We’ve heard you speak about the many benefits of a keto diet for conditions like type 2 diabetes, hypertension, and metabolic syndrome. What are some of the other medical conditions that a keto diet might be helpful for?
Those are the most common things people know that a low-carb, high-fat, or keto diet helps. Most people know about it as a weight loss tool, a fat-burning diet. But it does much more.
What’s exciting is that the research now is really getting started. For a long time—20 years since I’ve been involved in this space—we really weren’t able to do much research. There wasn’t much research money available. Now, that’s changed. There’s an annual meeting called The Metabolic Health Summit that has all these people coming together to look at the new research. It’s exciting to see.
In a clinic I see people getting better and have a lot of signals about what things are getting better. Most doctors and scientists won’t admit it or sign on until they know the mechanism of why it gets better. That’s frustrating, because doctors who use a keto diet see all these things get better and the researchers say it can’t happen because you don’t know why it happens. Well, the sun comes up every morning even though you don’t exactly know why it happens! There are so many things we see beyond weight loss, although most people think of it as a weight loss diet.
What are some of the other medical conditions that you see in your clinic on a daily basis that a keto diet would be great for?
The serious ones—the medically significant ones where other doctors send me their patients—include fatty liver, or non-alcoholic fatty liver disorder (NAFLD). It turns out that it’s the carbs in the food that cause the fat in the liver. I’ve seen doctors actually get that wrong, where the doctor will say that you have fat in the liver, so you have to stop eating fat in your food. No, that’s not how it works. It’s the sugar and starch in the food that causes the fatty liver. The reason this has become a medically serious issue is because fatty liver can cause cirrhosis of the liver or liver failure, and some people need liver transplants, if they can get access to it. It’s a big deal.
If you hear that you have fatty liver, it might even be a very small change in the liver function tests on a blood test. You want to take that seriously and start learning about how carbs affect you and your liver. Fatty liver gets better 100% on the keto diet. Our study was published 10 years ago on this, but it doesn’t get much airtime in the current culture.
How about PCOS (polycystic ovary syndrome)?
That’s another relatively common issue, with women not being able to have babies, infertility. I’ll be sent patients from other doctors when the OB/GYN fertility experts exhaust all of their medical treatments.
The big theme here is, most doctors are trained to use medicines or procedures, not implement lifestyle changes like keto diets. Let’s say a woman can’t get pregnant, she has extra hair growth on the body, and has irregular menstrual cycles. They may have an ultrasound of the ovary to diagnose this polycystic ovary disease, which can cause infertility and then the infertility doctors try the hormone changes, manipulations, shots, and even in vitro fertilization is tried. What happens to some people is they end up doing that and it doesn’t work and then the doctor says, “ Why don’t you go over to Dr. Westman and work on the weight.” It’s like an afterthought. If only they tried this first to see if it would work, because it’s very cheap to do a keto diet, you’re not using procedures and all that.
Doing this (a keto diet) can actually allow you to get pregnant in the first month or two! It’s almost miraculous. You may even get pregnant before the first menstrual period, which takes people by surprise. We make sure that women know that they can become pregnant very quickly if they change to a keto diet. If you don’t want to be pregnant, just know you have to take measures to not get pregnant!
It’s very gratifying. I’m not an OB/GYN specialist, but I’ve helped women get pregnant just by changing the diet. It’s because I helped the hormone changes by changing the diet, so that someone wasn’t eating the carbs.
The mechanism for this is not rocket science, which is another issue from the mechanistic world – a lot of these things are very simple. Even researchers say it can’t be that simple. The mechanism is that when you eat carbohydrates, the ovaries in women start secreting testosterone, which is the male hormone. Males and females both have testosterone and estrogen, but it’s the balance of that that makes us male or female. The carbohydrates cause the ovaries to produce testosterone. PCOS is really an overabundance of testosterone, the male hormone. So, if you cut the carbs out, the testosterone is reduced in the ovaries. The hormones change, you start getting periods, you start ovulating.
It’s important that other specialists try to help. I end up helping many of those people, because the other specialists didn’t think about changing the food and the lifestyle. I forgot to add earlier that I’ve helped people who had liver fatty liver come back in their transplanted liver. They already had fatty liver cirrhosis and they got a liver transplant, but the fatty liver was coming back in the new liver! So, the doctors finally sent them to me, after they got their transplanted liver!
How about joint pain?
It is very common for joint pains to get better, even if an orthopedic surgeon or a doctor has done an x-ray and they say it’s bone on bone, meaning the cartilage is gone. I have had people get better. I’ve seen arthritis get better. I try not to oversell this approach. This is my style. I’ll help someone and then see if these other things are getting better. I don’t overemphasize how much it can do.
People come back with their joint pains gone and it’s just an extra bonus. Of course, they’ll say it’s because they lost weight. I then ask them how soon it happened:
“In the first week or two.”
“And how much weight have you lost?”
“Not much.”
So, it’s not the weight loss. It’s the diet change that helps the arthritis.
We know now the mechanism, although it’s not worked out to the degree that some very skeptical scientists would want. Eating carbohydrates—especially sugar—causes inflammation in the body. The inflammation is often what’s causing the joint pains. You can reduce inflammation and joint pains rather quickly by cutting the carbs out of the diet or by doing a keto diet.
I was visited by an orthopedic surgeon – a doctor who does hip and knee replacements who lives in Sydney, Australia, Dr. Doran Sher and his medical support person, Dr. Paul Mason, do a keto diet program and Dr. Sher explained to me that many of the people who came to him for a joint replacement no longer need the joint replacement because the pain is gone! He estimated that about a third of the people didn’t need the joint replacements anymore. He was happy about that, because there was plenty of business anyway. He is just that kind of doctor who was helpful and glad that he didn’t have to do an operation on people.
No research studies that I’m aware of document to the degree that the most skeptical researcher would want, but this is a recurring thing that we see in the clinic: arthritis pain gets better.
Do things like skin tags, acne, and other skin conditions get better while following a keto diet?
Yes. Skin conditions generally get better. Even if you don’t have a medical condition, people tell me that their skin feels better, there’s a glow to it. When you think about it, the dermatologists who’ve written books about what to do with the diet and the skin, all promote a no-sugar diet. If you look at the popular diet books that are written by dermatologists, they’ve known for a long time that getting the sugar out is important.
Then, of course, what you are putting on the skin to make it softer and smoother is in many cases fats, oils. The skin does a lot better on a no-sugar, high-fat diet. Think of it as you eating the fat and then it gets distributed to the skin, without you having to rub it on the skin.
Even the ones that a doctor would use medicines for will get better, or in some cases go away. The big one is psoriasis. It’s uncommon, but there’s enough of it around that there are medicines being sold now to treat it. Guess what the medicines do: they block inflammation! From my perspective, you can take medicine to block inflammation or you can change the diet to prevent the inflammation in the first place. It’s really your choice.
Many doctors don’t understand the diet-inflammation connection, but I’ve seen psoriasis get better. If someone slips and they have some carbs, it will get worse fairly quickly. Eczema, acne, all of these things are improved. I’m waiting for the right person and I’ll help them to write the No More Acne diet book. I think that would be a big seller! You can’t persuade people to change, but many teenagers are sensitive to the fact that they might have acne. The low-carb keto diet really helps that a lot.
I was giving a talk at Duke University some years ago and one of the dermatology professors came up and told me after the talk that he traveled to an area in South America where there was no sugar. The community was so remote that there was no sugar. He was very curious, because the people had no acne during their adolescence. So, the fact that you get pimples and acne is not “normal” unless you’re having sugar! It’s not common. So, this is a very important thing, especially as we’re trying to target younger people to not have so much sugar.
I know this isn’t to do with skin, but another common thing that gets better is premenstrual syndrome (PMS) symptoms – menstrual cramps can often improve and in some cases go away, which is just another reason to introduce this to kids who are in their teenage years, especially if someone has a lot of acne and they don’t know what to do. Try it without refined sugar and starch and you may see some really significant change that helps the appearance. This lifts the mood, self-esteem, all that comes with being a teenager.
What about mental clarity and brain fog?
We’re going organ by organ, aren’t we! That’s probably why most people stick to a diet like this – they just don’t have the brain fog. They’re not falling asleep after meals anymore. They feel more energy. The brain does very well on ketones. You don’t have to have sugar in the diet. Your body will make all the sugar that it needs. It can make all the glucose in a process called gluconeogenesis.
As the ketones fuel the brain, some people tell me that they can feel it. The brain functions better. A dramatic example of this is a patient of mine who does these little puzzles, called Sudoku. He timed himself on the Sudoku and I remember he came in a month into the program and he was upset with me, because the time that he took to do the Sudoku was down. It took him longer. I told him to give it time. It takes time to adapt. And sure enough, six months into it, this patient was doing these puzzles faster than ever. This is a very sensitive measure of how the brain is working. You’re timing these very difficult puzzles!
So, mental clarity is probably a major reason why people continue to do this even though they got into it for a different purpose.
Can you comment on Alzheimer’s?
Alzheimer’s, also known as “type 3 diabetes,” is a problem of getting energy into the brain. It really never was a big deal until carbohydrates started being a big part of the Western diet.
Dr. Mary Newport started using coconut oil and other things to raise ketone levels and saw benefit in her husband. She went on the circuit talking about coconut oil for brain function and Alzheimer’s. Sadly, he didn’t have continued improvement, but the signal of ketones improving brain function is a strong one. I see it as more of a possible prevention for Alzheimer’s.
Even cancers may be improved; there’s a lot of research going on and there’s a lot of hope. I can’t say that it’s going to definitively help yet, but if you were looking for something to do in addition to the current treatments that your doctor is giving you, you might consider a keto diet for those conditions.
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