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

thanks Kelly for the species introduction and thank you to the meeting organizers Jeff Gerber and Rod Taylor here at low-pitched carb Denver 2019 I’ve been to a few discussions and appreciate a good deal of familiar faces now all right and I think that low-toned carb Denver truly has become the premier spot for medical professionals and health professionals including all all kinds and and shoppers as well but let’s give a big thanks to low carb Denver the deed of my talk today is Quito medicine have you heard of this before no probably not we are only coined the period okay we just it’s a neologism in a new word or phrase but it’s the practice of carbohydrate restriction if you look in the medical literature carbohydrate restraint is the phrase that you use to look for the evidence to support keto medicine my relationships are I’m still at Duke University as a associate prof of medication glad four days a few weeks and a clinical rehearsal that I’ll tell you about because I can’t do it all I’ve been belief as countless beings as I can and then started two brand-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-spirited carb keto diet in their algorithm specification so one of the purposes of the use 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 specification 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 preparing me facilitate him write these volumes so I came 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 dine steak and eggs and you know 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 experiment I was curious so I called dr.Atkins Bob Atkins I said to him do you need research and he said I have all the evidence I need I’ve been doing this 30 years and have you know 60,000 patients under his loop but he did say come identify for yourself so I get I returned skeptical but open-minded and didn’t start using the food immediately I never was employed by dr. Atkins other than he wrote the check first out of his personal funds to start the research going down at Duke University and the Durham VA oh so here’s a photograph 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 frost in a maniac snowstorm in the spring in New York City and then died of honcho hurts 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 accessible but Jackie was no Jack T has been so important for so many parties I want to give her a round of cheering here as you can see 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 prescription I’ve published 46 peer-reviewed papers on the keto diet you can search my mention 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 volumes found in the two new companies 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 done now and we’ve analyse 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 all the men or every woman and not just be concierge prescription but we’ve considered not there’s anything wrong with that but we’ve treated metabolic and inflammatory surroundings like obesity form 1 and type 2 diabetes PCOS IBS non-alcoholic fatty liver disease I have the possibilities of yet the sad reality to help people who’ve already had liver transplantings 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 transplanting and if you’ve gone through a commit it’s not easy especially a liver displace that’s the reality of today indigestion roughly 100% get-up-and-go lymphedema lipedema the latter are tribes who have been told there’s nothing for you keto works for them cardiovascular disease if you have any worry about heart disease the heart surgeon send me their patients when the patients are too heavy that they can’t do a nerve 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 post bariatric surgery weight gain yes we can help there and the draconian world 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 high-risk hitherto effective but long term probably no more effective than this kind of approach and yes heavines gain unknowingly unintended caused by mental health condition or mental health remedies steroids steroids up the nose for reaction that’s usually what happens this time of year you’re losing load it stopped have you started any new drug oh no what about the nasal spray that oh yeah it started that but is that a medicine you know so this is the keto medicine world where were at odds with a lot of the care that other doctors are using so in 2014 I created a end maintenance program with dr.Atkins Nurse Jackie a Burstein and we’ve put together over we calculated over 60,000 probably 60,000 63,000 patient contacts and I precisely wanna to Jack these trumpet a little bit because she worked with dr. Atkins for 30 years and speaks terribly eloquently about her know-how at the Atkins Center in New York City and it was her place that I sat in in 1998 in order to dispel all of the barriers that have that came up then and still come up now and it might be that you won’t really believe this until you sit in the power 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 countless 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 brand-new medical normal for laboratory tests and other other biomarkers so what about Quito is safe the body of testify now beats the FDA phase three requirements for approval of brand-new doses for the management of obesity I just wanted to simply 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 craved I wanted before a medical doctor helps this I want to make sure that it’s safe and effective at least at the standard of the US FDA men with diabetes hypertension coronary failure gout or kidney stones may require special consideration in monitoring but I’m pleasant with a modification for low-spirited sodium adjustment for low-toned vitamin K other perhaps potassium citrate supplements I can pretty much analyse everybody with a keto diet with monitoring 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 coronary thrombosis from diabetes which is totally reversible in most cases but now the the new epoch of discipline that we have just in the last say five to ten years abbreviating hyperinsulinemia and blood glucose also considers other conditions of for example heart failure and is a problem of insulin resist in many cases so it shapes 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 are you all right so epilim the far-left that they’re strong enough of an manifestation and a whole nother scientific land called the ketogenic nutrition 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 manufactured great efforts to teach this around the world yet it’s still not very well known among the medical mainstream and I’ve learned from their experience that you can push and propagandize and push in the medical mainstream but if there is a solid locate of physicians being studied and profiting from consuming remedies even in that epilepsy world they’ve been unable to make a dent and the idea of setting up just 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 thought that simply publishing newspapers would be sufficient parties would read them and then we modified the world that nature 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 people trying this in a relatively rare disease in receive that they would have improvements in their muscle function just on their own and it’s the grassroots cases now converting the academic both researchers and I invited to attend a see to really dispel the fear of these other academics to use a you know – a high-fat diet and someone and I assured them that would be okay to study this and I hope to see more study in those areas – but there was the people with this disease actually stripping together and changeable the academic researchers this is a common theme TBI painful intelligence injury neurodegenerative infections I framed these in the evolving sign 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 want it remember I want to have the evidence presented 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 illness horrific sickness 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 expert I’m an obesity remedy consultant and hitherto I still haven’t been taught all of the critical sort of sortings of information and knowledge adjusted that somebody that I’m doing wished 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 unhappily pretty much all well sadly the cardiologists pretty much all still are in the low-fat paradigm for nutrition medicine the endocrinologists are in the drug paradigm to treat diabetes and don’t even understand that it can be made the neurologic discipline actually 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 cases exactly by changing the menu and you would think that a gastroenterologist who is an internist goes into subspecialty you would think the gastroenterologist would know something about nutrient and nutrition and unhappily they’re not instruct so I can treat all of these things as a remedy experts so do we need another medical specialty is a question I developed 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 is currently working but I can’t become you follow it so there’s a disorder of well does it actually work do I have to do it you know 24 hours a day – I can’t I have that piece of cake on the weekends everybody else at school is doing if you do it right this will work it’s no different than saying you know I’m prescribing this lozenge you know it’s kind of large and you know you might have to take it every day but if it’s a drug and if you do it it will work now it took me following the science giving fortunes and lots of patients to have the confidence to say this so if you’re a medical doctor or dietitian you’ve never used this this imagine that this is an FDA approved pharmaceutical being sold by a drug company putting the information in front of your your face and it will work your patients will have better obedience they’ll follow it better because they’re not wondering in their head 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 confidence of a prescription drug that’s to ratify and I think that’s helpful from the practitioners level not all low-pitched carb diets 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 breather blood and urine and I’m still not sure of how to essentially 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 date 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 get the rep creation of data of how low-pitched do 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 dark-green on the roll at 50 grams total grams not net for the whole day you’ll get 30 to 50 percentage in ketosis depending on the medical concern 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 please so that’s why we use the 20 gram rule 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 good deal of free advice out there and please apply it use it safely it’s I feel like it’s dedicating people a motorcycle that a lot 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 taking beings 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 devote an hour doing a schooling 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 framed it out on YouTube a fraction of the hundreds of thousands of beings that have examined it email me for sheet four because it’s in there and I was even traveling in Europe last fall 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 refer of my next record 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 meat that they used and then what we did back in Duke Durham VA and Duke University is to validate the safety and effectiveness represent one of the first research teams to actually not do a study 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 cause family physicians or health practitioners primary persona 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 encouraging supporting and now in 2019 because of the influx of lots of information on the internet specially I help people uncomplicated keep it simple this really is a holistic practice because we’re apply meat as drug nutrient 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 yet maybe we need to create one I’m open to that maybe I cause patients tell their own story and it’s nothing idea 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 just listened to my storey and this is a you know it’s a skill perhap 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 discomfort you’re always caring people bring in their own shame and guilt and humiliation and the the doctor the state practitioner never does that but protruding to the base of basics I find has been really important no stunts no perpetual biomarker tracking is needed you can use the exactly real nutrients no special menus but the important thing to reassure beings in this kind of lifestyle change is that every day is a new day if “youve had” some carbs because granny you are well aware made you to eat it and thought you weren’t gonna ardour her anymore you know it’s okay precisely the next day you get on and go back to the tolerated menu so the let meat roster the special directory had 60,000 cases under its loop before we studied it at Duke University now there are a lot of the methods of get it on but I remember one of the purposes of the success of our platform know most of it is the special list of nutrients then of course I’ll say do there is a requirement to another menu roster have you lost it oh yes my puppy consume it well here it is again yeah even five years after someone has done the program they get confused by carbs or something shiny and they regained they’ve retrieved all their weight I’ll ask beings do you need another food schedule 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 remember if if people do it it will work don’t mystify that it doesn’t work and people know it that conveys 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 oblige that you know I informed her not to have fruit but apparently fruit doesn’t you know be pineapple ocean doesn’t fall under the general rubric of fruit because you know it’s in ocean and so she said that well I open up a can of pineapple and I pour it in the pitcher I necessitate like syrupy oh yeah and then I pour in the ocean and I say well is it sweet well yeah really up okay no not everyone has had a nutritional background and knows not even everyone in the South knows that when you suck tea it has sugar in it because that’s what they’ve always had of course we call it sweet tea but no in the southern United Mood you ask for tea it has sugar in it you have to ask for unsweet tea and you get that funny ogle 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 diet you know 23 hours 59 minutes and 30 seconds a date I said well what are you doing in that last 30 seconds well you are well aware I was get 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 solid burning this one gentleman curse that he was being strict and I felt him I belief him so I hindered envisaging how does it is it did you have an operation he said yeah what was it well I had a brand-new prosthetic leg put one over well was it different yeah I gave a you are well aware a Duke sign and then a UNC sign on the back because my bride likes UNC so it double-faced the value of the prosthetic leg and the reason he gained weight was that his prosthetic leg weighed more now I couldn’t detect that in my bioimpedance flake because it doesn’t work on him so you have to think you have to you know and sometimes I’ll look in the purse not because of the money but because these sugar things just prevent popping back in their people’s lives and that we cure get beings back on track that action so most people fail for for psychosocial rationalizations not because the pill doesn’t work not because the keto diet doesn’t work they’re idealistic expectancies how if you’re a practitioner you’ve heard reservoir I’ve only lost twenty pounds this month and I am NOT a glad and this is a huge success in any planned even this one so you have to adjust apprehensions perhaps beings may expect that you need to weigh things on a flake and and be very precise with measurements and that’s an old garb that doesn’t need to be done with this some people may be discouraged to try yet another food and our clinic you know the clinic of last resort I’ll listen very politely and then you know did you ever 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 are eligible to 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 products that learn you keto represents my produce not deepening the meat I’ve seen that mistake there’s a good deal of misinformation absurdity and then the resist by the medical establishment fortunately we’ve not had any any kind of medical law litigation 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 “whos got” bullied by the medical foundation and I’m glad you gripping them there Evelyn Tim Noakes Garrett Becky perhaps in the u.s.The beings in these councils are followed the science and realized that actually there’s a lot of discipline behind this and and that’s why I I promote that is something that on the public public statu as well friends and family I represent it certainly does kind of get into this sort of feeling of nutrient is love and you know that’s kind of a big picture entry if you’re if you have a family and you don’t have to always have menu for revels do other things stress no question stress can slow down weight loss it can realise you go back to eating carbs emotional eating but it’s a temporary stick and then of course we’re just caring like any kind of chronic relapsing position or problem we just help people get back on track on track or help them address the stress in a different way without the food physiology utterly there’s carbon there’s actually a brand-new textbook on menu addiction that’s out if you can search for that I gratify the author of the textbook on nutrient craving at the last low-carb USA West Palm Beach meeting hungers and thirst yeah they arise there you know what’s the difference between the imagination and the body anyway it’s all connected how the body use and chases overtime so actually in the obesity drug world-wide the condition or the disease of obesity mutates as people lose weight the metabolism modifies the psychosocial issues change so there’s actually a orbit of obesity drug and that’s where I’ve been schooling this and there are thousands of doctors in the US but simply a couple thousand who understand that and then we persistently combat the side effects of prescriptions that are weight promoting so I’ve come to really believe that sustained life-style alter compels integrated instructing and you know the coach or spouse being working with the practitioner not against and not making mixed letters and the purpose really is to guide mortals toward a personalized program I formerly had a psychologist come to my part and he said your program is brilliant it’s totally personalized and I said well I have a list of meat and I hand it out and he said yes everyone chooses what was require personalize it based on what they like and what they want to eat it’s brilliant I didn’t initiate it I authenticated it in the medical literature and I watched dietitians is largely meticulous about you know do you like fish yes do you like salmon no okay do you like tilapia no time you like cod no and all I do is paw a sheet of paper and say dine what you like no time needed for that here’s some preliminary results of a program that compounds 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 is currently working and the medical planned 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 learn merely at by instructs at a distance with diabetes again special monitoring is required but absolutely you can get people off insulin and medications and this kind of program jobs really well Tito may require something called a brand-new medical normal it’s a theme that we’ve heard at this conference have heard a lot we use macronutrient pieces that are paraphrase abnormal we cause people not at breakfast which is an abnormal eating demeanor “were having” parties with high ketone ranks which is not normal yeah and it differs 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 uptake there’s no magic caloric caloric appraisals are more complicated than has been mentioned in the past but there is a metabolic advantage the metabolic rate doesn’t go down as much on a keto diet the glucose and insulin degrees improve lipids improve and I just wanted to invest a time and what normal means for most laboratory tests normal is described as the middle 95% of a normal dispensation and this is just basic statistics so that even if everyone is quote healthful 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 ordinary can entail routinely observed that’s conventional you know he normally goes to work at nine lineages ordinarily have two children it’s normal to eat breakfast biomarker correlation this is where the rubber meets the road and why we need to collect new information because biomarkers don’t mean you have the disease it’s a prophecy 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 imagination is a port a time at which medicine does very best than injure so when you’re introducing doses or surgeries are you at a quality where on average most people will actually do better than be harmed for example what’s commonly find what’s normal in New York may be abnormal in Tokyo this gentleman treading 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 ordinary fluctuations 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 people that it’s yes it’s okay to have just as mildly heightened blood glucose when or after you exercise that’s what you’re supposed to do nutritional ketosis also defines normality because a high beta-hydroxybutyrate in the blood is nor is abnormal for carbohydrate eaters but is keto regular and then all these biomarkers it’s a kind of a grievou joke perhaps that the only thing that doesn’t get better is the total LDL that’s kind of a and we heard immense 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-priced it’s probably okay if the LDL is really high we just don’t know that for sure hitherto but it’s a triglyceride an HDL or examining huge every other biomarker is great you’re feeling hole 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 useful 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 journals PETA duties was about everyone when done right so like any life change it may require behavioral support to get started and even ongoing and I’ll view 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 new specialty of Kido medicine to develop practitioners I reckon 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 prescription safely most doctors have no training in this they don’t expect people 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 picture on that panel you get from the laboratories the brand-new citation range for nutritional ketosis is needed to reflect this new keto regular array thank you very much[ Applause]

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