Dr. Eric Westman is a renowned internist and researcher at Duke University, where he serves as Director of the Duke University Keto Medicine Clinic.
With over 25 years of experience in the field of low carb and ketogenic diets, Dr. Westman has been at the forefront of research and clinical practice. He is the co-author of the book "End Your Carb Confusion" and has helped countless individuals achieve life-changing results through low carb living.
In this episode, Dr. Westman delves into the world of low carb and ketogenic diets, sharing his pioneering work and insights gained from over 25 years in the field. He discusses his early collaboration with Dr. Atkins, the challenges faced in promoting low carb diets, and the growing acceptance of keto within the medical community.
We discuss the science behind low carb and ketogenic diets, and their remarkable impact on weight loss, diabetes reversal, and overall metabolic health. He also addresses common misconceptions surrounding dietary fat and cholesterol, and how to successfully implement a low carb lifestyle, navigate the potential pitfalls, and achieve sustainable weight loss.
Dr. Westman shares inspiring success stories from his clinical practice, demonstrating the transformative power of low carb diets in reversing diabetes and improving overall health.
The episode also touches upon the future of low carb in medicine, with Dr. Westman expressing optimism about the growing acceptance and recognition of these diets as effective therapeutic tools. He highlights the need for healthcare professionals to understand the role of food in preventing and treating metabolic conditions.
Whether you're looking to lose weight, reverse diabetes, or optimize your health, this episode provides the knowledge and motivation needed to embark on a successful low carb journey.
Don't miss this opportunity to learn from one of the world's leading experts in the field and discover the potential of low carb and ketogenic diets in transforming your health and well-being.
==================
Resources and Links:
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
Dr. Eric Westman is a renowned internist and researcher at Duke University, where he serves as Director of the Duke University Keto Medicine Clinic.
With over 25 years of experience in the field of low carb and ketogenic diets, Dr. Westman has been at the forefront of research and clinical practice. He is the co-author of the book "End Your Carb Confusion" and has helped countless individuals achieve life-changing results through low carb living.
In this episode, Dr. Westman delves into the world of low carb and ketogenic diets, sharing his pioneering work and insights gained from over 25 years in the field. He discusses his early collaboration with Dr. Atkins, the challenges faced in promoting low carb diets, and the growing acceptance of keto within the medical community.
We discuss the science behind low carb and ketogenic diets, and their remarkable impact on weight loss, diabetes reversal, and overall metabolic health. He also addresses common misconceptions surrounding dietary fat and cholesterol, and how to successfully implement a low carb lifestyle, navigate the potential pitfalls, and achieve sustainable weight loss.
Dr. Westman shares inspiring success stories from his clinical practice, demonstrating the transformative power of low carb diets in reversing diabetes and improving overall health.
The episode also touches upon the future of low carb in medicine, with Dr. Westman expressing optimism about the growing acceptance and recognition of these diets as effective therapeutic tools. He highlights the need for healthcare professionals to understand the role of food in preventing and treating metabolic conditions.
Whether you're looking to lose weight, reverse diabetes, or optimize your health, this episode provides the knowledge and motivation needed to embark on a successful low carb journey.
Don't miss this opportunity to learn from one of the world's leading experts in the field and discover the potential of low carb and ketogenic diets in transforming your health and well-being.
==================
Resources and Links:
Chances are, you wouldn't be listening to this podcast if you didn't need to change your life and get healthier.
So take action right now. Book a call with Dr. Ovadia's team.
One small step in the right direction is all it takes to get started.
How to connect with Stay Off My Operating Table:
Twitter:
Learn more:
Theme Song : Rage Against
Written & Performed by Logan Gritton & Colin Gailey
(c) 2016 Mercury Retro Recordings
Welcome folks. It's a stay off my operating table podcast with Dr Philip Ovedia. We're glad you're here. We've got a conversation today that Phil and our guest have set up. Sounds like it's going to be really interesting. I'm not sure what they're going to talk about, so I'm going to let Phil take it from here. Take it away, phil.
Dr. Philip Ovadia:Sounds good, jack, we have really today one of the OGs of OGs of metabolic health, low carb Eric Westman, I think will be well known to most of our audience but really interested in getting his perspective really on some of the history, how we got here, why things are the way they are today, and really understanding some of the science and practice of metabolic health which I think Dr Westman probably understands better than just about anyone around today. So with that I'm going to turn it over, eric, if you don't mind maybe giving a little bit of your background to our audience to get us started and then we can get into the conversation.
Dr. Eric Westman:Sure, well, thanks for having me. And it seems like yesterday, but when I was in practice as an ambulatory care doctor, internal medicine doctor at the VA hospital in Durham, north Carolina, where I still am, two of my patients came to me losing over 50 pounds each, and I didn't get any training in weight loss or diet for that matter. I asked them how they did it and they said they did this diet where all you do is you eat steak and eggs. And I thought this can't be good, right, this can't be right. But so I'm sure I leapt out of my chair and now I say, oh, you're doing carnival. But so 25 years ago, two of my patients did this diet. They lost weight, and I thought, gosh, this is easy, you don't even need a doctor to lose weight, they read books. And so one thing led to another.
Dr. Eric Westman:I ended up in Dr Atkins' office in Midtown Manhattan. He was at the end of a 30, 40-year career and I asked him what he did, because these two patients had done the Atkins diet. And he gave me this sheet of paper with a little handout and he said well, when people come here, we get them in this handout and everything seems to be fine and I said well, I like to study that. And so I approached Dr Atkins to study the Atkins diet. Now it's called many different things and even in some circles I don't mention the term Atkins because it still has a negative connotation. But now, through the lens of 20 years and a textbook this thick on low-carb, ketogenic diets, it turns out the Atkins diet is healthy and it's actually therapeutic if you have metabolic syndrome, overweight, diabetes, that sort of thing. So based on my patients' experience, I got quickly school in diet, but I didn't really know the hornet's nest that I was getting into. I was naive, I didn't know much about diet and they were eating steak and eggs. Those were healthy foods, right. So anyway, then I started to learn how controversial it was and how other people had to start doing research, and so we're kind of one of two teams in the US that started studying the Atkins or low-carb, high-fat or keto diets. The first phase of the Atkins diet is a keto metabolism diet. Jeff Voluk at UConn University of Connecticut, now at Ohio State, was also starting to study this diet at the same time and interestingly, he approached Dr Atkins about the same time and our first papers were published in the exact same month, 2002.
Dr. Eric Westman:So now I kind of laugh when someone says the Atkins diet that's terrible. I'm like no, that's just fine. Actually, everyone goes into ketosis if you don't eat for two or three days. I mean watch the reality shows where they go out and they don't eat for two or three days. They're still alive because they're burning their body fat Anyway. So that's how I got into it. I don't have any personal big weight loss story like a lot of doctors do. To come to this, it was really kind of observing the patients that I had, what had worked. But the concern about safety was real. And now I have no concerns about safety unless someone's been on medicine that might become too strong. So I still kind of think if you're in a clinical setting, if someone's on medications for diabetes and heart disease, they need to do this prescription strength kind of diet under medical supervision for safety, not because the diet's bad, but because the medicines get too strong. Got it, that's my short answer.
Dr. Philip Ovadia:Yeah, that's a great short intro and I guess one of the things that I've wondered through all of this and unfortunately Dr Atkins isn't still around for us to ask him, but you had the opportunity to work with him. Dr Atkins didn't discover this either, and we can go back to, I think, our last episode. We were talking about Dr Banting or Mr Banting and his work in the late 1800s, but what do you think it was that really allowed Dr Atkins to kind of rediscover this and become invested in it in the way that he did. And then yourself, dr Volick, dr Finney, all of these kind of what we call pioneers, but you're just sort of rediscovering stuff, but why did it catch on so much with them? And I guess you can say with us now, and yet the vast majority of our colleagues still think this is kind of heresy.
Dr. Eric Westman:Yeah Well, so I just clarified. I didn't work for Dr Atkins ever. I never was employed by the office. There are a couple doctors who still are in practice in New York City that kind of took Dr Atkins patients when he died and that was 2003. But I got to work with Jackie Eberstein, who was the nurse who worked with Dr Atkins for the last 20 years. He's still a friend and I call her from time to time.
Dr. Eric Westman:The story that I understand is Dr Atkins had a voracious appetite himself. He would be in line in New York City and if there was a line, a queue, he would get all upset and wanted to eat and be a no-noxious New Yorker, like well, I'm not from New York but anyway. So the story was he had to figure out how to control his own appetite. He read a Journal of the American Medical Association paper and I've tracked back to find that paper and so he was reading a Journal article, thinking he was doing something that was sanctioned or at least endorsed or supported by science, and his first diet, personally, was shrimp. It wasn't bacon.
Dr. Eric Westman:That was sort of the stereotypical Atkins diet was bacon, but he just would eat shrimp when he was in line in a restaurant and he would be fine. He could wait as long as he needed. It was his own personal problem with weight that got him an appetite. That got him into this. Apparently then he was the director of a company health director and helped a lot of people lose weight there. The magazine got wind of that and asked him to write an article.
Dr. Eric Westman:The article was very popular and you don't even have to do it right and it works because you're focusing on carbs as the fattening element in the food, which is the reality. And so the Vogue magazine article was very popular. And then he did his first book. I think the first book was 1972, and then a rewrite in the 1990s, and that's when I got interested in it through my own clinical patients. But as far as Dr Atkins knew, he was doing what the literature taught him to do, and then the world around him just changed. That said what he was doing was killing people. But he knew that he wasn't, and this is through Jackie Eberstein's eyes and her perspective, that they went to work every day because people were getting better.
Dr. Eric Westman:And what's fascinating is Dr Atkins made me put in our first paper the triglyceride HDL ratio in the table, and I said I don't know what is this ratio and he said no, you have to put this triglyceride HDL ratio. I did and it's there, and of course it got a lot better because it's a good marker for insulin resistance. And so, anyway, our first paper that I pitched to him after visiting the office in a day, and I had one sheet of paper. Here's what we want to do 50 people book on your diet for six months. We'll measure everything. We can publish it in a peer review journal.
Dr. Eric Westman:That was 2002, when we published a single arm study. But that's kind of my litmus test or minimal criteria. Someone says, well, what about the blank, the blank diet? I'll say, well, show me a paper, 50 people, six months, in a peer review journal, and I'll comment on it. So it really kind of weeds out a lot of the riffraff. We see there my colleagues back at Duke. I was in the research world and at first they were like what are you doing? You're crazy. And then, when the results were positive, they said, ah, it was like shooting fish in a bucket. You knew it was going to work and I said, well, come on, you can't have it both ways.
Dr. Eric Westman:So, that gets into your second question about the disconnect of what people see and about what they observe and what we're taught. And we were all talking about eating fat was bad, that eating butter and bacon would kill you, would slather your arteries. I mean, come on, and it was as kind of simple as fat on the arteries, fat in the food, duh. It's kind of like the sun goes around the earth, can't you see it, duh? Like that was worked out a long time ago. But it's only because children are given models of solar systems that we know. I mean, I can't tell that the earth's going around the sun. I mean personally. So I think in the medical school we're going to have to have models of how atherosclerosis happens, that it's not the fat clogging the arteries. You know you have the inflammation trying to repair it and well, wait, what would that model look like? It's a question for you.
Dr. Philip Ovadia:Yeah, no, very much so that we need to change that molecule. And again, very similar to, I guess, the Atkins story. It's not really new science that needs to be done to prove this. It's re-examination of the old science that really shows us that inflammation, insulin resistance, are much more powerful influencers of heart disease than this cholesterol, fat, especially dietary cholesterol and dietary fat, are. So it's just so interesting how, like I said, this isn't new science that we need to prove, as is oftentimes put forward. To people like you and I, it's really a matter of go look at the old science. This was proven long ago.
Dr. Eric Westman:Well, that's so true, but the power position. Often and I certainly felt, looking back, it's been over 25 years now since I knew this could work and and have talked about it and studied it and done umpteen presentations about it. It didn't occur to me at first to insist that people found data to say it was bad. When I look back the first paper with Jeff Volick he and I did a review article there were actually five or six papers that were supportive and the one article that nailed the put the nail in the coffin was 24 people and the LDL went up a little bit. It was in 1980. So when we were in 1998 looking at the review, looking back, it's like there were no studies that said it was bad and yet I felt compelled to have to prove it. And just like you're saying, no, we really don't have to prove that it's good, you have to prove that it's bad and yet that that's like I don't know, it's like you have to prove that sun doesn't go around the earth.
Dr. Eric Westman:I mean, how do you do that if everyone believes the opposite? Well, new data. But actually I really enjoyed hearing your lecture recently about inflammation and how, back a long time ago I think you've read some some old articles about how you know this arterial damage comes from inflammation. And here's the yeah, it's just rediscovering the old through the, the junk food and treatment of junk food with drug sort of last few decades we've been living through.
Dr. Philip Ovadia:Yeah, exactly, and the data that I mentioned in that talk was, you know, again going back to the 1800s and the work of Verschow, who you know described very well the effects of inflammation on the blood vessels. So talk about now your clinical experience. You know. So 30-ish years ago you go up, you see Dr Atkins, you're crazy enough to believe that this might work, and you come back to your practice in North Carolina and you start trying it with patients. And here you are, 30 years later and you're still doing it with patients. Talk about, kind of, some of the things that you've seen and some of the challenges that you've had to overcome to get people to try this.
Dr. Eric Westman:Yeah well. So like any good researcher, I didn't just take anyone else's word for it. I came back and I studied it. So not only did we study it once, we studied it five different times in five different venues and different clinical situations. So once I got a handle on how simple it could be to teach it and to get people to follow it, could I use Dr Atkins' system? He'd honed it with Jackie Everstein over 30 years. Again down here, people said, well, you cheated, you didn't even come up with the system. Well, yeah, but we studied it and validated it. So after these studies that we did and published, I have the wherewithal and political ability to talk to my colleagues here at Duke and the VA here in Durham and I said you know, I'd like to open a clinic using this, and this was in 2007, now opening a clinic.
Dr. Eric Westman:So after about 10 years of research, getting the public opinion about peer review and the public backlash then, and then the research money was totally drying up to study something like this it was. I couldn't sustain a research career. So I had to decide do I want to just do research on things that kind of aren't very good, mediocre? Do I want to study the DASH diet really and get paid but not really working on something that had results. And so I decided to open a clinic based on Dr Atkins' method and we call it the low carb keto diet, the first version of it. And one of the secrets or one of the things that Dr Atkins did is he kept people at 20 total carbs or less as long as people needed it. So the difference between the books they wrote the book saying stay at 20 grams or less for two weeks, then increase over. No, that's not what they did in the clinic.
Dr. Eric Westman:So if you're treating so I started treating obesity, diabetes and as a general internist myself an internal medicine specialist I decided to just treat anyone who would come. And I work side by side a safety net clinic where we have a teaching clinic at Duke and that's the general internal medicine is known as the teaching field inside of academic medicine. So I made sure my colleagues knew what I was doing, made sure they saw that people were getting better. I was sharing patients with them pretty quickly. So now I have a cohort of doctors at Duke in an academic center who value data, seeing that this actually can work, and I think that's helped me to, not only from outside influence, although I think the Duke name helps with that, although Duke got involved with some pretty wild. The rice diet actually started at Duke, but that you know that was 100 years ago, when actually that does work too. And so you're going to hear me say things like well, this certainly works, but there are a lot of things that can work.
Dr. Eric Westman:But so I started treating diabetes, reversing diabetes. I started treating GERD, heartburn going away and irritable bowel syndrome, and then a gastrointestinal fellow GI fellow at the University of North Carolina so, being in the academic world down here we have cross talk a little bit and there was a GI fellow who did a couple proof of concept studies showing GERD goes away almost 100% in just three days. Then by pH probe monitoring and you know this is probably the second most common thing that gets better after weight coming down GERD goes away, ids goes away. We did a PCOS paper where a common cause of infertility, polycystic ovary syndrome, gets better very quickly, at least in some people. These smaller studies that we did doesn't give us a good feel for how you know what percentage will get better.
Dr. Eric Westman:They just shows that you can fix these things on a low carb keto diet and then, finally, of these proof of concept studies, a fellow friend of mine who was a GI doctor said, hey, why don't we do fatty liver, you know? I said, well, you know, david, I don't deliver biopsies. I said, oh, I do. So you teach me the diet, I'll do the liver biopsies before and after, and in six months fatty liver is gone. Well, probably even sooner than that, but we didn't wait till it do the biopsy again until six months. And I guess, finally, then our diabetes study, which was, you know, we only needed 50 people to show the difference between a low glycemic and a keto diet in terms of glycemic control over six months. So it's amazing, if you have a really powerful intervention like this, you don't need many people in a study, which you know you look at other kinds of interventions that are very weak. You'll need thousands of people on the research study and oh look a thousand.
Dr. Eric Westman:No, you want to have an intervention that gets better. You know all the time, you know 100%, and that's kind of the research secret about this is that you don't need many people in order to find benefit. And then we compared it the diabetes study to a low glycemic diet. So it was actually a lower carb diet, just not as low as the keto approach. And still we, the low carb keto group, beat out the low glycemic group at six months in A1C reduction. And then no one listens. You know, but that's a year's pass.
Jack Heald:It's a really powerful idea. As somebody who doesn't know anything about research, I have but you know, and peripherally aware of these things I've kind of always had in my head the more people in the research study, the more trustworthy and reliable it is. But if you've only got 50 and everybody has a response, that is extraordinarily powerful. Yeah, I love that.
Dr. Eric Westman:Yeah Well, and I mean, it depends what you're looking at. Right, if you're doing an observational study and you're trying to find the relationship of red meat with heart disease, you need 50,000 people and even then the association is almost nothing, and association doesn't mean causation. But and then those people say, see, in this study of 50,000 people there wasn't much here, but because we don't want you to eat red meat, because it's unethical, we this is scientific proof that red meat causes heart disease. No, it's not. Yeah, you know, with meningitis or pneumonia, everyone died. It was 100% fatal. When penicillin was introduced, someone lived. They didn't need randomized trials or they didn't, you know it's because if the outcome is so dire, everyone dying.
Dr. Eric Westman:So then, one of the great stories I remember in clinical research training is that the scurvy treatment of just a lime or citrus only needed 12 people in the study to show that, because people were so in extremis and they didn't need many people in the study. And then the classic teaching sarcastic teacher we had, you know, this good thing they didn't have any statisticians who would have insisted on a power calculation. To, you know, they would have insisted on thousands of people and they never would have done this study to show that just a little citrus fruit could cure scurvy. But so that's the other thing I guess I should say. I went through clinical research training to learn how to do clinical trials, and at Duke we it's kind of known as the cardiology clinical trial university, where actually the current FDA commissioner, rob Kaeliff, is began here at Duke and actually kind of built this clinical trial fortress. It's now one of the little, one of the few skyscrapers, I would say a few towers down in downtown Durham. It's a research building.
Jack Heald:Bill, I want to ask about what happened. I you know, in my memory I'm thinking of Atkins was a 90s and early 90s kind of. That was when it became popularly known. I have no idea he published in 72. Yeah, so I'd like to. I'd like to hear about that, but I also I know you, you're going to follow up as well.
Dr. Eric Westman:So yeah, of course none of this came on my radar until the late 90s, when I was in training in medical school in the 80s and residency internal medicine in the 80s, and I didn't get any nutrition training other than what we did have at the University of Kentucky where I trained sort of the doctor known as the brand man, Jim Anderson. Dr Jim Anderson really nice fellow Endocrinologists had a popular book on oat bran and if you ate oat bran it would lower your cholesterol.
Dr. Eric Westman:So everyone was trying to lower that cholesterol, Lower this is, you know, the heyday of all of the trials, the lipid research clinics, that never really proves that LDL was a problem or that cholesterol in the food, but we just kind of assumed it. And you know the summary that Gary Taub's did in good calories, bad calories, and Nina Tysholtz and the Big Fat surprise were fantastic because they put all these studies in there and basically said, no, they didn't really prove that cholesterol was bad anywhere, you know. But so but that was my training and I actually I called Dr Anderson, I so I moved to Duke. Well, or they had kind of pushed me out, you need more research training, they told me, and and I did, I got a bio statistics degree at Duke and what was fascinating is I called Dr Anderson kind of the only one who I knew in this space and said you know, should I study the Atkins diet? You know, I mean, I had this experience and, and I remember Dr Anderson, I'll never forget his response.
Dr. Eric Westman:It was you know, I'm not really for that diet, I'm not a proponent, but he said it's a balanced diet in terms of micronutrients and in terms of nutrients.
Dr. Eric Westman:He said it is a balanced diet and I have to really hand it to him as a scientist. He didn't get on the bandwagon of any other kind of agenda and I wouldn't have studied it if he had said you know, don't do that. That's crazy. But I had known him for four years and I was a chief resident at the University of Kentucky, where you get to get, you get to know the attendings on a little deeper basis, you know, and he was a very reliable, sensible person and and so then you know the research ever since has actually been supportive, if well, except sometimes that LDL goes up, even today that so in my clinic it's not a day goes by where we don't have to talk about cholesterol in some form or other. You know all those eggs in the food or are my primary care doctor is all upset and nervous, and about my blood it's like well, no, they're not, they're really not worried, you know they have this fear because of their, their guideline, or their peers, or their, their, I don't know.
Dr. Eric Westman:I doubt that people get more money by getting people on on statins, but they do get a checkbox. You know how many of your diabetics are on statins? Check, check, you know. Anyway, I guess I left from the 70s and 80s to today, but you know?
Jack Heald:yeah, I'm still baffled. How did we go from where we were? I mean, what happened that all of a sudden? That is bad. Yeah, I mean by all of a sudden that was the 80s. I know it happened in the 80s, but what the heck?
Dr. Eric Westman:You know again, that being before my time, I hear other people talk about it it seems like there was a very courageous and and one single minded person, ansel Keys, who got on several committees of these non governmental, like the American Heart Association and the cardiology, the dietetics. I mean he kind of single handedly, by brute force, got these organizations involved. And then that with the industry, food development, somehow it just kind of left left across. Do we need science? You know well then, the guideline of the USDA food pyramid.
Dr. Eric Westman:I've seen pictures of movies of the McGovern committee and you can actually see Jordan McGovern say you know well, professor, we don't have time to wait for science. We politicians need to move now. And you know, as a let's see from Minnesota, which is largely agricultural state I think it was Mark Hagland there was some scientists who basically said you know, we need 2 million and at least $2 million in at least 5 years to come up with a guideline. And McGovern had gone to Pritikin, which was the heyday, a low, ultra low fat diet kind of program, and thought, well, if it's good for him, it's good for everyone, and so it was kind of a comedy of errors looking back.
Dr. Eric Westman:Definitely not scientific, you know, and I think, the players behind the scenes, the puppet tree is going out where the corporate interests that the food guide pyramid basically played into the promoting foods that America makes Lampoon by a recent comedian who basically said you know where are the coconuts? And there's no coconut oil being promoted by the US government because we don't make coconuts, I mean, we don't grow them, we're not a tropical area. So that's very something. Only a comedian can see the truth in that.
Dr. Philip Ovadia:Yeah, and then I think, once the pharmaceutical industry kind of piled on, you know the game was largely over, and you know I am about a decade behind you or so and by the time that I came in, you know there was really no question about this. I mean, it was accepted fact as it was taught to me that you know the whole diet heart hypothesis and our one and only focus needed to be on lowering people's cholesterol. So you know, that kind of leads us to, I know, another kind of topic that you've, you know, wrestled with over the years, and you know the low carb part of this versus the high fat part of this, you know, is it low carb or is it keto? You know, and you know, universally, or maybe for certain conditions, you know, is one of those perhaps more important than the other. So I'd love to kind of get your perspective on, you know, low carb versus high fat. Obviously they sort of go together, but they don't always have to go together.
Dr. Eric Westman:Yeah, Well, it's not easy to tease that apart. It's part and parcel of the same treatment that we've used. The intervention was always low carb and always high fat. And that gets the criticism of, well, what is it? And in my responses, well, I don't care, it works. So if you're a mechanistic kind of person you want to know, but I think through other research, if you didn't study it directly head to head, like different types of studies.
Dr. Eric Westman:The inflammatory effects of carbohydrates are reduced or eliminated on a low carb diet. So you're getting benefits from that. You're getting a lower glycemic, You're getting less blood sugar rise, less insulin rise on a lower carb diet, which is a salutary, it's a healthy thing, especially if you have type 2 diabetes. So you can reverse your type 2 diabetes with low carb, that part of that diet. If you had high fat and high carb, you're not going to reverse diabetes unless you keep the calories super low. So the whole idea of a keto diet or ketosis and all this is sort of this Frankenstein out there now of you have to drink ketones and eat. No, you don't. Your body makes ketones from its own fat store without you having to drink or eat ketones Again if you don't either drink food for two or three days, your body naturally starts burning its own fat. We store fat. We store energy is fat. So your body starts making its own ketones to substitute for where glucose was used mainly, and so your body goes into what's called nutritional ketosis or eukitonemia, meaning it's a normal level of ketone in the blood, or maybe it should be called normal ketoneemia, like normal glycemia. It's not ketosis. Ketosis has that abnormal osus feeling to it. It's definitely not ketoacidosis. So you don't need high fat to get into ketosis. Actually, you can just starve, eat nothing or fast for two or three days. Eat nothing and to get that ketosis.
Dr. Eric Westman:So in fact, the first diet kind of study for weight loss was feeding people just protein. So this is, you know, really no fat in the food. But you burned your body fat. So if you keep the protein down in calories, you're going to start burning your own body fat. So you get the ketosis even though you're not having high fat in the food. And that was always an interesting thing. It's not what's on your plate, it's what your cells are consuming. And if you're eating very little, your body's actually consuming its own fat, which raises the fat percentage to your cells point of view, Even though on the plate you might just have protein, your body is eating is burning its own fat. So that's where it gets kind of confusing If you add fat now to get the ketosis, or you add ketones and you don't want to do that, If you're trying to burn your body fat because you have to burn the fat that you eat before you burn the fat off your body, and yet this is the internet, Frankenkeetow Stein out there, that has, oh, you drink fat and oils and coconut.
Dr. Eric Westman:Well, so the context of why someone is doing this is really important. If you're trying to reverse diabetes, lose weight, treat the metabolic syndrome, you don't want to push fats and oils and things like that. And you don't have to worry about being in ketosis if you just keep the carbs really low. And so I you know when I say it was the Atkins diet first phase, which is a keto kind of diet. So there are no keto foods there. Ketosis is a metabolic state that is achieved by keeping the carbs or calories super low. But so that you can see where it gets very confusing.
Dr. Eric Westman:And someone recently told me that they went through the major health company. Now that's out there pushing a keto diet to reverse diabetes, which is great, it's one of those successes of a company and they told me that they wanted every meal. The company wanted this person to have 70% fat on the plate and I'm like no, no, no, no, no, that's it. It wasn't. He wasn't doing weight anymore, Wasn't reversing the diabetes, as the intention was.
Dr. Eric Westman:So even amongst those of us who should know better or you're under the purview of learning from people are know about this the internet confusion about how much fat you should have. I need more fat. No, no, no. I need more protein. Most people aren't calculating quantitatively, which makes it a problem. So one of the most common things I see today someone does a low carb, internet based keto diet for weight loss and they don't lose weight because they're eating copious amounts of cheese and putting cream in the coffee to make it. You know half and half cream, half coffee and all of the calories being consumed. I'll just write out you know, okay, you got a thousand calories from the cream and the cheese. Wow, so that's why they're not losing weight.
Jack Heald:But so you're you're, you're satisfied, you're sated, but and you're not putting the carbs in, which helps with the insulin resistance, but you're not burning your own fat, which If that's what you're trying to accomplish burning your own fat to lose the fat, then you know this is blindingly obvious now that you say it, but I don't think I'd ever really quite put it together. I have asked myself the question how is it helping me be in ketosis if I add ketones?
Dr. Eric Westman:I don't know You're going to have to burn those ketones too. Well, so little did I know. Remember my story? I went to Dr Atkins and said what do you do? Well, the sheet that I studied and borrowed and with permission, and now studied and I give out every day, and now I teach through my company or the internet basically hammered all these things out for over a 30-year practice. There's a little box on the sheet that says you must limit the cheese, the creams and oils, the mayonnaise, the really high fat items.
Dr. Eric Westman:And now in our surveys with people who we teach over the internet, teach our method, that's a big stepping stone or a big pitfall that people get into the unlimited. Well, but there's no carbs and cream, yeah, but there are a lot of calories. So actually we've learned that there are five or six major differences with what Dr Atkins taught circa 1998, 2000 and what the internet keto is teaching today. But because you're focusing on carbs, which is the main fattening element, again you don't have to do it very. Some people don't have to do it very strictly at all, which that confuses people, because how can you eat all of those Atkins bars and lose weight? Well, they didn't need. They didn't need really keto in the first place.
Jack Heald:So we call it they just needed to reduce calories.
Dr. Eric Westman:They just needed to reduce carbs and calories. Yeah yeah, so that is interesting to see how that plays out. But if you have metabolic syndrome, type 2, diabetes, a lot of weight to lose, then you want to be careful about the amount of those high calorie items the cheese, cream, oils, mayonnaise, that sort of thing. When Bulletproof Coffee came out, I had no idea what it was. Someone came in just starting telling me about it. I don't think this is good for weight loss and it really has never been studied in the context of weight loss.
Jack Heald:I remember the first time I heard about Bulletproof Coffee, I went butter in my coffee, you know, because I'm a huge fan of butter. Anyway, I went, okay, I'll try it. And of course it's awesome and tasty, tasty.
Dr. Eric Westman:Yeah Well, I remember the doctor who made it for me the first time and I got a little flush and a little buzz, nothing major. But so that's the focus on getting ketosis and ketones, which is new relatively. Thinking about all the potential benefits of ketosis and there are some I mean, if you have ketones around it seems to be anti-inflammatory, at least in theory, and then in these clinical trials and even in our patients, if you measure the inflammation it goes down. But I don't know the incremental benefit of how much bang you get for the keto buck. If you will, I'd be interested in your clinical experience.
Dr. Eric Westman:I don't pitch the, I don't teach our approach, as you have to have ketones and have to be measuring it, because in my area most people won't do that. I'm still in a relatively I don't know million people metropolitan area. It's not a huge area and I treat a lot of locals who you know they don't want, they don't have the money to check ketone monitors and yet if you teach it over the internet you'll get the percentage of people who do anything you say.
Dr. Eric Westman:I kind of watch in horror of some of these doctors doing as an influencer, saying oh yeah, I do this and I do that, and I was like, well, okay, that's another way to do it, but there are simpler methods. So so I don't know if you have to be in ketosis or not. Oh, that's kind of the next I hope the next decade or so will figure out in. Jeff Volick at Ohio State is still today. I asked him recently if I should tell my patients not to do a keto diet anymore and he said no. He flipped it the other way, like you did, phil. No evidence there's any harm of a keto diet. You know when it's properly formulated. And he's saying it now after 20 years of professor with hundreds of papers.
Dr. Eric Westman:So you know to at first. You know, 20 years ago I got there was, you know we were funded by Actons. You know we must be biased, we, you know. And in fact I thought the first thing you want to do if you have a controversial area that you publish a study is to get someone else to publish it again or to study it again. You know, to validate it. So then there won't be any. Oh well, you got funded by Actons. Of course you're going to find that result. It's like, well, I didn't have any skin in the game at the time, other than wanting to help people, which I guess that that old vicarious motivation isn't valued anymore. I guess.
Dr. Philip Ovadia:Yeah, it's seen as a conflict of interest these days, I guess.
Dr. Philip Ovadia:But and I think, yeah, largely, I agree, you know, to me.
Dr. Philip Ovadia:You know, I think there are some, some particular clinical conditions that ketosis is clearly, you know, useful for, beneficial when we're talking about some of the neurologic and now psychiatric conditions that are being treated with this and maybe some other unique circumstances.
Dr. Philip Ovadia:You know, I think the other advantage of kind of the keto approach, the high fat approach, on the, you know, when we look at the bigger picture, for me, you know, it's sort of a way of taking things to the extreme on the fat front to help us understand what we either don't understand or have misinterpreted around the role of dietary fat, you know. And so when I look at a popular, you know, when I look at people eating, you know, very high fat, ketogenic diets, and they're not all dropping dead of heart attacks instantly, you know, on some level that helps us, you know, maybe better understand what the true role of this is. And I do go back and forth. You know, obviously we have different technology available to us today than than Dr Atkins did, or certainly, you know, banting did when they figured out these diets, and we can measure. You know, we can use something like a CGM or we can use a ketone monitor.
Dr. Eric Westman:These days, oh, and there'll be continuous ketone monitors. You know not that I want anyone to do it.
Dr. Philip Ovadia:I won't mention that I might currently have one on my right arm as a beta test for a company. But yeah, you're right, you know I've. You know, as I've been doing it, I've kind of been struggling with is this really helping anything, you know, and will this help any?
Dr. Eric Westman:full disclosure. I still drive a car that has to.
Dr. Philip Ovadia:You know you have to turn the wheel on your own, so you haven't gone to self driving yet, so but yeah, it's always interesting to think about the role of technology. So, talking about, I guess, controversial new technologies, we'll call it, you know, I'd love to hear your perspective on the, the GLP one agonist, and the weight loss drugs that are now, of course, being very widely pushed both in the mainstream and in medical circles.
Dr. Eric Westman:Yeah, well, you know I was privy to a meeting as president of the obesity medicine association and past president when I was president, novo Nordus came beside and took us into a room and gave us this amazing presentation how we're going to be putting money into the development of weight loss drugs. And at that time all there was was Fentromene. In fact I kind of made fun of this organization I remember I'm past president. We make fun of ourselves. Perhaps I call them the Fentromene because they pushed a lot of Fentromene and and it still works today. I'll use some Fentromene. It's an appetite suppressant, but Novo basically put Novo Nordus put a lot of money into the research of these, these molecules that are hormones that the stomach and intestines secrete after you eat. So you know you could take an appetite suppressant to cut your hunger out, and many of them are like amphetamine, like or Adderall, like they're not really amphetamines but they cut the hunger out by some central effect. Or what if you injected the hormone that the stomach sends out after you eat and then all day long you'll just feel like you've already eaten? So it kind of tricks your brain into thinking that you've already eaten. And you know there are side effects.
Dr. Eric Westman:I follow in the world of drug development for weight. Bob Kushner at Northwestern is a loosely a loose colleague in the obesity world. He's a drug guy. I'm a lifestyle guy and he got up just like a. You know, hidden the candy store there was a drug that cut the hunger out and people would lose weight and of course they do it in combination with a diet. So people are given a low calorie diet with the drug in the clinical trials.
Dr. Eric Westman:But as he was giving this study results, he was also excited about it that a third of the people has significant nausea and stomach issues, that they stop the drug. And I'm thinking to myself, if I'm doing a practice and I'm giving out this all the time and a third of the people are getting side effects, I don't want to be involved with that. So one of my so years past, one of my doctors locally today, dr Friends uses a lot of the SGL, glp-1s excuse me, glp-1s and teaches hands out a nausea pill with the medication at the beginning. And just so, if a third of the people are gonna have a lot of nausea, you can just hand out a pill to handle the side effect of the pill. And so what I'm trying to say is lifestyle has always been there.
Dr. Eric Westman:Lifestyle will still be there If you're off the drug or you can't get it or you've only relied on the drug. I mean, that was the case with weight loss surgery. Weight loss surgery helps people lose weight but then it stops working and people regain the weight unless you deal with a lifestyle. So we'll be here if you are on one of those now and it stops working or you don't know what to do, and lifestyle will still be there and you can use it forever. Although I was a little skeptical although I'm not naive anymore, I like to be kind of innocent and eyes wide open and people can achieve things that they never thought they could, which is true, but the drug companies want to get everyone on the drugs forever, kind of like the statins, and this was leaked. No, it's actually pretty widely known, but at the show that Oprah led with just recently, one of the doctors who actually speaks for the industry said yeah, the companies are expecting that everyone will be on this drug for the rest of their lives, Like, wait a second.
Dr. Eric Westman:So on the one hand, it's kind of cool, although what do you want to do after a large Thanksgiving meal? Let's say this hormones coming out you don't want to do anything.
Dr. Eric Westman:So in my limited experience, a lot of people come to me saying this is making me tired or I just don't feel right. So it's actually giving me weight loss a bad name from the diet standpoint, because people come back on a low carb diet saying I have all this energy. I can't believe it. It's so wonderful and yet people will go through a lot of nausea and stomach pain in order to lose weight. That's kind of sad that.
Dr. Eric Westman:So it's taken the conversation from the most doctors from you need surgery, which was terrible because there's always lifestyle. Now it's while you need the drug and they're prescribing it and yet they don't know how to advise about the diet. They don't know how to ramp it up correctly in many cases. So I'm afraid it's a bit of a Pandora's box. There's some good, but hopefully the initial signal is not gonna be a bad one, which is some people actually get stomach issues that don't resolve when you stop the drug, and so when you go from FDA trials, where you have thousands of people now you have tens and hundreds of thousands, millions of people you're gonna learn a lot about that drug really quickly, and so I'm torn. The lifestyle has always been there. It will always be there if and when these other approaches don't work. Oh, the final thing about that first Oprah thing was that nobody mentioned food. Nobody mentioned the problem that we're dealing with is food, so it was like they just let the food industry off scot-free which corporates.
Dr. Eric Westman:They don't want to be anti-food, so they'll just treat it. My first introduction to this was the Atkins company has food products that help you lose weight. Well, if you use it correctly, the company that bought Atkins Nutritionals 20 years ago, when I was paying attention, was the Cinnabon, a company that owns Cinnabon as well. So they would make people get obese and then they'd give them food that make them thin, make them so I guess that's the business side, we call that a flywheel.
Jack Heald:I think, well, yeah.
Dr. Eric Westman:Well, so what do you think about this, drew? But so I just wanted to give the context that we were dying, we were really starving not the right term. We really needed new weight loss drugs 10 years ago when in the obesity medicine world there was nothing. So I'm kind of glad about that, but not entirely.
Dr. Philip Ovadia:Well, but, like you said, there wasn't nothing. There was diet and lifestyle and low carbohydrate diets, which are amazingly effective, but just don't seem to get the same push.
Dr. Eric Westman:But you're in the American medicine right. We teach doctors how to use drugs.
Dr. Philip Ovadia:They don't know how to do anything.
Dr. Eric Westman:If you don't have something that well, now it's all computerized, but we've trained even today. That's just I don't know how to. I'm really disappointed in internal medicine and family medicine. We basically only teach. I can't be a preceptor in our teaching clinic at Duke because I don't know the drugs, I don't want to use the drugs, I take people off the drugs. So anyway, yeah, I'm sorry Most doctors didn't know about lifestyle before.
Dr. Philip Ovadia:Yeah, yeah, I mean, and you know I just I don't see good things coming from these medications. I, like you said, I think you know the the plan of OK, you know, maybe they work in the short run and maybe they do, and maybe they can be a good tool in the short term to get people started down this route, but without the long term plan, you know, keeping people on these medications for life clearly isn't a tenable solution and the data that we're already seeing is that they don't hold up long term. You know we were seeing the significant weight regain and, of course, the limitations of cost and other side effects and so, yeah, I am concerned that this is going to leave us with a lot worse problems than we started with, because then some of the other data that we're now learning, that you know there's a disproportionate amount of lean, lean tissue, lean mass loss and muscle loss that may be putting in people, people into worse metabolic shape, even though they've lost all this weight is concerning to me as well.
Dr. Eric Westman:Yeah, and the the stronger medicines, the the GIP and GLP ones they're, you know, I don't know a third, again as strong. I mean, I've seen some people who just don't eat anything, which reminds me that this is going to set you up for lean body mass loss, just like the surgeries that weight loss surgery. You lose so fast that you lose muscle mass and yet the surgeons say, well, but they would have died, you know. And so in the medical weight loss world we want the healthiest kind of weight loss that we can achieve and the GLP ones, in the hands of an obesity specialist who knows the parameters of food. You know you need to have some protein every day. If you're losing more than five pounds a week, you contact me because you know that's just too fast. So but yeah, there's a lot of butts and and ifs. You know most doctors, I can know that.
Jack Heald:It occurs to me because, just simply because I'm sitting in this particular chair, I know what GLP one is, but our lay listeners may not realize. What you're talking about is ozempic. Yeah, we need to say this is ozempic, and there's probably others as well, but that's the one that's getting all the advertising dollars lately. So yeah, folks, these GLP one things are ozempic, the magic pill that's going to make you not be fat anymore.
Dr. Philip Ovadia:Ok, magic shot to be clear Magic shot. There is a there is now a pill version, but yeah, yeah, and then one day there'll be an enema, I'm sure.
Dr. Eric Westman:But so the I'm reminded of that social experiment that happened. You know, in our well, 1970s, 80s, the low fat diet movement really didn't have any. You know, the food pyramid didn't have any data behind it, didn't have any research, low fat and you got all these carbs with the biggest diabetes and obesity epidemic ever. But now we have a wave of people on ozempic and other. You know, I guess I should equal. You know sex and we go and and and and and Zep bound, and I have funny names, but we have all these people now that it's kind of this cohort that we're following. We really don't have strong data, but maybe a year ahead of everybody, right. So what have we started seeing now? In the longer term studies? Some worse things we're going to. There'll be a lot of people at risk for that, which you know.
Dr. Eric Westman:After doing drug trials, I realized I don't want to be the first one taking a drug, research drug Well, that's other people doing that. And even then, once it's out in the market, because of that, learning from Phase four, getting it out of the market. Phase four is the. What you learn when it's already out there. Phase three is the clinical trials. To get it approved that you want to wait a few years, so it's been out there, now tested on the tens of thousands or a million people and you'll hear the what really happens with the medicine. So I'm a little shy about new tech, at least measurements, that's one thing, but new, new pills and shots.
Dr. Philip Ovadia:Great, you know, I guess, before we wrap up, what I'd like to hear, and maybe be able to end this on a positive note, is what you've seen among the physician community in terms of acceptance of low carb. You know, you start with Dr Atkins, who was sort of on an island by himself and just out there talking about this, and contrast that with. You know, for instance, the recent meeting that you and I were at together. You know where we really had a pretty wide swath of medical practitioners interested in this and putting it into practice, and so I'd love to hear what you think the future holds for our colleagues, and will this continue to spread among among them?
Dr. Eric Westman:Yeah well, I think so and I hope so what I've observed I've taught this method at the Obesity Medicine Association for over 10 years now and no personally at least a handful of doctors who are using this in their practice full time. A lot of them use it part time and Gary Taubes wrote the book the Case for Keto, which essentially is 100 and 150 people interviewed about health practitioners about how they use it in their practice. But you know, the entrenched medical way to worry about cholesterol rather than diabetes and triglyceride HGO ratios is that's going to be a long one to try to counteract or at least to have them not push back that way. But I think you know, as paradigm shifts happen, they happen slowly and the real thing that I think will persuade people is that we get to fix things that they can't fix.
Dr. Eric Westman:And yet among doctors my age, they're kind of resigned to the fact that they don't fix things, they manage things, you know. But I'm really excited about the younger population. I was on a podcast by a resident doctor, you know, can you imagine doing a podcast during your residency? I mean, you're so busy anyway. But so the younger doctors now have this textbook from you know, from their starting point. You know the ketogenic textbook that has all the data and if you can start turning heads by reversing diabetes and by picking up where.
Dr. Eric Westman:So I usually take the worst case, send me your worst patients, the ones you don't want, and send them to me and I fix them and send them back. And then, because my secret is, I talk about food and so that's going to be the ultimate cure or the switch for whatever organization medical or nutritional, dietitian If you really understand how food is really the answer, it's the prevention and it's treatment. Even when you have these, then you're going to win because you know, like that Oprah show, they never mentioned food. So you got to deal with the food and I'm optimistic that there are enough doctors who care that they're going to just say hey look, you know your diabetes is gone, you feel better. You're playing with your grandkids. I don't care that your other doctors worried about your cholesterol level. It's not as important.
Jack Heald:Wow, Pretty simple Again.
Dr. Eric Westman:we've heard this story before, but it was Einstein, wasn't he, who said he can't explain something to a four year old. You don't understand you don't really understand it.
Jack Heald:Yeah, yeah, that's good. Just don't eat the carbs. So tell us, uh, our audience, uh, we didn't talk at all about, um, how you are currently serving the public outside of your clinic. So tell folks how they can can get more information and, uh, maybe deal with some of these problems they haven't figured out how to deal with yet.
Dr. Eric Westman:Yeah, well, thank you. And yes, I still am in practice at Duke University, actually coined the term Duke Keto Medicine Clinic and, you know, asked for approval from you know, and they say, sure, what that you know? Um, so people come out, I was the Keto, can I do another diet? I say, yeah, sure, I mean so it's not the only thing I do, but, um, trying to always have this option available as best as I can.
Dr. Eric Westman:If you go to Eric Westerman mdcom, you can download a sheet of paper. I used to have this sheet of paper out there and no one would get it. No one would take it. So it's $9.99 that you can download one sheet of paper. Otherwise it has no value. It's that's just crazy, but anyway.
Dr. Eric Westman:So then there there's a uh, a book that we've written and your carb confusion. If you like to read books and then adapt your life academy has courses you can take. If you really want deep dives into courses and we've done Keto made simple protein courses. We actually have other teachers now teaching at adapter life academy. Plus, we're really excited in rolling out a diabetes course in the spring of this year how to reverse diabetes, and I'm even teaching people how I would reduce the medicine in my patients so that if they want to learn from how I handle my patients, they're able to do that. Often we can't get doctors involved even to reduce medications, so that's how I'm trying to get the word out. Had actual life academycom or Eric Westman MDcom. Duke university Keto medicine clinic.
Jack Heald:Duke university Keto medicine clinic. Very good, all right, phil, I didn't realize there was anybody who'd been doing this longer than Eric Bird, but he's been doing it longer than Eric Bird. When Eric Bird first started doing it, however many years ago it was, so this is pretty cool. Thanks for introducing us.
Dr. Philip Ovadia:It is pretty cool and, yeah, dr Westman has been, like I said, probably, I think at this point, is more clinical experience with this than anyone, certainly, that I'm aware of, and it's been a real honor for me to learn from him and be able to interact with him at conferences and podcasts and all the other great forums that we have available to us today. So thank you, eric, and look forward to continuing to work with you, because, despite how long you've been doing it, you still have great energy for it and great enthusiasm for it, and I have a feeling you'll still be doing it for quite a while.
Dr. Eric Westman:Yeah, well, it's the benefit, the help that people get, that makes you go to the practice every day. Clearly, you get that sense as well. The reason we do this is people get better. And, yeah, I can't imagine I'll ever retire unless they kick me out, but thank you so much for having me.
Jack Heald:Well, this has been the stay off my operating table podcast. Our guest has been Dr Eric Westman. All his contact information you heard about here will be available on the show notes and we will talk to you guys next time.