Ketogenic and Carnivore Diets: 25 Years of Experience with Prof Eric Westman, MD

welcome to the plantree MD podcast with Dr Anthony chaffy where we discuss diet and nutrition and how this affects health and chronic disease and show you how you can use this to optimize your health and happiness both mentally and physically hello everyone thank you for joining me for another episode of the plant-free MD podcast I'm your host Dr Anthony chaffy and today I have a very special guest Dr Eric Westman who's joining me over from Duke University uh Dr Westman thank you so much for coming on it's such a pleasure to see you again well thanks for having me yeah I'm sure that most my listeners know who you are but for those who don't can you tell us a bit about yourself and what you do yeah so I'm a professor of medicine at Duke University Medical Center in Durham North Carolina and I've been at Duke for about 30 years U before that I I am an internal medicine physician I guess that's my first degree um went to Stanford univ University the University of Wisconsin and the University of Kentucky for my training and then Duke University for Fellowship training in what's called General Internal medicine for those in the medical world they know that the general internists are the teachers they're the ones who are the critics of the of other people within the medical world having worked in smoking sensation for about 10 years my my clinical practice was getting frustrating and and I was getting kind of burnt out in a Internal Medicine practice because my tools that I had really weren't fixing anything so I went out into obesity medicine got another sort of um it's not a degree but it's a certificate program and that was merging the low carb science that we started to do in right around the year 2000 and so for the last 15 20 years I've been practicing as an obesity medicine specialist which really means I'm an internal medicine specialist as well we reverse type 2 diabetes without medications so we're we're I think Superior to most Endocrinology diabetologists who are kind of still using the insulin and and eat high carb diets that sort of thing so that you know the the keto world today is really a manifestation of the evolution of the science that we started to do back around the year 2000 and Jeff volik at the at Ohio State University and then those studies were replicated all over the world for obesity and diabetes and I'm afraid For Better or For Worse we're partially responsible for the keto bread that's not really keto bread but it's kind of the brand out there of Keto being okay is because the the science on this has been going on and has been supportive really ever since the science started looking at it yeah perfect so H how how did you come to the the ketogenic side of things I know that you you've written many books on ketogenic diets you you Ain rediscovering Atkins diets and things like that and applying this to a patient base but how did you first come to that realization that this is something that could really be helpful for your patients yeah so as a clinical trial uh trained doctor I knew how to um design I I know how to design clinical trials and and uh so I'm an outcomes guy so the being in a clinic at a Veterans Affairs Hospital not seeing anyone get any results you know the I would send my patients to the dietitians for weight loss and they'd come back heavier so when two patients came to me having lost over 50 pounds on their own this was remarkable I mean it's like lightning hits once someone loses 50 pounds but no it hit twice right within a c period of time you know within memory and so was really by seeing two of my patients use the Atkins diet that woke me up to the fact that it could work there were still lingering questions about the safety and you know once I started to talk to my colleagues they said would say don't study that it's terrible and and then you I went to visit doctors who were using this it didn't look terrible and so as the science uh uh was assembled this actually always looked looked good which kind of leads me to the I I wasn't prejudiced or or someone recently said I had a curi it and an open mind well I mean doesn't everyone and and then I've learned no not everyone does so it was out of clinical practice that I was I learned this from my patients great well it's great that you had that open mind because um not everybody does I mean I think it's I think it's uh what we should do obviously as doctors you need to look at this and say wow that's something different that's something new I should look into this my mother's doctor was like that she with a low carbohydrate carnivore version of the keto diet she reversed her type 2 diabetes in two months came off all her oral medications significantly reduced her insulin then came off her insulin and her hb1c went from 8.9 to 6.1 and her doctor was a very bright lady and very well trained and she was also very curious person she said how the hell did you do this this doesn't happen diabetes is only a progressive disease it only gets worse we can mitigate it and slow it down through these various methods but it only gets worse it doesn't get better how the hell did you do this what the hell did you do and she told her she got very very interested in that and so I went in and spoke with her for a good hour and a half and she um you know she was a very clever lady she was a MB PhD from Harvard she had a PhD in Biochemistry from Harvard and and um you know really understood it so when I started talking to her on that that you know in the biochemistry of ketogenic diets and benefits I mean she was right on it and she said right well this is what we're doing changed everything around with my mom and as far as I know she started applying this to her her practice as well and then you see other people that just look at that go absolutely not couldn't possibly be that's just a fluke and I'm not going to look at it any further and so thankfully there are there are more people like yourself that are taking this in and and applying this um so when you started using this uh with your patient base um what sort of effects and results are you seeing now regularly is this something that can be applicable to everybody or there's certain cohorts that would be um better or worse uh outcomes with it or do you find it's pretty universally beneficial to your patients yeah well I I think it's important to have that distinction of the clinical care clinical patient and then just non-clinical healthy eating when you're when you're introducing anything that works for weight loss or for metabolic change you have to worry about medications that people are on and so but so if I'm not in the clinic if I'm just teaching someone who's not well I do get people coming to my clinic who don't need to come to the clinic they they're not on medicines they they could do this on their own like my patients did years ago but they don't know they can do it so I think this is healthy eating for anyone you know outside a clinical program once you get in the clinical program if someone does it it works I mean it's not so it's um unlike uh most medications there's a percentage of folks for whom it works really well some it doesn't work some have side effects no this pretty much across the board if someone does it it's going to work and and so that's a big part of the education I do at at the beginning it's you have no doubt that this is going to work because it's actually been studied now as much as a drug would have been studied for FDA approval and so yeah it's so um so well but the science shows that I mean if you go back and and that's I think an important um am important ammunition and backup to have to have the papers to show for the skeptical colleagues and and uh the Bowden Gunther bin was a um biochemist and physician in the US who did a paper in 2005 with 20 or so people with type two diabetes put them on a research board told them to just cut the carbs to ad Li it was you know ad live low carb 20 grams or so or less per day it worked in every month you know so of course that's only 20 in a row but the 20 in a row is a pretty good odds that some is going to work for everyone so right I mean that so have no doubt that this is going to work and on the other hand be ready to cut back on medications diabetes and Medicine really at first so that uh insulin and these other injectables need to be cut back really quickly and today most people are measuring the blood glucose which allows them to see the blood glucose come down really fast and cut back but we're um you know in a moment where just about any doctor now prescribes an injectable weight loss medicine and they think they they know all about obesity medicine which U is not true and I'm getting people coming to my office who are on these medicines and they're not told to watch out for their medicine to become too strong so I mean this is my public service announcement if someone if you're on a medicine weight loss shot or any that and and you're on other medication you got to be very careful other doctors may not necessarily be trained in what we call deprescribing and uh that is a concern because recently someone came in you know she was dizzy when she stood she didn't know why she was tired I mean your blood pressure was was way too low having lost 40 lbs on one of the shots and the doctors s tell her to watch out for the medicine coming down but anyway so coming back around yeah it's effect it's if you do it it works I within you know there's some people who you give them oh eat all the meat you want and and they make it like a competition it's not a competition it's a you know eat until you're comfortably full and so some people can have it eat or or um just kind of you know Nosh all day long and it doesn't work as well as for others but uh certainly even if you do that you keep the food very low in the carbs the blood sugar is going to come down and it will help with diabetes for sure uh but so diabetes obesity uh heartburn irritable bowel syndrome um PCOS uh arthritis pains um all of these things uh reliably will improve yeah fantastic and that that's what leads me to my my other uh question which was yeah what are some of the other benefits of a ketogenic diet I mean obviously you're you're in a specific scope of practice but do you do you apply this to other you know other other conditions as well well you know one of the reasons I stayed in a university practice was uh to be in an insurance pay system so I could understand the ins and outs of billing and and um and then also to be able to treat pretty much all comers so someone come to me with four or five different diseases they're on 10 or 15 medicine bring them on I mean that I I'll I'll handle it um and what's been fascinating is if you shift the body toward fat burning so you cut the carbs out and what I teach I guess you could call a carnivore is because what I was taught was you know eat as much as you want the fullness of meat poultry fish and shellfish and eggs and then you know two cups of leafy greens one cup of a non-starchy veggie it's under 20 total grams per day I I joke that it's carnivore is because carnivore I I see as a metabolic subset of the low carb kind of in keto approaches so when your body starts burning fat amazing things can happen and in fact people themselves find them uh in a couple instances they fixed themselves when the medical community was kind of at odds with what they were doing one example is the community of type one diabetes of course many of them followed Dr Richard K Bernstein's approach he has type one diabetes himself and father of someone with type one developed a Facebook group and we actually surveyed this Facebook group of super users of low carb for type one and it it was truly remarkable how good the blood glucose control could be how they parents weren't worried about the low blood sugars at night anymore and the paper that David lwig and the Harvard group had uh validated the doctor uh um lab values um basically was the most cited journal in the journal Pediatrics that year so the type one Community figure this out the mardal disease is a even rarer or well type one I say isn't rare but mardal disease is a kind of glycogen storage disease meaning the B's uh the body has trouble storing glycogen making it and so storing sugar so for years for the last 50 years the medical experts would say wake up the children at night and feed them sugar feed them starch CU they can't store Sugar and and so I met four individuals M with mcardell at a meeting one of these you know it was a society of metabolic Health the low carb USA meeting in San Diego and I said get up and tell your story and and they found that they could now walk up mountains where before they would feel exhausted after Walking 50 ft they uh one of the people told me the story she would pretend to tie her shoe when really she was just exhausted she she pretend to Window Shop because she was just exhausted one of the gentlemen told me that he ran for a train and became uh I had rabom myolysis had total muscle breakdown with CPK elevation kidney failure hospitalization that was totally transformed when they didn't eat carbs now they didn't know it but what they were doing is shifting their body to Fat utilization fat fatty acids and ketones and the muscles love to run on fatty acids and ketones it was the medical and and even research level fixation and belief that the muscles needed glycogen and needed to sore it that they were actually giving the wrong advice and developing well you know this is what happens with type 2 diabetes eat more carbs take my medicines right if it's not the only time but it's one of these things that the medical world had no answer for and these people figured it out plus the story continues the one of these people wrote a case series on it and I helped them get into literature and then now the world's experts on McArdle have shifted and they're studying low carb Keet diets so it's possible that you'll encounter people who have a new situation that no one else could fix you know they'll tell you I feel grave and and you know you have to just scratch your head and think a little bit that well one thing major thing that's happening now is your body is running on fat and the the benefits of that I think for these other conditions especially the glycogen storage diseases is going to be you know of the future major changes that this field you know of course Beyond type two diabetes that would be even major for you know monetarily in helping humans suffering type two diabetes and obesity are are even more important but but um these other orphan conditions just don't get much attention and so if you're someone watching this and you've had a rare medical condition and suddenly you're better you know we want to know about it in fact we um there are mechanisms now to get that information out and that all started with people going to a meeting and and sharing their experiences absolutely yeah you you mentioned uh Dr VC before he I mean he published a um the faster trial in 2016 we looked at Elite athletes on a ketogenic diet and they they' had been on a ketogenic diet for nine months to six 36 months average 20 months so they're very keto adapted and they and they looked exactly at that um at at what their muscles were using and they found that they were still oxidizing fat you using um fat oxidization for their muscles at over 90% V2 Max and so this is the old rumor that you know to be an elite supposed to Happ yeah exactly yeah and um but now he's showing that it is and so obviously someone and so that that makes perfect sense with people with cardal syndrome when they're they're not at 90% V2 Max however they they could they could be and so that's obviously going to cover them uh throughout their normal their normal daily life you know people get very worried about that no you have to have glycogen your muscles have to have glucose and they and they clearly don't and it's very important to show that although for decades the teaching if you were going to run was that you car blad the night before right so having Professor Tim noes recant basically in in the movie serial killers c r e l he rips out the chapter and says I was wrong and you run on fat for fuel uh again was even today in my area people well I'm going to go on a marathon I have to car blow theight no no no no um but uh and the ultra marathon Champion uh is carb guy but most ultramarathoners still are in the old view of eating carbs and you know uh but yeah the uh the I I think what happened is because these things were discovered first and medically discovered uh in in the context already of us as humans mostly eating lots of carbs that the medical world just kind of assumed that this was optimal you know normal the glucose got discovered first going back to the 1800s and when something's discovered first and the metabolism described sometimes that takes Primacy over other things uh I I've become kind of not begrudgingly but very slowly um into that area now where I do think that metabolically things work better if fat and ketones are the the main fuel the primary Fuel and even you go back to Dr Atkin's time he had a slide I remember he said you know fat is the backup Fuel and he even he had that sort of bias toward carbs being first I don't think that's really necessarily the case and you know after two or three days we all become fat burners because we store energy as fat on our bodies it it's that seems like the default mode and it's only recently we've had carbs in our but that's our life experiences so and you talk to uh world-renowned researchers they don't seem to get the idea that we live in a moment and you know they I think um you know we think we know everything when you know we're really just learning yeah hey everyone really happy to announce a new sponsor for the show and for everybody down in Australia Stockman steaks who are delivering highquality grass-fed and finished pasture raised beef and other meats flash frozen and vacuum sealed to your door something that I've been enjoying a lot of myself recently as well they also have a great range of specialty items such as high fat keto mints and carnivore beef and organs mints with liver kidneys and beef heart as well so use code cha today for free order of beef mints or another specialty gift along with your order at Stockman steaks.com you and I'll see you over there thanks guys we thought the Earth was flat for a while too you know that one didn't age so well and uh and I don't think this one will either I I I totally agree with you I think that the reason that we call the carbohydrate metabolism as a Fed metabolism that's why there was you know the terminology when I was taking biochemistry and then uh ketogenic metabolism as a as a fasting metabolism and this is when you're lost in the desert and your body's just trying to survive that that only makes sense if you you know if everybody's just eating carbs all the time we were you know by the time we were able to look at biochemistry from a at a molecular level everyone was eating carbohydrates so he said oh when you eat it looks like this and when you don't eat it looks like this it's normal to have a glucose rise after a meal yeah exactly and then insulin Rises normally and that just drives energy in a cell this is a normal process ignoring the fact that insulin affects hundreds of other physiological processes in your body and those are really important to keep in balance and also that ignoring the fact maybe not understanding the fact then that when you eat anything at all except carbohydrates it also looks like you're in a so-called fasting metabolism and I think that's starting to come around now in fact my niece is taking she's Premed and she's taking bioch or just took biochemistry and she said you know Uncle Anthony like they they don't call it a Fed metabolism there they call it a carbohydrate metabolism and a non-carbohydrate metabolism at least at University of Washington and so so that's good that's that's a bit of progress but I agree I think that that all of our heavy machinery biochemically comes to Bear when we're in that so-called fasting metabolism that ketogenic metabolism which I would argue looks to me as if it's our primary metabolic State and that seems to be the metabolic state of most animals in the wild they they've tested the blood of lions and wolves they're in ketosis even herbivore well 70% of animal species are carnivores and so they're getting fat and protein as their main fuel source but even herbivores that eat fibrous Foods they don't break that down for their constituent glucose molecules the bacteria and protozoa the microorganisms eat that and as a byproduct make short chain fatty acids and and die off and and make protein and so they're still getting fat and protein as well so I think that you know we're we're looking at this well no carbohydrates are our main our main fuel I guess we're thinking that we're more akin to hummingbirds than we are to any other form of life and we just need sugar all the time but I I would disagree and I think that when you see so many people's Health improve when you just have that that shift that metabolic shift I think that that speaks to this being a more of a Primacy State well but you know this is all testable so I I hope at least what I'd like to do now you know is to give the Baton to new researchers and clinical people as to say hey look don't worry too much about this okay you know study it right so yeah 25 years ago we our our first study was almost shut down because the hospital director got lobbied by a dietician to say we would kill people well the friends on the my friends on the research Committee just made me sanctioned me to do more reports to say you know is everyone still alive it was just a six-month St of low carb but back then that you know it was a heightened awareness and sensitivity to it so now you know this is worthy and and needs to be studied and there should be no IRB concerns about oh my God someone's not eating carbohydrates for two weeks you know so um I'm hoping that that communication has has made its way out and I mean for those of you who are doing this and you know I still think that we should monitor you know see a doctor every now and then and and uh um maybe look at the blood levels a little differently but but it's not like I have been telling people to do low carb keto carnivore is diets and then oh yeah don't you know see it in 20 years I mean I I follow people I I help them get off medicine and some people even need to come in every year to just make sure that you know everything's still okay and and um and even to come to a safe place where I'm not giving them a hard time about not eating carbs that that's still kind of frustrating that the a lot of the medical world is still giving push back about this it's a I understand if you have a different agenda and you're you're worried about um you know the people eating meat and things like that I mean that's an ethical reason ethical agenda but from a medical scientific standpoint that we shouldn't be hearing our patients get told that they're going to kill themselves by doing this you know yeah definitely I like I like how you to like carnivore is sort of diet I I explain that to people as well because you know a lot of the a lot of the uh data and science that supports a carnivore diet it comes directly from the ketogenic uh studies that have been done because it is a ketogen diet and so similar yeah exactly and so you should you should be able to get similar results on a ketogenic carnivore diet as you do on a on another ketogenic diet I sort of so I've I've described ketogenic diets as carnivore with a side salad and that's how I sort of get that across to people and they're oh okay that that makes sense and um and um I actually wanted to you mentioned type 1 diabetes I actually wanted to to to see if you've come across this before I've seen a number of people people that I've spoken to online you know type 1 diabetics definitely getting much better control U much more regular blood sugar levels very very regular um insulin dosages and things like that they're not having the big swings that can be unsafe and and even life-threatening but I have been hearing people saying that when they're in that honeymoon period that they just get diagnosed with type one and then they go on to a low carb kyogen diet um that some of them have been able to actually even come off insulin and I've actually had one patient where that was the case um she was in her early 30s she was a new presentation as a type 1 diabetic she uh presented the hospital with classic dka diabetic keto acidosis you know had lost you know like 20 pounds in in in a in a week and was viciously thirsty just just could not drink enough water and her husband took her into the hospital and she was inde Ka he brought he was a patient of mine he brought her in to see me about a week after she was discharged from the hospital uh we spoke about everything got her on to uh a very very yeah low ketogenic diet close to a carnivore diet but more keto than carnivore she still had a few uh non-starchy vegetables in in her diet and immediately her blood sugar normalized it was all over the place before that she was having these dips at night she was having all these hypo in problems couldn't get her dosing right and fair enough she's new to it but as soon as she went ketogenic it just leveled off completely leveled off and she was using very very clear defined amounts of of uh insulin and then steadily less and so I start I started checking her um C peptide and it actually after about 6 weeks it registered it was very low but it but it was there and so that's Gra that's very promising we continued on another six weeks later her C peptide was Plum normal her insulin was dead normal and she was not taking any exogenous insulin and so that was to my mind a pretty good result have you seen anything like that yourself yeah I've wondered that that might happen and it makes sense to me and I think that's a case study if you can get it together the on the iial editorial board of the Journal of metabolic health and not that that matters it's just that they they accept case studies and the reason that it might actually occur and it might be the tip of the iceberg that if there's an insult to the pancreas that makes it so it can't produce insulin it's going to look like type 1 diabetes if it's a temporary insult you know it's a it's a infection cross reaction um and and you get into the medical world they'll test you and they'll say you have type 1 diabetes and they'll never look again though I wonder if that is a tip of the iceberg meaning there are a lot of people who just have a temporary damage you know if like Ms can affect the the pancreas and other viruses but they don't let's say they don't do a total autoimmune destruction of the cells that make insulin it makes sense that some people's pancreas will wake up over time and and yet the medical world won't look right so it would be really interesting to look for more you know again hearing listening more anecdotes like this put them together U or even say if you had a group of type ones um and after X year so the honeymoon period you have to get through that because most endocrinologists will acknowledge that sure it's going to come back but then it's going to be gone uh but I wonder if he took a hundred people maybe five have had the insulin come back so testing the I I'll always T the C peptide in someone even if they tell me they have type one diabetes just in case uh and uh what what's interesting over time I've been to meetings where the the story was you know middle age my wife came down came down with type one and so then the husband came down I mean it it's the history was infectious so fascinating uh but no that's the first time I've heard a documented case of that and I'm not surprised I mean there's a so there's a biologic rationale why that would be yeah definitely oh that's great cool very cool yeah well I I was thinking about yeah writing that up as well and um yeah I Pro yeah if you need help let me know you know even the smhp has a small group of research support the Society of metabolic Health practitioners yeah very good um so I also did want to know obviously you you deal with with weight loss medicine is what would be your views on on the sort of the the current invogue treatments such as you know the the wois and oics and things like that is that something that you use in your practice or is that is that something you don't you don't find that you need or is it still beneficial even on on in this context well um so I teach a dietary approach we studied it published papers it's it's reliable it works you know have no doubt this will work so that's still what I like to lead with if someone's never never tried uh a prescription strength diet or or medications even pills and shots and surgery i' like to start with diet alone and just explain that if this clicks that's all you need most um doctors don't understand that most doctors now are are following the Pharma education and and the the um the effectiveness of these weight loss shots and and the the marketing is just everywhere now and so I have people coming in um story recently my my primary care doctor three months ago said you need to go see Dr Westman but it it's going to take three months so here want you get on this weight loss shot so had already lost 30 lbs of course the doctor didn't say watch your blood pressure so she came in with a blood systolic of you know 855 and was feeling dizzy tired so you know you got to watch out but so these are powerful medicines that the doctor needs to understand how they affect the other medications u i i well sometimes so the other curious thing that that's unusual is a third of people have significant nausea or stomach pain or diarrhea even in the clinical trials so a third of the people dropped out most drugs won't be taken to the market if it has that messy profile you know but the the market is so big and for those the 2third For Whom It Works without side effects it's having benefits so but some people will come to me now on a shot thinking that's the only way you can lose and have terrible nausea and just it's it so the doctors send out Zofran to treat the nausea of the medicine and and I try I try to explain what hey wait wait wait I can teach just with the with a diet and you don't even need these shots and but you know if someone gets on that and the other doctor didn't mention the diet they think that's the only way it's going to work so you know I am past president of a group of doctors that use these medicines um a lot and they use it safely with the teaching of diet with the medicine not all doctors are doing that and there is a concern of the muscle mass loss if you're not supporting the protein that you're not taking in and you're going to lose some muscle mass so the I guess the long story there are healthier ways to lose weight than to use one of the shots uh for some people it's a a godsend because it's it's simple they've hon down the delivery system that you know any even I could do it any even a doctor could inject which I'm not a surgeon sorry so you wouldn't understand that one but um uh I think there there's going to be kind of on balance in general that'll be more good than harm but I think you could do it even more elegantly by just changing the food and you know doing a carnivore diet and you're not subsequently getting the side effects and having to find we're in an awkward moment where the range of cost could be from $3 a month to $11,000 a month for an individual if the insurance isn't covering it and and some people are paying 500 out of pocket per month for these because they think there's no other alternative uh you know I I go to the weight loss meetings with other doctors who use this called the Obesity medicine Association and the uh concern or what I observe and it's just I guess an evolution of the field the medic have now influenced the meetings so that you as you might expect that now the booths are big and the doctors get free meals at the dinners and and and it's like Midas has come through with the gold touch to make the doctor meetings nicer and better and of course that's going to make these doctors prescribe medicines more uh but uh I think there's going to be more good than harm uh although I I have concerns um and you I think you want to use one of these medicines with someone trained in obesity medicine not just the family doc saying here take it yeah yeah I would agree and and especially with the the dietary advice as well because I think that's that's such a a big part that's missing from you know using these weight loss drugs or even weight loss surgeries I I know people who have gotten these surgeries done had patients that have gotten these surgeries done or have been on the oics ETC no one no one talks to them about proper diet and lifestyle they you know in fact um I had um one person I know had this weight loss surgery and they they formed a stricture and so it was a very you know narrow opening from their their stomach to their small intestine and they um couldn't really eat much of anything and so the dietary advice was you just need to drink a lot of soda and ice cream and just get as many carbs and sugar as you can because you need at least 1,200 calories it's like where are the nutrients you know why and and so you're telling these people to it doesn't the calories are the only thing that matter nutrients you know can take a wash and they were getting they were getting quite serious uh nutritional deficiencies and getting hair loss and other sorts of serious issues and when you when when you do that you're forcing them to limit the amount out that they're eating and then the will go inmic and cause gastroparesis and force the same issue but you're not teaching them what to eat and so they have this um they they sort of get worse um habits as a result of that they're just forced to eat less but they're they're eating the same bad things or even worse things it's just they're they're forced to eat less of it and I think at the end of that when you come off the OIC of the wovi or you you start stretching out your stomach again after a gastric sleep you you have these very bad eating habits and then that's typically why people regain this weight and they lose muscle mass they lose lean body mass and then they regain all of this uh you know adapost tissue and this fat and I think that's likely why I mean think if you're going to do a surgery or an OIC that you you have to do it in conjunction with a healthy lifestyle and diet otherwise you know what's the point well you know you're on and unfortunately that's not the the norm so if you have weight loss surgery you know you like the ruin y gastric bypass you you don't have to really say anything about food may people will lose 180 200 pounds over the next two years pretty reliably and so from the surgeon standpoint I could understand well you know it's you know not a surgical problem anymore right but then when the weight loss stops generally the surgeons don't want to hear from the patient because they want to operate and some will some won't and so we want people who have had weight loss surgery to come to obesity medicine doctors where we will welcome you with open arms and teach you how to maintain and and even lose more weight I mean it's very unusual for someone with weight loss surgery to achieve their High School wave I mean they no one's taught them how to do that and and we see that not on commonly teaching lifestyle because it'll continue to go down but yeah so that's the same concern with very low calorie diet programs the bar shake programs the the weight loss medicines that if no one teaches you how to sustain it it's just going to come back and and of course it plays into the drug company's hands where well we'll just keep you on it forever and and they've already kind of anticipated this with clinical trials that show well if you randomize then people to Placebo or the real thing out here people regain the weight so we'll just keep them well but you didn't teach them how to eat so so why not teach people how to eat up here they'll lose the weight using the the food based diet program and then they'll also maintain it but you know it's kind of like the wild west out there still you know cowboys and you know um you can uh say with without recourse that surgery is the only thing that works I see that and it's not true but if you're uh it's kind of like car salesman you know my car is the best well U there are a lot of cars that work a lot of programs that work in in my area there are you know half a dozen different programs that that work and different styles but you want to be in one that that will help you not only lose the weight but also sustain the weight loss and I don't see the the Pharma companies stepping up to help uh educate about diet which you know is it their job uh you know yeah I think so but but others don't yeah yeah well and it's yeah I mean I guess from their business perspective you know they they're more than happy with people being obese and eating garbage because then they get to to sell more of their of their products but of course that I mean that's and that and that can be their incentive and we can we just need to understand that you know that there it's not this um you know altruistic charity that they're they're just really hoping against hope to just better Humanity it's a business model and that's fine we just need to recognize it for what it is and if we want to if you want a cure if we want a long-term solution and um and and just a solution in general we're not we can't really rely on them uh to do that you know that reminds me me of uh have you seen this new movie called first do no Farm PM no seen it yet no Donald O'Neal who did serial killer serial killers 2 features aim mahra aim is a cardiologist in the UK who got in hot water questioning Statin use but in that uh movie which I highly recommend uh they interview Fiona Godley who's the past editor of the British meal journal and she kind of tells a story about the Statin drug companies and the industry and how they've asked the companies to open their data to be transparent about how good the the the drugs are and they they won't and so it makes me and she said you know they always did clinical trials to just show that their drug works better than Placebo right they didn't ever include a lifestyle or any other sort of thing and that's what we're going to see with Drug Company studies today they're just trying to prove that their drug Works Beyond Placebo without regard to let's say a different lifestyle approach or something and and yet what Fiona Dr godle said in that video or the film is they could have done that I mean how many how many gazillion dollars have been spent on these Placebo controlled studies when they could have added in something very simply to for the greater good of you know of the rest of us but that's not the the company agenda it's it's to get the approval of a drug now you know that's a great a plug for doing post marketing studies where now that drugs are out there what we do is we compare it compare a carnivore keto is uh study to these other medicines and I've seen people do that um in figures with not in a prospective randomized way but the results we get from diet alone are are comparable even you know without the side effects and and the the expense yeah and and and and more beneficial side effects as well you know some of pleotropic effects that that that add further benefit as well and and certainly a lot of um these benefits have been already shown in ketogenic diets already it's just a matter of of getting it out to the clinicians to start actually putting it into practice you know we've come across this information but it was certainly not spoonfed to me in in medical school or else where I came across this because I was investigating is is you know coming to the realization that I did a lot better on a carnivore diet humans biologically that's been our evolutionary past okay that makes sense to me but do we have any data on this what do we know what can we prove and I that's when I started really digging into the literature asking questions and trying to answer them by by looking into the literature and I came across the whole ketogenic body of of information thousands and thousands and thousands of studies and and that made sense to me it's like well this is a ketogenic diet typically you get rid of carbohydrates you replace it with protein and fat that often comes from meat and so a lot of these studies are looking at a high-fat meat-based ketogenic diet approach and and so that makes sense and so I found that and and that made a lot it made a lot of sense to me there's a lot of very good evidence showing and supporting the use of these um dietary interventions in in clinical practice and just in everyday life but what I come to realize is that there's there's because there's no product behind it it's not like there's a pharmaceutical drug or big keto or something like that it's not going to it's not going to get uh lobbied at medical schools to be taught or in residency programs or they're not going to be SP sponsoring major conferences they're going to draw a lot of people and they're not going to have drug reps coming in every Tuesday and Catering a lunch you know ketogenic lunch buying everybody's steaks or anything like that because there's there's no marketing budget because there's no product line and that's the thing we have to go find this ourselves I I had um colleague of mine who I remember we were were coming into Like A Tuesday meeting it was being catered by a by a drug rep and she's just really excited like oh I love Tuesdays and I was like oh free lunch and she said no it's like I just get to learn new research I always love it they presenting new research and new studies and I was like you know this isn't this isn't like the the research wing of the hospital coming in to tell us what they've discovered like this is this is this is a sales rep you know this is just they're telling us the the studies that you know fit their purpose to try to make us use their drug you know but but we think about it like that our continuing education it comes from these these reps that come to us and going to you know conferences and and we're just being spoonfed um but it's not going to happen with with this sort of intervention we have to go find it and so I I you know which is why I want to try to spread this out to as many clinicians as possible so they can start looking into this for themselves the information is there the evidence is is clearly there it just needs to be picked up and I'm still trying to figure out a way of like how do we how do we actually get this into those Tuesday meetings and and get this dispersed out to more people I don't know if you had thoughts on that hey guys just want to take a second to thank our sponsor at carnivore bar I don't promote many products because honestly all you need to be healthy is to just eat meat for those times that you're out hiking road tripping or stuck at work and you want nutritious snack that is just meat fat and salt if you want it the carnivore bar is a great option so I like this product not because it's just pure meat but also because I want the carnivore Market to thrive as well and the more we support meat only products the more meat only products there will be available in the mainstream so if this sounds like something you'd like to get behind check it out using my discount code Anthony to get 10% off which also applies to subscriptions giving you 25% off total all right thanks guys well I have couple thoughts um and on my way to that direct question in that movie first do no Farm aim Dr Mahal visits uh the he goes around the world and he visits Cape Town South Africa where Nelson Mandela and Gandhi had been and he talks to one of the leaders there and and he says well first you if you're going to make a revolution is you take over the education like this is a time honored way to do things right and and so basically Pharma has taken over the education of medical schools yeah it's clear um the other thought though I had was I did meet a a very um driven individual in Indonesia and Tio preto is the father of someone with cereal palsy a child who was told he would never walk and talk and and he sleuthed out well how how do you what do the children need in the brain and and they said well myin and and he said well how do they make milin Tio being engineer said well we can fix this and well you know it takes ketones and cholesterol and he said well let's give it to him so basically Tio has gone around Indonesia himself and Lobby doctors teaching them biochemistry so thinking that individuals can do this but I mean this is a heroic you know only the well one of the certain times when there's this heroic power or feeling of of energy is when your child is affected by something and you found something that fixes them so he's felt compelled to teach all through Indonesia put on a conference in Jakarta and I got to go to that meeting and the Facebook group they have is called keto fosis Indonesia and the overlap there with the mainly Muslim country is they're very comfortable with fasting it's you know something they learn through their their culture and religion and so so one one person could so we could develop an army of volunteers of people they they retired from their first career they they are now you know 70 and they they have all this energy now because they fixed their medical issues well let's put them in an army to teach it doesn't have to be a Pharma company or or doesn't have to be a lot of money involved to do this but that's uh Tio's experience which it was pretty amazing to hear yeah it' be great if we could get we get some people around to to go and and spread this around I I I would I would volunteer if we could get that going but but you have to bring food yeah yeah I me the doctors are are accustomed to being fed unfortunately in my area it's you know the fancy Steakhouse so but if you have leave behinds at the office I I'd love to have that yellow book edited by nutrition Network and Prof noes the ketogenic textbook I'd love to have that sent to Department chairs or or doctors locally or certainly if if you want to influence your doctor um you'll give them a present at at the office have it be that yellow textbook although it is you know 100 bucks or something so but educating you know that I guess that's my uh so belief that this can be uh solved oh oh but solving something um is the answer for having things change so when we can fix things that medical the medical EST establishment can't that's when people will gravitate toward this is that we just have to make the awareness be that you don't have to have type two diabetes you don't have to be on those medicines and I think the showing that we can do that and they can't is going to be how this area wins yeah absolutely so um just to wrap up I'm I'm conscious of your time but I did want to ask you one thing because it's something that comes up all the time people go into a ketogenic diet and um and all these things are getting better their diabetes getting better the metabolic markers are getting better their blood pressure coming down they're coming off medications but then their doctor checks their LDL and goes oh my goodness you have hypercholesterol you're going to die this is going to kill you um and people get very worried about that um coming from you know professor of medicine at Duke what what would be your response to that yeah so take a deep breath tell tell your doctor to take a deep breath and what you want to do is learn about a syndrome called metabolic syndrome so the old way to look at a cholesterol pan Chanel is to focus on the total and LDL cholesterol the new way is to look at the triglyceride and HDL cholesterol so I'll just pull up those four Labs over time and cover two of them the old old way oh it looks worse and then cover the other two the new way oh it all looks better so you have to have the ability to just insert the knowledge about the new way to look at the cholesterol panel and then most people will will follow although in my clinic if someone's doing a low carb keto carnivore approach for a decade or longer which they have I don't Focus so much on the cholesterol anymore and I'm going more directly to measuring the arteries themselves so in our area we can get ultrasounds of the arteries at low cost but people have to pay for it we can get coronary artery calcium scores and CT angiograms a little more expensive but the testing for these diseases is is the way to go because I've seen people with no arterial disease at all be put on a medicine for a cholesterol level so I teach my people in in in My Tribe to repeat after me cholesterol is not a disease cholesterol is not a disease atherosclerosis is the disease that you don't want to get and that's what we're treating with with treating cholesterol so if you don't have atherosclerosis you know especially if you've lived to the age of 70 and you don't have atherosclerosis there there's no reason to Beyond a medicine to treat a condition that you don't have and and and yet it the medical mainstream won't it doesn't compute they they'll still well but you might later and and know you wouldn't give chemotherapy to somebody for cancer on the odds that they have cancer that's basically what's happening with the cholesterol treatments now odds are you have it so we'll treat you well you know we can personalize things better than that and so it just takes a little education and and of course uh get a second opinion is the other way to say it or or say doctor thank you so much for your concern I I'm going to talk to my other doctor about it and and I'll be back and you know I've heard stories of doctors firing their patients well if you won't take it then get out well they must be on some kind of quot to have a percentage of their their folks on on a you know I just can't um see that as a rational way to to do things but most of the time people are not asked to look at the arterial system they they are just told to be on a drug because of a cholesterol level and we can do better than that yeah and so you've been you've been doing this for quite quite some time so like you said you'd have patients that upwards of a decade on these these diets that could have so-called high cholesterol I just think it's normal that's just what your body's trying to do if you fast for five days your LDL is going to go up too your body's trying to do that anyway um and is that what you're finding that people uh when you actually look at their vasculature are they free of disease with long-term ketogenic diets well you know that's a study I've never done and maybe time now to kind of roll out the people in my my clinic panel you know I've been more following the lmhr study that Dave Feldman cholesterol code looking at say a hundred people in a controlled study like he had uh but that I'm now finally getting the I don't know reputation or in a good way so that uh a medical student this last year reviewed the charts of our patients um that's the other thing we're trying to find money for research you can get un unpaid students to do this as part of their learning experience but he assembled all of the people we've been treating for heart failure and kind of in a strange Twist of drugs working through ketosis now the Cardiology world is waking up to the idea that ketones might help heart failure so this so he said well this is you put together 150 people that we had had with some sort of heart failure and you know no there weren't miraculous changes but you know uh the idea is that it was tolerable and and people lost weight and and uh that whole story about the sglt2 Inhibitors which cause glucose in the urine and also ketosis I think it's pretty established now that it helps heart failure through ketosis and now it's a matter of percolating through to the cardiologists that you can actually achieve ketosis without that medicine it's called keto it's called carnivore but no I mean that most of them are still in the this kind of barrier of you can't cross the high fat you know diet that they're still stuck in that old way of thinking it's just too bad yeah thankfully some are coming around in the in the low carb sort of groups there's there's one in Australia that I that I in in my area I just met him recently and he's all for ketogenic meat-based high fat approaches for his Cardiology patients and he made that same point about heart failure medication and ketones and he's he's very interested in in applying ketogenic diets to heart failure patients and so it may be that we we might be able to get a you know a small clinical trial going on that to see that and uh yeah I've seen I've seen the same thing anecdotally I've had um a several patients actually that have had actually quite severe uh heart failure congestive heart failure some es schic actually which is very interesting because if you have you if you have a heart attack you have this dead wall of your of your heart it's probably not going to come back to life but it seems that that the rest of the heart works better and there is some improvement you know going up from you know 15 20% uh injection fraction to 33% injection fraction in one case so that I mean that's that's going to make a big difference in that person's life and I've seen 20 to 50 20% 50% and of course there was 140 pound weight loss along at the same time but but that's okay too I mean that that's the other as I presented this years ago people were like well you're you're doing too much we don't know what the mechanism is and I well but but but so the diabetes is gone and the weight's down what's wrong with that but it could the weight loss be I never was so much a stickler on the mechanism I'm more of an outcomes kind of person and in a recent study of the heart function and heart fuel utilization the muscle itself runs on fatty acids and ketones and but in that paper in the abstract they wrote we were surprised that very little glucose was used and you know don't write that in a paper shows shows your ignorance that you know the heart knew it all along the heart knows that it like so anyway um I think they were just trying to emphasize the shock that uh yeah the heart does great with with fat yeah i' I've seen studies thing it's just being in ketosis and running on ketones can improve injection fraction by 30% or so just the ketones and um in that in that case the lady went you know up 15 or so points 15 20 points that was with an es schemi case I mean she had had a massive heart attack and had had heart failure as a result of that and then other non-ischemic cases I've seen even more dramatic improvements where they went one gentleman went from 14% ejection fraction to completely normal cardiac function in um I think it just less than 6 months very strict but it was it was massive massive Improvement you know there's kind of a strange irony or or deliciousness in the fact that the very diet that was thought to be the most harmful is the best is the best there's so many things that you know like the food pyramid needs to be turned totally upside down and then it's the best yeah yeah it is funny yeah it's it'sit bit of sweet irony that's yeah unfortunately a lot of collateral damage along the way unfortunately yeah yeah absolutely well uh Professor Westman thank you so much for your time I I I I could talk to you all day but I I don't want to monopolize your your time I really appreciate you taking the time to come out and speak with us um please let us know where we can follow you and find more of you and and support your work and and find your books well and thanks for having me I I really love what you're doing well I have an important announcement for those who have pre-diabetes or type 2 diabetes I have a free live webinar coming up on February 10th right and about the labs it's live I I go over the A1C the glucose but also triglyceride HDL and how low carnivore keto can reverse type 2 diabetes and so that's a free live seminar on labs for diabetes on February 10th and you can learn about that at my website adapt yourlife academy.com you just sign up for the the Bry live seminar there and we'll get you in touch but it's exciting to teach this to to people and more and more people are interested which is fantastic perfect well I'll make sure all those links go up and I will try to get this up uh in the next week or so so we can get it before that conference so we can help publicize that great Professor wman thank you so much for your time I really appreciate it take care take care hey guys thank you very much for taking the time out to listen to what I had to say if you like it then please like And subscribe to my YouTube channel and podcast and if you're on YouTube then please hit that little bell and subscribe and that'll let you know anytime I have a new video out which should be every week if not more and if you could share this with your friends that would help me get the word out and let me know that you like what I'm doing thanks again guys