Dr. Eric Westman – ‘Keto Medicine – The Practice Of Carbohydrate Restriction’

thanks Kelly for the manner foreword and thank you to the meeting organizers Jeff Gerber and Rod Taylor now at low-pitched carb Denver 2019 I’ve been to a few gatherings and verify a good deal of familiar faces now thanks for coming out and I are of the view that low-grade carb Denver really has become the premier spot for medical professionals and health professionals including all all kinds and and purchasers as well but let’s give a big thanks to low-pitched carb Denver the deed of my talk today is Quito medicine have you heard of this before no probably not we just coined the word okay we just it’s a neologism in a new word or word but it’s these best practices of carbohydrate restriction if you is currently considering the medical literature carbohydrate limited is the phrase that you use to look for the evidence to support keto medicine my affiliations are I’m still at Duke University as a accompany prof of prescription joyou four daytimes a week and a clinical rehearsal that I’ll tell you about because I can’t do it all I’ve been belief as countless parties as I can and then started two new companies to scale up the availability of this information I’m the past chairman of the board of the obesity medicine Association which now has the low-grade carb keto diet in their algorithm recommendation so part of the act that we’ve done is to get the OMA the OMA not a ma but OMA for obesity now there is a national organization in the US with low-carb keto diets in their guideline so I’m a co-author on several bibles I get royalties from keto clarity and cholesterol clarity and want to thank Jimmy Moore for procreating me help him write these works so I get started in the research and medicine of the keto diet in 1998 two of my patients had done this diet and I said you know you’re doing great what did what did you do how did you do this and they said well we ate steak and eggs and you are well aware I was skeptical they just said well I’ve read this book the Atkins diet book and I was curious a young physician in clinical study I was curious so I called dr.Atkins Bob Atkins I told us to him do you need research and he said I have all the evidence I need I’ve been doing this 30 times and have you know 60,000 patients under his loop but he did say come attend for yourself so I became I returned skeptical but open-minded and didn’t start using the nutrition immediately I never was employed by dr. Atkins other than he wrote the check firstly out of his personal funds to start the research going down at Duke University and the Durham VA oh so here’s a photo and that first visit from from the Atkins yeah that’s me on that far right there Jackie ever steen I still work with today unhappily dr. Atkins died in 2003 slipping on the sparkler in a freak snowstorm in the spring in New York City and then died of leader injuries shortly after so right when I was ready to go back to dr. Atkins saying you know I’ve done two studies I’m ready to learn he was no longer available but Jackie was no Jack T has been so important for so many parties I want to give her a round of praise now as “youre seeing” I didn’t develop the same personal connections with dr.Jack dr. Atkins as I has I have a with Nurse Jackie so 20 years later I’m dedicated to keto drug I’ve published 46 peer-reviewed papers on the keto diet you can search my appoint at PubMed MEDLINE Westman ec they’re all there I’ve tried to get as many other researchers and clinicians and other even non-medical people involved with the research I’ve been practicing keto medicine since 2006 that do wrote three records found in the two new corporations and what I’d like to share with you today is a combination of the research and clinical care that we and many other doctors have supposed to do now and we’ve discussed over 4,000 people at Duke within a university private practice in the insurance pay and Medicare Medicaid sort of practice and it was really important for me to maintain that connection to every man or every woman and not just be concierge prescription but we’ve treated not there’s anything wrong with that but we’ve given metabolic and inflammatory predicaments like obesity character 1 and kind 2 diabetes PCOS IBS non-alcoholic fatty liver disease I have the possibilities of hitherto the sad actuality to help people who’ve already had liver grafts from fatty liver because they’re developing fatty liver again and I don’t have the heart to tell him that they didn’t need the displace and if you’ve gone through a commit it’s not easy peculiarly a liver displace that’s the reality of today heartburn nearly 100% repair lymphedema lipedema these are tribes who have been told there’s nothing for you keto works for them coronary thrombosis if you have any worry about heart disease the heart surgeon send me their patients when individual patients are too heavy that they can’t do a stomach implant so the heart doctors are not afraid of this even when the heart has left the ventricular assist device is a pump that’s placed inside the chest with two tubes from the left ventricle to the aorta because the heart isn’t pumping anymore these are probably the sickest people who are still alive and walking around and they have no pulse because the pump is a continuous flow monitor or mechanism berth bariatric surgery value advantage yes we can help there and the draconian reality is most of the people who get bariatric surgery have never done a keto diet lchf diet before the surgery there’s no requirement for this to be done before a more risky yet effective but long term probably no more effective than this kind of approach and yes force gain inadvertently unintended caused by mental health condition or mental health drugs steroids steroids up the snout for reaction that’s usually what happens this time of year you’re losing value it stopped have you started any brand-new drug oh no what about the nasal spray that oh yeah it started that but is that a remedy you know so this is the keto medicine world where were at odds with a good deal of the management that other doctors are using so in 2014 I appointed a heel attention platform with dr.Atkins Nurse Jackie a Burstein and we’ve developed in partnership over we calculated over 60,000 probably 60,000 63,000 case contacts and I simply wanna to Jack these tusk a little bit because she worked with dr. Atkins for 30 years and speaks highly eloquently about her event at the Atkins Center in New York City and it was her bureau that I sat in in 1998 in order to be allowed to to dispel all of the barriers that have that been put forward then and still come up now and it might be that you won’t really believe this until you sit in the position of another practitioner and I’m sure the doctors from Canada the UK Australia South America they’re happy to have you visit them of course give them the heads-up that you’re coming okay so there are four key conclusions that I’d like to talk about today and this is after treating many numerous beings in the research setting and the clinical setting Quito is safe Quito is effective for more than type-2 diabetes pre-diabetes and obesity Quito works for virtually everyone when it’s done right and Quito requires a new medical normal for laboratory tests and other other biomarkers so what about Quito is safe the body of sign now outperforms the FDA phase three requirements for approval of brand-new dopes for the therapy of obesity I just wanted to exactly thank everyone who has contributed to the research so if it were a drug it would be FDA approved but of course there’s no requirement for a nutrition to be FDA approved for these things but that’s the level of evidence that I missed I demanded before a doctor employments this I want to make sure that it’s safe and effective at least at the requirements of the US FDA someones with diabetes hypertension heart failure gout or kidney stones may require special consideration in monitoring but I’m cozy with a modification for low-toned sodium qualifying for low-toned vitamin K other perhaps potassium citrate supplements I can pretty much discus everybody with a keto diet with observing keto is effective for more than type-2 diabetes pre-diabetes and obesity we already know keto treats these diseases and they’re at crome of comorbidities and it’s just tragic that so many people end up on dialysis lose their eyesight have cardiac infarction from diabetes which is totally reversible in most cases but now the the brand-new epoch of science that we have just in the last say five to ten years increasing hyperinsulinemia and blood glucose also analyse other conditions of for example heart failure and is a problem of insulin opposition in many cases so it prepares sense that you might use this for someone with heart failure anything that has insulin hyperinsulinemia this is the most effective dietary program other than a very low calorie program that will treat hyperinsulinemia it lowers the blood insulin very well so epilim the far-left that they’re strong enough of an prove and a whole nother scientific land called the ketogenic diet for epilepsy that in some cases children put on this sort of eating pattern have total resolution of their seizures overnight and now that’s been known for a hundred years of the group that Johns Hopkins Eric Asaf and the Charlie Foundation has drawn great efforts to teach this around the world hitherto it’s still not very well known among the medical mainstream and I’ve learned from their experience that you can push and push and push in the medical mainstream but if there is a solid cornerstone of doctors being qualified and profiting from squandering remedies even in that epilepsy world they’ve been unable to make a dent and the idea of time just let’s just let this child try it change in medication change in diet before using medication so it’s a kind of sobering I often are of the view that merely publishing papers would be sufficient people would read them and then we modified the world countries that behavior that’s not enough but so heartburn PCOS non-alcoholic fatty liver disease the most common cause of cirrhosis now liver failure glycogen storage disease this is a story of beings trying this in a relatively rare disease in conclusion that they would have improvements in their muscle function really on their own and it’s the grassroots cases now deepening the academic researchers and I invited to attend a satisfy to only allay the fear of these other professors to use a you know – a high-fat diet and someone and I helps to ensure that would be okay to study this and I hope to see more investigate in those areas – but there was the people with this disease actually stripping together and changeable the academic investigates this is a common theme TBI distressing mentality trauma neurodegenerative diseases I made these in the evolving suggestion categories because not only because they’re you know you get into cancer treatment and you talk about that you’re regarded as a quack I require it remember I want to have the evidence for clinical care like you would expect as a doctor for the use of drugs for example so we’re not there but to see the research on these ailments frightful maladies that we have now is really pretty exciting so should we consider Kito medicine a brand-new medical specialty I’ve been an internal medicine consultant I’m an obesity medicine consultant and hitherto I still haven’t been taught all of the critical sort of kinds of information and knowledge provided that somebody that I’m doing needs to know so I can treat heart disease as an internist I could have done that gone into cardiology as a internist I could have gone into endocrinology sadly pretty much all well unhappily the cardiologists pretty much all still are in the low-fat paradigm for diet medicine the endocrinologists are in the remedy paradigm to treat diabetes and don’t even understand that it can be made the neurologic plain really doesn’t understand that nutrition can be so powerful outside that you know childhood epilepsy thing which is huge but it gets poo-pooed gastroenterology I can treat heartburn and an inflammatory really serious GI circumstances exactly by changing the food and you would think that a gastroenterologist who is an internist goes into subspecialty you would think the gastroenterologist would know something about menu and nutrition and sadly they’re not taught so I can treat all of these things as a prescription specialists so do we need another medical specialty is a question I conjured to you Kido works for virtually everyone when it’s done right so I will say just like a prescription drug if you follow these action plans the one that we’ve developed it will work but I can’t form you follow it so there’s a confusion of well does it certainly labour do I have to do it you know 24 hours per day – I can’t I have that piece of cake on the weekends everyone else at faith is doing if you do it right this will work it’s no different than saying you know I’m prescribing this capsule you know it’s kind of large and you know you might have to take it every day but if it’s a prescription and if you do it it will work now it made me following the science plowing slews and lots of patients to have the confidence to say this so if you’re a doctor or dietitian you’ve never worked this this imagine that this is an FDA approved dope being sold by a drug company putting the information in front of your your face and it will work your patients will have better observance they’ll follow it better because they’re not wondering in their judgment is this gonna work when is this gonna fail like every other approach I’ve done so “youve got to be” I know in its we what you have to recommend this with the trust of a prescription drug that’s to ratify and I think that’s helpful from the practitioners level not all low-spirited carb nutritions are keto and the keto target of keto threshold is a moving target because it would used to be easy when we just had urine ketones but now we have breath blood and urine and I’m still not sure of how to basically use these so in my practice with a wide range of educational level and socio-economic level I don’t use them because I don’t feel it’s necessary if I can get everyone under 20 total carbs per epoch just about everyone will be in ketosis you don’t have to measure it it can be helpful for a lot of people and we’re now going the rep creation of data of how low-pitched time you have to go to get into ketosis some people will be in ketosis at 70 grams if they’re young and active I don’t even have that in light-green on the list at 50 grams total grams not net for the whole day you’ll get 30 to 50 percent in ketosis depending on the medical problem that there is the healthier you are the more carbs you can eat the younger you are the more carbs you can eat the more active you are the more carbs you can eat conversely the older the more sedentary the more postmenopausal you are the little carbs fewer carbs you can eat I know sorry don’t kill the messenger delight so that’s why we use the 20 gram ruler because pretty much everyone will be in ketosis we don’t have to measure it understanding how to do keto can be uncomplicated it can fit on a sheet of paper affectionately known as page 4 on Pinterest now because it was the fourth sheet of my handout at Duke University there’s a great deal of free advice out there and delight expend it use it safely it’s I feel like it’s devoting people a motorcycle that a great deal of people can ride it without the guidelines and and but if you have medical problems this is remember as strong as many prescription medicines and you may need help in safety prescribing go people off medication so I just go in and say you know eat as much as you want to meat poultry fish and shellfish and eggs oh but I know you’re not going to want much I do invest an hour doing a teach class which is available online if you can figure out how to find it it’s not hard I didn’t know that if I said oh and I’ll email it to you to these eight people around the room that when you settled it out on YouTube a fraction of the hundreds of thousands of beings that have verified it email me for sheet four because it’s in there and I was even traveling in Europe last-place precipitate and someone at the the security said oh you’re that Kido guy and I know excuse me and yes I said what page number is it page 4 he said today I don’t think I don’t think that’s gonna be the word of my next notebook but it may be because it can be that simple and and this is the strategy the teaching approach that came from dr.Atkins and Jack the Ebers dean’s office actually remember that visit 1998 I said what do you doing in there was the basic list of nutrients that they used and then what we did back in Duke Durham VA and Duke University is to validate the safety and effectiveness being one of the first research teams to actually not do research studies and publish it in the medical literature but what I’ve learned is that medicine it would have been taught in medical institution and all is not the most important therapeutic part the physicians or health practitioners primary capacity is to counsel to guide to cheerlead to detect carbs mostly and then to reduce medication safely so I find I’m listening I’m understanding what’s going on heartening supporting and now in 2019 because of the influx of lots of information on the internet peculiarly I help people uncomplicated keep it simple this really is a holistic practise because we’re expend meat as prescription menu is much more powerful than prescription when you get it right so rather than talk about cauliflower let’s talk rather than talk about metformin let’s talk about cauliflower I don’t think that’s in any medical clas hitherto perhaps we need to create one I’m open to that maybe I make patients tell their own story and it’s nothing liking that but the patient will come tell the story and then they’ll go away and say that dr.Westman is so great he listened to me he listened to my tale and this is a you know it’s a skill maybe the psychiatrist’s understand a busy doctor in a clinic has no time to listen and that’s so important but never dwell on the past there’s no shame no regret no embarrassment you’re always caring parties bring in their own shame and guilt and unease and the medical doctors the state practitioner never does that but remaining to the base of fundamentals I find has been really important no subterfuges no continual biomarker moving is needed you can use the merely real nutrients no special meat but the important thing to reassure beings in this kind of lifestyle change is that every day is a new day if you have some carbs because grandmother you are well aware coerced you to eat it and thought you weren’t gonna adoration her anymore you know it’s okay just the next day you get on and are returning to the granted menu so the accepted menu register the special list had 60,000 patients under its region before we studied it at Duke University now there are a lot of ways to do it but I see one of the purposes of the success of our platform know most of it is the special schedule of foods then of course I’ll say do you need another nutrient schedule have you lost it oh yes my hound eat it well here it is again yeah even five years after someone has done the program they came confused by carbs or something shiny and they regained they’ve recaptured all their weight I’ll ask parties do you need another meat list whether it’s working or not yeah you may have to be a bit of a detective and and this is gives me a little pause to do everything remotely it can work and as long as it’s working do remote work is fine but recollect if if beings do it it is currently working don’t disorient that it doesn’t work and people know it that symbolizes it’s not being done right for example I never told this person that she couldn’t have pineapple water and she came back having pineapple water I said well how do you conclude that you know I told her not to have fruit but apparently fruit doesn’t you know be pineapple irrigate doesn’t fall under the general rubric of fruit because you know it’s in irrigate and so she said that well I open up a can of pineapple and I swarm it in the pitcher I imply like syrupy oh yeah and then I pour in the water and I say well is it sweet well yeah genuinely up okay no not everyone has had a nutritional background and knows not even everyone in the South knows that when you drink tea it has carbohydrate in it because that’s what they’ve always had of course we call it sweet tea but no in the southern United Position you ask for tea it has carbohydrate in it you have to ask for unsweet tea and you get that funny watch of you know what’s wrong with you so a great deal of the this is rolling out in an environment that’s not necessarily keto friendly I had a patient who said while I’m doing your nutrition you know 23 hours 59 hours and 30 seconds a date I said well what are you doing in that last 30 seconds well you know I was going up in the middle of night eating Oreo cookies and dipping them in milk and no you have to do it all day long probably the most common mistake is falling victim to the Oh a little bit won’t hurt a little bit won’t yes a little bit can stop the ketosis can stop the weight loss the fat burning this one gentleman cus that he was being strict and I imagined him I believed him so I saved mulling how does it is it did you have an operation he said yeah what was it well I had a new prosthetic leg turn in well was it different yeah I leant a you are well aware a Duke sign and then a UNC sign on the back because my partner likes UNC so it double-faced the value of the prosthetic leg and the above reasons he gained weight was that his prosthetic leg weighed more now I couldn’t detect that in my bioimpedance proportion because it doesn’t work on him so you have to think you have to you know and sometimes I’ll look in the handbag not because of the money but because these sugar things exactly keep sounding back in their people’s lives and that we facilitate get beings back on track that course so most people fail for for psychosocial concludes not because the pill doesn’t work not because the keto diet doesn’t work they’re unreal expectations how if you’re a practitioner you’ve heard well I’ve only lost twenty pounds this month and I am NOT a joyful and this is a huge success in any platform even this one so you have to adjust expectancies perhaps beings may expect that you need to weigh things on a scale and and be very precise with measurements and that’s an old attire that doesn’t need to be done with this some people may be discouraged to try yet another diet and our clinic you know the clinic of last resort I’ll listen very politely and then you know did “youve been” do a low-carb keto lchf he said yeah and I’ll say well you haven’t done it with me so yeah but you can have that confidence when this is what you see day after day so it can be young it can be complicated by lots of different things especially with the internet and in commodities that educate you keto symbolizes my make not deepening the food I’ve seen that mistake there’s a good deal of misinformation absurdity and then the resist by the medical constitution fortunately we’ve not had any any kind of medical legal prosecution in the US you know knock on wood I think it’s because our environment is just very different and thank you to the doctors around the country and there are countries who get bullied by the medical constitution and I’m glad you hugging them there Evelyn Tim Noakes Garrett Becky perhaps in the u.s.The parties in these timbers are followed the science and realized that actually there’s a lot of discipline behind this and and that’s why I I promote this now on the public public position as well friends and family I imply it genuinely does kind of get into this sort of feeling of meat is love and you know that’s kind of a big picture item if you’re if you have a family and you don’t have to always have food for fetes do interesting thing stress no question stress can slow down weight loss it can constitute you go back to eating carbs emotional eating but it’s a temporary specify and then of course we’re just supportive like any kind of chronic relapsing mode or trouble we just help people get back on track on track or help them address the stress in a different way without the menu physiology perfectly there’s carbon there’s actually a new textbook on meat addiction that’s out if you can search for that I match the author of the textbook on food craving at the last low-carb USA West Palm Beach meeting desires and starve yeah they appear there you know what’s the distinctions between the brain and the body anyway it’s all connected how the body toils and shoots overtime so actually in the obesity drug nature the condition or the disease of obesity alterations as parties lose weight the metabolism changes the psychosocial issues change so there’s actually a domain of obesity medicine and that’s where I’ve been doctrine this and there are tens of thousands of physicians in the US but merely a pair thousand who understand that and then we incessantly duel the side effects of drugs that are weight promoting so I’ve come to really believe that sustained lifestyle mutate compels integrated instructing and you know the coach or collaborator being working with the practitioner not against and not affording desegregated messages and the purpose really is to guide mortals toward a personalized program I once had a psychologist come to my power and he said your program is brilliant it’s totally personalized and I said well I have a list of nutrients and I hand it out and he said yes everyone chooses exactly what they crave personalize it based on what they like and what they want to eat it’s brilliant I didn’t compose it I corroborated it in the medical literature and I watched dietitians be very scrupulous about you know do you like fish yes do you like salmon no okay do you like tilapia no do you like cod no and all I do is hand a sheet of paper and say gobble what you like no time needed for that here’s some preliminary results of a program that mixes a simple system of Education and personalized coaching and you can see on the left that just about every one has success when it’s done right we don’t know how to do it perfectly there’s still some stragglers but the you know like a prescription drug if you take it it will work and the medical platform means they had medical problems diabetes high-pitched blood pressure the non-medical on the right is if they didn’t have those problems and they were teach merely at by instructs at great distances with diabetes again special monitoring is required but utterly you can get parties off insulin and medications and this kind of program runs really well Tito may require something called a brand-new medical normal it’s a topic that we’ve heard at this conference have heard a lot we use macronutrient pieces that are repeat abnormal we tell people not at breakfast which is an abnormal eating behaviour “were having” people with high ketone positions which is not normal yeah and it differ from the medical care to tell someone that you don’t have to have diabetes we can fix it it does fall into what we expect or what’s normal in terms of weight loss is achieved by lowering the caloric intake there’s no wizard caloric caloric calculations are more complicated than has been mentioned in the past but there is a metabolic advantage the metabolic pace doesn’t go down as much on a keto diet the glucose and insulin degrees improve lipids improve and I wanted you to waste a instant and what regular means for most laboratory tests normal is described as the middle 95% of a ordinary distribution and this is just basic statistics so that even if everyone is quote health the the extremes are going to be called abnormal and so beware of this happens on the the tests that you see from the doctor from the laboratory that you get and normal can convey customarily observed that’s conventional you are well aware he normally goes to work at nine houses ordinarily have two children it’s normal to eat breakfast biomarker correlation this is where the rubber encounters the road and why we need to collect new information because biomarkers don’t mean you have the disease it’s a projection so abnormal you know the temperature of 102 is a fever a high LDL can predict a risk factor long-term down there it’s not like you’re on the edge of a face and risk factor bullying to take medicines to treat risk factors is not really good practice again this is maybe we need to teach practitioners how to do this differently and then abnormal in my psyche is a port a quality at which medication does very best than evil so when you’re introducing dopes or surgeries are you at a spot where on average most people will actually do better than be mischief for example what’s often said what’s normal in New York may be abnormal in Tokyo this gentleman accompanying down the street in New York City is normal and then he’s abnormal in a country where everyone is shorter okay that was supposed to be funny were it’s just too early in the morning okay but problems with biomarker correlation and they’re diaries written on this there are there are papers written on this the bottom line is what carbohydrate eaters this is the normal range among laboratory tests of beings what carbohydrate eaters have as normal may not be normal for those who don’t eat carbohydrates and now that you can measure blood pressure at home the the normal fluctuation of blood pressure has been confused as being abnormal now that you can measure glucose at home and ketones normal waverings in these levels are confused with being abnormal and this is going to keep the doctors in business for a long time in keto medicine because we reassure beings that it’s yes it’s okay to have just as mildly elevated blood glucose levels when or after you exercise that’s what you’re supposed to do nutritional ketosis also characterizes normality because a high beta-hydroxybutyrate in the blood is nor is abnormal for carbohydrate eaters but is keto normal and then all these biomarkers it’s a kind of a bestial joke perhaps that the only thing that doesn’t get better is the total LDL that’s kind of a and “weve heard” huge discussions on why the total LDL is not the be-all end-all the keto regular for cholesterol ohh time’s up I’m working on that one as a talk requires an hour it’s okay if the LDL is a little bit high it’s probably okay if the LDL is really high we just don’t know that for sure yet but it’s a triglyceride an HDL or examining enormous every other biomarker is great you’re feeling reservoir don’t worry about that LDL is the bottom line so in summary keto is safe and effective for obesity kind 2 diabetes keto may be used for many other conditions and I can foresee this field expanding into treating lots of different other conditions and I’ll be there when the evidence is there and published in peer-reviewed periodicals PETA studies was about everyone when done right so like any lifestyle change it may require behavioral support to get started and even ongoing and I’ll ensure people 10 times in this because they’re still waiting for it to stop working but it’s not with it’s not going to but it’s that mindset of everything else hasn’t worked so is there a brand-new specialty of Kido medicine to develop practitioners I study yes and the D prescribing of remedy is a cautionary note if you’re using this and you’re on medication make sure you talk to someone who understands how to get off the medication safely most doctors have no training in this they don’t expect beings to come off insulin in one day and that’s what we see it can happen caution is required when comparing labs for those in nutritional ketosis to normal values obtained from people who eat carbohydrates that’s the normal range you insure on that panel you get from the lab the brand-new citation scope for nutritional ketosis is needed to reflect this new keto regular wander thank you very much[ Applause]

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