At the Metabolic Health Summit meeting in Long Beach CA in February, Dr. Eric Westman spoke about his clinical experience with keto medicine. In his presentation, “Difficult Cases from a Keto Clinic,” he presented growing clinical evidence of the ketogenic diet in the treatment of diabetes and other diseases. Keto medicine has been around for over a century, with a case sited in a 1923 medical journal recommending carbohydrate restriction for a diabetic patient. Today, clinical evidence for ketogenic diets is past the level that would be required for FDA approval of a drug for the treatment of obesity.
The ketogenic diet is therapeutic for many diseases beyond obesity. There is existing strong evidence for keto-treating type-2 diabetes, epilepsy, GERD, PCOS, NAFLD, and IBS. There is ever-increasing emerging evidence for the ketogenic diet being beneficial for McArdles, traumatic brain injury, Alzheimers which is frequently called type-3 diabetes, and cancer. The Obesity Medicine Association is now endorsing the ketogenic diet.
The ketogenic diet can be uncomplicated with simple eating guidelines. Not all low-carb diets are ketogenic. Low carb diets are generally described as 50-100 grams of carbs per day, while a ketogenic diet is less than 50 grams of carbs per day. The principle is that as the body uses fat for fuel – either from consumed fat or one’s own body fat – instead of glucose from carbs, ketones are produced and provide the body with needed energy for metabolic healing.
A keto medicine principle is that obesity does not cause type-2 diabetes, but rather both are caused by excess blood glucose due to carb intake. Therefore, rather than treating insulin-resistance with more insulin, treating it with a keto nutritional solution of low or no carbs, adequate protein, and high fat will yield success.
The Duke Lifestyle Medicine Clinic was established as a “keto medicine” clinic in 2006 and since that time Dr. Westman has treated over 4000 patients. His clinic is considered the “clinic of last resort” and he treats patients that have metabolism and inflammation illnesses such as obesity, types 1 & 2 diabetes, 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.
Several case studies using keto medicine are presented with notable results: an obese patient losing 100-plus pounds; a hypertensive patient losing body weight and no longer requiring blood-pressure medication; type-2 diabetics coming off insulin within one week and another within three weeks; patients on multiple meds having their meds reduced or eliminated; reduced obesity and insulin for a liver transplant patient; and an obese patient with heart failure on a left-ventricular-assist-device being taken off of the heart transplant list.
If one is on insulin, blood glucose-control meds, has high blood pressure, or has a BMI greater than 50, one needs to see a medical provider who knows keto. Otherwise, one should enroll in a guided program with trained coaches. Be cautious of do-it-yourself programs because there is a lot of misinformation about keto in the public domain.
Below is Dr. Westman’s complete presentation.