Dr. Eric Westman: Keto Made Simple (Do I really need organic, grass-fed beef?)

with that I present dr. Eric Westman [Applause] [Music] thank you it's a pleasure to be here and my style is gonna be just a little different my talk today I'm complicated Kito do you really need organic grass-fed beef and the just to give you a little perspective of where I'm coming from I've been at Duke for about 28 years trained in clinical research and was part of the early clinical trials that were addressing the safety and healthiness of a low carb keto diet then now that's going back 20 years ago when we first started to look at it and we opened a clinical practice at Duke twelve years ago to implement what we had learned in the clinical trials to try to scale up what we know we have two new companies that were launching and I'm the past chairman of the board of the obesity medicine Association which is the largest group of medical weight loss doctors not the surgeons medical weight loss doctors in the world so there are a lot of different ways to go about weight loss and improving your health we teach other doctors how to do that at the OMA or obesity medicine Association we've been teaching the keto diet there for the last 10 years basically so going back to 1998 I started looking at keto and my patient skewed me in my two of my patients at the VA Medical Center in Durham we're doing this wacko diet steak and eggs and one of them lost 50 pounds and this was remarkable because no one really ever lost weight in my practice I would send people and well and it's not for me trying I referred all my patients to the dieticians and there were dietitians there and the VA is very well funded in some areas and but it never seemed to work so I followed that signal and now looking back we've published 46 peer-reviewed papers in good medical journals on the low-carb keto diet and then the Atkins Company asked Stephanie Jeff folic and I to rewrite or write the latest version of the Atkins book called the new Atkins for a new you and then Jimmy Moore asked me to be the color commentary for keto clarity and cholesterol clarity and it's interesting cuz once you start writing books then there's a presumption that you're just a book writer and I remember meeting dr. Atkins in 1998 he's one of my teachers and everyone thought he was just a book writer making money off the books and what he did didn't work but I visited the clinic and actually saw that it was working and I roped in Jackie a Burstein who helped me to create heal care for life and heal clinics and she was working for dr. Atkins back then and she's still working with me now so I've come a long way in fact my internal medicine is the best that I've ever been able to do my first training is an internal medicine it's just that I don't use medications it's pretty amazing [Applause] so what is a clinical researcher and clinical guy do at a university like Duke well my clinic has known as the clinic of last resort meaning people have tried everything else and they're desperate sound familiar people used to go to dr. Atkins clinic I kind of saw that as a kind of going up to the top of the mountain to visit the Guru and what dr. Atkins prescribed had to work and so I carry that model where people come to me desperate for this to work the first time and every time and so it's not monkeying dilly eating dilly dallying around it this has got to work so I've treated patients now not only with obesity and diabetes but also PCOS irritable bowel syndrome fatty liver GERD heartburn lymphedema cardiovascular disease the cardiologists who understand metabolic syndrome which is the high triglyceride low HDL in the blood send me their patients cardiologist send patients to me the ones that understand preventive cardiology today in fact the heart surgeons send me patients who are too large or have too many medical problems to do a transplant so what they do is they put a heart pump in the chest that helps the blood flow around these patients are probably the most sick people that are still alive and not in an intensive care unit and I help them lose weight so basically I've created a obesity medicine clinic at a university in a university setting where we treat all sorts of internal medicine and even surgical problems we help people with post bariatric surgery weight regain so no surgery is not the total final permanent answer and the harsh reality is that thirty to fifty percent of people who have had the bariatric surgery will regain almost all their weight over if they don't address lifestyle even weight control when medicines cause weight gain you know we screened for medicines that are what we call weight positive causing and probably the the sleeper that most people don't understand and doctors out there use it all the time because it's so effective are these intranasal steroid allergy sprays they are very potent and actually can make people gain weight reminds me of a patient recently who for whom the knee injection of cortisone was enough to stall the weight loss and so just be mindful of medications that you're taking too so at Duke if you came to see me on we would do an initial evaluation an hour-long teaching class and then I would see you about every month to make sure that things were working well to your satisfaction if you're on medications I would teach you what to do with those medicines and now on it's about a six to eight month waiting list depending on the time of year to see me at Duke University so I actually have my mission now is to bring Kido to the world but I can only see so many people at Duke so we started the company heel clinics heel clinics comm where you can go and I'll talk a little more about that and there was also a niche to provide truly low carb keto friendly foods and that's a company called adapter life so after 20 years of clinical research and clinical care and a university setting how do you help more people this is one method that I'm working on is to scale it up to have it become available more widely so he'll care is the clinical company and it's a guided keto path to healthy eating and living there are two modes or methods one is the non-medical weight loss the other is the medical management in the UK these are being called deep prescribing clinics or you get deep prescribed the drugs so he'll care or he'll you get the dietary recommendations which is basically a keto diet you get the personalized guidance and support and then there's medical medical supervision if needed so I've developed a comfort level and knowing that there's been a lot of coaching from people and there are a lot of great ways to do it but if you don't have a medical issue we can help you at a distance without that medical monitoring we may ask you to get some blood tests done that sort of thing but if you have a medical problem especially if you're on diabetes or high blood pressure medicines we strongly believe that medical supervision is needed and that's when you would have to see someone at a heel clinic think D prescribing clinic the adapter life Kido products you may have had a chance to sample them there are cereals and bars and coffee shots or collagen shots that are called now also with protein it's just a source of nutrition that doesn't have sugar in it and the keto bar is actually probably the pop most popular product so far at adapt your life switching gears and I'll come back full circle to what you can do and troubleshooting those kinds of things the harsh reality is that half of the u.s. is either obese or diabetic I have diabetes and that's getting worse and as we heard today in and I as outlined in two fantastic books the good calories bad calories by Gary Talib's and the big fat surprise by Nina ty Schultz this really all started when the and low-fat guidelines were instituted and it continues today sadly in the medical world doctors really are just taught about medications so this is where you get into the treatment of diabetes diabetes is manageable it's lifelong it's incurable all of these are words that are reassuring to you just just get on this escalator of increasing weight and diabetes and more medications it's really not a cure or fix but you can see here in the middle panel here one of the guidelines in graphic form basically is medication I mean there's a lack of confidence in the doctor that what they tell you to do will work in terms of lifestyle change because they don't know about a lifestyle change that works so that's the harsh reality that may be why many of you are on medicines are had to come off the medicines maybe even on your own but that is one of the roles of the heal clinics or D prescribing clinics to get you off those medicines so the current lifestyle recommendations although as we've seen they're changing changing slowly there's an old saying that doctors practice the way they were taught and residency meaning their while current guidelines may be changing your doctor may not change based on the current guidelines you may have to inform them about the other lifestyle changes that can work like the Kido you don't lifestyle let's see so what's the solution or what's one possible solution the ketogenic lifestyle actually can put obesity and type 2 diabetes into remission and the bottom line for the science is that when you eat carbs your blood sugar goes up your blood glucose and that creates that can end here in the green line when you don't eat carbs in a meal your blood glucose doesn't go up and that is now understood as the common mechanism between the road to diabetes with diabetes is an elevated blood glucose and the road to obesity because that insulin rise after the blood sugar rise is what creates the situation in your body to create the fat storage you don't have access to because you're storing the fat you don't have access to the fat energy so you get hungry again and you repeat this cycle it was kind of mystified me why someone may be carrying around the the equivalent of backpacks of food and their body and they're not eating the out of the backpack that that's basically the fat store the fat energy so what happens when you cut the carbohydrates out is your body burns what you eat so if you're not eating carbohydrates your body has to start burning fat and so you start burning fat the substitution of ketones for glucose is something we talk about a lot and measuring ketones and all but actually there's a you're using ketones but you're also using fat for energy so it's not just the ketones you measure fatty acids are going around and fueling your cells more so than the ketones it's interesting to see this obsession about ketones when I wish we could measure the fat in your blood although you measure the fat going down if you're losing weight by the weight going down but there's no current measure of measuring the fat in the blood thus we measure what you can measure and that's ketones ketones are converted from your body fat into ketones and that substitutes for glucose and most of your cells ketones are not that are not used for fuel are excreted by the kidneys although it makes no sense if you're totally keto adapted to lose ketones in the urine because it's energy so you may not show ketones in the urine after months or years of being keto adapted shifting to fat burning because you're actually using the ketones so much for energy thus the urine strips might not show ketones but the blood or the breath might and also ketosis or nutritional ketosis is safe and desirable the brain actually prefers ketones over glucose the heart muscle prefers ketones over glucose and babies are born in the state of ketosis pretty interesting huh I'm reminded of remember the Palmolive commercial where mad you're soaking and Palmolive you know you actually ketones in your blood even even when you're eat carbs most of the day you'll have some ketones it's a natural thing but now try to simplify things or make things more uh less complicated not all low carb diets are keto and the simplest way to really define a ketogenic diet is by the number of total grams of carbohydrate in the food for the whole day and you can actually pretty much be sure you're gonna be in ketosis if you're at zero grams of carbohydrates if you go to 20 grams of carbohydrates just about everyone will be in ketosis and if you go to 50 grams of carbohydrate total grams a day maybe depending on your metabolic state maybe half of people will be in ketosis so you could start at 50 measure ketones and then find your threshold or if someone's coming to me to have something work the first time we've come a long time this is the clinic of last resort I start people at the 20 grams of carbohydrate and in my experience that people may be at 40 and I take them from 40 to 20 and it starts working people might be doing 20 net carbs and because the net carb calculation is really adding more total carbs and it also allows for eating all sorts of different kinds of fake food products I'll see people go from 20 net carbs to 20 total carbs and it'll start working so remember that's my method it's I want this to work the first time every time and keep it simple so going Tito is actually simple you can have tasty satiating affordable foods and it's also good for you here is one list of foods with basically you can have as much as you want of meat poultry seafood and eggs of course I know that you're not gonna want much because your hunger goes away now that was the first kind of shock to the nutritional community you're not even limiting calories and you expect people to lose weight you're not even explicitly having people count calories yeah yeah it just works differently your hunger goes down you eat less and I would say that works about 95% of the time those 5% where it's not gonna work immediately you might be on medication you might have other intervening things like you know that one one minute every night you have Oreo cookies then you think you but I'm doing it for every minute every hour and minute of the day except that one minute without knowing that the others Oreo cookies would stop the fat-burning so just understanding how strict you have to be is a common mistake this list of foods was actually designed we don't really have a lot of people getting game foods in our area in North Carolina nor do they eat ulla canned fish this was a list of foods that made it into the documentary my big fat diet but Jay Wortman put a community on a low-carb keto diet in North Haven Coover and it's a CDC Canadian Broadcasting Company documentary you can watch so you have a list of foods tailored to your area and then you do have some salad greens and vegetables the second most common mistake that I see is having too many vegetables and salad greens because people have been taught you can have as much of those as you want but they do have carbohydrates and so while there are great minerals and vitamins in these foods you have to limit them if you're trying to stay a fat-burning machine or in ketosis nutritional ketosis and then you can have limited amounts of cheese cream and next mistake I see is that people don't realize that a zero carb oil has calories in it so while if you just watch this list of foods or read something you might say oh it's zero carbs I can have as much as I want because it matter well yes so calories do matter in the high-calorie items like creams and oils and mayonnaise and cheese are limited so that might be a common mistake that that you're doing you have to limit those just because calories do matter and the total amount of calories typically goes down and that's why people lose weight compared to what they were eating before now it may mean you have to relearn what you've been taught and this is why I do an initial teaching and then have people come back to make sure that there may not be a need for a course correction so when you're looking at a Nutrition Facts label you really don't need to look at the calories you don't need to look at the facts or the cholesterol and what you want to focus on is the carbohydrates when you're doing a total carbohydrate counting kind of diet you just look at the number that comes after total carbohydrates or total carbs G means grams so that you would look at that as 37 carbs per serving because it has carbs you look at the serving size and I'll use a for example a cauliflower or broccoli nutrition facts to show that even the vegetables on the allowed food list do have some carbohydrates in them so you're getting about 10 grams of carbohydrates from the vegetables and leafy greens when you're having two cups of leafy greens and one cup of a non starchy veggie and you know you could a nutrition fact that at any browser and find that out for yourself or you could just let us make it simple for you so do calories matter or not yes but you don't need to count them because for almost everyone at keto diet is a low calorie diet this was first published and probably the best Journal article that I've seen on this is a 2005 paper by Gunther Bowden where people were put on a metabolic Ward and everything they ate was monitored directly and so it becomes basically a 1,200 to 1,500 calorie per day type of diet or eating nutritional plan and so don't focus on the cow there's no restriction on eating meats or eggs or fats including saturated fats it's healthy filling so you can have bacon and and in North Carolina there's a fascination with these things called pork rinds and then you might see them as G children chicharones probably the best chicharones I've ever had was in the south america it was it really was like pork belly and so don't fear the fats as in my clinic we have a sign that says a slice of bacon a day keeps the doctor away I had to have that because someone was told by a doctor told this patient to have an apple a day and it destroyed his keto diet that one Apple 20 carbs for a medium-sized apple you don't have to eat the whole thing have you noticed and fine restaurants what they'll do is they'll give you a wafer thin piece of an apple you know and then a lot of fat with it so you don't have to have that whole serving size or that whole Apple if you will and then of course mayonnaise and and then different types of meats and butters fine eggs are great low carb does not mean no carb there's a lot of probably needless worry about no carb and it's fascinating to see the carnivore subgroup of low carb mount their evidence that actually you know plants put bad stuff and leaves so mammals won't eat them you know thinking of actually is plant leaves being a defense mechanism for the plant and and yet we're told we have to have them and it'll be interesting to see that line of research develop until the research is there we follow the more consensus view that you do have an allowed or recommended amount of carbohydrate in the form of low starchy or non starchy vegetables and you know the common ground for all of the different healthy eating patterns that I'm aware of really just takes away junk food and then vegetables and eggs are the common ground for even vegetarian types of diets they can be low carb too if you're just stepping back do I - do I need this to do this with my family can I do it my family yes you can or public health wise you know no you can't do keto and everyone okay well so rule number one would be just no sugar please you know no sugar and the drinks no sugar and the food and you're gonna have a huge effect if in the south the southern United States they could you know put a ban or tax on sweet tea sweet tea that would really be a public health measure I had a patient who came back and it was drinking sweet tea and I said you know you can't have sweet tea it has sugar in it he said well she said well you didn't tell me I couldn't have sweet tea and so in her mind sweet tea wasn't under the category of sugary drinks you know so that's one reason why we have people come back and making sure that however you interpret the information that it's going to work but sugar is really kind of the the big elephant in the room where if we reduce that remember the blood sugar goes up after you drink or eat sugar that creates an insulin rise to keep the blood sugar down and that is what creates the fattening hormonal situation in the body now what most people don't understand even some of the pundits out and in the world that grains pasta and starches get digested to sugar in our bodies very efficiently and so it's really not different when you're trying to do a keto diet you have to consider the bread the rice the potatoes pasta and muffins as sugar it looks different but it will raise the blood sugar if someone has a key Kito or glucose monitor then I'll ask people if you really wonder check your blood sugar an hour after you eat something and you'll see if it has sugar in it fruits and nuts as you know people say they're healthy and still today people look at me like but but I was told fruit is good for you and yeah but not when you're trying to do a keto diet because fruit is so sugary and now that you know that they've been a grower and for sweetness and that's the sugar inside it nuts represent the classic trigger food and if you remember back to that list of foods I showed you there are no nuts on there because just as a show of hands how many of you when you start eating nuts can't stop eating them yeah just about every hand goes up I'm told that there's a former statesman who would count out seven almonds every night and then eat them and and if you can do that and stay to that that's great I've been doing this about 20 years it took me ten years to give up jelly beans on Easter and and I still can't stop eating nuts so I just avoid the the unlimited amount and so if something occurs in my clinic I need to have it work the first time every time because people have come to me for it's the last resort then if half the people can't stop eating nuts I won't let anyone have the nuts just as a safety precaution but if you can have it and it works for you great is it okay the flavor water with pineapple slices and this is a popular thing to do well so in my mind I thought well you know maybe have a little cube of pineapple put it in there this one patient came back I said well explain to me how you make the pineapple water she said well I take the can of pineapple open it up pour it into the pitcher I mean well but you know with the sugary juice oh yeah just sugar so but so everyone else was having it at the home and the family really likes it and so just the reminder that checking in with someone who can help you make sure that it's working and that the teaching was was correct I've been doing this in the clinical setting we estimate now in a quality assurance we're starting to open the clinic records and do some research there under IRB guidance and approval we've treated about 5,000 people in the North Carolina area most of the people come from the area not like dr. Atkins practice where most people visited him in New York City and so in our area it's not always easy to get food of the highest quality and while we do have farmers markets most of my patients don't go there and so I found that actually the top priority in terms of what about food quality top priority is a nutritious low carb high fat diet and without too much concern about the food quality so can you have grass fed beef yes great can you have grain fed beef sure maybe it's not as good or optimally for for overall health and your membrane function but you can certainly lose weight by just eating at McDonald's for example off the dollar menu just don't eat the bun don't have the fries a lot of well intentioned doctors will just say well lose weight just don't eat fast food no no no no that's not a great piece of advice but so eat low carb but with the highest quality that you have access to you and that you can afford so farmers markets who really certainly encourage that no processed foods and deli meats are fine did anyone grow up with spam eating spam yeah not to call out any particular food but canned meats for some people they love them if you lived in the Big Island of Hawaii you could get spam and eggs at McDonald's so eating there just don't get the hashbrowns right so this doesn't have to be difficult I have people coming to me saying but I just can't I can't plant you know and that's why it doesn't work I just bite my tongue and listen to the story unit the plan just don't eat carbs okay artificial sweeteners no other artificial sweeteners and this is one of those things that cries out for science in meaning in lots of different people across different diseases and because I have a lot of people eating artificial sweeteners and drinking them and they do fine in terms of weight loss in terms of diabetes getting better and then some people can't have them and the people who can't have them are militant and try to tell all the people who can have them that they shouldn't have them because they can't have them as you have you noticed that sorry if you're one of those people who can't have them but try to relish in altruistic feeling of goodness that other people can yeah yeah that's like trying to tell the the wife that glory take confidence and glory and your husband losing faster than you are that's stuff oh not to call out any particular gender but that's usually the way it works you only only have stevia well you know there's a kind of a argument out there that it's natural so it must be better and that again that's not really a scientific principle to to use it's more of a marketing thing so the kinds of questions I get you well know bread what about whole-grain bread again it's the in someone's mind you might categorize something well no rice what about brown rice no no no all rice what about potatoes what about french fries well no those are made from potatoes so if you haven't been trained with nutrition like a nutritionist or dietitian your mind might not think of things in the same way that someone trained in nutrition thinks about it so you can talk about no fruit and that's probably the you know even with drama no fruit it's because you know what will I do without fruit but we can have helped people with fruit flavored things so using artificial sweeteners as the sweetener or you know non sugar sweeteners its stevia salt and sodium you don't have to worry about salt as much when you're doing a keto diet because the lower insulin levels allows the kidneys to get rid of the salt to a greater degree now but if you have high blood pressure and in the salt sensitive kind of high blood pressure I won't ask people to add salt so that's just as something something if you're in the medical clinic you have to worry about vegetables and seed oils we get into these kinds of interesting arguments and all I can all I can say is that there are people a lot of people who eat vegetable and seed oils and they lose weight on a keto diet now does it have an incremental benefit for health I don't know and I think that's something that needs to be studied in great detail alcoholic beverages some people can drink and lose weight and a low carb diet sorry if you can't take you know relishing the fact that other people can alcohol actually has a lot of calories in them as well yeah I use that the c-word so even though it might look like it's zero carbs and what the internet says as no carbs people tell me you know hard liquor and well they really can thwart weight loss and ketosis because of the calories so my teaching tells me that alcohol is burned first and then becomes carbohydrates and then comes the fat so if you want to be fat burning all the time primarily then keep the alcohol to a minimum sugar free snacks could be candies minced gums and bars but I'm one fellow it wasn't working you know I don't make people write down things at home that that's too much worked for most of my patients and I mean if you want to do that that's great but he came back I had him write out what he is eating and it looked really a low carb looked keto but he wasn't losing weight so sometimes I pull the old well you know sometimes you have to gain momentum and you know because I don't really know what's going on at home you might not tell me everything but he got up out of the chair I heard this chick it was those little candies in a box of Tic Tacs yeah and you counted out how many on there they actually do have carbs and he was having about 40 carbs a day because he was having several boxes of Tic Tacs so these little things can add up although most people can have those things in small amounts what about fasting well the Consensus world is waiting for high-level journal studies to show the metabolic effects certainly fasting if it means you're not hungry and you're eating once a day and a keto diet and you call it fasting I think that's fantastic so you don't have to eat three meals a day I don't use the therapeutic fastening in my practice although a lot of my patients will will you do it on their own and it seems to clearly work we're in the medical world waiting for is the safety threshold or even the metabolic effects in terms of body composition you know you can lose weight by getting bariatric surgery but the downside is that you lose lean body mass so it's not the optimal way to lose weight from a medical weight loss perspective so is it is gonna be as good as a keto with protein every day in terms of body composition the fasting idea we don't know and that's why you'll see this kind of yammering among the children here you know we know you shouldn't or you should and I think it's ok to eat less as long as you're not hungry that's my take on the fasting um do you have to exercise to lose weight no and but you should stay active any way you like I have people have come to me in wheelchairs they lose weight diet is really a hundred percent all you need keto diet and that probably the most shocking thing I ever say to people because they've even some people will tell me I had knee pain and I couldn't exercise so I didn't even try to lose weight because I know you have to exercise to lose weight no you don't have to and not that you just shouldn't exercise I get that gets misconstrued well yeah you don't have to exercise but you can and even there's a whole nother you know hours of lectures on how elite athletes are eating fat as fuel and actually winning races in record time so but I usually haven't had anyone yet in my clinic who's run a marathon by the way but certainly if you're getting information on the internet there are a lot of people who do that so I really don't focus on exercise at first I'll say when your body tells you to start exercising that's when we'll start working in that direction so you don't need food diaries don't need to track macronutrients if you're under the 20 total grams you're probably gonna be in ketosis so you don't have to check ketones don't have to check glucose unless you're on medication for diabetes and we're taking you off in a kind of deep prescribing manner but at the same time they can help you learn and focus so I have a lot of people who will even just take a book and write in what they eat on the write or use an app and put all that in there but there's this false expectation that the information you put in there is truly accurate you know the the Apple might not be the perfect size and the data that are put into the app might not be perfectly correct it might focus on net carbs when I'm using a total carb method it might at the end of the day tell you you haven't reached your calorie goal have you ever seen that on an app no ignore that you haven't reached you're fat and your protein goal no no no no so I started using this app and it I got tired of it saying how was your breakfast do you have an app that says you know how is your breakfast well I didn't have breakfast so we've got annoying so I started using it stopped using that app you know just eating when you're hungry stopping when you're full goes a long way do I have to eat keto forever well if I really get that deer in the head like you know look I'll say look I mean I'm teaching you a goal once you get there is it teach you a method to get to a goal once you get there you can reevaluate and then oh well okay you know or just do it till the next time and even then yeah just do it one day and you know your hunger will be gone and and if that's true then keep doing it and then that's usually the bargain that will get people started but once you started you really are finding this is a great way to live do you do I have to or can I add carbs no ID least a keto forever and you can do it the latest science is even suggesting that you may like the mice and the research studies live longer by not eating the carbon hydrates that that's pretty impressive but not those studies aren't done in humans yet but if you add carbs you still eat low carb high fat or keto you know again the bottom line don't have any form of sugar ever or in very small amounts this is the major take-home point of what I've learned anyway as a clinical researcher in nutrition some nuts and low glycemic fruits would be okay to bring in some dairy higher carb veggies like carrots and legumes you know watch the amount some whole grain breads whole grains but not bread excuse me are kind of the the guidance that we would give if obesity or the disease like diabetes starts returning of course and you would cut the carbohydrates down probably the most common mistake I see is the rapid and massive reintroduction of carbohydrates I'm going from 20 a day to say a hundred a day to me that's a huge increase now if you talk to an average dietitian they would say well that's still that's a little low carb but so remember I've been working in a world where people are eating about 20 carbs maybe 30 and so for metabolically your blood has 5 grams of glucose in it going around at any given time if your blood glucose is normal why would you ever want to introduce a hundred grams of glucose well if you like it you're healthy and your insulin goes up to bring it down a lot of people choose to live that way but just reintroduce carbs slowly if you do at all so is keto safe and effective yes Akito lifestyles healthy and therapeutic for many chronic medical conditions and the evidence from many scientific studies and decades of clinical practice surpasses what the FDA would require to approve a new drug so basically I'll say if you follow this it will work just like a drug that's approved by FDA the US FDA and doctors and you know when they prescribe an antibiotic that's FDA approved they know that it's gonna work so that were the same confidence this plan will work that's what I tell people so it gets away from the well there's it really gonna work or well then I say but it will only work if you do it right so uh I prescribe other doctors prescribe these large potassium pills and you know people come back to it I just couldn't swallow that big pill well the bill didn't work if you didn't swallow it right so the diet works if you do it I can't make you do it and but that's a sticking point for a lot of people they still are hung up on whether it works or not but with the same confidence and doctors are hung up on that it's just like drug approved by FDA individuals with diabetes hypertension heart failure Galit or kidney stones might require a special consideration and monitoring thus the idea of ad prescribing clinic and you might add in different supplements there are different types of monitoring for these sorts of conditions watch the vitamin K if someone's on a coumadin or or anticoagulant drug watch the sodium if someone has a history of heart failure or high blood pressure I have this book in the office are the two pages now the book is falling apart we've known the cause and effect for over a century and here in the principles and practice of medicine from 1923 the ten gram carbohydrate diet was prescribed to a 60 kilogram person which was normal then to treat diabetes it was also used to treat obesity of course in 1863 the century before it was first described in England as a weight loss method - so we lost the path one might argue that the medication focus and the low fat diet prominence got everyone off track and so it still works today thankfully a couple take-home points and any diet can cause weight loss and in the obesity medicine world we see all different kinds of diets and we see people after surgery and all that so and you'll hear that by some percolating through to doctors now who think they they've learned that you know any well the best diet isn't when you can stick to have you heard that you know so it's kind of percolate into these guidelines and well none not really the best diet is actually the one that fits your metabolism best so while you may lose weight and a low fat diet this is comparing the low fat diets to the keto diet the metabolic effects remember in terms of HDL going up here metabolic syndrome is the triglyceride going down it was just a good thing and the HDL going up which is a good thing the green bars are the keto diet the lowering that carbohydrates works better even though the weight loss is the same so different diets actually can have different metabolic effects and the keto one it's very effective for metabolic syndrome are more effective and then also for getting people into remission for type 2 diabetes this is just a graph that shows the amount of insulin this patient a for example was on 500 units of insulin per day someone comes I teach the class to the offices I teach the class I say are you gonna do it let's count up all your insulin it was cut it in half on the first day if your blood sugars are sort of normal in the 100's you know around six to eight in metric units and then this person is still on insulin but he's paying much less and he's a happy camper because he's not having to shoot it up as much insulin these patients my record that isn't on this slide those is a taking someone off 180 units of insulin in one day because you know he didn't tell me and you know who's gonna tell the weight loss doctor that he was drinking two liters of a sugary beverage every day and has basically was drinking the sugar and injecting the insulin he was taught to not drink sugary beverages and he no longer needed the insulin I mean so you may actually see this in the hospital if you work in hospitals and you takes make them fast or just take away the carbs the blood sugar can come down dramatically and if you don't reduce the insulin you will have hypoglycemia or low blood sugars and that can be life-threatening so the medicine can become too strong very fast and so just that's another just warning that you want to do this with a doctor who understands or health practitioner understands how fast things can get better if you're on medications but the keto benefits are much more than improved weight or blood glucose you've wait you have reduction of body fat different metabolic effects hypertriglyceridemia gets better the high triglyceride in the blood better than any other diet you might stay on this for your lifetime because you just feel better better mood your blood pressure goes down inflammation goes down there was a doctor who created a clinic an orthopedic surgeon a clinic keto clinic next to his practice so he could operate more get the weight down preoperatively and then you have better outcomes after losing weight before the surgery well he found that about 1/3 of the people who he was treating with a keto diet who was in line remind for the orthopedic surgery no longer needed the surgery after losing the weight because of weight loss and the inflammation and I looked them in the eye and said even if it's bone-on-bone because you know I get people looking at me it's bone-on-bone doctor and nothing's gonna help this and he said yeah even it's a bone on bone doesn't it doesn't matter what the x-ray shows you're not gonna operate on someone's knee unless they're having pain or no loss of function so that's pretty cool so I do a lot of consult consultation with people preoperatively the surgeons want to operate and get better outcomes so even non orthopedic surgery abdominal hernia as other kinds of things surgeons will send patients to me and I use a keto diet pain mobility sleeping better I would say most people continue this kind of lifestyle because it takes away the hunger so you're not obsessing about what you're gonna eat next or people just feel better have more energy and those are very valid reasons to continue the lifestyle of course the best evidence is how keto transforms lives I became a almost you know depressed internal medicine doctor you know this is the disillusion why did I can become a doctor I'm just pushing medicines and getting in insulin shots and and then you know what your patients die well I know they're actually grateful that you care for them but yeah we can't fix the that outcome yet now I'm a happy doctor who goes to work with people telling me that you know I haven't biked in years and now I'm back on my bike alright now I'm doing this I'm playing with my grandkids I'm doing all these things I didn't think I could could go back to doing that and so we give people hope any kind of obesity medicine treatment including using the keto diet and that's really what makes this gratifying kind of work to be in and teaching other doctors how to do this is an exciting position for me to be in so then they can help more and more people be able to do this now watching the science and we're observing different meetings now popping up the meeting in Tampa for a couple years will now be in LA the metabolic therapeutics conference and then the how state is putting on a conference Geoff Volek who's now there I will put on their first conference this fall and what's really exciting is not only the new basic science that's being done on epilepsy Alzheimer's cancer but also the the world is changing by anecdotes and Facebook with a recent publication of type one diabetes in the journal Pediatrics which was a survey of type one Grit Facebook members which was pretty incredible that a medical journal took a facebook survey but it was supported by actually surveying the doctors of the patients validating it as well David Ludwig is the was the lead behind that at Harvard so four people got up at a recent meeting in San Diego and said that their rare condition of McArdle's glycogen storage disease got better by going Quito and this is a time-honored condition where you can't store sugar in the muscle so feed the child sugar all day long because the muscle needs sugar right well so a generation of doctors trying to fix this never thought why not change the muscle to a fat-burning type of cell and so these people tried it on their own room or that's what Quito does behind the scenes changes you from a sugar burner to a fat burner and the muscle actually burns fat really well and so published a couple case studies or a case series it's called based on these people getting up in front of the conference we tracked them down and now that's changing the medical research world by your experiences and this really exciting to see groups of people get together and when you're at a certain like tipping point of a number of people doing something we you know it's incumbent upon the academics to take a look and then put it in literature so other people can look at it as well a little humor I guess it's sort of ironic humor there's some people who I wish I had a device like this remember from the movie movies men in black the device that erased the memory of the aliens that they just you know or involvement I really need a device that he races the memory of other diets and they people have done in the past and this medical student helped me come up with a prototype because it is okay to eat you know fat and eggs and all those things that and have salt even though people were taught that for so long but you don't need a magic wand or reprogram is it's just doing it over and over with the guidance at first so if you're just getting started what's step one what's getting and what's getting your way old habits applied to new diets yes it's like driving on the left-hand side of the road the rules are different if you're you know in England in the UK you don't want to drive on the right-hand side of the road like we do here in the u.s. you're discouraged to yet try another one just keep in mind that clinic of last resort it's pretty amazing to me even today that some people will have said they try everything even had the weight loss surgery and they never tried a keto diet it had been ostracized and thought to be so bad for so long it really wasn't part of the tool chest and still having trouble getting the dietitians to come on board to read the science and to use it in their practices although there are a growing number who are complicated incorrect or confusing programs it doesn't have to be all that difficult carb addictions you know you fight this the people blaming themselves for an addictive substance you see that that's part of addiction the the Oreo in the middle of the night that's not put in the MyFitnessPal and then you wonder why it's not working the person who is just kind of too ashamed to call out that they have a drinking problem on a Facebook group but I can they come in they talk to me I get the over all of this stuff in a supportive environment can help with all those things how your body unfulfilled realistic expectations the weight loss process with a keto diet is rarely a straight line down it will have fits and starts and more like a stair step pattern rather than a linear line down in terms of weight you want to figure out how your body works and changes and yes you are different thought I would be that kind of doctor who said you know everyone's different but everyone's different I can help normalize the expectations and in my clinical setting I'll see a pound or two of weight loss per week so that means four to eight pounds per month 50 to 100 pounds per year when you're absolutely strict so just to give you a context for that side effects of medicines we weight-loss doctors glow in taking away medicines that have side effects since you'll feel better and you'll think that it I did something magic when actually I just took away metformin that was causing you diarrhea you know so deep prescribing is a great philosophy they're taking away the medicines if you no longer need them stress no doubt and the onus or the feeling that I have to have Gramma's pie cooks cakes can't you know because food is love and and we help people through all those sorts of things or you just you have those things when you're on vacation you take a holiday not a Halloween or a hollom unthe the obesity medicine clinics pretty busy in the first part of January as you might surmise as people get back on track that's okay the social pressure of course you just learn to deal with that over time and or think of yourself as a leader as a trend setter the lifelong success is not about learning what to eat but focusing on the goal so the heal care for simple guidelines that we like to focus on are changing your focus number one think of it as a lifetime thing a short-term goal you know short-term success is not what this is about it's not a yo-yo diet where you do it and then you get back off it and it all comes back find your own measures of successes and and it's more broad than just using the weight on the scale biomarkers are great just how you feel our great markers learn what works for you and don't compare yourself to others and then keeping it as simple as I tried to outline here it's okay to have the best source of protein that you can afford you don't have to be totally militant about the types of oils and for a lot of people the straw that breaks the camel's back is the that little thing that well you know I noticed that the the burger wasn't grass-fed so I just ate the bun I can't make that up I mean how to get started on your lifetime of keto well if at least one of these applies to you you're on insulin blood glucose medicine you have high blood pressure your BMI is over 50 then seek a medical provider who knows the keto approach and he'll care is designed to provide that otherwise you have two options you can do a guided program with trained coaches there are many of them online including the heel clinics or you can do it yourself but you must learn what's factual and be very self-motivated there's lots of misinformation out there and I just wanted to kind of dispel all of the confusion that I've seen about how difficult it has to be and it doesn't have to be that way doesn't have to be different difficult so Hill care again is for those who can't do it by themselves it's providing ongoing personalized support and guidance there's real face-to-face visits if you need them to take get off medication there's one-on-one partnering either by phone or email or Skype FaceTime commitment coaching is a weekly program where you're with other people doing the same thing you are facilitated by trained coaches we set up a if you want some background on the science a lot of this information is put into a free power of low-carb kit which is downloadable at the heel clinics website and I thank you very much for your attention [Applause] [Music]

Channel: 2 Keto Dudes

Views: 232,057

Rating: 4.8598289 out of 5

Keywords:

Id: GH9IZHnyr2I

Length: 58min 13sec (3493 seconds)

Published: Sun Nov 04 2018