At the Low Carb Denver conference on March 10, Dr. Eric Westman coined a new phrase – “Keto Medicine” – which describes the science and protocol for treating many conditions using a carbohydrate restriction (ketogenic) diet. Based on his 21-year experience as a pioneering keto doctor and researcher, he made four key points.
Point #1: Keto is safe. The body of evidence surpasses FDA requirements for approval of new drugs. In other words, if the ketogenic diet were a drug, it would be FDA approved.
Point #2: Keto is effective for more than diabetes, pre-diabetes, and obesity. There is existing strong evidence for keto-treating epilepsy, GERD, PCOS, NAFLD, and IBS. There is ever-increasing emerging evidence for the ketogenic diet being beneficial for McArdles, traumatic brain injury, Alzheimer’s, which is frequently called type-3 diabetes, and cancer. The effectiveness of keto-treating many conditions is seen in Dr. Westman’s Duke Lifestyle Medicine Clinic which is considered the “clinic of last resort.” He treats patients that have metabolism and inflammation illnesses such as PCOS, IBS, NAFLD; those with cardiovascular illness such as heart failure and pre-heart transplant patients with left ventricular assist devices; and those with post-bariatric surgery weight re-gain.
Rather than treating individual diseases with individual specialties i.e. cardiovascular disease treated by cardiology, metabolic disease treated by endocrinology, cognitive impairment treated by neurology, gastro-intestinal issues treated by gastroenterology, etc. Dr. Westman asks the question “Should we consider keto medicine a new medical specialty?” since all of the above can be treated by keto-medicine.
Point #3: Keto works for virtually everyone when done right. There is a difference between a “low carb” diet and a ketogenic diet. The ketogenic diet has a ketone threshold of less than 50 grams of carbs per day. While the dietary guidelines are simple, and reducing medications is necessary, the most important role of the medical provider is to listen, understand, encourage, and support the patient. Most people fail for psychosocial reasons, so they need guidance in uncomplicating the confusion and navigating obstacles. Sustained lifestyle change requires personalized behavioral support as part of the patients’ program, and is provided by both one-on-one and group peer support. Preliminary results of keto nutrition combined with this coaching program at HEAL Diabetes and Medical Weight Loss Clinics resulted in weight loss of up to 60 pounds, and reduced or eliminated insulin, reduced or eliminated blood- sugar-lowering meds, and reduced A1C average from 8.5% to 6.6% in type 2 diabetics.
Point #4: Keto requires a new medical normal. Many variables, including behaviors, metabolic states, and test results that would be classified as “abnormal” on the Standard American Diet are considered normal on the ketogenic diet. Therefore caution is required when comparing labs for those in nutritional ketosis to “normal values” obtained from those who eat carbohydrates. A new reference range is needed to reflect a new “keto normal range.”
In summary, a new “Keto Medicine” approach may be needed to help practitioners gain new skills so they can help patients do it right.
Below is Dr. Westman’s complete presentation.