Dr Eric Westman Duke University Ketogenic Diet for Weight Loss and Brain Performance FULL VIDEO

[Music] you welcome welcome back to the Duke lifestyle medicine clinic I'm dr. Eric Westman and I'd like to teach you how to do the no sugar no starch diet today okay I try to put everything into the title of this so I named this program no sugar no starch and the reason for that is that this is a very scientific kind of diet when you have sugar and starch in the diet it raises the blood sugar and then insulin goes up in the blood and as a result insulin tells your body to make fat and store fat so I try to put all in the title at all to do with sugar starch and insulin and in a nutshell and I'll tell you all the details about that during this program I've had people come to me and say well I understand I need to get the sugar out but the diet didn't work for them because I didn't understand that starches really are just sugars all connected together so our bodies digest starches very efficiently into those basic sugars so eating a starch like potato pasta rice is just like having a teaspoon of table sugar ok sorry for the news I'm just burying bearing the news of how science looks at the diet in terms of the sugar in the starch you may have heard of this as a low carbohydrate diet because carbohydrate really is a general term for sugars and starches ok so this is a version of a very low carbohydrate diet as well look at the diet in another way though it really just consists of real food ok so we're getting rid of all the fake foods the junk foods that have been in the marketplace for so long so real food meaning meat fish cheese eggs salads and vegetables and I want to keep your carb content to about 20 grams of carbs for the whole day and if you've never counted carb grams a slice of bread has about 20 grams or maybe 10 grams of carbs and then an apple the size of my fist has 20 grams of carbs so that's why at first those are not on on the eating list ok so we have to avoid sugar bread fruit flour pasta really any other sugary starchy foods that has a high carb content ok now the way this works is that your hunger will go away so that you won't feel the need to eat so much so you'll be eating less not because I tell you to eat less I never talked about calories or portion sizes and what happens is your hunger goes down and you just start eating less and that's how you lose the weight or fix the diabetes or other metabolic problem that you have ok now on page 4 don't go to plates for yet but I'm paid for I have the list of foods that I want you to stick to so I'm going to make it really simple some people really like that oh you know the foods on page 4 that's what I need to eat black and white it's great other people hate it because oh it's black and white I can only eat the foods on page 4 but I've really simplified the whole approach into food list and we'll get to that in just a minute ok so some introductory material I I need to work through before I get to the allowed food list or page 4 for short some people have side effects the first few days or the first week you might notice cravings for foods that you're not eating cravings for the sugar or the fruit or the things you're not eating no problem the cravings will go away and by next week when I see you I'd like to see you all next week in the clinic the cravings should be gone in fact one of the first questions I ask you is are you hungry and if you say you're hungry something's wrong so by next week you ought to come back if you've done this for about a week and tell me that you're having no hunger at all that's the way I know it's working ok during this next week so if you're having some fatigue some lightheadedness that sort of thing what I want you to do is to drink bullion which is a salt substitute I know that this is the first violation of what you've been taught and I'm going to make okay I want you to have salt when you're not eating carbs especially during the first week if you're not feeling well and the reason for that is there are fluid shifts that happen during the first week and that can be very helpful if you have any question you can also just call me and I'll remind you of that during this first week drinking plenty of fluid is another way to minimize the side effects that you might get the first week and there's some other side effects that most people don't get and I really put them here for your reference so please turn the page to page two most of you will get some sort of sugar craving that's the you know the foods you've been eating for so long you may miss that now the cravings will pass but you can have a sugar-free beverage or sugar-free jell-o something like that to pour the sugar cravings you can treat the sugar cravings with those things probably the most popular sweet sweet treat is the sugar free jello with whipped cream on it so you can take some whipped cream put that on your sugar free jello and that will take the cravings away no real whipped cream that's right oh yeah no that's not suffering right so you have sweet things just not things sweetened with sugar I'll get back to that in a minute I do want you to use bullion if you don't have heart failure or high blood pressure and for those who have that I'll make a zero on your page for for the bullion if you don't have those though to prevent or minimize these transition symptoms we call them fatigue and lightheadedness that some people get bullion is very helpful that's the cube or the crystals just in hot water and you have one or two of those a day as a preventative ketosis is fine this is a diet that uses ketosis ketosis just means you're burning fat in fact that's what we want to do and there's a lot of confusion about ketosis because in the textbooks it's often mentioned in the context of diabetic ketoacidosis and if that's the only place they mention it doctors and health providers think that's what it is this is very different than diabetic ketoacidosis okay this is a normal state when you're burning fat so ketosis is fine ketones are really just fuels fuel chemicals that the body uses kind of like glucose kind of like sugar what happens if I slip well this is a very metabolic diet in fact I'm taking you from carb burning because you've been eating carbs to fat burning because when you don't eat carbs your body has to burn fat and what happens if you're in a fat-burning mode and you eat carbs is that your body stops burning the fat goes back to burning the carbs and so you may block the fat burning for two or three days if you slip and had some carbs so what that means is I bet people coming back saying I'm doing really well but I'm having carved on Monday and Friday well this won't work okay you have to be very strict to limiting the carbs every day because I'm taking it from carb burning to fat burning okay and another way to think of it is that we really just burn what we eat the humans are very flexible and adaptable so if you're eating carbs you'll burn them creating fat you'll burn them what this diet does is takes away the carbs out of the equation your body has to burn fat it's forced to do that it's very happy to do that in fact it starts looking around and saying I have fat right here so that's why you're not hungry because you're burning your own body fat okay so that's pretty neat this is a diet that really maximizes your body's ability to burn fat yes even one step further the fat you eat now is being handled differently than before it's handled in a way that you burn the fact that you eat you're not storing it like you used to be if you were burnt if you were eating carbs and fat and you were in a car burning mode okay the second violation of what you've been taught is I want you to eat fat because you're handling the fat differently in fact eating fat helps you burn fat because it revs up the enzymes that have to do with fat burning in your body it may not make sense at first but I'll remind you in the clinic that I want to eat fat and I want you to have salt okay this is kind of like I'm teaching you how to drive a car in England you know they do it wrong better well it's not wrong there well it's not wrong right it's just different so they drive on the left-hand side of the road in fact they make the cars with the steering wheel on the rock how about the right side not too left it's just a different way to go about it so you've been taught from out there that you should limit salt and limit fat and that's the low-fat way of going about it like driving on one side of the road I'm teaching you how to drive on the other side of the road and it works just fine but it means that you may have to you may have to disregard or unlearn what you've been taught from before okay so it's just a different way to go about it but that often causes confusion but I want to just want to just point that out to minimize confusion now I do want you to have a multivitamin like Centrum silver or generic equivalent if you're not menstruating female you don't need iron in the vitamins so please use an iron free multivitamin and I'm happy to check the vitamin if you bring it into the clinic fish oil is helpful for maximizing fat burning and especially helpful if you have high triglycerides in the blood but that's optional if you want to do this without the fish oil that's just fine turn the page to page 3 so many people ask about their blood cholesterol levels we'll check it before and after and what the research has shown is that the prediction of the cholesterol getting worse in everybody is wrong it was just wrong so most of the time the cholesterol gets better in fact the triglycerides and HDL cholesterol the the new way of looking at the blood panel gets better almost all the time so the good cholesterol will go up using this kind of diet more than anything else we know about and that that's really important for minimizing the heart disease risk okay a lot of research to support that now and the education of people is very slow I mean I still meet a lot of doctors and health care providers who don't know this yet so you can expect that you may have doctors who are concerned about that tell them not to worry why don't you check my book that's what happened to me if I go back to 1998 I had several patients doing this kind of diet I was working at the Veterans Hospital here in Durham and these two patients I remember them they were doing this diet losing all this weight and I didn't know anything about it I was very skeptical finally read the book said well your class were all going to get worse and one of them said well why don't you check it doc you are a doctor right he reminded me that I could check it two in a row the blood cholesterol got better even though everyone else that it was going to get worse I wasn't so over trained to ignore what I was seeing in front of me so that's really what led me to start inquiring and researching this diet further and many other doctors that are are where I was now about 13 years ago so they may be skeptical they may be maybe not know about this much at all so remind them to if they're worried about something to just check it your weights not the only thing that will improve you're going to notice that our energy levels better appetite control lots of things if you're a diabetic you can expect better blood Sugar's control if you're taking insulin I need to reduce that in half so I need to reduce it by 50% on the first day start this diet if you're taking insulin and you drop the carbs that you eat and you don't adjust the insulin level your blood sugar will fall and it will it may go down to dangerously low levels so that's why if you're taking diabetes medicines you need to do this with a physician who's understands how to do this okay bariatric doctors weight-loss doctors around the country know how to manage this sort of medication reduction lifestyle medicine the name of the clinic here also involves increasing activity and reducing stress I learned how to do this at one of the three lifestyle residential programs that are here in Durham North Carolina and I adapted what they did at the residential programs into an outpatient version of it and we've done this in the clinic now for five years here in the outpatient setting I find though that I really don't have to talk about activity and stress management at first I really just want control of your diet okay if you're exercising now fine if you're not don't worry about it when you're ready to exercise let me know really for for weight loss and for metabolic change the most important thing for me to have control of is your diet okay for many people that's a big release because they don't feel like the raise exercise or they can't and that's okay there's a common misconception that you have to exercise to lose weight and that's not the case we do have a support group that meets once a month across the street at the the tier house you're welcome to come there and at the current time it's so oversubscribed that if you call and they say there's no room just come anyway well we won't kick you out and we'll see you there are any every month or 20 to 30 people who are there talking about how to do low carb diets today in in our region or our area ok I've learned lots of things from the people who come these folks who are basically scouring the area for low carb things and sharing those ideas my information how to contact me is here at the bottom please email me or phone me I don't mind at all and if you're taking insulin and I'm managing your insulin reduction I'll give you the contact information so you'll be able to get me almost immediately ok turn to page four so that's all introductory stuff page four is the program ok if it's not on page four don't eat it here's what I want you to remember as a result of this ok if it's not on page four don't eat it you got it so this is the no sugar no starch diet I borrowed this list of foods from a practice that had used this approach for about 20 years so these foods are very carefully selected and honed through lots of different people but beginning at the top remember I want you to standard 20 grams of carbs per day and I don't care how you cook the foods a lot of misconceptions about this it's fried it must be bad or if it's baked it must be good no all I care about is whether there are carbs with the food so if there's breading that has carbs in it that's not good it's okay that it's ride a lot of people like to fry chicken in a combination of crushed pork skins with egg and because that has no carbs you can fry chicken there and becomes crispy and tasty so all the matters is whether there are carbs on the food or not how you prepare it doesn't matter to me okay now when you're hungry I want you to eat your choice as much as you want from these foods because they have no carbs okay so that's the meat poultry fish and shellfish and eggs you don't have to avoid the fat that comes with the foods and you don't have to deliberately limit the quantities of these foods but you should stop eating when you start feeling full okay so let me just go through these foods more specifically for meat I mean beef am burgers steak I still remember this Christmas prime rib that I had wood was a inch of fat around the edge and you can have that if you like it it's delicious and it helps you burn fat number eating fat helps you burn fat pork ham bacon these are all fine lamb veal and other meats processed meats like sausage pepperoni hot dogs are fine just want to make sure the carb content is less or about one gram per serving they can really you know just about makes everything taste better than that true and there's a lot of unnecessary fear about eating eating bacon I think that comes from the notion that eating fat is bad and I want you to forget that notion okay remember we're driving on the other hand of the road now the other side of the road poultry chicken turkey turkey duck I have a college professor who goes out and buys pheasant and has that with his wife I have another college professor who's divorced and doesn't own a pot and drive through the fast food in the morning and fast food at lunch and fast food at dinner and as long as he's not eating carbs that's fine it doesn't matter how you implement it the science says just watch the carbs okay fish shellfish a fine tuna tuna can be in a can it can be fresh frozen it can be flown in from the beach an hour ago after being caught I don't care all right that's all kind of gimmicky stuff I all I care about from the science side of things is whether there are carbohydrates in it or not don't forget shrimp scallops crab and lobster have no carbs okay eggs whole eggs are permitted without restrictions I think eggs are the perfect book food nutritionally you know if you think about it you can make a chicken out of an egg and we thought about it just salute the nutrition is so complete you can make a whole beating out of it so again the egg needs to be out you know causing bad fat now they're back in so eggs are fine boiled eggs come in handy for snacks throughout the day any questions about the proteins these are really the very nutritious sources of protein and fat that I want you to to focus on for the day now I do want you to have two cups of salad greens and one cup of a non starchy veggie for the day and that's some people look at that and say wow that's not many vegetables usually that's the women and then the men come in and say well that's a lot of vegetables you know so and yet they're all living and alive right so we're very flexible now in terms of the amounts two cups is roughly two fistfuls and you'll see me in the clinic say two fistfuls of leafy greens or two cupfuls and then one cupful or one fistful of the non starchy veggie okay you can go home and take your measuring cup and compared to your fist and then throughout the measuring cup because I don't want you to have to be that precise unfortunately these are so low on in the carbs on this list that there's a little wiggle room on it but that's the target I want two cups you know not too much more not too much less of the leafy greens and one cup of the non starchy veggies so salad greens or leafy greens included arugula bok choy cabbage chard chives undyed beet greens collard greens mushroom greens turnip greens kale lettuce parsley spinach radicchio greens radishes scallions and watercress basically if it's a leaf you can eat it for the non starchy veggies I want you to focus on just these okay artichokes asparagus broccoli Brussels sprouts cauliflower celery cucumber eggplant green beans he come on leeks mushrooms okra onions peppers pumpkin shallots snow peas sprouts sugar snap peas summer squash tomatoes rhubarb wax beans and zucchini there's a lot to choose from right you'll notice the conspicuous absence of some things you may have been eating like potatoes sweet potatoes corn these are just way too starchy okay corn is fed to animals to fatten them up that is a very commonly known in corn is said to eat to make a delicacy called fatty liver called Swan gras so it's not good when you're trying to lose weight and burn fat if all you did is have your protein sources and your salad greens and your veggies that's all the nutrition that your body needs even even during weight loss which is a bit of a stressful time for your body by this point someone usually says well where's my fruit right I've been told I have to have fruit every day it's not true so fruit is actually very sugary and will stop the weight loss using a low-carb approach very quickly so you have to be very careful about the amount of fruit if any I prefer you not have any okay so bullion I would like you to use up to two times a day if you don't have heart failure or hypertension and/or ankle swelling and that's to minimize the transition symptoms that can occur from growing from car burning to fat burning okay usually just the first couple weeks now to make this very delicious and fun you can have the foods down at the bottom in limited quantities cheese up to four ounces a day cream up the two tablespoons a day a moment about dairy milk as sugar in it it's called lactose and so that's why milk is off-limits now but you can have a heavy cream and you have got me mate you can have coffee maize or those kinds of things but you've got to watch the the carb content usually that's about one gram per serving you know the coffee mate doesn't fit the the real food definition so optimally I'd like you to have the real cream but in a pinch sometimes at the workplace and all you'll just have coffee mate available that's pretty low in carbs mayonnaise up to two tablespoons a day olives six a day avocado and a half of fruit a day lemon lime juice 2 teaspoons a day soy sauce 2 tablespoons pickles dill or sugar free up to two a day avocados and lemon lime lime juice are great for making guacamole or you're out at a restaurant having welcome away and at the bottom snacks can include pork rinds and skins they have no carbs in them at all pepperoni slices ham beef jerky a rollup is the closing term for when you take a piece of cheese or string cheese scroll it up in a piece of meat and eat that very quick if you tell me you only have 30 seconds to eat in the morning no problem make a couple roll-ups and you'll be good to go for the rest of the morning and deviled eggs my last thing on my list you know the best deviled eggs are not just for the holidays they're very tasty and one of the ways to make this a lifestyle that you can get used to okay it's not on page four don't eat it okay if you lose page four I'll give me another one I'll email you one again you know I have lots of page four some people put this up on their fridge take to the grocery store that sort of thing until you get the hang of the the foods that are very low in carbs so remember the science tells us that you want to keep the carbohydrate grams under 20 for the day and this list of foods you don't even have to count carb grams if you stay to this list and the quantities here you'll stay under the 20 grams okay so let's turn the next page put some little background information just to help you understand that often things you hear will be quite confusing confusing the primary restriction of diet is carbohydrates and carbohydrates are sugars and starches are the ones known as simple carbohydrates and complex carbohydrates and I've listed out the sugars and simple carbohydrates they are white sugar brown sugar honey maple syrup molasses corn syrup beer milk flavored yogurts fruit juice and fruit so those are off-limits and then starches are complex carbohydrates so they get digested to the simple sugars so it's just like having sugar so you have to avoid grains even whole grains rice cereals flour cornstarch breads pastas muffins bagels crackers starchy vegetables like slow cooked beans pinto beans lima beans black beans carrots parsnips corn peas potatoes french fries and potato chips okay now there are a couple of exceptions I've learned this from the low-carb support group there is a yogurt product that you can find it's only in our area available at Kroger it's called carb master yogurt you may want to write this down carb master yogurt has about 4 grams of carbohydrates and the servant and so I'm teaching you that there are a few exceptions to the if it's not on page four don't eat it rule right so that if you can keep the carbon grams under 20 for the day that is also the other other goal so Kroger carbon master yogurt is the name there's also a fruit juice product that is a diet for juice that has two grams per eight ounces and the brand in this area is Ocean Spray diet cranberry and that's very tasty very popular fats and oils are in carbs are out fats and oils are in because they have no carbs essentially they don't raise the blood sugar don't spike the the insulin level and that's that insulin level that makes our body makes that and store fat that we're trying to avoid so any fat and oil is fine as long as it's natural even butter design for salad dressings that means things like oil and vinegar blue cheese ranch Caesar Italian these are all fine watch out for the light dressings because these commonly have more carbohydrates the industry uses the term light to mean low and fat and then they added carbohydrates back generally to make it palatable the Cobb salad is a good choice because generally there's chopped eggs they can and green grated cheese that is also involved with that salad fats are important because they taste good and they make you feel full you know our bodies feel full in two ways you can stretch the stomach much like Oh going to a Chinese restaurant and you have all this rice and you stretch the stomach you feel full well the stretch goes down and you and you're hungry again a more elegant way to turn off the hunger is by eating protein and fat and when when protein and fat hit the stomach a chemical goes from the stomach to the brain that says I'm getting full right so in fact that signal of fullness lasts for a long time some cultures even use this to end the meal in France often you have cheese for dessert because that will turn off the appetite okay don't attempt to follow a low fat low carb diet I want you to have the fats and a good reason for that is that it will help you feel full you can have sweet things just nothing sweetened with sugar so any of these other sweeteners are fine like Splenda NutraSweet Rivia sweet'n low watch out for the sugar alcohols though because they can cause stomach upset and gasp and you'll find out you'll find those in the diabetic candies that are currently out there as I recall though on page four there's no diabetic candies right yeah okay so you know I'd say stick to page four you know things sneak in like I remember the gentleman who came back wasn't losing weight you know I don't make you write out what you eat at home that's too much work and this works so well you don't have to do that and yet another principle of what you've heard about it and losing weight that I violate you don't have to write down what you eat occasion I ask people to do that he came back he wasn't losing weight but I do ask you to write out what you're eating in the clinic so next time first thing you'll get is a page that says please just write out what you're reading and drinking so I can look at it so this gentleman comes back he's not losing weight I can't figure out by what he told me maybe where the problem is so I said okay this happens sometimes I'll see you next time well you got up out of the chair and I heard this chicken sit wait I know what that is they were tic tacs you know the sound of tic tacs I think right these little sugary things a one or two tic tacs is okay I mean there's a half a gram of a carbohydrate in each tic-tac when he was having two boxes full for the day that's not hard to do with you to them and then you know you're not paying attention likewise with sugar-free gum just be very careful usually the sugar-free gum has about one or two grams of carbs in it so you don't want to be using these frequently throughout the day so sweet things are alright but you have to watch out for these nuances about those things beverages there's really no magic number of drinks to have for the day really just let thirst be your guide and we do allow caffeine up to three servings a day roughly there's a lot of wiggle room there and it's very individual so most people can have coffee and other diet sodas as much as they want others can't so just try it and we'll go from there I'm teaching you the strictest version to get you on the right path and then we need to find how your body responds okay some people can eat more carbs than others depending on their age their gender their exercise activity level and so we'll find your individual level okay does anyone drink alcohol so at first I would say please stay away from alcohol every program like this works better if you don't drink alcohol but if you must there are some ways to drink low carb beverages and ask me about that in the clinic ok turn the page page six just as a reminder about quantities I don't really talk about quantities or portion sizes of the foods that have no carbs so one of the defining elements of this diet is that and always eat and still lose weight you just can't eat carbs so eat something that doesn't have carbs okay does that make sense so there's no no caloric limit and I want you to eat proteins and fats I might eat real foods but another part of the diet is that I want you to start listening to your body and if you start feeling full stop okay you don't have to eat everything on your plate okay many of us were raised with that in fact I was raised with the notion that I had to eat everything on my plate even though I was full right you may have had that experience too well I'm here to tell you you don't have heat every on your plate now okay maybe when you were a child but not not anymore okay at restaurants few days I'm given about twice as much as I can comfortably eat so I take home the rest with me and have it the next day here are some important tips and reminders the following items are not on the diet they're not on page 4 sugar bread cereal flour containing items fruit juices honey hole or skimmed milk yogurt canned soups dairy substitutes ketchup sweet condiments and relishes well that said there is a low carb ketchup that some of my patients have found that is one gram per serving so if you missing ketchup there also some ones you can make on your own that are very low in carbs I will show you about that watch out for these common mistakes fat-free or light diet products would happen there they cut out the fats and they added sugars coleslaw is just about every restaurant and fast-food place they add sugar to it so watch out sugar-free cookies and cakes just aren't low enough in in carbs so sugar free does not mean carb free okay watch the labels and I'll teach you how to do that in just a moment here are some both some cookbooks and websites that I recommend the most popular website for my patients for recipes is Linda's low carb menus and recipes that's HTTP colon slash slash een aw com slash low carb slash the recipe for make your own ketchup that tastes even better than the Heinz one is that Linda's low-carb the recipes for a really really popular thin and crispy crust pizza is that is that Linda's low-carb if you're wondering what to eat and you haven't found Linda's low-carb yet I'll bring it up in the clinic can show you print you out a couple recipes turn the page so if you err dieticians the top half of the page is what you want to see in terms of the protein and fats and the carbs you are getting carbs and in your veggies about 10 grams and then the bottom half the page shows you that this how simple it could be a sample date could look as simple as bacon and eggs for breakfast lunch grilled chicken salad pepperoni slices and a cheese stick burger patty or steak for dinner a green salad and green beans of butter it's real foods it's fixing your metabolic problem last thing I'd like to show you is how to look at a Nutrition Facts label from the low carb point of view the only number I want you to look at is the number that comes up after total carbohydrates okay so this is the nutrition facts for cauliflower and it shows seven grams of carbohydrates in that serving of cauliflower I'd like you to look you're looking at products to scan for things that have zero grams or 1 gram things like that if it has as much as 7 grams you have to be careful about the serving size okay because I want to keep you under 20 grams of carbs for the whole day okay there are two ways to count carbs total carbs and net carbs and I'm teaching you the total carb method today so between now and next time I'd like you to stick to page four remember if it's not on page four don't need it that's right and I look forward to seeing you all next time [Music] you [Music]

Channel: Brian

Views: 424,079

Keywords: Keto, Ketogenic, LCHF

Id: oNZsfluh0Uo

Length: 38min 53sec (2333 seconds)

Published: Fri Mar 10 2017