[Music]
dr. Westman has been working with
patients with obesity of the metabolic
syndrome of type 2 diabetes for more
than 30 years and in this lecture he
describes his practical experiences
gained from those 30 years there's
probably no one else in the world who
has had so much experience with this
thought in this disease as has dr.
Westman good morning and I'm going to
dive right in time short if you were not
here the last few days we've had people
come from all over the world to talk
about low carb diet research and the
latest thinking about low carb high fat
diets and this little study published in
2002 was putting 50 people on a diet for
six months to see what happens and
that's my litmus test if someone asked
me what about the blank diet I say has
the blank diet been studied over six
months with 50 people and published in a
journal so we know it will happen and
usually people fall silent when just
asked that simple question can you show
me a study based on whatever you're
promoting this was back in 2002 and the
prior article about this approach was in
1980 so there was a 22-year 22-year
barren wilderness of knowledge about
this kind of diet so what I'm going to
do this morning is give you great detail
I'm going to pretend you're in my class
at duke university medical center coming
to me to fix your lifestyle in a way
using the low-carb high-fat approach and
what happened on average in our first
study was this that over six months
there was a ten percent weight loss when
we didn't even say anything about
calories we didn't even follow people
that carefully we didn't even have a
dietitian and it still worked we went
back to the funding organization I don't
know why perhaps it's because I'm a
doctor be caps perhaps it's because I'm
a son of a doctor that I went to visit
doctors who have been using this
approach for their
careers and sat in their offices and
tried to put together a research
protocol based on what the doctors had
done and turns out that that was unique
among all of the studies that were done
and so we went back to our initial
Thunder who happened to be dr. Atkins
and said you need to do another study
that one wasn't enough and then we did
this a randomized control trial our
means randomization so in this study
people couldn't choose what to do they
either got the prevailing diet of the
time or of the era the low fat low
calorie or they got the low-carb
high-fat diet and again the results were
pretty phenomenal these are weight loss
results that are similar to what you
would expect with a drug with a
lifestyle change and as we saw over the
last few days these studies have been
replicated all over the world and i
think is dr. Ian felt from Sweden showed
that the score is now 25 20 low carb
overload fat and as we saw i'm not a big
numbers guy but you know if you're
talking about rugby and football and
soccer all that that's really a big
victory right one of the saving graces
of having patients is that sometimes
they come out and help and teach you
that's how I got into this two of my
patients did this diet and I was
skeptical I went through all of the same
kind of skepticism that I'm hearing from
you today cholesterol has to go up so
it's not good for you that's what I said
and during my first study when it was
going to be at least shackled a little
bit out of fear of causing harm with a
research study on a low-carb high-fat
diet in 1999 a patient gave me this book
which was the prevailing textbook of
medicine for for about 50 years it's the
william osler textbooks of medicine and
she was a used bookstore owner and said
doc I know this is North Carolina so i
put on my southern accent you know dr.
Westman i know you're kind of a history
buff and so I brought this book from my
book store I don't know if it might be
helpful I looked in it and and the diet
for diabetes in 1923 was the diet I
studying in 1999 and also in being
criticized for probably harming people
so before medicines were available for
diabetes the smartest people on earth I
hope the doctors okay maybe well back
then this is the guy that they were put
on a 10-gram carbohydrate diet so so
let's see I have to show you now then in
the clinic we go way beyond the research
as I learned yesterday these are the
diabetes studies we did and we also
learned yesterday that the cardio
metabolic risk goes down on a low-carb
high-fat diet because the triglyceride
goes down and the HDL goes up if you're
going to talk about cholesterol levels
the reduction of medication so you get
into something like diabetes is pretty
remarkable here's just a list of the
hemoglobin a1c going down with medicines
being taken away and for individuals
this is the kind of response that I see
I add up all of the insulin units on the
and here on the y-axis this is a hundred
units of insulin per day and in this
person the blood sugar the minimum and
maximum in our system we use milligrams
per deciliter 120 to 140 this would be
maybe seven to eight and the blood
sugars are as good over the six-week
period without a hundred units of
insulin after taking the carbohydrate
out of the diet and I teach you how to
do that let me just go through a bunch
so 80 units a day discontinued in one
week my personal world record is taking
someone off 180 units of insulin in one
day in retrospect actually this has
happened twice in one case the person
was drinking coca-cola the other case
they were eating bread pretty much all
day so a lot of people are on medication
to treat the food they eat you change
the food you have to change the medicine
this is a cautionary note if you're
going to try this at home and someone's
on medication you need to be careful you
need to be monitoring this I've even had
doctors mess up on this 60 units often a
couple weeks
really isn't much weight lost by that
time I've heard a lot of people say oh
well is the weight loss and now it can
be just the food and just to illustrate
so this is 17 pounds lost over three
weeks and the insulin off in three weeks
180 units off in a day please note also
i'm not going to show you much data on
the weight loss but over six weeks this
person lost 20 pounds so eight kilos
over that period of time 20 pounds again
that's the second row from the bottom
and 160 units off in six weeks now it's
not true for everyone and here it just
shows the type of insulin and you know
we're seeing people now on a 250 to 300
units 500 units of insulin a day the
insulin manufacturers have come out with
you 500 meaning it is so concentrated
you can actually give 500 units in a
very small amount of volume and as we
learned over the last few days that's
not the answer to fix diabetes it's
giving more insulin does not fix insulin
resistance just as a show of hands how
many are new today can you just okay so
I would say just about all of you
welcome we've had a great time great
hospitality I love South Africa now what
I would like to do is a time-honored
teaching technique called a role play so
I'm going to leave the stage get changed
like I'm going back to my office and you
are in patient coming to my class you
have to imagine we're in a room about
this size sitting around a table and I'm
going to teach you how to do a 20 gram
or less low carbohydrate high-fat diet
okay I'll be right back
welcome back last week when you were
here we met for about 45 minutes and I
listened to your story about how you got
here to this room and many of you are
here because you did what you were told
and what you're told we found out in
isn't correct and what I like to do I
looked at your labs if you hadn't had
blood tests done to look at your kidney
function liver function we repeated them
and they looked fine thyroid function
look good so you don't have to worry
about that remember you're in a medical
weight loss program and I'm your doctor
even though I'm talking about food it
may seem strange that's why I put on the
white coat to remind you that I'm a
doctor and I call this the no sugar no
starch diet because that's really the
basis for what happens in our body to
create fat and store the fat and make it
so you can't burn your fat is the sugars
and starches so a lot of people
understand the sugar in the food raises
the sugar in the blood and it turns out
that raising the sugar in the blood
raises insulin in the body to lower the
sugar and insulin has an unintended
effect today if it's how we were
designed though when insulin goes up it
tells our bodies to make fat and to
store fat and to even lock it up so that
you can't get to it this is why Sir you
would have lived much longer than I when
the famine came and not so long ago that
was every winter ma'am you would have
lived longer than me because you are a
good store of energy and so you can see
what was created in our body as a system
to save us from famine from winter time
is now a liability because when's the
last time you didn't have access to food
yeah so oh you eat a lot so timeout
so this technique called role playing or
is a so timeout I'll talk about this so
I developed for a poor the first time
you came to me I spent time I listened
to the story people come back I have
about a thirty percent cry rate in my
practice and actually I see that as a
good thing at first I was worried and
all that but for the first time I'm the
doctor who's listened to the story and
for a lot of people that's huge so so
it's not just a low-carb diet but it
really is just the low-carb diet but I
found that you have to develop rapport
when I'm going to be contravening
trumping going against what other people
have heard elsewhere so what people tell
me down the road I've been doing this
about eight years after the science was
collected I did started a clinical
practice at Duke and people tell me well
you know you're the first one that
listened to me you're so you develop the
report and and you get results quickly
and things change that you really well
you'll see oh wait you saw and then it's
really nothing new I'm teaching what was
taught about a hundred years ago for
diabetes okay time in the no shirt or no
starch diet so it's going to take us
about 45 minutes to work through this
and I'd like to see you back in a week
or so to make sure things are working
well so have you ever been told by your
doctor to go and just lose weight and
then they say come back in six months or
a year it's not very helpful is it in
fact the doctor might have said go and
exercise more exercise more well it
turns out exercise really is not helpful
for weight loss diet is more important
and it turns out that story of the blood
sure evening foods that raise the blood
sugar that raise the insulin and makes
your body store fat and lock it up will
help you to understand what's going on
behind the scenes so you want to lower
the insulin level one way to do that is
to lower the blood sugar level because
blood glucose technically but sure
because the blood sugar goes up insulin
goes up and why not takeaway foods that
raise the blood sugar
as an elegant way to lower the insulin
level so that's what's going on behind
the scenes another way to think about it
though is that we're taking your body
from being mostly a sugar burner a car
burner to a fat burner and Anna you've
probably never heard of this I see your
blank face it's a reassuring that its
new and I'm here for a good reason turns
out we burn what we eat we're pretty
adaptable as humans which is fantastic
you might call that being an omnivore
okay you can eat plants you can eat
animals and meat but if you're so if
you're eating carbohydrate you're going
to have to burn that carbohydrate now
ma'am what kind of weight do you want to
lose do you want to lose water weight no
your honor his muscle weight no you want
to that wait that's right you want to
lose fat weight so how can you lose fat
weight when you're burning sugar hmm
it's very difficult so if you're in a
car you have an accelerator and
accelerator and a break and the
accelerator is the fat burning and now
you're eating carbohydrate and you have
to burn them you're stopping the fat
burning so it makes sense to not eat
carbohydrate when you're trying to
maximize the fat burning in your body
and oh you've never heard of that before
well but it makes sense yeah well Oh
what you heard before didn't make sense
ah and it didn't work yeah I remember
your story you told me you tried
everything you try the low-fat you tried
the ultra low fat you tried the low
calorie you tried to the shakes and the
bars and all that well this is really
the fundamental principle of how our
bodies work it's through that insulin
level going up so I can pretty much
guarantee that if you follow this it's
going to work but I can't guarantee
you're going to do it so that's up to
you but I want your body to become a fat
burning machine now let's take that one
step further if you
have a out the window here you see the
cars if you have a car and it burns gas
or petrol what do you put in it gas
petrol yeah so if you have a body that's
a fat burning machine what do you put in
it you couldn't say it could you fat you
eat fat so if your body is a fat burning
machine it's okay to eat fat well I get
to go to meetings you know being a
professor here at Duke I get to meet
exciting and fun and radical people
around the world this dr. Steve Finney
taught me some years ago that we burn
what we eat and so if you want to burn
fat you don't want to eat carbohydrate
because that'll maximize your fat
burning make sense yeah and even then if
you're a fat burning machine it's okay
to eat the fat because you're going to
burn that fat and dr. Finney and dr.
volak did a study that actually showed
the fat and the then the blood goes down
even when you're eating more fat because
you're burning the fat so when you're
only eating a low-fat high-carb diet
you're not burning fat you're fat levels
are higher in the blood but now you may
not have heard that your doctors might
not have heard that your research
colleagues may not have heard that
because the paper just came out two
years ago now in the research world that
means that's recent I know in the media
world that's a known evil even wants to
talk about it anymore but so if i want
your body to be a fat burning machine
don't you yeah okay there are other
metabolic effects that can improve I
know you came here to help your
triglyceride and you came here to help
all of the other chronic medical
conditions that you had and actually
many of those things get better in my
knowledge about medications all of the
yeah I average the medicines that you're
all on then you're on an average of six
medicines so don't feel so bad time on
this is a medically significantly potent
intervention which is one reason why
people who are trained in a dieticians
as nutritionist
fear this method or are unaware of it
they're not taught it because if if I
treat someone and they're on a hundred
units of insulin like I showed you and I
don't reduce it immediately they're
going to have risk of a very low blood
sugar and this can be life-threatening
if you're driving a car and you pass out
from a low blood sugar and crash I don't
want that to happen so you're going to
it's an emotional thing we learned at
this conference I learned several things
one is that there's some problems that
you can fix rationally with new data and
there's some problems that are just
emotional and you can't fix them so or
it's more complicated than just
presenting data I think one of the push
backs that i have seen among very
well-intentioned people is that they are
just unaware of how potent something can
be the diet most of your doctors are not
going to know that diet is the most
important thing it's the most important
thing that they can influence in our
area and I was trained to give
medications instead of addressed the the
diet or the nutritional input so time in
sugars and starches are also known as
carbohydrates or I'm going to call them
carbs and they can be measured in grams
to maximize the fat burning it was found
empirically meaning in lots and lots and
lots and lots and lots thousands of
people that the carb intake should be
less than 20 grams or less per day so
the only number I want you to remember
is 20 can you remember that for 20 so 20
grams I want you to stay under 20 grams
of carbohydrate a day this means that
you have to avoid sugar bread pasta
flour fruit did you know a slice of
bread has 15 grams of carbs in it yeah
who would have Buddha thought the Apple
the fruit you noticed in my clinic on
the wall it says fruit is nature's candy
yeah an apple has 20 grams of
carbohydrate in it a banana 30 grams if
you want to maximize your fat burning in
your body you don't want to have that
much a sugar in start so no fruit no
flour nope no pasta yeah I didn't
remember you
raised in Italy and and your father was
a pasta maker and and yet you have a
problem with your weight hmm so another
way to think of this though is I want
you to eat real food have you ever seen
a pasta tree no that's right a bread
tree well uh breadfruit that very funny
yeah time out so it's amazing I give a
lot of information okay and it's in one
sitting and the reason one reason for
bringing people back making sure it's
working make sure to get people on the
right track I had this person come back
I don't make people write out what
they're they're eating there's too much
work one of my philosophies is to keep
it simple make it easy and this person
came back and she wrote down which he
was eating I make you do that when you
come back and she wrote that she was
having oatmeal which has lots of
carbohydrates in it fruit had lunch a
lot of sweet tea which is in an hour
area of the world is with sugar your
dirty it comes with sugar in it and you
have to ask for unsweet tea and and so I
taught a spent an hour going through
toddler this and she came back and I'm
doing the no carb diet and I said I
don't think so she's open I'm not having
soda I'm not having carbonation
so you know one of the great things
about this kind of world in life is that
I get to help people and that's what
makes things exciting every day is
different and some things you just you
think you're teaching the right thing so
i make sure i say carbohydrate a few
times but so careful if you just shorten
it to carbs it might get misinterpreted
ok back to the class you know you don't
have to remember any of this background
i remember sir that you grew up in south
carolina and went through the fourth
grade it's okay you know sometimes being
too educated is a liability because they
over edge they overthink things and so
all you have to do is stay to the food
on page four really that's all you have
to do and no don't go to page four yet
okay but I'll get the page 4 and go over
the foods that I want you to stick to so
one of the things that I learned from
other doctors doing this is that if I
made it pretty simple and clear what I
want you to eat the foods that I wanted
to eat that would help me in keeping you
on track and that's what I want I want
you to be successful but the way this
works when you stay to those foods is
your hunger will go away often in just
one day and then you're going to find
that you're eating less when you eat
less you eat fewer calories you will
start to lose weight if you have extra
fat weight on your body so that's how
it's going to work so you can remember
this i'm not going to quiz you on the
the insulin story and all that but i do
want you to remember that what number
did I want you to stand her again 20 20
great nice good like there's some side
effects I want you to be aware of most
people don't get them but occasionally
people will change the way they eat to
this way and they'll feel headache they
might feel some flu like symptoms muscle
aches things like that that's okay the
short-lived maybe less than a few days
but there are ways to overcome that
we've learned a few tricks like having
bullion and salt as a supplement the
first few days so if you don't have high
blood pressure or a history of heart
failure I'm a wreck
men that you have solved you might have
some muscle cramps down the road or have
trouble with less frequent bowel
movements milk of magnesia one teaspoon
at that time for about a week we'll make
that transition a little easier for you
sir I noticed that you were on narcotics
and you told me you had a problem with
constipation all your life and all that
I'm gonna want you to start on the milk
of magnesia right away just one teaspoon
at bedtime I remember that you had a
history of gout and you're worried about
gout coming on well we checked your uric
acid level and you're on allopurinol a
drug to lower the uric acid when the
uric acid fluctuates the gout flare can
happen now i'm going to give you a
medicine and my phone number if you get
a gout flare you call me I'm going to
have you go get a medicine to knock it
out initially there are things that
change including I might give you a gout
flare but then it won't happen again
it's like a hurdle I need to get you
over and so not to worry okay and that's
one reason why I had you come remember
I'm a doctor to see me we checked your
blood and well another point is if you
have a problem please call me not the
doctor who doesn't know how this works
and and someone you may have known they
may give you wrong the wrong advice and
I really want you to do this correctly I
remember that you had done every diet in
the past and but one of those diets who
thought it was the Askins a bob atkins
diet dr. Atkins there's this music star
Chet Atkins and and then Adele trait the
Adele Adkins you know you don't want to
do those Atkins diet you want to do the
doctor Atkins diet and and I'm here to
teach you how to do it right okay turn
the page and you may notice some sugar
cravings immediately there they will
pass oh you've had bread all your life
and you told me you can't imagine that
eating bread not to worry by next week
when you come back one of the first
questions I'm going to ask you is are
you hungry you should say no and are you
craving any foods and you should say no
but I know when you won't believe me yet
just stay tuned the bullion we mentioned
and bullion has solved yeah
we've been told not to have salt hmm
you've been taught not to have fat I
violate two rules that you've been
taught but you ended up in my clinic
having to hear this so what you were
taught that you followed apparently
didn't work so it's okay to have salt
the way our bodies handle salt when you
don't eat carbohydrate is very different
you're going to lose it very fast in
fact you might lose five to ten pounds
you might lose three to eight kilos the
first couple weeks because a lot of the
water is lost so it turns out when
you're eating carbohydrate you hold onto
salt in water more than you should you
ever felt bloated puffy you don yes
that's the carbohydrate telling your
carbohydrate raising the blood sugar
blood sugar raising the insulin insulin
telling your kidneys to hold on to salt
so when you lower the foods that have
carbs you lower the sugar you lower the
insulin you actually then let go of salt
and you might notice a big weight loss
the first week that's okay and it's not
going to persist over time I usually see
and you can expect a one to two pound
per week weight loss of fat loss when
you get over that first initial water
loss in the next section ketosis ketosis
is fine it just means your body's
burning fat and that's what you want
right you told me you wanted to get rid
of the weight and we agreed it was that
weight that you wanted to get rid of so
we want you to burn fat and that's what
ketosis is ketosis is commonly confused
with ketoacidosis that may be the only
time your doctor has heard about ketosis
or trained and heard about it saw it and
years ago but that's not what this is
the dr. Finney and dr. volek have
several books the advanced course if you
if you want them right now I'm going to
keep it real simple for you and they
describe that it's okay to have ketones
or what's called nutritional ketosis
it's not ketoacidosis what happens if I
slip well you know you have to follow
this diet strictly as one who my patient
said I realize if I'm not doing it
docked it's not going to
now that may seem silly may seem silly
but I know Allah many of you have tried
diets where you can fudge on one day and
make up for it the next day right right
if your calorie counting or something
you think it all works out and how did
that work for you oh yeah right so this
will work but you have to be strict now
the good news is that it's not hard to
be stretched when you're not hungry stay
tuned you'll be surprised that you're
just not hungry and it's relatively easy
to be strict if you eat carbohydrate you
might stop the fat burning for up to
three days or so you would diabetes it
might stop the fat burning for two weeks
we're finding now with the research so
the clinical world what I was taught is
it you have to be really strict than
what the science is finding is that if
you're in a fat burning mode which is
what you want and then you eat
carbohydrate your body has to turn off
all of those fat burning enzymes the
factory in our body if you will turn on
your car burning enzymes carb factory
and it may take a week or so to go back
and forth maximally so just be very
strict be very careful and what number
did well how many grams of carbs 30
really 20 thank you yeah that was a joke
sheet so you got it right however that
vitamins and supplements we do want you
to have a multivitamin it's kind of like
a safety net if you're not menstruating
or been told to have iron by your doctor
then it should be iron free I'm free
multivitamin but you really don't need
any extra added nutritional supplements
because the food you're going to eat is
so packed full of nutrition that it's
going to be just fine cholesterol many
of you have heard that this kind of diet
will affect cholesterol levels in a bad
way because it's not a low-fat diet and
you've heard that the low-fat diet fixes
everything that's why you can say it is
this is the predictions about how this
way of eating would adversely affect the
blood cluster
all didn't come true when the studies
were finally done so I was taught you
were probably taught the lay public was
taught to not eat fat because it would
raise the cholesterol the cholesterol
and the blood would cause heart disease
that whole thing is unraveling and what
you but even aside from that when the
studies were finally done what wasn't
predicted is that by not eating the
carbohydrate insulin would go down and
that would have a salutary effect on the
cholesterol so in fact if you have a
high blood triglyceride which is a risk
factor for heart disease that's going to
go down and if you have a low good
cholesterol that's going to go up so in
the old days what I was taught is just
look at the total cholesterol and the
LDL the the lousy cholesterol and many
doctors are still trained in that way
that's okay you teach them that the
triglyceride and HDL what's known as
metabolic syndrome in our world that
also gets better and so both of these
kinds of diets actually are successful
in reducing the cardio metabolic risk or
that heart disease risk not to worry oh
I know you told me that you kind of went
to sort of a panic reaction when you ate
fat that last time because you were
worried it was going to give you a heart
problem that's a good night that it's
going to be fine timeout questions I
mean next section I'm in just a moment
we go through the foods about was that
enough to through combat the cholesterol
of course you may not have SAT through
the three days of science we just went
through so stay tuned for those yes
so that my first the question is when
does this happen I see people the first
visit we call it a history and physical
the first time you see the doctor you
bring in all your records lab tests if
you can and then I bring people back
about a week later there are lots of
different ways to do it there's a the
residential programs in Durham where
people do it all on the same day but i'm
using this in an outpatient clinic you
come to see me I checked some lab tests
it takes about a week for them to come
back and then this class occurs the next
week and then I'll ask people to come
back a week or two after that so why not
iron yeah our body actually defends
against iron in most areas of the world
and hemochromatosis which is iron
overload is a condition that can occur
if you're taking too much iron so that's
the general nutritional principle that
goes beyond the low-carb diet that's
just trained a lot of the information
here is just general good nutrition not
specific for the low-carb high-fat diet
the time in at the end of the class
today I'm going to ask each of you to
stay just a moment and i'm going to
review what medicines you're on and if
we need to make adjustments about your
medication will do it at that time the
way I learned how to do this this is
called lifestyle medicine the three
components are diet activity and stress
management if you came to one of our
residential programs in Durham North
Carolina that's where I learned how to
do this people come to durham they spend
a thousand to fifteen hundred dollars a
week and they're told not to eat much
they're told to exercise many do some
don't and then they're also given stress
management techniques taught that it's
very effective I worked at one of the
programs in durham and that's how i got
excited about doing this as a living but
i found that when I see you haven't
moved to Durham you haven't you don't
taken time out of your life and going to
spend a month here you're yeah you go
back home I have to make this work in
your real-world setting so if you want
to spend a lot of time may
King food and I'll help you if you're if
you don't want to spend any time I'll
help you if you want to spend a lot of
money doing this I'll help you if you
don't want to spend much money that's my
job so they'll overtime I'll help figure
out how to make it fit in your lifestyle
but at first all I really need is
control of what you put in your mouth
your diet you don't need to exercise oh
you were told that yeah i know but
that's okay and remember I'm an internal
medicine specialist but they didn't
really teach us anything about how to
help people lose weight I had to go out
to get special training I'm what's
called an obesity medicine specialist
and that's all I do so if you come back
sit in front of me and say this isn't
working we're going to figure it out I'm
not just going to tell you to go do it
and never see you again we have a
support group for lifestyle change
there's a group that meets in town once
a month we meet in a local restaurant
and we'll teach you how to eat there we
have a good time yet not to worry i
don't give a lecture every time we will
talk about what's on your mind they
actually made us a support group on
facebook as a result of that called the
low-carb support group and so they're
over seven I think eight thousand
members now from around the world on
that support group it's all free and a
lot of people need to see other people
further down the road I'm not a great
cook great chef a lot of the people in
this support group will help you figure
out what to what to do if you like to
have a lot of different variety in the
food and and so remember the support
group as well so what do I want you to
eat turn the page to page four so
remember this is the no sugar no starch
diet just dive focuses on providing your
body with the nutrition it needs
proteins and fats while minimizing food
that your body does not need the
carbohydrates and to be most effective
you need to keep the dietary
carbohydrate down to 20 grams or less
per day your diets to be made
exclusively of the foods on this page if
the food is not on page 4 you can't have
now if you ask me can I have blank I'm
gonna say is blank on page four if you
lose page four I'll get you another page
for know this person told me the doll
gate page four so i can just gave him
another one it doesn't matter how you
prepare the food's all that matters is
the carbohydrate you eat carbohydrate
the blood sugar goes up the insulin goes
up your body's in a mode of making fat
and storing fat and so you can have oven
baked broiled stir-fried sauteed roasted
fried or grilled doesn't matter doesn't
matter how you prepare the food just
make sure there's no carbohydrate on it
you like fried chicken yeah no problem
you know you've had it all your life you
love it just make sure there's no
breading or carbohydrate on the coating
one of my patients discovered that they
could crush up pork rinds or chicharones
the plane or the BBQ doesn't matter and
crush it up kind of like bread crumbs
and roll your chicken and a little egg
and a little bread crumb and then fried
and says it's even better than before so
just make sure there's no carbohydrate
doesn't so fried foods are okay when
you're hungry eat as much as you want of
these foods because these foods have no
carbs that's the meat poultry fish and
shellfish eggs whole eggs not just the
egg whites I mean yeah it's okay if you
just have the egg whites but it's okay
to have the yolks in fact i think the
egg is the perfect nutritional package
just think of it you have an egg and
then it turns into an entire chicken but
j right no so you can't make a chicken
without the yolk I mean you can't make a
cow out of the steak right so you've
never heard that before you're told eggs
were bad that the scientists Jeff volek
has published several papers recently
that eating more eggs raises your good
cholesterol yeah it's kind of new it's
only the last couple years so a lot of
people haven't heard it yet
you may be thinking of that I'm saying a
lot of things that are different it's
kind of like the way I feel driving in a
town where like this town we and you're
on the wrong side of the road it might
feel strange to eat fat because you
haven't eaten fat so but for so long but
it's like I'm teaching you to drive on
the other side of the road at first it's
kind of weird the rules are different
though I keep wanting to get in the
right side of the car as a passenger and
it seems here that the steering wheels
on the wrong side it's the right but the
left oh you didn't know on my country ok
this is breaking the role play because
I'm in the US I messed that up but
anyway time out the point being it's
just different it's not wrong now it
would be the BBC America top gear guys
they say it's wrong that we drive on the
wrong side you might say we drive on the
wrong side but it's actually right for
us I even had one patient who had no
idea that people drove on the left hand
side of the road you can't assume some
things that I thought were common
knowledge about food about about life so
the sudden isn't wrong you can eat fat
you can have salt it's just that the
teaching you received was kind of like
learning how to drive on that side of
the road but still feels weird and this
morning I I swear we were going to get
it you're going to oncoming traffic
we're turning anyway I know it's fine
just trying to dramatize what you're
going to see and your patience and
yourself feeling yourself and other
people in alarmist politicians
dietitians doctors or just I'm against
driving on that right side of the road
oh well here I don't think I don't
advise you to drive on the right hand
side of the road ok so if you're not
doing a low-carb high-fat diet I
wouldn't advise you to listen to me all
right but if you are i would advise you
to listen to me but it still is weird
turning into I'm coming
we were fine this may take some time for
people to unlearn that emotional
reaction yeah because it is an emotional
reaction and the doctor told me my
mother told me or let me rephrase that
most the generation before or maybe two
in my my experience they were eating it
eating correctly and then all of the
guidelines and all this the government's
got involved in promoting the food the
country's make that's the USDA food
pyramid there was no science behind it
but it was basically a marketing tool to
promote the foods that America makes not
only a maze but subsidized so what a
great deal I mean we can give money well
no we can be lobbied to give money to
certain industries and then we can
actually just put out an advertisement
to have people eat those foods that we
subsidize and it's a win-win and unless
you care about what happens to an
individual person but that's not the the
governmental concern of that part of the
government so fortunately in the u.s.
there has been a connection of the
National Institutes of Health and the
USDA the United States Department of
Agriculture and they collaborate on the
guideline now time in I know you know
you're in that ph.d program over at the
University of North Carolina and you're
working on that guideline thing you know
that working on that paper to see
whether there really was evidence to
create the guideline back then I just
came back from a conference over and
Cape Town and so our presentation
there's another paper that just came out
and it showed that there really wasn't
enough evidence back when the guideline
was created to create the guideline so I
another way to say it is that the
standard for evidence to create a
guideline has changed and so what was
persuasive then isn't persuasive now so
I'm glad you're working on that project
but you've been scooped I'm sorry time
in so you know you can eat as much as
you one of these foods
they have no carbs and carbs the sugars
and starches raise the blood sugar raise
the insulin and insulin tells your body
to make fatim store fat poultry fish
shellfish tuna tuna can be in the can it
can be frozen it could be fresh there's
a restaurant over there in Chapel Hill
where you can pick the fish and they'll
kill it for you and have it that fresh
well you know that's okay there's still
no carbs no I've one of many of my
patients are professors at Duke
University which automatically means
they're really intelligent and one of
them goes to our fanciest food store in
town and gets pheasant and the pheasant
is not cheap but it's guaranteed to be
organic free-range and to have had a
happy life
now you can have that in that's fine oh
that's you can't afford that mmm but
that's okay I have another Duke
professor who doesn't own a pot or a pan
and he drives through the fast-food
restaurant called biscuitville which
will actually give you a no biscuit
low-carb bowl they don't even send the
biscuit out just the eggs and the meat
so he drives through there he drives
through the burger place and he just
says don't give me the bun of course he
doesn't have the fries he doesn't have
the diet soda and then he goes through
our chick chicken place and he asks for
the grilled chicken not the fried
chicken because the fried chicken at
those places have carbs on it so it's
okay so you can spend a lot of time a
lot of money or you don't have to you
can go to fast food fast food is not
evil in terms of the number of grams of
carbohydrates there's this gentleman Tom
Naughton who wrote a movie he was so
upset about the Super Size Me movie
remember where the guy went through and
said supersize me at mcdonalds it for a
month or so and he gained all this
weight the Tom basically said that's
just crazy no one's going to do that so
he went around the u.s. talking to
people about health and nutrition in
general he ended up basically writing a
low-carb high-fat movie it's called
Fathead the movie and in there he loses
10 to 15 kilos over a month by eating
fast food but he just didn't eat the bun
he didn't eat the fry he basically did
low-carb at the fast-food restaurant
yeah I know when I took your history you
said you you either fast food almost
every day because it's so cheap okay you
know I'll help you you wanted to go to
that fancy French restaurant every night
that's fine too dr. Atkins who had one
of these kinds of diet programs years
ago what lived in manhattan new york
city and he taught the kind of
higher-level diet that a lot of you here
in north carolina can't afford and
that's okay all that matters is the
carbohydrates and how many grams do i
want you under for the day 20 you got it
some people think that all you have is
meat and eggs and chicken and fish but
that's not the case
I want you to have every day 2 cups of
leafy greens and one cup of a non
starchy veggie and I want to make it so
simple you don't have to measure with
measuring cups and all that to take your
fist and compare it to this measuring
cup that's about the same size my fist
is exactly the size of a measuring cup
so what I want you to do is have two
fistfuls Oh your fists a little bigger I
think it's okay that you have a little
bit more lettuce every day yeah and and
oh but you're about the eye you're five
feet tall and you were 65 so you know
you're not the same height same way you
might need to eat a little more and you
might need to eat a little less and
actually your body will figure out how
much you need to eat so I'm not going to
tell you to to limit the portion of
foods that don't have carbohydrates it's
going to be automatic in other words you
can have as much bacon as you want but I
know you're not going to want much
because you're not gonna be hungry I
want you to stay to the leafy greens on
this list if you like it you can have it
you don't have to have it if you don't
like one of these non starchy veggies
like artichokes asparagus broccoli
brussel sprouts cauliflower celery
cucumber eggplant green beans he Camela
leeks mushrooms okra pepper onions
peppers pumpkin shallots no pea sprouts
sugar snap peas summer squash I mean you
have the hand out in front yeah okay yes
it but you weren't reading it sir I need
you to read it okay so I know you could
take this out John I you work over at
the hospital you went through medical
your doctor like me you can take it okay
time out the teaching is interesting I
mostly overcome preconceived notions and
fear and and it kind of Lee rational
with this good this is good because I
wouldn't have a job if I didn't have to
do that but so even friend of mine who's
trained in knows all this stuff may have
difficulty there's that old saying that
doctors make the worst patients so to a
certain degree that may be true here
don't assume much of anything and when a
lot of people got no nutrition training
a lot of people don't know what a car
biz and basically this we
one page of food was a brilliant thing
it was designed by dr. Atkins and i used
the clinic that dr. atkins used in his
clinic as the basis for our research
studies remember our research team was
the only one that went out and actually
ask doctors what they did and one of the
brilliant things that they did is to
keep the teaching rather simple I mean
so I do all the bells and whistles and
all that to help you understand not
everyone wants that I have professors I
have people on assistants who walked
from down the street so I have to know
how to teach at all those different
levels and that's why I'm sometimes
making people uncomfortable and and
sometimes just really not making people
uncomfortable at all it's going to
depend on who you're teaching on how to
do this and but really all that matters
is you stay to the foods on page 4
really that's all you have to do time in
so you got to have the one cup one fist
full of vegetables every day you think
that might not be much yeah you know
most most women think that that's not
many vegetables most men think that's a
lot of vegetables now we're all healthy
here well there's some debate about that
but it's okay the amount of vitamins and
nutrition that you need is sufficient
with the foods on this on this page so
if you don't have high blood pressure or
heart failure I want you to have two
servings of bullion or broth that has
salt in it don't use the low salt
bullion that will mitigate will reduce
the some of the side effects that some
people get now to make life tasty and so
that you can have bacon cheeseburgers of
course no bun you can have cheese up to
four ounces a day cream no milk milk has
sugar in it it's called lactose remember
so it's the cream that you can have got
your eyes lit up you don't have cream in
20 years you told me and you loved it
and still remember how it felt yeah it's
fantastic so one of the things that
makes this sustainable is having cream
another thing I didn't go through for
the sake of time I'm going to make you
read this and
there is bacon on that meat and one of
the meatless one of the reasons this is
sustainable is that you can have bacon
if you like it and I like it mayonnaise
olives avocado lemon lime juice soy
sauce pickles zero carb snacks so if the
food has no carbs it can't raise the
blood sugar can't raise the insulin so
basically you can have as much of it as
you want until you're comfortably
satisfied that means you can have
sugar-free jell-o or gelatin as much as
you want that the clear gelatin has no
carbs so if you have a sweet tooth and
you need that that's a probably the most
popular sweet treat for a little ready
whip or whipped cream or whatever
whipped cream topping you have that
doesn't have carbs in it and that's not
too bad it's a sugar-free jello with
whipped cream on it pork rinds have no
carbs in it sometimes there's a timeout
sometimes there's that but how many of
you eat pork rinds I'd say about fifty
percent that's amazing okay time in
pepperoni slices are very helpful ham
slices turkey slices if you take a piece
of cheese or cream cheese or butter and
you roll it up in a piece of meat like
this that's called a rollup you can have
one roll up for snack to roll ups for a
meal as you're running out the door
later work doesn't have to take a whole
lot of time beef jerky deviled eggs is
that this place far away they had this
think of biltong really nice it's really
good I asked my friends to send me some
yeah and i'll let you have some too yeah
if you want i have someone come back and
say that i'm tired of eating eggs I'm
tired of eating bacon well you don't
have to eat that if you don't like it
and so you may want to rotate what
you're eating that's page for any
questions about page four okay so
remember I might want you to stay of the
foods on page for the foods not on page
four you can't have it now it's so easy
and so simple that if all you did is
stay to the foods on page four with the
limitations on the foods that have
carbohydrates you will
under 20 grams of carbs so rest assured
sir you don't even have to count to 20
but you're the one that told me it's
easier to count to 20 then to count to
1,200 calories per day yeah it's true so
for a lot of people who don't want to
count and worry about all that stuff
that's a pretty simple method so turn to
page five on this diet no carbohydrates
are restricted not fat and calories but
carbohydrates and sugars are simple
carbs so you can't have them starches or
complex carbs so you can't have them
yeah even whole grain bread that's it's
still bread and have you found that
bread tree yet yeah you were looking out
the window and come on get back there no
see if I'm not successful teaching you
it's not going to work so I'm sorry if I
offend and and wake you up fats and oils
are fine fats don't raise the blood
sugar now you know I'm teaching the
low-carb high-fat 101 which means this
is going to work for you don't worry too
much about the details you know if you
ask me what the best fats and oils on
earth was I'd probably steer you toward
fats and oils that have more omega-3s
than Omega sixes but it's going to work
regardless of which oil you use based on
the carbohydrate restriction sweeteners
and desserts it's okay to have sweet
things it just can't be sweetened with
sugar that's that's forbidden okay
because sugar mmm raises the blood sugar
yeah it is that simple you may not
realize though that a teaspoon of sugar
has as much sugar as in your entire
bloodstream so you may have been given
the false impression that the amount
that we're given and we've eaten all our
lives is actually healthy when it's not
so very small amounts of sugar can raise
the blood sugar so just be very careful
after a day or so you're just not gonna
be hungry and it's going to be automatic
any of these other sweeteners are fine
choose one that you like some people
have sensitivities but there's really no
in any of these other to the degree that
there's harm and sugar so often I'll
compromise and say in order to get you
off sugar which has this health problem
it's okay to have an artificial
sweetener for a while and if you ask me
what the best diet on earth was I'd
probably say one that doesn't have
artificial sweeteners although you know
I hold out that we can probably come up
with a diet that's even better than
we've ever known before which is kind of
you told me sir you heard about the
paleo or primal diet thinking that our
noble savage ancestors knew how to do it
right that were we evolved that way well
I think we can probably even do better
than they did using the scientific
knowledge that we have today that just
you know as a researcher I hold out that
we don't know everything and that will
adjust what we do based on our new
knowledge beverages you can have as much
of the allowed beverage meaning with no
carbs as you want so okay they have
caffeine a lot of individual differences
there and we limited to three servings
per day kind of arbitrarily just so that
you don't go out and you know have 50
servings but that might be okay I don't
go to bed at night thinking all my
patients stayed to page four no I go to
bed thinking that one person didn't have
success or or I want you to have success
the there's no right or wrong it's how
your body handles the foods and there's
a lot of individual variation alcohol
it's at first we'd say for maximal
weight loss and metabolic change to not
have alcohol but what would the world be
like without alcohol so there are
individual differences when you're at
your goal we'll discuss how you can
reintroduce alcohol to make it so that
it's a sustainable lifestyle for you eat
when you're hungry you stop when you're
full how many of you were taught I eat
everything on your plate because they're
starving children in Africa you probably
were taught to eat everything on your
plate they're starving children in
America there are and there still are
today I don't think it's a matter of you
eating the food it's a distribution
anyway
yeah I have some professors I know
you're not one sir but who would like to
talk about that start so there's some
common mistakes that we go over here and
there's some websites that we mentioned
linda's low carb is a the most popular
website it's all free recipes and so if
you're not sure what to eat of course
look to page four stay to page four but
you might want to branch out and look at
that information looking at a food label
I want you to know what to look at in
terms of the low carbohydrate diet and
here we have total grams of carbs and
the fiber and sugars are underneath
total grams of carbs so all you have to
do is look at the total carbohydrate
level and look if it says zero grams you
can go for cauliflower has about seven
grams of carbohydrate in it per serving
and if you go some places and I know sir
you told me you were heading to South
Africa well a friend of mine sent me a
label it's a little different there they
don't include the fiber grams in the
carbohydrate grams so what I want you to
do is add the fiber grams to the total
grams when you're there and then that
will give you the total grams yeah in
europe and south africa they they came
out with labels that subtract out the
fiber to give the gram carb carb amount
but some people do absorb the fiber and
you're paying me the big bucks to make
it work and if you with diabetes high
blood pressure metabolic syndrome I know
you're gonna have to be really strict so
don't have any of that fiber that you
might absorb because I want this to work
for you the first time now it might work
for you oh yeah I was an author on that
book the new Atkins and it taught net
carbs where you subtract out the fiber
and the sugar alcohols and but I don't
want you to do that here so I'm teaching
you the old app consorting diet was a
diet first described in 1865 and that's
the way it was taught then those
products I want you to stay away from
unless you really know they're low in
total grams of carbs or you sir going to
South Africa adding the fiber to the
total will give you the total because
they subtracted out the fiber to give
you the total
yeah now I think what they were thinking
is that the fiber doesn't have any
impact on the blood sugar so they have
the total impact carbs on blood sugar
but what I've learned from the clinical
practice world and other doctors who
taught me is that the fiber grams can be
absorbed and raise the blood sugar and
make that cascade down to storing fat on
your body so we'll see you all next week
if you haven't made an appointment yet
please check with the clerk out front
and enjoy the foods now as you leave are
you on any medications fine okay and so
you have had a history of heart failure
I don't want you to use the bullion at
first you would the blood blood pressure
issue don't use the bullion or broths at
first with the diabetes we need to talk
on how to reduce your insulin today
because if we don't reduce it today and
you've had good control up till now you
risk having a very low blood sugar I
would rather have the blood sugar a
little high than to risk a low blood
sugar spell so can you sit around for a
minute great thanks and our time is up
and thank you very much
[Applause]
you
Practical implementation of a low carb diet Dr Eric Westman Learner Objectives: 1) At the end of this presentation, the learner will be able to define a low carbohydrate high fat diet 2) At the end of this presentation, the learner will be able to understand what foods are allowed and are not allowed on a low carb high fat diet 3) At the end of this presentation, the learner will be able to describe how to manage side effects associated with a low carbohydrate high fat diet References provided in folder entitled: “Presentations and synopsis”. Effect of 6-Month Adherence to a Very Low Carbohydrate Diet Program http://web.calstatela.edu/faculty/rdeleon/504/westman.pdf Very Low Carb Diet Program vs. Low Fat Diet Randomized Controlled Trial Yancy et al. Ann Intern Med 2004;140:769-777 http://www.ncbi.nlm.nih.gov/pubmed/15148063 The Effect of a Low-carbohydrate, Ketogenic Diet Versus a Low-glycemic Diet on Glycemic Control in Type 2 Diabetes Mellitus Nutrition & Metabolism 2008;5:36. http://www.nutritionandmetabolism.com/content/5/1/36