possible.  I even talk about this in my book, how there's two different pathways to achieving mitochondrial density. There's AMPK pathway and the PGC-1alpha pathway, and one is dependent upon extremely high intensity training that allows you to get to your goal, perhaps at a higher risk of injury and more trips to the pain cave, but allows you to get just as much mitochondrial density as the other pathway that's more like the long aerobic chronic cardio session.  So, yeah.  You obviously have done a very good job tapping into the fast high intensity pathway and paired that with kind of like, almost paradoxically, 'cause assume it's so glycogenic, this whole low carb or ketogenic type of approach, which is related, I want to talk a little bit about your fitness routine as well now, but first I want to talk about this whole Virta Health thing because that's really even more important in my opinion.  You're freaking trying reverse type 2 diabetes.  Tell me about this new company and what you're doing with that.

Sami:  Yeah.  So, our mission is to revert diabetes in a hundred million people by 2025.  And, yeah, it may sound ambitious, and perhaps it is, but the background is, I think most of your listeners probably know that type 2 diabetes is a massive, massive problem.  In America, there's about 30 million people, and globally more than 400 million people.  And you and me as taxpayers, all through our insurance payments, we waste about $200 billion a year in America on diabetes.  And so, when I realize that the underlying cause for type 2 diabetes is insulin resistance and that insulin resistance could systematically be reversed without surgery, without new drugs, without even exercise, and without even actually losing a lot of weight, I thought, “This is kind of nuts.”  It's nuts that if you have advanced type 2 diabetes today, your options are insulin therapy or some other hypoglycemic drug, or bariatric surgery.  And I thought, “This is just nuts.”  Why don't we create a protocol and treatment that's medically supervised and can be delivered anywhere, like through our own online clinic now.  But there has to be an alternative to these patients who are just managed with these expensive medications, with no light at the end of the tunnel, if you can systematically reverse this disease.  So, that's what we started 2014.  So, we're basically a treatment to reverse type 2 diabetes.  We've run a clinical trial, we've shown that it works.  The results last past two years.  So, it's not some sort of a crash course, one month or three months.  And the patients are very happy.  So, that's what we're trying to do.  And if all goes well, hopefully diabetes is a thing of the past in the next 15 years.

Ben:  Now, I've seen some interesting studies, Sami, on pancreatic cell regeneration in mice who undergo, for example, fasting or calorie restriction.  Is that what you're doing with Virta, or are you using some kind of a fancy multi-modal approach to diabetes?  Like what are you guys actually doing with the patients that you're working with?

Sami:  There's basically two key parts into our treatment protocol.  One is medication management.  And in most cases, that means pulling people safely and sustainably off of medications.  And so, that's one of the reason we are licensed providers in all 50 states because only physicians and licensed doctors who are full-time employees can obviously do that and know how to do that safely.  So, that's one part of it.  And then a second part of it is really the nutrition protocol.  We don't perform surgery and develop new pharmaceuticals.  And the nutrition protocol is highly individualized, but basically at the core of it is using individualized nutritional ketosis to reverse insulin resistance in a long-term, sustainable way.

So, those are the two key components.  And you need both those two, how do you manage many patients and how do you individualize something that can be very complex, nutritional ketosis, into basically any lifestyle and any kind of a medical and health situation.  And then we deliver that 100% remotely, which again, as I mentioned, is a licensed provider in all 50 states.  Obviously, it's possible today because everyone has a smartphone, everyone has a computer.  We send a bunch of sensors to people so we can collect all the data that we need. But that's basically how it works.  So, if you are our patient, you should feel and practically your experience is such that you have a doctor and a clinical team member that we call a coach basically following you 24/7.  When you need help, when something needs to change, we intervene and give you the right guidance.  That's the basic approach.

Ben:  What do you mean you say medication management?

Sami:  We've had patients who come in and with more than a hundred units of insulin, and insulin is a super potent hypoglycemic drug.  So, it gets your blood sugar down, which is part of the diabetes management.  Once we start getting your blood sugar down naturally, it is extremely interesting if you still take insulin on top of that.  In fact, you take insulin, you have hypoglycemia and it's either coma or death in minutes, not hours. So, you need to have a physician who knows how to safely titrate you off of insulin on an hourly or daily basis, depending on how we have to do.  So, somebody has to do that. Somebody who knows how to do it.  Somebody's who's legally allowed to do that and somebody who can do that safely.  So, that's an example.  So in this case, if we have a patient who comes in with a hundred units of insulin, somebody needs to say, “Okay, tomorrow morning, you take 30 units off.  And then maybe 50 units off.”  Whatever that might be.  And of course, that's individualized.  But that's what it means.

And then, of course, most people with type 2 diabetes or who had type 2 diabetes,  for a long time, they come with a bundle of chronic conditions.  So, most of our patients come in with a dozen or so medications.  So, if you are not a physician who really understands metabolic health, you have no idea which medicine you can touch and then which you should not touch.  And so, people who have hypertension medications, they have lipid medications, they have blood glucose medications, they have inflammation medications, they have pain medication like it's, you know how America, we're treating these diseases by treating symptoms.  So, people come in with a bag full of pills and injections.  So, you can't just say, “Stop taking those and change your nutrition.”  That would be life-threatening.

Ben:  Yeah.  It's actually very interesting that you're using this ketogenic approach in a medical model like this because I've seen evidence on leptin sensitivity and insulin sensitivity both improving on patients who are consuming a high fat diet as well as fasting glucose, and triglycerides, and thyroid.  But when it comes to insulin, have you guys, or has anybody looked into the mechanism of action?  Like what's going on?  Are high blood ketones somehow improving the expression of the insulin receptor on the cell's surface?  Are they just basically lowering blood glucose and that's resulting in better insulin sensitivity?  Do you guys know what's going on?

Sami:  What's very clear is that insulin resistance is the primary underlying cause of type 2 diabetes.  The mechanism of what causes insulin resistance is somewhat understood, but not fully understood.  And the same applies to the mechanism that reverses insulin resistance.  It's somewhat understood, but not fully understood.  And we'll be publishing some papers and some editorials around this topic.  And it's weird to think about that we are dealing with a 200 billion plus of our problem, and we as a collective with society and science, we do not explicitly understand the mechanism of what causes insulin resistance.  In fact, most of the world thinks it's just obesity.  Obesity is the primary contributor.  But that certainly isn't it.  What we have shown now, and we'll be publishing some of these results soon is when we reverse insulin resistance, we can see that the insulin resistance itself gets reversed.  Not just lowered glucose levels.  One of the things we measure is HOMA IR, which can be calculated from fasting glucose and fasting insulin.  And that substantially improves in our patients.  But the mechanism behind that, we'll be publishing more information about that probably in the next six to 12 months.

Ben:  Very cool.  And you guys are seeing good results with your patients?  This isn't just stuff that you're doing based on research?  You've actually seen reversal of type 2 diabetes?

Sami:  Yeah.  Absolutely.  So, what we've done is, one, we run a formal clinical trial of our own where we have almost 400 patients.  In the middle of America we've published the first set of peer-reviewed results already where we've shown that in majority of our patients, we've reversed type 2 diabetes and gotten patients off their medications.  And these patients are, average age near 60, average BMI near 40.  So, these aren't fit Ben Greenfields from the northwest.  This is the real deal.  Like you take a patient who is kind of at the tail-end of their diabetes suffering and we can pull or turn the clock back and reverse the disease.  So, we've already published a bunch of results, and there's a half a dozen papers coming out this year.  And the clinical trial itself is past two years  So, we have the data and practical experience to do this very sustainably because that's the most important thing.  And then similarly we’ve treated patients in commercial settings throughout the country and replicated the same results.  So, it really works.  And my goal is to make sure that every person within, with type 2 diabetes, it should be as easy to prescribe the Virta treatment as it is to prescribe the insulin or bariatric surgery.  And it should be covered by insurance.

Ben:  That's so cool.  I've done genetic testing with 23andMe and exported my results to a wide of variety of different websites that'll analyze your genetic results, and Promethease was one of those, for example.  I actually possess a lot of the snips that place me at a higher than normal risk for type 2 diabetes, which influences my own decision in great part to continue to adhere to a lower carbohydrate, kind of like a ketogenic approach or a semi-ketogenic approach.  And, of course, as I know that you've found, I think this was, and correct me if I'm wrong, your foray into an interest in this type of approach was fueled by performance just as much as health.  Am I correct?  You were using this type of approach back in your days of racing triathlon?

Sami:  Yeah.  Absolutely.  My wake up call to realizing that insulin resistance is something that you might be dealing with even if you're lean was completely accidental, and it happened to me, and that was really a hard moment to even start Virta Health.  And so what happened to me was, 2011, I won the world championships in triathlon in my age group.  And then 2012, I did my fastest Ironman, which was 8:24, and simultaneous that I found out that I was pre-diabetic.

Ben:  Oh, you did?  I didn't realize that.

Sami:  Yeah.  So I thought, “This is nuts.  It doesn't make any sense.  Like how can,” I didn't know what my body fat was, but you're pretty lean when you're doing an 8:24 Ironman.  And I thought, “This just doesn't make any sense.”  I started researching and reading published research, and this was how I ended up meeting with Dr. Steven Phinney, who's now my co-founder at Virta and our chief medical officer.  And that's how I found out that, “Oh, wow.  Insulin resistance is something that you can become even if you're lean, even if you exercise.  And if you can actually reverse insulin resistance without all these things we think I needed, which is bariatric surgery, or even more exercise, or even more dieting.”  So, that's how I ended up becoming very interested in this topic.  And then once it became clear to me that, “Hey.  There's an alternative evidence-based and very effective way to treating, not just treating, but reversing type 2 diabetes,” I just got so mad.  I was like, “I have to start this company.  I have to make this work because it makes economic sense; it makes sense for the patients.  And if we can do this at scale, we'll be saving so much money that, who knows, maybe we even have a lower tax rate in this country.”

Ben:  Yeah.  And you're doing a lot of good for people.  How'd you find out that you had pre-diabetes?  Were you just doing like a blood glucose monitor?

Sami:  Yeah.  Second part of your question, you were doing this for performance reasons.  I was tracking my fasting blood glucose practically on a daily basis.  And initially, I was like, “Well, if it's 115, 110 consistently, it doesn't really mean anything.”

Ben:  That's pretty high.

Sami:  I realized that I'm totally pre-diabetic and insulin resistant.  And I was doing that as I was testing how my blood glucose reacts to different sports [0:31:33] ______ while I'm exercising.  So, that's how I figured out that I'm metabolically actually pretty unhealthy.  And then I had high blood pressure, and all the markers of metabolic syndrome without being overweight and obese or having much actual body fat at all.  And so, that was kind of my wake up for myself.

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Ben:  You still do a lot of self-qualification.  Like your website, samiinkinen.com, like a lot of times, you've posted different experiments that you've done, things you've tested on yourself.  Have you been up to anything recently when it comes to self-quantification?  Any devices that you're playing around with or any experiments that you've done on your body that you've gotten interesting data from that you think would be of interest to listeners?

Sami:  Well, most of my time these days goes to building and scaling Virta Health and then trying to take care of these two little girls that we have.

Ben:  Are they twins?

Sami:  They're not, but we have a two-and-a-half year old and a half-a-year old.  Whole handful.  So, I haven't done anything particularly crazy.  I think my sort of main routine is I am a patient of Virta [0:34:52] ______ myself.  So, I track for them things that my doctor and coach here can see all the time, which is mainly glucose and blood ketones.  And then every, I would say, three to six months, I do a comprehensive metabolic health panel, blood work.  Now that I know what I'm doing, good news-bad news is really nothing changes.  It's all good.  And so, it's probably not nothing too super exciting there.  I would say more recently what I've tested out of curiosity is exogenous ketones, which we can talk about if you want.  And then probably the most valuable measurement tool that I use, and it really isn't a measurement tool is I try to pay a lot of attention to my energy level and my mood when I wake up and then during the day.  And I find that it is a way more powerful reading indicator than any kind of hormone levels or comprehensive metabolic health panel from blood.  I don’t see daily any change in my blood work, but I say daily, weekly, monthly change in kind of how I feel, and then I adjust my rest and training accordingly.

Ben:  Right.  So, you mentioned exogenous ketones.  That's obviously something that is the relatively new craze in the supplement industry, ketone esters and ketone salts.  And I've done podcasts on them in the past, but I'm curious what's your experience with them.

Sami:  Well, first of all, personally, I was just curious because now that there is this “crazy ketogenic diet”, which clearly is becoming the next fad, or maybe already is, I would say.  So, of course, in America, everybody smells money and says, “Well, if it's about getting your ketones high, why don't you drink or eat them.  That must be a great way to do that.  So, I've just experimented myself just out of curiosity.  On a more objectively level, I would say, one, I think of claims are way ahead of any kind of published evidence of science.  What you might read from a company trying to sell this stuff, be aware.  I would say that's one.  And then two is from a more practical perspective, our liver can crank up well more than a hundred grams of ketone bodies per day for free when you just eat the right stuff.  And so, if you look at it from that perspective, you might need to pay, depending on what kind of supplements you might be using, several thousand dollars per month to get the same amount of ketone production that your body can literally do for you for free.

Ben:  Right.  When you're saying several thousand dollars per month, you're talking about these ketone esters.  Like companies like HVMN and Dr. Veech's laboratory have come out with that are like $30 a serving.  Is that what you're referring to?

Sami:  Yeah.  Some of these products that you can from Amazon or somewhere.  When you look at the price and how many grams of ketones you're getting, when you compare it to a hundred or a hundred plus, plus, plus grams that your liver can crank out everyday.

Ben:  Right.  Oh, yeah.  So, you're saying not even ketone esters.  Just like the regular ketone salts.  Like even the less expensive products, your liver can make a copious amount of ketones compared to what's in those?

Sami:  Massive.  So, I think that's one thing just from a practical perspective.  And then from a health perspective, I think the area that is, it's worth remembering that, we need to remember that if the body's in ketosis, yes, you can measure blood ketones, or urine acetones, or breath acetones, and that's just one thing to measure.  But the fact that your body is in ketosis doesn't necessarily mean that that's the only thing that's happening that's giving you the health benefits.  And so, by just increasing your blood ketone levels by drinking or eating these ketone salts or esters doesn't necessarily mean that you're actually producing all the health effects.  ‘Cause the body's a complex biological system.  In order to get to ketosis, you have to lower glucose intake or carbohydrate intake.  And that alone has a whole other set of pathways that are being affected in your body.  I'd just be very careful that since we don't have the evidence yet, don't just try to optimize one that thing can't be measured because that may be completely irrelevant, or slightly irrelevant, for the metabolic health effects that you get while you're in nutritional ketosis.

And the example to think about is 30, 40 years ago, there was only one thing we could measure, or one thing that we could easily measure in blood was cholesterol.  So, we said, “Wow!  We can measure cholesterol.  We can see cholesterol levels.”  And now we have this thing called heart disease.  And when cholesterol is high, people tend to get heart disease.  Now, let's just from that and say we just need to get cholesterol down, so, let's start eating food that doesn't have cholesterol.  And obviously, now we know that that is a completely wrong hypothesis.  So, I would just be careful about that, that you say, “Oh, I'm in ketosis.  I have high ketone levels.  So, why don't I just drink more ketones so I get even higher levels.”  That's one little piece of the puzzle.  And if you don't have the rest of the puzzle, you may really potentially even cause harm too.  Now, that being said, it's completely possible that there will be therapeutic use cases for exogenous ketones.  I just don't think the science is there yet.  Maybe it could be for medical use.  Maybe it could be for [0:40:50] ______ reasons, military.  Who knows?  But I think it's pretty early.

Ben:  Interesting.  Do you take any supplements?

Sami:  Honestly, I literally take nothing.  Absolutely nothing.

Ben:  Really?  So, you're not like, via Virta Health, do any like calorie restriction mimetics like metformin or anything like that?

Sami:  We don't.  In fact, all our patients, like I said, one big focus is that we want to reverse type 2 diabetes for good and it has to be sustainable.  So, one of the things we measure is hunger, and we want to make sure that people are, they may feel hungry, but then we encourage them to eat.  So, we try to avoid situations where people are actually hungry for sustained periods of time.  The only thing I can think about that I've taken over the last six months is magnesium.  And I only take that if I've experienced any cramps, which really means that I haven't eaten the stuff I should have eaten in terms of real foods.  That probably happens once in, I don't know, three months, four months, five months.  But that's the only thing I can think about.  Other than that, I take caffeine as a… the only thing I can think that I take on an almost daily basis, and sometimes I have a week.

Ben:  I'm pretty sure caffeine doesn't count as a supplement.  I think it's just considered a part of the human bloodstream at this point.  I'm pretty sure humans have evolved to where we just basically are considered to have caffeine as a permanent part of our cellular makeup.  What about your diet?  I'm just curious.  For a guy like you who's combining, staying in good shape, doing a lot of these events, rowing to freaking Hawaii, does your diet still look kind of similar to what you were doing when you rowed to Hawaii?  Like lots of seeds, and nuts, and plants?  I guess, actually, Sami, what would be really interesting for folks is if you could walk us through, if there is a typical day for you, like a typical day of eating for you.

Sami:  Yeah.  You know, Ben, this is the most dangerous question ever in the world.  You go on record what exactly you eat, [chuckles] so people think they…

Ben:  You can always make stuff up.  You can be like, “Yeah, I have like heirloom kale blended up with some kind of fancy organic tomato for breakfast.”  But, no.  Seriously, what do you eat?

Sami:  First of all, on the high level, yes, I pretty much eat the same way as I've done for the last several years.  But I would say on a high level, I just try to eat real food and I eat when I'm hungry.  I try not to, well, I snack if I'm hungry in between meals, but I try not to get into the mode of snacking all the time ‘cause that’s the symptom of not eating something during the mealtimes.  But I guess, probably speaking, I'd say breakfast, I'm not a heavy breakfast eater.  But since I do all my workouts in the morning, I try to make sure that I always get something soon after the workout.  And typically, that is eggs or something like that.  It has some amount of protein.  And then if I happen to have butter, I might put a little bit more that I'm not hungry immediately.  So, that's kind of breakfast.  If I had a massive workout coming up, which is rare, but I might do a long weekend ride, then I might have a heavier breakfast of frittata or eggs and bacon, something like that.

Lunch is typically, it's pretty vegetable heavy.  Maybe there's some protein.  So, that might be like a salad.  Maybe there's a little bit of salmon or something like that.  But my lunch is usually pretty light.  And then, I'm probably a little bit hungry in the afternoon. So, I might have a snack that could be almonds, macadamia nuts, some sort of a salami stick or something like that.  And then dinner is definitely my largest meal, and I get quite a majority of my calories from the dinner, I would say.  And so, it's pretty salad heavy.  I love spinach.  Saute.  Mix it with parmesan cheese and butter.  And then my favorite protein, usually it's either fish or eggs.  I'm not a huge fan of red meat just for whatever personal taste reasons.  But I like ground beef, so, sometimes I mix that.  And then I might be, might want something there in the evening, so I might have full fat yogurt with some more macadamia nuts or coconut cream and coconut flakes mixed with some berries or something like that.  That's kind of an example of what I like to eat.  It depends on if I exercise a lot, then of course, you get much more hungry, and then you end up eating more.  But I try to keep it as simple as possible and not really eat any kind of double packaged crap.  I would say my only advice is I do drink protein drinks here and there.  It's just so convenient.  Especially in the morning if I'm in a rush after workout, I might just drink sort of a protein drink.  But that's probably the only, I don't even eat any bars.

Ben:  Yeah, man.  Protein drinks.  It's like a fart in a can.  There's a lot of them that aren't that bad these days, but I used to do bodybuilding.  I don't know if I ever told you this, like back before I did Ironman triathlon, I weighed like 40 pounds more, but it was just pure muscle.  And I was sponsored by this protein shake company called ABB, and they would just send me these big aluminum cans full of protein, and I would basically eat those and canned tuna fish all day long.  And I still cannot do a shaker cup and protein.  It just brings me back to those disgustingly, literally like constipated, nasty gut bodybuilding days.

Anyways though, the other thing I was going to ask you about was fasting.  I mean, obviously, like I mentioned, we see intermittent fasting or fasting protocols as something associated with pancreatic cell regeneration in diabetes.  Is that something, for those reasons, that you incorporate at all?  Do you do any weekly fasts, or monthly, or yearly fasts, or intermittent fasts, or anything like that?

Sami:  Well, I'll answer this tongue-in-cheek.  I say I always fast between meals. Sometimes that's one hour, sometimes that's six hours, seven hours, eight hours.  I never fast.  Well, one should ask the question: what does fasting mean?  If it means fasting more than 24 hours, the answer is absolutely, I never fast.  If it’s you know, I rarely 24 hours goes between my meals.  So, I really never fast.  And this is something that we have to address with a lot of our patients, Virta Health patients, because people find all kinds of stuff on the internet, and this is sort of another reasonably hot topic by people who want to improve their metabolic health.  There's a lot of fasting chatter going out and around.  And it's a little bit like exogenous ketones that the claims are way ahead of published evidence.  And certainly for people who are metabolically unhealthy and are perhaps on hypoglycemic or hypertensive drugs, these type of seven-day or even, I've seen these 30-day water fasts, and I'm not kidding when I'm going to say this is serious, is very dangerous.  It can be extremely dangerous.  So, we are very careful with our patients.  Most of them are very sick when they come in, that they should not be playing around with water fasting for a number of reasons.  My co-founder, Dr. Phinney, wrote a pretty long piece where he referenced all the published evidence around fasting and sort of highlighted the dangers.

Ben:  Really?  Is that available online?

Sami:  Yeah!  It's online.  We can make sure to put it into your show notes.

Ben:  Yeah.  If you send it to me, I'll put it in the show notes.  So, Dr. Steve Phinney is concerned about fasting?

Sami:  Yes.

Ben:  Interesting.  I personally have noticed a lot of positive benefits in terms of my hemoglobin A1C, and my fasted glucose, my inflammatory markers, and also even my gut health by doing what I do now, which is a weekly 24-hour fast.  Meaning from, and honestly, that could be because it also forces me to have a really good day of rest and recovery.  But from Saturday night at dinner until Sunday night at dinner, I fast.  I don't eat anything aside from, like I'll do some bone broth and a little bit of coffee and tea, but I really feel fantastic and also I think there's a spiritual aspect to it that a lot of people neglect.  Because I'm not exercising, 'cause I'm not comfortable exercising in a fasted state like that, I do a lot more meditation and a lot more kind of like introspective thought.  I'll go down to the sauna and I'll sit and do like candle stick meditation, or I'll go for kind of a quiet walk outside in the snow.  I kind of dig having that weekly period of time where you deny the body, right?

Sami:  Yeah.  And one needs to do always remember that if you are very healthy, you have a very good electrolyte balance, you are well-fed and fueled, and you don't have major metabolic health issues, not eating for 23 hours, or whatever it might be, from one meal to another, is probably all very, very likely, it's very, very healthy and safe for someone like you.  And then you take someone else who is metabolically [0:51:04] ______, is not eating very well, and then you assume he's low in potassium, he's low in this and that and is on hypoglycemic drugs and hypertensive drugs, and you do that exact thing that you said, which might be not just good, but it may be health improving for you, it may be very, very dangerous.  So, it's always [0:51:23] ______ these things. It's [0:51:25] ______ you and me, we could probably just walk out of our house and run 26 miles today, although that's not how much I run typically, and would be healthy. But you put someone else and say, “You have to run 26 miles,” they might need knee surgery the next day, right?  You always have to remember that.

Ben:  Yeah.  Exercise, a lot of athletes forget this, like crossfitters and people who listen to podcasts like this who are very physically active, like you and me, forget that exercise is a calorie restriction mimetic.  Just like ketones, and Metformin, and fasting are all either calorie restriction or calorie restriction mimetics, exercise is too.  And so athletes are already getting a lot of cellular apoptosis and a lot of the benefits of fasting, without fasting.  And of course, we all know that you could take that to the extreme and just exercise too much.  And like I mentioned, I've found benefit by forcing myself into at least one day a week of not exercising and also not eating that much.  And it works out pretty well.  But fasting for the general population is different than fasting for a pretty serious athlete, which is a lot of people who listen into this show are.

Sami:  Yeah.  And it's also the alternative, whether you compare it.  If you have a person who eats five bowls of Captain Crunch a day, five times a day, and then we would say, “Let's take one day a week when you eat nothing for 24 hours.”  It's' a pretty easy case to make that, blood sugar would probably come down, A1C would probably come down, and there would be some of this short-term metabolic health benefits if you take a massive five times a day sugar load out of your body.  The challenge is that something could go really badly wrong short-term, and then for most people, fasting is more of and leads more into yo-yo issues from an eating perspective, from a metabolic health perspective.  For very few people, it's sort of a sustainable approach.  But again, this could be another two-hour podcast with someone.  Perhaps my scientific co-founder Steve Phinney would want to have an entire podcast about fasting.

Ben:  Yeah.  Send me what he wrote on it, and I'll put a link to it in the show notes.  I'm sure some other people have interviewed him about him too.  I actually think my friend, Jimmy Moore, may have talked to him about it.  So, I'll hunt down some resources for people listening in and put them over at bengreenfieldfitness.com/Sami2.  That's bengreenfieldfitness.com/Sami2.

Sami, also, speaking of exercise as a calorie restriction mimetic, what does your fitness routine look like right now?  Are you still doing the kind of minimalist fitness routine?  Are you training for any competitions?

Sami:  Good question.  I was actually going to do an event or two this year.  In fact, one is I'm doing RAAM, or Race Across America, in June in a four-person team.  So, that's riding about 3,000 miles.  That's probably going to take six or seven days.  I'm doing that, and I was going to do a couple of triathlons as well.  So, doing a lot of endurance racing this year.  So, that's my plan for the year.  So, in terms of training, well first, I always try to think about what's my goal.  And in this case, I actually want to get into some sort of an endurance racing shape.  And so I think about two things mainly.  One, and the most important thing for me, is sort of the foundation of health.  And to me, the key things are sleep and nutrition.  And a lot of people forget that when they're like, “Oh.  When I exercise and start doing marathon, do a triathlon, it's all about the exercise piece.”  But you know, Ben, very well, that if you don't have a foundation of health, you just don't get that super compensation.  So, you need that sleep and right nutrition.  So, that's a big part of my training, that I get that right.  But then the second piece is the actual workouts.  I really only have about an hour and 15 minutes each day between 6:00 and 7:30 each day.

Ben:  That's funny.  That's like about, what I've identified also for me is I've got about typically only 60 to 80 minutes a day that I can train.

Sami:  Yeah.  Exactly.  So, that's kind of my time.  And within that window, I do everything that I do look.  And it's pretty similar to our last conversation a couple of years ago, that I do a couple of days of high intensity, one day of sort of lifting, stretching-slash-recovery.  And then maybe there's one day a week, Saturday usually, which is sort of a long day.  But the long days these days for me are two to maybe three, three and a half hour bike ride.  It's not a six hour bike ride.  So, that's really my approach.  This morning actually, I had run to pool, I swam less than 20 minutes, and then I ran back to my house and did a couple of run intervals while I was running.  So, that was all in 70 minutes.  So, that's my typical, kind of a mixed week workout.

Ben:  Now, what I've found though, for me, personally, is I've got a bunch of stuff going on in my office.  Like I use a standing workstation and a treadmill workstation, and I've got like a kettlebell sitting in here.  And every time, right now, 'cause I'm training for the RKC kettlebell certification, every time I walk out of my office, I got to stop and do 10 kettlebell swings on each side.  So, I work little things like that in throughout the day.  Are you using that type of approach as well?

Sami:  I don't.  Unfortunately.  I do stand.  I've become a standing desk advocate.  That's pretty much the only thing.  I don't, we used to do some pushups before we started meeting just for fun.  Those who wanted to participate.  But now that we've grown a little bit more, I've become conscious that I don't want to be the crazy CEO who makes everyone feel offended.  But that's a good idea.  Maybe I should get the kettlebell, or at least a pull-up bar.

Ben:  Yeah.  Word.  It works out pretty well for me.  You talked about strength training and how it really kept you in shape for rowing.  I do a great majority of my strength training, not as like a traditional strength training routine, but a lot of it's just like at little points throughout the day, I'll lift.  So, it works out pretty well.  So, Sami, Virta Health is the name of the organization that you have founded.  Dr. Steven Phinney is on your board.  We'll link to some of his thoughts on the dangers of fasting, maybe get him on the podcast at some point.  I'll also link to our previous podcast about How To Maximize Triathlon Success With Minimal Training Time, your website which always has an interesting post here and there.  And then for all of you listening in, that's going to be all at bengreenfieldfitness.com/Sami2.  That's bengreenfieldfitness.com/Sami2.

So, Sami, I want to thank you so much for coming on the show, man, and sharing all this stuff with us.  I love what you're doing, your approach.  I like that you're a bad ass athlete, but also a businessman who manages to juggle the two and do both very successfully.  So, good on you, as they say Down Under.

Sami:  Well, thank you.  You're too kind!  And thanks for having me again.  I really enjoyed.

Ben:  Awesome.  Alright, folks.  Well, I'm Ben Greenfield along with Sami Inkinen of samiinkinen.com and virtahealth.com signing out from bengreenfieldfitness.com.



Sami Inkinen is the CEO & Founder of San Francisco based Virta Health. Virta is an online specialty medical clinic that reverses type 2 diabetes safely and sustainably, without the risks, costs, or side effects of medications or surgery. Sami is also an active investor in companies advancing human health and performance as an angel investor and Venture Partner at Obvious Ventures.

Previously, Sami was a co-founder, COO and President of Trulia until it’s IPO and eventual sale for $3.6B. Sami, an avid athlete, is a triathlon world champion in his age group, and recently rowed across the Pacific Ocean from California to Hawaii unsupported with his wife at a record speed to raise awareness about healthy nutrition. Sami received his Masters in Physics from the Helsinki University of Technology and MBA from Stanford University.

The last time Sami and I spoke in the podcast How To Maximize Triathlon Success With Minimal Training Time, we discussed how Sami has a busy work life that only allows him a maximum of about 12 hours per week to train, and in that interview, he revealed his secrets, including:

-What 99% of Ironman triathletes do wrong…

-How a typical week of Sami’s triathlon training goes…

-Sami’s top swim sessions and strategies (including the use of a swimming snorkel)…

-How the combination of indoor cycling and a Computrainer can save you tons of time…

-Sami’s top run workout on the track…

-How Sami uses something called Restwise to track recovery, and what he really thinks about other training recovery tools…

-What Sami eats and what he avoids eating…

-And much more!

Now Sami's back, and during our discussion, you'll discover:

-The story of Sami's crazy low-carb rowing adventure to Hawaii, fueled by dehydrated vegetables, jerky and nuts…8:30

-What Sami's been up to with the creation of Virta Health…18:15

-How Virta Health works in a shockingly effective way to reverse Type II diabetes…26:45

-How Sami is quantifying his health, his sleep, his fitness and other lifestyle parameters…34:00

-What Sami's diet looks like now…42:30

-Dr. Steven Phinney's thoughts on the dangers of fasting…48:00

-The supplements Sami takes or does not take for maintaining a low-carb lifestyle, anti-aging and beyond…52:00

-And much more!

Resources from this episode:

-How To Maximize Triathlon Success With Minimal Training Time

Sami Inkinen

The Virta Health Website


Dr. Steven Phinney's thoughts on the dangers of fasting

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