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

thanks Kelly for the category preface 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 consultations and meet a good deal of familiar faces now thanks for coming out and I considered that low-pitched carb Denver genuinely has become the premier spot for medical professionals and health professionals including all all kinds and and customers as well but let’s give a big thanks to low carb Denver the title 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 phrase but it’s the practice of carbohydrate restriction if you look in the medical literature carbohydrate restriction 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 affiliate prof of medication joyful four eras a few weeks and a clinical rule that I’ll tell you about because I can’t do it all I’ve been teaching as countless people 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 medication Association which now has the low carb keto diet in their algorithm specification so part of the labor 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 constituting me facilitate him write these records so I went 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 snack steak and eggs and you are familiar with I was skeptical they just said well I’ve read this book the Atkins diet book and I was curious a young doctor in clinical study I was curious so I announced 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 times and have you know 60,000 cases under his loop but he did say come learn for yourself so I went 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 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 sadly dr. Atkins died in 2003 slipping on the frost in a monstrosity snowstorm in the spring in New York City and then died of president traumata shortly thereafter 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 beings I want to give her a round of cheering now as you can see I didn’t develop the same personal a link with dr. Jack dr. Atkins as I has I have a with Nurse Jackie so 20 years later I’m dedicated to keto medication I’ve published 46 peer-reviewed articles on the keto diet you can search my honour 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 bibles 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 given over 4,000 beings 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 medication but we’ve given not there’s anything wrong with that but we’ve analyse metabolic and inflammatory plights like obesity category 1 and kind 2 diabetes PCOS IBS non-alcoholic fatty liver disease I have the opportunity hitherto the sad reality 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 send it’s not easy especially a liver displace that’s the reality of today indigestion almost 100% croak lymphedema lipedema these are folks 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 individual patients are too heavy that they can’t do a centre displace so the heart physicians 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 tubings 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 perpetual move observe or mechanism affix bariatric surgery value amplification yes we can help there and the coarse actuality 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 weight increase unknowingly unintended caused by mental health condition or mental health medications steroids steroids up the nose for allergy 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 lots of the care that other doctors are using so in 2014 I procreated a heel caution planned with dr.Atkins Nurse Jackie a Burstein and we’ve developed in partnership over we calculated over 60,000 probably 60,000 63,000 patient contacts and I precisely wanna to Jack these cornet a little bit because she worked with dr. Atkins for 30 times and speaks particularly eloquently about her suffer at the Atkins Center in New York City and it was her role 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 is a possibility that you won’t really believe this until you be engaged in the agency of another practitioner and I’m sure medical 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 numerous numerous parties 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 ground now surpasses the FDA phase three requirements for approval of new doses for the therapy of obesity I want to precisely 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 food to be FDA approved for these things but that’s the level of evidence that I demanded I demanded before a medical doctor usages this I want to make sure that it’s safe and effective at least at the requirements of the US FDA men with diabetes hypertension coronary failure gout or kidney stones may require special consideration in monitoring but I’m comfy with a qualifying for low-spirited sodium adjustment for low-toned vitamin K other perhaps potassium citrate augments 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 heart disease from diabetes which is totally reversible in most cases but now the the new era of discipline that we have just in the last say five to ten years reducing hyperinsulinemia and blood glucose levels also gives other conditions of for example heart failure and is a problem of insulin resist in many cases so it spawns 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 suggestion and a whole nother scientific domain 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 made great efforts to teach this around the world more 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 locate of physicians being trained and profiting from use drugs even in that epilepsy world they’ve been unable to make a dent and the relevant recommendations of really 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 merely publishing papers would be enough parties would read them and then we deepened the world that road 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 locate that they would have improvements in their muscle function precisely on their own and it’s the grassroots cases now reforming the academic both researchers and I invited to attend a gratify to merely allay the concerns 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 experiment in those areas – but there was the people with this disease actually stripping together and changing the academic investigates this is a common theme TBI distressing ability hurt neurodegenerative infections I settled these in the evolving proof lists 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 demand it remember I want to have the evidence for clinical care like you would expect as a medical doctor for the purpose of applying remedies for example so we’re not there but to see the research on these maladies terrifying ailments 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 specialist I’m an obesity prescription consultant and yet I still haven’t been taught all of the critical sort of sorts of information and knowledge defined 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 sadly pretty much all well sadly the cardiologists pretty much all still are in the low-fat paradigm for food medicine the endocrinologists are in the medication paradigm to treat diabetes and don’t even understand that it can be switched the neurologic realm certainly doesn’t understand that nutrition can be so strong outside that you are familiar with childhood epilepsy thing which is huge but it gets poo-pooed gastroenterology I can treat heartburn and an inflammatory really serious GI milieu only by changing the nutrient and you would think that a gastroenterologist who is an internist goes into subspecialty you would think the gastroenterologist would know something about meat and nutrition and unhappily they’re not taught so I can treat all of these things as a medicine consultants so do the work requires another medical specialty is a question I fostered to you Kido works for virtually everyone when it’s done right so I will say just like a prescription drug if you follow this plan the one that we’ve developed it is currently working but I can’t build you follow it so there’s a disarray of well does it really labour 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 church 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 drug and if you do it it will work now it took me following the science treating lots and lots of cases to have the confidence to say this so if you’re a doctor or dietitian you’ve never squandered this this imagine that this is an FDA approved narcotic being marketed by a drug company putting the information in front of your your face and it will work your patients will have better compliance 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 confidence of a prescription drug that’s to ratify and I think that’s helpful from the practitioners level not all low-toned 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 gulp 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 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 get the rep creation of data of how low-spirited 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 lettuce on the directory at 50 grams total grams not net for the whole day you’ll get 30 to 50 percent 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 satisfy 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 lot of free advice out there and delight implement it use it safely it’s I feel like it’s leaving parties 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 numerous prescription medicines and you may need help in safety prescribing do parties 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 waste an hour doing a learn class which is available online if you can figure out how to find it it’s not hard-handed 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 employed it out on YouTube a fraction of the hundreds of thousands of people that have watched it email me for sheet four because it’s in there and I was even traveling in Europe last-place fail 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 call 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 do here 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 represent 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 school 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 supporting 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 pattern because we’re use meat as medication food is much more powerful than remedy 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 academy hitherto maybe we need to create one I’m open to that maybe I make cases 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 just listened to me he listened to my floor and this is a you know it’s a procedure maybe the psychiatrist’s understand a hectic physician in a clinic has no time to listen and that’s so important but never dwell on the past there’s no shame no remorse no awkwardnes you’re always caring beings bring in their own shame and guilt and unease and the the doctor the state practitioner never does that but persisting to the base of essentials I find has been really important no gambits no endless biomarker tracking is needed you can use the simply real meat no special foods but the important thing to reassure beings in this kind of lifestyle change is that every day is a brand-new day if you have some carbs because grandmother you know coerced you to eat it and thought you weren’t gonna affection her anymore you know it’s okay simply the next day you come along and go back to the gave food so the stood nutrient roster the special register had 60,000 patients under its belt before we studied it at Duke University now there are a lot of the methods of get it on but I visualize one of the purposes of the success of our program know most of it is the special schedule of menus then of course I’ll say do there is a requirement to another meat index have you lost it oh yes my dog feed 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 parties do you need another meat 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 make remote work is fine but retain if if people do it it is currently working don’t baffle that it doesn’t work and people know it that implies 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 draw that you know I informed her not to have fruit but apparently fruit doesn’t you know be pineapple liquid 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 spew it in the pitcher I convey like syrupy oh yeah and then I pour in the irrigate and I say well is it sweet well yeah truly up okay no not everyone has had a nutritional background and knows not even everyone in the South knows that when you imbibe 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 District you ask for tea it has sugar in it you have to ask for unsweet tea and you get that funny regard of you know what’s wrong with you so a good 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 are familiar with 23 hours 59 instants and 30 seconds a daylight I said well what are you doing in that last 30 seconds well you are familiar with 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 overweight burning this one gentleman cus that he was being strict and I speculated him I believed him so I prevented reflecting 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 set a you know a Duke sign and then a UNC sign on the back because my wife likes UNC so it redoubled the force 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 magnitude because it doesn’t work on him so you have to think you have to you know and sometimes I’ll look in the pocketbook not because of the money but because these sugar things exactly keep sounding back in their people’s lives and that we cure get parties back on track that space so most people fail for for psychosocial grounds not because the pill doesn’t work not because the keto diet doesn’t work they’re unrealistic expectations how if you’re a practitioner you’ve heard well I’ve only lost twenty pounds this month and I am NOT a glad and this is a huge success in any curriculum even this one so you have to adjust anticipations perhaps beings may expect that you need to weigh things on a magnitude and and be very precise with measurements and that’s an old practice that doesn’t need to be done with this some people may be discouraged to try yet another nutrition 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 can have that confidence when this is what you receive day after day so it can be young it can be complicated by lots of different things especially with the internet and in concoctions that coach you keto means my make not converting the meat I’ve seen that mistake there’s a lot of misinformation sillines and then the opposition by the medical constitution fortunately we’ve not had any any kind of medical legal dispute 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 foundation and I’m glad you gripping them there Evelyn Tim Noakes Garrett Becky perhaps in the u.s.The beings in these councils is followed the science and realized that actually there’s a lot of science 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 convey 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 festivities do other things stress no question stress can slow down weight loss it can start you go back to eating carbs psychological eating but it’s a temporary lodge and then of course we’re just encouraging like any sort of chronic relapsing precondition or problem we just help people get back on track on track or help them address the stress in another way without the food physiology utterly there’s carbon there’s actually a brand-new textbook on nutrient addiction that’s out if you can search for that I satisfy the author of the textbook on food craving at the last low-carb USA West Palm Beach meeting hungers and emptines yeah they occur there you know what’s the difference between the intellect and the body anyway it’s all connected how the body cultivates and chases overtime so actually in the obesity medication life the condition or the disease of obesity converts as parties lose weight the metabolism modifies the psychosocial issues change so there’s actually a study of obesity medicine and that’s where I’ve been learn this and there are millions of physicians in the US but simply a pair thousand who understand that and then we perpetually battle the side effects of drugs that are weight promoting so I’ve come to really believe that sustained lifestyle deepen expects integrated instructing and you know the coach or spouse being working with the practitioner not against and not demonstrating desegregated words 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 entrust it out and he said yes everyone chooses exactly what they crave personalize it based on what they like and what the fuck is want to eat it’s brilliant I didn’t form it I authorized it in the medical literature and I watched dietitians be very scrupulous about you are familiar with 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 handwriting a sheet of paper and say gobble 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 get it on perfectly there’s still some stragglers but the you know like a prescription drug if you take it it will work and the medical program means they had medical problems diabetes high blood pressure the non-medical on the right is if they didn’t have those problems and they were learn merely at by tutors at a distance with diabetes again special monitoring is required but absolutely you can get beings off insulin and medications and this kind of program wields really well Tito may require something called a new medical normal it’s a topic that we’ve heard at this conference have heard a lot we use macronutrient constitutions that are quote abnormal we cause beings not at breakfast which is an abnormal eating demeanor we have people with high-pitched ketone grades 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 uptake there’s no spell caloric caloric measurings 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 elevations improve lipids improve and I wanted you to expend a instant and what ordinary means for most laboratory tests ordinary is described as the middle 95% of a normal delivery and well 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 lab that you get and ordinary can signify frequently observed that’s conventional you are familiar with he normally goes to work at nine lineages naturally have two children it’s normal to eat breakfast biomarker correlation this is where the rubber converges the road and why we need to collect new information because biomarkers don’t mean you have the disease it’s a prediction 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 sentiment is a port a quality at which treatment does more good than evil so when you’re introducing stimulants or surgeries are you at a moment where on average most people will actually do better than be harmed for example what’s frequently observed 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 bibles written on this there are there are articles 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 was not possible to 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 parties that it’s yes it’s okay to have just as mildly hoisted 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 ordinary and then all these biomarkers it’s a kind of a viciou joke perhaps that the only thing that doesn’t get better is the total LDL that’s kind of a and we 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 increase it’s probably okay if the LDL is really high-priced we just don’t know that for sure hitherto but it’s a triglyceride an HDL or appearing huge 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 character 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 magazines PETA cultivates was about everyone when done right so like any life-style change it may require behavioral support to get started and even ongoing and I’ll hear people 10 years 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 recall yes and the D prescribing of drug 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 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 realise on that panel you get from the laboratories the brand-new remark array for nutritional ketosis is needed to reflect this new keto regular wander expressed appreciation for very much[ Applause]

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