You’ve been advocating a keto diet in your clinic for over 15 years now. How has your method of keto changed your patients’ lives over the years?
In so many different ways. Where do I begin?! We often focus on the medical problems getting better; we do a lot of talks about diabetes, obesity, heartburn, PCOS, and all that, but that just scratches the surface. Now, any kind of program that helps people get rid of hunger rather effortlessly, any program that allows people to eat great foods and then leads to weight loss or weight maintenance, these change people’s lives in many different ways beyond the medical realm. But definitely, the medical problems get better. It’s so obvious to me now that these medications are treating the bad lifestyle – meaning diet, activity, and stress, are all out of whack. Doctors use medications for that. So for sure, the medical problems get better. That’ll change your life.
Nutrition is more powerful than prescription medication. How so?
Absolutely. If you just line up all of the medications that I can take away from someone by changing their lifestyle, using a keto diet is what I do on a carb-restricted diet. I could take away 10 medicines from people as they start changing their lifestyle. That tells me that it’s as powerful in some people as 10 medicines.
How long typically does it take for patients to start feeling the initial benefits of the diet?
The hunger goes away in just a day or two. If you’re trying to do something to help you with hunger or cravings or weight loss, that’s really pretty fast. It’s remarkable because people will often lament, saying, “Oh, what am I going to do without my bread and my fruit? I’ve had it all every day!” Well, those cravings go away remarkably fast. What you notice when you get to a healthier way of eating – and really, that’s all I talk about at first – I don’t need exercise to help people have dramatic changes in their life, which often is mystifying to people because they’ve been taught that they have to exercise, but you don’t. Diet is so important and the effects are very quick.
How long might it take for people on their medications to work with their doctors and wean off these medications?
That’s an important point – if you’re taking medications and you’re being treated for a medical problem, you want to be sure that you’re getting supervision to be able to get off the medication safely. It can be as fast as on the first day. I need to reduce diabetes medicines to avoid low blood sugar. That depends on how controlled someone is, how tightly controlled or loosely controlled their blood sugar is. I typically see a 50 to 100-point drop in the glucose level. That’s in milligrams per deciliter, so that’s going to be a 10 to 15-millimole drop on the first day of the blood glucose. If I don’t instruct people and tell them to watch out and be sure to keep measuring their blood sugar, it can go too low. That’s the most dramatic change that can happen.
Other medicines that take a little longer, but still are remarkable to be able to take people off them, are the blood pressure meds, heartburn medicines, and arthritis medicines. The way you take them away is the reverse of how you started the medicine. Let’s say you were using a blood pressure medicine when the top number (systolic) was at 130 repeatedly, then when the top number comes down to 120, 110 repeatedly, you start tapering back the medication. For blood glucose, if you added a medicine when the blood glucose was say, 110, or 120 mg/dL, and just when you hit that point as you’re coming down, you start reducing the medicine, reversing the way the medicine was given. It’s not difficult to learn, but most doctors just have never done it. They don’t expect that that’s going to happen. I expect that to happen now. (When a patient adopts a keto diet.)
It’s very important that folks work with their doctors when it comes to adjusting medications. This is definitely not something that you want to do on your own, correct?
Well, that’s if you have medical issues. I’ve treated so many different people and we’ve started to treat people through digital classes, and others have done that for years now, and I’m comfortable changing the food. You don’t need medical supervision unless you have a medical problem.
Why would you say that your keto method is easiest to sustain long term, and what exactly is “internet keto?”
The method that we’ve used has been around for 150 years, so we know the long-term effects of it, and that’s why I can be confident. I’ve used it for 15 in my practice, 20 years if you count the clinical research that we did here at Duke University. The proof is how long someone is able to sustain it, and I’ve seen people sustain it for that period of time.
Evidence-based keto is what was used in the studies by all the different investigators around the world versus what’s being taught or learned on the internet today. Internet keto is a double-edged sword. It’s great that the popularity has gone way up, but it’s not so great that people feel like they have to buy special products to do a keto diet. That’s probably the number one thing that people think they have to do is buy these products. In my clinic, I see people coming in saying, “It’s getting too expensive,” and I say, “Well, what are you doing? This doesn’t have to be expensive.” They’re telling me all the products and pills and supplements and things that they’re taking because they think that is what keto means. And that’s one way to do it. That way works for some people, but keto really means that you’re burning fat. If you’re trying to lose fat weight or treat diabetes, you want to burn your body fat, your ketones come from the body fat burning from within. You don’t have to buy products or pills or all these ketone things that are out there for sale. That’s probably the number one misunderstanding of what keto is: internet-based keto versus evidence-based keto, which is a food-based program.
What sort of success can people expect to get if they implement your method?
It’s important to be all-in. It’s important to do it strictly. If you follow this, it will work and change lives. If a doctor prescribes you a pill, you don’t say, “Well, maybe I’ll take it half the time.” You do like the prescription says and take it every day. If you follow this every day, the cravings go away in a day or two. If you have weight to lose, it’s one to two pounds per week. That’s what I typically see on average over a month, so it’s not a direct linear thing. It’s 4 to 8 pounds per month and 50 to 100 pounds per year. I can get most people off of insulin within two to four weeks, sometimes even in just one day. The results from the medical side are really pretty astounding alongside all of the other things people are physically able to do.
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