Discover Internet-Based vs Evidence-Based Keto Weight Loss –
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I’m dr eric westman and it’s my pleasure to be at the public health collaborate collaboration conference 2021 i wish i could be there in person with you and i’d like to share some insights from being in the low carb keto space for over 20 years now and also sharing some information we’ve just gathered in terms of the internet use of a keto diet the good and the bad so the title of my talk is internet-based versus evidence-based keto again i’m dr eric westman i’m an associate professor of medicine at duke university in durham north carolina and i’m director of the duke keto medicine clinic my disclosures and conflicts i’ve been at duke now for over 30 years i am past chairman of the board of the obesity medicine association which is the largest group of doctors medical weight loss doctors in the world they use keto diets they use medications they use very low calorie diets it’s not the surgeons it’s the medical weight loss specialist i’m also founder of a company called adapt your life which has keto products and education and i’ll be talking about a survey we did of some of these people later on i’m also author of several books including cholesterol clarity keto clarity and end your carb confusion my latest book and your carb confusion came out in the last six months and it’s my latest thinking about how to tailor low carb diets for a particular type of metabolism you may have heard about me teaching in various conferences this is a string a screenshot i think from diet doctor a lot of my videos are at that doctor.com and i’ve seen the studies be used names like lchf for low carb high fat lckd low carb ketogenic diet is what we use in our literature in the strictest sense generic sense carbohydrate restriction is what we use it’s restricting carbohydrate in the diet to various degrees and it’s very successful for the use of treating obesity metabolic syndrome diabetes as i’ll show in this talk now in the u.s you may have seen me on these peer-reviewed publication not i mean these are our uh magazines that appear up here at the grocery store checkout you know in the aisle as you check out you have you know the people magazine tabloids and then women’s world but i have to say you know here i was back in 2014 while the covers kind of sensationalized the the approaches the inside stories have been actually pretty accurate and i have to probably reflect that i’ve helped more people through being on these magazine covers than than the journals that i’ve published in that i’ll go over on so our group the duke really kind of set the foundation for other research and then for the use and and popular use of a keto diet dr yancey and i started many years ago on this now on the right side the prescription strength keto is kind of the tagline that got picked up by women’s world i’ve been using that as i teach because there are different levels of carb restriction and and i’ll talk about that just a little bit in what we do at duke and no i i don’t think the average person is going to lose 60 pounds in a month and i wasn’t in charge of writing the cover but the inside story is actually pretty accurate i have to thank people like judy judy tucker who’s someone who used our method and allowed to be interviewed in there it’s very inspirational to see people have these kinds of results um the real evidence space that i’ve been involved in generating started back in 2002 and there has been a taboo on studying low-carb keto diets even to this day even though i’ll go over some of the research this time it’s not like it’s being studied with dozens of studies by our national institutes of health in the u.s nor i believe in the uk so there’s kind of a still an anti-fat anti-low-carb bias when i was looking at the studies in 1998 two of my patients at the veterans affairs hospital where i was working did this diet and i was curious about it the last study i could find was published in 1980 and it was a very small study and it kind of just showed that it was terrible and you should never do a low carb diet money but when you look at the detail there were only 24 people in it and the detail actually showed that it was effective for weight loss but because the ldl went up they said you can’t use this diet and that’s a theme we’re going to see that even to this day some doctors some people will be afraid of this way of eating because of that ldl and now we know that the low carb keto diet works by a different mechanism by fixing the metabolic syndrome so we don’t have to worry about the lvl and it’s interesting to go back to see that 40 years ago people were worried about the ldl even then and even today that myth and misperception still persists so but on the bottom left this is our paper in 2002 the bottom right that’s jeff vollek’s paper 2002 at the university of connecticut he and bill cramer started some studies and steve finney has helped jeff vollek through the years now at ohio state we we’ve been generating the clinical research being in the clinical setting and jeff and steve have been developing research for the last 20 years and the kind of metabolic platform of taking people and studying them not necessarily in a clinic but when i reflect now you know this has been almost 20 years since our first studies and there have been now studies after studies showing the same things that a low-carb diet works really well this is the first round of studies where low-carb diet beat out low-fat diets pretty much in any head-to-head comparison the randomized control trials that were done and now there are meta analyses of these studies so multiple meta analyses so that here they are the obesity randomized trials over 12 months duration showing because of the diamond on the left excuse me on the right figure but at the bottom and then the left side of the line of identity you actually have a summary measure the diamond doesn’t cross the middle line so it’s statistically significant that low carb diets are better than low fat diets when it comes to weight loss and you know i’ve always been a little bit shy of touting that and just saying that you know low fat diets can work a lot of different diets can work but low carb works too in fact you might even say it works better well my colleague will yancey at duke was had that in his mind wow this is better than a low fat diet what if we gave low-fat diet a diet and a drug meaning a drug to block fat absorption so this was a low-carb diet compared to a low fat diet with a fat blocking drug called orlistat also known as zenecal or ally now over the counter and you can see here this is a randomized trial in va meaning veterans affairs our our veteran hospital system outpatient settings these were people with medical illnesses and the low-carb ketogenic diet in red on average worked about the same as the diet in a drug the low-fat diet and a fat blocking drug so the diet is as good or better as a diet and a drug so you even you don’t even have to use the drug if you choose this type of diet i really like this figure because um my colleague dr yancey was one of the first to develop this sort of you can see every person on this figure the light lines that’s each individual and then the dark line is the mean you can see that the greatest weight loss occurred in someone on the low carb diet this was you know losing 30 percent or 30 kilos over that 48 week period that’s pretty amazing to see that kind of result and this is typically what we see today there’s a variable range of weight loss some people who don’t do the diet at all don’t lose weight and a diet is as good as or better than a diet and a drug so as i mentioned there are all these different studies and hats off to you the public health collaboration of the uk because i use this all the time there’s so many studies that we have to summarize them and what great summary you have on the website compare comparing all the rcts in tabular form or an infographic form and so i still use this showing that the score is 31 to nothing if you compare statistically significant weight loss and these different randomized trials so a little twist on interpreting this i use the um the idea that this body of evidence would surpass the fda usfda food and drug administration criteria for phase 3 trials for approval of new drugs so that is if it were a drug it would be fda approved there’s that many studies now that many people on drug or on diet and that is reassuring to a lot of people who still you know was that safe and well it’s as safe as any kind of drug that’s been evaluated by fda for use in humans that’s pretty amazing and it’s all been done without a big company to do it because there’s no big company to do those fda phase 3 trials and also there’s no process or requirement for a diet to be tested by any regulatory agency like this maybe maybe there should be then low carb diets would be one of the only ones available for use some doctors and and people wait for guidelines to approve it so the very low carb diet is in the algorithm guideline of the obesity medicine association this is the largest group of medical weight loss doctors in the world and in the middle bottom section of this the very low carb diet under 50 grams a day wither without nutritional ketosis is in their guideline and you can also see that side by side the low calorie diet section you could do restricted fat diets as well if that’s what you choose to do great also the third kind of dietary approach we have as obesity medicine specialists is that very low calorie diet on the far right and then those circumstances you purchase the products you have physician supervision and they’re they are effective as well the advantage of a restricted carbohydrate diet is that you don’t have to buy products you don’t have to buy pills and you learn how to do it just by changing the food switching from obesity to diabetes you may not have known that low carb diets were used for the treatment of diabetes 100 years ago so you may know the story of william banting in london 1864 the first treatise on weight loss was a low-carb diet but it was actually also used for diabetes not just obesity so this is the textbook of sir william osler we all as internists and family medicine doctors stand up just a little straighter when we hear sir william osler’s name because he is the father of internal medicine this book is the textbook they used to teach doctors in 1923 and interestingly insulin which was discovered in 1921 didn’t make it into this textbook so that just shows you how slow comparatively to today things changed then but you can see in the middle here the quantity of food required by a severe diabetic patient in the purple box carbohydrate 10 grams of carbohydrates for the whole day 75 grams of protein 150 grams of fat 15 grams of alcohol yes man some of my patients find looked straight to that alcohol i mean i can have alcohol and say yes in small amounts you know it’s not a deal breaker if you control the amount but the strict diet is similar to what i teach people today foods without sugar meat poultry game fish clear soups gelatine eggs butter olive oil coffee tree tea cracked cocoa and you know it’s reassuring to me not always to everyone else but reassuring to me that this is what doctors figured out before there were any medications to distract them in the treatment of diabetes so when you all you have is dietary change choose a low-carb diet for the treatment of diabetes we’ve known that for a long long time now now the studies modern day studies kind of recapitulating what we knew you know so we’ve gone through an area era where researchers and doctors didn’t know that diabetes was used 100 low carb diets were used to treat diabetes 100 years ago so it’s like they’ve had to re-re-do the studies and there aren’t quite as many studies on diabetes as there are for treating obesity but when you look compared to other types of diets this is called a network meta-analysis where the width of the bar and the size of the node or circle at the end of the bar reflects how much data there are either in study number of studies or number of people in the studies the low carb diet on the lower left-hand side has almost as much or better amount of data than even the mediterranean diet or vegetarian diets so uh while the growing there’s a growing number of studies um it makes sense to lower the carbs in the food because it’s the carbs in the food that raise the blood sugar and diabetes is a phenomenon characterized by high blood sugar you might say even defined by that so this is a pioneering study i have to go into the detail known as the virgin health study or the hallberg study sarah hallberg wrote one of the first papers it’s called effectiveness and safety of a novel care model for the management of type 2 diabetes and they recruited 262 people with type 2 diabetes and and obesity are overweight a bmi of 40.4 on average just about everyone was caucasian but what they did is they taught the ketogenic diet through classes or a web-based program and the goal was nutritional ketosis for two years they achieved that with all the stops they threw i mean they had people do blood ketone measurements they had people check their body weights they had a computer app to monitor they had a doctor available inside the computer or iphone app so the doctor would help people d prescribe or get off medication safely and the astounding result is that the a1c reduced from 7.6 to 6.3 percent at one year this is better than drugs and and actually it took people off drugs during this intervention so and then it was reduced the a1c went up just a little at two years but not much still significantly lower at six point seven percent at two years this is on average the body weight change is fourteen percent at a year and ten percent at two years diabetes was reversed in 54 of people meaning normal blood sugars off medications and was put into remission in 18 of participants this is astounding results using a keto diet and you know monitoring and surveillance and having people use high-tech sort of things um but it just shows what can happen when people follow it so don’t be um how should i say uh discouraged that not everyone follows it so the averages go down in all of our clinical trials there was variable outcome based on how well people followed it but kind of like in the early years of using exercise or telling people to exercise you know you wouldn’t say oh no and we’ll exercise ever what you do is you come out with new ways to help people exercise and fit the style of people and you wouldn’t say oh no one can exercise don’t do it what happened is treadmills and gyms and all these ways to help people exercise came about and i hope that happens as well for low-carb diets now if you wait for the diabetes recommendation by organizations wait no longer a very low carb diet is supported by the american diabetes association here’s a paper that’s a kind of a paper evidence and recommendation from the american diabetes association published in 2019 called nutrition therapy for adults with diabetes or pre-diabetes a consensus report and in there is a low-carb diet a low-fat diet a low glycemic diet they’re all in there because there’s evidence for all of these now you don’t have to wait any longer for guideline approval and i know some organizations like our dietitians wait for these kinds of recommendations here you go there it is it’s um from the american diabetes association now this is a deeper dive into the detail of what happens on a low carb diet with nutritional ketosis and this is from the hallberg verde health study that bon puri is the first author of this paper in nutritional ketosis pretty much everything gets better except and if we go down the list here at the top the weight loss as uh in kilograms is you know like 12 percent so that’s to the left of the line zero in the middle that’s the direction you want it to go the hemoglobin a1c went down you know 18 percent that’s the direction you want to go that way the systolic blood pressure went down the diastolic went down april b went down about a went up that’s what you want the ratio went down triglycerides go down oh and then the one thing out of all of these things that didn’t go in the direction you want on average is that calculated ldl that old ldl that in 1980 got dr larosa and his 26 subject study to derail the use of a low-carb keto diet for the next what in 1980 for the next 40 years do not be distracted by the ldl cholesterol please watch everything else get better and and i just have to kind of laugh because i i and i have people who come to me so concerned that everything has gotten better but it’s often because their other doctor is concerned about it so let me explain why you shouldn’t be concerned about it so jeff volik borrowing on jerry reaven’s idea dr gerald reaven at stanford talked about this years ago the insulin resistance side of things the metabolic syndrome the high triglyceride low hgl this is comparing the low-fat diets to keto diets and in green the keto diets work better to target the metabolic syndrome which is not the total in ldl cholesterol so in tabular forms keto addresses insulin resistance and the metabolic syndrome so the old way of looking at the lipid profile is the ldl in total but that’s not how we look at it in terms of insulin resistance and metabolic syndrome so here on the right the the new keto normal we don’t look at ldl in total anymore and i know other doctors will look at it they are doctors in my area that want to treat cholesterol like it’s a disease cholesterol is not a disease it’s in our bodies for a reason it’s healthy to have so we look at the triglycerides so metabolic syndrome is elevated triglycerides reduced hdl cholesterol abdominal obesity or increased waist circumference elevated blood pressure and elevated glucose and all of these things get better on a low carb keto diet or nutritional ketosis as i showed you there so please please please don’t get hung up on the ldl cholesterol even during weight loss steve finney years ago wrote a brilliant paper that said that was titled transient hypercholesterolemia of weight loss and i send that around to other doctors who start worrying about the cholesterol as people are still losing weight but no don’t check the cholesterol while people are losing weight and unless you’re trying to confirm that the triglyceride went down or some other you know abnormality that’s really off the the normal what would you normally expect because during weight loss the cholesterol can go up transiently and then it will come down when people are done losing weight so the evidence-based key i wanted to reflect upon the methods of the studies that that we’ve gone over and that i’ve experienced and read and studied and talked about for the last 20 years we focus on carbohydrate restriction and these are nutritionally complete diet programs and there’s an emphasis on real food and protein rather than fat or ketones as the primary nutrient we didn’t talk about that and it was understood that the ketones would come from the body fat you don’t have to take ketones to have to generate ketones in the urine or the blood they’re coming from your own body fat when you’re burning the body fat so the third bullet there you may have heard the term well formulated adequate protein ketogenic diet because it’s not high protein and it’s uh it’s these are another whole area of myths and misconceptions the fourth bullet the ad-lib food intake reduce is reduced by the reduction in hunger so i know there’s this whole hoopla about calories or calorie and all that i knew from our first study that people ate less there wasn’t some magic about ketosis i mean maybe now we know maybe you get a 200 calorie per day advantage but the lion’s share of the weight loss comes from the fact that people eat less it’s not magic um so there’s a reduction in hunger for just about everyone so very few studies that i’ve read and followed through the years have involved adding mct or medium chain triglyceride oils a phenomenon you may have in your area in the u.s it’s all over the place adding fats and ketone drinks and ketone pills and all these have never been studied for weight loss obesity or diabetes or metabolic syndrome there are very few studies that involve computer apps other than the virta health study and ketone measurements there are a few um studies but not many the most of them have not involved the the detail that you can get in precision and macro calculation that’s available on these apps and most of these studies have not involved ketone measurements other than maybe urine ketones not necessarily the blood or the breath so the technology has advanced beyond the research and i’ve seen it trip up people as i’ll explain in just a minute um so a lot of the uh clinical experience i have in perspective is from the duke keto medicine clinic that we started in 2006 and i’ve treated thousands of patients with all sorts of diseases and including the ones you saw i will treat someone with just about any disease as long as we’re monitoring the disease and monitoring the diet and have a motivated person who i can trust will actually do it correctly so we can treat pcos the cause of infertility ibs nafld or fatty liver disease gerd heartburn and heart failure and it turns out some interesting recent research on ketones being like a super fuel for the heart and used for heart failure it’s um i think we’re going to see more of that the doctors who are have patients on the waiting list for heart transplants send me their patients to help them lose weight before a transplant and some of the most sickest people who are still ambulatory and walking around have these lvads or left ventricular assist devices you listen and there’s no heart tone because the heart is so weak but you’ll hear a remember on the chest of the motor of the pump that’s pushing the blood around that it’s an incredible technology and duke happens to have one of the largest places in the world with these vats or lvads and i’ve helped several people lose weight in order to get a heart transplant some people have even lost so much weight they didn’t need the transplant anymore which is kind of huge post bariatric surgery weight regain now of course i i might add if you’re going to use this in people who are this sick you need to understand that disease process so i’m an internal medicine trained specialist who came from that ilk of you know i can treat anybody as long as i can monitor them and and this gives me that uh kind of um as long as i’m working with the specialist who understands something like this pre-heart transplant situation i feel comfortable using this it’s not for the the average uh you know person um post bariatric surgery weight regain weight gain caused by medications you know no problem these days i’m seeing uh people who’ve gained 150 pounds on long-term steroid treatment and i just wonder why why didn’t the doctors think about it you know 100 pounds ago you know anyway we can still help those folks um so just briefly our method to teach keto is uncomplicated it’s using real foods we teach people that protein comes first the fats come with the proteins as long as you’re eating from animal sources and but you can run your body and carbs are fat it’s your choice if you choose to eat carbs you have to burn them because you can’t store them so if you want to use fat for fuel just don’t eat carbs and your body has to start burning fat starts burning the fat off your body then the ketones come from there so when you’re hungry you eat as much as you want of these foods until you’re comfortably full the meat poultry fish and shellfish and eggs you don’t avoid the fat in real foods but you don’t add fat if you’re trying to lose fat weight off your body and then there is a limit on vegetables and leafy greens because these have carbs in them we tell people to limit to two cups of leafy greens a day and one cup of a non-starchy vegetable a day and then to make things simple we say you must stay to the vegetables on this list and they’re just it’s just simplifying these are vegetables that have about four to five total grams of carbs per cup and so but it means that some people who don’t even have computers to look things up can be able to follow this because we’ve done that work for them to find the super low carb vegetables and leafy greens now there is a limit to the the cheese creams and oils and mayonnaise because the doctors who use this method know that it’s often um this area where people are not losing weight they have so much cheese creams and oils and mayonnaise and the method that i learned was actually one developed by doctors in clinical practice and we were the ones that studied this method that had been used for 30 years in clinical practice so i i kind of inherited or started studying the um or borrowed the the knowledge from other doctors who would use this and they learned that you had to limit the amount of these high calorie though zero carb items and then zero carb snacks of course because they don’t raise the blood glucose they don’t raise the blood insulin level they don’t create the fattening signal you can have as much sugar-free jello or gelatine pork rinds chicharrones pepperoni slices low-carb jerky boiled eggs or or any other thing that fits your local ethnic and you know geographic um predilection so so you may want to change the foods on this type of list to meet the needs of the people that you’re dealing with um in your practice so this today though the poor girl is the internet-based keto it’s like this big fire hose of confusing information and um while most of the information i get here is from the internet and from a survey of people mostly from the us i have to wonder if this is not happening in in your country as well where you’re finding that people go to the internet and try to learn and then they get all sorts of strange misconceptions so i’d like to just give you some um perspective on this so through the years the bottom middle of this fire hose coming at you the low carb high fat or low carb ketogenic diet is what we study it’s what doctors use since the banting diet the frederick allen the osler diet you limit the carbs cause carb restriction you use total carbs not net um and that’s really what evidence-based keto is but today the confusion comes from on the upper left-hand side the ketogenic diet for epilepsy which is a related but different type of approach for children who might have seizures if they have any carbs at all they have to be very careful about the ketone levels and they are very careful about the macros and now that we have ketone monitors the focus on ketone levels has come in which really has not been necessary or even a focus in the evidence-based keto literature that’s out there and then enter in this keto confusion the idea that came from paleo primal that you had to be very careful about the food quality so you had to have grass-fed beef you had to add locally grown things or even you know share a cow with a neighbor and put it you know and you know where it comes from well that’s okay that it doesn’t necessarily use keto metabolism and it’s not really necessary i mean it’s great if you can so in my area where i have people from all socioeconomic levels there are a lot of people who just eat at fast food places and they would have no idea how to do a paleo primal kind of diet and they couldn’t afford it so i have learned to meet people where they are depending on how much money they have how much time they want to spend although if you’re able to change the food environment and but with your food dollar fantastic we need to do that but it’s not necessary to get success on a keto diet so the reason the internet information can be problematic is the success can be thwarted by internet keto so the belief that purchasing a product is necessary will often make people think that they can’t afford it but the belief that drinking or eating ketones or adding more fat is needed to get into ketosis defines the basic principle that the fat on your body will give you ketones and but no one will teach you that if they’re selling a product there’s a belief that measuring with an app is necessary and that can over complicate things make it out of reach for people who don’t understand the apps um and uh makes you rely on other things other than your body’s signals of hunger and satiety which is really what we want you to focus on when you’re doing this and so keto becomes complicated confusing off-putting to a lot a lot of people or it works for a while and then stops weren’t working because of burnout or lack of money and so um this is one reason that it’s a blessing and a curse that it’s there’s so much information on the internet now about keto diets um adapter life had these meetings on saturdays in the us we went around the country and brought together from 200 to 400 people it was great it’s one of those things you don’t know what you got till it’s gone we loved going around the country met so many people and had doctors who were local and experts come speak at those events so we pivoted since we can’t travel this last year into a digital education type of system and created several master classes the keto made simple master class we launched and now we have survey results on two cohorts of these classes and you know i have to give a shout out to diabetes.com.uk arjun and charlotte um and uh campbell um because you helped reduce my fear about using the internet and worrying about people not doing it right or having bad uh outcomes uh so um although we’re really careful about people to let them know if they’re on medicine they i’m not gonna help them reduce medications but we’ve now taught over 1200 students and two cohorts of these classes and the master class consists of videos me giving two hours of video chalk talk so to speak and then well powerpoints print materials three weeks of a private group to get started just so that we can overcome that initial hurdle that a lot of people have of just getting started and then we’ve helped people lose over a ton two thousand pounds in just these two classes i didn’t want to focus on that here but wanted to tell you that people had results and and the survey that we gave 75 percent had already been on keto for a while so people coming into these classes we often were at a plateau or thought it just wasn’t going to work anymore 25 were just fresh beginners but 98 of the folks said they learned something new about keto that they hadn’t known before you know where they learned it basically on the internet and so i want to show you the top 10 misconceptions about how to do a keto diet that were fixed by coming into this master class the prescription strength keto that you know resulted in these people losing 2000 pounds over a three week period when you aggregate all of their results so the top 10 things that that people didn’t really fully understand measuring ketones is not required so we don’t ask people to measure ketones we restrict the carbs and but a lot of people think you have to measure ketones number nine macrocalculation is not required so the confusing you know i didn’t hit my macros for the day or or the app tells me i need to eat more protein or more fat you don’t need any of that um and often that confuses people or makes it too complicated now if you use an app and it helps you to focus on the food that you’re having great and you’re having success great but if you’re not having success this may be what trips you up is that you’re making the eating to the app recommendation rather than what your body says number eight medium chain triglyceride mct ketone drinks or pills are not required you don’t have to fall victim to the ads now that it pop up on any anytime i use youtube as a teaching tool i get these keto something ads i just politely tell my patients to eat just ignore that and and um so you don’t have to have these kinds of products now i know a lot of people use them they seem to do fine great um a little pearl is that if someone has nausea or stomach upset or diarrhea or gas and they’re using any of these products these products might be doing it because stomach upset and gas are very uncommon on a evidence-based keto kind of diet that’s food based number seven fasting is not required i know a lot of people will get into this sort of sub domain of of uh keto and think you have to be fasting now it works like a charm because you eat less and you eat less often but um really not a whole lot of studies using fasting in addition to low carb diets and i think on the far right that you’re probably getting the benefit of autophagy just because you’re in that fat burning mode the the folks who have studied autophagy have used fasting but they have not studied just the keto metabolism when you’re eating protein which is giving you the fasting type of metabolism which is fat burning so fasting is not required but if it happens from within that you eat once a day that’s great that’s how my teaching is number six nuts nut flour and nut butters are not okay uh a common misconception that you’re gonna have nuts and and and most people can’t control them so one of the you know in the trenches learning that that i inherited and studied is that things like nuts are classic trigger foods meaning it triggers your hunger you can’t control them and then you deny or even kind of ignore that you had them when you come to the doctor i mean you know it’s because you want to please the doctor and so no nuts i say no nuts no nut flour no nut butters um for a lot of people the almond flour is used to kind of recreate breads and and cakes and things and it just gets people into trouble if they need prescription strength keto you know for diabetes or for really losing lots and lots of weight peanut butter for a lot of people is a trigger food myself included i was raised with that and i can eat the whole jar in one sitting and so some of the common sense is to avoid trigger foods and nuts and nut flour and that butter are trigger foods for in my estimation about 50 of the people that i see in a clinical setting so just no don’t have them number five vegetables are not unlimited common mistake is well but i thought vegetables were unlimited on a low fat diet there’s no limit yeah this isn’t a low fat diet it’s a low carb diet the rules are different and there’s a limit to the vegetables and stays of the non-starchy vegetables on my list please number four net carbs is not prescription keto so prescription keto uses total carbs i’ve had some people go from net carbs to total carbs eating fewer carbs and it starts working and if they hadn’t been told that they would think they would have bailed out and said well keto didn’t work for me so here’s an example of what’s coming onto the market now zero net carb bread and i have patients who oh look zero carb and they naively think it’s great but i teach from the get-go look at the back or the side of the product and look at the total carbs on the label so this zero net carb bread actually is seven grams total don’t get into the mistake of assuming the fiber grams and the sugar alcohols don’t impact the metabolism because in some people they do so remember my standpoint is i have to have this work the first time every time like a prescription drug or i wouldn’t have a job i mean this is basically my job teaching this having people come back because it works so avoid the neck carves at all possible now if it’s working for you great but if it’s not working try total carbs number three artificial sweeteners are not forbidden very interesting kind of lore out there you know i thought even artificial sweeteners were worse than sugar some of my patients will tell me and um no it’s okay so sugar is the bad guy sugar raises the blood sugar blood glucose raises the insulin these artificial sweeteners or even real ones like stevia monk fruit count them as part of your total carbs which is my recommendation and they’re not to be avoided or be forbidden in fact i need them to get many of my harsher sugar addicts off of sugar and then what will happen is most people will unlearn the sweet things will become sweeter and you’ll see you know have the sensation that things you didn’t think were sweet before become sweet and most people will kind of just gradually wean themselves off the non-sugar sweeteners but some people will persist and have the non-sugar sweeteners forever i i don’t think that’s a big issue that whole paper that came out that said artificial sweeteners make people eat more sugar was done in the context of a paper where people were allowed to have sugar so when someone’s on our program they’re not allowed to have sugar so if the sweet tooth is perpetuated they just have more of the artificial sweeteners without sugar which doesn’t impact the blood sugar or the insulin so don’t fear the artificial sweeteners number two expensive clean food is not required we have some very expensive grass-fed beef whole foods is one of these expensive grocery stores that if you had to go there i mean you would you would um i don’t know 60 percent of the people in our area wouldn’t be able to afford the food so you don’t have to have these this is a farmers market that occurs you know once a week in our local area which is great i mean i hope we support our local sourcing of food and that may be an answer to help us solve the global food issue but it’s not necessary and if you focus on this then you’re keeping it out of reach of people who can’t afford it or can’t have the wherewithal to go to these places to get the food and so now number one the top misconception or myth of internet keto is that cheese fats and oils are unlimited and they are not unlimited so but i have people come up but the butter has no carbs i could eat as much as i want right no no no no so a clinic-based program that’s been used in lots and lots of people has a restriction on the high calorie items the highest the cheese the fats and oils the cream the mayonnaise these all have a limit in our teaching and in programs that have this kind of approach where you have kind of a loose you know eat as much as you would like and there is a limit on the fats and the you might call them the high calorie dairy if you will i don’t know it doesn’t matter how you say it it’s where the fat consumption can become very high in calories things like fat bombs which didn’t exist in our studies on now we have companies coming up with fat bomb like candies and all this you can very easily eat a couple hundred calories in these things that i don’t recommend them um so be careful about cheese that’s probably one of the most common over consumed foods that make something like this doesn’t work and i you know um uh recommend cheeses of course and that people explore very nice variety of cheeses but you still have to have a limit so wrapping up the internet-based versus evidence-based keto is what’s going on today in the u.s probably in the uk evidence-based keto is safe and effective when done right and keto works for virtually everyone when done right meaning focusing on real foods not products not adding oils and fats and butters and things like that beware of the use of products or methods that might impair the success and safety of you know the inner internet based keto if you’re watching this and you you’re following keto and you the internet keynote’s not working consider tweaking one of these things that i mentioned and it might improve them if you took a class like from the scratch you would have pretty much all of these things erased and like rebooting but you might find changing one of these things will get you some success and of course if medical conditions are present then monitoring to safely deep prescribe medications is needed is is essential we don’t want you to become sick from the medicines becoming too strong and this is a prescription strength sort of dietary program thank you so much for your attention and i wish you a wonderful meeting i hope we can get traveling just as soon as possible um having been in the keto world low carb eye fat world now for 20 years i just want to express the the um excitement i have that people are able to use this without censorship and yeah there might still be some flack from other doctors or or the media but the science is solid and is so helpful to reverse or and prevent the diseases that i couldn’t reverse i just managed them as an internist or family medicine doctor so this is a tool that is so useful i hope it spreads i’ve helped to start the society of metabolic health practitioners which is a international group to try to get an interdisciplinary group of doctors dietitians physician assistants exercise physiologists check out the society of metabolic health practitioners if you want to join a group that’s actively using this and teaching the evidence-based keto approaches thank you again and hope to see you soon you
Best Way to Get Back on Track After a Cheat Day
Most of us recognize taking in less calories than you shed which continues to be to be the same. Let’s take an example: Do you assume you would certainly have more success consuming 1400 calories a day and also burning 2000? Or would certainly you rather take in 2000? And also shed 3000 as well as it motivates a better effect to burn fat from storage space, although you’re eating more.Burning 3,000 calories might appear impossible for some folks, but you can enhance the number of calories you shed with the foods you eat (and when you eat them), the supplements you take (and when you take them), and the workout you perform. Right here are some referrals for even more effective-and reliable- a weight loss that doesn’t include starving yourself!
How To Start A Low Carb Diet
Low carbohydrate diet plans include eliminating carbohydrates from your diet plan, or a minimum of limiting them, as well as adding even more healthy proteins and fats. However also if you cut out grains, starchy vegetables and also fruits, will it still help you shed weight, and much more notably, will you be healthy as well as will the weight-loss results last?
What’s All The Fuss About The Raw Food Diet?
Up till lately several specialists (and also the general public) did not see a link between diet as well as wellness. The good news is, there is a currently a more growing recognition in between the food we eat and also the state of our health. This recognition has brought the raw food diet a little extra into the spotlight. So specifically is a raw food diet? Right here’s a glance at the fundamentals …
The Ketogenic Diet
The ketogenic diet plan is a popular option to get your health on course really promptly. It’s extremely different from various other diets you have experienced and also works truly well for many individuals.
Longer Life With A Healthy Diet
Health and wellness is much better than riches. Much better health and wellness is taken into consideration crucial for human joy as well as health. Individuals who are literally as well as emotionally healthy and balanced likewise play a really vital role in the economic development of their country as they are much more productive as well as live longer
Natural Ways to Lose Weight or Burn Fat Review
Do you know that a minimum of 2.8 million adults die yearly as an outcome of being overweight or obese? (From Research) Do you recognize that a lot of health-related problems as well as obstacles belong to obesity?
All About Intermittent Fasting
Recurring Fasting is a nutritional strategy of not consuming for a collection amount of time. What people don’t realize is that there are various sorts of intermittent fasting approaches, each with their own private collection of benefits varying from weight loss to improved brain power.
To Be or Not To Be: A Debate on Veganism
Veganism might operate in various means to cause an improvement in our lives. This features health advantages, decreased anxiety on the atmosphere and is likewise an extra efficient method to make the most effective out of our all-natural resources.
Is a Full Fletched Millets Diet Good For You?
One is nearly certain to have actually found out about millets or might also have actually tried millets at some time in the past. Yet it very often takes place that people are blind-sided of the top qualities that this food grain is had with. Nourishment content of millets may take one by shock. If one makes millets a part of one’s everyday diet regimen, it features a host of benefits for one’s health.
Popular Food Fads You Should Not Believe
Food trends are widespread, with many thinking them without checking out the evidence. Below are a few of the common ones that medical professionals listen to from several of their clients.